Chronic fatigue among bank workers in Brazil

The present study examines the prevalence of chronic fatigue (CF) among bank workers in Brazil and possible associations with gender and working conditions. The study sample included all 735 workers from the department of data processing of a state bank. CF was assessed using the Chalder Fatigue Scale. Working conditions and socio-demographic, socio-economic and psychosocial factors at work were analysed. Psychiatric symptoms were measured with the SRQ-20. The overall estimate of the prevalence of CF was 8.7% [95% confidence intervals (95% CI) = 6.4-10.9%]: 7.8% (95% CI = 5.5-10.7%) among men and 11.0% (95% CI = 6.7-16.9%) among women. The male-female difference was not statistically significant, even after adjusting for minor psychiatric disorders. The overall prevalence of CF without minor psychiatric disorders was 4.5% (95% CI = 2.7-6.3%): 3.9% (95% CI = 1.9-5.9%) among men and 6.4% (95% CI = 2.0-10.1%) among women. In the final model, risk factors for CF were fast work speed [odds ratio (OR) = 3.5], dissatisfaction at work (OR = 3.1), minor psychiatric disorders (OR = 6.8), and medium (OR = 1.8) and heavy domestic workload (OR = 12.0). CF is common among these bank workers and is associated with psychosocial factors at work. Particularly among women, domestic workload, marital status and the presence of young children were associated with CF in the stratified analysis. Domestic workload may add physical and mental stress, putting employees at risk for CF from overload, or CF may cause workers to perceive domestic work as heavy.     

Maternal occupation and adverse pregnancy outcomes: a Finnish population-based study

BACKGROUND: There is accumulating evidence that the type of work and environmental exposures in the working environment may have adverse effects on foetal development. AIM: To compare the risk of low birth weight (LBW), small-for-gestational age (SGA) and pre-term delivery (PD) in broad categories of maternal occupation including farming and forestry; factory, mining and construction; office, non-manual and service work and housewives. METHODS: The study population consisted of 2568 singleton newborns of women who participated in The Finnish Prenatal Environment and Health Study after the delivery (response rate 94%). Information on maternal occupation and work during pregnancy was collected after the delivery. The health outcomes were LBW (<2500 g), SGA and PD (<37 weeks). RESULTS: In newborns of women working in factories, mining and construction, the risk of LBW (adjusted odds ratio [OR] 3.66, 95% confidence interval [CI] 1.15-11.62), SGA (adjusted OR 1.53, 95% CI 0.73-3.21), but not the risk of PD (adjusted OR 0.64, 95% CI 0.19-2.22), was higher compared with newborns of housewives. In newborns of farmers and forestry workers, the risks of PD (adjusted OR 2.38, 95% CI 1.01-5.65), LBW (adjusted OR 2.86, 95% CI 0.78-11.58) and SGA (adjusted OR 1.51, 95% CI 0.62-3.65) were all elevated. In office, non-manual and service workers, the corresponding estimates were lower (LBW: 1.62, 0.67-3.95; SGA: 1.45, 0.92-2.28; PD: 1.18, 0.69-2.01). CONCLUSIONS: There were substantial differences in the risk of adverse pregnancy outcomes between the main branches of industry.     

Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders in Massage Practitioners

INTRODUCTION: Massage practitioners are at high risk for work-related musculoskeletal disorders (WMSDs). We investigated the prevalence and risk factors. METHODS: We randomly selected 161 visually impaired practitioners. Demographics, musculoskeletal symptoms, and working postures were analyzed with multivariate logistic regression. RESULTS: Results indicated that about 71.4% had at least one WMSD in 12 months. Prevalence rates were finger or thumb, 50.3%; shoulder, 31.7%; wrist, 28.6%; neck, 25.5%; arm or elbow, 23.6%; forearm, 20.5%; and back, 19.3%. Working duration >20 years had an adjusted odds ratio (OR) for finger or thumb 4.0-4.5 with 95% confidence interval (CI) 1.5-13.8, client contact >4 h/day (adjusted OR for finger = 3.2, 95% CI=1.3-8.1), and < or =7-kg pulp-pinch strength (adjusted OR for upper extremity = 2.9-3.2, 95% CI=1.2-8.3). Adjusted ORs for lower-back symptoms were 3.1 (95% CI=1.3-7.8) and 3.6 (95% CI=1.4-9.6), respectively, for lack of neutral neck posture and for inappropriate working-table height. CONCLUSION: WMSDs were prevalent among massage practitioners.     

建筑工人下背部工作相关肌肉骨骼疾患影响因素分析

目的 分析建筑工人下背部工作相关肌肉骨骼疾患(work-related musculoskeletal disorders, WMSDs)的患病现状和影响因素。方法 选择北京市、辽宁省、山东省和广东省等地共8家建筑公司的453名建筑工人为研究对象,采用《肌肉骨骼疾患调查问卷》收集研究对象各部位WMSDs的患病情况,应用多因素logistic回归分析模型分析建筑工人下背部WMSDs的影响因素。结果 研究对象WMSDs总患病率为43.7%,其中患病率从高到低排序为下背部24.1%、肩部18.3%、颈部14.6%、上背部12.4%、手腕部12.1%、足踝部6.0%、腿部5.5%、膝部5.1%及肘部5.1%。研究对象的多部位WMSDs患病率为28.9%。多因素logistic回归分析模型分析结果显示,以初中及以下组为参考组,高中及中专文化程度是建筑工人罹患WMSDs的保护因素(OR=0.390, 95%CI:0.179～0.849,P=0.018);长时间蹲或跪姿(OR=1.818, 95%CI:1.053～3.138,P=0.032)、搬运重物(每次>20 kg)(OR=2.876, ...     

Disabling musculoskeletal pain and its relation to somatization: a community-based postal survey

BACKGROUND: Somatization (a tendency to report distress from somatic symptoms) is a little studied, but potentially important, confounder and effect modifier in occupational studies of musculoskeletal disease. AIMS: To assess the role of somatization as a risk factor for disabling regional pain. METHODS: A questionnaire was mailed to 4998 subjects of working age. Questions were asked about chronic and disabling pain in the past 12 months affecting the arm, low back, knee or combinations of these sites. Distress from physical symptoms was assessed using elements of the Brief Symptom Inventory and mental well-being was assessed using the short-form 36 (SF-36). Associations were examined by modified Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CI). RESULTS: Among 2632 responders, 24% reported chronic pain and 25% disabling pain at one or several sites. Risk of chronic or disabling pain increased strongly according to the number of somatic symptoms reported as bothersome. For example, the HR for chronic upper limb pain in those distressed by > or =2 somatic symptoms in the past 7 days versus none was 3.9 (95% CI 2.9-5.3), and that of disabling upper limb pain was 5.8 (95% CI 4.1-8.3). Similar patterns were found for the low back and knee, and there was a gradient of increasing risk according to the number of sites with disabling pain. In comparison, associations with SF-36 mental well-being score were weaker. CONCLUSION: Somatizing tendency should be evaluated as a possible confounder or effect modifier in studies of occupational risk factors for musculoskeletal pain.     

Risk factors for cytomegalovirus seropositivity in a population of day care educators in Montréal, Canada

BACKGROUND: Horizontal transmission of cytomegalovirus (CMV) is common in the day care setting. Day care educators appear to be at a high risk of infection; however, studies are limited. AIMS: To determine the proportion of CMV-seropositive female educators in the day care setting and to identify associated risk factors. METHODS: Educator- and day care-level risk factors for CMV seropositivity were obtained by questionnaires from day care educators and directors, respectively. Sera were collected from educators and analyzed by enzyme-linked immunosorbent assay. Significant independent risk factors for CMV seropositivity were determined using a multivariable logistic regression model which was fitted using the generalized estimating equation method. RESULTS: CMV seroprevalence in 473 female educators from 81 day care centers in Montréal, Canada, was 57%. Significant risk factors for CMV seropositivity were (i) increasing age (OR5-yr = 1.19; 95% CI = 1.05-1.35), (ii) low-income country of birth (OR = 10.23; 95% CI = 2.64-39.50) or middle-income country of birth (OR = 4.99; 95% CI = 2.39-10.40), (iii) having > or =2 children of their own (OR = 1.98; 95% CI = 1.19-3.31) and (iv) child-to-educator ratio >6 (18-35 months old) in a day care center (OR = 1.87; 95% CI = 1.25-2.81). CONCLUSIONS: Day care educators have risks for CMV infection related to their work in the day care setting, as well as personal risk factors. A review of current guidelines for the prevention of CMV infection in day care is needed to ensure that recommendations are evidence based.     

Identifying workers at risk of sickness absence by questionnaire

BACKGROUND: Sickness absence is an important economic problem, because of high costs and lost productivity. Determining factors associated with increased risk of sickness absence may lead to the development of preventive measures. AIMS: To determine whether self-report questionnaires can identify those employees at risk of sickness absence METHODS: Prospective study of 238 healthy administrative workers. Participants completed a questionnaire proven to be valid and consistent. The questionnaire consisted of 116 items about health, work and working conditions. Sickness absence was followed-up for a period of 1 year. RESULTS: The questionnaires of 191 workers (80%) were suitable for analysis. The number of reported health complaints was significantly (P < 0.01) associated with sickness absence (OR 2.18; 95% CI 1.32-3.61). Concentration problems were correlated with more frequent absences, and both nervous complaints and coping problems with longer duration. Age (OR 0.96; 95% CI 0.93-0.99; P = 0.02) and job insecurity (OR 0.68; 95% CI 0.47-0.98; P = 0.04) were negatively associated with sickness absence. Psychosocial and physical work factors were not associated with sickness absence. CONCLUSIONS: Questionnaires on health and work can identify employees at future risk of sickness absence. Workers who report multiple health complaints, especially concentration problems, nervous complaints or coping problems, may be at increased risk of sickness absence.     

Risk perception and attitudes towards HIV in Serbian health care workers

BACKGROUND: Health care workers (HCWs) are at risk of occupational exposure to human immunodeficiency virus (HIV). AIM: To investigate the perception of professional risk from, and the knowledge, attitudes and practice of HCWs to HIV and AIDS in Serbia. METHODS: Cross-sectional study of 1,559 Serbian HCWs using self-administered anonymous questionnaires. Chi-square testing and multiple logistic regression analysis were applied. RESULTS: Eighty-nine per cent of HCWs believed that they were at risk of acquiring HIV through occupational exposure. The perception of professional risk was higher among HCWs frequently exposed to patients' blood and body fluids (OR 7.9, 95% CI 4.4-14.5), who used additional personal protection if the HIV status of patient was known (OR 2.6, 95% CI 1.5-4.6), who had experienced sharp injuries within the last year (OR 1.9, 95% CI 1.0-3.8) or who had been tested for HIV (OR 2.1, 95% CI 1.2-3.5), and among HCWs who had treated HIV-positive patients (OR 1.7, 95% CI 1.1-2.8). The majority of respondents had deficient knowledge about modes of HIV transmission. Attitudes towards HIV-positive patients were significantly different by occupation. Seventy per cent of HCWs used appropriate protection during their daily work with patients. CONCLUSIONS: HCWs require specific educational programmes and training protocols to ensure that they are adequately protected when carrying out high quality care.     

Fish processing work: the impact of two sex dependent exposure profiles on musculoskeletal health

OBJECTIVES: To evaluate the impact of work tasks, physical exposure, and psychosocial factors on the risk of musculoskeletal disorders in men and women, in a defined industrial setting. METHODS: 116 male and 206 female fish industry workers were compared with 129 men and 208 women with more varied work. Physical and psychosocial work load as well as musculoskeletal complaints were recorded by a questionnaire. A physical examination was performed and an observation method was used for work evaluation. 196 male and 322 female former fish processing workers received a postal questionnaire. RESULTS: The women workers in the fish industry had worse working conditions than the men for repetitiveness, constrained neck postures, and psychosocial work environment. They also had higher prevalences of complaints of the neck and shoulder (prevalence odds ratio (POR) 1.9; 95% confidence interval (95% CI) 1.1 to 3.2), neck and shoulder and elbow and hand complaints (POR 2.9; 95% CI 1.8 to 4.7 and POR 2.8; 95% CI 1.6 to 4.7, respectively). The women more often than the men left the industry because of neck and upper limb complaints. Also, women in other work had a higher prevalence of complaints of the neck and shoulder (POR 2.3; 95% CI 1.1 to 5.1) than the men. The men in the fish processing industry had a higher prevalence of complaints of the neck and shoulder than the men in other work (POR 3.6; 95% CI 1.6 to 8.0). This difference was not shown up by the questionnaire. CONCLUSIONS: Despite superficially similar work, there were clear sex differences in physical exposure and psychosocial work environment. Work in the fish processing industry was associated with a high risk of neck and upper limb disorders in women, which was probably mainly due to their extremely repetitive work tasks; the corresponding men had less repetitive work and less disorders. Also, a healthy worker effect on neck and upper limb disorders was found. The advantage of a physical examination compared with a questionnaire is clearly shown.

 

     

Factors influencing uptake of influenza vaccination among hospital-based health care workers

BACKGROUND: Vaccination of health care workers against influenza has been shown to lower mortality among elderly patients, but uptake of voluntary vaccination among health care workers remains low. AIMS: Factors influencing uptake of vaccination were examined among a cross-section of health care workers based in an NHS Trust. METHODS: A structured, self-administered questionnaire was mailed to a random sample of health care workers based in the acute services sector of a UK National Health Service Trust, 6 months following a voluntary immunization programme implemented as part of the Scottish Executive Health Department winter planning arrangements for 2000-2001. The programme was promoted using posters in clinical areas and a single leaflet given to all staff through a paycheck advice note. RESULTS: Five hundred and fifty-one health care workers (53%) responded to the questionnaire and influenza vaccination was accepted by 150 (28%). The occupational health poster strongly influenced the decision to accept vaccination [odds ratio (OR) = 11.01; 95% confidence interval (CI) = 2.13-56.80; P < 0.0001]. Other significant influences included female sex (OR = 9.11; 95% CI = 1.26-65.72) and perceived risk of contracting flu without the vaccine (OR = 7.70; 95% CI = 1.44-41.05). Misconceptions regarding the purpose of the vaccination campaign were common and concern regarding possible side-effects was a deterring factor for vaccination uptake. CONCLUSION: Our study showed that visual material displayed throughout the workplace strongly influenced the acceptance of influenza vaccination. Future campaigns should also emphasize the positive benefits to patients of health care worker immunization, with readily accessible information regarding side-effects available from all sources.     

Risk factors for work-related musculoskeletal disorders in an aluminum smelter

A cross-sectional study of selected jobs in an aluminum smelter was conducted to assess the prevalence of work-related musculoskeletal disorders (WMDs), and to estimate their association with physical and psychosocial characteristics of the jobs. A structured interview and physical exam were used to assess the musculoskeletal health status of the participants, and a self-administered questionnaire was used to assess the psychosocial factors. Observational job analysis was conducted to evaluate 37 potential physical risk factors. Complete data were available for 104 subjects. The prevalence of WMDs on interview and physical exam were 0.8%, 14.9%, 11.6%, 14.9%, and 17.4% for the neck, shoulder, elbow/forearm, hand/wrist, and low back regions, respectively. Unconditional multiple logistic regression was used to model the relationship between physical and psychosocial factors and health status. Years of forearm twisting were found to be a significant predictor for hand/wrist disorders on interview (OR = 17, 95% CI = 2.9–106); for elbow/foream disorders on physical exam and interview (OR = 37, 95% CI = 3.0–470); and for shoulder disorders on interview (OR = 92, 95% CI = 7.3–∞) and on interview and physical exam (OR = 46, 95% CI = 3.8–550). Low decision latitude was also found to be significant for the shoulder on interview (OR = 4.5, 95% CI = 1.3–16). High job satisfaction (OR = 5.9, 95% CI = 1.4–25) and low social support (OR = 5.3, 95% CI = 1.3–22) were associated with low back pain report on interview; only high job satisfaction (OR = 5.3, 95% CI = 1.1–26) was associated with low back pain on both interview and physical exam. Am. J. Ind. Med. 32:66-75, 1997. © 1997 Wiley-Liss, Inc.     

Musculoskeletal Problems in the Tomato Growing Industry: 'Tomato Trainer's Shoulder'?

Tomato training entails highly repetitive shoulder muscle contractions,static contractions and work at shoulder level, factors linkedin other working groups with neck and shoulder complaints. Thefrequency of musculoskeletal complaints was compared using theNordic Questionnaire in 56 tomato trainers and 52 other matchedglasshouse workers whose job did not include these work taskfactors. A higher 12- month (odds ratio (OR) = 5.9; [95% confidenceinterval (Cl) = 2.4–16.7] and 7- day (OR = 3.6, Cl = 1.2–11.1)period prevalence of shoulder complaint was recorded in trainersthan in pickers and deleafers. Other upper limb and upper trunkcomplaints were also more common in tomato trainers, highlightingan area of ergonomic concern.     

Occupational factors associated with low back pain in urban taxi drivers

BACKGROUND: Urban taxi drivers differ from other professional drivers in their exposures to physical and psychosocial hazards in the work environment. Epidemiological data on low back pain (LBP) of this occupational group are very scarce. AIMS: To examine LBP in taxi drivers and its association with prolonged driving and other occupational factors. METHODS: We analyzed the cross-sectional data from the Taxi Drivers' Health Study. Standardized instruments were used to collect information on personal factors, work-related physical and psychosocial factors and driving time profiles. LBP prevalence was assessed using the modified Nordic Musculoskeletal Questionnaire. Multiple logistic regression models were employed for statistical analyses. RESULTS: Of 1242 drivers, 51% reported LBP in the past 12 months, significantly (P < 0.001) higher than other professional drivers (33%) in Taiwan. After adjusting for the effects of demographic characteristics, lifestyle factors, anthropometric measures and socioeconomic positions, we found that driving time >4 h/day [prevalence odds ratio (POR) 1.78; 95% CI 1.02-3.10], frequent bending/twisting activities while driving (adjusted OR 1.86; 95% CI 1.15-2.99), self-perceived job stress (POR 1.75; 95% CI 1.20-2.55), job dissatisfaction (POR 1.44; 95% CI 1.05-1.98) and registration type were the major occupational factors significantly associated with higher LBP prevalence in taxi drivers. CONCLUSIONS: We have identified that long driving time and several physical and psychosocial factors are associated with high prevalence of LBP in taxi drivers. This should be further investigated in prospective studies. Future studies are needed to examine the potential adverse effects of prolonged exposure to low levels of whole-body vibration.     

Influence of work environment on emotional health in a health care setting

BACKGROUND: Radical changes are taking place in health care services and might be expected to cause job dissatisfaction, absenteeism, somatic complaints and mental health problems. Research in this area is limited and focused primarily on nurses. AIM: To understand the impact of the work environment on the emotional health of doctors and nurses in a general hospital setting. METHODS: Cross-sectional study using self-reported questionnaires including the General Health Questionnaire, the Posttraumatic Stress Disorder (PTSD) Checklist for Civilians, the Trauma Experiences and Work Environment Scale. RESULTS: The response rates for the study were 28% (60) for doctors and 54% (431) for nurses. Whilst the prevalences of psychiatric disorder, anxiety, depression and PTSD were higher for doctors compared with nurses, this was not statistically significant. Both groups reported witnessing someone badly injured or killed as their most distressing experience (doctors 46% versus nurses 41%). Using multiple logistic regression, significant predictors of emotional health was task orientation for doctors (OR = 1.96, 95% CI = 1.1-3.6), and PTSD (OR = 17.2, 95% CI = 6.0-49.6), work pressure (OR = 1.2, 95% CI = 1.01-1.4) and innovation (OR = 0.81, 95% CI = 0.70-0.94) for nurses. CONCLUSION: The prevalence of psychiatric disorder among the doctors and nurses was similar to that in Britain. Elements of the work environment did impact on the emotional health of health care workers. Organizational development initiatives should include employee mental health issues in order to create a more positive work environment.     

Morbidity in expatriates--a prospective cohort study

BACKGROUND: Expatriates comprise an important, but rarely studied subset of international travellers. This study was performed to assess the incidence of health events in an expatriate group and to evaluate factors affecting this incidence. METHODS: A cohort of 2020 Foreign and Commonwealth Office (FCO) staff and partners living abroad were followed-up over 1 year. The main outcome measure was incidence of illness or injury serious enough to require consultation with a doctor. Data collection was by means of a self-administered questionnaire. Poisson regression was used to estimate the rates of health events and to test for association between health events and a number of independent variables. RESULTS: The incidence of health events was 21%. Trauma (incidence 5%), musculoskeletal disorders (incidence 4%) and infectious disease (incidence 3%) were the principal causes of morbidity. The incidence of psychological disorders was low (1%). Of significance, employees were at increased risk of morbidity when compared to partners, with a higher incidence of health events [incidence rate ratio (IRR) 1.4, 95% CI 1.1-1.9] and psychological disorders (IRR 5.9, 95% CI 1.0-34.1). Moreover, unaccompanied employees were at increased risk of health events (IRR 1.3, 95% CI 1.0-1.7), and of traumatic injury (IRR 2.3, 95% CI 1.3-4.3) when compared to accompanied employees. CONCLUSION: While the morbidity in FCO personnel is low in comparison to other expatriate groups, the higher risk of morbidity in employees and unaccompanied individuals merits further research, particularly to ascertain whether work demands, isolation or risk-taking behaviour are contributory factors.     

Receptionists' perceptions of violence in general practice

BACKGROUND: Violence and threatening behaviour towards health care employees is a recognized hazard. There is a lack of research into the perceptions of general practice (GP) receptionists about this important workplace hazard. AIM: To determine the factors that influence reception staff perceptions regarding the risk of future violent and threatening incidents at work. METHODS: A cross-sectional survey using a self-administered postal questionnaire was carried out among reception staff working in 49 GPs in two UK National Health Service Primary Care Trusts. RESULTS: Forty-nine (72%) practices agreed to participate. Two hundred and seven (68%) reception staff participated. Receptionists who reported having been threatened or attacked in the past 12 months were more likely to be worried about being threatened [odds ratio (OR) 4.9; 95% confidence interval (CI) 2.0-11.8] or attacked (OR 4.6; 95% CI 1.8-11.2) in the future. Receptionists with higher neuroticism scores were more worried about the future possibility of violence. Staff who felt safe and supported at work (P = 0.003) and staff who had lower background sources of stress at work (P < 0.001) were less likely to feel they would be threatened or attacked at work. Staff who had received training about violent and abusive incidents felt safer at work (OR = 1.27; 95% CI 1.04-1.55). CONCLUSION: Previous episodes of threats or attacks at work make receptionists more worried about future episodes. Factors which reduce reception staff anxieties about violence and threat at work are working in a supportive environment where work stressors are controlled and receiving training on how to deal with violent, threatening and difficult behaviour.     

Upper body quadrant pain in bus drivers

The aims of this study were to evaluate the prevalence of upper body quadrant pain among Israeli professional urban bus drivers and to evaluate the association between individual, ergonomic, and psychosocial risk factors and occurrence of neck pain. Three hundred and eighty-four male urban bus drivers were consecutively enrolled in the study. Data pertaining to work-related ergonomic and psychosocial stress factors were collected. The 12-month prevalence of neck pain was 21.2%, followed by shoulder: 14.7%, upper back: 8.3%, elbow: 3.0%, and wrist: 3.0% pain. Prevalence of neck pain was associated with uncomfortable seats (odds ratio; OR [95% confidence interval; CI]: 2.2 [1.2-4.3], back support (2.3 [1.2-4.2]), and steering wheel (2.2 [1.1-4.5]). Drivers with neck pain reported significantly higher prevalence of pain in the upper back (OR [95% CI]: 5.9 [2.7-12.9]), shoulders (8.1 [4.3-15.3]), and wrists (7.0 [2.0-21.8]) compared to drivers without neck pain. Work-related organizational stress factors were not associated with neck pain prevalence.     

Predictors of Persistent Elbow Tendonitis Among Auto Assembly Workers

INTRODUCTION: Lateral and medial epicondylitis associated with work activity is a common upper extremity musculoskeletal disorder with a prevalence of 4-30% depending upon the work setting and diagnostic criteria. The influence of treatment, ergonomic factors, medical history, psychosocial variables, and aging on the improvement of symptoms has not been well defined. METHODS: This was a prospective cohort study of a cohort of 45 workers with active elbow tendonitis for an average of 13 months. Complete resolution of symptoms was the defined outcome measure. RESULTS: The predictive factors for persistent elbow tendonitis included older age (OR = 1.1, 95% CI: 0.99, 1.33), higher hand repetition level for their job(s) (OR = 2.5, 95% CI: 1.00, 6.25), more deviation from a neutral wrist position during the work activity (OR = 2.0, 95% CI: 0.80, 5.56), and lower perceived decision authority on the job (OR = 0.9, 95% CI: 0.79, 0.98). Other ergonomic, psychosocial, and electrophysiologic measures were not predictive. The models had relatively high sensitivity and specificity. Treatment effects could not be evaluated due to incomplete data available. CONCLUSIONS: Older workers with jobs requiring more repetition and awkward wrist postures, and less decision authority were less likely to have resolution of their elbow tendonitis. IMPLICATIONS: Workers at highest risk for persistent elbow tendonitis should be placed at jobs with lower repetition levels and that use more neutral wrist postures. Effective interventions must address both the ergonomic and psychosocial risk factors in a multifaceted approach to this problem.     

Air blast circuit breaker noise and hearing loss: a multifactorial model for risk assessment

The assessment of the risk to hearing from impulse noise exposure may be a problem for the occupational physician because existing legislative and international noise exposure standards deal primarily with continuous noise, and are not valid in excess of the peak exposure limit of 200 pa (140 dB). Noise exposure in excess of this level, for example that due to firearms, is frequently perceived as harmful, but this is not necessarily the case, as impulse noise standards do, in fact, allow exposure with a maximum in the order of 6.3 kPa (170 dB). To illustrate this, a cross-sectional group of electrical transmission workers have been studied who were exposed to significant levels of impulse noise from air blast circuit breakers and firearms. Important hearing loss factors have been identified by means of a specially designed questionnaire. Using the Health & Safety Executive definition, the risk of hearing loss was determined by calculating prevalence odds ratios (ORs) for exposure to these factors. The OR for those with fewer than eight unprotected air blast circuit breaker exposures was 2.27 (95% confidence interval (CI), 1.01-5.08), whilst for those with more than eight exposures the OR was 2.10 (95% CI, 0.97-4.54). For firearm exposure, ORs of 1.61 (95% CI, 0.95-2.74) were noted in the medium exposure group and 2.05 (95% CI, 1.08-3.86) in the high exposure group. When all the factors were included in the model, the most significant factor was age. The study gives support to the impulse noise exposure criteria, confirming the borderline risk from air blast circuit breaker noise exposure and the relative safety of moderate gunfire exposure.     

南京市男男性行为者新型毒品使用情况及相关因素

  目的  了解南京市男男性行为者（men who have sex with men,MSM）新型毒品的使用情况及其相关因素。  方法  采用滚雪球、同伴推荐和互联网招募等方式招募MSM参加调查。采用多因素Logistic回归分析模型分析新型毒品使用的相关因素。  结果  876名MSM中,29.6%自述使用过新型毒品,人类免疫缺陷病毒（human immunodeficiency virus,HIV）和梅毒的感染率分别为9.5%和9.0%。控制了相关社会人口学因素的影响后,新型毒品使用者近6个月与同性发生无保护肛交（OR=1.83,95% CI:1.35~2.47,P < 0.001）、近6个月多性伴（OR=2.25,95% CI:1.65~3.05,P < 0.001）、HIV感染（OR=1.95,95% CI:1.21~3.17,P=0.007）和梅毒感染（OR=1.71,95% CI:1.02~2.84,P=0.040）的可能性较高。多因素分析结果显示,年龄<30岁（OR=1.50,95% CI:1.07~2.11,P=0.020）、性取向自我认定为同性恋（OR=1.65,95% CI:1.16~2.34,P=0.005）、互联网交友（OR=1.58,95% CI:1.07~2.35,P=0.022）、月收入≥ 5000元（OR=1.57,95% CI:1.13~2.17,P=0.007）、性角色自我认定为"被插入方"（OR=1.55,95% CI:1.04~2.32,P=0.033）的MSM使用新型毒品的可能性较高。  结论  南京市MSM新型毒品使用比例较高,新型毒品使用和HIV感染、梅毒感染及高危性行为有关联,新型毒品使用的危害性和警示性教育应成为MSM社区参与宣传教育关注的重点。