Objectives: This study explored the associations between biomechanical and psychosocial work factors and musculoskeletal symptoms in vineyard workers. Methods: This cross-sectional study was based on a random sample of 2,824 male and 1,123 female vineyard workers in France. Data were collected using a self-administered questionnaire. Neck/shoulder, back and upper and lower extremity symptoms were evaluated using the Nordic questionnaire. Biomechanical exposures included 15 tasks related to vineyard activities. Psychosocial work factors included effort-reward imbalance and overcommitment, measured using the effort-reward imbalance model, and low job control and insufficient material means. Statistical analysis was performed using logistic regression analysis, and the results were adjusted for age, body mass index, educational level, work status and years in vineyard. Results: Pruning-related factors increased the risk of upper extremity pain for both genders, of back pain for men and of neck/shoulder and lower extremity pain for women. Driving increased the risk of neck/shoulder and back pain among men. Psychosocial work factors, which were insufficient material means, overcommitment (both genders), effort-reward imbalance (men) and low job control (women), were associated with musculoskeletal symptoms, back and upper extremity pain for both genders and neck/shoulder and lower extremity pain for men. Conclusions: These results underlined that both biomechanical and psychosocial work factors may play a role in musculoskeletal pain among vineyard workers. Prevention policies focusing on both biomechanical and psychosocial work exposures may be useful to prevent musculoskeletal symptoms.

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Objectives: We investigated the effects of fatigue on NK cell function and lymphocyte subpopulations in nurses performing shift work using a longitudinal design. Methods: Fifty-seven female nurses engaged in shift work at a hospital in Japan were selected for our study cohort. The hospital used a counterclockwise rotating three-shift system. Night shifts followed day shifts after a seven-hour interval. Immune parameters measured at the beginning of the day shift through to the end of the night shift were compared between two groups stratified by their level of fatigue. Statistical differences were evaluated after adjusting for baseline immune values and other demographic features. Results: Subjective feelings of fatigue increased progressively from the beginning of day shifts to the end of night shifts. From the beginning of day shifts to the end of night shifts, NK cell activity and CD16⁺CD56⁺ lymphocytes decreased, while CD3⁺ and CD4⁺ lymphocytes increased. The group with the greater increase in fatigue showed a larger decrease in NK cell activity and a larger increase in CD4⁺lymphocytes when compared with the group reporting less fatigue. These findings did not change after adjusting for demographic factors and sleep hours. Conclusion: Our data suggest that shift work has deleterious effects on NK cell function and that the effects depend on the degree of fatigue. Proper management of shift work may lessen fatigue in workers and also ameliorate many health problems experienced by shift workers.

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Objectives: Pneumoconiosis in China remains a disease with substantial public health significance. Diagnostic standards for the pneumoconioses are based on traditional film-screen radiography (FSR). However, FSR is increasingly being replaced with digital radiographic imaging, which has become the predominant technology available in Chinese clinical practice. To evaluate the applicability of digital direct readout radiography (DR) images in the recognition of pneumoconioses, we compared the profusion of small opacities and large opacities between FSR and DR radiographs. Methods: We enrolled 161 pneumoconioses patients and 31 dust-exposed workers during the course of the study, with FSR and DR images obtained from all participants. Each chest film was interpreted by five readers using the Chinese Diagnostic Criteria classification of radiographs of pneumoconiosis, as were DR images displayed on medical-grade computer monitors. Results: No statistically significant differences were observed when the data were analyzed by small opacity profusion subcategory except for 1/1. The overall intermodality agreement of small opacities was good, with a weighted kappa (κ) of 0.77. Conclusions: DR images with soft copy display are equivalent with respect to image quality and the recognition and classification of small parenchymal lung opacities. Additionally, we observed likeness between modalities with respect to the classification of large opacities. Overall, our study findings demonstrate that in a population of Chinese workers with pneumoconiosis, direct readout digital systems are equivalent to traditional film-screen radiography in the recognition and classification of small pneumoconiotic opacities.

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Objectives: To investigate associations between occupational exposure to cooking oil fumes (COFs) and potential oxidative and genotoxic effects in kitchen workers. Methods: Sixty-seven male kitchen workers and 43 male controls from Chinese restaurants in Guangzhou were recruited. For all the participants, the levels of 1-hydroxypyrene (1-OHP) and 8-hydroxy-2-deoxyguanosine (8-oxodG) in urine, binucleated micronucleus (BNMN) frequency, comet tail length and tail DNA% in peripheral blood lymphocytes (PBLs) and malondialdehyde (MDA) and superoxide dismutase (SOD) in serum were measured. The inhalable particulates (PM₁₀) in their workplaces were also monitored. Results: Our results showed that the exposed group had a significantly higher median level of urinary 1-OHP than that of the control group (p<0.01). In addition, the median levels of 8-oxodG, BNMNs, tail length and MDA in the exposed group were markedly higher than those of the controls (p<0.01). These differences, except that of MDA, appeared not to be modified by the potential confounders: age, BMI, smoking and alcohol consumption. A univariate regression analysis showed that greater 1-OHP, 8-oxodG, BNMNs, tail length and MDA were associated with years working in a kitchen and cooking time per day. All these positive associations remained after adjusting for the four confounders in a subsequent multivariate linear regression analysis. Conclusions: Occupational exposure to COFs led to increased oxidative damage in Chinese kitchen workers. The health consequences of these oxidative changes need further investgation. Urinary 1-OHP and 8-oxodG are noninvasive and effective biomarkers for assessment of oxidative damage in restaurants workers.

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Objectives: Previous studies examining the association between job stress and blood lipids have produced mixed findings. We sought to investigate the association between job stress and blood lipids among Chinese workers. Methods: A total of 544 subjects (367 men and 177 women) without known diseases from the Stress and Health in Shenzhen Workers (SHISO) cross-sectional study were analyzed. Job stress was evaluated by the effort-reward imbalance (ERI) model. The associations between job stress and blood lipids, such as for total cholesterol (TCHO), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), were explored by multiple linear regression. The association between job stress and combined dyslipidemia was examined by multiple logistic regression. Results: Compared with their corresponding low level groups, groups with high levels of effort, overcommitment and ERI had a significantly increased risk of combined dyslipidemia with adjusted odd ratios (ORs) of 3.5 (95% CI 1.8-6.7), 4.2 (95% CI 2.3-7.7) and 2.7 (95% CI 1.5-5.1), respectively, whereas high rewards significantly reduced the risk of combined dyslipidemia (adjusted OR 0.3, 95% CI 0.2-0.6) compared with low rewards. Effort, overcommitment and ERI were significantly positively related to TG and LDL-C, while rewards were inversely related to them. No significant associations were observed between job stress and TCHO and HDL-C. The results were similar for men and women. Conclusions: Effort, overcommitment, low reward and ERI increased the risk of dyslipidemia among Chinese workers, and they were significantly associated with TG and LDL-C rather than TCHO or HDL-C. Increasing blood lipids may be the possible link between job stress and coronary heart disease.

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Objectives: Metabolic equivalents (METs) and relative metabolic rate (RMR) as calculated by oxygen uptake (VO₂) are often used to assess physical exertion. In practice, accurate measurements of VO₂ are difficult; heart rate (HR) values represent an alternate index of physical exertion. We investigated whether one can assess physical exertion based on HR in the workplace, even if the physical task in question involves alternating periods of strenuous anaerobic activity and rest. We also examined the potential usefulness of assessments based on percentage of heart rate reserve (%HRR) and percentage of oxygen uptake reserve (% VO₂R). Methods: Six healthy men were asked to perform several physical movements. HR and VO₂ were recorded in real time. Results: HR and VO₂ are significantly correlated even under conditions of various repeated intermittent movements including anaerobic exertion. Cumulative fatigue results in inadequate recovery in various parameters indicating sufficient rest times, whereas VO₂ values recover immediately. One movement may generate large differences in HR among individuals, but not in VO₂. We found no significant differences between dispersion for %HRR and VO₂R. However, as with HR, %HRR values indicated insufficient recovery after strenuous exertion. Conclusions: VO₂ alone does not adequately reflect the exertion entailed by certain physical activities. HR is more useful than VO₂ in evaluating the exertion required by physical labor in individual workers. While we can use %HRR and % VO₂R to compare physical exertion from individual to individual, %HRR is more valuable, since % VO₂R can underestimate physical exertion in recovery periods for the same reasons as VO₂.

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Objectives: This study investigated changes in craniocervical and trunk flexion angles and gluteal pressure on both sides during visual display terminal (VDT) work with continuous cross-legged sitting. Methods: The gluteal pressures of ten VDT workers, who were recruited from laboratories, were measured using a Teckscan system and videotaped using a single video camera to capture the craniocervical and trunk flexion angles during VDT work at 30 s, 10, 20 and 30 min. Results: The craniocervical angle was significantly increased at 10 and 20 min compared with the initial angle (p<0.05). The trunk flexion angle was significantly decreased at 30 s, 10, 20 and 30 min (p<0.05). The gluteal pressure of the crossed-leg side significantly increased at 30 s, 10 and 20 min (p<0.05). The gluteal pressure of the uncrossed-leg side significantly decreased at 30 s (p<0.05). Conclusion: We found that cross-legged sitting during VDT work may exert disadvantageous postural effects resulting from craniocervical and trunk flexion angles and gluteal pressure. Therefore, this posture could not be recommended during long-term VDT work.

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Objectives: To determine the incidence rate of work-related aggression and violence (WRAV) against doctors and investigate risk factors and psychological influences of WRAV doctors. Methods: We sent a self-administered questionnaire on WRAV committed by patients and their associates to 1,148 doctors in Nara Prefecture, Japan. We calculated the incidence rate of WRAV using the number of incidents encountered during the previous 12 mo and the doctor's average weekly working hours. Risk factors for the incidence WRAV were analyzed by Poisson regression, and the influence of WRAV on the symptoms of post-traumatic stress disorder (PTSD) was evaluated by multiple logistic regression analysis. Results: A total of 758 (66.0%) doctors returned the questionnaire. The incidence rate of WRAV was 0.20 [95% CI: 0.17-0.24]×10^-3 per practice hour. Adjusted incidence rate ratios of WRAV were significantly increased among doctors 1) with a shorter career (11.0; 95% CI: 5.0-24.2), 2) working in a region with the lowest average taxable income (1.6; 1.1-2.4), and 3) whose specialties were dermatology (3.8; 2.3-6.3), psychiatry (2.7; 1.3-5.6) and ophthalmology (1.9; 1.2-3.2). Of 289 subjects who had encountered WRAV at least once during their career, 26 doctors (8.2%) had symptoms suggestive of PTSD due to the most severe incident. Conclusions: Doctors encountered WRAV at an incidence rate of 0.20×10^-3 per practice hour, and some of them might develop PTSD. Countermeasures are required to maintain sound health and safe workplaces for doctors.

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Objectives: The purpose of this study was to determine the prevalence of professional burnout experienced by Turkish judo coaches and to compare possible differences in the three burnout dimensions based on coaching experience in years and satisfaction status of their sport administrators. Methods: The data were obtained by using a three-section questionnaire including a socio demographic data form and the Turkish version of the Maslach Burnout Inventory from 65 judo coaches working in the Turkish Judo and Kurash Federation. Results: In the analysis of data, descriptive statistics (mean and standard deviation) and one-way ANOVA tests were used. This study showed that judo coaches have medium level burnout experience. The results also showed that there were significant differences in the emotional exhaustion levels of judo coaches based on coaching experience in years and satisfaction status from their sport administrators. Conclusions: Burnout appears to be a problematic issue for judo coaches. When coaches begin to feel emotionally depleted, they distance themselves from athletes, and experience a reduced sense of meaning about their work; it is likely to affect the quality of the athletic experience for both the coach and the athletes.

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Objective: To prioritize the educational content in psychiatry teaching materials for occupational physicians. Methods: A preparatory investigation was performed that included interviews with 13 psychiatrists who were well acquainted with occupational health and practices. Brainstorming among the psychiatrists and 12 occupational physicians was used to develop a list of educational content related to psychiatric issues that should be required for occupational physicians. Using a questionnaire survey constructed based on the preparatory investigations, 135 specialists with extensive experience in occupational medicine were asked to prioritize the selected items. Results: A total of 67 specialists responded to the questionnaire. The following were recommended as high educational priorities for occupational physicians to master: awareness and diagnosis of mood disorders, being able to appropriately deal with depressed workers, screening for depression, understanding cases that should be referred for special treatment, appropriate action for a suicidal person, understanding symptoms that require cooperation in an emergency with a specialist, acquisition of the attitude and skills used in active listening and awareness of diseases such as alcohol dependence, adjustment disorders and schizophrenia. Conclusions: What has been presented here is a consensus view of specialists in this field. The items included were those obtained from sitting in on the discussions of psychiatrists and occupational physicians. They represent indicators for the development of teaching materials.

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Objectives: To determine work stress, and stress-coping strategies, and to analyze their the relationships in order to improve health-promoting lifestyle of nurses in Taiwan. Methods: Three hundred eighty-five nurses who had work experience for more than 6 mo, were selected from four district hospitals in Kaohsiung and Ping Tung. We used a stratified cluster random sampling method for the selection. The nurses answered a self-report questionnaire, which was categorized into four sections: personal background data, work stress, stress-coping strategies, and health-promoting lifestyle. Results: The findings indicate work stress and the health promoting lifestyle of nurses are at a higher level, with stress-coping strategies being at a medium level. Work stress and stress-coping strategies were significantly and positively correlated. Professional relationships, managerial role, personal responsibility, and recognition of work stress and the responsibilities of a health-promoting lifestyle were negatively correlated. Managerial role, personal responsibility, and organizational atmosphere of work stress as well as realization, an item of health-promoting lifestyle, were negatively correlated. Recognition of work stress and stress management, items of health-promoting lifestyle, were negatively correlated. Health responsibility, and self-actualization, items of health-promoting lifestyle, as well as stress-coping strategies were negatively correlated. Nutrition, an item of health-promoting lifestyle, and the support stress-coping strategy was negatively correlated. Conclusions: Nurses have greater work pressure and better work stress-coping strategies, but worse health responsibility and realization of a health-promoting lifestyle. We suggest hospitals build good relationships and appropriately increase employment of nurses through a good work atmosphere to achieve nurses' realization of a health-promoting lifestyle.

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Background: Petrochemical industries are known as sources of many toxic chemicals. Safety and health risks of the petrochemical workers employed at Map Ta Phut Industrial Estate, located in Rayong, Thailand, are potentially high. Methods: The research materials consisted of documents emanating from statutory reports on safety in working with toxic chemicals and the results of interviews by questionnaire among 457 petrochemical workers regarding occupational health and safety issues. Results: Most of workers who were working with toxic chemicals had knowledge and awareness of health risks and chemical hazards at work. We found that safe behavior at work through read the safety information among operational workers less than non-operational workers around 10%. Most of workers had perceived occupational health and safety management in their companies. Some companies revealed that they had not been performing biological monitoring of blood or urine for their health examination reports and that workplace exposure monitoring had not correlated well with health examination of workers. Conclusions: Our study suggested that occupational health and safety for petrochemical industries requires standards and guidelines for workers' health surveillance aimed at protection of workers.

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