The burden of occupational injury attributable to high temperatures in Australia, 2014-19: a retrospective observational study.

OBJECTIVES: To assess the population health impact of high temperatures on workplace health and safety by estimating the burden of heat-attributable occupational injury in Australia. STUDY DESIGN, SETTING: Retrospective observational study; estimation of burden of occupational injury in Australia attributable to high temperatures during 2014-19, based on Safe Work Australia (work-related traumatic injury fatalities and workers' compensation databases) and Australian Institute of Health and Welfare data (Australian Burden of Disease Study and National Hospital Morbidity databases), and a meta-analysis of climate zone-specific risk data. MAIN OUTCOME MEASURE: Burden of heat-attributable occupational injuries as disability-adjusted life years (DALYs), comprising the numbers of years of life lived with disability (YLDs) and years of life lost (YLLs), nationally, by Köppen-Geiger climate zone, and by state and territory. RESULTS: During 2014-19, an estimated 42 884 years of healthy life were lost to occupational injury, comprising 39 485 YLLs (92.1%) and 3399 YLDs (7.9%), at a rate of 0.80 DALYs per 1000 workers per year. A total of 967 occupational injury-related DALYs were attributable to heat (2.3% of occupational injury-related DALYs), comprising 890 YLLs (92%) and 77 YLDs (8%). By climate zone, the heat-attributable proportion was largest in the tropical Am (12 DALYs; 3.5%) and Aw zones (34 DALYs; 3.5%); by state and territory, the proportion was largest in New South Wales and Queensland (each 2.9%), which also included the largest numbers of heat-attributable occupational injury-related DALYs (NSW: 379 DALYs, 39% of national total; Queensland: 308 DALYs; 32%). CONCLUSION: An estimated 2.3% of the occupational injury burden in Australia is attributable to high ambient temperatures. To prevent this burden increasing with global warming, adaptive measures and industry-based policies are needed to safeguard workplace health and safety, particularly in heat-exposed industries, such as agriculture, transport, and construction.

Incidence and mortality from malignant mesothelioma 1982-2020 and relationship with asbestos exposure: the Australian Mesothelioma Registry.

OBJECTIVES: Malignant mesothelioma is an uncommon cancer associated with asbestos exposure, predominantly occupational. Asbestos has been banned in Australia since 2003 but mesothelioma has a long latency and incident cases continue to present. The Australian Mesothelioma Registry was incepted to collect systematic data about incidence and mortality alongside asbestos exposure. METHODS: Benefiting from the Australian national system of cancer notification, all incident cases of mesothelioma in all states and territories are fast-tracked and notified regularly. Notified patients are contacted asking for consent to collect exposure information, initially by postal questionnaire and subsequently by telephone interview. Age-standardised annual incidence rates and mortality rates were calculated. Asbestos exposure was categorised as occupational, non-occupational, neither or, both; and as low, or high, probability of exposure. RESULTS: Mesothelioma incidence appears to have peaked. The age-standardised incidence rates have declined steadily since the early 2000s (peaking in males at 5.9/100 000 and in all-persons at 3.2/100 000), driven by rates in males, who comprise the majority of diagnosed cases. Rates in women have remained fairly stable since that time. Age-standardised mortality rates have followed similar trends. Mesothelioma remains the most common in those aged over 80 years. Nearly all (94%) cases were linked with asbestos exposure (78% occupational in men; 6.8% in women). CONCLUSIONS: With effective control of occupational asbestos use, the decline in age-standardised incidence and death rates has occurred. Incidence rates among women, in whom occupational asbestos exposure is rarely detectable, remain unchanged, pointing to the role of household and /or environmental asbestos exposure.

Impact of legislative reform on worker fatalities in New Zealand workplaces: a 30-year retrospective population-level analysis.

OBJECTIVES: To determine the impact of major legislative changes to New Zealand's Occupational Health and Safety (OHS) legislation with the adoption of the Robens model as a means to control occupational risks on the burden and risk of work-related fatal injury (WRFI). METHODS: Population-based comparison of WRFI to workers aged 15-84 years occurring during three periods: before (pre:1985-1992), after legislative reform (post-1:1993-2002) and after subsequent amendment (post-2:2003-2014). Annual age-industry standardised rates were calculated with 95% CI. Multivariable Poisson regression was used to estimate age-adjusted annual percentage changes (APC) for each period, overall and stratified by high-risk industry and occupational groups. RESULTS: Over the 30-year period, 2053 worker deaths met the eligibility criteria. Age-adjusted APC in rates of worker WRFI changed little between periods: pre (-2.8%, 95% CI 0.0% to -5.5%); post-1 (-2.9%, 95% CI -1.3% to -4.5%) and post-2 (-2.9%, 95% CI -1.3% to -4.4%). There was no evidence of differences in slope. Variable trends in worker WRFI were observed for historically high-risk industry and occupational groups. CONCLUSIONS: The rate of worker WRFI decreased steadily over the 30-year period under examination and there was no evidence that this pattern of declining WRFI was substantially altered with the introduction of Robens-styled OHS legislative reforms. Beyond headline figures, historically high-risk groups had highly variable progress in reducing worker WRFI following legislative reform. This study demonstrates the value in including prereform data and high-risk subgroup analysis when assessing the performance of OHS legislative reforms to control occupational risks.

Decade of fatal injuries in workers in New Zealand: insights from a comprehensive national observational study.

INTRODUCTION: Current priorities and strategies to prevent work-related fatal injury (WRFI) in New Zealand (NZ) are based on incomplete data capture. This paper provides an overview of key results from a comprehensive 10-year NZ study of worker fatalities using coronial records. METHODS: A data set of workers, aged 15-84 years at the time of death who died in the period 2005-2014, was created using coronial records. Data collection involved: (1) identifying possible cases from mortality records using selected external cause of injury codes; (2) linking these to coronial records; (3) retrieving and reviewing records for work-relatedness; and (4) coding work-related cases. Frequencies, percentages and rates were calculated. Analyses were stratified into workplace and work-traffic settings. RESULTS: Over the decade, 955 workers were fatally injured, giving a rate of 4.8 (95% CI 5.6 to 6.3) per 100 000 worker-years. High rates of worker fatalities were observed for workers aged 70-84 years, indigenous Maori and for males. Workers employed in mining had the highest rate in workplace settings while transport, postal and warehousing employees had the highest rate in work-traffic settings. Vehicle-related mechanisms dominated the mechanism and vehicles and environmental agents dominated the breakdown agencies contributing to worker fatalities. DISCUSSION: This study shows the rates of worker fatalities vary widely by age, sex, ethnicity, occupation and industry and are a very serious problem for particular groups. Future efforts to address NZ's high rates of WRFI should use these findings to aid understanding where preventive actions should be prioritised.

Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis.

Pediatric neuroblastoma (NB) patients receive multi-modal therapy and may experience care fragmented among multiple institutions with a significant travel burden, which has been associated with poor outcomes for some adult cancers. We hypothesized that fragmented care for pediatric NB patients is associated with inferior outcomes compared to treatment consolidated at one location. We reviewed paper and electronic records for pediatric NB patients who received ≥1 hematopoietic stem cell transplant (HSCT) at Duke from 1990-2017. Fragmented care was defined by treatment at >1 institution and grouped by 2 institutions vs. 3+ institutions. Distances were calculated using Google Maps. To compare all care groups, we used Fisher's Exact and Kruskal-Wallis tests for demographic and treatment characteristics, Kaplan-Meier for unadjusted overall survival (OS), and Cox proportional hazards for factors associated with OS. Of 127 eligible patients, 102 (80.3%) patients experienced fragmented care, with 17 treated at 3+ facilities. Kaplan-Meier analysis did not associate fragmented care with increased mortality (log-rank p = 0.13). With multivariate analysis, only earlier diagnostic decade and greater distance to HSCT remained significantly associated with worsened OS. In this single institutional study, we found fragmented care did not impact overall survival. Worsened overall survival was associated with increased travel distance for HSCT and further research should aim to improve supportive processes for patients undergoing HSCT for high-risk neuroblastoma.

Decade of variable progress: trends in fatal injury in workers in New Zealand from a national observational study.

INTRODUCTION: Analyses of secular trends in work-related fatal injury in New Zealand have previously only considered the total working population, potentially hiding trends for important subgroups of workers. This paper examines trends in work-related fatalities in worker subgroups between 2005 and 2014 to indicate where workplace safety action should be prioritised. METHODS: A dataset of fatally injured workers was created; all persons aged 15-84 years, fatally injured in the period 2005-2014, were identified from mortality records, linked to coronial records which were then reviewed for work relatedness. Poisson regression modelling was used to estimate annual percentage change in rates by age, sex, ethnicity, employment status, industry and occupation. RESULTS: Overall, worker fatalities decreased by 2.4% (95% CI 0.0% to 4.6%) annually; an average reduction of 18 deaths per year from baseline (2005). Significant declines in annual rates were observed for younger workers (15-29 and 30-49 years), indigenous Maori, those in the public administration and service sector, and those in community and personal service occupations. Increases in annual rates occurred for workers in agriculture and forestry and fisheries sectors and for labourers. Rates of worker deaths in work-traffic settings declined faster than in workplace settings. DISCUSSION: Although overall age-standardised rates of work-related fatal injury have been declining, these trends were variable. Sources of injury risk in identifiable subgroups with increases in annual rates need to be urgently addressed. This study demonstrates the need for regular, detailed examination of the secular trends to identify those subgroups of workers requiring further workplace safety attention.

The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study.

BACKGROUND: Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. METHODS: Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. RESULTS: Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. CONCLUSIONS: There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.

Fifteen-week window for recurrent muscle strains in football: a prospective cohort of 3600 muscle strains over 23 years in professional Australian rules football.

OBJECTIVES: To determine the rates of muscle strain injury recurrence over time after return to play in Australian football and to quantify risk factors. METHODS: We analysed Australian Football League player data from 1992 to 2014 for rates of the four major muscle strain injury types (hamstring, quadriceps, calf and groin) diagnosed by team health professionals. Covariates for analysis were: recent history (≤8 weeks) of each of the four muscle strains; non-recent history (>8 weeks) of each; history of hip, knee anterior cruciate ligament, knee cartilage, ankle sprain, concussion or lumbar injury; age; indigenous race; match level and whether a substitute rule was in place. RESULTS: 3647 (1932 hamstring, 418 quadriceps, 458 calf and 839 groin) muscle strain injuries occurred in 272 759 player matches. For all muscle strains combined, the risk of injury recurrence gradually reduced, with recurrence risks of 9% (hamstring), 5% (quadriceps), 2% (calf) and 6% (groin) in the first match back and remaining elevated for 15 weeks after return to play. The strongest risk factor for each muscle injury type was a recent history of the same injury (hamstring: adjusted OR 13.1, 95% CI 11.5 to 14.9; calf OR 13.3, 95% CI 9.6 to 18.4; quadriceps: OR 25.2, 95% CI 18.8 to 33.8; groin OR 20.6, 95% CI 17.0 to 25.0), followed by non-recent history of the same injury (hamstring: adjusted OR 3.5, 95% CI 3.2 to 3.9; calf OR 4.4, 95% CI 3.6 to 5.4; quadriceps OR 5.2, 95% CI 4.2 to 6.4; groin OR 3.5, 95% CI 3.0 to 4.0). Age was an independent risk factor for calf muscle strains (adjusted OR 1.6, 95% CI 1.3 to 2.0). Recent hamstring injury increased the risk of subsequent quadriceps (adjusted OR 1.8, 95% CI 1.2 to 2.7) and calf strains (OR 1.8, 95% CI 1.2 to 2.6). During the 'substitute rule' era (2011-2014), hamstring (adjusted OR 0.76, 95% CI 0.67 to 0.86), groin (OR 0.78, 95% CI 0.65 to 0.93) and quadriceps (OR 0.70, 95% CI 0.53 to 0.92) strains were less likely than outside of that era but calf (OR 1.6, 95% CI 1.3 to 1.9) strains were more likely than before the substitute rule era. CONCLUSION: Recent injury is the greatest risk factor for the four major muscle strains, with increased risk persisting for 15 weeks after return to play.

HIV prevalence and related behaviours of older people in Botswana - secondary analysis of the Botswana AIDS Impact Survey (BAIS) IV.

The focus of HIV interventions in Botswana, a country with the second highest prevalence of HIV in the world, remains targeted at those aged 15-49 years despite a growing cohort of older people living with the disease - driven largely by the successful roll-out of antiretroviral therapy (ART). Primarily utilising the Botswana AIDS Impact Survey IV, we set out to examine HIV related characteristics and behaviours of this often ignored older cohort (50-64 years) relative to younger (25-49 years) adults. Analysis revealed that more than 80% of older people living with HIV were on ART. HIV prevalence among this older cohort was 24.6% in 2013 compared to 35.1% among the younger cohort, p < 0.0001. Prevalence in older adults was higher among older males (27.8%) than females (21.9%), p = 0.02. Furthermore, 58.9% of older adults acknowledged being sexually active, with 59.0% of these admitting to inconsistent condom use during sexual intercourse. In addition to this low condom usage, older men (6.0%) were significantly more likely to be unaware of their HIV-positive status than older women (3.0%), p = 0.002. While HIV prevalence showed a dramatic increase among older men over time (17.2% in 2004, to 23.4% in 2008, to 27.8% in 2013), the trend was flatter among older women (16.3% in 2004, to 22.4% in 2008, to 21.9% in 2013). These trends are likely attributable to a large increase in ART coverage and uptake. Going forward, more targeted interventions acknowledging the ageing epidemic are important to consider.

Prevalence of occupational exposure to asthmagens derived from animals, fish and/or shellfish among Australian workers.

OBJECTIVE: Several animal, fish and/or shellfish derived substances encountered in the workplace can initiate or exacerbate asthma. The aims of this study were: to produce a population-based estimate of the current prevalence of occupational exposure to animal, fish and/or shellfish derived asthmagens, to identify the main circumstances of exposures and to identify occupations with the highest proportions of exposed respondents. METHODS: We used data from the Australian Work Exposure Study-Asthma, a national telephone survey that investigated the current prevalence of occupational exposure to asthmagens among Australian workers. A web-based tool was used to collect job task information and assign exposure to asthmagens, including animal, fish and/or shellfish derived asthmagens. Prevalence ratios to determine risk factors for exposure were estimated using modified Poisson regression. RESULTS: Of the 4878 respondents, 12.4% were exposed to asthmagens derived from animals, fish and/or shellfish. Exposure to these asthmagens was significantly higher in workers residing in regional and remote areas, compared with major cities. The main circumstance of exposure to animal derived asthmagens was through cleaning up rat/mice infestations, while the main circumstance of exposure to fish and/or shellfish derived asthmagens was through preparing and cooking salmon. Occupational groups with the highest proportion of exposure to animal or fish and/or shellfish derived asthmagens were farmers/animal workers and food workers, respectively. CONCLUSIONS: This is the first study investigating occupational exposure to animal, fish and/or shellfish derived asthmagens in a nationwide working population. The results of this study can be used to inform the direction of occupational interventions and policies to reduce work-related asthma.

The prevalence of exposure to high molecular weight asthmagens derived from plants among workers in Australia.

BACKGROUND: Limited information is available on exposure to high molecular weight (HMW) asthmagens derived from plants and on the main occupations and tasks that result in such exposure among workers. METHODS: Data were collected as part of the Australian Work Exposures Study-Asthma. We estimated adjusted prevalence ratios (aPR) using modified Poisson regression models to determine which factors were associated with exposure. RESULTS: A 12.8% of 4878 workers were exposed to HMW asthmagens derived from plants. The highest prevalence of exposure was found among farmers/animal workers, education workers, and food processing workers. The main circumstances of exposure were through handling flour, freesias, or through raising livestock. Exposure was more common among female workers (aPR = 1.26, 1.10-1.43) than males, while it was lower among workers born overseas (aPR = 0.70, 0.57-0.86) than those born in Australia. CONCLUSION: Prevention of exposure to HMW asthmagens derived from plants requires a broad strategy targeting different tasks and occupations.

Ultrasound Guidance Does Not Improve the Results of Shock Wave for Plantar Fasciitis or Calcific Achilles Tendinopathy: A Randomized Control Trial.

OBJECTIVE: To establish whether the use of ultrasound to direct shock waves to the area of greater calcification in calcaneal enthesopathies was more effective than the common procedure of directing shock waves to the point where the patient has the most tenderness. DESIGN: Two-armed nonblinded randomized control trial with allocation concealment. SETTING: The Sports Clinic at Sydney University. PATIENTS: Participants 18 years or older with symptomatic plantar fasciitis (PF) (with heel spur) or calcific Achilles tendinopathy (CAT). Seventy-four of 82 cases completed treatment protocol and 6-month follow-up. INTERVENTIONS: Patients were randomized to receive either ultrasound-guided (UG) or patient-guided (PG) shock wave at weekly intervals over 3 to 5 weeks. MAIN OUTCOME MEASURES: Reduced pain on visual analog scale (VAS) and improved functional score on Maryland Foot Score (MFS) (for PF) or Victorian Institute of Sport Assessment-Achilles (VISA-A) (for CAT). Follow-up was at 6 weeks and 3 and 6 months. RESULTS: Comparative 6-month improvements in MFS for the 47 PF cases were PG +20/100 and UG +14/100 (P = 0.20). Comparative 6-month improvement in VISA-A score for the 27 CAT cases were PG +35/100 and UG +27/100 (P = 0.37). Comparative (combined PF and CAT) 6-month improvement in VAS pain scores for all 38 PG cases were +38/100 with +37/100 for all 36 UG shock wave cases. CONCLUSIONS: Although both treatment groups had good clinical outcomes in this study, results for the 2 study groups were almost identical. CLINICAL RELEVANCE: This study shows that there is no major advantage in the addition of ultrasound for guiding shock waves when treating calcaneal enthesopathies (PF and CAT).

Global Mortality From Firearms, 1990-2016.

Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions. Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. Design, Setting, and Participants: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Exposures: Firearm ownership and access. Main Outcomes and Measures: Cause-specific deaths by age, sex, location, and year. Results: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35). Conclusions and Relevance: This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.

Isocyanates in Australia: Current exposure to an old hazard.

Exposure to isocyanates has consistently been reported as the most common cause of occupational asthma. The objectives of this study were to assess how many Australian workers are currently exposed to isocyanates, identify the occupations with highest proportion of exposed workers and identify the main circumstances of exposures. Data comes from the Australian Workplace Exposure Study-Asthma, a national telephone survey which explored the prevalence of current occupational exposure to 227 asthmagens, grouped into 27 groups, among current Australian workers aged 18-65 years. A web-based tool, OccIDEAS, was used to collect job task information and to assign exposure to asthmagens, including isocyanates. Of the 4,878 eligible participants, 2.5% of them were deemed to be probably exposed to isocyanates at work in their current job (extrapolated to 3.0% of the Australian working population). The majority of those exposed were males (90.8%). The most common tasks undertaken that led to these exposures were using expanding foam fillers/sprays and isocyanate and/or polyurethane paints. Exposure occurred mainly among construction workers, wood workers, and painters or printers. This study investigating occupational exposure to isocyanates in a national working population provides information that can be used to inform the direction of occupational interventions and policies to decrease occupational asthma.

Prevalence of exposure to occupational carcinogens among farmers.

INTRODUCTION: Farmers experience a range of carcinogenic exposures, including some pesticides, fuels, engine exhausts, metals, some organic solvents, silica, wood dusts and solar radiation. However many studies investigating the risk of cancer in farmers focus on pesticide exposure alone. The aim of this study was to determine which carcinogens Australian farmers are exposed to, the prevalence and circumstances of those exposures, and the use of protective equipment. METHODS: The study used data from the Australian Work Exposures Study (AWES) a cross-sectional study conducted in 2012 that investigated the prevalence of carcinogen exposure among Australian workers. This was supplemented with data from AWES-Western Australia (WA), conducted in 2013, which followed the same methodology but in Western Australian workers only. A total of 5498 Australian workers were interviewed about the tasks they carry out in their workplace. The 166 participants who worked in farming (126 men and 40 women, with an age range of 18-65 years) are the focus of this article. RESULTS: On average, farmers had been exposed to five different carcinogens. Highest numbers of exposures occurred among men and those working on mixed crop and livestock farms. Solar radiation, diesel engine exhaust and certain solvents were the most prevalent exposures, each with over 85% of farmers exposed. The main tasks leading to exposure were working outdoors, using and repairing farming equipment and burning waste. Sun protection and closed cabs on machinery were the most frequently used forms of protection. CONCLUSIONS: Farmers are a high risk group in relation to carcinogen exposure. The variation in tasks that they undertake results in exposure to a wide variety of different carcinogens that require similarly varied control measures.

Effects of Aging on Musical Performance in Professional Orchestral Musicians.

BACKGROUND: The physical and psychological demands of playing a musical instrument are likely to be affected by age-related decline in function, including physical, cognitive, psychological, and organ-related changes. However, the complex neurophysiological demands of playing a musical instrument may delay many normal aging-related changes. AIM: This study compared professional classical musicians of different ages, using a range of physical and psychological measures, to discover how increasing age might affect work performance and to identify possible risk and protective factors for physical and psychological health as the musicians age. SUBJECTS: 377 professional orchestral musicians from eight Australian orchestras (70% response rate), ages 18 to 68 yrs (mean 42.1). Multiple standardized physical and psychological tools were used to evaluate the impact of age on a range of physical and mental health variables. RESULTS: Age was not statistically associated with frequency or severity of performance-related musculoskeletal disorders, ratings of perceived exertion, QuickDASH scores, use of beta-blockers, workplace satisfaction, and most psychological tests. Differences were observed on SPIN (social anxiety) scores, with lowest scores in the oldest age group (10.66 in 55+ yrs vs 17.83 in 18-30 yrs, p=0.016). Older musicians had higher BMIs and fewer practice sessions per day than younger musicians and also were more likely to consume alcohol on 5+ days/wk (44% vs 9%, p=0.003). CONCLUSION: Advancing age does not appear to exert undue negative impacts on physical and psychological health or performance capacity of professional orchestral musicians. However, dwindling numbers in the older age groups may suggest a "survivor" effect, whereby those who develop significant age-related decrements may cease professional performance at earlier ages. Longitudinal studies on the professional trajectories of professional orchestral musicians are needed to explore this question further.

Estimation of the global burden of mesothelioma deaths from incomplete national mortality data.

BACKGROUND: Mesothelioma is increasingly recognised as a global health issue and the assessment of its global burden is warranted. OBJECTIVES: To descriptively analyse national mortality data and to use reported and estimated data to calculate the global burden of mesothelioma deaths. METHODS: For the study period of 1994 to 2014, we grouped 230 countries into 59 countries with quality mesothelioma mortality data suitable to be used for reference rates, 45 countries with poor quality data and 126 countries with no data, based on the availability of data in the WHO Mortality Database. To estimate global deaths, we extrapolated the gender-specific and age-specific mortality rates of the countries with quality data to all other countries. RESULTS: The global numbers and rates of mesothelioma deaths have increased over time. The 59 countries with quality data recorded 15 011 mesothelioma deaths per year over the 3 most recent years with available data (equivalent to 9.9 deaths per million per year). From these reference data, we extrapolated the global mesothelioma deaths to be 38 400 per year, based on extrapolations for asbestos use. CONCLUSIONS: Although the validity of our extrapolation method depends on the adequate identification of quality mesothelioma data and appropriate adjustment for other variables, our estimates can be updated, refined and verified because they are based on commonly accessible data and are derived using a straightforward algorithm. Our estimates are within the range of previously reported values but higher than the most recently reported values.

Australian work exposures studies: occupational exposure to pesticides.

BACKGROUND: Pesticides are widely used in some occupational settings. Some pesticides have been classified as carcinogens; however, data on the number of workers exposed to pesticides are not available in Australia. The main aim of this study was to estimate the current prevalence of pesticide exposure in Australian workplaces. METHODS: The analysis used data from the Australian Work Exposures Study, a series of nationwide telephone surveys which investigated work-related prevalence and exposure to carcinogens and asthmagens, including pesticides, among current Australian workers. Information about the respondents' current job and various demographic factors was collected in a telephone interview using the web-based tool OccIDEAS. Workers were considered exposed to pesticides if they reported applying or mixing pesticides in their current job. RESULTS: Of the 10 371 respondents, 410 (4%) respondents were assessed as being exposed to pesticides in the workplace, with exposure being more likely among males, individuals born in Australia, individuals with lower education level and those residing in regional or remote areas. Glyphosate was the most common active ingredient used by workers. CONCLUSIONS: This is the first study to describe the prevalence of occupational pesticide exposure in Australia and one of the few recent studies internationally.

Is cost a structural barrier preventing men who have sex with men accessing condoms? A systematic review.

A systematic review was undertaken to determine whether cost is a structural barrier preventing men who have sex with men (MSM) accessing condoms. Studies were examined from a range of countries where condoms have been distributed free to particular populations and also those where condoms were available at a cost to the individual. The study inclusion criteria were: published between January 1990 and September 2014 inclusive; published in any language, discussed cost as a barrier to condom use, discussed cost barriers to MSM accessing condoms and included a measure of outcome. Articles were systematically extracted from MEDLINE, Embase, PyschINFO and Informat using the five search terms; Male Homosexuality, Access, Cost, Cost and Cost analysis, Condoms. Sixty-four articles were initially identified and 11 included in the final review. The included studies used cost-utility analysis, qualitative, cross-sectional, cohort or randomised control trial design. Large-scale free distribution programmes and smaller targeted programmes showed positive correlations in reducing the burden of disease from HIV and other sexually transmitted infections through eliminating the issue of cost. Decreasing the cost of condoms, and providing them for no cost, appears to increase their utilisation amongst MSM and possibly reduce the burden from HIV and other sexually transmitted infections. Inequality and stigma remain important barriers to MSM accessing and using condoms particularly in the developing world.

Incidence and survival trends for malignant pleural and peritoneal mesothelioma, Australia, 1982-2009.

BACKGROUND: Australia is known to have had one of the highest per-capita asbestos consumption rates, yet there are few contemporary reports on malignant mesothelioma trends. METHODS: Data on 10 930 people with malignant pleural mesothelioma (MPM) and 640 people with malignant peritoneal mesothelioma diagnosed in Australia during 1982-2009 were analysed. Observed incidence rate trends were quantified. Incidence rates were projected up to 2030 using observed incident cases during 1982-2012. The relative per-decade change in excess mortality during 1999-2009 was estimated. RESULTS: During 1982-2009, acceleration in MPM age-standardised incidence rates were highest for women and those aged 75 years and above, with average annual percentage changes of +4.9 (95% CI 3.6 to 6.2) and +7.2 (95% CI 5.4 to 9.0), respectively. Age-standardised incidence rates for men with MPM aged 0-64 years decelerated rapidly during 2003-2009, an average annual percentage change of -5.1% (95% CI -7.6% to -2.5%). Overall, male age-specific MPM incidence rates in the age group of 65-74 year during 2010-2030 are projected to decline with rates projected to increase for older men and women with MPM. There was a statistically significant 16% relative reduction in the excess mortality rate (EMR) up to 5 years postdiagnosis for people diagnosed with malignant pleural and peritoneal mesothelioma combined in 2009 compared with those diagnosed in 1999, an EMR ratio of 0.84 (95% CI 0.77 to 0.92). CONCLUSIONS: Australia's malignant mesothelioma incidence rates appear to have reached maximum levels but with differences over time by age, gender and tumour location. Improvements over time in survival provide a glimpse of hope for this almost invariably fatal disease.