Journal of Occupational Health

BackgroundTeleworking is associated with lifestyle risk factors, such as insufficient physical activity (PA) and increased sedentary time (ST); however, effective interventions tailored to teleworkers are lacking. We aimed to evaluate the effectiveness of a 12-week multicomponent occupational lifestyle intervention on daily step counts among Japanese teleworkers. MethodsThis 12-week, two-arm, parallel-group, cluster randomised controlled trial conducted across 12 clusters in six Japanese companies involved 310 teleworkers (mean age 43.0 years; 72.6% men) randomized to the intervention (6 clusters, n=156) or a waitlist control group (6 clusters, n=154). The multicomponent occupational lifestyle intervention included individual (online lectures, feedback, and email messages), physical (posters and a pop-up), and organizational (encouraging messages from an executive) strategies. The primary outcome was the change in daily step counts, measured using an accelerometer over 14 consecutive days at baseline and at week 12. Analyses were based on the intention-to-treat approach using a generalised estimating equation model. FindingsThe intervention group showed an adjusted mean change in daily step counts of +219 steps (95% confidence interval [CI] -165 to 604), compared with +188 steps (95% CI -183 to 560) in the control group. The adjusted between-group difference was +55 steps (95% CI -550 to 660; p=0.844). No significant effects on the secondary outcomes (ST, light PA, or moderate-to-vigorous PA) were observed. InterpretationThe multicomponent occupational lifestyle intervention did not significantly increase daily step counts among Japanese teleworkers. Therefore, further studies should be done on tailored interventions for teleworkers. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSTeleworking has increased globally, particularly following the coronavirus disease pandemic, and has been associated with reduced physical activity and increased sedentary behaviour, both of which are risk factors for cardiovascular disease. Previous studies have also reported that telework environments may contribute to musculoskeletal and other somatic symptoms. Multicomponent interventions in traditional office settings can effectively increase physical activity and reduce sedentary time. These interventions commonly employ strategies at multiple levels of the social-ecological model, including individual approaches (e.g., lectures or incentives), interpersonal approaches (e.g., team-based activities), environmental modifications (e.g., office rearrangements or sit-stand desks), and organisational support (e.g., leadership encouragement). The applicability of such interventions to teleworking populations remains unclear because teleworkers face distinct challenges such as social isolation, blurred work-life boundaries, and heterogeneous home working environments. These contextual differences highlight the need for interventions specifically tailored to teleworkers. Added value of this studyWe evaluated the effectiveness of a multicomponent occupational lifestyle intervention specifically designed for teleworkers, a population whose work environment differs substantially from traditional office settings. Our findings provide novel evidence that can inform the development of more targeted strategies to promote physical activity in evolving work environments. This study also provides objective measurements of physical activity using accelerometers, enabling detailed evaluation of step counts, sedentary time, and different activity intensities among teleworkers. Additionally, we used daily diaries to distinguish activity patterns across workdays, weekends, teleworking days, and commuting days, providing a nuanced understanding of behavioural patterns in remote work contexts. Implications of all the available evidenceOur findings indicate that low-cost, remotely delivered multicomponent interventions may be insufficient to produce meaningful behavioural change among teleworkers. Similar strategies, including individual, physical, and organisational components, have been effective in traditional workplace interventions; however, their implementation in teleworking environments may not adequately address the specific challenges faced by remote workers. In particular, the lack of strong sociocultural support mechanisms, such as team-based step competitions or workplace champions, may limit engagement and reduce the effectiveness of such programmes. Therefore, further investigation is needed to explore more diverse and targeted intervention strategies, identify the specific needs and behavioural patterns of teleworkers, and apply more precise eligibility criteria to better address heterogeneity within teleworking populations.

IntroductionMusculoskeletal injuries (MSKIs) are ubiquitous in the U.S. military, especially among high-performing service members such as Marines. Given that female service members only started to be assigned to ground combat roles since December 2015, evaluation of sex on MSKI risk in ground combat occupations has not been possible until there was an ample population to study. The purpose of this population-level epidemiological study was to assess (1) if female sex was a salient risk factor for MSKI in Marines serving in different military occupations, including combat arms, and (2) the effects of integration period on MSKI risk among female Marines. Materials and MethodsA population-based epidemiological retrospective cohort study of all U.S. Marines was performed assessing female sex, occupation, and integration period on the prevalence of MSKI from 2011 through 2020. The Military Health System Data Repository was utilized to identify initial healthcare encounters for diagnosed ankle-foot, knee, lumbopelvic-hip, thoracocostal, cervicothoracic, shoulder, elbow, or wrist-hand complex injuries. Prevalence was calculated for female and male Marines in each occupational category (combat, combat support, aviators, aviation support, services) during the pre-integration (2011-2015) and post-integration (2016-2020) periods. ResultsDuring the pre-integration period, 520/1,000 female Marines (n=13,985) and 299/1,000 male Marines (n=142,158) incurred MSKIs. In the post-integration period, the prevalence increased to 565/1,000 female Marines (n=17,608) and 348/1,000 male Marines (n=161,429). In the multivariable evaluation of sex, occupation, integration period, and the interaction of sex and occupation on combined MSKIs, only female sex was a significant factor for injury (prevalence ratio [PR]=1.99), with service in ground combat and aviation occupations identified as protective factors when compared with services occupations (PR=0.69). When these same factors were evaluated for specific MSKI outcomes, female sex remained a robust factor in all lower quarter (PR=1.75-2.63) and upper quarter (PR=1.38-2.36) injuries except for shoulder injuries. Service in ground combat and aviation occupations was protective for all lower quarter injuries (PR=0.46-0.71). In the upper quarter, ground combat was protective for all injuries except for elbow injuries (PR=0.67-0.77). Serving as an aviator was a risk factor for cervicothoracic (PR=1.57) and thoracocostal (PR=1.22) injuries and a protective factor for shoulder (PR = 0.73) and wrist-hand (PR = 0.46) injuries. Adjusted risk for lumbopelvic-hip (PR=1.13), ankle-foot (PR=1.53), cervicothoracic (PR=1.19), thoracocostal (PR=1.14), and elbow (PR=1.48) injuries significantly increased during the post-integration period. There was a significant sex-by-period interaction for shoulder injuries alone, with female sex in the post-integration epoch found to be salient (PR=1.26). ConclusionsFemale sex was a salient factor for MSKI, with service in ground combat and aviation occupations identified as protective factors when compared with services occupations. In the evaluation of specific MSKIs, female sex remained a robust and significant factor in all lower quarter injuries and upper quarter injuries except for shoulder injuries. There was only a significant sex-by-period interaction for shoulder conditions, with an increased risk of these injuries in female Marines in the post-integration period.

IntroductionTraditional bone-setting remains a culturally significant healthcare practice in low- and middle-income countries, particularly in regions like Sudan where modern orthopedic services are often inaccessible or unaffordable .This study examines the role of traditional healing practices in orthopedic care in White Nile State, Sudan, assessing patient perceptions, treatment effectiveness, and sociocultural factors influencing healthcare choices. MethodsA cross-sectional analytical study was conducted among 147 patients, 7 traditional healers, and 4 orthopedic practitioners in urban and rural areas of White Nile State. Data were collected using structured questionnaires and interviews, focusing on treatment preferences, perceived effectiveness, and barriers to integration. Descriptive and inferential statistics were used to analyze quantitative data, while thematic analysis was applied to qualitative responses from healers and practitioners. ResultsFractures (45.6%) and arthritis (23.1%) were the most common orthopedic conditions. 30.6% of patients initially sought traditional treatment, all eventually utilized modern care (medication 71.4%, surgery 42.9%). Traditional healing was perceived as somewhat effective by 40% of users, whereas 59.9% rated modern care as very effective. Key factors influencing treatment choices included cultural beliefs (29.9%), accessibility (18.4%), and cost (16.3%). No significant demographic associations were found with treatment preference or effectiveness (p > 0.05). Traditional healers predominantly treated dislocations (100%) and fractures (71.4%) using manual techniques, with 57.1% referring complex cases to modern practitioners. Barriers to collaboration included lack of communication (85.7% of healers) and differing treatment philosophies (50% of practitioners). ConclusionThis study highlights the persistent dual reliance on traditional and modern orthopedic care in Sudan, with modern treatments perceived as more effective yet traditional methods remaining culturally entrenched especially in rural areas. The path forward requires bridging these systems through mutual respect, shared protocols, and community engagement to ensure safe, equitable, and effective musculoskeletal care for all Sudanese patients.

PurposeThe GIG-OSH cohort was established to investigate the impact of digital platform work on occupational safety and health (OSH), working and employment conditions, and health in seven countries in Europe. ParticipantsThe cohort comprises 3,945 digital platform workers from seven European countries. The sample includes both web-based workers (e.g., micro-tasking, freelance design) and on-location workers (e.g., delivery, transport). Participants were recruited using non-probabilistic sampling strategies tailored to national contexts, including social media advertising, recruitment through micro-task platforms, and on-site field outreach. Multidimensional data have been collected through online surveys (implemented via REDCap) covering sociodemographic characteristics, working and employment conditions, psychosocial risks, algorithmic management, and physical and mental health indicators. Findings to dateParticipants had a mean age of 32.6 years at baseline (SD 10.4), and the majority are male (58.8%), with a higher concentration of migrants in on-location tasks (62.2%) compared to web-based tasks (48.8%). Regarding educational attainment, 55.4% of the total cohort holds a tertiary degree, reaching 64.4% among web-based workers. Platform work intensity varies significantly: on-location workers averaged 85.4 hours of work in the last month, while web-based workers averaged 47.0 hours. Mean income from platform work as a percentage of the national median was 20.6% (SD 22.2). The mean WHO-5 Well-Being Index score was 58.7 (SD 20.3), which is notably lower than the European general population average (69.4), indicating poorer mental health outcomes among cohort members. Future plansThe GIG-OSH cohort represents the first large-scale, longitudinal study examining occupational safety and health among digital platform workers across multiple European countries. Future waves will prioritize developing precise tools to measure hourly earnings and unpaid waiting time. Future research should aim to include underrepresented subgroups, such as medical and domestic care workers, and explore potential linkage with administrative records to evaluate long-term health trajectories and the impact of new EU labour regulations. Strengths and limitations of this studyO_LIThis is the first large-scale longitudinal cohort to examine occupational safety and health among platform workers across multiple European countries, addressing an important evidence gap. C_LIO_LIThe inclusion of both web-based and on-location workers enables comparative analyses across diverse task types, employment conditions, and national contexts. C_LIO_LIRecruitment strategies tailored to national contexts enhanced feasibility but limited the representativeness of samples and precluded national-level weighting or benchmarking. C_LIO_LIHigh attrition between waves and the absence of harmonized classifications (e.g., education levels) across countries may constrain the generalizability and longitudinal consistency of findings. C_LIO_LIDespite relying on self-reported data, the study used stakeholder-informed instruments and captured a wide range of occupational hazards--such as psychosocial and algorithmic risks--not typically addressed in conventional labour surveys. C_LI

ObjectiveThe study aimed to analyze factors associated with cotinine levels as an early risk indicator for chronic diseases and students readiness to quit smoking in Praya Barat District. MethodsThis study used a cross-sectional design involving 563 high school students in Praya Barat District. Data analysis was performed using the Chi-square test and multiple logistic regression to identify determinants of high cotinine levels. ResultsA total of 67% of subjects had high cotinine levels, indicating high levels of nicotine exposure among students. The results of the analysis showed that the main determinants of high cotinine levels were cigarette consumption of [&ge;]5 cigarettes/day (AOR=2.426; 95% CI=1.534-3.838; p<0.001), male gender (AOR=2.100; 95% CI=1.358-3.250; p=0.001), family members who smoke (AOR=2.149; 95% CI=1.359-3.399; p=0.001), rarely of exercise (AOR=2.155; 95% CI=1.350-3.440; p=0.001), and personal history of chronic disease (AOR=2.646; 95% CI=1.653-4.234; p<0.001). Meanwhile, willingness to participate in a smoking cessation program did not show a significant relationship (p=0.093). ConclusionsMost students showed high cotinine levels, indicating significant exposure to nicotine and a potential risk of chronic disease in the future. The most influential factors were active smoking behavior, a family environment of smokers, and low levels of physical activity.

Background Inflammatory markers play an important role in the pathophysiology of Lumbar disc herniation (LDH). This study presents a comprehensive multi-assessment of the inflammatory landscape by combining serum inflammatory cytokines quantification, their diagnostic performance, associations with radiological features, and integrating the experimental findings into an in-silico protein-protein interaction network. Methods A multifaceted study design was utilized to quantify and compare the distribution of selected inflammatory cytokines in patients with LDH and control subjects. The diagnostic ability of these cytokines was assessed using receiver operating characteristic curve analysis. The cytokines values were correlated with selected radiological findings including disc herniation subtypes (protrusion, extrusion, and sequestration), and further categorized as contained and non-contained in patients using a Spearmans rank correlation test. Additionally, computational analysis was performed to identify the central hubs and functionally enriched pathways. Results In patients with LDH, IL-6 and IL-1{beta} showed statistically significant (IL-6: p < 0.001; IL-1{beta}: p = 0.001) rise, but IL-6 showed high diagnostic and discriminative power (AUC = 0.99; cut-off: 19.99 pg/mL). Further IL-1{beta} exhibited a positive correlation with non-contained disc herniation (extrusion and sequestration), while displaying a significant (p < 0.05) negative correlation with protrusion. In silico analysis identified IL-1{beta}, IL-8, TNF-, IL-6, IL-1, CSF2, CSF3, and IL-10 as central hubs, with IL-1{beta} being the top ranked hub in determining functionally enriched cytokine-cytokine receptor interaction. Conclusions Study confirmed IL-6 as a powerful diagnostic marker for LDH, while IL-1{beta} aids in determining contained and non-contained disc herniation. Further, IL-1{beta} was identified as the central hub, triggering functionally enriched pathways in the pathogenesis of LDH.

Background: The prevalence of lumbar disc herniation (LDH) is increasing, and the associated pain and functional limitations severely impact patients' quality of life. Daoyin, a traditional Chinese exercise, has a history of thousands of years in managing musculoskeletal pain. However, its application in LDH has not been sufficiently investigated, and there is a notable scarcity of rigorous randomized controlled trials (RCTs). This paper outlines the protocol for an RCT based on the theory of goal attainment (TGA), which aims to investigate whether Daoyin is more effective than other exercise therapies in improving symptoms in patients with LDH. Methods: We conducted a 6-week RCT in which participants were randomly assigned to either Daoyin or core stability exercise (CSE). During the first two weeks, the participants performed their assigned exercises five times per week. Outcome data were collected at baseline, week 2, and week 6. The primary outcome was pain intensity at 6 weeks, which was assessed via the visual analogue scale (VAS). The secondary outcomes included the Japanese Orthopaedic Association (JOA) score, the Oswestry Disability Index (ODI), the MOS 36-item Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), surface electromyography (sEMG), gait analysis, and electroencephalography (EEG). A generalized estimating equation (GEE) model will be used to analyse longitudinal changes and between-group differences. Discussion: This trial seeks to assess the efficacy of Daoyin for LDH and to elucidate its underlying neuromuscular mechanisms. Should the intervention prove feasible, the findings will inform the design of a subsequent large-scale RCT and are expected to contribute to a solid evidence base for the broader clinical application of Daoyin. Trial registration: https://itmctr.ccebtcm.org.cn/, Registration number (ITMCTR2025001239).

Purpose: Alpha-gal syndrome (AGS) is an emerging health issue. This syndrome, caused by the bites of ticks, induces allergic reactions to the sugar molecule galactose-alpha-1,3-galactose after exposure to non-primate mammalian meat and other byproducts. Agricultural workers spend significant time outdoors placing them at an increased risk for tick bites and tick-borne diseases, like AGS. This study aimed to characterize farmers and ranchers' prior knowledge, symptomology, and diagnostic experiences with AGS. Methods: We conducted a cross-sectional survey of more than 200 farmers and ranchers with a self-reported AGS diagnosis. The survey captured farmers and ranchers' experiences related to prior knowledge and experience with tick bites and AGS, reported symptoms, and obtaining a diagnosis. Findings: A total of 201 respondents across 26 states participated in the survey, with the majority from Missouri and Oklahoma. We identified four distinct symptom clusters, with the most reported symptoms being abdominal cramping, diarrhea, itchy skin, and nausea. Women more often reported gastrointestinal discomfort, and men were more likely to be in the mild symptom category. On average, participants reported 2.98 medical provider visits before receiving a diagnosis, most being diagnosed by general practitioners and allergists. Conclusions: No previous studies have focused on the symptom and diagnostic experiences of farmers and ranchers with AGS. Capturing such data is essential as these workers may experience unique occupational challenges following AGS diagnosis. The diagnostic experience data support a continuing need to educate and empower AGS patients and providers, especially agricultural workers and providers serving rural communities.

PurposeTo evaluate the predictive value of the thoracic spine-clavicle angle (TSCA) and the thoracic cage-clavicle angle (TCCA) for immediate postoperative shoulder balance. MethodsA total of 154 Lenke type 1 and 2 AIS patients who underwent corrective surgery in our hospital were included. The degree of clavicle angle (CA), thoracic spine tilt angle (TSTA), thoracic cage tilt angle (TCTA), proximal thoracic curve (PTC) Cobb angle, and main thoracic curve (MTC) Cobb angle were measured on standing full-length posteroanterior spine radiographs before and after surgery. Five parameters, TSCA, TCCA, correction rate of PTC, correction rate of MTC, relative PT/MT residual Cobb angle (RRCA), were calculated. Multinomial Logistic Regression was used to determine the risk factors of PSB. A p-value of less than 0.05 was considered statistically significant. ResultsFor TCCA, in group R (vs group B), pre-op right high (vs pre-op left high) (OR=8.102, 95%CI [1.650, 39.786], p=0.01) and RRCA (OR=1.015, 95%CI [1.004, 1.026], p=0.009) are risk factors. Pre-op left high (vs pre-op right high) (OR=0.123, 95%CI [0.025, 0.606], p=0.01) and correction rate of MTC (OR=0.886, 95%CI [0.809, 0.971], p=0.009) are protective factors. Correction rate of PTC shows no significant effect. In group L (vs group B), pre-op left high (vs pre-op right high) (OR=2.648, 95%CI [1.084, 6.469], p=0.033) is a risk factor. Pre-op right high (vs pre-op left high) (OR=0. 378, 95%CI [0. 155, 0.922], p=0. 033) is a protective factor. Correction rate of PTC, correction rate of MTC, and RRCA show no significant effect. ConclusionPreoperative shoulder balance, as defined by the TCCA, serves as an independent risk factor for PSB. Using postoperative balanced shoulders as the reference group, preoperative left shoulder high (vs right high) significantly increased the risk of postoperative left shoulder high, while significantly reducing the risk of postoperative right shoulder high. Preoperative right shoulder high (vs left high) significantly increased the risk of postoperative right shoulder high, while significantly reducing the risk of postoperative left shoulder high. The correction rate of MTC was an independent protective factor against postoperative right shoulder high, whereas RRCA was an independent risk factor for postoperative right shoulder high.

Work-related stress is a major public health issue affecting workers across various sectors. Individuals experiencing work-related stress are more likely to consume psychoactive substances, primarily alcohol, tobacco, and cannabis, as well as psychoactive medications, which may be used as coping mechanisms. Work-related stress is also associated with adverse outcomes such as burnout, depression, anxiety, and sleep disorders. In France, early childhood professionals, including "ATSEMs", "animateurs", and "agents dentretien", play a crucial role in the education, care, and well-being of children but are exposed to high levels of occupational stress due to the emotionally demanding nature of their work and the associated physical strain, making them vulnerable to substance use, burnout, depression, anxiety, and sleep disorders. This cross-sectional epidemiological study, conducted at a single time point, will be carried out among early childhood professionals working in schools for children in Orleans Metropole, Communaute de Communes des Terres du Val de Loire (CCTVL), and Fleury-les-Aubrais. Ethical approval for this study was obtained from the Ethics Committee of the Centre Hospitalier Universitaire dOrleans (assigned reference number is CERO 2511-02). The study aims to provide a better understanding of the relationship between work-related stress and the use of psychoactive substances and medications among early childhood professionals, as well as the association between work-related stress and burnout, depression, anxiety, and sleep disorders. Data will be collected anonymously using self-administered online questionnaires, accessed via a QR code printed on flyers distributed to participants. The same QR code will also provide access to an information sheet explaining that the study complies with ethical guidelines and that proceeding implies non-objection to participation. Based on calculations performed using BiostaTGV, a sample size of 265 participants is required. Statistical analysis will be conducted using SPSS software. Studying these associations is essential for informing the development of targeted interventions and prevention.

Background Trials in occupational populations, such as surgeons, face feasibility challenges due to high workload, restricted availability, and clinical heterogeneity, which may compromise recruitment, adherence, and retention. Objective To prespecify the feasibility framework and progression criteria for an internal pilot phase embedded within a pragmatic randomized controlled trial (RCT) comparing Mechanical Diagnosis and Therapy with generalized exercise in surgeons with chronic spinal pain. Design Protocol for a prespecified internal pilot phase embedded within a pragmatic, two-arm, parallel-group RCT. Methods The internal pilot will include the first four months of recruitment and aims to randomize at least 12 participants. Feasibility will be assessed across predefined domains, i.e., recruitment, eligibility, consent, intervention uptake, adherence, retention, data completeness, and treatment fidelity. Each domain is operationally defined and linked to prespecified progression criteria to ensure interpretability and decision-making utility. Criteria will be interpreted collectively to guide trial continuation. A minimal qualitative process evaluation will be embedded. Ethics and dissemination The host trial has received ethical approval (N-20240046) and is registered at ClinicalTrials.gov (NCT07293130). The findings from the internal pilot will be reported in a separate feasibility manuscript.

ObjectiveHealthcare workers (HCWs) are at increased risk of COVID-19 infection and play a critical role in influencing public vaccine acceptance. This study aimed to assess vaccination coverage and identify the determinants of vaccine uptake among healthcare workers in Cameroon, in order to inform targeted strategies to strengthen immunization programs and improve epidemic preparedness. ResultsAmong 406 participants (75.6% female, 65.5% aged 30-44 years, 61.3% nurses), 42.4% were fully vaccinated against COVID-19, while only 4.7% had completed the cholera vaccine series. Coverage varied across districts, with Biyem-Assi (53.0%) and Odza (46.0%) recording the highest COVID-19 uptake, and Nkolndongo (11.5%) leading for cholera vaccination. Independent predictors of COVID-19 uptake included being a nurse (aOR = 3.96; 95% CI: 2.07-7.81; p = 0.001) and laboratory technician professions (aOR = 8.00; 95% CI: 1.38-69.8; p =0.032). For cholera vaccination, working in internal medicine wards (aOR=11.2; 95% CI: 1.04-120; p = 0.046) and being a nurse (aOR = 1.54; p = 0.001) emerged as significant predictors. Although 62.8% of HCWs perceived their work environment as high-risk, knowledge of recommended vaccines was limited, with only 18.7% aware of cholera vaccination recommendations. Strengthening vaccine education, improving accessibility, and reducing financial barriers could enhance vaccine acceptance among HCWs. These findings provide important insights for designing targeted immunization strategies in Cameroon and similar contexts.

ObjectiveTo characterize associations between tattooing and health status. MethodsWe used data from [~]27,000 respondents to the 2020-2022 Utah Behavioral Risk Factor Surveillance System (BRFSS). Multivariable Poisson regression was used to calculate prevalence ratios (PR) and 95% confidence intervals (CI) associating ever receiving a tattoo with physical/mental health status. ResultsIn this cross-sectional study, ever receiving a tattoo was associated with self-reported "poorer" vs. "excellent" overall health, particularly among women (PR=3.08 [95% CI: 2.26- 4.21]). Tattooing was also associated with obesity (women, PR=1.40 [95% CI: 1.22-1.61]; men, PR=1.21 [95% CI: 1.04-1.40]) and chronic pain (women, PR=1.59 [95% CI: 1.43-1.77]; men, PR=1.55 [95% CI: 1.37-1.76]). Tattooed individuals were more likely to have been diagnosed with a depressive disorder (women, PR=1.64 [95% CI: 1.53-1.75]; men, PR=1.55 [95% CI: 1.39-1.73]) and to have had six or more teeth removed, vs. none (women, PR=2.18 [95% CI: 1.61-2.96]; men, PR=2.88 [95% CI: 2.10-3.95]). ConclusionsPublic health entities may consider partnering with tattoo studios and conventions to provide information about nutrition, exercise, dental care, mental health resources, and health screenings.

BackgroundLung cancer compensation systems for occupational exposure to asbestos commonly apply Helsinki criteria, which assume 4% excess lung cancer risk per fibre-year of asbestos exposure. The Probability of Causation (PoC) is [&ge;]50% at 25 fibre-years (risk doubling threshold). Large case-control studies have suggested steeper exposure-response relations at lower exposures. We aimed to estimate PoC of asbestos-related lung cancer to evaluate exposure thresholds for compensation of lung cancer cases occupationally exposed to asbestos. MethodsRelative risk of asbestos-related lung cancer was estimated using two approaches: O_LIA meta-regression of 22 occupational studies forming the core evidence on cumulative asbestos exposure and lung cancer since the 1980s (130,341 participants). C_LIO_LIA meta-analysis of the recently conducted SYNERGY pooled case-control study (14 studies, 37,866 participants), adjusted for age, sex, smoking, and study. C_LI The likelihood that lung cancer was caused by asbestos was estimated as the PoC with 95% prediction intervals (95%PI). ResultsOccupational cohort studies produced a shallow exposure-response relation with substantial heterogeneity (I{superscript 2} = 92.7%). SYNERGY showed a steeper relation with 6.8% (95%PI: 0%-17.7%) lung cancer risk increase per fibre-year and lower heterogeneity (I{superscript 2} = 63.4%). PoC [&ge;]50% occurred at 62.93 (point estimate) and 18.2 fibre-years (upper 95%PI) for occupational asbestos studies, compared to 10.5 and 4.3, respectively, in SYNERGY. ConclusionsThe SYNERGY pooled case-control study provided exposure-response estimates that are more representative of current exposure to lower mixed asbestos fibres in the Netherlands, supporting lower exposure thresholds than the existing Helsinki criteria when estimating PoC in compensation contexts.

BackgroundNon-communicable diseases (NCDs) are the leading cause of mortality in Iran, driven largely by modifiable lifestyle risk factors. Healthcare providers play a pivotal role in delivering preventive lifestyle recommendations, yet the extent and effectiveness of these efforts remain unclear. This study aimed to assess the distribution of lifestyle counseling across sociodemographic and clinical subgroups and its association with health behavior status in Iran using data from the 2021 WHO STEPS survey. MethodsWe conducted a cross-sectional analysis of 27,704 included adults participating in the nationally representative 2021 STEPS survey in Iran. Data on delivery of ten specific lifestyle recommendations within the past 12 months, covering diet, physical activity, weight management, and tobacco non-initiation/cessation, were collected. Associations between recommendation delivery and health behaviors were analyzed using logistic regression models. ResultsOnly 33.4% (95% Confidence Interval (CI): 32.8-34.0) of participants received all ten lifestyle recommendations, while 10.7% (10.2-11.1) received no recommendations. Recommendations were more frequently delivered to females, rural residents, and individuals with multiple comorbidities, indicating a risk-based response by healthcare providers. Notably, tobacco non-initiation/cessation advice was not more commonly offered to patients with multiple chronic conditions. Delivery of lifestyle counseling was associated with positive behavior status: individuals who received weight loss/ maintaining normal weight and physical activity advice were more likely to engage in sufficient physical activity (adjusted odds ratio 1.21(1.13-1.29)), and among current smokers, receiving tobacco cessation recommendation was associated with higher tobacco quitting attempt (aOR: 1.83(1.49-2.24)). A dose-response relationship was observed between the number of nutritional recommendations received and better diet quality (aOR for 6 vs. [&le;]2 recommendations: 1.32 (1.24-1.41)). Geographical disparities were evident, with eastern provinces receiving the least comprehensive counseling. ConclusionDelivery of lifestyle recommendations by healthcare providers in Iran shows variation by sociodemographic and clinical factors and is positively associated with behavior status. These findings highlight the effectiveness of provider-delivered lifestyle counseling and the need for more consistent, equitable, and targeted delivery, particularly for high-risk individuals and underserved regions, to strengthen national NCD prevention efforts.

BackgroundHealth behaviors established during young adulthood significantly shape the long-term risk of non-communicable diseases and mental health disorders. Although behaviors such as diet, physical activity, sleep, and substance use are often targeted individually, growing evidence suggests these behaviors function as an interconnected system. However, the organization of lifestyle behaviors at the system level, and which behaviors exert the greatest structural influence, remains poorly understood, particularly in non-Western populations. PurposeThis study aimed to model the interdependence of lifestyle behaviors among university students in China and identify key behaviors with the greatest structural influence within a lifestyle network. MethodsWe analyzed cross-sectional survey data from 5,652 university students in China, assessing seven lifestyle behaviors (diet, physical activity, sleep quality, social engagement, green and blue space exposure, alcohol use, and tobacco use) as well as symptoms of anxiety and depression. A pairwise Markov random field model was used to construct a lifestyle network and identify behavioral clusters and influential behaviors. Network stability and subgroup invariance were evaluated using bootstrap and permutation procedures. ResultsThree stable behavioral clusters were identified: (1) a positive lifestyle cluster (diet, physical activity, social engagement, and environmental exposure), (2) a distress-sleep cluster (sleep problems, anxiety, and depression), and (3) a substance-use cluster (alcohol and tobacco use). Dietary behavior consistently emerged as the most central behavior in the network, with extensive connections to both behavioral and psychological domains. Physical activity played a more peripheral role. Strong coupling between sleep problems and emotional distress was observed, consistent with systems theories of mental health. ConclusionsThese findings support a systems-based framework for understanding health behaviors in young adulthood. Identifying structurally influential behaviors, particularly dietary behavior, can provide leverage points for targeted health interventions. The study highlights implications for public health policy and intervention design, particularly in non-Western university populations.

BackgroundOutdoor workers are particularly vulnerable to the adverse impacts of heat, but many studies focus on heat exposure in residential settings only. This leads to a limited understanding of the full mortality burden due to occupational heat exposures. Here, we aimed to improve estimates of the total, short-term mortality burden attributable to outdoor occupational heat exposure in the United States (US). MethodsWe developed a panel data set for 3,108 US counties during 2010-2019 by linking all-cause mortality among the working age population, derived from CDC WONDER, with the prevalence of workers exposed to outdoor occupational heat, which integrates data on wet bulb globe temperature, workplace activities, and employment counts. We developed a quasi-Poisson regression model adjusted for ambient temperature, total precipitation, and county and state-year fixed effects to estimate short-term excess deaths attributable to outdoor occupational heat exposure. FindingsNationwide, approximately 3.8% (95% CI: 2.5-5.8%) of all workers were annually exposed to dangerous wet-bulb globe temperatures. This outdoor occupational heat exposure resulted in approximately 9,800 (3,100-17,000) annual excess deaths in the working age population. An estimated 62% of excess deaths occurred in the most socially vulnerable counties despite accounting for 25% of workers. InterpretationThe mortality burden of occupational heat exposure is likely far larger than 39 officially reported annual deaths that the Bureau of Labor Statistics reports for this time period. The workplace should be an explicit focus of heat policies, advocacy, and adaptation measures. FundingUS Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health.

BackgroundTobacco use among young people remains a major public health concern in Indonesia, where smoking prevalence is high and metabolic risk factors such as overweight and hypertension are increasing. Evidence linking smoking behavior, particularly e-cigarette use, to early cardiometabolic risk in low- and middle-income countries is still limited. This study examined overweight and hypertension profiles among young smokers using nationally representative data from Indonesia. MethodsThis secondary analysis used data from the Indonesian Health Survey 2023. Participants were young adults aged 18-25 years with complete information on smoking status, anthropometry, and blood pressure (n = 12,770). Smoking status was categorized as conventional smokers, e-smokers, and dual smokers. Outcomes included overweight/obesity (BMI [&ge;]23 kg/m2), central obesity (waist circumference [&ge;]90 cm for men and [&ge;]80 cm for women), and hypertension ([&ge;]130/80 mmHg). Logistic regression models estimated adjusted odds ratios (AOR) controlling for age, gender, smoking duration, residence, and socioeconomic proxy variables. ResultsMost respondents were conventional smokers (94%), followed by dual smokers (4%) and e-smokers (2%). E-smokers showed higher mean BMI and the greatest prevalence of overweight/obesity (40%) and central obesity (18%). After adjustment, e-smokers and dual smokers had higher odds of overweight/obesity (AOR = 1.37 and 1.41, respectively) and central obesity (AOR = 1.47 and 1.53, respectively) compared with conventional smokers. Hypertension prevalence (11-13%) did not differ significantly across smoking categories. ConclusionAmong young Indonesian smokers, e-cigarette and dual use were associated with higher odds of overweight and central obesity but not hypertension. These findings highlight the importance of integrating tobacco control with early metabolic risk prevention strategies targeting youth.

ObjectivesCardiovascular diseases (CVDs) remain a global health priority, with oral health linked to cardiovascular risk. However, existing studies have mainly focused on limited periodontal measures and lack analyses of multidimensional oral health. MethodsUsing data from 4,564 participants in the China Multi-Ethnic Cohort, this study employed an exposure-wide analysis to systematically examine associations between multidimensional oral health indicators and multiple CVD-related outcomes, and to evaluate the role of blood and urine-based biomarkers as potential mediators. ResultsWe found that indicators regarding caries, periodontal status, and occlusal function were significantly associated with carotid plaque prevalence. Sex-stratified analyses confirmed that all significant associations were concentrated in females, instead of males. Age-stratified analyses showed distinct patterns, with meaningful associations concentrated among participants under 65, where indicators regarding caries, periodontal status, and occlusal function were related to the FRS. In adults aged 65 and older, only the number of functional tooth units was associated with carotid plaque. Mediation analyses identified multiple blood biomarkers, including hemoglobin A1c and Platelet Large Cell Ratio, as partial mediators. ConclusionsThese findings indicate that multidimensional oral health correlates with cardiovascular outcomes, with obvious sex and age differences, and that blood biomarkers play an important mediating role. Our findings provide new insights that extend beyond traditional periodontal associations by highlighting the relevance of multidimensional oral health to cardiovascular risk, supporting its consideration in cardiovascular prevention.

ObjectivesRising temperatures are a major climate-related hazard for U.S. workers, increasing heat-related illness and a broad range of occupational injuries through indirect pathways often overlooked in economic evaluations. We examined the association between temperature and occupational injury and illness and quantified heat-attributable injuries (including illnesses) and costs in New York State. MethodsWe conducted a time-stratified case-crossover study of 591,257 workers compensation (WC) claims during the warm season (2016-2024). Daily maximum temperature was linked to injury date and county and modeled using natural cubic splines, with effect modification by industry and worker characteristics. ResultsInjury risk increased with temperature, becoming statistically significant at approximately 78{degrees}F. Relative to 65{degrees}F, injury odds increased to 1.06 (95% CI: 1.01-1.10) at 80{degrees}F, 1.12 (1.07-1.18) at 90{degrees}F, and 1.17 (1.11-1.23) at 95{degrees}F. Overall, 5.0% of claims (2,322 annually) were attributable to heat. At temperatures [&ge;]80{degrees}F, an estimated 1,729 excess injuries occurred annually, generating approximately $46 million in WC costs. An estimated $3.2 million to $36.1 million in medical expenditures were associated with incomplete claims, likely borne outside the WC system. ConclusionsThese findings demonstrate substantial economic costs not fully captured within WC and support workplace heat protections as a cost-containment strategy that can reduce health care spending and strengthen workforce resilience.