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The use of ultraviolet germicidal irradiation (UVGI) to combat disease transmission has come into the international spotlight again because of the recent SARS-CoV-2 pandemic and ongoing outbreaks of multidrug resistant organisms in hospitals. Although the implementation of ultraviolet disinfection technology is widely employed in healthcare facilities and its effectiveness has been repeatedly demonstrated, the use of such technology in the commercial sector has been limited. Considering that most disease transmission occurs in commercial, public, and residential indoor environments as opposed to healthcare facilities, there is a need to understand whether ultraviolet (UV) disinfection technology can be effective for mitigating disease transmission in these environments. The results presented here demonstrate that the installation of fixed in-room UVGI air cleaners in commercial buildings, including restaurants and offices, can produce significant reductions in both airborne and surface-borne bacterial contamination. Total airborne reductions after UV implementation at six separate commercial sites averaged 73% (p < 0.0001) with a range of 71–88%. Total non-high touch surface reductions after implementation averaged 55% (p < 0.0001) with a range of 28–88%. All reductions at the mitigated sites were statistically significant. The mean value of indoor airborne bacteria was 320 CFU/m3 before intervention and 76 CFU/m3 after. The mean value of indoor non-high touch surface borne bacteria was 131 CFU/plate before intervention and 47 CFU/plate after. All test locations and controls had their required pandemic cleaning procedures in place for pre- and post-sampling events. Outdoor levels of airborne bacteria were monitored and there was no significant correlation between the levels of airborne bacteria in the outside air as opposed to the indoor air. Rooms with fixed in-room UVGI air cleaners installed had significant CFU reductions on local surface contamination, which is a novel and important finding. Installation of fixed in-room UVGI air cleaners in commercial buildings will decontaminate the indoor environment and reduce hazardous exposure to human pathogens. [ABSTRACT FROM AUTHOR]

The article reflects on the need for instilling an awareness of a holistic approach to safety and health programs in the professional safety workforce. It mentions that aim is to identify where occupational safety efforts could augment such holistic wellness efforts and to establish the boundaries for occupational safety and health professionals.

Purpose: Multimorbidity research typically focuses on chronic and common diseases in patient and/or older populations. We propose a multidimensional multimorbidity score (MDMS) which incorporates chronic conditions, symptoms, and health behaviors for use in younger, presumably healthier, working populations. Methods: Cross-sectional study of 372,370 Spanish workers who underwent a standardized medical evaluation in 2006. We computed a MDMS (range 0-100) based on the sex-specific results of a multicorrespondence analysis (MCA). We then used Cox regression models to assess the predictive validity of this MDMS on incident sickness absence (SA) episodes. Results: Two dimensions in the MCA explained about 80 % of the variability in both sexes: (1) chronic cardiovascular conditions and health behaviors, and (2) pain symptoms, in addition to sleep disturbances in women. More men than women had at least one condition (40 vs 15 %) and two or more (i.e., multimorbidity) (12 vs 2 %). The MDMS among those with multimorbidity ranged from 16.8 (SD 2.4) to 51.7 (SD 9.9) in men and 18.5 (SD 5.8) to 43.8 (SD 7.8) in women. We found that the greater the number of health conditions, the higher the risk of SA. A higher MDMS was also a risk factor for incident SA, even after adjusting for prior SA and other covariates. In women, this trend was less evident. Conclusions: A score incorporating chronic health conditions, behaviors, and symptoms provides a more holistic approach to multimorbidity and may be useful for defining health status in working populations and for predicting key occupational outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine the responsiveness of the Work Role Functioning Questionnaire (Spanish version) (WRFQ-SpV) so that it could be used in evaluative studies. Methods: A longitudinal survey was performed. Combinations of distribution- and anchor-based approaches were used. Five hypotheses were tested, examining validity of change scores. The consensus-based standards for the selection of health status measurement instruments (COSMIN) guided the study design. Results: One hundred two participants (mean age, 47.3 years; SD = 10.3 years) completed the WRFQ-SpV twice, within a mean interval of 3.7 (SD = 1.8) months. Four hypotheses were confirmed and one was rejected. It was verified that the WRFQ-SpV was able to detect (true) changes over time. Conclusion: Suggestive evidence about the possible use of the WRFQ-SpV with evaluative purposes was provided. More research is needed to examine the instrument responsiveness for groups whose health is stable or deteriorates. [ABSTRACT FROM AUTHOR]

The article discusses a study to evaluate the frequency and distribution of new secondary diagnoses during a sickness absence (SA) episode and their effect on duration of non-work related SA in Spain. The study found that the effect of an increasing number of codiagnoses on the duration of the SA episode was seen by a decreasing hazard ratio, and the effect was found to be greater in men. New conditions arising during an SA significantly prolong its duration.

This study was designed to conduct systematic reviews of existing evaporative cooling system maintenance guidelines and of published Legionnaires' disease outbreaks to determine what, if any, maintenance practices were in place at the time of the disease outbreaks and then to contrast the reported practices with the published guidelines for evaporative cooling systems. For the first review, similarities in the reported recommendations were assessed; in the second review, any reported information about the state of the evaporative cooling system during the outbreak investigation was summarized. The systematic reviews yielded 38 current guidelines for evaporative cooling systems and 38 published outbreak investigations. The guidelines varied regarding the recommended type and dose of biocides, frequency of general inspections and total system maintenance, the preferred disinfection and cleaning procedures when testing a system for microbiological contamination, the type and frequency of testing procedures, and interpretation of test results. Overall, the maintenance guidelines did not contain sufficiently detailed procedures to prevent the problems that were observed in the outbreak investigations. These maintenance procedures included lack or improper use of a biocide; infrequent testing for microbiological contamination; improper use or maintenance of drift eliminators; and lack of a total system cleaning within 6 months of the outbreak for cooling systems that were either under continuous use, recently started up, or frequently switched on and off. This study suggests that more specific and standardized maintenance guidelines for the control of Legionella bacteria are needed and that these guidelines must be properly implemented to help reduce further Legionnaires' disease outbreaks associated with evaporative cooling systems. [ABSTRACT FROM AUTHOR]

Causal inferences are a vital and intrinsic part of assessing the risk of adverse effects on human populations and ecological resources from biological, chemical, physical, and psychosocial stressors. While it is well known that a statistical association does not necessarily imply a causal association, the central role of causal theory in health and ecological risk assessment is often overlooked. In this article, we present a succinct account of causal theory in the health sciences, emphasize the importance of differentiating between formal and informal approaches to causal inference, describe the weight-of-evidence process that is currently the predominant means of inferring causality in the context of science-based regulatory decisions, and discuss the effects of causal theory on the current and future practice of risk assessment. Our aim is to highlight the significance of decisions about causation and causal inference, and to suggest that explicit, well-considered choices will serve to strengthen the scientific underpinnings of regulatory decision-making. [ABSTRACT FROM AUTHOR]

The association between exposure to selected chemical carcinogens, occupations or industries and bladder cancer is well established, and it is estimated that 20-27% of bladder cancers are attributable to occupational exposures. The risk of bladder cancer stemming from an occupational exposure depends not only on compound carcinogenicity, exposure intensity and workplace characteristics, but also on individual susceptibility to these cancers. Regulatory controls in industrialized nations have resulted in a decreased burden of exposure to bladder carcinogens in the workplace. Unfortunately, the same is unlikely in many developing countries, where risky technologies may have been transferred from more developed countries, and where enforcement of regulations and worker protection are likely to be less stringent. [ABSTRACT FROM AUTHOR]

The association between exposure to selected chemical carcinogens, occupations or industries and bladder cancer is well established, and it is estimated that 20--27% of bladder cancers are attributable to occupational exposures. The risk of bladder cancer stemming from an occupational exposure depends not only on compound carcinogenicity, exposure intensity and workplace characteristics, but also on individual susceptibility to these cancers. Regulatory controls in industrialized nations have resulted in a decreased burden of exposure to bladder carcinogens in the workplace. Unfortunately, the same is unlikely in many developing countries, where risky technologies may have been transferred from more developed countries, and where enforcement of regulations and worker protection are likely to be less stringent. [ABSTRACT FROM AUTHOR]

The association between exposure to selected chemical carcinogens, occupations or industries and bladder cancer is well established, and it is estimated that 20–27% of bladder cancers are attributable to occupational exposures. The risk of bladder cancer stemming from an occupational exposure depends not only on compound carcinogenicity, exposure intensity and workplace characteristics, but also on individual susceptibility to these cancers. Regulatory controls in industrialized nations have resulted in a decreased burden of exposure to bladder carcinogens in the workplace. Unfortunately, the same is unlikely in many developing countries, where risky technologies may have been transferred from more developed countries, and where enforcement of regulations and worker protection are likely to be less stringent. [ABSTRACT FROM PUBLISHER]

Background and objectives: CRP is elevated in several inflammatory diseases; however, little is known about its association with asthma. Methods: The study evaluated the associations between CRP, asthma and asthma symptoms using data on 8020 adults ≥20 years of age from the latest US National Health and Nutrition Examination Survey. Results: The prevalence estimates of current asthma, wheezing and nocturnal cough were 3.6% (95% CI: 2.9–4.4), 14.7% (95% CI: 13.7–15.8) and 4.6% (95% CI: 3.8–5.3), respectively. Geometric mean of CRP was 0.20 mg/dL (95% CI: 0.19–0.21). The majority of female (69.5%) respondents were in the fourth (highest) quartile of CRP. Mean CRP levels were significantly higher in non-Hispanic blacks as compared with non-Hispanic whites. The adjusted odds of current asthma and past asthma (as compared with no asthma) were 1.60 (95% CI: 1.02–2.53) and 1.43 (95% CI: 1.07–1.91), respectively, greater in the fourth quartile of CRP. The adjusted odds of presence of both wheezing and nocturnal cough were 2.18 and 3.40 in the third and fourth quartile of CRP, respectively. Conclusions: This study shows that adults with asthma and asthma symptoms have higher levels of CRP. The potential use of CRP as a clinically useful marker for asthma severity and control should be further explored. [ABSTRACT FROM AUTHOR]

The authors evaluated determinants of response to Internet-based surveys in a sample (n = 5600) of Texas healthcare professionals. Participants were given the option of responding by mail or over the Web (response, 66%). Internet respondents were younger (p < .001), had worked fewer years in healthcare (p < .001), and were more likely to be male (p < .001) and to work in a hospital (p = .007). Missing questionnaire items were significantly higher among Web responders with regard to age, sex, race, body mass index, and smoking (p < .001). In the final multivariate logistic regression, only male gender (odds ratio [OR] = 2.09, 95% CI = 1.56-2.80) and younger age remained significantly associated with response over the Internet. Age quartile and responding electronically were inversely associated. Taken together with a priori knowledge of the demographic and professional profile of a study population, these findings can be useful in planning and implementation of surveys among healthcare workers. [ABSTRACT FROM AUTHOR]

Approximately 1800 workers in pipe manufacturing plants in the United States may have been exposed to β-napthlyamnine between 1970 and 1996. Once the chemical was detected, the contaminated additive in the resin was identified and discontinued. A bladder cancer-screening program was initiated in 1999. An annual two-stage screening program was developed to test for microscopic hematuria (stage one) and cytology (stage two), with a urology referral of positive or suspicious cytology. This paper presents the program methodology, cohort enumeration, recruitment, and enrollment strategies, and screening protocol. Enrollment data from the first 3 years are presented. Annual screening of a cohort of current and former employees is feasible. Original personnel records are often incomplete, making cohort identification important. Personal contact and follow-up are key elements of successful recruitment and retention. [ABSTRACT FROM AUTHOR]

This study characterized and assessed self-reported levels of compliance with universal precautions (UP) among hospital-based physicians, and determined significant factors associated with both compliance and noncompliance. The physicians (n = 322) were a subgroup of a larger study population of hospital-based health care workers recruited from three geographically distinct locations (n = 1746), and were surveyed using a detailed confidential questionnaire that assessed personal, work-related, and organizational factors. Compliance with UP was measured through 11 items that examined how often physicians followed specific recommended work practices. Compliance was found to vary among the 11 items: they were high for certain activities (eg, glove use, 94%; disposal of sharps, 92%) and low for others (eg, wearing protective clothing, 55%; not recapping needles, 56%). Compliance with all items was low (31% to 38%). Stepwise logistic regression revealed that noncompliant physicians were likely to be age 37 or older, to report high work stress, and to perceive a conflict of interest between providing patient care and protecting themselves. Compliant physicians were more likely to be knowledgeable and to have been trained in universal precautions, to perceive protective measures as being effective, and to perceive an organizational commitment to safety. [ABSTRACT FROM AUTHOR]

Evaluates self-reported levels of compliance with universal precautions among hospital-based physicians in the United States and determines significant factors associated with compliance and noncompliance. Participants of the study; Questionnaire development and study variables; Statistical analysis; Difference of universal precautions from other isolation techniques.

The article reports that workplace safety and health are affected by new employment arrangements, intensification of work organization demands, climate change and technological advancements. It informs that the U.S. It mentions that the implementation of Total Worker Health (TWH) policies in the workplace requires considerable interprofessional collaboration in the workplace.

Investigating asthma as an effect modifier between adverse birth outcomes and neurodevelopmental disabilities (NDDs) across different races is crucial for tailored interventions and understanding variable susceptibility among diverse populations. Data were collected through the National Survey of Children's Health. This cross-sectional study included 131,774 children aged 0 to 17 years. Study exposures comprised adverse birth outcomes including preterm birth and low birth weight. Weighted prevalence estimates and odds ratios with 95% confidence intervals (CIs) among children with and without adverse birth outcomes were calculated for NDDs including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, and several others including behavior problems. Adjusted odds ratios were stratified by asthma status and separate interactions were assessed for each outcome. Of 131,774 participants, 10,227 were born low birth weight (9.12%; 95% CI: 8.77% to 9.49%), 14,058 were born preterm (11.35%; 95% CI: 10.94% to 11.76%), and 16,166 participants had asthma (11.97%; 95% CI: 11.58% to 12.37%). There were 68,100 males (51.11%), 63,674 females (48.89%), 102,061 non-Hispanic Whites (NHW) (66.92%), 8,672 non-Hispanic Blacks (NHB) (13.97%), and 21,041 participants (19.11%) categorized as other. NHB children with adverse birth outcomes had higher prevalence of several NDDs compared to NHW children. Asthma was not shown to be an effect modifier of the association between adverse birth outcomes and NDDs. Nevertheless, these results suggest that NDDs are more prevalent within US children with adverse birth outcomes, with higher rates among NHB compared to NHW children. These findings support screening for NDDs in pediatric health care settings among patients with adverse birth outcomes, particularly among those from ethnic minority backgrounds. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence, types. and risk fuctors of musculoskeletal injuries in a military security forces population. Methods: Demographic and diagnostic data were retrieved on enlisted US Air Force security forces personnel who served on active duty between January 2009 and December 2018. Incidence rates and ratios were calculated using Poisson regression. Results: During 251.787 person-years of exposure, 62,489 personnel served on active duty. Of these, 40,771 (65.2%) were diagnosed with at least one musculoskeletal injury. The majority (60.1%) of the 164,078 unique musculoskeletal in.juries were inflammation and pain secondary to overuse. After adjusting for other factors. women had a 31% higher injury rate than men. and those who were overweight and obese had 15% and 30% higher rates, respectively, than normal-weight peers. Conclusions: Modifiable and non-modifiable factors contribute to musculoskeletal injuries in the security forces career field. [ABSTRACT FROM AUTHOR]

Objectives. To analyze changes in occupational health inequity between 2011 and 2018 among workers in Central America. Methods. Data were collected by face-to-face interviews at the workers' homes for the 2 Central America Working Conditions Surveys (n = 12 024 in 2011 and n = 9030 in 2018). We estimated health inequity gaps by means of absolute and relative population attributable risks and the weighted Keppel index. We stratified all analyses by gender. Results. Between 2011 and 2018, the proportion of workers reporting poor self-perceived health decreased both in women (from 32% to 29%) and men (from 33% to 30%). However, the health inequity gaps remained wide in the 4 stratifiers. Measured by the Keppel index, health inequity gaps between countries increased from 22% to 39% in women and from 20% to 29% in men. Conclusions. While health improved between 2011 and 2018, health inequity gaps remained wide. Wider health inequity gaps were observed between countries than by gender, age, occupation, or education. Public Health Implications. This first benchmark of occupational health inequities in Central America could be useful when developing and evaluating the impact of public policies on work. [ABSTRACT FROM AUTHOR]

Background: Oropharyngeal cancers associated with high-risk human papillomavirus (HR-HPV) infection are increasing in the United States, especially among men. We evaluated the prevalence and predictors of concurrent (genital and oral) and concordant (same-type) HR-HPV infections in the United States.Methods: We used the National Health and Nutrition Examination Survey from 2009 to 2016. Predictors were assessed via multivariable logistic regression.Results: Among 10 334 respondents, 172 (2.1%) had concurrent infections (109 [3.5%] men and 63 [0.76%] women]. Ninety-three (1.0%) had concordant infections (54 [1.6%] men and 39 [0.5%] women). Predictors of concurrence in men included the following: no longer married versus married (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3-4.9), living with a partner versus married (3.0; 1.2-7.5), and having 2-5 lifetime oral sex partners (3.0; 1.2-7.5). In women they included the following: no longer married versus married (3.6; 1.3-10.3), ≥2 recent sex partners (4.6; 1.4-15.6 for 2-5 partners and 3.9; 1.1-14.3 for ≥6 partners), and marijuana use (2.2; 1.0-4.5). The predictor of concordance in men and women was no longer married versus married (3.5; 1.2-9.9 in men and 3.2; 1.1-9.4 in women).Conclusions: Concurrent and concordant HR-HPV infections occur at a high rate, especially among men, and are associated with behavioral factors. This underscores the importance of HPV vaccination, screening, and education in men. [ABSTRACT FROM AUTHOR]

The occupational hazards and respiratory symptoms of domestic cleaners in USA are largely unknown. We conducted a cross-sectional study among 56 Hispanic female domestic cleaner on their health status and frequency of cleaning products used and tasks performed. While women used multi-use products (60.0%) and toilet bowl cleaners (51.8%) most days of the week, many (39.3%) reported not using personal protective equipment while cleaning. Itchy/watery eyes (61.8%) and itchy nose (56.4%) were the most frequently reported symptoms. A history of physician-diagnosed asthma was reported by 14.3% while 33.9% had symptoms of bronchial hyperresponsiveness (BHR). In conclusion, this vulnerable population has high prevalence of physician-diagnosis asthma and BHR symptoms and is potentially exposed to myriad occupational hazards. Further research exploring associations between products use, cleaning tasks and respiratory symptoms is warranted. [ABSTRACT FROM AUTHOR]

The article presents a study which was cross-sectional, with patient safety culture (PSC) and employee safety culture (ESC) measurement tools being administered concurrently. Topics discussed include information on role of ESC and PSC in developing interventions and allocating resources to target each type of culture; use of the ESC and PSC measure of one type of safety culture as a surrogate for the other; and use of follow-up communication strategy.

Objective: Health care workers are at risk for work-related asthma, which may be affected by changes in cleaning practices. We examined associations of cleaning tasks and products with work-related asthma in health care workers in 2016, comparing them with prior results from 2003. Methods: We estimated asthma prevalence by professional group and explored associations of self-reported asthma with job-exposure matrix-based cleaning tasks/products in a representative Texas sample of 9914 physicians, nurses, respiratory/occupational therapists, and nurse aides. Results: Response rate was 34.8% (n = 2421). The weighted prevalence rates of physician-diagnosed (15.3%), work-exacerbated (4.1%), and new-onset asthma (6.7%) and bronchial hyperresponsiveness symptoms (31.1 %) were similar to 2003. New-onset asthma was associated with building surface cleaning (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.10-3.33), use of ortho-phthalaldehyde (OR, 1.77; 95% CI, 1.15-2.72), bleach/quaternary compounds (OR, 1.91; 95% CI, 1.10-3.33), and sprays (OR, 1.97; 95% CI, 1.12-3.47). Conclusion: Prevalence of asthma/bronchial hyperresponsiveness seems unchanged, whereas associations of new-onset asthma with exposures to surface cleaning remained, and decreased for instrument cleaning. [ABSTRACT FROM AUTHOR]

Focuses on flexible employment and health inequalities. Influence of trade unions on progressive labour market regulatory policymaking in European Union countries; Demand made by European employers for a supply of a full time workforce which will allow them to compete in a global market characterised by continuous technical and organisational change; Argument that flexible employment has become a necessary condition to increase productivity in global environment.

Purpose: Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies.Methods: In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work.Results and Conclusions: Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices. [ABSTRACT FROM AUTHOR]

Employment has transitioned from stable to more flexible schemes. Little is known about the effects of dynamic working lives and mortality. We examined the association of employment, unemployment and inactivity on mortality among workers born in 1926–1988, in a nested case-control study of workers from the Spanish WORKss cohort. Cases were all deaths that occurred during 2004–2013 and controls were living persons, matched for sex and age at the time the case occurred. We had information on employment from 1981 to 2013. Logistic regression was used to measure the associations between the 3 employment history indicators separately by sex. There were 53,989 cases and an equal number of controls (n = 107,978). More than 16 years employed showed a protective effect against mortality in women (OR = 0.88, 95%CI: 0.81, 0.94) and men (OR = 0.76, 95%CI: 0.70, 0.79). The number of spells and time in unemployment and inactivity were significantly related to mortality in men, but not women. Sensitivity analyses by labor relationship showed stronger associations of unemployment (OR = 1.42, 95%CI: 1.13, 1.78) and inactivity (OR = 1.34; 95%CI: 1.09, 1.65) for temporary workers. Employment gaps are detrimental to health and have worse effects if the gaps occur without unemployment benefits or after temporary contracts. These results may drive improvement of labor and social policies that protect workers against the potential negative effects of dynamic work lives. [ABSTRACT FROM AUTHOR]

BACKGROUND: We have recently shown that biomarker levels of selected metals are higher in Asians than in other U.S. ethnic groups, with important differences within selected Asian subgroups. Much of this difference may be dietary in origin; however, this is not well established. OBJECTIVE: We evaluated dietary intake of toxic metals as a source of increased biomarker levels of metals among U.S. Asians. METHODS: We estimated daily food consumption and dietary intake of arsenic, cadmium, lead, and mercury by combining 24-hr dietary intake recall data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES) with data from the USDA Food Composition Intake Database and FDA Total Dietary Study. We analyzed associations between dietary metal intake and biomarker levels of the metals using linear regression. Further, estimated food consumption and metal intake levels were compared between Asians and other racial/ethnic groups (white, black, Mexican American, and other Hispanic) and within three Asian subgroups (Chinese, Indian Asian, and other Asians). RESULTS: Significant associations (p < 0.05) were found between biomarker levels and estimated dietary metal intake for total and inorganic arsenic and mercury among Asians. Asians had the highest daily fish and rice consumption across the racial/ethnic groups. Fish was the major contributor to dietary mercury and total arsenic intake, whereas rice was the major contributor to inorganic arsenic dietary intake. Fish consumption across the Asian subgroups varied, with Asian Indians having lower fish consumption than the other Asian subgroups. Rice consumption was similar across the Asian subgroups. CONCLUSIONS: We confirmed that estimated dietary intake of arsenic (total and inorganic) and mercury is significantly associated with their corresponding biomarkers in U.S. Asians, using nationally representative data. In contrast, estimated dietary intake of cadmium and lead were not significantly associated with their corresponding biomarker levels in U.S. Asians. CITATION: Awata H, Linder S, Mitchell LE, Delclos GL. 2017. Association of dietary intake and biomarker levels of arsenic, cadmium, lead, and mercury among Asian populations in the United States: NHANES 2011-2012. Environ Health Perspect 125:314-323; http://dx.doi. org/10.1289/EHP28 [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Centers for Disease Control and Prevention (CDC) recently found that Asians have considerably higher biomarker levels of cadmium, lead, mercury, and arsenic than whites, blacks, Mexican Americans, and other Hispanics in the United States. OBJECTIVE: Our goal was to further evaluate the higher metal biomarker levels among Asians. METHODS: Biomarker data (blood cadmium, blood lead, blood mercury, urinary total arsenic, and urinary dimethylarsinic acic) from individuals ≥ 6 years of age were obtained from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). We compared geometric mean levels of these five metal biomarkers in Asians with those of four other NHANES race/ethnic groups (white, black, Mexican American, and other Hispanic), and across three Asian subgroups (Chinese, Asian Indian, and other Asian). We also evaluated associations between biomarker levels and sociodemographic, physical, dietary, and behavioral covariates across the Asian subgroups. RESULTS: Asians had significantly higher levels of all five metal biomarkers than other race/ethnic groups (p < 0.05), regardless of sociodemographic, physical, dietary, behavioral, or geographic characteristics. We also found variations in biomarker levels across the Asian subgroups. In general, Asian Indians had lower levels than the other two Asian subgroups, except for blood lead. The following characteristics were found to be significant predictors of several biomarker levels: sex, age, education, birthplace, smoking, and fish consumption. CONCLUSIONS: Overall, the Asian group had the highest geometric mean biomarker levels for all of the five metal variables. Furthermore, we provided evidence that significant variations in the biomarker levels are present across the Asian subgroups in the United States. CITATION: Awata H, Linder S, Mitchell LE, Delclos GL. 2017. Biomarker levels of toxic metals among Asian populations in the United States: NHANES 2011-2012. Environ Health Perspect 125:306-313; http://dx.doi.org/10.1289/EHP27 [ABSTRACT FROM AUTHOR]

We aim to examine the impact of corticosteroids use on ADHD among children with asthma by administration routes. A population-based, cross-sectional analysis included pediatric patients ages 5–20 years old from the 2016 and 2019 Kids Inpatient Database (unweighted N = 111,702). ICD-10-CM codes were used to identify corticosteroids use, asthma, and ADHD cases. Survey logistic regression models with purposeful variable selection algorithms were built to examine the association between corticosteroids use, and ADHD by asthma severity and age. An inverse probability weighting (IPW) approach was used to help further control residual confounding, Among children aged 5–11 years old, the odds of ADHD were significantly higher in children with moderate to severe asthma who used inhaled corticosteroids than nonusers (moderate asthma: adjusted odds ratios [aOR] 1.46, 95% confidence interval [CI] 1.14–2.44; severe asthma: aOR 1.61, 95% CI 1.18–2.21). Although oral corticosteroid use was not independently associated with ADHD in young children, combined use of inhaled and oral corticosteroid had almost 5 times higher odds of use among ADHD in children with severe asthma vs. nonusers (aOR 4.85, 95% CI 2.07 − 11.35). No associations were found between any corticosteroid use and ADHD among asthmatic children aged 12–20 years. In this retrospective analysis, we found inhaled corticosteroids were positively associated with ADHD in younger children with moderate to severe asthma, but not in older children. [ABSTRACT FROM AUTHOR]

Background: Certifying physicians play a key role in the management of sickness absence and are often provided with guidelines. Some of these guidelines contain statements on expected sickness absence duration, according to diagnosis. We were interested in exploring the evidence base of these statements. Methods: We identified guidelines through a survey of EUMASS members and a literature search of the Internet and PubMed. We extracted the statements and methods from the guidelines. We compared: diagnoses that were addressed, expected durations and development processes followed. Next, we presented our findings to the developers, to afford them an opportunity to comment and/or correct any misinterpretations. Results: We identified 4 guidelines from social insurance institutions (France, Serbia, Spain and Sweden) and 4 guidelines from private organisations (1 Netherlands, 3 US). Guidelines addressed between 63 and some 63000 health conditions (ICD 10 codes). Health conditions overlapped among guidelines. Direct comparison is hampered by differences in coding (ICD 9 or 10) and level of aggregation (three or four digit, clustering of diseases and treatment situations). Expectations about duration are defined as minimum, maximum, and optimum or mean or median and percentile distribution, stratified to age and work requirements. In a sample of 5 diagnoses we found overlap in expected duration but also differences. Guidelines are developed differently, pragmatic expert consensus being used most, supplemented with data on sickness absence from different registers, other guidelines and non-systematic literature reviews. The effectiveness of these guidelines has not yet been formally evaluated. Conclusions: Expectations about duration of sickness absence by diagnosis are expressed in several guidelines. The expectations are difficult to compare, their evidence base is unclear and their effectiveness needs to be established. [ABSTRACT FROM AUTHOR]

Few extensive, national clinical databases exist on the health of migrant and seasonal farmworkers (MSFWs). Electronic health records (EHRs) are increasingly utilized by Federally Qualified Health Centers (FQHCs) and have the potential to improve clinical care and complement current surveillance and epidemiologic studies of underserved working populations, such as MSFWs. The aim of this feasibility study was to describe the demographics and baseline clinical indicators of patients at an FQHC by MSFW status. The authors described 2012 patient demographics, social history, medical indicators, and diagnoses by MSFW status from the de-identified EHR database of a large, multisite Colorado Migrant Health Center (MHC). Included in the study were 41,817 patients from 2012: 553 (1.3%) MSFWs, 20,665 (49.4%) non-MSFWs, and 20,599 (49.3%) who had no information in the MSFW field. MSFWs were more often male, married, employed, Hispanic, and Spanish-speaking compared with non-MSFWs. The most frequent diagnoses for all patients were hypertension, overweight/obesity, lipid disorder, type 2 diabetes, or a back disorder. Although there were significant missing values, this feasibility study was able to analyze medical data in a timely manner and show that Meaningful Use requirements can improve the usability of EHR data for epidemiologic research of MSFWs and other patients at FQHCs. The results of this study were consistent with current literature available for MSFWs. By reaching this vulnerable working population, EHRs may be a key data source for occupational injury and illness surveillance and research. [ABSTRACT FROM AUTHOR]

Animal care and use personnel in research laboratory facilities are inherently exposed to a variety of workplace hazards. The health and safety of the workforce working directly with or around research animals is of paramount importance, and as such, an occupational health and safety program for at-risk staff is essential. In order to maximize participation in and the effectiveness of health and safety training and occupational health program enrollment for animal care and use personnel at an academic health sciences university, an innovative annual “health fair” was developed and implemented at The University of Texas Health Science Center at Houston. This event allows personnel working in positions that present exposure risk to research animals to be able to obtain hazard-specific health and safety training, re-enroll in the occupational health oversight program and update their medical history, and participate in the institution’s other safety programs as required by job title or assigned job tasks. By providing a comprehensive health fair that offers convenient access to the necessary safety training and occupational health services in one location during a designated period of time, management and staff are incentivized to participate and have reported satisfaction with and appreciation of the convenient access. Summarized here is how we plan, organize, and effectively execute the annual health fair so that other institutions who might wish to use this strategy can learn from our approach. [ABSTRACT FROM AUTHOR]

Aims To examine changes in the use of alcohol, cannabis and hypnotics/sedatives between two periods (before and during Spain's economic crisis), and to identify differences in the change between employed and unemployed individuals. Design Using cross-sectional data from four editions of the Spanish Household Survey on Alcohol and Drugs, we selected economically active individuals aged 16-64 years (total sample = 62 440) and defined two periods, pre-crisis [period 1 (P1) = 2005-07] and crisis (P2 = 2009-11). Poisson regression models with robust variance were fitted to obtain prevalence ratios (PR) of heavy and binge drinking and multinomial regression models to obtain relative risk ratios (RRR) of cannabis and hypnotic/sedative use between the two periods, also considering the interaction between period and employment status. Findings While the prevalence of alcohol use remained stable, heavy drinking declined in P2 in men both overall [PR = 0.73; 95% confidence interval (CI) = 0.67-0.79] and in the two age groups (16-34 and 35-64 years), and also in women overall (PR = 0.86; 95% CI = 0.75-0.99) and in the older age group. In contrast, binge drinking increased overall in P2 in men (PR = 1.17; 95% CI = 1.12-1.22) and in women (PR = 1.62; 95% CI = 1.49-1.76), and in both age groups. No differences in the change were observed between employed and unemployed individuals. Overall cannabis use remained stable in P2, but unemployed men and women of the older age group were more likely to have increased sporadic use compared to their employed counterparts (RRR = 2.24; 95% CI = 1.36-3.68 and RRR = 3.21; 95% CI = 1.30-7.93, respectively). Hypnotic/sedative use remained stable in P2 in men, but unemployed men were less likely to have increased heavy use in P2 compared with employed men (RRR = 0.69; 95% CI = 0.49-0.97). In women, heavy use increased in P2 overall and in the older age group, irrespective of employment status. Conclusion During a period of economic recession in Spain, heavy drinking decreased and binge drinking increased. Sporadic cannabis use increased among older unemployed men and women. Heavy use of hypnotics/sedatives increased among employed men while older women increased use irrespective of employment status. [ABSTRACT FROM AUTHOR]

Background: Areca nut (AN) is an addictive substance consumed in the Southeast region and is highly associated with oral premalignant lesions and oral cancer. The impact of AN use in the United States (US) is largely unknown, but the products are readily available and probably used by a significant fraction of Asian immigrants or descendants living in the US. We aimed at assessing AN use prevalence among the Asian community in Houston, Texas.Methods: A cross-sectional questionnaire was used to interview adult individuals (≥ 18 years of age) who self-identified as Asian immigrants or descendants residing in Houston. Means, frequencies, and proportions were reported. Factors associated with AN use were evaluated using logistic regression.Results: We surveyed 275 individuals (58% women, 43% between 35-54 years old, 67% born outside of the US, and 6% concurrent smokers). Among respondents, 91% were familiar with AN products, 17% self-reported ever use of AN products in the US, and 31% had friends/family members who were AN ever users. AN use was significantly associated with being Indian Subcontinent immigrants or descendants (ISID) (OR = 3·9; CI: 1·10,13·81; p = 0·035) and having friends/family members using AN products (OR = 6·2; CI: 1·69, 22·69; p = 0·006).Conclusions: Our findings provide quantitative data on the prevalence of AN ever use and context for future AN prevention and cessation interventions specific to the Southeast Asian groups living in the US mainland. This is crucial for the prevention and control of oral cancer and other detrimental conditions related to AN consumption. [ABSTRACT FROM AUTHOR]

United States (US) youth consume an average of 10 teaspoons of added sugar from sugar-sweetened beverages (SSB) on any given day. Few population-based studies have examined the association between SSB consumption and asthma in children and adolescents. This study aimed to examine the association between SSB consumption and asthma in the US pediatric population. Analytical cross-sectional study. A total of 9,938 children aged 2-to-17 years old who participated in the 2011-2016 National Health and Nutrition Examination Surveys. SSB consumption was categorized into 3 groups based on the caloric intake from 24-hour food recall data as follows: 1) no consumption (0 kcal/day); 2) moderate consumption (1-499 kcal/day); and 3) heavy consumption (≥ 500 kcal/day). The primary outcome of interest was self-reported current asthma condition. Asthma prevalence estimates were significantly higher in heavy (16.4%) and moderate (11.0%) SSB consumers versus non-consumers (7.5%) (p < 0.05 for both comparisons). The adjusted odds of asthma were twice that among children with heavy SSB consumption (aOR 2.01, 95% confidence interval [CI] 1.31-3.08) versus non-SSB consumers. The odds of asthma were higher among those who consumed fruit drinks (aOR 2.51, 95% CI 1.55-4.08), non-diet soft drinks (aOR 1.89, 95% CI 1.23-2.89) and sweet tea (aOR 1.87, 95% CI 1.13-3.09) compared to nondrinkers. The effect was independent of obesity status (p-interaction = 0.439). Findings here suggest a dose-response relationship between SSB intake and asthma diagnosis, therefore controlling SSB consumption may potentially improve pulmonary health risk in the US pediatric population. [ABSTRACT FROM AUTHOR]

While the epidemiologic literature suggests certain maternal occupational exposures may be associated with reduced measures of size at birth, the occupational literature employing fetal biometry data to assess fetal growth is sparse. The present study examines associations between maternal occupational exposures and ultrasound-measured fetal growth. We included 1,739 singleton pregnancies from the INfancia y Medio Ambiente (INMA) project (2003-2008). At 32 weeks of pregnancy, interviewers ascertained mothers' employment status and assessed job-related physical loads, work schedules, and job strain during pregnancy. Job titles were linked to a job-exposure matrix to estimate exposure to 10 endocrine disrupting chemical (EDC) groups. We calculated z-scores from longitudinal growth curves representing trajectories from 0-12, 12-20 and 20-34 gestational weeks for abdominal circumference (AC), biparietal diameter (BPD), femur length (FL), and estimated fetal weight (EFW). Linear mixed models clustered by IMNA region (i.e., Gipuzkoa, Sabadell, Valencia) were used to examine associations between occupational exposures and fetal growth. Effect estimates are presented as percentage change in fetal growth. There was limited evidence of associations between work-related non-chemical stressors and fetal growth. We observed associations of similar magnitude between multiple EDC groups and decreased EFW trajectories during 20-34 gestational weeks (phthalates: -1.4% [-3.5, 0.6%]; alkylphenolic compounds (APCs): -1.1% [-2.3, 0.1%]; miscellaneous chemicals: -1.5% [-3.7, 0.8%]), while miscellaneous chemicals were associated with increased BPD from 12-20 weeks (2.1% [0.8, 3.5%]). Notably, 67% of women exposed to phthalates were hairdressers; 68% of women exposed to APCs worked as domestic cleaners. In conclusion, we found limited evidence that maternal occupational exposures impact fetal growth. Further research should consider the combined impact of multiple workplace exposures. [ABSTRACT FROM AUTHOR]

Background: Sickness absence (SA) is an important social, economic and public health issue. Identifying and understanding the determinants, whether biological, regulatory or, health services-related, of variability in SA duration is essential for better management of SA. The conditional frailty model (CFM) is useful when repeated SA events occur within the same individual, as it allows simultaneous analysis of event dependence and heterogeneity due to unknown, unmeasured, or unmeasurable factors. However, its use may encounter computational limitations when applied to very large data sets, as may frequently occur in the analysis of SA duration. Methods: To overcome the computational issue, we propose a Poisson-based conditional frailty model (CFPM) for repeated SA events that accounts for both event dependence and heterogeneity. To demonstrate the usefulness of the model proposed in the SA duration context, we used data from all non-work-related SA episodes that occurred in Catalonia (Spain) in 2007, initiated by either a diagnosis of neoplasm or mental and behavioral disorders. Results: As expected, the CFPM results were very similar to those of the CFM for both diagnosis groups. The CPU time for the CFPM was substantially shorter than the CFM. Conclusions: The CFPM is an suitable alternative to the CFM in survival analysis with recurrent events, especially with large databases. [ABSTRACT FROM AUTHOR]

The phosphoinositide-3 kinase (PI3K)–AKT– mammalian target of rapamycin (mTOR) pathway is an important cellular pathway controlling cell growth, tumorigenesis, cell invasion and drug response. We hypothesized that genetic variations in the PI3K–AKT–mTOR pathway may affect the survival in muscle invasive and metastatic bladder cancer (MiM-BC) patients. We conducted a follow-up study of 319 MiM-BC patients to systematically evaluate 289 single-nucleotide polymorphisms (SNPs) of 20 genes in the PI3K–AKT–mTOR pathway as predicators of survival. In multivariate Cox regression, AKT2 rs3730050, PIK3R1 rs10515074 and RAPTOR rs9906827 were significantly associated with survival. In combined analysis, we found a cumulative effect of these three SNPs on survival. With the increasing number of unfavorable genotypes, there was a significant trend of higher risk of death in multivariate Cox regression (P for trend <0.001) and shorter median survival time in Kaplan–Meier estimates (P log rank <0.001). This is the first study to evaluate the role of germ line genetic variations in the PI3K–AKT–mTOR pathway genes as predictors of MiM-BC clinical outcomes. These findings warrant further replication in independent populations and may provide information on disease management and development of target therapies. [ABSTRACT FROM PUBLISHER]

Abstract: The Osnabruck model, and another under development by the South Carolina Sustainable Universities Initiative, are the only two EMS models that have been proposed specifically for colleges and universities, although several guides are now available. The Environmental Management System Implementation Model for U.S. Colleges and Universities detailed in this paper, an adaptation of the ISO 14001 standard and USEPA recommendations, has been tailored to U.S. colleges and universities for use in streamlining the implementation process. In using this three-phased implementation model created for the U.S. research and academic setting, it is hoped that these highly specialized institutions will be provided with a clearer and more cost-effective path towards the implementation of an EMS and greater compliance with local, state and federal environmental legislation. [Copyright &y& Elsevier]

Abstract: A census of 925 U.S. colleges and universities offering masters and doctorate degrees was conducted in order to study the number of elements of an environmental management system possessed by small, medium and large institutions. A 30% response rate was received with 273 responses included in the final data analysis. Overall, the number of environmental management system elements implemented among the 273 institutions ranged from 0 to 16, with a median of 12. The proportion of U.S. colleges and universities that reported having implemented a structured, comprehensive environmental management system is discussed. Stratified analyses were performed by institution size, Carnegie Classification and job title. [Copyright &y& Elsevier]

Background: The U.S. population is aging and is expected to double by the year 2030. The current study evaluated the prevalence of asthma and its correlates in the elderly Hispanic and non-Hispanic white population. Methods: Data from a sample of 3021 Hispanics and non-Hispanic White subjects, 65 years and older, interviewed as part of an ongoing cross-sectional study of the elderly in west Texas, were analyzed. The outcome variable was categorized into: no asthma (reference category), current asthma, and probable asthma. Polytomous logistic regression analysis was used to assess the relationship between the outcome variable and various socio-demographic measures, self-rated health, asthma symptoms, quality of life measures (SF-12), and various occupations. Results: The estimated prevalence of current asthma and probable asthma were 6.3% (95%CI: 5.3-7.2) and 9.0% (95%CI: 7.8-10.1) respectively. The majority of subjects with current asthma (Mean SF-12 score 35.8, 95%CI: 34.2-37.4) or probable asthma (35.3, 34.0-36.6) had significantly worse physical health-related quality of life as compared to subjects without asthma (42.6, 42.1-43.1). In multiple logistic regression analyses, women had a 1.64 times greater odds of current asthma (95%CI: 1.12-2.38) as compared to men. Hay fever was a strong predictor of both current and probable asthma. The odds of current asthma were 1.78 times (95%CI: 1.24-2.55) greater among past smokers; whereas the odds of probable asthma were 2.73 times (95%CI: 1.77-4.21) greater among current smokers as compared to nonsmokers. Similarly fair/poor self rated health and complaints of severe pain were independently associated with current and probable asthma. The odds of current and probable asthma were almost two fold greater for obesity. When stratified by gender, the odds were significantly greater among females (p-value for interaction term = 0.038). The odds of current asthma were significantly greater for farm-related occupations (adjusted OR = 2.09, 95%CI: 1.00-4.39); whereas the odds were significantly lower among those who reported teaching as their longest held occupation (adjusted OR = 0.36, 95%CI = 0.18-0.74). Conclusion: This study found that asthma is a common medical condition in the elderly and it significantly impacts quality of life and general health status. Results support adopting an integrated approach in identifying and controlling asthma in this population. [ABSTRACT FROM AUTHOR]

Cleaners have an elevated risk for the development or exacerbation of asthma and other respiratory conditions, possibly due to exposure to cleaning products containing volatile organic compounds (VOCs) leading to inflammation and oxidative stress. This pilot study aimed to quantify total personal exposure to VOCs and to assess biomarkers of inflammation and pulmonary oxidative stress in 15 predominantly Hispanic women working as domestic cleaners in San Antonio, Texas, between November 2019 and July 2020. In partnership with a community organization, Domésticas Unidas, recruited women were invited to attend a training session where they were provided 3M 3500 passive organic vapor monitors (badges) and began a 72-hr sampling period during which they were instructed to wear one badge during the entire period ("AT," for All the Time), a second badge only while they were inside their home ("INS," for INSide), and a third badge only when they were outside their home ("OUT," for OUTside). At the end of the sampling period, women returned the badges and provided blood and exhaled breath condensate (EBC) samples. From the badges, 30 individual VOCs were measured and summed to inform total VOC (TVOC) concentrations, as well as concentrations of the following VOC groups: aromatic hydrocarbons, alkanes, halogenated hydrocarbons, and terpenes. From the blood and EBC samples, concentrations of serum C-reactive protein (CRP) and EBC 8-isoprostane (8-ISP) and pH were quantified. Data analyses included descriptive statistics. The 72-hr average of personal exposure to TVOC was 34.4 ppb and ranged from 9.2 to 219.5 ppb. The most prevalent class of VOC exposures for most women (66.7%) was terpenes, specifically d-limonene. Overall, most women also experienced higher TVOC concentrations while outside their home (86.7%) as compared to inside their home. Serum CRP concentrations ranged from 0.3 to 20.3 mg/dL; 8-ISP concentrations ranged from 9.5 to 44.1 pg/mL; and EBC pH ranged from 7.1 to 8.6. Overall, this pilot study demonstrated personal VOC exposure among Hispanic domestic cleaners, particularly to d-limonene, which may result from the use of scented cleaning products. [ABSTRACT FROM AUTHOR]

In vitro and in vivo studies have shown that carotenoid supplementation is associated with decreased DNA damage, but the role of dietary carotenoids in cancer risk remains controversial because epidemiologic studies have yielded conflicting results. Limited data exist regarding the role of dietary carotenoids in the context of constitutional genetic instability in cancer risk. This case-control study estimated dietary carotenoid intake [microg/(kJ . d)] from a FFQ for 423 patients with bladder cancer and 467 healthy controls, and quantified baseline and benzo[a]pyrene diol epoxide (BPDE)- and gamma-radiation-induced DNA damage in the peripheral blood lymphocytes using the comet assay. Overall, intake of total carotenoids was lower (P < 0.01) for bladder cancer cases (mean +/- SD: 1273.4 +/- 688.9) compared with healthy controls (1501.3 +/- 791.5). When categorized into quartiles, there was an inverse association between increasing levels of carotenoid intake and bladder cancer risk with greatest protective effect [odds ratio (OR) = 0.56, 95% CI, 0.37-0.85] in the quartile with the highest level of intake. Baseline and mutagen-induced DNA damage was significantly higher in cases than in controls; when analyzed jointly with carotenoid intake, high DNA damage and low carotenoid intake were associated with the highest risk. For example, with high baseline DNA damage and low total carotenoid intake, the OR was 3.08 (95% CI, 1.64-5.77); with high baseline DNA damage and high total carotenoid intake, the risk was somewhat attenuated (OR = 2.49, 95% CI, 1.28-4.84). The risk was decreased further for low baseline DNA damage and low total carotenoid intake (OR = 2.18; 95% CI, 1.13-4.22). This study provides evidence of a preventive role for carotenoids in bladder cancer, and these data may have important implications for cancer prevention, especially for individuals susceptible to DNA damage. [ABSTRACT FROM AUTHOR]

It would be useful for researchers, practitioners, and decision-makers to anticipate the hazards that workers will face in the future. The focus of this study is a systematic review of published information to identify and characterize scenarios and hazards in the future of work. Eleven bibliographic databases were systematically searched for papers and reports published from 1999 to 2019 that described future of work scenarios or identified future work-related hazards. To compile a comprehensive collection of views of the future, supplemental and ad hoc searches were also performed. After screening all search records against a set of predetermined criteria, the review yielded 36 references (17 peer-reviewed, 4 gray, and 15 supplemental) containing scenarios. In these, the future of work was described along multiple conceptual axes (e.g. labor market changes, societal values, and manual versus cognitive work). Technology was identified as the primary driver of the future of work in most scenarios, and there were divergent views in the literature as to whether technology will create more or fewer jobs than it displaces. Workforce demographics, globalization, climate change, economic conditions, and urbanization were also mentioned as influential factors. Other important themes included human enhancement, social isolation, loneliness, worker monitoring, advanced manufacturing, hazardous exposures, sustainability, biotechnology, and synthetic biology. Pandemics have not been widely considered in the future of work literature, but the recent COVID-19 pandemic illustrates that was short-sighted. Pandemics may accelerate future of work trends and merit critical consideration in scenario development. Many scenarios described 'new' or 'exacerbated' psychosocial hazards of work, whereas comparatively fewer discussed physical, chemical, or biological hazards. Various preventive recommendations were identified. In particular, reducing stress associated with precarious work and its requirements of continual skill preparation and training was acknowledged as critical for protecting and promoting the health and well-being of the future workforce. In conclusion, the future of work will be comprised of diverse complex scenarios and a mosaic of old and new hazards. These findings may serve as the basis for considering how to shape the future of work. [ABSTRACT FROM AUTHOR]

Some occupations potentially entailing exposure to cadmium, arsenic, lead, selenium, nickel, and chromium have been associated with an increased risk of exocrine pancreatic cancer (EPC), but no studies have assessed whether body concentrations of such compounds differed among subjects occupationally exposed and unexposed. No studies which found that exposure to such metals increased the risk of EPC assessed whether past occupations were the source of exposure. The aim was to analyse the relationship between toenail concentrations of trace elements and occupational history in EPC patients. The study included 114 EPC cases personally interviewed on occupational history and lifestyle factors. Occupations were coded according to the International Standard Classification of Occupations 1988. Selected occupational exposures were assessed by two industrial hygienists and with the Finnish job-exposure matrix (Finjem). Concentrations of 12 trace elements were determined in toenail samples by inductively coupled plasma mass spectrometry. Adjusted geometric means (aGMs) and 95% confidence intervals (95% CI) were calculated. Patients occupationally exposed to aromatic hydrocarbon solvents (AHs) had higher concentrations of cadmium, manganese, lead, iron and vanadium. The aGM of cadmium concentrations for cases exposed to any pesticide was 0.056 μg/g [95% CI: 0.029–0.108], and, for unexposed cases, 0.023 μg/g [0.017–0.031]. Patients occupationally exposed to pesticides had higher concentrations of cadmium and manganese. Higher concentrations of vanadium, lead and arsenic were related to exposure to formaldehyde. Vanadium and lead were also associated with exposure to chlorinated hydrocarbon solvents, and arsenic was related to exposure to polycyclic aromatic hydrocarbons (PAHs). Patients occupationally exposed to AHs, pesticides, chlorinated hydrocarbon solvents, formaldehyde, volatile sulphur compounds and PAHs had higher concentrations of several metals. These elements may account for some of the occupational risks previously reported for pancreatic cancer. • Concentrations of cadmium and manganese were higher in patients with pancreatic cancer exposed to pesticides • Cadmium, manganese, lead, iron and vanadium were higher in patients with pancreatic cancer exposed to aromatic hydrocarbons • Vanadium and lead were higher in patients exposed to chlorinated hydrocarbon solvents and to formaldehyde • Arsenic was higher in patients exposed to formaldehyde and to polycyclic aromatic hydrocarbons • Trace elements may explain some occupational risks previously observed for pancreatic cancer [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Cross-Cultural Adaptation and Health Questionnaires Validation: Revision and Methodological Recommendations" in a 2013 issue is presented.

A letter to the editor is presented in response to the article "Association between exposure to secondhand smoke and sleep bruxism in children: a randomised control study," by L. Montaldo and colleagues in 2012 issue.

A letter to the editor and the author's response to the article "Assessing Maintenance of Evaporative Cooling Systems in Legionellosis Outbreaks," which discusses legionellosis as an environmental and occupational health hazard, published in the previous issue of the journal is presented.