Lung transplantation (LT) is emerging as a critical final treatment for end-stage lung diseases including pneumoconiosis. Outcomes of single lung transplantation (SLT) and double lung transplantation (DLT) in pneumoconiosis remain understudied. This study evaluates clinical differences between the two procedures in pneumoconiosis patients to guide therapeutic decision-making for this occupational population. This retrospective cohort study included 119 pneumoconiosis patients undergoing LT at The Affiliated Wuxi People’s Hospital of Nanjing Medical University between Jan 2018 and Dec 2022. The choice of SLT versus DLT was primarily driven by clinical judgment of high surgical risk, primarily due to severe pleural adhesions or calcification deemed too risky for bilateral pneumonectomy. Data on demographics, intraoperative and postoperative characteristics and patient survival were collected to compare SLT and DLT outcomes using Mann-Whitney U test and Pearson’s chi-square test. The primary outcome was 1-year posttransplant survival. Posttransplant survival was assessed by Kaplan-Meier analysis and Cox proportional hazards models. Of all the transplant recipients, 61 (51.3
The COVID-19 pandemic required healthcare workers (HCWs) to use personal protective equipment (PPE) for prolonged periods, raising concerns about its possible relationship with musculoskeletal disorders (MSDs). PPE-related discomfort, however, is multidimensional, encompassing both direct wearing burden and organisational aspects of its deployment. How these two dimensions relate to MSDs has rarely been examined. This cross-sectional study analysed 565 Korean physicians, nurses and medical technicians who had directly cared for patients with COVID-19. A 17-item PPE Discomfort Scale was developed and its factor structure was examined using exploratory factor analysis with oblique rotation. As an exploratory objective, cross-sectional associations between PPE-related discomfort and MSDs were examined using hierarchical modified Poisson regression, adjusting sequentially for demographic, occupational, ergonomic and psychosocial covariates. Exploratory factor analysis yielded two factors; direct wearing burden (Factor 1) and organisational vulnerability (Factor 2). The prevalence of MSDs was 37.2
Abstract Background Seafarers are exposed to unique occupational stressors that place sustained demands on the autonomic nervous system. Heart rate variability (HRV) represents a promising non-invasive tool for assessing mental and physical strain in maritime settings. However, its methodological application in real field conditions remains poorly characterized, and existing HRV guidelines do not specifically address the methodological challenges of maritime field studies. Methods A scoping review was conducted following PRISMA guidelines. Eleven maritime field studies measuring HRV in operational or semi-operational settings were included and assessed for device selection, measurement quality, analysis methods, HRV metrics, and covariates. Results Chest strap systems were the most frequently used ( n = 8) and showed sufficient validity for field use. Methodological heterogeneity in reporting of recording duration, analysis software, artifact handling and HRV parameters was high across studies. Operational factors including sailing schedule and work-rest organization were the most commonly examined covariates and were most frequently associated with significant HRV findings. Recurring findings were small and predominantly male populations, shared participant cohorts across multiple studies, and incomplete methodological reporting. Conclusion Overall, the studies utilized HRV appropriately for their respective aims. HRV measurement in maritime field settings is feasible but methodologically demanding, and it remains an underexplored domain, which limits the conclusions that can be drawn. More detailed and standardized reporting is necessary. Based on the recurring methodological reporting gaps, this review proposes a maritime-specific reporting checklist and an overview of recommended methodological options for future studies. Larger study populations are needed to account for confounding factors on board ships.
Abstract Background Migrant live-in caregivers play an important role in home-based long-term care, yet their working and living conditions remain largely underregulated. Despite increasing evidence of precarious employment and health risks among live-in caregivers internationally, little is known about their occupational health risks and access to occupational health care. Methods This qualitative interview study is part of the project Live-In Health and reports findings from 16 semi-structured interviews with Polish live-in caregivers (15 females and one male) working in German private households. Interviews were conducted in Polish, transcribed, translated into German, and analyzed using qualitative content analysis following an inductive-deductive approach. Identified work-related strains and risks were structured in four main domains according to established occupational risk assessment frameworks from the German care sector. Results Participants reported extensive occupational health risks across the four main domains: physical strain (e.g., musculoskeletal strain from patient transfers), psychological strain (e.g., social isolation, conflicts with agencies, emotional burden), occupational safety and health including working hours (e.g., long working hours, insufficient recovery time, lack of preparation and insurance coverage), and exposure to biological and hazardous substances (e.g., wound care, unhygienic living conditions). Access to occupational and general health care in Germany was largely absent. Preventive services, occupational medical examinations, and accident insurance coverage were inconsistently available or missing altogether. Live-ins described substantial barriers related to legal ambiguity, agency practices, lack of information, and unclear responsibilities. At the same time, informal support from families, ambulatory care services, and peer networks emerged as partial coping resources. Conclusions Polish live-in caregivers in Germany are exposed to considerable occupational health risks while remaining largely excluded from occupational health care structures. The findings highlight substantial gaps in the implementation of existing occupational safety and health regulations for caregivers in private households. Strengthening occupational health protection for live-in caregivers requires enforceable working time regulations, reliable insurance coverage, accessible occupational health services, and clearer oversight of intermediary agencies. Tailored, low-threshold occupational health approaches are urgently needed to address the structural vulnerabilities of this workforce and to ensure healthy and sustainable care provision for the growing demand in home-based care for older people in Germany.
Agricultural workers in Tanzania face substantial occupational health risks associated with pesticide exposure, yet national biomonitoring data remain limited. Organophosphate and carbamate pesticides inhibit acetylcholinesterase (AChE), an established biomarker of pesticide exposure and early biological effect. This study evaluated erythrocyte AChE inhibition among agricultural workers across multiple farming systems and geographic regions in Tanzania. A cross-sectional study was conducted between January 2020 and December 2025 within the framework of occupational safety assessments coordinated by the Tanzania Plant Health and Pesticides Authority (TPHPA). A total of 1,387 agricultural workers from Arusha, Kilimanjaro, Morogoro, Mbeya/Songwe, and Coastal regions were recruited using multistage stratified sampling. Participants were classified as pesticide-exposed workers if they directly handled pesticides during agricultural activities and as apparently unexposed workers if they had no direct occupational pesticide handling responsibilities. Erythrocyte AChE activity was measured using the Test-mate ChE Cholinesterase Test System (Model 400). Statistical analyses included independent-samples t-tests, one-way and two-way analysis of variance (ANOVA), mixed-effects regression models, Pearson correlation analyses, and Tukey’s Honest Significant Difference post-hoc tests. Pesticide-exposed workers had significantly lower AChE levels compared with apparently unexposed workers (21.52 ± 2.41 vs. 28.47 ± 6.93 U/g Hb; mean difference = 6.95 U/g Hb; 95
The purpose of this pilot study was to evaluate simultaneous exposure to hand-arm vibration (HAV) and heat among grounds maintenance workers. Ten groundskeepers employed at a southern US institution were recruited. Individual workers’ exposure to HAV and heat was monitored during their regular work shift for three days. HAV exposure was measured using tri-axial vibration dosimeters worn on both hands of the participants to obtain daily vibration exposure (A(8)) and vibration total value (ahv) for each power tool used. Daily HAV exposure dose was determined using ahv for all tools used and corresponding tool operation duration. Lifetime cumulative HAV exposure dose (ahv−lifetime) was determined based on ahv for all tools used and exposure history obtained from a questionnaire. Personal heat exposure was evaluated using a wearable device to collect estimated core body temperature (CBT). Environmental heat metrics, including heat index (HI) and wet bulb globe temperature (WBGT), were determined using a WBGT monitor. Environmental parameters, including ambient temperature, relative humidity, and solar radiation, were also measured using a portable weather station. Mean A(8) values of the ten individual workers ranged from 0.8 to 3.3 m/s2 for the right hand and 0.7 to 2.9 m/s2 for the left hand. Tool-specific mean ahv ranged from 2.3 to 4.8 m/s2 for the right hand and 2.6 to 6.2 m/s2 for the left hand. The daily HAV exposure dose ranged from 6.2 to 23.7 m/s2 for the right hand and from 4.6 to 23.4 m/s2 for the left hand. The ahv−lifetime range was 1,128.5 to 172,333.0 and 1,102.4 to 161,462.6 h∙m/s2 for the right and left hands, respectively. The daily mean of estimated CBT of the individual workers ranged from 36.7 to 39.1 °C. The daily mean HI and WBGT values were from 20.7 to 48.9 °C and from 17.5 to 37.5 °C, respectively. The average ambient temperature, relative humidity, and solar radiation were 30.3 ± 4.1 °C, 59.9 ± 14.5
Emerging infectious disease threats may reactivate concerns about employment instability and economic disruption, particularly in regions marked by labor informality, social inequality, and limited social protection. Although the effects of COVID-19 on employment have been widely documented, less is known about how workers perceive the potential labor consequences of future health emergencies. This study aimed to assess perceived labor-related repercussions of a potential new pandemic among workers in Latin America. An analytical cross-sectional study was conducted using secondary data from an online survey administered to workers from more than ten Latin American countries between June and July 2022, during the early phase of the 2022 mpox outbreak. Participants were asked about the expected impact of a potential new pandemic on their employment, salary, and overall work situation. Associations between perceived labor-related repercussions and sociodemographic and occupational factors were evaluated using Poisson generalized linear models with a log link and robust variance, adjusted for country of residence. Among 850 surveyed workers, 64.2
This explorative study investigated the associations between working hours, biological aging, and all-cause and cardiovascular disease (CVD) mortality, and assessed the potential mediating role of lifestyle factors. We utilized data from the Older Finnish Twin Cohort, which comprised 9246 participants who had reported their weekly working hours in 1990. Biological aging was assessed using blood-based epigenetic aging measures in a subsample (n = 740). We used a counterfactual mediation approach. Lifestyle-related factors, including leisure-time physical activity (LTPA), alcohol consumption, body mass index (BMI), smoking, and sleep, were considered potential mediators. Between-within twin models were used to evaluate the extent to which shared familial factors confounded the observed associations. During the mean 28-year follow-up period, 20.5
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death after cardiovascular disease and stroke. A 2019 American Thoracic Society (ATS) statement estimated that 13–15
Workers who handle hazardous substances are at risk of health impairments, occupational diseases and even premature death. Occupational diseases are preventable, but early detection, diagnosis and intervention remain inadequate. Therefore, we aim to gain insight into the determinants of timely identification of health effects caused by exposure to hazardous substances in the workplace as perceived by occupational health professionals. We conducted seventeen online semi-structured interviews among Dutch occupational hygienists and occupational physicians on their perspectives and experiences in identifying chemical-related health effects in the workplace. The interviews were transcribed verbatim and the data were analysed using the Capability, Opportunity, Motivation-Behaviour (COM-B) model. Occupational hygienists and occupational physicians experience limited knowledge, skills, and self-efficacy for timely identification of chemical-related health effects. These modifiable determinants hinder effective collaboration between these occupational health professionals in translating exposure to hazardous substances into health effects and vice versa. Moreover, different system-level determinants in the Netherlands further impede this collaboration. Existing tools for occupational health professionals reinforce this gap by supporting either exposure assessment or health effect evaluation, rarely bridging the two. As a result, current tools are often tailored to a single professional group. The results from our study suggest that gaps in knowledge, skills and self-efficacy hinder timely identification of chemical-related health effects in the Netherlands. The findings of this study can inform the development of multidisciplinary interventions and multifaceted strategies aimed at improving prevention of chemical-related occupational disease and timely implementation of appropriate (workplace) measures.
Occupational environments with dust, noise, and high vocal demands can adversely impact voice production. Iron and steel workers encounter several environmental risk factors that may impair vocal function, nevertheless, objective acoustic and self-reported voice outcomes in this population have not been thoroughly investigated. This study aimed to evaluate the acoustic and self-reported voice characteristics of iron and steel manufacturing workers and compare these findings with those of a normophonic control group. This cross-sectional comparative research comprised 128 male participants: 64 steel and iron factory workers and 64 normophonic controls. Voice evaluation consisted of F0, jitter, shimmer, noise-to-harmonics ratio, smoothed cepstral peak prominence, Acoustic Voice Quality Index, maximum phonation time, Voice Handicap Index-10 and Voice-Related Quality of Life. Mann-Whitney U tests or Welch’s t-tests were used for between-group comparisons, as appropriate. Iron and steel workers had significantly lower F0 and smoothed cepstral peak prominence values and higher jitter, shimmer, noise-to-harmonics ratio, and Acoustic Voice Quality Index scores than controls (all p < 0.01). The maximum phonation time was significantly shorter in workers (p < 0.001). The mean Voice Handicap Index-10 score among workers exceeded the Turkish threshold, and the Voice-Related Quality of Life scores were significantly lower than those of controls (p < 0.001). Iron and steel industry workers had lower acoustic and self-reported markers of voice quality than normophonic individuals. These findings indicate that exposure to industrial noise and airborne irritants may be associated with subclinical changes in voice characteristics. In occupational health, a comprehensive voice assessment can serve as a time-saving, non-invasive screening tool to support early diagnosis and prevention of work-related voice problems.
Manganese (Mn) is an essential heavy metal, required for the normal development of many organ systems and is crucial to brain growth and development. At high exposure concentrations, Mn is a neurotoxicant. Mn exposure has been associated with motor, behavioral and cognitive impairment. Few studies have assessed the association between Mn exposure and cognitive function using NHANES data. This study re-explored the association between blood manganese concentrations and cognitive function through a re-analysis of NHANES 2011–2014 data using a larger combined sample and composite cognitive z-score methodology. A representative survey of the US population (60–80 years of age) completed objective cognitive function assessments and metal biomonitoring (n = 2,439). We created a composite cognitive z-score by using the average of the standardized scores of the six cognitive tests (three trials of CERAD Word List Learning Test, CERAD delayed recall, Animal fluency test and DSST) and compared to adjusted blood Mn. Linear regression was performed by constructing three models (univariate model, a model with all covariates and a model with only significant covariates). Confounding by gender, age, race/ethnicity, education level, total number of people in the family, smoking history and income (family monthly poverty level category) are included in the models. Median Mn was 8.71 µg/L with an IQR of 6.94–11.16. There was a statistically significant association between quartiles of blood Mn and composite z-score, only in the univariate model. However, in linear regression analyses, adjusting for potential confounders, blood Mn as a continuous variable was not statistically associated with the composite cognitive z-score (µg/L, β = 0.0038, 95
Previous systematic reviews have adopted binary exposure classifications without characterizing the heterogeneity of welding fume exposures. We aimed to estimate lung cancer risk from welding fumes with systematic exposure characterization by process type, base material, and metal fume component, and to examine evidence for related high-temperature processes. We searched PubMed, Embase, and Web of Science through July 2025 for cohort, case-control and other epidemiological studies. Exposure information was systematically extracted from full-text descriptions and classified by welding process, base material, and metal fume component. Separate random-effects meta-analyses were performed for comparative risk and standardized ratio estimates. Of 86 studies meeting inclusion criteria, 58 were included in quantitative synthesis after excluding 12 overlapping cohorts and 16 high-risk-of-bias studies; 39 comparative risk and 22 standardized ratio studies were analyzed. The pooled relative risk was 1.51 (95
Despite ongoing TB control efforts, health workers (HWs) in Thailand remain at risk for latent tuberculosis infection (LTBI), yet the burden of LTBI in Thai HWs is insufficiently characterized. This study aimed to determine LTBI proportions across preplacement, post-exposure, and annual screening approaches, and to identify factors associated with LTBI among HWs. This retrospective analysis (2016–2022) utilized secondary data from an LTBI surveillance program at a large Thai tertiary hospital. HWs underwent LTBI screening with interferon-gamma release assays (IGRAs) through three surveillance approaches: preplacement, post-exposure, and annual screening in high-risk units (2021–2022). LTBI was defined as IGRA-positive in the absence of active TB. Demographic and exposure characteristics were recorded; associations were analyzed using chi-square and Mann–Whitney U tests. An exploratory restricted analysis using multivariable logistic regression was also performed to assess between-cohort patterns. Between 2016 and 2020, LTBI was detected in 198 of 1,823 HWs (10.9
The informal economy encompasses all economic activities carried out by workers or economic units that are not adequately covered by formal legal or regulatory frameworks. National data from India indicate that 53.7
Abstract Background The newly developed GENESIS-UV metric is based on occupational UV exposure measurements in about 1,000 outdoor-workers (covering 250 different occupational settings). The GENESIS-UV metric calculates occupational exposure values for the standard erythema dose (SED) that differ substantially from those produced by the “Wittlich metric” which applies multiple correction factors to a fixed SED reference value of 300 SED per year. This Wittlich metric has served as the basis for calculating occupational UV exposure of occupational disease No. 5103 (“squamous cell carcinoma or multiple actinic keratoses caused by natural UV radiation”) in Germany since 2015. In a large case-control study (“FB181”, 632 cases and 632 individually matched control subjects), a positive dose-response relationship between UV exposure estimated using the “Wittlich metric” and squamous cell carcinoma (SCC) of the skin could be derived. This study aimed to investigate whether the increased SCC risk for high occupational UV exposure found in the FB181 study can be reflected with the new GENESIS-UV metric. Methods Based on propensity-score matched data from the FB181 study, odds ratios (OR) with 95% confidence intervals (CI) for categorized occupational UV exposure were calculated using conditional logistic regression analysis. The analyses were adjusted for age, sex, skin phototype, and non-occupational UV exposure. To examine the suitability of the GENESIS-UV metric, exposure was calculated using both the Wittlich metric and the GENESIS-UV metric. The goodness of fit was assessed using the Akaike information criterion (AIC). Results When applying the Wittlich metric, individuals with high cumulative occupational UV exposure (≥ 90th percentile) show a statistically significant increase in OR of 1.95 (95% CI 1.19–3.18). When applying the GENESIS-UV metric, the corresponding OR for reaching or exceeding the 90th percentile is 2.23 (95% CI 1.36–3.65). The goodness of fit of the GENESIS-UV metric is substantially better than that of the Wittlich metric (AIC of 748.0 versus 758.6). Conclusions Applying the newly developed GENESIS-UV metric, we were able to confirm the positive dose-response relationship between occupational UV exposure and squamous cell carcinoma of the skin in this sensitivity analysis of the FB181 case-control study. The GENESIS-UV metric proves to be suitable for determining occupational UV exposure.
Climate-related hazards are intensifying worldwide, posing escalating risks to not only agricultural productivity but also mental health. Farmers in low- and middle-income countries are particularly vulnerable, yet the psychological impacts of climate disasters on these populations remain underexplored. This study aimed to examine the associations between climate-related hazard exposure and mental health outcomes among farmers in southern Thailand, a region heavily affected by climate disasters, including floods, droughts, and storms. A community-based cross-sectional survey was conducted among 346 farmers in four districts of Chumphon and Surat Thani Provinces, classified as high- or low-climate hazard exposure areas, via five-year disaster records. Data on sociodemographic and behavioral characteristics, climate experiences, and coping strategies were collected via structured questionnaires. Mental health outcomes were assessed via the validated Thai version of the Depression, Anxiety, and Stress Scales (DASS-21). Multivariable logistic regression was applied to estimate adjusted odds ratios (aORs) to assess the associations between climate hazard exposure and adverse mental health outcomes. Depression was significantly more prevalent among farmers in high-exposure areas (49.7
Pest control workers may be exposed to zoonotic pathogens during their work, yet data on the prevalence of zoonotic infections in this occupational group in Germany is scarce. This study investigated the seroprevalence of antibodies against four pathogens commonly transmitted by rodents and pigeons among pest control workers in Germany. Blood samples of participants were analysed for antibodies against hantavirus, Leptospira, lymphocytic choriomeningitis virus (LCM virus) and Chlamydia psittaci. Additional data was collected using a questionnaire. Among the 154 participants, five were seropositive for hantavirus (3.2
Falls from heights are a leading cause of occupational injury and death globally, with construction workers disproportionately affected. In South Africa, employers must ensure that workers performing fall-risk tasks are certified as fit to work at heights, yet regulations provide little guidance on how such assessments should be conducted. Within a broader two-phase research project undertaken by the authors, Phase 1 comprised a scoping review that identified limited peer-reviewed evidence and a lack of standardised frameworks for assessing fitness for work at heights, followed by a qualitative study that found inconsistent, predominantly medicalised assessment practices that inadequately reflect job-specific risks and demands. In response, a draft interdisciplinary consensus statement was developed. This study reports Phase 2, a structured expert consensus process undertaken to systematically revise and consolidate the draft consensus statement. A virtual Modified Nominal Group Technique was conducted with six experts from occupational medicine, occupational health nursing, occupational therapy, and construction health and safety. Participants reviewed the draft consensus statement prior to a facilitated online discussion, followed by an anonymous post-session rating survey. Quantitative ratings were analysed using medians and interquartile ranges against predefined consensus criteria, while qualitative data from transcripts, field notes, and participant annotations were analysed using directed qualitative content analysis. Consensus was achieved on 20 of 27 items, indicating strong support for the draft statement’s overall structure and intent. Items not reaching consensus mainly concerned definitional clarity, occupational risk-exposure profiling, and follow-up procedures. Revisions focused on clarifying terminology; strengthening guidance on occupational risk exposure and worker–job specification; recognising behavioural and psychosocial factors alongside physical, cognitive, and environmental considerations; and introducing the concept of a competent, registered and authorised person. This study presents an interdisciplinary consensus statement, developed through expert consensus, providing a principles- and process-based framework for assessing fitness for work at heights. It promotes consistent, transparent, job-specific, risk-based fitness assessments beyond generic medical certification. Future efforts should focus on translating this framework into practical tools and evaluating its feasibility across various construction settings.
