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Standardized Mortality Ratios and the "Healthy Worker Effect": Scratching Beneath the Surface
Abstract
The age-standardized mortality ratio (SMR) is a relative index of mortality, expressing the mortality experience of the study population relative to that of a comparison ("standard") population. With the general population as the "standard", the SMR for an occupational population will underestimate the mortality experience of that latter population (since it comprises individuals necessarily healthy enough to be employable --and whose mortality risk is therefore initially lower than the general population average). However, this "healthy worker effect" does not equally to all groups within the study population. Therefore, if one attempts to adjust for this effect, the summary nature of the SMR must be recognized, and allowance must be made for variation in the healthy worker effect between different age groups, different races, different work-status groups, different causes of death, and different elapsed-time periods of observation.
... In third place, particularly where older workers are concerned, there is the risk of data on working conditions being misinterpreted, due to what has been termed a "healthy worker effect" (McMichael, 1976) on the size and compo' sition of the older workforce in different national settings. In a nutshell, in countries where older workers who are experiencing health problems have the opportunity to leave the labour market, either through early retirement or through disability schemes, the share of older workers covered by surveys like the EVCS, which only collect data on those in employment, can be quite small. ...
... In the other countries studied here, it would appear that physically or emotionally challenging working conditions are more frequently associated with early labour market exit strategies (Madero-Cabib et aL, 702I). In the Czech Republic, Italy and lreland, the sharp decrease in employment rates for men and women aged 60+ would seem to suggest that the relatively low levels of challenging physical or emotional working conditions declared in the EWCS actually reflect the "healthy worker effect" described in the 6rst section of this chapter (McMichael, 1976). In this case, individuals subject to unfavourable working conditions are more likely to opt for labour market exit strategies than those who are not subject to such challenges (Wahrendorf et al., 2017a). ...
... If the teachers had been assigned to another role aside from teaching, they were contacted by telephone to schedule an interview. A search for teachers who were on leave during T2 was conducted to minimize the healthy worker bias [15] and to identify teachers who no longer worked as teachers due to health problems. ...
... Follow-up losses due to the teacher strike during T2 reduced the statistical power of the study to detect certain differences that could have resulted in significance, even though the profiles of the respondents and non-respondents were similar, except for the number of daily shifts worked. The "healthy worker effect" is another type of bias that cannot be disregarded, as those who are healthier tend to remain active in their jobs, leading to a process of progressive selection of healthier workers [15]; therefore, this effect may have attenuated the prospective association between burnout and different outcomes, as those with the highest burnout levels might have already left the profession when the cohort study started. Despite these limitations, the present study provides a scientific contribution through its analysis of the relationship between burnout and teacher health with a prospective design. ...
Background
The present objective was to verify whether burnout (emotional exhaustion [EE], depersonalization [DP] and low professional efficacy [PE]) is a risk factor for long-term sickness absence (LTSA; ≥30 consecutive days) from the teaching role.
Methods
This was a prospective cohort study with two years of follow-up that investigated 509 elementary and high-school teachers. Burnout was identified by the Maslach Burnout Inventory. Poisson regression with robust variance was used to adjust for possible confounders.
Results
The incidence of LTSA was 9.4%. High EE levels were associated with LTSA in the crude analysis, but the association lost statistical significance after adjustments (for sex, age, perception of work-life balance, general self-rated health, chronic pain and depression). High DP levels were associated with this outcome, even after all adjustments (relative risk=1.80; 95% confidence interval: 1.05–3.09). Low PE levels were not related to LTSA.
Conclusion
The results reinforce the need to improve teachers’ work conditions to reduce burnout, particularly DP, and its consequences.
... We also observed several differences between afloat and ashore personnel that may signal a healthy worker effect (McMichael, 1976) among the afloat group. In a military context, this type of effect is often referred to as the healthy warrior or deployer effect (McLaughlin et al., 2008), and suggests that military personnel who are fit to serve in more rigorous roles (e.g. ...
Despite emerging public concern regarding the sleep health of military personnel over the past two decades, there remains a dearth of research examining sleep health among naval personnel assigned to sea duty. This study examined sleep metrics (e.g. fatigue, short sleep duration) and mental (e.g. posttraumatic stress disorder, depression) and physical health (e.g. type 2 diabetes, bodily pain) outcomes among naval personnel with recent sea duty (i.e. afloat) compared with naval personnel with recent shore duty (i.e. ashore). Prevalence ratios and mean differences for all outcomes were estimated and adjusted for demographic and military variables, and subsequently stratified by obesity. Sleep metrics were similar between afloat and ashore sailors except for short sleep duration, while sailors with recent shore duty had poorer physical health compared with those with
recent sea duty. Stratified analyses suggested naval personnel with obesity had a higher proportion of nearly all adverse sleep-related health outcomes than those without obesity. Among participants without obesity, afloat personnel were more likely to report very short sleep (≤ 5 hours) and fewer hours of average nightly sleep, but were less likely to report physical health outcomes compared with ashore personnel. These findings suggest potential differences in sleep metrics and sleep-related health outcomes between afloat and ashore naval personnel.
Additional research examining sleep outcomes using more objective measures is required to further investigate these findings, which may inform strategies to foster consolidated sleep despite environmental and occupational challenges in order to maintain high-performing naval personnel.
... Overall, results showed that Swedish veterans who have served abroad are in a relatively good psychological and physiological health state (Aux Military, 2021b;Petrus et al., 2019). This is often attributed to veterans being highly selected, thus generally being fitter and healthier at enlistment than the general population, a tendency referred to as the healthy soldier effect (McMichael, 1976;Pethrus et al., 2019). Another possible explanation may be so-called self-selection, as those more psychologically strong and resilient are assumed to deploy more often (Jacobson et al., 2012). ...
... As a result, these data may underestimate the burden of disease due to the healthy worker effect. 7 Lastly, most cross-sectional evaluations of WMSDs lack the necessary granularity to identify the etiology and chronicity of injuries with workplace exposures. Without an accurate assessment of WMSD disease burden or the etiology of common injuries, it becomes challenging to encourage investment in policy change and initiatives to mitigate work-related pain and injury among surgeons. ...
... This was a missed opportunity to establish associations between particular behavioural practices and outcomes, such as TB, HIV, and silicosis. Finally, we cannot rule out the "healthy worker effect" [46]. People who died or were too sick to avail themselves at work-based screening sites and at the two occupational health clinics may have had worse knowledge and practices and, thus, were more likely to be sicker than those who attended WBS and were enrolled in the study. ...
In Zimbabwe, artisanal and small-scale miners (ASMs) have a high prevalence of tuberculosis (TB), human immunodeficiency virus (HIV), and silicosis. Previous studies on ASMs utilised programme data, and it was not possible to understand reasons for the high prevalence of these comorbidities. We conducted a cross-sectional study to investigate the knowledge, attitudes, and practices of ASMs regarding TB, HIV, and silicosis. We enrolled a convenience sample of 652 ASMs. Their mean (standard deviation) age was 34.2 (10.8) years. There were 602 (92%) men and over 75% had attained secondary education. A total of 504 (80%) of the ASMs knew that TB is a curable disease, and 564 (87%) knew that they were at higher risk of TB than the general population. However, they were less likely to know that HIV increases the risk of TB disease, 340 (52%), with only 226 (35%) who perceived the risk of TB infection to be high among ASMs. Only 564 (59%) were aware that silica dust causes permanent and incurable lung diseases. Six hundred and twenty (97%) showed a positive attitude towards healthcare when they were sick, and 97% were willing to use special respirators to prevent dust inhalation. On practices, only 159 (30%) reported consistent use of either cloth or respirators to prevent dust inhalation. Three hundred and five (49%) ASMs reported consistent use of condoms outside their homes and 323 (50%) reported use of water to suppress dust. Only 480 (75%) of ASMs sought healthcare services when sick. ASMs cited challenges of accessing healthcare services due to lack of money to pay for healthcare (50%), long distances to clinics (17%), and the shortage of medicines at clinics (11%). Effective control of TB, silicosis, and HIV among ASMs requires addressing the identified knowledge gaps and barriers that are faced by ASMs in accessing personal protective equipment and healthcare services. This will require multisector collaboration and the involvement of ASMs in co-designing a package of healthcare services that are tailored for them.
... This variability was mainly due to a high number of observations with low lifting loads (0-499 kg). Furthermore, workers with high physical capacity, who may tolerate high lifting loads, could represent a relatively large part of the total observations in the ≥5000 kg interval, suggestive of a healthy worker effect (38). Conversely, the large inter-individual variations in lifting loads presently observed could represent a potential to homogenize the lifting tasks and volume more equally between warehouse workers. ...
Objectives:
Limited knowledge exists about the association of lifting loads on a daily basis with physical and mental symptoms among warehouse workers. This study investigated associations between objectively measured lifting load and low-back pain (LBP), mental stress, and bodily fatigue after work and the following morning.
Methods:
Warehouse workers (N=85) from the retail industry replied to daily questionnaires before and after work for 21 days about LBP intensity, mental stress, and bodily fatigue (outcome, all scales 0-10). We assessed lifting exposure using company records from the warehouse logistic systems on total lifting load (kg) per workday. Associations between variables were tested using linear mixed models with repeated measures controlling for relevant confounders.
Results:
Mean daily lifting load was 1667.2 kg (range: 0-9998.4 kg). Compared to lifting 0-499 kg during a workday, lifting 500-1999 kg was associated with 0.59 points [95% confidence interval (CI) 0.10-1.08] elevated LBP intensity after work, while lifting ≥5000 showed a higher LBP intensity of 1.26 points (95% CI 0.48-2.03). LBP intensity remained elevated the following morning. Lifting ≥5000 kg was associated with higher mental stress after work of 0.74 points (95% CI 0.10-1.37), while no association was observed for bodily fatigue.
Conclusions:
Higher daily lifting loads were associated with higher LBP intensity after work and the following morning. These findings suggest that warehouses should consider the daily lifting loads when organizing warehouse work to prevent development of LBP, eg, using company records to provide a more equal distribution of daily lifting loads between workers.
... One of the limitations of the cross-sectional study is that the study is performed at one specific point in time. As a result, cross-section studies only identifies survivors of the studied effect and fails to include workers who have been removed from the workforce as a result of injuries or diseases associated with their occupation 31 . In an effort to avoid this omission, we sought to include in this survey female artisanal fishermen/shellfish gatherers that had suspended work in the previous year, since their absence from work could have been related work-related injury. ...
Introdução: a pesca em pequena escala é responsável por pelo menos 40% do pescado consumido no mundo e, no Brasil, o trabalhador desse setor é o pescador artesanal, que contabiliza um a cada 200 brasileiros. Por se tratar de uma atividade da economia informal, as patologias que afetam esses pescadores são praticamente invisíveis nas estatísticas oficiais do país. Nesse contexto, os distúrbios musculoesqueléticos representam um grande problema socioeconômico e de saúde pública, mas sua prevalência é pouco conhecida entre trabalhadores não formais. Objetivo: estimar a prevalência de distúrbios musculoesqueléticos nos membros inferiores e fatores associados, em pescadores artesanais/marisqueiras de Saubara, Bahia, Brasil. Metodologia: trata-se de um estudo transversal, utilizando o Nordic Musculoskeletal Questionnaire, a versão brasileira do Job Content Questionnaire e um questionário sobre demandas físicas, para a coleta de informações em uma amostra aleatória de pescadores artesanais/marisqueiras, ocorridaem 2013. Resultados: a prevalência de distúrbios musculoesqueléticos em membros inferiores na amostra foi de 65,5% (n=137); a prevalência no segmento coxa/joelho, perna e tornozelo/pé foi de 48,7% (n=92), 47,7% (n=95) e 38,1% (n=72), respectivamente. Observaram-se também alta frequência de obesidade, baixa escolaridade, baixos salários, idade precoce para o início do trabalho e carga horária excessiva. Fatores como idade, tabagismo, demandas físicas, tempo de trabalho, ausência de pausas e trabalho anterior, estavam associados aos referidos distúrbios. Conclusão: A alta prevalência de distúrbios musculoesqueléticos dos membros inferiores em pescadoras artesanais indica a necessidade de desenvolver estratégias de prevenção, diagnóstico e notificação dessas doenças.
... The study has a number of limitations. One limitation is the healthy-worker survivor effect (McMichael 1976). Due to noisy, dusty, and demanding work in paper mills, less healthy workers tend to terminate their employment or be transferred to lower exposed positions in the mills. ...
Objective
To elucidate whether occupational noise exposure increases the mortality from ischemic heart disease (IHD) and stroke, and if exposure to paper dust modified the risks.
Methods
We studied 6686 workers from soft paper mills, with occupational noise exposure, < 85 dBA, 85–90 dBA and > 90 dBA, and high (> 5 mg/m³) exposure to paper dust. Person-years 1960–2019 were stratified according to gender, age, and calendar-year. Expected numbers of deaths were calculated using the Swedish population as the reference and standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were assessed.
Results
SMR for IHD was 1.12 (95% CI 0.88–1.41) for noise < 85 dBA, 1.18 (95% CI 0.90–1.55) for 85–90 dBA, and 1.27 (95% CI 1.10–1.47) among workers exposed > 90 dBA. Joint exposure to high noise exposure and high exposure to paper dust resulted in slightly higher IHD mortality (SMR 1.39, 95% CI 1.15–1.67). SMR for ischemic stroke was 0.90 (95% CI 0.37–2.15) for noise < 85 dBA, 1.08 (95% CI 0.45–2.59) for 85–90 dBA, and 1.48 (95% CI 0.99–2.00) among workers exposed > 90 dBA. High noise exposure and high exposure to paper dust resulted in higher ischemic stroke mortality (SMR 1.83, 95% CI 1.12–2.98).
Conclusion
Noise levels > 90 dBA was associated with increased IHD mortality. Combined exposures of noise and paper dust may further increase the risks. Our results do not provide support for a causal relationship for ischemic stroke. Residual confounding from smoking has to be considered. Workers need to be protected from occupational noise levels exceeding 90 dBA.
... 2. Публикация McMichael A.J. et al., 1974 [11] была недоступна; на наличие в ней термина 'healthy worker effect' указано в работе [12]. Поиск на соответствующую точную конструкцию через PubMed первой по хронологии идентифицирует работу McMichael A.J., 1976 [13], в которой термин имеется уже в названии. ...
A systematic review, combining analysis (on means after deleting outliers from samples) and meta-analysis for Standardized mortality ratio (SMR) versus the general population for total and all-cancer mortality for professional drivers (men only) of various countries (cohorts of Great Britain, Denmark, Iceland, Italy, Canada, Russia, Singapore, Switzerland and Sweden (1988–2002); data for the USA (1978) were not available; 13 papers in total) were conducted. The criteria for the search and selection of sources (PubMed, Google, Cochrane Systematic Reviews and reference lists of publications) were: a) a cohort of drivers only, without adding other employees of auto enterprises; b) the presence in the study of index of total mortality (‘all causes’) and/or mortality from all malignant neoplasms (‘all cancer’); c) the expression of mortality rates only in the SMR index. A combined analysis and meta-analysis showed a weak healthy worker effect (HWE; meta-analysis: SMR=0.92, 95% confidence intervals (CI): 0.85, 0.99, the presence of HWE was judged by the value of the upper CI<1.0). There are also trends towards HWE for overall mortality for taxi and truck drivers (SMR=0.9–0.93), but the samples are too small to draw conclusions. For other groups of drivers HWE was not found. In both types of synthetic studies, no SMR for HWE was observed for mortality from all malignancies, either for the general group of drivers (8 countries; 16 cohorts) or for individual occupational groups. There were slight increases in SMR (by 3–10%), the magnitude of which, according to epidemiological canons, is difficult to prove, and according to the risk scale by R.R. Monson corresponds to no effect. The absence of significant risks both in terms of the integral indicator of well-being (life expectancy, inversely proportional to SMR), and in terms of mortality from all types of malignant neoplasms for professional drivers makes it unlikely that the population of Russia will experience increased mortality due to ever-increasing mass motorization.
... populations is largely unknown. Due to the healthy worker effect (McMichael, 1976), morbidity in our source population was assumed to be decreased in comparison with the general population. However, reported sensory-related factors, such as ASD or ADHD, seem to be as prevalent as or even more prevalent in our sample in comparison to the general population. ...
Sensory processing includes receiving, modulating, integrating and organizing of sensory stimuli, and producing a behavioral response to these stimuli. It involves all information received through the various sensory modalities, for instance visual, auditory, olfactory, gustatory, tactile, vestibular, proprioceptive or interoceptive information. Difficulties in sensory processing are highly prevalent with autism spectrum disorder (ASD) and are part of the diagnostic criteria for ASD presented in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Moreover, these difficulties are increasingly associated with other types of psychopathology as well. Sensory processing difficulties have also been associated with various behavioral problems, in particular internalizing behaviors. With respect to the association of sensory processing difficulties with more externalizing behaviors, such as aggressive or violent behavior, research in adolescent and adult populations is far more limited. The research presented in this thesis was conducted to explore the relevance of sensory processing difficulties for (forensic) psychiatric clinical practice, both from a psychopathological and behavioral perspective. Several studies were performed to investigate the association of sensory processing difficulties with psychiatric disorders and with externalizing behavior in adolescent and adult clinical and non-clinical populations. In addition, the thesis contains methodological investigations of clinical instruments developed for the measurement and screening of sensory processing difficulties or externalizing behavior.
... This study has a number of methodological issues that should be acknowledged. The first is the issue of potential sample selection and the risk of the "healthy worker effect" (McMichael, 1976). Health, work ability, and ERI showed just a slight change over time, what may in part also be the result of sample selection, which may have reduced the variability in self-rated health, perceived work ability, and ERI, as decreases in such variables can result in a premature exit from the workforce (Boissonneault & de Beer, 2018;Doshi et al., 2008;Hintsa et al., 2015;Topa et al., 2018) and subsequent dropout from the sample. ...
Preferred retirement age (PRA) is one key dimension when studying retirement decision-making. However, little is known concerning how PRA develops over the late career years. This study used a person-centered approach to longitudinally investigate trajectories of PRA and how they differ in self-rated health, perceived work ability, and effort-reward imbalance (ERI) at baseline levels and over 6 years. The study used data from four waves (2010, 2012, 2014, and 2016) of the Swedish Longitudinal Occupational Survey of Health. The sample consisted of 1,510 individuals aged 50-55 in 2010, who answered to the questionnaire for those in paid work (including self-employment) at the baseline and at least one of the following waves. Results from the latent class growth curve modeling show both within-and between-person variability in PRA over the 6-year span. We found four distinct trajectories, which differed both at the baseline levels and in the patterns of change in PRA: "C1: normative, relatively stable PRA" (42% of all participants); "C2: considerably early, increasing PRA" (6% of the participants); "C3: late, relatively stable PRA" (4% of the participants); and "C4: early, increasing PRA" (49% of the participants). Participants revealed a clear preference for retirement before the age of 65. Trajectories comprising earlier PRA showed poorer self-rated health, poorer work ability, and higher levels of ERI at the baseline and over time. The findings reinforce the importance of healthy work environments that promote work ability and facilitate a balance between efforts and rewards for encouraging longer working lives.
... O estudo apresenta limitações que devem ser consideradas na leitura de seus resultados. A primeira diz respeito ao delineamento transversal, que impossibilita inferir conclusões em termos de causalidade entre as variáveis (Carlson & Morrison, 2009); a segunda é no que tange à característica da amostra não probabilística, que não permite a generalização de seus resultados; e a terceira refere-se ao "efeito do trabalhador sadio", viés característico em estudos transversais em epidemiologia ocupacional que, muitas vezes, exclui o possível doente (McMichael, 1976). Essa é uma situação que pode subestimar o tamanho dos riscos identificados, pois é possível que os profissionais mais afetados estejam afastados do trabalho, não tenham sido acessados pela técnica de estratégia de coleta de dados ou recusaram-se a participar. ...
Este estudo teve como objetivo a identificação dos fatores associados aos transtornos mentais comuns (TMC) em motoristas de transporte coletivo de passageiros, em uma amostra de 258 motoristas pertencentes ao quadro funcional de duas empresas de transporte coletivo. Para a coleta de dados, foram utilizados o Questionário de Dados Sociodemográficos, Laborais e Estressores Ocupacionais e o Self-Reporting Questionnaire (SRQ-20). Realizaram-se análises bivariadas (qui-quadrado de Pearson) entre todas as variáveis independentes. Para a análise dos TMC e relação com as variáveis independentes, foi utilizada análise de regressão logística bivariada e a odds ratio (OR), que consiste na razão de chances de aquisição do agravo entre expostos e não expostos. Os resultados identificaram como preditoras dos transtornos mentais comuns as variáveis pouco tempo de intervalo; falta de suporte social; falta de autonomia; e escala de trabalho.
... These findings may be influenced by the healthy worker effect (HWE), a phenomenon observed in studies of occupational exposure and disease where people who remain actively employed for longer periods have a consistent tendency to exhibit better health than the population at large. 36 This effect is difficult to characterize statistically due to the inherent absence of information for individuals who do not enter the workforce or whose employment status changes; however, the presence of the HWE in firefighting has been characterized in a cohort of German firefighters 37 and in studies of firefighters in the US. 38 It may occur when susceptible subpopulations or individuals experiencing adverse health effects leave the workforce (often these are individuals who may be highly exposed) or if a firefighter's job and task or years of service are associated with exposure levels over time. ...
Objective:
To examine associations between years of firefighting service and eight chronological age-adjusted measures of blood leukocyte epigenetic age acceleration: Horvath, Hannum, SkinBloodClock, Intrinsic, Extrinsic, PhenoAge, GrimAge, and DNAm telomere length.
Methods:
A repeated measures analysis of data from 379 incumbent firefighters from eight career departments and 100 recruit firefighters from two of the departments, across the United States.
Results:
Incumbent firefighters had on average greater epigenetic age acceleration compared to recruit firefighters, potentially due to the cumulative effect of occupational exposures. However, among incumbent firefighters, additional years of service were associated with epigenetic age deceleration, particularly for GrimAge, a strong predictor of mortality.
Conclusions:
Long-term studies with more specific occupational exposure classification are needed to better understand the relationship between years of service and aging biomarkers.
... A healthy worker effect is a bias that arises from observational studies in occupational settings without an accurate control group [189]. First of all, the working population might be healthier than the general population [190], causing an underestimation of the risks for employees, i.e., the healthy worker hire effect. Additionally, employees who encounter work-related symptoms early on might have left their employment and thus would not show up in these observational occupational studies, i.e., the healthy worker survivor effect [189,191]. ...
A significant part of adult-onset asthma is caused by occupational exposure to both high- and low-molecular-mass agents. Insects are occasionally described to cause occupational allergy in professions including anglers and fishers, laboratory workers, employees of aquaculture companies, farmers, bakers, sericulture workers and pet shop workers. Occupational insect allergies are often respiratory, causing asthma or rhinoconjunctivitis, but can be cutaneous as well. The European Union recently approved three insect species for human consumption, enabling an industry to develop where more employees could be exposed to insect products. This review overviews knowledge on occupational insect allergy risks and the tools used to diagnose employees. Despite the limited availability of commercial occupational insect allergy diagnostics, 60.9% of 164 included reports used skin prick tests and 63.4% of reports used specific IgE tests. In 21.9% of reports, a more elaborate diagnosis of occupational asthma was made by specific inhalation challenges or peak expiratory flow measurements at the workplace. In some work environments, 57% of employees were sensitized, and no less than 60% of employees reported work-related symptoms. Further development and optimization of specific diagnostics, together with strong primary prevention, may be vital to the health conditions of workers in the developing insect industry.
... Históricamente se ha considerado que el trabajo es un factor protector para la salud de las personas, contrariamente con el riesgo que se ha reportado para los sujetos que se encuentran desempleados. Este fenómeno, que se conoce en la literatura como el efecto del trabajador sano, hace referencia a la tendencia estadística constante que presentan las personas con un empleo activo a registrar una tasa de mortalidad más baja que la población general (McMichael, 1976); comportamiento estadístico que, sin embargo, podría responder a los efectos que generan los procesos de selección de las organizaciones que incorporan mecanismos de exclusión laboral contra personas que padecen alguna enfermedad invalidante. Por otra parte, la evidencia científica reportada durante los últimos años ha demostrado que las personas sin trabajo podrían tener 23 Al respecto, algunos autores han reportado que el número de intentos suicidas podría ser mayor; pues, otros autores han reportado que únicamente entre el 10% y el 40% de los intentos suicidas llegaría a provocar la muerte (Belsher et al., 2019). ...
El capítulo aborda el suicidio en contextos laborales. Las factores de riesgo asociados a tal fenómeno, así como también las ocupaciones y profesiones con mayor riesgo suicida. Además, se profundiza en su definición como accidente laboral, y las complejidades legales de tal hipótesis jurídica. Finalmente, se propone el desarrollo de un Modelo de Autopsia Psicológico Integrado - Laboral (MAPI-L) como herramienta de gran valor dentro del ámbito jurídico-laboral, dada su comprobada utilidad en la investigación de suicidios y/o muertes indeterminadas. Ello, en tanto viabiliza una exploración retrospectiva –en profundidad– sobre el funcionamiento sociopsicolaboral de un sujeto previo a su muerte, levantando la evidencia probatoria suficiente que permite, por una parte, una comprensión integral del acto suicida y, por otro lado, la formulación de dictámenes jurídicos basados en evidencia científica. Todo lo cual resulta factible en la medida que –los hallazgos reportados– sean el producto de un trabajo metodológicamente científico y tenga su fundamento en evidencia empírica lograda mediante un criterio técnico, de manera que los resultados obtenidos en la autopsia psicológica puedan ser verificables frente al juez..///
The chapter deals with suicide in a work context. The risk factors associated with this phenomenon, as well as the occupations and professions with the highest suicidal risk. In addition, it delves into its definition as a work accident, and the legal complexities of such a legal hypothesis. Finally, the development of an Integrated Psychological Autopsy Model - Labor (MAPI-L) is proposed as a tool of great value within the legal-labour field, given its proven usefulness in the investigation of suicides and/or undetermined deaths. This, while enabling a retrospective exploration –in depth– on the socio-psychological functioning of a subject prior to his death, raising sufficient probative evidence that allows, on the one hand, a comprehensive understanding of the suicidal act and, on the other hand, the formulation of legal opinions based on scientific evidence. All of which is feasible to the extent that the reported findings are the product of methodologically scientific work and are based on empirical evidence achieved through technical criteria, so that the results obtained in the psychological autopsy can be verifiable against the judge.
... As such, disease-related polymorphisms that would be identified in cohorts of nonhealthy patients (i.e., from persons who are ineligible to donate blood) would be intrinsically not amenable to identification as a result of our study design. On the other hand, while sufficiently healthy to donate blood and as a result probably has biases similar to other 'healthy worker' cohorts (77), the donor population enrolled in this study also includes phenotypes of potential clinical relevance to disease phenotypes (e.g., to cardiovascular and other disease risk factors, such as obesity (27), smoking (23), and alcohol consumption (25)) but at a lower rate than the general population. As such, some of the genome-wide associations reported here (e.g., carnitine and SLC22A16) may be translationally relevant beyond transfusion medicine when interpreted in the context of markers relevant to specific diseases (e.g., carnitine metabolism and obesity (27)). ...
The Red Blood Cell (RBC)-Omics study, part of the larger NHLBI-funded Recipient Epidemiology and Donor Evaluation Study (REDS-III), aims to understand the genetic contribution to blood donor RBC characteristics. Previous work identified donor demographic, behavioral, genetic, and metabolic underpinnings to blood donation, storage, and (to a lesser extent) transfusion outcomes, but none have yet linked the genetic and metabolic bodies of work. We performed a Genome-Wide Association (GWA) analysis using RBC-Omics study participants with generated untargeted metabolomics data to identify metabolite quantitative trait loci (mQTL) in RBCs. We performed GWA analyses of 382 metabolites in 243 individuals imputed using the 1000 Genomes Project phase 3 all-ancestry reference panel. Analyses were conducted using ProbABEL and adjusted for sex, age, donation center, number of whole blood donations in the past two years, and first ten principal components of ancestry. Our results identified 423 independent genetic loci associated with 132 metabolites (p < 5x10-8). Potentially novel locus-metabolite associations were identified for the region encoding heme transporter FLVCR1 and choline, and for lysophosphatidylcholine acetyltransferase LPCAT3 and lysophosphatidylserine 16.0, 18.0, 18.1, and 18.2; these associations are supported by published rare disease and mouse studies. We also confirmed previous metabolite GWA results for associations including N(6)-Methyl-L-lysine and protein PYROXD2, and various carnitines and transporter SLC22A16. Association between pyruvate levels and G6PD polymorphisms was validated in an independent cohort and novel murine models of G6PD deficiency (African and Mediterranean variants). We demonstrate that it is possible to perform metabolomics-scale GWA analyses with a modest, trans-ancestry sample size.
... Eine Schwäche des Längsschnitts ist, dass die Stichprobe nur noch aus Beschäftigten bestand, die zu beiden Zeitpunkten an der Befragung teilgenommen haben. Dies könnte zu einer Selektion im Sinne des "healthy worker effects" geführt haben [22]. ...
Zusammenfassung
Zielsetzung Ziel des Betrages ist es, die Erwerbsperspektive von älteren Beschäftigten in Berufen des Gesundheitsdienstes im Berufsgruppenvergleich darzustellen. Dabei werden drei Aspekte der Erwerbsperspektive unterschieden: bis zu welchem Alter die Beschäftigten noch arbeiten wollen, können und planen.
Methoden Datengrundlage sind die zweite (2014) und dritte (2018) Welle der repräsentativen lidA-Studie, welche Beschäftigte der Geburtsjahrgänge 1959 und 1965 seit 2011 im Abstand von 3 bis 4 Jahren befragt. In deskriptiven Quer- und Längsschnittanalysen werden fünf Berufsgruppen des Gesundheitsdienstes mit weiteren Berufsgruppen verglichen (NStichprobe=2.580).
Ergebnisse Die untersuchten Berufsgruppen unterscheiden sich deutlich in ihrer Erwerbsperspektive. Auffällig sind Beschäftigte in Pflegeberufen, denn sie wollen im Mittel früh aus dem Erwerbsleben aussteigen; vor allem aber können sie nicht so lange arbeiten wie sie planen. Längsschnittanalysen zeigen, dass sich die Erwerbsperspektive mit dem Herannahen an das Regelrenteneintrittsalter verlängert.
Schlussfolgerungen Pflegeberufe sind Risikogruppen in Bezug auf den Erwerbsverbleib und bedürfen besonderer Aufmerksamkeit auf betrieblicher Ebene. Die Ergebnisse zeigen erstmals die individuelle Veränderung der Erwerbsperspektive über die Zeit, was eine Chance für die Personalführung impliziert.
... This includes a lower prevalence of hypertension, diabetes, and other comorbidities, smoking, and overweight. 45 Accordingly, rates of total mortality and cardiovascular disease in former elite sports participants are typically lower than the general population 31 46 47 -an exemplar of the so-called 'healthy worker' effect, perhaps, 48 and/ or an indication of the health-protecting properties of higher levels of physical activity. Thus, dementia rates in the general population are more likely to be higher than athletic groups. ...
... First, those who experienced a workplace injury were employed by definition-they may have been healthier than the cohort of patients with nonworkplace injuries, who may or may not be employed. 19 Second, those who had a workplace injury had 45% lower odds of being prescribed OAT. As OAT prescription is a likely proxy for OUD, this finding may reflect that employed individuals were less likely to suffer from OUD and were, thus, less likely to experience drug poisoning. ...
Background:
There has been increasing scrutiny of opioid prescribing following injury because of concerns that prescribed opioids may contribute to addiction and overdose. This study aimed to better understand the relationship between injury, opioids prescribed before and after injury, and non-medical drug poisoning.
Data and methods:
Working age (15 to 65 years old) residents of British Columbia's Fraser Health region with an injury that involved an emergency department visit were included. Factors examined included the prescription of opioid and opioid agonist therapy (OAT) medications before and after injury, age, sex, work-related injuries, and socioeconomic status, as well as how they were associated with non-medical drug poisoning risk and post-injury prescriptions.
Results:
Opioid-naive individuals (those without an opioid prescription captured before their injury) who were prescribed OAT medication-a marker of opioid use disorder-following their injury had a higher risk of subsequent non-medical drug poisoning (Hazard ratio (HR): 21.4 to 22.4 compared with opioid-naive individuals without an opioid or OAT prescription). Post-injury opioid prescription in these individuals increased poisoning risk (HR: 1.27 compared with those without a prescription). Being of male sex (HR: 1.80), being younger (HR: 0.76 for every 10-year increase in age) and living in the lowest-income neighbourhoods (HR: 1.44 compared with the middle quintile) increased poisoning risk. Compared with injuries sustained outside of work, work-related injuries reduced risk (HR: 0.62).
Interpretation:
Among a cohort of British Columbians visiting emergency departments following an injury, opioid prescribing in patients who were opioid-naive appears to be a minor contributor to non-medical drug poisoning, particularly when compared with other patient factors, such as being male, being younger and having a low socioeconomic status.
... First described in the literature in Kang and Bullman in 1996, 1 the HSE was initially conceptualized as an extension of the "healthy worker effect," a term coined to describe more favorable mortality rates in the employed population. 2,3 The HSE has been proposed to be due to a number of factors, including the initial physical screening for healthy recruits, emphasis on physical fitness during service, and better healthcare during and after service. 1 A large meta-analysis describing this effect analyzed 12 articles exploring the HSE spanning 1974 to 2004 in over 2.4 million Veterans. 4 Results revealed strong evidence for the HSE, with a standardized mortality ratio (SMR) of 0.76 for deployed Veterans and 0.73 for nondeployed Veterans. ...
Introduction
The healthy soldier effect (HSE) describes a phenomenon of enduring health and lower mortality among veterans due in part to initial screening procedures and health care access. Although early data were supportive of a broad HSE among former military members, more recent investigations have suggested a possible attenuation of the effect with older age. The present study aimed to provide an update of the HSE using an expansive Veterans Health Administration (VHA)–wide sample with a particular focus on age and sex effects.
Materials and Methods
Mortality data for veterans within the VHA were obtained from the VHA Support Service Center program office and compared to mortality data from the general U.S. population spanning FY2014 to the second quarter of FY2020. The standardized mortality ratio (SMR) was calculated for the overall sample and for age- and sex-specific cohorts. Mortality rate ratios were also calculated and compared across sexes.
Results
Lower SMRs were observed in veterans compared to the general U.S. population (SMR 0.866). This effect was most prominent in younger and very old veterans, although a higher mortality was seen in the 55- to 64-year age cohort (SMR 1.371 for males and 1.074 for females). The HSE in females was lower than that in males in the <55-year age group but became higher in older cohorts.
Conclusions
This is the largest investigation to date examining the HSE in U.S. veterans and includes younger veterans from more recent military eras. Higher mortality among the 55- to 74-year age groups merits further investigation, as does the relatively higher mortality among older female veterans. Our findings have implications for the provision of health care and preventative care to these veterans most at risk for higher mortality.
... The use of the IPA in this study involved a detailed and systematic analysis of the subjective experiences of working as an IC nurse, the perceptions of aging in the workplace, and thoughts regarding extended working lives in a particular healthcare setting in Sweden. The nurses that were interviewed had a good health and were very satisfied with their job and the organization, which means that there is a risk of sample selection issues resulting from a potential "healthy worker effect" [112]. This means that nurses with poorer health or those dissatisfied with their job or the workplace may have already left nursing or decided to not participate in this study. ...
To counteract the shortage of nurses in the workforce, healthcare organizations must encourage experienced nurses to extend their working lives. Intensive care (IC) has higher nurse-to-patient ratios than other settings, which includes a particular susceptibility to staff shortage. This qualitative study investigated how older IC nurses experienced their working life and their reflections on the late-career and retirement. Semi-structured interviews with 12 IC nurses in Sweden (aged 55–65 years) were analyzed using an interpretative phenomenological analysis approach. The results showed that nurses planned to continue working until the age of 65 and beyond. When reflecting on their late-career decisions, nurses considered nine areas covering individual, work, and organizational factors as being central to their ability and willingness to stay. Overall, the nurses had good health and were very satisfied and committed to their job and to the organization. They mentioned having both the job and personal resources required to cope with the physical and mental job demands, which were perceived as motivational challenges, rather than hinders. They also reflected on various human resource management practices that may promote aging-in-workplace. These findings may inform organizations aiming at providing adequate conditions for enabling healthy and sustainable working lives for IC nurses.
... 38 Almost half (44%) of the women in our sample with high physical job demand in their last job before retirement were not eligible for the pension for women compared with only 25% in the group exposed to low physical job demand (the figures were 41% for high PSI and 27% for low PSI). Thus, the strongly positive selection of women in high-demand jobs eligible for early retirement may have induced a socalled healthy worker effect (McMichael, 1976;Sewdas et al., 2018). Positive selection of employees eligible for early retirement may have also caused the small difference in average employment exit age of 6 months between women in low-and high-demand jobs in our sample of women eligible for early retirement 39 . ...
Early retirement options are usually targeted at employees at risk of not reaching their regular retirement age in employment. An important at-risk group comprises older employees who have worked in demanding jobs for many years. This group may be particularly negatively affected by the abolition of early retirement options. To measure differences in labor market reactions of employees in low- and high-demand jobs, we exploit the quasi-natural experiment of a cohort-specific pension reform that increased the early retirement age for women from 60 to 63 years. Based on a large administrative dataset, we use a regression-discontinuity approach to estimate the labor market reactions. Surprisingly, we find the same relative employment increase of about 25% for treated women who were exposed to low and to high job demand. For older women in demanding jobs, we also do not find substitution effects into unemployment, partial retirement, disability pension, or inactivity. Eligibility for the abolished early retirement option required high labor market attachment. Thus, we argue that this eligibility rule induced a positive selection of healthy workers into early retirement. We propose alternative policies that protect workers exposed to high job demand better against the negative consequences of being unable to reach their statutory retirement age in employment.
... We, therefore, cannot rule out selection bias. It could be that the more healthy nurses with higher work ability were more likely to participate in the survey, posing a healthy worker effect (McMichael 1976), but it could also be that the nurses who were more dissatisfied with their working conditions or their work ability were more motivated to participate. Nevertheless, the results indicate an association between SOC-strategies and work ability, but caution should be taken when generalising the results to other populations of nurses and other occupational groups. ...
Background: Individual use of selection, optimisation, and compensation (SOC) is positively associated with work ability; however, this association has never been explored at the group or leadership levels.
Aim: The aim of this study is to explore the strength of associations between employee-rated use of SOC at the individual, group, and leadership levels and self-rated work ability among nurses. Method: A random sample of 2000 nurses were invited to participate in a questionnaire survey, among whom 785 responded.
Results: Employee-rated use of SOC at the individual and group levels was positively associated with self-rated work ability when controlling for psychosocial working environment factors and health. The association was strongest at the group level.
Conclusion: Efforts to enhance the collective use of SOC may prove beneficial to maintain the work ability of nurses and retain them in the profession.
... However, it should be noted that these measures were self-reported as well. Third, the Hawthorne effect(Wickström & Bendix, 2000) and the healthy work effect(McMichael, 1976) could not be ignored in this study. ...
Aims
To compare nurses’ non‐optimal eating behaviours across different shifts, to examine whether non‐day shifts were related to deviation from optimal dietary behaviours compared with day shifts and whether such deviation was related to non‐optimal macronutrient intake.
Design
This is a 4‐day intensive longitudinal study.
Methods
A convenience sample of hospital nurses was recruited in Taiwan. From September 2018 through January 2019, 120 participants completed 4‐days of 24‐h dietary recalls. One‐way ANOVA and Kruskal–Wallis H test were used to compare differences in energy and macronutrient intake and frequency of meals and snacking, respectively. Generalized linear regressions examined (1) the associations between shiftwork schedules and non‐optimal eating behaviours and (2) associations between non‐optimal eating and high energy contribution of non‐optimal macronutrients.
Results
Nurses consumed less energy on evening and night shifts compared with day shifts. However, energy intake from snacking was higher on evening and night shifts relative to day shifts. Nurses consumed less meals but had higher snacking frequency on non‐day shifts. In addition, high energy intake from snacking was positively associated with high energy intake from saturated fat.
Conclusions
Nurses were more likely to have non‐optimal eating behaviours on non‐day shifts, which may contribute to an increased intake of saturated fat; thus, increasing their risk of chronic diseases. Strategies to improve non‐day shift nurses' non‐optimal eating behaviours may be beneficial to their health.
Impact
Shiftwork is known to affect nurses' eating behaviours; however, which shift is associated with unhealthy eating remains inconclusive. Despite lower energy intakes, nurses had higher intake by snacking on evening and night shifts. High snacking intake was associated with a high intake of saturated fat. Hospitals can increase the availability of healthy foods on evening or night shifts, which may improve non‐day shift nurses' non‐optimal eating behaviours.
... That study reported Standardized Mortality Ratios (SMRs) of 0.62 (95% CI 0.58, 0.66) for all causes of death, 0.71 (95% CI 0.56, 0.88) for all cancers, and 0.91 (95% CI 0.47, 1.60) for leukemia but did not estimate a dose-response. In addition, both these studies compared cohorts of highly selected submariners with the general population, so the reported SMRs reflect healthy hire biases to varying degrees (McMichael 1976;Wang and Miettinen 1982;Checkoway et al. 2004). ...
Background:
Men stationed on nuclear-powered submarines are occupationally exposed to external ionizing radiation at very low levels and radiation dose for each individual is closely monitored. Little is known about ionizing radiation (IR) risks of cancer mortality for populations with levels of cumulative ionizing radiation exposure this low.
Materials and methods:
This historical cohort study followed 85,033 enlisted men who had served on a nuclear-powered submarine in the U.S. Navy between 1969 and 1982 to determine patterns of cancer mortality. Occupational radiation doses were measured by badge dosimeters for each individual for all periods of Navy service potentially involving radiation exposure. Deaths were ascertained through 1995 by searches of multiple national mortality databases. Within-cohort dose-response relationships for cancer mortality were estimated using linear Poisson regression models. Individual level smoking status was not available so cancer risks were estimated separately for cancers with and without previously published evidence of consistently moderate or strong associations with smoking.
Results:
A total of 584 cancer deaths occurred during a follow-up period of up to 27 years. The mean and median cumulative occupational radiation doses received while in the Navy were 5.7 and 1.1 milliSieverts (mSv) respectively, range 0-242 mSv. Mortality Excess Relative Risks (ERRs) per 10 mSv and 95% confidence intervals (CI) were 0.053 (CI -0.03, 0.17) for all cancers, 0.052 (CI -0.03, 0.18) for all solid cancers, and 0.003 (CI -0.29, 0.30) for leukemias excluding chronic lymphocytic leukemia. The ERRs per 10 mSv were 0.052 (CI -0.07, 0.17) for cancers previously associated with smoking and 0.012 (CI -0.10, 0.12) for cancers that were not.
Conclusions:
The ERR point estimates for solid cancers and leukemia were statistically compatible with those reported in previous published studies of other ionizing radiation-exposed and monitored cohorts, albeit with wide confidence intervals. This study, with high quality measurements of in-Navy occupational external IR doses, high follow-up proportion, and detailed IR dose-response analyses, is consistent with the premise of a small excess cancer risk from low-dose IR.
... Foremost, the sample was predominantly non-Hispanic white, so results may not generalize to other demographic groups. Also, the test setting could have biased recruitment of older individuals towards those in exceptionally good health -i.e., a 'healthy worker effect' (38). This may partially explain why some participants in the 58-77 age category show the same or a lower olfactory detection threshold as those in the 18-37 age category. ...
Purpose
Many widely-used psychophysical tests of olfaction have limitations that can create barriers to adoption outside research settings. For example, tests that measure the ability to identify odors may confound sensory performance with memory recall, verbal ability, and past experience with the odor. Conversely, threshold-based tests typically avoid these issues, but are labor intensive. Additionally, many commercially available olfactory tests are slow and may require a trained administrator, making them impractical for use in a short wellness visit or other broad clinical assessment.
Methods
We tested the performance of the Adaptive Olfactory Measure of Threshold (ArOMa-T) – a novel odor detection threshold test that employs an adaptive Bayesian algorithm paired with a disposable odor-delivery card – in a non-clinical sample of individuals (n=534) at the 2021 Twins Day Festival in Twinsburg, OH.
Results
Participants successfully completed the test in under 3 min with a false alarm rate of 9.6% and a test-retest reliability of 0.61. Odor detection thresholds differed by sex (∼3.2-fold) and between the youngest and oldest age groups (∼8.7-fold), consistent with prior work. In an exploratory analysis, we failed to observe evidence of detection threshold differences between participants who reported a history of COVID-19 and matched controls who did not. We also found evidence for broad-sense heritability of odor detection thresholds.
Conclusion
Together, these data indicate the ArOMa-T can determine odor detection thresholds. The ArOMa-T may be particularly valuable in clinical or field settings where rapid and portable assessment of olfactory function is needed.
... Whether our results are generalizable to other (working and non-working) populations is largely unknown. Due to the healthy worker effect [35], morbidity in our source population was assumed to be decreased in comparison with the general population. However, reported sensory-related factors, such as ASD or ADHD, seem to be as prevalent as or even more prevalent in our sample in comparison to the general population. ...
Although previous research suggests an association between sensory processing and perceived stress in a broad spectrum of mental health conditions, it remains unclear whether this phenomenon occurs independently from psychopathology. The present study investigated the association between sensory processing patterns, perceived stress and occupational burnout as a stress-related condition in a working population. We focused on different aspects of sensory processing and used the momentum of a particularly stressful period: during the first months of the global COVID-19 crisis. A total of 116 workers at a mental healthcare institution in The Netherlands completed the Adolescent/Adult Sensory Profile (AASP), the Perceived Stress Scale (PSS-10) and the Burnout Assessment Tool (BAT). Our results demonstrated that higher scores on sensory sensitivity and low registration were associated with higher scores on perceived stress and core burnout symptoms. Sensory hypersensitivity was also associated with more secondary burnout symptoms. Associations were not driven by underlying sensory-related disorders (e.g., ASD or ADHD). In conclusion, sensory processing difficulties are relevant predictors of stress and occupational burnout, also in healthy employees. This phenomenon warrants further attention, as relatively simple adjustments in working environment may possess important preventive effects.
... The cohort displayed a strong healthy worker effect (HWE), with a 13% lower risk of mortality from CeVD than the general population of England and Wales, adjusted for age, sex and calendar period (95% CI: 10,16). This is unsurprising as the HWE is typically observed in occupational cohorts and arises because the occupational group must be healthy enough to be employed and so have a lower risk of mortality than the general population (21). The health of radiation workers is also routinely monitored by their employers and they must be sufficiently healthy to remain in radiation work. ...
Exposure to ionizing radiation can damage the cerebrovascular system, however there is uncertainty regarding the effects after chronic exposure to low doses of radiation, such as that experienced by the public and those occupationally exposed. This study uses data from the UK National Registry for Radiation Workers cohort to assess the association between low-dose exposure to external radiation and cerebrovascular disease (CeVD) mortality. Poisson regression was used to estimate the Excess Relative Risk of CeVD mortality per Sievert (ERR/Sv) of radiation exposure. Estimates were obtained for all CeVD combined, ischemic stroke, hemorrhagic stroke and other/ill-defined CeVD. Results were adjusted for attained age, calendar period, sex, employer, industrial category and employment length. 166,812 nuclear workers (3,665,413 person-years) were included. By the end of 2011, 23% were dead including 3,219 deaths with an underlying cause of CeVD. The ERR/Sv for all CeVD deaths was 0.57 (95% CI: 0.00, 1.31; p = 0.05). Increased CeVD mortality rates were observed after doses as low as 10–20 mSv. However, a linear-exponential model fit the data significantly better than a linear model (p = 0.02). In the sub-type analyses, no evidence of linear associations were observed, however the patterns of response appeared to differ and there was some suggestion of an increased risk of hemorrhagic stroke at lower doses. These results are broadly consistent with other occupational cohort studies and suggest external radiation exposure may increase CeVD risk at lower doses than current ICRP protection guidelines suggest. Exploration of factors driving the observed dose-response shape, the potential impact of the healthy worker survivor effect, and further studies of cohorts with data on other potential confounders would be valuable.
Profissionais da área da saúde estão expostos a diversos estressores ocupacionais, que, se persistentes, podem levar à Síndrome de Burnout, fenômeno psicossocial, constituído por três dimensões: Exaustão Emocional, Despersonalização e Baixa Realização Profissional. O presente estudo buscou identificar a relação entre a Síndrome de Burnout e variáveis sociodemográficas e laborais em 282 técnicos de enfermagem que trabalham em três hospitais de Porto Alegre. Como instrumentos de pesquisa forma utilizados um questionário para levantamento das variáveis sociodemográficas e o MBI – Maslach Burnout Inventory – HSS. Os resultados revelam que os participantes do sexo feminino, casados e que trabalham de 20 a 30 horas semanais apresentam maior exaustão emocional, despersonalização e menor realização profissional.
The study of the function of external respiration for the purpose of prenosological diagnosis of respiratory pathology related to work is an urgent task in the development of measures for the prevention of health disorders in workers. The study aims to conduct a hygienic assessment of the chemical factor of working conditions and indicators of respiratory function in metalworking workers engaged in the metalworking process using lubricant cooling liquids. We have examined 250 male workers of the Saratov metalworking enterprise. The main group consisted of 145 people working in contact with lubricants and coolants, the control group consisted of 105 people not in contact with lubricants and coolants. The researchers have conducted a hygienic assessment of the chemical factor of working conditions in the workplace and a spirometric study of the function of external respiration in workers. The results of the study were statistically processed using the Statistica 10 program. The concentrations of chemicals in the workers' breathing zone comply with the hygienic requirements for the air of the working area corresponding to permissible working conditions (Class 2). According to spirometry data, the researchers have identified respiratory function values corresponding to the appropriate values, in the absence of statistically significant differences in spirometric indicators between the main and control groups. To identify the etiological contribution of chronic exposure to lubricants and coolants to the formation of respiratory pathology of workers, it is necessary to conduct additional in-depth clinical, laboratory, functional and epidemiological studies taking into account pollutants present in the air of the working area and their combined effects. Ethics. The studies were conducted in compliance with Ethical standards and principles of conducting medical research with human participation, set out in the Helsinki Declaration of the World Medical Association (ed. 2013). Written consent of respondents was obtained to participate in the study. The study was approved by the local Ethical Committee of the Saratov Hygiene Research Center of the Federal State Budgetary Institution "Federal Research Center for Medical and Preventive Technologies of Public Health Risk Management" (Protocol No. 10 of 03/16/2023).
Worker and work-related musculoskeletal symptoms are prevalent among surgeons operating on human patients. Despite incidence rates for accidents among veterinarians and their staff being 2.9 times higher than that of general practitioners of human medicine, little is known about musculoskeletal symptoms among veterinary surgeons. In this study, 212 board-certified members of the American College of Veterinary Surgeons responded to a survey regarding various work-related activities and their experience with musculoskeletal symptoms in 10 different body regions. Across all body regions, reported pain increased from before to after a typical day of surgery (p <.01). Gender, weight, age, and years performing surgery were worker factors that were related to pain (p <.05), while number of procedures, practice focus, and proportion of minimally invasive surgery were work factors related to pain (p <.05). Our findings suggest that musculoskeletal symptoms are prevalent among veterinary surgeons and may help provide evidence for guidelines for minimising musculoskeletal injuries in veterinary surgery.Practitioner summary: Little is known about the risk factors for musculoskeletal symptoms (MSS) among veterinary surgeons. This cross-sectional survey of veterinary surgeons investigates worker and work factors related to MSS. We show that MSS are prevalent and identify key factors providing evidence that MSS are a concern in veterinary surgery.
Objective:
Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale.
Methods:
The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire.
Results:
The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good - excellent (α = 0.74-0.93) internal consistency and moderate - good (ICC = 0.64-0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis.
Conclusions:
The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.
Objective
To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer.
Design
Multinational cohort study.
Setting
Cohorts of workers in the nuclear industry in France, the UK, and the US included in a major update to the International Nuclear Workers Study (INWORKS).
Participants
309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years.
Main outcome measures
Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer.
Results
The study included 103 553 deaths, of which 28 089 were due to solid cancers. The estimated rate of mortality due to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in the more recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos.
Conclusions
This major update to INWORKS provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality based on some of the world’s most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiation protection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.
Objectives:
To elucidate whether occupational exposure to soft paper dust increases the incidence of cancer.
Methods:
We studied 7988 workers in Swedish soft paper mills from 1960 to 2008, of whom 3233 (2 187 men and 1046 women) had more than 10 years of employment. They were divided into high exposure (>5 mg/m3 for >1 year) or lower exposure to soft paper dust based on a validated job-exposure matrix. They were followed from 1960 to 2019, and person-years at risk were stratified according to gender, age, and calendar-year. The expected numbers of incident tumors were calculated using the Swedish population as the reference, and standardized incidence ratios (SIR) with 95% confidence intervals (95% CI) were assessed.
Results:
Among high-exposure workers with more than 10 years of employment, there was an increased incidence of colon cancer (SIR 1.66, 95% CI 1.20-2.31), small intestine cancer (SIR 3.27, 95% CI 1.36-7.86), and thyroid gland cancer (SIR 2.68, 95% CI 1.11-6.43), as well as lung cancer (SIR 1.56, 95% CI 1.12-2.19). Among the lower-exposed workers there was an increased incidence of connective tissue tumors (sarcomas) (SIR 2.26, 95% CI 1.13-4.51) and pleural mesothelioma (SIR 3.29, 95% CI 1.37-7.91).
Conclusion:
Workers in soft paper mills with high exposure to soft paper dust have an increased incidence of large and small intestine tumors. Whether the increased risk is caused by paper dust exposure or some unknown associated factors is unclear. The increased incidence of pleural mesothelioma is probably linked to asbestos exposure. The reason for increased incidence of sarcomas is unknown.
Introduction
Previous research comparing veteran and civilian mental health (MH) outcomes often assumes stable rates of MH service use over time and relies on standardisation or restriction to adjust for differences in baseline characteristics. We aimed to explore the stability of MH service use in the first 5 years following release from the Canadian Armed Forces and the Royal Canadian Mounted Police, and to demonstrate the impact of using increasingly stringent matching criteria on effect estimates when comparing veterans with civilians, using incident outpatient MH encounters as an example.
Methods
We used administrative healthcare data from veterans and civilians residing in Ontario, Canada to create three hard-matched civilian cohorts: (1) age and sex; (2) age, sex and region of residence; and (3) age, sex, region of residence and median neighbourhood income quintile, while excluding civilians with a history of long-term care or rehabilitation stay or receipt of disability/income support payments. Extended Cox models were used to estimate time-dependent HRs.
Results
Across all cohorts, time-dependent analyses suggested that veterans had a significantly higher hazard of an outpatient MH encounter within the first 3 years of follow-up than civilians, but differences were attenuated in years 4–5. More stringent matching decreased baseline differences in unmatched variables and shifted the effect estimates, while sex-stratified analyses revealed stronger effects among women compared with men.
Conclusions
This methods-focused study demonstrates the implications of several study design decisions that should be considered when conducting comparative veteran and civilian health research.
Background/objectives:
Shift work has been linked to unhealthy eating behaviors such as imbalanced diet, or increased empty calorie food/beverage consumption. However, most research has focused on the impact of shift timing. The concept of shift work is complex, and it contains several domains such as shift timing, intensity, and speed. Previous studies have suggested that greater shift intensity and quicker shift speed may contribute to adverse health effects. However, evidence regarding associations between other domains of shift work and empty calorie food/beverage consumption has been relatively lacking. Therefore, the purpose of this study was to evaluate how other shift work domains related to empty calorie food/beverage consumption and whether different shift work domains interacted to influence the intake of foods or beverages.
Design:
A 14-day intensive longitudinal study employing ecological momentary assessment.
Settings and participants:
Eighty registered nurses working in 24 accredited Taiwanese hospitals (i.e., 9 medical centers, 12 regional hospitals, and 3 district hospitals) were recruited.
Methods:
During the study period, a convenience sample of 77 participants completed 2444 momentary surveys about empty calorie food/beverage consumption on a smartphone. Three shift work domains (shift timing, intensity, and speed) were evaluated based on registry-based work schedules. To study how these shift work domains influenced empty calorie food/beverage consumption, we employed three-level mixed-effects regression models for data analyses.
Results:
Findings suggested that greater night shift intensity increased the likelihood of sugar-sweetened beverage intake (odds ratio = 1.64, 95% confidence interval [1.01, 2.68]). The impacts of work shift intensity and shift timing on sugar-sweetened beverage consumption varied by shift speed. Among participants assigned a schedule with either medium or rapid shift speed, higher work shift intensity was associated with a higher probability of sugar-sweetened beverage consumption. Compared to day shifts, those who were assigned a quicker shift speed on evening shifts were more likely to consume sugar-sweetened beverages. However, associations between night shift intensity and sugar-sweetened beverage intake did not change by shift speed. Furthermore, shift intensity and shift timing did not interact to affect empty calorie food/beverage consumption.
Conclusions:
This study demonstrated assignments of shift schedules (i.e., high night shift intensity, more changes in shift timings) might influence workers' consumption of empty calorie foods/beverages. Therefore, identifying and mitigating hazardous shift schedules may help to improve shift workers' eating behaviors and benefit their overall health.
Objective:
This study aimed to investigate the prospective association of lifting duration and lifting load with the risk of long-term sickness absence (LTSA).
Methods:
We followed manual workers with occupational lifting (N=45 346) from the Work Environment and Health in Denmark Study (2012-2018) for two years in a high-quality national register on social transfer payments (DREAM). Cox regressions with model-assisted weights were employed to estimate the risk of LTSA from lifting duration and loads.
Results:
During follow-up, 9.6% of the workers had an episode of LTSA. Compared to workers with seldom lifting (reference), workers lifting ½ and ¾ of the workday had increased risk of LTSA [hazard ratios (HR) of 1.36 [95% confidence interval (CI) 1.20-1.56] and 1.22 (95% CI 1.07-1.39)], respectively. Lifting load showed a positive exposure-response association with LTSA (trend test, P<0.01), with HR for lifting 5-15, 16-29, and ≥30 kg at 1.11 (95% CI 1.02-1.22), 1.17 (95% CI 1.03-1.34), and 1.29 (95% CI 1.11-1.50), respectively. Age-stratified analyses showed increased risk of LTSA among workers ≥50 years with a high proportion of work-related lifting compared to their younger counterparts.
Conclusions:
Occupational lifting for ½ the workday increased the risk of LTSA, while higher occupational lifting load exacerbated this risk in an exposure-response manner. The study underscores the importance of reducing both lifting duration and loads for prevention of LTSA at the workplace, especially among older workers.
The author investigates issues related to the professional ability of a person, analyzes the current state of terminology, including the terms "healthy worker effect", "healthy migrant effect", concludes that it is necessary to unify the scientific and medical terminology used in scientific research into the "healthy worker effect.
Background:
The degree to which routine, non-World Trade Center (WTC) firefighting exposures contribute to the WTC exposure-obstructive airway disease (OAD) relationship is unknown. Our objective was to compare the frequency of self-reported OAD diagnoses in WTC-exposed firefighters from the Fire Department of the City of New York (FDNY) compared with non-WTC-exposed firefighters from other cities and the general population.
Methods:
A total of 9792 WTC-exposed male FDNY firefighters and 3138 non-WTC-exposed male firefighters from Chicago, Philadelphia, and San Francisco who were actively employed on 9/11/01 and completed a health questionnaire were included. Logistic regression estimated odds ratios of self-reported asthma and COPD diagnoses in firefighters (WTC-exposed vs. non-WTC-exposed; all firefighters vs. general population), adjusting for age, race, smoking status, and last medical visit.
Results:
WTC-exposed firefighters were, on average, younger on 9/11 (mean ± SD = 40.2 ± 7.4 vs. 44.1 ± 9.1) and less likely to report ever-smoking (32.9% vs. 41.8%) than non-WTC-exposed firefighters. Odds of any OAD and asthma were 4.5 and 6.3 times greater, respectively, in WTC-exposed versus non-WTC-exposed. Odds of COPD were also greater in WTC-exposed versus non-WTC-exposed, particularly among never-smokers. Compared with the general population, WTC-exposed firefighters had greater odds of both asthma and COPD, while the nonexposed had lower odds of asthma and greater odds of COPD.
Conclusions:
Odds ratios for OAD diagnoses were greater in WTC-exposed firefighters versus both non-WTC-exposed and the general population after adjusting for covariates. While asthma and other OADs are known occupational hazards of firefighting, WTC exposure significantly compounded these adverse respiratory effects.
Many widely used psychophysical olfactory tests have limitations that can create barriers to adoption. For example, tests that measure the ability to identify odors may confound sensory performance with memory recall, verbal ability, and prior experience with the odor. Conversely, classic threshold-based tests avoid these issues, but are labor intensive. Additionally, many commercially available tests are slow and may require a trained administrator, making them impractical for use in situations where time is at a premium or self-administration is required. We tested the performance of the Adaptive Olfactory Measure of Threshold (ArOMa-T) – a novel odor detection threshold test that employs an adaptive Bayesian algorithm paired with a disposable odorant delivery card – in a non-clinical sample of individuals (n=534) at the 2021 Twins Day Festival in Twinsburg, OH. Participants successfully completed the test in under 3 min with a false alarm rate of 7.5% and a test-retest reliability of 0.61. Odor detection thresholds differed by sex (~3.2-fold lower for females) and age (~8.7-fold lower for the youngest versus the oldest age group), consistent with prior studies. In an exploratory analysis, we failed to observe evidence of detection threshold differences between participants who reported a history of COVID-19 and matched controls who did not. We also found evidence for broad-sense heritability of odor detection thresholds. Together, this study suggests the ArOMa-T can determine odor detection thresholds. Additional validation studies are needed to confirm the value of ArOMa-T in clinical or field settings where rapid and portable assessment of olfactory function is needed.
Background
Although evidence suggests relationships between some crude oil components and glycemic dysregulation, no studies have examined oil spill-related chemical exposures in relation to type 2 diabetes mellitus (DM) risk. This study examined the relationship between total hydrocarbon (THC) exposure among workers involved in the 2010 Deepwater Horizon (DWH) oil spill and risk of DM up to 6 years afterward.
Methods
Participants comprised 2660 oil-spill cleanup or response workers in the prospective GuLF Study who completed a clinical exam and had no self-reported DM diagnosis prior to the spill. Maximum THC exposure was estimated with a job-exposure matrix based on interview data and personal measurements taken during cleanup operations. We defined incident DM by self-reported physician diagnosis of DM, antidiabetic medication use, or a measured hemoglobin A1c value ≥ 6.5%. We used log binomial regression to estimate risk ratios (RRs) for DM across ordinal categories of THC exposure. The fully adjusted model controlled for age, sex, race/ethnicity, education, employment status, and health insurance status. We also stratified on clinical body mass index categories.
Results
We observed an exposure-response relationship between maximum daily ordinal THC exposure level and incident DM, especially among overweight participants. RRs among overweight participants were 0.99 (95% CI: 0.37, 2.69), 1.46 (95% CI: 0.54, 3.92), and 2.11 (95% CI: 0.78, 5.74) for exposure categories 0.30–0.99 ppm, 1.00–2.99 ppm, and ≥3.00 ppm, respectively (ptrend = 0.03).
Conclusion
We observed suggestively increasing DM risk with increasing THC exposure level among overweight participants, but not among normal weight or obese participants.
Ältere Menschen sind gegenüber invasiven Infektionen und Sepsis besonders vulnerabel mit ungünstiger Prognose. Staphylococcus aureus und Haemophilus influenzae können beide invasive Infektionen verursachen. Oft geht eine asymptomatische Besiedelung einer Infektion voraus und ist ein Risikofaktor für eine invasive Infektion. Daher wurde eine bizentrische Querschnittstudie in den Regionen Aachen und Würzburg durchgeführt, um die Prävalenz von H. influenzae, S. aureus und MRSA (Methicillin resistenter S. aureus) bei asymptomatischen Senioren zu bestimmen, wie auch Risikofaktoren für eine Besiedelung. Von Oktober 2012 bis Mai 2013 wurden 677 Erwachsenen im Alter von 65 Jahren oder älter eingeschlossen, die zu Hause oder in Seniorenheimen lebten. Die Prävalenz von H. influenzae bei älteren Menschen war mit einer Trägerrate von nur 1,9% ([95% CI: 1,0 - 3,3%]; 13/677) sehr niedrig. Trägerisolate waren überwiegend nicht typisierbare H. influenzae, zeigten eine hohe clonale Diversität und waren alle Ampicillin-sensibel. Die Prävalenz von S. aureus war mit 28,5% ([95% CI: 25,1 - 32,1%]; 193/677) hoch, wie für die deutsche Allgemeinbevölkerung bekannt, während MRSA bei weniger als 1% der Teilnehmer gefunden wurde (0,7% [95% CI: 0,2 - 1,7%]; 5/677). Die Prävalenz von H. influenzae, S. aureus und MRSA unterschied sich nicht signifikant zwischen selbständig zu Hause lebenden Senioren und Pflegeheimbewohnern. Ältere, selbständig lebende Menschen mit höherem Bildungsniveau hatten signifikant höhere Kolonisierungsraten mit S. aureus (adjusted OR: 1,905 [95% CI: 1,248 - 2,908]; p = 0,003). Bei Pflegeheimbewohnern war eine Kolonisierung signifikant mit Verheiratet sein assoziiert (adjusted OR: 3,367 [95% CI: 1,502 - 7,546]; p = 0,003). Diese Ergebnisse unterstreichen die Bedeutung von sozio-demographischen Faktoren für eine Kolonisierung mit S. aureus und schließen eine Lücke bei epidemiologischen Daten zu H. influenzae.
Background
Studies indicate that physical activity during leisure and work have opposite associations with cardiovascular disease (CVD) risk factors, referred to as the physical activity health paradox. We investigated how sedentary behaviour and physical activity types during leisure and work are associated with systolic blood pressure (SBP), waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C) in an adult general population sample using compositional data analysis.
Methods
Participants wore accelerometers for 7 days (right thigh and iliac crest; 24 h/day) and had their SBP, WC, and LDL-C measured. Accelerometer data was analysed using the software Acti4 to derive daily time spent in sedentary behaviour and physical activity types. The measure of association was quantified by reallocating time between sedentary behaviour and 1) walking, and 2) high-intensity physical activity (HIPA; sum of climbing stairs, running, cycling, and rowing), during both domains.
Results
In total, 652 participants were included in the analyses (median wear time: 6 days, 23.8 h/day). During leisure, the results indicated that less sedentary behaviour and more walking or more HIPA was associated with lower SBP, while during work, the findings indicated an association with higher SBP. During both domains, the findings indicated that less sedentary behaviour and more HIPA was associated with a smaller WC and lower LDL-C. However, the findings indicated less sedentary behaviour and more walking to be associated with a larger WC and higher LDL-C, regardless of domain.
Conclusions
During leisure, less sedentary behaviour and more walking or HIPA seems to be associated with a lower SBP, but, during work, it seems to be associated with a higher SBP. No consistent differences between domains were observed for WC and LDL-C. These findings highlight the importance of considering the physical activity health paradox, at least for some risk factors for CVD.
Background
The current knowledge on the epidemiology and clinical manifestation of airplane headache is mostly derived from case series and small cohort studies without evidence from large populations.
Methods
This cross-sectional study was conducted over a five-month period in the arrival area of two international airports in Germany. 50,000 disembarking passengers were addressed about headaches during their flight to determine headache prevalence, and those confirming and willing to participate underwent a structured interview.
Results
Headache during travel was reported by 374 passengers (0.75%), and 301 underwent a structured interview. One hundred and one (0.2%) met the diagnostic criteria of airplane headache. Six passengers suffered from migraines and 134 from tension-type headaches. The differences in the age and gender distribution between the airplane headache and non-airplane headache groups were not statistically significant. The onset (79.2%), duration (82.2%), and location (73.3%) of airplane headache mostly complied with current diagnostic criteria but pain intensity (42.6%) and quality (42.6%) did less so.
Conclusion
Our data suggest a substantially lower prevalence of airplane headaches than previously reported. The pain intensity and quality seem less characteristic than assumed, suggesting a need to refine the current diagnostic criteria.
The sensation of pain is frequent in teachers and its relationship with the practice of free-time physical activity still needs more scientific evidence. This study analyzed the association between free-time physical activity and pain symptoms experienced by teachers during the day and at bedtime. In this cross-sectional study, data were obtained through individual interviews and the fulfillment of an activity diary by teachers from a city located in southern Brazil. Statistical analysis was performed using logistic regression adjusted for sociodemographic, lifestyle and health variables. Among the 141 teachers included, pain perception was reported during the day by 66.7% and at bedtime by 66.0%. Analyses adjusted for sex, age, body mass index and time spent watching television indicated that practicing more than 240 minutes/week of free-time physical activity was associated with a lower likelihood of reported pain during the day (odds ratio, OR=0.18; 95% confidence interval, CI: 0.06–0.54) and at bedtime (OR=0.28; 95% CI: 0.10–0.79) compared to practicing ≤60 minutes/week of free-time physical activity. These associations lost statistical significance after the additional adjustment for depressive symptoms. In summary, this study showed that teachers who practiced more than 240 minutes/week of physical activity in free-time were less likely to report pain during the day and at bedtime. Depressive symptoms had an important confounding effect on this association. A multidisciplinary approach can optimize preventive strategies for pain prevention and management through health education programs in the workplace.
The various problems encountered in cohort mortality studies are discussed. One is the difficulty of finding an adequate control group. The influence of various factors may lead to wrong conclusions.