Development of an interprofessional task-based learning program in the field of occupational health: a content validity study.

OBJECTIVE: One of the duties of the educational system is to provide situations in which students learn the tasks corresponding to their future careers in an interprofessional team. This study was designed to develop an interprofessional task-based training program. METHODS: This was a curriculum development study conducted by content validity methodology in two stages: 1) 'framework development' which resulted in the creation of the framework items; and 2) 'evaluation of the framework' (judgment and quantification). The first stage consisted of task identification, generation of sub-tasks, and assimilation of items into a usable format. The second stage consisted of the judgment -quantification of the content validity of items and the framework. After that, the framework of the tasks of the occupational health team was finalized in the expert panel. After explaining the tasks, a matrix for task-expected roles in the occupational health team and a matrix for task-required skills to perform each task were developed. The next step determined the appropriate teaching and assessment methods for each task. Finally, an expert panel reviewed and approved the components of the interprofessional task-based training program. RESULTS: Integrating the interprofessional education strategy with task-based learning was considered innovative in occupational health team training. In the development stage, 48 items were extracted, and then 35 tasks were generated in the step of identification of tasks. In the second step, 174 sub-tasks were developed. The tasks and sub-tasks were categorized into seven areas. After the stage of evaluation of the framework, 33 tasks were categorized into seven main areas, including "assessment and identification of workplace hazards" (n = 10), "control of occupational hazards" (n = 4), "determining the appropriate job position for each person" (n = 3), "occupational health examinations" (n = 6), "management of occupational/work-related diseases" (n = 5), "inter-organizational and inter-disciplinary relations, and legal judgment" (n = 3) and "education and scholarship in occupational health services" (n = 2). CONCLUSION: The results of the present study can be used in developing the use of the interprofessional strategy and task-based training as two appropriate strategies for the purposeful development of learners' abilities in the fields involved in providing occupational health services in their future careers.

The experiences of preparation and engagement of educators in teaching e-portfolio.

INTRODUCTION: A teaching e-portfolio is used to organize the collation and presentation of documents about teaching for the development and evaluation of educators. The current study was aimed at describing teaching e-portfolio components at Shahid Sadoughi University of Medical Sciences. As well, we examined the performance and experience of educators in engaging in the teaching e-portfolio. MATERIALS AND METHODS: This study was conducted at Shahid Sadoughi University in 2018-2022 in three main stages: (1) Development of the teaching e-portfolio; (2) Implementing teaching e-portfolio, and evaluating teaching documentation quantitatively; and (3) Exploration of educators' experiences by a conventional content analysis introduced by Graneheim and Lundman. The teaching e-portfolio was developed from the perspective of the components, domains, and criteria of scholarship of teaching and learning. The teaching e-portfolio documented the educational activities of educators in 12 areas, including philosophy of education (1 activity), curriculum planning (4 activities), evaluation (7 activities), teaching and learning (1 activity), e-learning (1 activity), professional development in education (1 activity), scholarly activities (2 activities), mentoring and counseling (3 activities), educational leadership (2 activities), education research (6 activities), education reform project (1 activity), and production of scholarship of teaching and learning (13 activities). The educators recorded the documentation of educational activities in their teaching e-portfolio. Their documentation was reviewed by two peers. The reviewers delivered constructive feedback to improve the educators' performance. The quantitative performance of educators in different activities in teaching e-portfolio was examined by descriptive tests (frequency and percentage). The experiences of educators were explored by the conventional content analysis approach which was introduced by Graneheim and Lundman. RESULTS: In the present study, 148 educators registered in the teaching e-portfolio. A total of 1488 documents of educational activities were registered in the e-portfolio from 2018 to 2022, and 55.24% of the activities received feedback in the peer review process. The experience of participants was categorized into a theme "fear and hope in utilizing teaching e-portfolio". This theme consisted of three categories: "motivational roadmap for personal and professional development in the future", "concern about the consequences of continuous monitoring", and "restriction of resources and capability as resistance sources". CONCLUSION: The current study showed that the participation of educators in a teaching e-portfolio was at an acceptable level. Support systems and educational policies played an effective role in guiding educators to participate in educational development activities. The educators perceived the teaching e-portfolio as a two-faceted tool. Teaching e-portfolio can provide a road map for their personal and professional development to achieve excellent teaching. As well, the teaching e-portfolio was recognized as a tool for continuous performance monitoring and detection of the inefficiency of teaching quality activities. This perception, along with limited resources such as time, weak technological literacy, and difficulty in working with electronic devices and systems, led to resistance from educators to involve in teaching e-portfolio.

Health risk assessment of inhalational exposure to heavy metals in drivers working in an urban desert city in the Middle East.

Heavy metals are threatening the lives of people around the world. This study aims to quantify the adverse health risks of seven heavy metals, including arsenic, cadmium, cobalt, chromium, lead, manganese, and nickel in taxi drivers in an urban desert city, Yazd, Iran. The exposure concentrations were determined through air sampling in the breathing zone of 40 randomly selected intercity taxi drivers, 20 in winter and 20 in summer, in 2019. An ICP-MAS spectrometer was applied to measure the elements. Target hazard quotient (THQ) and excessive cancer risk (ECR) indices were applied to calculate the non-cancer and cancer risks based on the United States Environmental Protection Agency (USEPA) guidelines, respectively. The results showed that arsenic and lead had the highest exposure concentrations among the seven measured heavy metals while cobalt and chromium metals had the lowest concentrations. Arsenic, cadmium, manganese, and nickel would probably cause some adverse non-carcinogenic health problems (THQ > 1) in the drivers over their working life. The percentile 95% ECR of measured heavy metals was 1.3E - 03 in total, which is much higher than the value of 1E - 06. The concentration of arsenic and nickel was higher in winter than in summer. Taxi drivers in Yazd city are at considerable health risk; therefore, swift and serious controlling measures should be taken by responsible authorities. Besides, the taxi drivers should be educated about heavy metals' health effects and their protective behaviors.

Decomposing socioeconomic inequality in poor mental health among Iranian adult population: results from the PERSIAN cohort study.

BACKGROUND: Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. METHODS: The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. RESULTS: The estimated E for poor mental health was - 0.012 (95% CI: - 0.0144, - 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. CONCLUSION: There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.

The effect of industrial noise exposure on attention, reaction time, and memory.

PURPOSE: Noise, a common physical hazard in many workplaces, may affect different aspects of human cognitive function. In this study, the effect of exposure to noise on some aspects of cognitive function was assessed in industrial workers. MATERIALS AND METHODS: This was a cross-sectional study on 84 individuals exposed to noise level higher than 85 dBA in a metal industry (noise group), comparing a group of workers from the same industry (n = 80) with exposure to noise level lower than 80 dBA (control group). The individuals in the noise group were classified as well according to noise intensity into: high exposure (90 dBA and higher) and low exposure (between 85 and 90 dBA). Selective attention score, divided attention score, selective response time, divided response time, and memory scale were measured before and after work shift. Data were analyzed by SPSS (Ver. 16) using Kolmogorov-Smirnov test, paired t test, Student's t test and Mann-Whitney U test were used to compare mean difference of the variables between two groups. p < 0.05 was considered as significant. RESULTS: All measured cognitive functions were significantly changed after work shift in the noise group and the difference was statistically significant between noise and control group. Exposure to higher noise intensity caused more change in cognitive function. CONCLUSION: Exposure to noise higher than 85 dBA affects some aspects of cognitive function (reaction time, attention and memory).

Association between noise exposure and diabetes: A systematic review and meta-analysis.

BACKGROUND: The prevalence of diabetes is on rise worldwide and environmental factors are being increasingly recognized to be involved in this rise. An emerging body of evidence has evaluated the impact of long-term exposure to noise on diabetes mellitus, highlighting the need to synthesize this evidence. OBJECTIVES: To systematically review and conduct meta-analysis of the available evidence on the association between long-term exposure to transport and occupational noise exposure and diabetes mellitus. METHODS: Selected databases were searched for available evidence published till September 13th, 2017 following MOOSE guidelines. The quality of articles was assessed using the Newcastle-Ottawa Scale. Random effects meta-analysis was applied to abstract combined estimates for diabetes mellitus per 5 dB increase in noise exposure. We evaluated the heterogeneity applying Cochran's Q test and quantified it using I2 statistic. Meta-regressions were conducted to identify sources of heterogeneity. Publication bias was evaluated using funnel plot and Egger's test. RESULTS: Fifteen studies met our inclusion criteria of which nine including five prospective cohorts, two cross-sectional and two case-control studies with a total number of 444460 adult participants and 17430 diabetes mellitus cases included in meta-analyses. We observed a 6% (95% confidence interval (CI): 3%, 9%) increase in the risk of diabetes mellitus per 5 dB increase in noise exposure regardless of its source. Source-specific analyses were suggestive for stronger associations for air traffic noise (combined odds ratio: 1.17; 95% CI: 1.06, 1.29 per 5 dB increase in exposure) flowed by road traffic noise (combined odds ratio: 1.07; 95% CI: 1.02, 1.12). We observed some indications of publication bias; however the findings were robust after trim and fill test. Meta-regression analyses showed that the adjustment in general, and not specifically related to air pollution, could predict the between-study heterogeneity in reported associations. CONCLUSIONS: The results indicate an increased risk of diabetes mellitus associated with noise exposure, mainly related to air and road traffic.

Anthropometric hand dimensions in a population of Iranian male workers in 2012.

BACKGROUND: The mismatch between the hand size of workers and the size of industrial instruments is a growing concern; it can lead to various musculoskeletal complications. Currently, there are few reliable studies available to address this concern in Iran. This study was conducted to measure 30 upper-extremity parameters in a group of Iranian industrial workers. METHODS: This study is a cross-sectional study on 529 workers. The study population was randomly selected from male Iranian industrial workers who were referred to the Yazd hospital occupational medicine clinic for surveillance evaluations. RESULTS: The M (SD) age of the participants was 30.13 (8.29) years. Statistical analysis was performed using the mean, standard deviation and 5th, 50th and 90th percentiles for each measured hand dimension. A considerable number of dimensions were significantly different between the measurements of right and left hands in each examinee. The results showed significant differences between Iranian hand size and that of other populations. CONCLUSION: This study provided a valuable databank of hand dimensions in a population of Iranian male workers. These data can be used by manufacturers in designing high-quality hand-tools and industrial gloves, taking into consideration Iranian worker characteristics.

Concurrent effect of noise exposure and smoking on extended high-frequency pure-tone thresholds.

OBJECTIVE: Concurrent effect of noise and smoking on hearing loss is a recent concern. In this study, the concurrent effect of noise and smoking on hearing loss in conventional frequencies and frequencies higher than 8 kHz was assessed. DESIGN: This was a cross-sectional study on workers exposed to noise who were divided into two groups: smokers and non-smokers. Hearing thresholds were assessed by conventional audiometry, and HFA. Data were analysed using non-parametric tests and Student's t-test. STUDY SAMPLE: There were 212 workers. RESULTS: Ninety-seven subjects were smokers and 115 individuals were non-smokers. All subjects were exposed to 92.1 ± 2.4 dBA (Leq8h). The highest threshold in conventional and high-frequency audiometry was observed at 6 kHz and 16 kHz, respectively. Hearing threshold at frequencies above 1 kHz was significantly higher in the smokers than non-smokers. There was no correlation between hearing thresholds and pack-years of smoking. CONCLUSIONS: Concurrent exposure to noise and smoking may be associated with more hearing loss than exposure to noise alone in the conventional and high frequencies. However, other differences between smokers and non-smokers may explain these differences as well.

Simultaneous effects of noise exposure and smoking on OAEs.

Noise is one of the most pervasive hazardous factors in the workplace. Noise-induced hearing loss (NIHL) is the most common disorder related to noise exposure. Smoking is probably associated with hearing loss. The simultaneous effect of noise and smoking on hearing is a recent concern. In this study, we assessed the simultaneous effect of noise and smoking on standard pure tone audiometry (PTA) and distortion product otoacoustic emissions (DP-OAEs). This was an historical cohort study on 224 workers exposed to noise who were divided into two groups: Smokers and nonsmokers. DP-OAE response amplitudes were assessed. Data were analyzed by SPSS software (version 19) using Student's t-test and Mann-Whitney U test. One hundred and five subjects were smokers (case group) and 119 individuals were nonsmokers (control group). All the subjects were exposed to 91.08 + 2.29 dBA [time-weighted average (TWA) for an 8 h work shift]. Mean DP-OAE response amplitude at frequencies higher than 1,000 Hz was significantly higher in the smokers than the nonsmokers. This study showed that smoking can aggravate the effect of noise on hearing in DP-OAEs.

Ergonomic intervention, workplace exercises and musculoskeletal complaints: a comparative study.

BACKGROUND: Musculoskeletal disorders are among the most prevalent occupational disorders in different jobs such as office work. Some interventions such as ergonomic modifications and workplace exercises are introduced as the methods for alleviating these disorders. In this study we compared the effect of ergonomic modifications and workplace exercises on musculoskeletal pain and discomfort in a group of office workers. METHODS: In an interventional study on office workers, the effect of two interventions was compared. Ergonomic modification consisted of correcting the arrangement of workstation and changing some equipment; workplace exercises included stretching exercises focusing on neck, shoulders, low back, and hand and wrist. Musculoskeletal complaints were assessed and compared before and after 1 month interventions. RESULTS: The frequency of musculoskeletal complaints was high before the study. Both interventions significantly reduced complaints in a similar manner except for low back pain which was reduced in exercise group more than the other group. CONCLUSION: In this study we found a beneficial short-term effect for both ergonomic modifications and stretching work-place exercises on reducing musculoskeletal pain in office workers.

Evaluation of respiratory system in textile-dyeing workers.

BACKGROUND: Despite the presence of many textile and dyeing plants in Iran, we couldn't find similar studies in this country. Forthermore, considering progress in the dyeing process and engineering controls, assessment of respiratory system is important for these workers. The present study was performed to evaluate the respiratory system in dyeing workers. METHODS: In a cross-sectional study, 101 dyeing workers (all dyeing workers in yazd) and 90 workers without respiratory exposures (control group), were evaluated. A questionnaire was filled for each participant included Venables questionnaire and some other questions about age, work experience, personal or familial history of asthma or atopy, acute and chronic respiratory symptoms; Then spirometry was performed before and after the shift work Results: The frequency of acute and chronic respiratory symptoms was significantly higher among dyeing workers than controls. According to the Venables questionnaire, 11.9% of the dyeing workers suffered from asthma. Means of FVC and FEV1 of pre-shift spirometry were lower than control (p< 0.001). Across-shift spirometry showed significant reduction of FVC (p< 0.001), FEV1 (p< 0.001), FEF25-75% (p= 0.05) and FEF25% (p= 0.007) in dyeing workers compared to the control group. CONCLUSION: Evaluation of dyeing workers' respiratory system in this study showed that despite development in dyeing processes and engineering controls, workers in this job show more prevalent acute and chronic symptoms, and across-shift changes in spirometric parameters were significantly higher in this work group than the control group. Therefore it is necessary to pay attention to the control of respiratory exposures in this job.

Noise-induced Hearing Loss: Continuous versus Impact/impulse Noise.

Background: Impact/impulse and continuous noise are two main causes of noise-induced hearing loss (NIHL) in workplaces. The aim of this study was to compare the effects of impulse/impact noise and continuous noise on hearing status. Methods: In this study, 259 workers referred to the occupational medicine clinic of Shahid Rahnemoun hospital, Yazd, Iran, entered the study and were divided into two groups: with exposure to impact/impulse noise and with exposure to continuous noise. Hearing thresholds were measured and compared between the two groups by pure-tone audiometry (PTA). The frequency of hearing loss and audiometric notch according to the results of PTA was compared between the two groups. Data were analyzed by SPSS (ver. 16) using Student's t-test, Chi-square test, and Mann-Whitney U test. Results: Hearing thresholds were significantly higher at all frequencies in the impact noise group. The hearing threshold at 6000 Hz was higher than other frequencies in both groups. The frequency of hearing loss at high frequencies was higher in the impact group. The frequency of audiometric notch was not significantly different between the two groups. Conclusions: The results of this study showed that hearing loss after exposure to impact/impulse noise is probably more frequent and more severe than exposure to continuous noise, but the pattern of hearing loss is similar in both types of noise exposure.

Effect of workplace noise on hearing ability in tile and ceramic industry workers in Iran: a 2-year follow-up study.

INTRODUCTION: Noise as a common physical hazard may lead to noise-induced hearing loss, an irreversible but preventable disorder. Annual audiometric evaluations help detect changes in hearing status before clinically significant hearing loss develops. This study was designed to track hearing threshold changes during 2-year follow-up among tile and ceramic workers. METHODS: This follow-up study was conducted on 555 workers (totally 1110 ears). Subjects were divided into four groups according to the level of noise exposure. Hearing threshold in conventional audiometric frequencies was measured and standard threshold shift was calculated for each ear. RESULTS: Hearing threshold was increased during 2 years of follow-up. Increased hearing threshold was most frequently observed at 4000, 6000, and 3000 Hz. Standard threshold shift was observed in 13 (2.34%), 49 (8.83%), 22 (3.96%), and 63 (11.35%) subjects in the first and second years of follow-up in the right and left ears, respectively. CONCLUSIONS: This study has documented a high incidence of noise-induced hearing loss in tile and ceramic workers that would put stress on the importance of using hearing protection devices.

Efficacy of low-level laser therapy in the management of tinnitus due to noise-induced hearing loss: a double-blind randomized clinical trial.

Background. Several remedial modalities for the treatment of tinnitus have been proposed, but an effective standard treatment is still to be confirmed. In the present study, we aimed to evaluate the effect of low-level laser therapy on tinnitus accompanied by noise-induced hearing loss. Methods. This was a double-blind randomized clinical trial on subjects suffering from tinnitus accompanied by noise-induced hearing loss. The study intervention was 20 sessions of low-level laser therapy every other day, 20 minutes each session. Tinnitus was assessed by three methods (visual analog scale, tinnitus handicap inventory, and tinnitus loudness) at baseline, immediately and 3 months after the intervention. Results. All subjects were male workers with age range of 30-51 years. The mean tinnitus duration was 1.85 ± 0.78 years. All three measurement methods have shown improved values after laser therapy compared with the placebo both immediately and 3 months after treatment. Laser therapy revealed a U-shaped efficacy throughout the course of follow-up. Nonresponse rate of the intervention was 57% and 70% in the two assessment time points, respectively. Conclusion. This study found low-level laser therapy to be effective in alleviating tinnitus in patients with noise-induced hearing loss, although this effect has faded after 3 months of follow-up. This trial is registered with the Australian New Zealand clinical trials registry with identifier ACTRN12612000455864).

An epidemiologic study on anthropometric dimensions of 7-11-year-old Iranian children: considering ethnic differences.

Anthropometric data can be used to identify the physical dimensions of equipment, furniture, clothing and workstations. The use of poorly designed furniture that fails to fulfil the users' anthropometric dimensions, has a negative impact on human health. In this study, we measured some anthropometric dimensions of Iranian children from different ethnicities. A total of 12,731 Iranian primary school children aged 7-11 years were included in the study and their static anthropometric dimensions were measured. Descriptive statistics such as mean, standard deviation and key percentiles were calculated. All dimensions were compared among different ethnicities and different genders. This study showed significant differences in a set of 22 anthropometric dimensions with regard to gender, age and ethnicity. Turk boys and Arab girls were larger than their contemporaries in different ages. According to the results of this study, difference between genders and among different ethnicities should be taken into account by designers and manufacturers of school furniture. PRACTITIONER SUMMARY: In this study, we measured 22 static anthropometric dimensions of 12,731 Iranian primary school children aged 7-11 years from different ethnicities. Descriptive statistics such as mean, standard deviation and key percentiles were measured for each dimension. This study showed significant differences in a set of 22 anthropometric dimensions in different genders, ages and ethnicities.

The relationship between noise-induced hearing loss and cognitive function.

INTRODUCTION: NIHL may affect some domains of cognitive function. This study was conducted to assess the relationship between NIHL and working memory, attention and response time. MATERIALS AND METHODS: This was a cross-sectional study on 154 textile workers with exposure to noise higher than 85dBA in a textile factory. The participants were divided into two groups: with and without NIHL and some domains of cognitive function were compared between two groups. Wechsler working memory test and Stroop color-word test were used to measure working memory, selective attention and response time. Data were analyzed by SPSS (ver. 24) using student's T test, and multiple linear regression model. RESULTS: Totally, 154 workers entered the study (77 with NIHL and 77 without NIHL). All participants were males. Working memory score and response time were higher and interference score was lower in NIHL group, although only the difference in working memory was significant. Due to the significant difference of age and work history between case and control groups, cognitive parameters were compared between two groups after adjusting for these two variables, but the significance was not changed. CONCLUSION: This study showed that noised-exposed middle-aged males with NIHL had probably a lower working memory span than their counterparts without NIHL.

Effective components of teachers' professionalism in viewpoints of various stakeholders.

BACKGROUND: The teacher must conduct educational responsibilities in the best way by observing the ethical principles to meet students' educational needs. The aim of the study was to investigate the main factors of professionalism among faculty members from the viewpoints of various stakeholders including learners, peers, and educational officials, as well as the components were assessed from the viewpoints of the stakeholders. MATERIALS AND METHODS: This was a descriptive analytical study conducted in two phases. In the first phase, a questionnaire was developed and validated to assess the professional behavior of faculty members. In the second phase, the evaluation of the teachers' professional behavior was done from the viewpoint of various stakeholders, including learners, middle and senior education managers and peers. The participants were faculty members from 10 schools enrolled in the study by census (n = 427). To extract the factors that constitute professional behavior in faculty members, exploratory factor analysis was used. Data were summarized using descriptive indices (mean, standard deviation, and percent). Exploratory factor analysis (EFA) was used to extract the factors that constitute professional behavior in faculty members. Data was analyzed by using SPSS software (version 23.0). RESULTS: In the first phase, the questionnaire with 11 items was developed. The validity and reliability of the tool was confirmed. The mean (SD) of the faculty members' scores was 4.54(±0.34), with a minimum score of 2.33 and a maximum score of 5.00. The highest scores of faculty members were reported in the items of "altruism to colleagues and students" and the lowest scores were related to "feedback seeking and feedback acceptance". Professional behavior was categorized under two domains: accountability to professional duties and adherence to professional values. Fifty percent of the participants followed the adherence to professional values (P = 0.22), but less than 50% of the individuals followed the adherence to professional duties significantly (P = 0.002). CONCLUSION: The results of the present study showed that adherence to professional duties was low in faculty members. Assessment of individuals' adherence in these two domains showed that faculty members' compliance in the domain of accountability to professional duties was significantly lower.

Association between different patterns of shift work and liver function tests: A cross-sectional analysis of Shahedieh PERSIAN cohort data, Iran, 2020.

BACKGROUND: Recent studies suggest that shift work may cause liver dysfunction. OBJECTIVE: This study aimed to examine the relationship between different patterns of shift work and elevated level of liver enzymes. METHODS: In this cross-sectional study, 1910 workers aged 35 to 70 years were selected with simple random sampling from 9978 participants of the recruitment phase of Shahedieh PERSIAN cohort study. Level of serum liver enzymes (ALT, AST, ALP, and GGT) and ALT/AST ratio was compared between shift workers and non-shift workers, and among employees working in different patterns of shift work. Data were analyzed by SPSS (version 21.0) using Student's T test, Mann-Whitney U test, chi-square test, Kruskal Wallis test, and logistic regression. RESULTS: Among 1347 males (71%) and 563 females (29%) with a mean age of 40.4±7.4 years, 469 were shift workers. Fixed evening type shift was the most common (30.3%) and fixed night-shift was the least common (0.9%) type of shift work. The mean blood levels of liver enzymes was not significantly different between shift workers and non-shift workers. In comparison between different patterns of shift work, the mean serum level of GGT was significantly higher in individuals with slow rotating shifts than those with fixed evening shifts, rapid rotating, split and fixed 24 hour shifts (p≤0.001). After adjusting for confounding factors only elevated AST was significantly higher in shift workers. CONCLUSION: There was only a significant association between shift work and elevated AST, and no relationship was found with ALT, ALP, GGT, and ALT/AST ratio.

Association between occupational noise exposure and diabetes: A systematic review and meta-analysis.

BACKGROUND: In addition to the well-known risk factors of diabetes, evidence is accumulating on the negative role of environmental and occupational factors such as noise exposure. We conducted a systematic review and meta-analysis on the association between long-term occupational noise exposure and diabetes. METHODS: We systematically searched evidence in PubMed, Scopus, and Web of Science (until August 2022) according to the PRISMA protocol. Risk of bias was assessed using the Newcastle-Ottawa scale. Random-effects meta-analysis was applied separately for risk ratio (odds ratio, relative risk) and hazard ratio. We evaluated the heterogeneity and publication bias. We applied meta-regressions to identify sources of heterogeneity. The overall body of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. RESULTS: Of 533 retrieved articles, twelve studies (11 on non-gestational, and one on gestational diabetes) on total 106,045 population (23,996 diabetic cases) met our inclusion criteria; of which eight studies were cross-sectional, three were cohorts, and one was case-control. Only 40% of papers (five out of 12) had fair, good or very good quality, and most of the papers had poor or very poor quality in terms of risk of bias. We observed a non-significant increased risk of diabetes in association with occupational noise exposure (combined risk estimates: 1.16, 95% confidence interval [CI]: 0.97: 1.34; I2 = 57.7%). Doing separate meta-analyses on cohort and rest of studies, we found similar findings (cohort studies (n = 3): combined risk estimate: 1.17; 95% CI: 0.84: 1.50; I2 = 79%; cross-sectional studies (n = 8): combined risk estimate: 1.26; 95% CI: 0.93: 1.58; I2 = 50.4%). We found no indication of publication bias. CONCLUSIONS: The overall evidence on the association between occupational noise exposure and diabetes is heterogeneous, limited, and mostly with low quality. More robust studies in terms of population selection, exposure and outcome assessment, and adjustment for confounders are necessary.