Endometrial hyperplasia-related inflammation: its role in the development and progression of endometrial hyperplasia

Abstract

Background

Endometrial hyperplasia (EH) is one of the most common gynecologic diseases in the world. Different statistical categories implicate an imbalance of estrogens and progestogens in the etiology of this disease. We propose that inflammation also plays a key role in the progression of endometrial hyperplasia.

Objective

The aim of this study is to evaluate the role of inflammation in the transformation and progression of endometrial hyperplasia, using local inflammatory cytokines and nonspecific protease levels, CD 45⁺ expression, and histological examination.

Design

The study included 107 patients (ages 29–49 years) with different forms of endometrial hyperplasia. The enrolled patients were randomized into one of the four groups: normal endometrium (n = 18) as the control group, simple hyperplasia (n = 41), complex hyperplasia without atypia (n = 36), complex atypical hyperplasia or endometrioid adenocarcinoma (n = 12).

Methods

The following were evaluated for patients with different forms of EH: steroid hormone levels in blood serum and uterine flushings, immunohistochemical estrogen and progesterone receptor expression patterns in the endometrial tissue, CD 45⁺ (common leukocyte antigen) expression, the levels of the cytokines IL-1β, IL-6, and TNF-α, and nonspecific proteases and their inhibitors.

Results

The level of estradiol in blood serum and especially in uterine flushings was elevated dramatically in simple EH as compared to that of controls, but there was no significant difference between estradiol levels among the different forms of EH. The estimation of CD 45⁺, the levels of the cytokines IL-1β, IL-6, and TNF-α, and the activity of proteases (elastase-like and trypsin-like activities) and their inhibitors showed that levels of nonspecific inflammatory markers increase with EH progression.

Conclusions

We suggest that the initial responsibility for the development of simple endometrial hyperplasia belongs to systemic hyperestrogenemia and, in particular, local hyperestrogenia, but that the role of inflammatory processes increases in complex and atypical EH. Development of inflammatory changes in endometrial hyperplasia may be considered as a factor in the promotion and progression of pathology, as well as an attributed risk factor for malignancy in endometrial hyperplasia. In this study, we have established a role for CD 45⁺ expression cells, non-specific proteases, and the inflammatory cytokines IL-1β, IL-6, and TNF-α in endometrial hyperplasia-related inflammation.

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Prevalence of airflow obstruction among ever-employed US adults aged 18-79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007-2010

Objectives

To estimate the prevalence of spirometry-defined airflow obstruction among ever-employed US adults.

Methods

Data from the 2007 to 2010 National Health and Nutrition Examination Survey (NHANES) for adults 18–79 years with valid spirometry and longest held occupation were analysed. The age-standardised prevalence of spirometry-defined airflow obstruction was estimated overall and by smoking status.

Results

Age-standardised prevalence of airflow obstruction was 13.7% (95% CI 12.4% to 15.0%) and was highest in participants aged 60–79 years (17.4%, 95% CI 15.2% to 19.6%), males (14.8%, 95% CI 12.0% to 17.6%), non-Hispanic whites (15.4%, 95% CI 13.8% to 16.7%) and ever smokers (19.1%, 95% CI 16.6% to 21.5%). Age-standardised prevalence of airflow obstruction was >20% for installation, maintenance and repair occupations (p=22.1%, 95% CI 16.5% to 27.8%), and for construction and extraction occupations (20.7%, 95% CI 13.5% to 27.9%).

Conclusions

Prevalence of airflow obstruction varied by demographic characteristics and occupational factors with a higher prevalence among ever smokers for most demographic characteristics and occupational factors. Study findings emphasise the importance of monitoring the lung function of workers in occupations with a high prevalence of airflow obstruction.

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Sputum neutrophils are elevated in smelter workers, and systemic neutrophils are associated with rapid decline in FEV1

Objectives

In a previous study on smelter workers we, found significant relationship between exposure to dust and accelerated annual decline in forced expiratory volume in 1 s (FEV₁). In this cross-sectional study at the end of a follow-up, we aimed to investigate the possible association between annual decline in FEV₁ and markers of airways, and systemic inflammation in smelter workers.

Methods

Employees (n=76 (27 current smokers)) who had been part of a longitudinal study (9–13 years) that included spirometry (>6 measurements) and respiratory questionnaires, performed induced sputum, exhaled NO and had blood drawn. Participants with annual decline in FEV₁≥45 mL were compared with participants with annual decline <45 mL; also 26 non-exposed controls were included.

Results

Compared with non-exposed controls, smelter workers demonstrated a significantly increased percentage of neutrophils (mean (SD)) (57% (17) vs 31% (15)) and matrix metalloproteinases 8 (MMP-8) levels in sputum, and MMP-9, surfactant protein D (SpD) and transforming growth factor β (TGFb) levels in blood. A significant association in FEV₁≥45 mL was found for blood neutrophils when controlling for smoking habits (OR=1.7 (95% CI 1.0 to 2.8), p=0.045). Airway and blood protein markers were not associated with annual decline in FEV₁.

Conclusions

All workers displayed airway and systemic inflammation characterised by increased levels of neutrophils and MMP-8 in sputum, and MMP-9, SpD and TGFβ in blood compared with non-exposed controls. Blood neutrophils in particular were significantly elevated in those workers with the most rapid decline in lung function. A similar observation was not seen with airway neutrophils. In the present study, we were able to identify systemic but not airway inflammatory markers that can predict increased decline in FEV₁ in smelter workers.

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Personal exposure to ultrafine particles from PVC welding and concrete work during tunnel rehabilitation

Objectives

To investigate the exposure to number concentration of ultrafine particles and the size distribution in the breathing zone of workers during rehabilitation of a subsea tunnel.

Methods

Personal exposure was measured using a TSI 3091 Fast Mobility Particle Sizer (FMPS), measuring the number concentration of submicrometre particles (including ultrafine particles) and the particle size distribution in the size range 5.6–560 nm. The measurements were performed in the breathing zone of the operators by the use of a conductive silicone tubing. Working tasks studied were operation of the slipforming machine, operations related to finishing the verge, and welding the PVC membrane. In addition, background levels were measured.

Results

Arithmetic mean values of ultrafine particles were in the range 6.26x10⁵–3.34x10⁶. Vertical PVC welding gave the highest exposure. Horizontal welding was the work task with the highest maximum peak exposure, 8.1x10⁷ particles/cm³. Background concentrations of 4.0x10⁴–3.1x10⁵ were found in the tunnel. The mobility diameter at peak particle concentration varied between 10.8 nm during horizontal PVC welding and during breaks and 60.4 nm while finishing the verge.

Conclusions

PVC welding in a vertical position resulted in very high exposure of the worker to ultrafine particles compared to other types of work tasks. In evaluations of worker exposure to ultrafine particles, it seems important to distinguish between personal samples taken in the breathing zone of the worker and more stationary work area measurements. There is a need for a portable particle-sizing instrument for measurements of ultrafine particles in working environments.

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Can psychosocial work conditions protect against age-related cognitive decline? Results from a systematic review

According to the use it or lose it hypothesis, intellectually stimulating activities postpone age-related cognitive decline. A previous systematic review concluded that a high level of mental work demands and job control protected against cognitive decline. However, it did not distinguish between outcomes that were measured as cognitive function at one point in time or as cognitive decline. Our study aimed to systematically review which psychosocial working conditions were prospectively associated with high levels of cognitive function and/or changes in cognitive function over time. Articles were identified by a systematic literature search (MEDLINE, Web of Science (WOS), PsycNET, Occupational Safety and Health (OSH)). We included only studies with longitudinal designs examining the impact of psychosocial work conditions on outcomes defined as cognitive function or changes in cognitive function. Two independent reviewers compared title-abstract screenings, full-text screenings and quality assessment ratings. Eleven studies were included in the final synthesis and showed that high levels of mental work demands, occupational complexity or job control at one point in time were prospectively associated with higher levels of cognitive function in midlife or late life. However, the evidence to clarify whether these psychosocial factors also affected cognitive decline was insufficient, conflicting or weak. It remains speculative whether job control, job demands or occupational complexity can protect against cognitive decline. Future studies using methodological advancements can reveal whether workers gain more cognitive reserve in midlife and late life than the available evidence currently suggests. The public health implications of a previous review should thereby be redefined accordingly.

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Erratum: Mortality rates by occupation in Korea: a nationwide, 13-year follow up study

Lee HE, Kim HR, Chung YK, et al. Mortality rates by occupation in Korea: a nationwide, 13-year follow up study. Occup Environ Med 2016;doi:10.1136/oemed-2015-103192

This letter contains an error in the calendar year of follow-up of the cohort. The correct follow-up period was 1995–2009. The affected text has been corrected to now read:

Mortality was determined by matching death between July 1995 and December 2009 according to a nationwide registry of the Korea National Statistical Office.

The cohort data set was sent to the Korea National Statistical Office (KNSO) for matching deaths between July 1995 and December 2009.

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Cost-benefit analysis of overhead lift use peer coaching

Patient handling through lifting and moving of patients or residents, especially in a long-term care setting, is a key risk factor leading to injuries in healthcare workers.1–3 These injuries cause enormous pain and suffering to the healthcare workers and their families, as well as impose an enormous economic burden on society through productivity losses, and increase in healthcare costs and workers compensation costs. Many of these patient handling injuries can be prevented through appropriate use of engineering control interventions, for example, through the introduction of overhead lift equipment, in long-term care facilities.4

The paper by Tompa et al5 uses an analytic approach to evaluate a peer coaching programme for an overhead lift use intervention in the long-term care sector in British Columbia, Canada, by assessing its impact on reduction of injuries for healthcare workers (related to patient handling). It...

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Environmental and occupational particulate matter exposures and ectopic heart beats in welders

Objectives

Links between arrhythmias and particulate matter exposures have been found among sensitive populations. We examined the relationship between personal particulate matter ≤2.5 µm aerodynamic diameter (PM_2.5) exposures and ectopy in a panel study of healthy welders.

Methods

Simultaneous ambulatory ECG and personal PM_2.5 exposure monitoring with DustTrak Aerosol Monitor was performed on 72 males during work and non-work periods for 5–90 h (median 40 h). ECGs were summarised hourly for supraventricular ectopy (SVE) and ventricular ectopy (VE). PM_2.5 exposures both work and non-work periods were averaged hourly with lags from 0 to 7 h. Generalised linear mixed-effects models with a random participant intercept were used to examine the relationship between PM_2.5 exposure and the odds of SVE or VE. Sensitivity analyses were performed to assess whether relationships differed by work period and among current smokers.

Results

Participants had a mean (SD) age of 38 (11) years and were monitored over 2993 person-hours. The number of hourly ectopic events was highly skewed with mean (SD) of 14 (69) VE and 1 (4) SVE. We found marginally significant increases in VE with PM_2.5 exposures in the sixth and seventh hour lags, yet no association with SVE. For every 100 μg/m³ increase in sixth hour lagged PM_2.5, the adjusted OR (95% CI) for VE was 1.03 (1.00 to 1.05). Results persisted in work or non-work exposure periods and non-smokers had increased odds of VE associated with PM_2.5 as compared with smokers.

Conclusions

A small increase in the odds of VE with short-term PM_2.5 exposure was observed among relatively healthy men with environmental and occupational exposures.

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Impact of aggregating exposure information from cases and controls when building a population-based job-exposure matrix from past expert evaluations

Objectives

To assess whether the inclusion of data from cases would bias a job-exposure matrix (JEM), we evaluated whether exposures were systematically different between cases and controls from a large historical case–control study.

Methods

Data included 10 381 jobs assessed for occupational exposure to 294 agents within a lung cancer case–control study. For each sex, 1 JEM was developed from case jobs, and 1 from control jobs: with occupation (four-digit occupational codes), time period (1945–1959, 1960–1984, 1985–1995) and agent axes. We estimated concordance in exposure status (defined as probability of exposure threshold ≥5%) and exposure metrics of probability and intensity of exposure, between the 2 JEMs.

Results

Of all hypothetical occupation-period-agent combinations, most had no or few observations. Among males there were 8136 common cells (24—occupational codes, 3—periods, 226—agents), containing sufficient observations for comparison with 92% concordance in exposure status; discordance was equally likely to be towards cases or controls. Females had 1710 common cells (9—occupational codes, 3—periods, 114—agents) with 93% concordance in exposure status; discordant cells were more likely to reflect greater exposure among cases. Among concordantly exposed cells, probability and intensity of exposures were highly correlated between the case JEM and control JEM (Kendall >0.50), and absolute differences were small (median difference in probability <1.5%, median ratio in intensity=1.00) for both sexes.

Conclusions

Agreement between the case JEM and control JEM was high, suggesting that aggregating the case and control information in our study into a single JEM is justifiable given the benefits of increased sample size.

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Prediction of all-cause occupational disability among US Army soldiers

Introduction

Long-term occupational disability rates associated with eventual discharges from military service have risen sharply among active-duty US Army soldiers during the last three decades, with important implications for soldier health and national security alike. To address this problem, we built predictive models for long-term, all-cause occupational disability and identified disability risk factors using a very large, multisource database on the total active-duty US Army.

Methods

We conducted a cross-temporal retrospective cohort study and used mixed-effects logistic regression models to derive and validate disability risk assignments. The derivation cohort included 510 616 US Army soldiers on duty in December 2012, and the validation cohort included 483 197 soldiers on duty in December 2013.

Results

The predictive model yielded an overall c-statistic of 85.97% (95% CI 85.61% to 86.32%). Risk thresholds at the population's 75th and 95th centiles identified 80.53% and 42.08%, respectively, of the disability designations that occurred population wide during the subsequent 9 months. Frequent work excusals, high outpatient care utilisation and psychotropic medication use were the strongest independent predictors of later disability.

Conclusions

These findings indicate that predictive models using diverse data types can successfully anticipate long-term occupational disability among US Army soldiers and could be used for disability risk screening.

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Remarkable response in 2 cases of Advanced Poorly Differentiated Thyroid Carcinoma with liposomal doxorubicin plus cisplatin.

Remarkable response in 2 cases of Advanced Poorly Differentiated Thyroid Carcinoma with liposomal doxorubicin plus cisplatin.

Cancer Biol Ther. 2016 Jun 14;:0

Authors: Yang H, Chen Z, Wu M, Lei T, Yu H, Ge M

Abstract
BACKGROUND: Poorly Differentiated Thyroid Carcinoma (PDTC), especially advanced PDTC, is an aggressive disease and displays a much poorer prognosis compared with well differentiated thyroid carcinoma. Surgery is the recommended treatment in the early stage of PDTC, however, no effective treatment modalities are currently available for advanced PDTC.
METHODS: Two advanced PDTC patients with no radioiodine uptake adopted a cytotoxic chemotherapy with liposomal doxorubicin (35 mg/m(2), day 1) plus cisplatin (75 mg/m(2), day1-3) every 3 weeks. Computer tomography (CT) was performed after 6 cycles (case 1) or 5 cycles (case 2) of chemotherapy.
RESULTS: Our patients achieved remarkable response with one a Complete Remission (CR) and the other a very good Partial Remission (PR).
CONCLUSION: Our findings indicate that liposomal doxorubicin-based chemotherapy regimens might produce response in PDTC patients, and improve their overall survival and quality of life. Hence we believe this result is very important for oncologists in treating PDTC.

PMID: 27302615 [PubMed - as supplied by publisher]

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Remarkable response in 2 cases of Advanced Poorly Differentiated Thyroid Carcinoma with liposomal doxorubicin plus cisplatin.

Remarkable response in 2 cases of Advanced Poorly Differentiated Thyroid Carcinoma with liposomal doxorubicin plus cisplatin.

Cancer Biol Ther. 2016 Jun 14;:0

Authors: Yang H, Chen Z, Wu M, Lei T, Yu H, Ge M

Abstract
BACKGROUND: Poorly Differentiated Thyroid Carcinoma (PDTC), especially advanced PDTC, is an aggressive disease and displays a much poorer prognosis compared with well differentiated thyroid carcinoma. Surgery is the recommended treatment in the early stage of PDTC, however, no effective treatment modalities are currently available for advanced PDTC.
METHODS: Two advanced PDTC patients with no radioiodine uptake adopted a cytotoxic chemotherapy with liposomal doxorubicin (35 mg/m(2), day 1) plus cisplatin (75 mg/m(2), day1-3) every 3 weeks. Computer tomography (CT) was performed after 6 cycles (case 1) or 5 cycles (case 2) of chemotherapy.
RESULTS: Our patients achieved remarkable response with one a Complete Remission (CR) and the other a very good Partial Remission (PR).
CONCLUSION: Our findings indicate that liposomal doxorubicin-based chemotherapy regimens might produce response in PDTC patients, and improve their overall survival and quality of life. Hence we believe this result is very important for oncologists in treating PDTC.

PMID: 27302615 [PubMed - as supplied by publisher]

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Remarkable response in 2 cases of Advanced Poorly Differentiated Thyroid Carcinoma with liposomal doxorubicin plus cisplatin.

Remarkable response in 2 cases of Advanced Poorly Differentiated Thyroid Carcinoma with liposomal doxorubicin plus cisplatin.

Cancer Biol Ther. 2016 Jun 14;:0

Authors: Yang H, Chen Z, Wu M, Lei T, Yu H, Ge M

Abstract
BACKGROUND: Poorly Differentiated Thyroid Carcinoma (PDTC), especially advanced PDTC, is an aggressive disease and displays a much poorer prognosis compared with well differentiated thyroid carcinoma. Surgery is the recommended treatment in the early stage of PDTC, however, no effective treatment modalities are currently available for advanced PDTC.
METHODS: Two advanced PDTC patients with no radioiodine uptake adopted a cytotoxic chemotherapy with liposomal doxorubicin (35 mg/m(2), day 1) plus cisplatin (75 mg/m(2), day1-3) every 3 weeks. Computer tomography (CT) was performed after 6 cycles (case 1) or 5 cycles (case 2) of chemotherapy.
RESULTS: Our patients achieved remarkable response with one a Complete Remission (CR) and the other a very good Partial Remission (PR).
CONCLUSION: Our findings indicate that liposomal doxorubicin-based chemotherapy regimens might produce response in PDTC patients, and improve their overall survival and quality of life. Hence we believe this result is very important for oncologists in treating PDTC.

PMID: 27302615 [PubMed - as supplied by publisher]

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Endometrial hyperplasia-related inflammation: its role in the development and progression of endometrial hyperplasia

Abstract

Background

Endometrial hyperplasia (EH) is one of the most common gynecologic diseases in the world. Different statistical categories implicate an imbalance of estrogens and progestogens in the etiology of this disease. We propose that inflammation also plays a key role in the progression of endometrial hyperplasia.

Objective

The aim of this study is to evaluate the role of inflammation in the transformation and progression of endometrial hyperplasia, using local inflammatory cytokines and nonspecific protease levels, CD 45⁺ expression, and histological examination.

Design

The study included 107 patients (ages 29–49 years) with different forms of endometrial hyperplasia. The enrolled patients were randomized into one of the four groups: normal endometrium (n = 18) as the control group, simple hyperplasia (n = 41), complex hyperplasia without atypia (n = 36), complex atypical hyperplasia or endometrioid adenocarcinoma (n = 12).

Methods

The following were evaluated for patients with different forms of EH: steroid hormone levels in blood serum and uterine flushings, immunohistochemical estrogen and progesterone receptor expression patterns in the endometrial tissue, CD 45⁺ (common leukocyte antigen) expression, the levels of the cytokines IL-1β, IL-6, and TNF-α, and nonspecific proteases and their inhibitors.

Results

The level of estradiol in blood serum and especially in uterine flushings was elevated dramatically in simple EH as compared to that of controls, but there was no significant difference between estradiol levels among the different forms of EH. The estimation of CD 45⁺, the levels of the cytokines IL-1β, IL-6, and TNF-α, and the activity of proteases (elastase-like and trypsin-like activities) and their inhibitors showed that levels of nonspecific inflammatory markers increase with EH progression.

Conclusions

We suggest that the initial responsibility for the development of simple endometrial hyperplasia belongs to systemic hyperestrogenemia and, in particular, local hyperestrogenia, but that the role of inflammatory processes increases in complex and atypical EH. Development of inflammatory changes in endometrial hyperplasia may be considered as a factor in the promotion and progression of pathology, as well as an attributed risk factor for malignancy in endometrial hyperplasia. In this study, we have established a role for CD 45⁺ expression cells, non-specific proteases, and the inflammatory cytokines IL-1β, IL-6, and TNF-α in endometrial hyperplasia-related inflammation.

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Prevalence of airflow obstruction among ever-employed US adults aged 18-79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007-2010

Objectives

To estimate the prevalence of spirometry-defined airflow obstruction among ever-employed US adults.

Methods

Data from the 2007 to 2010 National Health and Nutrition Examination Survey (NHANES) for adults 18–79 years with valid spirometry and longest held occupation were analysed. The age-standardised prevalence of spirometry-defined airflow obstruction was estimated overall and by smoking status.

Results

Age-standardised prevalence of airflow obstruction was 13.7% (95% CI 12.4% to 15.0%) and was highest in participants aged 60–79 years (17.4%, 95% CI 15.2% to 19.6%), males (14.8%, 95% CI 12.0% to 17.6%), non-Hispanic whites (15.4%, 95% CI 13.8% to 16.7%) and ever smokers (19.1%, 95% CI 16.6% to 21.5%). Age-standardised prevalence of airflow obstruction was >20% for installation, maintenance and repair occupations (p=22.1%, 95% CI 16.5% to 27.8%), and for construction and extraction occupations (20.7%, 95% CI 13.5% to 27.9%).

Conclusions

Prevalence of airflow obstruction varied by demographic characteristics and occupational factors with a higher prevalence among ever smokers for most demographic characteristics and occupational factors. Study findings emphasise the importance of monitoring the lung function of workers in occupations with a high prevalence of airflow obstruction.

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Sputum neutrophils are elevated in smelter workers, and systemic neutrophils are associated with rapid decline in FEV1

Objectives

In a previous study on smelter workers we, found significant relationship between exposure to dust and accelerated annual decline in forced expiratory volume in 1 s (FEV₁). In this cross-sectional study at the end of a follow-up, we aimed to investigate the possible association between annual decline in FEV₁ and markers of airways, and systemic inflammation in smelter workers.

Methods

Employees (n=76 (27 current smokers)) who had been part of a longitudinal study (9–13 years) that included spirometry (>6 measurements) and respiratory questionnaires, performed induced sputum, exhaled NO and had blood drawn. Participants with annual decline in FEV₁≥45 mL were compared with participants with annual decline <45 mL; also 26 non-exposed controls were included.

Results

Compared with non-exposed controls, smelter workers demonstrated a significantly increased percentage of neutrophils (mean (SD)) (57% (17) vs 31% (15)) and matrix metalloproteinases 8 (MMP-8) levels in sputum, and MMP-9, surfactant protein D (SpD) and transforming growth factor β (TGFb) levels in blood. A significant association in FEV₁≥45 mL was found for blood neutrophils when controlling for smoking habits (OR=1.7 (95% CI 1.0 to 2.8), p=0.045). Airway and blood protein markers were not associated with annual decline in FEV₁.

Conclusions

All workers displayed airway and systemic inflammation characterised by increased levels of neutrophils and MMP-8 in sputum, and MMP-9, SpD and TGFβ in blood compared with non-exposed controls. Blood neutrophils in particular were significantly elevated in those workers with the most rapid decline in lung function. A similar observation was not seen with airway neutrophils. In the present study, we were able to identify systemic but not airway inflammatory markers that can predict increased decline in FEV₁ in smelter workers.

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Personal exposure to ultrafine particles from PVC welding and concrete work during tunnel rehabilitation

Objectives

To investigate the exposure to number concentration of ultrafine particles and the size distribution in the breathing zone of workers during rehabilitation of a subsea tunnel.

Methods

Personal exposure was measured using a TSI 3091 Fast Mobility Particle Sizer (FMPS), measuring the number concentration of submicrometre particles (including ultrafine particles) and the particle size distribution in the size range 5.6–560 nm. The measurements were performed in the breathing zone of the operators by the use of a conductive silicone tubing. Working tasks studied were operation of the slipforming machine, operations related to finishing the verge, and welding the PVC membrane. In addition, background levels were measured.

Results

Arithmetic mean values of ultrafine particles were in the range 6.26x10⁵–3.34x10⁶. Vertical PVC welding gave the highest exposure. Horizontal welding was the work task with the highest maximum peak exposure, 8.1x10⁷ particles/cm³. Background concentrations of 4.0x10⁴–3.1x10⁵ were found in the tunnel. The mobility diameter at peak particle concentration varied between 10.8 nm during horizontal PVC welding and during breaks and 60.4 nm while finishing the verge.

Conclusions

PVC welding in a vertical position resulted in very high exposure of the worker to ultrafine particles compared to other types of work tasks. In evaluations of worker exposure to ultrafine particles, it seems important to distinguish between personal samples taken in the breathing zone of the worker and more stationary work area measurements. There is a need for a portable particle-sizing instrument for measurements of ultrafine particles in working environments.

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Can psychosocial work conditions protect against age-related cognitive decline? Results from a systematic review

According to the use it or lose it hypothesis, intellectually stimulating activities postpone age-related cognitive decline. A previous systematic review concluded that a high level of mental work demands and job control protected against cognitive decline. However, it did not distinguish between outcomes that were measured as cognitive function at one point in time or as cognitive decline. Our study aimed to systematically review which psychosocial working conditions were prospectively associated with high levels of cognitive function and/or changes in cognitive function over time. Articles were identified by a systematic literature search (MEDLINE, Web of Science (WOS), PsycNET, Occupational Safety and Health (OSH)). We included only studies with longitudinal designs examining the impact of psychosocial work conditions on outcomes defined as cognitive function or changes in cognitive function. Two independent reviewers compared title-abstract screenings, full-text screenings and quality assessment ratings. Eleven studies were included in the final synthesis and showed that high levels of mental work demands, occupational complexity or job control at one point in time were prospectively associated with higher levels of cognitive function in midlife or late life. However, the evidence to clarify whether these psychosocial factors also affected cognitive decline was insufficient, conflicting or weak. It remains speculative whether job control, job demands or occupational complexity can protect against cognitive decline. Future studies using methodological advancements can reveal whether workers gain more cognitive reserve in midlife and late life than the available evidence currently suggests. The public health implications of a previous review should thereby be redefined accordingly.

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Erratum: Mortality rates by occupation in Korea: a nationwide, 13-year follow up study

Lee HE, Kim HR, Chung YK, et al. Mortality rates by occupation in Korea: a nationwide, 13-year follow up study. Occup Environ Med 2016;doi:10.1136/oemed-2015-103192

This letter contains an error in the calendar year of follow-up of the cohort. The correct follow-up period was 1995–2009. The affected text has been corrected to now read:

Mortality was determined by matching death between July 1995 and December 2009 according to a nationwide registry of the Korea National Statistical Office.

The cohort data set was sent to the Korea National Statistical Office (KNSO) for matching deaths between July 1995 and December 2009.

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Cost-benefit analysis of overhead lift use peer coaching

Patient handling through lifting and moving of patients or residents, especially in a long-term care setting, is a key risk factor leading to injuries in healthcare workers.1–3 These injuries cause enormous pain and suffering to the healthcare workers and their families, as well as impose an enormous economic burden on society through productivity losses, and increase in healthcare costs and workers compensation costs. Many of these patient handling injuries can be prevented through appropriate use of engineering control interventions, for example, through the introduction of overhead lift equipment, in long-term care facilities.4

The paper by Tompa et al5 uses an analytic approach to evaluate a peer coaching programme for an overhead lift use intervention in the long-term care sector in British Columbia, Canada, by assessing its impact on reduction of injuries for healthcare workers (related to patient handling). It...

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Environmental and occupational particulate matter exposures and ectopic heart beats in welders

Objectives

Links between arrhythmias and particulate matter exposures have been found among sensitive populations. We examined the relationship between personal particulate matter ≤2.5 µm aerodynamic diameter (PM_2.5) exposures and ectopy in a panel study of healthy welders.

Methods

Simultaneous ambulatory ECG and personal PM_2.5 exposure monitoring with DustTrak Aerosol Monitor was performed on 72 males during work and non-work periods for 5–90 h (median 40 h). ECGs were summarised hourly for supraventricular ectopy (SVE) and ventricular ectopy (VE). PM_2.5 exposures both work and non-work periods were averaged hourly with lags from 0 to 7 h. Generalised linear mixed-effects models with a random participant intercept were used to examine the relationship between PM_2.5 exposure and the odds of SVE or VE. Sensitivity analyses were performed to assess whether relationships differed by work period and among current smokers.

Results

Participants had a mean (SD) age of 38 (11) years and were monitored over 2993 person-hours. The number of hourly ectopic events was highly skewed with mean (SD) of 14 (69) VE and 1 (4) SVE. We found marginally significant increases in VE with PM_2.5 exposures in the sixth and seventh hour lags, yet no association with SVE. For every 100 μg/m³ increase in sixth hour lagged PM_2.5, the adjusted OR (95% CI) for VE was 1.03 (1.00 to 1.05). Results persisted in work or non-work exposure periods and non-smokers had increased odds of VE associated with PM_2.5 as compared with smokers.

Conclusions

A small increase in the odds of VE with short-term PM_2.5 exposure was observed among relatively healthy men with environmental and occupational exposures.

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Impact of aggregating exposure information from cases and controls when building a population-based job-exposure matrix from past expert evaluations

Objectives

To assess whether the inclusion of data from cases would bias a job-exposure matrix (JEM), we evaluated whether exposures were systematically different between cases and controls from a large historical case–control study.

Methods

Data included 10 381 jobs assessed for occupational exposure to 294 agents within a lung cancer case–control study. For each sex, 1 JEM was developed from case jobs, and 1 from control jobs: with occupation (four-digit occupational codes), time period (1945–1959, 1960–1984, 1985–1995) and agent axes. We estimated concordance in exposure status (defined as probability of exposure threshold ≥5%) and exposure metrics of probability and intensity of exposure, between the 2 JEMs.

Results

Of all hypothetical occupation-period-agent combinations, most had no or few observations. Among males there were 8136 common cells (24—occupational codes, 3—periods, 226—agents), containing sufficient observations for comparison with 92% concordance in exposure status; discordance was equally likely to be towards cases or controls. Females had 1710 common cells (9—occupational codes, 3—periods, 114—agents) with 93% concordance in exposure status; discordant cells were more likely to reflect greater exposure among cases. Among concordantly exposed cells, probability and intensity of exposures were highly correlated between the case JEM and control JEM (Kendall >0.50), and absolute differences were small (median difference in probability <1.5%, median ratio in intensity=1.00) for both sexes.

Conclusions

Agreement between the case JEM and control JEM was high, suggesting that aggregating the case and control information in our study into a single JEM is justifiable given the benefits of increased sample size.

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Prediction of all-cause occupational disability among US Army soldiers

Introduction

Long-term occupational disability rates associated with eventual discharges from military service have risen sharply among active-duty US Army soldiers during the last three decades, with important implications for soldier health and national security alike. To address this problem, we built predictive models for long-term, all-cause occupational disability and identified disability risk factors using a very large, multisource database on the total active-duty US Army.

Methods

We conducted a cross-temporal retrospective cohort study and used mixed-effects logistic regression models to derive and validate disability risk assignments. The derivation cohort included 510 616 US Army soldiers on duty in December 2012, and the validation cohort included 483 197 soldiers on duty in December 2013.

Results

The predictive model yielded an overall c-statistic of 85.97% (95% CI 85.61% to 86.32%). Risk thresholds at the population's 75th and 95th centiles identified 80.53% and 42.08%, respectively, of the disability designations that occurred population wide during the subsequent 9 months. Frequent work excusals, high outpatient care utilisation and psychotropic medication use were the strongest independent predictors of later disability.

Conclusions

These findings indicate that predictive models using diverse data types can successfully anticipate long-term occupational disability among US Army soldiers and could be used for disability risk screening.

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Association between pain catastrophising and musculoskeletal disorders is modified by past injuries in Malaysian military recruits

Objectives

Pain catastrophising is defined as exaggerated negative thoughts, which can occur during an actual or anticipated painful experience, such as musculoskeletal injuries (MSI) or disorders (MSD). The aims of this study are to examine the association between pain catastrophising and MSI and MSD in Malaysian Army male recruits, and evaluate the effects of past injury.

Methods

A cohort of 611 male Malaysian Army recruits were recruited and followed up at 3 and 6 months. Pain catastrophising, MSD, sociodemographic and work factors were measured using a self-administered questionnaire, and MSI incidence was retrieved from the medical records. Multivariable fixed effects regression was used to model the cumulative incidence of MSD and MSI.

Results

Approximately 12% of the recruits were diagnosed with incident MSI and 80% reported incident MSD. Higher pain catastrophising at baseline was associated with higher 6 month MSD risk (adjusted OR (aOR) 1.6 per 1 SD increase of Pain Catastrophising Scale (PCS) scores; 95% CI 1.2 to 2.0), and longitudinally associated with MSD incidence (aOR 1.2, 95% CI 1.1 to 1.4). Pain catastrophising was not associated with MSI incidence (aOR 1.0, 95% CI 0.8 to 1.3). The association between pain catastrophising and self-reported MSD was stronger among recruits with self-reported past injury (p for interaction <0.001).

Conclusions

Pain catastrophising was able to predict symptomatic MSD, and not physician-diagnosed MSI, and these findings are directly related to individual health beliefs. Pain catastrophising has a greater influence on how military recruits perceived their musculoskeletal conditions during training, and efforts to reduce pain catastrophising may be beneficial.

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International perspective on common core competencies for occupational physicians: a modified Delphi study

Objectives

The competencies required of occupational physicians (OPs) have been the subject of peer-reviewed research in Europe and individual countries around the world. In the European Union (EU), there has been development of guidance on training and common competencies, but little research has extended beyond this. The aim of this study was to obtain consensus on and identify the common core competencies required of OPs around the world.

Methods

A modified Delphi study was carried out among representative organisations and networks of OPs in a range of countries around the world. It was conducted in 2 rounds using a questionnaire based on the specialist training syllabus of a number of countries, expert panel reviews and conference discussions.

Results

Responses were received from 51 countries around the world, with the majority from Europe (60%; 59%) and North and South America (24%; 32%) in rounds 1 and 2, respectively. General principles of assessment and management of occupational hazards to health and good clinical care were jointly considered most important in ranking when compared with the other topic areas. Assessment of disability and fitness for work, communication skills and legal and ethical issues completed the top five. In both rounds, research methods and teaching and educational supervision were considered least important.

Conclusions

This study has established the current priorities among OPs across 51 countries of the common competencies required for occupational health (OH) practice. These findings can serve as a platform for the development of common core competencies/qualifications within specific geographical regions or internationally. This is particularly pertinent with globalisation of commerce and free movement within the EU.

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Occupational activity across adult life and its association with grip strength

Grip strength is commonly used in epidemiological studies as a marker of upper body muscle strength.1 Weaker grip strength from early adulthood onwards has been related to a wide range of subsequent health outcomes including higher mortality rates,23 and increased risk of mobility disability4 and chronic disease.35 In addition, muscle weakness is a key component of common age-related disorders including frailty and sarcopenia. Identifying modifiable factors associated with grip strength across life is thus important.

Evidence from intervention studies across the adult age range suggests that specific types of activity, namely resistance training, improve grip strength in the short term.67 However, what is less clear is whether members of the general population undertake the 'right' types and intensity of activity as part of their everyday lives to realise these benefits...

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Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature.

Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature.

Tex Heart Inst J. 2016 Jun;43(3):236-40

Authors: Thangam M, Nathan S, Kar B, Petrovic M, Patel M, Loyalka P, Buja LM, Gregoric ID

Abstract
We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicardium that caused atrial fibrillation and atrial flutter. Histologic analysis of his epicardial lesions yielded a diagnosis of sarcoidosis. This patient's atrial arrhythmia was successfully treated with a hybrid operation that involved resection of his atrial appendage, an Epicor maze procedure, and radiofrequency ablation during a catheter-based electrophysiologic study. The cardiac sarcoidosis was successfully managed with corticosteroid therapy. Our case report shows that sarcoidosis can initially manifest itself as syncope with new-onset atrial arrhythmia. Sarcoidosis is important in the differential diagnosis because of its progressive nature and its potential for treatment with pharmacologic, surgical, and catheter-based interventions.

PMID: 27303240 [PubMed - in process]

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Characteristics of teeth referred to a public dental specialist clinic in Endodontics

Abstract

Aim

To investigate referrals to a specialist clinic in Endodontics in relation to previously root filled teeth and to determine how many of these teeth had a history of symptoms and the extent to which antibiotics were prescribed.

Methodology

The total number of referrals to the specialist clinic in endodontics in Gothenburg, Sweden in 2011 was investigated retrospectively by means of patient records. The endodontic status together with the presence or absence of symptoms was registered. The following variables were also examined: gender, age, tooth number and lower or upper jaw. Additionally for root filled teeth, the type of restoration, the technical quality of the root filling, and the presence of apical periodontitis were registered. The use of antibiotics was examined for all of the included teeth. Statistical analysis was performed using Generalized Estimating Equation (GEE) methods applied to uni-variable and multivariable logistic regression.

Results

A total of 1117 patient records were investigated, including 1341 referred teeth. Pain and/or swelling were recorded for 658 (54.3%) teeth. Symptoms were significantly more associated with females (P < 0.0001) and molar teeth (P < 0.0001). Seven hundred twenty-nine (54.4%) of the referred teeth were root filled, and of these, 377 (56.0%) were associated with pain and/or swelling. Root filled teeth restored with a post and core were less frequently related to symptoms (P = 0.009). One hundred sixty-two (22.3%) root filled teeth were treated with antibiotics, which was significantly more frequent than for non-root filled teeth (P < 0.0001). Also, root filled teeth with an adequate root filling were significantly associated with more frequent antibiotics prescriptions (23.8%) than root filled teeth with an inadequate root filling (17.0%) (P = 0.0010).

Conclusion

Root filled teeth constituted the majority of cases referred to this specialist clinic in endodontics. The majority of these teeth were associated with symptomatic conditions, and antibiotics were prescribed to approximately 20% of the patients referred for a root filled tooth. The findings suggest that symptomatic root filled teeth may be a substantial clinical problem in general dentistry and contribute to avoidable prescription of antibiotics.

This article is protected by copyright. All rights reserved.

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Agonist-induced sensitisation of the irritant receptor ion channel TRPA1

Abstract

The TRPA1 ion channel is expressed in nociceptive (pain-sensitive) neurons and responds to a wide variety of chemical irritants, such as acrolein in smoke or isothiocyanates in mustard. Here we show that in the absence of extracellular calcium the current passing through TRPA1 gradually increases (sensitises) during prolonged application of agonists. Activation by an agonist is essential, because activation of TRPA1 by membrane depolarisation did not cause sensitisation. Sensitisation is independent of the site of action of the agonist, because covalent and non-covalent agonists were equally effective, and is long-lasting following agonist removal. Mutating N-terminal cysteines, the target of covalent agonists, did not affect sensitisation by the non-covalent agonist carvacrol, which activates by binding to a different site. Sensitisation is unaffected by agents blocking ion channel trafficking or by block of signalling pathways involving ATP, protein kinase A or the formation of lipid rafts, and does not require ion flux through the channel. Examination of the voltage dependence of TRPA1 activation shows that sensitisation is accompanied by a slowly developing shift in the voltage dependence of TRPA1 towards more negative membrane potentials, and is therefore intrinsic to the TRPA1 channel. Sensitisation may play a role in exacerbating the pain caused by prolonged activation of TRPA1.

This article is protected by copyright. All rights reserved

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Hyponatremia alters the biophysical properties of neuronal cells independently of osmolarity: a study on Ni2+-sensitive current involvement

Hyponatremia is the most frequent electrolyte disorder encountered in hospitalized patients and it can cause a wide variety of neurological symptoms. Most of the negative effects of this condition on neuronal cells are due to cell swelling following the reduction of plasma osmolarity, although in hyponatremia different membrane proteins are supposed to be involved in the conservation of neuronal volume. We have recently reported detrimental effects of hyponatremia on two different neuronal cell lines, SK-N-AS and SH-SY5Y, independent of osmotic alterations. Here we aimed to study, in the same cell lines, whether hyponatremic condition can per se cause electrophysiological alterations and if these effects vary over time. Accordingly, we made experiments in low sodium medium either in hypo-, Osm(-), or iso-osmotic condition, Osm(+), for a short (24 h) or long time (7 d). By a patch pipette in voltage clamp condition, we recorded possible modifications of cell capacitance, C_m, and membrane conductance, G_m. Our results indicate that both Osm(-) or Osm(+) medium, C_m and G_m show a similar increase but such effects are differently dependent on time in culture. Notably, regarding to the possibly involved mechanisms for the maintenance of C_m, G_m and G_m/C_m in Osm(+) condition, we observed a greater contribution of Na⁺/Ca²⁺ exchanger respect to Osm(-) and control. Overall, these novel electrophysiological results help us understand the mechanisms of volume regulation following ionic perturbation. Our results can also have relevance in a translational perspective because the Na⁺/Ca²⁺ exchanger can be considered a target for planning novel therapies.

This article is protected by copyright. All rights reserved

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Endometrial hyperplasia-related inflammation: its role in the development and progression of endometrial hyperplasia

Abstract

Background

Endometrial hyperplasia (EH) is one of the most common gynecologic diseases in the world. Different statistical categories implicate an imbalance of estrogens and progestogens in the etiology of this disease. We propose that inflammation also plays a key role in the progression of endometrial hyperplasia.

Objective

The aim of this study is to evaluate the role of inflammation in the transformation and progression of endometrial hyperplasia, using local inflammatory cytokines and nonspecific protease levels, CD 45⁺ expression, and histological examination.

Design

The study included 107 patients (ages 29–49 years) with different forms of endometrial hyperplasia. The enrolled patients were randomized into one of the four groups: normal endometrium (n = 18) as the control group, simple hyperplasia (n = 41), complex hyperplasia without atypia (n = 36), complex atypical hyperplasia or endometrioid adenocarcinoma (n = 12).

Methods

The following were evaluated for patients with different forms of EH: steroid hormone levels in blood serum and uterine flushings, immunohistochemical estrogen and progesterone receptor expression patterns in the endometrial tissue, CD 45⁺ (common leukocyte antigen) expression, the levels of the cytokines IL-1β, IL-6, and TNF-α, and nonspecific proteases and their inhibitors.

Results

The level of estradiol in blood serum and especially in uterine flushings was elevated dramatically in simple EH as compared to that of controls, but there was no significant difference between estradiol levels among the different forms of EH. The estimation of CD 45⁺, the levels of the cytokines IL-1β, IL-6, and TNF-α, and the activity of proteases (elastase-like and trypsin-like activities) and their inhibitors showed that levels of nonspecific inflammatory markers increase with EH progression.

Conclusions

We suggest that the initial responsibility for the development of simple endometrial hyperplasia belongs to systemic hyperestrogenemia and, in particular, local hyperestrogenia, but that the role of inflammatory processes increases in complex and atypical EH. Development of inflammatory changes in endometrial hyperplasia may be considered as a factor in the promotion and progression of pathology, as well as an attributed risk factor for malignancy in endometrial hyperplasia. In this study, we have established a role for CD 45⁺ expression cells, non-specific proteases, and the inflammatory cytokines IL-1β, IL-6, and TNF-α in endometrial hyperplasia-related inflammation.

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Prevalence of airflow obstruction among ever-employed US adults aged 18-79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007-2010

Objectives

To estimate the prevalence of spirometry-defined airflow obstruction among ever-employed US adults.

Methods

Data from the 2007 to 2010 National Health and Nutrition Examination Survey (NHANES) for adults 18–79 years with valid spirometry and longest held occupation were analysed. The age-standardised prevalence of spirometry-defined airflow obstruction was estimated overall and by smoking status.

Results

Age-standardised prevalence of airflow obstruction was 13.7% (95% CI 12.4% to 15.0%) and was highest in participants aged 60–79 years (17.4%, 95% CI 15.2% to 19.6%), males (14.8%, 95% CI 12.0% to 17.6%), non-Hispanic whites (15.4%, 95% CI 13.8% to 16.7%) and ever smokers (19.1%, 95% CI 16.6% to 21.5%). Age-standardised prevalence of airflow obstruction was >20% for installation, maintenance and repair occupations (p=22.1%, 95% CI 16.5% to 27.8%), and for construction and extraction occupations (20.7%, 95% CI 13.5% to 27.9%).

Conclusions

Prevalence of airflow obstruction varied by demographic characteristics and occupational factors with a higher prevalence among ever smokers for most demographic characteristics and occupational factors. Study findings emphasise the importance of monitoring the lung function of workers in occupations with a high prevalence of airflow obstruction.

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Sputum neutrophils are elevated in smelter workers, and systemic neutrophils are associated with rapid decline in FEV1

Objectives

In a previous study on smelter workers we, found significant relationship between exposure to dust and accelerated annual decline in forced expiratory volume in 1 s (FEV₁). In this cross-sectional study at the end of a follow-up, we aimed to investigate the possible association between annual decline in FEV₁ and markers of airways, and systemic inflammation in smelter workers.

Methods

Employees (n=76 (27 current smokers)) who had been part of a longitudinal study (9–13 years) that included spirometry (>6 measurements) and respiratory questionnaires, performed induced sputum, exhaled NO and had blood drawn. Participants with annual decline in FEV₁≥45 mL were compared with participants with annual decline <45 mL; also 26 non-exposed controls were included.

Results

Compared with non-exposed controls, smelter workers demonstrated a significantly increased percentage of neutrophils (mean (SD)) (57% (17) vs 31% (15)) and matrix metalloproteinases 8 (MMP-8) levels in sputum, and MMP-9, surfactant protein D (SpD) and transforming growth factor β (TGFb) levels in blood. A significant association in FEV₁≥45 mL was found for blood neutrophils when controlling for smoking habits (OR=1.7 (95% CI 1.0 to 2.8), p=0.045). Airway and blood protein markers were not associated with annual decline in FEV₁.

Conclusions

All workers displayed airway and systemic inflammation characterised by increased levels of neutrophils and MMP-8 in sputum, and MMP-9, SpD and TGFβ in blood compared with non-exposed controls. Blood neutrophils in particular were significantly elevated in those workers with the most rapid decline in lung function. A similar observation was not seen with airway neutrophils. In the present study, we were able to identify systemic but not airway inflammatory markers that can predict increased decline in FEV₁ in smelter workers.

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Personal exposure to ultrafine particles from PVC welding and concrete work during tunnel rehabilitation

Objectives

To investigate the exposure to number concentration of ultrafine particles and the size distribution in the breathing zone of workers during rehabilitation of a subsea tunnel.

Methods

Personal exposure was measured using a TSI 3091 Fast Mobility Particle Sizer (FMPS), measuring the number concentration of submicrometre particles (including ultrafine particles) and the particle size distribution in the size range 5.6–560 nm. The measurements were performed in the breathing zone of the operators by the use of a conductive silicone tubing. Working tasks studied were operation of the slipforming machine, operations related to finishing the verge, and welding the PVC membrane. In addition, background levels were measured.

Results

Arithmetic mean values of ultrafine particles were in the range 6.26x10⁵–3.34x10⁶. Vertical PVC welding gave the highest exposure. Horizontal welding was the work task with the highest maximum peak exposure, 8.1x10⁷ particles/cm³. Background concentrations of 4.0x10⁴–3.1x10⁵ were found in the tunnel. The mobility diameter at peak particle concentration varied between 10.8 nm during horizontal PVC welding and during breaks and 60.4 nm while finishing the verge.

Conclusions

PVC welding in a vertical position resulted in very high exposure of the worker to ultrafine particles compared to other types of work tasks. In evaluations of worker exposure to ultrafine particles, it seems important to distinguish between personal samples taken in the breathing zone of the worker and more stationary work area measurements. There is a need for a portable particle-sizing instrument for measurements of ultrafine particles in working environments.

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Can psychosocial work conditions protect against age-related cognitive decline? Results from a systematic review

According to the use it or lose it hypothesis, intellectually stimulating activities postpone age-related cognitive decline. A previous systematic review concluded that a high level of mental work demands and job control protected against cognitive decline. However, it did not distinguish between outcomes that were measured as cognitive function at one point in time or as cognitive decline. Our study aimed to systematically review which psychosocial working conditions were prospectively associated with high levels of cognitive function and/or changes in cognitive function over time. Articles were identified by a systematic literature search (MEDLINE, Web of Science (WOS), PsycNET, Occupational Safety and Health (OSH)). We included only studies with longitudinal designs examining the impact of psychosocial work conditions on outcomes defined as cognitive function or changes in cognitive function. Two independent reviewers compared title-abstract screenings, full-text screenings and quality assessment ratings. Eleven studies were included in the final synthesis and showed that high levels of mental work demands, occupational complexity or job control at one point in time were prospectively associated with higher levels of cognitive function in midlife or late life. However, the evidence to clarify whether these psychosocial factors also affected cognitive decline was insufficient, conflicting or weak. It remains speculative whether job control, job demands or occupational complexity can protect against cognitive decline. Future studies using methodological advancements can reveal whether workers gain more cognitive reserve in midlife and late life than the available evidence currently suggests. The public health implications of a previous review should thereby be redefined accordingly.

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Erratum: Mortality rates by occupation in Korea: a nationwide, 13-year follow up study

Lee HE, Kim HR, Chung YK, et al. Mortality rates by occupation in Korea: a nationwide, 13-year follow up study. Occup Environ Med 2016;doi:10.1136/oemed-2015-103192

This letter contains an error in the calendar year of follow-up of the cohort. The correct follow-up period was 1995–2009. The affected text has been corrected to now read:

Mortality was determined by matching death between July 1995 and December 2009 according to a nationwide registry of the Korea National Statistical Office.

The cohort data set was sent to the Korea National Statistical Office (KNSO) for matching deaths between July 1995 and December 2009.

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Cost-benefit analysis of overhead lift use peer coaching

Patient handling through lifting and moving of patients or residents, especially in a long-term care setting, is a key risk factor leading to injuries in healthcare workers.1–3 These injuries cause enormous pain and suffering to the healthcare workers and their families, as well as impose an enormous economic burden on society through productivity losses, and increase in healthcare costs and workers compensation costs. Many of these patient handling injuries can be prevented through appropriate use of engineering control interventions, for example, through the introduction of overhead lift equipment, in long-term care facilities.4

The paper by Tompa et al5 uses an analytic approach to evaluate a peer coaching programme for an overhead lift use intervention in the long-term care sector in British Columbia, Canada, by assessing its impact on reduction of injuries for healthcare workers (related to patient handling). It...

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Environmental and occupational particulate matter exposures and ectopic heart beats in welders

Objectives

Links between arrhythmias and particulate matter exposures have been found among sensitive populations. We examined the relationship between personal particulate matter ≤2.5 µm aerodynamic diameter (PM_2.5) exposures and ectopy in a panel study of healthy welders.

Methods

Simultaneous ambulatory ECG and personal PM_2.5 exposure monitoring with DustTrak Aerosol Monitor was performed on 72 males during work and non-work periods for 5–90 h (median 40 h). ECGs were summarised hourly for supraventricular ectopy (SVE) and ventricular ectopy (VE). PM_2.5 exposures both work and non-work periods were averaged hourly with lags from 0 to 7 h. Generalised linear mixed-effects models with a random participant intercept were used to examine the relationship between PM_2.5 exposure and the odds of SVE or VE. Sensitivity analyses were performed to assess whether relationships differed by work period and among current smokers.

Results

Participants had a mean (SD) age of 38 (11) years and were monitored over 2993 person-hours. The number of hourly ectopic events was highly skewed with mean (SD) of 14 (69) VE and 1 (4) SVE. We found marginally significant increases in VE with PM_2.5 exposures in the sixth and seventh hour lags, yet no association with SVE. For every 100 μg/m³ increase in sixth hour lagged PM_2.5, the adjusted OR (95% CI) for VE was 1.03 (1.00 to 1.05). Results persisted in work or non-work exposure periods and non-smokers had increased odds of VE associated with PM_2.5 as compared with smokers.

Conclusions

A small increase in the odds of VE with short-term PM_2.5 exposure was observed among relatively healthy men with environmental and occupational exposures.

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Impact of aggregating exposure information from cases and controls when building a population-based job-exposure matrix from past expert evaluations

Objectives

To assess whether the inclusion of data from cases would bias a job-exposure matrix (JEM), we evaluated whether exposures were systematically different between cases and controls from a large historical case–control study.

Methods

Data included 10 381 jobs assessed for occupational exposure to 294 agents within a lung cancer case–control study. For each sex, 1 JEM was developed from case jobs, and 1 from control jobs: with occupation (four-digit occupational codes), time period (1945–1959, 1960–1984, 1985–1995) and agent axes. We estimated concordance in exposure status (defined as probability of exposure threshold ≥5%) and exposure metrics of probability and intensity of exposure, between the 2 JEMs.

Results

Of all hypothetical occupation-period-agent combinations, most had no or few observations. Among males there were 8136 common cells (24—occupational codes, 3—periods, 226—agents), containing sufficient observations for comparison with 92% concordance in exposure status; discordance was equally likely to be towards cases or controls. Females had 1710 common cells (9—occupational codes, 3—periods, 114—agents) with 93% concordance in exposure status; discordant cells were more likely to reflect greater exposure among cases. Among concordantly exposed cells, probability and intensity of exposures were highly correlated between the case JEM and control JEM (Kendall >0.50), and absolute differences were small (median difference in probability <1.5%, median ratio in intensity=1.00) for both sexes.

Conclusions

Agreement between the case JEM and control JEM was high, suggesting that aggregating the case and control information in our study into a single JEM is justifiable given the benefits of increased sample size.

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Prediction of all-cause occupational disability among US Army soldiers

Introduction

Long-term occupational disability rates associated with eventual discharges from military service have risen sharply among active-duty US Army soldiers during the last three decades, with important implications for soldier health and national security alike. To address this problem, we built predictive models for long-term, all-cause occupational disability and identified disability risk factors using a very large, multisource database on the total active-duty US Army.

Methods

We conducted a cross-temporal retrospective cohort study and used mixed-effects logistic regression models to derive and validate disability risk assignments. The derivation cohort included 510 616 US Army soldiers on duty in December 2012, and the validation cohort included 483 197 soldiers on duty in December 2013.

Results

The predictive model yielded an overall c-statistic of 85.97% (95% CI 85.61% to 86.32%). Risk thresholds at the population's 75th and 95th centiles identified 80.53% and 42.08%, respectively, of the disability designations that occurred population wide during the subsequent 9 months. Frequent work excusals, high outpatient care utilisation and psychotropic medication use were the strongest independent predictors of later disability.

Conclusions

These findings indicate that predictive models using diverse data types can successfully anticipate long-term occupational disability among US Army soldiers and could be used for disability risk screening.

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Association between pain catastrophising and musculoskeletal disorders is modified by past injuries in Malaysian military recruits

Objectives

Pain catastrophising is defined as exaggerated negative thoughts, which can occur during an actual or anticipated painful experience, such as musculoskeletal injuries (MSI) or disorders (MSD). The aims of this study are to examine the association between pain catastrophising and MSI and MSD in Malaysian Army male recruits, and evaluate the effects of past injury.

Methods

A cohort of 611 male Malaysian Army recruits were recruited and followed up at 3 and 6 months. Pain catastrophising, MSD, sociodemographic and work factors were measured using a self-administered questionnaire, and MSI incidence was retrieved from the medical records. Multivariable fixed effects regression was used to model the cumulative incidence of MSD and MSI.

Results

Approximately 12% of the recruits were diagnosed with incident MSI and 80% reported incident MSD. Higher pain catastrophising at baseline was associated with higher 6 month MSD risk (adjusted OR (aOR) 1.6 per 1 SD increase of Pain Catastrophising Scale (PCS) scores; 95% CI 1.2 to 2.0), and longitudinally associated with MSD incidence (aOR 1.2, 95% CI 1.1 to 1.4). Pain catastrophising was not associated with MSI incidence (aOR 1.0, 95% CI 0.8 to 1.3). The association between pain catastrophising and self-reported MSD was stronger among recruits with self-reported past injury (p for interaction <0.001).

Conclusions

Pain catastrophising was able to predict symptomatic MSD, and not physician-diagnosed MSI, and these findings are directly related to individual health beliefs. Pain catastrophising has a greater influence on how military recruits perceived their musculoskeletal conditions during training, and efforts to reduce pain catastrophising may be beneficial.

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International perspective on common core competencies for occupational physicians: a modified Delphi study

Objectives

The competencies required of occupational physicians (OPs) have been the subject of peer-reviewed research in Europe and individual countries around the world. In the European Union (EU), there has been development of guidance on training and common competencies, but little research has extended beyond this. The aim of this study was to obtain consensus on and identify the common core competencies required of OPs around the world.

Methods

A modified Delphi study was carried out among representative organisations and networks of OPs in a range of countries around the world. It was conducted in 2 rounds using a questionnaire based on the specialist training syllabus of a number of countries, expert panel reviews and conference discussions.

Results

Responses were received from 51 countries around the world, with the majority from Europe (60%; 59%) and North and South America (24%; 32%) in rounds 1 and 2, respectively. General principles of assessment and management of occupational hazards to health and good clinical care were jointly considered most important in ranking when compared with the other topic areas. Assessment of disability and fitness for work, communication skills and legal and ethical issues completed the top five. In both rounds, research methods and teaching and educational supervision were considered least important.

Conclusions

This study has established the current priorities among OPs across 51 countries of the common competencies required for occupational health (OH) practice. These findings can serve as a platform for the development of common core competencies/qualifications within specific geographical regions or internationally. This is particularly pertinent with globalisation of commerce and free movement within the EU.

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Occupational activity across adult life and its association with grip strength

Grip strength is commonly used in epidemiological studies as a marker of upper body muscle strength.1 Weaker grip strength from early adulthood onwards has been related to a wide range of subsequent health outcomes including higher mortality rates,23 and increased risk of mobility disability4 and chronic disease.35 In addition, muscle weakness is a key component of common age-related disorders including frailty and sarcopenia. Identifying modifiable factors associated with grip strength across life is thus important.

Evidence from intervention studies across the adult age range suggests that specific types of activity, namely resistance training, improve grip strength in the short term.67 However, what is less clear is whether members of the general population undertake the 'right' types and intensity of activity as part of their everyday lives to realise these benefits...

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Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature.

Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature.

Tex Heart Inst J. 2016 Jun;43(3):236-40

Authors: Thangam M, Nathan S, Kar B, Petrovic M, Patel M, Loyalka P, Buja LM, Gregoric ID

Abstract
We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicardium that caused atrial fibrillation and atrial flutter. Histologic analysis of his epicardial lesions yielded a diagnosis of sarcoidosis. This patient's atrial arrhythmia was successfully treated with a hybrid operation that involved resection of his atrial appendage, an Epicor maze procedure, and radiofrequency ablation during a catheter-based electrophysiologic study. The cardiac sarcoidosis was successfully managed with corticosteroid therapy. Our case report shows that sarcoidosis can initially manifest itself as syncope with new-onset atrial arrhythmia. Sarcoidosis is important in the differential diagnosis because of its progressive nature and its potential for treatment with pharmacologic, surgical, and catheter-based interventions.

PMID: 27303240 [PubMed - in process]

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Characteristics of teeth referred to a public dental specialist clinic in Endodontics

Abstract

Aim

To investigate referrals to a specialist clinic in Endodontics in relation to previously root filled teeth and to determine how many of these teeth had a history of symptoms and the extent to which antibiotics were prescribed.

Methodology

The total number of referrals to the specialist clinic in endodontics in Gothenburg, Sweden in 2011 was investigated retrospectively by means of patient records. The endodontic status together with the presence or absence of symptoms was registered. The following variables were also examined: gender, age, tooth number and lower or upper jaw. Additionally for root filled teeth, the type of restoration, the technical quality of the root filling, and the presence of apical periodontitis were registered. The use of antibiotics was examined for all of the included teeth. Statistical analysis was performed using Generalized Estimating Equation (GEE) methods applied to uni-variable and multivariable logistic regression.

Results

A total of 1117 patient records were investigated, including 1341 referred teeth. Pain and/or swelling were recorded for 658 (54.3%) teeth. Symptoms were significantly more associated with females (P < 0.0001) and molar teeth (P < 0.0001). Seven hundred twenty-nine (54.4%) of the referred teeth were root filled, and of these, 377 (56.0%) were associated with pain and/or swelling. Root filled teeth restored with a post and core were less frequently related to symptoms (P = 0.009). One hundred sixty-two (22.3%) root filled teeth were treated with antibiotics, which was significantly more frequent than for non-root filled teeth (P < 0.0001). Also, root filled teeth with an adequate root filling were significantly associated with more frequent antibiotics prescriptions (23.8%) than root filled teeth with an inadequate root filling (17.0%) (P = 0.0010).

Conclusion

Root filled teeth constituted the majority of cases referred to this specialist clinic in endodontics. The majority of these teeth were associated with symptomatic conditions, and antibiotics were prescribed to approximately 20% of the patients referred for a root filled tooth. The findings suggest that symptomatic root filled teeth may be a substantial clinical problem in general dentistry and contribute to avoidable prescription of antibiotics.

This article is protected by copyright. All rights reserved.

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Agonist-induced sensitisation of the irritant receptor ion channel TRPA1

Abstract

The TRPA1 ion channel is expressed in nociceptive (pain-sensitive) neurons and responds to a wide variety of chemical irritants, such as acrolein in smoke or isothiocyanates in mustard. Here we show that in the absence of extracellular calcium the current passing through TRPA1 gradually increases (sensitises) during prolonged application of agonists. Activation by an agonist is essential, because activation of TRPA1 by membrane depolarisation did not cause sensitisation. Sensitisation is independent of the site of action of the agonist, because covalent and non-covalent agonists were equally effective, and is long-lasting following agonist removal. Mutating N-terminal cysteines, the target of covalent agonists, did not affect sensitisation by the non-covalent agonist carvacrol, which activates by binding to a different site. Sensitisation is unaffected by agents blocking ion channel trafficking or by block of signalling pathways involving ATP, protein kinase A or the formation of lipid rafts, and does not require ion flux through the channel. Examination of the voltage dependence of TRPA1 activation shows that sensitisation is accompanied by a slowly developing shift in the voltage dependence of TRPA1 towards more negative membrane potentials, and is therefore intrinsic to the TRPA1 channel. Sensitisation may play a role in exacerbating the pain caused by prolonged activation of TRPA1.

This article is protected by copyright. All rights reserved

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Hyponatremia alters the biophysical properties of neuronal cells independently of osmolarity: a study on Ni2+-sensitive current involvement

Hyponatremia is the most frequent electrolyte disorder encountered in hospitalized patients and it can cause a wide variety of neurological symptoms. Most of the negative effects of this condition on neuronal cells are due to cell swelling following the reduction of plasma osmolarity, although in hyponatremia different membrane proteins are supposed to be involved in the conservation of neuronal volume. We have recently reported detrimental effects of hyponatremia on two different neuronal cell lines, SK-N-AS and SH-SY5Y, independent of osmotic alterations. Here we aimed to study, in the same cell lines, whether hyponatremic condition can per se cause electrophysiological alterations and if these effects vary over time. Accordingly, we made experiments in low sodium medium either in hypo-, Osm(-), or iso-osmotic condition, Osm(+), for a short (24 h) or long time (7 d). By a patch pipette in voltage clamp condition, we recorded possible modifications of cell capacitance, C_m, and membrane conductance, G_m. Our results indicate that both Osm(-) or Osm(+) medium, C_m and G_m show a similar increase but such effects are differently dependent on time in culture. Notably, regarding to the possibly involved mechanisms for the maintenance of C_m, G_m and G_m/C_m in Osm(+) condition, we observed a greater contribution of Na⁺/Ca²⁺ exchanger respect to Osm(-) and control. Overall, these novel electrophysiological results help us understand the mechanisms of volume regulation following ionic perturbation. Our results can also have relevance in a translational perspective because the Na⁺/Ca²⁺ exchanger can be considered a target for planning novel therapies.

This article is protected by copyright. All rights reserved

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Cancer stem cell as therapeutic target for melanoma treatment.

Cancer stem cell as therapeutic target for melanoma treatment.:

Cancer stem cell as therapeutic target for melanoma treatment.

Histol Histopathol. 2016 Jun 15;:11791

Authors: Alamodi AA, Eshaq AM, Hassan SY, Al Hmada Y, El Jamal SM, Fothan AM, Arain OM, Hassan SL, Haikel Y, Megahed M, Hassan M

Abstract
Human malignant melanoma is a highly aggressive skin tumor that is characterized by its extraordinary heterogeneity, propensity for dissemination to distant organs and resistance to cytotoxic agents. Although chemo- and immune-based therapies have been evaluated in clinical trials, most of these therapeutics do not show significant benefit for patients with advanced disease. Treatment failure in melanoma patients is attributed mainly to the development of tumor heterogeneity resulting from the formation of genetically divergent subpopulations. These subpopulations are composed of cancer stem-like cells (CSCs) as a small fraction and non-cancer stem cells that form the majority of the tumor mass. In recent years, CSCs gained more attention and suggested as valuable experimental model system for tumor study. In melanoma, intratumoral heterogeneity, progression and drug resistance result from the unique characteristics of melanoma stem cells (MSCs). These MSCs are characterized by their distinct protein signature and tumor growth-driving pathways, whose activation is mediated by driver mutation-dependent signal. The molecular features of MSCs are either in a causal or consequential relationship to melanoma progression, drug resistance and relapse. Here, we review the current scientific evidence that supports CSC hypothesis and the validity of MSCs-dependent pathways and their key molecules as potential therapeutic target for melanoma treatment.

PMID: 27301538 [PubMed - as supplied by publisher]

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Cancer stem cell as therapeutic target for melanoma treatment.

Cancer stem cell as therapeutic target for melanoma treatment.:

Cancer stem cell as therapeutic target for melanoma treatment.

Histol Histopathol. 2016 Jun 15;:11791

Authors: Alamodi AA, Eshaq AM, Hassan SY, Al Hmada Y, El Jamal SM, Fothan AM, Arain OM, Hassan SL, Haikel Y, Megahed M, Hassan M

Abstract
Human malignant melanoma is a highly aggressive skin tumor that is characterized by its extraordinary heterogeneity, propensity for dissemination to distant organs and resistance to cytotoxic agents. Although chemo- and immune-based therapies have been evaluated in clinical trials, most of these therapeutics do not show significant benefit for patients with advanced disease. Treatment failure in melanoma patients is attributed mainly to the development of tumor heterogeneity resulting from the formation of genetically divergent subpopulations. These subpopulations are composed of cancer stem-like cells (CSCs) as a small fraction and non-cancer stem cells that form the majority of the tumor mass. In recent years, CSCs gained more attention and suggested as valuable experimental model system for tumor study. In melanoma, intratumoral heterogeneity, progression and drug resistance result from the unique characteristics of melanoma stem cells (MSCs). These MSCs are characterized by their distinct protein signature and tumor growth-driving pathways, whose activation is mediated by driver mutation-dependent signal. The molecular features of MSCs are either in a causal or consequential relationship to melanoma progression, drug resistance and relapse. Here, we review the current scientific evidence that supports CSC hypothesis and the validity of MSCs-dependent pathways and their key molecules as potential therapeutic target for melanoma treatment.

PMID: 27301538 [PubMed - as supplied by publisher]

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