Carpal tunnel syndrome among Manitoba workers: Results from the Manitoba Occupational Disease Surveillance System.

BACKGROUND: Carpal tunnel syndrome (CTS) is associated with occupational high-force repetitive tasks and vibration. This project examines the relationship between CTS and work to: (1) identify jobs and industries with increased CTS risk; (2) explore whether there is a sex difference in the risk of CTS after controlling for occupation; and (3) determine whether any observed relationships persist after excluding Workers Compensation Board (WCB) accepted time-loss CTS claims. METHODS: We linked 95.5% of time-loss WCB claims from 2006 to 2019 to provincial administrative health data. The cohort included 143,001 unique person-occupation combinations. CTS cases were defined as at least two medical claims for (ICD-9 354) within a 12-month period or a surgical claim for CTS from 2 years before the WCB claim to 3 years after. WCB accepted CTS time-loss claims not identified by the medical claims were also included. RESULTS: A total of 4302 individuals (3.0%) met the CTS definition. Analysis revealed that the hazard ratios (HRs) of CTS vary considerably with occupation. Sex-based differences in CTS risks were observed, both in low- and high-risk occupations. In many occupations with increased HR, the HR remained elevated after excluding accepted time-loss WCB cases. CONCLUSIONS: The risk of developing CTS varied with occupation. Job titles with ergonomic risk factors had higher risks than those with lower exposures. This finding remained after eliminating time-loss compensated WCB cases, suggesting that all cases of CTS in high risk jobs are not identified in WCB statistics. Female workers in some job titles had excess CTS cases compared to male workers within the same job title.

A qualitative review of social media sharing and the 2022 monkeypox outbreak: did early labelling help to curb misinformation or fuel the fire?

BACKGROUND: Misinformation, defined as a claim that is false or misleading, considers information that is both shared with the intention of causing harm, and information that is false with no ill intent. Early attempts to downplay the risk of monkeypox (mpox) by singling out men who have sex with men (MSM) may have had the ill effect of stigmatising this group in discussions online. The aim of this study was to evaluate themes present on Instagram related to the 2022 mpox outbreak under #monkeypox. Specifically, this study sought to determine if the pervasive narratives surrounding the coronavirus disease 2019 (COVID-19) pandemic, particularly related to government mistrust and conspiracy, were penetrating discussions about mpox. METHODS: A total of 255 posts under #monkeypox (the top 85 posts per day, every 10days in July 2022) were collected on Instagram. A content analysis approach, which seeks to quantify themes present, was utilised to evaluate themes present in posts under #monkeypox. RESULTS: Contrary to previous research investigating public health misinformation online, the majority of posts under #monkeypox were categorised as accurate information (85.9%). Moreover, a surprising number of posts were classified as anti-misinformation (32.9%), whereby users actively worked to debunk false information being shared online related to mpox. CONCLUSIONS: We hypothesise that early labelling of the disease as one that strictly affects online MSM communities has resulted in the digital community coming together to fact-check and debunk misinformation under #monkeypox on Instagram.

Time spent in the sun and the risk of developing non-Hodgkin lymphoma: a Canadian cohort study.

PURPOSE: The objective was to explore the relationship of sun behavior patterns with the risk of developing non-Hodgkin lymphoma (NHL). METHODS: Sun behavior information from Alberta's Tomorrow Project, CARTaGENE, and Ontario Health Study were utilized. The relationship between time in the sun during summer months and risk of NHL was assessed using Cox proportional hazard models with age as the time scale and adjustment for confounders. Cohorts were analyzed separately and hazard ratios (HR) pooled with random effects meta-analysis. Joint effects of time in the sun and use of sun protection were examined. Patterns of exposure were explored via combinations of weekday and weekend time in the sun. RESULTS: During an average follow-up of 7.6 years, 205 NHL cases occurred among study participants (n = 79,803). Compared to < 30 min daily in the sun, we observed HRs of 0.84 (95% CI 0.55-1.28) for 30-59 min, 0.63 (95% CI 0.40-0.98) for 1-2 h, and 0.91 (95% CI 0.61-1.36) for > 2 h. There was suggestive evidence that > 2 h was protective against NHL with use of sun protection, but not without it. Compared to < 30 min daily, moderate exposure (30 min to 2 h on weekdays or weekend) was associated with a lower risk of NHL (HR 0.63, 95% CI 0.43-0.92), while intermittent (< 30 min on weekdays and > 2 h on weekends) and chronic (> 2 h daily) were not. CONCLUSION: This study provides evidence of a protective effect of moderate time spent in the sun on NHL risk.

Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: A review of the literature.

The LGBTQ+ community is at higher risk of certain cancers but is less likely to participate in screening programs or engage with preventive healthcare. Despite this, the barriers and facilitators to cancer screening are not well understood in this population. We conducted a literature review of research related to LGBTQ+ participation in cancer screening, as well as barriers and facilitators to participation. Following abstract and full-text screening, 50 studies were included in the final synthesis. Compared to their heterosexual counterparts, lesbian and bisexual women were less likely to participate in cervical cancer screening and mammography, but gay and bisexual men were more likely to participate in anal and colorectal cancer screening. Transgender individuals had lower rates of screening than cisgender individuals for all cancer types. Barriers to participation were found at the individual-, provider-, and administrator-level, and good communication with a healthcare provider was the strongest facilitator. These results provide reasonable first steps toward improving participation rates for LGBTQ+ populations in cancer screening. Patient-centered approaches should draw on core guiding principles to inform the provision of care, including anticipating LGBTQ+ patients, improving knowledge about care for these patients, and confronting individually-held biases that may affect care, in order to improve care experiences and participation rates in preventive services.

Exposure to low-dose radiation in occupational settings and ischaemic heart disease: a systematic review and meta-analysis.

Ionising radiation is a human carcinogen, but the evidence is less clear that exposure to low-dose ionising radiation (LDIR) increases the risk of adverse cardiovascular outcomes. We synthesised the literature of chronic occupational exposure to LDIR and cardiovascular disease, particularly for ischaemic heart disease (IHD).The literature search was conducted using three databases including studies published between 1990 and 2022. A quality assessment of the studies was completed using the Office of Health and Assessment and Translation Risk of Bias Rating Tool. We conducted meta-analyses for IHD mortality using random effects models using measures of excess relative risk per sievert (ERR/Sv) obtained from internal cohort comparisons, as well as with standardised mortality ratios (SMRs) from external cohort comparisons.We identified 2189 articles, and of these, 26 provided data on IHD and were retained. Most studies were classified as having a 'moderate' level of risk of bias. Fourteen and 10 studies reporting external radiation doses were included in meta-analyses using SMR and ERR/Sv, respectively. The meta-summary SMR was 0.81 (95% CI 0.74 to 0.89) with evidence of reduced risk but high heterogeneity across studies. For internal cohort measures, the summary ERR/Sv for a lagged exposure of 10 years was 0.10 (95% CI 0.01 to 0.20) with low heterogeneity. The subgroup analysis by lagged exposure time showed the strongest association were for the 15 and 20 years lag.Our findings suggest that occupational exposure to LDIR increases the risk IHD mortality and highlight the relevance of internal cohort comparisons.

Daily changes in ambient air pollution concentrations and temperature and suicide mortality in Canada: Findings from a national time-stratified case-crossover study.

INTRODUCTION: Worldwide, approximately 1900 people die by suicide daily. Daily elevations in air pollution and temperature have previously been linked to a higher risk of death from suicide. To date, there have been relatively few studies of air pollution and suicide, particularly at a national level. National analyses play an important role in shaping health policy to mitigate against adverse health outcomes. METHODS: We used a time-stratified case-crossover study design to investigate the influence of short-term (i.e., day to day) interquartile range (IQR) increases in air pollutants (nitrogen dioxide [NO2], ozone [O3], and fine particulate matter [PM2.5]) and temperature on suicide mortality in Canada between 2002 and 2015. For air pollution models, odds ratios (ORs) derived from conditional logistic regression models were adjusted for average daily temperature, and holidays. For temperature models, ORs were adjusted for holidays. Stratified analyses were undertaken by suicide type (non-violent and violent), sex, age, and season. RESULTS: Analyses are based on 50,800 suicide deaths. Overall, temperature effects were stronger than those for air pollution. A same day IQR increase in temperature (9.6 °C) was associated with a 10.1% increase (95% confidence interval (CI): 9.0%-11.2%) of death from suicide. For 3-day average increase of O3 (IQR = 14.1 ppb), PM2.5 (IQR = 5.6 µg/m3) and NO2 (IQR = 9.7 ppb) the corresponding risks were 4.7% (95% CI: 3.9, 5.6), 3.4% (95% CI: 3.0, 3.8), and 2.0% (95% CI: 1.1, 2.8), respectively. All pollutants showed stronger associations with suicide during the warmer season (April-September). Stratified analyses revealed stronger associations for both temperature and air pollution in women. CONCLUSIONS: Daily increases in air pollution and temperature were found to increase the risk of death from suicide. Females, particularly during warmer season, were most vulnerable to these exposures. Policy decisions related to air pollution and climate change should consider effects on mental health.

Acute myocardial infarctions identified in the Manitoba Occupational Disease Surveillance System: A linkage of worker's compensation and provincial health data.

INTRODUCTION: The purpose of this study was to identify jobs and industries that may be associated with increased or decreased risk of myocardial infarction. METHODS: We linked provincial health care data with Workers Compensation Board (WCB) of Manitoba claims data to create the Manitoba Occupational Disease Surveillance System (MODSS). Workers were eligible for inclusion in this study if their WCB claim listed an occupation, their claim could be linked to health data, they had an accepted non-acute myocardial infarction (AMI) compensation time loss claim and were free of a recent (<1 year) AMI diagnosis at the start of disease follow-up. AMI cases were identified as the most-responsible diagnosis in the hospitalization file (ICD-9 410 or ICD-10 I20). Cases were included if they occurred after the WCB record injury date until end of coverage, either through moving out of province, reaching age 65, death, or the end of the study period (March 1, 2020). RESULTS: We identified 1880 incident AMIs amongst 150,022 claims recorded in the MODSS (1.25%). A number of industries and occupations were found to have higher and lower AMI rates. Care providers and educational, legal, and public protection support occupations had a lower hazard ratio (HR; 0.64; 95% confidence interval [CI]: 0.44-0.92) compared to the overall cohort. Female chefs and cooks, and male butchers and bakers had elevated AMI HRs. Both male and female transport and heavy equipment operators and related maintenance occupations had increased HRs (1.48; 95% CI: 1.30-1.67). Often male and female workers employed in the same occupations had congruent AMI risks, but this was not always the case. CONCLUSIONS: The linkage of a WCB data set with provincial health claims data led to the identification of a number of occupations with elevated risks of AMI in Manitoba. This was most notable in the transportation industry. Identifying work areas with increased risk of AMIs could lead to targeted educational efforts and potential workplace modifications to lower this risk.

Timely diagnostics and safe procedures in children with anterior mediastinal masses (AMMs): a qualitative review of the AMM protocol at BC Children's Hospital in Vancouver BC.

The presence of an anterior mediastinal mass should prompt rapid triage, workup and treatment to effectively manage and prevent emergent complications. Implementation of an AMM protocol can ensure the response is standardized and coordinated. Importantly, such a protocol can encourage prompt multi-disciplinary communication to mitigate risks associated with procedures required for timely diagnosis. The aim of this review is to evaluate the BC Children's Hospital's Pediatric New/Suspected Anterior Mediastinal Mass (AMM) Protocol. Retrospective chart review was conducted for 18 patients admitted from February 2016 to May 2020 with AMM for whom the protocol was enacted. Primary parameters assessed presence of high-risk feature at time of presentation, time from admission and/or protocol activation to specific time points, including imaging, first diagnostic procedure, and diagnosis. Data regarding perioperative management, including anesthetic considerations and peri-operative complications, was also collected. Mean time from protocol activation to first diagnostic procedure and diagnosis were 1.88 days (range 0-7) and 2.24 days (range 0-7), respectively. The majority of procedures were conducted under sedation (n = 77, 64%), followed by general anesthetic (GA; n = 34, 28%) and local anesthetic (n = 10, 8%). Despite 15 cases having more than one high risk feature, pre-operative steroids were only administered for four of the total 158 procedures (3%) and extracorporeal life support (ECLS) and otolaryngology (ENT) were only required for immediate availability for seven procedures (4%). Furthermore, only 10 procedures (8%) had associated complications and none of these complications resulted in patient death. Our data demonstrate that implementation of a streamlined multi-disciplinary protocol can expedite time to diagnosis without impacting patient safety.

Short-term changes in meteorological conditions and suicide: A systematic review and meta-analysis.

BACKGROUND: Suicide is a leading cause of death, particularly for young adults. Suicidal behaviours are influenced by a wide-range of personal, social, and cultural factors. Emerging evidence suggests that daily changes in meteorological conditions, including temperature, increases the risk of suicide. METHODS: We conducted a systematic review and meta-analysis of studies that examined associations between either daily, or weekly, variations for eight meteorological variables and suicide outcomes (attempts, or deaths). Meta-analytic methods were applied to derive summary measures of association using random effect models. We assessed the heterogeneity in these associations by region and biological sex. RESULTS: We identified 29 studies of suicide. Of these, 26 reported associations between temperature, while fewer studies reported on rain (n = 4), solar radiation (n = 4), humidity (n = 3), sunshine (n = 3), atmospheric pressure (n = 2), wind (n = 2) and cloud cover (n = 2). The overall relative risk for suicide deaths/attempts per 1 °C increase in ambient temperature was 1.016 (95% CI: 1.013-1.019). Subgroup analysis of temperature found stronger associations with suicide when using the maximum rather than the mean daily temperature, among men, and for completed suicides relative to attempts. Regionally, the strongest associations were found in the East Asia and Pacific region. While associations were found for solar radiation and cloud coverage and suicide, we did not undertake a meta-analysis for these exposures as it was not possible to standardize measures of association across studies. Statistically significant associations were not observed for other identified meteorological variables. CONCLUSIONS: Our findings suggest that daily increases in temperature increase the risk of suicide, particularly, among men and in the East Asia and Pacific region.

Increased urban greenness associated with improved mental health among middle-aged and older adults of the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVES: Some studies suggest that residential surrounding greenness is associated with improved mental health. Few of these studies have focussed on middle-aged and older adults, explored the modifying effects of social determinants of health, or accounted for the extent to which individuals interact with their neighbourhood environments. METHODS: We analysed cross-sectional data collected from 26,811 urban participants of the Canadian Longitudinal Study of Aging who were between 45 and 86 years of age. Participants provided details on socioeconomic characteristics, health behaviours, and their frequency of neighbourhood interactions. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants' residential addresses at a buffer distance of 500 m. Four self-reported measures of mental health were considered: The Center for Epidemiologic Studies Depression Scale (CES-D-10; short scale), past diagnosis of clinical depression, perceptions of mental health, and the Satisfaction with Life Scale (SWLS). Regression models were used to describe associations between greenness and these outcomes, and spline models were fit to characterize the exposure-response function between greenness and CES-D-10 scores. Stratified analyses evaluated whether associations varied by sociodemographic status. RESULTS: In adjusted models, we observed a 5% (Odds Ratio (OR) = 0.95; 95% CI = 0.90, 0.99) reduced odds of depressive symptoms in relation to an interquartile range increase of NDVI (0.06) within a 500 m buffer of the participant's residence. Similarly, we found an inverse association with a self-reported clinical diagnosis of depression (OR = 0.97; 95% CI = 0.92-1.01). Increases in surrounding greenness were associated with improved perceptions of mental health, and the SWLS. Our spline analyses found that beneficial effects between greenness and the CES-D-10 were strongest among those of lower income. CONCLUSIONS: These findings suggest that residential greenness has mental health benefits, and that interventions to increase urban greenness can help reduce social inequalities in mental health.

Barriers and facilitators for the safe handling of antineoplastic drugs.

INTRODUCTION: Antineoplastic drugs are widely used in the treatment of cancer. However, some are known carcinogens and reproductive toxins, and incidental low-level exposure to workers is a health concern. CAREX Canada estimated that approximately 75,000 Canadians are exposed to antineoplastic drugs in workplace settings. While policies and guidelines on safe handling of antineoplastic drugs are available, evidence suggests that compliance is low. In this paper, we identify barriers and facilitators for safe handling of antineoplastic drugs in workplace settings. METHODS: We utilized a unique method to study public policy which involved compiling policy levers, developing a logic model, conducting a literature review, and contextualizing data through a deliberative process with stakeholders to explore in-depth contextual factors and experiences for the safe handling of antineoplastic drugs. RESULTS: The most common barriers identified in the literature were: poor training (46%), poor safety culture (41%), and inconsistent policies (36%). The most common facilitators were: adequate safety training (41%), leadership support (23%), and consistent policies (21%). Several of these factors are intertwined and while this means one barrier can cause other barriers, it also allows healthcare employers to mitigate these barriers by implementing small but meaningful changes in the workplace. CONCLUSION: The combination of barriers and facilitators identified in our review highlight the importance of creating work environments where safety is a priority for the safe handling of antineoplastic drugs. The results of this study will assist policy makers and managers in identifying gaps and enhancing strategies that reduce occupational exposure to antineoplastic drugs.

Screening-level assessment of cancer risk associated with ambient air exposure in Aamjiwnaang First Nation.

The manuscript reports findings from a screening-level assessment of cancer risk from outdoor air in Aamjiwnaang First Nation. Ambient air pollution can contribute to cardiovascular/respiratory diseases, and certain types of cancer. Certain communities may be at higher risk to the negative health impacts due to their geographical proximity to pollution sources. Outdoor air concentrations were mapped and the Lifetime Excess Cancer Risks (LECR) associated with long-term exposure to known carcinogens were estimated. LECR results for both benzene and 1,3-butadiene were above one per million. The LECR for benzene was 6.4 per million when the Health Canada slope factor was applied and 12.0 when using the US EPA. For 1,3-butadiene the LECR estimate was 8.8 per million. This work provides a better understanding of environmental exposures and potential associated cancer risks for residents in the Aamjiwnaang community and highlights the need for further air monitoring and a more detailed risk assessment.

Using geographic information systems to estimate potential pesticide exposure at the population level in Canada.

Residents in close proximity to agricultural land are at risk of higher pesticide exposures. The purpose of this study was to generate national population-level exposure estimates for Canada for three commonly applied pesticides that are suspected carcinogens (2,4-dichlorophenoxyacetic acid (2,4-D), glyphosate and chlorothalonil). Using geographic information systems, pesticide exposure was estimated for every - census subdivision (CSD) in Canada (n = 5054) by combining raster-based surfaces for the distribution of crops with average crop-specific pesticide application rates data. Analyses examined all identified crops in combination with different pesticide application rates to obtain a cumulative potential total exposure. Specifically, the number of acres of particular crops were calculated for each CSD and then multiplied by the average pesticide application rates data, summed across crops, and combined with population data by CSD to provide a potential pesticide exposure estimate for each CSD. Results demonstrate that the population exposure varies greatly depending on agricultural production by CSD region. For example, in Ontario, the 2,4-D application rate was an average of 361 kg/km2, while in Saskatchewan, which primarily grows field/cereal crops, 2,4-D application rates were much higher (3810 kg/km2). The highest potential exposures to all three pesticides were in the prairie provinces (Alberta, Saskatchewan, Manitoba) along with Prince Edward Island, Southern Quebec and British Columbia. This work can be used in conjunction with other exposure assessment approaches to better understand overall pesticide exposure among Canada's general population.

Solar ultraviolet radiation exposure among outdoor workers in Alberta, Canada.

BACKGROUND: Outdoor workers are at risk of prolonged and high solar ultraviolet radiation (UVR) exposure, which is known to cause skin cancer. The objectives of this study were to characterize the UVR exposure levels of outdoor workers in Alberta, Canada, and to investigate what factors may contribute to their exposure. METHODS: This study collected objective solar UVR measurements from outdoor workers primarily in Alberta during the summer of 2019. Workers were recruited via the management or health and safety teams from building trade unions and employers. Calibrated, electronic UVR dosimeters were worn by workers on their hardhats, wrists, or lapels for five working days. Data on workers' demographics, jobs, sun protection behaviors, and personal risk factors were collected using questionnaires, and meteorological data for each sampling day were noted. Mean daily exposure measured as the standard erythemal dose (SED) was calculated and compared to the international occupational exposure limit guideline (1.3 SED). Marginal models were developed to evaluate potential determinants of occupational solar UVR exposure. RESULTS: In total, 883 measurements were collected from 179 workers. On average, workerswere exposed to 1.93 SED (range: 0.03-16.63 SED) per day. Just under half of workers (45%) were exposed to levels exceeding the international exposure limit guideline. In the bivariate analyses, landscape and maintenance workers, as well as trade and recreation workers, had the highest levels of exposure (average: 2.64 and 1.84 SED, respectively). Regional variations were observed, with the "other" cities/regions (outside of Edmonton and Calgary) experiencing the highest average levels (2.60 SED). Workers who placed the dosimeters on their hardhats experienced higher levels compared to the other groups. Exposure was highest on sunny and mixed days. Education, trade, city, dosimeter placement, forecast, hair colour, and number of hours outside were included in the final exposure model, of which trade, dosimeter placement, forecast, and number of hours outside at work were statistically significant. CONCLUSIONS: Exposure to elevated solar UVR levels is common among outdoor workers in Alberta. The study findings can help inform future monitoring studies and exposure reduction initiatives aimed at protecting workers.

Emergency intubation of children outside of the operating room.

Intubation of children outside of the operating room is performed infrequently and is often associated with life-threatening adverse events. This review aims to clarify the contributors to adverse events encountered during intubations outside of the operating room and provide preventative strategies. The primary contributors to adverse events during non-operating room intubations are physiologically and situationally difficult airways; anatomically difficult airways are rare. Systems-based changes, including a shared mental model, standardization in equipment and its location, checklist use, physiological resuscitation prior to resuscitation, dose titration of induction agent, multi-disciplinary team training in the technical and nontechnical aspects of non-operating room intubation, debrief post-real and simulated events, and regular audit of performance all reduce life-threatening intubation-related adverse events in children. Intubation of children outside of the operating room may be performed safely through engagement of all critical care specialties, shared learning, and focus on patient-centered care delivery.

The current burden of cancer attributable to occupational exposures in Canada.

Exposure to occupational carcinogens is often overlooked as a contributor to the burden of cancer. To estimate the proportion of cancer cases attributable to occupational exposure in Canada in 2011, exposure prevalence and levels of 44 carcinogens were informed by data from the Canadian carcinogen exposure surveillance project (CAREX Canada). These were used with Canadian Census (between 1961 and 2011) and Labour Force Survey (annual surveys between 1976 and 2013) data to estimate the number of workers ever exposed to occupational carcinogens. Risk estimates of the association between each carcinogen and cancer site were selected mainly from published literature reviews. Population attributable risks were estimated using Levin's equation and applied to the 2011 cancer statistics from the Canadian Cancer Registry. It is estimated that 15.5 million Canadians alive in 2011 were exposed, during at least one year between 1961 and 2001, to at least one carcinogen in the workplace. Overall, we estimated that in 2011, between 3.9% (95% CI: 3.1%-8.1%) and 4.2% (95% CI: 3.3%-8.7%) of all incident cases of cancer were due to occupational exposure, corresponding to lower and upper numbers of 7700-21,800 cases. Five of the cancer sites - mesothelioma, non-melanoma skin cancer, lung, female breast, and urinary bladder - account for a total of 7600 to 21,200 cancers attributable to occupational exposures such as solar radiation, asbestos, diesel engine exhaust, crystalline silica, and night shift work. Our study highlights cancer sites and occupational exposures that need recognition and efforts by all stakeholders to avoid preventable cancers in the future.

Exposure to crystalline silica in Canadian workplaces and the risk of kidney cancer.

OBJECTIVES: The causes of kidney cancer are not well understood though occupational exposures are thought to play a role. Crystalline silica is a known human carcinogen, and despite previous links with kidney disease, there have been few studies investigating its association with kidney cancer. We addressed this research gap using a population-based case-control study of Canadian men. METHODS: Questionnaire data were obtained from individuals with histologically confirmed kidney cancer, and population-based controls recruited from eight Canadian provinces (1994-1997). An industrial hygienist characterised participants' lifetime occupational exposure, and their confidence in the assessment (possibly, probably or definitely exposed) to silica on three dimensions (intensity, frequency and duration), and cumulative exposure was estimated. Logistic regression was used to estimate ORs and 95% CIs, adjusting for potential confounders. RESULTS: Nearly half of the 689 kidney cancer cases (49%) and 2369 controls (44%) had ever been occupationally exposed to crystalline silica. In a fully adjusted model, workers ever-exposed to silica had a slightly increased risk of kidney cancer relative to those who were unexposed (OR 1.10, 95% CI 0.92 to 1.32). Odds were modestly (and generally not statistically significantly) increased for models with duration of exposure and cumulative exposure, though exposure-response relationships were not evident. CONCLUSIONS: Our findings do not provide evidence that occupational exposure to crystalline silica increases risk of kidney cancer in men.

Burden of non-melanoma skin cancer attributable to occupational sun exposure in Canada.

PURPOSE: Outdoor workers are exposed daily to solar ultraviolet radiation, an important contributor in the development of non-melanoma skin cancer. This study aimed to quantify the health burden of non-melanoma skin cancers among outdoor workers in Canada. METHODS: Solar ultraviolet radiation exposure and estimates of exposure levels were applied to employment information from Canada census data to determine the exposed population in the risk exposure period (1961-2001). Risk estimates were drawn from meta-analyses selected based on quality and relevance to the current study. Population-attributable fractions were calculated using Levin's equation and attributable cases were estimated based on incidence data reported by the Canadian Cancer Society. RESULTS: In 2011, 6.31% (4556 cases) of non-melanoma skin cancer cases were estimated to be attributable to occupational exposure to solar ultraviolet radiation. The majority of these cases occurred in men in the agriculture or construction industries. CONCLUSIONS: These estimates of the burden of non-melanoma skin cancer in Canada identify the need for further prevention efforts, particularly in agriculture and construction. Introducing workplace sun safety measures could be an important area for policy development.

The impact of night shift work on breast cancer: Results from the Burden of Occupational Cancer in Canada Study.

BACKGROUND: We estimated the proportion and number of female breast cancer cases in Canada attributable to night shift work, a probable cause of breast cancer. METHODS: Levin's equation was used to calculate population attributable fractions (PAFs) among Canadian women who ever worked night/rotating shifts from 1961 to 2000, accounting for labor turnover and survival to the year 2011. The calculated PAFs were applied to 2011 Canadian breast cancer incidence statistics to obtain the number of attributable cases. RESULTS: Approximately 1.5 million women ever worked night/rotating shifts during 1961-2000 and survived to 2011. The PAFs ranged from 2.0% (95% confidence interval [CI]: 1.4-6.2) to 5.2% (95% CI: 3.7-13.6), and 470 to 1200 incident breast cancer cases in 2011 were likely due to shift work, of which 38% would have been diagnosed among women in health-related occupations. CONCLUSIONS: More research is needed to increase the certainty of this association, but current evidence supports workplace-based prevention.

Indoor tanning and the risk of developing non-cutaneous cancers: a systematic review and meta-analysis.

PURPOSE: Despite a strong association between indoor tanning and the risk of cutaneous cancers, the relationship between indoor tanning and non-cutaneous cancers is unknown. Our objective was to estimate the association of indoor tanning with developing non-cutaneous cancers. METHODS: We conducted a systematic literature review and meta-analysis of the association between indoor tanning and non-cutaneous cancer sites. Associations were estimated using random effects models. Heterogeneity was investigated through subgroup analyses and the Q-test and I2 statistics. RESULTS: From 15 identified studies, 33 effect estimates for 12 cancer sites were included in the review. Adjustment for sun exposure was a significant source of heterogeneity in the association of indoor tanning and non-cutaneous cancer risk (meta-regression p = 0.0043). When restricting to studies that adjusted for solar ultraviolet radiation (7 studies and 19 effect estimates) a potential increased risk was observed among ever users of indoor tanning devices with the risk of hematologic malignancies (pooled relative risk = 1.11; 95% CI 0.96-1.28), with differing effects observed by hematologic types and subtypes of non-Hodgkin lymphoma. No association was observed among solid non-cutaneous cancers (pooled relative risk = 0.98; 95% CI 0.94-1.19). Neither study design nor geographical region was significant sources of heterogeneity in these associations. CONCLUSION: When controlling for sun exposure, indoor tanning does not protect against solid non-cutaneous cancers and may increase the risk of some hematologic malignancies. Given the well-established relationship with skin cancer and potential relationship with hematologic malignancies, efforts to reduce the use of indoor tanning devices should continue.