Previous evidence suggests that severe heat illness may cause permanent acute damage to the heart, kidneys, and liver, which may possibly lead to chronic and even fatal disorders. We investigated ...whether individuals who had been hospitalized for severe heat illness were at increased risk of cause-specific and total mortality. A cohort mortality study was conducted of male and female US Army personnel hospitalized for heat illness (HI) from 1971 to 2000 using appendicitis (APX) as the reference. Hospitalization records were acquired from the Total Army Injury and Health Outcomes Database (TAIHOD) for 3971 cases of HI and 17,233 APX reference cases. Subject vital status was established through the National Death Index. HI cases had a 40% increased risk of all-cause mortality compared to APX cases. Further examining cause-specific deaths, male cases of HI were at an increased rate of death from cardiovascular disease (CVD) (rate ratio (RR)=1.71, 95% confidence interval (CI): 1.01, 2.89) and ischemic heart disease (IHD) (RR=2.23, 95% CI: 1.02, 4.90) compared to APX reference cases. Our findings provide preliminary evidence for increased risk of mortality among those who have experienced prior hospitalization for heat illness.
Background: Exposure to metalworking fluids has been previously associated with prostate cancer mortality in a cohort of autoworkers. Our objective was to further explore this finding in a study of ...prostate cancer incidence in the same cohort, with reduced misclassification of outcome. Methods: We conducted a nested case-control study in the General Motors cohort of autoworkers. Incident cases of prostate cancer (n = 872) were identified via the Michigan Cancer Registry from 1985 through 2000. Controls were selected using incidence-density sampling with 5:1 ratio. Using cumulative exposure (mg/m³-years) as the dose metric, we first examined varying lengths of lags (0-25 years). Then, we evaluated consecutive windows of exposure: 25 or more years before risk age, and fewer than 25 years. We used penalized splines to model the relative risk as a smooth function of exposure, and adjusted for race and calendar year of diagnosis in a Cox model. Results: Risk of prostate cancer increased with exposure to soluble and straight fluids 25 years or more before risk age but not with exposure in the last 25 years. The relationship with soluble fluids was piecewise linear, with a small increase in risk at lower exposures followed by a steeper rise. By contrast, the relationship with straight fluids was linear, with a relative risk of 1.12 per 10 mg/m³--years of exposure (95% confidence interval = 1.04-1.20). Conclusions: Exposure to oil-based fluids, soluble and straight, is modestly associated with prostate cancer risk among autoworkers, with a latency period of at least 25 years.
The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most ...affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: (a) PE will increase, (b) workers in PE will become more precarious, (c) workers in PE will face unemployment without being officially laid off, (d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and (e) PE might be a factor in deterring the control of or in generating new COVID-19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis.
The aim of the present study was to evaluate the association and impact of occupational exposure and diseases of the shoulder and neck. Prevalence rates, odds ratios, aetiological fractions, and ...their confidence intervals were computed for pooled and non-pooled data of previous published reports. By comparison with office workers and farmers, dentists had an increased odds ratio for cervical spondylosis (two studies) and for shoulder joint osteoarthrosis. Meat carriers, miners, and "heavy workers" also had significantly higher rates of cervical spondylosis compared with referents. Compared with iron foundry workers, civil servants had a significant odds ratio (4.8) of cervical disc disease and a 0.79 aetiological fraction. Whether this was due to exposure or healthy worker effect was not clear. In four occupational groups with high shoulder-neck load an odds ratio of 4.0 was found for thoracic outlet syndrome with an aetiological fraction of 0.75. Rotator cuff tendinitis in occupational groups with work at shoulder level (two studies) showed an odds ratio of 11 and an aetiological fraction of 0.91. Keyboard operators had an odds ratio of 3.0 for tension neck syndrome (five studies). Unfortunately, owing to the scanty description of the work task, the exposure could be analysed only by job title. Examination of published reports shows clearly that certain job titles are associated with shoulder-neck disorders. High rates and aetiological fractions for rotator cuff tendinitis and tension neck syndrome suggest that preventive measures could be effective. Although job descriptions are brief, the associations noted suggest that highly repetitive shoulder muscle contractions, static contractions, and work at shoulder level are hazardous exposure factors. In reports of cross sectional studies of occupational shoulder-neck disorders presentation of age, exposure, and effect distribution may help for future meta-analysis.
Work-related musculoskeletal disorders (WRMSDs) by definition are a subset of musculoskeletal disorders (MSDs) that arise out of occupational exposures. While traditional exposure assessment ...techniques have proved to be successful in identifying ergonomic exposures that are epidemiologically linked to these disorders, some are troubled by the lack of one-to-one correspondence between specific occupational exposure profiles and specific MSDs. In the absence of more sophisticated hypotheses that might explain the occurrence of WRMSDs in a variety of exposure patterns, the aetiologic relationships may (again) be called into question. Another unanswered question is whether specific types of WRMSDs have qualitatively different exposure-response relationships. A clearer understanding of the underlying pathomechanisms associated with specific WRMSDs could help future researchers better determine how and when various occupational exposure profiles become pathogenic. Such knowledge could also be used to design exposure assessment tools to capture exposure information more relevant to the risk of WRMSDs. The main goals of this paper are to summarize several recently described pathomechanisms, most of which have been discussed primarily in clinical and experimental literature that might not be widely read by occupational health scientists. Suggestions are made as to how future research could evaluate whether these phenomena are relevant to the effects of physical exposures and the underlying disease processes of common WRMSDs.
Wesseling et al. respond Wesseling, Catharina; Crowe, Jennifer; Hogstedt, Christer ...
American journal of public health (1971),
03/2014, Letnik:
104, Številka:
3
Journal Article
Recenzirano
Odprti dostop
We appreciate Ventres' observations and share his goal to reduce CKD incidence "by occupational, environmental, and health-related reforms that make this work agricultural labor more humane." In our ...summary of the workshop on the Mesoamerican nephropathy (MeN) in San José, Costa Rica, November 2012, we also noted the need for a broad understanding of the epidemic and we call readers' attention to the full report(1) that details the comprehensive discussion of the epidemic including the issues raised by Ventres. In the workshop, we took account of the several points raised in his letter, but in our editorial we wished to call special attention to the growing evidence of heat stress and dehydration as an essential cofactor in a likely multifactorial disease etiology. (Am J Public Health. Published online ahead of print January 16, 2014: e1. doi:10.2105/AJPH.2013.301803).
Background Uncontrolled confounding by personal exposures like smoking can limit the inferential power of occupational cohort studies. We developed and demonstrate a refinement of an existing type of ...sensitivity analysis, indirect adjustment, for evaluating the potential magnitude of confounding by alcohol and tobacco. Results of a large retrospective cohort study of laryngeal cancer and exposure to metalworking fluids (MWF) are used to illustrate the methods. Methods Data on smoking and drinking habits representative of the study cohort were obtained from a sample of US manufacturing workers from the 1977 National Health Interview Survey (NHIS). Two different mechanisms were assumed to affect the distribution of confounding factors between MWF exposure groups: socially determined and chance differences. Chance variation was investigated with Monte Carlo sampling from the NHIS survey distribution of smoking and drinking. An upper bound on systematic differences in smoking and drinking was set by assuming that differences between exposure groups within the same unionized blue collar workforce were very unlikely to be larger than differences between blue and white collar manufacturing workers in the NHIS data. Results Under plausibly large differences in smoking and drinking habits among MWF exposure groups occurring by either mechanism, the exposure–risk association was unlikely to have been over- or under-estimated by as much as 20%. Conclusions When comparing exposure groups within the same working population, it is unlikely that either systematic or chance differences in smoking and drinking habits will cause as much as a 20% change in the relative risk in large studies. While this study focused on an occupational exposure and laryngeal cancer, there are many situations in which epidemiologists are concerned that unmeasured ‘lifestyle factors’ may differ among exposure groups, and it would appear that the likely confounding effect of such differences will often be modest.
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