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Adil H, Maqsood M, Kadri HM, Ahmed H, Iqbal MF, Nizamani M, Hussain T, Syed N, Asghar L. Long working hours and obstetric complications: A cross-sectional study among female doctors. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100302. [PMID: 39011059 PMCID: PMC11247145 DOI: 10.1016/j.eurox.2024.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 07/17/2024] Open
Abstract
Objective To investigate the effects of long working hours on pregnancy complications and obstetric outcomes among female doctors working in tertiary care hospitals of Karachi. Study design A cross-sectional study was conducted on 149 female MBBS graduates (mean age: 33.5 ± 7.3 years) who had conceived at least once, currently working in two tertiary-care hospitals of Karachi. Data was collected through a self-administered questionnaire containing questions regarding demography and course of 1st pregnancy of the participants including working hours, antenatal and natal complications. Means and standard deviations were calculated for continuous variables with frequencies and percentages for categorical variables. The association between long working hours and different antenatal and natal complications was investigated using Chi-square test and T-test. Results Out of 149 participants included in final analysis, 85.9 % doctors gave birth to alive babies while 12.8 % had miscarriages and 1.3 % had stillbirth. Mean working hours during the three trimesters were found to be 53.76, 53.66 and 48.7, respectively. 43 % doctors experienced at least one antenatal complication during their pregnancy. Women who worked more than or equal to 55 h per week during 1st, 2nd and 3rd trimester of their pregnancy experienced more antenatal complications than women who worked less than 55 h (p-value=0.042, 0.021 and 0.018 respectively). 61.7 % females experienced at least one natal complication, most common of which was induction of Labour (39.1 %). Natal complications were significantly associated with increased workload during 2nd trimester (mean 58 vs 46 h, p-value 0.040). Doctors belonging to surgical specialty had 2.7 times higher risk of developing at least one natal complication than doctors of medical specialty (95 % Cl: 1.235-5.870). Conclusion Long working hours during pregnancy are associated with antenatal complications among female doctors. Natal complications were only significantly related to long working hours during 2nd trimester of pregnancy, however, female surgeons are more prone to develop natal complications than doctors belonging to medical specialties.
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Affiliation(s)
- Hasna Adil
- 5th Year Medical Student, Dow Medical College (DUHS), Karachi, Pakistan
| | - Mehwish Maqsood
- 5th Year Medical Student, Dow Medical College (DUHS), Karachi, Pakistan
| | - Hasina M Kadri
- Department of Community Medicine, Dow Medical College (DUHS), Karachi, Pakistan
| | - Hafsa Ahmed
- 5th Year Medical Student, Dow Medical College (DUHS), Karachi, Pakistan
| | - Muhammad F Iqbal
- 5th Year Medical Student, Dow Medical College (DUHS), Karachi, Pakistan
| | - Misbah Nizamani
- 5th Year Medical Student, Dow Medical College (DUHS), Karachi, Pakistan
| | - Tooba Hussain
- 5th Year Medical Student, Dow Medical College (DUHS), Karachi, Pakistan
| | - Nabiha Syed
- 5th Year Medical Student, Dow Medical College (DUHS), Karachi, Pakistan
| | - Lawiza Asghar
- 5th Year Medical Student, Dow Medical College (DUHS), Karachi, Pakistan
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Braz MG, Figueiredo DBS, Golim MA, Grassi TF, da Costa BRB, De Martinis BS, Braz LG. Veterinarians exposed to inhaled anesthetic present chromosome damage, apoptosis and cell cycle changes. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2024; 65:96-102. [PMID: 38333941 DOI: 10.1002/em.22586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
This cross-sectional study evaluated, for the first time, DNA damage, viability, and cell death of lymphocytes and cell cycle phases of mononuclear and polymorphonuclear cells in veterinarians exposed to the volatile anesthetic isoflurane. Veterinarians who were occupationally exposed to isoflurane (exposed group; n = 20) and matched-unexposed individuals (volunteers without occupational exposure; n = 20) were enrolled in the study. DNA damage was assessed in lymphocytes by micronucleus (MN) and phosphorylated histone gamma-H2AX (γ-H2AX). Cell viability, cytotoxicity, and the cell cycle were evaluated by flow cytometry. Isoflurane was detected in urine samples by headspace gas chromatography-mass spectrometry. Compared with unexposed subjects, veterinarians occupationally exposed to isoflurane (25.7 ± 23.7 μg/L urine) presented statistically higher MN frequencies, lymphocytic apoptosis rates, and numbers of polymorphonuclear cells in the G0/G1 stage. Additionally, the exposed group presented statistically lower proportions of viable lymphocytes and G2/M polymorphonuclear cells. Our findings indicate that veterinarians who are frequently exposed to inhaled anesthetic exhibit chromosomal and cell damage in addition to changes in peripheral blood cell proliferation.
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Affiliation(s)
- Mariana G Braz
- Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | | | - Marjorie A Golim
- Clinical Hospital of Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Tony F Grassi
- Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Bruno R B da Costa
- Faculty of Pharmaceutical Sciences, University of Sao Paulo - USP, Ribeirao Preto, Brazil
| | - Bruno S De Martinis
- Faculty of Philosophy, Sciences and Letters, University of Sao Paulo - USP, Ribeirao Preto, Brazil
| | - Leandro G Braz
- Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
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Adane HA, Iles R, Boyle JA, Gelaw A, Collie A. Maternal Occupational Risk Factors and Preterm Birth: A Systematic Review and Meta-Analysis. Public Health Rev 2023; 44:1606085. [PMID: 37937117 PMCID: PMC10625911 DOI: 10.3389/phrs.2023.1606085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/01/2023] [Indexed: 11/09/2023] Open
Abstract
Objective: This systematic review and meta-analysis aimed to summarize the evidence on the relationship between physical occupational risks (high physical workload, long working hours, shift work, whole-body vibrations, prolonged standing, and heavy lifting) and preterm birth. Methods: A systematic review and meta-analysis was conducted across six databases to investigate the relationship between physical occupational risks and preterm birth. Result: A comprehensive analysis of 37 studies with varying sample sizes found moderate evidence of positive associations between high physical workload, long working hours, shift work, whole-body vibration, and preterm birth. Meta-analysis showed a 44% higher risk (OR 1.44, 95% CI 1.25-1.66) for preterm birth with long working hours and a 63% higher risk (OR 1.63, 95% CI 1.03-2.58) with shift work. Conclusion: Pregnant women in physically demanding jobs, those working long hours or on shifts, and those exposed to whole-body vibration have an increased risk of preterm birth. Employers should establish supportive workplaces, policymakers implement protective measures, healthcare providers conduct screenings, and pregnant women must stay informed and mitigate these job-related risks. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], Identifier [CRD42022357045].
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Affiliation(s)
- Haimanot Abebe Adane
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ross Iles
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jacqueline A. Boyle
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Asmare Gelaw
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Alex Collie
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Olika MK, Dessalegn ZM, Mekonin GT, Aboye MB, Wedajo MB, Ilala TT, Abebe DM, Demissie WR. Effect of Inhalational Anesthetics Exposure on Reproductive Outcomes and Its Predictors Among Healthcare Personnel in Jimma Zone Public Hospitals: A Comparative Cross-Sectional Study. Int J Womens Health 2022; 14:1555-1568. [DOI: 10.2147/ijwh.s376459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022] Open
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Figueiredo DBS, Aun AG, Souza KM, Nishimoto IH, Silva MAP, de Carvalho LR, Braz LG, Braz MG. High anesthetic (isoflurane) indoor pollution is associated with genetic instability, cytotoxicity, and proliferative alterations in professionals working in a veterinary hospital. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:71774-71784. [PMID: 35606583 DOI: 10.1007/s11356-022-20444-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
This is the first study to monitor anesthetic pollution in veterinary operating rooms (VOR) and assess the toxicological impact of the inhalational anesthetic isoflurane (exposed group) compared to matched volunteers (control group). DNA damage was evaluated in mononuclear cells by the comet assay while genetic instability (including micronucleus-MN), cell proliferation, and cell death markers were assessed by the buccal MN cytome assay. Residual isoflurane concentrations in VOR (air monitoring) lacking the scavenging system were assessed by infrared spectrophotometry; the mean concentration was 11 ppm (≥ 5 times above the international recommended threshold). Comet assay results did not differ between groups; however, both younger exposed professionals (with higher week workload) compared to older individuals exposed for the same period and older professionals with greater time of exposure (years) compared to those in the same age group with fewer years of exposure presented higher DNA damage. The exposed group had a higher frequency of MN, nuclear buds, binucleated cells, karyorrhexis, and karyolysis and a lower frequency of basal cells than the control group. Exposed women were more vulnerable to genetic instability and proliferative index; exposed men presented more cytotoxicity. High WAG exposure has deleterious effects on exposed professionals.
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Affiliation(s)
- Drielle B S Figueiredo
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Aline G Aun
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Kátina M Souza
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Igor H Nishimoto
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Mariane A P Silva
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Lídia R de Carvalho
- Institute of Biosciences, São Paulo State University - UNESP, 250, Prof. Dr. Antônio Celso Wagner Zanin, Botucatu, 18618-689, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Mariana G Braz
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil.
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Alibrandi A, Merlino L, Guarneri C, Ingrasciotta Y, Zirilli A. Non-Motherhood between Obligation and Choice: Statistical Analysis Based on Permutation Tests of Spontaneous and Induced Abortion Rates in the Italian Context. Healthcare (Basel) 2022; 10:healthcare10081514. [PMID: 36011171 PMCID: PMC9408515 DOI: 10.3390/healthcare10081514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This paper aims to examine two relevant phenomena in the context of public health: spontaneous abortion (SA) and induced abortion (IA). SA is one of the most common complications of pregnancies; IA is a conscious choice that is made by the mother/couple. (2) Methods: Permutation tests were applied to SA and IA standardized rates detected by ISTAT (2016–2020). The NPC test, chosen for its optimal properties, was applied to compare different Italian territorial divisions (stratifying for year and age classes of women) and analyze the trend of years by stochastic ordering. (3) Results: Only for SA, there are significant differences among the three territorial divisions: the South records higher SA standardized rates than the North and the Center; the rates of IA are similar. Relating to distinct women age classes, the SA standardized rates do not show significant differences among the three analyzed geographical areas; different results are highlighted for IA. Stochastic ordering shows that only the IA standardized rates are characterized by a significant monotonous decreasing trend over the years. (4) Conclusion: The SA phenomenon has shown a decreasing trend that could be justified by the progress of science. For IA, we can certainly say that the general decrease in the phenomenon is due to the greater use of contraceptive methods that help to prevent unwanted pregnancies.
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Affiliation(s)
- Angela Alibrandi
- Department of Economics, University of Messina, 98122 Messina, Italy
- Correspondence: ; Tel.: +39-090-676-8025
| | | | - Claudio Guarneri
- Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98125 Messina, Italy
| | - Ylenia Ingrasciotta
- Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98125 Messina, Italy
| | - Agata Zirilli
- Department of Economics, University of Messina, 98122 Messina, Italy
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Oliveira LA, P El Dib R, Figueiredo DBS, Braz LG, Braz MG. Spontaneous abortion in women occupationally exposed to inhalational anesthetics: a critical systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:10436-10449. [PMID: 33415631 DOI: 10.1007/s11356-020-11684-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
Occupational exposure to inhalational anesthetics has been associated with health problems, including reproductive issues. Considering the scarcity and outdated nature of reviews concerning this relevant topic, which has implications for indoor pollution/environmental science/public health, this critical review aimed to systematically evaluate whether exposure to inhalational anesthetics is associated with abortion. Seven databases were searched with no language or year restrictions. Of the 3881 search results, 18 observational studies were included. Some studies demonstrated a significant association between occupational exposure to inhalational anesthetics and spontaneous abortion, especially among professionals who work for longer periods and/or in an environment without gas scavenging/ventilation systems, which may favor the occurrence of abortion in this population. Due to considerable heterogeneity and limitations, it cannot be concluded whether an association exists between occupational exposure to anesthetics and the occurrence of abortion. However, more well-designed studies should be performed, especially in less economically developed countries that do not have access to quality anesthetic gas scavenging/ventilation systems, thereby bringing this issue into sharp focus. This review highlights the need for scientific knowledge in this area and the extensive use of scavenging equipment and in the workplace to minimize exposure and reduce the risk of abortion.
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Affiliation(s)
- Lara A Oliveira
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Regina P El Dib
- Evidence-Based Medicine Unit, São Paulo State University - UNESP, Botucatu, Brazil
- McMaster University, Hamilton, Canada
| | - Drielle B S Figueiredo
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Leandro G Braz
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Mariana G Braz
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil.
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Measurement of anesthetic pollution in veterinary operating rooms for small animals: Isoflurane pollution in a university veterinary hospital. Braz J Anesthesiol 2021; 71:517-522. [PMID: 33685758 PMCID: PMC9373702 DOI: 10.1016/j.bjane.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Inhaled anesthetics are used worldwide for anesthesia maintenance both in human and veterinary operating rooms. High concentrations of waste anesthetic gases can lead to health risks for the professionals exposed. Considering that anesthetic pollution in a veterinary surgical center in developing countries is unknown, this study aimed, for the first time, to measure the residual concentration of isoflurane in the air of operating rooms for small animals in a Brazilian university hospital. Method Residual isoflurane concentrations were measured by an infrared analyzer at the following sites: corner opposite to anesthesia machine; breathing zones of the surgeon, anesthesiologist, and patient (animal); and in front of the anesthesia machine at three time points, that is, 5, 30 and 120 minutes after anesthesia induction. Results Mean residual isoflurane concentrations gradually increased in the corner opposite to anesthesia machine and in the breathing zones of the surgeon and the anesthesiologist (p < 0.05). There was an increase at 30 minutes and 120 minutes when compared to the initial time points in the animal's breathing zone, and in the front of the anesthesia machine (p < 0.05). There was no significant difference at measurement sites regardless of the moment of assessment. Conclusion This study reported high residual isoflurane concentrations in veterinary operating rooms without an exhaust system, which exceeds the limit recommended by an international agency. Based on our findings, there is urgent need to implement exhaust systems to reduce anesthetic pollution and decrease occupational exposure.
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Braz MG, Silva MAP, Figueiredo DBS, Aun AG, Marques LSK, Lara JR, Braz LG. Genetic instability assessed by telomere length and micronucleus in physicians exposed to anesthetics. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2020; 61:843-847. [PMID: 32390193 DOI: 10.1002/em.22380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/21/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
This study evaluated both telomere length (TL) and micronucleus (MN) as indicators of genome instability in 40 anesthesiologists occupationally exposed to anesthetics and in 40 physicians without occupational exposure to anesthetics who were matched by age, sex, and lifestyle. Blood and buccal samples were collected from both groups at the same period. Anesthetic exposure assessment was performed. The studied groups were assessed regarding relative TL by quantitative polymerase chain reaction and MN by buccal MN assay. Mean trace concentrations of anesthetics were below two parts per million. No significant differences between groups were found for both biomarkers. However, MN frequency was slightly increased (1.9-fold; p = .094) in the exposed group compared to the control group and in the exposed males (2.4-fold; p = .090) compared to unexposed males. TL and age showed a significant negative correlation. Anesthetic occupational exposure below recommended levels is not associated with changes in TL and MN in anesthesiologists.
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Affiliation(s)
- Mariana G Braz
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Mariane A P Silva
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Drielle B S Figueiredo
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Aline G Aun
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Lais S K Marques
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Juliana R Lara
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
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Braz MG, Carvalho LIM, Chen CYO, Blumberg JB, Souza KM, Arruda NM, Filho DAA, Resende LO, Faria RTBG, Canário CD, de Carvalho LR, Corrêa CR, Braz JRC, Braz LG. High concentrations of waste anesthetic gases induce genetic damage and inflammation in physicians exposed for three years: A cross-sectional study. INDOOR AIR 2020; 30:512-520. [PMID: 31930534 DOI: 10.1111/ina.12643] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
This cross-sectional study analyzed the impact of occupational waste anesthetic gases on genetic material, oxidative stress, and inflammation status in young physicians exposed to inhalational anesthetics at the end of their medical residency. Concentrations of waste anesthetic gases were measured in the operating rooms to assess anesthetic pollution. The exposed group comprised individuals occupationally exposed to inhalational anesthetics, while the control group comprised individuals without anesthetic exposure. We quantified DNA damage; genetic instability (micronucleus-MN); protein, lipid, and DNA oxidation; antioxidant activities; and proinflammatory cytokine levels. Trace concentrations of anesthetics (isoflurane: 5.3 ± 2.5 ppm, sevoflurane: 9.7 ± 5.9 ppm, and nitrous oxide: 180 ± 150 ppm) were above international recommended thresholds. Basal DNA damage and IL-17A were significantly higher in the exposed group [27 ± 20 a.u. and 20.7(19.1;31.8) pg/mL, respectively] compared to the control group [17 ± 11 a.u. and 19.0(18.9;19.5) pg/mL, respectively], and MN frequency was slightly increased in the exposed physicians (2.3-fold). No significant difference was observed regarding oxidative stress biomarkers. The findings highlight the genetic and inflammatory risks in young physicians exposed to inhalational agents in operating rooms lacking adequate scavenging systems. This potential health hazard can accompany these subjects throughout their professional lives and reinforces the need to reduce ambient air pollution and consequently, occupational exposure.
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Affiliation(s)
- Mariana G Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Lorena I M Carvalho
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Chung-Yen O Chen
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Jeffrey B Blumberg
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Kátina M Souza
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Nayara M Arruda
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Daniel A A Filho
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Ludimila O Resende
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Renata T B G Faria
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Clara d'A Canário
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Lídia R de Carvalho
- Department of Bioestatistics, Institute of Biosciences, São Paulo State University - UNESP, Botucatu, Brazil
| | - Camila R Corrêa
- Department of Pathology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - José Reinaldo C Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
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Cai C, Vandermeer B, Khurana R, Nerenberg K, Featherstone R, Sebastianski M, Davenport MH. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:563-576. [PMID: 31276631 DOI: 10.1016/j.ajog.2019.06.051] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUD An increasing number of original studies suggest that exposure to shift work and long working hours during pregnancy could be associated with the risk of adverse pregnancy outcomes, but the results remain conflicting and inconclusive. OBJECTIVE To examine the influences of shift work and longer working hours during pregnancy on maternal and fetal health outcomes. DATA SOURCES Five electronic databases and 3 gray literature sources were searched up to March 15, 2019. METHODS OF STUDY SELECTION Studies of all designs (except case studies and reviews) were included, which contained information on the relevant population (women who engaged in paid work during pregnancy); exposure (rotating shift work [shifts change according to a set schedule], fixed night shift [typical working period is between 11:00 pm and 11:00 am] or longer working hours [>40 hours per week]);comparator (fixed day shift [typical working period is between 8:00 am and 6:00 pm] or standard working hours [≤40 hours per week]); and outcomes (preterm delivery, low birthweight [birthweight <2500 g], small for gestational age, miscarriage, gestational hypertension, preeclampsia, intrauterine growth restriction, stillbirth, and gestational diabetes mellitus). TABULATION, INTEGRATION, AND RESULTS From 3305 unique citations, 62 observational studies (196,989 women) were included. "Low" to "very low" certainty evidence from these studies revealed that working rotating shifts was associated with an increased odds of preterm delivery (odds ratio, 1.13; 95% confidence interval, 1.00-1.28, I2 = 31%), an infant small for gestational age (odds ratio, 1.18, 95% confidence interval, 1.01-1.38, I2 = 0%), preeclampsia (odds ratio, 1.75, 95% confidence interval, 1.01-3.01, I2 = 75%), and gestational hypertension (odds ratio, 1.19, 95% confidence interval, 1.10-1.29, I2 = 0%), compared to those who worked a fixed day shift. Working fixed night shifts was associated with an increased odds of preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.03-1.42; I2 = 36%) and miscarriage (odds ratio, 1.23; 95% confidence interval, 1.03-1.47; I2 = 37%). Compared with standard hours, working longer hours was associated with an increased odds of miscarriage (odds ratio, 1.38; 95% confidence interval, 1.08-1.77; I2 = 73%), preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.11-1.33; I2 = 30%), an infant of low birthweight (odds ratio, 1.43; 95% confidence interval, 1.11-1.84; I2 = 0%), or an infant small for gestational age (odds ratio, 1.16, 95% confidence interval, 1.00-1.36, I2 = 57%). Dose-response analysis showed that women working more than 55.5 hours (vs 40 hours) per week had a 10% increase in the odds of having a preterm delivery. CONCLUSION Pregnant women who work rotating shifts, fixed night shifts, or longer hours have an increased risk of adverse pregnancy outcomes.
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Pro-Con Debate: Nitrous Oxide for Labor Analgesia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4618798. [PMID: 31531352 PMCID: PMC6720045 DOI: 10.1155/2019/4618798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/19/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Abstract
This Pro-Con debate will provide the practitioner with an evidence-based knowledge approach to assist the clinician in determining whether to employ (Pro) or not to employ (Con) this technique in the obstetrical suite for labor analgesia. Nitrous oxide has been used safely in dentistry and medicine for many centuries. However, accumulating preclinical and clinical evidence increasingly suggests previously unrecognized adverse maternal and fetal effects of nitrous oxide, which warrants reconsideration of its use in pregnant women and a more detailed informed consent. Nitrous oxide is associated with metabolic, oxidative, genotoxic, and transgenerational epigenetic effects in animals and humans that may warrant limiting its usefulness in labor. This debate will discuss and review the clinical uses, advantages, and disadvantages of nitrous oxide on occupational effects of nitrous oxide exposure, neuroapoptosis, FDA warning on inhalational anesthetics and the developing brain, research limitations, occupational exposure safety limits, effects on global warming, and potential for diversion.
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Alshora WBI, Mohammad Kalo B. Prevalence and factors associated with pregnancy loss among physicians in King Abdul-Aziz University Hospital, Saudi Arabia. Taiwan J Obstet Gynecol 2018; 57:231-235. [DOI: 10.1016/j.tjog.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/29/2022] Open
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Meisner J, Vora MV, Fuller MS, Phipps AI, Rabinowitz PM. Maternal veterinary occupation and adverse birth outcomes in Washington State, 1992-2014: a population-based retrospective cohort study. Occup Environ Med 2018; 75:359-368. [PMID: 29478007 DOI: 10.1136/oemed-2017-104817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Women in veterinary occupations are routinely exposed to potential reproductive hazards, yet research into their birth outcomes is limited. We conducted a population-based retrospective cohort study of the association between maternal veterinary occupation and adverse birth outcomes. METHODS Using Washington State birth certificate, fetal death certificate and hospital discharge data from 1992 to 2014, we compared birth outcomes of mothers in veterinary professions (n=2662) with those in mothers in dental professions (n=10 653) and other employed mothers (n=8082). Relative risks (RRs) and 95% CIs were estimated using log binomial regression. Outcomes studied were premature birth (<37 weeks), small for gestational age (SGA), malformations and fetal death (death at ≥20 weeks gestation). Subgroup analyses evaluated risk of these outcomes among veterinarians and veterinary support staff separately. RESULTS While no statistically significant associations were found, we noted a trend for SGA births in all veterinary mothers compared with dental mothers (RR=1.16, 95% CI 0.99 to 1.36) and in veterinarians compared with other employed mothers (RR=1.37, 95% CI 0.96 to 1.96). Positive but non-significant association was found for malformations among children of veterinary support staff. CONCLUSIONS These results support the need for further study of the association between veterinary occupation and adverse birth outcomes.
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Affiliation(s)
- Julianne Meisner
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Center for One Health Research, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Manali V Vora
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Mackenzie S Fuller
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Amanda I Phipps
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Peter M Rabinowitz
- Center for One Health Research, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
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Deng HB, Li FX, Cai YH, Xu SY. Waste anesthetic gas exposure and strategies for solution. J Anesth 2018; 32:269-282. [PMID: 29404778 DOI: 10.1007/s00540-018-2448-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/02/2018] [Indexed: 12/15/2022]
Abstract
As inhaled anesthetics are widely used, medical staff have inevitably suffered from exposure to anesthetic waste gases (WAGs). Whether chronic exposure to WAGs has an impact on the health of medical staff has long been a common concern, but conclusions are not consistent. Many measures and equipment have been proposed to reduce the concentration of WAGs as far as possible. This review aims to dissect the current exposure to WAGs and its influence on medical staff in the workplace and the environment, and summarize strategies to reduce WAGs.
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Affiliation(s)
- Hai-Bo Deng
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China
| | - Feng-Xian Li
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China
| | - Ye-Hua Cai
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China.
| | - Shi-Yuan Xu
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China.
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Scheftel JM, Elchos BL, Rubin CS, Decker JA. Review of hazards to female reproductive health in veterinary practice. J Am Vet Med Assoc 2017; 250:862-872. [PMID: 28358639 PMCID: PMC5678953 DOI: 10.2460/javma.250.8.862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review publications that address female reproductive health hazards in veterinary practice, summarize best practices to mitigate reproductive risks, and identify current knowledge gaps. DESIGN Systematized review. SAMPLE English-language articles describing chemical, biological, and physical hazards present in the veterinary workplace and associations with adverse reproductive outcomes or recommendations for minimizing risks to female reproductive health. PROCEDURES Searches of the CAB abstracts database were performed in July 2012 and in May 2015 with the following search terms: veterinarians AND occupational hazards and vets.id AND occupational hazards.sh. Searches of the PubMed database were conducted in November 2012 and in May 2015 with the following medical subject heading terms: occupational exposure AND veterinarians; anesthetics, inhalation/adverse effects AND veterinarians; risk factors AND pregnancy AND veterinarians; pregnancy outcome AND veterinarians; and animal technicians AND occupational exposure. Two additional PubMed searches were completed in January 2016 with the terms disinfectants/toxicity AND female AND fertility/drug effects and veterinarians/psychology AND stress, psychological. No date limits were applied to searches. RESULTS 4 sources supporting demographic trends in veterinary medicine and 118 resources reporting potential hazards to female reproductive health were identified. Reported hazards included exposure to anesthetic gases, radiation, antineoplastic drugs, and reproductive hormones; physically demanding work; prolonged standing; and zoonoses. CONCLUSIONS AND CLINICAL RELEVANCE Demographic information suggested that an increasing number of women of reproductive age will be exposed to chemical, biological, and physical hazards in veterinary practice. Information on reproductive health hazards and minimizing risk, with emphasis on developing a safety-focused work culture for all personnel, should be discussed starting in veterinary and veterinary technical schools and integrated into employee training.
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Fowler HN, Holzbauer SM, Smith KE, Scheftel JM. Survey of occupational hazards in Minnesota veterinary practices in 2012. J Am Vet Med Assoc 2016; 248:207-18. [PMID: 26720089 DOI: 10.2460/javma.248.2.207] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify the scope of occupational hazards encountered by veterinary personnel and compare hazard exposures between veterinarians and technicians working in small and large animal practices. DESIGN Cross-sectional survey. POPULATION Licensed veterinarians and veterinary staff in Minnesota. PROCEDURES A survey of Minnesota veterinary personnel was conducted between February 1 and December 1, 2012. Adult veterinary personnel working in clinical practice for > 12 months were eligible to participate. Information was collected on various workplace hazards as well as on workplace safety culture. RESULTS 831 eligible people responded, representing approximately 10% of Minnesota veterinary personnel. A greater proportion of veterinarians (93%; 368/394) reported having received preexposure rabies vaccinations than did veterinary technicians (54%; 198/365). During their career, 226 (27%) respondents had acquired at least 1 zoonotic infection and 636 (77%) had been injured by a needle or other sharps. Recapping of needles was reported by 87% of respondents; the most common reason reported by veterinarians (41%; 142/345) and veterinary technicians (71%; 238/333) was being trained to do so at school or work. Recent feelings of depression were reported by 204 (25%) respondents. A greater proportion of technicians (42%; 155/365) than veterinarians (21%; 81/394) indicated working in an environment in which employees experienced some form of workplace abuse. CONCLUSIONS AND CLINICAL RELEVANCE Veterinary personnel in Minnesota were exposed to several work-related hazards. Practice staff should assess workplace hazards, implement controls, and incorporate instruction on occupational health into employee training.
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Exposition du personnel soignant au protoxyde d’azote. ARCH MAL PROF ENVIRO 2016. [DOI: 10.1016/j.admp.2015.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone. Anesthesiol Res Pract 2015; 2015:354184. [PMID: 26693222 PMCID: PMC4674584 DOI: 10.1155/2015/354184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/11/2015] [Indexed: 12/19/2022] Open
Abstract
Potential health hazards from waste anesthetic gases (WAGs) have been a concern since the introduction of inhalational anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaled WAG from the patient breathing zone was measured 8 inches from the patient's mouth in the PACU. Maximum sevoflurane WAG levels in the patient breathing zone exceeded National Institute for Occupational Safety and Health (NIOSH) RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of anesthetic exposure. This study demonstrated that clinically relevant inhalational anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure.
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van Melick MJGJ, van Beukering MDM, Mol BW, Frings-Dresen MHW, Hulshof CTJ. Shift work, long working hours and preterm birth: a systematic review and meta-analysis. Int Arch Occup Environ Health 2014; 87:835-49. [PMID: 24584887 DOI: 10.1007/s00420-014-0934-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Specific physical activities or working conditions are suspected for increasing the risk of preterm birth (PTB). The aim of this meta-analysis is to review and summarize the pre-existing evidence on the effect of shift work or long working hours on the risk of PTB. METHODS We conducted a systematic search in MEDLINE and EMBASE (1990-2013) for observational and intervention studies with original data. We only included articles that met our specific criteria for language, exposure, outcome, data collection and original data that were of at least of moderate quality. The data of the included studies were pooled. RESULTS Eight high-quality studies and eight moderate-quality studies were included in the meta-analysis. In these studies, no clear or statistically significant relationship between shift work and PTB was found. The summary estimate OR for performing shift work during pregnancy and the risk of PTB were 1.04 (95% CI 0.90-1.20). For long working hours during pregnancy, the summary estimate OR was 1.25 (95% CI 1.01-1.54), indicating a marginally statistically significant relationship but an only slightly elevated risk. CONCLUSION Although in many of the included studies a positive association between long working hours and PTB was seen this did reach only marginal statistical significance. In the studies included in this review, working in shifts or in night shifts during pregnancy was not significantly associated with an increased risk for PTB. For both risk factors, due to the lack of high-quality studies focusing on the risks per trimester, in particular the third trimester, a firm conclusion about an association cannot be stated.
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Affiliation(s)
- M J G J van Melick
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, PO Box 5800, Maastricht, 6202 AZ, The Netherlands,
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Takeuchi M, Rahman M, Ishiguro A, Nomura K. Long working hours and pregnancy complications: women physicians survey in Japan. BMC Pregnancy Childbirth 2014; 14:245. [PMID: 25060410 PMCID: PMC4121483 DOI: 10.1186/1471-2393-14-245] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies have investigated the impact of occupational risk factors on health outcomes among physicians. However, few studies have investigated the effects on pregnancy outcomes among physicians. In this study, we examined the association between working hours during pregnancy and pregnancy complications among physicians. Methods A cross-sectional study was based on a survey conducted in 2009-2011 of 1,684 alumnae (mean age, 44 ± 8 years) who had graduated from 13 private medical schools in Japan. Data on threatened abortion (TA), preterm birth (PTB), and the number of working hours during the first trimester of pregnancy were obtained via retrospective assessments. Results Of the 939 physicians with a first pregnancy, 15% experienced TA and 12% experienced PTB. Women who experienced TA (mean weekly working hours: 62 h vs. 50 h, P < .0001) or PTB (62 h vs. 50 h, P < .0001) had longer weekly working hours during the first trimester than did those without pregnancy complications. Compared with women who worked 40 hours or less per week, women who worked 71 hours or more per week had a three-fold higher risk of experiencing TA (95% confidence interval (CI): 1.7-6.0) even after adjusting for medical specialty, maternal age, and current household income. The risk of experiencing PTB was 2.5 times higher (95% CI:1.2-5.2) in women who worked 51-70 hours and 4.2 times higher (95% CI: 1.9-9.2) in women who worked 71 hours or more even after adjusting for specialty, maternal age, and current household income. The trend in the P statistic reflecting the effect of the quartile of hours worked per week (40 hours, 41-50 hours, 51-70 hours, ≥71 hours) on TA or PTB was 0.0001 in the multivariate logistic regression models. Conclusion These results suggest that working long hours during the first trimester of pregnancy is associated with TA and PTB. Electronic supplementary material The online version of this article (doi:10.1186/1471-2393-14-245) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Kyoko Nomura
- Teikyo University Support Center for Women Physicians and Researchers, 2-11-1 Kaga, Itabashi-ku 173-8605 Tokyo, Japan.
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A study of handling cytotoxic drugs and risk of birth defects in offspring of female veterinarians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6216-30. [PMID: 24927037 PMCID: PMC4078575 DOI: 10.3390/ijerph110606216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/17/2022]
Abstract
We examined the association of occupational exposure to handling cytotoxic drugs at work with risk of birth defects among a cohort of female veterinarians. This study is a follow up survey of 321 female participants (633 pregnancies) who participated in the Health Risks of Australian Veterinarian project. Data on pregnancies and exposure during each pregnancy was obtained by self-administered mailed questionnaire. Female veterinarians handling cytotoxic drugs during their pregnancy had a two-fold increased risk of birth defects in their offspring (RR = 2.08, 95% CI (1.05–4.15)). Results were consistent in subgroup analysis of those who graduated during the period of 1961 to 1980 (RR = 5.04, 95% CI (1.81, 14.03) and in those working specifically in small and large animal practice. There was no increased risk in the subgroup that graduated after 1980. Women with unplanned pregnancies were more likely to handle cytotoxic drugs on a daily basis (RR = 1.86, 95% CI, 1.00–3.48) and had a higher increased risk of birth defects than those who planned their pregnancies in recent graduates and in those who worked specifically in small animal practice (RR = 2.53, 95% CI, 1.18–5.42). This study suggests that the adverse effects of handling cytotoxic drugs in pregnant women may include an increased risk of birth defects. Pregnancy intention status is an important health behavior and should be considered in prenatal programs.
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Shirangi A, Fritschi L, Holman CDJ, Morrison D. Mental health in female veterinarians: effects of working hours and having children. Aust Vet J 2013; 91:123-30. [PMID: 23521096 DOI: 10.1111/avj.12037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Personal, interpersonal and organisational factors have been suggested as possible causes of stress, anxiety and depression for veterinarians. We used established psychological scales to measure (1) levels of distress and work-related stress (anxiety and depression) and (2) the demographic and work characteristics of female veterinarians in relation to anxiety, depression and mental health. METHODS A national cross-sectional survey of a cohort population was conducted and self-administered questionnaires were received from 1017 female veterinarians who completed the mental health section of the survey. Using linear and logistic regression analyses, we examined demographic and work-related factors associated with overall stress measured by the General Health Questionnaire scale and the Affective Well-Being scale (Anxiety-Contentment Axis and Depression-Enthusiasm Axis). RESULTS More than one-third (37%) of the sample was suffering 'minor psychological distress', suggesting the stressful nature of veterinary practice. Women with two or more children had less anxiety and depression compared with those who had never been pregnant or were childless. Longer working hours were associated with increased anxiety and depression in female veterinarians overall and in stratified samples of women with and without children. CONCLUSION Among the work characteristics of veterinary practice, long working hours may have a direct effect on a veterinarian's health in terms of anxiety, depression and mental health. The finding also indicates that women with two or more children have less anxiety and depression than women who have never been pregnant or childless women.
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Affiliation(s)
- A Shirangi
- School of Population Health, Faculty of Medicine and Dentistry, The University of Western Australia, Crawley, Western Australia, 6009, Australia.
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Palmer KT, Bonzini M, Harris EC, Linaker C, Bonde JP. Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review with meta-analysis. Occup Environ Med 2013; 70:213-22. [PMID: 23343859 PMCID: PMC3653070 DOI: 10.1136/oemed-2012-101032] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the evidence relating preterm delivery (PTD), low birth weight, small for gestational age (SGA), pre-eclampsia and gestational hypertension to five occupational exposures (working hours, shift work, lifting, standing and physical workload). We conducted a systematic search in Medline and Embase (1966 to 2011), updating a previous search with a further 6 years of observations. METHODS As before, combinations of keywords and medical subject headings were used. Each relevant paper was assessed for completeness of reporting and potential for important bias or confounding, and its effect estimates abstracted. Where similar definitions of exposure and outcome existed we calculated pooled estimates of relative risk (RR) in meta-analysis. RESULTS Analysis was based on 86 reports (32 cohort investigations, 57 with usable data on PTD, 54 on birth weight and 11 on pre-eclampsia/gestational hypertension); 33 reports were new to this review. For PTD, findings across a substantial evidence base were generally consistent, effectively ruling out large effects (eg, RR>1.2). Larger and higher quality studies were less positive, while meta-estimates of risk were smaller than in previous analyses and best estimates pointed to modest or null effects (RR 1.04 to 1.18). For SGA, the position was similar but meta-estimates were even closer to the null (eight of nine RRs ≤ 1.07). For pre-eclampsia/gestational hypertension the evidence base remains insufficient. CONCLUSIONS The balance of evidence is against large effects for the associations investigated. As the evidence base has grown, estimates of risk in relation to these outcomes have become smaller.
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Affiliation(s)
- Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
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Allweiler SI, Kogan LR. Inhalation anesthetics and the reproductive risk associated with occupational exposure among women working in veterinary anesthesia. Vet Anaesth Analg 2013; 40:285-9. [PMID: 23387328 DOI: 10.1111/vaa.12014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 01/22/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate reproductive health issues for women working in veterinary anesthesia compared with those working in veterinary critical care. Reproductive health issues were classified as time to conceive, fertility treatment, miscarriage, and children with birth defects. STUDY DESIGN Questionnaire-based survey. METHODS A survey was designed to assess the reproductive health of female personnel working in veterinary anesthesia. To account for other job related factors that might impact reproductive health (i.e. stress, heavy lifting, long working hours and varying schedules), women working in veterinary critical care were used as a comparison group. RESULTS There were 295 respondents including, (209 faculty and staff working in veterinary anesthesia and 86 in veterinary critical care). There were no statistical differences in length of time to conceive, number of couples receiving fertility treatment, miscarriages, and children with birth defects between the two groups. CONCLUSIONS This study did not show a statistically significant difference in reproductive risk for women working in veterinary anesthesia when compared to women working in veterinary critical care. Overall the incidence for reproductive health problems is similar to the risk for the general population of females in North America.
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Affiliation(s)
- Sandra I Allweiler
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA.
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Palanisamy A. Maternal anesthesia and fetal neurodevelopment. Int J Obstet Anesth 2012; 21:152-62. [DOI: 10.1016/j.ijoa.2012.01.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 01/21/2012] [Accepted: 01/28/2012] [Indexed: 12/01/2022]
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Silva TPPD, Moreira JC, Peres F. Serão os carrapaticidas agrotóxicos? Implicações na saúde e na percepção de riscos de trabalhadores da pecuária leiteira. CIENCIA & SAUDE COLETIVA 2012; 17:311-25. [DOI: 10.1590/s1413-81232012000200006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/08/2010] [Indexed: 11/22/2022] Open
Abstract
O presente artigo tem por objetivo caracterizar os riscos relacionados ao uso de agrotóxicos na pecuária leiteira, no que tange a questões de legislação, de saúde e da percepção de riscos de trabalhadores dessa atividade. Para tanto, baseia-se em articulação metodológica que incluiu: a) revisão sistemática da literatura de referência sobre o objeto da pesquisa; b) análise da legislação correlata (produtos veterinários e agrotóxicos); c) identificação de perigos relacionados a produtos veterinários formulados à base de princípios ativos regulados como agrotóxicos; d) e análise da percepção de riscos de um grupo de trabalhadores da pecuária leiteira. A análise dos resultados do estudo apontou uma situação de especial interesse para o campo da Saúde Coletiva. No que diz respeito aos trabalhadores da pecuária leiteira, a invisibilidade de riscos associados ao manejo de agrotóxicos de uso veterinário aumenta sua exposição e está relacionada a diversos problemas de saúde, em especial nas mulheres. Esta mesma invisibilidade leva a um negligenciamento do respeito ao período de carência. Parte dos problemas pode estar associada à não classificação dos inseticidas de uso veterinários como agrotóxicos, o que torna necessária e urgente a discussão do tema.
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Shirangi A, Nieuwenhuijsen M, Vienneau D, Holman CDJ. Living near agricultural pesticide applications and the risk of adverse reproductive outcomes: a review of the literature. Paediatr Perinat Epidemiol 2011; 25:172-91. [PMID: 21281330 DOI: 10.1111/j.1365-3016.2010.01165.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Over the last decade, there has been growing concern about the possible health effects, including a number of adverse reproductive outcomes, from pesticide exposure of people living near agricultural fields. This systematic review evaluates the current epidemiological evidence on the association between living near agricultural pesticide applications and adverse reproductive outcomes, including congenital malformations, stillbirth, intrauterine growth retardation (IUGR), low birthweight, preterm birth and miscarriage. We identified and reviewed 25 studies from a systematic search of the main scientific databases and other sources published in 1950-2007. Study methods and main results were summarised and tabulated according to the year of study, design and type of adverse reproductive outcome. The levels of evidence for reproductive toxicity in humans contributed by each study were assessed and the main limitations associated with these studies discussed. Residential proximity to agricultural pesticide applications may be an important source of ambient environmental exposure, but because of the underlying methodological difficulties, the strength of evidence for its relationship with adverse reproductive outcomes is generally weak and varied between outcomes. The evidence suggested an association for congenital malformations, but because of methodological limitations, such as poor exposure measurement and potentially inadequate control of confounding, a firm conclusion remains beyond reach. For the other outcomes (stillbirth, IUGR, low birthweight, preterm birth and miscarriage) the evidence for any associations was equivocal at best, but some leads warrant further investigation. Improved exposure assessment methods are needed to obtain a more reliable assessment of any risks.
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Affiliation(s)
- Adeleh Shirangi
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
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Abstract
The current article covers some of the major themes that emerged in 2009 in the fields of obstetric anesthesiology, obstetrics, and perinatology, with a special emphasis on the implications for the obstetric anesthesiologist.
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Affiliation(s)
- J M Mhyre
- Department of Anesthesia, Division of Obstetric Anesthesia, Women's Hospital, University of Michigan Health System, Ann Arbor, MI 48109-5278, USA.
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