Thoracic dust exposure is associated with lung function decline in cement production workers.

We hypothesised that exposure to workplace aerosols may lead to lung function impairment among cement production workers.Our study included 4966 workers in 24 cement production plants. Based on 6111 thoracic aerosol samples and information from questionnaires we estimated arithmetic mean exposure levels by plant and job type. Dynamic lung volumes were assessed by repeated spirometry testing during a mean follow-up time of 3.5 years (range 0.7-4.6 years). The outcomes considered were yearly change of dynamic lung volumes divided by the standing height squared or percentage of predicted values. Statistical modelling was performed using mixed model regression. Individual exposure was classified into quintile levels limited at 0.09, 0.89, 1.56, 2.25, 3.36, and 14.6 mg·m(-3), using the lowest quintile as the reference. Employees that worked in administration were included as a second comparison group.Exposure was associated with a reduction in forced expiratory volume in 1 s (FEV1), forced expiratory volume in 6 s and forced vital capacity. For FEV1 % predicted a yearly excess decline of 0.84 percentage points was found in the highest exposure quintile compared with the lowest.Exposure at the higher levels found in this study may lead to a decline in dynamic lung volumes. Exposure reduction is therefore warranted.

Exposure to thoracic aerosol in a prospective lung function study of cement production workers.

INTRODUCTION: An exposure study was conducted as part of a multi-national longitudinal study of lung function in cement production workers. AIM: To examine exposure to thoracic aerosol among cement production workers during a 4-year follow-up period. METHODS: Personal shift measurements of thoracic aerosol were conducted among the cement production workers within seven job types, 22 plants, and eight European countries (including Turkey) in 2007, 2009, and 2011. The thoracic sub-fraction was chosen as the most relevant aerosol fraction related to obstructive dynamic lung function changes. Production factors, job type, and respirator use were recorded by questionnaire. The exposure data were log-transformed before mixed models analysis and results were presented by geometric mean (GMadj) exposure levels adjusted for plant or job type, worker, and season as random effects. RESULTS: A total of 6111 thoracic aerosol samples were collected from 2534 workers. Repeated measurements were obtained from 1690 of these workers. The GMadj thoracic aerosol levels varied between job types from 0.20 to 1.2mg m(-3). The highest exposure levels were observed for production, cleaning, and maintenance workers (0.79-1.2mg m(-3)) and could reach levels where the risk of lung function loss may be increased. The lowest levels were found for administrative personnel (0.20mg m(-3)) serving tasks in the production areas. Office work was not monitored. GMadj exposure levels between plants ranged from 0.19 to 2.0mg m(-3). The time of year/season contributed significantly to the total variance, but not year of sampling. Production characteristics explained 63% of the variance explained by plant. Workers in plants with the highest number of employees (212-483 per plant) were exposed at a level more than twice as high as those in plants with fewer employees. Other production factors such as cement production, bag filling, and tidiness were significant, but explained less of the exposure variability. These determinants factors can be useful in qualitative exposure assessment and exposure prevention in the cement production industry. Respirator use was minor at exposure levels <0.5mg m(-3) but more common at higher levels. CONCLUSION: Production, cleaning, and maintenance work were the job types with highest exposure to thoracic aerosol in cement production plants. However, plant had an even larger effect on exposure levels than job type. The number of employees was the most important factor explaining differences between plants. Exposure reached levels where the risk of lung function loss may be increased. No significant differences in exposure between sampling campaigns were observed during the 4-year study period.

Analysis of polymorphisms in the circadian-related genes and breast cancer risk in Norwegian nurses working night shifts.

INTRODUCTION: Some studies have suggested that night work may be associated with an increased risk of breast cancer in nurses. We aimed to explore the role of circadian gene polymorphisms in the susceptibility to night work-related breast cancer risk. METHODS: We conducted a nested case-control study of Norwegian nurses comprising 563 breast cancer cases and 619 controls within a cohort of 49,402 Norwegian nurses ages 35 to 74 years. We studied 60 single-nucleotide polymorphisms (SNPs) in 17 genes involved in the regulation of the circadian rhythm in cases and controls. The data were analyzed in relation to the two exposure variables "maximum number of consecutive night shifts ever worked" and "maximum number of consecutive night shifts worked for at least 5 years." The odds of breast cancer associated with each SNP was calculated in the main effects analysis and in relation to night shift work. The statistically significant odds ratios were tested for noteworthiness using two Bayesian tests: false positive report probability (FPRP) and Bayesian false discovery probability (BFDP). RESULTS: In the main effects analysis, CC carriers of rs4238989 and GG carriers of rs3760138 in the AANAT gene had increased risk of breast cancer, whereas TT carriers of BMAL1 rs2278749 and TT carriers of CLOCK rs3749474 had reduced risk. The associations were found to be noteworthy using both the FPRP and BFDP tests. With regard to the effect of polymorphisms and night work, several significant associations were observed. After applying FPRP and BFDP in women with at least four night shifts, an increased risk of breast cancer was associated with variant alleles of SNPs in the genes AANAT (rs3760138, rs4238989), BMAL1 (rs2290035, rs2278749, rs969485) and ROR-b (rs3750420). In women with three consecutive night shifts, a reduced risk of breast cancer was associated with carriage of variant alleles of SNPs in CLOCK (rs3749474), BMAL1 (rs2278749), BMAL2 (rs2306074), CSNK1E (rs5757037), NPAS2 (rs17024926), ROR-b (rs3903529, rs3750420), MTNR1A (rs131113549) and PER3 (rs1012477). CONCLUSIONS: Significant and noteworthy associations between several polymorphisms in circadian genes, night work and breast cancer risk were found among nurses who had worked at least three consecutive night shifts.

Dust exposure is associated with increased lung function loss among workers in the Norwegian silicon carbide industry.

OBJECTIVES: To investigate the relationship between dust exposure and annual change in lung function among employees in Norwegian silicon carbide (SiC) plants using a quantitative job exposure matrix (JEM) regarding total dust. METHODS: All employees, 20-55 years of age by inclusion (n=456), were examined annually for up to 5 years (1499 examinations). Spirometry was performed at each examination, and a questionnaire encompassing questions of respiratory symptoms, smoking status, job and smoking history, and present job held was completed. A JEM was constructed based on 1970 personal total dust exposure measurements collected during the study period. The association between lung function and total dust exposure was investigated using linear mixed models. RESULTS: The annual change in forced expiratory volume (FEV) in one second per squared height, FEV1/height(2), per mg/m(3) increase in dust exposure was -2.3 (95% CI -3.8 to -0.79) (mL/m(2))×year(-1). In an employee of average height (1.79 m) and exposure (1.4 mg/m(3)) the estimated contribution to the annual change in FEV1 associated with dust was 10.4 mL/year. The annual change in FEV1/height(2) in current, compared with non-smokers was -1.9 (-7.2 to 3.4) (mL/m(2))×year(-1). The estimated overall annual decline in FEV1 among current and non-smokers in the highest exposed group was -91.2 (-124.3 to -58.1) (mL/m(2))×year(-1) and -49.0 (-80.2 to -17.8) (mL/m(2))×year(-1), respectively. CONCLUSIONS: Dust exposure, expressed by a quantitative JEM, was found to be associated with an increased yearly decline in FEV1 in employees of Norwegian SiC plants.

Breast cancer among nurses: is the intensity of night work related to hormone receptor status?

The aim of this study was to investigate whether night work is related to breast cancer receptor status. The effect of night work on the risk of estrogen receptor- and progesterone receptor-defined breast cancers was evaluated in 513 nurses diagnosed with breast cancer between 1996 and 2007 and in 757 frequency-matched controls, all of whom were selected from a cohort of Norwegian nurses. Odds ratios for the exposure "duration of work with a minimum of 6 consecutive night shifts" were compared for tumor subgroups with respect to the common control group through the use of polytomous logistic regression. Statistically significant associations were observed between breast cancer and work durations of ≥ 5 years with ≥ 6 consecutive night shifts, with the highest risk observed for progesterone receptor-positive tumors (odds ratio = 2.4, 95% confidence interval: 1.3, 4.3; P-trend = 0.01). When the exposure variable was dichotomized (ever/never worked ≥ 6 consecutive night shifts), a borderline statistically significant heterogeneity (P = 0.05) was seen between progesterone receptor-positive and progesterone receptor-negative tumors in postmenopausal women. The association observed between consecutive night shifts and progesterone receptor-positive cancers suggests that progesterone could play an important role in the detrimental effects of night work.

Rotating night shift work and polymorphism of genes important for the regulation of circadian rhythm.

OBJECTIVE: People living in industrialized societies have developed specific working schedules during the day and at night, including permanent night shifts and rotating night shifts. The aim of this study was to examine the association between circadian polymorphisms and rotating night shift work. METHODS: This cross-sectional study comprised 709 nurses and midwives (348 current rotating and 361 current day workers). Genetic polymorphism of selected clock genes BMAL1 (rs2279287), CLOCK (rs1801260), PER1 (rs2735611), PER2 (rs2304672), PER3 (rs10462020), CRY1 (rs8192440), CRY2 (rs10838527, rs10838527) was determined using real-time polymerase chain reaction (PCR) assays. RESULTS: There were no differences in BMAL1, CLOCK, CRY2, PER1, PER2, and PER3 genotypes among nurses and midwives working rotating night and day shifts. The frequency of women with rare CRY1 TT genotype was higher in the group of rotating night shift than day workers (17.0% versus 13.9%, P=0.06). Moreover, CRY1 TT genotype was associated with the total rotating shift-work duration, compared to women rarely working night shifts. CONCLUSIONS: These results suggest that CRY1 (rs8192440) polymorphism may influence the adaptation to the rotating night shift work among nurses and midwives.

Circadian gene expression in peripheral blood leukocytes of rotating night shift nurses.

OBJECTIVE: It has been hypothesized that the underlying mechanism of elevated breast cancer risk among long-term, night-working women involves circadian genes expression alteration caused by exposure to light at night and/or irregular work hours. The aim of the present study was to determine the effect of rotating night shift work on expression of selected core circadian genes. METHODS: The cross-sectional study was conducted on 184 matched nurses and midwives, who currently work either day or rotating night shifts, to determine the effect of irregular work at night on circadian gene expression in peripheral blood leukocytes. Transcript levels of BMAL1, CLOCK, CRY1, CRY2, PER1, PER2, and PER3 were determined by means of quantitative real-time polymerase chain reaction (PCR). RESULTS: After adjusting for hour of blood collection, there were no statistically significant changes of investigated circadian genes among nurses and midwives currently working rotating night shifts compared to nurses working day shifts. The highest expression of PER1 messenger ribonucleic acid (mRNA) was observed for women currently working shifts who had worked >15 years in rotating night shift work. PER1 gene expression was associated with the lifetime duration of rotating night shift work among women currently working night shifts (P=0.04). PER1 and PER3 transcript levels in blood leukocytes were significantly down-regulated in the later versus early hours of the morning between 06.00-10.00 hours (ß-coefficient -0.226, P=0.001 and ß-coefficient -0.181, P<0.0001, respectively). CONCLUSIONS: These results suggest that current rotating night shift work does not affect circadian gene expression in human circulating leukocytes. In analysis of the peripheral clock in human studies, the hour of blood collection should be precisely specified.

Lung cancer incidence among Norwegian silicon carbide industry workers: associations with particulate exposure factors.

OBJECTIVES: An increased lung cancer risk associated with total dust exposure in the silicon carbide (SiC) industry has previously been reported. The aim of the present study was to examine the relative importance of specific exposure factors by using a comprehensive, historic job exposure matrix based on about 8000 measurements. METHODS: Cumulative exposure to total and respirable dust, respirable quartz, cristobalite, and SiC particles and SiC fibres was assessed for 1687 long-term workers employed during 1913-2003 in the Norwegian SiC industry. Standardised incidence ratios for lung cancer, with follow-up during 1953-2008, were calculated stratified by cumulative exposure categories. Poisson regression analyses were performed using both categorised and log-transformed cumulative exposure variables. RESULTS: The lung cancer incidence was about twofold increased at the highest level of exposure to each of the exposure factors (standardised incidence ratios 1.9-2.3 for all agents). Internal analyses showed associations between exposure level and lung cancer incidence for all investigated factors, but a significant trend only for total dust and cristobalite. In multivariate analyses, cristobalite showed the most consistent associations, followed by SiC fibres. CONCLUSIONS: The results indicated that crystalline silica in the form of cristobalite was the most important occupational exposure factor responsible for lung cancer excess in the Norwegian SiC industry. SiC fibres seemed to have an additional effect.

Rotating night shift work and mammographic density.

BACKGROUND: An increased risk of breast cancer has been observed in night shift workers. Exposure to artificial light at night and disruption of the endogenous circadian rhythm with suppression of the melatonin synthesis have been suggested mechanisms. We investigated the hypothesis that rotating night shift work is associated with mammographic density. METHODS: We conducted a cross-sectional study on the association between rotating night shift work characteristics, 6-sulfatoxymelatonin (MT6s) creatinine adjusted in a spot morning urine sample, and a computer-assisted measure of mammographic density in 640 nurses and midwives ages 40 to 60 years. The associations were evaluated using regression models adjusted for age, body mass index, menopausal status, age at menopause, age at menarche, smoking, and the calendar season of the year when mammography was conducted. RESULTS: The adjusted means of percentage of mammographic density and absolute density were slightly higher among women working rotating night shifts but not statistically significant [percentage of mammographic density = 23.6%, 95% confidence interval (CI), 21.9%-25.4% vs. 22.5%, 95% CI, 20.8%-24.3%; absolute density = 23.9 cm(2), 95% CI, 21.4-26.4 cm(2) vs. 21.8 cm(2), 95% CI, 19.4-24.3 cm(2) in rotating night shift and day shift nurses, respectively). There were no significant associations between the current or cumulative rotating night shift work exposure metrics and mammographic density. No association was observed between morning MT6s and mammographic density. CONCLUSIONS: The hypothesis on the link between rotating night shift work, melatonin synthesis disruption, and mammographic density is not supported by the results of the present study. IMPACT: It is unlikely that the development of breast cancer in nurses working rotating night shifts is mediated by an increase in mammographic density.

Night shift work characteristics and 6-sulfatoxymelatonin (MT6s) in rotating night shift nurses and midwives.

OBJECTIVES: Synthesis of melatonin follows a circadian cycle, with high melatonin levels during the night and low levels during the day. Light exposure at night has been hypothesised as one of potential mechanisms of breast carcinogenesis in the night shift workers through inhibition of melatonin synthesis. The aim of the study was to examine a number of determinants for night shift work in relation to 6-sulfatoxymelatonin (MT6s), primary melatonin metabolite. METHODS: The cross-sectional study included 354 nurses and midwives (aged 40-60 years) currently working on rotating night shifts and 370 working days only. Data from questionnaires and 1-week diaries were used to characterise current job and total occupational history. Associations between rotating night shift work characteristics and MT6s (creatinine adjusted) in spot morning urine were tested in multiple linear regression models. RESULTS: No significant differences were found for MT6s concentrations between women currently working on rotating night shifts and those working only day shifts (means 47.2 vs 45.7 ng/mg Cr, respectively). The adjusted means among rotating night shift nurses and midwives varied depending on the department of employment, from 35.1 ng/mg Cr in neonatology to 68.2 ng/mg Cr in the orthopaedics department. Women working eight or more night shifts per month had significantly lower MT6s levels than those having fewer night shifts per month (37.9 vs 47.4 ng/mg Cr, respectively). Total night shift work history was not associated with MT6s. CONCLUSIONS: The results of this study indicate that working eight or more night shifts per month may disrupt the synthesis of melatonin.

Work at night and breast cancer--report on evidence-based options for preventive actions.

In 2007, the International Agency for Research on Cancer classified shift work involving circadian disruption as probably carcinogenic to humans (group 2A), primarily based on experimental and epidemiologic evidence for breast cancer. In order to examine options for evidence-based preventive actions, 16 researchers in basic, epidemiological and applied sciences convened at a workshop in Copenhagen 26-27 October 2011. This paper summarizes the evidence from epidemiological and experimental studies and presents possible recommendations for prevention of the effects of night work on breast cancer. Among those studies that quantified duration of shift work, there were statistically significant elevations in risk only after about 20 years working night shift. It is unclear from these studies whether or not there is a modest but real elevated risk for shorter durations. Hence, restriction of the total number of years working night shift could be one future preventive recommendation for shift workers. The diurnal secretion of melatonin by the pineal gland with peak in secretory activity during the night is a good biochemical marker of the circadian rhythm. Disruption of the diurnal melatonin secretion pattern can be diminished by restricting the number of consecutive night shifts. Reddish light and reduced light intensity during work at night could potentially help diminish the inhibitory activity of light with strong intensity on the melatonin secretion, but further mechanistic insight is needed before definite recommendations can be made. Earlier or more intensive mammography screening among female night shift worker is not recommended because the harm-benefit ratio in this age group may not be beneficial. Preventive effects of melatonin supplementation on breast cancer risk have not been clearly documented, but may be a promising avenue if a lack of side effects can be shown even after long-term ingestion. Women with previous or current breast cancer should be advised not to work night shifts because of strong experimental evidence demonstrating accelerated tumor growth by suppression of melatonin secretion. Work during the night is widespread worldwide. To provide additional evidence-based recommendations on prevention of diseases related to night shift work, large studies on the impact of various shift schedules and type of light on circadian rhythms need to be conducted in real work environments.

Hospital admissions for neurological and renal diseases among dentists and dental assistants occupationally exposed to mercury.

OBJECTIVES: For many years an amalgam containing metallic mercury, which has been associated with neurological and renal diseases, has been used in dentistry. In this nationwide study we compared hospital admissions due to neurological and renal diseases among dentists and dental assistants to admissions in controls. METHODS: This register-based cohort study included all Danish workers employed in dental clinics, general practitioners' clinics or lawyers' offices between 1964 and 2006. We compared dentists with general practitioners and lawyers, and dental assistants with medical secretaries, nurses and legal secretaries. We also compared dentists and dental assistants employed during periods with high occupational mercury exposure with dentists and dental assistants employed during periods with less mercury exposure. We followed all subjects in a nationwide register of hospital admissions. We analysed risk of neurological diseases, Parkinson's disease and renal diseases using a Cox regression model. RESULTS: The cohort consisted of 122,481 workers including 5371 dentists and 33,858 dental assistants. For neurological diseases, no association was observed for dental assistants, while for dentists an increasing risk for periods with less mercury exposure was observed. Among dental assistants, a negative association between employment length and risk of neurological disease was observed. Admissions for renal disease among dental assistants were increased during periods with less mercury exposure compared with controls. For dentists a non-significant increased risk was observed between employment length and renal disease risk. CONCLUSIONS: Our nationwide study does not indicate that occupational exposure to mercury increases the risk of hospital admissions for neurological, Parkinson's or renal diseases.

Night work and breast cancer risk among Norwegian nurses: assessment by different exposure metrics.

Associations between night work and breast cancer risk were investigated in a nested case-control study within a cohort of 49,402 Norwegian nurses. A total of 699 (74%) of the live cases diagnosed in 1990-2007 and 895 (65%) controls, cancer free at the time of sampling, were interviewed about work history and potential risk factors. The odds ratios for risk of breast cancer in relation to different exposure metrics were estimated by multivariate unconditional logistic regression models. No increase of risk was found after long duration of work by nurses working ≥3 night shifts per month. Small, nonsignificantly increased risks were observed for exposure to ≥30 years in hospitals or other institutions (odds ratio (OR) = 1.1), ≥12 years in schedules including night work (OR = 1.3), ≥1,007 night shifts during the lifetime (OR = 1.2), and lifetime average number of ≥4 night shifts per month (OR = 1.2). Nonsignificantly increased risks of breast cancer were observed in nurses who worked ≥5 years with ≥4 (OR = 1.4) and ≥5 (OR = 1.6) consecutive night shifts. Significantly increased risks were seen in nurses who worked ≥5 years with ≥6 consecutive night shifts (OR = 1.8, 95% confidence interval: 1.1, 2.8). The results suggest that risk may be related to number of consecutive night shifts.

Mortality from non-malignant respiratory diseases among workers in the Norwegian silicon carbide industry: associations with dust exposure.

OBJECTIVES: Increased mortality from asthma, chronic bronchitis and emphysema has previously been reported among workers in the silicon carbide (SiC) industry. The objective of the present study was to evaluate the influence of specific exposure factors on mortality from obstructive lung diseases (OLD), using a newly revised job-exposure matrix. MATERIALS AND METHODS: 1687 long-term workers employed in 1913-2003 in the Norwegian SiC industry were characterised with respect to cumulative exposure to quartz, cristobalite, SiC particles and SiC fibres. Standardised mortality ratios (SMRs) for underlying causes of death, 1951-2007, were calculated stratified by category of cumulative exposure, and Poisson regression analyses of OLD were performed using cumulative exposure variables. RESULTS: An increased total mortality (SMR 1.1, 95% CI 1.0 to 1.2) and increased mortality from cancer, non-malignant respiratory diseases and external factors, were observed. The SMR of OLD was increased at the highest level of cumulative exposure to all investigated exposure factors. In the internal analyses, a twofold increased risk of OLD was observed with increasing levels of cumulative exposure to SiC particles. In a multivariate model, SiC particles showed the most stable increased risk estimate when controlled for other exposure factors, among workers with less than 15 years of employment. Among workers with more than 15 years of employment, crystalline silica, primarily cristobalite, seemed to be the most important exposure factor. CONCLUSION: Exposure to SiC and crystalline silica may contribute to OLD development among SiC industry workers in different time windows, and possibly through different mechanisms.

Self-reported symptoms and neuropsychological function among tunnel workers previously exposed to acrylamide and N-methylolacrylamide.

OBJECTIVE: The aim of this study was to examine possible exposure-related symptoms and neuropsychological changes among tunnel workers previously exposed to grout containing acrylamide and N-methylolacrylamide. METHODS: In a cross sectional study, 44 male tunnel workers previously exposed to acrylamide and N-methylolacrylamide during grouting operations were exam-in-ed with neuropsychological tests, 2-10 years after last exposure. The control group consisted of 49 male tunnel workers with no history of acrylamide exposure. Questionnaires were used to assess retrospectively recalled symptoms during work and current symptoms at the time of the examination. RESULTS: The prevalence of paresthesia in hands and legs, and leg cramps during work peri-ods were higher in the exposed than control group. Self-reported prevalence of skin irritation, peeling of skin on the hands, white-finger attacks, headache, and breathlessness was also higher among the exposed workers. The Q-16 questionnaire on current symptoms indicated higher symptom prevalence among the exposed of impaired memory and concentration, emotional change, sleep disturbances, tiredness, headache, and sensory or motor changes. In contrast, no association was found between neuropsychological test results and acrylamide exposure, adjusting for relevant confounders. However, selected motor symptoms were associated with the corresponding results on tests for motor function. CONCLUSIONS: Despite higher prevalences of self-reported current symptoms among the acrylamide-exposed compared to the control group, we did not find an association between occupational acrylamide exposure and health out-comes as measured by the chosen neuropsychological tests. Observed associations between chemical exposure and self-reported symptoms should be interpreted with great caution.

Cancer incidence among short- and long-term workers in the Norwegian silicon carbide industry.

OBJECTIVES: A previous study among workers in the Norwegian silicon carbide industry, followed until 1996, revealed an excess incidence of lung and total cancer. The present study adds nine years of follow-up and focuses on cancer risk among short- and long-term workers, based on the assumption that these two groups have different exposure and lifestyle characteristics. METHODS: The total cohort for this study comprised 2612 men employed for >6 months between 1913 and 2003. The follow-up period for cancer was 1953-2005. Short-term workers were defined as having <3 years of total employment in the industry. We estimated standardized incidence ratios (SIR) using national rates as the expected values. RESULTS: Among the short-term workers, we observed an overall excess incidence of cancer [SIR 1.4, 95% confidence interval (95% CI) 1.2-1.6], with an excess of lung cancer (SIR 2.6, 95% CI 1.9-3.5) as the most important contributing factor. The long-term workers also had an excess incidence of total cancer (SIR 1.2, 95% CI 1.1-1.3) and lung cancer (SIR 1.7, 95% CI 1.3-2.2). We also observed an increased risk of cancers at other sites, specifically among short-term workers. CONCLUSIONS: We observed an increased risk of cancer (especially in the lung but also at other sites) among both short- and long-term workers. Dust exposure in the silicon carbide industry may have contributed to the increased risk among long-term workers, whereas the increased risk among short-term workers may be due to a combination of occupational and lifestyle factors.

Self-reported versus expert-assessed work-relatedness of pain in the neck, shoulder, and arm.

OBJECTIVES: The aim of this study was to compare self-reported work-relatedness of neck-shoulder and arm pain with experts' assessments based on specific criteria. METHODS: A sample of 217 employed participants in the Oslo Health Study 2000-2001, aged 30, 40, and 45 years, who reported neck-shoulder or arm pain in the past month, underwent a health examination. A criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders was used to -establish clinical diagnoses and assess the work-relatedness of pain with respect to the subject's present job. We measured agreement between the participants and experts on whether pain was related to work as observed agreement, positive and negative specific agreement, and kappa. RESULTS: A major proportion of the cases were assessed as work-related, somewhat more frequently by self-report than when assessed by experts (80% versus 65% for neck-shoulder pain, and 78% versus 72% for arm pain, respectively). However, there was considerable disagreement as to which cases were work-related. The experts disagreed more frequently in cases that were reported as non-work-related (particularly for neck-shoulder pain and cases reported by men). Positive specific agreement was fairly high (76-85% in the total population), while negative specific agreement was lower (37-51%). Kappa values were also low (0.16-0.34). CONCLUSIONS: Compared with expert assessment, self-reporting did not seem to particularly exaggerate work-relatedness. Nevertheless, there was considerable disagreement, especially on cases assessed as non-work--related. However, agreement will depend on the case definitions and the criteria for work-relatedness used both by the participants and the experts.

Are occupational factors important determinants of socioeconomic inequalities in musculoskeletal pain?

OBJECTIVES: The aim of this study was to quantify socioeconomic inequalities in low-back pain, neck-shoulder pain, and arm pain in the general working population in Oslo and to examine the impact of job characteristics on these inequalities. METHODS: All economically active 30-, 40-, and 45-year-old persons who attended the Oslo health study in 2000-2001 and answered questions on physical job demands, job autonomy, and musculoskeletal pain were included (N=7293). Occupational class was used as an indicator of socioeconomic status. The lower occupational classes were compared with higher grade professionals, and prevalences, prevalence ratios, prevalence differences, and population attributable fractions were calculated. RESULTS: There were marked, stepwise socioeconomic gradients for musculoskeletal pain, steeper for the men than for the women. The relative differences (prevalence ratios) were larger for low-back pain and arm pain than for neck-shoulder pain. The absolute differences (prevalence differences) were the largest for low-back pain. Physical job demands explained a substantial proportion of the absolute occupational class inequalities in low-back pain, while job autonomy was more important in explaining the inequalities in neck-shoulder pain and arm pain. The estimated population attributable fractions supported the impact of job characteristics at the working population level, especially for low-back pain. CONCLUSIONS: In this cross-sectional study, physical job demands and job autonomy explained a substantial proportion of occupational class inequalities in self-reported musculoskeletal pain in the working population in Oslo. This finding indicates that the workplace may be an important arena for preventive efforts to reduce socioeconomic inequalities in musculoskeletal pain.

Nerve conduction, visual evoked responses and electroretinography in tunnel workers previously exposed to acrylamide and N-methylolacrylamide containing grouting agents.

The study examines possible persisting effects on the peripheral nervous system and visual system in tunnel workers previously exposed to acrylamide and N-methylolacrylamide during grouting work. We compared neurophysiological function in 44 tunnel workers previously exposed during grouting operations (2-10 years post exposure), with 49 tunnel workers with no history of exposure to acrylamide. Nerve conduction velocities (NCV), distal delay, F-response and amplitude in median and ulnar nerves of the right arm, peroneal, sural and tibial nerves of the right leg, visual evoked response (VER) and electroretinography (ERG) were measured. VER and ERG were also performed in 24 subjects more recently exposed to acrylamide grout (16 months post exposure). Exposure to acrylamide containing grouts was assessed by questionnaires. A statistically significant reduction in the mean sensory NCV of the sural nerve (p=0.005), as well as a non-significant reduction of sural amplitude was found in the previously exposed group compared to the control group. VER latencies to the onset of the occipital potential (N75) were prolonged in both exposed groups compared to the control group (p<0.05). ERG 30 Hz flicker amplitude was reduced in the recently exposed group compared to the referents (p<0.05). The results indicate slight subclinical, but persistent toxic effects in the sural nerve and the visual system in tunnel workers exposed to N-methylolacrylamide and acrylamide during grouting operations.