Prevalence and predictors of high-frequency hearing loss among mine workers in Gujarat, western India: a cross-sectional study on the need to implement a comprehensive hearing conservation program.

BACKGROUND: High-frequency hearing loss (HFHL) stands as a prevalent occupational morbidity globally, with numerous associated risk factors, some of which are modifiable. In the context of a comprehensive hearing conservation program, the initial steps involve early screening and identification of workers with these modifiable risk factors, aiming to reduce the prevalence of hearing loss. Our objective was to estimate the prevalence of HFHL and determine its predictors among mine workers. METHODS: We conducted a cross-sectional study among 226 mine workers in ten open-cast mines in Gujarat state, the western part of India, in November 2020. We collected data on socio-demography, addiction, occupation history and comorbidities, along with anthropometric, blood pressure, and blood sugar measurements. Audiometric evaluations using a portable diagnostic audiometer were employed to assess HFHL, defined as a hearing threshold exceeding 25 decibels (dB) at high frequencies (3000, 4000, 6000, and 8000 Hz). A generalized linear model (GLM) with a binomial family was performed to determine the predictors significantly predicting HFHL after adjusting for confounding variables. RESULTS: The prevalence of HFHL was 35% (95% CI: 29-42%) in our study setting. Office workers demonstrated a prevalence of 19%, whereas other job categories displayed a higher prevalence of 42%, resulting in a significant prevalence difference of 23% and a prevalence ratio of 2.2. The GLM analysis revealed that variables, such as noise exposure during work [adjusted prevalence ratio (aPR) 2.3 (95% CI: 1.2-4.7, p = 0.018)] and noise exposure duration [aPR 1.1 (95% CI: 1.0-1.1, p = 0.042)], were significant predictors of HFHL. CONCLUSIONS: In our study setting, mine workers exhibited a high prevalence of HFHL, with exposure to workplace noise and duration being modifiable predictors. Because HFHL advances slowly and is generally undetected by the individual, we recommend periodic testing using audiometry to identify it among mine workers and, if possible, shifting them from mining activities to office. Furthermore, we advocate for the implementation of a comprehensive hearing conservation program to the extent possible.

Predictors of pulmonary dysfunction vis-à-vis the hypertension status of mine workers in Gujarat, western India: A cross-sectional study on the need to further investigate the role of anti-hypertensive drugs.

BACKGROUND: Mine workers face various health risks from occupational hazards, notably dust-related pulmonary dysfunction. This dysfunction is also attributed to diverse risk factors and health conditions. Despite the variety of underlying mechanisms, conflicting evidence persists regarding hypertension as a potential risk factor for such dysfunction. OBJECTIVE: To determine the predictors of pulmonary dysfunction vis-à-vis the hypertension status of mine workers. METHODS: We conducted a cross-sectional study among 444 mine workers from ten open-cast mines in Gujarat state (western part of India) from November 2020 to February 2022. We collected data on demographics, occupation, addiction, and comorbidities, including measurements like anthropometry, blood pressure, blood sugar, haemoglobin, and lipid levels. Hypertension was confirmed based on self-reported history and/or onsite blood pressure measurement, while pulmonary functions were assessed using a spirometer (expressed as forced expiratory volume in the first second FEV1 and forced vital capacity FVC). Multiple linear regression analysis was performed to determine the significant predictor of FEV1 or FVC vis-à-vis the hypertension status after adjusting for confounding variables. In addition, we assessed the effect of anti-hypertensive medications on pulmonary dysfunction. RESULTS: A total of 41% (95% CI: 36-45%) of mine workers were suffering from hypertension. On multiple linear regression, only being a male and work experience duration were the significant predictors of FEV1 [0.900 (0.475-1.092), p=<0.001; -0.029 (-0.034 - -0.021, p=<0.001] and FVC [1.088 (0.771-1.404), p=<0.001; -0.031 (-0.038 - -0.024, p = 0.001] respectively. While unadjusted analysis indicated hypertension led to FEV1 and FVC reduction, this effect lost significance after adjusting for confounders. Nevertheless, subgroup analysis revealed those on antihypertensive medications had reductions in FEV1 and FVC by -0.263 (95% CI: -0.449 - -0.078, p = 0.006) L and -0.271 (95% CI: -0.476 - -0.067, p = 0.009) L respectively. CONCLUSION: In our study among mine workers, alterations in lung function (FEV1 and FVC) on spirometry were predicted by gender and duration of work experience, while hypertension did not serve as a predictor. It is noteworthy that antihypertensive drugs were found to reduce lung functions on spirometry, highlighting the need for further research.

Biological Response Modifiers in Rheumatoid Arthritis: Systematic Review and Meta-analysis of Safety.

OBJECTIVE: To analyze available evidence on the safety of different biological response modifiers which are used for a treatment of rheumatoid arthritis (RA). MATERIALS AND METHODS: We searched systematically for randomized controlled clinical trials on treatment of RA with different biological response modifiers, followed by a systematic review with meta-analysis. Trials were searched from MEDLINE and Cochrane Library databases. The following safety parameters reported in the selected trials were analyzed: number of patients suffering any adverse event (AE), withdrawal due to AEs, serious AE (SAEs), infections, serious infections, infusion reactions, injection site reactions, malignancies, and overall mortality. Undesired effects were estimated using combined relative risks (RR) and number needed to harm (NNH). Heterogeneity was evaluated by Cochrane's Q and I2 statistics. RESULTS: According to inclusion criteria, a total of 43 trials (20,504 patients) were included in this study. A total number of AEs were found more with abatacept (RR: 1.05, NNH: 21.93). Withdrawal due to AEs was found with all biologicals, highest with anakinra (RR: 3.48, NNH: 15.70). Patients receiving newer tumor necrosis factor-alpha inhibitors, golimumab, were more likely to develop SAEs (RR: 2.44, NNH: 12.72) and infection (RR: 1.25, NNH: 10.09), and in certolizumab, serious infections (RR: 2.95, NNH: 37.31) were found more. Infusion reaction develops more with rituximab (RR: 1.52, NNH: 8.47). Etanercept showed the highest risk to develop infusion site reaction (RR: 5.33, NNH: 4.65). Biologicals showed no difference to their control counterparts in malignancy and mortality risk. CONCLUSION: This meta-analysis helps to clarify some frequently encountered and unanswered safety questions of different biological response modifiers, a new class of drugs, in the clinical care of RA patients.