Objectives:Major depression is a leading cause of psychiatric morbidity and may be influenced by psychosocial factors in the workplace, although evidence so far remains circumstantial. This paper ...reviews follow-up studies addressing the risk of major depression and depressive symptoms relative to psychosocial stressors in the working environment and evaluates the evidence for causality.Method:Follow-up studies were identified by a systematic Medline search combining search terms for the outcome and measures of job-related psychosocial factors. The quality of the studies was evaluated using 22 criteria related to their potential for bias and confounding.Results:Sixteen company or population-based studies including some 63 000 employees were identified. Validated multi-item scales were used to measure perceived psychosocial stressors in most of the studies. Major depression was defined by clinical criteria in seven studies and by symptom scales in another seven. The follow-up period ranged from 1 to 13 years. The prevalence of depressive disorder varied substantially, suggesting a high degree of study heterogeneity. The adjusted relative risk for onset of a major depressive episode according to job stressors ranged from 0.5 to 1.5 in 44 of 61 reported associations with various psychosocial factor dimensions. Associations were strongest and most consistent for job strain defined as high demand and low decision latitude among men. Most studies shared common limitations such as lack of independent measures of exposure and outcome and potential confounding. Although a meta-analysis would technically be possible, heterogeneity across studies evidenced by variation in the prevalence of depression made this unfeasible.Conclusion:This review provides consistent findings that perception of adverse psychosocial factors in the workplace is related to an elevated risk of subsequent depressive symptoms or major depressive episode; however, methodological limitations preclude causal inference. Studies implementing objective measures of job stressors or independent outcome ascertainment are warranted.
BACKGROUND The global obesity epidemic has paralleled a decrease in semen quality. Yet, the association between obesity and sperm parameters remains controversial. The purpose of this report was to ...update the evidence on the association between BMI and sperm count through a systematic review with meta-analysis. METHODS A systematic review of available literature (with no language restriction) was performed to investigate the impact of BMI on sperm count. Relevant studies published until June 2012 were identified from a Pubmed and EMBASE search. We also included unpublished data (n = 717 men) obtained from the Infertility Center of Bondy, France. Abstracts of relevant articles were examined and studies that could be included in this review were retrieved. Authors of relevant studies for the meta-analysis were contacted by email and asked to provide standardized data. RESULTS A total of 21 studies were included in the meta-analysis, resulting in a sample of 13 077 men from the general population and attending fertility clinics. Data were stratified according to the total sperm count as normozoospermia, oligozoospermia and azoospermia. Standardized weighted mean differences in sperm concentration did not differ significantly across BMI categories. There was a J-shaped relationship between BMI categories and risk of oligozoospermia or azoospermia. Compared with men of normal weight, the odds ratio (95% confidence interval) for oligozoospermia or azoospermia was 1.15 (0.93-1.43) for underweight, 1.11 (1.01-1.21) for overweight, 1.28 (1.06-1.55) for obese and 2.04 (1.59-2.62) for morbidly obese men. CONCLUSIONS Overweight and obesity were associated with an increased prevalence of azoospermia or oligozoospermia. The main limitation of this report is that studied populations varied, with men recruited from both the general population and infertile couples. Whether weight normalization could improve sperm parameters should be evaluated further.
Bonde explores how to get conclusive evidence on endocrine disruption at the workplace. The health consequences of reproductive hazards at the workplace may be grave for the individual and society. ...Ensuring a working environment that protects reproductive health must be a high priority. With reference to the precautionary principle, it may be tempting to exclude pregnant women from work that may carry the slightest theoretical risk. But this approach may have strong social and economic consequences for the women who thus do not necessarily benefit from the doubt. Many people need to know more. While experimental studies are important for risk assessment, most rely on epidemiology to address real world occupational exposure scenarios. Epidemiological methods and populations are available, but to ensure progress, a provision of resources is needed to refine assessment of occupational exposure to endocrine disrupting chemicals by ambient air and biological measurements.
Atopic dermatitis (AD) has considerable multidimensional personal and societal costs. However, the extend to which the patient's work life is affected due to AD is more sparsely described in the ...literature. The objective of this review was to examine the impact on work life for patients with AD, with a specific focus on choice of education and occupation, sick leave, social compensations and change of job due to AD. A systematic literature search was performed in PubMed, EMBASE and Web og Science up to 7 February 2017 for articles on the impact on work life for patients with AD. Results were summarized taking several measures of study quality into account. The search identified twenty‐three articles, whereof five studies assessed the influence of AD on educational or job choice, without any consistent conslusion, while eight of nine studies with respect to sick leave and two on disability pensions found AD to have a negative impact. Studies of change or loss of job and AD showed more diverse results, as not all studies documented a negative effect of AD on work life. Atopic dermatitis imposes a burden extending beyond personal, emotional and financial costs. This review strongly implies that AD affects sick leave, and though not fully clarified, possible also job choice, change or loss of job and even disability pensions for the more severe cases.
BACKGROUND
Perfluorinated compounds (PFCs) have been suspected to adversely affect human reproductive health. The aim of this study was to investigate the associations between PFC exposure and male ...semen quality.
METHODS
PFCs were measured in serum from 588 partners of pregnant women from Greenland, Poland and Ukraine who provided a semen sample, using liquid chromatography tandem mass spectrometry. Perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) could be detected in >97% of the samples. The associations between levels of these compounds and semen volume, sperm concentration, total sperm count, motility and morphology were assessed.
RESULTS
Across countries, sperm concentration, total sperm count and semen volume were not consistently associated with PFOS, PFOA, PFHxS or PFNA levels. The proportion of morphologically normal cells was 35% lower 95% confidence interval (CI): 4–66%) for the third tertile of PFOS exposure as compared with the first. A similar reduction was found in relation to increasing PFHxS levels. At the third PFOA exposure tertile, the percentage of motile spermatozoa was 19% (95% CI: 1 to 39%) higher than in the first.
CONCLUSIONS
The most robust finding in the present study was the negative associations between PFOS exposure and sperm morphology suggesting adverse effects of PFOS on semen quality, possibly due to interference with the endocrine activity or sperm membrane function. It cannot be excluded that this association and the positive association between PFOA and semen motility, which was not consistent across countries, might represent a chance finding due to the multiple statistical tests being performed.
BACKGROUND Recent studies indicate that not only women's but also men's obesity has adverse effects on fecundity and since fecundity is a couple concept, we examined fecundity in relation to ...overweight and obesity of the couple. We also examined the association between weight changes and fecundity over time. METHODS Between 1996 and 2002, 64 167 pregnant women enrolled in the Danish National Birth Cohort were interviewed during and 18 months after pregnancy. Information on body mass index (BMI) and waiting time to pregnancy (TTP) was available for 47 835 couples. RESULTS Among men and women with a BMI of 18.5 kg/m2 or more, we found a dose-response relationship between increasing BMI group and subfecundity (a TTP of more than 12 months): Odds ratio (OR) = 1.32 (95% CI: 1.26–1.37) for women and OR = 1.19 (95% CI: 1.14–1.24) for men. Among 2374 women with an initial BMI of 18.5 kg/m2 or more, who participated more than once in the Danish National Birth Cohort, each kilogram increment in weight between the two pregnancies was associated with a 2.84 (95% CI: 1.33–4.35) days longer TTP. CONCLUSIONS Couples have a high risk of being subfecund if they are both obese.
Objectives: To examine the risk of affective and stress related disorders among men and women employed in human service professions. Methods: Population based case-control study using data from ...national registers. Cases (n = 28 971) were identified in the Danish Psychiatric Central Research Register among all hospitalised patients and outpatients aged 18–65 who received a first time ever diagnosis of affective (ICD-10, F30–39) or stress related (ICD-10, F40–48) disorder from 1 January 1995 to 31 December 1998. Each case was assigned five never admitted referents (n = 144 855) of the same gender and age, randomly drawn from a 5% sample of the Danish population obtained from Statistics Denmark’s Integrated Database for Labour Market Research. Occupation held the year before matching was classified according to the Danish version of the International Classification of Occupation. Health care, education, social work, and customer services were defined as human service professions and constituted 21% of all employed in the study. Adjusted risks (hazard ratios) relative to all other occupations were calculated for 24 human service occupations. Results: The relative risk of depression in human service professions was 1.35 (95% CI 1.24 to 1.47) for women and 1.49 (95% CI 1.29 to 1.73) for men. The risk of stress was 1.18 (95% CI 1.11 to 1.26) for women and 1.49 (95% CI 1.32 to 1.67) for men. Specific professions contributed differentially to the magnitude of risk, with education and social services displaying the highest risks. No increase in risks was found in customer service occupations. Gender was a significant modifying factor with the highest risk levels in men. Conclusions: There was a consistent association between employment in human service occupations and the risk of affective and stress related disorders. Risks were highest for men working in these typically female professions. More work is needed to distinguish work hazards from effects attributable to selection mechanisms and personality characteristics.
STUDY QUESTION
Does prenatal exposure to perfluoroalkyl substances (PFASs) have long-term effects on female reproductive function?.
SUMMARY ANSWER
Our results suggest an association between in utero ...exposure to perfluorooctanoic acid (PFOA) and delay in age of menarche.
WHAT IS KNOWN ALREADY
Previous cross-sectional studies have reported possible effects of PFASs on female reproduction including reduced fecundity, delayed puberty and accelerated age at menopause. Only limited data exist from follow-up studies on long-term implications of prenatal exposure to PFASs.
STUDY DESIGN, SIZE, DURATION
In this study we used data from a Danish population-based cohort established in 1988–1989. Of 1212 eligible pregnant women, 965 participated. Follow-up was initiated in 2008 on the female offspring at ∼20 years of age. Three hundred and sixty seven (84%) daughters answered a questionnaire and 267 (61%) daughters furthermore attended clinical examinations which were conducted in 2008–2009.
PARTICIPANTS/MATERIALS, SETTING, METHODS
The final study population consisted of 343 daughters of which 254 had attended the clinical examinations and 89 had answered the questionnaire only. Levels of PFASs in maternal serum from pregnancy week 30 were used as a measure of prenatal exposure and related to age of menarche, menstrual cycle length, levels of reproductive hormones and follicle number of the daughters. Data were divided into three groups according to tertiles of maternal concentrations of PFASs (low, medium, high).
MAIN RESULTS AND THE ROLE OF CHANCE
In adjusted regression analyses, daughters exposed to higher levels of PFOA in utero had a 5.3 (95% confidence interval: 1.3; 9.3) months later age of menarche compared with the reference group of lower PFOA. Crude (P = 0.05) and adjusted (P = 0.01) trend tests also indicated a relationship between higher prenatal PFOA exposure and delay of menarche.
LIMITATIONS, REASONS FOR CAUTION
We did not measure the exact amount of PFASs to which the daughters had been exposed prenatally. Instead we used PFAS concentrations in maternal serum as surrogates. However, PFASs are efficiently transferred to the fetus via placenta. Information on age of menarche was collected retrospectively but the time interval for recall in our study was relatively short (2–10 years). The remaining outcome measures depended on participation in clinical examination which reduced the number of observations leading to limited statistical power and risk of selection bias.
WIDER IMPLICATIONS OF THE FINDINGS
Since PFASs can be detected in humans all over the world, effects of prenatal exposure on female reproductive function later in life may have wide health implications.
STUDY FUNDING/COMPETING INTEREST(S)
The study was supported by the Danish Council for Independent Research (271-05-0296, 09-065631), the Danish Ministry of Interior and Health (0-302-02-18/5), the Danish Council for Strategic Research (09-067124 (Centre for Fetal Programming), 09-063072, 2101-06-0005), the Novo Nordisk Foundation, the Aarhus University Research Foundation, the Frimodt-Heineke Foundation, the Foundation of Maria Dorthea and Holger From, the Beckett-Foundation, the Research Grant of Organon and the Foundation of Lily Benthine Lund. There are no competing interests.
Trial registration number
Not applicable.
Aims: To quantify the relative contribution of work related physical factors, psychosocial workplace factors, and individual factors and aspects of somatisation to the onset of neck/shoulder pain. ...Methods: Four year prospective cohort study of workers from industrial and service companies in Denmark. Participants were 3123 workers, previously enrolled in a cross sectional study, where objective measurement of physical workplace factors was used. Eligible participants were followed on three subsequent occasions with approximately one year intervals. Outcomes of interest were: new onset of neck/shoulder pain (symptom cases); and neck/shoulder pain with pressure tenderness in the muscles of the neck/shoulder region (clinical cases). Results: During follow up, 636 (14.1%) participants reported neck/shoulder pain of new onset; among these, 82 (1.7%) also had clinical signs of substantial muscle tenderness. High shoulder repetition was related to being a future symptom case, and a future clinical case. Repetition was strongly intercorrelated with other physical measures. High job demands were associated with future status as a symptom case, and as a clinical case. A high level of distress predicted subsequent neck/shoulder pain, and neck/shoulder pain with pressure tenderness. Conclusions: High levels of distress, and physical and psychosocial workplace factors are predictors of onset of pain in the neck and/or shoulders, particularly pain with pressure tenderness in the muscles.
Numerous studies describe the occurrence of post-traumatic stress disorder following disasters, but less is known about the risk of major depression.
To review the risk of depressive disorder in ...people surviving disasters and in soldiers returning from military deployment.
A systematic literature search combined with reference screening identified 23 controlled epidemiological studies. We used random effects models to compute pooled odds ratios (ORs).
The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30-3.98), technological disaster OR = 1.44 (95% CI 1.21-1.70), terrorist acts OR = 1.80 (95% CI 1.38-2.34) and military combat OR = 1.60 (95% CI 1.09-2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06-1.87).
Disasters and combat experience substantially increase the risk of depression. Whether psychological trauma per se or bereavement is on the causal path is unresolved.
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