Physical workload and cardiopulmonary parameters in relation to individual capacity of bulk waste workers - a cross-sectional field-study.

PURPOSE: Waste collection is considered particularly heavy work, although no previous study has yet investigated the strain of bulk waste collection. The aim of this study is to determine the workload of bulk waste workers in practice. METHOD: We conducted a cross-sectional field-study. Fourteen male volunteers from the bulk waste collection of the municipal sanitation department in Hamburg, Germany, were included. Performance was determined by cardiopulmonary exercise testing under laboratory conditions. During the shift, each worker was accompanied by a researcher, and heart rate (HR) was recorded under field conditions using an HR watch with a belt system. We examined mean HR, relative heart rate (RHR), relative aerobic strain (RAS), calculated oxygen uptake ([Formula: see text])  and individual ventilatory threshold 1 (VT1) as parameters of workload during their daily work. RESULTS: During the shift, HR was scaled: 102 bpm (SD 10.2), RHR: 36.9%, [Formula: see text]: 1267 ml/min (SD 161), RAS: 49.4% (SD 9.3), and [Formula: see text] in relation to VT1: 75% (SD 18.5). There was no significant difference between oxygen consumption during the main task of lifting and carrying bulky waste and the individual [Formula: see text] at VT1. CONCLUSION: Although the burden of the main task of lifting and carrying bulky waste is very high (at VT1 for more than 3 h), interruptions from other tasks or formal breaks spread the burden over the entire shift. The total workload exceeded most recommendations in the literature across the different work periods. However, the total burden remains below VT1, the only parameter that takes individual endurance performance into account. We recommend again VT1 as an individual upper limit for prolonged occupational work.

Does working in an extremely cold environment affects lung function?: 10 years follow-up.

OBJECTIVE: The aim of this study is to investigate whether there is an association between brief but repeated exposures to extremely cold temperatures over many years and pulmonary function. METHODS: We performed a retrospective analysis of the data collected over 10 years in the context of the extended medical examinations of storeworkers exposed to extremely cold temperatures. We considered forced vital capacity (FVC), forced expiratory volume in one second (FEV1), Tiffeneau-Pinelli index (FEV1/FVC), CO diffusion capacity (DL,CO) and Krogh-factor (CO diffusion capacity relative to recorded alveolar volume, DL,CO/VA) reported as %-predicted. We analysed trends in outcome parameters with linear mixed models. RESULTS: 46 male workers participated in at least two extended medical examinations between 2007 and 2017. Overall 398 measure points were available. All lung function parameters had values above the lower limit of normality at the first examination. In the multivariate model including smoking status and monthly intensity of cold exposure (≤ 16 h/month vs. > 16 h/month) FEV1%-predicted and FVC %-predicted had a statistically significant positive slope (FEV1, 0.32% 95% CI 0.16% to 0.49% p < 0.001; FVC 0.43% 95% CI 0.28% to 0.57% p < 0.001). The other lung function parameters (FEV1/FVC %-predicted, DL,CO %-predicted, DL,CO/VA %-predicted) showed no statistically significant change over time. CONCLUSIONS: Long term intermittent occupational exposure to extreme cold temperatures (-55 °C) does not appear to cause irreversible deleterious changes in lung function in healthy workers, thus the development of obstructive or restrictive lung diseases is not expected.

Evolution of work ability, quality of life and self-rated health in a police department after remodelling shift schedule.

BACKGROUND: There exists a great diversity of schedules concerning the way shift work is organized and implemented with ample agreement regarding recommendable features of a shift system. In order to adapt the shift schedule of a metropolitan police department to current recommendations, a remodelled shift schedule was introduced in 2015. The aim of this study was to evaluate the potential associations between the remodelled shift schedule and work ability, quality of life and self-rated health after one and five years. METHODS: A controlled before-and- after study was conducted during the piloting phase (2015-2016) as well as a 5-year follow-up using paper questionnaires. Outcome parameters included work ability, quality of life and self-rated health. RESULTS: Work ability, quality of life and self-rated health improved after the first year of the newly implemented shift schedule among police officers working in the piloting police stations compared to those working according to the former schedule. In 5-year follow-up differences between indicators diminished. CONCLUSIONS: The implementation of a remodelled shift schedule including more 12-h shifts accompanied by more days off and a coherent weekend off duty was not associated with detrimental effects to work ability, quality of life or self-reported health among police officers.

Police officers' work-life balance, job satisfaction and quality of life: longitudinal effects after changing the shift schedule.

OBJECTIVES: To evaluate mental health-related outcomes of police officers 5.5 years after implementing a new alternating shift schedule which was supposed to improve their health and work-life balance. DESIGN: Pre-post study design with a baseline survey at the beginning of the piloting of the new shift schedule in 2015 and another survey 5.5 years later in 2020. SETTING: Police departments of a German metropolitan police force piloting the new shift schedule. PARTICIPANTS: 116 shift-working police officers out of a population of 1673 police officers at the follow-up date. INTERVENTIONS: New shift schedule based on occupational health recommendations. OUTCOMES MEASURES: Work-life balance, job satisfaction and quality of life. METHODS: Mixed analyses of variances were used to test the hypotheses of within-subject and between-subject differences regarding time and gender. RESULTS: We found partly significant differences between the baseline and follow-up survey for work-life balance (F(1, 114) = 6.168, p=0.014, ηp² = 0.051), job satisfaction (F(1, 114) = 9.921, p=0.002, ηp² = 0.080) and quality of life (F(1, 114) = 0.593, p=0.443, ηp² = 0.005). Neither significant differences between male and female police officers nor interaction effects of time and gender were found. CONCLUSION: An increase was found for each of the three outcomes 5.5 years after implementing the new shift schedule. The results contribute to the current state of research on mental health-related outcomes of working conditions in shift work. On this basis, recommendations for designing shift schedules can be deduced to promote mental health and job satisfaction for employees in shift work.

Musculoskeletal pain among offshore wind industry workers: a cross-sectional study.

OBJECTIVE: To assess whether there are differences in musculoskeletal pain among different types of occupations offshore and their relationship to ergonomic demands. METHODS: We conducted a web-based cross-sectional survey among workers from offshore wind energy companies operating within the German exclusive economic zone. We selected workers with regular offshore commitments and at least 28 days spent offshore in the past year (n = 268). Musculoskeletal pain was assessed using the Subjective Health Complaints inventory (SHC), which considers the past month. RESULTS: Of the 268 male participants eligible for analysis, 54% reported back pain 50.4% neck pain, 40.3% lower back pain, 35.5% shoulder, 23.3% arm and 22.1% leg pain, all of them during the past month. Compared to other offshore occupations, technicians reported more frequently arm (OR 3.13; 95% CI 1.58-6.19), back (OR 1.97; 95% CI 1.15-3.39), shoulder (OR 1.94; 95% CI 1.11-3.40) and neck pain (OR 1.89; 95% CI 1.11-3.22). After adjusting for age and nationality, lifting and carrying heavy loads were associated with all types of pain except leg pain. Overhead work, work in awkward postures, and the use of personal protection equipment and heavy tools was associated with shoulder, back and arm pain. CONCLUSIONS: Our findings suggest that occupational health counselling, health promotion and preventive interventions of offshore wind energy workers needs to consider the specific tasks of the employee and be particularly tailored to the ergonomic needs of technicians.

Sleep quality of offshore wind farm workers in the German exclusive economic zone: a cross-sectional study.

OBJECTIVES: To assess the quality of sleep of employees in the German offshore wind industry and to explore factors associated with poor sleep quality. DESIGN: Web-based cross-sectional survey. SETTING: Offshore companies operating in wind farms within the German exclusive economic zone. PARTICIPANTS: Workers with regular offshore commitments and at least 28 days spent offshore in the past year (n=268). OUTCOME MEASURES: Sleep quality in the past 4 weeks, troubles falling asleep or sleeping through in the past 4 weeks, differences in sleep quality between offshore deployments and onshore leaves. RESULTS: Having problems with sleep onset was reported by 9.5% of the respondents. 16.5% reported troubles with maintaining sleep three or more times per week. The overall quality of sleep was rated as very bad by only 1.7% of the participants. 47.9% of the workers reported their quality of sleep to be worse during offshore commitments than when being onshore. Higher levels of exposition to noise, vibrations and poor air quality were associated with sleeping troubles and poorer sleep quality. Sharing the sleep cabin with colleagues was associated with troubles sleeping through. No association was found for working in rotating shifts and for regularity of the offshore commitments. CONCLUSIONS: Workers in our study showed frequent sleep problems and poorer sleep quality offshore than onshore. Our results indicate that higher degrees of exposure to noise, vibrations and artificial ventilation are associated with poor sleep quality rather than organisational factors such as shift-work and type of working schedule. In view of the high demands of the offshore workplace and the workers' particular recovery needs, addressing sleep disorders should be part of any health and safety management strategy for this workplace.

Workplace health promotion for employees working in offshore wind parks in the German exclusive economic zone: a mixed-methods study.

OBJECTIVES: To investigate the awareness and use of health promotion offers among offshore wind workers and to study associations with demographic and workplace characteristics. To examine employees' reasons for (non-)participation and their wishes for health promotion activities offshore. DESIGN: Mixed-methods study presenting the results from semistructured telephone interviews and a web-based cross-sectional survey. SETTING: Offshore wind parks in the German exclusive economic zone in the North and Baltic Seas. PARTICIPANTS: 21 offshore workers in the qualitative study (19 male/2 female; all German). 303 offshore workers in the quantitative study (287 male/13 female; 275 German/24 other nationalities). OUTCOME MEASURES: Awareness and use of workplace health promotion offers and associations with demographic and workplace characteristics (age, work schedule and wind park phase); reasons for (non-)participation; needs and wishes for health promotion offers. RESULTS: Few workers indicated being aware of health promotion programmes at their workplace. Single offers were reported, with fitness facilities being the most common offer employees recognised and had used (n=168, 55.6%). Employees with a regular work schedule were more likely to have used fitness facilities offshore (adjusted OR (AOR)=3.22, 95% CI 1.53 to 6.80). Workers in the construction phase were more likely to have used massages (AOR=8.19, 95% CI 2.82 to 23.77). Younger workers were less likely to belong to the group of those who were aware of fitness facilities but had not used them (AOR=0.43, 95% CI 0.19 to 0.98). Employees expressed various needs and wishes for behavioural and environmental preventive measures offshore. CONCLUSIONS: The results demonstrate a perceived need among the workers for the development of health promotion programmes offshore. Since the awareness and use of offers may partly depend on personal and organisational characteristics, this should be taken into account in the planning of health promotion activities.

Linking quantitative demands to offshore wind workers' stress: do personal and job resources matter? A structural equation modelling approach.

BACKGROUND: Employees in the offshore wind industry are exposed to various job demands, increasing the workers' risk of experiencing strain reactions. However, personal and job resources might play a role in the stressor-strain context. The aim of this study was (1) to examine the link between offshore employees' quantitative demands and stress, and (2) to study the role of personal and job resources (psychological detachment from work, social support, and influence at work) in this stressor-strain relationship. METHODS: Two hundred fifty offshore wind workers responded to an anonymous web-based survey, assessing the workers' quantitative demands, social support, influence at work, psychological detachment from work, and stress. Descriptive statistical analyses and structural equation modelling were applied to test the hypotheses. RESULTS: Correlation analyses revealed substantial associations between employees' quantitative demands, personal and job resources, and stress. Results of structural equation modelling indicated a good fit of the hypothesized model. Quantitative demands were positively related to stress, and psychological detachment from work partially mediated this relationship. Social support was negatively related to stress, while influence at work was not. Neither social support nor influence at work moderated the stressor-strain or stressor-detachment relationship. CONCLUSIONS: The results contribute to the current knowledge on the topic. They can be used to design health promotion interventions aimed at reducing offshore employees' quantitative demands, fostering their ability to mentally detach from work, and enhancing social support at the offshore workplace.

A cross-sectional survey of physical strains among offshore wind farm workers in the German exclusive economic zone.

OBJECTIVES: To assess the physical strains of employees in the German offshore wind industry, according to job type and phase of the wind farm (under construction or operation). DESIGN: Web-based cross-sectional survey. SETTING: Offshore wind farm companies operating within the German exclusive economic zone. PARTICIPANTS: Male workers with regular offshore commitments and at least 28 days spent offshore in the past year (n=268). OUTCOME MEASURES: Physical strains (eg, climbing, noise, working overhead, with twisted upper body or in confined spaces, vibration, heavy lifting, humidity, odours). RESULTS: The most frequently mentioned physical strain was 'climbing' with 63.8% of the respondents reporting to be always or frequently confronted with climbing and ascending stairs during offshore work. Work as a technician was associated with a greater exposition to noise, vibrations, humidity, cold, heat, chemical substances, lifting/carrying heavy loads, transport of equipment, working in non-ergonomic positions and in cramped spaces, as well as climbing.Indeed, statistical analyses showed that, after adjusting for phase of the wind farm, age, nationality, offshore experience, work schedule and type of shift, compared with non-technicians, working as a technician was associated with more frequently lifting/carrying of heavy loads (OR 2.58, 95% CI 1.58 to 4.23), transport of equipment (OR 2.06 95% CI 1.27 to 3.33), working with a twisted upper body (OR 2.85 95% CI 1.74 to 4.69), working overhead (OR 2.77 95% CI 1.67 to 4.58) and climbing (OR 2.30 95% CI 1.40 to 3.77). Working in wind farms under construction was strongly associated with increased and decreased exposure to humidity (OR 2.32 95% CI 1.38 to 3.92) and poor air quality (OR 0.58 95% CI 0.35 to 0.95), respectively. CONCLUSIONS: Workers on offshore wind farms constitute a heterogeneous group, including a wide variety of occupations. The degree of exposure to detrimental physical strains varies depending on the type of job. Technicians are more exposed to ergonomic challenges than other offshore workers.

Healthy offshore workforce? A qualitative study on offshore wind employees' occupational strain, health, and coping.

BACKGROUND: Offshore work has been described as demanding and stressful. Despite this, evidence regarding the occupational strain, health, and coping behaviors of workers in the growing offshore wind industry in Germany is still limited. The purpose of our study was to explore offshore wind employees' perceptions of occupational strain and health, and to investigate their strategies for dealing with the demands of offshore work. METHODS: We conducted 21 semi-structured telephone interviews with employees in the German offshore wind industry. The interviews were transcribed and analyzed in a deductive-inductive approach following Mayring's qualitative content analysis. RESULTS: Workers generally reported good mental and physical health. However, they also stated perceptions of stress at work, fatigue, difficulties detaching from work, and sleeping problems, all to varying extents. In addition, physical health impairment in relation to offshore work, e.g. musculoskeletal and gastrointestinal complaints, was documented. Employees described different strategies for coping with their job demands. The strategies comprised of both problem and emotion-focused approaches, and were classified as either work-related, health-related, or related to seeking social support. CONCLUSIONS: Our study is the first to investigate the occupational strain, health, and coping of workers in the expanding German offshore wind industry. The results offer new insights that can be utilized for future research in this field. In terms of practical implications, the findings suggest that measures should be carried out aimed at reducing occupational strain and health impairment among offshore wind workers. In addition, interventions should be initiated that foster offshore wind workers' health and empower them to further expand on effective coping strategies at their workplace.

"It's still a great adventure" - exploring offshore employees' working conditions in a qualitative study.

BACKGROUND: Despite the particular demands inherent to offshore work, little is known about the working conditions of employees in the German offshore wind industry. To date, neither offshore employees' job demands and resources, nor their needs for improving the working conditions have been explored. Therefore, the aim of this study was to conduct a qualitative analysis to gain further insight into these topics. METHODS: Forty-two semi-structured telephone interviews with German offshore employees (n = 21) and offshore experts (n = 21) were conducted. Employees and experts were interviewed with regard to their perceptions of their working conditions offshore. In addition, employees were asked to identify areas with potential need for improvement. The interviews were analysed in a deductive-inductive process according to Mayring's qualitative content analysis. RESULTS: Employees and experts reported various demands of offshore work, including challenging physical labour, long shifts, inactive waiting times, and recurrent absences from home. In contrast, the high personal meaning of the work, regular work schedule (14 days offshore, 14 days onshore), and strong comradeship were highlighted as job resources. Interviewees' working conditions varied considerably, e.g. regarding their work tasks and accommodations. Most of the job demands were perceived in terms of the work organization and living conditions offshore. Likewise, employees expressed the majority of needs for improvement in these areas. CONCLUSIONS: Our study offers important insight into the working conditions of employees in the German offshore wind industry. The results can provide a basis for further quantitative research in order to generalize the findings. Moreover, they can be utilized to develop needs-based interventions to improve the working conditions offshore.

Content of Asthmagen Natural Rubber Latex Allergens in Commercial Disposable Gloves.

The use of natural rubber latex (NRL) gloves in many occupations may lead to latex sensitization, allergic asthma, and skin reactions. Due to their good properties and environmental safety NRL gloves are still being used in the healthcare setting, but also in the food industry, by hairdressers, cleaners, etc. The aim of our study was to assess the protein and NRL allergen content in commercial gloves by different methods, including a new assay. Twenty commercially available NRL gloves were analyzed. Protein extraction was performed according to the international standard ASTM D-5712. Total protein content was measured with a modified Lowry method, NRL content with the CAP Inhibition Assay, the Beezhold ELISA Inhibition Assay, and an innovative ELISA with IgY-antibodies extracted from eggs of NRL-immunized hens (IgY Inhibition Assay). We found a high protein content in a range of 215.0-1304.7 µg/g in 8 out of the 20 NRL gloves. Seven of the 20 gloves were powdered, four of them with a high protein content. In gloves with high protein content, the immunological tests detected congruently high levels of NRL allergen. We conclude that a high percentage of commercially available NRL gloves still represent a risk for NRL allergy, including asthma. The modified Lowry Method allows to infer on the latex allergen content.

Patients' views of adverse events in primary and ambulatory care: a systematic review to assess methods and the content of what patients consider to be adverse events.

BACKGROUND: Patient safety gained widespread public attention in the last 20 years. However, most patient safety research relied upon professionals' exceptions and was realised especially in the hospital sector. Gradually patients' attention has been focused on safety campaigns in inpatient care. We aimed to better assess patients' perceptions in primary and ambulatory care. METHODS: A systematic review was conducted by use of database searches with additional reference and hand searching. The search strategy implied MeSH-terms relating to adverse events, incident reporting and outpatient care. Relevant articles were selected by applying defined eligibility criteria. Studies exclusively based on hospital data as well as the professionals' point of view were excluded. RESULTS: We included 19 studies. Patients were able to identify events that were traditionally recognised by the medical community as technical medical aspects (e.g. errors in diagnosis). An important field of patient participation in prevention of adverse events was proposed in the medication process. Most reported events however could be described as service quality incidents. Communication problems were shown to have implications on the occurrence of technical medical aspects and patients' satisfaction of their care. Further, unsatisfied patients were more likely to recognize adverse events. CONCLUSION: Patients' perception of patient safety in primary and ambulatorycare broadened the previous focus on technical medical aspects. Especially communication factors played an important role in the occurrence and consequence of adverse events and patients' satisfaction. Future research should concentrate on developing possible ways to integrate patients' views and participation in ensuring safety in outpatient care.

Measured by the oxygen uptake in the field, the work of refuse collectors is particularly hard work: Are the limit values for physical endurance workload too low?

PURPOSE: Collecting waste is regarded as a benchmark for "particularly heavy" work. This study aims to determine and compare the workload of refuse workers in the field. We examined heart rate (HR) and oxygen uptake as parameters of workload during their daily work. METHODS: Sixty-five refuse collectors from three task-specific groups (residual and organic waste collection, and street sweeping) of the municipal sanitation department in Hamburg, Germany, were included. Performance was determined by cardiopulmonary exercise testing (CPX) under laboratory conditions. Additionally, the oxygen uptake (VO2) and HR under field conditions (1-h morning shift) were recorded with a portable spiroergometry system and a pulse belt. RESULTS: There was a substantial correlation of both absolute HR and VO2 during CPX [HR/VO2 R 0.89 (SD 0.07)] as well as during field measurement [R 0.78 (0.19)]. Compared to reference limits for heavy work, 44% of the total sample had shift values above 30% heart rate reserve (HRR); 34% of the individuals had mean HR during work (HRsh) values that were above the HR corresponding to 30% of individual maximum oxygen uptake (VO2,max). All individuals had a mean oxygen uptake (VO2,1h) above 30% of VO2,max. CONCLUSION: HR as well as the measurement of VO2 can be valuable tools for investigating physiological workload, not only under laboratory conditions but also under normal working conditions in the field. Both in terms of absolute and relative HR and oxygen consumption, employment as a refuse collector should be classified in the upper range of defined heavy work. The limit of heavy work at about 33% of the individual maximum load at continuous work should be reviewed.

Health status and health-related quality of life of municipal waste collection workers - a cross-sectional survey.

BACKGROUND: Waste collection workers are exposed to several occupational stressors which may affect their quality of life. Our aim was to assess the health status and health-related quality of life (HRQoL) of municipal waste collection workers of a big German city. METHODS: Cross-sectional study with a non-random sample of 65 (62 male, 3 female) workers of the Hamburg sanitation department, volunteering to participate in the study. We assessed the prevalence of reported health complaints and health problems. HRQoL was assessed with the self-administered EQ-5D-5L questionnaire and its visual analogue scale (VAS). RESULTS: The most common health problems were musculoskeletal complaints (back pain reported by 67.2 %, other musculoskeletal complaints 15.4 %). Asthma or chronic obstructive pulmonary disease (COPD) was reported by 15.4 % of the workers. All participants reporting having a diagnosis of asthma or COPD had been or were active smokers. Our findings indicate an impaired HRQoL among the investigated occupational group. Regarding EQ-5D 68.3 % reported at least "slight" problems in one or more dimensions, and almost one third (31.7 %) reported "no problems" in any dimension. Problems were most frequently reported in the dimension "pain/discomfort" (64.1 % of the workers). The mean VAS value was 80.9 (13.2). The presence of back pain was associated with limitations in HRQoL (RR 3.1; 95 %-CI 1.5-6.1). The EQ5D VAS score was statistically significantly lower among waste collectors with back pain (77.9 SD 14.1) compared to those with no back complaints (88.0 SD 7.6, p < 0.01). CONCLUSIONS: Back complaints are common among municipal waste collectors and are associated with considerable impairments in their HRQoL. Interventions to enhance ergonomic work are needed in order to reduce back complaints and enhance HRQoL in this occupational group.

Mortality study of chemical workers exposed to dioxins: follow-up 23 years after chemical plant closure.

OBJECTIVES: To examine the long-term effects of dioxin-exposure, particularly with regard to cancer mortality, in a follow-up 23 years after closure of the chemical plant (Hamburg, Germany). METHODS: The study comprised all persons (1191 men/398 women) employed in the plant on a full-time basis for a minimum of 3 months between 1952 and 1984 when the plant was closed down. Mortality follow-up was performed for the period from 1952 up to the reference date of 31 December 2007. Subjects entered the cohort at the date of their first employment in the plant. We calculated standardised mortality ratios (SMRs) using the population of Hamburg as reference. RESULTS: The vital status could be determined for 96.5% of the study group (1145 men and 389 women). For men, there was an increase in overall mortality (ICD-9 1-999) (SMR=1.14, 95% CI 1.06 to 1.23), all-cancer mortality (SMR=1.37, 95% CI 1.21 to 1.56) and specific mortality from respiratory cancer (ICD-9 161, 162, 163) (SMR=1.64, 95% CI 1.32 to 2.03), oesophageal cancer (ICD-9 150) (SMR=2.56, 95% CI 1.27 to 4.57), rectum cancer (ICD-9 154) (SMR=1.96, 95% CI 0.98 to 3.51), as well as diseases of the circulatory system (ICD-9 390-459) (SMR=1.16, 95% CI 1.02 to 1.31). For women, there was an increase in breast cancer mortality (ICD-9 174) (SMR=1.86, 95% CI 1.12 to 2.91). CONCLUSIONS: The results of this extended follow-up are consistent with those of previous analyses of the cohort and with those of other cohorts. Our findings support the carcinogenic effect of dioxin compounds.

Prostate cancer and toxicity from critical use exemptions of methyl bromide: environmental protection helps protect against human health risks.

BACKGROUND: Although ozone-depleting methyl bromide was destined for phase-out by 2005, it is still widely applied as a consequence of various critical-use-exemptions and mandatory international regulations aiming to restrict the spread of pests and alien species (e.g. in globalized transport and storage). The withdrawal of methyl bromide because of its environmental risk could fortuitously help in the containment of its human toxicity. METHODS: We performed a systematic review of the literature, including in vitro toxicological and epidemiological studies of occupational and community exposure to the halogenated hydrocarbon pesticide methyl bromide. We focused on toxic (especially chronic) or carcinogenic effects from the use of methyl bromide, on biomonitoring data and reference values. Eligible epidemiological studies were subjected to meta-analysis. RESULTS: Out of the 542 peer reviewed publications between 1990-2011, we found only 91 referring to toxicity of methyl bromide and 29 using the term "carcinogenic", "neoplastic" or "mutagenic". Several studies provide new additional data pertaining to the mechanistic aspects of methyl bromide toxicity. Few studies have performed a detailed exposure assessment including biomonitoring. Three evaluated epidemiological studies assessed a possible association between cancer and methyl bromide. Overall, exposure to methyl bromide is associated with an increased risk of prostate cancer OR, 1.21; 95% CI (0,98-1.49), P = 0.076. Two epidemiological studies have analyzed environmental, non-occupational exposure to methyl bromide providing evidence for its health risk to the general public. None of the epidemiological studies addressed its use as a fumigant in freight containers, although recent field and case reports do refer to its toxic effects associated with its use in shipping and storage. CONCLUSIONS: Both the epidemiological evidence and toxicological data suggest a possible link between methyl bromide exposure and serious health problems, including prostate cancer risk from occupational and community exposure. The environmental risks of methyl bromide are not in doubt, but also its health risks, especially for genetically predisposed subjects, should not be underestimated.

Lung function in asbestos-exposed workers, a systematic review and meta-analysis.

BACKGROUND: A continuing controversy exists about whether, asbestos exposure is associated with significant lung function impairments when major radiological abnormalities are lacking. We conducted a systematic review and meta-analysis in order to assess whether asbestos exposure is related to impairment of lung function parameters independently of the radiological findings. METHODS: MEDLINE was searched from its inception up to April 2010. We included studies that assessed lung function parameters in asbestos exposed workers and stratified subjects according to radiological findings. Estimates of VC, FEV1 and FEV1/VC with their dispersion measures were extracted and pooled. RESULTS: Our meta-analysis with data from 9,921 workers exposed to asbestos demonstrates a statistically significant reduction in VC, FEV1 and FEV1/VC, even in those workers without radiological changes. Less severe lung function impairments are detected if the diagnoses are based on (high resolution) computed tomography rather than the less sensitive X-ray images. The degree of lung function impairment was partly related to the proportion of smokers included in the studies. CONCLUSIONS: Asbestos exposure is related to restrictive and obstructive lung function impairment. Even in the absence of radiological evidence of parenchymal or pleural diseases there is a trend for functional impairment.

Mapping research on health systems in Europe: a bibliometric assessment.

OBJECTIVE: Europe's health care decision-makers are facing an increasingly complex and rapidly changing landscape. It is crucial that health care problems are addressed with evidence-informed policy and that evidence finding is aimed at those topics most urgent on policy agendas. Research on health systems addresses the macro-level of health care delivery and aims at generating evidence for policy-making. Our aim was to assess the field of health systems research in Europe, primarily based on an analysis of the published literature. METHODS: Starting from current definitions of health systems, during 2004-09 we identified four thematic areas for research and defined keywords to construct a sensitive literature search limited to European research. RESULTS: The database search resulted in 26,945 hits between 2004-09. Until 2008, the annual number of publications on health systems research increased at an average rate of 5.2%. Most (88%) were in English. The largest producer of research on health systems has been the UK (nearly 10,000 in six years; 37% of the total for Europe), which is also the country most frequently the object of research. In contrast, seven countries had produced no publications. There were modest correlations between a country's research production and its gross domestic product (r = 0.62) but less so with its population size (0.33). The most frequent keywords were 'patients' (49% of all references), 'patient satisfaction' (27%), 'organization and administration' (23%), 'education' (19%) and 'attitude of health personnel' (13%). Closer inspection of a sub-sample of 1000 abstracts revealed that only 24% met our definition of 'health systems research' rather than other fields of health services research. CONCLUSION: There is a wide-spread need to develop health systems research capacity, in particular in eastern European countries, and to address the effects of health care reform, particularly the effects of privatization and commercialization of health services.

The effects of gatekeeping: a systematic review of the literature.

OBJECTIVE: To assess the effects of physician-centred gatekeeping on health, health care utilization, and costs by conducting a systematic review of the literature. METHODS: Systematic search in PubMed (MEDLINE and Pre-MEDLINE), EMBASE, and the Cochrane Library, from the databases' respective inception dates up to January 2010, using the search words "gatekeeping", "gatekeeper*", "first contact", and "self-referral". We included RCTs, CCTs, cohort studies, CBAs, and interrupted time-series. We included only studies in which the gatekeeper function was exercised by a physician and that reported health and patient-related outcomes including quality of life and satisfaction, quality of care, health care utilization, and/or economic outcomes (e.g. expenditures or efficiency). Selection was made independently by two reviewers and discrepancies were solved by consensus after discussion. Data on target population, intervention, additional interventions, study results, and methodological quality were extracted. Methodological quality was assessed independently by two reviewers following the previously defined criteria. Discrepancies were solved by consensus after discussion. RESULTS: This review includes 26 studies in 32 publications. The majority of studies (62%) reported data from the United States and in most gatekeeping was associated with lower utilization of health services (up to -78%) and lower expenditures (up to -80%). However, there was great variability in the magnitude and direction of the differences. CONCLUSION: Overall, the evidence regarding the effects of gatekeeping is of limited quality. Many studies are available regarding the effects on health care utilisation and expenditures, whereas effects on health and patient-related outcomes have been studied only exceptionally and are inconclusive.