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1.  Psychosocial work factors in new or recurrent injuries among hospital workers: a prospective study 
Purpose
Accumulating evidence suggests an important role for psychosocial work factors in injury, but little is known about the interaction between psychosocial factors and previous injury experience on subsequent injury risk. We examined the relationships between psychosocial work factors and new or recurrent injury among hospital workers.
Methods
We studied 492 hospital workers including 116 cases with baseline injury and 376 injury-free referents at baseline over follow-up. Job strain, total support, effort– reward imbalance, overcommitment, and musculoskeletal injury at baseline were examined in logistic regression models as predictors of new or recurrent injury experienced during a 2-year follow-up period.
Results
The overall cumulative incidence of injury over follow-up was 35.6 % (51.7 % for re-injury among baseline injury cases; 30.6 % for new injury among referents). Significantly increased risks with baseline job strain (OR 1.26; 95 % CI 1.02–1.55) and effort–reward imbalance (OR 1.42; 95 % CI 1.12–1.81) were observed for injury only among the referents. Overcommitment was associated with increased risk of injury only among the cases (OR 1.58; 95 % CI 1.05–2.39).
Conclusions
The effects of psychosocial work factors on new or recurrent injury risk appear to differ by previous injury experience, suggesting the need for differing preventive strategies in hospital workers.
doi:10.1007/s00420-015-1038-x
PMCID: PMC4567977  PMID: 25761631
Work-related injury; Injury recurrence; Psychosocial factors; Overcommitment; Job strain; Effort–reward imbalance; Hospital workers
2.  Personal exposure to benzene and 1,3-butadiene during petroleum refinery turnarounds and work in the oil harbour 
Purpose
Petroleum refinery workers’ exposure to the carcinogens benzene and 1,3-butadiene has decreased during normal operations. However, certain occupational groups or events at the refineries still involve a risk of higher exposures. The aim of this study was to examine the personal exposure to benzene and 1,3-butadiene at refinery turnarounds and during work in the oil harbour.
Methods
Personal exposure measurements of benzene and 1,3-butadiene were taken during work shifts, with a priori assumed higher benzene exposure, using PerkinElmer diffusive samplers filled with Carbopack X. Mean exposure levels were calculated, and repeated exposure measurements, when available, were assessed using mixed effect models. Group and individual compliance with the Swedish occupational exposure limit (OEL) was tested for the different exposure groups.
Results
Mean benzene exposure levels for refinery workers during the three measured turnarounds were 150, 610 and 960 µg/m3, and mean exposures for oil harbour workers and sewage tanker drivers were 310 and 360 µg/m3, respectively. Higher exposures were associated with handling benzene-rich products. Most occupational groups did not comply with the Swedish OEL for benzene nor did the individuals within the groups. The exposure to 1,3-butadiene was very low, between <1 and 3 % of the Swedish OEL.
Conclusions
Work within the petroleum refinery industry, with potential exposure to open product streams containing higher fractions of benzene, pose a risk of personal benzene exposures exceeding the OEL. Refinery workers performing these work tasks frequently, such as contractors, sewage tanker drivers and oil harbour workers, need to be identified and protected.
doi:10.1007/s00420-016-1163-1
PMCID: PMC5052356  PMID: 27568022
Benzene; 1,3-Butadiene; Exposure; Refinery turnaround; Oil harbour
3.  Long-term physical workload in middle age and disability pension in men and women: a follow-up study of Swedish cohorts 
Purpose
The study investigates the association between level of long-term physical workload in middle age and disability pension (DP) before 61 years of age with adjustments made for early life factors, level of education, and psychosocial working conditions. Associations with DP overall, DP due to musculoskeletal disorders and DP due to psychiatric disorders were examined.
Methods
The study is based on cohorts of 21,809 Swedish men and women born in 1948 and 1953, with data on physical workload estimated with a job exposure matrix based on occupational titles in 1985 and 1990 and follow-up data on diagnosis-specific DP in the years 1991–2009. Data on paternal education and intelligence were collected in primary school. Data on level of education were taken from administrative records. Data on psychosocial working conditions were estimated with a job exposure matrix based on occupational titles in 1990.
Results
Long-term exposure to high physical workload measured 5 years apart at around age 40 was strongly associated with DP due to musculoskeletal disorders up to the age of 61 among both men (HR 5.44, 95 % CI 3.35–8.84) and women (HR 3.82, CI 95 % 2.88–5.08). For women, the association between high physical load and overall DP was also significantly increased (HR 2.33, CI 95 % 1.92–2.82). The increased risks remained but were clearly attenuated after adjustments for fathers’ education, IQ in childhood, achieved education and level of control at work.
Conclusions
Exposure to high physical workload is associated with long-term risk of DP due to musculoskeletal disorders, even though adjustments for early life factors, level of education and psychosocial working conditions clearly attenuated the risks.
doi:10.1007/s00420-016-1156-0
PMCID: PMC5052305  PMID: 27476023
Cohort study; Education; IQ; Job control; Job exposure matrix; Musculoskeletal disorder
4.  Current and cumulative night shift work and subclinical atherosclerosis: results of the Gutenberg Health Study 
Purpose
The study examines the association between exposure to current and cumulative night shift work and subclinical parameters of atherosclerosis.
Methods
Participants of a population-based cohort study (the Gutenberg Health Study, N = 15,010) aged 35–64 years were examined at baseline (2007–2012). Investigations included measurements of arterial stiffness, vascular function [reactive hyperaemia (RH) index], and intima media thickness (IMT). Also, a complete job history (including up to 15 periods), occupational exposures, a variety of lifestyle, and dispositional variables were enquired.
Results
Night shift work was performed by 1071 out of 8065 currently employed individuals. The strongest association after adjustment for age, sex, job complexity level, being a manager, overtime work, and noise appeared for more than 660 night shifts within the last 10 years and a significantly increased arterial stiffness of 0.33 m/s. This reflects a 4 % flow velocity increase for individuals with more than 660 night shifts compared to non-night workers. Regarding the entire professional life, night shift workers showed a significantly decreased vascular function by −0.054 RH index points by using the same adjustment. IMT values did not differ statistically from non-night workers. Lifestyle and dispositional factors showed an influence on all used subclinical atherosclerosis parameters.
Conclusions
The cross-sectional results demonstrate an association between night work and detrimental changes in the atherosclerotic process. The association is more pronounced with more years in night shift and is partly explained by lifestyle and dispositional factors. Longitudinal analyses are necessary to confirm the results.
doi:10.1007/s00420-016-1150-6
PMCID: PMC5052298  PMID: 27379667
Night shift work; Arterial stiffness; Vascular function; Intima media thickness; Occupation; Population based
5.  Association between subchronic and chronic lead exposure and levels of antioxidants and chemokines 
Purpose
This study aimed to compare the influence of lead on the non-enzymatic antioxidant defenses and the levels of chemokines in workers subchronically and chronically exposed to lead.
Methods
The study population was divided into three groups. The first group consisted of male workers subchronically exposed to lead for 40 ± 3.2 days, while the second group included male workers chronically exposed to lead. The third group was a control group.
Results
The levels of uric acid and bilirubin were significantly higher after a subchronic exposure to lead compared to the baseline by 22 and 35 %, respectively. Similarly, the values of total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) increased by 15, 50, and 33 %, respectively. At the same time, the levels of thiol groups and albumin decreased by 5 and 8 %, respectively. Additionally, the levels of interleukin-8 (IL-8) and macrophage inflammatory protein-1β (MIP-1β) were significantly higher after a subchronic exposure to lead compared to the baseline by 34 and 20 %, respectively. Moreover, IL-8 level was significantly higher by 40 % in the group of workers chronically exposed to lead than in the control group, while the level of interferon gamma-induced protein-10 (IP-10) was significantly lower by 28 %.
Conclusions
Similar to chronic lead exposure, subchronic exposure to lead is associated with elevated blood levels of uric acid and bilirubin in humans. This probably results in increased TAC value despite thiol depletion. However, the compensatory activation of non-enzymatic antioxidant defenses seems to be insufficient to protect against lead-induced oxidative stress, which may be additively enhanced by the pro-inflammatory action of chemokines, especially IL-8.
doi:10.1007/s00420-016-1144-4
PMCID: PMC5005401  PMID: 27294390
Subchronic exposure to lead; Chronic exposure to lead; Non-enzymatic antioxidants; Uric acid; Chemokines
6.  Information and communication technology demands at work: the association with job strain, effort-reward imbalance and self-rated health in different socio-economic strata 
Purpose
The use of information and communication technology (ICT) is common in modern working life. ICT demands may give rise to experience of work-related stress. Knowledge about ICT demands in relation to other types of work-related stress and to self-rated health is limited. Consequently, the aim of this study was to examine the association between ICT demands and two types of work-related stress [job strain and effort-reward imbalance (ERI)] and to evaluate the association between these work-related stress measures and self-rated health, in general and in different SES strata.
Methods
This study is based on cross-sectional data from the Swedish Longitudinal Occupational Survey of Health collected in 2014, from 14,873 gainfully employed people. ICT demands, job strain, ERI and self-rated health were analysed as the main measures. Sex, age, SES, lifestyle factors and BMI were used as covariates.
Results
ICT demands correlated significantly with the dimensions of the job strain and ERI models, especially with the demands (r = 0.42; p < 0.01) and effort (r = 0.51; p < 0.01) dimensions. ICT demands were associated with suboptimal self-rated health, also after adjustment for age, sex, SES, lifestyle and BMI (OR 1.49 [95 % CI 1.36–1.63]), but job strain (OR 1.93 [95 % CI 1.74–2.14) and ERI (OR 2.15 [95 % CI 1.95–2.35]) showed somewhat stronger associations with suboptimal self-rated health.
Conclusion
ICT demands are common among people with intermediate and high SES and associated with job strain, ERI and suboptimal self-rated health. ICT demands should thus be acknowledged as a potential stressor of work-related stress in modern working life.
doi:10.1007/s00420-016-1140-8
PMCID: PMC5005402  PMID: 27193569
ICT demands; Job strain; Effort-reward imbalance; Self-rated health; Socio-economic status
7.  Associations of multisite pain with healthcare utilization, sickness absence and restrictions at work 
Purpose
Despite the apparent importance of multisite musculoskeletal pain (MMP) for functioning, there is still a lack of studies that have investigated the influence of MMP on healthcare utilization (HU), sickness absence (SA) and restrictions of work (RW). This study described the HU, SA and RW due to musculoskeletal pain (MP) in different body sites and according to number of pain sites and investigated associations between number of pain sites with these three outcomes in workers from Bahia, Brazil.
Methods
This study was based on two cross-sectional surveys carried out in 2010 and 2012. The response in the pooled data was 97 % (n = 1070, 228 women and 842 men). Interviewer-administered questionnaire was used with questions on HU, SA and RW due to MP. The number of pain sites is the sum score of eight body sites with pain in previous 12 months. Covariates were age, gender, physical and psychosocial work demands, leisure-time physical activities and body mass index. Cox regression models, properly applied to a cross-sectional study, determined the associations between number of pain sites with the three outcomes.
Results
Prevalence of MP in the previous 12 months is 81.2 %, and MMP accounted for two-thirds of pain. We found consistently increasing occurrence of HU, SA and RW with increasing number of pain sites. For individuals with pain in four or more body sites, the utilization of health care was 1.7-fold the utilization by workers with single-site pain. Having pain in four or more sites increased the prevalence of SA 3.6-fold and of RW 4.0-fold compared with having single-site pain, after adjustment by covariates.
Conclusions
The functional consequences of pain depend on how much body regions are affected, i.e., the more widespread pain, the higher the likelihood of medical consumption, sickness absence and restricted work. Given the high comorbidity, the number of pain sites, instead of specific body site of pain, seems to be a useful measure to anticipate interventions at workplaces for musculoskeletal disease prevention.
doi:10.1007/s00420-016-1141-7
PMCID: PMC5005403  PMID: 27173450
Multisite pain; Sickness absence; Widespread pain; Work disability; Musculoskeletal pain; Healthcare utilization
8.  Impact of night-shift work on the prevalence of erosive esophagitis in shipyard male workers 
Purpose
Whether night-shift work is a risk factor for gastroesophageal reflux disease is controversial. The aim of this study was to investigate the association between night-shift work and other factors, and erosive esophagitis.
Methods
A cross-sectional study with 6040 male shipyard workers was performed. Esophagogastroduodenoscopic examination and a survey about night-shift work status, lifestyle, medical history, educational status, and marital status were conducted in all workers. The odds ratios of erosive esophagitis according to night-shift work status were calculated by using the logistic regression model.
Results
The prevalence of erosive esophagitis increased in the night-shift workers [odds ratio, 95 % confidence interval: 1.41 (1.03–1.94)]. According to multiple logistic regression models, night-shift work, obesity, smoking, and alcohol consumption of ≥140 g/week were significant risk factors for erosive esophagitis. By contrast, Helicobacter pylori infection was negatively associated with erosive esophagitis.
Conclusion
Night-shift work is suggested to be a risk factor for erosive esophagitis. Avoidance of night-shift work and lifestyle modification should be considered for prevention and management of gastroesophageal reflux disease.
doi:10.1007/s00420-016-1130-x
PMCID: PMC4927591  PMID: 27129469
Night-shift work; Prevalence; Erosive esophagitis; Male workers
9.  Occupational exposure of cashiers to Bisphenol A via thermal paper: urinary biomonitoring study 
Purpose
As an essential component of polycarbonate plastics and epoxy resins, Bisphenol A (BPA) is found in numerous industrial and consumer products. BPA may cause adverse health effects because of its endocrine activity. General population exposure to this compound mainly through diet is well documented. Thermal paper was also identified as a source of BPA through dermal intake. In this study, we investigated whether frequent contact with thermal paper is associated with an increase in urinary BPA excretion.
Methods
We evaluated the exposure to BPA in cashiers and in non-occupationally exposed workers from several workplaces. Urinary BPA was quantified in free (unconjugated) and total (unconjugated plus conjugated) forms in 24-h and spot urine samples using LC–MS/MS. BPA concentration in thermal paper was also measured from each workplace. In addition, participants provided information on job, food and drink, tobacco consumption and hands wash during the sampling period through a questionnaire.
Results
Urine samples were collected from 90 cashiers and 44 controls. Free and total BPA were detected in all samples. The median urinary total BPA concentration was 3.54 µg/L (2.89 µg/g creatinine) for controls and 8.92 µg/L (6.76 µg/g creatinine) for cashiers. For the free BPA, the median urinary concentration was 0.20 µg/L (0.21 µg/g creatinine) for controls and 0.28 µg/L (0.22 µg/g creatinine) for cashiers. Any correlation was found between the urinary concentration levels and the number of thermal receipts handled. Hand washes frequency, age, job length of service and tobacco consumption had also no effect on the BPA excretions.
Conclusion
A significant increase in urinary total BPA concentration was observed for cashiers handling daily thermal paper receipts. However, no significant increase was observed in urinary free BPA concentration. These findings are particularly interesting for risk assessment since all available data on occupational exposure to BPA through thermal paper were obtained from models or from simulated experiments.
doi:10.1007/s00420-016-1132-8
PMCID: PMC4927604  PMID: 27126703
Bisphenol A; Thermal paper; Cashiers; Exposure; Biomonitoring; Urine
10.  Implementation of the participatory approach for supervisors to prevent sick leave: a process evaluation 
Purpose
To perform a process evaluation of a multifaceted strategy to implement the participatory approach for supervisors to prevent sick leave in three organisations.
Methods
The implementation strategy incorporated a working group meeting with stakeholder representatives, supervisor training, and optional supervisor coaching. Context, recruitment, reach, dose delivered, dose received, fidelity, and satisfaction with the strategy were assessed at organisational and supervisor level using questionnaires and registration forms.
Results
At least 4 out of 6 stakeholders were represented in the working group meetings, and 11 % (n = 116) of supervisors could be reached. The working group meetings and supervisor training were delivered and received as planned and were well appreciated within all three organisations. Three supervisors made use of coaching. At 6-month follow-up, 11 out of 41 supervisors (27 %) indicated that they had applied the participatory approach at least one time.
Conclusion
The implementation strategy was largely carried out as intended. However, reach of both supervisors and department managers should be improved. Future studies should consider targeting employees with the strategy.
doi:10.1007/s00420-016-1118-6
PMCID: PMC4871914  PMID: 26970753
Participatory approach; Prevention; Process evaluation; Sick leave; Supervisors; Workplace
11.  Temporal patterns of sitting at work are associated with neck–shoulder pain in blue-collar workers: a cross-sectional analysis of accelerometer data in the DPHACTO study 
Background
Our aim was to examine the extent to which temporal patterns of sitting during occupational work and during leisure-time, assessed using accelerometry, are associated with intense neck–shoulder pain (NSP) in blue-collar workers.
Methods
The population consisted of 659 Danish blue-collar workers. Accelerometers were attached to the thigh, hip, trunk and upper dominant arm to measure sitting time and physical activity across four consecutive days. Temporal sitting patterns were expressed separately for work and leisure by the proportion of total time spent sitting in brief bursts (0–5 min), moderate (>5–20 min) and prolonged (>20 min) periods. The peak NSP intensity during the previous 3 months was assessed using a numerical rating scale (range 0–10) and dichotomized into a lower (≤4) and higher (>4) NSP score. Logistic regression analyses with multiple adjustments for individual and occupational factors were performed to determine the association between brief, moderate and prolonged sitting periods, and NSP intensity.
Results
Time in brief bursts of occupational sitting was negatively associated with NSP intensity (adjusted OR 0.68, 95 % CI 0.48–0.98), while time in moderate periods of occupational sitting showed a positive association with NSP (adjusted OR 1.32, 95 % CI 1.04–1.69). Time in prolonged periods of occupational sitting was not associated with NSP (adjusted OR 0.78, 95 % CI 0.78–1.09). We found no significant association between brief, moderate or prolonged sitting periods during leisure, and NSP.
Conclusion
Our findings indicate that the association between occupational sitting time and intense NSP among blue-collar workers is sensitive to the temporal pattern of sitting.
doi:10.1007/s00420-016-1123-9
PMCID: PMC4871928  PMID: 26935311
Neck pain; Sedentary; Time pattern; Physical activity; Occupational health
12.  Response to the letter to the editor from Morfeld 
doi:10.1007/s00420-016-1121-y
PMCID: PMC4871917  PMID: 26898208
13.  Inflammatory markers and exposure to airborne particles among workers in a Swedish pulp and paper mill 
Purpose
To study the relationship between exposure to airborne particles in a pulp and paper mill and markers of inflammation and coagulation in blood.
Methods
Personal sampling of inhalable dust was performed for 72 subjects working in a Swedish pulp and paper mill. Stationary measurements were used to study concentrations of total dust, respirable dust, PM10 and PM2.5, the particle surface area and the particle number concentrations. Markers of inflammation, interleukins (IL-1b, IL-6, IL-8, and IL-10), C-reactive protein (CRP), serum amyloid A (SAA), and fibrinogen and markers of coagulation factor VIII, von Willebrand, plasminogen activator inhibitor, and D-dimer were measured in plasma or serum. Sampling was performed on the last day of the work free period of 5 days, before and after the shift the first day of work and after the shifts the second and third day. In a mixed model analysis, the relationship between particulate exposures and inflammatory markers was determined. Sex, age, smoking, and BMI were included as covariates.
Results
The average 8-h time-weighted average (TWA) air concentration levels of inhalable dust were 0.30 mg/m3, range 0.005–3.3 mg/m3. The proxies for average 8-h TWAs of respirable dust were 0.045 mg/m3. Significant and consistent positive relations were found between several exposure metrics (PM 10, total and inhalable dust) and CRP, SAA and fibrinogen taken post-shift, suggesting a dose–effect relationship.
Conclusion
This study supports a relationship between occupational particle exposure and established inflammatory markers, which may indicate an increased risk of cardiovascular disease.
doi:10.1007/s00420-016-1119-5
PMCID: PMC4871919  PMID: 26875192
C-reactive protein (CRP); Fibrinogen; Interleukins (IL-1b, IL-6, IL-8 and IL-10); PM10; PM2.5; Respirable dust; Serum amyloid A (SAA)
14.  Improving fit to work assessments for rail safety workers by exploring work limitations 
Purpose
We aim to provide evidence for improving fit to work assessments for rail safety workers and raised the question whether adding an assessment of work limitations is useful. Therefore, we assessed differences in the proportions of perceived work limitations and reported health complaints and whether older age or having health complaints are risk factors for having work limitations.
Methods
Job requirements for rail safety workers are ‘vigilance and clear judgment’, ‘good communication abilities’, ‘sufficient eye sight’ and ‘task-required physical abilities’. We invited 1000 workers to fill in a questionnaire about perceived work limitations and health problems related to their job requirements. Proportions of the two were compared by using the McNemar test. Associations were analyzed by using univariate logistic regression.
Results
Among 484 rail safety workers, we found statistically significant differences between the proportions of reported health complaints (2–26 %) and work limitations (10–32 %). No significant associations were found between older age and work limitations, except for workers in the age group 40–50 years regarding physical abilities. This was not found for the age group over 50 years. For each age category, workers reporting health complaints related to ‘vigilance and clear judgment’ and ‘sufficient physical abilities’ had a statistically significant increased risk for reporting work limitations as well (ORs 2.4–17.9).
Conclusions
Our results indicate that fit to work assessments should include both health complaints and work limitations. Our results do not substantiate the assumption that workers over 40 years of age are at increased risk for work limitations in general.
doi:10.1007/s00420-016-1117-7
PMCID: PMC4871920  PMID: 26867594
Occupational health; Occupational safety; Transportation; Health status; Work fitness
15.  Reproductive disorders among cosmetologists and hairdressers: a meta-analysis 
Purpose
Occupational risks for reproductive disorders among hairdressers and cosmetologists have been examined in numerous epidemiological studies, although the results of those studies have been inconsistent. Therefore, we conducted a meta-analysis of published studies to evaluate the risks of reproductive disorders among cosmetologists and hairdressers.
Methods
We searched the MEDLINE, EMBASE, and Cochrane Library databases, as well as the reference lists of relevant publications, to identify studies for our analysis. After careful consideration, 19 eligible studies were included in the meta-analysis. We also performed systematic evaluations of publication bias, heterogeneity, and publication quality.
Results
Study-specific odds ratios (ORs) were weighted using the inverse of their variance to calculate fixed- and random-effect pooled estimates. The meta-analysis revealed a significantly increased risk of infertility (OR 1.15, 95 % CI 1.03–1.28), fetal death (OR 1.14, 95 % CI 1.04–1.24), and preterm delivery (OR 1.04, 95 % CI 1.00–1.07) among hairdressers and cosmetologists.
Conclusion
These findings indicate that hairdressers and cosmetologists have a higher risk of reproductive disorders, compared to the general population.
doi:10.1007/s00420-016-1112-z
PMCID: PMC4871926  PMID: 26821358
Reproductive disorder; Hairdresser; Cosmetologist; Meta-analysis
16.  [No title available] 
PMCID: PMC4828476  PMID: 26747456
17.  Is musculoskeletal pain a consequence or a cause of occupational stress? A longitudinal study 
Objectives
Longitudinal studies have linked stress at work with a higher incidence of musculoskeletal pain. We aimed to explore the extent to which musculoskeletal pain is a cause as opposed to a consequence of perceived occupational stress.
Methods
As part of the international CUPID study, we collected information from 305 Italian nurses, at baseline and again after 12 months, about pain during the past month in the low back and neck/shoulder, and about effort-reward imbalance (ERI) (assessed by Siegrist’s ERI questionnaire). Poisson regression was used to assess the RR of ERI >1 at follow-up according to report of pain and of ERI >1 at baseline.
Results
Among nurses with ERI ≤1at baseline, ERI >1 at follow-up was associated with baseline report of pain in the low back (RR=2.7, 95%CI1.4-5.0) and neck/shoulder (RR=2.6, 95%CI 1.3-5.1). However, there was no corresponding association with persistence of ERI in nurses who were already had ERI >1 at baseline. Associations of ERI at baseline with pain at follow-up were weak.
Conclusions
Our results suggest that the well documented association between job stress and musculoskeletal pain is not explained entirely by an effect of stress on reporting of pain. It appears also that workers who report musculoskeletal pain are more likely to develop subsequent perceptions of stress. This may be because pain renders people less tolerant of the psychological demands of work. Another possibility is that reports of pain and stress are both manifestations of a general tendency to be aware of and complain about symptoms and difficulties.
doi:10.1007/s00420-014-0982-1
PMCID: PMC4437793  PMID: 25261316
Back pain; neck pain; shoulder pain; longitudinal study; occupational exposure; effort reward imbalance
18.  [No title available] 
PMCID: PMC4828479  PMID: 26615549
20.  The occurrence of musculoskeletal complaints among professional musicians: a systematic review 
Purpose
This study gives a systematic overview of the literature on the occurrence of musculoskeletal complaints in professional instrumental musicians.
Methods
A systematic review. Nine literature databases were searched without time limits on June 25, 2015, also the complete index of the journal Medical Problems of Performing Artists (MPPA) until June 2015 (30;2) was searched, and citation tracking and reference checking of the selected articles were performed. The search consisted of the combination of three groups of keywords: musician (e.g., musician, violin, music student, instrument player) AND musculoskeletal (e.g., musculoskeletal, tendon, shoulder, arthritis) AND epidemiology (e.g., prevalence, incidence, occurrence).
Results
The initial literature search strategy resulted in 1258 potentially relevant articles. Finally, 21 articles describing 5424 musicians were included in this review. Point prevalences of musculoskeletal complaints in professional musicians range between 9 and 68 %; 12-month prevalences range between 41 and 93 %; and lifetime prevalences range between 62 and 93 %. Ten out of 12 studies show a higher prevalence of musculoskeletal complaints among women. Brass instrumentalists are reported to have the lowest prevalence rates of musculoskeletal complaints. The neck and shoulders are the anatomic areas most affected; the elbows are least affected. Although some information is reported concerning age, the high risk of bias in and between these studies makes it impossible to present reliable statements with respect to this.
Conclusion
Musculoskeletal symptoms are highly prevalent among musicians, especially among women instrumentalists. Future research concerning the epidemiology of musculoskeletal complaints among musicians should focus on associated risk factors and follow the current guidelines to optimize scientific quality.
doi:10.1007/s00420-015-1090-6
PMCID: PMC4786597  PMID: 26563718
Occupational; Epidemiology; Arts; Music; Musician; PRMD
21.  [No title available] 
PMCID: PMC4828480  PMID: 26559948
22.  [No title available] 
PMCID: PMC4828488  PMID: 26515185
23.  [No title available] 
PMCID: PMC4828478  PMID: 26483290
24.  Basal cell carcinoma in farmers: an occupation group at high risk 
Introduction
Skin cancer is the most commonly diagnosed cancer type worldwide, and 80 % of skin cancers are basal cell carcinoma (BCC). The main risk factor for developing BCC is exposure to ultraviolet radiation (UVR), particularly high-dose exposure at a young age. Outdoor workers, particularly farmers, are at high risk of developing BCC. However, studies of BCC in this population are scant.
Objective
To comprehensively evaluate all cases of BCC of the head and neck region treated during the years 2007–2013 at our hospital in Poland, and to compare the tumour characteristics in farmers to non-farmers.
Materials and methods
Retrospective analysis of 312 patients treated for head and neck BCC during the study period (2007–2013).
Results
Most patients (198 cases; 63 %) were males, with 114 females (37 %). Median age was 73 years (range 32–96 years). The most common tumour location was the nose and cheek (114 pts; 37 %) followed by the auricle (82 pts; 26 %), lips (54 pts; 18 %), scalp (26 pts; 8 %), and eye (36 pts; 12 %). The most common disease stage on presentation was stage T2 (104 pts, 33 %), followed by stage T1 (79 pts; 25 %), stage T3 (89 pts; 28 %), and stage T4 (40 pts; 14 %). By occupation, farmers accounted for 33 % of all patients (102 of 312 pts). The most common tumour localisations in the farmer subgroup were the nose and cheek (50 pts; 49 %; p < 0.001; odds ratio [OR] 2.19; 95 % confidence interval [CI] 1.35–3.57), followed by the auricle (32 pts; 31 %), scalp (16 pts; 16 %), ocular region (3 pts; 3 %), and lips (1 pt; 1 %). Patients in the farmer group were significantly younger than non-farmers (62 vs. 73 years; p < 0.001; OR 0.90, 95 % CI 0.88–0.93). Farmers were significantly more likely to present disease recurrence (27 vs. 12 % of cases; p < 0.001; OR 5.94; 95 % CI 2.86–12.33).
Conclusion
The results highlight the increased incidence and risk of recurrence of BCC in farmers. It is therefore necessary to consider enhancing educational programmes and other preventative measures in this occupational group and to evaluate the effectiveness of such programmes.
doi:10.1007/s00420-015-1088-0
PMCID: PMC4786594  PMID: 26464316
Basal cell carcinoma; Farmers; Sun; Exposure; Recurrence; Occupation
25.  Occupational noise exposure and hearing: a systematic review 
Purpose
To give a systematic review of the development of noise-induced hearing loss (NIHL) in working life.
Methods
A literature search in MEDLINE, Embase, Web of Science, Scopus, and Health and Safety Abstracts, with appropriate keywords on noise in the workplace and health, revealed 22,413 articles which were screened by six researchers. A total of 698 articles were reviewed in full text and scored with a checklist, and 187 articles were found to be relevant and of sufficient quality for further analysis.
Results
Occupational noise exposure causes between 7 and 21 % of the hearing loss among workers, lowest in the industrialized countries, where the incidence is going down, and highest in the developing countries. It is difficult to distinguish between NIHL and age-related hearing loss at an individual level. Most of the hearing loss is age related. Men lose hearing more than women do. Heredity also plays a part. Socioeconomic position, ethnicity and other factors, such as smoking, high blood pressure, diabetes, vibration and chemical substances, may also affect hearing. The use of firearms may be harmful to hearing, whereas most other sources of leisure-time noise seem to be less important. Impulse noise seems to be more deleterious to hearing than continuous noise. Occupational groups at high risk of NIHL are the military, construction workers, agriculture and others with high noise exposure.
Conclusion
The prevalence of NIHL is declining in most industrialized countries, probably due to preventive measures. Hearing loss is mainly related to increasing age.
Electronic supplementary material
The online version of this article (doi:10.1007/s00420-015-1083-5) contains supplementary material, which is available to authorized users.
doi:10.1007/s00420-015-1083-5
PMCID: PMC4786595  PMID: 26249711
NIHL; ISO; Population studies; Vibration; Cardiovascular risk factors; Chemicals; Leisure-time noise; Mechanisms

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