Introduction Military service involves potential exposure to a range of physical, chemical, and biological hazards that could impact reproductive health. Females represent 20% of Australian Defence Force (ADF) members and, like many military services, the ADF is prioritizing their recruitment and retention. However, given that females have different physiology and anthropometry, specific female occupational research is essential. This systematic review aimed to retrieve and summarize the findings of research involving currently serving ADF personnel with outcomes relevant to male or female reproductive health or any aspect of female health.Materials and Methods Reproductive and female health studies between January 2002 and April 2023 that included serving ADF members were identified through a systematic search of 5 scientific databases. Data were extracted and synthesized, alongside a risk of bias assessment following PRISMA-ScR guidelines.Results Overall, 8 studies relating to reproductive health and 14 studies related to female health were identified. Studies were methodologically heterogeneous: few studies were at low risk of bias and few covered the same health outcome, preventing pooling of data. Four studies of males concluded that deployment to the Middle East was not associated with risk of infertility or birth defects. Female reproductive health studies provided very limited data. Other female health research primarily covered musculoskeletal disorders and injuries from basic training.Conclusions Studies of reproductive and female health in ADF members do not currently provide a cohesive or comprehensive body of evidence in either area. This review serves as a systematic map of the existing evidence to identify gaps and set future strategic research agendas. More high-quality longitudinal studies with sex-stratified analyses are urgently needed, as is a strategic focus on health outcomes that may affect military preparedness and fitness for deployment.

OBJECTIVES:While injuries/illnesses among emergency responders during extreme bushfires in Victoria, Australia, are well-documented, the impact of bushfire periods on return-to-work (RTW) outcomes is less understood. This study investigates whether workers' compensation claims lodged during extreme bushfire periods are associated with slower RTW, more lost work time and time-off-work relapse. METHODS:Workers' compensation claims made by emergency responders in Victoria (Australia), 2005-2023, were analysed. Claims for injuries/diseases occurring during bushfire periods were compared with those made during non-bushfire periods. Time to first full RTW was determined from income compensation payments as time until first payment cessation of ≥10 days. RTW was analysed using Cox regression models. Compensated workdays and time-off-work relapse occurrences were modelled using generalised linear models and logistic regression, respectively. RESULTS:Among 11 773 claims, 398 (3.4%) were lodged during extreme bushfires. Extreme bushfire period claims were associated with longer time to RTW (HR of 0.81, 95% CI 0.73 to 0.91). In extreme bushfire periods, median compensated days per claim were 74 (IQR 20, 346) versus 58 (18, 212) in other time periods. In the adjusted modelling, the count ratio for extreme bushfire periods (vs other time periods) was 1.13 (95%CI 1.01 to 1.27): a 13% increase in expected compensated days. Time-off-work relapse occurrence was not significantly affected by extreme bushfire periods. CONCLUSION:In emergency responders, bushfire period claims were associated with increased duration of time off work. Tailored RTW programmes that proactively gauge claim complexity associated with exposure to extreme bushfires, as well as provision of targeted services, should be considered.

Bushfires (also known as wildland or forest fires) expose emergency responders to occupational hazards under exceptional circumstances. Whilst the health impacts of structural firefighting have been studied, less is known about the non-respiratory health impacts or risk of mortality amongst bush firefighters, who can be volunteers. More information about health risks is needed to generate effective prevention strategies. To critically evaluate and synthesise the published evidence about the non-respiratory health risks and risk of mortality associated with bushfire fighting. A systematic literature search was conducted in Medline, Scopus, and Embase to identify studies evaluating morbidity or mortality or associated risk factors among bushfire fighters. The quality of included studies was evaluated twice independently using a specific quality assessment tool. Twenty-seven studies were included. 11(41

BACKGROUND:Around 2.5 million people in the UK are absent from work due to ill health, yet, for many, accessing work-orientated vocational support (VS) to facilitate return to work (RTW) is challenging. The majority of fit notes are issued in primary care, making this an ideal setting to provide VS. AIM:As part of the Work And Vocational advicE (WAVE) randomised controlled trial (RCT), we explored the delivery of VS by trained vocational support workers (VSWs), from the perspectives of patients, VSWs, employers, and GPs. DESIGN & SETTING:In the WAVE RCT, patients from 10 UK general practices were randomised to the offer of usual care or usual care plus VS. This qualitative study explored stakeholder perspectives of the VS intervention. METHOD:Semi-structured interviews were conducted with participants in the intervention arm (n = 10), employers, VSWs, and GPs (n = 5). Interviews were audio-recorded, transcribed, and analysed using thematic analysis. Public and patient involvement and engagement was embedded throughout. RESULTS:Taking a person-centred, individualised approach to VS enabled VSWs to identify and mitigate RTW obstacles and support participants' self-efficacy to proactively negotiate RTW. The perceived independence of the VSWs from employers and health care was considered important and facilitated more open discussions about capabilities and RTW planning. CONCLUSION:Findings indicated that individualised and independent VS offered to patients referred from primary care was perceived by all stakeholders to be valuable to patients absent from work due to illness and supported their RTW planning. These insights can inform future models of VS.

BACKGROUND:The fabrication and installation of artificial (engineered) stone countertops is a relatively new cause of silicosis. Our aim was to investigate silicosis rates in Victoria, Australia, and the association with stone countertop industry work. METHODS:Workers' compensation claims for silicosis from January 1, 1991 to December 31, 2022 were analyzed across 8-year time periods. Incidence rates per 100,000 persons were calculated by time period, age, and sex. Additionally, incident silicosis cases were reported to a clinical registry by respiratory physicians from May 1, 2019 to December 31, 2022, and analyzed by referral source and occupational history. RESULTS:Over 32 years, there were 536 workers' compensation claims for silicosis (98.9% male, median age 40 years). In total, 482 (89.9%) were received between 2015 and 2022, a 27-fold increase from the previous 8-year period. The incidence rate for silicosis claims in the adult population increased from 0.12 per 100,000 in 1991-1998 to 2.38 per 100,000 in 2015-2022. In the clinical registry there were 210 incident cases between 2019 and 2022; 97% worked in the countertop industry, 95% with artificial stone. Almost all (89%) cases had been referred following participation in a government screening program for stone countertop industry workers. CONCLUSION:There has been a major rise in compensation claims for silicosis in Victoria. Active screening of stone countertop workers led to the diagnosis of almost all registered incident silicosis cases. This underscores the risk to stone countertop workers and highlights the potential for under-recognition of silicosis without screening at-risk workers, especially in countries where artificial stone has become popular.

Rationale: Silicosis is an occupational lung disease caused by the inhalation of respirable crystalline silica dust. Presentation is highly variable, with early stages often being asymptomatic. Exertional dyspnoea is often reported without significant lung function reduction or radiological changes. X-ray velocimetry (XV) ventilation analysis is a 4-dimensional method for quantifying lung ventilation that may provide greater sensitivity to lung physiological impairment associated with disease development and progression. The aim of this study was to examine the correlation between traditional lung function measures and novel measures of lung ventilation in patients with silicosis. Methods: Patients with silicosis were recruited from the Alfred Hospital's Occupational Respiratory Clinic in Melbourne, Australia between April 2023 and November 2024. Eligibility included being over the age of 18 years and able to provide consent. Respiratory measures included FVC% predicted from spirometry; total respiratory resistance (Rs5) and total respiratory elastance (AX5) from forced oscillation technique (FOT). XV metrics (4DMedical), included mean specific ventilation (MSV) defined as ratio of volume change during a single tidal inspiratory breath to the volume at end-expiration and ventilation heterogeneity (VH), a non-dimensional indicator of the spread of the ventilation frequency distribution. Dyspnoea was assessed using the modified Medical Research Council Dyspnoea scale (mMRC) and Dyspnoea-12 questionnaire. Correlations were assessed using Pearson's correlation coefficients and are based on whole lung inspiratory data. Results: 14 participants (100% male) had average age 45.14 years (SD 8.64, range 31-59 years), BMI 26.52 ± 4.17kg/m2 and average FVC% predicted of 87.29 ±14.86, with 71% having simple silicosis. Higher FVC% predicted was associated with lower MSV and VH, however correlations were weak to moderate (Table 1). Measures of ventilation showed weak correlation with dyspnoea scores. There were no differences in MSV or VH between those with simple or complicated silicosis. Conclusion: Preliminary analysis suggests XV ventilation metrics are negatively correlated to FVC% predicted, positively correlated with levels of dyspnoea and similar in both simple and complicated cases of silicosis. These modest associations may indicate that XV metrics measure aspects of respiratory function that are not captured by conventional measures, but larger samples and further analysis is needed.

OBJECTIVE:To assess Australian clinical guidelines for their inclusion of sex and gender. DESIGN, SETTING:Survey of all clinical guidelines published in Australia from 1 January 2014 to 31 April 2024 that employed methods such as Grading of Recommendations, Assessment, Development, and Evaluations, or were endorsed, approved or acknowledged by the National Health and Medical Research Council or another major national body, or concerned marginalised groups. MAIN OUTCOME MEASURES:Use of the terms "sex", "gender", "female", "male", "women", "men", "girl" and "boy"; definitions of "sex" and "gender"; and incorporation of sex- and gender-relevant guidance. RESULTS:The 80 eligible guidelines were from 51 organisations and covered 27 areas of practice. No sex- or gender-related terms were found in 12 of the guidelines. Of the remaining 68 guidelines, most used some of these terms only a few times, with 34 of them using "gender" to mean "sex". "Sex" and "gender" were defined to some extent in four guidelines. There was no reference to clinical practice concerning sex in 15 of the guidelines. A total of 46 guidelines made no mention of clinical practice concerning gender, only 12 included gender-relevant practice in any detail, and the remaining 22 either implied aspects of gender awareness without stating this or mentioned "psychosocial" or "cultural" considerations. Guidelines drew on heterogeneous research, some of which provided no sex-disaggregated data. CONCLUSIONS:Guideline development bodies should be encouraged to assess evidence for its treatment of sex and gender, to enable strategies to counter inequity and discrimination.

Objectives Many individuals diagnosed with inflammatory arthritis are of working age and experience challenges in maintaining employment. The WORKWELL vocational rehabilitation programme, delivered by occupational therapists in National Health Service rheumatology clinics, is designed to support job retention by aligning individuals' abilities with their work demands. As part of a multicentre randomized controlled trial, this qualitative process evaluation explored therapists' and line managers' perspectives on the training, implementation and delivery of WORKWELL to inform its future integration and scalability.Methods A qualitative study was conducted using semi-structured interviews with 18 occupational therapists (26 interviews in total, pre- and post-trial) and 5 line managers across 17 National Health Service Trusts in England, Wales, and Scotland. Reflexive thematic analysis was applied inductively, followed by a deductive Normalization Process Theory analysis to explore intervention coherence, engagement, implementation and sustainability.Results Before the trial, work support was inconsistent, with occupational therapists providing informal advice and signposting but lacking structured vocational rehabilitation assessments. Post-trial, therapists viewed WORKWELL as a valuable, structured intervention, enhancing job retention support. Remote delivery during COVID-19 was well-received, improving accessibility. However, implementation challenges included time constraints, increased workloads and staffing shortages. Line managers had limited involvement but recognized the programme's benefits, though concerns about long-term sustainability remained.Conclusions WORKWELL was successfully integrated into National Health Service practice, with remote delivery enhancing accessibility. Addressing workforce constraints, managerial engagement and digital integration could improve long-term feasibility and impact, ensuring sustained access to job retention support for people with inflammatory arthritis.Trial registration ClinicalTrials.gov NCT03942783; ISRCTN Registry ISRCTN61762297. What does this mean for patients?Many people with inflammatory arthritis, such as rheumatoid arthritis (RA), experience difficulties at work, with nearly half leaving employment within 10 years. In rheumatology clinics, occupational therapists (OTs) provide work advice, but support is often brief and unstructured.To improve job retention, therapists were trained to deliver WORKWELL, a structured vocational rehabilitation (VR) programme designed to help people with arthritis stay in work while managing their condition. In a study, participants were randomly assigned to receive either usual care alone or usual care plus WORKWELL, which included tailored work assessments and strategies to help them manage work challenges.After the study, we interviewed therapists and line managers to understand their experiences delivering WORKWELL in the National Health Service (NHS), including the training they received, how they felt about implementing the programme and the challenges they faced.Despite staff shortages and increasing NHS pressures, WORKWELL was successfully implemented, including remote consultations during COVID-19, which improved access for some patients. However, challenges remain, including longer waiting times and limited NHS resources. Findings highlight the need for targeted work support for people with arthritis and suggest that an online version of WORKWELL could improve access to job retention support in the future.

The COVID-19 pandemic enforced changes on employment circumstances for all workers but older workers experiencing job loss are less likely to return to work than younger individuals. Under normal circumstances, job loss is a well-recognised risk factor for poor mental health, while it is unclear whether working from home is beneficial or harmful to mental health. We systematically reviewed the literature to explore the association between enforced changes in employment (job loss, working from home or being furloughed) and anxiety in the adult population, with a particular focus on older workers. The protocol was registered in June 2021 in the International Prospective Register of Systematic Reviews database. We searched Medline, Embase, PsycInfo and CINAHL (January 2020–July 2023) databases for studies including older adults (some of the study sample were workers aged over 50 years). Results were presented by narrative review, complemented by a vote-counting technique and effect direction plots to summarise the relationship between exposures and anxiety. Forty-eight studies from several countries met the inclusion criteria, including 39 cross-sectional and nine longitudinal studies. The prevalence of anxiety varied between studies due to different tools and cut-offs chosen, reaching as high as 63

Objectives:This study aimed to qualitatively examine the delivery of the WORKWELL trial, a job retention vocational rehabilitation (JRVR) programme designed to help individuals with inflammatory arthritis (IA) maintain employment. A qualitative process evaluation used the Normalization Process Theory (NPT) to understand participant experiences and identify factors influencing implementation and outcomes. Methods:Data were collected via one-to-one telephone interviews with trial participants at 12 and 36 months. An inductive reflexive thematic analysis was followed by a deductive analysis based on NPT's four constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results:Sixty-two participants (mean age 51.0; 82.3% female) were interviewed, most diagnosed with RA (75.8%). Four secondary themes were generated under NPT constructs. For 'Coherence', themes included 'Exploring the Purpose and Impact of Taking Part in WORKWELL' and 'Questionnaires as Instrument for Reflection'. In 'Cognitive Participation', the theme was 'Commitment and Investment to WORKWELL'. For 'Collective Action', we identified 'Key Actions for Successful WORKWELL', and under 'Reflexive Monitoring', the theme was 'Suggestions for Improving WORKWELL'. These themes reflected participants' mixed feelings about the intervention, finding value in the intervention but highlighting the need for more tailored, timely and relevant content. Workplace support was crucial but often insufficient. Follow-up calls from researchers to ensure questionnaire completion were seen as a way to reflect and monitor their conditions. The pandemic's impact on work environments also influenced outcomes. Conclusion:Findings suggest that WORKWELL provided work support for participants, though its impact could be enhanced through greater customization, early intervention and stronger workplace engagement. Trial registration:ClinicalTrials.gov NCT03942783. Registered on 8 May 2019. ISRCTN Registry ISRCTN61762297. Registered on 13 May 2019. Retrospectively registered.

BACKGROUND:Silicosis has re-emerged in middle- and high-income countries globally due to high silica exposures from manufacturing and fabrication of artificial stone countertops. No studies have reported the costs of workers' compensation claims for silicosis; we therefore examined cost trends in Victoria, Australia, and projected claim costs to 2031. METHODS:Data from the WorkSafe Victoria Compensation Research Database were used to identify all silicosis compensation claims among males from 2019 to 2024, and claim rates were estimated per year and age group. Using Poisson regression model estimates, claim cost projections were calculated for 2025-2031, separately for statutory (no-fault) and common law (fault-based) payments. RESULTS:From 2019 to 2024, there were 663 silicosis compensation claims made by 356 males aged 15-74 years in Victoria. Cumulative costs totaled AU $111.78 million. Annual cost projections suggest an increase over time, with a total of AU $29.88 million per year by 2031. Most claims remained active for over a year, particularly those by workers aged 25-54 years. Within 4-year follow-up, common law (fault-based) payments accounted for approximately 30% of total costs but dominated younger workers' claims. Projected 2031 costs were highest for claims by workers aged 35-44 years. CONCLUSIONS:This study presents the first comprehensive estimate of projected workers' compensation costs for silicosis, highlighting a sustained financial burden driven by ongoing claims among younger workers. As artificial stone continues to be used internationally, these findings underscore the need for regulatory action to prevent a foreseeable health and economic burden.

Background In 2014, an open-cut coal mine caught fire in a rural area of Australia. Local residents were affected by dense black smoke over several weeks. Little evidence was available to guide health policy-makers about risks to health, vulnerable populations or strategies for harm mitigation. A long-term health study was commissioned, which showed excess cardiac-related deaths in the 6 months following the fire. Methods An adult cohort of 4,056 people was recruited in 2016-17 using the electoral roll, sampling from the town with the highest exposure to coal mine fire smoke and another similar town without significant exposure. To estimate individual-level smoke exposure, participant`s time-location diaries were blended with high resolution estimates of hourly fire-related PM2.5 based on meteorological and chemical transport models. All-cause mortality data were obtained up to mid-2023 (six to seven years after the cohort was established, and nine years after the fire) by linkage with the National Death Index. Cardiac-related deaths were identifiable up to December 2021 and predicted thereafter to mid-2023. Differences in all-cause mortality were evaluated with Cox proportional-hazards models and differences in cardiac mortality with a competing risk survival model. Results In total, 2,725 (67%) cohort members consented to linkage. Residents of both towns were similar except those in the minimally exposed town were more socio-economically advantaged. Over six to seven years of follow-up, 303 (11%) of the sample died. While all-cause mortality was not increased, mortality from cardiac causes was increased in association with PM2.5 exposure, robust to adjustment for known confounders. Discussion In a community where we have previously shown excess cardiac deaths in the 6 months following the fire, we now find additional excess cardiac mortality between 2 and 9 years after the event, associated with mine fire PM2.5 exposure. This finding concords with a growing body of evidence after acute exposure to wildfires and chronic exposures from household or ambient air pollution. Measures are needed to protect individuals from exposure to smoke during and after large fire events. ### Competing Interest Statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michael J Abramson reports financial support was provided by Pfizer Inc. Michael J Abramson reports financial support was provided by Boehringer Ingelheim Corp USA. Michael J Abramson reports financial support was provided by Sanofi. Michael J Abramson reports financial support was provided by GlaxoSmithKline Inc. ### Funding Statement This work was funded by the Victorian Department of Health. The paper presents the views of the authors and does not represent the views of the Department. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Monash University Human Research Ethics Committee (MUHREC; Project ID: 25680; previously CF15/872 - 2015000389 and 6066) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Over half of individuals diagnosed with inflammatory arthritis (IA) are of working age, often facing work instability due to the condition. The Workwell vocational rehabilitation programme, delivered by occupational therapists in NHS rheumatology clinics, aims to help individuals with IA retain their jobs by aligning their abilities with job demands. Conducted as part of a multicentre randomised controlled trial (RCT), this qualitative process evaluation explored therapists’ and their line managers’ perspectives on the training, delivery, and implementation of the intervention, providing critical insights to improve the program’s future application. A qualitative design was employed using semi-structured pre- and post-trial interviews with therapists and line managers from 17 NHS Trusts across England, Wales and Scotland. Interviews were transcribed verbatim and analysed using a two-step approach: an inductive thematic analysis followed by deductive analysis guided by Normalisation Process Theory (NPT) constructs of coherence, cognitive participation, collective action, and reflective monitoring. These constructs informed the interpretation of how the intervention was integrated into clinical practice and its potential for scalability. Pre-trial interviews revealed that work-related support provided by occupational therapists was inconsistent, with referrals often coming from other health professionals or through patient self-referral. While therapists addressed work-related issues during consultations, the use of standardised work assessments was limited. Work advice typically lasted only 10-15 minutes, and most therapists expressed hope that the Workwell programme would offer a more structured approach to assessment and intervention planning. In post-trial interviews, Workwell was perceived as a valuable and structured intervention. Therapists appreciated the training and toolkit, which enabled them to address work-related challenges more effectively. Remote delivery, particularly during the COVID-19 pandemic, was considered an effective adaptation, with most patients completing the intervention remotely. However, therapists reported challenges in implementing the programme due to time constraints, increased workloads, and staffing shortages. Line managers were less involved and largely relied on therapists for feedback. While they recognised the benefits of the programme, they expressed concerns about its time-intensive nature and the difficulties of sustaining it given post-pandemic resource limitations in the NHS. The Workwell programme demonstrated successful adaptability and integration into NHS services, including during the pandemic, with remote delivery showing promise for future practice. Nevertheless, challenges such as resource constraints and rising patient demand must be addressed to ensure sustainability. These insights highlight the need for continued investment in vocational rehabilitation programs and the potential benefits of digitising the Workwell program to facilitate its widespread implementation and accessibility. Y. Prior: None. S. Battista: None. A. Mathew: None. J. Parker: None. S. Gates: None. A. Ching: None. A. Hammond: None. K. Radford: None. P. Holland: None. T.W. O’Neill: None. K. Walker-Bone: None.

Background/Objectives: Patient safety is directly linked with health and wellbeing of healthcare workers. In the UK, COVID-19 severely disrupted healthcare, with surgeons tackling prolonged waiting lists and working longer hours under high stress. This study explored the biomechanical and psychosocial demands on hospital surgeons, as well as their experience of pain and work-life balance post-pandemic. Methods: A questionnaire was developed combining validated tools assessing physical demands; modified job demand, control, and support; the WHO-5 wellbeing index; work–life balance from the Copenhagen Psychosocial Questionnaire; musculoskeletal pain; job satisfaction and retirement intentions. An online survey was developed using the Qualtrics© (Provo, UT, USA) platform and circulated through surgical networks using snowball sampling. Poisson regression modelling with robust confidence intervals was used to explore relationships between work-related factors and musculoskeletal pain, and associations with retirement intentions. Results: In total, 242 replies were received. Surgeons frequently reported strenuous occupational activities and work–life imbalance, and one in six reported job dissatisfaction. Only 17% reported no pain; the one-month prevalence of pain ranged from 46% at the lower back to 12% at the ankle, and pain was frequently disruptive. Better work–life balance had a protective effect for pain (PRR = 0.92, 95% CI = 0.85–0.99), while risk of pain increased with increasingly physically demanding activities at work (PRR = 1.04, 95% CI = 1.01–1.07) in the age- and sex-adjusted models. Job dissatisfaction was associated with intention to retire early (PRR = 1.83, 95% CI = 1.02–3.27). Conclusions: This study demonstrated high physical and mental demands among surgeons and poor work–life balance. Physical and emotional links to pain were identified. Fit surgeons ensure safe patient care. Our findings suggest that surgeons were facing health issues and work–life conflict post-pandemic, potentially limiting their job satisfaction and career span. A follow-up study is recommended.

Work participation is beneficial for health. Diabetes mellitus is highly prevalent among adults, and although it poses a substantial healthcare cost burden, the true burden might be greater than is currently appreciated through effects on work participation. This Review summarizes the evidence regarding the effect of diabetes mellitus on paid employment. Several studies report increased risks of unemployment, early retirement and productivity loss among those with diabetes mellitus. The presence of diabetes mellitus complications and comorbidities probably further decreases work participation. Studies of workplace interventions demonstrate that work ability can be improved in people with diabetes mellitus. However, most existing research does not consider work characteristics (for example, type of work and working hours) in diabetes mellitus management. Whether diabetes mellitus itself increases occupational injury risk is unclear, with conflicting results reported. Most studies were cross-sectional and limited by use of self-reported diabetes mellitus and outcome measures, without consideration of the type of diabetes mellitus. Guidance on diabetes mellitus and employment has, to date, not been strongly grounded in evidence. Detailed research exploring factors implicated in work outcomes for people with diabetes mellitus, including age, sex, occupation and diabetes mellitus type, is needed to inform policy and support sustainable employment for those with diabetes mellitus. Participating in paid work is known to have beneficial effects; however, how diabetes mellitus might affect work participation is unclear. This Review outlines the available evidence and highlights research gaps.

OBJECTIVES:Compared with silicosis, there has been less research on other respiratory diseases in stone benchtop industry workers. Therefore, we explored respiratory symptoms, airflow obstruction and asthma, including associations with workplace dust exposure, in these workers. METHODS:This study included voluntary participants from a stone benchtop industry screening programme conducted in Victoria, Australia, which included chest X-rays, respiratory function tests and a respiratory symptom questionnaire. Asthma status was determined based on self-report, and respiratory function tests were used to measure airflow obstruction. The associations between workplace dust exposure and respiratory symptoms were compared using logistic regression, adjusting for age, smoking status and silicosis. RESULTS:The prevalence of self-reported asthma in this cohort was 20% (90/450 workers). Workers with histories of high workplace dust exposure, even those without silicosis, were more likely to have self-reported asthma and to report respiratory symptoms. Those with obstruction but no bronchodilator response on respiratory function tests were more likely to report histories of high workplace dust exposure. For over half of workers with wheeze or difficulty breathing, symptoms improved at weekends and/or on holidays. CONCLUSIONS:There was a high prevalence of self-reported asthma in stone benchtop industry workers and an association between workplace dust exposure and airflow obstruction without bronchodilator response, as well as self-reported asthma, independent of silicosis. These findings suggest a potential role of artificial stone dust exposure in the development of obstructive lung disease, in addition to silicosis.

BACKGROUND:The premenopause-to-perimenopause transition is defined by the Stages of Reproductive Aging Workshop +10 (STRAW+10) criteria according to changed menstrual cycle frequency. However, this approach is unhelpful for women and gender-diverse people with oligomenorrhoea or amenorrhoea, and also because a range of diverse symptoms have been ascribed to menopause. We investigated the prevalence and severity of symptoms from the late reproductive stage to late postmenopause, identifying those which might best differentiate menopause onset. METHODS:The Australian Women's Midlife Years (AMY) Study was a nationally representative cross-sectional study of women aged 40-69 years who were recruited via a non-probability panel using online and offline sources between Oct 27, 2023, and March 19, 2024. To be eligible, participants needed to be able to complete a questionnaire in English. Menopausal symptoms were assessed using the Menopause-specific Quality of Life (MENQOL) questionnaire. Symptom prevalence and severity over the previous 4 weeks was calculated with 95% CIs, with prevalence ratios adjusted for age, BMI, and other demographic variables. FINDINGS:8096 women were recruited: 5509 women were classified using STRAW+10 as premenopausal (n=1250), early perimenopausal (n=344), late perimenopausal (n=271), and postmenopausal (n=3644). Among moderately-to-severely bothersome symptoms, hot flushes showed the greatest change in prevalence from premenopause (8·8% [95% CI 7·2-10·4]) to late perimenopause (37·3% [31·5-43·0]; adjusted prevalence ratio 4·74 [95% CI 3·64-6·19]). Less variation was apparent for other symptoms, including poor memory and low mood. Vaginal dryness was the most discriminative sexual symptom from premenopause to late perimenopause (adjusted prevalence ratio 2·54 [95% CI 1·78-3·61]). Women with vasomotor symptoms and changed menstrual flow had more prevalent moderately-to-severely bothersome symptoms compared with women without vasomotor symptoms. Compared with premenopausal women with vasomotor symptoms and changed menstrual flow, early perimenopausal women with vasomotor symptoms reported a higher prevalence of poor memory (adjusted prevalence ratio 1·36 [95% CI 1·06-1·75]). INTERPRETATION:Our findings suggest that moderately-to-severely bothersome vasomotor symptoms can reliably indicate the onset of perimenopause in women with oligomenorrhoea or amenorrhoea. Although other symptoms might be caused or exacerbated by menopause, other factors contributing to their occurrence need to be considered and included in management and care. Additionally, treatment options and care pathways are crucial to improve wellbeing during the perimenopause. FUNDING:National Health and Medical Research Council. TRANSLATIONS:For the Chinese and Spanish translations of the abstract see Supplementary Materials section.