Occupational and Environmental Medicine

Recent industry surveys have reported widespread concern about mental health, working conditions, and harassment in the UK film and television industry, but no peer-reviewed empirical study has examined the determinants of occupational burnout in this workforce. The present study tested whether physical health, mental wellbeing, perceived public stigma, intrinsic job quality, and sexual harassment exposure predict burnout in industry professionals. A cross-sectional online survey was completed by 415 individuals across more than 100 job titles, with 286 also completing an optional harassment module. Mental wellbeing sat well below population norms, with 68% scoring in the range indicative of probable depressive symptoms and 82% in the high-exhaustion range on the Maslach Burnout Inventory General Survey. Mental wellbeing and intrinsic job quality were the strongest predictors of burnout (R2 = .56), with meaningfulness accounting for most of the job-quality effect. Working hours independently predicted emotional exhaustion. Harassment exposure was associated with burnout in women but not men, approximately 30% mediated by mental wellbeing; sexist behaviour directly predicted exhaustion in women. Workers with a disability reported higher stigma. Burnout was strongly associated with intent to leave, and the findings collectively indicate an industry-wide occupational health concern requiring structural rather than individual-level intervention.

Objectives To investigate the association between time spent in NHS Type 1 emergency departments (EDs, consultant led 24 hour services with full resuscitation facilities) and risk of leaving employment and hospitalisation after leaving the department alive up to two years after attendance. Methods We conducted a retrospective cohort study using linked administrative data from the NHS Emergency Care Dataset, Hospital Episode Statistics, Census 2021, and mortality records. ED length of stay was categorised from under 2 hours to 12 hours or more. Cox proportional hazards models were fitted to estimate the association between ED length of stay and subsequently leaving employment or being hospitalised over a two year follow-up period, adjusting for demographic, socioeconomic, and clinical characteristics. Results Our study population comprised 3,347,008 individuals aged 25 to 64 who attended a Type 1 ED in England between April 2021 and March 2023. For leaving employment, adjusted hazard ratios (aHRs) increased from 1.04 (95% CI 1.03 to 1.06) for stays of 2 to <4 hours to 1.21 (1.17 to 1.24) for 12 hours or more, compared with stays under 2 hours. A similar but more pronounced gradient was observed for post-discharge hospitalisation, with aHRs rising from 1.06 (1.04 to 1.07) at 2 to <4 hours to 1.95 (1.91 to 1.99) for stays of 12 hours or more. Conclusions Prolonged time spent in the ED is associated with poorer outcomes among working-age employees, including reduced labour market participation and increased hospital use. These findings suggest that long ED stays may have wider and longer-term implications beyond immediate clinical outcomes, including potentially for national labour markets and economic growth.

Current health risk assessments from thirdhand exposure to methamphetamine (meth) to occupants of contaminated residences when no cooking or use is still occurring assume that inhalation exposure is insignificant. After Wright et al. (2021) reported substantial meth concentrations in a contaminated residence, the present study was conducted to further test the hypothesis that concentrations were high enough to contribute to total occupant dose. Air sampling was conducted in contaminated residences that had been previously sampled for surface contamination. Samples were collected on personal sampling pumps in fixed locations on treated glass fiber filters is cassettes and analyzed by gas or liquid chromatography with mass spectroscopy. Sixty-nine samples were collected from eighteen residences for the study. Meth concentrations ranged from 0.02 to 15 ug/m3. Concentrations in supply air vents were significantly higher than in return vents or in ambient air. Residences with no HVAC systems (baseboard heat) had airborne concentrations similar to residences with HVAC systems turned off, and lower than when HVAC was on. Whether a residence was occupied or not did not show differences. All data from residences with HVAC had a significant correlation with surface concentrations (R2 = 0.61) but some factors that affected results were not determined in the study. In the context of the risk assessment and regulatory standard established by California and adopted in several other states, the inhalation exposure would approximately double total occupant dose for infants, and this population would exceed the California reference dose by approximately 100%. Further studies should be conducted to refine these estimates and determine the factors that influence airborne concentrations.

Background While overall application volume by ethnic minority doctors into UK postgraduate medical training has expanded significantly, workforce diversity varies substantially across specialties. Previous reports have suggested that doctors from certain ethnic backgrounds and international medical graduates (IMGs) experience lower likelihoods of securing training posts, but granular longitudinal evaluations across all specialty training levels and recruitment stages remained limited. Therefore, this study evaluates longitudinal trends in self-reported ethnicity and country of qualification across postgraduate medical training in England between 2021 and 2025, maps specialty representation, and tests the hypothesis that recruitment success rates differ significantly between ethnic minority and White baseline applicants. Methods We conducted a retrospective national longitudinal analysis of mandatory NHS specialty recruitment data across England from 2021 to 2025, encompassing over 300,000 applications across ST1/CT1 (entry-level) and ST3+ (higher specialty) pathways. Applicants were categorised into census-aligned broad and granular ethnic groups, alongside IMG classifications. Unadjusted odds ratios (ORs) with 95% confidence intervals were calculated using White graduates and internal sub-ethnic baselines as comparators. Specialty-level ecological correlations (Spearman's rho) were performed to evaluate whether international workforce reliance moderated ethnic recruitment disparities. Results Between 2021 and 2025, applicant volume expanded rapidly, with ethnic minority applicants and IMGs comprising numerical majorities. However, Asian and Black applicants experienced substantially lower odds of receiving training offers compared to White baseline applicants across multiple high-volume specialties (e.g., emergency medicine and anaesthetics at ST1, where Black applicants faced multi-fold reductions in success odds: OR 0.03 to 0.05, p<0.001). Granular analyses revealed notable intra-ethnic heterogeneity, including lower success among Pakistani and Bangladeshi applicants compared to Indian applicants. Furthermore, UK graduates maintained higher offer success than IMGs across most specialties. Ecological correlations demonstrated that higher international applicant reliance was moderately and significantly associated with wider recruitment disparities at higher training levels for Black applicants {rho}=-0.43, p=0.019). Conclusions Centralised medical recruitment in England exhibits some persistent ethnic and international qualification disparities despite rising application diversity. The findings highlight the necessity of disaggregating ethnic groups and addressing subjective evaluation vulnerabilities within multi-stage recruitment processes to foster equity. Trial registration: Not applicable

Those leaving military service frequently present with complex psychosocial problems, but military veterans are often reluctant to engage with statutory healthcare provision. Specialist mental health services have recently been established in the UK to specifically support military veterans with their psychological and social wellbeing. We explored the treatment and support provided by the London branch of a military veterans mental health and wellbeing service (Op COURAGE) from the perspectives of the multidisciplinary service team and their partner organisations and collaborators. We conducted semi-structured interviews with multidisciplinary service staff and members of their partner organisations and external agencies. Qualitative data were analysed using framework analysis.?A total of 16 professionals participated in this study, comprising five service staff, eight collaborators and three partner agency participants. Five themes with subthemes were identified, including (1) blended networks, (2) staff inclusivity and sensitivity, (3) spectrum of psychosocial interventions and holistic support, (4) referral mechanisms, and (5) (in)visibility of the service and advertising. Our evaluation highlighted the advantages of a multidisciplinary team and collaborative partnerships to meet the psychosocial needs of veteran and their significant others. We have proposed that service improvement could include increasing advertisement about this specialist service, deepening knowledge about veterans among staff and further involving veterans and key stakeholders in service decisions.

Background: Workplace discrimination and violence against health workers including sexual harassment is a societal problem worldwide. We aimed to assess the frequency, predictive factors, and effects of sexual harassment using a nationwide survey of physicians working in Switzerland. Materials and Methods: We conducted a self-administered questionnaire survey of physicians working in Swiss healthcare institutions. The questionnaire assessed experiences of sexual harassment at work, including frequency, types, and sources of harassment. It also asked about the impact of sexual harassment, whether incidents were reported, and what actions were taken following a report. Results: Among the 1837 physicians that participated in the survey, 575 (31.3%) had experienced sexual harassment at least once during their career. Among those reporting sexual harassment, 39.1% of women and 13.2% of men had experienced harassment at least once in their job. Women reported more verbal harassment, while men reported more physical harassment. Women were also more likely to face both forms combined. The main sources of harassment were colleagues of the same profession (46.7%), patients (42.3%), and superiors (41.0%). The most frequently reported impacts included stress (60.1%), emotional exhaustion (34.7%), reduced motivation at work (30%), and considering leaving the job (7.5%). Gender-men was associated with a lower likelihood of experiencing harassment 0.24 (0.18 to 0.31), whereas working in the German-speaking region was associated with a slightly higher likelihood of having experienced sexual harassment at least once (OR 1.35, 95% CI:1.02-1.81). Conclusions: Sexual harassment is common among physicians in Swiss healthcare institutions. It adversely affects the mental health and career trajectories of both men and women yet remains widely underreported due to fears of reprisals and inaction. Institutions should effectively intervene to ensure that reported incidents result in appropriate actions, and that those who report them receive adequate protection from reprisals.

Background: Observational studies have linked air pollution to otitis media, but confounding and reverse causation preclude causal inference. We used two-sample Mendelian randomization (MR) to assess genetic causal effects of six air pollutants on non-suppurative otitis media, represented by otitis media with effusion (OME). Methods: Exposure GWAS for PM2.5, PM2.5 absorbance, PM2.5-10, PM10, NO2 and NOx were obtained from UK Biobank (MRC-IEU), and the outcome was FinnGen R13 H8_NONSUPPNAS (12,397 cases, 464,237 controls). Inverse-variance weighting was primary, with MR-Egger, weighted median and mode, MR-PRESSO, leave-one-out and Steiger analyses, reverse MR and exploratory multivariable MR (MVMR). Asthma, allergic rhinitis and chronic rhinosinusitis served as positive controls, and three suppurative otitis media phenotypes served as negative controls. Results: After false-discovery-rate correction, none of the six pollutants was significantly associated with OME; the sole nominal signal was PM10 (OR=1.555, 95% CI 0.947-2.553, P=0.081), which reversed with the 88-SNP pooled set (OR=0.64, 0.24-1.69, P=0.365). At 80% power, minimum detectable ORs ranged widely from 1.69 to 32.09; only PM2.5-10 and PM10 had values near 2, so moderate effects (OR 1.2-1.5) cannot be excluded. Confirmatory positive controls using phenotype-specific instruments were strongly positive, whereas negative-control outcomes showed no associations (all FDR>0.85). Every nominal reverse-MR signal had a significant MR-Egger intercept (the PM2.5 absorbance signal also showed significant heterogeneity and MR-PRESSO tests), indicating horizontal pleiotropy rather than reverse causation. MVMR was exploratory only, as conditional F statistics were below 10. Conclusions: We found no evidence for large-effect genetic causal associations between the six air pollutants and OME. These null findings argue against large, lifetime-average causal effects, and the associations reported in observational studies may instead reflect residual confounding, shared comorbidity or differences in exposure windows.

Background Interruptions are common in hospital outpatient departments (OPDs) and are linked to error. Many are clinically necessary, so the aim is to regulate them. Most interventions target the individual clinician. Little is known about how doctors manage interruptions in practice or what makes their strategies work. Methods Qualitative study using focus groups and interviews with 42 doctors working in UK National Health Service OPDs (19 sessions, September to November 2025). Participants were purposively sampled by clinical experience and self-reported patient complexity. Data were analysed using Framework Analysis, informed by Cognitive Load Theory and Social Identity Theory. Results We developed four themes. (1) Pre-emptive protection of attention. Doctors withdrew, signalled unavailability and set thresholds for interrupting. These depended on colleagues learning and sharing the norm, which staff rotation eroded. (2) Sharing the burden through team coordination. Designated roles and time-limited rotas moved interruptions to colleagues with capacity set aside for them and made interrupting legitimate. (3) Real-time cognitive repair. Doctors asked interrupters to wait while they secured the task, and rebuilt the consultation on return, sometimes with the patient's help. Asking a colleague to wait depended on seniority or team membership; some trainees described difficulty doing this with senior colleagues. (4) Organisational recognition as the precondition for sustainable regulation. Where supervision was built into job plans, the interruptions it generated were expected and doctors held capacity in reserve for them. Advice, vetting and telephone queries were rarely counted as work. Conclusions Each strategy served a cognitive purpose, and social and organisational conditions decided whether it was perceived to work. Interventions could make norms shared and roles explicit, count interruption work in job plans and keep routes open for junior staff to raise concerns. Evaluations should ask who is able to use them.

Objectives To examine the prevalence of interruptions during UK secondary care outpatient consultations, their association with clinician mental workload, and the strategies clinicians use to manage them. Design Nationwide cross-sectional online survey. Setting Secondary care outpatient clinics, United Kingdom. Participants A sample of 465 UK secondary care doctors across a range of grades and specialties, recruited through a medical defence organisation's network. Primary and secondary outcome measures Mental workload (NASA Task Load Index, Raw-TLX); interruption frequency; perceived cognitive impact of interruptions; task resumption difficulty; perceived social effects on colleague interactions and team cohesion; and interruption-management strategy use. Results 61.1% of clinicians reported being interrupted often or very often, and mean overall workload was high (Raw-TLX 66.2, SD 11.5). Interruption frequency, patient complexity and perceived cognitive impact were each associated with higher workload across multiple NASA-TLX subscales. In fully adjusted models, interruption frequency retained independent associations with overall workload (beta = 1.79, p = 0.004) and temporal demand (beta = 0.94, p < 0.001). Task resumption difficulty was associated with worse perceived performance (beta = -0.59, p = 0.014), while perceiving interruptions as socially positive was associated with better performance (beta = 0.75, p = 0.003) and lower frustration (beta = -1.16, p < 0.001). Years of experience showed only small effects, and self-reported strategy use (38.7%) was not consistently associated with lower workload. Exploratory natural language processing of open-text descriptions identified three strategy clusters; cognitive offloading, anticipating and preparing, and blunt responses, with distinct emotional profiles. Conclusions Interruptions were commonly reported during UK secondary care outpatient consultations and were associated with measurable cognitive and temporal burden. The perceived social framing of interruptions was independently associated with frustration and self-rated performance. Binary strategy use showed no consistent workload association, indicating a need for system-level approaches addressing interruption frequency, task resumption support and the social context of interruptions rather than reliance on individual coping.

Introduction: Pesticide exposure has been associated with poorer mental health, yet little is known about whether seasonal fluctuations in agricultural pesticide use are associated with cyclical changes in mood among people living in agricultural communities. We evaluated associations between 10 peak and off-peak pesticide spray seasons and ecological momentary assessment (EMA)-derived mood in a floricultural region in Ecuador. Methods: 496 participants completed repeated EMA surveys across 10 assessment administrations over 2.5 years (2022-2024), including one single-assessment administration and nine 10-day bursts (Nobservations=14,332). Mood outcomes included negative affect (sadness, anxiety, stress, anger, tiredness, difficulty concentrating; overall mean=2.79, Standard Deviation [SD]=1.32), positive affect (happiness, motivation; overall mean=4.21, SD=1.60), and behavioral dysregulation (aggression and impulsivity, overall mean=1.86, SD=1.29). Generalized linear mixed models estimated pooled, between-person and within-person associations between peak pesticide spray seasons and mood, adjusting for demographic and longitudinal factors Effect modification by sex, floricultural occupation, and cohabitation with a floricultural worker was assessed. Results: Peak spray seasons were associated with higher negative affect ({beta}=0.11 [0.06, 0.16]) and behavioral dysregulation ({beta}=0.10 [0.05, 0.15]) but not positive affect ({beta}=0.01 [-0.05, 0.07]). Associations were driven by within-person changes. Sex modified associations with negative affect, which were stronger in males than females. Floricultural occupation modified associations, with poorer mood, greater behavioral dysregulation and lower positive affect among floricultural workers than non-workers. Discussion: Peak pesticide spray seasons were associated with worsening of negative affect and behavioral dysregulation. EMA may provide a sensitive approach for detecting short-term neurobehavioral changes associated with seasonal pesticide exposure.

Background: Non-optimal air temperature increases the risk of preterm birth, but how temperature-related risks may translate into future population burden remains uncertain. We aimed to estimate the association between temperature and preterm birth in Sweden and assess how preterm birth burden may change under plausible future temperature conditions. Methods: We conducted a nationwide population-based cohort study of singleton births in Sweden from 1973 to 2018. Weekly mean temperature was assigned at the parish level according to maternal residence. Cox proportional hazards models with a distributed lag nonlinear model were used to estimate nonlinear and delayed associations between temperature and preterm birth. The estimated exposure response relationship and baseline hazards were then incorporated into an individual-based microsimulation of gestational progression under projected temperatures for 2025 to 2055. Future projections were examined across multiple climate models under SSP1-2.6 and SSP3-7.0 scenarios. Outcomes included the annual number and cumulative incidence of preterm births and the temperature-attributable fraction. Results: Among 4,338,825 singleton births, 211,397 (4.9%) were preterm. Temperature preterm birth associations were modest overall. The clearest increase in hazard was observed following exposure to very low temperatures, particularly -10C at short lags. Higher temperatures showed no clear increase in risk. From 2025 to 2055, the annual cumulative incidence of preterm birth and the temperature-attributable fraction was expected to remain broadly stable, with limited differences between emissions scenarios. In contrast, the absolute number of preterm births was expected to over the projection period, primarily reflecting increases in the projected number of pregnancies rather than substantial changes in temperature-associated risk. Conclusions: Very low temperatures were associated with a modest short-term increase in preterm birth risk in Sweden, hot temperatures showed little evidence of increased risk. Applying these associations to future climate conditions suggested limited changes in preterm birth incidence or the proportion attributable to temperature through 2055. However, the absolute burden of preterm birth may increase as the population at risk grows. This highlights the importance of considering demographic change alongside climate projections when assessing future maternal and neonatal health burden.

Background Hospital outpatient departments (OPDs) deliver specialist care at scale, under close scrutiny over waiting times. Interruptions are common in this setting and are linked to error. Little is known about how they cause harm, for whom, and under what conditions. Methods Qualitative study using focus groups and interviews with 42 doctors working in UK National Health Service OPDs (19 sessions, September to November 2025). Participants were purposively sampled by clinical experience and self-reported patient complexity. Data were analysed using the Framework Method, informed by Cognitive Load Theory and Social Identity Theory, with independent double coding of 10% of transcripts (kappa = 0.97) and participant validation. Results We developed four themes. (1) Interruptions as a structural and increasingly ambiguous feature of clinical work. Interruptions were a normal part of clinical coordination, but new communication channels lacked shared norms about urgency, so each doctor had to judge what mattered. (2) The hidden cognitive cost of interruptions. The main cost came from returning to the interrupted task. This cost grew with complexity and was only partly offset by experience. (3) The social fabric of interruption burden. Transient teams weakened the norms that regulate interrupting, and approachability and hierarchy concentrated the burden on particular doctors. (4) The social amplification of cognitive burden. Understaffing multiplied cognitive costs. Doctors used familiarity and track record to decide which requests deserved attention, so concerns from junior or unfamiliar colleagues risked being discounted. Conclusions Interruptions are structural, and their impact depends on cognitive and social conditions. Reducing interruption frequency alone may miss the main risk. Interventions should support task resumption, protect capacity at busy times, rebuild shared communication norms and take account of the receiver's capacity when designing escalation.

Background: Commercial spaceflight now carries civilians on short missions, yet their stress-axis physiology is poorly described. Earlier shuttle data suggest that sympathetic responses predominate after short flights and glucocorticoid responses after long ones. The neutrophil-to-lymphocyte ratio (NLR) is a low-cost readout of both. Methods: Preregistered secondary analysis of open clinical laboratory data (NASA Open Science Data Repository OSD-569 and OSD-575) from the four Inspiration4 crew members, each sampled seven times: three draws before launch, one the day after return (R+1) and three during recovery (R+45 to R+194). Log-transformed NLR was modelled with a linear mixed model with a random intercept per crew member and Kenward-Roger inference. Lymphocyte and eosinophil counts and C-reactive protein were secondary outcomes with false discovery rate correction. Results: All 28 draws were analysed. NLR at R+1 did not differ from pre-flight (fold change 1.04; 95% CI 0.81 to 1.34; p = 0.73); two crew members increased (+25% and +46%) and two decreased (-27% and -11%). During recovery NLR was 23% lower than pre-flight (fold change 0.77; 95% CI 0.64 to 0.92; p = 0.005). No secondary outcome changed after correction; lymphocytes were 18% lower at R+1 (95% CI -35% to +4%; q = 0.31). Between-person differences explained 58% of the variance. An ordinary regression ignoring repeated measures missed the recovery effect (p = 0.08). Conclusions: A 3-day orbital flight produced no consistent leukocyte stress signature one day after return. The lower NLR during recovery suggests that pre-flight values, not recovery values, deviate from the resting state, which has implications for how baselines are defined in short-duration spaceflight studies.

ObjectivesTo estimate the prevalence of objective peripheral neuropathy, and to test whether self-reported use of personal protective equipment (PPE) is associated with lower neuropathy risk, among adults attending a community hospital in a Nigerian population exposed to both agrochemicals and mining. DesignClinic-based cross-sectional study (June-November 2025), reported per STROBE. SettingInfant Jesus Community Hospital, Ishiagu, Ebonyi State, a community combining smallholder farming with granite and lead-zinc mining. Participants285 adults ([&ge;]18 years) attending the outpatient screening department; people with known diabetes were excluded. Main outcome measuresPeripheral neuropathy on the Michigan Neuropathy Screening Instrument (MNSI) examination -- an instrument validated in diabetic populations -- defined a priori as an abnormal 10 g monofilament test or absent/reduced ankle reflexes; three alternative case definitions were pre-specified. PPE use was scored 0-12. Associations were estimated by multivariable logistic regression adjusted for age and sex. ResultsThe proportion screening positive was 47.0% (95% CI 41.2-52.8) under the primary definition and ranged from 29.8% to 56.8% across definitions. PPE use was near-absent (89.1% never used gloves; 43.2% used none) and showed no detectable protective association (adjusted OR 0.97 per point, 95% CI 0.88-1.06). Men used PPE more than twice as often as women (55.1% vs 24.5%, p<0.001), yet neuropathy did not differ by sex (41.6% vs 49.5%, p=0.27). Only age was associated with neuropathy (adjusted OR 1.02 per year, p=0.02). ConclusionsNearly half of the adults sampled screened positive for peripheral neuropathy, and protective equipment showed no detectable protective association. Because PPE use was near-absent, the study cannot separate ineffective protection from too little protection to measure, and the cross-sectional design precludes causal inference. The equal burden across sexes despite markedly unequal protective behaviour is consistent with community-wide environmental exposure; reducing the total toxic load is a plausible priority that direct exposure measurement should now test.

Background Cardiovascular disease (CVD) risk prediction is an important component of primary prevention, particularly in populations with increasing cardiometabolic risk. Several risk prediction models are available, but their estimates may differ because of differences in derivation populations, predictors, calibration, and cardiovascular outcomes. Evidence comparing these models within Indian occupational populations remains limited. This study compared 10-year CVD risk estimates generated by the World Health Organization/International Society of Hypertension (WHO/ISH) cardiovascular risk charts, the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equation (ASCVD-PCE), and the Framingham general cardiovascular disease risk equation among university employees in India. Methods A comparative observational study was conducted using standardized health assessment data from 266 university employees. Participants aged 40-74 years were selected to provide a common analytical age range across the three risk prediction approaches. Of 127 employees within this age range, three with documented previous ischemic heart disease were excluded because the analysis focused on primary prevention. The final analytical cohort comprised 124 participants. Blood pressure was assessed using a standardized protocol involving three readings at five-minute intervals, with repeat assessments during three subsequent weekly visits for employees with elevated initial readings. Ten-year cardiovascular risk was estimated using the 2019 WHO/ISH laboratory-based risk charts for the South Asian region, the ASCVD-PCE, and the 2008 Framingham general CVD equation. Agreement between risk categories was assessed using Cohen's kappa and linear weighted kappa. Agreement was also examined at [&ge;]10% and [&ge;]20% thresholds. Results The mean age of the 124 participants was 47.63 {+/-} 6.45 years, and 86.3% were male. Diabetes was present in 25.8%, smoking/tobacco use in 19.4%, and 29.0% were receiving antihypertensive treatment. Mean estimated risk was 5.94% for WHO/ISH, 5.95% for ASCVD-PCE, and 12.86% for Framingham. High risk ([&ge;]20%) was identified in 2.4%, 4.8%, and 20.2% of participants by WHO/ISH, ASCVD-PCE, and Framingham, respectively. Exact four-category agreement was 70.2% between WHO/ISH and ASCVD-PCE, compared with 31.5% between WHO/ISH and Framingham and 26.6% between ASCVD-PCE and Framingham. Cohen's kappa was 0.502 for WHO/ISH versus ASCVD-PCE, 0.079 for WHO/ISH versus Framingham, and 0.047 for ASCVD-PCE versus Framingham. Weighted kappa values were 0.639, 0.323, and 0.342, respectively. Conclusion WHO/ISH and ASCVD-PCE produced closely similar mean risk estimates and substantially greater categorical agreement than either model showed with the Framingham equation. Framingham generated considerably higher 10-year CVD risk estimates and classified a larger proportion of participants into higher-risk categories. These findings highlight the importance of model selection when cardiovascular risk assessment is undertaken in Indian occupational populations and support cautious interpretation of risk estimates derived from models developed in different populations and for different cardiovascular endpoints. Keywords: cardiovascular disease; risk prediction; WHO/ISH; ASCVD; Pooled Cohort Equation; Framingham; India; occupational health; university employees; risk classification

Abstract Objective To estimate the burden and patterns of multimorbidity and cardiometabolic multimorbidity among university employees undergoing a comprehensive health assessment programme, and to examine demographic and behavioural factors associated with multimorbidity. Design Cross-sectional study. Setting A public university in Maharashtra, India. Participants A total of 266 university employees who underwent a comprehensive health assessment were included. Main outcome measures Multimorbidity was defined as the presence of two or more of nine chronic conditions: hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease, chronic kidney disease, thyroid disease, stroke, chronic obstructive pulmonary disease and cancer. Cardiometabolic multimorbidity was defined as the presence of two or more of hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease and chronic kidney disease. Results Hypertension was identified in 119 participants (44.7%), comprising 50 participants with pre-existing hypertension and 69 newly identified during the assessment. Dyslipidaemia was present in 189 (71.1%) and diabetes mellitus in 45 (16.9%). Overall, 108 participants (40.6%) had multimorbidity and 103 (38.7%) had cardiometabolic multimorbidity. The prevalence of multimorbidity increased progressively with age, from 17.5% among participants aged <30 years to 83.3% among those aged [&ge;]60 years. The predominant exact multimorbidity patterns were hypertension with dyslipidaemia alone (49 participants) and hypertension, diabetes mellitus and dyslipidaemia (27 participants). Overall, 173 participants (65.0%) had at least one newly identified hypertension, diabetes mellitus or dyslipidaemia diagnosis. In multivariable logistic regression, age (adjusted OR [aOR] 1.058 per year, 95% CI 1.027 to 1.091), BMI (aOR 1.163 per kg/m2, 95% CI 1.076 to 1.257) and tobacco use (aOR 3.296, 95% CI 1.377 to 7.888) were independently associated with multimorbidity. The model had an area under the receiver operating characteristic curve of 0.731. Conclusion Multimorbidity affected approximately two in five university employees, with cardiometabolic conditions accounting for most of the observed disease clustering. Comprehensive health assessment identified a substantial burden of previously unrecognised chronic disease. Integrating institutional or occupational health assessment with longitudinal primary care follow-up may provide an opportunity for earlier detection, risk-factor modification and coordinated management of multimorbidity. Keywords: Multimorbidity; cardiovascular diseases; hypertension; diabetes mellitus; dyslipidaemia; occupational health; university employees; India

Background: Millions of textile and agricultural workers inhale organic dust containing endotoxin, an exposure associated with impaired respiratory function. However, the underlying biological pathways remain unclear. We conducted a two-cohort epigenome-wide association study (EWAS) to identify airborne endotoxin-associated DNA methylation (DNAm) alterations and pathways. Methods: In the discovery phase, we compared blood DNAm in 281 endotoxin-exposed cotton workers and 253 unexposed silk-workers from the Shanghai Textile Worker Study (STWS) measured using Illumina MethylationEPICv2 arrays. STWS endotoxin assessment combined detailed work histories and onsite measurements. For targeted parallel validation, we tested STWS signals in 686 incident lung cancer cases and 683 matched controls from the Shanghai Women's Health Study (SWHS), using occupation-derived low, medium, or high exposure-intensity ranks based on published evidence. To gain biological insight, we analyzed pathway enrichment, immune-cell composition, DNAm inflammation risk scores (IRSs), and respiratory phenotype associations in STWS. Results: In STWS, we identified 36 epigenome-wide significant DNAm sites (P<5e-8), of which, 35 were hypomethylated. Among 30 sites testable in SWHS, 18 had concordant effect directions, and four were nominally significant: cg11869499 (POLG; P=0.041), cg16290931 (TSKS; P=0.044), cg05019530 (EPIC1; P=0.042), and cg26033526 (PSMB9/TAP1; P=0.013). Enrichment implicated immune and signal-transduction pathways, including IgSF cell-adhesion-molecule signaling (FDR=8.2e-6;). Neutrophil were higher in cotton workers than in silk workers (63.5% vs 58.9%, p=7.52e-10). Cumulative endotoxin was associated with higher CRP-based IRSs, which showed the most consistent associations with lower lung function and airflow obstruction. Conclusions: Our EWAS findings suggest that occupational endotoxin may operate partly through immune-cell composition and inflammatory pathways.

Background: Long-term mortality data among Brazilian police officers and firefighters are scarce. This study investigated the leading causes of death in Brazilian male military police officers and firefighters over three decades, comparing their mortality and mean age at death with those of the male population. Methods: We retrospectively analyzed death records of male military police officers and firefighters from Espirito Santo (ES), Brazil, from 1988 to 2019. Mortality was analyzed across three decades and the standardized mortality ratios (SMRs) for the three leading causes were calculated using the male populations of ES and Brazil as references. Results: Overall, 2,198 deaths were identified, with a mean age at death of 59 {+/-} 18.5 years, compared with 60.5 {+/-} 23.9 years among men in ES and 63.4 {+/-} 23.7 years among Brazilian men. Mean age at death was 36 {+/-} 9 years among active-duty and 68 {+/-} 13 years among inactive personnel. Across the study population, the leading causes of death were circulatory system diseases (32%), external causes (26%) and neoplasms (15%). Circulatory disease mortality was higher in the second and third decades compared with both reference populations, whereas external-cause mortality shifted from higher, in the first two decades, to lower than expected in the last decade. Neoplasm mortality was higher relative to Brazil only in the last decade. Conclusion: Mortality patterns differed by cause and over time. The younger mean age at death among active-duty personnel, together with cause-specific excess mortality, highlights the importance of long-term occupational health surveillance and preventive strategies.

Background: Substance use during pregnancy can substantially increase risk for postpartum depression and anxiety symptoms, which can have lasting effects on family functioning and child development. However, substance use is often conceptualized as a binary exposure, limiting our understanding of whether specific patterns of use are associated with maternal mental health in the perinatal period. Here, we examined longitudinal patterns of prenatal alcohol use and smoking in relation to maternal depressive and anxiety symptoms across pregnancy and the first two years postpartum. Methods: We analyzed prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based cohort from the UK. Alcohol and cigarette use were assessed across all three trimesters and modeled as longitudinal patterns (abstained, persistent, intermittent, discontinued). Maternal depressive and anxiety symptoms were measured from the second trimester through 21 months postpartum using the Crown-Crisp Experiential Index. Results: Persistent alcohol use was associated with higher depressive and anxiety symptoms and slower symptom declines over time, while women with intermittent or discontinued use had symptom profiles similar to abstainers. By contrast, persistent, intermittent, and quitting smoking patterns were associated with higher symptom levels overall, with persistent smoking additionally associated with steeper declines in symptoms over time. Conclusion: Our findings highlight the importance of considering the persistence and cessation of substance use during pregnancy in the context of maternal mental health, pointing to patterns of persistent substance use as a potential target to inform screening and early intervention for women at higher risk for perinatal psychological distress.

Background: Previous studies indicated that regional fluctuations in COVID-19 impact were associated with socioeconomic, demographic and environmental factors early in the pandemic. It is unclear whether factors associated with regional COVID-19 mortality and SARS-CoV-2 infections changed over the course of the pandemic. Methods: We evaluated the association of ecological factors with municipality-specific COVID-19 mortality in the national population of Austria between January 2020 and June 2023. Analyses were conducted separately per calendar year and pooled across years via random-effects meta-analysis. Outcomes were analysed using univariable and multivariable zero-inflated negative binomial (ZINB) regression, including annually averaged environmental exposome exposure (including air pollution and UV radiation), socioeconomic, demographic and infection dissemination predictors with significance threshold set to p<0.005. Secondary analysis modelled SARS-CoV-2 infections using of negative-binomial model (NB). Two additional approaches for smaller predictor set selection were applied as sensitivity analyses. Results: Within the entire observation period 18,430 COVID-19 deaths were reported. In univariable analyses (pooled RR (99.5% CI)), COVID-19 mortality was significantly associated with the proportion of commuters (0.79 (0.73-0.86)), residents aged 75-84 (1.18 (1.01-1.37)) and [&ge;]85 years (1.29 (1.04-1.60)), residents with at most compulsory education (1.15 (1.02-1.29)), employed residents aged 15-64 (0.89 (0.85-0.93)), and homeowners (0.91 (0.83-0.99)), as well as with precipitation (0.94 (0.89-0.99)) and the average time with a mean temperature of 5-15 C (0.95 (0.90-0.99)). In multivariable analyses the share of population aged 85 or older (1.30 (1.09-1.54)) and home ownership (0.92 (0.87-0.98)) were independently significant. Mortality predictor estimates were relatively stable across pandemic years. Across 5,963,882 documented SARS-CoV-2 infections share of employed in 15- to 64-year-olds (1.01 (1.01-1.02)), part-time employment rate (1.01 (1.00-1.02)) and district level nursing care allowance recipiency (0.97 (0.95-0.98)) were associated with detected infections. Overnight stays, population 85 or older, income, compulsory education or less and air pollution all had multiple significant estimates with opposite directionality, leading to non-significant overall associations. Sensitivity analyses outcomes mirrored main analyses outcomes. Conclusions: Throughout the pandemic in Austria, demographic and socioeconomic factors were associated with COVID-19 mortality and infections, but many associations, especially for infections, were unstable over time. These findings underscore the importance of structural vulnerabilities in epidemic impact.