Agreement in Occupational Exposures Between Men and Women Using Retrospective Assessments by Expert Coders.
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ABSTRACT:
SUBMITTER: Lacourt A
PROVIDER: S-EPMC6775225 | biostudies-literature | 2018 Nov
REPOSITORIES: biostudies-literature
Publications
Agreement in Occupational Exposures Between Men and Women Using Retrospective Assessments by Expert Coders.
Lacourt Aude A Labrèche France F Goldberg Mark S MS Siemiatycki Jack J Lavoué Jérôme J
Annals of work exposures and health 20181101 9
<h4>Objectives</h4>To estimate the level of agreement and identify notable differences in occupational exposures (agents) between men and women from retrospective assessments by expert coders.<h4>Methods</h4>Lifetime occupational histories of 1657 men and 2073 women from two case-control studies, were translated into exposure estimates to 243 agents, from data on 13882 jobs. Exposure estimates were summarized as proportions and frequency-weighted intensity of exposure for 59 occupational codes b ...[more]
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Project description:BACKGROUND:While the expert-based occupational exposure assessment approach has been considered the reference method for retrospective population-based studies, its implementation in large study samples has become prohibitive. To facilitate its application and improve upon it we developed, in the context of a Montreal population-based study of prostate cancer (PROtEuS), a hybrid approach combining job-exposure profiles (JEPs) summarizing expert evaluations from previous studies and expert review. We aim to describe the hybrid expert method and its impacts on the exposures assigned in PROtEuS compared to those from a previous study coded using the traditional expert method. METHODS:Applying the hybrid approach, experts evaluated semi-quantitative levels of confidence, concentration and frequency of exposure to 313 agents for 16,065 jobs held by 4005 subjects in PROtEuS. These assessments were compared to those from a different set of jobs coded in an earlier study of lung cancer, conducted on the same study base, for 90 blue-collar occupations and 203 agents. Endpoints evaluated included differences in the number of exposures and in the distribution of ratings across jobs, and the within-occupation variability in exposure. RESULTS:Compared to jobs from the lung cancer study, jobs in PROtEuS had on average 0.3 more exposures. PROtEuS exposures were more often assigned definite confidence ratings, but concentration and frequency levels tended to be lower. The within-occupation variability in ratings assigned to jobs were lower in PROtEuS jobs for all metrics. This was particularly evident for concentration, although considerable variability remained with over 40% of occupation/agent cells in PROtEuS exposed at different levels. The hybrid approach reduced coding time by half, compared to the traditional expert assessment. CONCLUSIONS:The new hybrid expert approach improved on efficiency and transparency, and resulted in greater confidence in assessments, compared to the traditional expert method applied in an earlier study involving a similar set of jobs. Assigned ratings were more homogeneous with the hybrid approach, possibly reflecting clearer guidelines for coding, greater coherence between experts and/or reliance on summaries of past assessments. Nevertheless, significant within-occupation variability remained with the hybrid approach, suggesting that experts took into account job-specific factors in their assessments.
| S-EPMC6377721 | biostudies-other
Project description:Implementation of probabilistic analyses in exposure assessment can provide valuable insight into the risks of those at the extremes of population distributions, including more vulnerable or sensitive subgroups. Incorporation of these analyses into current regulatory methods for occupational pesticide exposure is enabled by the exposure data sets and associated data currently used in the risk assessment approach of the Environmental Protection Agency (EPA). Monte Carlo simulations were performed on exposure measurements from the Agricultural Handler Exposure Database and the Pesticide Handler Exposure Database along with data from the Exposure Factors Handbook and other sources to calculate exposure rates for three different neurotoxic compounds (azinphos methyl, acetamiprid, emamectin benzoate) across four pesticide-handling scenarios. Probabilistic estimates of doses were compared with the no observable effect levels used in the EPA occupational risk assessments. Some percentage of workers were predicted to exceed the level of concern for all three compounds: 54% for azinphos methyl, 5% for acetamiprid, and 20% for emamectin benzoate. This finding has implications for pesticide risk assessment and offers an alternative procedure that may be more protective of those at the extremes of exposure than the current approach.
| S-EPMC5936674 | biostudies-literature
Project description:BackgroundSarcoidosis most commonly affects lungs and intrathoracic lymph nodes, but any other organ can be involved. In epidemiological studies, many occupational and environmental exposures have been linked to sarcoidosis but their relationship with the disease phenotype has barely been studied.ObjectiveTo investigate how occupational and environmental exposures prior to diagnosis relate to organ involvement in patients with sarcoidosis METHODS: We retrospectively studied patients seen at a sarcoidosis clinic between 2017 and 2020. Patients were included if they had a clinical presentation consistent with sarcoidosis and histologically confirmed epithelioid granulomas or had Löfgren syndrome. In a case-case analysis using multivariable logistic regression we calculated odds ratios (OR) of prespecified exposure categories (based on expert ascertainment) for cases with a given organ involvement versus cases without this organ involvement.ResultsWe included 238 sarcoidosis patients. Sarcoidosis limited to pulmonary involvement was associated with exposure to inorganic dust prior to diagnosis (OR 2.11; 95% confidence interval [CI] 1.11-4.17). Patients with liver involvement had higher odds of contact with livestock (OR 3.68; 95% CI 0.91-12.7) or having jobs with close human contact (OR 4.33; 95% CI 1.57-11.3) than patients without liver involvement. Similar associations were found for splenic involvement (livestock: OR 4.94, 95% CI 1.46-16.1; close human contact: OR 3.78; 95% CI 1.47-9.46). Cardiac sarcoidosis was associated with exposure to reactive chemicals (OR 5.08; 95% CI 1.28-19.2) or livestock (OR 9.86; 95% CI 1.95-49.0). Active smokers had more ocular sarcoidosis (OR 3.26; 95% CI 1.33-7.79).ConclusionsOur study indicates that, in sarcoidosis patients, different exposures might be related to different organ involvements-hereby providing support for the hypothesis that sarcoidosis has more than one cause, each of which may promote a different disease phenotype.
| S-EPMC8351152 | biostudies-literature
Project description:assessment of baseline functional status of older patients during and after intensive care unit (ICU) admission is often hampered by challenges related to the critical illness such as cognitive dysfunction, neuropsychological morbidity and pain. To explore the reliability of assessments by carefully chosen proxies, we designed a discriminating selection of proxies and evaluated agreement between patient and proxy responses by assessing activities of daily living (ADLs) at 1 month post-ICU discharge.patients ?60 years old admitted to the medical ICU were enrolled in a prospective parent cohort studying delirium. Proxies were carefully screened at ICU admission to choose the best available respondent. Follow-up interviews, including instruments for ADLs, were conducted 1 month after ICU discharge. We examined 179 paired patient-proxy follow-up interviews. Kappa statistics assessed inter-observer agreement, and McNemar's exact test assessed response differences.patients averaged 73.3 ± 8.1 years old with 29% having evidence of cognitive impairment. Proxies were most commonly spouses (38%) or children (39%). Overall, there was substantial (? ? 0.6) to excellent agreement (? ? 0.8) between patients and proxies on assessment of all but one basic and one instrumental ADL.proxies carefully chosen at ICU admission show high levels of inter-observer agreement with older patients when assessing current functional status at 1 month post-ICU discharge. This motivates further study of proxy assessments that could be used earlier in critical illness to assess premorbid functional status.
| S-EPMC4411220 | biostudies-literature
Project description:STUDY QUESTION:Is there an association between maternal occupational exposure to solvents, pesticides and metals as assessed by expert-based assessment and congenital anomalies in the offspring? SUMMARY ANSWER:There is an association between maternal occupational exposure to solvents and congenital anomalies in the offspring, including neural tube defects, congenital heart defects and orofacial clefts. WHAT IS KNOWN ALREADY:One important environmental risk factor for development of congenital anomalies is maternal occupational exposure to chemicals in the workplace prior to and during pregnancy. A number of studies have assessed the association with often conflicting results, possibly due to different occupational exposure assessing methods. STUDY DESIGN, SIZE, DURATION:For this systematic review with meta-analysis, the search terms included maternal occupation, exposure, congenital anomalies and offspring. Electronic databases MEDLINE and EMBASE were searched for English studies up to October 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS:Two reviewers independently screened all citations identified by the search. Case-control studies and cohort studies were included if (I) they reported on the association between maternal occupational exposure to solvents, pesticides or metals and congenital anomalies, and (II) assessment of occupational exposure was performed by experts. Data on study characteristics, confounders and odds ratios (ORs) were extracted from the included studies for four subgroups of congenital anomalies. Methodological quality was assessed using the Newcastle-Ottawa Scale. In the meta-analysis, random effects models were used to pool estimates. MAIN RESULTS AND THE ROLE OF CHANCE:In total, 2806 titles and abstracts and 176 full text papers were screened. Finally, 28 studies met the selection criteria, and 27 studies could be included in the meta-analysis. Our meta-analysis showed that maternal occupational exposure to solvents was associated with neural tube defects (OR: 1.51, 95%CI: 1.09-2.09) and congenital heart defects (OR: 1.31, 95%CI:1.06-1.63) in the offspring. Also maternal occupational exposure to glycol ethers, a subgroup of solvents, was associated with neural tube defects (OR: 1.93, 95%CI: 1.17-3.18) and orofacial clefts (OR: 1.95, 95%CI: 1.38-2.75) in the offspring. Only one study investigated the association between maternal occupational exposure to solvents and hypospadias and found an association (OR: 3.63, 95%CI: 1.94-7.17). Results of the included studies were consistent. In our meta-analysis, we found no associations between occupational exposure to pesticides or metals and congenital anomalies in the offspring. LIMITATIONS, REASONS FOR CAUTION:A limited number of studies was included, which made it impossible to calculate pooled estimates for all congenital anomalies, analyse individual chemicals or calculate exposure-response relations. Bias could have been introduced because not all included studies corrected for potentially confounding factors. WIDER IMPLICATIONS OF THE FINDINGS:Employers and female employees should be aware of the possible teratogenic effects of solvent exposure at the workplace. Therefore, is it important that clinicians and occupational health specialist provide women with preconception advice on occupational solvent exposure, to reduce the congenital anomaly risk. STUDY FUNDING/COMPETING INTEREST(S):NSp was paid by the Graduate School of Medical Sciences (MD/PhD program), UMCG, Groningen, the Netherlands. EUROCAT Northern Netherlands is funded by the Dutch Ministry of Health, Welfare and Sports. There are no competing interests. REGISTRATION NUMBER:CRD42017053943.
| S-EPMC6505450 | biostudies-literature
Project description:PurposeIn medical education, peer assessment is considered to be an effective learning strategy. Although several studies have examined agreement between peer and faculty assessments regarding basic life support (BLS), few studies have done so for advanced resuscitation skills (ARS) such as intubation and defibrillation. Therefore, this study aimed to determine the degree of agreement between medical students' and faculty assessments of ARS examinations.MethodsThis retrospective explorative study was conducted during the emergency medicine (EM) clinical clerkship of fourth-year medical students from April to July 2020. A faculty assessor (FA) and a peer assessor (PA) assessed each examinee's resuscitation skills (including BLS, intubation, and defibrillation) using a checklist that consisted of 20 binary items (performed or not performed) and 1 global proficiency rating using a 5-point Likert scale. The prior examinee assessed the next examinee after feedback and training as a PA. All 54 students participated in peer assessment. The assessments of 44 FA/PA pairs were analyzed using the intraclass correlation coefficient (ICC) and Gwet's first-order agreement coefficient.ResultsThe PA scores were higher than the FA scores (mean±standard deviation, 20.2±2.5 [FA] vs. 22.3±2.4 [PA]; P<0.001). The agreement was poor to moderate for the overall checklist (ICC, 0.55; 95% confidence interval [CI], 0.31 to 0.73; P<0.01), BLS (ICC, 0.19; 95% CI, -0.11 to 0.46; P<0.10), intubation (ICC, 0.51; 95% CI, 0.26 to 0.70; P<0.01), and defibrillation (ICC, 0.49; 95% CI, 0.23 to 0.68; P<0.01).ConclusionSenior medical students showed unreliable agreement in ARS assessments compared to faculty assessments. If a peer assessment is planned in skills education, comprehensive preparation and sufficient assessor training should be provided in advance.
| S-EPMC8089466 | biostudies-literature
Project description:In the last decade, more than half of U.S. children were born to working mothers and 65% of working men and women were of reproductive age. In 2004 more than 28 million women age 18-44 were employed full time. This implies the need for clinicians to possess an awareness about the impact of work on the health of their patients and their future offspring. Most chemicals in the workplace have not been evaluated for reproductive toxicity, and where exposure limits do exist, they were generally not designed to mitigate reproductive risk. Therefore, many toxicants with unambiguous reproductive and developmental effects are still in regular commercial or therapeutic use and thus present exposure potential to workers. Examples of these include heavy metals, (lead, cadmium), organic solvents (glycol ethers, percholoroethylene), pesticides and herbicides (ethylene dibromide) and sterilants, anesthetic gases and anti-cancer drugs used in healthcare. Surprisingly, many of these reproductive toxicants are well represented in traditional employment sectors of women, such as healthcare and cosmetology. Environmental exposures also figure prominently in evaluating a woman's health risk and that to a pregnancy. Food and water quality and pesticide and solvent usage are increasingly topics raised by women and men contemplating pregnancy. The microenvironment of a woman, such as her choices of hobbies and leisure time activities also come into play. Caregivers must be aware of their patients' potential environmental and workplace exposures and weigh any risk of exposure in the context of the time-dependent window of reproductive susceptibility. This will allow informed decision-making about the need for changes in behavior, diet, hobbies or the need for added protections on the job or alternative duty assignment. Examples of such environmental and occupational history elements will be presented together with counseling strategies for the clinician.
| S-EPMC2335294 | biostudies-other
Project description:ObjectiveThis paper describes the retrospective exposure assessment conducted to assess occupational exposures for the Genes and Environmental Exposures in Veterans (GENEVA) study, a case-control study investigating the joint contribution of genetics and environmental exposures to the risk of amyotrophic lateral sclerosis (ALS) among military veterans.MethodsOccupational histories for 1597 study participants collected as part of the GENEVA study were the basis for this retrospective exposure assessment. The data set included 15528 jobs held from 1924 to 2010, representing 4539 unique industry and occupation (I&O) combinations. Three industrial hygiene experts were recruited to independently rate occupational exposures to specific agents previously associated with an increased risk of ALS. Utilizing information on industry, job title, tasks performed, and materials used for each job held, raters assigned exposures associated with each I&O for the 'current time' defined as the period after 1995 (post-1995). The exposure assessment targeted agents identified as potential occupational risk factors for ALS. Experts rated semi-quantitatively exposure intensity in five exposure categories (0-4) for Group A agents (lead, formaldehyde, hydrocarbon solvents, and chlorinated solvents) and qualitatively as yes/no (1/0) exposed for Group B agents (mercury, selenium, arsenic, polychlorinated biphenyls, electromagnetic field, pesticides, and viral agents). Confidence scores (0-3) were reported for every I&O rated based on raters' experience with that industry and/or job. Each I&O was assigned an average exposure score of the raters and an alternative exposure rating was developed for each I&O by excluding low confidence (<2) scores before averaging. Exposure reconstruction for jobs held pre-1995 was done by comparing exposure data extracted from the OSHA Chemical Exposure and Health Database (CEHD) during pre-1995 and post-1995. For agents with limited exposure data in the CEHD, pre-1995 exposures were determined based on raters' judgment.ResultsThe proportion of I&O combinations determined to be 'exposed' ranged from 0.1 to 26% across different agents, with the highest values corresponding to hydrocarbon solvents and the lowest to selenium. Industries with the highest proportion of exposed records include manufacturing, utilities, healthcare, and military with non-combat jobs. Analyses for raters' reliability showed the best agreement between the raters when rating exposure to viral agents (kappa = 0.67), hydrocarbon solvents (kappa = 0.53), and lead (kappa = 0.50). The proportion of 'exposed' I&O combinations increased for hydrocarbon solvents, chlorinated solvents, and pesticides when exposure ratings were adjusted by raters' confidence. Compared to post-1995, exposures in the earlier period (pre-1995) were deemed higher or the same for most of the agents and lower for formaldehyde and electromagnetic field exposures.ConclusionsOur results indicate that using raters' confidence assessment in determining exposure scores increases both the proportion of I&O combinations regarded as exposed and the intensity scores, suggesting raters tend to be conservative in their assessment when they lack detailed knowledge of an industry or job.
| S-EPMC5388189 | biostudies-literature
Project description:Biofouling is the accumulation of organisms on surfaces immersed in water. It is of particular concern to the international shipping industry because it increases fuel costs and presents a biosecurity risk by providing a pathway for non-indigenous marine species to establish in new areas. There is growing interest within jurisdictions to strengthen biofouling risk-management regulations, but it is expensive to conduct in-water inspections and assess the collected data to determine the biofouling state of vessel hulls. Machine learning is well suited to tackle the latter challenge, and here we apply deep learning to automate the classification of images from in-water inspections to identify the presence and severity of fouling. We combined several datasets to obtain over 10,000 images collected from in-water surveys which were annotated by a group biofouling experts. We compared the annotations from three experts on a 120-sample subset of these images, and found that they showed 89% agreement (95% CI: 87-92%). Subsequent labelling of the whole dataset by one of these experts achieved similar levels of agreement with this group of experts, which we defined as performing at most 5% worse (p [Formula: see text] 0.009-0.054). Using these expert labels, we were able to train a deep learning model that also agreed similarly with the group of experts (p [Formula: see text] 0.001-0.014), demonstrating that automated analysis of biofouling in images is feasible and effective using this method.
| S-EPMC7854599 | biostudies-literature
Project description:BackgroundThe relationship between smoking status or second-hand smoking and occupational injuries has been the subject of considerable study, but few have studied the relationship between nicotine dependence and occupational injuries. The objective of this study was to investigate the relationship between nicotine dependence and occupational injury among employees at a range of Korean companies.MethodsInitially, the personal and occupational characteristics and nicotine dependences of workers were measured, and 12 months later a survey was used to determine whether subjects had experienced any occupational injury. This study was conducted in several workplaces on 6,893 male workers in manufacturing and service industries that received health screening at Inha University Hospital in Incheon.ResultsThe adjusted odds ratios (ORs) of occupational injury in the low, moderate, and high nicotine dependence groups were 1.38 (95% confidence interval [CI]: 1.04-1.84), 1.52 (95% CI: 1.10-2.10), and 1.71 (95% CI: 0.92-3.19), respectively. For smokers only, adjusted ORs tended to increase linearly (p for trend < 0.05). When only smokers were included, analysis of continuous FTND (Fagerstrom Test of Nicotine Dependence) scores showed that adjusted OR increased by 1.10 (95% CI: 1.03-1.19) per FTND point. After stratifying the data by working type and working hours per week, the non-shift work group maintained this relationship (OR: 1.13, 95% CI: 1.04-1.24) and OR was higher in the group that works more than 60 hours per week with FTND score as a continuous variable (OR: 1.24, 95% CI: 1.07-1.44).ConclusionsThe study shows nicotine dependency might affect occupational injury. From a short-term perspective, addressing worker's nicotine dependence by giving an adequate break time or smoking area might reduce work-related injuries.
| S-EPMC8203833 | biostudies-literature