INTRODUCTION:Musculoskeletal disorders are known to result from physical demands at the workplace. Identification of risks specific to particular trades may encourage work modification to prevent new onset conditions. METHODS:In a Canadian cohort study of male and female welders and electrical workers, we collected self-reports of low-back pain, shoulder pain, and symptoms suggestive of vibration white finger (VWF) at each 6-monthly contact for up to 5 yr. Physician records of back and shoulder/joint disorders and Raynaud's syndrome were extracted from the Alberta administrative health database (AHDB). At each contact, participants completed questions on ergonomic work factors. We computed cumulative hours exposed for 6 factors: whole-body vibration, hand-arm vibration, manipulating heavy objects, working at or above shoulder height, working while crouching or kneeling, and work in cold environments. The relation of current and log cumulative exposures to health outcomes was identified by proportional hazards regression, adjusting for sex, age, body mass index, smoking, anxiety, and depression. RESULTS:Of 1,885 workers recruited January 2011 to September 2017, 872 welders and 812 electrical workers recorded symptoms and workplace demands on at least one occasion, with 693 welders and 567 electrical workers matched to the AHDB. In final models, whole-body vibration was related overall to each self-reported health outcome with backpain risk most in evidence for male welders (HR = 1.10 log increase/h of exposure: 95% CI, 1.05 to 1.15, P < 0.001). Working in a crouching position and in cold temperatures also contributed to back pain in welders. Cumulative hours working at or above shoulder height increased welders' risk of shoulder pain (HR = 1.07 log increase/h of exposure: 95% CI, 1.03 to 1.11, P = 0.001). Working at or above shoulder height was related to both back and shoulder pain in the electrical trades, where cumulative exposure to hand-arm vibration was an additional factor for shoulder pain (HR = 1.06 log increase/h of exposure: 95% CI, 1.01 to 1.10, P = 0.007). Manipulating heavy loads was a further risk factor for back and shoulder pain for women in electrical work. There were only 3 incident cases of Raynaud's syndrome in physician records: symptoms suggestive of VWF related strongly to work in cold environments but not to hand-arm vibration. Physician records of back pain did not reflect specific workplace demands, but physician records of shoulder/joint conditions were greater, overall, in those with longer exposure to whole-body vibration and to current hand-arm vibration in electrical workers. CONCLUSION:Vibration, a well-recognized hazard, was a risk factor for all outcomes but with whole-body vibration more evidently a risk for welders and hand-arm vibration for electrical workers. The final models of risk factors differed importantly between the two trades, suggesting specific targets for intervention.

Prior studies have investigated individual single nucleotide polymorphisms (SNPs) as risk factors for the development of lung disease in swine operation workers. The aim of this study was to determine the collective effects of multiple SNPs and a polygenic risk score (PRS) in swine operation workers and identify workers at a higher risk of airway disease. This study included 374 full-time swine operation workers and 411 non-farming rural residents. Least absolute shrinkage and selection operator (LASSO) with 10-fold cross-validation was used to identify SNPs, which were used to calculate a PRS score for airway obstruction. Decision tree was applied to dichotomize the PRS score into two genetic susceptible groups (high vs. low). Logistic regression was employed to examine the association between dichotomous PRS score and airway obstruction. All workers were divided into two PRS genetic susceptible groups (high vs. low) by a cutoff value of 4.196. Logistic regression showed that workers in the high PRS group were 5.5-fold more likely to be associated with airway obstruction compared to workers in the low PRS group after controlling for potential confounders. A PRS score was identified as a useful tool in identifying workers at increased risk of airway obstruction in swine operations.

Introduction: Respiratory ill-health in welders is well documented but without a clear indication of exposures responsible. Methods: In a Canadian cohort study of welders and electrical workers, we collected self-reports of asthma/wheeze and rhinitis at each 6-monthly contact for up to 5 years. Physician diagnoses of asthma and chronic obstructive pulmonary disease (COPD/bronchitis) were extracted from the Alberta administrative health database (AHDB). Welders provided task-specific information at each contact. Estimates were derived for cumulative exposure to particulates, chromium, and nickel. Factors associated with time to first and recurrent events were identified by proportional hazards regression, adjusting for sex, age, and smoking. Results: Of 1001 welders and 884 workers in electrical trades recruited, 1338 in Alberta were matched to the AHDB. Welders were more at risk of physician-diagnosed COPD/bronchitis than those in the electrical trades (HR for first report=1.87; 95% CI=1.27-2.77) but not of asthma. Times to first self-report of asthma/wheezing (HR=1.58; 95% CI=1.23-2.04) and rhinitis (HR=1.29; 95%CI=1.11-1.49) were shorter in welders. Among welders, time to physician-diagnosed asthma was weakly related to cumulative nickel exposure (mg/m(3)_h/100) (HR=1.08; 95% CI=1.00-1.17). COPD/bronchitis was related to cumulative exposure to total dust (g/m(3)_h) (HR=1.01; 95% CI=1.00-1.03) and to chromium (mg/m(3)_h/100) (HR=1.14; 95% CI=1.04-1.26). The risk of both asthma and COPD/bronchitis reduced with time using local exhaust ventilation. Self-reported rhinitis increased with cumulative nickel exposure (HR=1.00; 95% CI=1.00-1.01). Conclusions: Welders were at increased risk of COPD/bronchitis, with risk related to cumulative dust and chromium exposure. Nickel exposure increased the risk of asthma and rhinitis.

OBJECTIVES:To synthesize evidence relevant for informed decisions concerning cognitive testing of older physicians. METHODS:Relevant literature was systematically searched in Medline, EMBASE, PsycInfo, and ERIC, with key findings abstracted and synthesized. RESULTS:Cognitive abilities of physicians may decline in an age range where they are still practicing. Physician competence and clinical performance may also decline with age. Cognitive scores are lower in physicians referred for assessment because of competency or performance concerns. Many physicians do not accurately self-assess and continue to practice despite declining quality of care; however, perceived cognitive decline, although not an accurate indicator of ability, may accelerate physicians' decision to retire. Physicians are reluctant to report colleagues' cognitive problems. Several issues should be considered in implementing cognitive screening. Most cognitive assessment tools lack normative data for physicians. Scientific evidence linking cognitive test results with physician performance is limited. There is no known level of cognitive decline at which a doctor is no longer fit to practice. Finally, relevant domains of cognitive ability vary across medical specialties. CONCLUSION:Physician cognitive decline may impact clinical performance. If cognitive assessment of older physicians is to be implemented, it should consider challenges of cognitive test result interpretation.

Multimorbidity, which is defined as having at least two or more chronic diseases concurrently, has been a rising public health issue in recent years in Canada and worldwide. The increasing prevalence of multimorbidity has posed a burden on the current health care system and quality of life for the Canadian population. There is a lack of up-to-date research on determinants of multimorbidity in the Canadian population, which is necessary to better understand and prevent multimorbidity. This study aims to determine the prevalence and risk factors of multimorbidity in the middle-aged and older Canadian adult population. Multivariable logistic regression analyses incorporating survey weights and biologically plausible interactions were conducted to examine the determinants of multimorbidity using data from the 2017/2018 Canadian Community Health Survey (CCHS). Of the 113,290 CCHS participants, 82,508 subjects who were aged 35 years and above were included in the study. The prevalence of multimorbidity was 22.20% (95% CI: 21.74%, 22.67%) and was greater for females. Multimorbidity was more likely in subjects who were obese, abstaining from alcohol, inactive, had a lower education level, widowed, divorced, or separated and was less likely among subjects living in Quebec. The protective effect of household income on multimorbidity decreased with age. Current smokers who reported extreme stress were more likely to have multimorbidity. Multimorbidity is associated with various determinants that need to be considered in chronic disease control and prevention. These results suggest that future research should focus not only on these determinants but also on the relationships between them. A future longitudinal study is required to provide causal evidence for the study findings.

Objective The aim of this study was to examine the effect of multimorbidity and the joint effect of chronic diseases on all-cause mortality among subjects aged 35 years and above. Study Design Population-based retrospective cohort study. Methods Multimorbidity was defined by the respondent’s self-report of having two or more chronic diseases of the nine considered. The Canadian Community Health Surveys conducted in 2003/2004, 2005/2006 and 2007 to 2014 were linked with the Canadian Vital Statistics Death Database to examine the association between multimorbidity and all-cause mortality in subjects aged 35 years and above. Cox’s proportional hazards models were used to estimate risk of multimorbidity on death after adjusting for the confounders in three age groups. Results Multimorbidity had an increased risk of death in all three age groups with the youngest having the highest risk after adjusting for potential confounders (35 to 54 years: hazard ratio (HR) = 3.77, 95% CI: 3.04, 4.67; 55 to 64 years: HR = 2.64, 95% CI: 2.36, 2.95; 65 years and above: HR = 1.71; 95% CI:1.63,1.80). Subjects with cancer had the highest risk of death in the three age groups. When the interactions between chronic diseases were considered, subjects with COPD and diabetes had a significantly increased risk of death in comparison to those without COPD or diabetes in the 55 to 64 years. (HR = 2.59, 95% CI: 2.01, 3.34). Conclusions Prevention of multimorbidity should be targeted not only in the older population but also in the younger populations. Synergistic effects of chronic diseases should be considered in the management of multimorbidities.

Objective: The coexistence of asthma and COPD (asthma + COPD) is a condition found among patients who present with clinical features of both asthma and COPD. Epidemiological evidence points to an increasingly disproportionate burden of asthma + COPD and COPD in females. The objective of this cross-sectional study is to identify female and male-specific epidemiological and clinical characteristics associated with asthma + COPD.Methods: Baseline data from the comprehensive cohort of Canadian Longitudinal Study on Aging (CLSA) were used in this cross-sectional study which included 30,097 subjects between the ages of 45- and 85-years Participants were categorized into four mutually exclusive groups: asthma + COPD, COPD-only, asthma-only and neither asthma nor COPD.Results: The prevalence was significantly greater in females than males for asthma + COPD (2.71% vs. 1.41%; p < 0.001), COPD-only (3.22% vs. 2.87%; p < 0.001) and asthma-only (13.31% vs. 10.11%; p < 0.001). The association between smoking and asthma + COPD was modified by age in females. Osteoporosis and underactive thyroid disease were significantly more prevalent in females than in males in asthma + COPD, COPD-only and asthma-only groups. In asthma + COPD group, a greater proportion of respiratory symptoms associated with asthma was observed in females whereas a greater proportion of respiratory symptoms associated with COPD was observed in males. Severity of airway obstruction determined by spirometry measurements was greater in males than females.Conclusions: In the Canadian adult population, several epidemiological and clinical characteristics in asthma + COPD varied between females and males. The findings in this study will help healthcare professional in the recognition and management of coexisting asthma and COPD in females and males.

Abstract Introduction Welders are exposed through welding fume to particles and metals, including nickel and chromium, that may act as respiratory sensitizers. In a Canadian study of male and female welders we investigated the relation of modelled welding exposures to episodes of asthma/wheeze and rhinitis. Methods Welders who had been registered in an apprenticeship were recruited and followed up at 6-month intervals for up to five years. Women were recruited from across Canada, men just from Alberta. At each contact participants were asked about their health and specifically about symptoms of asthma and rhinitis and age these had first occurred. A complete job history was taken and at each contact after recruitment the participant completed a detailed welding task questionnaire. A job exposure matrix was developed, reflecting type of welding, base metal and consumables. This was validated against urinary metal concentration. Results 1001 welders, including 447 women, were recruited. In bivariate analyses, hours of welding/week, hours grinding/day and estimated exposures to total particles, manganese, nickel and aluminum were related to episodes of asthma/wheeze. Hours welding, grinding and nickel exposure were related to rhinitis. In multivariable models, including all exposures and confounders, the number of hours welding/week and hours grinding/day were related to asthma/wheeze episodes and hours grinding and nickel exposure to rhinitis. Conclusions Duration of welding tasks was related to episodes of asthma/wheeze and rhinitis. There was less evidence that estimated metal concentrations were associated with respiratory ill-health, having adjusted for hours welding.

OBJECTIVES:To determine the relationship between ergonomic demands of the job at conception and fetal loss (miscarriage or stillbirth).METHODS:Women with a welding or electrical trade apprenticeship were identified across Canada for the Women's Health in Apprenticeship Trades-Metal and Electrical study. They completed a reproductive and employment history at recruitment and every 6 months for up to 5 years to provide details on pregnancies and work demands. Job at conception was identified and fetal loss examined in relation to ergonomic exposures/demands, allowing for potential confounders.RESULTS:A total of 885 women were recruited; 447 in welding and 438 in electrical trades. Of these, 574 reported at least one pregnancy. Analysis of 756 pregnancies since the woman started in her trade suggested no increased risk of fetal loss in those choosing welding rather than electrical work. Among 506 pregnancies conceived during a period working in a trade, 148 (29.2%) ended in fetal loss: 31.2% (73/234) in welding, and 27.6% (75/272) in electrical work. Detailed exposure information was available for 59% (299/506) of these pregnancies. In welders, the risk of fetal loss was increased with whole-body vibration (prevalence ratio [PR] = 2.14; 95% confidence interval [CI] 1.39-3.31) and hand-arm vibration for > 1 hour/day (PR = 2.15; 95% CI 1.33-3.49). In electrical workers risk increased with more than 8 days working without a rest day (PR = 2.29; 95% CI 1.25-4.17). Local exhaust ventilation reduced risk in welders.CONCLUSIONS:There was no significant increase in fetal loss in welding trades compared to electrical work. Vibration, largely from grinding, and extended work rotations appear to be potentially modifiable factors of some importance.

Abstract Objectives Welding is a physically demanding job that entails exposure to metal fume and particles. There is little information on the effect of welding exposures on the outcome of a pregnancy conceived during a period when a woman was employed as a welder. Methods Women welders recruited to the Workers Health in Apprenticeship Trades—Metal and Electrical (WHAT-ME) study were followed-up every 6 months for up to 5 years (January 2011–August 2018), and every pregnancy recorded. At the first 6-month follow-up, a detailed questionnaire was completed for the most recent day in welding, and this information was collected again at each follow-up and also from questionnaires completed during pregnancy. The date of conception was estimated for each pregnancy and the job at that date identified. Exposures to ergonomic factors, work schedule and perceptions of noise, heat and cold were extracted for the job at conception. Exposures to metals (aluminum, chromium, manganese, and nickel) and particles in welding fume were estimated from previously validated exposure algorithms reflecting the welding process, base metal and consumables of the job at the conception date. The effects of exposures were estimated in multilevel multivariable models allowing for confounding. Results There were 242 pregnancies conceived by a welder working in her trade, 87 were before the first follow-up, 3 were after first follow-up but detailed information was not collected, 22 of those potentially included in the assessment group were in-trade but not welding leaving 122 pregnancies in 90 welders for analysis. Of these 91 resulted in a live birth and 31 in a fetal loss (27 miscarriages and 4 stillbirths). Mean birth weight for live births was 3365 g and gestation 39.4 weeks. Final models showed that risk of fetal loss increased with manipulating heavy objects [odds ratio (OR) = 5.13, 95% confidence interval (CI) 2.04–12.92], whole-body vibration (OR = 5.86, 95% CI 1.81–18.92), a higher rating for noise exposure intensity (OR = 1.52, 95% CI 1.24–1.85), and decreased with use of local exhaust ventilation (OR = 0.20, 95% CI 0.03–1.18). Gestation decreased with perceived heat intensity (β = −0.15, 95% CI −0.29 to −0.02) and number of previous pregnancies (β = −0.35, 95% CI −0.65 to −0.05). Birth weight was lower in those reporting whole-body vibration (β = −596 g, 95% CI −924 to −267) and increased with the welder’s body mass index (β = 36 g, 95% CI 12–61). Estimates of exposure to metals and particles were unrelated to gestation or birth weight. In a bivariate analysis, allowing for the same welder reporting >1 pregnancy, estimated airborne aluminum exposure (and to a lesser degree exposure to nickel and particles) was related to greater risk of fetal loss (OR = 1.52, 95% CI 1.04–2.24) but neither aluminum nor the other estimated elements of welding fume added to the final model. Conclusions In this group of women actively engaged in welding during the time surrounding conception, the outcome of pregnancy was strongly related to work exposures, particularly vibration (reported in grinding tasks), manipulation of heavy objects, and perceived intensity of noise and heat. The study was unable to show an independent effect of exposure to metal fume constituents.

Objective: To document the occurrence and recovery outcomes of sports-related concussions (SRCs) presenting to the Emergency Department (ED) in a community-based sample. Design: A prospective observational cohort study was conducted in 3 Canadian hospitals. Setting: Emergency Department. Patients: Adults (>= 17 years) presenting with a concussion to participating EDs with a Glasgow Coma Scale score >= 13 were recruited. Interventions: Patient demographics (eg, age and sex), clinical characteristics (eg, history of depression or anxiety), injury characteristics (eg, injury mechanisms and loss of consciousness and duration), and ED management and outcomes (eg, imaging, consultations, and ED length of stay) were collected. Main outcome measures: Patients' self-reported persistent concussion symptoms, return to physical activity status, and health-related quality of life at 30 and 90 days after ED discharge. Results: Overall, 248 patients were enrolled, and 25% had a SRC. Patients with SRCs were younger and reported more physical activity before the event. Although most of the patients with SRCs returned to their normal physical activities at 30 days, postconcussive symptoms persisted in 40% at 90 days of follow-up. After adjustment, there was no significant association between SRCs and persistent symptoms; however, patients with concussion from motor vehicle collisions were more likely to have persistent symptoms. Conclusion: Although physically active individuals may recover faster after a concussion, patients returning to their physical activities before full resolution of symptoms are at higher risk of persistent symptoms and further injury. Patient-clinician communications and tailored recommendations should be encouraged to guide appropriate acute management of concussions.

Abstract Objectives Men and women working in the welding trades undergo the same apprenticeship training but it is unknown whether, once in the trade, their exposures differ. Comparison of urinary metal concentrations, having adjusted for estimated airborne exposure, may provide an answer. Methods Men and women were recruited to a cohort study of workers in the welding and electrical trades (the Workers Health in Apprenticeship Trades-Metal working and Electrical [WHAT-ME study]). They completed a recruitment questionnaire and further questionnaires every 6 months for up to 5 years. At each follow-up, they gave details on employment and, if welding, answered trade-specific questionnaires. Urine samples were collected by mail. Welding exposure matrices were developed to estimate metal exposures from welding process, base metal, and consumables. Urinary metal concentrations, determined by ICP-MS, were compared by trade (welding or electrical). Within welding, the relation of urinary concentrations to estimated airborne exposure was examined, with adjustment for potential confounders including sex, use of respiratory protective equipment (RPE), and time spent outdoors. Natural logarithms were taken of exposure estimates and urinary concentrations, to reduce skew. All regression analyses included creatinine concentration. Results Urinary metal concentrations were analysed for 12 metals in 794 samples. Antimony, arsenic, lead, and mercury had a high proportion of samples with no metal detected and were not considered further. The urinary concentrations of aluminum, cadmium, chromium, cobalt, copper, manganese, nickel, and zinc were compared for welders (434 samples) and electrical workers (360). After adjustment for potential confounders, welders had higher urinary concentrations for aluminum (β = 0.13 95%CI 0.03–0.24) and chromium (β = 0.66 95%CI 0.55–0.77). Of 434 welder urines, 334 could be matched securely to detailed information about the most recent day welding. For these, an estimate of airborne exposure was made for aluminum, chromium, manganese, and nickel. Male welders were estimated to have higher airborne exposure to chromium and nickel than women welders. No difference was seen in the estimated exposures for aluminum or manganese (or total dust). Regression analyses of the relation of urinary metals to estimated exposure showed a good concordance for aluminum (β = 0.09 95%CI 0.04–0.15 (P < 0.001) and chromium (β = 0.11 95%CI 0.05–0.17 P < 0.001). The concordance for manganese and nickel was positive, but much weaker. Urinary concentrations of aluminum and nickel were somewhat lower with increasing time wearing RPE and, for chromium and nickel, with time working outdoors. Having adjusted for estimated exposure, creatinine and other confounders, male welders had lower urine concentrations of aluminum (β = −0.35 95%CI −0.51 to −0.19 P < 0.001) chromium (β = −0.38 95%CI −0.57 to −0.19 P < 0.001) and manganese (β = −0.36 95%CI −0.49 to −0.23 P < 0.001) than female welders. Conclusion Welders had higher urinary concentrations of aluminum and chromium than electrical workers. Exposure estimates of aluminum and chromium for welders were a valid representation of the airborne exposures to these metals. Although male welders were estimated to have higher exposures of chrome and nickel than female welders, the higher urinary metal concentrations in women welders is of concern, particularly for women who may conceive while in the trade.

BACKGROUND:Sensitization to allergens encountered in baking, and allergic disease including asthma and rhinitis, is recognized. Attempts to reduce this risk have been instituted in some workplaces, but awareness remains low. This study aimed to quantify the current risk among Alberta bakers.AIMS:To estimate the onset of sensitization to bakery allergens and allergic disease among trainee bakers at the outset of their career.METHODS:Trainees attending one of the two bakery programmes were recruited between 2015 and 2018. At entry, an interview was held and spirometry and skin prick tests were performed. Participants were contacted every 6 months by telephone or online interview for 3 years to update work and health information. An exit interview was completed between 2018 and 2019 for all who could be contacted. Exposure was estimated using collected work history and a job exposure matrix was prepared for this study.RESULTS:A total of 220 individuals participated in the entry interview, 204 completed one or more periodic interviews and 113 completed the exit interview. Six who completed exit testing developed new sensitization to bakery antigens, an incidence of 2.49/100 person-years. Positive skin prick tests for bakery antigens were associated with bread making. Rhinitis symptoms were associated with total flour dust and new-onset rhinitis to months in trade. New-onset asthma was related to cumulative exposure to flour improvers.CONCLUSIONS:Trainee bakers in Alberta remain at risk of sensitization and occupational respiratory disease.

ABSTRACT Physician health is strongly connected to patient health outcomes such that barriers to seeking help and medical care for impaired physicians may compromise patient safety and quality of care. It is important to understand and identify barriers that may reduce the likelihood of physicians seeking help. Using medical licensure questions that necessitate self-reporting of health conditions is one of the ways regulatory bodies such as the College of Physicians and Surgeons of Alberta (CPSA) seeks to protect the public and ensure physician competency. The objective of this paper is to review the current body of literature on the impact of these medical licensure questions on physician health-seeking behavior as well as patient care. Five online databases (Scopus, APA PsychINFO, Web of Science, PubMed, and MEDLINE) were searched using combined key terms to identify relevant articles. Based on the inclusion and exclusion criteria, nine primary quantitative studies were selected. Results suggest that licensure applications with questions on previous impairments and mental health condition acts as both a barrier to reporting and to seeking care. These findings highlight the need for further research in examining the utility of health licensure questions in identifying impaired physicians and their impact on the quality of patient care.

Objective:Determine effects on respiratory health of firefighters attending a catastrophic wildfire.Methods:Within the Alberta Administrative Health Database, we identified five community-based controls for each firefighter in a cohort of 1234 deployed to the 2016 Fort McMurray fire. Spirometry records were identified and a stratified sample assessed clinically. We estimated PM2.5 particles exposure.Results:Firefighters had an increased risk of asthma consultation post-fire (OR new onset asthma = 2.56; 95%CI 1.75 to 3.74). Spirometry showed decreased FEV1 and FVC with increasing exposure. In the clinical assessment, 20% had a positive MCT and 21% BWT. Those with ongoing fire-related symptoms had a higher concurrence of positive MCT and BWT (OR = 4.35; 95%CI 1.11 to 17.12). Lower diffusion capacity related to higher exposure.Conclusions:Massive exposures during a wildfire are associated with non-resolving airways damage.

Introduction: Firefighters were working in exceptionally difficult conditions during the Fort McMurray/Horse River fire in May 2016. Methods: From mid-May, we recruited firefighters from 13 fire services as they returned from the fire. In October 2016 we extended recruitment to all Alberta-based firefighters deployed to the fire. In December 2017–May 2018 we sent a first online follow-up: this concentrated on mental health supports. The second follow-up, in October 2018–January 2019, included screening scales for respiratory ill-health and PTSD. All three contacts included visual analogue scales for chest symptoms and the Hospital Anxiety and Depression Scale. We estimated exposure to PM2.5, and calculated an exposure mitigation index from reports of respiratory protective equipment (RPE). Results: We recruited 1,234 firefighters and examined the relation of respiratory symptoms to estimated particulate exposure. The relation was strong immediately post fire but weakened over time. We found less chest tightness and cough in those whose RPE in the first week mitigated exposure by at least 10%. We examined the relation between particulate exposure and mental ill-health from screening questionnaires and found those with high exposure (reflecting the ferocity of the fire) had poorer mental health scores. Firefighters reporting their “worst moment during the fire” was life threatening were more anxious at second follow-up. Overall both anxiety and depression scores increased at successive contacts, more so in those with mental ill-health recorded in physician billing records before the fire. Discussion: The results from this study overall suggest on-going fire-related health effects in a substantial minority of firefighters, similar to those reported in the longitudinal follow-up of firefighters after the collapse of the World Trade Centre. Self-reports of both respiratory symptoms and mental ill-health were strongly related, soon after the fire, to estimated particulate exposures. Anxiety increased over time since the fire in those who felt their life or safety had been threatened, underlining the need for ongoing support. Our conclusions about the benefits of rapid research relate particularly to the collection of biomarkers of exposure as quickly and widely as possible, and the establishment of a nominal list of participants before they are too widely dispersed.

OBJECTIVE Patients with concussion frequently present to the emergency department (ED). Studies of athletes and children indicate that concussion symptoms are often more severe and prolonged in females compared with males. Given infrequent study of concussion symptoms in the general adult population, the authors conducted a sex-based comparison of patients with concussion. METHODS Adults (≥ 17 years of age) presenting with concussion to one of three urban Canadian EDs were recruited. Discharged patients were contacted by telephone 30 and 90 days later to capture the extent of persistent postconcussion symptoms using the Rivermead Post Concussion Symptoms Questionnaire (RPQ). A multivariate logistic regression model for persistent symptoms that included biological sex was developed. RESULTS Overall, 250 patients were included; 131 (52%) were women, and the median age of women was significantly higher than that of men (40 vs 32 years). Women had higher RPQ scores at baseline (p < 0.001) and the 30-day follow-up (p = 0.001); this difference resolved by 90 days. The multivariate logistic regression identified that women, patients having a history of sleep disorder, and those presenting to the ED with concussions after a motor vehicle collision were more likely to experience persistent symptoms. CONCLUSIONS In a community concussion sample, inconsequential demographic differences existed between adult women and men on ED presentation. Based on self-reported and objective outcomes, work and daily activities may be more affected by concussion and persistent postconcussion symptoms for women than men. Further analysis of these differences is required to identify different treatment options and ensure adequate care and management of injury.

Abstract Objectives The Fort McMurray fire in Alberta, Canada, devastated the townsite in May 2016. First responders were heavily exposed to smoke particles. Blood samples taken from firefighters in May and August/September 2016 were used to measure concentrations of inflammatory markers in plasma and the relation of these markers to exposures and respiratory ill-health. Methods Blood samples were drawn from firefighters from two fire services, who also completed questionnaires about tasks and exposures during their deployment to the fire and about respiratory symptoms. Plasma was analysed for 42 inflammatory markers in a multiplex assay. At Service A, samples were collected twice, within 19 days of the start of the fire (early sample) and again 14–18 weeks later (late sample). At Service B, only late samples were collected, at 16–20 weeks. Principal component (PC) scores were extracted from markers in plasma from the early and late samples and, at both time periods, the first two components retained. PC scores were examined against estimated cumulative exposures to PM2.5 particles, self-rated physical stressors during the fire, and time since the last deployment to an active fire. The relation of component scores and exposure estimates to respiratory health were examined, using self-ratings at the time of the blood draw, a validated respiratory screening questionnaire (the European Community Respiratory Health Survey [ECRHS]) some 30 months after the fire, and clinical assessments in 2019–2020. Results Repeat blood samples were available for 68 non-smoking first responders from Service A and late samples from 160 non-smokers from both services. In the 68 with two samples, marker concentrations decreased from early to late samples for all but 3 of the 42 markers, significantly so (P < 0.05) for 25. The first component extracted from the early samples (C1E) was unrelated to respiratory symptoms but the second (C2E) was weakly related to increased cough (P = 0.079) and breathlessness (P = 0.068) and a lower forced expiratory volume in one second/forced expiratory capacity (FEV1/FVC)(β = –1.63, 95% CI –3.11 to –0.14) P = 0.032. The first PC at 14–20 weeks (C1L) was unrelated to exposure or respiratory health but the second PC (C2L) from these late samples, drawn from both fire services, related to cumulative PM2.5 exposure. In a multivariate model, clustered within fire service, cumulative exposure (β = 0.19, 95% CI 0.09–0.30), dehydration (β = 0.65, 95% CI 0.04–1.27) and time since last deployed to a fire (β = –0.04, 95% CI –0.06 to –0.01) were all related to the C2L score. This score was also associated with respiratory symptoms of wheezing, chest tightness, and breathlessness at the time of the blood draw but not to symptoms at later follow-up. However, apart from the lower FEV1/FVC at 15–19 days, the marker scores did not add to regression models that also included estimated cumulative PM2.5 exposure. Conclusions Concentrations of persisting inflammatory markers in the plasma of firefighters deployed to a devastating fire decreased with time and were related to estimates of exposure. Although not a powerful independent predictor of later respiratory ill-health, they may serve as an indicator of previous high exposure in the absence of contemporary exposure estimates.

Objective: Determine effects on respiratory health of firefighters attending a catastrophic wildfire. Methods: Within the Alberta Administrative Health Database, we identified five community-based controls for each firefighter in a cohort of 1234 deployed to the 2016 Fort McMurray fire. Spirometry records were identified and a stratified sample assessed clinically. We estimated PM2.5 particles exposure. Results: Firefighters had an increased risk of asthma consultation post-fire (OR new onset asthma = 2.56; 95%CI 1.75 to 3.74). Spirometry showed decreased FEV1 and FVC with increasing exposure. In the clinical assessment, 20% had a positive MCT and 21% BWT. Those with ongoing fire-related symptoms had a higher concurrence of positive MCT and BWT (OR = 4.35; 95%CI 1.11 to 17.12). Lower diffusion capacity related to higher exposure. Conclusions: Massive exposures during a wildfire are associated with non-resolving airways damage.

Workers in swine operations may be at increased risk of developing respiratory problems. These respiratory conditions are more prevalent among workers who are smokers. Tumor necrosis factor (TNF) genes play an important role in human immune responses to various respiratory hazards. This study aimed to investigate whether polymorphisms in TNF genes might alter the effects of smoking on lung function among workers in swine operations. Three hundred and seventy-four full-time workers from large swine operations and 411 non-farming rural dwellers in Saskatchewan were included in this study. Information on demographic and lifestyle characteristics, pulmonary function, and blood samples were obtained. Multiple linear regression analyses were used in the statistical analysis. Three promoter polymorphisms (rs1799724, rs361525, and rs1800629) in the TNF gene were investigated. Only the interaction term between smoking status and rs1799724 was significant in the multiple regression models. Among workers with the rs1799724 polymorphism (TT+TC), current smokers exhibited significantly lower lung function than nonsmokers. These associations were not observed among workers with the wild-type (CC). These findings were not observed among non-farming rural dwellers. Data demonstrated the possible involvement of TNF gene in (1) development of adverse respiratory conditions among workers who are smokers, (2) importance of smoking cessation among workers, especially those with polymorphisms in the TNF gene, and (3) potential implications in treatment, screening, and prevention.