Occupational and Environmental Medicine

Objectives The association between occupational physical activity (OPA) and cardiovascular disease (CVD) may depend on how OPA is classified. This study examined the association between OPA and incident CVD using individual level and occupational group level classifications, and assessed whether factors contributing to attenuation differed. Methods A total of 137,592 employed UK Biobank participants aged 40 to 69 years who were free of CVD at baseline were included. OPA was classified using (i) individual level self reported physical activity at work and (ii) occupational group level two digit Standard Occupational Classification. Associations with incident CVD were examined using Cox proportional hazards models. Attenuation of associations by sociodemographic, lifestyle, health, occupational and psychosocial factors was assessed using univariate adjustments and Heller's coefficient. Results During 1,656,378 person-years of follow up (median 12.6 years), 10,465 incident CVD events occurred. The association between OPA and CVD differed markedly according to exposure classification. High individual level self reported OPA was associated with increased CVD incidence after full adjustment [hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.10 to 1.27]. In contrast, no association was observed when OPA was classified at the occupational-group level using Standard Occupational Classification groupings (HR 1.00, 95% CI 0.94 to 1.06). Sociodemographic and health factors accounted for the greatest attenuation across both classifications, whereas psychosocial factors contributed primarily to associations based on individual-level self-reported OPA. Conclusions The association between occupational physical activity and incident cardiovascular disease differed substantially according to how OPA was classified. These findings highlight exposure classification as a critical consideration when interpreting evidence on the physical activity paradox.

Aims To explore how workplace environments and racialised hierarchies shape racial inequities in career progression and how the Covid-19 pandemic response influenced these inequities. Design Longitudinal and cross-sectional qualitative study using semi-structured interviews. Methods Semi-structured interviews were conducted with 27 student nurses, healthcare assistants and qualified nurses and 24 senior leaders and management staff recruited in England between January 2019 and March 2021. Data were analysed using thematic analysis. Results Data from 51 healthcare professionals were included in the analysis. Guided by sociological theory on inequality diversions and racialised organisations, three main themes were identified: (1) hidden pipelines to career progression highlights how racial positioning influences unequal career trajectories shaped by informal networks, organisational norms and perceptions of competence; (2) impact of the response to the Covid-19 pandemic illustrates how the pandemic disrupted and reinforced racialised career barriers and (3) psychological effects of racialised inequities on racially minoritised staff captures the emotional burden of navigating these inequities. Conclusion NHS staff perspectives on racialised inequities in career progression highlight the power informal networks have in staff accessing managers who control opportunities. While some staff found new opportunities during the Covid-19 response, others, particularly senior racially minoritised staff, felt redeployments and remote working further hindered their development.

Work-related musculoskeletal disorders (WRMSDs) constitute the primary occupational health burden among healthcare professionals (HCPs) globally and directly threaten health workforce sustainability, a critical concern for Sustainable Development Goal 3 (Good Health and Well-being) and SDG 8 (Decent Work and Economic Growth). Despite high prevalence in Cameroon, downstream occupational effects and management strategies across hospital levels remain undocumented. A hospital-based, analytical cross-sectional study was conducted across five referral hospitals in Douala, Cameroon (2019-2022). A total of 561 HCPs were enrolled by stratified random sampling. The Modified Nordic Musculoskeletal Questionnaire and structured interviews assessed WRMSD occupational effects and management strategies. Data were analysed using IBM SPSS v26; chi-square tests and logistic regression assessed associations (p < 0.05). The 12-month WRMSD prevalence was 83.4% (468/561). WRMSDs caused absenteeism in 83.4% of affected HCPs ({chi}2 = 14.414; p < 0.001), reduced daily activity capacity in 55.6%, and job dissatisfaction in 60.4%; 38.9% were considering a career change. Management was predominantly reactive: fitness training (76.3%), rest (41.4%), and non-steroidal anti-inflammatory drugs (NSAIDs; 37.3%). Only 15.0% received physiotherapy referral, and no hospital had a formal WRMSD protocol. WRMSDs impose a substantial and measurable occupational burden on HCPs in Douala. Current management is reactive, non-standardised, and under-integrated with physiotherapy. Evidence-based, multicomponent prevention programmes, physiotherapy integration, and a national occupational health policy are urgently required to protect the healthcare workforce and advance SDG 3 and SDG 8 targets in Cameroon.

The prevalence of shift work-centric industries and the rise of flexible working render it crucial to investigate the health risks posed by unnatural patterns of work and sleep. Shift working in healthcare has been linked to emotional dysregulation, reduced alertness, and cognitive impacts, with Shift Work Disorder (SWD) classified as a circadian rhythm sleep-wake disorder in the DSM-5. These impacts have historically been attributed to schedule-related sleep disturbances; however certain individuals appear more acutely affected. One measure of individual inflexibility to altered routines is chronotype distinctness, an amplitude dimension of the Caen Chronotype Questionnaire (CCQ). Here, we use Structural Equation Modelling (SEM) to unravel the mechanisms by which sleep and chronotype distinctness govern the neuropsychiatric symptom profiles of a cohort of National Health Service (NHS) shift workers (n=102). We constructed a measurement model, extracting latent constructs from questionnaires for sleep disturbances (PSQI), chronotype distinctness (CCQ), mood disorder (MDQ), depression (PHQ8) and emotional reactivity (ERS), and cognitive assessments. Correlations were identified between constructs, then translated into two SEMs - day and rotating shifts respectively - with sleep and distinctness as predictors of detrimental effects. Models were tested for direct effects, significant paths, and overall model fit. We found that, whilst sleep governed fatigue-based symptoms in day-shift workers, chronotype distinctness determined the severity of adverse effects in rotating-shift workers, including mood disorders and cognitive impairments. We surmise that high chronotype distinctness should be considered a risk factor for adverse effects surrounding night and rotating-shift work, and that interventions should incorporate chronotype-specific remediation.

Background: Work-related musculoskeletal pain (MSP) is a prevalent concern among factory workers, impacting productivity, absenteeism, and overall quality of life. Factory workers, who perform repetitive tasks and engage in physically demanding work, are particularly susceptible to work-related MSP. Methods: This descriptive cross-sectional quantitative study included 148 factory workers (29 females and 119 males) from two factories in Kigali, surveyed between November 2023 and January 2024. Data were collected using a structured questionnaire that included demographic items, the Modified Nordic Musculoskeletal Questionnaire (M-NMQ) to assess work-related musculoskeletal pain (MSP) symptoms in nine body regions over the previous 12 months and seven days, and questions regarding interference of symptoms with normal work activities. The Coping Strategies Questionnaire (CSQ) was administered to identify coping practices among factory workers. Data analysis comprised descriptive statistics, including mean, frequency, Wilson 95% confidence intervals, and percentage values, calculated using SPSS version 25.0. Results: Participants were predominantly male (119/148, 80.4%), and 98/148 (66.2%) had worked at the factory for more than five years. Overall, 113/148 reported symptoms in at least one body region during the previous 12 months (76.4%, 95% CI 68.9-82.5). The lower back (90/148, 60.8%), shoulders (71/148, 48.0%), neck (61/148, 41.2%), and knees (58/148, 39.2%) were most frequently affected. Symptoms prevented normal work for 41/148 (27.7%, 95% CI 21.1-35.4), and 57/148 reported symptoms during the previous seven days (38.5%, 95% CI 31.1-46.5). Among 113 participants with 12-month symptoms, the most frequent Always responses were seeking medical help (78/113, 69.0%), rest and recovery (75/113, 66.4%), and medication use (59/113, 52.2%); ergonomic adjustment was least frequent (10/113, 8.8%). Conclusion: Self-reported work-related MSP symptoms were common, particularly in the lower back and shoulder, while ergonomic adjustments were uncommon. Frequent medication use highlights the need for comprehensive interventions combining ergonomic training, physiotherapy, and adequate recovery; however, these findings do not establish causation or intervention effectiveness.

Occupational ocular injuries are a preventable yet neglected public health problem, particularly in low- and middle-income countries. Maintenance workers are exposed to diverse ocular hazards daily, yet compliance with protective measures is consistently poor. A descriptive cross-sectional study was conducted among 85 maintenance workers at the Maintenance and Essential Services Organization (MESO) of Kwame Nkrumah University of Science and Technology (KNUST), Ghana, recruited through stratified convenience sampling across seven occupational sections. A structured questionnaire assessed knowledge of ocular hazards and protective equipment, attitudes toward ocular safety, and safety practices. Data were analyzed using IBM SPSS version 26 (IBM Corp., Armonk, NY, USA); chi-square and Fishers exact tests assessed associations (p < 0.05). Participants were predominantly male (84/85, 98.8%), with a mean age of 44.5 {+/-} 10.4 years. Overall knowledge was good (mean 9.40 {+/-} 1.59 out of 11), but attitude and practice scores were average (2.78 {+/-} 0.92 and 3.27 {+/-} 0.93, respectively). Most workers correctly identified goggles and face shields as protective, but only about half recognized that ordinary sunglasses and spectacles offer inadequate protection. Although 97.6% (83/85) recognized the need for ocular protection, only 7.1% (6/85) reported consistent protective eyewear use, and fewer than half (45.9%, 39/85) had received formal ocular safety training. Routine general protective equipment use was significantly associated with ocular protection use (Fishers exact test, p = 0.011). Sand and dust particles were the leading causes of injury and only 25% (5/20) of injured workers sought formal care. Workers demonstrated good knowledge but poor attitudes and practices toward ocular safety, suggesting that knowledge alone does not translate into protective behaviour even within a relatively well-resourced institutional setting. Findings suggest that limited access to task-appropriate protective eyewear may represent an important institutional barrier. Institutional PPE supply and section-specific safety training are essential to bridge this knowledge-practice gap.

Objective Sarcomas are rare tumors of connective tissue that can develop in soft-tissue, viscera organs, or bones. Previous occupational studies have mainly focused on men and soft-tissue sarcomas. This study describes associations between occupations and sarcomas, in men and women, for soft-tissue sarcomas (STS), including visceral sarcomas, and bone sarcomas (BS). Methods The ETIOSARC study was a multicenter case-control study conducted across six French geographical areas between 2019 and 2023. Occupational histories were collected by interview and coded according to the International Standard Classification of Occupations (2008). Conditional logistic regression models were applied to estimate odds ratios with 90% confidence intervals for each occupation included in the study. Results A total of 374 male cases (336 STS and 38 BS), 371 female cases (335 STS and 36 BS), and 1,387 controls were included. Positive associations were observed among male STS for painters (OR=5.37, 90% CI=1.83-15.71), waiters (OR=4.54, 90% CI=1.88-10.97), and among male BS for electricians (OR=3.67, 90% CI=0.91-14.86). Among women, increased STS risk was found among real estate agents (OR=3.48, 90% CI=1.03-11.79), food preparation assistants (OR=3.47, 90% CI=1.09-11.04), and administrative and executive secretaries (OR=2.37, 90% CI=1.45-3.86). For BS, a higher risk was observed among sales workers (OR=5.61, 90% CI=1.65-18.99). Conclusions Our study highlights hitherto unreported occupational associations with sarcomas, among both men and women, as well as the importance of sex-stratified analyses. Further research should aim to confirm these results and disentangle the respective roles of occupational exposures, environmental factors, and lifestyle characteristics.

Background: Health and administrative professionals in tertiary hospitals face high levels of occupational stress, mental illness, and multimorbidity. The integrated measurement of these multidimensional health aspects is essential for informing effective workplace health promotion strategies. Objective: To describe the general health status of federal public hospital staff and correlate the measured health dimensions to inform institutional health promotion initiatives. Methods: A cross-sectional, online survey study was conducted at Hospital Universitario dos Servidores do Estado (HUSE) between November and December 2025. Data collection was performed via online REDCap questionnaires covering sociodemographic profiles and validated instruments (SRQ-20, MIDAS, AUDIT, WHOQOL-BREF, PHI, WHOQOL-SRPB BREF, CBI, GPAQ, and EPSO). Descriptive statistics, comparisons across employment ties (permanent vs. contracted staff), and Spearman correlation matrices were calculated. Results: Among 197 accesses, 117 completed the informed consent, and 86 finished all questionnaires. Participants were predominantly female, aged 40 to 60 years, and Christian. Screening positivity was 25% for common mental disorders, 21% for headache-related disability, and 10% for harmful drinking. Burnout scores clustered in the second quartile, while quality of life, happiness, and spirituality scores were in the upper third. Median physical activity was 670 min/week. Mental symptoms (SRQ-20), headache (MIDAS), and burnout (CBI) correlated positively with each other and negatively with quality of life, happiness, spirituality, and institutional support (EPSO). Conclusion: The set of instruments proved feasible for situational health diagnosis among hospital staff. Although the sample size was limited in this baseline wave, the initiative fostered workplace health awareness, driving concrete initiatives, including an on-site functional gym and workplace vaccination campaigns.

Background: General illness-related sick leave among teachers represents a relevant public health and workforce management issue. However, long-term population-based evidence describing its distribution and associated factors in Latin American urban educational systems remains limited. This study aimed to characterize the occurrence, distribution, duration, and sociodemographic, occupational, temporal, and territorial factors associated with general illness-related sick leave among public school teachers in Bogota between 2010 and 2025. Methods: A retrospective cohort study was conducted using integrated administrative databases from the Bogota District Department of Education. The primary outcome was the occurrence of at least one general illness-related sick leave episode in a teacher-month observation. Descriptive analyses were performed to characterize sociodemographic and occupational patterns. A multivariable logistic regression model was used to estimate associations. Month and year were included as temporal fixed effects to account for seasonal patterns, academic-calendar effects, pandemic-related disruption, and secular changes. Results: The cohort included 59,697 unique teachers, contributing 537,025 teacher-year observations from teachers with an active employment record between January 1, 2010, and July 31, 2025. Overall, 41.59% of teacher-year observations included at least one general illness-related sick leave episode, and 83.26% of teachers had at least one episode at any time during follow-up. Respiratory diseases accounted for the largest share of episodes, followed by musculoskeletal and infectious diseases. Mean duration varied substantially by diagnostic category, ranging from short respiratory and infectious episodes to longer absences related to neoplasms, circulatory diseases, injuries, and mental health conditions. In the multivariable teacher-month model, sick leave occurrence was associated with age, sex, occupational role, teaching area, contract type, locality, calendar month, and calendar year. Lower odds were observed among male teachers, principals, and teachers with provisional contracts, while temporal and territorial variation was observed across months, years, and localities. Conclusions: General illness-related sick leave among public school teachers in Bogota showed consistent sociodemographic, occupational, temporal, and territorial patterns. Respiratory and musculoskeletal conditions accounted for the largest share of episodes, while chronic, neoplastic, injury-related, circulatory, and mental health conditions were associated with longer durations. These findings provide population-level evidence to inform occupational health surveillance, seasonal preparedness, and workforce planning strategies within urban educational systems.

Abstract Background. Acrylamide, a neurotoxicant in heated foods and smoke, is linked to occupational neuropathy, but evidence regarding chronic, low-level population exposure remains limited. We evaluated the association between acrylamide exposure biomarkers and peripheral neuropathy among U.S. adults. Methods. A total of 2,266 NHANES 2003-2004 participants (age >40) were analyzed. Exposure was assessed via hemoglobin adducts (HbAA/HbGA); neuropathy via monofilament testing >1 site). Survey-weighted logistic regression models adjusted for confounders. Sensitivity analyses included cubic splines, diabetes stratification, and multiple imputation. Results. Neuropathy prevalence was 15.5%. In adjusted models, neither adduct was associated with neuropathy (HbAA OR: 0.98, 95% CI: 0.82-1.17; HbGA OR: 0.91, 95% CI: 0.77-1.08). No dose-response gradient was observed. Expected risk factors (age, diabetes) showed strong associations, validating model sensitivity. The null result remained robust across sensitivity analyses, including a stricter outcome definition and multiple imputation (pooled OR: 0.97, 95% CI: 0.83-1.14). Conclusions. Acrylamide adducts were not associated with peripheral neuropathy in this national sample. General population levels (~55-70 pmol/g) lie well below established occupational no-observed-adverse-effect levels (~510 pmol/g) and clinical neuropathy thresholds (~6,000 pmol/g), providing a mechanistically coherent explanation for this null result.

Background: Vaccine hesitancy and logistical barriers continue to limit influenza vaccination uptake among healthcare personnel. The STRENGTH initiative evaluated employee drivers of influenza vaccine acceptance in healthcare workgroups with lower vaccination compliance. Methods: This mixed-methods program evaluation used a custom Epic electronic medical record dashboard to identify workgroups with lower influenza vaccination rates, followed by focus groups, targeted worksite vaccination clinics, and an anonymous survey. Survey data from 73 respondents were analyzed using descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests, chi-square or Fisher exact tests, and Spearman rank correlations. Results: Respondents had a mean age of 44.8 years (SD 11.3); 36 of 70 respondents reporting binary gender were male. Convenience of worksite vaccination received the highest importance ratings (mean 4.72/5), followed by protection from influenza (mean 4.38/5). Both were rated significantly above the neutral midpoint of 3 (Wilcoxon p<0.001). The strongest observed Spearman correlations were between peer pressure and leadership participation (rho=0.47) and between protection from influenza and willingness to receive a future combined influenza/COVID-19 vaccine (rho=0.42). Conclusions: Convenience and perceived protection were the most important vaccination drivers. Employer-sponsored workplace vaccination programs can reduce logistical barriers while providing opportunities for targeted education and trust-building. Keywords: influenza vaccination; healthcare workers; vaccine hesitancy; occupational health; workplace vaccination; employer-sponsored vaccination

Background: Endocrine-disrupting chemicals (EDCs) in consumer products are ubiquitously detected in human biospecimens, yet most epidemiological studies examine single chemicals rather than real-world co-exposures. We evaluated associations between a mixture of seven urinary chemical biomarkers and systemic inflammation. Methods: Survey-weighted log-log regression models adjusted for age, sex, race/ethnicity, poverty-income ratio, and survey cycle were conducted with Benjamini-Hochberg FDR correction (primary analysis, N=4,864). A sensitivity analysis additionally adjusted for body mass index and smoking status (N=4,494). Results: In the primary analysis, 5 of 7 chemicals showed significant associations after FDR correction: ethylparaben ({beta} = -0.056, FDR P < .001), propylparaben ({beta} = -0.026, FDR P = .007), bisphenol A ({beta} = +0.052, FDR P = .005), monoethyl phthalate ({beta} = +0.043, FDR P = .002), and monocyclohexyl phthalate ({beta} = +0.215, FDR P = .007). The WQS mixture index was significantly associated with CRP ({beta} = +0.056, 95% CI [0.031, 0.081], P < .001), with monocyclohexyl phthalate carrying the largest mixture weight (0.342). In the BMI- and smoking-adjusted sensitivity analysis, associations attenuated to null for all chemicals, though MCP preserved direction ({beta} = +0.129) and the WQS mixture direction was maintained ({beta} = +0.018). Two multiple imputation sensitivity analyses confirmed that monocyclohexyl phthalate was the only chemical to maintain a positive direction across all four analytical specifications (primary complete-case, BMI-adjusted complete-case, primary-aligned imputation, and BMI-adjusted imputation), reaching statistical significance in three of four specifications and providing convergent evidence of a robust MCP-inflammation association. Conclusions: The chemical mixture showed a significant collective association with systemic inflammation, consistent with a cumulative pro-inflammatory burden from co-exposure to multiple consumer product chemicals. These findings suggest that regulatory approaches should shift from single-chemical to mixture-based risk assessment frameworks for consumer product safety.

Abstract Background: Hospital discharge from coronary care units (CCUs) is commonly framed as a discrete clinical or administrative endpoint. This event-based conceptualisation obscures the ongoing nursing and interprofessional work undertaken across the admission to stabilise discharge readiness. Aim: To theorise discharge readiness in CCUs as anticipatory nursing and interprofessional work and to examine how professional roles, organisational systems and service contexts shape discharge across two national context. Design: Qualitative study utilising reflexive thematic analysis. Methods: Semi-structured interviews and focus groups were conducted with 37 clinicians (nurses, allied health professionals and medical staff) working in CCUs in Australia and the United Kingdom. Reflexive Thematic Analysis was undertaken inductively within each dataset, followed by higher-level interpretive integration. Results: Four interrelated themes conceptualised discharge readiness as: (1) anticipatory nursing work initiated at admission and sustained through ongoing assessment, coordination and documentation; (2) negotiated readiness achieved through interprofessional alignment and distributed expertise; (3) discharge documentation as a site of organisational tension shaping workflow and communication; and (4) discharge flow constrained by system-level pressures, downstream service availability and policy logics. Across both national contexts, nurses were positioned as custodians of discharge readiness through continuous monitoring, relational coordination and informal risk management, although enactment varied by organisational setting. Conclusion: This study contributes to nursing scholarship by positioning discharge readiness not as a single decision point, but as an emergent outcome of anticipatory nursing labour, interprofessional negotiation and organisational systems. By making visible the distributed and often hidden work underpinning discharge, the findings extend existing models of transitional care and provide a theoretically grounded foundation for strengthening discharge practice in coronary care nursing.

ABSTRACT Background: Scapholunate instability (SLI) represents the most prevalent form of carpal instability and is increasingly recognized as a clinically significant occupational condition in manual-labor populations. Repetitive forceful gripping, sustained wrist loading, and awkward joint postures inherent to construction, manufacturing, and heavy industry may predispose workers to progressive scapholunate ligament compromise; however, the specific biomechanical mechanisms underlying dynamic grip force transmission in symptomatic laborers remain poorly characterized. Objective: This study aimed to quantify dynamic grip force profiles and wrist kinematics in manual laborers exhibiting clinical signs of scapholunate instability; compare these biomechanical parameters with asymptomatic worker controls; and identify occupation-specific loading patterns that may contribute to scapholunate ligament compromise. Methods: A cross-sectional observational design was employed. Forty-two male manual laborers, mean age 36.4 (SD 7.2 )years; mean occupational exposure 9.8 (SD 4.1) years, were recruited from construction and surgical instrument manufacturing sites in Sialkot District, Pakistan. Participants were stratified into a symptomatic group (n = 21) based on positive Watson scaphoid shift test, dorsal wrist pain, and functional limitation, and an asymptomatic control group (n = 21). Dynamic grip force was measured using a calibrated Jamar dynamometer across five standardized trials. Wrist kinematics were captured during a simulated gripping task using electrogoniometry. Surface electromyography (sEMG) recorded flexor digitorum superficialis, flexor carpi ulnaris, and extensor carpi radialis longus activity. Scapholunate gap was confirmed radiographically. Statistical analyses included independent samples t-tests, Pearson correlation, and logistic regression ( = 0.05). Results: Symptomatic workers demonstrated significantly reduced grip force (28.4 (SD 5.6) kg versus 41.7 (SD 6.3) kg; p < 0.001) and elevated wrist ulnar deviation during peak gripping (22.3 (SD 4.1) degrees versus 14.6 degrees (SD 3.8) degrees ; p = 0.002) compared with controls. sEMG amplitude of flexor digitorum superficialis was paradoxically elevated in the symptomatic group (mean difference 18.3 microvolts; 95% CI 11.4-25.2), suggesting compensatory hyperactivation. Scapholunate gap correlated positively with years of occupational exposure (r = 0.67; p < 0.001). Logistic regression identified wrist ulnar deviation angle (OR = 2.14; 95% CI 1.43-3.19) and grip force asymmetry (OR = 1.87; 95% CI 1.21-2.89) as independent predictors of instability signs. Conclusions: Manual laborers with work-related scapholunate instability signs exhibit distinct biomechanical signatures during dynamic gripping, including reduced force output, abnormal wrist posture, and compensatory neuromuscular recruitment. Occupational exposure duration is a significant predictor of radiographic scapholunate dissociation. These findings support the integration of ergonomic risk screening and early biomechanical assessment into occupational health protocols for manual labor populations in low- and middle-income settings. Abbreviations: CI: confidence interval, DRUJ: distal radioulnar joint, EMG/sEMG: (surface) electromyography, FCU: flexor carpi ulnaris, FDS: flexor digitorum superficialis, MSD: musculoskeletal disorder, OR: odds ratio, ROM: range of motion, SL/SLI: scapholunate/scapholunate instability, SLIL: scapholunate interosseous ligament, SLAC: scapholunate advanced collapse, WMSDs: work-related musculoskeletal disorders, SD: standard deviation. Keywords: scapholunate instability; dynamic gripping; manual labor; wrist biomechanics; carpal kinematics; occupational ergonomics; grip force; electromyography; Watson scaphoid shift test; work-related musculoskeletal disorders

Objectives: To examine how self-reported physical activity and walking pace in UK healthcare workers differ ethnicity, migration status, and job role. Design: Prospective cohort study with 6 waves of data collection between 2020 and 2025, analysed using multi-level logistic regression, informed by the UK REACH patient and professional advisory group. Setting: Healthcare settings across the UK. The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) cohort. Participants: 18,721 healthcare workers employed in the UK: 28.2% Allied Health Professionals; 75% female; 34% from ethnic minority backgrounds; and 32% born overseas. Main outcome measures: Physical activity and walking pace, as measured by the General Practice Physical Activity Questionnaire (GPPAQ). A Total Physical Activity score, and a separate Exercise and Cycling score excluding occupational physical activity were derived. Results: Walking pace and physical activity varied significantly by ethnicity, migration status and job role. Compared to White UK-born staff, slower walking pace was reported in ethnic minority staff, with differences greater in staff born overseas (e.g. Asian UK (aOR 0.63, 95%CI 0.56 to 0.71, p<0.001), Asian overseas (aOR 0.38, 95%CI 0.35 to 0.42, p<0.001)). Compared to White UK-born staff, lower odds of reporting being physically active were reported in multiple ethnic groups. Differences were larger for Exercise and Cycling, indicating that occupational physical activity accounted for a large proportion of total physical activity in several groups (e.g. Total Physical Activity: Asian overseas-born (aOR 0.79, 95%CI 0.72 to 0.87, p<0.001); Exercise and Cycling: Asian overseas-born (aOR 0.61, 95%CI 0.56 to 0.67, p=<0.001). Compared toMedicalstaff, Nursing and Midwifery staff, Pharmacy staff, Dental staff, Other staff, and Healthcare Scientists hadsignificantly lower odds of reporting being physically active. Ambulance staff had higher odds of reporting being physically active when using the Total Physical Activity score (aOR 1.64, 95%CI 1.37 to 1.97 p<0.001), but lower odds for Exercise and Cycling (aOR 0.61 95%CI 0.53 to 0.72, p<0.001). Conclusions: Self-reported physical activity and walking pace vary significantly in UK healthcare workers, by ethnicity, migration status, and job role. Our findings have important implications for understanding workforce health and ethnic health inequalities.

Objectives To identify research priorities for improving the mental health of neurodivergent higher education (HE) students by exploring the perspectives of individuals with lived experience. Design Qualitative study using an online survey. Data was analysed using a deductive-inductive, hybrid semantic thematic analysis. Setting UK higher education institutions. Participants 104 current and former neurodivergent HE students with diverse neurodivergent profiles and intersecting identities. Main outcome measures Participant recommendations regarding priorities for future research on neurodivergent student mental health. Results Six themes were identified and were grouped into (1) general recommendations for research and (2) recommendations specific to neurodivergence within a HE context. Participants prioritised a shift away from medical model approaches towards research informed by social and strengths-based perspectives. Key priorities included improving understanding of diagnostic barriers and misdiagnosis, reducing stigma, investigating institutional barriers within HE, evaluating the effectiveness of support and accommodations and examining the experiences of underrepresented and intersectional groups. Participants emphasised the need for research on more flexible teaching practices, sensory-friendly learning environments, integrated mental health and educational support and alternatives to diagnosis-dependent access to services. Conclusions Future research should move beyond descriptive accounts towards evaluating interventions and current support provision to understand if they improve the mental health of neurodivergent students. Adopting intersectional approaches, moving beyond binary deficit- or strengths-based frameworks and focusing on inclusive, needs-based support rather than diagnosis-led systems are likely to produce more equitable and effective outcomes for neurodivergent students in higher education.

Background Sleep, mood, and affective states are mutually connected. There is a paucity of studies, however, that have considered bidirectional relationships between daily sleep-affective dyads in naturalistic settings, particularly for shift workers. Objective To evaluate the dynamic and temporal interplay of daily smartphone-based self-reported sleep measurements, dimensions of affective experience and cognitive processing in UK shift working nurses. Methods The EClocker Study prospectively monitored 102 National Health Service (NHS) nurses (aged 25-61 years, 83.3% female) working standard (day shift) and non-standard (fast rotating shifts) schedules over a two-week period. Smartphone-based Experience Sampling Methodology (ESM) recorded daily sleep, mood, momentary affect and cognitive attentional functioning. Self-reported burnout, emotional dysregulation, emotion reactivity and affective dimensions (positive and negative) were also collected. Findings Overall, NHS nurses reported a high prevalence of depressive symptoms, stress, burnout and sleep-circadian rhythm disturbances. Generalised Additive Modelling (GAMs) revealed that NHS nurses higher perceived sleep quality predicted better next-day mood state, while better daytime mood was associated with reduced sleep onset latency, such that participants reported falling asleep faster. In contrast, daytime mood or affect (positive and negative) had no substantial, direct impact on nurses subjective sleep parameters (sleep quality, sleep duration, sleep efficiency). Exposure to fast rotating night shifts across the two-week study was associated with more frequent response errors on a Choice Reaction Time (CRT) cognitive task, while daytime somnolence did not adversely influence nurses momentary reaction time speeds or attentional function. Conclusions Clinically relevant sleep impairments, insomnia-related symptoms, elevated stress, and poor mood were pervasive in a sample of UK NHS nurses, regardless of shift type. Sleep quality impacted next-day mood and daytime mood impacted sleep latency, while rotating shifts led to an increase in cognitive errors. Recognising the impact of shiftwork and designing interventions to promote better sleep quality offer potential to enhance mood and performance in healthcare professionals. Clinical implications We need to implement and evaluate interventions that regularise sleep patterns and promote sleep quality to alleviate mood symptoms among frontline NHS shift workers.

Objectives: Research on mental health in agriculture has increased in recent years; however, it remains largely focused on farmers themselves and is predominantly male-oriented. The mental health of farm wives and partners, many of whom play integral roles in farm operations, business management, and family life, remains difficult to characterise. This study therefore aims to explore the prevalence and causes of mental health challenges among farm wives and partners, and to investigate their use of, and barriers to, mental health support services. Methods: Quantitative data was collected using over 450 structured questionnaire responses that assessed mental health prevalence, contributing stressors and support service utilisation. Results: Findings indicate that there is a high prevalence of mental ill health amongst farm wives, seemingly due to industry stressors and support role overwhelm. Interpersonal relationships played a significant role in the types of mental distress experienced and highlighted the toll that farm life can take on farm wives' social and emotional connections. Despite a range of formal and informal support services being available, and effective when used, significant barriers to accessing these services were identified, including both practical difficulties and self-stigmatisation due to cultural beliefs. Conclusions: Farm wives and partners experience substantial mental health burdens linked to their diverse and often underrecognized roles within agricultural systems. In future, targeted interventions are needed to reduce stigma, improve service accessibility, and recognize women's contributions within farm enterprises. Further research and dedicated investment are also essential to better understand and help improve the mental health of this overlooked population within agricultural industries.

Ambient particulate matter (PM) is a well-established environmental risk factor for non-communicable diseases, yet its influence on mitochondrial function remains poorly defined. Mitochondrial DNA copy number (mtDNA-CN) serves as a biomarker of mitochondrial biogenesis, making it a candidate exposure biomarker. We conducted the study per PRISMA guidelines (PROSPERO-CRD420261320957) and examined the association between ambient PM exposure and mtDNA-CN. Risk of bias was assessed using Joanna Briggs Institute tools, and relative and absolute changes in mtDNA-CN were pooled using random-effects models, with subgroup analyses by pollutant type and descriptive synthesis of mechanistic evidence. Of 1,224 records identified, 24 studies met inclusion criteria for quantitative analysis, with 12 reporting percentage change and 12 reporting absolute values, covering 13,092 participants. PM exposure was significantly associated with decreased percentage mtDNA-CN (ES: -4.90; 95% CI: -7.97 to -1.82; p = 0.002), while absolute mtDNA-CN levels increased significantly (ES = 0.55; 95% CI: 0.05 to 1.04; p = 0.030). Mechanistic pathways contributing included mtDNA hypermethylation, impaired mitochondrial biogenesis and dynamics. Our findings show ambient PM exposure alters mtDNA-CN, though directionality differs by metric, pointing to the need for larger prospective studies to validate mtDNA-CN as a reliable biomarker of airborne PM and nanoparticulate exposure.

Objectives The 2016 Draft National Institute for Occupational Safety and Health (NIOSH) universal protocol ''A Performance Test Protocol for Closed System Transfer Devices Used During Pharmacy Compounding and Administration of Hazardous Drugs.'' employing ATD GC MS with the 2016 Draft NIOSH proposed challenge agent 2 Phenoxyethanol (2 POE, 2.5% w/v in water) was used to assess the containment performance of two barrier and two air-cleaning CSTDs in a head-to-head test with replication (n=4) for both NIOSH tasks 1 (drug preparation) and 2 (drug administration). The study objective was to assess the containment performance of both physical barrier and air-cleaning CSTDs. Methods ChemoLock barrier (ICU Medical, USA), ChemoLock air-cleaning (ICU Medical, USA), PhaSeal barrier (Becton Dickinson, USA), and Tevadaptor air-cleaning (Simplivia, IL now marketed as Chemfort) CSTDs were evaluated using the 2016 Draft NIOSH universal test protocol for Task 1 (n=4) and Task2 (n=4). A 100 mL empty IV bag, accessed with a CH-10 ChemoClave bag spike was used with the IV administration set in Task 2 to avoid pressurisation of the occluded administration set during the simulated ''IV push''. Air samples were collected (GilAir pump) at 100mL/minute for 30 minutes on Tenax TA thermal desorption (TD) tubes (Markes, UK). 2 POE, a semi-volatile surrogate mimicking hazardous drugs was prepared at 2.5% w/v solution in MilliQ water. This was aliquoted (50mL) into drug vials and crimp sealed with a butyl rubber stopper (Adelphi, UK). 2 POE was analysed against a calibration curve (n=8) in the range 0.6ng to 200ng using analytical methods published previously. Chromeleon v7.3 CDS (Thermo Scientific, UK) was used for analysis based on detection of SIM ions (M/Z: 77, 94, 138). Blank TD tubes (n=85) were used to determine the experimental LOD and LLOQ. Negative control tests (employing MilliQ water as surrogate) were performed for each CSTD Task 1 (n=1) and Task 2 (n=1). An open ''needle and syringe'' positive control test was performed at 5 and 10 microlitre volumes in the NIOSH chamber to demonstrate system suitability. Results Chamber cleaning and analysis performed between tests, gave average blank values (n=85) of 0.05{+/-}0.01 ppbv (95% confidence interval). The experimental limit of detection (LOD) and quantification (LLOQ) for the tests was 0.16{+/-}0.01 ppbv and 0.41{+/-}0.01 ppbv respectively. The positive control tests produced signals of 3.13 ppbv (n=1) and 6.59 ppbv (n=1) for 5 microlitre and 10 microlitre releases of 2 POE respectively and demonstrated system suitability to quantify down to a 650 nanolitre liquid release volume. (1) ChemoLock barrier, (2) ChemoLock air-cleaning, (3) BD PhaSeal barrier and (4) Tevadaptor air-cleaning CSTDs all generated <LLOQ signals for both NIOSH tasks 1 and 2. No statistically significant difference was found between the containment performance of the two air-cleaning and the two physical barrier CSTDs evaluated in this study. Conclusions System suitability was demonstrated using deliberate releases of the 2 POE surrogate at 5 and 10 microlitre volumes producing 2-POE concentrations in the NIOSH chamber of 3.13 ppbv and 6.59 ppbv respectively. Evaluation of the containment performance gave <LLOQ (0.41{+/-}0.01ppbv) for all four of the CSTDs tested in the study: (1) ChemoLock barrier, (2) ChemoLock air-cleaning, (3) BD PhaSeal barrier and (4) Tevadaptor air-cleaning, based on testing of four replicates of each technology in both NIOSH Task 1 and NIOSH Task 2. There was no statistically significant difference in containment found between the two air-cleaning and the two barrier CSTDs evaluated in this study.