Explore the vast range of titles available.

ObjectivesTrichloroethylene, a chlorinated solvent widely used for metal degreasing, is classified by the International Agency for Research on Cancer as a kidney carcinogen. Other chlorinated solvents are suspected carcinogens, most notably the cleaning solvent perchloroethylene, although it is unclear whether they are associated with kidney cancer. We investigated kidney cancer associations with occupational exposure to 6 chlorinated solvents (trichloroethylene, perchloroethylene, 1,1,1-trichloroethane, carbon tetrachloride, chloroform, and methylene chloride) within a case–control study using detailed exposure assessment methods.MethodsCases (n=1217) and controls (n=1235) provided information on their occupational histories and, for selected occupations, on tasks involving potential exposure to chlorinated solvents through job-specific interview modules. Using this information, an industrial hygienist assessed potential exposure to each solvent. We computed ORs and 95% CIs for different exposure metrics, with unexposed participants as the referent group.Results1,1,1-trichloroethane, carbon tetrachloride, chloroform, and methylene chloride were not associated with kidney cancer. Among jobs with high exposure intensity, high cumulative hours exposed to perchloroethylene was associated with increased risk, both overall (third tertile vs unexposed: OR 3.1, 95% CI 1.3 to 7.4) and after excluding participants with ≥50% exposure probability for trichloroethylene (OR 3.0, 95% CI 0.99 to 9.0). A non-significant association with high cumulative hours exposed to trichloroethylene was observed (OR 1.7, 95% CI 0.8 to 3.8).ConclusionsIn this study, high exposure to perchloroethylene was associated with kidney cancer, independent of trichloroethylene. Additional studies are needed to further investigate this finding.

Background Work circumstances can substantially negatively impact health. To explore this, large occupational cohorts of free-text job descriptions are manually coded and linked to exposure. Although several automatic coding tools have been developed, accurate exposure assessment is only feasible with human intervention. Methods We developed OPERAS, a customizable decision support system for epidemiological job coding. Using 812,522 entries, we developed and tested classification models for the Professions et Catégories Socioprofessionnelles (PCS)2003, Nomenclature d’Activités Française (NAF)2008, International Standard Classifications of Occupation (ISCO)-88, and ISCO-68. Each code comes with an estimated correctness measure to identify instances potentially requiring expert review. Here, OPERAS’ decision support enables an increase in efficiency and accuracy of the coding process through code suggestions. Using the Formaldehyde, Silica, ALOHA, and DOM job-exposure matrices, we assessed the classification models’ exposure assessment accuracy. Results We show that, using expert-coded job descriptions as gold standard, OPERAS realized a 0.66–0.84, 0.62–0.81, 0.60–0.79, and 0.57–0.78 inter-coder reliability (in Cohen’s Kappa) on the first, second, third, and fourth coding levels, respectively. These exceed the respective inter-coder reliability of expert coders ranging 0.59–0.76, 0.56–0.71, 0.46–0.63, 0.40–0.56 on the same levels, enabling a 75.0–98.4% exposure assessment accuracy and an estimated 19.7–55.7% minimum workload reduction. Conclusions OPERAS secures a high degree of accuracy in occupational classification and exposure assessment of free-text job descriptions, substantially reducing workload. As such, OPERAS significantly outperforms both expert coders and other current coding tools. This enables large-scale, efficient, and effective exposure assessment securing healthy work conditions. Plain language summary Work can expose us to health risks, such as asbestos and constant noise. To study these risks, job descriptions are collected and classified by experts to standard codes. This is time-consuming, expensive, and requires expert knowledge. To improve this coding, we created computer code based on Artificial Intelligence that can both automate this process and suggest codes to experts, who can then check and change it manually if needed. Our system outperforms both expert coders and other available tools. This system could make studying occupational health risks more efficient and accurate, resulting in safer work environments. Langezaal, van den Broek, et al. develop a decision support system for epidemiological job coding. This system is used for occupational classification and exposure assessment of job descriptions and performs better than both expert coders and alternative currently available tools.

Purpose Tobacco smoking and occupational exposures are the leading risk factors for developing urothelial bladder carcinoma (UBC), yet little is known about the contribution of these two factors to risk of UBC recurrence. We evaluated whether smoking status and usual adult occupation are associated with time to UBC recurrence for 406 patients with muscle-invasive bladder cancer submitted to The Cancer Genome Atlas (TCGA) project. Methods Kaplan–Meier and Cox proportional hazard methods were used to assess the association between smoking status, employment in a high-risk occupation for bladder cancer, occupational diesel exhaust exposure, and 2010 Standard Occupational Classification group and time to UBC recurrence. Results Data on time to recurrence were available for 358 patients over a median follow-up time of 15 months. Of these, 133 (37.2%) experienced a recurrence. Current smokers who smoked for more than 40 pack-years had an increased risk of recurrence compared to never smokers (HR 2.1, 95% CI 1.1, 4.1). Additionally, employment in a high-risk occupation was associated with a shorter time to recurrence (log-rank p  = 0.005). We found an increased risk of recurrence for those employed in occupations with probable diesel exhaust exposure (HR 1.8, 95% CI 1.1, 3.0) and for those employed in production occupations (HR 2.0, 95% CI 1.1, 3.6). Conclusions These findings suggest smoking status impacts risk of UBC recurrence, although several previous studies provided equivocal evidence regarding this association. In addition to the known causal relationship between occupational exposure and bladder cancer risk, our study suggests that occupation may also be related to increased risk of recurrence.

Epidemiologic studies of occupational lead exposure have suggested increased risks of cancers of the stomach, lung, kidney, brain, and meninges; however, the totality of the evidence is inconsistent. We investigated the relationship between occupational lead exposure and cancer incidence at the five abovementioned sites in two prospective cohorts in Shanghai, China. Annual job/industry-specific estimates of lead fume and lead dust exposure, derived from a statistical model combining expert lead intensity ratings with inspection measurements, were applied to the lifetime work histories of participants from the Shanghai Women's Health Study (SWHS; n = 73,363) and the Shanghai Men's Health Study (SMHS; n = 61,379) to estimate cumulative exposure to lead fume and lead dust. These metrics were then combined into an overall occupational lead exposure variable. Cohort-specific relative hazard rate ratios (RRs) and 95% confidence intervals (CIs) comparing exposed and unexposed participants were estimated using Cox proportional hazards regression and combined by meta-analysis. The proportions of SWHS and SMHS participants with estimated occupational lead exposure were 8.9% and 6.9%, respectively. Lead exposure was positively associated with meningioma risk in women only (n = 38 unexposed and 9 exposed cases; RR = 2.4; 95% CI: 1.1, 5.0), particularly with above-median cumulative exposure (RR = 3.1; 95% CI: 1.3, 7.4). However, all 12 meningioma cases among men were classified as unexposed to lead. We also observed non-significant associations with lead exposure for cancers of the kidney (n = 157 unexposed and 17 ever exposed cases; RR = 1.4; 95% CI: 0.9, 2.3) and brain (n = 67 unexposed and 10 ever exposed cases; RR = 1.8; 95% CI: 0.7, 4.8) overall. Our findings, though limited by small numbers of cases, suggest that lead is associated with the risk of several cancers in women and men. Liao LM, Friesen MC, Xiang YB, Cai H, Koh DH, Ji BT, Yang G, Li HL, Locke SJ, Rothman N, Zheng W, Gao YT, Shu XO, Purdue MP. 2016. Occupational lead exposure and associations with selected cancers: the Shanghai Men's and Women's Health Study cohorts. Environ Health Perspect 124:97-103; http://dx.doi.org/10.1289/ehp.1408171.

ObjectivesLead is a suspected carcinogen that has been inconsistently associated with kidney cancer. To clarify this relationship, we conducted an analysis of occupational lead exposure within a population-based study of kidney cancer using detailed exposure assessment methods.MethodsStudy participants (1217 cases and 1235 controls), enrolled between 2002 and 2007, provided information on their occupational histories and, for selected lead-related occupations, answered questions regarding workplace tasks, and use of protective equipment. Industrial hygienists used this information to develop several estimates of occupational lead exposure, including probability, duration and cumulative exposure. Unconditional logistic regression was used to compute ORs and 95% CIs for different exposure metrics, with unexposed subjects serving as the reference group. Analyses were also conducted stratifying on several factors, including for subjects of European ancestry only, single nucleotide polymorphisms in ALAD (rs1805313, rs1800435, rs8177796, rs2761016), a gene involved in lead toxicokinetics.ResultsIn our study, cumulative occupational lead exposure was not associated with kidney cancer (OR 0.9, 95% CI 0.7 to 1.3 for highest quartile vs unexposed; ptrend=0.80). Other lead exposure metrics were similarly null. We observed no evidence of effect modification for the evaluated ALAD variants (subjects of European ancestry only, 662 cases and 561 controls) and most stratifying factors, although lead exposure was associated with increased risk among never smokers.ConclusionsThe findings of this study do not offer clear support for an association between occupational lead exposure and kidney cancer.

ObjectivesThe validity of surrogate measures of retrospective occupational exposure in population-based epidemiological studies has rarely been evaluated. Using toenail samples as bioindicators of exposure, we assessed whether work tasks and expert assessments of occupational metal exposure obtained from personal interviews were associated with lead and manganese concentrations.MethodsWe selected 609 controls from a case–control study of bladder cancer in New England who had held a job for ≥1 year 8–24 months prior to toenail collection. We evaluated associations between toenail metal concentrations and five tasks extracted from occupational questionnaires (grinding, painting, soldering, welding, working near engines) using linear regression models. For 139 subjects, we also evaluated associations between the toenail concentrations and exposure estimates from three experts.ResultsWe observed a 1.9-fold increase (95% CI 1.4 to 2.5) in toenail lead concentrations with painting and 1.4-fold increase (95% CI 1.1 to 1.7) in manganese concentrations with working around engines and handling fuel. We observed significant trends with increasing frequency of both activities. For lead, significant trends were observed with the ratings from all three experts. Their average ratings showed the strongest association, with subjects rated as possibly or probably exposed to lead having concentrations that were 2.0 and 2.5 times higher, respectively, than in unexposed subjects (ptrend <0.001). Expert estimates were only weakly associated with manganese toenail concentrations.ConclusionsOur findings support the ability of experts to identify broad contrasts in previous occupational exposure to lead. The stronger associations with task frequency and expert assessments support using refined exposure characterisation whenever possible.

Objectives Growing evidence suggests that gender-blind assessment of exposure may introduce exposure misclassification, but few studies have characterised gender differences across occupations and industries. We pooled control responses to job-specific, industry-specific and exposure-specific questionnaires (modules) that asked detailed questions about work activities from three US population-based case–control studies to examine gender differences in work tasks and their frequencies. Methods We calculated the ratio of female-to-male controls that completed each module. For four job modules (assembly worker, machinist, health professional, janitor/cleaner) and for subgroups of jobs that completed those modules, we evaluated gender differences in task prevalence and frequency using χ2 and Mann–Whitney U tests, respectively. Results The 1360 female and 2245 male controls reported 6033 and 12 083 jobs, respectively. Gender differences in female:male module completion ratios were observed for 39 of 45 modules completed by ≥20 controls. Gender differences in task prevalence varied in direction and magnitude. For example, female janitors were significantly more likely to polish furniture (79% vs 44%), while male janitors were more likely to strip floors (73% vs 50%). Women usually reported more time spent on tasks than men. For example, the median hours per week spent degreasing for production workers in product manufacturing industries was 6.3 for women and 3.0 for men. Conclusions Observed gender differences may reflect actual differences in tasks performed or differences in recall, reporting or perception, all of which contribute to exposure misclassification and impact relative risk estimates. Our findings reinforce the need to capture subject-specific information on work tasks.

The epidemiologic evidence for the carcinogenicity of lead is inconsistent and requires improved exposure assessment to estimate risk. We evaluated historical occupational lead exposure for a population-based cohort of women ( n =74,942) by calibrating a job-exposure matrix (JEM) with lead fume ( n =20,084) and lead dust ( n =5383) measurements collected over four decades in Shanghai, China. Using mixed-effect models, we calibrated intensity JEM ratings to the measurements using fixed-effects terms for year and JEM rating. We developed job/industry-specific estimates from the random-effects terms for job and industry. The model estimates were applied to subjects’ jobs when the JEM probability rating was high for either job or industry; remaining jobs were considered unexposed. The models predicted that exposure increased monotonically with JEM intensity rating and decreased 20–50-fold over time. The cumulative calibrated JEM estimates and job/industry-specific estimates were highly correlated (Pearson correlation=0.79–0.84). Overall, 5% of the person-years and 8% of the women were exposed to lead fume; 2% of the person-years and 4% of the women were exposed to lead dust. The most common lead-exposed jobs were manufacturing electronic equipment. These historical lead estimates should enhance our ability to detect associations between lead exposure and cancer risk in the future epidemiologic analyses.

ObjectiveExposure-oriented questionnaire modules provide crucial task information for occupational exposure assessment. We evaluated the effectiveness of an algorithm for automatically assigning modules during interviews in a hospital-based case-control study in Asia.MethodsWe used a rule-based expert system based on a keyword search of occupational history responses and screening questions pertaining to paints/stains, solvents/glues/degreasers, and engineered woods to assign jobs to one of 23 modules. If no module was identified, we assigned a Work Location module that redirected some participants to more detailed modules. Post interview, each job was coded to standardized occupation and industry classifications. For each job and industry code we determined the ‘ideal’ module. We reviewed each ‘ideal’ vs. ‘assigned’ module combination and characterized potential information loss: none, task loss, and industry loss. We evaluated the screening questions’ positive and negative predictive value (PPV, NPV) compared to task responses for jobs assigned the Solvent module. For those redirected from the Work Location to the Solvent module, we calculated the task prevalence.ResultsThe algorithm assignment for 26,608 jobs was based on keywords for 55.4% and screening questions for 8.6%; the remainder received the work location module. Potential information loss was identified for 8.8% of jobs (7.2% task loss; 1.6% industry loss). For the 5,847 jobs completing the Solvent module, the overall PPV and NPV of the screening questions was 82.4% and 70.0%, respectively, with higher NPVs for engineered woods and paints/stains than for solvents/glues/degreasers. The Work Location re-directed 663 jobs to the Solvent module; the most frequently-reported activities for these jobs were cleaning hands with solvents (14%), paint bystander (8.0%), cleaning/degreasing bystander (5.1%) and glues/adhesives bystander (5.0%).ConclusionsOverall, our automated approach resulted in excellent capture of tasks of interest. Jobs identified with potential information loss will be prioritized for additional review during exposure assessment efforts.

Research on communication of illness in friendships is fundamental to understanding biopsychosocial implications of disease. The goal of this study was to determine how disclosure of Hashimoto’s disease impacts individuals’ psychological and social well-being in friendships. This qualitative study used Communication Privacy Management Theory and Social Penetration Theory theoretical frameworks to examine disclosure decisions, processes, and relational implications of disclosure. Participants (n = 12), all female, engaged in semi-structured interviews to share their experiences of disclosing Hashimoto’s disease in close friendships. Results revealed that women with Hashimoto’s disease encounter positive and negative experiences when disclosing their illness to a close friend. For some, the decision to disclose was effortless, while others engaged in a more involved decision making process for how to initially disclose, and how much to disclose all together. During the disclosure, having an invisible disease with inconsistent symptoms added an additional element in navigating the disclosure conversation. Some women navigated the process easily, as their friend provided the response they needed, whether this was emotional support, physical support, or simply being there to listen. Other women had more challenging disclosures to navigate when their friends reacted in ways unanticipated, such as being unsupportive and unreceptive. Results showed that disclosures of Hashimoto’s disease continued across time as the time after being diagnosed progressed. Some friendships were strengthened after disclosing Hashimoto’s disease to a close friend, while others decreased in closeness or even resolved. Disclosures for many lead to increased social support, which may contribute towards increased health benefits. In the future, research on this topic can be expanded through studying disclosures to various relationships as well as expanding on other implications of the illness.