Sleep-disordered breathing in male subjects with a history of nose-throat surgery.

The question addressed in this study was: could a history of nose-throat surgery represent a risk factor for sleep-disordered breathing? Three hundred and fifty French male employees answered a sleep / respiration questionnaire and had anthropometric measurements. A history of nose and/or throat surgery-mostly tonsillectomy or tonsillectomy plus adenoïdectomy- was given by 69 (19.7%) of the subjects ("at risk" group). The prevalence of snoring, breathing pauses during sleep or grasping was similar in "at risk" and control (no history) subjects, but the prevalence of two symptoms: excessive daytime sleepiness and "waking up with headaches", was significantly higher in the group at risk. The present results suggest the persistence of minor (residual?) airway obstruction in subjects with a history of nose/throat surgery. This obstruction could be responsible for an alteration of declared sleep quality, although not severe enough for eliciting breathing pauses.

Roles of age, length of service and job in work-related injury: a prospective study of 63,620 person-years in female workers.

BACKGROUND: The roles of age, length of service and job in various work-related injury types are unknown and deserve investigations among female workers. This study assessed their roles in the occurrence of injury. METHODS: Three-year prospective study of all 22,952 permanently employed women at the French national railway company: 63,620 person-years, 756 injuries with working days lost, coded using the company's injury classification derived from that of the French health insurance scheme. We investigated the incidence of four types of injury: fall on same level, fall to lower level, materials/equipment/objects handling, and other injuries. Data were analyzed using negative binomial regression. RESULTS: Workers aged <25 were subject to a higher risk for all types of injuries. Older workers (45-55 years) were subject to a higher injury risk for fall on same level and fall to lower level. For fall on same level as for fall to lower level the relative risk decreased steadily with increasing length of service with the company, from 1.60 for 1 year to 0.50-0.60 for ≥30 years. For injuries due to materials/equipment/objects handling the relative risk decreased from 1.05 for one year to 0.49 for 5-9 years, and then increased to about 1.50 for 20-29 years and ≥30 years. CONCLUSIONS: Younger and shorter lengths of service were at risk for various types of injuries. Higher length of service was at risk for injury due to materials/equipment/objects handling. Preventive measures should consider the respective risks associated with age, years of employment and job.

Prevalence of dementia in mountainous village of Sicily.

The progressive and rapid aging of population is the demographic characteristic in the Western countries. This rapid process of aging is causing an increasing burden on the social and health-care services. In this context, the precise knowledge of the environmental, socio-economical and clinical characteristics of the elderly population is mandatory to find the correct strategies to achieve the successful aging. Our study aimed to investigate the functional and clinical characteristics of the elderly (aged 60 to 85 years) of San Teodoro (1500 inhabitants), a rural village of Central Sicily, in particularly considering the dementia prevalence. In 2005, all the elderly between 60 and 85 years old were invited to participate to the study. The list of the potential participants was obtained from the Registry office of the municipality. The final number of the eligible subjects was 374. Rate of participation was 74.9% (280 subjects, 120 M and 160 F). The study was conducted door-to-door. Dementia prevalence was 7.1% (20 subjects, 8 M and 12 F), with 60% Alzheimer's disease and 15% vascular dementia, slightly higher than that of the European countries (6%). The high prevalence of hypertension (80.3%) and the low education level, two important risk factors for dementia, could explain in part the difference observed.

Association of physical job demands, smoking and alcohol abuse with subsequent premature mortality: a 9-year follow-up population-based study.

This study assessed the relationships of physical job demands (PJD), smoking, and alcohol abuse, with premature mortality before age 70 (PM-70) among the working or inactive population. The sample included 4,268 subjects aged 15 or more randomly selected in north-eastern France. They completed a mailed questionnaire (birth date, sex, weight, height, job, PJD, smoking habit, alcohol abuse (Deta questionnaire)) in 1996 and were followed for mortality until 2004 (9 yr). PJD score was defined by the cumulative number of the following high job demands at work: hammer, vibrating platform, pneumatic tools, other vibrating hand tools, screwdriver, handling objects, awkward posture, tasks at heights, machine tools, pace, working on a production line, standing about and walking. The data were analyzed using the Poisson regression model. Those with PM-70 were 126 (3.81 per 1,000 person-years). The leading causes of death were cancers (46.4% in men, 57.1% in women), cardiovascular diseases (20.2% and 11.9%), suicide (9.5% and 7.1%), respiratory diseases (6.0% and 4.8%), and digestive diseases (2.4% and 4.8%). PJD3, smoker, and alcohol abuse had adjusted risk ratios of 1.71 (95% CI 1.02-2.88), 1.76 (1.08-2.88), and 2.07 (1.31-3.26) respectively for all-cause mortality. Manual workers had a risk ratio of 1.84 (1.00-3.37) compared to the higher socio-economic classes. The men had a two-fold higher mortality rate than the women; this difference became non-significant when controlling for job, PJD, smoker and alcohol abuse. For cancer mortality the factors PJD3, smoker, and alcohol abuse had adjusted risk ratios of 2.00 (1.00-3.99), 2.34 (1.19-4.63), and 2.22 (1.17-4.20), respectively. Health promotion efforts should be directed at structural measures of task redesign and they should also concern lifestyle.

Relationships of physical job tasks and living conditions with occupational injuries in coal miners.

This study assessed the relationships of job tasks and living conditions with occupational injuries among coal miners. The sample included randomly selected 516 underground workers. They completed a standardized self-administred questionnaire. The data were analyzed via logistic regression method. The rate of injuries in the past two years was 29.8%. The job tasks with significant crude relative risks were: power hammer, vibrating hand tools, pneumatic tools, bent trunk, awkward work posture, heat, standing about and walking, job tasks for trunk and upper/lower limbs, pain caused by work, and muscular tiredness. Logistic model shows a strong relationship between the number of job tasks (JT) and injuries (adjusted ORs vs. JT 0-1: 2.21, 95%CI 1.27-3.86 for JT 2-6 and 3.82, 2.14-6.82 for JT>or=7), and significant ORs>or=1.71 for face work, not-good-health-status, and psychotropic drug use. Musculoskeletal disorders and certain personality traits were also significant in univariate analysis. Therefore job tasks and living conditions strongly increase the injuries, and occupational physicians could help workers to find remedial measures.

Association of vitamin B12, folate and homocysteine with functional and pathological characteristics of the elderly in a mountainous village in Sicily.

BACKGROUND: Homocysteine is associated with age, folate and vitamin B(12). Our study investigated the functional and clinical characteristics of the elderly (aged 60-85 years) of San Teodoro, a village in Central Sicily, and evaluated associations with vitamin B(12), folate and homocysteine. METHODS: Subjects (n=280) were examined after door-to-door recruitment using interview, physician examination and laboratory tests. RESULTS: A total of 19.3% of the population had a low blood level of folate (<7 nmol/L) and 3.2% had low vitamin B(12) concentration (<100 pmol/L). The level of dependency, determined by the Barthel index, influenced homocysteine blood levels (p<0.0001), independent of age (p<0.0001), folate (p=0.0028) and vitamin B(12) (p=0.0165). Homocysteine was significantly associated with stroke (p=0.0027) and peripheral arterial vascular disease (p=0.0001), but not with myocardial infarction, angina pectoris, venous thrombosis or cancer. Vitamin B(12) was lower in myocardial infarction and higher in diabetes and venous thrombosis compared to the other diseases. CONCLUSIONS: The prevalence of deficits in folate and vitamin B(12) was paradoxically high in the mountainous northeastern area of Sicily. Our study also underlines the association of homocysteine with dependency of the elderly and with stroke and peripheral arteriopathy.

Association of thyroid dysfunction with vitamin B12, folate and plasma homocysteine levels in the elderly: a population-based study in Sicily.

BACKGROUND: Association of thyroid dysfunction with plasma homocysteine levels and vitamin B(12) has previously been reported. We evaluated these associations in the elderly in San Teodoro, a mountainous village of Sicily. METHODS: Subjects (n=279) aged 60-85 years (119 males and 160 females) were examined using self-reported signs, clinical examination and laboratory tests. RESULTS: Hypothyroidism and/or goiter were two characteristics that were not associated with a significant change in homocysteine when compared with euthyroidism and the absence of goiter. Vitamin B(12) was significantly higher in subjects in the first quartile of the thyroid-stimulating hormone distribution, compared with those in the fourth quartile (371+/-207 vs. 297+/-196 pmol/L, p=0.0121). Homocysteine was significantly higher in the first quartile of the free tri-iodothyronine distribution compared to the third quartile (18.0+/-5.7 vs. 16.0+/-6.2 micromol/L, p=0.0130) and was correlated with log tri-iodothyronine in euthyroid subjects (p=0.0254). In multivariate analysis, homocysteine was associated with vitamin B(12) (p=0.0014), folate (p<0.0001), creatinine (p<0.0001) and age (p<0.0001), but not with either free tri-iodothyronine (p=0.7680), tetra-iodothyronine (p=0.5706) or thyroid-stimulating hormone (p=0.2294). CONCLUSIONS: Our results suggest that the influence of thyroid hormones on homocysteine is much weaker in elderly subjects than in selected patients with hypothyroidism.

Contributions of occupational hazards and human factors in occupational injuries and their associations with job, age and type of injuries in railway workers.

OBJECTIVES: To assess the contributions of environmental hazards, technical dysfunctions, lack of work organization, know-how and job knowledge, and other human factors in occupational injuries and their relationships with job, age and type of accidents in railway workers. METHODS: The sample included 1,604 male workers, having had at least one occupational injury with sick leave during a 2-year period in voluntary French railway services. A standardized questionnaire was filled in by the person-in-charge of prevention, with the injured worker. Data analysis was performed via the chi(2) independence test and adjusted odds ratios (OR) with Mantel-Haenszel test. RESULTS: The environmental hazards were implicated in 24.7%, technical dysfunctions in 16.0%, lack of work organization in 13.7%, lack of know-how in 17.6%, lack of job knowledge in 5.2%, and the other human factors in 31.9% of occupational injuries. The injuries caused by lack of know-how or job knowledge were more represented in workers aged less than 30 (ORs adjusted for job 1.45, 95% CI 1.02-2.06 and 2.06, 1.22-3.49, respectively), those by environmental hazards in energy and electrical traction maintenance operators and train drivers (ORs adjusted for age 2.04, 1.16-3.58 and 1.80, 1.01-3.20, respectively), and those by lack of work organization in mechanical maintenance operators and in energy and electrical traction maintenance operators (ORs adjusted for age 2.24, 1.13-4.45 and 1.83, 1.30-2.57, respectively). The causes considered were strongly related with the type of injuries. CONCLUSIONS: This study found that environmental hazards, technical dysfunctions, lack of work organization, lack of knowledge and other human factors had important contributions in injuries, and they were related to job, age and type of injuries. These findings are useful for prevention. Training is necessary for young workers. The occupational physician could help the workers to be more aware of the risks.

Effect of sporting activity practice on susceptibility to motion sickness.

The theory of visuo-vestibular conflict is the most commonly accepted to explain motion sickness. Visual, vestibular and proprioceptive afferences are involved in balance control and this function can be improved by physical and sporting activities (PSA). The purpose of the present survey was to investigate the relationships between motion sickness susceptibility (MSS) in adulthood and PSA, and especially proprioceptive PSA. A questionnaire concerning MSS and PSA was filled in by 1829 students (22.3+/-3.4 years of age, 799 males). Subjects having practised a sport before the age of 18 have less MSS than the other subjects (P<0.001). It should be noted that subjects who practised proprioceptive PSA before the age of 18 have less MSS than subjects who practised bioenergetic PSA before this age. By practising PSA, subjects are less dependent on visual input and use vestibular afferences better. A process of habituation can be involved in better managing conflicting sensory afferences reducing susceptibility to motion sickness. The practice of proprioceptive PSA develops the proprioceptive afferences and improves their treatment by the central nervous system. This additional appropriate input associated with an increase in vestibular weight compared to vision helps overcome visuo-vestibular conflict.

Habitual loud snoring. A study of prevalence and associations in 850 middle-aged French males.

BACKGROUND: Most studies on habitual snoring have focused on its prevalence. However, from the clinical point of view, the intensity of snoring is of upmost importance, as it suggests the existence of sleep apnoeas. OBJECTIVES: The aim of the study was to assess the prevalence of loud snoring using a standard questionnaire and to evaluate the anthropometric and sleep characteristic differences between loud and light snorers in a sample of middle-aged males. METHODS: The subjects were middle-aged active male employees. They completed a structured sleep questionnaire and had standard anthropometric measurements. Subjects reporting habitual snoring (> or =3 nights/week) were further classified as loud or light snorers. RESULTS: Of the 850 male subjects volunteering, 149 (17.5%) were habitual loud snorers. Loud snorers were older and had a greater waist-to-hip ratio as compared with light snorers. In univariate analysis, loud snoring was associated with gasping/snorting during sleep, breathing stops during sleep, waking up too early, excessive daytime sleepiness and falling asleep while watching TV. Logistic regression identified four independent associates of loud snoring: gasping during sleep, excessive daytime sleepiness, falling asleep watching TV and age. CONCLUSIONS: Loud snoring is present in a significant proportion of middle-aged men and is associated with central obesity and age. It disturbs sleep and elicits significant daytime sleepiness. Its association with breathing pauses (univariate) and its independent association with gasping during sleep suggests that loud snoring could be considered a clinical correlate of obstructive sleep apnoeas.

Correlates of occupational injuries for various jobs in railway workers: a case-control study.

Few studies have simultaneously addressed the role of occupational factors, individual characteristics and living conditions in occupational injuries, and to the best of our knowledge none on railway workers. This survey assessed the roles of these factors in various types of injuries and for various jobs in French railway workers. This case-control study was conducted on 1,305 male workers with an occupational injury during a one-year period and 1,305 male controls. A standardized questionnaire was administrated by an occupational physician. Data were analyzed by the logistic regression method. The significant factors found for all the injuries combined were: young age (<30 yr) (adjusted odds ratio 1.47, 95% CI 1.01-2.14), 5 yr or less in present job (1.43, 1.15-1.78), sleep disorders (1.30, 1.08-1.57), current smoker (1.27, 1.08-1.50), and no do-it-yourself or gardening activity (1.23, 1.02-1.48). Young age, sleep disorders, and smoking were common for several types of injuries. The role of these factors differed between various job categories. Among injured workers sick leaves of eight days or over were more frequent in current smokers and overweight subjects. In conclusion, young age, lack of experience, job dissatisfaction, sleep disorders, smoking, and lack of physical activity increase the risk of occupational injuries. The risks induced were related with jobs. Preventive measures concerning work conditions and these factors could be conducted in railway workers generally, and especially in workers most at risk. The occupational physician could make workers more sensitive to these risks and help them to improve their living conditions during medical examinations.

Sensorial organisation favouring higher visual contribution is a risk factor of falls in an occupational setting.

The contribution of intrinsic balance control factors to fall mechanisms has received little investigation in studies on occupational accidents. The aim of this study was to assess whether postural regulation in falling workers might have specificities in terms of sensorimotor strategies and neuromuscular responses to balance perturbations. Nine multi-fall-victims (MF), 43 single-fall-victims (SF) and 52 controls (C) were compared on performance measurements of static and dynamic postural control. MF and SF had the worst postural performance both in the static and slow dynamic tests, particularly in eyes closed conditions, suggesting a high dependency on visual cues and a lower use of proprioception. Moreover, the sensorial analysis showed that MF and SF relied less on vestibular input in the development of balance strategy and had more difficulties in maintaining a correct upright stance when proprioceptive input was altered. Finally, MF showed longer latency responses to unexpected external disturbance. Overall, postural control quality increased in the order MF, SF and C. MF and SF adopted particular sensorimotor organisation, placing them at an increased risk of falling in specific sensory environments. Strategies incorporating visual information involve using the cognitive processes causing delayed and less accurate fall avoidance responses, in contrast to adaptative strategies based on proprioceptive and vestibular information.

Relationships between certain individual characteristics and occupational injuries for various jobs in the construction industry: a case-control study.

BACKGROUND: There is little published about the role of individual characteristics in occupational injuries. Construction workers have a high rate of injury; we assessed 11 personal characteristics in this professional sector. METHODS: A case-control study was conducted on 880 male workers who had had at least one occupational injury during a 2-year period and 880 controls. A questionnaire was administered by an occupational physician. Statistical analysis was made via logistic regression method. RESULTS: Young age (<30 years), sleep disorders and current smoker influenced all the injuries combined. Sleep disorders and young age were common risk factors for several jobs. Physical disabilities and no sporting activity had a role in masons, and 5 years or less in present job in plumbers and electricians only. Sleep disorders influenced both the injuries with and without hospitalization; young age, current smoker, and physical disability influenced those without hospitalization only. CONCLUSIONS: Young age, sleep disorders, smoking, disabilities, sporting activity, and experience influenced the occupational injuries. The risk for each worker depended on his job. Occupational physicians could inform the workers of these risks and encourage them to take remedial action.

Relationships of job, age, and life conditions with the causes and severity of occupational injuries in construction workers.

OBJECTIVES: To assess the relationships of job, age, and life conditions with the causes and severity of occupational injuries in male construction labourers. METHODS: The sample included 880 male construction workers having had at least one occupational injury with subsequent sick leave. The survey used a standardised questionnaire, filled in by the occupational physician in the presence of the subject: socio-demographic data, job, safety training, smoking habit, alcohol consumption, sporting activities, physical disabilities, hearing, vision, and sleep disorders. Statistical analysis was via the logistic regression method. RESULTS: Logistic models showed that falls and injuries from the handling of objects or hand tools was similar for all jobs, while masons, plumbers and electricians had a higher risk of injury from moving objects, and carpenters, roofers and civil-engineering workers were more exposed to injury from construction machinery and devices. Age <30 was related to injury from hand tools [adjusted OR (95%CI) 2.20 (1.28-3.79)]; sleep disorders and hearing disorders to those from moving objects [ORs 2.29 (1.27-4.12) and 1.85 (1.01-3.41) respectively]; no sporting activity to those from the handling of objects [OR 1.54 (1.09-2.17)]; and being overweight to falls on the same level [OR 2.04 (1.30-3.21)] and falls to a lower level [OR 1.55 (1.13-2.13)]. Injuries from the handling of objects were less frequent in overweight workers [OR 0.62 (0.46-0.84)]. Injuries with hospitalisation or sick leave > or =60 days were associated with age > or =30 and hearing disorders. CONCLUSIONS: The causes of injuries were related to jobs. Prevention through working conditions could be made against the revealed risks. The risks for each worker depended on age, body mass index, hearing disorders, sleep disorders, and sporting activities. The occupational physician could inform the workers of these risks and encourage them to practise sporting activities and reduce their hearing disorders and sleep disorders.

Relationships of job and some individual characteristics to occupational injuries in employed people: a community-based study.

This study assessed the associations of job and some individual factors with occupational injuries among employed people from a general population in north-eastern France; 2,562 workers were randomly selected from the working population. A mailed auto-questionnaire was filled in by each subject. Statistical analysis was performed with loglinear models. The annual incidence rate of at least one occupational injury was 4.45%. Significant contributing factors for occupational injuries were job category (60.8%), sex (16.2%), regular psychotropic drug use (8.5%), age groups (7.5%), and presence of a disease (7.0%). The men had higher risk than the women (adjusted odds-ratio 1.99, 95% CI 1.43-2.78). Compared to executives, intellectual professionals and teachers, labourers had the highest risk (6.40, 3.55-11.52). They were followed by farmers, craftsmen and tradesmen (6.18, 2.86-13.08), technicians (3.14, 1.41-6.70), employees (2.94, 1.59-5.48) and other subjects (3.87, 1.90-7.88). The young (< or = 29 yr) showed an increased risk. Similar odds-ratios were observed for regular psychotropic drug use (1.54, 1.16-2.05) and the presence of a disease (1.50, 1.11-2.02). Univariate analysis showed that smoking habit, overweight and excess alcohol use were also associated with injuries. The loglinear model results showed that there were associations between some of these independent factors. It was concluded that job, sex, young age, smoking habit, excess alcohol use, overweight, psychotropic drug use, and disease influenced the occupational injuries. Preventive measures concerning work conditions, risk assessment and job knowledge should be conducted in overall active population, especially in men, young workers, smokers, alcohol users, overweight workers and in individuals with a disease or psychosomatic disorders.