Occupational and Environmental Health

Blue–yellow dyschromatopsia in toluene-exposed workers Abstract Purpose To evaluate the effects of a chronic occupational exposure to toluene on color vision. Methods Color vision was tested in 51 workers exposed to pure toluene and in 51 matched control subjects. Current exposure was determined by biological monitoring. Blood samples were taken at the end of a Friday shift. Color vision ability was assessed using the Ishihara plates (to screen for congenital dyschromatopsia), the Farnsworth panel D-15 test, the Lanthony panel D-15 desaturated test, the Velhagen plates, and the Standard Pseudoisochromatic Plates Part 2. Results Median toluene concentration was 1.59 mg/l (quartiles 0.78 and 2.65). The whole group of workers did not perform worse than the controls. The same applies to 20 printers, who regularly assessed hues. Assessed with the most sensitive Lanthony panel D-15 desaturated test, color vision of 24 permanently exposed assistants was impaired (median color confusion index of the 1st eyes 1.08 vs. 1.02, p < 0.02; 2nd eyes 1.08 vs. 1.0, p < 0.05; sign test). The assistants made almost exclusively blue–yellow errors. The other color vision tests did not reveal any differences between the groups. Conclusion Changes in the retina are a possible explanation for the observed blue–yellow dyschromatopsia.

Emotional demands and exhaustion: cross-sectional and longitudinal associations in a cohort of Danish public sector employees Abstract Purpose To examine cross-sectional and longitudinal associations between content-related emotional demands at work and exhaustion, and to investigate if these associations were modified by other psychosocial work characteristics. Methods In 2007, 4489 Danish public service employees participated in the PRISME study by completing postal questionnaires, and 3224 participated in the follow-up in 2009. Content-related emotional demands were measured by a scale (scored 1 to 5) based on five work-content-related items, and exhaustion was measured with the general exhaustion scale from the Copenhagen Burnout Inventory (CBI) (scored 1 to 5). The cross-sectional and longitudinal associations with exhaustion were analysed in the same model and adjusted for effects of potential confounders. Effect modifications were examined separately for self-reported emotional enrichment, meaningful work, job control, social support at work and quantitative demands. Results Exhaustion increased with increasing emotional demands, both cross-sectionally and longitudinally. However, although statistically significant, the effect was small. In the longitudinal analysis, a one unit increase in emotional demands was associated with a 0.03 unit (95% CI: 0.01–0.06) increase in exhaustion. We found statistically significant effect modification for three of six potentially modifying work characteristics. The effect of emotional demands on exhaustion was lower for participants with high levels of emotional enrichment (cross-sectionally and longitudinally), high levels of meaningful work (longitudinally), and higher for high levels of quantitative demands (cross-sectionally). Conclusions Increasing content-related emotional demands were associated with increasing levels of exhaustion, cross-sectionally and longitudinally. This effect was reduced if the work was experienced as emotionally enriching and meaningful.

The influence of wind turbine visibility on the health of local residents: a systematic review Abstract Purpose The health effects of visible wind turbine features on residents were investigated. Further, it was examined, if visual annoyance has an influence on residents' health, and if wind turbine visibility impacts residents' health independently of or in combination with acoustical aspects. Methods Medical databases, Google Scholar, public health institutions, and reference lists were searched systematically (PROSPERO registry number: CRD42016041737). Two independent reviewers screened titles/abstract and full texts, extracted data, and critically appraised the methodology of included studies. Study findings were analyzed qualitatively and quantitatively. Results Seventeen studies from 19 publications of varying methodological quality were included (two cohort studies, fifteen cross-sectional studies). The pooled prevalence of high annoyance due to altered views and shadow flicker was 6% each. The results of other health effects were inconsistent, with some indications showing that direct wind turbine visibility increases sleep disturbance. Annoyance by direct visibility, shadow flicker, and blinking lights was significantly associated with an increased risk for sleep disorders. One study indicated reactions to visual wind turbine features may be influenced by acoustical exposures. Conclusions In interpreting the results, the differing methodological quality of the included studies needs to be considered. Direct and indirect wind turbine visibility may affect residents' health, and reactions may differ in combination with noise. Further, annoyance by wind turbine visibility may interact as mediator between visual exposures and the health of local residents. To confirm the results, more high-quality research is needed.

Relationships of leisure-time physical activity and work ability between different occupational physical demands in adult working men Abstract Purpose Leisure-time physical activity (LTPA) is known to be associated with positive health benefits, but the role of occupational physical demands remains inconsistent. The purpose of the current study was to assess the relationship between LTPA and work ability in different occupational physical activity (OPA) levels between young adult men. Methods We performed physical activity measurements in work and leisure time with the long version of International Physical Activity Questionnaire (IPAQ) and work ability with the Work Ability Index (WAI) in 921 Finnish employed male volunteer participants. The participants were divided into LTPA tertiles I (< 8 MET-h/week), II (8–28 MET-h/week), and III (> 28 MET-h/week) and OPA tertiles I (0 MET-h/week), II (< 64 MET-h/week), and III (≥ 64 MET-h/week). Results There was a significant relationship between LTPA and WAI in OPA tertiles (adjusted for age, alcohol consumption, working class status, BMI, and employment years). Moreover, each LTPA tertile showed significant linear associations with WAI (P < 0.001). Conclusion LTPA is positively associated with work ability among young adult men. More specifically, the relationships between LTPA and WAI were significantly greater in physically demanding jobs than in more passive jobs. Our results indicate the importance of LTPA, particularly with individuals under higher work-related physical strain.

Cumulative physical workload and mobility limitations in middle-aged men and women: a population-based study with retrospective assessment of workload Abstract Purpose To assess the association between exposure to physical workload throughout working life and risk of mobility limitations in midlife in a population-based Danish cohort. Methods The study was cross-sectional with a retrospective exposure assessment, and data were from a questionnaire used in the Copenhagen Aging and Biobank. Cumulative physical workload was estimated by combining information about the participants' employments and data from a job exposure matrix. Daily amount of lifting was standardised in ton-years (lifting 1000 kg/day/year) and grouped in 5 exposure groups (no/minor (1–2 ton-years)/low (3–10 ton-years)/moderate (11–20 ton-years)/high exposure (> 20 ton-years)). The outcome was self-reports of mobility limitations (running 100 m, walking 400 m, and climbing stairs to the 2nd floor) in midlife. The association between exposure and outcome was analysed using logistic regression models. Results We included 4996 men and 2247 women, mean age 56 years. 21% of men and 10% of women were in the highest exposure-group (> 20 ton-years). Higher cumulative exposure was associated with higher odds for mobility limitations. Exposure to more than 20 ton-years compared to no exposure increased the odds for limitations in walking, age-adjusted odds ratio (OR) 3.2 (95% CI: 2.4–4.3) for men, 2.3 (1.4–3.8) for women. Corresponding results for running: 2.5 (2.2–3.0) for men, 1.6 (1.2–2.2) for women, and for limitations in climbing stairs: 4.2 (3.3–5.2) for men, 1.7 (1.2–2.4) for women. Results were attenuated when confounders were added. Conclusions Exposure to physical workload throughout working life is associated with higher odds for mobility limitations in midlife.

Long working hours and depressive symptoms: moderating effects of gender, socioeconomic status, and job resources Abstract Purpose Systematic reviews and meta-analyses have found inconsistent associations between working hours and depressive symptoms. The purpose of this study was to investigate the possible moderators of this association, using data from a large-scale cross-sectional survey. Methods A total of 16,136 Japanese employees (men 83.5%; women 16.5%) responded to a self-administered questionnaire inquiring about overtime working hours during the previous month and depressive symptoms (Center for Epidemiologic Studies Depression scale), as well as moderating factors including gender, age, marital status, socioeconomic status, commuting time, sleeping hours per day, job control and worksite social support (Job Content Questionnaire), neuroticism (Eysenck's Personality Questionnaire Revised), and social desirability (Social Desirability Scale) (response rate, 85%). We conducted sequential regression analyses to investigate the main effects and interaction effects of all moderating variables. Results The association between overtime working hours and depressive symptoms was significantly moderated by gender (interaction effect: β = 0.03), age (β = − 0.02), manager (β = 0.03), sleeping hours (β = − 0.02), job control (β = − 0.03), and neuroticism (β = 0.02). Among workers engaged in 80 + hours of overtime, higher depressive symptoms were reported by women, younger employees, non-managers, employees with low job control, low worksite social support, and high neuroticism. A significant main effect of long overtime working hours on depressive symptoms was also observed even after controlling for all independent variables (β = 0.02). Conclusions Long overtime working hours is associated with depressive symptoms. We also found significant heterogeneity in the association according to employee characteristics, which may explain the inconsistent findings in previous literature.

Association between the return-to-work hierarchy and self-rated health, self-esteem, and self-efficacy Abstract Purpose This study aimed to examine whether change of employer and/or job upon return-to-work after work-related injuries and diseases is related to health outcomes; self-rated health, self-esteem, and self-efficacy were used as indicators. Methods Data from the Panel Study of Workers' Compensation Insurance in Korea were used. A total of 1,610 workers who had returned to work after work-related injuries and diseases were included. The workers were divided into four groups according to their return-to-work characteristics: same employer, same job (n = 660); same employer, different job (n = 57); different employer, same job (n = 318); and different employer, different job (n = 575). Self-rated health, Rosenberg Self-Esteem Scale, and Self-Efficacy Scale scores were used as outcome variables. Logistic regression analysis was used. Results Compared to workers who had returned to the same employer and same job, those who had returned to the same employer but a different job were less likely to report good self-rated health (odds ratio [OR] 0.54; confidence interval [CI] 0.30–0.97). Those returning to a different employer but the same job were less likely to report good self-rated health (0.47, 0.35–0.64) and high self-esteem (0.73, 0.55–0.96). Those returning to a different employer and different job were less likely to report good self-rated health (0.49, 0.38–0.63), high self-esteem (0.68, 0.54–0.86), and high self-efficacy (0.66, 0.52–0.83). Conclusions Change of employer and/or job related to health outcomes. Returning to the same employer and same job should be set as a goal in the vocational rehabilitation process.

Enhancing medical evaluations of sick-listed employees: an educational intervention to improve professional practice of physicians performing work ability assessments of employees on long-term sick leave Abstract Purpose Long-term sick leave (LTSL) is a complex phenomenon. Medical and non-medical factors can delay return-to-work (RTW); therefore, the assessment of work ability is complicated. A checklist for identifying factors associated with delayed RTW was developed in a prior study to facilitate the exploration of barriers and facilitators for RTW. The purpose of the present study was to determine if use of the checklist enhances professional practice of physicians performing work ability assessments of employees on long-term sick leave and whether the reporting of work ability assessments improved when using the checklist in the routinely practice-based context. Methods An educational intervention study was performed using qualitative framework analysis. Thirty-five Dutch physicians were asked to identify and report the barriers and facilitators for RTW and the consequences for the work ability and for the prognosis regarding work reintegration using the checklist. A pre-post qualitative analysis of the medical records was performed using a gradual classification of the reporting of the work ability to evaluate the change in reporting following the educational intervention. Results A total of 337 work ability assessments were performed using the checklist. The identification of factors influencing RTW and the comprehensiveness of the medical records increased when compared with the reporting before the educational intervention. The reporting of the work ability assessments improved after the educational intervention. Most physicians reported at least one of the factors of the checklist. 72% participants reported and described adequately at least one factor. 48% participants reported how the factors influenced the work ability, 20% participants reported how the factors influenced the prognosis regarding RTW and 12% participants reported which advice was provided by the physician to influence the barriers for RTW. Conclusions Use of the checklist enhances professional practice of physicians performing work ability assessments of employees on long-term sick leave and is associated with increased identification of barriers and facilitators for RTW. The use of the checklist should be considered to improve professional practice of physicians performing work ability assessments.

An educational intervention to improve knowledge about prevention against occupational asthma and allergies using targeted maximum likelihood estimation Abstract Purpose Occupational asthma and allergies are potentially preventable diseases affecting 5–15% of the working population. However, the use of preventive measures is often insufficient. The aim of this study was to estimate the average treatment effect of an educational intervention designed to improve the knowledge of preventive measures against asthma and allergies in farm apprentices from Bavaria (Southern Germany). Methods Farm apprentices at Bavarian farm schools were asked to complete a questionnaire evaluating their knowledge about preventive measures against occupational asthma and allergies (use of personal protective equipment, personal and workplace hygiene measures). Eligible apprentices were randomized by school site to either a control or an intervention group. The intervention consisted of a short educational video about use of preventive measures. Six months after the intervention, subjects were asked to complete a post-intervention questionnaire. Of the 116 apprentices (70 intervention group, 46 control group) who answered the baseline questionnaire, only 47 subjects (41%; 17 intervention group, 30 control group) also completed the follow-up questionnaire. We, therefore, estimated the causal effect of the intervention using targeted maximum likelihood estimation. Models were controlled for potential confounders. Results Based on the targeted maximum likelihood estimation, the intervention would have increased the proportion of correct answers on all six preventive measures by 18.4% (95% confidence interval 7.3–29.6%) had all participants received the intervention vs. had they all been in the control group. Conclusions These findings indicate the improvement of knowledge by the educational intervention.

Low radon exposures and lung cancer risk: joint analysis of the Czech, French, and Beaverlodge cohorts of uranium miners Abstract It is well established that high radon exposures increase the risk of lung cancer mortality. The effects of low occupational exposures and the factors that confound and modify this risk are not clear and are needed to inform current radiation protection of miners. The risk of lung cancer mortality at low radon exposures (< 100 working-level months) was assessed in the joint cohort analysis of Czech, French, and Canadian uranium miners, employed in 1953 or later. Statistical analysis was based on linear Poisson regression modeling with grouped cohort survival data. Two sensitivity analyses were used to assess potential confounding from tobacco smoking. A statistically significant linear relationship between radon exposure and lung cancer mortality was found. The excess relative risk per working-level month was 0.022 (95% confidence intervals: 0.013–0.034), based on 408 lung cancer deaths and 394,236 person-years of risk. Time since exposure was a statistically significant modifier; risk decreased with increasing time since exposure. A tendency for a decrease in risk with increasing attained age was observed, but this was not statistically significant. Exposure rate was not found to be a modifier of the excess relative risk. The potential confounding effect of tobacco smoking was estimated to be small and did not substantially change the radon–lung cancer mortality risk estimates. This joint cohort analysis provides strong evidence for an increased risk of lung cancer mortality from low occupational radon exposures. The results suggest that radiation protection measures continue to be important among current uranium miners.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com