Occupational and environmental medicine

To examine the prevalence of depressive symptoms and suicidal ideation, their comorbidity, and associated risk factors in adolescence. A self-administered questionnaire was completed in class by students in three middle schools (grades 6 through 8) enrolling more than 3,200 students. Usable questionnaires were obtained from 2,614 (81.5%), of which 924 were Anglo and 1,354 were of Mexican origin Depression was measured using the 20-item Center for Epidemiologic Studies Depression Scale and suicidal ideation using four items on thoughts of death and suicide. The minority adolescents reported significantly higher crude prevalence rates of symptoms of depression and thoughts of suicide than their Anglo counterparts. Prevalence rates were highest for females of Mexican origin. There was a strong association between depression and suicidal ideation in both ethnic groups. Multivariate logistic regression analyses indicated significant correlates of depressive symptoms were suicidal ideation (adjusted odds ratio = 10.9), loneliness, and use of English, in that order. Significant correlates of suicidal ideation were depression (adjusted odds ratio = 10.6), loneliness, two-parent household, use of English, and being of Mexican origin. More than 80% of those with high ratings on suicidal ideation scored as depressed in both ethnic groups. Results are consistent with other studies suggesting rates of suicidal ideation among adolescents are in the 10% to 20% range, while rates of depressive symptoms are in the 35% to 50% range using standard caseness scores. Mexican-American youths appear to be at higher risk than Anglo youths, particularly for suicidal ideation. In addition, it appears that youths who are lonely are more likely to report higher rates of both depression and suicidal ideation. The data also indicate that youths who spoke only or mostly English reported lower rates of depression and suicidal ideation, suggesting that acculturation may play a role as well.

ObjectivesThe risk of diabetes mellitus may be elevated among persons exposed to some pesticides, including cholinesterase-inhibiting insecticides (organophosphates and carbamates). The objective of this study was to investigate how acetylcholinesterase activity was associated with mean blood glucose levels among smallholder farmers in Uganda.MethodsWe conducted a short-term follow-up study among 364 smallholder farmers in Uganda. Participants were examined three times from September 2018 to February 2019. At each visit, we measured glycosylated haemoglobin A (HbA1c) as a measure of long-term average blood glucose levels. Exposure to organophosphate and carbamate insecticides was quantified using erythrocyte acetylcholinesterase normalised by haemoglobin (AChE/Hb). For a subgroup of participants, fasting plasma glucose (FPG) was also available. We analysed HbA1c and FPG versus AChE/Hb in linear mixed and fixed effect models adjusting for age, sex, physical activity level, and consum...

To determine prevalence and incidence of carpal tunnel syndrome (CTS) in a modern meat packing plant. The secondary objective was to explore the relation between ethnicity and CTS. Six hundred and sixty five workers were interviewed and examined to find the prevalence of CTS. Subsequently, 421 workers without CTS were followed up and examined at a median interval of 253 days; of those, 333 remained without CTS and were again examined at a median interval of 148 days. The prevalence and incidence of CTS was 21% and 11/100 person-years, respectively. The incidence for Asian mixed, white, and other ethnicities was 12.0, 12.2, and 7.2 cases/100 person-years, respectively. The observed incidence for men and women was 9.7 and 18.4 cases/100 person-years, respectively. This difference was not quite significant (p = 0.068) with an estimated relative risk (women v men) of 1.9 (95% confidence interval (95% CI) 0.9 to 3.8). The interaction between sex and use of tools was significant (p = 0.04), however, although the relative risk for CTS in women who used tools was 4.2 the numbers were small and not significant. The relative risk for men who used tools was 0.64 and not significant. The percentage of incident cases with comorbid disease was only 6.3% (3/47). The prevalence and incidence of CTS in this workforce were higher than in the general population. However, the prevalence of CTS in this modern, mechanised plant was not significantly different from that reported in older plants. No relation was found between ethnicity, age, body mass index, and CTS for either prevalence or incidence. Comorbid disease among the cases of CTS is significantly less than that found in other industry.

Occupational stress is an emerging problem among physician and nurses, and those working in intensive care settings are particularly exposed to the risk of developing burnout. To verify what types of interventions to manage occupational stress and burn out within neonatal intensive care units (NICUs) have been introduced so far and to verify their efficacy among caregivers. PsycINFO (PsycINFO 1967–July week 3 2019), Embase (Embase 1996–2019 week 29) e Medline (Ovid MEDLINE(R) without revisions 1996–July week 2 2019) were systematically searched combining MeSH and free text terms for “burn out” AND “healthcare provider” AND “NICU”. Inclusion criteria were interventions directed to healthcare providers settled in NICUs. Only English language papers were included. Six articles were included in the final analysis. All the studies reported an overall efficacy of the interventions in reducing work-related stress, both when individual focused and organisation directed. The analysis reveale...

ObjectiveObservational studies indicate an association between working nights and miscarriage, but inaccurate exposure assessment precludes causal inference. Using payroll data with exact and prospective measurement of night work, the objective was to investigate whether working night shifts during pregnancy increases the risk of miscarriage.MethodsA cohort of 22 744 pregnant women was identified by linking the Danish Working Hour Database (DWHD), which holds payroll data on all Danish public hospital employees, with Danish national registers on births and admissions to hospitals (miscarriage). The risk of miscarriage during pregnancy weeks 4–22 according to measures of night work was analysed using Cox regression with time-varying exposure adjusted for a fixed set of potential confounders.ResultsIn total 377 896 pregnancy weeks (average 19.7) were available for follow-up. Women who had two or more night shifts the previous week had an increased risk of miscarriage after pregnancy w...

Prevalence studies show high levels of burnout, anxiety, fatigue and other symptoms of distress among medical doctors. However, there are very few randomized controlled trials testing interventions against these problems. This randomized controlled trial (NCT02838290; ClinicalTrials.gov, 2016) tested interventions teaching 227 doctors about the psychology of burnout, stress, coping with patient death, and managing distress, as well as giving them information about prevalence rates among doctors. Primary outcomes included burnout, anxiety, insomnia, grief, alcohol/drug use, binge eating, physical symptoms, and psychiatric morbidity. The outcomes were tested before and after the interventions with a 7-day time-lag. The intervention significantly decreased doctors’ levels of burnout (e.g. emotional exhaustion and depersonalization) and anxiety. Doctors in the control group had no significant changes in these signs of distress. The intervention did not significantly reduce other health and habit-related outcomes potentially because these need a longer time-lag than 7 days. Interventions teaching doctors about the psychology of work-related distress reduce burnout and anxiety by helping doctors realize that distress is a normal, human reaction to external stressors, common in medicine, and solvable by learning about psychological coping strategies.