Indoor solid fuels, outdoor air pollution (PM1, PM2.5, and PM10), and heatwave are all modifiable environmental factors. However, their mixed effects on Cardiometabolic Multimorbidity (CMM) and its core component diseases (diabetes, heart disease, and stroke) remain unclear. In this study, four diseases analysis cohorts (CMM: n = 10,273; diabetes: n = 9,893; heart disease: n = 9,536; and stroke: n = 10,466) were constructed using data from the five waves (2011, 2013, 2015, 2018, and 2020) of the CHARLS. A time-varying Cox proportional hazards model was used to estimate the hazard ratio (HR) for environmental factor exposure. The Cumulative Risk Index (CRI) and the Quantile g-computation (Qgcomp) model were employed to assess the cumulative effect and component weights of coexposure to multiple environmental factors. The single-exposure analysis indicated that indoor solid fuels use significantly increased heart disease (HR = 1.118, 95
This work evaluates the scientific foundation and practical applicability of the Health Guidance Caution Zone (HGCZ) defined in the ISO 2631–1 standard for assessing health risks from whole-body vibration. The primary objective is to investigate the HGCZ’s derivation process, its underlying data sources, and its effectiveness in predicting adverse health outcomes across various occupational environments. This study examines the relationship between vibration metrics—such as frequency-weighted acceleration and vibration dose value—and reported musculoskeletal, neurological, and vascular outcomes, while also considering the role of individual confounding factors, including posture, age, and body mass index, in shaping exposure–response relationships. HGCZ boundaries were identified as pragmatic expert compromises rather than being derived from quantitative dose–response relationships. While the zone is a reasonable predictor for low back pain in seated operators, it lacks empirical support for neck, shoulder, or vascular outcomes. Analysis of aviation data showed that most flight scenarios reached caution thresholds significantly faster than traditional land-based driving, while individual factors such as posture and body mass index were found to modify actual health outcomes. We suggest the evolution of the HGCZ toward a probabilistic framework, where fixed thresholds are complemented by models linking exposure magnitude and duration to the likelihood of specific health outcomes (not only low back pain). Supported by biomechanical modelling and segment-specific frequency weightings, this approach would enable a more accurate assessment of WBV risk, extending rather than replacing the current framework.
The aim of this study is to describe the levels of occupational exposure to the most common cancer-causing agents in the Italian industrial context, with a particular focus on age differences to identify high-risk groups of young workers. Data on exposure to carcinogens were extracted from the national occupational exposures database (SIREP), covering exposure measurements collected between 1996 and 2024. Thirteen carcinogenic agents with over 10,000 recorded measurements were analysed. Exposure intensity was categorised as low, medium, or high according to European regulatory standards. Multinomial logistic and linear mixed-effects regression models, adjusted for gender and calendar period, were used to assess the association between age and exposure level. A total of 457,291 exposure measurements were selected for the main carcinogens registered in SIREP. Exposed workers (159,582) were only in a small proportion women (9
Male farmers are frequently exposed to various environmental and occupational hazards that may be related to cancer risk. Long-term cancer incidence trends in male farmers in Taiwan remain unclear. This study examined temporal trends in cancer incidence among male farmers over a 24-year period. Using Taiwan’s Longitudinal Health Insurance Database of Patients with Catastrophic Illnesses (2000–2023), we conducted a nationwide cohort study of agricultural workers whose aged 15–84 (N= 2,426,531). ICD-O-3 and the corresponding ICD-9-CM and ICD-10-CM codes from the Taiwan Cancer Registry Annual Report were used to identify annually incident cancer cases. Age-standardized incidence rates, age-standardized rate ratios, and age-standardized incidence ratios were calculated. A Joinpoint regression and age-period-cohort model were used to identify and examine temporal trends across the study period. Overall cancer incidence was higher among male farmers compared to the male general population, with an increasing temporal trend from 2000 to 2023. Lip and lung cancers showed a significantly increased annual average percentage change (AAPC) value, age effect, period effect, and cohort effect for the study period, while liver cancer showed a decreasing AAPC, period effect, and cohort effect, with an increasing age effect over the entire study period. This study provides evidence that lung and lip cancer incidence among male farmers increased significantly over the study period, while liver cancer decreased. As exposure varies by agricultural activity and farm type, further research is needed to identify specific exposures that are related to the higher risk of cancer in this population.
To examine the association between shift work and all-cause and cause-specific mortality in the U.S. population and assess whether biological age acceleration mediates this relationship. A prospective cohort study included 7548 adults from the National Health and Nutrition Examination Survey (NHANES) 2005–2010, with mortality follow-up through 2019. Shift work included regular night, evening, or rotating shifts versus daytime schedules. Primary outcomes were all-cause, cardiovascular (CVD), and cancer mortality. Among 7548 participants (mean follow-up 11.6 years), 358 deaths occurred. Shift work was associated with significantly increased all-cause mortality after full adjustment (HR = 1.52; 95
Evidence remains limited on how PM2.5-related mortality risk has evolved under sustained air-quality improvement following the implementation of the Clean Air Action (CAA), and how such changes have influenced related health benefits. This study aimed to investigate temporal changes in short-term PM2.5-related cardiorespiratory mortality associations and to quantify the respective contributions of PM2.5 concentration reductions and risk changes to mortality outcomes. We conducted a multi-county time-series study in the Sichuan Basin, China, covering the period from 2014 to 2022. An extended two-stage analytical framework was applied to estimate county -specific PM2.5-mortality associations, followed by pooled analyses. Longitudinal meta-regression was used to assess annual trends in excess risk (ER), and period-specific analyses were performed across different stages of the CAA. Scenario analyses were conducted to quantify mortality changes attributable to PM2.5 concentration reductions and to temporal changes in the exposure–response relationship. A significant nonlinear temporal pattern in ER per 10 μg/m3 increase in PM2.5 was observed (P < 0.001), characterized by an increase during 2014–2016, a decline during 2017–2019, and an increase again during 2020–2022. Corresponding ERs for the three periods were 0.7
We examined leisure-time physical activity (LTPA) and active commuting (AC) and their associations with subsequent sickness absence (SA) among young and early midlife employees. The 2017 Helsinki Health Study survey among employees of the City of Helsinki aged 19–39 was prospectively linked to register-based data on total, short- and long-term SA spells (2017–2020). LTPA (n=3618) and AC (n=3513) were assessed as weekly metabolic equivalent (MET) hours in 2017. LTPA was categorized into five groups based on intensity and weekly volume (inactivity, moderate, moderate-to-vigorous, vigorous and high vigorous) and AC into four groups (inactive, low moderate, moderate-to-vigorous, vigorous). Analyses were stratified by sex and adjusted for sociodemographic and lifestyle factors using negative binomial regression to estimate incidence rate ratios (IRRs) and their 95
OBJECTIVE:The Effort-Reward Imbalance (ERI) model is widely used to explain work-related stress and its health consequences. In policing, ERI research has primarily focused on sworn officers, while civilian employees have received limited attention. The purpose of this study was to examine whether ERI variables are associated with mental health and occupational functioning among police employees, and whether these associations differ between sworn officers and civilian personnel. METHODS:This cross-sectional study included sworn police officers and civilian employees in the Norwegian police. A random sample of 4000 employees was invited to complete an online survey, and 560 employees participated. Effort, reward, and overcommitment were measured with the 16-item short ERI questionnaire, and the ERI ratio was calculated from the effort and reward scales. Anxiety symptoms, depressive symptoms, work engagement, and job-related self-efficacy were assessed using separate questionnaires. Group differences were examined using analyses of covariance, and associations between ERI predictors and outcome variables were tested using hierarchical regression analyses with interaction terms for occupational role. RESULTS:In the covariate-adjusted analytic sample (N = 558), no significant differences were observed between sworn officers and civilian employees in ERI variables, mental health outcomes, or occupational functioning. Higher ERI ratio was associated with higher anxiety symptoms (β = 0.28) and depressive symptoms (β = 0.33) and with lower work engagement (β = - 0.27) and job-related self-efficacy (β = - 0.16). Overcommitment showed stronger associations with anxiety symptoms (β = 0.50) and depressive symptoms (β = 0.46) and was inversely associated with job-related self-efficacy (β = - 0.28) and work engagement (β = - 0.14). Occupational role did not moderate these associations. CONCLUSIONS:The findings support the ERI model by demonstrating consistent associations between effort-reward imbalance, overcommitment, mental health, and occupational functioning in policing. Neither the levels of the ERI variables nor their associations with the outcomes differed by occupational role, suggesting that ERI processes operate similarly across occupational categories within a highly regulated welfare-state context.
Deepwater Horizon oil spill (DWHOS) responders potentially experienced multiple stressors. We examined associations between DWHOS deployment-related stressor patterns and neurological and endocrine/metabolic conditions among U.S. Coast Guard active duty responders who completed post-deployment surveys (n = 3102). Deployment-related stressor patterns were identified using principal component analysis of self-reported stressors. Neurological and endocrine/metabolic outcomes were classified from military health encounter records. Associations between principal components (PCs) and incident outcomes (2010–2015) were estimated through Cox proportional hazards regression. A five-component solution explained 79.2
To examine effects of night work on low-grade systemic inflammation, measured as high-sensitivity C-reactive protein (hsCRP concentration), in hospital-employed women. We analyzed baseline data from 929 women in the 1001 nights-cohort. Seven self-reported metrics captured night work history (never, past, current), night work duration (years) and recency (time since last night shift), current schedule (e.g., permanent night or 2- or 3-shift work), and intensity (number of weekly and consecutive night shifts, and night shifts in the past six days). We measured hsCRP concentration in blood. Associations between night work and log-transformed hsCRP concentration were estimated using generalized linear models: Model 1 adjusted for age and education; Model 2 additionally for body mass index (BMI), blood pressure, and health behaviors; Model 3 further for sleep duration and quality. Permanent night workers had a 49
Thai sugarcane workers often work in very hot, humid conditions. This study investigated the effect of heat stress exposure on heat-related symptoms and severe heat-related symptoms associated with heat stroke in Thai sugarcane workers. Sugarcane workers in Nakhon Sawan Province, Thailand, recruited during cooler and hotter months of 2023 provided information on demographics, health behaviours, working conditions, and 21 heat-related symptoms, including 8 severe heat-related symptoms. Environmental heat was assessed using Wet-Bulb Globe Temperature (WBGT). Full shift time-weighted average effective WBGTs (WBGTeff-FS-TWA) were estimated and adjusted for clothing to represent heat stress exposure. Associations between heat stress exposure and symptom counts were examined using generalised negative binomial regression, adjusting for available confounders. Generalised binary logistic regression assessed associations between heat stress exposure and having ≥ 10 heat-related symptoms or ≥ 3 severe heat-related symptoms. The mean measured WBGT was 28.9 ± 2.6 °C. The mean WBGTeff-FS-TWA was 31.3 ± 2.8 °C, with more than 40
ObjectivesThis study aimed to investigate the associations between urinary metabolites of Volatile organic compounds (mVOCs) and serum Lactate dehydrogenase (LDH) levels in a representative sample of the U.S. adults.MethodsWe analyzed data from 4907 participants in NHANES 2011-2018. Seventeen urinary mVOCs were measured, and serum LDH was used as the outcome. Generalized linear models (GLM), restricted cubic splines (RCS), and weighted quantile sum (WQS) regression were used to assess linear, nonlinear, and mixture effects. Sensitivity analyses were conducted using urinary creatinine-corrected mVOC concentrations, and quantile g-computation (qgcomp) was applied as an alternative mixture modeling approach to validate the robustness of our findings. Furthermore, false discovery rate (FDR) correction was applied to account for multiple comparisons.ResultsSeveral mVOCs were significantly associated with serum LDH. Notably, 2MHA, 34MHA, ATCA, and CYMA showed robust inverse associations, while PHEM was positively associated with LDH. RCS models revealed non-linear exposure-response relationships for multiple mVOCs. WQS regression indicated that both positively and negatively weighted mVOCs contributed to LDH levels, with DHBMA as a major positive contributor and 34MHA as a negative contributor. Most associations remained stable after sensitivity analyses.ConclusionsThis study demonstrates that urinary mVOCs are associated with serum LDH levels, suggesting potential subclinical toxic effects of VOC exposure. These findings underscore the need for environmental risk management and further investigation into the biological pathways linking VOCs to systemic health outcomes.
Long-term hearing effects of occupational noise exposure below 85 dBA TWA remain insufficiently characterized in semiconductor manufacturing environments. This study evaluated longitudinal hearing-threshold changes among silicon wafer manufacturing workers exposed to moderate workplace noise over approximately 20 years. This retrospective cohort study examined serial pure-tone air-conduction audiometry (0.5–6 kHz) in 71 male semiconductor workers exposed to process-specific noise levels ranging from 72.2 to 80.9 dBA TWA. Participants were classified into normal-hearing (n = 53) and hearing-impaired (n = 18) groups according to Korean special health examination criteria and further categorized by manufacturing process: Process A (utilities), Process B (ingot processing), and Process C (wafer slicing). Longitudinal hearing-threshold changes were analyzed using repeated-measures ANOVA and compared with ISO 1999:2013 reference predictions. Both groups demonstrated significant deterioration in high-frequency hearing thresholds, particularly at 4–6 kHz (p < 0.001). Workers with normal baseline hearing showed threshold shifts of approximately 6–8 dB at 4 kHz and 8–10 dB at 6 kHz during follow-up, whereas workers with pre-existing hearing impairment demonstrated substantially greater progression. Process C, which had the highest recent exposure levels, showed the most pronounced longitudinal deterioration. Observed high-frequency threshold shifts were greater than conservative ISO 1999 reference predictions despite exposure levels below 85 dBA. Prolonged exposure to moderate occupational noise below current regulatory limits was associated with progressive high-frequency hearing deterioration in semiconductor manufacturing workers. These findings suggest that cumulative exposure duration and process-specific exposure characteristics should be considered in occupational hearing conservation programs.
Precarious employment (PE), characterized by job insecurity, instability, low wages, and limited access to social protections, has been linked to adverse health outcomes. This study examines whether PE, measured using a newly validated precarious employment index (PEI), is associated with high stress and poor self-rated health (SRH) in Danish workers. We conducted a cross-sectional study including 3339 Danish workers aged 18–45 years. The PEI captures six dimensions of working conditions: instability, salary, power and rights, work task planning, work time planning, and workers’ collective. PEI scores ranged from 0 (no PE) to 100 (most PE) and were dichotomized at the mean + 1 Standard Deviation (SD) into “no PE” and “PE”; 15
The health effects of high and moderate doses of ionizing radiation are recognized, but the impacts at lower doses are less clear. Medical workers represent the largest occupational group exposed to radiation. Herein, we examine mortality patterns in a Canadian cohort of medical workers, sex differences in risk, and trends in exposure over time. Annual whole-body effective doses for 301,740 medical workers between 1951 and 2018 were obtained from the Canadian National Dose Registry. Dose trends were characterised by job class and sex. Underlying cause of death was ascertained using linkage to mortality data through 2020. Standardized mortality ratios (SMRs) were estimated to compared the risk of mortality among 124,180 workers with with a lifetime cumulative dose > 0 mSv to the Canadian general population. Internal cohort comparisons incorporated person-time and events among unexposed workers. Poisson regression was used for internal cohort comparisons to explore healthy worker bias. The mean annual radiation dose among workers declined from 0.56 mSv during 1948–1977 to 0.09 mSv in 2000–2018. Compared to the general Canadian population, all-cause mortality was lower for both men (SMR = 0.54, 95
It is analyzed whether differences in how the daily usage time is determined in a population exposed to hand-transmitted vibration are the cause of discrepancies between exposure-response models constructed for vibration-induced white finger (VWF). The predictions of the models are then used to evaluate the one in ISO 5349-1:2001. Pooled analyses employing data from epidemiologic studies of vibration-exposed occupations deemed the most reliable, together with published ratios between daily tool or machine usage times determined by questionnaire or interview and measured values, are used to construct exposure-response relations. These models are compared to those in which the daily usage time is not compensated. Of 17 data points, for 7 the usage time ratio is greater than 1, and for the rest the ratio is equal to 1. Adjusting daily vibration exposures, expressed as A(8)-values, by means of such ratios, results in reductions of varying magnitude. However, the exposure-response models show minor changes, and the scatter in the data points previously observed remains. Methods for estimating 10 m/s^2 .
This study examined associations between urinary 3-diethyl-carbamoyl benzoic acid (DCBA), the principal metabolite of the insect repellent DEET, and liver fibrosis (LF) as well as non-alcoholic fatty liver disease (NAFLD) using a nationally representative sample. Network toxicology approaches were employed to explore underlying molecular mechanisms. We analyzed 5,960 adults from NHANES with DCBA measurements obtained through liquid chromatography-tandem mass spectrometry. LF severity was determined using NAFLD Fibrosis Score (NFS ≥ 0.676), whereas NAFLD was identified via sex-specific alanine aminotransferase criteria. Weighted logistic regression models incorporated progressive adjustment for demographic, anthropometric, and clinical factors. Network toxicology identified molecular targets, with molecular docking and dynamics simulations validating mechanistic pathways. DCBA exposure showed significant positive correlations with LF risk after full adjustment (OR = 1.254, 95
Currently, there is no standardized method to quantify musculoskeletal health of hand-arm vibration syndrome (HAVS). This study evaluated passive stiffness (PS) of the abductor pollicis brevis (APB) muscle among groundskeepers and examined the potential relationship of the PS with lifetime hand-arm vibration (HAV) exposure of the workers. PS of APB muscle was measured using a myotonometer among 17 groundskeepers and 10 office workers for 3 days. Study participants’ HAV exposure, demographic information, social history, and health-related information were pulled from our previous studies conducted in parallel with the present study. Linear mixed models were employed to estimate the association between lifetime HAV exposure dose and PS. The average PS for right and left hands was 509.7 N/m (range 402.2–752.9 N/m) and 501.7 N/m (range 380.4–660.7 N/m), respectively, in the exposure group and 422.0 N/m (range 365.0–517.2 N/m) and 430.3 N/m (range 359.2–591.9 N/m), respectively, in the reference group. A significant positive association between lifetime HAV exposure and PS was observed in the multivariable linear mixed model after adjusting for age, body mass index, and race/ethnicity (right hand: β = 6.972 and p-value = 0.0128; left hand: β = 9.039 and p-value = 0.0108). A significant association between lifetime HAV exposure and PS was found, supporting PS measurement using myotonometry as a promising health indicator for muscular disorders induced by HAV.
Malignant Mesotelioma (MM) is known for its association with asbestos exposure and long latency. Few studies examine a large series of MM patients investigating the past exposure intensity by autopsy findings. The aim was to describe the characteristics of MM cases diagnosed in Friuli Venezia Giulia, a region with several shipyards, and to assess past exposure levels by biological/histological markers, paying attention to some parameters of occupational exposure. For the period 1995–2023, all MM cases were retrieved from the Regional registry and information on diagnosis and exposure were evaluated. Pleural plaques (PP), lung fibrosis and asbestos bodies (ABs) counts were identified by autopsy reports and their relationship to past asbestos exposure was analyzed. Out of 1756 patients (1,487 men, 269 women; mean age at diagnosis 72.3 ± 10.4 years), autopsy reports were available for 896 cases (763 males and 133 females). PP, lung fibrosis and high ABs count (≥ 10,000 per gram of dry lung tissue) were more often present in men and in occupational exposure group than in women and in non-occupational one (p = 0.01). Among males occupationally exposed to asbestos (567 pleural and 33 peritoneal mesotheliomas), individuals with PP (66
So far there is no reference value for lead (Pb) established for the not occupationally exposed Ghanaian population. This is of special interest and will enable interpretation of data from high-risk areas like the Agbogbloshie e-waste dumpsite. The study suggests preliminary reference values for populations in Southern and Western Ghana. Blood specimens from non-exposed population were obtained in three key regions (Ashanti-Offinso, Western-Eikwe and Greater Accra-Accra). Three age groups were evaluated (15–24, 25–34, > 34 years). Individual habits (nutrition, occupation etc.) were documented using a standardized questionnaire. Graphite furnace atomic absorption spectrometry was used for Pb analysis. There was a total of 292 participants (Offinso = 124, Eikwe = 130, Accra = 38). The total mean Pb blood concentration of the Southern Ghanaian population was 43.3 µg/l ± 17.7, with a mean of 48.3 µg/l ± 17.2 for men and a mean of 38.1 µg/l ± 16.8 for women (P = .2.93–10). This value is twice as high as the mean Pb level among Germans, and higher than in most European countries. The 95th percentile for the total collective in Ghana was 81 µg/l and 76 µg/l for men and women, respectively. Based on the 95th percentile of the non-exposed population > 25 years data suggest a preliminary reference value for Pb in Ghana of 81 µg/l for men and of 76 µg/l for women. Since environmental load decreases with increasing distance when unleaded fuel became standard this should be re-evaluated in about 10 years. Future studies should include the eastern and northern regions of Ghana and the analysis of soil for its Pb content as environmental factor.
