Transient risk factors of acute occupational injuries: a case-crossover study in two Danish emergency departments.

Objectives The objectives of this study were to (i) identify transient risk factors of occupational injuries and (ii) determine if the risk varies with age, injury severity, job task, and industry risk level. Method A case-crossover design was used to examine the effect of seven specific transient risk factors (time pressure, disagreement with someone, feeling sick, being distracted by someone, non-routine task, altered surroundings, and broken machinery and materials) for occupational injuries. In the study, 1693 patients with occupational injuries were recruited from a total of 4002 occupational injuries seen in 2013 at two emergency departments in Denmark. Effect estimates were calculated using the matched-pair interval approach. Results Increased risk for an occupational injury was found for time pressure [odds ratio (OR) 1.6, 95% confidence interval (95% CI) 1.3-2.0], feeling sick (OR 2.7, 95% CI 1.9-3.9), being distracted by someone (OR 3.1, 95% CI 2.3-4.1), non-routine task (OR 8.2, 95% CI 5.3-12.5), altered surroundings (OR 20.9, 95% CI 12.2-35.8), and broken machinery or materials (OR 20.6, 95% CI 13.5-31.7). The risk of occupational injury did not vary substantially in relation to sex, age, job task, industry risk level, or injury severity. Conclusion Use of a case-crossover design identified several worker-related transient risk factors (time pressure, feeling sick, being distracted by someone) that led to significantly increased risks for occupational injuries. In particular, equipment (broken machinery or materials) and work-practice-related factors (non-routine task and altered surroundings) increased the risk of an occupational injury. Elaboration of results in relation to hazard period and information bias is warranted.

Interferon-beta treatment in patients with multiple sclerosis does not alter CYP2C19 or CYP2D6 activity.

AIMS: To determine CYP2C19 and CYP2D6 activity in patients with multiple sclerosis (MS) before and during interferon (IFN)-beta treatment. METHODS: CYP2C19 and CYP2D6 activities were assessed using the probe drugs mephenytoin and debrisoquine, respectively. Urinary mephenytoin (S/R) and debrisoquine (debrisoquine/hydroxy-debrisoquine) metabolic ratios (MR) were determined in 10 otherwise healthy Caucasian multiple sclerosis (MS) patients in the initial stage of the disease, prior to and 1 month after commencing treatment with IFN-beta (Avonex, Rebif or Betaferon). In addition, CYP2C19*2, CYP2C19*3, CYP2D6*3, CYP2D6*4, and CYP2D6*5 genotyping was performed. RESULTS: There was no significant difference in the (S)/(R) mephenytoin ratio (mean difference 0.04; 95% CI -0.03, 0.11) or the debrisoquine MR (mean difference 0.29; 95% CI -0.44, 1.02) before and during regular IFN-beta treatment in extensive metabolizers (EM) (P = 0.5 and P = 0.4 for the respective probe drugs; n = 9 subjects). There were also no differences between the different IFN-beta treatments (P = 0.6 for the (S)/(R) mephenytoin ratio and P = 0.7 for the debrisoquine MR; anova; n = 10). CONCLUSIONS: IFN-beta treatment did not affect the activity of CYP2C19 or CYP2D6. The results suggest that it is safe to administer CYP2C19 or CYP2D6 substrates, without dose adjustment, to patients treated with IFN-beta.