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Zhou M, Theologis AA, O’Connell GD. Understanding the etiopathogenesis of lumbar intervertebral disc herniation: From clinical evidence to basic scientific research. JOR Spine 2024; 7:e1289. [PMID: 38222810 PMCID: PMC10782075 DOI: 10.1002/jsp2.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 01/16/2024] Open
Abstract
Lumbar intervertebral disc herniation, as a leading cause of low back pain, productivity loss, and disability, is a common musculoskeletal disorder that results in significant socioeconomic burdens. Despite extensive clinical and basic scientific research efforts, herniation etiopathogenesis, particularly its initiation and progression, is not well understood. Understanding herniation etiopathogenesis is essential for developing effective preventive measures and therapeutic interventions. Thus, this review seeks to provide a thorough overview of the advances in herniation-oriented research, with a discussion on ongoing challenges and potential future directions for clinical, translational, and basic scientific investigations to facilitate innovative interdisciplinary research aimed at understanding herniation etiopathogenesis. Specifically, risk factors for herniation are identified and summarized, including familial predisposition, obesity, diabetes mellitus, smoking tobacco, selected cardiovascular diseases, disc degeneration, and occupational risks. Basic scientific experimental and computational research that aims to understand the link between excessive mechanical load, catabolic tissue remodeling due to inflammation or insufficient nutrient supply, and herniation, are also reviewed. Potential future directions to address the current challenges in herniation-oriented research are explored by combining known progressive development in existing research techniques with ongoing technological advances. More research on the relationship between occupational risk factors and herniation, as well as the relationship between degeneration and herniation, is needed to develop preventive measures for working-age individuals. Notably, researchers should explore using or modifying existing degeneration animal models to study herniation etiopathogenesis, as such models may allow for a better understanding of how to prevent mild-to-moderately degenerated discs from herniating.
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Affiliation(s)
- Minhao Zhou
- Department of Mechanical EngineeringUniversity of California, Berkeley (UC Berkeley)BerkeleyCaliforniaUSA
| | - Alekos A. Theologis
- Department of Orthopaedic SurgeryUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Grace D. O’Connell
- Department of Mechanical EngineeringUniversity of California, Berkeley (UC Berkeley)BerkeleyCaliforniaUSA
- Department of Orthopaedic SurgeryUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
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Lu CC, Liang JK. Exploring factors that influence the cardiovascular health of bus drivers for the improvement of transit safety. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:1263-1272. [PMID: 36046884 DOI: 10.1080/10803548.2022.2120259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The causes of traffic accidents include sudden cardiovascular disease events of drivers that go undetected in routine physical examinations of their health. While increased attention has been paid to proactive driver management by the frequent monitoring of drivers' mental and physical condition to avoid such events, very few studies have examined the deeper risk factors that influence the cardiovascular health of bus drivers represented by workload and scheduling. To fill this knowledge gap, this study adopts a data mining approach to exploring the factors influencing the cardiovascular health of intercity bus drivers using their daily cardiovascular measurement data along with their schedules and routine physical examination results. Ten influencing factors were identified, including medical history, late-night habits and afternoon and evening driving schedules. The present findings will be useful for preventing accidents where cardiovascular disease is involved, which in turn will help improve transit safety.
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Affiliation(s)
- Chung-Cheng Lu
- Department of Transportation and Logistics Management, National Yang Ming Chiao Tung University, Taiwan
| | - Jyun-Kai Liang
- Department of Applied Psychology, Hsuan Chuang University, Taiwan
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Harada Y, Masuyama T, Yokose M, Shimizu T. Acute-on-Chronic Pattern of Isolated Upper Back Pain in a Patient With Acute Coronary Syndrome. Cureus 2023; 15:e34923. [PMID: 36938165 PMCID: PMC10016740 DOI: 10.7759/cureus.34923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
The aim of this case report is to describe the diagnostic pitfalls of acute coronary syndrome in patients with relatively atypical presentation and how we can prevent diagnostic errors in such a patient, particularly focusing on occupational information. A 66-year-old male, a professional taxi driver, presented with severely deteriorated chronic upper back pain on the left side. Furthermore, the upper back pain was exacerbated by changes in position. An orthopedist examined the patient and arrived at a provisional diagnosis of musculoskeletal pain. However, as the patient was concerned about his cardiopulmonary diseases, he visited another physician. Although musculoskeletal pain was still considered as the most possible diagnosis, the physician advised him additional tests for cardiovascular diseases because he had some risk factors such as smoking, hypertension, and dyslipidemia, and the physician thought that "taxi driving" was a high-risk occupation for cardiovascular diseases. Finally, the patient was diagnosed with acute coronary syndrome, and the pain abated soon after percutaneous coronary intervention. Musculoskeletal pain is very common in professional drivers, and isolated upper back pain worsened by changes in position is a characteristic of musculoskeletal disease. However, since professional drivers also have a higher risk of cardiovascular diseases, physicians should consider the coexistence of two types of conditions. This case underscores that if physicians could utilize occupational information to assess patients' risks, diagnostic accuracy would improve, particularly in patients presenting with atypical symptoms and signs, which are at risk of diagnostic errors.
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Affiliation(s)
- Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
| | - Taiki Masuyama
- Department of Cardiovascular Medicine, Dokkyo Medical University Hospital, Mibu, JPN
| | - Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
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Herttua K, Ahrenfeldt LJ, Paljarvi T. Risk of major chronic diseases in transport, rescue and security industries: a longitudinal register-based study. Occup Environ Med 2021; 79:162-168. [PMID: 34462305 DOI: 10.1136/oemed-2021-107764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the risk of hospitalisation for major chronic diseases across representative transport, rescue and security industries. METHODS We performed a register-based study of 624 571 workers from six industries in Denmark between 2000 and 2005, followed up hospitalisation for chronic diseases up to 17 years, and compared with a 20% random sample of the economically active population. RESULTS HR from the Cox regression models showed that seafarers had higher risk of lung cancer (men: 1.54, 95% CI 1.31 to 1.81; women: 1.63, 95% CI 1.13 to 2.36), and male seafarers had higher risk of diabetes (1.32, 95% CI 1.21 to 1.43) and oral cancer (1.51, 95% CI 1.21 to 1.88). Men and women in land transport had increased risk of diabetes (men: 1.68, 95% CI 1.63 to 1.73; women 1.55, 95% CI 1.40 to 1.71) and chronic respiratory disease (men: 1.21, 95% CI 1.16 to 1.25; women 1.42, 95% CI 1.32 to 1.53). Among women, a higher risk of gastrointestinal cancer was observed in aviation (1.53, 95% CI 1.23 to 1.89) and police force (1.29, 95% CI 1.01 to 1.65), oral cancer in defence forces (1.83, 95% CI 1.20 to 2.79), and chronic respiratory disease in rescue service (1.47, 95% CI 1.21 to 1.77), while men in defence forces, police force and rescue service had mainly lower risk of these chronic diseases. CONCLUSIONS We observed considerable health disparities from chronic diseases across transport, rescue and security industries, with workers in seafaring and land transport generally bearing the greatest relative burden.
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Affiliation(s)
- Kimmo Herttua
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Tapio Paljarvi
- Department of Psychiatry, University of Oxford, Oxford, UK
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The prevalence of signs and symptoms of laryngopharyngeal reflux and laryngeal precancerous lesions in urban taxi drivers. Eur Arch Otorhinolaryngol 2020; 277:2285-2291. [DOI: 10.1007/s00405-020-05983-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
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A Structured Health Intervention for Truckers (SHIFT): A Process Evaluation of a Pilot Health Intervention in a Transport Company. J Occup Environ Med 2019; 60:377-385. [PMID: 29271840 DOI: 10.1097/jom.0000000000001258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To undertake a process-evaluation of a structured health intervention for truckers (SHIFT) implemented in a sample of UK lorry drivers. METHODS A combination of "debrief interviews," focus groups and one-to-one interviews, in addition to observations and reflections of the two lead researchers were used to collect data on the acceptability of SHIFT from a group of 16 lorry drivers and four transport managers. RESULTS The SHIFT program was considered relevant and acceptable to lorry drivers. It provided them with health information tailored to their specific health needs, long-lasting tools and techniques, which helped to raise their awareness of key health issues and helped to stimulate lifestyle changes during their daily routine. CONCLUSION This process-evaluation suggests that the SHIFT program should now be evaluated on a larger scale and tested through fully randomized controlled trials.
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Costello S, Attfield MD, Lubin JH, Neophytou AM, Blair A, Brown DM, Stewart PA, Vermeulen R, Eisen EA, Silverman DT. Ischemic Heart Disease Mortality and Diesel Exhaust and Respirable Dust Exposure in the Diesel Exhaust in Miners Study. Am J Epidemiol 2018; 187:2623-2632. [PMID: 30137203 DOI: 10.1093/aje/kwy182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 08/14/2018] [Indexed: 12/24/2022] Open
Abstract
Diesel exhaust is a suggested risk factor for ischemic heart disease (IHD), but evidence from cohorts using quantitative exposure metrics is limited. We examined the impact of respirable elemental carbon (REC), a key surrogate for diesel exhaust, and respirable dust (RD) on IHD mortality, using data from the Diesel Exhaust in Miners Study in the United States. Using data from a cohort of male workers followed from 1948-1968 until 1997, we fitted Cox proportional hazards models to estimate hazard ratios for IHD mortality for cumulative and average intensity of exposure to REC and RD. Segmented linear regression models allowed for nonmonotonicity. Hazard ratios for cumulative and average REC exposure declined relative to the lowest exposure category before increasing to 0.79 and 1.25, respectively, in the highest category. Relative to the category containing the segmented regression change points, hazard ratios for the highest category were 1.69 and 1.54 for cumulative and average REC exposure, respectively. Hazard ratios for RD exposure increased across the full exposure range to 1.33 and 2.69 for cumulative and average RD exposure, respectively. Tests for trend were statistically significant for cumulative REC exposure (above the change point) and for average RD exposure. Our findings suggest excess risk of IHD mortality in relation to increased exposure to REC and RD.
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Affiliation(s)
- Sadie Costello
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Michael D Attfield
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Jay H Lubin
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Andreas M Neophytou
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Daniel M Brown
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | | | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ellen A Eisen
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Hannerz H, Larsen AD, Garde AH. Long weekly working hours and ischaemic heart disease: a follow-up study among 145 861 randomly selected workers in Denmark. BMJ Open 2018; 8:e019807. [PMID: 29909368 PMCID: PMC6009463 DOI: 10.1136/bmjopen-2017-019807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/07/2018] [Accepted: 05/11/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The aim of the present study was to test if incidences of ischaemic heart disease (IHD) and usage of antihypertensive drugs are independent of weekly working hours (WWH) among full-time employees in Denmark. DESIGN AND PARTICIPANTS Data on WWH from participants of the Danish labour force surveys, 1999-2013, were linked on an individual level to national registers with data on socioeconomic status (SES), industry, emigrations, redeemed prescriptions, hospital contacts and deaths. Participants were followed until the end of 2014 (on average 7.7 years). Poisson regression was used to model incidence rates as a function of WWH. The analyses were controlled for calendar time, time passed since start of follow-up, employment in the healthcare industry, age, sex, SES and night work. RESULTS In total, we found 3635 cases of IHD and 20 648 cases of antihypertensive drug usage. The rate ratio of IHD was 0.95 (95% CI 0.85 to 1.06) for 41-48 compared with 32-40 WWH and 1.07 (0.94 to 1.21) for >48 compared with 32-40 WWH. The corresponding rate ratios for antihypertensive drug usage were 0.99 (0.95 to 1.04) and 1.02 (0.97 to 1.08). No statistically significant interactions between WWH and sex, SES and night work, respectively, were found. CONCLUSION In this Danish sample, we did not find any statistically significant association between WWH and IHD or antihypertensive drug usage.
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Affiliation(s)
- Harald Hannerz
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Anne Helene Garde
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Amadi CE, Grove TP, Mbakwem AC, Ozoh OB, Kushimo OA, Wood DA, Akinkunmi M. Prevalence of cardiometabolic risk factors among professional male long-distance bus drivers in Lagos, south-west Nigeria: a cross-sectional study. Cardiovasc J Afr 2018; 29:106-114. [PMID: 29457826 PMCID: PMC6008896 DOI: 10.5830/cvja-2018-006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/14/2018] [Indexed: 12/30/2022] Open
Abstract
Background Professional drivers are known to be at high risk of cardiovascular disease (CVD). This study was carried out to highlight these risk factors and their predictors among male long–distance professional bus drivers in Lagos, southwest Nigeria, with a view to improving health awareness in this group. Methods Socio–demographic data, anthropometric indices, blood pressure, fasting plasma blood glucose levels and lipid and physical activity profiles of 293 drivers were measured. Results Mean age of the study population was 48 ± 9.7 years; 71.0 and 19.5% of the drivers used alcohol and were smokers, respectively; and 50.9% were physically inactive. The prevalence of overweight and obesity was 41.7 and 21.1%, respectively, while 39.7 and 13.9% were hypertensive and diabetic, respectively. Ninety (31.3%) subjects had impaired fasting glucose levels while 56.3% had dyslipidaemia. Predictors of hypertension were age and body mass index (BMI). BMI only was a predictor of abnormal glucose profile. Conclusion Professional male long–distance bus drivers in this study showed a high prevalence of a cluster of risk factors for CVD.
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Affiliation(s)
- Casmir E Amadi
- Department of Medicine, College of Medicine, University of Lagos, Nigeria.
| | - Tim P Grove
- National Heart and Lung Institute, Imperial College, London
| | - Amam C Mbakwem
- Department of Medicine, College of Medicine, University of Lagos, Nigeria
| | - Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Nigeria
| | | | - David A Wood
- National Heart and Lung Institute, Imperial College, London
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Wei C, Gerberich SG, Ryan AD, Alexander BH, Church TR, Manser M. Risk factors for unintentional occupational injury among urban transit bus drivers: a cohort longitudinal study. Ann Epidemiol 2017; 27:763-770. [DOI: 10.1016/j.annepidem.2017.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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Laal F, Madvari RF, Balarak D, Mohammadi M, Dortaj E, Khammar A, Adineh HA. Relationship between musculoskeletal disorders and anthropometric indices among bus drivers in Zahedan city. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2017; 24:431-437. [DOI: 10.1080/10803548.2017.1334335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fereydoon Laal
- Student Research Committee, Shahid Beheshti University of Medical Sciences, IR Iran
| | | | - Davoud Balarak
- Department of Environmental Health, Zahedan University of Medical Sciences, IR Iran
| | - Mahdi Mohammadi
- Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, IR Iran
| | - Elahe Dortaj
- Department of Occupational Health, Zahedan University of Medical Sciences, IR Iran
| | - Abdolali Khammar
- Department of Occupational Health, Zahedan University of Medical Sciences, IR Iran
| | - Hossein Ali Adineh
- Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, IR Iran
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Varela-Mato V, O’Shea O, King JA, Yates T, Stensel DJ, Biddle SJH, Nimmo MA, Clemes SA. Cross-sectional surveillance study to phenotype lorry drivers' sedentary behaviours, physical activity and cardio-metabolic health. BMJ Open 2017. [PMID: 28637722 PMCID: PMC5577867 DOI: 10.1136/bmjopen-2016-013162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Elevated risk factors for a number of chronic diseases have been identified in lorry drivers. Unhealthy lifestyle behaviours such as a lack of physical activity (PA) and high levels of sedentary behaviour (sitting) likely contribute to this elevated risk. This study behaviourally phenotyped UK lorry drivers' sedentary and non-sedentary behaviours during workdays and non-workdays and examined markers of drivers cardio-metabolic health. SETTING A transport company from the East Midlands, UK. PARTICIPANTS A sample of 159 male heavy goods vehicle drivers (91% white European; (median (range)) age: 50 (24, 67) years) completed the health assessments. 87 (age: 50.0 (25.0, 65.0); body mass index (BMI): 27.7 (19.6, 43.4) kg/m2) provided objective information on sedentary and non-sedentary time. OUTCOMES Participants self-reported their sociodemographic information. Primary outcomes: sedentary behaviour and PA, assessed over 7 days using an activPAL3 inclinometer. Cardio-metabolic markers included: blood pressure (BP), heart rate, waist circumference (WC), hip circumference, body composition and fasted capillary blood glucose, triglycerides, high-density lipopreotein cholesterol, low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels. These cardio-metabolic markers were treated as secondary outcomes. RESULTS Lorry drivers presented an unhealthy cardio-metabolic health profile (median (IQR) systolic BP: 129 (108.5, 164) mm Hg; diastolic BP: 81 (63, 104) mm Hg; BMI: 29 (20, 47) kg/m2; WC: 102 (77.5, 146.5) cm; LDL-C: 3 (1, 6) mmol/L; TC: 4.9 (3, 7.5) mmol/L). 84% were overweight or obese, 43% had type 2 diabetes or prediabetes and 34% had the metabolic syndrome. The subsample of lorry drivers with objective postural data (n=87) accumulated 13 hours/day and 8 hours/day of sedentary behaviour on workdays and non-workdays (p<0.001), respectively. On average, drivers accrued 12 min/day on workdays and 6 min/day on non-workdays of moderate-to-vigorous PA (MVPA). CONCLUSION Lorry drivers demonstrate a high-risk cardio-metabolic profile and are highly sedentary and physically inactive. Interventions to reduce sitting and increase MVPA during breaks and leisure time to improve cardio-metabolic health are urgently needed. Educational programmes to raise awareness about diet and exercise are recommended.
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Affiliation(s)
- Veronica Varela-Mato
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Lifestyle and Physical Activity Biomedical Research Unit, NIHR Leicester-Loughborough Diet, Loughborough, UK
| | - Orlagh O’Shea
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - James A King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Lifestyle and Physical Activity Biomedical Research Unit, NIHR Leicester-Loughborough Diet, Loughborough, UK
| | - Thomas Yates
- Lifestyle and Physical Activity Biomedical Research Unit, NIHR Leicester-Loughborough Diet, Loughborough, UK
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - David J Stensel
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Lifestyle and Physical Activity Biomedical Research Unit, NIHR Leicester-Loughborough Diet, Loughborough, UK
| | - Stuart JH Biddle
- Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Melbourne, Australia
| | - Myra A Nimmo
- College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Stacy A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Lifestyle and Physical Activity Biomedical Research Unit, NIHR Leicester-Loughborough Diet, Loughborough, UK
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Möhner M, Wendt A. A critical review of the relationship between occupational exposure to diesel emissions and lung cancer risk. Crit Rev Toxicol 2017; 47:185-224. [PMID: 28322628 DOI: 10.1080/10408444.2016.1266598] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In 2012, a working group of the International Agency for Research on Cancer classified diesel exhaust (DE) as a human carcinogen (Group 1). This decision was primarily based on the findings of the Diesel Exhaust in Miners Study (DEMS). The disparity between the results of various methodological approaches applied to the DEMS led to several critical commentaries. An expert panel was subsequently set up by the Health Effects Institute to evaluate the DEMS results, together with a large study in the trucking industry. The panel concluded that both studies provided a useful basis for quantitative risk assessments (QRAs) of DE exposure. However, the results of both studies were non-definitive as the studies suffer from several methodological shortcomings. We conducted a critical review of the studies used by the International Agency for Research on Cancer (IARC) working group to evaluate the relationship between DE and lung cancer. The aim was to assess whether the available studies support the statement of a causal relationship and, secondarily if they could be used for QRA. Our review highlights several methodological flaws in the studies, amongst them overadjustment bias, selection bias, and confounding bias. The conclusion from our review is that the currently published studies provide little evidence for a definite causal link between DE exposure and lung cancer risk. Based on two studies in miners, the DEMS and the German Potash Miners study, QRA may be conducted. However, the DEMS data should be reanalyzed in advance to avoid bias that affects the presently published risk estimates.
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Affiliation(s)
- Matthias Möhner
- a Division Work and Health , Federal Institute for Occupational Safety and Health , Berlin , Germany
| | - Andrea Wendt
- a Division Work and Health , Federal Institute for Occupational Safety and Health , Berlin , Germany
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Juszczyk G, Czerw A, Tatara T, Duda-Zalewska A, Walusiak-Skorupa J, Słoniewski R, Staniszewska A, Olejniczak D, Religioni U. Cost intensity of identifying contraindications to driving a company car through psychological tests on the basis of real-world data in Poland. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2016; 23:553-557. [PMID: 27590171 DOI: 10.1080/10803548.2016.1221911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study objective was to determine the cost intensity of identifying contraindications to fleet car driving in preventive care. BACKGROUND The objective of a psychological examination is to identify impaired psychomotor function as well as any intellectual, cognitive or emotional incapacities, which may seriously impede safety. METHOD Real-world data were collected from the healthcare provider in Poland. A total of 8111 anonymous records from psychomotor tests performed between January 1 and December 31, 2012 were analysed. RESULTS The number needed to screen to identify one person with contraindications to driving was 737. An individual examination costs PLN 150, thus the estimated cost of identifying one case was PLN 110,550 (EUR 25,000). The average number of tests in a small enterprise with 20-50 fleet cars was estimated at 5-25 in a 5-year period and their cost at PLN 3750 (PLN 750 annually). CONCLUSION Health check-ups include ophthalmological and neurological consultations; therefore, psychological examination of fleet car drivers may be considered excessive due to cost and limited preventive value. High costs may be burdensome mainly to larger companies. APPLICATION A final decision regarding necessity of psychological testing should be preceded by medical assessment of the risk of work accidents.
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Affiliation(s)
- Grzegorz Juszczyk
- a Department of Public Health , Medical University of Warsaw , Poland
| | - Aleksandra Czerw
- a Department of Public Health , Medical University of Warsaw , Poland
| | - Tomasz Tatara
- a Department of Public Health , Medical University of Warsaw , Poland
| | | | - Joanna Walusiak-Skorupa
- b Department of Occupational Diseases and Toxicology , Institute of Occupational Medicine , Poland
| | - Robert Słoniewski
- a Department of Public Health , Medical University of Warsaw , Poland
| | - Anna Staniszewska
- c Department of Experimental and Clinical Pharmacology , Medical University of Warsaw , Poland
| | | | - Urszula Religioni
- a Department of Public Health , Medical University of Warsaw , Poland
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Abstract
In the United States (U.S.), cardiovascular disease (CVD) is a major leading cause of death. Despite the high mortality rate related to CVD, little is known about CVD risk factors among urban taxi drivers in the U.S. A cross-sectional design was used to identify the predictors of high cardiovascular risk factors among taxi drivers. Convenience sampling method was used to recruit 130 taxi drivers. A structured questionnaire was used to obtain the data. The sample was male (94 %), age mean (45 ± 10.75) years, married (54 %), born outside of the USA (55 %), had some college or below (61.5 %), night drivers (50.8 %), and driving on average 9.7 years and 41 h/week. About 79 % of them were eligible for CVD prevention, and 35.4 % had high CVD risk factors (4-9 risk factors). A CVD high-risk profile had a significant relationship with the subjects who were ≥55 years old; had hypertension, diabetes, or hyperlipidemia; were drinking alcohol ≥2 times/week; and had insufficient physical activity. Subjects who worked as a taxi driver for more than 10 years (OR 4.37; 95 % CI 1.82, 10.50) and had mental exertion from cab driving >5 out of 10 (OR 2.63; 95 % CI 1.05, 6.57) were more likely to have a CVD high-risk profile. As a conclusion, system-level or worksite interventions include offering healthy food at taxi dispatching locations, creating a work culture of frequent walking breaks, and interventions focusing on smoking, physical activity, and weight management. Improving health insurance coverage for this group of workers is recommended.
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Affiliation(s)
- Rami Azmi Elshatarat
- Department of Medical and Surgical Nursing, College of Nursing, Taibah University, Medina, Saudi Arabia.
| | - Barbara J Burgel
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
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Schroeder GD, Guyre CA, Vaccaro AR. The epidemiology and pathophysiology of lumbar disc herniations. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.semss.2015.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Rosso GL, Perotto M, Feola M, Bruno G, Caramella M. Investigating obesity among professional drivers: the high risk professional driver study. Am J Ind Med 2015; 58:212-9. [PMID: 25603943 DOI: 10.1002/ajim.22400] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study is to detect the main individual and transportation factors associated with obesity and its prevalence among Italian professional drivers (PDs). METHODS We performed a cross-sectional questionnaire survey. Data from PDs (n = 497) were used for analyses. RESULTS Sixty-one percent of participants were either overweight or obese according to their body mass index. Predictive factors for obesity were traveling more than 40,000 miles per year (odds ratio [OR] 4.20, confidence interval [CI] 1.41-12.56) and hours spent behind the wheel per day (OR 1.27, CI 1.02-1.58). Bus drivers had half the risk of being obese compared to truck drivers (OR 0.45, CI 0.23-0.87). An inverse association was detected between educational attainment and obesity (OR 0.32, CI 0.11-0.90). CONCLUSIONS PDs with high number of driving hours per day, miles driven per year, and low educational level should be subject to special educational programs to reduce and prevent obesity.
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Affiliation(s)
- Gian Luca Rosso
- S.C. Emergenza Urgenza 118; A.S.L. CN1; Cuneo Italy
- Divisione Medicina del Lavoro; Servizi Medici s.r.l.; Cuneo Italy
| | | | - Mauro Feola
- Riabilitazione Cardiologica - Unità scompenso cardiaco; A.S.L. CN1; Cuneo Italy
| | - Graziella Bruno
- Dipartimento di Medicina Interna; Università degli Studi di Torino; Torino Italy
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Prevalence and Risk Factors of Hypertension among Male Occupational Bus Drivers in North Kerala, South India: A Cross-Sectional Study. ISRN PREVENTIVE MEDICINE 2014; 2014:318532. [PMID: 24971195 PMCID: PMC4045462 DOI: 10.1155/2014/318532] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 01/27/2014] [Indexed: 11/18/2022]
Abstract
Background. Hypertension is a leading cause of morbidity and mortality worldwide. We aimed to evaluate the prevalence of hypertension in a population of male bus drivers in North Kerala, India. Methods. The study population included male bus drivers of Corporation Bus stand Kozhikode, Kerala. Blood pressure, height, and weight of subjects were measured, and relevance was obtained using a structured questionnaire. Results. Age varied from 21 to 60 years (mean 36.5 ± 8.4). Among 179 bus drivers studied, 16.8% (30/179) had normal BP, 41.9% (75/179) had prehypertension, and 41.3% (74/179) had hypertension. Isolated systolic HTN was seen in 6.70% (12/179) individuals. Out of 74 hypertensives, 9 (12.1%) were aware of their hypertension, while 3 (4.0%) were medicated and only 1 (1.3%) had BP adequately controlled. Age > 35 years (P = 0.015), BMI ≥ 23 kg/m2 (P = 0.007), supporting more than four family members (P = 0.011), and taking main meals from restaurants on most working days (P = 0.017) were independently associated with HTN in binary logistic regression. Conclusion. Prevalence of hypertension was high among bus drivers. Age > 35 years, elevated BMI, supporting a large family, and dietary habits associated with the job showed significant association with hypertension. Primary and secondary prevention strategies need to be emphasized in this occupational group.
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Neophytou AM, Picciotto S, Hart JE, Garshick E, Eisen EA, Laden F. A structural approach to address the healthy-worker survivor effect in occupational cohorts: an application in the trucking industry cohort. Occup Environ Med 2014; 71:442-7. [PMID: 24727736 DOI: 10.1136/oemed-2013-102017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Occupational cohort studies are often challenged by the Healthy Worker Survivor Effect, which may bias standard methods of analysis. G-estimation of structural failure time models is an approach for reducing this type of bias. Accelerated failure time models have recently been applied in an occupational cohort but cumulative failure time models have not. METHODS We used g-estimation of a cumulative failure time model to assess the effect of working as a long-haul driver on ischaemic heart disease mortality in a cohort of 30 448 men employed in the unionised US trucking industry in 1985. Exposure was defined by job title and based on work records. We also applied g-estimation of an accelerated failure time model as a sensitivity analysis and approximated HRs from both models to compare them. RESULTS The risk ratio (RR) obtained from the cumulative failure time model, comparing the observed risk under no intervention to the risk had nobody ever been exposed as a long-haul driver, was 1.09 (95% CI 1.02 to 1.16). The RR comparing the risk had everyone been exposed as long-haul driver for 8 years to the risk had nobody ever been exposed was 1.20 (95% CI 1.04 to 1.46). After HR approximations, accelerated failure time model results were similar. CONCLUSIONS The cumulative failure time model can effectively control time-varying confounding by Healthy Worker Survivor Effect, and provides an easily interpretable effect estimate. RRs estimated from the cumulative failure time model indicate an elevated ischaemic heart disease mortality risk for long-haul drivers in the US trucking industry.
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Affiliation(s)
- Andreas M Neophytou
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
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Palmer KT, Griffin M, Ntani G, Shambrook J, McNee P, Sampson M, Harris EC, Coggon D. Professional driving and prolapsed lumbar intervertebral disc diagnosed by magnetic resonance imaging: a case-control study. Scand J Work Environ Health 2012; 38:577-81. [PMID: 22249859 PMCID: PMC3436743 DOI: 10.5271/sjweh.3273] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate whether whole-body vibration (WBV) is associated with prolapsed lumbar intervertebral disc (PID) and nerve root entrapment among patients with low-back pain (LBP) undergoing magnetic resonance imaging (MRI). METHODS A consecutive series of patients referred for lumbar MRI because of LBP were compared with controls X-rayed for other reasons. Subjects were questioned about occupational activities loading the spine, psychosocial factors, driving, personal characteristics, mental health, and certain beliefs about LBP. Exposure to WBV was assessed by six measures, including weekly duration of professional driving, hours driven at a spell, and current 8-hour daily equivalent root-mean-square acceleration A(8). Cases were sub-classified according to whether or not PID/nerve root entrapment was present. Associations with WBV were examined separately for cases with and without these MRI findings, with adjustment for age, sex, and other potential confounders. RESULTS Altogether 237 cases and 820 controls were studied, including 183 professional drivers and 176 cases with PID and/or nerve root entrapment. Risks associated with WBV tended to be lower for LBP with PID/nerve root entrapment but somewhat higher for risks of LBP without these abnormalities. However, associations with the six metrics of exposure were all weak and not statistically significant. Neither exposure-response relationships nor increased risk of PID/nerve root entrapment from professional driving or exposure at an A(8) above the European Union daily exposure action level were found. CONCLUSIONS WBV may be a cause of LBP but it was not associated with PID or nerve root entrapment in this study.
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Affiliation(s)
- Keith T Palmer
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, UK.
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Hart JE, Garshick E, Smith TJ, Davis ME, Laden F. Ischaemic heart disease mortality and years of work in trucking industry workers. Occup Environ Med 2012; 70:523-8. [PMID: 22992341 DOI: 10.1136/oemed-2011-100017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Evidence from general population-based studies and occupational cohorts has identified air pollution from mobile sources as a risk factor for cardiovascular disease. In a cohort of US trucking industry workers, with regular exposure to vehicle exhaust, the authors previously observed elevated standardised mortality ratios for ischaemic heart disease (IHD) compared with members of the general US population. Therefore, the authors examined the association of increasing years of work in jobs with vehicle exhaust exposure and IHD mortality within the cohort. METHODS The authors calculated years of work in eight job groups for 30,758 workers using work records from four nationwide companies. Proportional hazard regression was used to examine relationships between IHD mortality, 1985-2000, and employment duration in each job group. RESULTS HRs for at least 1 year of work in each job were elevated for dockworkers, long haul drivers, pick-up and delivery drivers, combination workers, hostlers, and shop workers. There was a suggestion of an increased risk of IHD mortality with increasing years of work as a long haul driver, pick-up and delivery driver, combination worker, and dockworker. CONCLUSION These results suggest an elevated risk of IHD mortality in workers with a previous history of regular exposure to vehicle exhaust.
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Affiliation(s)
- Jaime E Hart
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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Environmental determinants of obesity‐associated morbidity risks for truckers. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2012. [DOI: 10.1108/17538351211239162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hirata RP, Sampaio LMM, Leitão Filho FSS, Braghiroli A, Balbi B, Romano S, Insalaco G, de Oliveira LVF. General characteristics and risk factors of cardiovascular disease among interstate bus drivers. ScientificWorldJournal 2012; 2012:216702. [PMID: 22701350 PMCID: PMC3373126 DOI: 10.1100/2012/216702] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/26/2012] [Indexed: 12/31/2022] Open
Abstract
Workers in the transportation industry are at greater risk of an incorrect diet and sedentary behavior. The aim of our study was to characterize a population of professional bus drivers with regard to clinical and demographic variables, lipid profile, and the presence of cardiovascular risk factors. Data from 659 interstate bus drivers collected retrospectively, including anthropometric characteristics, systolic and diastolic blood pressure, lipid profile, fasting blood glucose, meatoscopy, and audiometry. All participants were male, with a mean age of 41.7 ± 6.9 years, weight of 81.4 ± 3.3 kg, and BMI 27.2 ± 3.3 Kg/m²; the mean abdominal and neck circumferences were 94.4 ± 8.6 cm and 38.9 ± 2.2 cm; 38.2% of the sample was considered hypertensive; mean HDL cholesterol was 47.9 ± 9.5 mg/dL, mean triglyceride level was 146.3 ± 87.9 mg/dL, and fasting glucose was above 100 mg/dL in 249 subjects (39.1%). Drivers exhibited reduced audiometric hearing at 4-8 kHz, being all sensorineural hearing loss. The clinical characterization of a young male population of interstate bus drivers revealed a high frequency of cardiovascular risk factors, as obesity, hypertension, hyperlipidemia, and hyperglycemia, as well as contributing functional characteristics, such as a low-intensity activity, sedentary behavior, long duration in a sitting position, and high-calorie diet, which lead to excessive weight gain and associated comorbidities.
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Affiliation(s)
- Raquel Pastréllo Hirata
- Rehabilitation Sciences Master and PhD Program, Nove de Julho University, Avenida Francisco Matarazzo, 612 Agua Branca, 05001-100 Sao Paulo, SP, Brazil. raquel
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Siu SC, Wong KW, Lee KF, Lo YYC, Wong CKH, Chan AKL, Fong DYT, Lam CLK. Prevalence of undiagnosed diabetes mellitus and cardiovascular risk factors in Hong Kong professional drivers. Diabetes Res Clin Pract 2012; 96:60-7. [PMID: 22225960 DOI: 10.1016/j.diabres.2011.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
Abstract
AIMS To investigate the prevalence of undiagnosed diabetes mellitus (DM) and cardiovascular risk factors among professional drivers in Hong Kong. METHODS Chinese professional drivers with no history of DM were invited to complete a questionnaire on their health status, followed by taking their body measurements, fasting blood glucose (FG) and lipids. 75g OGTT were performed when FG≥5.6 to <7.0mmol/L. RESULTS Of these 3376 drivers (male 92.6%, mean age 50.9±7.6 years), the prevalence of undiagnosed DM, prediabetes, and metabolic syndrome was 8.1% (272/3376, 95% CI 7.1-9.0%), 10.0% (337/3376, 95% CI 9.0-11.0%) and 26.8% (904/3376, 95% CI 25.3-28.3%) respectively, while the corresponding WHO Standard Population age-standardized prevalence was 7.8%, 9.0% and 24.7% respectively. Many of them were obese (51.2%), had hypertension (57.0%) and high cholesterol (58.7%), and a third had hypertriglyceridaemia (34.9%) and low HDL-cholesterol (29.3%). Their median working hours were 60.0 (IQR 14)h. Majority had exercise <1h/week (56.0%) and ate out ≥6times/week (54.9%). CONCLUSIONS Hong Kong professional drivers have higher prevalence of undiagnosed DM, cardiovascular risk factors and metabolic syndrome than the general population. Therefore, health care measures targeting against them should be taken to prevent and detect DM and cardiovascular diseases.
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Affiliation(s)
- S C Siu
- Diabetes Centre, Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, 19 Eastern Hospital Road, Hong Kong SAR, China.
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Abstract
INTRODUCTION The Occupational Hospitalization Register (OHR) is an ongoing register for research and surveillance established by the National Research Centre for the Working Environment in the 1980s. This review puts in perspective the contributions from the OHR to the understanding of relation between work and the burden of diseases in general and circulatory disease in particular. RESEARCH TOPICS This review covers selected topics in which studies based on OHR has contributed to the scientific knowledge during more than two decades. One PhD thesis and so far 49 OHR studies have contributed to the estimation of the excess fraction of several diseases attributable to work and to the identification of relative risks for occupational diseases like circulatory diseases, diseases of the nervous system, musculoskeletal disorders, pulmonary disease, infertility, and recently also mental disorders. CONCLUSION OHR is a cost-effective instrument for surveillance of health consequences of the working environment and social conditions as well as a valuable register for ad-hoc studies of the aetiology of occupational diseases.
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Affiliation(s)
- Finn Tüchsen
- National Research Centre for Working Environment, Copenhagen, Denmark.
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Schmucker U, Seifert J, Haasper C, Lob G, Matthes G, Stengel D, Ottersbach C, Frank M, Hinz P, Ekkernkamp A, Bernickel R. [Accidents, illness and injuries involved in road haulage : consequences for medical care and prevention]. Unfallchirurg 2011; 115:1022-30. [PMID: 21607793 DOI: 10.1007/s00113-011-1988-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reviews basic characteristics of road traffic crashes of heavy vehicles and the current health status of truck drivers. It summarises previous findings from research with a focus on orthopaedic diseases and injuries. These findings comprise a risky health behaviour and high prevalence of associated diseases which can be attributed to both the occupational framework and personal risk-taking behavioural patterns. These are of major importance given the increasing number of drivers and the consequences for acute care and prevention. On the other hand there is a substantial lack of medical care for the drivers on the road. Therefore this article presents the"DocStop Initiative" for medical care on the road, an initiative that runs an international network of care providers (http://www.docstop-online.eu).
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Affiliation(s)
- U Schmucker
- AG Prävention von Verletzungen der Deutschen Gesellschaft für Unfallchirurgie e.V., Berlin, Deutschland.
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Apostolopoulos Y, Sönmez S, Shattell MM, Belzer M. Worksite-induced morbidities among truck drivers in the United States. ACTA ACUST UNITED AC 2010; 58:285-96. [PMID: 20608567 DOI: 10.3928/08910162-20100625-01] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A critical review was conducted of social, psychological, and health science literature on the array of health risks and morbidities of truckers. Multilevel worksite-induced strains (e.g., long work hours and fatigue, shift work and sleep deprivation, postural fatigue and exposure to noise and vibration, sedentary lifestyle and unhealthy diet, exposure to diesel exhaust fumes, and other occupational stressors) were categorized into six primary morbidities for truckers: (1) psychological and psychiatric disorders; (2) detriments resulting from disrupted biological cycles; (3) musculoskeletal disorders; (4) cancer and respiratory morbidities; (5) cardiovascular disease; and (6) risk-laden substance use and sexual practices. Elevated morbidity risks suggest the need for the design and implementation of systematic epidemiological research and environmental interventions in the transport sector.
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Affiliation(s)
- Yorghos Apostolopoulos
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA.
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Abstract
A critical review was conducted of social, psychological, and health science literature on the array of health risks and morbidities of truckers. Multilevel worksite-induced strains (e.g., long work hours and fatigue, shift work and sleep deprivation, postural fatigue and exposure to noise and vibration, sedentary lifestyle and unhealthy diet, exposure to diesel exhaust fumes, and other occupational stressors) were categorized into six primary morbidities for truckers: (1) psychological and psychiatric disorders; (2) detriments resulting from disrupted biological cycles; (3) musculoskeletal disorders; (4) cancer and respiratory morbidities; (5) cardiovascular disease; and (6) risk-laden substance use and sexual practices. Elevated morbidity risks suggest the need for the design and implementation of systematic epidemiological research and environmental interventions in the transport sector.
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Chen CC, Shiu LJ, Li YL, Tung KY, Chan KY, Yeh CJ, Chen SC, Wong RH. Shift work and arteriosclerosis risk in professional bus drivers. Ann Epidemiol 2010; 20:60-6. [PMID: 19804986 DOI: 10.1016/j.annepidem.2009.07.093] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 06/23/2009] [Accepted: 07/01/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE Professional bus drivers are at increased risk for cardiovascular disease, but the underlying causes are unclear. Professional bus drivers often follow shift schedules. Especially, an association between shift work and early manifestations of cardiovascular disease has not been elucidated. Thus we investigated the links between shift work and arteriosclerosis risk in professional bus drivers. METHODS Questionnaires were administered to 184 bus drivers on demographic characteristics, lifestyle, and occupational history from 5 transportation companies in Taiwan. Brachial-ankle pulse wave velocity (baPWV) was measured using a volume-plethysmographic apparatus. Body mass index, waist circumference, biochemical variables, and blood pressure were also measured. RESULTS Arteriosclerotic risk factors (age, weekly driving hours, systolic blood pressure, diastolic blood pressure, and insulin level) differed in part among different groups of drivers. Long-term shift drivers had higher baPWV compared to regular drivers and short-term shift drivers (1594 cm/s vs. 1497 and 1432, p<0.01). Our multiple regression model showed that age (p<0.01) and diastolic blood pressure (p<0.01) were positively associated with baPWV in our professional drivers. After adjusting for all covariates, we observed that baPWV increased by 3.6 cm/s for per 1-year increment in years of shift driving. CONCLUSIONS Long-term shift work could increase the risk of arteriosclerosis in professional bus drivers. Larger studies would be necessary to provide further evidence regarding this finding.
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Affiliation(s)
- Chun-Chieh Chen
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan 40242
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Lee MLT, Whitmore G, Laden F, Hart JE, Garshick E. A case-control study relating railroad worker mortality to diesel exhaust exposure using a threshold regression model. J Stat Plan Inference 2009; 139:1633-1642. [PMID: 19221608 PMCID: PMC2642623 DOI: 10.1016/j.jspi.2008.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A case-control study of lung cancer mortality in U.S. railroad workers in jobs with and without diesel exhaust exposure is reanalyzed using a new threshold regression methodology. The study included 1256 workers who died of lung cancer and 2385 controls who died primarily of circulatory system diseases. Diesel exhaust exposure was assessed using railroad job history from the US Railroad Retirement Board and an industrial hygiene survey. Smoking habits were available from next-of-kin and potential asbestos exposure was assessed by job history review. The new analysis reassesses lung cancer mortality and examines circulatory system disease mortality. Jobs with regular exposure to diesel exhaust had a survival pattern characterized by an initial delay in mortality, followed by a rapid deterioration of health prior to death. The pattern is seen in subjects dying of lung cancer, circulatory system diseases, and other causes. The unique pattern is illustrated using a new type of Kaplan-Meier survival plot in which the time scale represents a measure of disease progression rather than calendar time. The disease progression scale accounts for a healthy-worker effect when describing the effects of cumulative exposures on mortality.
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Affiliation(s)
- Mei-Ling Ting Lee
- Biostatistics Division, College of Public Health, Ohio State University, Columbus, OH, USA
| | - G.A. Whitmore
- Desautels Faculty of Management, McGill University, Montreal, Canada
| | - Francine Laden
- Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Jaime E. Hart
- Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Eric Garshick
- Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, USA
- Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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Shibuya H, Cleal B, Mikkelsen KL. Work injuries among drivers in the goods-transport branch in Denmark. Am J Ind Med 2008; 51:364-71. [PMID: 18320581 DOI: 10.1002/ajim.20568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Goods-transport drivers in Denmark had an elevated rate of hospital contact due to injury compared with the skilled/semiskilled workforce in general in recent years. There is a need to elucidate the causes of their work injuries. METHODS We analyzed the Danish National Work Injury Register for the 10-year period 1993-2002. RESULTS The vast majority (92.6%) of the work injuries among goods-transport were sustained under non-traffic activities, that is, collecting, loading, unloading, and delivering goods. They fell from height (22.3%), suffered from overexertion (14.2%), got caught between/under objects (12.6%), collided with objects (12.0%), slipped/tripped (10.6%), or got struck by falling objects (9.0%). CONCLUSIONS There is a clear need for efforts to prevent work injuries under non-traffic activities among goods-transport drivers in Denmark. For this end, it is necessary to involve not only the drivers' employers for reinforcement of safety procedures, but also the employers' customers for improvement of the physical environment, in which drivers collect, load, unload, and deliver goods.
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Affiliation(s)
- Hitomi Shibuya
- National Research Centre for the Working Environment, Copenhagen, Denmark.
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Hospital Contacts Due to Injuries Among Male Drivers Working for Road Goods-Transport Contractors in Denmark. Int J Occup Med Environ Health 2008; 21:59-66. [DOI: 10.2478/v10001-008-0005-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Locomotor diseases among male long-haul truck drivers and other professional drivers. Int Arch Occup Environ Health 2007; 81:821-7. [DOI: 10.1007/s00420-007-0270-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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Laden F, Hart JE, Smith TJ, Davis ME, Garshick E. Cause-specific mortality in the unionized U.S. trucking industry. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:1192-6. [PMID: 17687446 PMCID: PMC1940099 DOI: 10.1289/ehp.10027] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 04/27/2007] [Indexed: 04/14/2023]
Abstract
BACKGROUND Occupational and population-based studies have related exposure to fine particulate air pollution, and specifically particulate matter from vehicle exhausts, to cardiovascular diseases and lung cancer. OBJECTIVES We have established a large retrospective cohort to assess mortality in the unionized U.S. trucking industry. To provide insight into mortality patterns associated with job-specific exposures, we examined rates of cause-specific mortality compared with the general U.S. population. METHODS We used records from four national trucking companies to identify 54,319 male employees employed in 1985. Cause-specific mortality was assessed through 2000 using the National Death Index. Expected numbers of all and cause-specific deaths were calculated stratifying by race, 10-year age group, and calendar period using U.S. national reference rates. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated for the entire cohort and by job title. RESULTS As expected in a working population, we found a deficit in overall and all-cancer mortality, likely due to the healthy worker effect. In contrast, compared with the general U.S. population, we observed elevated rates for lung cancer, ischemic heart disease, and transport-related accidents. Lung cancer rates were elevated among all drivers (SMR = 1.10; 95% CI, 1.02-1.19) and dockworkers (SMR = 1.10; 95% CI, 0.94-1.30); ischemic heart disease was also elevated among these groups of workers [drivers, SMR = 1.49 (95% CI, 1.40-1.59); dockworkers, SMR = 1.32 (95% CI, 1.15-1.52)], as well as among shop workers (SMR = 1.34; 95% CI, 1.05-1.72). CONCLUSIONS In this detailed assessment of specific job categories in the U.S. trucking industry, we found an excess of mortality due to lung cancer and ischemic heart disease, particularly among drivers.
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Affiliation(s)
- Francine Laden
- Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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Abstract
The widespread use of outsourcing in the service industry has major consequences for the employment relationship. In particular, outsourcing diminishes absolute employer control of firm operations. This article focuses on this new relationship through a study of the occupational health and safety requirements established in connection with the outsourcing of public bus transport in Denmark.
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Okunribido OO, Shimbles SJ, Magnusson M, Pope M. City bus driving and low back pain: a study of the exposures to posture demands, manual materials handling and whole-body vibration. APPLIED ERGONOMICS 2007; 38:29-38. [PMID: 17225292 DOI: 10.1016/j.apergo.2006.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A cross-sectional study was conducted to investigate worker exposure to posture demands, manual materials handling (MMH) and whole body vibration as risks for low back pain (LBP). Using validated questionnaire, information about driving experience, driving (sitting) posture MMH, and health history was obtained from 80 city bus drivers. Twelve drivers were observed during their service route driving (at least one complete round trip) and vibration measurements were obtained at the seat and according to the recommendations of ISO 2631 (1997), for three models of bus (a mini-bus, a single-decker bus, a double-decker bus). The results showed that city bus drivers spend about 60% of the daily work time actually driving, often with the torso straight or unsupported, perform occasional and light MMH, and experience discomforting shock/jerking vibration events. Transient and mild LBP (not likely to interfere with work or customary levels of activity) was found to be prevalent among the drivers and a need for ergonomic evaluation of the drivers' seat was suggested.
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Affiliation(s)
- Olanrewaju O Okunribido
- Department of Environmental and Occupational Medicine, Liberty Safework Research Centre, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZP, Scotland.
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Tüchsen F, Hannerz H, Roepstorff C, Krause N. Stroke among male professional drivers in Denmark, 1994-2003. Occup Environ Med 2006; 63:456-60. [PMID: 16735481 PMCID: PMC2092514 DOI: 10.1136/oem.2005.025718] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES (1) To estimate the relative risk of stroke among various groups of professional drivers; (2) to determine if any excess risk should be attributed to infarction or haemorrhage; (3) to estimate the relative risk ratio for stroke among professional drivers living in Greater Copenhagen compared to those living outside the metropolis. METHODS A cohort of 6285 bus drivers, 4204 car, taxi, and van drivers, and 25,879 heavy truck and lorry drivers were followed up for hospital admission due to stroke and sub-diagnoses in the period 1994-2003. Using hospital admission for all economically active men as the standard, the standardised hospitalisation ratios (SHR) were calculated, taking age and county into consideration. RESULTS There was a high SHR for stroke among all groups of professional drivers (SHR = 132; 95% CI 121-141). Among car, taxi, and van drivers the SHR was 157 (95% CI 132-189), among bus drivers it was 139 (95% CI 119-163), and among heavy truck and lorry drivers it was 124 (95% CI 113-136). The excess risk for all groups of professional drivers was highest for cerebrovascular infarction (SHR = 139; 95% CI 124-155) and lowest for non-traumatic intracranial haemorrhage (SHR = 113; 95% CI 96-133). The excess risks for all groups were significantly higher for cerebrovascular infarction than for non-traumatic intracranial haemorrhage (relative risk ratio (RRR) 1.23; 95% CI 1.01-1.51). The RRR of stroke among drivers in the metropolitan area compared to rural areas was 1.13 (95% CI 0.94-1.36). The RRR for stroke among car, taxi, and van drivers compared to drivers of heavy trucks and of lorries was 1.28 (95% CI 1.03-1.57). CONCLUSION All groups of professional drivers are at increased risk of stroke. The excess risk is more due to cerebral infarctions than to non-traumatic intracranial haemorrhage. The risk of stroke is higher among drivers carrying passengers than among drivers carrying goods.
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Affiliation(s)
- F Tüchsen
- Department of Surveillance and Epidemiology, National Institute of Occupational Health, Copenhagen Ø, Denmarkk.
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Chen JC, Chen YJ, Chang WP, Christiani DC. Long driving time is associated with haematological markers of increased cardiovascular risk in taxi drivers. Occup Environ Med 2006; 62:890-4. [PMID: 16299099 PMCID: PMC1740933 DOI: 10.1136/oem.2005.020354] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To examine the association between driving time and changes in haematological markers of increased risks for cardiovascular diseases (CVD). METHODS The authors conducted a cross sectional analysis of baseline data from the Taxi Drivers' Health Study cohort in Taipei, Taiwan. They retrieved information on comorbidity, laboratory tests, age, and anthropometric measures from medical records of 1157 subjects (mean age 44.6 (SD 8.6) years). Whole blood cell (WBC) count was used as the primary haematological marker for increased CVD risk, and platelet count and haematocrit as the secondary markers. Standardised questionnaires were implemented to collect information on demographics, lifestyle, work related physical and psychosocial factors, and driving time profiles. Multiple regression was used to estimate the adjusted effects of driving time on three haematological markers. RESULTS The mean measured hematological marker was 6656 (SD 1656) cells x10(6)/l for WBC, 47.2 (SD 3.5) % for hematocrit, and 243 (SD 52) cells x10(9)/l for platelets. The driving time was 264 (SD 76) hours/month. Compared with drivers who drove < or =208 hours/month (1st quartile cut off), drivers who drove >208 hours/month had a higher WBC count (by 317 x10(6)/l; 95% CI 99 to 535), haematocrit (by 0.8%; 95% CI 0.3 to 1.2), and platelets (7.9 x10(9)/l; 95% CI 1.0 to 14.8). After adjusting for conventional CVD risk factors (age, sex, smoking, hypertension, diabetes, and hypercholesterolaemia), obesity, alcohol drinking, regular exercise, and sociodemographics (education, marital status, income, and so on), long driving time was still associated with significant increases in WBC and platelets, whereas the effect on haematocrit was diminished and became statistically non-significant. Additional controls for physical workload, self-perceived job stress, and job dissatisfaction did not alter the associations with increased WBC and platelets. CONCLUSIONS Longitudinal studies are needed to confirm the observed cross sectional association and to further examine the specific occupational exposures accountable for the association between driving time and haematological markers of systemic inflammation and haemostatic alteration.
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Affiliation(s)
- J-C Chen
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
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Malinauskiene V, Grazuleviciene R, Nieuwenhuijsen MJ, Azaraviciene A. Myocardial infarction risk and occupational categories in Kaunas 25-64 year old men. Occup Environ Med 2002; 59:745-50. [PMID: 12409533 PMCID: PMC1740244 DOI: 10.1136/oem.59.11.745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To investigate the risk of a first time myocardial infarction (MI) among different occupational categories in 25-64 year old men in Kaunas, Lithuania, a country in a transition market economy. METHODS Case-control study among men aged 25-64 who were residents in Kaunas between 1997 and 2000. First time, non-fatal MI cases (n = 448) were identified from the MI hospital register (International Classification of Diseases, 10th revision, code I21). Controls (n = 1777) were selected and matched on age, gender, and city district of residence. Information was obtained on occupation, smoking, hypertension, psychosocial, and behavioural factors. The International Standard Classification of Occupations (ISCO) was used to code for occupational categories. The relation between MI and occupational categories was evaluated by logistic regression analysis, adjusting for a number of selected risk factors. RESULTS Legislators, senior officials, and managers (1st ISCO category) had a twofold increased risk for MI compared to craft and related trades workers (7th ISCO category) after adjustment for age, district, smoking, hypertension, obesity, stress, education, and employment duration. An increased risk for professionals (2nd ISCO category) and plant and machine operators and assemblers (8th ISCO category) was also observed. Employment duration in the last occupation for 20 years and more almost doubled the risk of MI in the whole population. We also found an increased risk for other traditional IHD risk factors such as smoking and arterial hypertension. CONCLUSIONS Differences in first time MI risk among occupational categories were found. Legislators, senior officials, and managers (1st ISCO category), professionals (2nd ISCO category), and plant and machine operators and assemblers (8th ISCO category) were at an increased risk. Differences in psychosocial factors in transition market economy countries may contribute to observed results.
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Affiliation(s)
- V Malinauskiene
- Laboratory of Environmental Epidemiology, Institute of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
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