The latest medical research on Occupational & Environmental Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about occupational & environmental medicine gathered by our medical AI research bot.

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A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence.

Obesity Reviews

The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and ...

Multiple Sources of the Outbreak of Legionnaires' Disease in Genesee County, Michigan, in 2014 and 2015.

Environmental Health Perspectives

A community-wide outbreak of Legionnaires' disease (LD) occurred in Genesee County, Michigan, in 2014 and 2015. Previous reports about the outbreak are conflicting and have associated the outbreak with a change of water source in the city of Flint and, alternatively, to a Flint hospital.

The objective of this investigation was to independently identify relevant sources of Legionella pneumophila that likely resulted in the outbreak.

An independent, retrospective investigation of the outbreak was conducted, making use of public health, health care, and environmental data and whole-genome multilocus sequence typing (wgMLST) of clinical and environmental isolates.

Strong evidence was found for a hospital-associated outbreak in both 2014 and 2015: a) 49% of cases had prior exposure to Flint hospital A, significantly higher than expected from Medicare admissions; b) hospital plumbing contained high levels of L. pneumophila; c) Legionella control measures in hospital plumbing aligned with subsidence of hospital A-associated cases; and d) wgMLST showed Legionella isolates from cases exposed to hospital A and from hospital plumbing to be highly similar. Multivariate analysis showed an increased risk of LD in 2014 for people residing in a home that received Flint water or was located in proximity to several Flint cooling towers.

This is the first LD outbreak in the United States with evidence for three sources (in 2014): a) exposure to hospital A, b) receiving Flint water at home, and c) residential proximity to cooling towers; however, for 2015, evidence points to hospital A only. Each source could be associated with only a proportion of cases. A focus on a single source may have delayed recognition and remediation of other significant sources of L. pneumophila. https://doi.org/10.1289/EHP5663.

Environmental Health Practice Challenges and Research Needs for U.S. Health Departments.

Environmental Health Perspectives

Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations.

A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments.

A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic.

EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161.

Blood Lead Levels and Risk of Atherosclerosis in the Carotid Artery: Results from a Swedish Cohort.

Environmental Health Perspectives

Lead exposure has been associated with increased incidence of adverse clinical cardiovascular outcomes. Atherosclerosis has been suggested as one of the underlying mechanisms, and findings from experimental studies support this, but human data are scarce.

Our objective was to determine the association between environmental lead exposure based on blood lead (B-Pb) concentrations and the prevalence of atherosclerotic plaque in the carotid artery.

We used cross-sectional data from the Malmö Diet and Cancer Study cardiovascular cohort (MDCS-CC; recruitment in 1991-1994) covering 4,172 middle-aged men and women. B-Pb at baseline, measured by inductively coupled plasma mass spectrometry, was used as the exposure biomarker. The presence of atherosclerotic plaque in the carotid artery was determined by B-mode ultrasonography. We used logistic regression to estimate odds ratios (ORs) for prevalence of plaque in the carotid artery according to B-Pb quartiles.

The median B-Pb was 25 μ g / L (range: 1.5-258), and 36% of the cohort had any atherosclerotic plaque. After controlling for confounders and known cardiovascular risk factors, the OR for prevalence of plaque in the highest quartile (Q4) of B-Pb compared with the lowest quartile (Q1) was 1.35 (95% CI: 1.09, 1.66) in the total group, 1.58 (95% CI: 1.20, 2.08) among women, and 1.18 (95% CI: 0.83, 1.69) among men. Among women, associations were limited to those who were postmenopausal [OR for Q4 vs. Q 1 = 1.72 (95% CI: 1.26, 2.34) vs. OR = 0.96 (95% CI: 0.49, 1.89 in premenopausal women)]. Associations were weak and nonsignificant in never-smokers [OR for Q4 vs. Q 1 = 1.14 (95% CI: 0.81, 1.61)].

Our study shows an association between B-Pb concentrations and occurrence of atherosclerotic plaque in the carotid artery, adding evidence for an underlying pro-atherogenic role of lead in cardiovascular disease. Associations appeared to be limited to postmenopausal (vs. premenopausal) women. https://doi.org/10.1289/EHP5057.

A systematic review of the Australian food retail environment: Characteristics, variation by geographic area, socioeconomic position and associations with diet and obesity.

Obesity Reviews

There is strong support across multiple sectors for the implementation of policies to create healthier food environments as part of comprehensive s...

Exposure to traffic noise and gestational weight gain and postpartum weight retention: a cohort study.

Occupational and Environmental Medicine

Transportation noise has been associated with markers of obesity. We aimed to investigate whether road traffic and railway noise were associated with weight gain during and after pregnancy.

Among the women participating in the Danish National Birth Cohort, 74 065 reported on weight before and during the pregnancy (gestational week 30) and 52 661 reported on weight before and 18 months after pregnancy. Residential address history from conception to 18 months after pregnancy was obtained in national registers, and road traffic and railway noise were modelled for all addresses. Associations between noise and gestational weight gain (GWG) and postpartum weight retention (PPWR) were analysed using the linear and log-binomial regression.

A 10 dB(A) higher road traffic noise was associated with an increase in GWG of 3.8 g/week (95% CI 2.3 to 5.3) and PPWR of 0.09 kg (95% CI 0.02 to 0.16). For PPWR, this association seemed confined to women who were overweight (0.17 kg, 95% CI 0.02 to 0.32) or obese (0.49 kg, 95% CI 0.26 to 0.73) before pregnancy. Further adjustment by nitrogen dioxide reduced GWG risk estimates and slightly increased PPWR risk estimates. Railway noise ≥65 dB(A) was associated with an increase in GWG of 4.5 g/week (95% CI -2.7 to 11.6) and PPWR of 0.26 kg (95% CI -0.09 to 0.60) compared with levels <55 dB(A).

Our findings suggest that road traffic noise is associated with weight gain during and after the pregnancy, which adds to the literature linking transportation noise to adiposity.

Do gender and psychosocial job stressors modify the relationship between disability and sickness absence: An investigation using 12 waves of a longitudinal cohort.

Scandinavian Journal of Work, Environment

Objectives A considerable proportion of the working population reports a disability. These workers may be at risk of adverse outcomes, including lo...

Is the association between poor job control and common mental disorder explained by general perceptions of control? Findings from an Australian longitudinal cohort.

Scandinavian Journal of Work, Environment

Objectives This study sought to examine the influence of general perceptions of control on the association between job control and mental health. M...

Variability and predictors of weekly pesticide exposure in applicators from organic, sustainable and conventional smallholder farms in Costa Rica.

Occupational and Environmental Medicine

Estimates of pesticide exposure among applicators from low- and middle-income countries (LMICs) are scarce, and exposure assessment methods are sometimes costly or logistically unfeasible. We examined the variability in weeklong pesticide exposure among applicators in Costa Rica and its predictors.

We conducted a cross-sectional survey among 221 pesticide applicators from organic, sustainable and conventional farms in 2016. We administered structured questionnaires to assess pesticide application practices at two time points (4-6 weeks apart). We adapted an existing algorithm to fit the context of smallholders and derive weekly pesticide exposure scores. We used linear mixed-effect models to examine within-worker and between-worker score variability. We then identified sociodemographic and occupational predictors of weekly pesticide exposure scores.

We observed high within-worker and between-worker variability in weekly pesticide exposures (eg, up to 180-fold and 70-fold differences in average weekly exposures within and between workers, respectively; intraclass correlation coefficient=0.4). Applicators working on conventional and sustainable farms had exposure scores twofold and 1.5-fold higher than those working in organic farms, respectively. Farm workers who received training on pesticide use had weekly pesticide exposure scores of 33% (95% CI 1% to 55%) lower than those who did not receive any training.

In this study of applicators from smallholder farms in Costa Rica, we determined the importance of collecting questionnaire data on self-reported pesticide use repeatedly due to its high variability within workers and absence of application records. Our questionnaire-based exposure algorithm could allow the calculation of semiquantitative estimates of average pesticide exposure for applicators from other LMICs.

Supporting parents of children aged 2-13 with toileting difficulties: Group-based workshops versus individual appointments.

Australian Occupational Therapy Journal

Toileting is a key activity of daily living and an important milestone in children's development. Difficulties with this process can cause stress to both child and parents and negatively affect their wellbeing. This study compared the perceived parental competence and child wellbeing of families attending a group-based workshop on toileting issues with families attending an individual appointment at a continence clinic.

All parents attending the workshops and attending the clinic between July 2016 and December 2017 were invited to participate in the study. The children were aged between 2 and 13 years. Three measures were used: 1) Parenting Sense of Competence Scale; (2) the Revised Quality of Life Questionnaire for Children (KINDLR) and (3) Parent self-assessment of information and support needs. Participants completed all measures at three points: prior to intervention, 1 week and 1 month post-intervention.

Data were collected from 89 parents attending the workshops and 46 parents attending the clinic. Children were not assessed. Non-parametric tests were used to examine between group differences. Within group changes overtime were examined using Friedman's two-way analysis of variance. Parents who attended the workshop showed significant increases in parenting sense of competence and perceived child quality of life post-intervention. Although there were significant differences between and pre- and post-measures for workshop attendees, there were no significant differences found between the two groups indicating that both forms of intervention had beneficial results.

These results suggest that group-based workshops can positively impact parents' perceived competence in managing their child's toileting issues and wellbeing. Further research is recommended to explore the relationship between parenting competence and child wellbeing and to determine which aspects of the workshops were most beneficial.

An exploratory study of verbal feedback on occupational performance for improving self-awareness in people with traumatic brain injury.

Australian Occupational Therapy Journal

Impaired self-awareness negatively impacts on how well persons with traumatic brain injury (TBI) learn and use strategies needed in daily life. Verbal feedback is a component of metacognitive strategy training recommended for addressing impaired self-awareness in TBI rehabilitation. Yet, it remains unknown how effectively verbal feedback on occupational performance improves self-awareness for the specific occupation involved. This study investigated the effect of verbal feedback on task-specific self-awareness for individuals with TBI.

A secondary analysis was conducted on selected data extracted from a randomised, assessor-blinded controlled trial in which 36 participants with impaired self-awareness post-TBI were allocated into two feedback intervention groups, verbal feedback and a control condition of experiential feedback only. All participants engaged in four sessions of meal preparation with an occupational therapist using a metacognitive strategy training approach. Participants in the verbal feedback group received feedback on their performance in a discussion with the occupational therapist following each session. Task-specific self-awareness was measured using discrepancy scores (therapist ratings minus self-ratings) on a Meal Independence Rating Scale (MIRS). Data were analysed using a mixed 2 × 2 analysis of variance.

Positive MIRS discrepancy scores at pre-intervention reflected the propensity of participants to over-estimate their abilities There was a significant main effect of time, indicating overall gains in task-specific self-awareness at post-intervention (p = .01), but no significant group-by-time interaction. Changes in participants' self-ratings post-intervention were minimal. Instead, reduced MIRS discrepancy scores resulted largely from changes in therapists' ratings, indicating improvement in occupational performance.

Participants in both groups demonstrated improvements in occupational performance, but this did not correspond with changes in task-specific self-awareness. In this small sample, there was no statistically significant improvement in self-awareness associated with the provision of verbal feedback after occupational performance over and above the benefits of experiential feedback.

Occupational radiation exposure and excess additive risk of cataract incidence in a cohort of US radiologic technologists.

Occupational and Environmental Medicine

Previous analyses of cataract in radiation-exposed populations have assessed relative risk; radiogenic excess additive risk (EAR), arguably of more public health importance, has not been estimated. Previous analysis of a large prospective cohort of US radiologic technologists (USRT) quantified excess relative risk of cataract in relation to occupational radiation dose. We aim to assess EARs of cataract.

We estimated EARs of cataract/cataract surgery in the USRT cohort using generalised additive models in relation to occupational radiation exposure, and assessed risk modification by a priori-selected cataract risk factors (diabetes, body mass index, smoking, race, sex, birth-year, ultraviolet B (UVB) radiation exposure).

There were 11 345 cataract diagnoses and 5440 of cataract surgery during 832 462 and 888 402 person-years of follow-up, respectively. Cumulative occupational radiation exposure was associated with self-reported cataract, but not with cataract surgery, with EAR/104 person-year Gy=94 (95% CI: 47 to 143, p<0.001) and EAR/104 person-year Gy=13 (95% CI: <0 to 57, p=0.551), respectively. There was marked (p<0.001) variation of EAR by age and by diabetes status, with risk higher among persons ≥75 years and diabetics. There were indications of elevated risk among those with higher UVB radiation (p=0.045), whites (p=0.056) and among those with higher levels of cigarette smoking (p=0.062). Elevated additive risk was observed for estimated occupational radiation eye-lens doses <100 mGy (p=0.004) with no dose-response curvature (p=0.903).

The elevated additive risks associated with low-dose radiation, if confirmed elsewhere, have important public health and clinical implications for radiation workers as well as regulatory measures.