At-risk Occupations Research Articles

Scoping review of exposure questionnaires and surveys in interstitial lung disease

BackgroundMany interstitial lung diseases (ILDs) have clear causal relationships with environmental and occupational exposures. Exposure identification can assist with diagnosis, understanding disease pathogenesis, prognostication and prevention of disease progression and...

Risk of chronic obstructive pulmonary disease in a large cohort of Ontario, Canada workers

Although several occupational exposures have been linked to the risk of COPD; limited data exists on sex-specific differences. This study aimed to identify at-risk occupations and sex differences for COPD risk. Cases were identified in a large surveillance system established through the linkage of former compensation claimants’ data (non-COPD claims) to physician visits, ambulatory care data, and hospital inpatient data (1983–2020). Cox proportional hazard models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for occupation groups (occupation at time of claim), stratified by sex. HRs were indirectly adjusted for cigarette smoking using another population dataset. A total of 29,445 male and 14,693 female incident cases of COPD were identified. Increased risks were observed in both sexes for construction (HRmale 1.15, 95% CI 1.12–1.19; HRfemale 1.54, 95% CI 1.29–1.83) transport/equipment operating (HRmale 1.32, 95% CI 1.28–1.37; HRfemale 1.53, 95% CI 1.40–1.68) farming (HRmale 1.23, 95% CI 1.15–1.32; HRfemale 1.19, 95% CI 1.04–1.37) and janitors/cleaners (HRmale 1.31, 95% CI 1.24–1.37; HRfemale 1.40, 95% CI 1.31–1.49). Increased risks were observed for females employed as chefs and cooks (HR 1.44, 95% CI 1.31–1.58), bartenders (HR 1.38, 95% CI 1.05–1.81), and those working in food/beverage preparation (HR 1.34, 95% CI 1.24–1.45) among other occupations. This study demonstrates elevated risk of COPD among both male and female workers potentially exposed to vapours, gases, dusts, and fumes, highlighting the need for occupational surveillance of COPD.

Underreporting of Work-Related COVID-19 Cases in Norway.

Background: This register-based study provides a profile of work-related Covid-19 cases reported by physicians to the Norwegian Labor Inspection Authority (NLIA). Methods: All the reports of work-related Covid-19 cases reported by a physician to the NLIAs Registry for Work-Related Diseases (RAS) between February 2020 and February 2022 were included. Descriptive statistics and the incidence rate of reported cases were computed for age, gender, and occupation. Results: Two hundred and seventeen work-related Covid-19 cases were reported to RAS during the study period. Sixty-five percent of the cases were females (n = 141), and 35 percent (n = 76) were males. Doctors, nurses, and ambulance personnel yielded higher incidence rates than other healthcare and nonhealthcare occupations. Conclusions: This study indicates that women aged 25-39 and employed in the healthcare sector had the highest reported incidence and number of work-related Covid-19 cases. Physician underreporting of work-related Covid-19 cases is an important finding. Plausibly, underreporting is more substantial for at-risk non-healthcare occupations such as waiters, bartenders, food couriers, and taxi drivers than occupations in healthcare.

Occupational risk of COVID-19 in foreign-born employees in Denmark.

Foreign-born workers in high-income countries experience higher rates of COVID-19 but the causes are only partially known. To examine if the occupational risk of COVID-19 in foreign-born workers deviates from the risk in native-born employees in Denmark. Within a registry-based cohort of all residents employed in Denmark (n = 2 451 542), we identified four-digit DISCO-08 occupations associated with an increased incidence of COVID-19-related hospital admission during 2020-21 (at-risk occupations). The sex-specific prevalence of at-risk employment in foreign born was compared with the prevalence in native born. Moreover, we examined if the country of birth modified the risk of a positive SARS-CoV-2 polymerase chain reaction (PCR) test and COVID-19-related hospital admission in at-risk occupations. Workers born in low-income countries and male workers from Eastern Europe more often worked in at-risk occupations (relative risks between 1.16 [95% confidence interval {CI} 1.14-1.17] and 1.87 [95% CI 1.82-1.90]). Being foreign-born modified the adjusted risk of PCR test positivity (test for interaction P < 0.0001), primarily because of higher risk in at-risk occupations among men born in Eastern European countries (incidence rate ratio [IRR] 2.39 [95% CI 2.09-2.72] versus IRR 1.19 [95% CI 1.14-1.23] in native-born men). For COVID-19-related hospital admission, no overall interaction was seen, and in women, country of birth did not consistently modify the occupational risk. Workplace viral transmission may contribute to an excess risk of COVID-19 in male workers born in Eastern Europe, but most foreign-born employees in at-risk occupations seem not to be at higher occupational risk than native born.

COVID-19-related hospital admission in spouses of partners in at-risk occupations.

This study aimed to quantify the risk of COVID-19-related hospital admission in spouses living with partners in at-risk occupations in Denmark during 2020-21. Within a registry-based cohort of all Danish employees (N=2 451 542), we identified cohabiting couples, in which at least one member (spouse) held a job that according to a job exposure matrix entailed low risk of occupational exposure to SARS-CoV-2 (N=192 807 employees, 316 COVID-19 hospital admissions). Risk of COVID-19-related hospital admission in such spouses was assessed according to whether their partners were in jobs with low, intermediate or high risk for infection. Overall and sex-specific incidence rate ratios (IRR) of COVID-19-related hospital admission were computed by Poisson regression with adjustment for relevant covariates. The risk of COVID-19-related hospital admission was increased among spouses with partners in high-risk occupations [adjusted IRR (IRRadj)1.59, 95% confidence interval (CI) 1.1-2.2], but not intermediate-risk occupations (IRRadj 0.97 95% 0.8-1.3). IRR for having a partner in a high-risk job was elevated during the first three pandemic waves but not in the fourth (IRRadj 0.48 95% CI 0.2-1.5). Sex did not modify the risk of hospital admission. SARS-CoV-2 transmission at the workplace may pose an increased risk of severe COVID-19 among spouses in low-risk jobs living with partners in high-risk jobs, which emphasizes the need for preventive measures at the workplace in future outbreaks of epidemic contagious disease. When available, effective vaccines seem essential.

Occupational risk of COVID-19 related hospital admission in Denmark 2020-2021: a follow-up study.

Mounting evidence indicates increased risk of COVID-19 among healthcare personnel, but the evidence on risks in other occupations is limited. In this study, we quantify the occupational risk of COVID-19-related hospital admission in Denmark during 2020-2021. The source population included 2.4 million employees age 20-69 years. All information was retrieved from public registers. The risk of COVID-19 related hospital admission was examined in 155 occupations with at least 2000 employees (at-risk, N=1 620 231) referenced to a group of mainly office workers defined by a COVID-19 job exposure matrix (N=369 341). Incidence rate ratios (IRR) were computed by Poisson regression. During 186 million person-weeks of follow-up, we observed 2944 COVID-19 related hospital admissions in at-risk occupations and 559 in referents. Adjusted risk of such admission was elevated in several occupations within healthcare (including health care assistants, nurses, medical practitioners and laboratory technicians but not physiotherapists or midwives), social care (daycare assistants for children aged 4-7, and nursing aides in institutions and private homes, but not family daycare workers) and transportation (bus drivers, but not lorry drivers). Most IRR in these at-risk occupations were in the range of 1.5-3. Employees in education, retail sales and various service occupations seemed not to be at risk. Employees in several occupations within and outside healthcare are at substantially increased risk of COVID-19. There is a need to revisit safety measures and precautions to mitigate viral transmission in the workplace during the current and forthcoming pandemics.

The social ecology of COVID-19 prevalence and risk in Montreal, QC, Canada.

This descriptive study examined the social ecology of COVID-19 risk exposure across Montreal (Quebec, Canada) by comparing fifteen neighborhoods with contrasting COVID-19 prevalence. Census 2016 data were combined with an online survey (n = 502) of residents living in the targeted neighborhoods. Chi-square and t-test were used to analyze the differences in sample proportions and means.As of October 1, 2020, compared to the least affected Montreal neighborhoods, the most Impacted neighborhoods had a 2.6 times higher COVID-19 prevalence (2370.9 active cases per 100,000 residents) and a 2.5 times higher death rate (260.6 deaths per 100,000 people). High prevalence neighborhoods were lower income, more highly racialized, denser, and had a larger share of public transit users than least affected neighborhoods.Compared with respondents from the least affected neighborhoods, survey respondents in high prevalence neighborhoods were more likely to report a lower income, hold at-risk occupations, live in apartment buildings, use public transit, and perceive themselves at risk of becoming infected with COVID-19 and less capable of avoiding COVID-19 transmission, but less likely to comply with stay-at-home recommendations. No significant differences between neighborhoods were found in terms of compliance with recommended COVID-19 hygiene preventive measures (mask wearing and hand washing).Resultssuggest that at-risk occupations and a lower capacity to avoid COVID-19 exposure, but not differences in compliance with public sanitary directives, were key factors associated with higher neighborhood prevalence of COVID-19.

The Impact of Psychological Capital on Well-Being of Social Workers: AMixed-Methods Investigation.

Social workers are often faced with long working hours, high job demands, and poor work-life balance, which can have detrimental effects on their well-being. It is therefore important to identify the protective factors that enable social workers to flourish and thrive. Psychological capital (PsyCap) is conceptualized as a higher-order core construct that encompasses hope, efficacy, resilience, and optimism. This study aims to investigate the impact of PsyCap on social workers' well-being and explore the underlying mechanisms of this relationship. It expands the literature by adopting a multifaceted model of well-being, accounting for the temporal order of variables, including a qualitative component, and examining the effects of PsyCap in an at-risk occupation. A two-wave prospective survey with a three-month interval was conducted with a sample of 400 full-time social workers in Hong Kong, followed by individual in-depth interviews. The quantitative results showed that PsyCap was positively associated with job satisfaction and positive affect, and negatively associated with negative affect and psychological and physical distress. The qualitative results showed that the components of PsyCap share problem-focused processes with cognitive, conative, and affective functions. The theoretical and practical implications are discussed in relation to the social services industry.

Identifying scenarios and risk factors for Q fever outbreaks using qualitative analysis of expert opinion.

Q fever is an important zoonotic disease perceived to be an occupational hazard for those working with livestock. Outbreaks involving large numbers of people are uncommon, but the increasing case incidence coupled with changing environmental and industry conditions that promote transmission of Q fever has raised concerns that large and serious outbreaks could become more frequent. The aim of this study was to use expert opinion to better understand how large Q fever outbreaks might occur in an Australian context and to document factors believed to be drivers of disease transmission. Focus groups were conducted with human and animal health professionals across several Australian states. All discussions were recorded, transcribed verbatim and imported into NVIVO for thematic analysis. Four anthropogenic risk factors (disease awareness, industry practices, land use, human behaviour) and three ecological risk factors (physical environment, agent dissemination, animal hosts) emerged from the data. Analysis of expert opinions pointed to the existence of numerous scenarios in which Q fever outbreaks could occur, many of which depict acquisition in the wider community outside of traditional at‐risk occupations. This perception of the expansion of Q fever from occupational‐acquisition to community‐acquisition is driven by greater overarching economic, political and socio‐cultural influences that govern the way in which people live and work. Findings from this study highlight that outbreaks are complex phenomena that involve the convergence of diverse elements, not just that of the pathogen and host, but also the physical, political and socioeconomic environments in which they interact. A review of the approaches to prevent and manage Q fever outbreaks will require a multisectorial approach and strengthening of community education, communication and engagement so that all stakeholders become an integrated part of outbreak mitigation and response.

823Suicide of welfare and care support workers: a retrospective mortality study in Australia 2001-2016

Abstract Background Emerging evidence suggests that people working in the welfare and health care industry have poorer mental health than other occupational groups; however, there has been little examination of suicide among this group. In this study, we examine suicide rates amongst welfare and care support workers and compare them to rates among human service workers, and all other occupations in Australia. Methods We used data from the National Coroners Information System (NCIS) to obtain records of death due to intentional self-harm between the years 2001 to 2016. We calculated age-standardised suicide rates and incident rate ratios to compare the suicide rates across different occupational groups. Results The age-standardised suicide rate of males is the highest amongst welfare and carers (24.1 per 100,000). After adjusting for age and year of death, we found that men working as welfare workers and carers have a significantly higher suicide rate than men working in other occupations (IRR 1.43, CI 1.2-1.7). Furthermore, male human service workers have a slightly lower rate of suicide than those working in other occupations (IRR 0.73: CI 0.66-0.82). The finding was similarly noted in female suicide deaths, however, the higher suicide rate in female welfare workers was not statistically significant (IRR 1.12 CI 0.9-1.39). Conclusion The suicide rates of welfare and care-related occupations are as high as occupations which are identified as at-risk occupations for male suicide in Australia. Key message There is a need for targeted programs to improve the suicide health literacy among welfare and care support workers.

Epidemiology and risk factors of scrub typhus in Taiwan: A nationwide database study from 1996 to 2014.

Scrub typhus (ST) is one of the most underdiagnosed, potentially fatal febrile diseases in the Asia-Pacific region. We conducted a comprehensive review of the risk factors of ST over 19years using data from a nationwide database. We used data on ST from the nationwide database of the Taiwan Centers for Disease Control from 1996 to 2014 to analyse the incidence rates and relative risks of ST according to different regions. The trends of incidence rates over the study period were also evaluated. The distribution of confirmed ST cases was mapped using geographic information system software. The characteristics of confirmed ST cases and non-ST cases (cases with suspected ST but negative test findings) were compared. Among the 38,127 reported cases, there were 6,791 (17.8%) confirmed ST cases. The overall incidence rate of ST in Taiwan was 1.49 per 100,000 residents per year. The trend of incidence rates increased over time. The Island region had the highest incidence rate (56.55 per 100,000 residents per year), followed by the Eastern region (15.13 per 100,000 residents per year). More confirmed ST cases were distributed in mountainous areas of Taiwan Main Island and Island region. Compared to non-ST cases, individuals with confirmed ST were younger (median [interquartile range] age: 44 [26-57] years versus 45 [30-60]years, p<.001) and more likely to engage in at-risk occupations (29.4% versus 13.3%, p<.001), including farming and animal husbandry (16.6% versus 9.0%, p<.001) and the armed forces (12.3% versus 3.5%, p<.001); however, they had a lower rate of animal contact (12.8% versus 20.1%, p<.001). ST is an endemic disease in Taiwan, particularly in the Island region, Eastern region and mountainous areas. Patients engaged in at-risk occupations and presenting with acute febrile diseases should undergo investigations for ST.

THE INFLUENCE OF QUARANTINE RESTRICTIONS ON THE DEVELOPMENT OF OCCUPATIONAL BURNOUT IN EDUCATORES OF HIGHER EDUCATION AL INSTITUTIONS OF UKRAINE

Occupational burnout syndrome most often occurs among professionals of the at-risk occupations, i.e. those who work in close contact with people and have to communicate a lot and intensively with others. This group includes educational specialists (teachers, educators, psychologists), medical professionals, and sale representatives. Fatigue, weakness, lack of interest in their activities against the background of chronic stress, is well known to many people, especially workaholics, who strive to do as much as possible, resulting in emotional burnout. With the onset of the Covid-19 pandemic, burnout has taken on a different form due to isolation, fears for the lives and health of family members, and distance from workplaces and well-accustomed co-workers. Distance learning has created new challenges for teachers and students of HEIs. Study before quarantine was already complicated, given the heavy workload, the large volume of the curriculum, and the constant lack of free time. Working in such rhythm makes it difficult to maintain mental health and prevent emotional burnout. The professional activity of university educators is characterized by increased responsibility, a wide range of commitments and the need for continuous professional development. In addition to the educational process, the teacher is responsible for the implementation of methodological, organizational, educational and research work. The influence of stressors on a teacher’s health contributes to the emergence of the syndrome of occupational burnout. “Quarantine” factors influencing the development of occupational burnout can be assigned into two groups: organizational and psychological factors related to the novel special organization of work in quarantine; psychological factors associated with the new psychological features of the professional activity and their own subjective characteristics. To prevent the development of occupational burnout, psychologists recommend to take care of yourself; do not forget about rest; realistically estimate own capabilities and, accordingly, plan work and time; do not make unnecessary commitments; do not demand too much from yourself; work should bring joy.

Exposure to COVID-19: is there a disproportionate burden on low-paid jobs in France?

Although a majority of COVID-19 victims are among the elderly, workers holding low-paid jobs in the essential service sectors and those who are more likely to trade their health for economic reasons may be particularly exposed. Our aim is to gather existing data suggesting a disproportionate burden of the epidemic on the lower income categories.We focus on the situation of France, which has been hard hit. Workers highly exposed to the risk of COVID-19 infection are those who routinely have close face-to-face contacts with the public/colleagues, and/or exposure to infectious agents. Prior knowledge on usual working conditions can help us highlight at-risk occupations and related risks outside the work environment during the epidemic. We analysed national data on working conditions (CT2013), exposure to occupational hazards (SUMER2017) and a flash survey conducted during the lockdown.Before the lockdown (mid-March 2020), at least 8.8 million of workers were highly exposed to Covid-19 in France. There were however sharp disparities across occupational groups. As high as 41% of the bottom quarter of earners belonged to the highly exposed group, as opposed to 12% of the top quarter of earners. Apart from health care workers and first responders, other frontline workers with low-pay such as cleaners, personal aids and cashiers are among the most exposed. The situation has yet changed during the lockdown, with teleworking, reduced hours/layoffs, and type and timing of protective measures taken by employers. Lower salary workers have been highly exposed to the risk of COVID-19 infection. They may carry a heavy health burden related to the current crisis, especially when not sufficiently protected. Their occupational risks are further compounded by their transportation and housing conditions, along with comorbidities and access to healthcare. This lays ground to greater spread and severity of the disease among working-age and older working-class adults.

Blood Lead Levels among Blood Donors and High-Risk Occupational Groups in a Mining Area in Ghana: Implications for Blood Transfusion among Vulnerable Populations.

Lead poisoning has been a major global health problem for decades, and blood transfusion has been suspected as a neglected potential source of lead exposure. Children and pregnant women are most vulnerable to the toxic effects of lead and over 40 percent of blood transfused in Ghana is given to children under 5 years. However, there is little data on the levels of lead in donor blood and the main sources of lead exposure in the Ghanaian population. This study compared blood lead levels (BLL) among selected occupations at risk of lead exposure with healthy blood donors in nonexposed occupations in a Ghanaian mining area. We enrolled 40 participants each from the following high-risk occupational groups: small scale miners, painters/sprayers, drivers/fuel station attendants, and auto-mechanics as well as 40 healthy blood donors (made up of teachers, traders, and office workers). One millilitre of blood was collected from each participant for determination of their BLL, haemoglobin concentration, and blood film morphology. A total of 200 participants made up of 186 (93%) males and 14 (7%) females were enrolled. The mean age of participants was 28.6 ± 8.2 years and their geometric mean (GM) BLL was 6.3 GSD 1.4 µg/dL [95% CI: 6.0 – 6.6]. Participants in high risk occupations had significantly higher GM BLL of 6.7 µg/dL [95% CI :6.4−7.0] compared to 5.0 µg/dL [95% CI: 4.4−5.7] for healthy blood donors [p < 0.001]. The prevalence of elevated BLL (≥5 µg/dL) among the entire study participants, high risk occupations and blood donors was 84.5%, 89.4% and 65% respectively. There was significant association between elevated BLLs and working in an at-risk occupational group [aOR = 3.58, p = 0.014]. Haemoglobin concentration was not significantly associated with elevated BLLs. Basophilic stippling was not observed in any of the blood smears. Blood lead levels were high in blood donors and at-risk occupations in the study area and occupation was associated with elevated BLLs. It is important that measures to safeguard the integrity of donor blood go beyond screening for infectious diseases to include screening individuals in high-risk occupations for lead and other heavy metals to ensure that donor blood from such individuals is safe and does not pose potential danger to the health of vulnerable populations such as children and pregnant women.

PTSD as the second tsunami of the SARS-Cov-2 pandemic.

Since the first cases, the coronavirus disease (COVID-19) rapidly spread around the world, with hundred-thousand cases and thousands of deaths. Post-traumatic stress disorder (PTSD) is a common consequence of major disasters. Exceptional epidemic situations also promoted PTSD in the past. Considering that humanity is undergoing the most severe pandemic since Spanish Influenza, the actual pandemic of COVID-19 is very likely to promote PTSD. Moreover, COVID-19 was renamed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). With a poor understanding of viruses and spreading mechanisms, the evocation of SARS is generating a great anxiety contributing to promote PTSD. Quarantine of infected patients evolved to quarantine of 'infected' towns or popular districts, and then of entire countries. In the families of cases, the brutal death of family members involved a spread of fear and a loss of certainty, promoting PTSD. In the context of disaster medicine with a lack of human and technical resources, healthcare workers could also develop acute stress disorders, potentially degenerating into chronic PTSD. Globally, WHO estimates 30-50% of the population affected by a disaster suffered from diverse psychological distress. PTSD individuals are more at-risk of suicidal ideation, suicide attempt, and deaths by suicide - considering that healthcare workers are already at-risk occupations. We draw attention towards PTSD as a secondary effect of the SARS-Cov-2 pandemic, both for general population, patients, and healthcare workers. Healthcare policies need to take into account preventive strategy of PTSD, and the related risk of suicide, in forthcoming months.

Exploration of the health status of experienced New Brunswick paramedics

Literature reports that paramedics represent an at-risk occupation for the development of health problems. At least half of the paramedic population presents at least one risk factor associated with a negative health condition. These reports may suffer a "mono-method bias" where most reported outcomes are based on a single screening tool approach (may attenuate or inflate the prevalence). The current study characterizes the health status of a cohort of twenty-five experienced New Brunswick (Canadian province) paramedics. To understand possible limitations of past research, health status was characterized using four different methods: two methods using only one health measure and two were combined methods, integrating outcomes from at least two health measures to determine the prevalence of a given health status. Mono-bias was observed when using the single health measure methods. The difference among the four methods highlighted that a third of the cohort seemed unaware of their health condition. This result shed additional light on paramedics' health, where a high proportion of paramedics worked without knowledge of their health conditions. Based on a two health measures combined method, it was observed that only two-fifths of the current sample had no health conditions or could otherwise be considered as a "healthy". Because the literature has focused on single screening methods, our results were difficult to compare. However, there was a consensus that paramedics represent an at-risk occupation comprised of health problems. This study was exploratory and should be the basis for further research.

Estimation of the burden of leptospirosis in New Zealand.

Human leptospirosis mainly affects people in close occupational contact with domestic livestock and their products in New Zealand. The disease has an unquantified impact on both human health and animal production in the country. This study aimed to estimate the burden of leptospirosis in terms of disability-adjusted life years (DALYs) and cost associated with loss due to absence from work, treatment of disease, animal production loss and cost of vaccination. Previously published studies of abattoir workers farmers, and veterinarians, reporting annual risks of influenza-like illness attributable to Leptospira infection, were used to estimate the expected number of cases in a year. The cost of lost animal production was based on results of observational studies in beef cattle, sheep and deer conducted in New Zealand. Expected median annual number of severe and mild cases of human leptospirosis was 2,025 (95% probability interval [95% PI] 1,138-3,422). Median annual DALYs were 0.42 (95% PI: 0.06-2.40) per 100,000 people for the entire population, and 15.82 (95% PI: 2.09-90.80) per 100,000 people working in at-risk occupations (i.e. abattoir workers, farmers and veterinarians). Human infection resulted in a median cost of 4.42 (95% PI: 2.04-8.62) million US dollars (USD) due to absence from work and disease treatment. Median production loss cost in beef cattle, sheep and deer was USD 7.92 (95% PI: 3.75-15.48) million, while median vaccination cost in cattle, (including dairy), sheep and deer was USD 6.15 (95% PI: 5.30-7.03) million. Total annual cost of leptospirosis plus vaccination was USD 18.80 (95% PI: 13.47-27.15) million, equivalent to USD 440,000 (95% PI: 320,000-640,000) per 100,000 people. This study provides an estimate of the disease burden and cost of leptospirosis in New Zealand that could support occupational health authorities and livestock industries in assessing interventions for this disease.

Exposure to Welding Fumes, Hexavalent Chromium, or Nickel and Risk of Lung Cancer.

To investigate the risk of lung cancer after exposure to welding fumes, hexavalent chromium (Cr(VI)), and nickel, we analyzed 3,418 lung cancer cases and 3,488 controls among men from 2 German case-control studies (1988-1996). We developed a welding-process exposure matrix from measurements of these agents, and this was linked with welding histories from a job-specific questionnaire to calculate cumulative exposure variables. Logistic regression models were fitted to estimate odds ratios with confidence intervals conditional on study, and they adjusted for age, smoking, and working in other at-risk occupations. Additionally, we mutually adjusted for the other exposure variables under study. Overall, 800 cases and 645 controls ever worked as regular or occasional welders. Odds ratios for lung cancer with high exposure were 1.55 (95% confidence interval (CI): 1.17, 2.05; median, 1.8 mg/m3 × years) for welding fumes, 1.85 (95% CI: 1.35, 2.54; median, 1.4 μg/m3 × years) for Cr(VI), and 1.60 (95% CI: 1.21, 2.12; median, 9 μg/m3 × years) for nickel. Risk estimates increased with increasing cumulative exposure to welding fumes and with increasing exposure duration for Cr(VI) and nickel. Our results showed that welding fumes, Cr(VI), and nickel might contribute independently to the excess lung cancer risk associated with welding. However, quantitative exposure assessment remains challenging.

Occupational Exposure to Manganese and Fine Motor Skills in Elderly Men: Results from the Heinz Nixdorf Recall Study.

Exposure to manganese (Mn) may cause movement disorders, but less is known whether the effects persist after the termination of exposure. This study investigated the association between former exposure to Mn and fine motor deficits in elderly men from an industrial area with steel production. Data on the occupational history and fine motor tests were obtained from the second follow-up of the prospective Heinz Nixdorf Recall Study (2011-2014). The study population included 1232 men (median age 68 years). Mn in blood (MnB) was determined in archived samples (2000-2003). The association between Mn exposure (working as welder or in other at-risk occupations, cumulative exposure to inhalable Mn, MnB) with various motor functions (errors in line tracing, steadiness, or aiming and tapping hits) was investigated with Poisson and logistic regression, adjusted for iron status and other covariates. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for substantially impaired dexterity (errors >90th percentile, tapping hits <10th percentile). The median of cumulative exposure to inhalable Mn was 58 µg m-3 years in 322 men who ever worked in at-risk occupations. Although we observed a partly better motor performance of exposed workers at group level, we found fewer tapping hits in men with cumulative Mn exposure >184.8 µg m-3 years (OR 2.15, 95% CI 1.17-3.94). MnB ≥ 15 µg l-1, serum ferritin ≥ 400 µg l-1, and gamma-glutamyl transferase ≥74 U l-1 were associated with a greater number of errors in line tracing. We found evidence that exposure to inhalable Mn may carry a risk for dexterity deficits. Whether these deficits can be exclusively attributed to Mn remains to be elucidated, as airborne Mn is strongly correlated with iron in metal fumes, and high ferritin was also associated with errors in line tracing. Furthermore, hand training effects must be taken into account when testing for fine motor skills.

Asbestos-related disease in upholsterers

ABSTRACTBefore its use was banned in developed countries, asbestos was widely applied in upholstery. However, the risk of asbestos diseases among upholsterers has only rarely been reported. In this case series, we present a first series of 6 workers employed in small workshops who developed several asbestos-related diseases, including pleural plaques, pleural fibrosis, and asbestosis. Exposures were intermittent and difficult to quantify, but lung asbestos content assessed by bronchoalveolar lavage was high in the 3 patients evaluated. In conclusion, upholstery work should be considered an at-risk occupation for developing asbestos-related diseases during the 20th century.