The course of physical functional limitations and occupational conditions in a middle-aged working population in France

ABSTRACT: BACKGROUND: Physical functional limitations (PFL) have mainly been studied in older populations. The aim of this study was to better understand the course of PFL and associations with occupational factors by gender in a middle-aged working population. METHODS: The data came from 16,950 workers in the ESTEV (Enquete Sante Travail et Vieillissement) cohort in France. PFL were assessed using the physical abilities section of the Nottingham Health Profile. Occupational conditions were measured with a self-administered questionnaire covering physical and psychosocial factors in 1990 and 1995. Multivariate analyses were used to assess the associations. RESULTS: The PFL appearance rate in 1995 was the same by gender (6.3%); the rate of PFL recovery was higher in men (23.9% versus 20.9%). Age was an independent factor of PFL at age 47 years or older in both genders after adjusting for confounding factors. The PFL appearance rate in 1995 was higher with physical occupational exposure in 1990, such as awkward work with a dose relation in both genders, while the PFL recovery rate decreased significantly only for men. Exposure to psychosocial occupational conditions, such as having the means to produce quality work in 1990, was significantly associated with a decreased PFL appearance rate in 1995 in both genders, and having high decision latitude in 1990 was associated with a decreased PFL appearance rate in 1995 only in men. Changes in exposure to occupational factors between 1990 and 1995 were associated with the PFL appearance and recovery rates in 1995 in both genders. CONCLUSIONS: After five years, the course of PFL in this working population changed and was associated with physical and psychosocial occupational factors. Relationships were stronger for the PFL appearance rate in both genders and were weaker for recovery from PFL, mainly among women.     

Stability and change of volume and intensity of physical activity as predictors of hypertension

AIMS: Controversy exists concerning intensity of physical activity and risk of hypertension. Also, the association between long-term changes in physical activity and hypertension is poorly known. Therefore we investigated how the stability and change of volume and intensity of physical activity are associated with the risk of hypertension in Finnish men and women. METHODS: A total of 3,931 men and 4,381 women responded to three questionnaires on health and lifestyle. Baseline data were gathered from two questionnaires, in 1975 and 1981. The subjects were 24-51 years of age, healthy, and non-hypertensive at baseline (1981). At the end of the follow-up, in 1990, the subjects responded to a third questionnaire, according to which we assessed the cumulative incidence of hypertension between 1982 and 1990. RESULTS: The cumulative incidence of hypertension from 1982 to 1990 was 10.2% in men and 8.0% in women. In men, the risk of hypertension was higher among those who were persistently not participating in vigorous physical activity (i.e. in both 1975 and 1981) (odds ratio, 1.60; 95% confidence interval, 1.15 to 2.24; p=0.006) than among those persistently participating, when all confounding factors were adjusted for. Among those participating in vigorous activity only in 1975 or in 1981 the risk was not significantly increased compared with those participating persistently. Volume of physical activity was not associated with hypertension. In women, there was no association between physical activity and incidence of hypertension. CONCLUSIONS: Compared with inactivity, persistent vigorous physical activity predicts a low risk of hypertension in men.     

Do risk factors explain more of the social gradient in self-reported health when adjusting for baseline health?

BACKGROUND: It has often been debated the extent to which known risk factors explain socio-economic differences in health. While common in mortality studies, few studies of morbidity adjust for baseline health. In this study, we argue that there are sound reasons to do so, and examine whether a set of risk factors explain a larger part of social gradients in men and women's self-rated health (SRH) in Denmark when controlling for previous health. METHODS: We use interval regression models on longitudinal survey data from 1990 and 1995 separately for Danish male and female workers aged 18-59. RESULTS: Large social gradients are found in SRH for both men and women. The included risk factors (smoking, body mass index, high blood pressure and job satisfaction) reduce the educational gradient in SRH by 40% (based on highest versus no education), the wage gradient by 18% and leaves occupational gradients (based on no employment versus white collar workers) unaltered for men. For women, similar gradients are altered by 6 and 22 and 14% in cross-sectional models. Controlling for baseline health 5 years earlier, the risk factors reduce the education, occupation and wage gradients by 45, -15 and 17% for men and by 5, 25 and 15% for women. CONCLUSION: The findings suggest that common risk factors do not explain a larger fraction of social health inequalities in dynamic than in static models of self-reported health.     

Pleural malignant mesothelioma and non-occupational exposure to asbestos in Casale Monferrato, Italy.

OBJECTIVES--To assess and quantify the occurrence of pleural malignant mesotheliomas in people who neither experienced occupational exposure to asbestos nor were married to (or known to live with) workers exposed to asbestos in the workplace. The study was conducted in the area of the local health authority of Casale Monferrato, in north western Italy, where a large factory that produced asbestos cement was active up to 1985. No other major activities related to asbestos have ever been present in the area. METHODS--A retrospective survey covering the period 1980 to 1991 identified 126 incident pleural malignant mesotheliomas histologically diagnosed among residents in the local health authority (population at the 1981 census 98,000). Submission of 83 of 95 cases diagnosed during 1980-9 for revision by a panel of five expert pathologists led to the exclusion of 21. The 31 cases diagnosed in 1990-1 were not submitted for revision. For 64 of the 105 retained cases, information derived from different sources (rosters of the employees in the asbestos cement factory dated back to 1907, list of their spouses, clinical records) did not suggest occupational or paraoccupational exposure to asbestos. RESULTS--Incidence excludes cases for which there was some suggestion of occupational or paraoccupational exposure to asbestos. Incidence of histologically confirmed malignant mesothelioma among residents in the local health authority (annual x 100,000; age adjusted) was 4.2 in men and 2.3 in women (based on 26 and 18 cases respectively). In both sexes, rates in 1985-9 were higher than in the previous quinquennium. Corresponding estimates for 1990-1 (based on unrevised diagnoses) suggest similar rates in men and women. CONCLUSION--Rate ratios which are four to six times those measured by conventional Italian cancer registries can hardly be totally explained by bias produced by lack of recognition of occupational or paraoccupational exposure. The problem of proving this type of negative data is common to other circumstances of alleged cancer clusters of environmental (non occupational) origin.     

Chronic neck and shoulder pain,age, and working conditions: longitudinal results from a large random sample in France

Aims: To analyse the effects of age and occupational factors on both the incidence and the disappearance of chronic neck and shoulder pain after a five year follow up period.

Methods: A prospective longitudinal investigation (ESTEV) was carried out in 1990 and 1995 in seven regions of France. A random sample of male and female workers born in 1938, 1943, 1948, and 1953 was selected from the occupational physicians' files. In 1990, 21 378 subjects were interviewed (88% of those contacted), and 87% were interviewed again in 1995. Chronic neck and shoulder pain satisfying specific criteria, and psychosocial working conditions were investigated by a structured self administered questionnaire and a clinical examination.

Results: Prevalence (men 7.8%, women 14.8% in 1990) and incidence (men 7.3%, women 12.5% for the period 1990–95) of chronic neck and shoulder pain increased with age, and were more frequent among women than men in every birth cohort. The disappearance rate of chronic neck and shoulder pain decreased with age. Some adverse working conditions (repetitive work under time constraints, awkward work for men, repetitive work for women) contributed to the development of these disorders, independently of age. Psychosocial factors seemed to play a role in both the development and disappearance of chronic neck and shoulder pain. Data did not show specific interactions between age and working conditions.

Conclusions: The aging of the workforce appears to contribute to the widespread concern about chronic neck and shoulder pain. A better understanding of work activity regulation of older workers can open up new preventive prospects.

     

Sinonasal cancer in the Italian national surveillance system: Epidemiology,occupation, and public health implications

Background

Sinonasal cancer (SNC) is a rare tumor with predominant occupational etiology associated with exposures to specific carcinogens. The aim of this study is to describe SNC cases recorded in Italy in the period 2000‐2016.

Methods

Clinical information, occupational history, and lifestyle habits of SNC cases collected in the Italian Sinonasal Cancer Register were examined. Age‐standardized rates were estimated.

Results

Overall, 1529 cases were recorded. The age‐standardized incidence rates per 100 000 person‐years were 0.65 in men and 0.26 in women. Occupational exposures were predominant among the attributed exposure settings, primarily to wood and leather dusts. Other putative causal agents included chrome, solvents, tannins, formaldehyde, textile dusts, and pesticides. Many cases had unknown exposure.

Conclusions

Epidemiological surveillance of SNC cases and their occupational history is fundamental for monitoring the occurrence of the disease in exposed workers in industrial sectors generally not considered at risk of SNC as well as in non‐occupational settings.

     

Gender differences in carpal tunnel syndrome? occupational and non-occupational risk factors in a population-based case-control study

PURPOSE: To determine the role of occupational and personal risk factors of carpal tunnel syndrome (CTS) separately in men and women.METHODS: Men (n = 404) and women (n = 404) younger than 65 years with first surgery for CTS in 1995/96 were sampled at random from the Bremen population (0.65 million) and matched to controls by age and gender sampled from the population registry. A self-administered questionnaire with 77 questions inquired about personal factors and activities during work and private environment (response: 60% of eligible cases and 52% in controls, respectively).RESULTS: CTS risk increased with body mass index (BMI): odds ratio for each unit of BMI [kg/m(2)] OR(men) = 1.13; (95%-confidence-limits CL(men) 1.06, 1.20), OR(women) = 1.09 (CL(women) 1.04, 1.14). Multivariate analysis adjusting for BMI showed more pronounced risks in men compared with women for repetitive movements of the hand: OR(m) = 2.89 (CL 1.82, 4.58); OR(w) = 2.10 (CL 1.37, 3.22), for forceful grip: OR(m) = 2.69 (CL 1.70, 4.27); OR(w) = 2.29 (CL 1.43, 3.66), but not for household chores: OR(m) = 0.64 (CL 0.40, 1.03); OR(w) = 0.88 (CL 0.34, 2.29). Women worked less hours per week than men but manual exposures remained more relevant in men after adjustment. Exposure-response-relationships could be demonstrated for all work related exposures. Women were at higher risk for CTS if they had had more than two births or a history of hysterectomy. Adding these factors to the logistic model still showed an association between manual work and CTS. Blinded expert rating (manual vs. non-manual) of jobs held by respondents and non-respondents and by cases and controls did not reveal relevant selection effects or recall-bias.CONCLUSIONS: CTS is a work related disease in both men and women, the fraction attributable to work in the Bremen population under age 65 is estimated to be 33% in men and 15% in women. Funding: German Federal Ministry for Education & Research: 01 EG 9512.     

Sex differences in the associations of socioeconomic status with undiagnosed diabetes mellitus and impaired glucose tolerance in the elderly population: the KORA Survey 2000

BACKGROUND: Sex differences in the associations of socioeconomic status (SES) with prevalence of undiagnosed diabetes mellitus, impaired glucose tolerance (IGT) and known risk factors of type 2 diabetes mellitus were investigated in an elderly population. METHODS: Oral glucose tolerance tests were carried out in 1354 randomly selected subjects (697 men, 657 women) aged 55-74 years in the population-based KORA Survey 2000, Augsburg, Germany. Odds ratios (ORs) and 95% confidence intervals (CIs) for undiagnosed diabetes or IGT by education, occupation and income were estimated using logistic regression controlling for age, waist circumference, blood pressure, triglycerides, physical activity, smoking and alcohol intake. RESULTS: All three SES variables were significantly inversely related to body mass index, waist circumference and low physical activity in women (P < 0.05). In men, these associations were weaker or absent. Using the lowest category as reference, occupational status was significantly associated with undiagnosed diabetes in women (adjusted OR 0.5; 95% CI 0.3-0.8) after controlling for risk factors in multivariate regression. The OR was also reduced with higher income in women (adjusted OR, diabetes: 0.7; 95% CI 0.5-1.03). Among men, no significant relations of the SES indicators with unknown diabetes were observed. However, the odds of having IGT was lower with higher occupational status in men (adjusted OR 0.7; 95% CI 0.5-0.9). CONCLUSIONS: Undiagnosed type 2 diabetes was related to low SES defined by occupation or income in women only. In men, low occupational status was independently associated with higher IGT risk. Educational level was not related to glucose disorders in both sexes in the elderly population.     

Exploring the gender gap in healthcare management

A 1990 study by ACHE and the University of Iowa compared the career attainments and attitudes of a group of male and female healthcare executives. The research showed that among men and women who had entered the field at the same time and had achieved similar educational levels, women did not fare as well as men in terms of salary, position level, or job satisfaction. A follow-up to this study, which consisted of two parts, was conducted in 1995 by ACHE, the University of Alabama at Birmingham, and Lamalie Amrop International to learn whether the gender gap had narrowed. The 1990 study divided respondents into groups according to the year they entered healthcare management: 1971-1975, 1976-1980, or 1981-1985. The first part of the 1995 project was a replication study that paralleled the 1990 study, dividing a new pool of respondents into three groups: 1976-1980, 1981-1985, and 1986-1990. The second part of the follow-up project was a panel study, in which respondents from the 1990 study were surveyed again. Following are highlights from the 1995 study.     

Trend of increase in the incidence of acute myocardial infarction in a Japanese population: Takashima AMI Registry, 1990-2001

The incidence and mortality of acute myocardial infarction (AMI) remain low in Japan despite major dietary changes and worsening cardiovascular risk factors, a situation that should have resulted in a substantial increase in AMI rates (Japanese paradox). The current trend in the incidence of AMI was examined for the period 1990-2001 by use of data from the Takashima AMI Registry covering a stable population of approximately 55,000 in central Japan. AMI incidence rates (per 100,000 person-years) and 95% confidence intervals were calculated for 1990-1992, 1993-1995, 1996-1998, and 1999-2001. The incidence trend was determined by calculating the average annual change in percentage across the years. There were 352 (men: n = 224; women: n = 128) registered first-ever AMI cases during 1990-2001. The age-adjusted incidence rate of all AMI showed a gradual increase from 39.9 (95% confidence interval (CI): 29.8, 50.0) in 1990-1992 to 62.6 (95% CI: 51.5, 73.7) in 1999-2001. In men, the age-adjusted incidence rate increased from 66.5 (95% CI: 46.4, 86.6) in 1990-1992 to 100.7 (95% CI: 78.6, 122.7) in 1999-2001. In women, fluctuation was observed after an initial steep increase. The average annual incidence increased by 7.6% (95% CI: 3.5, 11.7) among men and by 8.3% (95% CI: 1.02, 15.6) among women. To the best of the authors' knowledge, this is the first study to report an increasing trend of AMI in a Japanese population.     

Squamous cell cancer of the maxillary sinus in Hokkaido, Japan: a case-control study

A case-control study of squamous cell cancer of the maxillary sinus was performed in Hokkaido with 106 cases and 212 controls matched for sex, age (within five years), and residence (same health centre region). Univariate analyses showed that a history of chronic sinusitis (relative risk, RR = 3.2), nasal polyps (RR = 5.0), an occupational history of being a carpenter, joiner, furniture worker, or other woodworker (RR = 2.9), and current or past smoking habits (RR = 3.0) were statistically significant risk factors for men. No single item was a significant risk factor for women.     

Squamous cell cancer of the maxillary sinus in Hokkaido, Japan: a case-control study.

A case-control study of squamous cell cancer of the maxillary sinus was performed in Hokkaido with 106 cases and 212 controls matched for sex, age (within five years), and residence (same health centre region). Univariate analyses showed that a history of chronic sinusitis (relative risk, RR = 3.2), nasal polyps (RR = 5.0), an occupational history of being a carpenter, joiner, furniture worker, or other woodworker (RR = 2.9), and current or past smoking habits (RR = 3.0) were statistically significant risk factors for men. No single item was a significant risk factor for women.     

Malignant mesothelioma in Basse-Normandie, a French population study. Descriptive analysis, prognostic factors and survival

BACKGROUND: Malignant mesothelioma is a pleural and/or peritoneal tumor closely related to asbestos exposure, and its incidence should continue to increase during the first two decades of the 21(rst)century. The main prognostic factors described for this tumor are older age, sex, tumor stage and histological type. The aim of this study was to assess the incidence of pleural and peritoneal malignant mesothelioma in the County of Basse-Normandie (France), as well as their epidemiological characteristics, and the prognostic factors related to survival duration. METHODS: Cases were identified through repeated inquiries among all chest physicians and pathologists of the County of Basse-Normandie. A special care was taken in the validation of the diagnosis of each case. Incidence of mesothelioma was determined according to sex and age (5 years categories). Qualitative and quantitative variables were compared with the use of chi-square or Student's t tests respectively. Survival rate was calculated by Kaplan-Meier method, and prognostic factors were studied by means of Cox model. RESULTS: Study population consisted in all 80 malignant mesothelioma cases diagnosed in Basse-Normandie between the 1(rst) of September 1995 and the 31(rst) of August 1999. Annual incidence rates of pleural mesothelioma were 1.1/100 000 in men and 0.23/100 000 in women; annual incidence rates for peritoneal mesothelioma were 0.21/100 000 in men and 0.13/100 000 in women. Asbestos exposure was present in 63 cases (78.8%). The study of geographic distribution of mesothelioma cases revealed the influence of the main asbestos industrial settings, as well as the numerous scattered cases related to other occupational exposure. Mean survival duration was 9 months for pleural mesothelioma and 5 months for peritoneal mesothelioma. After adjustment on age, death risk was higher in asbestos-exposed than in non asbestos-exposed cases. CONCLUSION: This study confirms that malignant mesothelioma is closely related to asbestos exposure, but not only in main asbestos industrial settings. It suggests that asbestos exposure may take place among prognostic factors of this tumor.     

Agricultural work and the risk of Parkinson's disease in Denmark, 1981-1993

OBJECTIVES: This study examined the possible association between agricultural and horticultural work and the subsequent morbidity of Parkinson's disease. METHODS: Fixed cohorts of 2,273,872 men and women aged 20-59 years on 1 January 1981 and identified in the Central Population Register of Denmark were followed, and all first-time hospitalizations with Parkinson's disease as the principal diagnosis during the 13 years until 31 December 1993 were recorded. Standardized hospitalization ratios (SHR) were calculated using all gainfully employed persons as the standard and by multiplying the ratio by 100. Ninety-five percent confidence intervals (95% CI) were calculated on the assumption of a Poisson distribution. RESULTS: A high risk of Parkinson's disease was found for the men and women in agriculture and horticulture (134 cases, SHR 132, 95% CI 111-156). Statistically significantly high risks were found for farmers (79 cases, SHR 130, 95% CI 103-163) and for all men in agriculture and horticulture (109 cases, SHR 134, 95% CI 109-162). CONCLUSIONS: A consistent pattern of high Parkinson's disease morbidity was found among occupational groups employed in agriculture and horticulture.     

Time trends and occupational risk factors for peritoneal mesothelioma in Sweden.

Epidemiologic data on peritoneal mesothelioma are scarce but exposure to asbestos is an identified risk factor. To characterize the disease, time trends, age-incidence relationships, and occupational risk factors for peritoneal mesothelioma were studied based on the Swedish Family-Database covering years 1961 to 1998. Peritoneal mesothelioma is a rare disease and only 96 male and 113 female cases were recorded during the 38-year period. Age-standardized incidence of the disease has increased for men until 1985 and leveled off thereafter. The incidence in women has been equally high but it has continued to increase toward the end of the follow-up period. The incidence was maximal at an age around 80 years for both genders. No female occupational or socioeconomic group was at risk. For men, 29% of the cases had typical asbestos related jobs with a SIR of 1.70. Bricklayers and plumbers had the highest risk of 7.22 and 5.12, respectively. Within limits of the sample size, no evidence was noted for risk from environmental exposures to asbestos because the risk of farmers and that of urban residents were not different.     

What mediates the inverse association between education and occupational disability from back pain?--A prospective cohort study from the Nord-Trøndelag health study in Norway

Low education is consistently associated with an increased risk of back pain disability, but the underlying mechanisms for this relationship are poorly understood. In a seven-year prospective observational study of 38,426 employed men and women between 25 and 59 years in Norway, we investigated to what extent occupational class, working conditions and individual lifestyle mediated the effect of formal education on disability pensioning from back pain. Each additional year of formal education was associated with decreased risk for disability pensioning from back pain for both men [age adjusted Hazard Ratio (HR) 0.77; (95% Confidence Interval, 0.72-0.82)] and women [HR 0.76(0.71-0.82)]. Adjustment for occupational class and factors related to working conditions (authority to plan own work, physically demanding work, concentration and attention and job satisfaction) and individual lifestyle (smoking, body mass index, physical exercise and alcohol consumption) reduced the effect of education by 39% [HR 0.86(0.79-0.93)] for men and by 21% [HR 0.81(0.73-0.89)] for women. Working conditions contributed most to the explanation for men, while occupational class, working conditions and life style factors contributed equally for women. Subgroup analyses indicate small differences between full-time and part-time employees, while some differences were found between subcategories of back diseases. The study indicates that there is a strong and unexplained effect of education on back pain disability pensioning, which is not mediated by occupational class, working conditions or individual lifestyle.     

The role of mediating factors in the association between social deprivation and low birth weight in Germany

This study examines whether the association between social inequalities and low birth weight (LBW) (occurring in both pre- and full-term births) in Germany can be explained by several potentially confounding factors. These include maternal age, occupational status, marital status, nationality, employment status, smoking, prenatal care, psychosocial stress, obesity, short stature, short inter-pregnancy interval, chronic conditions, and several obstetrical risk factors such as pregnancy induced hypertension. We also examined how the risk for LBW varies over time within each socioeconomic group. We analyzed routinely collected perinatal data on singletons born in the federal state of Lower Saxony, Germany, in 1990, 1995, and 1999 (n = 182,444). After adjustment for all potentially confounding factors in multivariate logistic regression models, working class women, unemployed women, single mothers, and women over 39 years of age were at increased risk for pre- and full-term LBW infants. Migrant status was not related to LBW. We examined variations in the risk for LBW over time within groups, using the 1990 birth cohort as the referent group for the 1995 and 1999 birth cohorts. Compared to 1990, in 1999 women aged 19-34 years, housewives, unemployed women, women of German nationality and women with partners had higher risks for pre- and full-term LBW infants; the eldest subgroup had lower risks for LBW after adjustment for confounding factors. The factors we examined partly explain the social inequalities in LBW occurring in pre- and full-term infants. The subgroups with higher rates of LBW in 1999 compared to 1990, included women experiencing childbirth in an optimal stage of life or in a privileged social context. Public health policies in Germany should target social inequalities contributing to the aetiology of LBW and to the factors that result in increased LBW rates.     

Occupational and leisure time physical activity and the risk of nonfatal acute myocardial infarction in Italy

PURPOSE: Physical activity has long been related to a reduced risk of coronary heart disease (CHD), including acute myocardial infarction (AMI). However, the quantitative estimates of the possible protective role of physical activity appear to vary across studies and populations. METHODS: A case-control study conducted in Italy between 1995 and 1999, including 507 incident cases below 79 years (378 men, 129 women) with a first episode of AMI, and 478 controls (297 men, 181 women) admitted to hospitals for acute conditions. RESULTS: Compared with the lowest level of occupational physical activity, the multivariate odds ratios (OR) of AMI for the highest level were 0.61 (95% confidence interval [CI], 0.38-0.97) at age 15 to 19 years, 0.57 (95% CI, 0.34-0.95) at age 30 to 39 years, and 0.51 (95% CI, 0.29-0.90) at age 50 to 59 years. The corresponding values for leisure time activity were 0.54 (95% CI, 0.38-0.77), 0.86 (95% CI, 0.57-1.30), and 1.00 (95% CI, 0.57-1.74), respectively. The association was consistent across strata of age, sex, education, smoking, and other selected covariates. CONCLUSIONS: The attributable risk for low occupational exercise at age 30 to 39 years was over 10%, indicating the scope for further intervention on this modifiable risk factor in this Italian population, particularly in consideration of the public health importance of CHD.