Wireless phone use in childhood and adolescence and neuroepithelial brain tumours: Results from the international MOBI-Kids study.

In recent decades, the possibility that use of mobile communicating devices, particularly wireless (mobile and cordless) phones, may increase brain tumour risk, has been a concern, particularly given the considerable increase in their use by young people. MOBI-Kids, a 14-country (Australia, Austria, Canada, France, Germany, Greece, India, Israel, Italy, Japan, Korea, the Netherlands, New Zealand, Spain) case-control study, was conducted to evaluate whether wireless phone use (and particularly resulting exposure to radiofrequency (RF) and extremely low frequency (ELF) electromagnetic fields (EMF)) increases risk of brain tumours in young people. Between 2010 and 2015, the study recruited 899 people with brain tumours aged 10 to 24 years old and 1,910 controls (operated for appendicitis) matched to the cases on date of diagnosis, study region and age. Participation rates were 72% for cases and 54% for controls. The mean ages of cases and controls were 16.5 and 16.6 years, respectively; 57% were males. The vast majority of study participants were wireless phones users, even in the youngest age group, and the study included substantial numbers of long-term (over 10 years) users: 22% overall, 51% in the 20-24-year-olds. Most tumours were of the neuroepithelial type (NBT; n = 671), mainly glioma. The odds ratios (OR) of NBT appeared to decrease with increasing time since start of use of wireless phones, cumulative number of calls and cumulative call time, particularly in the 15-19 years old age group. A decreasing trend in ORs was also observed with increasing estimated cumulative RF specific energy and ELF induced current density at the location of the tumour. Further analyses suggest that the large number of ORs below 1 in this study is unlikely to represent an unknown causal preventive effect of mobile phone exposure: they can be at least partially explained by differential recall by proxies and prodromal symptoms affecting phone use before diagnosis of the cases. We cannot rule out, however, residual confounding from sources we did not measure. Overall, our study provides no evidence of a causal association between wireless phone use and brain tumours in young people. However, the sources of bias summarised above prevent us from ruling out a small increased risk.

Pregnancy and perinatal conditions and atopic disease prevalence in childhood and adulthood.

BACKGROUND: Previous studies showed controversial results for the influence of pregnancy-related and perinatal factors on subsequent respiratory and atopic diseases in children. The aim of this study was to assess the association between perinatal variables and the prevalence of asthma, bronchial hyperreactivity (BHR), flexural eczema (FE), allergic rhinitis, and sensitization in childhood and early adulthood. METHODS: The studied population was first examined in Munich and Dresden in 1995/1996 at age 9-11 years. Participants were followed until age 19-24 years using questionnaires and clinical examinations. Associations between perinatal data and subsequent atopic diseases were examined using logistic regression analyses adjusting for potential confounders. RESULTS: Cesarean section was statistically significantly associated with BHR in early adulthood (odds ratio 4.8 [95% confidence interval 1.5-15.2]), while assisted birth was associated with presence of asthma symptoms in childhood (2.2 [1.2-3.9]), FE symptoms (2.2 [1.2-4.3]) and doctor's diagnosis of atopic dermatitis (1.9 [1.0-3.4]) in childhood, and sensitization in early adulthood (2.2 [1.1-4.3]). Lower birth length (1.9 [1.1-3.2]), lower birthweight (0.5 [0.3-0.9]), and higher birthweight (0.6 [0.4-1.0]) were predictive of sensitization in early adulthood compared to average birth length and birthweight, respectively. None of the other perinatal factors showed statistically significant associations with the outcomes. CONCLUSIONS: Our results indicate that children who are born by cesarean section and especially by assisted birth, might be at greater risk for developing asthma, FE, and sensitization and should hence be monitored. Prenatal maternal stress might partly explain these associations, which should be further investigated.

Snap-fits and upper limb functional limitations in German automotive workers.

BACKGROUND: The use of snap-fit fasteners in automotive assembly has increased in the last 10 years. Their impact on musculoskeletal function of the upper limbs in assembly workers is not well described. AIMS: To investigate the association between snap-fit assembly and upper limb functional limitations (ULFLs) in workers after a large-scale expansion of snap-fit assembly by a German automotive company. METHODS: Cross-sectional data on blue-collar production workers' exposure to snap-fit assembly and ULFLs were collected from medical check-ups and company registers. The association between duration of snap-fit assembly and ULFLs, and the dose-response relationship between the two were analysed using logistic regression, adjusted for body mass index, gender and employment duration before snap-fit exposure. RESULTS: The study group included 10722 workers. Within the company, 8.4, 6.9 and 10.3% were exposed to snap-fit 1-12, 13-24 and ≥25 months, respectively. After adjusting for confounders, snap-fit exposure for 1-12 months [odds ratio (OR) = 1.59, 95% confidence interval (CI) 0.88-2.88] and 13-24 months (OR = 1.48, 95% CI 0.76-2.88) was not statistically significantly associated with ULFLs compared with an unexposed group. However, exposure to ≥25 months of snap-fit assembly was statistically significant associated with ULFLs showing >2-fold risk (OR = 2.44, 95% CI 1.52-3.92). No clear dose-response relationship was found. CONCLUSIONS: Our study suggests a negative long-term impact from snap-fit assembly on workers' upper limb function. Company physicians should be vigilant for signs of upper limb musculoskeletal disorders among workers exposed to snap-fit assembly.

Attitude of medical students towards occupational safety and health: a multi-national study.

BACKGROUND: Work-related diseases contribute immensely to the global burden of diseases. Better understanding of attitudes of health care workers towards occupational safety and health (OSH) is important for planning. OBJECTIVE: To assess the attitude of medical students towards OSH around the globe. METHODS: A questionnaire assessing the attitude towards OSH was administered to medical and paramedical students of 21 Medical Universities across the globe. In the current study 1895 students, aged 18-36 years, from 17 countries were included. After having performed a principal components analysis, the associations of interest between the identified components and other socio demographic characteristics were assessed by multivariate linear regression. RESULTS: Principal component analysis revealed 3 components. Students from lower and lower-middle-income countries had a more positive attitude towards OSH, but the importance of OSH was still rated higher by students from upper-income countries. Although students from Asian and African continents showed high interest for OSH, European and South-Central American students comparatively rated importance of OSH to be higher. Paramedical students had more positive attitude towards OSH than medical students. CONCLUSION: The attitude of students from lower-income and lower-middle-income towards importance of OSH is negative. This attitude could be changed by recommending modifications to OSH courses that reflect the importance of OSH. Since paramedical students showed more interest in OSH than medical students, modifications in existing health care system with major role of paramedics in OSH service delivery is recommended.

Are primary school students exposed to higher noise levels than secondary school students in Germany?

BACKGROUND: Noise, one of the major environmental nuisances, affects the learning ability of children negatively. OBJECTIVE: With the assumption that in the existing German 4-type school system children are exposed to various noise levels in each type of school, we investigated the association between children's school type and environmental noise level. METHODS: In this cross-sectional study, we included 550 children, primary and secondary school students, aged 8-12 years, and who lived in 4 Bavarian cities. The environmental noise level was assessed by personal 24-h dosimeter measurements. The associations of interest were assessed by linear regression. RESULTS: The average day noise level of 80.0 dB(A) was relatively high, exceeding the threshold level of 60 dB(A). In the model adjusted for sex, socioeconomic status (SES), and place of residence, noise level was significantly higher for primary schools by almost 2.3 dB(A); however, after additional adjustments for age, this association was distorted. The mean night noise level of 43.7 dB(A) was not associated with the school level. We could not find any significant differences in the noise level between different types of secondary schools. CONCLUSION: We found evidence that in Germany, children, especially of a younger age from primary school, are exposed to high noise levels during day in and outside the school environment. School administration and parents should work to make schools less noisy and more accomplished for learning to achieve a bright future for the children.

MRSA-ST398 in livestock farmers and neighbouring residents in a rural area in Germany.

Prevalence of and risk factors associated with MRSA-ST398 carriage in 1872 (response 70%) farmers and neighbouring residents in a pig- and poultry-dense area in Germany were investigated using a cross-sectional study and self-sampling nasal swabs. In the population, 1% without occupational livestock contact and 24% with occupational livestock contact tested positive for MRSA-ST398. The group without occupational livestock contact was 3·8 times [95% confidence interval (CI) 1·5-9·3] more likely to be colonized if a household member had livestock contact and 3·2 times (95% CI 1·4-7·4) more likely if they regularly made private farm visits (e.g. to buy eggs or milk). In the group with occupational livestock contact, pig contact had an odds ratio of 7·1 (95% CI 2·9-17·2) for MRSA-ST398 acquisition. This is the first study to associate private farm visits with acquisition of MRSA; more research to explore the exact transmission routes is necessary.

[Objective assessment of total noise exposure over 24 hours: a cross-sectional study in Bavaria]. / Objektive Bestimmung der 24-Stunden-Gesamtlärmbelastung: eine Querschnittsstudie in Bayern.

INTRODUCTION: Noise can affect well-being and performance of individuals and might be associated with an increased risk of cardiovascular events. To date most epidemiological studies considered exposure from a single source of noise. The EU Environmental Noise Directive (2002/49/EC) requires a summative measurement of ambient noise. This study aimed to capture the participants' exposure to environmental noise by means of personal noise dosimetry. METHODS: Children (n=628, participation=61%, age 8-12 years), adolescents (n=632, participation=58%, age 13-17 years) and adults (n=482, participation=40%, age 18-65 years) were selected randomly from the population registry of 4 Bavarian towns and were invited to participate in a 24-h measurement using noise dosimetry. Noise exposures during day and night were analyzed separately. In addition, predictors of noise exposure were assessed. RESULTS: For daytime noise exposure mean±standard deviation were in children 80.0±5.8 dB(A), in adolescents 76.0±6.2 dB(A), in adults 72.1±6.1 dB(A) (p(ANOVA)<0.001). During the day personal noise exposure was statistically significantly higher for participants from smaller towns than for those living in Munich, while nighttime noise exposure was highest for participants from Munich [44.1±7.2 dB(A)]. CONCLUSION: The summative noise exposure in urban Bavaria is high, in particular among children at daytime. Increased exposure levels in children might be caused by themselves while, e.g., playing. Whether the higher daytime exposure in towns is due to high noise levels commuting between home and work has to be assessed in future studies.

Case-based e-learning to improve the attitude of medical students towards occupational health, a randomised controlled trial.

OBJECTIVES: Undergraduate medical teaching in occupational health (OH) is a challenge in universities around the world. Case-based e-learning with an attractive clinical context could improve the attitude of medical students towards OH. The study question is whether case-based e-learning for medical students is more effective in improving knowledge, satisfaction and a positive attitude towards OH than non-case-based textbook learning. METHODS: Participants, 141 second year medical students, were randomised to either case-based e-learning or text-based learning. Outcome measures were knowledge, satisfaction and attitude towards OH, measured at baseline, directly after the intervention, after 1 week and at 3-month follow-up. RESULTS: Of the 141 participants, 130 (92%) completed the questionnaires at short-term follow-up and 41 (29%) at 3-month follow-up. At short-term follow-up, intervention and control groups did not show a significant difference in knowledge nor satisfaction but attitude towards OH was significantly more negative in the intervention group (F=4.041, p=0.047). At 3-month follow-up, there were no significant differences between intervention and control groups for knowledge, satisfaction and attitude. CONCLUSIONS: We found a significant decrease in favourable attitude during the internship in the experimental group compared with the control group. There were no significant differences in knowledge or satisfaction between case-based e-learning and text-based learning. The attitude towards OH should be further investigated as an outcome of educational programmes.

The occupational contribution to severe exacerbation of asthma.

The goal of this study was to identify occupational risk factors for severe exacerbation of asthma and estimate the extent to which occupation contributes to these events. The 966 participants were working adults with current asthma who participated in the follow-up phase of the European Community Respiratory Health Survey. Severe exacerbation of asthma was defined as self-reported unplanned care for asthma in the past 12 months. Occupations held in the same period were combined with a general population job-exposure matrix to assess occupational exposures. 74 participants reported having had at least one severe exacerbation event, for a 1-yr cumulative incidence of 7.7%. From regression models that controlled for confounders, the relative risk (RR) was statistically significant for low (RR 1.7, 95% CI 1.1-2.6) and high (RR 3.6, 95% CI 2.2-5.8) biological dust exposure, high mineral dust exposure (RR 1.8, 95% CI 1.02-3.2), and high gas and fumes exposure (RR 2.5, 95% CI 1.2-5.5). The summary category of high dust, gas, or fumes exposure had RR 3.1 (95% CI 1.9-5.1). Based on this RR, the population attributable risk was 14.7% among workers with current asthma. These results suggest occupation contributes to approximately one in seven cases of severe exacerbation of asthma in a working population, and various agents play a role.

Healthy hire effect, job selection and inhalation exposure among young adults with asthma.

The aim of the present study was to assess whether asthma onset prior to entering the workforce influences whether a person holds a subsequent job with asthma-related inhalation exposures. The data of 19,784 adults from the European Community Respiratory Health Survey were analysed. For each respondent, a current or previously held job was linked to a job exposure matrix assigning high, low or no exposure to dust, gases or fumes. Jobs were also categorised according to the risk of exposures related to occupational asthma. Associations between asthma and subsequent occupational exposures were assessed using logistic regression models, with a random intercept for study centre and fixed adjustment for age, sex, type of study sample and smoking status. Of the respondents, 8% (n = 1,619) reported asthma with onset before completion of full-time education. This population was at decreased risk of having a job with high (odds ratio 0.79; 95% confidence interval 0.68-0.92) or low (0.91; 0.80-1.03) exposure to dust, gases or fumes. The associations were consistent across exposure types (dusts, gases or fumes) and for jobs with a high risk of occupational asthma. Adults with asthma onset prior to entering the workforce may be less likely to hold jobs involving inhalation exposures.

e-Learning strategies in occupational legal medicine based on problem solving through "CASUS" system.

The use of online teaching tools facilitate the incorporation of self-learning methods. With a view to encouraging convergence in teaching tools and methods in Occupational Legal Medicine, an initiative was set up within the classes of Legal and Forensic Medicine at Saragossa University, as part of the EU funded NetWoRM project, which has been led since 1999 by Ludwig-Maximilians-Universität in Munich (Germany). The interest of medical students in Occupational Legal Medicine has so far been low and in addition different aspects complicate the teaching of Occupational Legal Medicine at medical schools: One reason for the low interest is the limited availability of bedside teaching, one of the students' most favourite and effective way to learn. The reason for that is that most medical schools with occupational departments only have outpatient clinics. "Interesting" patients who be need for educational purposes are therefore only available for a limited part of the day. However, in order to recognize and prevent occupational disorders each medical student and physician needs profound clinical knowledge in Occupational Legal Medicine. This project has proven to be highly efficient in permitting the creation and validation of teaching tools which cover and improve the traditional training of the Occupational Legal Medicine programme imparted in the degree of Medicine.

GA2LEN (Global Allergy and Asthma European Network) addresses the allergy and asthma 'epidemic'.

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. The Global Allergy and Asthma European Network (GA(2)LEN), a Sixth EU Framework Program for Research and Technological Development (FP6) Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle allergy in its globality. The Global Allergy and Asthma European Network has benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA(2)LEN the world leader in the field. Besides these activities, research has also been carried out and the first papers are being published. Achievements of the Global Allergy and Asthma European Network can be grouped as follows: (i) those for a durable infrastructure built up during the project phase, (ii) those which are project-related and based on these novel infrastructures, and (iii) the development and implementation of guidelines. The major achievements of GA(2)LEN are reported in this paper.

An international prospective general population-based study of respiratory work disability.

BACKGROUND: Previous cross-sectional studies have shown that job change due to breathing problems at the workplace (respiratory work disability) is common among adults of working age. That research indicated that occupational exposure to gases, dust and fumes was associated with job change due to breathing problems, although causal inferences have been tempered by the cross-sectional nature of previously available data. There is a need for general population-based prospective studies to assess the incidence of respiratory work disability and to delineate better the roles of potential predictors of respiratory work disability. METHODS: A prospective general population cohort study was performed in 25 centres in 11 European countries and one centre in the USA. A longitudinal analysis was undertaken of the European Community Respiratory Health Survey including all participants employed at any point since the baseline survey, 6659 subjects randomly sampled and 779 subjects comprising all subjects reporting physician-diagnosed asthma. The main outcome measure was new-onset respiratory work disability, defined as a reported job change during follow-up attributed to breathing problems. Exposure to dusts (biological or mineral), gases or fumes during follow-up was recorded using a job-exposure matrix. Cox proportional hazard regression modelling was used to analyse such exposure as a predictor of time until job change due to breathing problems. RESULTS: The incidence rate of respiratory work disability was 1.2/1000 person-years of observation in the random sample (95% CI 1.0 to 1.5) and 5.7/1000 person-years in the asthma cohort (95% CI 4.1 to 7.8). In the random population sample, as well as in the asthma cohort, high occupational exposure to biological dust, mineral dust or gases or fumes predicted increased risk of respiratory work disability. In the random sample, sex was not associated with increased risk of work disability while, in the asthma cohort, female sex was associated with an increased disability risk (hazard ratio 2.8, 95% CI 1.3 to 5.9). CONCLUSIONS: Respiratory work disability is common overall. It is associated with workplace exposures that could be controlled through preventive measures.

Serum leptin and adiponectin levels and their association with allergic sensitization.

BACKGROUND: Obesity and respiratory allergies have increased in parallel in industrialized countries. We have recently shown an association between obesity and allergic sensitization whereby obesity diminished the protective effect of childhood farm contact. OBJECTIVE: To assess whether taking obesity into account allergic sensitization is associated with adipokine levels in blood and whether this effect is modified by childhood farm contact. METHODS: Serum samples of 231 adult participants (age 18-45 years) of the Lower Saxony Lung Study were analysed for leptin and adiponectin by ELISA. Subjects were elected to represent equal-sized groups with respect to obesity (<30 vs> or =30 kg/m(2)), childhood farm contact, specific IgE to ubiquitous allergens and sex. Multiple logistic regression models were adjusted for potential confounders. RESULTS: Leptin levels were positively related to the prevalence of sensitization (highest vs lowest quartile odds ratio 6.7, 95% confidence interval 2.0-22.4). For adiponectin levels, a weak, not statistically significant inverse association with sensitization was shown (highest vs lowest quartile 0.4, 0.2-1.1). The association between leptin and sensitization appeared to be more pronounced in subjects with farm contact; however, the effect modification was not statistically significant. CONCLUSION: These findings suggest that adipokines might be involved in the causal pathway between obesity and allergic sensitization.

Aprendizaje, mediante casos prácticos online en Medicina del Trabajo. Experiencia de la Universidad de Zaragoza en el proyecto Europeo NetWorm / No disponible

El uso de métodos de aprendizaje online facilita la incorporación de métodos de auto-aprendizaje que pueden ser un buen instrumento de apoyo para la enseñanza en un contexto internacional. Con esta filosofía y con la vista puesta en el compromiso de convergencia en métodos de aprendizaje en Medicina del Trabajo y en Medicina Legal, se pues en marcha una iniciativa desde la Cátedra de Me3dicina Legal y Forense de la Universidad de Zaragoza, como parte del Proyecto NetWorm de la Unión Europea, liderado desde 1999 por la Universidad Ludwig-Maximilians de Múnich (Alemania) Este proyecto ha resultado ser de una gran eficiencia, permitiendo la creación y validación de casos en Medicina Legal y del Trabajo en el programa de la Licenciatura en Medicina(AU)

The use of online teaching tools facilitate the incorporation of methods in self-learning which could provide a good instrument for teaching support and even help in common training activities in an international context. Based on this philosophy and with a view to encouraging convergence in teaching tools and methods in Occupational and Legal Medicine, an initiative was set up within the Master Classes of Legal and Forensic Medicine at Saragossa University, par of the EU funded NetWorm project, with has been led since 1999 by Lud wigMaximilians-Universität in Munich (Germany). This project has proven to be highly efficient in permitting the creation and validation of casus in Occupational Legal Medicine programme imparted to students in the Medicine degree(AU)

[Passive smoking--health consequences and effects of exposure prevention]. / Passivrauchen: Gesundheitliche Folgen, Effekte einer Expositionskarenz und Präventionsaspekte.

Passive smoking is the third leading but preventable cause of death worldwide. It is associated with an elevated risk of developing acute respiratory diseases, obstructive lung disorders, lung cancer, and cardiovascular disease. Whereas the dose-response relationship between second-hand smoke exposure and respiratory diseases is likely to be linear, a non-linear dose-response curve has been observed with respect to acute cardiovascular events. This explains the disproportionately high risk of myocardial infarction among passive smokers as compared to unexposed individuals. Over the last ten years, exposure to second-hand smoke has declined in Germany, but it is still substantial. With passive smoking in the home being a difficult target for preventive measures, public smoking bans have recently been shown to greatly reduce second-hand smoke-related morbidity and mortality. In addition, such measures are usually well tolerated and highly relevant regarding legal aspects related to workplace issues. This article summarises the current evidence on the health consequences of passive smoking and on the favourable effects of public smoking bans.

Occupation and adult onset of rhinitis in the general population.

OBJECTIVES: Occupational exposures have been associated with an increased risk of new-onset rhinitis in apprentices. However, population-based prospective data are scarce and do not cover new onset of rhinitis later in life. The authors studied the association between occupational exposure and adult onset of rhinitis prospectively. METHODS: The data of 4994 participants (age at follow-up 28-57 years) from 27 centres of the European Community Respiratory Health Survey II who were symptom-free at baseline were analysed. As outcome at follow-up self-reported (a) nasal allergies ("allergic rhinitis") and (b) runny, blocked nose for 12 months a year ("perennial rhinitis") were used. Occupational exposures at any time during follow-up were defined by job title. RESULTS: The cumulative incidence of allergic rhinitis, perennial rhinitis and both conditions was 12%, 11% and 3%, respectively. Compared to office workers, male medical professionals were at increased risk of new onset of allergic rhinitis (OR 3.0; 95% CI 1.4 to 6.4). Odds ratios were reduced in metal workers not involved in metal making or treating (0.3; 95% CI 0.1 to 0.7). For perennial rhinitis ORs were significantly increased in cleaners (1.4; 95% CI 1.0 to 2.1). CONCLUSIONS: Cleaners and medical professionals may be at increased risk for adult-onset rhinitis.