Immigration, work and health in Spain: the influence of legal status and employment contract on reported health indicators

Objective

To analyze the relationship of legal status and employment conditions with health indicators in foreign-born and Spanish-born workers in Spain.

Methods

Cross-sectional study of 1,849 foreign-born and 509 Spanish-born workers (2008–2009, ITSAL Project). Considered employment conditions: permanent, temporary and no contract (foreign-born and Spanish-born); considered legal statuses: documented and undocumented (foreign-born). Joint relationships with self-rated health (SRH) and mental health (MH) were analyzed via logistical regression.

Results

When compared with male permanently contracted Spanish-born workers, worse health is seen in undocumented foreign-born, time in Spain ≤3 years (SRH aOR 2.68, 95% CI 1.09–6.56; MH aOR 2.26, 95% CI 1.15–4.42); in Spanish-born, temporary contracts (SRH aOR 2.40, 95% CI 1.04–5.53); and in foreign-born, temporary contracts, time in Spain >3 years (MH: aOR 1.96, 95% CI 1.13–3.38). In females, highest self-rated health risks are in foreign-born, temporary contracts (aOR 2.36, 95% CI 1.13–4.91) and without contracts, time in Spain >3 years (aOR 4.63, 95% CI 1.95–10.97).

Conclusions

Contract type is a health determinant in both foreign-born and Spanish-born workers. This study offers an uncommon exploration of undocumented migration and raises methodological issues to consider in future research.     

Experience and attitude of rural women to IPV in Nigeria

Aim

In Nigeria, few studies that have addressed intimate partner violence (IPV) to women have been carried out in urban settings. The purpose of the study was to determine the prevalence, types and factors associated with experience of IPV among rural women in Oyo State, Nigeria. Attitude to wife beating was also assessed.

Subject and methods

300 rural women aged between 15 and 49 years selected by multistage sampling method were interviewed using semi-structured interviewer administered questionnaire.

Results

Lifetime prevalence of IPV was 64.0 %, controlling behavior was 42.0 %, psychological violence ?34.7 %, physical violence ?28.0 % and sexual violence ?11.6 %. Predictors of controlling behavior were monthly income?>?$67(OR?=?2.2; 95% CI: 1.2–4.1) and age of partner ≤34 years (OR?=?2.8; 95 % CI: 1.3–6.2). Respondents in relationship for more than 10 years were more likely to experience psychological violence (OR?=?5.7; 95 % CI 2.1–15.2). Predictors of physical violence were being in relationship for ≥3 years (OR?=?3.8; 95 % CI: 1.1–13.3) and partner consuming alcohol (OR?=?2.1; 95 % CI: 1.1–4.1). Partner’s educational level (at least secondary) (OR?=?5.7; 95 % CI: 1.2–24.6) and alcohol consumption (OR?=?3.0; 95 % CI: 1.3–6.7) were predictors of sexual violence. About 24.4 % of women justified wife beating. The most common reason for justification was that the woman had been unfaithful (28 %).

Conclusion

IPV is a common experience among Nigerian rural women. Partners need education on dangers of alcohol use and its association with IPV. Different strategies are needed to prevent and reduce IPV.     

Substanzkonsum und Gewaltwiderfahrnisse Jugendlicher

Background

Teen dating violence is discussed as a potential risk factor for harmful behaviour. For prevention strategies it is interesting to see the extent to which evidence can be found in epidemiological studies.

Methods

We searched the databases CINAHL, EMBASE, PsycINFO, Cochrane Library, Web of Science as well as in the free web for longitudinal studies which examined substance consumption as a result of teen dating violence.

Results

Seven studies fulfilled the inclusion criteria. Each one study described teen dating violence to increase marijuana consumption among girls (odds ratio [OR] 2.1, 95% confidence interval [95% CI] 1.22–3.70) and boys (OR 1.34, 95% CI 1.03–1.74), two studies with mixed sex population in boys (class 8: b = 0.55, p < 0.01; class 12: b = 1.14, p < 0.001) and in both sexes (ERR = 1.21, 95% CI 0.96–1.52; ERR = 1.30, 95% CI 0.81–2.11). Four studies observed increased consumption of tobacco in mixed sex group populations (B = 0.31, SE = 0.14, p < 0.03), in girls (OR 2.28, 95% CI 1.39–3.74; OR 1.53, 95% CI 1.13–2.06; OR 2.15, 95% CI 1.07–4.35) or boys (OR 3.04, 95% CI 1.16–7.95), whereas alcohol consumption was measured in 2 studies: in girls (OR 1.44, 95% CI 1.03–1.74) and in mixed sex study populations (B = 0.25, SE = 0.14; p < 0.5). Two studies described an increased substance dependence in girls (ß = 0.16; CI 0.06–0.26) and in mixed sex study population (OR = 10.61; p < 0.011).

Conclusion

The low effect dimensions, limitations caused by the study design and the lack of consideration of confounders presuppose that such interpersonal violence cannot be considered as a risk factor.

     

Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City,Vietnam

Objectives

Male sex workers (MSW) in Vietnam face high levels of stigma related to sex work, which may be associated with depression and increased vulnerability to HIV.

Methods

In 2010, 300 MSW completed a behavioral and psychosocial survey. Multivariable models assessed factors associated with sex work-related stigma and the association between stigma and depression.

Results

Factors associated with increased stigma included having disclosed sexual orientation to healthcare workers (b 1.75, 95 % CI 0.69–2.80), meeting clients in the street/park (b 1.42, 95 % CI 0.32–2.52), and having been forced to have sex without a condom (b 2.36, 95 % CI 1.27–3.45). Factors associated with decreased stigma included meeting clients via the telephone or internet (b ?1.26, 95 % CI ?2.39 to ?0.12) and receiving financial support from family or friends (b ?1.31, 95 % CI ?2.46 to ?0.17). Stigma was significantly associated with increased odds of depression (AOR 1.07, 95 % CI 1.01–1.15).

Conclusions

Addressing stigma and depression in HIV prevention interventions is crucial for tailoring these programs to MSWs’ needs, and may result in decreased HIV spread.     

Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis

Objectives

To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood.

Methods

A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I ² test.

Results

Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse. The combined ORs for anxiety were 2.52 (95 % CI: 2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18) for physical abuse.

Conclusions

High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.     

Egg consumption and risk of GI neoplasms: dose–response meta-analysis and systematic review

Purpose

Previous epidemiological studies on egg consumption and the risk of gastrointestinal (GI) neoplasms suggest a positive association; however, data are limited and the evidence remains controversial. This study aims to investigate and quantify the potential dose–response relationship with an evaluation of cancer site-specific differences.

Methods

Relevant studies were identified after the literature search via electronic databases until January 2014. Subgroup analysis for serving portions was performed using two standardized classification methods: (1) less than 3, or 3 or more eggs per week; (2) less than 3, 3–5, or more than 5 eggs per week. Method two excludes studies that only reported consumption frequency. Pooled adjusted odds ratios (ORs) comparing highest and lowest categories of dietary pattern scores were calculated using a random-effects model.

Results

Thirty-seven case–control and seven cohort studies were included for meta-analysis, which contained a total of 424,867 participants and 18,852 GI neoplasm cases. The combined odds ratio (OR) was calculated to 1.15 (95 % CI 1.09–1.22; p value heterogeneity <0.001), showing only a slight increase in risk. The correlation was stronger for colon cancers 1.29 (95 % CI 1.14–1.46; p value heterogeneity <0.22). Dose–response analysis revealed similar results with stratification methods, and the ORs for an intake of <3 and ≥3 eggs per week were 1.14 (95 % CI 1.07–1.22; p value heterogeneity = 0.38) and 1.25 (95 % CI 1.14–1.38; p value heterogeneity = 0.25), respectively. With method 2, the ORs for an intake of <3, 3–5, and >5 eggs per week were 1.13 (95 % CI 1.06–1.21; p value heterogeneity = 0.25), 1.14 (95 % CI 1.01–1.29; p value heterogeneity = 0.06), and 1.19 (95 % CI 1.01–1.39; p value heterogeneity <0.001), respectively.

Conclusion

This study provides evidence that egg consumption is associated with a positive dose–response association with the development of GI neoplasms.     

Abuse and neglect of older persons in seven cities in seven countries in Europe: a cross-sectional community study

Objectives

We aimed to investigate the prevalence rate of abuse (psychological, physical, sexual, financial, neglect) of older persons (AO) in seven cities from seven countries in Europe (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden), and to assess factors potentially associated with AO.

Methods

A cross-sectional study was conducted in 2009 (n = 4,467, aged 60–84). Potentially associated factors were grouped into domains (domain 1: age, gender, migration history; domain 2: education, occupation; domain 3: marital status, living situation; domain 4: habitation, income, financial strain). We calculated odds ratios (OR) with their respective 95 % confidence intervals (CI).

Results

Psychological AO was the most common form of AO, ranging from 10.4 % (95 % CI 8.1–13.0) in Italy to 29.7 % (95 % CI 26.2–33.5) in Sweden. Second most common form was financial AO, ranging from 1.8 % (95 % CI 0.9–3.2) in Sweden to 7.8 % (95 % CI 5.8–10.1) in Portugal. Less common was physical AO, ranging from 1.0 % (95 % CI 0.4–2.1) in Italy to 4.0 % (95 % CI 2.6–5.8 %) in Sweden. Sexual AO was least common, ranging from 0.3 (95 % CI 0.0–1.1) in Italy and Spain to 1.5 % (95 % CI 0.7–2.8) in Greece. Being from Germany (AOR 3.25, 95 % CI 2.34–4.51), Sweden (OR 3.16, 95 % CI 2.28–4.39) or Lithuania (AOR 2.45, 95 % CI 1.75–3.43) was associated with increased prevalence rates of AO.

Conclusion

Country of residence of older people is independent from the four assessed domains associated with AO. Life course perspectives on AO are highly needed to get better insight, and to develop and implement prevention strategies targeted at decreasing prevalence rates of AO.     

Effects of a dietetic treatment in older, undernourished, community-dwelling individuals in primary care: a randomized controlled trial

Purpose

Undernutrition is a prevalent problem in older, community-dwelling individuals. Aim of this study was to determine the effects of a dietetic treatment in older, undernourished, community-dwelling individuals.

Methods

A parallel randomized controlled trial was performed in 146 non-institutionalized, undernourished individuals aged ≥65 years in primary care. Participants were randomly assigned to the intervention (referral to and treatment by a trained dietitian) or control group (no referral). Body weight, physical performance, handgrip strength, energy intake, protein intake and fat-free mass were assessed at baseline, after 3 months and after 6 months.

Results

All randomized participants (n = 146) were included in the intention-to-treat generalized estimating equations analysis (72 in intervention and 74 in control group). No treatment effect was found on the primary outcomes body weight (β = 0.49 kg, 95 % CI: ?0.15–1.12), physical performance (β = 0.15 points, 95 % CI: ?0.33–0.64) and handgrip strength (β = 0.49 kg, 95 % CI: ?0.62–1.60). Furthermore, no treatment effect was found for the secondary outcomes. Predefined subgroup analyses showed a treatment effect on body weight in physically active participants (β = 1.25 kg, 95 % CI: 0.70–2.11) and not in inactive participants (β = ?0.20 kg, 95 % CI: ?1.16–0.75).

Conclusions

After 6 months, a dietetic treatment by trained dietitians does not lead to increases in body weight and physical functioning in older, undernourished, community-dwelling individuals.     

Is health-related quality of life between 90 and 180 days following stroke associated with long-term unmet needs?

Purpose

Understanding the relationship between health-related quality of life (HRQoL) and long-term unmet needs is important for guiding services to optimise life following stroke. We investigated whether HRQoL between 90 and 180 days following stroke was associated with long-term unmet needs.

Methods

Data from Australian Stroke Clinical Registry (AuSCR) registrants who participated in the Australian Stroke Survivor Needs Survey were used. Outcome data, including the EQ-5D, are routinely collected in AuSCR between 90 and 180 days post-stroke. Unmet needs were assessed at a median of 2 years and categorised into: health; everyday living; work/leisure; and support domains. Multivariable regression was used to determine associations between the EQ-5D dimensions and the likelihood of experiencing unmet needs and the visual analogue scale (VAS) (rating 0–100) and number of reported unmet needs.

Results

In total, 173 AuSCR registrants completed the Needs Survey (median age 69 years, 67 % male; 77 % ischaemic stroke). VAS scores were negatively associated with the number of reported long-term unmet needs [irr 0.98, (95 % CI 0.97, 0 99) p < 0.001]. Having EQ-5D activity limitations was associated with unmet living needs (aOR 4.5, 95 % CI 1.1, 18.8). Requiring living supports at 90–180 days was associated with unmet health needs (aOR 4.9, 95 % CI 1.5, 16.1). Those with pain at 90–180 days were less likely to report unmet health (aOR 0.09, 95 % CI 0.02, 0.4) and support needs (aOR 0.2, 95 % CI 0.06, 0.6).

Conclusion

Routinely collected HRQoL data can identify survivors at risk of experiencing long-term unmet needs. This information is important for targeting service delivery to optimise outcomes following stroke.

     

Major depressive disorder, panic disorder, and post-traumatic stress disorder in Korean subway drivers

Purpose

The purposes of this study are to investigate the prevalence of major depressive disorder, panic disorder, and post-traumatic stress disorder (PTSD) in Korean subway drivers, and find the association between these disorders and the drivers’ person-under-train (PUT) experiences.

Methods

A total of 826 subway drivers who participated in a cross-sectional work and health survey were included for this study. The Korean version of the Composite International Diagnostic Interview 2.1 was applied to assess major depressive disorder, panic disorder, and PTSD. The date of PUT, whether victim died, and how many PUTs the drivers experienced were asked using a structured questionnaire.

Results

The standardized prevalence ratios (SPRs) for lifetime prevalence of panic disorder and PTSD in subway drivers were 13.3 (95 % confidence interval [CI] 6.6–22.4) and 2.1 (95 % CI 1.1–3.4), respectively. In lifetime prevalence, after adjusting for age, education, income, and working career, the drivers who experienced PUT had significantly higher risks for panic disorder (odds ratio [OR] = 4.2, 95 % CI 1.2–16.6) and PTSD (OR = 4.4, 95 % CI 1.3–16.4). In 1-year prevalence, the drivers who experienced PUT had a significantly higher risk for PTSD (OR = 11.7, 95 % CI 1.9–225.8). There was no significant value of SPR and OR in major depressive disorder.

Conclusions

This study suggests that Korean subway drivers are at higher risk for panic disorder and PTSD compared to the general population, and PUT experience is associated with panic disorder and PTSD. Drivers who have experienced PUT should be treated quickly, sympathetically, and sensitively by a psychological professional and their colleagues, so they can return to work soon.     

The genotype of the transporter associated with antigen processing gene affects susceptibility to colorectal cancer in Japanese

Objective

Although colorectal cancer (CRC) is one of the most frequent malignancies in Japan, the associated genetic factors remain to be elucidated. Functional loss of the transporter associated with antigen processing (TAP) 1 gene induces carcinogenesis. We investigated whether single nucleotide polymorphisms (SNPs) in the TAP1 gene (rs735883) are associated with susceptibility to CRC in a Japanese population.

Methods

The study participants were 143 cases and 243 clinical controls. After extracting DNA from their peripheral blood cells, genotyping was conducted by the polymerase chain reaction–restriction fragment length polymorphism method.

Results

Participants with a mutated allele had an increased risk for CRC. The adjusted odds ratios for the C/T, T/T, and the mutation type (C/T + T/T) compared to that of wild type (C/C) were 2.27 [95 % confidence interval (CI), 1.43–3.67], 1.95 (95 % CI, 0.88–4.30), and 2.22 (95 % CI, 1.42–3.55), respectively. Furthermore, a significant trend in the rate of cases was observed with an increasing number of mutated alleles (P for trend = 0.0068).

Conclusions

The genotype of the TAP1 gene is associated with susceptibility to CRC.     

Prognostic value of quality of life measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma

Purpose

Pretreatment quality of life (QoL) has been used to predict survival in cancer patients. In this study, we examined the prognostic value of QoL measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma (NPC).

Methods

We enrolled 273 patients with NPC who had been curatively treated for more than 1 year. The EORTC QLQ-C30 and H&N35 questionnaires were completed 1 year after radiotherapy. The predictability of QoL variables on disease-specific survival (DSS) and overall survival (OS) was analyzed using Cox’s proportional hazards models.

Results

Twenty-nine (10.6 %) patients developed locoregional relapse and 27 (9.9 %) had distant metastasis after the QoL survey with subsequent 5-year DSS and OS rates of 87.9 % and 84.0 %, respectively. Based on the QLQ-C30, scales of physical functioning, fatigue, and appetite loss significantly predicted DSS and OS (p < 0.05). In the H&N35, only sexuality was significantly correlated with DSS and OS (p < 0.05). An increment of 10 points in physical functioning (HR: 0.69; 95 % CI: 0.48–0.90; p = 0.004) or a decline of 10 points in fatigue problems (HR: 1.40; 95 % CI: 1.19–1.61; p = 0.0002), appetite loss (HR: 1.21; 95 % CI: 1.03–1.40; p = 0.02), and sexuality (HR: 1.14; 95 % CI: 1.02–1.25; p = 0.019) was associated with better OS.

Conclusion

Some QoL variables measured after the treatment provide prognostic value on subsequent survival in patients with NPC.     

The effect of workplace smoking bans on heart rate variability and pulse wave velocity of non-smoking hospitality workers

Objectives

To investigate the effect of a change in second-hand smoke (SHS) exposure on heart rate variability (HRV) and pulse wave velocity (PWV), this study utilized a quasi-experimental setting when a smoking ban was introduced.

Methods

HRV, a quantitative marker of autonomic activity of the nervous system, and PWV, a marker of arterial stiffness, were measured in 55 non-smoking hospitality workers before and 3–12 months after a smoking ban and compared to a control group that did not experience an exposure change. SHS exposure was determined with a nicotine-specific badge and expressed as inhaled cigarette equivalents per day (CE/d).

Results

PWV and HRV parameters significantly changed in a dose-dependent manner in the intervention group as compared to the control group. A one CE/d decrease was associated with a 2.3 % (95 % CI 0.2–4.4; p = 0.031) higher root mean square of successive differences (RMSSD), a 5.7 % (95 % CI 0.9–10.2; p = 0.02) higher high-frequency component and a 0.72 % (95 % CI 0.40–1.05; p < 0.001) lower PWV.

Conclusions

PWV and HRV significantly improved after introducing smoke-free workplaces indicating a decreased cardiovascular risk.     

Factors influencing self-reported anxiety or depression following stroke or TIA using linked registry and hospital data

Purpose

Approximately 30–50% of survivors experience problems with anxiety or depression post-stroke. It is important to understand the factors associated with post-stroke anxiety or depression to identify effective interventions.

Methods

Patient-level data from the Australian Stroke Clinical Registry (years 2009–2013), from participating hospitals in Queensland (n?=?23), were linked with Queensland Hospital Emergency and Admission datasets. Self-reported anxiety or depression was assessed using the EQ-5D-3L, obtained at 90–180 days post-stroke. Multivariable multilevel logistic regression, with manual stepwise elimination of variables, was used to investigate the association between self-reported anxiety or depression, patient factors and acute stroke processes of care. Comorbidities, including prior mental health problems (e.g. anxiety, depression and dementia) coded in previous hospital admissions or emergency presentations using ICD-10 diagnosis codes, were identified from 5 years prior to stroke event.

Results

2853 patients were included (median age 74; 45% female; 72% stroke; 24% transient ischaemic attack). Nearly half (47%) reported some level of anxiety or depression post-stroke. The factors most strongly associated with anxiety or depression were a prior diagnosis of anxiety or depression [Adjusted Odds Ratio (aOR) 2.37, 95% confidence interval (95% CI) 1.66–3.39; p?<?0.001], dementia (aOR 1.91, 95% CI 1.24–2.93; p?=?0.003), being at home with support (aOR 1.41, 95% CI 1.12–1.69; p?=?<?0.001), and low socioeconomic advantage compared to high (aOR 1.59, 95% CI 1.21–2.10; p?=?0.001). Acute stroke processes of care were not independently associated with anxiety or depression.

Conclusions

Identification of those with prior mental health problems for early intervention and support may help reduce the prevalence of post-stroke anxiety or depression.

     

Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana,Mexico

Background

Mexico’s 2009 “narcomenudeo reform” decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers’ drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge.

Methods

Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar’s tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers’ ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform.

Results

Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4–3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3–4.3), methamphetamine (aOR 2.2, 95% CI 1.4–3.2), and marijuana (aOR 2.5, 95% CI 1.6–4).

Conclusions

Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives bundling occupational safety information with relevant legal content demonstrate clear promise. Our findings underscore additional efforts needed to raise technical knowledge of the law among personnel tasked with its enforcement. Police professionalization, including minimum educational standards, appear critical for aligning policing with harm reduction goals.

     

The role of lifestyle, health, and work in educational inequalities in sick leave and productivity loss at work

Purpose

To investigate the influence of lifestyle, health, and work conditions in the association between education and productivity loss at work and sick leave.

Methods

Employees of six companies filled out a questionnaire on demographics, lifestyle-related, health, and work-related factors, and productivity loss at work and sick leave at baseline (n = 915) and after 1-year (n = 647).

Results

Employees with a low education were more likely to report productivity loss at work (OR = 1.49, 95 % CI 0.98–2.26) and sick leave (OR = 1.81, 95 % CI 1.15–2.85). After adjustment for lifestyle, health, and work conditions, the association between education and productivity loss at work did not attenuate. Work conditions attenuated the association between low education and sick leave (OR = 1.62, 95 % CI 1.01–2.61), and additional adjustment for health and lifestyle-related factors further reduced the strength of the association (OR = 1.42, 95 % CI 0.86–2.34).

Conclusion

Work conditions and lifestyle-related factors partly explained the association between education and sick leave, but did not influence the association between education and productivity loss at work. The educational differences in sick leave prompt for interventions that address behavioral aspects as well as work-related and lifestyle-related factors.     

Musculoskeletal symptoms and psychosocial work environment,among Swedish commercial pilots

Purpose

The associations between psychosocial work conditions and health in pilots are understudied, and therefore, the associations between the psychosocial work conditions and musculoskeletal problems among Swedish commercial pilots were investigated.

Methods

In 2010, a self-administered questionnaire study was performed among pilots in one Swedish commercial airline: 354 pilots participated (61 %). Musculoskeletal symptoms and the psychosocial work conditions measured by the demand control social support model were investigated. Odds ratios (OR) with 95 % confidence interval (95 % CI) were expressed per change of one unit on the interquartile score scale.

Results

Pilots on long-haul flights had less elbow symptoms (OR 0.34, 95 % CI 0.14–0.85), and women had more hand symptoms (OR 2.90, 95 % CI 1.11–7.52). There were associations between high work demands and symptoms from the neck (OR 2.04, 95 % CI 1.45–2.88), shoulders (OR 1.46, 95 % 1.05–2.03), elbows (OR 1.79, 95 % CI 1.10–2.90) and low back (OR 1.42, 95 % CI 1.02–1.96) in pilots. Low social support was associated with symptoms from the neck (OR 1.87, 95 % 1.35–2.58), shoulders (OR 1.56, 95 % CI 1.14–2.14) and low back (OR 1.63, 95 % CI 1.18–2.24). Low supervisor support was associated with neck (OR 1.67, 95 % CI 1.22–2.27), shoulders (OR 1.38, 95 % CI 1.02–1.87) and low back symptoms (OR 1.48, 95 % CI 1.09–2.01). The associations were mainly found among first officers.

Conclusions

Musculoskeletal symptoms in pilots can be affected by poor psychosocial work conditions such as high demands and low social support, especially for first officers. The psychosocial aspects of organisational changes in commercial airlines should be taken into consideration.     

MTHFR C677T genotype and cardiovascular risk in a general population without mandatory folic acid fortification

Purpose

Meta-analyses have suggested an effect of MTHFR C677T genotype (rs1801133), a proxy for blood total homocysteine, on cardiovascular disease (CVD) in populations with low population dietary folate. The aim was to examine the association and effect modification by serum folate and vitamin B12 levels between MTHFR and CVD-related outcomes in a general population with no mandatory folic acid fortification policy.

Methods

The study population included 13,748 adults retrieved from pooling of four population-based studies conducted in Denmark. MTHFR genotype, serum folate (measured in approximately 9,356 individuals), and serum vitamin B12 (9,215 individuals), hypertension, and dyslipidemia were measured at baseline, and participants were followed for a mean of 10.5–11.7 years in central registries for diagnoses of stroke (623 incidents), ischaemic heart disease (IHD) (835 incidents), and all-cause mortality (1,272 incidents).

Results

The MTHFR genotype (TT vs. CC/CT) was not associated with hypertension [OR (95 % CI) 1.09 (0.95–1.25)], dyslipidemia [OR (95 % CI) 0.97 (0.84–1.11)], stroke [HR (95 % CI) 0.92 (0.69–1.23)], and all-cause mortality [HR (95 % CI) 0.94 (0.77–1.14)], either overall, or in participants with low serum folate or B12 status (P values for interactions 0.15–0.94). Individuals with the MTHFR TT genotype had a higher risk of IHD (HR (95 % CI) 1.38 (1.11–1.71)), but this association was not modified by folate status (P value for interaction 0.45).

Conclusions

Our results do not support a causal relationship between homocysteine and CVD. However, we cannot exclude a direct causal effect of MTHFR C677T genotype on IHD.