Multiple sclerosis (MS) is an autoimmune disease with complex aetiology involving genetic, environmental and lifestyle factors. Shift work disrupts circadian rhythms and is a potential occupational risk factor for MS, with exposure before age 20 thought to be of additional risk.
To investigate associations between retrospective lifetime shift work exposure and MS diagnosis and between prospective shift work exposure and incident MS over 13 years of follow-up in the UK Biobank cohort.
Participants that were in work and free of MS at baseline were followed up for 13 years, and lifetime exposure to night, day and mixed shift work was assessed in a subset of participants. Logistic regression and Cox proportional hazard models were applied to test associations between shift work and MS diagnosis, controlling for demographic and lifestyle confounders.
Lifetime exposure to mixed, day or night shift work was not associated with an increased risk of MS diagnosis. No significant associations were observed for early-life shift work exposure or in prospective analysis of those reporting shift work at baseline. Factors such as female sex, smoking, childhood obesity and reduced sunlight exposure were consistently associated with higher MS risk.
There was no evidence for an association between shift work and the risk of MS diagnosis in this cohort, in retrospective analysis of lifetime exposure or in prospective studies of shift work at baseline following 13 years of follow-up. Further research is needed to elucidate mechanisms and latitudinal variations in shift work-related MS risk.
A recent meta-analysis confirmed that chest X-ray (CXR) has low sensitivity for diagnosing silicosis. We re-estimated previously published dose-response relationships between cumulative respirable crystalline silica (RCS) exposure and silicosis risk, under the assumptions that sensitivity was either fixed or relative to the population proportion of severe silicosis.
We combined unpublished logistic regression models from Scottish coal miners with meta-analysis results to model how CXR sensitivity changed according to cumulative RCS exposure. We assumed specificity was 0.95. Among mining cohorts, we calculated the difference in the cumulative risk of silicosis between the unadjusted and fixed and relative scenarios. Finally, we re-estimated a published dose-response meta-analysis and associated absolute risk reductions (ARR).
The cumulative risk of silicosis was substantially higher in both the fixed and relative sensitivity scenarios compared with the unadjusted estimate in all mining cohorts. This was most pronounced in the relative scenario and when cumulative RCS exposures were below approximately 6 mg/m3-years. A reduction in cumulative RCS exposure from 4 to 2mg/m3-years corresponded to larger ARRs in the fixed and relative scenarios than the unadjusted scenario; 382 (95% CI 361 to 399) and 529 (95% CI 353 to 592) cases per 1000 miners compared with 313 (95% CI 288 to 333) cases per 1000 miners, respectively.
We relied on a single estimate of the proportion of severe disease to link sensitivity and cumulative RCS exposure. Nevertheless, adjusting for the reduced diagnostic accuracy of CXR for silicosis suggests the burden of silicosis is underestimated in published mining cohorts.
The 2011 Fukushima Daiichi Nuclear Power Plant accident involved approximately 20 000 emergency workers. Given the scale and nature of the accident, concerns have been raised regarding the long-term health of the emergency workers. This study presents the first 10 year overview of mortality among these workers.
We analysed the mortality data for 19 358 male emergency workers (mean age in 2012: 45.5 years; SD: 11.3) from 2012 to 2021. Mortality data were monitored through linkage to national vital statistics, including the dates and causes of death. Standardised mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated using the general male population in Japan as a reference, standardised by calendar year and attained age (5 year age groups).
During 190 700 person-years of follow-up, 708 deaths were identified. The overall SMR was 0.86 (95% CI 0.80 to 0.93). SMRs for all solid cancers and radiation-associated solid cancers and leukaemia were below 1.0 during 2012–2014, approached 1.0 during 2015–2017 and exceeded 1.0 during 2018–2021, suggesting marginal excess mortality (both P values for trend <0.05). In contrast, the increasing trends were less evident for neoplasms excluding radiation-associated solid cancers and leukaemia. No elevated SMR for suicide was observed.
The overall mortality among Fukushima emergency workers was lower than expected based on general population rates, likely reflecting the healthy-worker effect. However, marginal elevations in SMRs for all solid cancers and for radiation-associated solid cancers and leukaemia emerged during later follow-up, highlighting the importance of continued health monitoring in this population.
Musculoskeletal pain (MSP) is a major occupational health challenge and a leading cause of disability and economic burden worldwide. However, prospective evidence on how pain intensity across multiple body regions affects long-term labour market participation and production losses remains limited. This study quantifies working-life expectancy (WLE) and working years lost (WYL) associated with multisite MSP among senior workers and introduces a novel method to estimate its related economic burden.
The study includes 23 071 Danish employees aged 50–66 years from the SeniorWorkingLife study (2018 and 2022), linked to national labour-market registers through 2024. Self-reported pain intensity (low, moderate, high) in four body regions was examined. WLE and WYL were estimated using the expected labour market affiliation method, and economic costs were calculated from individual wage data.
Moderate-to-high pain in two body regions was associated with reduced WLE and higher production losses. Employees with high back and leg pain had mean annual losses of 8167 per person (58.8 million total), with 38% attributable to sickness absence. Total losses linked to back and leg pain were estimated at 2.0 billion (0.5% of Denmark’s GDP).
MSP in senior workers, particularly when affecting multiple body regions, imposes a substantial economic burden through reduced WLE and increased sickness absence. Targeted interventions are needed to manage MSP and sustain employment among older workers.
To assess the association between parental occupational pesticide exposures at birth and adult testicular germ cell tumour (TGCT) by histological subtype and the agreement between two pesticide job-exposure matrices (JEM).
TGCT cases (n=454) and matched controls (n=670) aged 18–45 years were recruited from 20 French university hospitals into the TESTIS national case-control study. Paternal and maternal jobs at birth were obtained from interviews of participants and their mothers/relatives and coded into official nomenclatures (International Standard Classification of Occupations, French nomenclature of activity-1999). Two complementary JEMs, ALOHA+ and FRIJEM, assessed occupational exposure to all pesticides, herbicides, insecticides, fungicides with ALOHA+ for each parent by linking job titles to JEM-derived probability and intensity estimates (no/low/high). Cohen’s Kappa coefficient () assessed their agreement. ORs and 95% CIs comparing exposure and levels of exposure with no exposure were estimated using conditional logistic regression adjusted for literature-based covariates statistically associated with TGCT and stratified by histological subtypes.
Agreement between ALOHA+and FRIJEM was moderate to substantial ( 0.52–0.80). A statistically non-significant higher TGCT risk was observed for high paternal occupational pesticide exposure with ALOHA+ (OR 1.95, CI 0.98 to 3.84) and FRIJEM (OR 1.70, CI 0.88 to 3.28). With ALOHA+, statistically significant positive associations were seen for high paternal occupational exposure to herbicides (overall: OR 4.23, CI 1.75 to 10.22; seminomas: OR 4.78, CI 1.79 to 12.77; non-seminomas: OR 3.53, CI 1.21 to 10.3) and fungicides (overall: OR 2.09, CI 1.05 to 4.18; seminomas: OR 2.31, CI 1.02 to 5.23). No statistically significant associations were observed for other levels of paternal exposure or pesticide groups nor for maternal exposure.
Only high paternal occupational exposure to pesticides at birth, especially herbicides and fungicides, was positively associated with TGCT.
We aimed to investigate the association between occupational standing, walking and forward bending during pregnancy and the risk of miscarriage.
This register-based study examined all labour-active pregnant women in Denmark between 2004 and 2018, comprising 803 829 pregnancies among 475 312 women. Occupational exposure to standing, walking and forward bending ≥30° was assessed with a quantitative, pregnancy-specific job exposure matrix, based on the woman’s occupational code in the occupational and industry register, at the year of pregnancy start. Information on miscarriage was retrieved from the Danish National Patient Register (DNPR). Statistics Denmark, the Danish Medical Birth Registry and the DNPR provided information on potential confounders. Absence data, sourced from the Danish Register for Evaluation and Marginalisation (DREAM), were assessed as an effect modifier. We estimated adjusted hazard ratios (aHRs) using Cox regression.
All three exposures were associated with increased hazards for miscarriage. The aHR for miscarriage was 1.03 (95% CI: 1.02 to 1.04) per additional hour of occupational standing, 1.18 (95% CI: 1.15 to 1.22) per additional hour of occupational walking and 1.36 (95% CI: 1.30 to 1.41) per additional hour of occupational forward bending. The aHR was more pronounced among women with absence from work the preceding week than among those without. Post hoc quartile analyses indicated a consistent exposure–response relationship for forward bending, while the associations for standing and walking decreased at the highest quartile.
We found an elevated risk of miscarriage associated with all three occupational exposures. Replication in comparable populations incorporating smoking status and other health information is needed to validate these associations.
Inhalation of crystalline silica dust causes lung cancer, although evidence assessing risk at low levels of exposure is needed. We sought to estimate the association between cumulative silica exposure and lung cancer risk in a cohort of miners in Ontario, Canada.
A cohort of 48 772 hard rock miners enumerated from a medical surveillance programme was followed for lung cancer diagnoses in the Ontario Cancer Registry from 1964 through 2022. Silica dust exposure was estimated using a linear prediction model based on 12 325 personal sampling measurements from Ontario mines. Exposure–response associations were estimated, with adjustments for uranium mining, arsenic dust and screening CXR. Probabilistic bias analysis was used to evaluate differential outcome misclassification due to loss to follow-up using a known bias parameter.
3218 lung cancer cases were diagnosed during a median of 44 years of follow-up. Positive associations between cumulative silica exposure and incident lung cancer rates were observed in all categories of exposure, with 0.5–2.0 mg/m3-years of exposure associated with 1.33 times (95% CI 1.06 to 1.66) the adjusted rate of lung cancer compared with<0.5 mg/m3-years. The positive exposure–response association remained after excluding known silicotics and increased in magnitude when excluding radon-exposed uranium miners. Bias adjustment for outcome misclassification increased the monotonicity and slope of the exposure–response relationship, but attenuated the IRR in the 0.5–2.0 mg/m3-year category to 1.08.
Silica exposure was positively associated with lung cancer risk at low levels of cumulative exposure in a universally exposed population of miners. Findings were robust to suspected sources of bias.
The risks to lung health from workplace hazards remain incompletely understood and may still be overlooked by workers, employers and healthcare professionals. We used an online tool to collect European population-based data relating to workplace exposures, training and lung health.
A targeted industry-specific digital tool, enquiring about the link between respiratory symptoms and work, was made accessible online over a 24-month period.
22 393 individuals (mean age 43.6 years) responded; 55.7% were female, 46.7% completed in English, 19.9% in Portuguese, 17.8% in French, 10.5% in Dutch and 5% in German. 47% reported nasal symptoms, 42% cough, 21% chest tightness and 20% wheeze. 8412 (37.6%) reported at least one work-related symptom. The use of workplace training (11%) and guidance (17%) to prevent respiratory ill health was uncommon. 980 (5.9%) had changed their job because it had affected their breathing. Increasing age (OR 1.02 per year age increase), completion language (English (OR 0.66), French (OR 0.39)), workplace (bakery (OR 1.64), mine (OR 1.91), sports centre (OR 3.03) and farm (OR 1.77)) and workplace training (OR 0.71) were significantly associated with this outcome. These workers also had more work-related symptoms (p<0.001) and complained of more wheeze (p<0.001) and nasal symptoms (p<0.001). 919 (5.6%) workers with a more likely diagnosis of occupational asthma were more female, had less workplace guidance and training and had co-workers with health complaints.
This tool has reached real-world working populations and these findings identify the need for further awareness raising, education and social media interventions.
Smoking remains a major preventable cause of lung and cardiovascular disease. This randomised controlled trial evaluated EILA, a mobile application using artificial intelligence, for promoting smoking cessation among hospital workers.
A randomised controlled trial was conducted. Hospital workers (n=43) were recruited from a German university hospital from May 2022 to March 2023. Inclusion criteria comprised age ≥18, Fagerström score ≥3 or 10 cigarettes per day, ownership of a suitable smartphone, motivation to quit smoking and no addiction to other psychoactive substances. Participants were randomised by sealed envelopes to EILA intervention (n=25) or a wait-list control (n=18) receiving a primary care-style intervention, with crossover after 3 months. The primary outcome was the cessation rate. Secondary outcomes comprised nicotine dependence, mental health and cardiovascular risk, all measured using validated questionnaires.
At the 6-month follow-up, the relative risk for continued smoking was reduced to 0.91 (n=51, 95% CI 0.7 to 1.2), and nicotine dependence, measured by the Fagerström Test, decreased significantly from 4.41±1.93 to 3.32±2.69 (n=19, p=0.014). PROCAM score for cardiovascular risk was reduced from 35.22±12.47 to 31.9±13.24 (n=36, p=0.008).
The digital health application EILA was linked to increased smoking cessation rates, although without achieving statistical significance. Nevertheless, the results indicate reductions in nicotine dependence and cardiovascular risk, supporting EILA as a scalable and flexible intervention for promoting health in hospital workers.