Fertility and pregnancy in adrenal insufficiency.

Despite the availability of adrenal hormone replacement therapy, patients with adrenal insufficiency can be affected by reduced fertility and parity. Patients with well-managed adrenal insufficiency are expected to have uneventful pregnancies and favourable outcomes, but an increased risk of maternal and neonatal complications has been reported in some cases. Many physiological changes occur to the hypothalamic-pituitary-adrenal (HPA) axis during pregnancy, often making a new diagnosis and management of adrenal insufficiency challenging. The management of adrenal insufficiency also needs to reflect the physiologic changes of pregnancy, often requiring increased doses of glucocorticoid as pregnancy progresses and in some circumstances mineralocorticoid replacement (in primary adrenal insufficiency patients only), especially in the third trimester. To date, there are no prospective data guiding management of adrenal insufficiency in pregnancy. In this review, we focus on the impact of adrenal insufficiency on fertility and parity based on the aetiology of adrenal insufficiency and provide a practical approach to the management of patients with adrenal insufficiency before and during pregnancy.

The impact of COVID-19 lockdown on glycaemic control in young adults with type 1 diabetes mellitus.

BACKGROUND: In December 2019, a novel coronavirus strain, COVID-19, was identified in Wuhan, China. The first case was reported in the Republic of Ireland that month. Since then, along with many other countries worldwide, Ireland has imposed intermittent strict lockdowns to mitigate the spread of the virus. AIMS: To investigate the impact of lockdown on glycaemic control in young adult patients with type 1 diabetes mellitus. METHODS: Pre- and post-lockdown HbA1c levels were recorded for 118 patients attending the Young Adult Diabetes clinic in Beaumont Hospital, Dublin, and the results were compared. Changes in weight, insulin requirements and incidence of DKA/severe hypoglycaemia were also assessed. RESULTS: HbA1c results were 3.81 mmol/mol lower post-lockdown. Weight increased by 1.8 kg. Both of these results were statistically significant. CONCLUSIONS: Lockdown was associated with improved glycaemic control in young adult diabetic patients, and also with an increase in body weight. Changes in lifestyle factors associated with lockdown may explain this finding.

Prevalence of hearing protection device non-use among noise-exposed US workers in 2007 and 2014.

BACKGROUND: This study estimated the prevalence of hearing protection device (HPD) non-use among US workers exposed to hazardous workplace noise and provided risk estimates. METHODS: Self-reported data from the National Health Interview Survey in 2007 (15,852 workers) and 2014 (23,656 workers) were examined. Weighted prevalence and adjusted prevalence ratios of HPD non-use (using HPDs half the time or less when exposed to hazardous noise) were estimated by demographic, industry, and occupation. Differences in the prevalences of non-use were estimated and compared. RESULTS: The prevalence of HPD non-use was 53% among all noise-exposed workers in 2014. Workers in the Accommodation and Food Services industry had the highest prevalence (90%) and risk (PR: 2.47, 95% confidence interval: 1.54-3.96) of HPD non-use. The industries with the lowest prevalences of noise exposure, including Finance and Insurance (2%) and Health Care and Social Assistance (4%), had some of the highest prevalences of HPD non-use (80% and 83%, respectively). There were no statistically significant changes in HPD non-use among industries between 2007 and 2014. Among occupations, HPD non-use increased 37% in Arts, Design, Entertainment, Sports and Media, and decreased 39% in Architecture and Engineering. CONCLUSION: The prevalence of HPD non-use remains high; especially within industries and occupations with fewer noise-exposed workers. These groups need targeted attention to increase awareness and compliance. Employers should require HPD use and trainings among noise-exposed workers and provide an assortment of HPDs tailored to noise level and type, workplace environment, communication and audibility needs, and individual comfort and convenience.

The association between janitor physical workload, mental workload, and stress: The SWEEP study.

BACKGROUND: Approximately 2.38 million janitors are employed in the U.S. While high physical workload may explain a lost-work days rate 2.7 times greater than other occupations, little is known about the association between janitors' physical workload, mental workload, and stress. OBJECTIVE: The objective of this study was to assess the associations between physical (ergonomic) and mental workload exposures and stress outcomes among janitors. METHODS: Questionnaire data, focused on ergonomic workload, mental workload and stress, were collected from Minnesota janitors for a one-year period. Physical workload was assessed with Borg Scales and Rapid Entire Body Assessments (REBA). Mental workload assessment utilized the NASA Task Load Index (TLX). Stress assessments utilized single-item ordinal stress scale (SISS) and Perceived Stress Scale-4 (PSS-4) measures. Descriptive and multivariable analyses, including bias adjustment, were conducted. RESULTS: Odds ratios (OR) and 95% confidence intervals (CI) for ergonomic workload (task frequency) effects on SISS were: REBA (1.18 OR, 1.02-1.37 CI); Borg (1.25 OR, 1.00-1.56 CI); combined REBA and Borg (1.10 OR, 1.01-1.20 CI). Mental workload was associated with higher PSS-4 levels (0.15 Mean Difference, 0.08-0.22 CI) and a 3% increased risk for each one-unit increase in the SISS scale (1.03 OR, 1.02-1.05 CI). CONCLUSIONS: This research demonstrated a moderate effect of physical and mental workloads on stress among janitors.

Janitor ergonomics and injuries in the safe workload ergonomic exposure project (SWEEP) study.

INTRODUCTION: A Minnesota union identified to researchers at the University of Minnesota a concern relevant to a possible relation between their daily workload and outcome of occupational injuries among a population of janitors. OBJECTIVE: To assess if the ergonomic workload is related to injuries among janitors. METHODS: Following an initial group discussion among janitors, which identified common and hazardous tasks potentially leading to occupational injuries, a questionnaire was developed, pre-tested, and distributed to the janitors. Questions addressed various exposures, including workload, and comprehensive information regarding injury occurrence over two six-month sequential periods (May 2016-October 2016, November 2016-April 2017). Quantitative ergonomic analyses were performed on a sub-group of janitors (n = 30); these included data collection to identify Borg Perceived Exertion (Borg) and Rapid Entire Body Assessment (REBA) scores. Descriptive, multivariable with bias adjustment analyses were conducted on the resulting data. RESULTS: Eight tasks were found to be common for janitors. All average REBA scores for the tasks were identified in the high-risk category. The task of repeatedly emptying small trash cans (<25lb) was significantly related to injuries. Average Borg scores fell between the very light perceived exertion and somewhat difficult perceived exertion categories. Multivariable regression analyses indicated that age-sex-standardized ergonomic workload, measured by task frequencies and REBA or Borg scores, was positively related to injury occurrence. CONCLUSIONS: Standardized ergonomic workload was positively related to injury occurrence. This information serves as a basis for further research and potential intervention efforts.

Knowledge of work-related injury reporting and perceived barriers among janitors.

INTRODUCTION: The goal of this study was to evaluate and improve janitors' knowledge of workers' rights and responsibilities for assessing and reporting work-related injuries, and to determine the barriers for reporting occupational injuries. METHODS: Questionnaires, designed to collect data retrospectively for two, sequential six-month periods, were disseminated to 1200 full-time unionized janitors in the Twin Cities. Immediately following the baseline questionnaire administration, a randomly selected sub-group of janitors (~600) received information on workers' rights and responsibilities for reporting injuries; six-months later a questionnaire comparable to the baseline questionnaire was disseminated to the 1200 janitors. Analyses included basic descriptive analyses and identification of potential differences in proportions of job-specific reporting barriers pre-post-intervention. RESULTS: Among the participating janitors (n = 390), approximately half (53%) were initially unsure of what an OSHA 300 Log was; 56% reported not knowing what workers' compensation was. At baseline, in both intervention and non-intervention groups, approximately 25% reported having a perceived barrier to reporting an injury to their employer. Reported barriers included "fear," "reporting takes too long," "being unsure of the reporting process," and an "understanding that injuries are a part of the job." At follow-up, among the intervention group, there was an important reduction (24%-12%) in having a perceived barrier for reporting a work-related injury. CONCLUSIONS: A majority of janitors lacked knowledge and awareness of OSHA injury reporting and Workers' Compensation. In order to improve reporting, it is essential to educate employees on OSHA and Workers' Compensation and inform janitors of the injury reporting process through training. Practical applications: Future intervention efforts must focus on the specific barriers for reporting occupational injuries and be tailored specifically to the janitor population. To reduce underreporting of injuries, they must be encouraged to report their occupational injuries. Barriers to reporting these injuries must be eliminated.

A review of reproductive outcomes of women with two consecutive miscarriages and no living child.

The definition of recurrent miscarriage ranges from two miscarriages according to the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology, to three consecutive pregnancy losses as defined by the Royal College of Obstetricians and Gynaecologists. Recent guidelines emphasise the need for further research on the effect of various recurrent miscarriage definitions on diagnosis, treatment and prognosis. Our study examines the management and pregnancy outcomes of nulliparous women attending Cork University Maternity Hospital's Pregnancy Loss Clinic, between 2009 and 2014, with their second consecutive first-trimester miscarriage. Information was sourced from the Pregnancy Loss Clinic's database, hospital patient management and laboratory systems, and clinical letters. 294 women were identified. A subsequent pregnancy was conceived by 82.3% (242/294) of women, with 72.7% (176/242) achieving a live birth. In conclusion, supportive care and selective medical management in dedicated pregnancy loss and early pregnancy clinics achieve excellent reproductive outcomes. Impact Statement What is already known on this subject? The definition of recurrent miscarriage is varied. It ranges from two miscarriages according to the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology, to three consecutive pregnancy losses as defined by the Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage affects between 1 and 5% of women. Past studies suggest several causative factors, including epidemiologic, genetic, anatomical and endocrine. These factors may be identified in up to 50% of women with recurrent losses. Subsequent pregnancy outcomes are reported as excellent. However, recent guidelines focus on the need for further research on the effect of the various recurrent miscarriage definitions on diagnosis, investigation, treatment and prognosis. What the results of this study add? This study examined the management and pregnancy outcomes of women with two consecutive losses. A causative factor was identified in 29.3% of women in our cohort. A subsequent pregnancy was conceived by 82.3%, with 72.7% achieving a live birth. We suggest that supportive care is the single most effective therapy for women with two consecutive losses. What the implications are of these findings for clinical practice and/or further research? Over-investigation and empirical treatment should be avoided, with a greater emphasis placed on psychological support and risk factor modification in this group. Investigation protocols must be refined to only search for causes of recurrent miscarriage with evidence based treatment. Evaluation of supportive care in randomised control trials is needed.

Janitor workload and occupational injuries.

BACKGROUND: This study was designed to identify potential effects of workload and sleep on injury occurrence. METHODS: Questionnaires were disseminated to janitors in the SEIU Local 26 union; 390 responded and provided information on workload, sleep, and injury outcomes. Quantitative measurements of workload and sleep were collected via FitBit devices from a subset of 58 janitors. Regression techniques were implemented to determine risk. RESULTS: Thirty-seven percent reported increased workload over the study period Adjusted analyses indicated a significant effect of change in workload (RR: 1.94; 95%CI: 1.40-2.70) and sleep hours (RR: 2.21; 95%CI: 1.33-3.66) on occupational injury. Among those with sleep disturbances, injury risk was greater for those with less than five, versus more than five, days of moderate to vigorous physical activity; RR: 2.77; 95%CI: 1.16-6.59). CONCLUSIONS: Increased workload and sleep disturbances increased the risk of injury, suggesting employers should address these factors to mitigate occupational injuries.

Occupational Injury Among Janitors: Injury Incidence, Severity, and Associated Risk Factors.

OBJECTIVE: Determine injury incidence and severity and potential associated risk factors for injury, among janitors. METHODS: Questionnaires were disseminated to 1200 full-time janitors in the Service Employees International Union (SEIU) Local 26 union; 390 responded and provided information on their injury experiences and exposures, based on personal characteristics and work-related activities. Multivariable analyses, including bias adjustment, were implemented using directed acyclic graphs to determine potential risk. RESULTS: Among the janitors, 34% reported experiencing at least one injury; 16% of cases resulted in hospital admittance. Significantly increased risks were identified for age, ethnicity, shift start time, and physician-diagnosed depression. CONCLUSIONS: Knowledge of specific risk and protective factors is valuable, and can serve as a basis for further in-depth studies and inform the development of targeted intervention strategies aimed to reduce occurrence of these injuries.

Occupational Noise Exposure of Employees at Locally-Owned Restaurants in a College Town.

While many restaurant employees work in loud environments, in both dining and food preparation areas, little is known about worker exposures to noise. The risk of hearing loss to millions of food service workers around the country is unknown. This study evaluated full-shift noise exposure to workers at six locally-owned restaurants to examine risk factors associated with noise exposures during the day shift. Participants included cooks, counter attendants, bartenders, and waiters at full-service restaurants with bar service and at limited-service restaurants that provided counter service only. Assessments were made on weekdays and weekends, both during the summer and the fall (with a local university in session) to examine whether the time of week or year affects noise exposures to this population in a college town. In addition, the relationships between noise exposures and the type of restaurant and job classification were assessed. One-hundred eighty full-shift time-weighted average (TWA) exposures were assessed, using both Occupational Safety and Health Administration (OSHA) and National Institute for Occupational Safety and Health (NIOSH) criteria. No TWA measurements exceeded the 90 dBA OSHA 8 hr permissible exposure limit, although six projected TWAs exceeded the 85 dBA OSHA hearing conservation action limit. Using NIOSH criteria, TWAs ranged from 69-90 dBA with a mean of 80 dBA (SD = 4 dBA). Nearly 8% (14) of the exposures exceeded the NIOSH 8-hr 85 dBA. Full-shift exposures were larger for all workers in full-service restaurants (p < 0.001) and for cooks (p = 0.003), regardless of restaurant type. The fall semester (p = 0.003) and weekend (p = 0.048) exposures were louder than summer and weekdays. Multiple linear regression analysis suggested that the combination of restaurant type, job classification, and season had a significant effect on restaurant worker noise exposures (p < 0.001) in this college town. While evening/night shift exposures, where noise exposures may be anticipated to be louder, were not assessed, this study identified that restaurant type, job classification, time of week, and season significantly affected the noise exposures for day-shift workers. Intervention studies to prevent noise-induced hearing loss (NIHL) should consider these variables.