Journal of Occupational Health

BackgroundWork-related musculoskeletal symptoms such as pain, stiffness, and swelling are a common occupational health issue that affect well-being and increase healthcare costs. Continuous physical effort, long hours of sitting, and poor awareness of proper ergonomics often lead to or worsen these conditions. ObjectiveThis study determined the frequency of musculoskeletal symptoms and the associated risk factors with musculoskeletal symptoms among field health workers in Bin Qasim Town, Karachi. Material & MethodsA cross-sectional study was employed and collected data from Karachi based pre-urban communities i.e.: Ibrahim Hydri, Rehri Goth and Bhains Colony. Study duration was 9 months. MSK symptoms were assessed using the standardized Nordic Musculoskeletal Questionnaire (NMQ). Prevalence of MSK symptoms was assessed over 12 months and 7 days. Participants with pain in [≥]2 regions of the upper or lower limbs were classified as having upper or lower limb symptoms, respectively. Multivariable logistic regression was used to identify associated factors for MSK symptoms in last 12 months. Results132 participants were recruited. Most frequently reported pain region in the last 12 months was lower back 111(84%) and shoulder 81(61%). Similarly, the most affected region in the last 7 days was also lower back 39(29%) followed by shoulder 33(25%). Upper limb MSK symptoms were significantly associated with bachelors or higher educated (OR=3.38; 95% CI: 0.67-7.42), sitting 3-4 h/day (OR=3.46; 95% CI: 1.11-10.75), and walking 3-4 h/day (OR=2.88; 95% CI: 1.05-7.85). In lower limb, married workers had 2 times higher odds of lower limb MSK symptoms (OR=2.36; 95% CI:1.04 - 5.35), while those who worked > 30 hours/week had 67% lower odds of having lower limb MSK symptoms (OR=0.33, 95% CI:0.15 - 0.72). ConclusionField health workers frequently reported MSK symptoms in both limbs. Preventive strategies such as ergonomic training, task rotation, and targeted support for married female workers are recommended to reduce the long-term impact.

ObjectiveTo assess the prevalence, determinants, and health associations of vitamin D deficiency among workers in Cikarang, Indonesia. MethodsCross-sectional study of 107 workers. Serum 25(OH)D was measured by ECLIA; deficiency was <20 ng/mL. Data included demographics, occupation, sun exposure, diet, anthropometry, laboratory parameters, and self-reported health. Analyses used t-test/Mann-Whitney U, chi-square, and multivariable regression. ResultsDeficiency was prevalent (57.9%; median 18.6 ng/mL). Males had higher levels (+7.60 ng/mL) and lower risk (OR 8.56), while younger age (<38.5 years) showed lower levels (-5.60 ng/mL) and higher risk (OR 4.73; all p<0.0001). Greater sun exposure increased levels, whereas sunscreen use and greater clothing coverage reduced them. Only sex and age remained significant. ConclusionVitamin D deficiency is common, especially among female and younger workers, with modifiable sun-avoidance behaviors contributing. LEARNING OUTCOMESO_LISummarize the prevalence and key determinants of vitamin D deficiency among industrial workers in equatorial Indonesia, contributing to limited occupational health data in this setting. C_LIO_LIHighlight the role of modifiable behaviors--particularly sun exposure and sun-avoidance practices--in influencing vitamin D status among workers. C_LIO_LIEmphasize the need for targeted workplace interventions, including safe sun exposure strategies and nutritional support, especially for high-risk groups such as female and younger workers. C_LI

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.

BackgroundWork-related stress (WRS) accounts for 52% of self-reported work-related ill-health. In 2004, the Health and Safety Executive (HSE) developed the Management Standards (MS), aimed at helping organisations reduce WRS. This work investigates WRS post implementation, with reference to six MS risk factor domains: control, support, relationships, demand, change, and role. MethodCases of WRS were extracted from The Health and Occupation Research (THOR) database and mapped to the six domains. Trends in WRS incidence rates attributed to each of the domains were split at 2004 and compared with the overall WRS trend using mixed generalised regression models. ResultsBefore 2004, annual incidence in WRS increased by 1.4%(-0.5%,3.1%), whereas after 2004, there was a decrease of -0.9%(-1.5%,-0.2%), based on 10,815 WRS cases reported between 1996 and 2019. Three of the six MS domains (demands, relationships, and change) were reported in [~]82% of cases. Pre-2004, four of the six domains were observed to be increasing per year. Post 2004, cases increasingly contained multiple precipitating events e.g. demands + another (+2.6% per year) and relationships + another (6.1%). Reports of the two most common domains decreased post 2004 (demands -0.46%, relationships -0.55% per year), whereas incidence in less common domains increased (change 1.1%, support 2.4%, control 4.8%, role 4.7%). ConclusionTrends in WRS, and their common risk factors appear to be decreasing gradually, since introduction of MS in 2004. However, less common risk factors are becoming more prominent, contributing to reporting of WRS with multiple risk factors.

ObjectivesTo investigate the epidemiology of acute sports-related upper-extremity injuries in young athletes, with a particular focus on the frequency, anatomical distribution, injury types, and mechanisms of digit injuries. MethodsThis single-center retrospective observational study included athletes aged [&le;]22 years who sustained acute sports-related upper-extremity injuries between January 2017 and November 2025. Digit injuries were defined as injuries involving the thumb and fingers at or distal to the metacarpophalangeal joint. Injury characteristics, mechanisms, and sports categories were analyzed using descriptive statistics. ResultsA total of 1,219 acute sports-related upper-extremity injuries were analyzed. Digit injuries were the most common injury location, accounting for 412 cases (33.8%), followed by shoulder (30.7%), elbow (17.5%), wrist (14.4%), and palm injuries (3.6%). Jammed finger was the most frequent injury type, comprising 64.8% of digit injuries, followed by fractures (20.1%) and dislocations (5.3%). Most injuries were caused by contact mechanisms (90.3%), with ball contact being the predominant cause (49.5%). Ball sports accounted for 85.4% of all digit injuries. ConclusionsDigit injuries represent the most frequent acute sports-related upper-extremity injuries in athletes aged [&le;]22 years, with jammed finger accounting for the majority of cases. Most injuries were associated with ball contact, highlighting the need for preventive strategies and appropriate initial management for digit injuries in young athletes.

IntroductionPressure sores are a major health problem in people with spinal cord injury resulting in ischaemic tissue lesions caused by prolonged pressure against a bony surface. Conventional therapies are often defective and fundamental researches on the healing process of pressure sores must be enriched in order to understand any novel therapies that may be applied. We focalize on pressure sores fibroblasts as dermal fibroblasts perform a critic role in wound healing by populating the wound site to produce extracellular matrix. After characterizing morphological and the genetic profile of healthy fibroblasts and fibroblasts from pressure ulcers, we conducted an analysis of fibroblast proliferation, migration and myofibroblastic differentiation capacity. Materials and Methodsafter acquisition of dermal explants and fibroblasts culture, we conducted histological analysis, an evaluation of gene expression by RT-qPCR and an assessment of fibroblasts proliferation and migration capacity through IncuCyte. A study of the differentiation of fibroblasts into myofibroblasts through the detection of Alpha-Smooth Muscle Actin (-SMA) expression by immunofluorescence was also conducted. Resultshistological analysis showed histological analysis showed dermal disorganization in pressure sore compared with health skin, differences in morphological aspects and density of fibroblasts. Pressure sore fibroblasts express less genes coding for ECM proteins, metalloproteases, collagen III, Connective tissue growth factor (CTGF) and ACTA2 coding for -SMA. Pathological fibroblasts appear to proliferate less quickly than healthy fibroblasts but no differences in migration capacity were found. After stimulation under TGF-{beta}, pressure sore fibroblasts lose their ability to differentiate into myofibroblasts compared to healthy fibroblasts and this could be in relation with a less expression of ACTA2. ConclusionAll of our results highlight a morphological, genetic and functional difference between healthy and pathological fibroblasts which have a modified phenotype, less effective for skin repair. This suggests that new therapies for chronic wounds must take into account the environment in which they are applied and that pathological cells do not necessarily respond to treatments in the same way as healthy cells. Our results are not statistically significant, although several trends emerge. This is explained by the heterogeneity of the patients medical history and requires repetition of the experiments.

BackgroundInflammatory 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. MethodsA 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. ResultsIn 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. ConclusionsStudy 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).

Background Occupational exoskeletons are used to reduce physical workload and prevent work-related musculoskeletal disorders in physically demanding jobs. Although laboratory studies demonstrate reduced muscle load during simulated manual work tasks, evidence from long-term, real-world implementations remains very limited. The RELAX project aims to investigate the long-term effects of a passive back-support exoskeleton (BSE) during manual order-picking work in a Danish warehouse, focusing on health and socio-economic outcomes. Methods This 18-month controlled in-field intervention study compares outcomes at two warehouse departments: one where workers use a passive BSE and a control group where workers perform work tasks as usual. Approximately 90 full-time workers will be followed during the intervention period with questionnaires, interviews and company-registered performance indicators. Primary outcomes include perceived work intensity and musculoskeletal discomfort, while secondary outcomes include sickness absence, employee turnover, productivity and cost effectiveness. Furthermore, a process evaluation will be conducted based on questionnaires, focus-group interviews, and reported exoskeleton use. Quantitative effects will be analysed using difference-in-difference analysis with generalized linear mixed models to account for repeated measures over time. Employee turnover will be analysed using time-to-event analysis, and qualitative focus-group interviews will be analysed using reflexive thematic analysis to explore implementation processes and contextual factors. Cost-effectiveness and return on investment will be assessed by comparing the investment with potential savings in costs and resource use. Discussion By combining longitudinal quantitative outcomes with qualitative process evaluation, the study seeks to provide ecologically valid evidence on the effectiveness, feasibility and sustainability of occupational exoskeleton implementation. This approach will help clarify whether long-term exoskeleton use improves worker health without compromising productivity and may inform future workplace guidelines and large-scale adoption strategies.

PurposeAlpha-gal syndrome (AGS) is an emerging health issue. This syndrome, caused by the bites of ticks, induces allergic reactions to the sugar molecule galactose--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. MethodsWe 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. FindingsA 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. ConclusionsNo 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.

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.

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.

BackgroundRisky sexual practices contribute significantly to the transmission of sexually transmitted infections (STIs) and HIV/AIDS. Taxi and three-wheeled vehicle drivers may be particularly vulnerable due to occupational mobility and related lifestyle factors. However, evidence on this population in Ethiopia remains limited. MethodsA community-based cross-sectional study was conducted among taxi and three-wheeled vehicle drivers in Arba Minch town, Ethiopia, from July 26 to August 26, 2025. Participants were selected using a simple random sampling technique. Data were collected using an interviewer-administered questionnaire through the Kobo Toolbox mobile application. Data were exported to SPSS version 27 for cleaning and analysis. Binary logistic regression analysis was performed to identify factors associated with current risky sexual practices. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used, and statistical significance was declared at p < 0.05. ResultsA total of 640 drivers participated in the study (response rate: 97.6%). The prevalence of lifetime risky sexual practices was 46.9% (95% CI: 43.0%-50.8%), while the prevalence of current risky sexual practices was 37.2% (95% CI: 33.4%-41.1%). Factors independently associated with current risky sexual practices included living alone (AOR = 3.01; 95% CI: 2.03-4.45), not discussing sexual and reproductive health issues (AOR = 2.09; 95% CI: 1.17-3.75), substance use (AOR = 1.69; 95% CI: 1.10-2.61), attending nightclubs (AOR = 2.04; 95% CI: 1.41-2.96), and exposure to pornographic materials (AOR = 2.19; 95% CI: 1.49-3.23). ConclusionA substantial proportion of taxi and three-wheeled vehicle drivers reported engaging in risky sexual practices, indicating a significant and overlooked public health concern within this occupational group. These practices were independently associated with modifiable behavioral and lifestyle factors, including substance use, nightlife attendance, and inadequate communication on sexual and reproductive health issues. The findings underscore the urgent need for innovative, multi-sectoral interventions that extend beyond conventional health service delivery. Integrating basic sexual and reproductive health education and risk-reduction messaging into driver licensing and refresher training programs may provide a feasible and scalable opportunity to reach this mobile and high-risk population. Such integration, in collaboration with transport authorities and public health sectors, has the potential to improve awareness, promote safer behaviors, and reduce vulnerability to risky sexual practices among drivers.

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.

Occupational activities play a critical role in shaping patterns of infectious disease transmission, as work-related contact, exposure duration, and environmental conditions vary substantially across jobs. Evidence from infectious disease outbreaks, including tuberculosis and other respiratory infections, shows that occupations involving frequent close contact and crowded settings face elevated exposure risk, highlighting the need for systematic occupational risk assessment to inform public health action. This study adopts a data-driven approach to characterize occupational risk for infectious disease transmission in the Philippine workforce. Using job-specific indicators such as encounter frequency, work shift duration, and crowd density, unsupervised clustering methods were applied to group occupations into distinct risk profiles. Unlike predefined sector-based classifications, this approach identifies latent groupings that capture shared exposure characteristics and socioeconomic context. The resulting clusters reveal a clear gradient in exposure risk across occupations, with high-risk roles often concentrated among jobs with lower to moderate income levels, while lower-risk occupations tend to be associated with higher income and greater structural capacity for risk mitigation. These findings provide a framework for occupational risk stratification that is directly relevant for public health planning. Overall, this study demonstrates the value of integrating occupational and socioeconomic data to support targeted workplace interventions, risk-informed surveillance, and more equitable allocation of public health resources for infectious disease prevention and control in the Philippine context.

The end-of-career stage of the police lifecycle represents a profound shift in identity and psychological stability, yet it remains historically neglected in research. This mixed-methods study investigated perspectives of UK police leavers and those approaching retirement (N = 325) regarding desired improvements to organisational support. Content analysis identified four themes: Holistic support and long-term welfare, Institutional culture and professional worth, Navigating the structural transition, and Individual and systemic perspectives. Findings suggest that the psychological contract between the officer and the organisation is often breached at the exit point, shifting from a relational bond to a transactional disposal. Middle-ranking officers and early leavers report the highest levels of institutional abandonment. To address these gaps, this paper makes recommendations for developing effective transitions. By implementing post-service welfare, and adopting structured resettlement models, police organisations can fulfil their duty of care and mend the psychological contract for those who have served.

IntroductionOccupational stress among rescue workers is a major global public health concern. Rescue workers, including paramedics, firefighters, and disaster response teams, are consistently exposed to traumatic events, long working hours, physical hazards, and emotionally charged situations. These chronic stressors make them one of the most vulnerable groups to psychological distress, burnout, anxiety, depression, and post-traumatic stress disorders. In the local context of Pakistan, workplace mental health remains a neglected area. Despite stress and burnout being widely reported in these sectors, limited evidence-based interventions are available. Therefore, the study aims to develop and evaluate a locally tailored intervention to improve the mental health and psychosocial well-being of rescue workers. ObjectivesO_LITo develop a culturally appropriate stress management intervention to promote mental health for rescue workers in Rawalpindi. C_LIO_LITo validate the content and structure of stress management intervention for rescue workers C_LIO_LITo evaluate the effectiveness of stress management intervention for rescue workers in Rawalpindi C_LI MethodThe ethical approval of the study has already been obtained from the ethical review board of Health Services Academy (00013/HSA/PhD-2022) and Rescue 1122 District Headquarters, Rawalpindi. Data will be collected after obtaining informed written consent from relevant stakeholders. Data collection will start from April 2026 and will be completed in six months. Data compilation and results are expected by December 2026. Data collection will involve a scoping review to explore stress determinants and intervention components, and then a qualitative phase in which data will be collected through focus group discussions from potential Stakeholders (rescue workers, mental health experts, and program managers) to identify and validate stress determinants. Triangulation of data will be done to integrate qualitative findings with findings from the review. In the second phase, validation will be done by intervention development experts. The third phase aims to evaluate the effectiveness of the developed intervention using a quasi-experimental pre-post design. A total of 154 participants evaluated with the Perceived Stress Scale Score will be employed through a stratified sampling technique. The primary outcome is defined as remission from stress at 3 months, measured with the PSS. DiscussionIt is anticipated that the study will result in the development of a culturally appropriate and evidence-based stress management intervention for rescue workers, thus contributing to sustainable improvement in rescuers mental health and job performance.

This study aimed to clarify aerosol exposure risks throughout the workflow of a Biosafety Level 2 (BSL-2) polymerase chain reaction (PCR) laboratory, validate the suitability of the {Phi}X174 bacteriophage as an indicator virus, and provide evidence for biosafety control measures. The {Phi}X174 bacteriophage was used to simulate viral samples, and a concentration-bacteriophage plaque standard curve was constructed (R2=0.998). Five operational steps in a simulated PCR laboratory were quantitatively monitored for aerosol concentration using double-layer agar plates, with blank controls used to eliminate interference. Statistical analysis was employed to identify risk differences. Sample homogenization ((5.67 {+/-} 1.23) x 104 plaque-forming units (PFU)/m3) and nucleic acid extraction ((3.45 {+/-} 0.89) x 104 PFU/m3) were identified as high-/very high-risk steps. The viral load in the samples was strongly positively correlated with the aerosol concentration (r = 0.926, P <0.001), with aerosol levels linearly decreasing with increasing distance in high-risk steps. The {Phi}X174 bacteriophage demonstrated high detection sensitivity (101 PFU/ml) and demonstrated safety compatibility with BSL-2 laboratories. Aerosol risks in PCR laboratories exhibit step-specific differentiation, and {Phi}X174 serves as an ideal indicator virus. Proposed strategies such as equipment upgrades and personal protective equipment (PPE) grading can reduce exposure risks.

BackgroundHealthcare workers are at increased risk of post-traumatic stress disorder (PTSD) due to prolonged exposure to high-stress clinical environments. Although the Health Belief Model (HBM) has been widely used to explain health behaviors, its application to psychological outcomes such as PTSD remains limited. The role of cognitive-emotional processes, particularly experiential avoidance, in linking health beliefs to trauma symptoms is not well understood. MethodsThis study adopted a quantitative cross-sectional design to collect data from 475 healthcare workers in Ekiti State, Nigeria. Participants completed standardized measures assessing Health Belief Model constructs, experiential avoidance, and PTSD symptoms. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM), with bootstrapping used to test direct, indirect (mediation), and moderation effects. Cluster analysis was also conducted using SPSS to validate differences in PTSD symptom severity across psychological constructs and demographic variables. ResultsExperiential avoidance significantly predicted PTSD symptoms ({beta} = 0.395, 95% CI [0.231, 0.565]). HBM constructs were negatively associated with experiential avoidance ({beta} = - 0.198, 95% CI [-0.270, -0.108]) and PTSD symptoms ({beta} = -0.119, 95% CI [-0.216, -0.006]). Mediation analysis indicated that experiential avoidance partially mediated the relationship between HBM constructs and PTSD ({beta} = -0.078, 95% CI [-0.132, -0.037]), with a total effect of - 0.197. Age moderated the relationship between HBM and experiential avoidance ({beta} = -0.114, 95% CI [-0.207, -0.025]) as well as the indirect pathway to PTSD. Sex significantly predicted PTSD symptoms ({beta} = 0.358, 95% CI [0.214, 0.501]). Cluster analysis showed that experiential avoidance and perceived barriers significantly differentiated high and low PTSD symptom groups. ConclusionThe findings support a conditional cognitive-emotional model in which Health Belief Model constructs influence PTSD symptoms both directly and indirectly through experiential avoidance. Demographic factors shape the strength of these relationships, while perceived barriers and experiential avoidance emerge as key determinants of trauma-related distress among healthcare workers.

BackgroundChronic Kidney Disease of unknown etiology is a growing health concern in low-and middle-income countries. While occupational heat stress is recognized as a potential contributor to kidney dysfunction among agricultural workers, the causal relationship between heat stress, core body temperature (Tc), and kidney function remains unclear. MethodsWe conducted an observational study over two harvest seasons in Guatemala, following 148 male sugarcane workers across six months. Heat stress was measured using heat index (HI) and Tc with ingestible telemetric temperature pills. Particulate matter (PM) exposure was measured using personal breathing zone samplers worn during the work shift. We evaluated changes in kidney function using pre-and post-shift estimated glomerular filtration rate (eGFR). We applied G-computation to estimate causal effects and modeled hypothetical policy interventions reducing HI, Tc, and PM exposure, simulating occupational heat reduction strategies. ResultsThe average daily HI was 37.4 {degrees}C (SD: 2.0) with an average Tc increase of 1.16 {degrees}C (SD: 0.48) per shift. Both HI and Tc were associated with declines in eGFR across the work shift. At an HI of 34 {degrees}C, workers experienced an average eGFR decline of about 5 mL/min/1.73 m{superscript 2}, while at 40 {degrees}C the decline exceeded 16 mL/min/1.73 m{superscript 2}. High HI early in the season and elevated Tc later in the season contributed to kidney decline. A simulated intervention reducing HI exposure by 5% improved eGFR change by 1.46 mL/min/1.73 m{superscript 2}. PM exposure did not have a significant impact on eGFR decline. ConclusionReducing workday heat exposure may mitigate acute kidney function decline. These findings support the development of policy interventions aimed at reducing external heat exposure and internal heat strain to protect kidney health. More research is needed to investigate the potential contribution of other environmental factors, including PM exposure.