Cardiovascular disease mortality among retired workers chronically exposed to intense occupational noise.

OBJECTIVE: The aim of this study, conducted among retired workers (≥65 years), is to estimate the association between long-term risk of cardiovascular disease (CVD) death and (1) duration of occupational noise exposure in career and (2) noise-induced hearing loss (NIHL), the latter being used as an indicator of adverse effects for long-term exposure to occupational noise. METHODS: Data from screening activities of occupational NIHL were paired to data from death records and were used for this study. A nested case-control analysis was performed. Each case was matched with three controls for length of follow-up and economic sector. A total of 161 CVD deaths occured during an average follow-up of 6.8 years. Conditional logistic regression models were used to estimate the risk (OR) of CVD death by tertiles of duration of noise exposure and of NIHL. RESULTS: Conditional logistic regression models indicated that prolonged duration of noise exposure (≥36.5 years) (3rd tertile) was associated with an increased risk of CVD death (OR 1.70; 95 % CI 1.10-2.62), as compared with shorter duration (<27 years) (first tertile). Moderate NIHL (2nd tertile) (OR 1.64; 95 % CI 1.04-2.6) and severe NIHL (3rd tertile) (OR 1.66; 95 % CI 1.06-2.60) were also associated with an increase in risk of CVD death. CONCLUSIONS: Results are consistent with recent findings on the chronic effects of occupational noise exposure persisting after retirement although it is less than during active working life.

Occupational noise exposure and noise-induced hearing loss are associated with work-related injuries leading to admission to hospital.

OBJECTIVE: This study focuses on work-related injuries that required admission to hospital in a population of male workers exposed to occupational noise (≥80 dBA) which some displayed a hearing loss due to their exposure. METHODS: The study population count 46 550 male workers, 1670 (3.6%) of whom incurred at least one work-related injury requiring admission to hospital within a period of 5 years following hearing tests conducted between 1987 and 2005. The noise exposure and hearing loss-related data were gathered during occupational noise-induced hearing loss (NIHL) screening. The hospital data were used to identify all members of the study population who were admitted, and the reason for admission. Finally, access to the death-related data made it possible to identify participants who died during the course of the study. Cox proportional hazards model taking into account hearing status, noise levels, age and cumulative duration of noise exposure at the time of the hearing test established the risk of work-related injuries leading to admission to hospital. RESULTS: For each dB of hearing loss, a statistically significant risk increase was observed (HR=1.01 dB 95% CI 1.006 to 1.01). An association (HR=2.36 95% CI 2.01 to 2.77) was also found between working in an occupational ambient noise ≥100 dBA and the risk of injury. CONCLUSIONS: From a safety perspective, this issue is highly relevant; especially when workers are exposed to intense ambient noise and NIHL.

Falls risk and hospitalization among retired workers with occupational noise-induced hearing loss.

This study sought to ascertain whether occupational noise-induced hearing loss (NIHL) increased the risk of falls requiring hospitalization among retired workers. The study population consisted of males (age ≥ 65) with an average occupational noise exposure of 30.6 years and whose mean bilateral hearing loss was 42.2 dB HL at 3, 4, and 6 kHz. Seventy-two retired workers admitted to hospitals after a fall were matched with 216 controls from the same industrial sectors. Conditional logistic regression models were used to estimate the risk (odds ratio; [OR]) of falls leading to hospitalization by NIHL categories. Results showed a relationship between severe NIHL (≥ 52.5 dB HL) and the occurrence of a fall (OR: 1.97, CI95%: 1.001-3.876). Reducing falls among seniors fosters the maintenance of their autonomy. There is a definite need to acquire knowledge about harmful effects of occupational noise to support the prevention of NIHL and ensure healthier workplaces.

Active smoking and secondhand smoke increase breast cancer risk: the report of the Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk (2009).

Four authoritative reviews of active smoking and breast cancer have been published since 2000, but only one considered data after 2002 and conclusions varied. Three reviews of secondhand smoke (SHS) and breast cancer (2004-2006) each came to different conclusions. With 30 new studies since 2002, further review was deemed desirable. An Expert Panel was convened by four Canadian agencies, the Ontario Tobacco Research Unit, the Public Health Agency of Canada, Physicians for a Smoke-Free Canada and the Canadian Partnership Against Cancer to comprehensively examine the weight of evidence from epidemiological and toxicological studies and understanding of biological mechanisms regarding the relationship between tobacco smoke and breast cancer. This article summarises the panel's full report (http://www.otru.org/pdf/special/expert_panel_tobacco_breast_cancer.pdf). There are 20 known or suspected mammary carcinogens in tobacco smoke, and recognised biological mechanisms that explain how exposure to these carcinogens could lead to breast cancer. Results from the nine cohort studies reporting exposure metrics more detailed than ever/never and ex/current smoker show that early age of smoking commencement, higher pack-years and longer duration of smoking increase breast cancer risk 15% to 40%. Three meta-analyses report 35% to 50% increases in breast cancer risk for long-term smokers with N-acetyltransferase 2 gene (NAT2) slow acetylation genotypes. The active smoking evidence bolsters support for three meta-analyses that each reported about a 65% increase in premenopausal breast cancer risk among never smokers exposed to SHS. The Panel concluded that: 1) the association between active smoking and breast cancer is consistent with causality and 2) the association between SHS and breast cancer among younger, primarily premenopausal women who have never smoked is consistent with causality.

Could driving safety be compromised by noise exposure at work and noise-induced hearing loss?

OBJECTIVE: A study was conducted to verify if there is an association between occupational noise exposure, noise-induced hearing loss and driving safety expanding on previous findings by Picard, et al. (2008) that the two factors did increase accident risk in the workplace. METHODS: This study was made possible when driving records of all Quebec drivers were made available by the Societe de l'assurance automobile du Quebec (SAAQ is the state monopoly responsible for the provision of motor vehicle insurance and the compensation of victims of traffic accidents). These records were linked with personal records maintained by the Quebec National Institute of Public Health as part of its mission to prevent noise induced hearing loss in the workplace. Individualized information on occupational noise exposure and hearing sensitivity was available for 46,030 male workers employed in noisy industries who also held a valid driver's permit. The observation period is of five years duration, starting with the most recent audiometric examination. The associations between occupational noise exposure levels, hearing status, and personal driving record were examined by log-binomial regression on data adjusted for age and duration of exposure. Daily noise exposures and bilateral average hearing threshold levels at 3, 4, and 6 kHz were used as independent variables while the dependent variables were 1) the number of motor vehicle accidents experienced by participants during the study period and 2) participants' records of registered traffic violations of the highway safety code. The findings are reported as prevalence ratios (PRs) with their 95% confidence intervals (CIs). Attributable numbers of events were computed with the relevant PRs, lesser-noise, exposed workers and those with normal hearing levels making the group of reference. RESULTS: Adjusting for age confirmed that experienced workers had fewer traffic accidents. The data show that occupational noise exposure and hearing loss have the same effect on driving safety record than that reported on the risk of accident in noisy industrial settings. Specifically, the risk of traffic accident (PR = 1.07 (CI 95% [1.01; 1.15]) is significantly associated with the daily occupational noise exposures >or= 100 dBA. For participants having a bilateral average hearing loss ranging from 16 to 30 dB, the PR of traffic accident is 1.06 (CI 95% [1.01; 1.11]) and reaches 1.31 (CI 95% [1.2; 1.42]) when the hearing loss exceeds of 50 dB. A reduction in the number of speeding violations occurred among workers occupationally exposed to noise levels >or= 90 dBA and those with noise-induced hearing loss >or=16 dB. By contrast, the same individuals had an increase in other violations of the Highway safety code. This suggests that noise-exposed workers might be less vigilant to other traffic hazards. CONCLUSION: Daily occupational noise exposures >or= 100 dBA and noise-induced hearing losses-even when just barely noticeable-may interfere with the safe operation of motor vehicles.

Association of work-related accidents with noise exposure in the workplace and noise-induced hearing loss based on the experience of some 240,000 person-years of observation.

This retrospective study explores the association between occupational noise exposure at the time of hearing tests, permanent noise-induced hearing loss and work-related accident risk. Log-binomial analysis was used to first ascertain the association between study variables according to activity sector (North American Industry Classification System, NAICS) and accident context while controlling for age. Second part of the paper estimates the overall number of accidents attributable to occupational noise or the associated hearing loss (excess fraction). Study was carried on a sample of 52,982 male workers exposed to a minimum of 80 dBA on a daily basis and whose hearing was examined at least once between 1983 and 1996 by public health authorities of Quebec. These participants evidenced bilateral average hearing threshold levels at 3, 4 and 6 kHz ranging from normal (< or = 15 dB) to hearing loss in excess of 50 dB as a result of chronic occupational noise exposure (subjects otherwise otologically normal). The occupational accident count of these workers was derived from the individual histories registered with the Quebec workers' compensation board for the 1983-1998 period. Results show an association between accident risk and worker's hearing sensitivity. For example, a hearing loss of 20 dB corresponds to a rise of accident risk equal to 1.14 when controlling for age and occupational noise exposure at the time of hearing tests. NAICS economic activity sectors where association is the most noticeable are "Metal Transformation", "Metal Product Manufacturing" and "Transportation Equipment Manufacturing". "Passive accidents" (PR per decibel of hearing loss = 1.008; CI 95 (1.007; 1.010)) and "same-level falls" (1.007; CI 95 (1.003; 1.010)) are the two accidents categories most strongly associated with hearing loss. Overall, 12.2% of accidents considered in this study were attributable to a combination of noise exposure in the workplace (> or = 90 dBA) and noise-induced hearing loss.

Tobacco industry links to faculties of medicine in Canada.

BACKGROUND: The tobacco industry uses various strategies to promote itself as a socially responsible, ethical industry, including establishing links with health institutions and medical research. The purpose of this study was to identify the relationships between the tobacco industry and Canadian faculties of medicine, specifically research funding and donations from tobacco industry sources, and faculty-specific policies regarding the acceptance of tobacco industry funds. METHODS: Information about policies and practices regarding research funding and donations from 1996-1999 was requested from the 16 Canadian faculties of medicine and their parent universities, as part of a larger cross-sectional survey-centred study that examined links between the tobacco industry and Canadian universities. RESULTS: All 16 faculties of medicine (100%) reported on research funding and 11/16 (70%) reported on donations from the tobacco industry. Twenty-five percent (4/16) of the faculties received research funding from the tobacco industry and 27% (3/11) received donations. No Canadian medical school had a policy that banned tobacco industry research funding or donations. INTERPRETATION: The tobacco industry have made donations and given research funding to faculties of medicine in Canada. This may present major conflicts of interest that undermine public health and have implications for the scientific integrity of the medical research enterprise. Faculties of medicine should consider developing policies that prohibit tobacco industry research funding and donations, with the intent of preventing conflicts and precluding ethical dilemmas arising from links with the tobacco industry. They should also encourage parent universities to establish similar policies at an institutional level.