Work-related psychosocial and mechanical risk factors for neck/shoulder pain: a 3-year follow-up study of the general working population in Norway

Purpose

This study examines the impact of work-related psychosocial and mechanical exposure on the development of neck/shoulder pain in the general working population.

Methods

A randomly drawn cohort from the general population in Norway aged 18–66 was followed up for 3 years (n = 12,550, response rate = 67 %). Eligible respondents were in paid work during the reference week in 2006 and 2009, or temporarily absent from such work (n = 6,745). Four work-related psychosocial factors and six mechanical exposures were measured. Outcomes of interest were moderate or severe neck/shoulder pain at follow-up adjusted for baseline neck/shoulder pain.

Results

In total, 16.9 % (1,138 individuals) reported neck/shoulder pain during the last month at follow-up. Work related psychosocial predictors of neck/shoulder pain were high job demands (highest OR 1.41, 95 % CI 1.11–1.78) and low levels of supportive leadership (highest OR 1.66, 95 % CI 1.08–2.54). Mechanical factors were neck flexion (highest OR 1.77, 95 % CI 1.31–2.39) and lifting in awkward postures (highest OR 1.81, 95 % CI 1.21–2.71). The estimated population risk attributable to these factors was about 23 %. The relative risk for neck/shoulder pain associated with psychosocial exposure was slightly influenced by adjustment for physical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress.

Conclusions

Highly demanding jobs, neck flexion and awkward lifting appear as the most important predictors of neck/shoulder pain.     

Physical Activity and Risk of Preterm Birth in a Cohort of African American Women

Background

Few studies have identified modifiable risk factors that are associated with the prevention of preterm delivery (PTD). This study examined the relationship between PTD and physical activity during pregnancy.

Risk for low back pain from different frequencies, load mass and trunk postures of lifting and carrying among female healthcare workers

Purpose

To investigate the risk of developing non-chronic and chronic low back pain (LBP) from frequency, load mass and trunk postures of occupational lifting and carrying among female healthcare workers.

Methods

A total of 9,847 workers in eldercare answered a questionnaire about occupational lifting and carrying frequency (rarely, occasionally and frequently), load mass (low: 1–7 kg, moderate: 8–30 kg and heavy: >30 kg), trunk posture (upright or forward bent back), and days with LBP in 2005. The odds ratio (OR) for developing non-chronic (1–30 days the last 12 months) and chronic (>30 days the last 12 months) LBP reported in 2006 from these characteristics of occupational lifting and carrying was investigated with multi-adjusted logistic regressions among female healthcare workers without LBP in 2005 (n = 1,612).

Results

Frequently lifting and carrying low load mass with forward bent back doubled the risk for developing chronic LBP (OR: 2.14; 95 % CI: 1.02–4.50). Occasionally and frequently lifting or carrying of any load mass with upright back did not increase the risk for chronic LBP. Lifting and carrying did not increase the risk for non-chronic LBP.

Conclusions

Preventive initiatives for LBP among healthcare workers ought to pay attention to frequent lifting and carrying of low load mass with forward bent back.     

Shift work,long working hours and preterm birth: a systematic review and meta-analysis

Purpose

Specific physical activities or working conditions are suspected for increasing the risk of preterm birth (PTB). The aim of this meta-analysis is to review and summarize the pre-existing evidence on the effect of shift work or long working hours on the risk of PTB.

Methods

We conducted a systematic search in MEDLINE and EMBASE (1990–2013) for observational and intervention studies with original data. We only included articles that met our specific criteria for language, exposure, outcome, data collection and original data that were of at least of moderate quality. The data of the included studies were pooled.

Results

Eight high-quality studies and eight moderate-quality studies were included in the meta-analysis. In these studies, no clear or statistically significant relationship between shift work and PTB was found. The summary estimate OR for performing shift work during pregnancy and the risk of PTB were 1.04 (95 % CI 0.90–1.20). For long working hours during pregnancy, the summary estimate OR was 1.25 (95 % CI 1.01–1.54), indicating a marginally statistically significant relationship but an only slightly elevated risk.

Conclusion

Although in many of the included studies a positive association between long working hours and PTB was seen this did reach only marginal statistical significance. In the studies included in this review, working in shifts or in night shifts during pregnancy was not significantly associated with an increased risk for PTB. For both risk factors, due to the lack of high-quality studies focusing on the risks per trimester, in particular the third trimester, a firm conclusion about an association cannot be stated.     

Environmental cadmium exposure and osteoporosis: a review

Objectives

To review the published literature investigating the association between cadmium exposure and osteoporosis.

Methods

A review of published peer-reviewed literature based on a priori criteria was completed. Odds ratios (OR) were abstracted or estimated from observational studies to calculate a pooled OR using inverse variance weighted random effects models.

Results

The review identified seven studies with a pooled OR of OR = 2.22 (95 % CI: 1.16, 4.28) [I ² = 54.8 % (p < 0.05)] (comparing highest urine cadmium category to lowest). In women over the age of 50 years, the pooled OR was 1.82 (95 % CI: 1.63, 2.02) [I ² = 73.1 % (p < 0.05)]. A dose response evaluation (six studies) suggested increasing odds for osteoporosis with increasing urine cadmium levels.

Conclusions

This review detected an association between cadmium exposure and the occurrence of osteoporosis in a small number of cross-sectional studies which requires confirmation in using prospective study design.     

Social and health related risk factors for low cardio respiratory fitness in German adolescents: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

Aim

A high cardio respiratory fitness level (CRF) has been shown to be associated with cardiovascular disease risk factors. It is the objective of these analyses to compare risk factors for low CRF between girls and boys and to investigate whether the impact of social inequality on CRF can fully be explained by the known risk factors for low CRF.

Subjects and methods

German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was a cross-sectional population representative study; the present analyses include 5,908 participants (11–17 years) in whom CRF was measured by a submaximal cycle ergometer test. The odds ratios (OR) from sex stratified, age-adjusted logistic regression models analysing the chance of low CRF were calculated and a multivariate logistic regression model was built.

Results

Multivariate models showed that low CRF was associated with high body fat (girls: OR 3.53; 95 % Confidence Interval (CI) 2.71-4.59; boys OR 6.69; 95 % CI 3.86–11.6), physical inactivity (girls: OR 3.09; 95 % CI 2.12–5.52; boys OR 4.25; 95 % CI 2.53–7.15) and extensive media use. Beyond these factors, adjusted analyses showed that low socio-economic status in boys and two-sided migration background in girls were associated with low CRF.

Conclusion

CRF in German youths shows social inequality and cultural and sex differences which cannot fully be explained by the known risk factors for low CRF. Cardiovascular prevention should consider social inequality and should involve measures against overweight, lack of physical activity and abundance of sedentary activities.     

Perceived physical exertion during healthcare work and risk of chronic pain in different body regions: prospective cohort study

Purpose

To estimate the risk of developing chronic musculoskeletal pain in different body regions from varying degrees of perceived physical exertion during healthcare work.

Methods

Prospective cohort study among 4,977 Danish female healthcare workers responding to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using multi-adjusted logistic regression analysis, the risk of developing chronic pain (>30 days last year) at follow-up in the low back, neck/shoulder, and knees—among those without pain (0 days last year) in these respective body regions at baseline—from moderate and strenuous (reference: light) perceived physical exertion during healthcare work was modeled.

Results

Adjusted for age, BMI, tenure, smoking status, and leisure physical activity, strenuous perceived physical exertion during healthcare work increased the risk of chronic low back pain (OR 3.16, 95 % CI 1.79–5.57) and chronic knee pain (OR 1.87, 95 % CI 1.19–2.94) at follow-up among those without pain in these respective body regions at baseline. With additional adjustment for psychosocial work conditions, only the risk of developing chronic low back pain from strenuous physical exertion remained significant (OR 1.99, 95 % CI 1.02–3.88). Strenuous physical exertion was not a risk factor for chronic neck pain, and moderate physical exertion was not a risk factor for chronic pain in any of the body regions.

Conclusion

Strenuous perceived physical exertion during healthcare work is a risk factor especially for developing chronic pain in the low back. The possible preventive effect of reducing strenuous physical exertion should be tested in randomized controlled trials.     

Glycemic index, glycemic load and endometrial cancer risk: results from the Australian National Endometrial Cancer study and an updated systematic review and meta-analysis

Purpose

The relationship between habitual consumption of foods with a high glycemic index (GI) and/or a diet with a high glycemic load (GL) and risk of endometrial cancer is uncertain, and relatively few studies have investigated these associations. The objectives of this study were to examine the association between GI/GL and risk of endometrial cancer using data from an Australian population-based case–control study and systematically review all the available evidence to quantify the magnitude of the association using meta-analysis.

Methods

The case–control study included 1,290 women aged 18–79 years with newly diagnosed, histologically confirmed endometrial cancer and 1,436 population controls. Controls were selected to match the expected Australian state of residence and age distribution (in 5-year bands) of cases. For the systematic review, relevant studies were identified by searching PubMed and Embase databases through to July 2011. Random-effects models were used to calculate the summary risk estimates, overall and dose–response.

Results

In our case–control study, we observed a modest positive association between high dietary GI (OR 1.43, 95 % CI 1.11–1.83) and risk of endometrial cancer, but no association with high dietary GL (OR 1.15, 95 % CI 0.90–1.48). For the meta-analysis, we collated information from six cohort and two case–control studies, involving a total of 5,569 cases. The pooled OR for the highest versus the lowest intake category of GI was 1.15 (0.95–1.40); however, there was significant heterogeneity (p 0.004) by study design (RR 1.00 [95 % CI 0.87–1.14] for cohort studies and 1.56 [95 % CI 1.21–2.02] for case–control studies). There was no association in the dose–response meta-analysis of GI (RR per 5 unit/day increment of GI 1.00, 95 % CI 0.97–1.03). GL was positively associated with endometrial cancer. The pooled RR for the highest versus the lowest GL intake was 1.21 (95 % CI 1.09–1.33) and 1.06 (95 % CI 1.01–1.11) per 50 unit/day increment of GL in the dose–response meta-analysis.

Conclusion

The pooled results from observational studies, including our case–control results, provide evidence of a modest positive association between high GL, but not GI, and endometrial cancer risk.     

Incidence rates of surgically treated rhegmatogenous retinal detachment among manual workers,non-manual workers and housewives in Tuscany,Italy

Purpose

Candidate risk factors for idiopathic rhegmatogenous retinal detachment (RRD) include heavy manual handling (requiring Valsalva’s maneuver). We assessed incidence rates of surgically treated idiopathic RRD among manual workers, non-manual workers and housewives resident in Tuscany, Italy.

Methods

We retrieved all hospital discharge records bearing a principal diagnosis corresponding to RRD coupled with retinal surgery for any resident of Tuscany during 1997–2009. After elimination of repeated admissions and patients with coexistent, associated conditions (including recent trauma), subjects aged 25–59 years were classified as manual workers, non-manual workers or housewives. Population data were extracted from the 2001 census.

Results

We identified 1,946 eligible cases (1,142 men). Among men, manual workers experienced a 1.8-fold higher age-standardized rate per 100,000 person-years than non-manual workers [17.4 (95 % confidence interval (CI) 16.1–18.7) vs. 9.8 (95 % CI 8.8–10.8)]. Age-standardized rates among women were 1.9-fold higher for manual workers [11.1 (95 % CI 9.8–12.3)] and 1.7-fold higher for housewives [9.5 (95 % CI 8.3–10.8)] than in non-manual workers [5.7 (95 % CI 4.8–6.6)].

Conclusions

This large population-based study suggests that manual workers are affected by idiopathic RRD requiring surgical treatment more often than non-manual workers. The higher rates of surgically treated RRD experienced by manual workers are in accord with the hypothesis that heavy manual handling may have a causal role.     

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.     

Coffee and caffeine intake and risk of endometriosis: a meta-analysis

Purpose

The potential association between endometriosis and coffee/caffeine consumption has been analysed in several epidemiological studies. In order to establish whether caffeine influences the risk of endometriosis, we provide to summarize the evidence from published studies on this issue.

Methods

We performed a meta-analysis of epidemiological studies published up to January 2013. We computed summary relative risks (RR) of endometriosis for any, high and low versus no coffee/caffeine consumption.

Results

We identified a total eight studies, six case–control and two cohort studies, including a total of 1,407 women with endometriosis. The summary RR for any versus non-consumption were 1.26 [95 % confidence interval (CI) 0.95–1.66] for caffeine and 1.13 (95 % CI 0.46–2.76) for coffee consumption; the overall estimate was 1.18 (95 % CI 0.92–1.49). The summary RR were 1.09 (95 % CI 0.84–1.42) and 1.09 (95 % CI 0.89–1.33) for high and low caffeine consumption as compared to no consumption, respectively.

Conclusion

The present meta-analysis provided no evidence for an association between coffee/caffeine consumption and the risk of endometriosis. Coffee/caffeine consumption, as currently used in diet, does not carry a health risk.     

The use of household cleaning products during pregnancy and lower respiratory tract infections and wheezing during early life

Objective

To evaluate the effects of household use of cleaning products during pregnancy on infant wheezing and lower respiratory tract infections (LRTI).

Methods

In four prospective Spanish birth cohorts (n = 2,292), pregnant women reported the use of household cleaning products. When infants were 12–18 months old, current cleaning product use and infant’s wheezing and LRTI were reported. Cohort-specific associations between the use of specific products and respiratory outcomes were evaluated using multivariable regression analyses and estimates were combined using random-effects meta-analyses.

Results

The period prevalence of LRTI was higher when sprays (combined odds ratio (OR) = 1.29; 95 % confidence interval (CI) 1.04–1.59) or air fresheners (OR = 1.29; CI 1.03–1.63) were used during pregnancy. The odds of wheezing increased with spray (OR = 1.37; CI 1.10–1.69) and solvent (OR = 1.30; CI 1.03–1.62) use. The associations between spray and air freshener use during pregnancy and both outcomes remained apparent when these products were not used after pregnancy. Nevertheless, the estimates were higher when post-natal exposure was included.

Conclusion

The use of cleaning sprays, air fresheners and solvents during pregnancy may increase the risk of wheezing and infections in the offspring.     

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.

     

Effect of using repeated measurements of a Mediterranean style diet on the strength of the association with cardiovascular disease during 12 years: the Doetinchem Cohort Study

Background

In cohort studies, often only one baseline measurement of dietary intake is available. This may underestimate the strength of the association with cardiovascular diseases (CVD).

Objective

The main objective is to compare the strength of the association of a Mediterranean style diet with CVD using one baseline measurement of diet versus three repeated measurements over a 10-year period.

Design

We used dietary and lifestyle data of three rounds of the Doetinchem Cohort Study. At baseline, 7,769 persons aged 20–65 years were examined. Diet was assessed with a 178 item validated food-frequency questionnaire and operationalized with the Mediterranean Diet Score (MDS) ranging from 0 to 9. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CI). Analyses were adjusted for age, sex, and repeated measurements of smoking, sports, total energy intake, and educational level.

Results

Comparing an MDS of ≥5.5–9 to an MDS of 0–<3.5, baseline MDS was associated with a 23 % lower risk [HR 0.77 (95 % CI 0.53–1.11)] and the updated mean with a 35 % lower risk [HR 0.65 (0.43–0.97)] of a composite of fatal CVD, nonfatal myocardial infarction, and stroke (composite CVD). For fatal CVD, baseline MDS was associated with a 13 % lower risk [HR 0.87 (0.36–2.07)] and the updated mean with a 56 % lower risk [HR 0.44 (0.19–1.05)].

Conclusion

The strength of the association between a Mediterranean style diet and CVD is likely underestimated because most studies so far used only one baseline measurement.     

Case–control study of knee osteoarthritis and lifestyle factors considering their interaction with physical workload

Aims

The aim of this study is to examine the dose–response relationships between age, “lifestyle factors” (body mass index, tobacco smoking, sports), and symptomatic knee osteoarthritis in a population-based case–control study. Additionally, the study aims to investigate the mode of interaction between body mass index (BMI) and physical workload (occupational kneeling/squatting and lifting/carrying of loads) with respect to the risk of symptomatic knee osteoarthritis.

Methods

In five orthopedic clinics and five practices, 295 male patients aged 25–70 with radiographically confirmed knee osteoarthritis associated with chronic complaints were recruited. The control group comprised 327 male control subjects. In a structured personal interview, body weight at different ages, body height, cumulative amount of smoking, and cumulative duration of different sports activities until the date of first diagnosis of knee osteoarthritis were elicited. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression analysis. An interaction analysis for the parameters BMI and kneeling/squatting respective lifting/carrying of loads was performed. Population attributable risks (PAR) for knee osteoarthritis were determined for BMI solely and for the combination of BMI with occupational kneeling/squatting and lifting/carrying of loads, respectively.

Results

Age and overweight were strongly associated with the diagnosis of knee osteoarthritis. Compared with persons less than 35 years old, persons who were at least 65 years old had an odds ratio (OR) of 19.0 (95% CI 6.1–58.7) for knee osteoarthritis. Persons with a BMI ≥ 28.41 kg/m² had a strongly elevated risk of knee osteoarthritis (OR 10.8; 95% CI 4.8–24.3) compared to persons with a BMI < 22.86 kg/m². Heavy tobacco smoking (≥55.5 pack years) was associated with a decreased knee osteoarthritis risk in comparison with never-smoking (OR 0.2; 95% CI 0.1–0.5). Ball games (handball, volleyball, basketball) and cycling were associated with symptomatic knee osteoarthritis (OR 4.0; 95% CI 1.8–8.9 and OR 3.7; 95% CI 1.7–7.8 in the highest category of cumulative duration, respectively); to a weaker degree jogging, swimming, and soccer also were positively related to symptomatic knee osteoarthritis. Combining the two parameters, BMI and kneeling/squatting into one variable led to a multiplicative interaction mode for symptomatic knee osteoarthritis. For persons with elevated BMI in combination with moderate to high exposure to occupational kneeling/squatting, the population attributable risk (PAR) was 4%. The PAR for elevated BMI in combination with moderate to high exposure to occupational lifting/carrying of loads was 7%.

Conclusions

In accordance with the literature, we find a strong association between BMI and knee osteoarthritis risk. Considering the relatively high prevalence of occupational manual materials handling, prevention of knee osteoarthritis should not only focus on body weight reduction, but should also take into account work organizational measures particularly aiming to reduce occupational lifting and carrying of loads.     

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.     

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.     

Physical inactivity of adults and 1-year health care expenditures in Brazil

Objectives

To analyze the association between physical inactivity in different domains and direct public healthcare expenditures in adults and to identify whether the clustering of physical inactivity in different domains would contribute to increased public healthcare.

Methods

The sample composed of 963 adults randomly selected in a middle-size Brazilian city. Annual healthcare expenditure was estimated including all items registered in the medical records in the last 12 months prior to the interview. Habitual physical activity was estimated using Baecke questionnaire, which considers three components of physical activity (work, sports and leisure-time activities).

Results

Higher healthcare expenditures of medicines were associated with lower physical activity at work (OR 1.58 [1.06–2.35]), sport (OR 1.57 [1.12–2.18]) and physical inactivity in three domains (OR 2.12 [1.18–3.78]). Expenditures related to medicine (r = 0.109 [95 % CI 0.046–0.171]) and overall expenditures (r = 0.092 [95 % CI 0.029–0.155]) were related to physical inactivity, independently of age, sex, smoking, blood pressure and obesity.

Conclusions

Physically inactive subjects in different domains of physical activity have increased likelihood to be inserted at groups of higher healthcare expenditure.

     

The effects of heat stress and its effect modifiers on stroke hospitalizations in Allegheny County,Pennsylvania

Purpose

Heat has been known to increase the risk of many health endpoints. However, few studies have examined its effects on stroke. The objective of this case-crossover study is to investigate the effects of high heat and its effect modifiers on the risk of stroke hospitalization in Allegheny County, Pennsylvania.

Methods

We obtained data on first stroke hospitalizations among adults ages 65 and older and daily meteorological information during warm seasons (May–September) from 1994 to 2000 in Allegheny County, Pennsylvania. Using conditional multiple logistic regressions, the effects of heat days (any day with a temperature greater than the 95th percentile) and heat wave days (at least two continuous heat days) on the risk of stroke hospitalization were investigated. The potential interactions between high heat and age, type of stroke, and gender were also examined.

Results

Heat day and heat wave at lag-2 day were significantly associated with an increased risk for stroke hospitalization (OR 1.121, 95 % CI 1.013–1.242; OR 1.173, 95 % CI 1.047–1.315, respectively) after adjusting for important covariates. In addition, having two or more heat wave days within the 4 day window prior to the event was also significantly associated with an increased risk (OR 1.119, 95 % CI 1.004, 1.246) compared to having no heat wave days during the period. The effect of high heat on stroke was more significant for ischemic stroke, men, and subjects ages 80 years or older.

Conclusions

Our study suggests that high heat may have adverse effects on stroke and that some subgroups may be particularly susceptible to heat.     

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.