STUDY DESIGN.Review.
OBJECTIVE.To formally introduce “degenerative cervical myelopathy” (DCM) as the overarching term to describe the various degenerative conditions of the cervical spine that cause ...myelopathy. Herein, the epidemiology, pathogenesis, and genetics of conditions falling under this hypernym are carefully described.
SUMMARY OF BACKGROUND DATA.Nontraumatic, degenerative forms of cervical myelopathy represent the commonest cause of spinal cord impairment in adults and include cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, and degenerative disc disease. Unfortunately, there is neither a specific term nor a specific diagnostic International Classification of Diseases, Tenth Revision code to describe this collection of clinical entities. This has resulted in the inconsistent use of diagnostic terms when referring to patients with myelopathy due to degenerative disease of the cervical spine.
METHODS.Narrative review.
RESULTS.The incidence and prevalence of myelopathy due to degeneration of the spine are estimated at a minimum of 41 and 605 per million in North America, respectively. Incidence of cervical spondylotic myelopathy–related hospitalizations has been estimated at 4.04/100,000 person-years, and surgical rates seem to be rising. Pathophysiologically, myelopathy results from static compression, spinal malalignment leading to altered cord tension and vascular supply, and dynamic injury mechanisms. Occupational hazards, including transportation of goods by weight bearing on top of the head, and other risk factors may accelerate DCM development. Potential genetic factors include those related to MMP-2 and collagen IX for degenerative disc disease, and collagen VI and XI for ossification of the posterior longitudinal ligament. In addition, congenital anomalies including spinal stenosis, Down syndrome, and Klippel-Feil syndrome may predispose to the development of DCM.
CONCLUSION.Although DCMs can present as separate diagnostic entities, they are highly interrelated, frequently manifest concomitantly, present similarly from a clinical standpoint, and seem to be in part a response to compensate and improve stability due to progressive age and wear of the cervical spine. The use of the term “degenerative cervical myelopathy” is advocated.Level of Evidence5
Laboratory-acquired infections due to a variety of bacteria, viruses, parasites, and fungi have been described over the last century, and laboratory workers are at risk of exposure to these ...infectious agents. However, reporting laboratory-associated infections has been largely voluntary, and there is no way to determine the real number of people involved or to know the precise risks for workers. In this study, an international survey based on volunteering was conducted in biosafety level 3 and 4 laboratories to determine the number of laboratory-acquired infections and the possible underlying causes of these contaminations. The analysis of the survey reveals that laboratory-acquired infections have been infrequent and even rare in recent years, and human errors represent a very high percentage of the cases. Today, most risks from biological hazards can be reduced through the use of appropriate procedures and techniques, containment devices and facilities, and the training of personnel.
Background
Healthcare workers can suffer from occupational stress as a result of lack of skills, organisational factors, and low social support at work. This may lead to distress, burnout and ...psychosomatic problems, and deterioration in quality of life and service provision.
Objectives
To evaluate the effectiveness of work‐ and person‐directed interventions compared to no intervention or alternative interventions in preventing stress at work in healthcare workers.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, NIOSHTIC‐2 and Web of Science up to November 2013.
Selection criteria
Randomised controlled trials (RCTs) of interventions aimed at preventing psychological stress in healthcare workers. For organisational interventions, interrupted time‐series and controlled before‐and‐after (CBA) studies were also eligible.
Data collection and analysis
Two review authors independently extracted data and assessed trial quality. We used Standardised Mean Differences (SMDs) where authors of trials used different scales to measure stress or burnout. We combined studies that were similar in meta‐analyses. We used the GRADE system to rate the quality of the evidence.
Main results
In this update, we added 39 studies, making a total of 58 studies (54 RCTs and four CBA studies), with 7188 participants. We categorised interventions as cognitive‐behavioural training (CBT) (n = 14), mental and physical relaxation (n = 21), combined CBT and relaxation (n = 6) and organisational interventions (n = 20). Follow‐up was less than one month in 24 studies, one to six in 22 studies and more than six months in 12 studies. We categorised outcomes as stress, anxiety or general health.
There was low‐quality evidence that CBT with or without relaxation was no more effective in reducing stress symptoms than no intervention at one month follow‐up in six studies (SMD ‐0.27 (95% Confidence Interval (CI) ‐0.66 to 0.13; 332 participants). But at one to six months follow‐up in seven studies (SMD ‐0.38, 95% CI ‐0.59 to ‐0.16; 549 participants, 13% relative risk reduction), and at more than six months follow‐up in two studies (SMD ‐1.04, 95% CI ‐1.37 to ‐0.70; 157 participants) CBT with or without relaxation reduced stress more than no intervention.
CBT interventions did not lead to a considerably greater effect than an alternative intervention, in three studies.
Physical relaxation (e.g. massage) was more effective in reducing stress than no intervention at one month follow‐up in four studies (SMD ‐0.48, 95% CI ‐0.89 to ‐0.08; 97 participants) and at one to six months follow‐up in six studies (SMD ‐0.47; 95% CI ‐0.70 to ‐0.24; 316 participants). Two studies did not find a considerable difference in stress between massage and taking extra breaks.
Mental relaxation (e.g. meditation) led to similar stress symptom levels as no intervention at one to six months follow‐up in six studies (SMD ‐0.50, 95% CI ‐1.15 to 0.15; 205 participants) but to less stress in one study at more than six months follow‐up. One study showed that mental relaxation reduced stress more effectively than attending a course on theory analysis and another that it was more effective than just relaxing in a chair.
Organisational interventions consisted of changes in working conditions, organising support, changing care, increasing communication skills and changing work schedules. Changing work schedules (from continuous to having weekend breaks and from a four‐week to a two‐week schedule) reduced stress with SMD ‐0.55 (95% CI ‐0.84 to ‐0.25; 2 trials, 180 participants). Other organisational interventions were not more effective than no intervention or an alternative intervention.
We graded the quality of the evidence for all but one comparison as low. For CBT this was due to the possibility of publication bias, and for the other comparisons to a lack of precision and risk of bias. Only for relaxation versus no intervention was the evidence of moderate quality.
Authors' conclusions
There is low‐quality evidence that CBT and mental and physical relaxation reduce stress more than no intervention but not more than alternative interventions. There is also low‐quality evidence that changing work schedules may lead to a reduction of stress. Other organisational interventions have no effect on stress levels. More randomised controlled trials are needed with at least 120 participants that compare the intervention to a placebo‐like intervention. Organisational interventions need better focus on reduction of specific stressors.
COVID-19 as an occupational disease Carlsten, Christopher; Gulati, Mridu; Hines, Stella ...
American journal of industrial medicine,
April 2021, Volume:
64, Issue:
4
Journal Article
Peer reviewed
Open access
The impact of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 permeates all aspects of society worldwide. Initial medical reports and media coverage ...have increased awareness of the risk imposed on healthcare workers in particular, during this pandemic. However, the health implications of COVID-19 for the global workforce are multifaceted and complex, warranting careful reflection and consideration to mitigate the adverse effects on workers worldwide. Accordingly, our review offers a framework for considering this topic, highlighting key issues, with the aim to prompt and inform action, including research, to minimize the occupational hazards imposed by this ongoing challenge. We address respiratory disease as a primary concern, while recognizing the multisystem spectrum of COVID-19-related disease and how clinical aspects are interwoven with broader socioeconomic forces.
Background
This is the second update of a Cochrane Review originally published in 2009. Millions of workers worldwide are exposed to noise levels that increase their risk of hearing disorders. There ...is uncertainty about the effectiveness of hearing loss prevention interventions.
Objectives
To assess the effectiveness of non‐pharmaceutical interventions for preventing occupational noise exposure or occupational hearing loss compared to no intervention or alternative interventions.
Search methods
We searched the CENTRAL; PubMed; Embase; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific s; and OSH UPDATE to 3 October 2016.
Selection criteria
We included randomised controlled trials (RCT), controlled before‐after studies (CBA) and interrupted time‐series (ITS) of non‐clinical interventions under field conditions among workers to prevent or reduce noise exposure and hearing loss. We also collected uncontrolled case studies of engineering controls about the effect on noise exposure.
Data collection and analysis
Two authors independently assessed study eligibility and risk of bias and extracted data. We categorised interventions as engineering controls, administrative controls, personal hearing protection devices, and hearing surveillance.
Main results
We included 29 studies. One study evaluated legislation to reduce noise exposure in a 12‐year time‐series analysis but there were no controlled studies on engineering controls for noise exposure. Eleven studies with 3725 participants evaluated effects of personal hearing protection devices and 17 studies with 84,028 participants evaluated effects of hearing loss prevention programmes (HLPPs).
Effects on noise exposure
Engineering interventions following legislation
One ITS study found that new legislation in the mining industry reduced the median personal noise exposure dose in underground coal mining by 27.7 percentage points (95% confidence interval (CI) −36.1 to −19.3 percentage points) immediately after the implementation of stricter legislation. This roughly translates to a 4.5 dB(A) decrease in noise level. The intervention was associated with a favourable but statistically non‐significant downward trend in time of the noise dose of −2.1 percentage points per year (95% CI −4.9 to 0.7, 4 year follow‐up, very low‐quality evidence).
Engineering intervention case studies
We found 12 studies that described 107 uncontrolled case studies of immediate reductions in noise levels of machinery ranging from 11.1 to 19.7 dB(A) as a result of purchasing new equipment, segregating noise sources or installing panels or curtains around sources. However, the studies lacked long‐term follow‐up and dose measurements of workers, and we did not use these studies for our conclusions.
Hearing protection devices
In general hearing protection devices reduced noise exposure on average by about 20 dB(A) in one RCT and three CBAs (57 participants, low‐quality evidence). Two RCTs showed that, with instructions for insertion, the attenuation of noise by earplugs was 8.59 dB better (95% CI 6.92 dB to 10.25 dB) compared to no instruction (2 RCTs, 140 participants, moderate‐quality evidence).
Administrative controls: information and noise exposure feedback
On‐site training sessions did not have an effect on personal noise‐exposure levels compared to information only in one cluster‐RCT after four months' follow‐up (mean difference (MD) 0.14 dB; 95% CI −2.66 to 2.38). Another arm of the same study found that personal noise exposure information had no effect on noise levels (MD 0.30 dB(A), 95% CI −2.31 to 2.91) compared to no such information (176 participants, low‐quality evidence).
Effects on hearing loss
Hearing protection devices
In two studies the authors compared the effect of different devices on temporary threshold shifts at short‐term follow‐up but reported insufficient data for analysis. In two CBA studies the authors found no difference in hearing loss from noise exposure above 89 dB(A) between muffs and earplugs at long‐term follow‐up (OR 0.8, 95% CI 0.63 to 1.03 ), very low‐quality evidence). Authors of another CBA study found that wearing hearing protection more often resulted in less hearing loss at very long‐term follow‐up (very low‐quality evidence).
Combination of interventions: hearing loss prevention programmes
One cluster‐RCT found no difference in hearing loss at three‐ or 16‐year follow‐up between an intensive HLPP for agricultural students and audiometry only. One CBA study found no reduction of the rate of hearing loss (MD −0.82 dB per year (95% CI −1.86 to 0.22) for a HLPP that provided regular personal noise exposure information compared to a programme without this information.
There was very‐low‐quality evidence in four very long‐term studies, that better use of hearing protection devices as part of a HLPP decreased the risk of hearing loss compared to less well used hearing protection in HLPPs (OR 0.40, 95% CI 0.23 to 0.69). Other aspects of the HLPP such as training and education of workers or engineering controls did not show a similar effect.
In three long‐term CBA studies, workers in a HLPP had a statistically non‐significant 1.8 dB (95% CI −0.6 to 4.2) greater hearing loss at 4 kHz than non‐exposed workers and the confidence interval includes the 4.2 dB which is the level of hearing loss resulting from 5 years of exposure to 85 dB(A). In addition, of three other CBA studies that could not be included in the meta‐analysis, two showed an increased risk of hearing loss in spite of the protection of a HLPP compared to non‐exposed workers and one CBA did not.
Authors' conclusions
There is very low‐quality evidence that implementation of stricter legislation can reduce noise levels in workplaces. Controlled studies of other engineering control interventions in the field have not been conducted. There is moderate‐quality evidence that training of proper insertion of earplugs significantly reduces noise exposure at short‐term follow‐up but long‐term follow‐up is still needed.
There is very low‐quality evidence that the better use of hearing protection devices as part of HLPPs reduces the risk of hearing loss, whereas for other programme components of HLPPs we did not find such an effect. The absence of conclusive evidence should not be interpreted as evidence of lack of effectiveness. Rather, it means that further research is very likely to have an important impact.
This symposium comprised five oral presentations dealing with recent findings on Mn-related cognitive and motor changes from epidemiological studies across the life span. The first contribution ...highlighted the usefulness of functional neuroimaging of the central nervous system (CNS) to evaluate cognitive as well as motor deficits in Mn-exposed welders. The second dealt with results of two prospective studies in Mn-exposed workers or welders showing that after decrease of Mn exposure the outcome of reversibility in adverse CNS effects may differ for motor and cognitive function and, in addition the issue of plasma Mn as a reliable biomarker for Mn exposure in welders has been addressed. The third presentation showed a brief overview of the results of an ongoing study assessing the relationship between environmental airborne Mn exposure and neurological or neuropsychological effects in adult Ohio residents living near a Mn point source. The fourth paper focused on the association between blood Mn and neurodevelopment in early childhood which seems to be sensitive to both low and high Mn concentrations. The fifth contribution gave an overview of six studies indicating a negative impact of excess environmental Mn exposure from air and drinking water on children's cognitive performance, with special attention to hair Mn as a potential biomarker of exposure. These studies highlight a series of questions about Mn neurotoxicity with respect to cognitive processes, forms and routes of exposure, adequate biomarkers of exposure, gender differences, susceptibility and exposure limits with regard to age.
Background
Chronic exposure to stress has been linked to several negative physiological and psychological health outcomes. Among employees, stress and its associated effects can also result in ...productivity losses and higher healthcare costs. In‐person (face‐to‐face) and computer‐based (web‐ and mobile‐based) stress management interventions have been shown to be effective in reducing stress in employees compared to no intervention. However, it is unclear if one form of intervention delivery is more effective than the other. It is conceivable that computer‐based interventions are more accessible, convenient, and cost‐effective.
Objectives
To compare the effects of computer‐based interventions versus in‐person interventions for preventing and reducing stress in workers.
Search methods
We searched CENTRAL, MEDLINE, PubMed, Embase, PsycINFO, NIOSHTIC, NIOSHTIC‐2, HSELINE, CISDOC, and two trials registers up to February 2017.
Selection criteria
We included randomised controlled studies that compared the effectiveness of a computer‐based stress management intervention (using any technique) with a face‐to‐face intervention that had the same content. We included studies that measured stress or burnout as an outcome, and used workers from any occupation as participants.
Data collection and analysis
Three authors independently screened and selected 75 unique studies for full‐text review from 3431 unique reports identified from the search. We excluded 73 studies based on full‐text assessment. We included two studies. Two review authors independently extracted stress outcome data from the two included studies. We contacted study authors to gather additional data. We used standardised mean differences (SMDs) with 95% confidence intervals (CIs) to report study results. We did not perform meta‐analyses due to variability in the primary outcome and considerable statistical heterogeneity. We used the GRADE approach to rate the quality of the evidence.
Main results
Two studies met the inclusion criteria, including a total of 159 participants in the included arms of the studies (67 participants completed computer‐based interventions; 92 participants completed in‐person interventions). Workers were primarily white, Caucasian, middle‐aged, and college‐educated. Both studies delivered education about stress, its causes, and strategies to reduce stress (e.g. relaxation or mindfulness) via a computer in the computer‐based arm, and via small group sessions in the in‐person arm. Both studies measured stress using different scales at short‐term follow‐up only (less than one month). Due to considerable heterogeneity in the results, we could not pool the data, and we analysed the results of the studies separately. The SMD of stress levels in the computer‐based intervention group was 0.81 standard deviations higher (95% CI 0.21 to 1.41) than the in‐person group in one study, and 0.35 standard deviations lower (95% CI ‐0.76 to 0.05) than the in‐person group in another study. We judged both studies as having a high risk of bias.
Authors' conclusions
We found very low‐quality evidence with conflicting results, when comparing the effectiveness of computer‐based stress management interventions with in‐person stress management interventions in employees. We could include only two studies with small sample sizes. We have very little confidence in the effect estimates. It is very likely that future studies will change these conclusions.
Background
Dentistry is a profession with a high prevalence of work‐related musculoskeletal disorders (WMSD) among practitioners, with symptoms often starting as early in the career as the student ...phase. Ergonomic interventions in physical, cognitive, and organisational domains have been suggested to prevent their occurrence, but evidence of their effects remains unclear.
Objectives
To assess the effect of ergonomic interventions for the prevention of work‐related musculoskeletal disorders among dental care practitioners.
Search methods
We searched CENTRAL, MEDLINE PubMed, Embase, PsycINFO ProQuest, NIOSHTIC, NIOSHTIC‐2, HSELINE, CISDOC (OSH‐UPDATE), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) Search Portal to August 2018, without language or date restrictions.
Selection criteria
We included randomised controlled trials (RCTs), quasi‐RCTs, and cluster RCTs, in which participants were adults, aged 18 and older, who were engaged in the practice of dentistry. At least 75% of them had to be free from musculoskeletal pain at baseline. We only included studies that measured at least one of our primary outcomes; i.e. physician diagnosed WMSD, self‐reported pain, or work functioning.
Data collection and analysis
Three authors independently screened and selected 20 potentially eligible references from 946 relevant references identified from the search results. Based on the full‐text screening, we included two studies, excluded 16 studies, and two are awaiting classification. Four review authors independently extracted data, and two authors assessed the risk of bias. We calculated the mean difference (MD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% confidence intervals for dichotomous outcomes. We assessed the quality of the evidence for each outcome using the GRADE approach.
Main results
We included two RCTs (212 participants), one of which was a cluster‐randomised trial. Adjusting for the design effect from clustering, reduced the total sample size to 210. Both studies were carried out in dental clinics and assessed ergonomic interventions in the physical domain, one by evaluating a multi‐faceted ergonomic intervention, which consisted of imparting knowledge and training about ergonomics, work station modification, training and surveying ergonomics at the work station, and a regular exercise program; the other by studying the effectiveness of two different types of instrument used for scaling in preventing WMSDs. We were unable to combine the results from the two studies because of the diversity of interventions and outcomes.
Physical ergonomic interventions. Based on one study, there is very low‐quality evidence that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs (RR 0.57, 95% CI 0.23 to 1.42; 102 participants), or feet (RR 0.64, 95% CI 0.29 to 1.41; 102 participants) when compared to no intervention over a six‐month period. Based on one study, there is low‐quality evidence of no clear difference in elbow pain (MD −0.14, 95% CI −0.39 to 0.11; 110 participants), or shoulder pain (MD −0.32, 95% CI −0.75 to 0.11; 110 participants) in participants who used light weight curettes with wider handles or heavier curettes with narrow handles for scaling over a 16‐week period.
Cognitive ergonomic interventions. We found no studies evaluating the effectiveness of cognitive ergonomic interventions.
Organisational ergonomic interventions. We found no studies evaluating the effectiveness of organisational ergonomic interventions.
Authors' conclusions
There is very low‐quality evidence from one study showing that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs or feet when compared to no intervention over a six‐month period. This was a poorly conducted study with several shortcomings and errors in statistical analysis of data. There is low‐quality evidence from one study showing no clear difference in elbow pain or shoulder pain in participants using light weight, wider handled curettes or heavier and narrow handled curettes for scaling over a 16‐week period.
We did not find any studies evaluating the effectiveness of cognitive ergonomic interventions or organisational ergonomic interventions.
Our ability to draw definitive conclusions is restricted by the paucity of suitable studies available to us, and the high risk of bias of the studies that are available. This review highlights the need for well‐designed, conducted, and reported RCTs, with long‐term follow‐up that assess prevention strategies for WMSDs among dental care practitioners.
This Viewpoint discusses sources of anxiety revealed in conversations with health care workers (HCWs) in the early weeks of the coronavirus disease 2019 (COVID-19) pandemic, and the importance of ...expressions of gratitude from leadership for HCWs' commitment and willingness to put themselves in harm's way as a means to ameliorate that anxiety.
Silicosis Leung, Chi Chiu, Dr; Yu, Ignatius Tak Sun, Prof; Chen, Weihong, Prof
The Lancet (British edition),
05/2012, Volume:
379, Issue:
9830
Journal Article
Peer reviewed
Summary Silicosis is a fibrotic lung disease caused by inhalation of free crystalline silicon dioxide or silica. Occupational exposure to respirable crystalline silica dust particles occurs in many ...industries. Phagocytosis of crystalline silica in the lung causes lysosomal damage, activating the NALP3 inflammasome and triggering the inflammatory cascade with subsequent fibrosis. Impairment of lung function increases with disease progression, even after the patient is no longer exposed. Diagnosis of silicosis needs carefully documented records of occupational exposure and radiological features, with exclusion of other competing diagnoses. Mycobacterial diseases, airway obstruction, and lung cancer are associated with silica dust exposure. As yet, no curative treatment exists, but comprehensive management strategies help to improve quality of life and slow deterioration. Further efforts are needed for recognition and control of silica hazards, especially in developing countries.
PDF
