Despite a robust hearing conservation program, military personnel continue to be at high risk for noise induced hearing loss (NIHL). For more than a decade, a number of laboratories have investigated ...the use of antioxidants as a safe and effective adjunct to hearing conservation programs. Of the antioxidants that have been investigated, N-acetylcysteine (NAC) has consistently reduced permanent NIHL in the laboratory, but its clinical efficacy is still controversial. This study provides a prospective, randomized, double-blinded, placebo-controlled clinical trial investigating the safety profile and the efficacy of NAC to prevent hearing loss in a military population after weapons training.
Of the 566 total study subjects, 277 received NAC while 289 were given placebo. The null hypothesis for the rate of STS was not rejected based on the measured results. While no significant differences were found for the primary outcome, rate of threshold shifts, the right ear threshold shift rate difference did approach significance (p = 0.0562). No significant difference was found in the second primary outcome, percentage of subjects experiencing an adverse event between placebo and NAC groups (26.7% and 27.4%, respectively, p = 0.4465). Results for the secondary outcome, STS rate in the trigger hand ear, did show a significant difference (34.98% for placebo-treated, 27.14% for NAC-treated, p-value = 0.0288). Additionally, post-hoc analysis showed significant differences in threshold shift rates when handedness was taken into account.
While the secondary outcomes and post-hoc analysis suggest that NAC treatment is superior to the placebo, the present study design failed to confirm this. The lack of significant differences in overall hearing loss between the treatment and placebo groups may be due to a number of factors, including suboptimal dosing, premature post-exposure audiograms, or differences in risk between ears or subjects. Based on secondary outcomes and post hoc analyses however, further studies seem warranted and are needed to clarify dose response and the factors that may have played a role in the observed results.
•A Phase II-like study assessed the efficacy and safety of orally-administered NAC.•Despite use of ear plugs, 37% of subjects exhibited significant threshold shift.•NAC was safe and well tolerated compared to placebo.•Based on limited preliminary data, groups did not show significance differences.•Post hoc and Sign tests suggested that there may be a treatment effect.
Summary Objective The study aimed to review the prevalence of self-reported voice disorders in singers. Study Design The study is a systematic review and meta-analysis. Methods A systematic review of ...five major scientific databases was conducted. An extensive search strategy was used considering the rules of each database. Original articles were included only if they had data related to self-perception of dysphonia in the past. Furthermore, heterogeneity and its relative significance were assessed. Results There were 2371 articles identified; duplicates were deleted, screenings were conducted, and inclusion and exclusion criteria were applied. The final analysis was conducted on 11 studies. The most implemented instruments for the study were customized questionnaires. The findings about singing styles, voice use, and age were found to be different among subjects. The overall prevalence of self-reported dysphonia in singers was 46.09% (95% confidence interval: 38.16–54.12). The heterogeneity was considerable among the studied samples (I2 = 90.59%). Four groups were then established—students, teachers, classical, and nonclassical—and compared regarding overall prevalence (21.76% in students, and significantly higher and nondifferent in the other three groups, 55.15%, 40.53%, and 46.96%, respectively) and heterogeneity (low only for the students' studies). Conclusion Although with low homogeneity, singers present a high prevalence of self-perceived dysphonia over their careers. Singing students were the group with a lower prevalence. On the other hand, traditional and popular music singers, as well as singing teachers, revealed significantly higher prevalence of self-perceived dysphonia. Overall, singers are likely to report voice disorders, no matter their singing style or skills. This highlights the need of a preventive approach to address voice disorders in traditional and untrained singers.
A variety of chemicals have been linked to occupational liver diseases, including several solvents and mixtures thereof, pesticides, and metals. Workplace exposures have been associated with ...virtually the entire spectrum of acute and chronic liver diseases. However, their prevalence is inadequately quantified and their epidemiology limited. Occupational liver diseases may result from high accidental or from prolonged lower level exposures. Whereas the former is uncommon and easily recognised, the latter are relatively more frequent but often overlooked because they may display normal values of conventional markers, have an insidious onset and be asymptomatic or be obfuscated and confounded by concurrent conditions. In addition, specific tests of toxicity are not available, histopathology may not be revealing and the assessment of internal dose of chemicals is usually not decisive. Given these circumstances, the diagnosis of these liver disorders is challenging, one of exclusion and often requires an interdisciplinary approach. These recommendations offer a classification of the type of liver injuries associated with occupational exposures – based in part on the criteria for drug-induced liver injury – a grading of their severity, and the diagnostic and preventive criteria for chemically induced occupational liver disease.
Coal mining remains a sizable industry, with millions of working and retired coal miners worldwide. This article provides an update on recent advances in the understanding of respiratory health ...issues in coal miners and focuses on the spectrum of disease caused by inhalation of coal mine dust, termed coal mine dust lung disease. In addition to the historical interstitial lung diseases (coal worker's pneumoconiosis, silicosis, and mixed dust pneumoconiosis), coal miners are at risk for dust-related diffuse fibrosis and chronic airway diseases, including emphysema and chronic bronchitis. Recent recognition of rapidly progressive pneumoconiosis in younger miners, mainly in the eastern United States, has increased the sense of urgency and the need for vigilance in medical research, clinical diagnosis, and exposure prevention. Given the risk for disease progression even after exposure removal, along with few medical treatment options, there is an important role for chest physicians in the recognition and management of lung disease associated with work in coal mining.
Background
Skin diseases constitute up to 40% of all notified occupational diseases in most European countries, predominantly comprising contact dermatitis, contact urticaria, and skin cancer. While ...insufficient prevention of work‐related skin diseases (WRSD) is a top‐priority problem in Europe, common standards for prevention of these conditions are lacking.
Objective
To develop common European standards on prevention and management of WRSD and occupational skin diseases (OSD).
Method
Consensus amongst experts within occupational dermatology was achieved with regard to the definition of minimum evidence‐based standards on prevention and management of WRSD/OSD.
Results
By definition, WRSDs/OSDs are (partially or fully) caused by occupational exposure. The definition of OSD sensu stricto additionally includes diverging national legal requirements, with an impact on registration, prevention, management, and compensation. With the implementation of the classification of WRSD/OSD in the International Classification of Diseases (ICD) 11th Revision in future, a valid surveillance and comparability across countries will be possible. Currently, WRDS and OSD are still under‐reported. Depending on legislation and regulations, huge differences exist in notification procedures in Europe, although notification is crucial to prevent chronic and relapsing disease. Facilities for early diagnosis, essential for individual patient management, should be based on existing guidelines and include a multidisciplinary approach. Patch testing is essential if contact dermatitis persists or relapses. Workplace exposure assessment of WRSD/OSD requires full labelling of product ingredients on material safety data sheets helping to identify allergens, irritants and skin carcinogens. Comparable standards in primary, secondary and tertiary prevention must be established in Europe to reduce the burden of WRSD/OSD in Europe.
Conclusion
The adoption of common European standards on prevention of WRSD/OSD will contribute to reduce the incidence of OSD and their socio‐economic burden.
AbstractObjectiveVascular surgeons may experience physical discomfort during open and endovascular procedures. We aimed to understand and quantify the timing, severity, and location of the pain, as ...well as to identify how pain correlates with other factors. MethodsAn electronic survey was distributed to 1164 members of the Society for Clinical Vascular Surgery during the summer of 2016. There were 1089 (93.6%) surveys that were successfully delivered and 263 responses received (response rate of 24.2%). The survey was designed to quantify pain before, during, and after surgical procedures using the modified Borg scale. Questions aimed at determining surgeon workload, type of practice, burnout, and professional satisfaction were also included. ResultsOf the 263 total responses, 184 responders were male (82.1%). Workload data revealed that more than 87% of surgeons operate 3 or more days per week and 4 or more hours per day. Lead garments were worn by 48.4% these surgeons every day, with 91.4% wearing lead at least once per week. Pain was present in 74.7% of surgeons before beginning an operation, in 92.3% during an operation, and in 96.8% at completion. Before, during, and after surgery, 12.2% of vascular surgeons (n = 32) experience at least moderate pain. Years in practice had no effect on these results, and although not reaching statistical significance, there was a trend correlating surgeons who wear lead experiencing more pain immediately after performing an operation ( P = .090). Of these surgeons, 31.4% acknowledged seeking medical help, although only 4.4% reported pain to their institutions. Professional satisfaction among vascular surgeons was inversely correlated with pain. Those expressing satisfaction with their profession had less pain before and two days after performing surgery ( P ≤ .005). Self-reported burnout among surgeons positively correlated with increased pain. Burned out surgeons reported more pain while performing surgery ( P ≤ .001), immediately after performing surgery ( P ≤ .001), and persistent pain ( P ≤ .001). ConclusionsPhysical discomfort during the performance of daily duties by vascular surgeons is ubiquitous. Our survey shows a correlation between self-reported workplace burnout and an increased severity of work-related pain. Additional studies are needed to determine the causality of these correlations and what potential interventions can be undertaken to decrease all work-related pain.
Dental professionals are subjected to higher risks for musculoskeletal disorders (MSDs) than other professional groups, especially the hand region. This study aims to investigate the prevalence of ...hand complaints among dentists (Ds) and dental assistants (DAs) and examines applied therapies.
For this purpose, an online questionnaire analysed 389 Ds (240female/149male) and 406 DAs (401female/5male) working in Germany. The self-reported data of the two occupational groups were compared with regard to the topics examined. The questionnaire was based on the Nordic Questionnaire (self-reported lifetime, 12-month and 7-day MSDs prevalence of the hand, the conducted therapy and its success), additional occupational and sociodemographic questions as well as questions about specific medical conditions.
30.8% of Ds affirmed MSDs in the hand at any time in their lives, 20.3% in the last twelve months and 9.5% in the last seven days. Among DAs, 42.6% reported a prevalence of MSDs in the hand at any time in their lives, 31.8% in the last 12 months and 15.3% in the last seven days. 37.5% of the Ds and 28.3% of the DAs stated that they had certain treatments. For both, Ds and DAs, physiotherapy was the most frequently chosen form of therapy. 89.7% of Ds and 63.3% of DAs who received therapy reported an improvement of MSDs.
Although the prevalence of MSDs on the hand is higher among DAs than among Ds, the use of therapeutic options and the success of therapy is lower for DAs compared to Ds.
Background
Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, ...challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work‐related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience‐promoting training programmes.
Objectives
To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).
Search methods
We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.
Selection criteria
Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post‐traumatic growth versus no intervention, wait‐list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well‐being or quality of life. Secondary outcomes were resilience factors.
Data collection and analysis
Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post‐test only).
Main results
We included 44 RCTs (high‐income countries: 36). Thirty‐nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies).
Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face‐to‐face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive‐behavioural therapy) versus unspecific comparators (e.g. wait‐list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support.
Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains.
At post‐intervention, very‐low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD −0.29, 95% CI −0.50 to −0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD −0.61, 95% CI −1.07 to −0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD −0.06, 95% CI −0.35 to 0.23; 5 studies, 231 participants; very‐low certainty evidence) or well‐being or quality of life (SMD 0.14, 95% CI −0.01 to 0.30; 13 studies, 1494 participants; very‐low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very‐low certainty evidence).
Authors' conclusions
For healthcare professionals, there is very‐low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post‐intervention.
The paucity of medium‐ or long‐term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high‐quality replications and improved study designs.
The majority of miscarriages are sporadic and most result from genetic causes that are greatly influenced by maternal age. Recurrent pregnancy loss (RPL) is defined by two or more failed clinical ...pregnancies, and up to 50% of cases of RPL will not have a clearly defined etiology.
Background
Worldwide, the number of SARS‐CoV‐2 infections is increasing. Serological immunoglobulin tests may help to better understand the development of immune mechanisms against SARS‐CoV‐2 in ...COVID‐19 cases and exposed but asymptomatic individuals. The aim of this study was to investigate exposure to SARS‐CoV‐2, symptoms, and antibody responses in a large sample of healthcare workers following a COVID‐19 outbreak.
Methods
A COVID‐19 outbreak among staff members of a major German children's and women's hospital was followed by massive RT‐PCR SARS‐CoV‐2 tests and provided the opportunity to study symptoms, chains of infection, and SARS‐CoV‐2–specific antibody responses (IgG and IgA) by ELISA. Study participants were classified as COVID‐19 cases, and persons with close, moderate, or no exposure to SARS‐CoV‐2 in the clinical setting, respectively.
Results
Out of 201 study participants, 31 were COVID‐19 cases. While most study participants experienced many symptoms indicative for SARS‐CoV‐2 infection, anosmia and coughing were remarkably more frequent in COVID‐19 cases. Approximately 80% of COVID‐19 cases developed some specific antibody response (IgA and IgG) approximately 3 weeks after onset of symptoms. Subjects in the non‐COVID‐19 groups had also elevated IgG (1.8%) and IgA values (7.6%) irrespective of contact history with cases.
Conclusion
We found that a significant number of diseased did not develop relevant antibody responses three weeks after symptom onset. Our data also suggest that exposure to COVID‐19 positive co‐workers in a hospital setting is not leading to the development of measurable immune responses in a significant proportion of asymptomatic contact persons.
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