Work-related Exposure Research Articles

Capture and coding of industry and occupation measures: Findings from eight National Program of Cancer Registries states

Although data on industry and occupation (I&O) are important for understanding cancer risks, obtaining standardized data is challenging. This study describes the capture of specific I&O text and the ability of a web-based tool to translate text into standardized codes. Data on 62 525 cancers cases received from eight National Program of Cancer Registries (NPCR) states were submitted to a web-based coding tool developed by the National Institute for Occupational Safety and Health for translation into standardized I&O codes. We determined the percentage of sufficiently analyzable codes generated by the tool. Using the web-based coding tool on data obtained from chart abstraction, the NPCR cancer registries achieved between 48% and 75% autocoding, but only 12-57% sufficiently analyzable codes. The ability to explore associations between work-related exposures and cancer is limited by current capture and coding of I&O data. Increased training of providers and registrars, as well as software enhancements, will improve the utility of I&O data.

Work-related biomechanical exposure and job strain in midlife separately and jointly predict disability after 28 years: a Finnish longitudinal study.

Objectives We investigated whether the extent of biomechanical exposures and job strain in midlife separately and jointly predict disability in old age. Methods Participants of the Finnish Longitudinal Study on Aging Municipal Employees (FLAME) in 1981 (aged 44-58 years) responded to disability questionnaires in 2009 (1850 women and 1082 men). Difficulties in performing five activities of daily living (ADL) and seven instrumental ADL (IADL) were used to assess severity of disability (score range: 0-12, 0=no disability). Information on biomechanical exposures and job strain was collected by questionnaire at baseline. Adjusted prevalence proportion ratios (PR) and 95% confidence intervals (95% CI) were modelled using mixed negative binomial regression with robust variance. The joint effect of two exposures was quantified using the concept of relative excessive risk due to interaction (RERI). Results The overall prevalence of disability (score: 1-12) was 46.7% (women: 41%; men: 57%). Compared to low-level exposures in an adjusted model, the PR of high baseline biomechanical exposures for each one unit increase in the disability score was 1.31 (95% CI 1.10-1.55) and PR of high job strain was 1.71 (95% CI 1.26-2.32). Associations were rather similar in gender-stratified analyses. Furthermore, the joint effect (high strain/high biomechanical) was multiplicative (women: PR 1.32, 95% CI 1.21-1.45; men: PR 1.27, 95% CI 1.13-1.44), but no additive effect was observed when fully adjusted. Conclusion High biomechanical exposure and job strain in midlife were strongly associated with the severity of disability in later life. The workplace could serve as arena for preventive interventions regarding disability in old age.

Work-Related Biomechanical Exposure and Job Strain as Separate and Joint Predictors of Musculoskeletal Diseases: A 28-Year Prospective Follow-up Study.

We investigated how work-related biomechanical exposure and job strain in midlife separately and jointly predicted back and degenerative musculoskeletal diseases (MSDs). A total of 6,257 employees participated in the Finnish Longitudinal Study on Aging Municipal Employees (FLAME) in 1981 and were followed up for 28 years. Risk ratios and the relative excessive risk due to interaction and 95% confidence intervals were modeled for separate and joint prediction estimates, respectively. After adjustment for confounders, job strain predicted degenerative MSDs among women after 4 and 11 years of follow-up. After 11 years, both exposures predicted both types of MSDs among men. Joint exposure predicted both types of MSDs after 4 years among women (for back MSDs, risk ratio (RR) = 1.58, 95% confidence interval (CI): 1.15, 2.18; for degenerative MSDs, RR = 1.59, 95% CI: 1.21, 2.07) and men (for back MSDs, RR = 1.50, 95% CI: 1.05, 2.15; for degenerative MSDs, RR = 1.61, 95% CI: 1.16, 2.22) and both types of MSDs after 11 years (for back MSDs, RR = 1.72, 95% CI: 1.21, 2.43; for degenerative MSDs, RR = 1.68, 95% CI: 1.25, 2.46) among men only, but the relative excessive risk due to interaction was not significant throughout. However, after 28 years, the separate and joint exposures did not predict MSDs. Workplace interventions should be focused on reducing job strain along with biomechanical exposure for possible prevention of MSDs in working life and around the time of retirement, but there may be other pathways of onset of MSDs in old age.

Component-Resolved and Complementary Tests in the Diagnosis of Occupational Allergy: Advantages and Limitations

Enhancing the repertoire of in vitro methods together with the development of recombinant technology in the field of allergy diagnosis brought tremendous advances in understanding allergens, allergic reactions, and patients’ care. This review is focusing not only on component-resolved diagnosis with occupational allergens, complementary methods, their advantages to improve the in vitro diagnosis for occupational allergy but also their limitations. Up to now, the number of occupational asthma sensitizers characterized on the molecular level and their availability for routine diagnosis is very low. One exception, however, is Hevea brasiliensis latex as an important occupational allergen source. H. brasiliensis latex is an excellent model for the useful application of recombinant single allergens for improvement of routine diagnostics. Despite the many efforts and excellent research in the field of baker’s asthma to characterize the occupationally relevant allergens the results are highly diverse. No major allergen can be identified and the IgE-sensitization profile of each baker showed great inter-individual variation. Therefore, for routine diagnosis of baker’s asthma, the assessment of allergen-specific IgE with the whole wheat (and/or rye) flour extract is still recommended. Unfortunately, no wheat allergens relevant for baker’s asthma are commercially available, although they might help to discriminate between wheat-induced food allergy, grass pollen allergy, and baker’s asthma. In particular cases with discrepancy between different diagnostic tests, the determination of basophil activation test is a recommended option. Flow cytometry determination of CD63 or CD203c on basophils induced by stimulation with the relevant allergen is a good clinically validated test and also useful for the diagnosis of occupational allergy. It is still necessary to increase the knowledge of occupational allergen molecules and include standardized tools into routine diagnostic. For the future, combination of new diagnostic tools and biomarkers, platforms, and complementary methods in occupational allergy and asthma diagnosis is a promising option. In addition, integration of these possibilities in workplace-related allergy and asthma studies is helpful to understand the complex interaction between work-related exposure, individual susceptibility and health outcome.

Subchronic, Low-Level Intraperitoneal Injections of Manganese (IV) Oxide and Manganese (II) Chloride Affect Rat Brain Neurochemistry.

Manganese (Mn) is neurotoxic and can induce manganism, a Parkinson-like disease categorized as being a serious central nervous system irreversible neurodegenerative disease. An increased risk of developing symptoms of Parkinson disease has been linked to work-related exposure, for example, for workers in agriculture, horticulture, and people living near areas with frequent use of Mn-containing pesticides. In this study, the focus was placed on neurochemical effects of Mn. Rats were dosed intraperitoneally with 0.9% NaCl (control), 1.22 mg Mn (as MnO2)/kg bodyweight (bw)/day, or 2.5 mg Mn (as MnCl2)/kg bw/day for 7 d/wk for 8 or 12 weeks. This dosing regimen adds relevant new knowledge about Mn neurotoxicity as a consequence of low-dose subchronic Mn dosing. Manganese concentrations increased in the striatum, the rest of the brain, and in plasma, and regional brain neurotransmitter concentrations, including noradrenaline, dopamine (DA), 5-hydroxytrytamine, glutamate, taurine, and γ-amino butyric acid, and the activity of acetylcholinesterase changed. Importantly, a target parameter for Parkinson disease and manganism, the striatal DA concentration, was reduced after 12 weeks of dosing with MnCl2. Plasma prolactin concentration was not significantly affected due to a potentially reduced dopaminergic inhibition of the prolactin release from the anterior hypophysis. No effects on the striatal α-synuclein and synaptophysin protein levels were detected.

Understanding patient perceptions and risk for hepatitis C screening.

The specific aims were to identify specific themes and barriers to viral hepatitis C (HCV) testing and to determine if testing rates increased when patients self-identify their risk factors and were offered testing. This study was conducted at a Federally Qualified Health Centre (FQHC) in an underserved neighbourhood located in the Mountain West. This descriptive study used survey and group-level electronic health record (EHR) data. Adults 18years and older who speak and write in English or Spanish and arrived for care at a FQHC were recruited to complete a survey. The 10-item survey assessed demographics, HCV risk, willingness to test, and reasons for not testing. Screening rates during the survey period were compared with the baseline 2014 rates using EHR data. EHR demographic, testing, and incidents of positive HCV infections data were analysed and compared with survey data. The typical participant (N=111) was female (74%), Baby Boomer (1945-1965) generation (45%), white (86%), and uninsured (54%). Top 6 self-identified risks were tattoo and/or body piercings (47.7%), Baby Boomer (36%), multiple sex partners (18%), work-related exposure (8.1%), non-injection drug use (8.1%), and injection drug use (7.2%). Only 78% of Baby Boomers identified being a Baby Boomer as a risk. Eighty-one percent of participants did not want to test. Testing did not increase during the study period (2.9tests/wk in 2014 and 2.1tests/wk during the survey period). Main reasons not to test were "I do not have any risk factors" (30.2%), concerned with cost (15.1%), tested in the past (15.1%), other reasons (9.3%), not feeling well (5.8%). More than one main reason was selected by 17% of the participants. Baby Boomers did not self-identify risk. Also, testing incidence did not increase when patients self-identified risk and were offered testing. Many participants did not identify risk which is a barrier to testing.Additional barriers to overcome are concerns with cost and comfort in the clinical setting.

Diagnostic yield of CT urography in the evaluation of hematuria in young patients in a military population.

To assess the diagnostic yield of a computed tomography urography (CTU) study in patients less than 50years of age, who have a history of military service, and who are at increased risk of urological cancers secondary to harmful practices and work-related exposures. 137 Consecutive patients who underwent CTU between 2012 and 2013 for new onset of hematuria were included. Initial review of the clinical interpretations of the CTU studies grouped the studies into negative and positive exams for any urological findings. Review of the patients' medical records and subsequent radiology studies determined microscopic versus gross hematuria at presentation and any findings after their CTU study consistent with a urologicalmalignancy. The positive exams were reviewed by second readers, blinded to the clinical interpretation of the initial CTU studies, who first read the unenhanced images. The readers characterized findings as visible on non-contrast CT alone or they requested contrast-enhanced images. Each urological finding was recorded for each patient. Of the 137 included patients, 84 had micro-hematuria and 53 had gross hematuria. There were a total of 99 negative examinations of the 137 included patients. Contrast was requested 14 times to confirm 11 benign cysts. No findings concerning for malignancy were found by the readers or on subsequent record reviews for each patient. An unenhanced CT may be appropriate to evaluate new onset microscopic, and possibly gross hematuria, in patients younger than 40, even in patients at increased risk of urologic cancer.

Abstract No. 41 - Lack of exposure and percieved occupational hazards as barriers to entry into IR for women: a survey of 143 female medical students

To explore factors contributing to low IR application rates among female medical students and identify commonly held perceptions of IR. A self-administered 32-question survey based on a 2006 American College of Cardiology questionnaire1 was distributed to 10 medical schools nationwide. Demographic questions included age, year of training, marital status, undergraduate major and whether or not the respondent had children. Questions regarding medical training included whether the respondent had completed one or more clerkships in IR, surgery and radiology, and if, when and how they had first been exposed to IR. Questions regarding perceptions of IR were also included as well as an open response question on how recruitment of female medical students could be improved. One hundred and forty three women responded to the survey with all four years of medical training represented (MS1: 24%, MS2: 28%, MS3: 31%, MS4:17%). Respondents reported completing clerkships in IR (3.5%), surgery (70%) and radiology (12%). A majority of respondents (60.1%) reported that they had no exposure to IR. Of those who had previous exposure to the field, 30% identified exposure through a shadowing experience, 11.2% through a clerkship and 4.9% through IR research. Of all respondents, 9.1% agreed or strongly agreed that they had been discouraged from pursuing a career in IR and only 4.9% responded that as a woman they were more likely to pursue a career in IR, while 21% responded they were less likely. The most common deterrents to pursuing an IR career identified were: work-related radiation exposure (51.8%), work/life balance (36.4%), and training length (29.4%). To the question of how recruitment of women could be improved, free text responses most frequently mentioned a lack of exposure to IR and specifically, to female role models in the field. Both real and perceived barriers may deter female medical Student’ss from pursuing a career in IR. An understanding of both is critical to identifying changes that can be implemented early in medical training in order to improve recruitment of women into the field.

Work-related exposures and disorders among physical therapists: experiences and beliefs of professional representatives assessed using a qualitative approach

BackgroundAccording to international study results, physical therapists are afflicted with work-related musculoskeletal, psychosocial and dermal disorders as well as infections. The few existing studies in German-speaking regions focus mainly on dermal and psychosocial exposures and resulting complaints. An overview of all relevant work-related exposures and complaints of physical therapists is currently lacking.We sought to identify work-related exposures based on the subjective experiences and beliefs of physiotherapeutic representatives, in order to identify relevant work-related complaints and diseases. Likewise we aimed to compare the international evidence with the actual situation of physical therapists in Germany.MethodsTwo complementary qualitative approaches were used: 1) a focus group discussion with representatives of professional physiotherapy associations as well as health and safety stakeholders and 2) qualitative semi-structured telephone interviews incorporating currently employed physical therapists. The group discussion was conducted applying a moderation technique, and interviews were analyzed using the content analysis approach by Mayring.ResultsThe focus group discussion with five participants and the 40 semi-structured interviews with physical therapists identified comparable results. The main exposures of physiotherapeutic work were considered to be musculoskeletal (e.g., awkward body postures during treatment, patient transfers, passive mobilization), psychosocial (e.g., statutory audit of prescriptions and the associated conflicts with doctors and health insurance providers) and partly dermal and infectious (e.g., wet work and risk of infection) factors. Diseases of the spine, wrist or finger joints, burnout syndrome and infections were mentioned as possible consequences.ConclusionsThe subjective data generated by both groups (focus group discussion and interviews) were comparable and consistent with the current state of research. The results provide new insight regarding work-related exposures and diseases of physical therapists working in Germany. These findings aided the design of a German-wide representative survey of practicing physical therapists.

Editorial introductions

Editorial introductions

Testing an Intervention to Decrease Healthcare Workers’ Exposure to Antineoplastic Agents

To develop and test a worksite intervention that protects healthcare workers who handle antineoplastic drugs from work-related exposures. . Intervention study. . A university hospital in a large midwestern metropolitan area and its outpatient chemotherapy infusion clinic. . 163 staff (nurses, pharmacists, and pharmacy technicians) who work with antineoplastic agents. . A self-report survey measured workplace and individual factors to assess use of personal protective equipment (PPE). Wipe samples were tested for surface contamination. An intervention incorporating study findings and worker input was developed. . PPE use was the dependent variable, and the independent variables included knowledge of the hazard, perceived risk, perceived barriers, interpersonal influence, self-efficacy, conflict of interest, and workplace safety climate. . PPE use was lower than recommended and improved slightly postintervention. Self-efficacy and perceived risk increased on the post-test survey. Chemical residue was found in several areas. Awareness of safe-handling precautions improved postintervention. The unit where nurses worked was an important predictor of safety climate and PPE use on the pretest but less so following the intervention. . Involving staff in developing an intervention for safety ensures that changes made will be feasible. Units that implemented workflow changes had decreased contamination. . Worksite analysis identifies specific targets for interventions to improve antineoplastic drug handling safety.

Romanian Questionnaire to Assess the Prevalence of Occupational Hand Eczema among Healthcare Providers

Abstract Occupational skin diseases have an unknown prevalence in Romania, although they are considered the most frequent occupational diseases reported in Western European countries. Self-reported hand eczema among healthcare providers by questionnaire aims to estimate the prevalence of work-related hand eczema and associated risk factors in hospitals and outpatient units in Romania. The aim of this study is to discuss and to validate a questionnaire for surveying work-related skin diseases and exposure among healthcare providers.

Allergy in severe asthma.

It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma.

Impact of touring, performance schedule, and definitions on 1-year injury rates in a modern dance company

ABSTRACTThere is ongoing debate about how to define injury in dance: the most encompassing one or a time-loss definition. We examined the relationship between touring, performance schedule and injury definition on injury rates in a professional modern dance company over one-year. In-house healthcare management tracked 35 dancers for work-related musculoskeletal injuries (WMSI), time-loss injuries (TLinj), complaints, and exposure. The year was divided into 6 segments to allow comparison of effects of performance, rehearsal, and touring. Injuries/segment were converted into injuries/1000-h dance exposure. We conducted negative binomial regression analysis to determine differences between segments, P ≤ 0.05. Twenty WMSI, 0.44 injuries/1000-h, were sustained over one-year. WMSI were 6 times more likely to occur in Segment-6, compared with other segments (incident rate ratio = 6.055, P = 0.031). The highest rate of TLinj and traumatic injuries also occurred in Segment-6, reflecting concentrated rehearsal, New York season and performances abroad. More overuse injuries occurred in Segment-2, an international tour, attributed to raked stages. Lack of methods to quantify performance other than injury may mask effects of touring on dancer’s well-being. Tracking complaints permits understanding of stressors to specific body regions and healthcare utilisation; however, TLinj remain the most important injuries to track because they impact other dancers and organisational costs.

Why Does Disaster Recovery Work Influence Mental Health?: Pathways through Physical Health and Household Income.

Disaster recovery work increases risk for mental health problems, yet the mechanisms underlying this association are unclear. We explored links from recovery work to post-traumatic stress (PTS), major depression (MD), and generalized anxiety disorder (GAD) symptoms through physical health symptoms and household income in the aftermath of the Deepwater Horizon oil spill. As part of the NIEHS GuLF STUDY, participants (N=10,141) reported on cleanup work activities, spill-related physical health symptoms, and household income at baseline, and mental health symptoms an average of 14.69weeks (SD=16.79) thereafter. Cleanup work participation was associated with higher physical health symptoms, which in turn were associated with higher PTS, MD, and GAD symptoms. Similar pattern of results were found in models including workers only and investigating the influence of longer work duration and higher work-related oil exposure on mental health symptoms. In addition, longer worker duration and higher work-related oil exposure were associated with higher household income, which in turn was associated with lower MD and GAD symptoms. These findings suggest that physical health symptoms contribute to workers' risk for mental health symptoms, while higher household income, potentially from more extensive work, might mitigate risk.

Chronic Eosinophilic Pneumonia in a Cardboard Factory Worker With Inadequate Response to Prednisone

SESSION TITLE: Student/Resident Case Report Poster - Occupational and Environmental Lung Diseases SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Occupation related exposures in paper and pulp factory workers have been implicated in chronic bronchitis, asthma, and general symptoms of breathlessness. Symptoms have been attributed to exposure to paper dust as well as non-organic chemicals. We describe a case of chronic eosinophilic pneumonia (CEP) in a patient with prolonged employment at a cardboard factory. CASE PRESENTATION: A 62 year old male with 25 year history of working in a cardboard factory presented with complaints of dyspnea, cough, malaise. He has been symptomatic for 20 years but was diagnosed with asthma and treated with albuterol with poor control and frequent recurrence. Exam revealed bilateral rales. Computer tomography (CT) of the chest showed extensive upper lobe pulmonary interstitial and alveolar lung disease. Bronchoalveolar lavage (BAL) showed intense eosinophilia (99%) and pathology exam of wedge resection of right middle lobe was consistent with CEP with features of organizing pneumonia. Prednisone 40mg daily was started but tapered to 20 mg over 6 months with continued employment. He began requiring oxygen at 3 L/min, received short term disability, and stopped working. 4 months later, a repeat CT showed stable ground glass opacities and increased interstitial markings. Spirometry revealed FEV1 49%, FVC 45%, and DLCO was 29% predicted. BAL demonstrated persistent yet improved eosinophilia (30%). DISCUSSION: Patients with CEP improve quickly with systemic steroids and exposure avoidance. Our patient had poor response to prednisone which could be attributed to his continued work-related exposure. We hypothesize that even after exposure cessation the additional pathology of organizing pneumonia likely contributed to poor steroid responsiveness. CONCLUSIONS: Our aim is to describe a case of refractory chronic eosinophilic pneumonia probably caused by prolonged non-organic chemical and paper dust exposures from working in a cardboard factory. Reference #1: Westberg H, Elihn K, Andersson E, Persson B, Andersson L, Bryngelsson IL, Karlsson C, Sjögren B. Inflammatory markers and exposure to airborne particles among workers in a Swedish pulp and paper mill. Int Arch Occup Environ Health. 2016 Feb 13. Reference #2: Arakawa H, Kurihara Y, Niimi H, Nakajima Y, Johkoh T, Nakamura H. Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients. AJR Am J Roentgenol. 2001 Apr;176(4):1053-8. Reference #3: Murgia N, Torén K, Kim JL, Andersson E. Risk factors for respiratory work disability in a cohort of pulp mill workers exposed to irritant gases. BMC Public Health. 2011 Sep 6;11:689. DISCLOSURE: The following authors have nothing to disclose: Kirill Lipatov, Tasnim Lat, Rachael Pattison, Darwin Ashbaker, Shekhar Ghamande No Product/Research Disclosure Information

Australian work exposures studies: occupational exposure to pesticides

BackgroundPesticides are widely used in some occupational settings. Some pesticides have been classified as carcinogens; however, data on the number of workers exposed to pesticides are not available in Australia....

Early work-related physical exposures and low back pain in midlife: the Cardiovascular Risk in Young Finns Study

ObjectiveTo examine whether heavy physical workload in young adulthood increases the risk of local and radiating low back pain (LBP) in midlife.MethodsLongitudinal nationally representative Young Finns Study data among women...

Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States.

Tinnitus is a common problem for millions of individuals and can cause substantial negative effects on their quality of life. A large epidemiologic study of tinnitus and its management patterns in the US adult population is lacking. To quantify the epidemiologic features and effect of tinnitus and to analyze the management of tinnitus in the United States relative to the 2014 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines. This cross-sectional analysis of the representative 2007 National Health Interview Survey (raw data, 75 764 respondents) identified a weighted national sample of adults (age, ≥18 years) who reported tinnitus in the preceding 12 months. Data were collected in November 2014 at the University of California, Irvine, and Harvard Medical School. In addition to quantifying prevalence, severity, duration, and regularity of tinnitus, specific data regarding noise exposure and tinnitus management patterns during health care visits were analyzed. Among an estimated (SE) 222.1 (3.4) million US adults, 21.4 (3.4) million (9.6% [0.3%]) experienced tinnitus in the past 12 months. Among those who reported tinnitus, 27% had symptoms for longer than 15 years, and 36% had nearly constant symptoms. Higher rates of tinnitus were reported in those with consistent exposure to loud noises at work (odds ratio, 3.3; 95% CI, 2.9-3.7) and during recreational time (odds ratio, 2.6; 95% CI, 2.3-2.9). Years of work-related noise exposure correlated with increasing prevalence of tinnitus (r = 0.13; 95% CI, 0.10-0.16). In terms of subjective severity, 7.2% reported their tinnitus as a big or a very big problem compared with 41.6% who reported it as a small problem. Only 49.4% had discussed their tinnitus with a physician, and medications were the most frequently discussed recommendation (45.4%). Other interventions, such as hearing aids (9.2%), wearable (2.6%) and nonwearable (2.3%) masking devices, and cognitive behavioral therapy (0.2%), were less frequently discussed. The prevalence of tinnitus in the United States is approximately 1 in 10 adults. Durations of occupational and leisure time noise exposures correlated with rates of tinnitus and are likely targetable risk factors. Management options suggested by the recently published AAO-HNSF guidelines were followed infrequently.

Development and validation of a web-based questionnaire for surveying the health and working conditions of high-performance marine craft populations

BackgroundHigh-performance marine craft crews are susceptible to various adverse health conditions caused by multiple interactive factors. However, there are limited epidemiological data available for assessment of working conditions at sea....