Top

Journal of Occupational Medicine and Toxicology

Published in:

Open Access 01-12-2018 | Research

Work-related outcomes in randomized, double blind, placebo-controlled trials in osteoarthritis – are they adequately reported in journal publications? A systematic review

Authors: Daniel Sowah, Flora Balat, Sebastian Straube

Published in: Journal of Occupational Medicine and Toxicology | Issue 1/2018

Abstract

Background

Osteoarthritis (OA) has a high prevalence in Western societies and can affect an individual’s life in a number of domains, including work. In our experience, treatment trials on OA, however, rarely report work-related outcomes. Here we conducted a systematic review to assess the reporting of work-related outcomes in randomized, double blind, placebo-controlled trials in OA. Our systematic review also compared two search strategies for identifying eligible publications, one where work-related terms were included in the database search string (A) and one where this was not the case and work-related outcomes were identified by searches of full text Portable Document Formats (PDFs) (B). Search strategy A would conventionally be used and would only identify publications where work-related terms were mentioned in the title or abstract. Search strategy B presents the innovation of full text PDF searching and would identify publications were work-related terms were reported in the full text, regardless of whether they are mentioned in the title and abstract or not. We hypothesize that search strategy B identifies more relevant publications than search strategy A.

Methods

Electronic database searching was performed in Medline (Pubmed) from database inception to February 23, 2017 to identify peer-reviewed articles of randomized, double blind, placebo-controlled treatment trials in OA of the hand, hip, or knee, available as full-text PDFs. For search strategy A, search terms to identify work-related outcomes were included in the database search string, while search strategy B did not have these terms included in the database search string, but instead involved full text PDF searching. We included English language articles only and only those articles where searchable PDFs were available, to enable a comparison between search strategies A and B. Additionally, included studies also needed to report on pain intensity in relation to the work-related outcomes.

Results

Search strategy A yielded 50 hits combined for hand, hip or knee OA that mentioned some work-related concept in the title or abstract; 12 articles had to be excluded because they were not available as searchable PDFs. Screening of the remaining 38 articles resulted in only two articles that satisfied our inclusion criteria. Search strategy B yielded 986 hits, out of which 201 articles were excluded because searchable full text PDFs were not available. PDF full text searching and further screening resulted in 10 articles that were considered eligible for our review.

Conclusions

Work-related outcomes are rarely reported in journal publication on randomized, double blind, placebo-controlled trials of hand, hip or knee OA. Searching full text PDFs yields more eligible articles than searching titles and abstracts only.

Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis. prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis. 1966;25(1):1–24.CrossRef

Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355–69.CrossRef

Cho HJ, Morey V, Kang JY, Kim KW, Kim TK. Prevalence and risk factors of spine, shoulder, hand, hip, and knee osteoarthritis in community-dwelling koreans older than age 65 years. Clin Orthop Relat Res. 2015;473(10):3307–14. https://doi.org/10.1007/s11999-015-4450-3.CrossRefPubMedPubMedCentral

Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–56.PubMedPubMedCentral

Turkiewicz A, de Verdier M G, Engstrom G, et al. Prevalence of knee pain and knee OA in southern sweden and the proportion that seeks medical care. Rheumatology (Oxford). 2015;54(5):827–35. https://doi.org/10.1093/rheumatology/keu409.CrossRef

Kim C, Linsenmeyer KD, Vlad SC, et al. Prevalence of radiographic and symptomatic hip osteoarthritis in an urban United States community: the Framingham osteoarthritis study. Arthritis Rheumatol. 2014;66(11):3013–7. https://doi.org/10.1002/art.38795.CrossRefPubMedPubMedCentral

Felson DT. Clinical practice. osteoarthritis of the knee. N Engl J Med. 2006;354(8):841–8.CrossRef

Hunter DJ, Felson DT. Osteoarthritis. BMJ. 2006;332(7542):639–42.CrossRef

Sharma AR, Jagga S, Lee SS, Nam JS. Interplay between cartilage and subchondral bone contributing to pathogenesis of osteoarthritis. Int J Mol Sci. 2013;14(10):19805–30. https://doi.org/10.3390/ijms141019805.CrossRefPubMedPubMedCentral

10.

Andrew R, Derry S, Taylor RS, Straube S, Phillips CJ. The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain. Pain Pract. 2014;14(1):79–94. https://doi.org/10.1111/papr.12050.CrossRefPubMed

11.

Langley P, Muller-Schwefe G, Nicolaou A, Liedgens H, Pergolizzi J, Varrassi G. The impact of pain on labor force participation, absenteeism and presenteeism in the European Union. J Med Econ. 2010;13(4):662–72. https://doi.org/10.3111/13696998.2010.529379.CrossRefPubMed

12.

Wolf I, Friede T, Hallier E, Straube S. Work-related outcomes in randomised placebo-controlled pain trials: a systematic review and meta-analysis. J Occup Med Toxicol. 2014;9:25–6673-9-25. eCollection 2014. https://doi.org/10.1186/1745-6673-9-25.CrossRefPubMedPubMedCentral

13.

Stevinson C, Lawlor DA. Searching multiple databases for systematic reviews: added value or diminishing returns? Complement Ther Med. 2004;12(4):228–32.CrossRef

14.

Egger M, Smith GD, O'Rourke K. Introduction: rationale, potentials, and promise of systematic reviews - systematic reviews in health care: meta-analysis in context, second edition - egger - wiley online library. In: Egger M, Smith GD, Altman DG, editors. Systematic reviews in health care: Meta-analysis in context. Vol 2018. Second Edition ed. London: BMJ Publishing Group; 2008. p. 3–19. Accessed 2 Sept 2018. https://doi.org/10.1002/9780470693926.ch1.CrossRef

15.

Schiff M, Minic M. Comparison of the analgesic efficacy and safety of nonprescription doses of naproxen sodium and ibuprofen in the treatment of osteoarthritis of the knee. J Rheumatol. 2004;31(7):1373–83.PubMed

16.

Wang X, Cao Y, Pang J, et al. Traditional Chinese herbal patch for short-term management of knee osteoarthritis: a randomized, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med. 2012;2012(171706):1–9.

17.

Pastinen O, Forsskahl B, Marklund M. Local glycosaminoglycan polysulphate injection therapy in osteoarthritis of the hand. A placebo-controlled clinical study. Scand J Rheumatol. 1988;17(3):197–202.CrossRef

18.

Lequesne M, Maheu E, Cadet C, Dreiser RL. Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hip. Arthritis Rheum. 2002;47(1):50–8. https://doi.org/10.1002/art1.10239.CrossRefPubMed

19.

Smugar SS, Schnitzer TJ, Weaver AL, Rubin BR, Polis AB, Tershakovec AM. Rofecoxib 12.5 mg, rofecoxib 25 mg, and celecoxib 200 mg in the treatment of symptomatic osteoarthritis: results of two similarly designed studies. Curr Med Res Opin. 2006;22(7):1353–67. https://doi.org/10.1185/030079906X104876.CrossRefPubMed

20.

Essex MN, O'Connell M, Bhadra BP. Response to nonsteroidal anti-inflammatory drugs in african americans with osteoarthritis of the knee. J Int Med Res. 2012;40(6):2251–66.CrossRef

21.

Hochberg MC, Fort JG, Svensson O, Hwang C, Sostek M. Fixed-dose combination of enteric-coated naproxen and immediate-release esomeprazole has comparable efficacy to celecoxib for knee osteoarthritis: two randomized trials. Curr Med Res Opin. 2011;27(6):1243–53.CrossRef

22.

Schein JR, Kosinski MR, Janagap-Benson C, Gajria K, Lin P, Freedman JD. Functionality and health-status benefits associated with reduction of osteoarthritis pain. Curr Med Res Opin. 2008;24(5):1255–65. https://doi.org/10.1185/030079908X291912.CrossRefPubMed

23.

Arjmandi BH, Khalil DA, Lucas EA, et al. Soy protein may alleviate osteoarthritis symptoms. Phytomedicine. 2004;11(7–8):567–75.CrossRef

24.

Chappell AS, Ossanna MJ, Liu-Seifert H, et al. Duloxetine, a centrally acting analgesic, in the treatment of patients with osteoarthritis knee pain: a 13-week, randomized, placebo-controlled trial. Pain. 2009;146(3):253–60. https://doi.org/10.1016/j.pain.2009.06.024.CrossRefPubMed

25.

Chappell AS, Desaiah D, Liu-Seifert H, et al. A double-blind, randomized, placebo-controlled study of the efficacy and safety of duloxetine for the treatment of chronic pain due to osteoarthritis of the knee. Pain Pract. 2011;11(1):33–41. https://doi.org/10.1111/j.1533-2500.2010.00401.x.CrossRefPubMed

26.

Golden HE, Moskowitz RW, Minic M. Analgesic efficacy and safety of nonprescription doses of naproxen sodium compared with acetaminophen in the treatment of osteoarthritis of the knee. Am J Ther. 2004;11(2):85–94.CrossRef

27.

Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med. 2004;46(4):398–412.CrossRef

28.

Muchmore L, Lynch WD, Gardner HH, Williamson T, Burke T. Prevalence of arthritis and associated joint disorders in an employed population and the associated healthcare, sick leave, disability, and workers’ compensation benefits cost and productivity loss of employers. J Occup Environ Med. 2003;45(4):369–78.CrossRef

29.

Patel AS, Farquharson R, Carroll D, et al. The impact and burden of chronic pain in the workplace: A qualitative systematic review. Pain Pract. 2012;12(7):578–89. https://doi.org/10.1111/j.1533-2500.2012.00547.x.CrossRefPubMed

30.

Rolfson O, Wissig S, van Maasakkers L, et al. Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: Consensus of the international consortium for health outcomes measurement hip and knee osteoarthritis working group. Arthritis Care Res (Hoboken). 2016;68(11):1631–9. https://doi.org/10.1002/acr.22868. CrossRef

31.

Fan X, Straube S. Reporting on work-related low back pain: data sources, discrepancies and the art of discovering truths. Pain Manag. 2016;6(5):553–9.CrossRef

32.

Barthel HR, Peniston JH, Clark MB, Gold MS, Altman RD. Correlation of pain relief with physical function in hand osteoarthritis: Randomized controlled trial post hoc analysis. Arthritis Res Ther. 2010;12(1):R7. https://doi.org/10.1186/ar2906.CrossRefPubMedPubMedCentral

33.

Nieman DC, Shanely RA, Luo B, Dew D, Meaney MP, Sha W. A commercialized dietary supplement alleviates joint pain in community adults: a double-blind, placebo-controlled community trial. Nutr J. 2013;12(1):154–2891–12-154. https://doi.org/10.1186/1475-2891-12-154.CrossRefPubMedPubMedCentral

34.

Pope JE, Prashker M, Anderson J. The efficacy and cost effectiveness of N of 1 studies with diclofenac compared to standard treatment with nonsteroidal antiinflammatory drugs in osteoarthritis. J Rheumatol. 2004;31(1):140–9.PubMed

35.

Richmond JS, Gunadasa S, Bland M, MacPherson H. Copper bracelets and magnetic wrist straps for rheumatoid arthritis – analgesic and anti-inflammatory effects: a randomised double-blind placebo controlled crossover trial. PLoS One. 2013;8(9):e71529.CrossRef

36.

Taibi DM, Bourguignon C, Gill TA. A feasibility study of valerian extract for sleep disturbance in person with arthritis. Biol Res Nurs. 2009;10(4):409–17. https://doi.org/10.1177/1099800408324252.CrossRefPubMed

37.

Cheras PA, Myers SP, Paul-Brent PA, Outerbridge KH, Nielsen GV. Randomized double-blind placebo-controlled trial on the potential modes of action of SheaFlex70 in osteoarthritis. Phytother Res. 2010;24(8):1126–31. https://doi.org/10.1002/ptr.3075.CrossRefPubMed

38.

Ernst E. Avocado-soybean unsaponifiables (ASU) for osteoarthritis - a systematic review. Clin Rheumatol. 2003;22(4–5):285–8. https://doi.org/10.1007/s10067-003-0731-4.CrossRefPubMed

39.

Florete OG, Xiang J, Vorsanger GJ. Effects of extended-release tramadol on pain-related sleep parameters in patients with osteoarthritis. Expert Opin Pharmacother. 2008;9(11):1817–27. https://doi.org/10.1517/14656566.9.11.1817.CrossRefPubMed

40.

Gana TJ, Pascual ML, Fleming RR, et al. Extended-release tramadol in the treatment of osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled clinical trial. Curr Med Res Opin. 2006;22(7):1391–401. https://doi.org/10.1185/030079906X115595.CrossRefPubMed

41.

Jabbari B, Machado D. Treatment of refractory pain with botulinum toxins--an evidence-based review. Pain Med. 2011;12(11):1594–606. https://doi.org/10.1111/j.1526-4637.2011.01245.x.CrossRefPubMed

42.

Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: A randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2007;56(7):2278–87. https://doi.org/10.1002/art.22739.CrossRefPubMed

43.

Maheu E, Mazieres B, Valat JP, et al. Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month followup demonstrating a persistent effect. Arthritis Rheum. 1998;41(1):81–91. https://doi.org/10.1002/1529-0131(199801)41:13.0.CO;2-9.CrossRefPubMed

44.

Moskowitz RW, Sunshine A, Brugger A, Lefkowith JB, Zhao WW, Geis GS. American pain society pain questionnaire and other pain measures in the assessment of osteoarthritis pain: a pooled analysis of three celecoxib pivotal studies. Am J Ther. 2003;10(1):12–20.CrossRef

45.

Plosker GL, Lyseng-Williamson KA. Buprenorphine 5, 10 and 20 μg/h transdermal patch: A guide to its use in chronic non-malignant pain. CNS Drugs. 2012;1((26(4))):367–73.CrossRef

46.

Rozendaal RM, Koes BW, Weinans H, et al. The effect of glucosamine sulphate on osteoarthritis: design of a long-term randomised clinical trial [ISRCTN54513166]. BMC Musculoskelet Disord. 2005;6:20.CrossRef

47.

Turan Y, Bayraktar K, Kahvecioglu F, et al. Is magnetotherapy applied to bilateral hips effective in ankylosing spondylitis patients? a randomized, double-blind, controlled study. Rheumatol Int. 2014;34(3):357–65. https://doi.org/10.1007/s00296-013-2941-7. CrossRefPubMed

48.

Willich SN, Rossnagel K, Roll S, et al. Rose hip herbal remedy in patients with rheumatoid arthritis - a randomised controlled trial. Phytomedicine. 2010;17(2):87–93. https://doi.org/10.1016/j.phymed.2009.09.003.CrossRefPubMed

49.

Alfredo PP, Bjordal JM, Dreyer SH, et al. Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: A randomized double-blind study. Clin Rehabil. 2012;26(6):523–33. https://doi.org/10.1177/0269215511425962.CrossRefPubMed

50.

Auw Yang KG, Raijmakers NJ, van Arkel ER, et al. Autologous interleukin-1 receptor antagonist improves function and symptoms in osteoarthritis when compared to placebo in a prospective randomized controlled trial. Osteoarthr Cartil. 2008;16(4):498–505.CrossRef

51.

Babul N, Noveck R, Chipman H, Roth SH, Gana T, Albert K. Efficacy and safety of extended-release, once-daily tramadol in chronic pain: A randomized 12-week clinical trial in osteoarthritis of the knee. J Pain Symptom Manage. 2004;28(1):59–71. https://doi.org/10.1016/j.jpainsymman.2003.11.006 CrossRefPubMed

52.

Brown JP, Boulay LJ. Clinical experience with duloxetine in the management of chronic musculoskeletal pain. A focus on osteoarthritis of the knee. Ther Adv Musculoskelet Dis. 2013;5(6):291–304. https://doi.org/10.1177/1759720X13508508. CrossRefPubMedPubMedCentral

53.

Burch F, Fishman R, Messina N, et al. A comparison of the analgesic efficacy of tramadol contramid OAD versus placebo in patients with pain due to osteoarthritis. J Pain Symptom Manag. 2007;34(3):328–38.CrossRef

54.

Cibere J, Thorne A, Kopec JA, et al. Glucosamine sulfate and cartilage type II collagen degradation in patients with knee osteoarthritis: randomized discontinuation trial results employing biomarkers. J Rheumatol. 2005;32(5):896–902.PubMed

55.

Frakes EP, Risser RC, Ball TD, Hochberg MC, Wohlreich MM. Duloxetine added to oral nonsteroidal anti-inflammatory drugs for treatment of knee pain due to osteoarthritis: results of a randomized, double-blind, placebo-controlled trial. Curr Med Res Opin. 2011;27(12):2361–72.CrossRef

56.

Hsieh RL, Lo MT, Liao WC, Lee WC. Short-term effects of 890-nanometer radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. Arch Phys Med Rehabil. 2012;93(5):757–64.CrossRef

57.

Hsieh R, Liao W, Lee W. Local and systemic cardiovascular effects from monochromatic infrared therapy in patients with knee osteoarthritis: A double-blind, randomized, placebo-controlled study. Evid Based Complement Alternat Med. 2012;2012(583016):eCAM.

58.

Hsieh RL, Lo MT, Lee WC, Liao WC. Therapeutic effects of short-term monochromatic infrared energy therapy on patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. J Orthop Sports Phys Ther. 2012;42(11):47–56.CrossRef

59.

Ilan DI, Liporace FA, Rosen J, Cannavo D. Efficacy of rofecoxib for pain control after knee arthroscopy: a prospective, randomized, double-blinded clinical trial. Arthroscopy. 2004;20(8):813–8.CrossRef

60.

Jia L, Wang Y, Chen J, Chen W. Efficacy of focused low-intensity pulsed ultrasound therapy for the management of knee osteoarthritis: A randomized, double blind, placebo-controlled trial. Sci Rep. 2016;6:35453. https://doi.org/10.1038/srep35453.CrossRefPubMedPubMedCentral

61.

Kannus P, Natri A, Niittymäki S, Järvinen M. Effect of intraarticular glycosaminoglycan polysulfate treatment on patellofemoral pain syndrome. A prospective, randomized double-blind trial comparing glycosaminoglycan polysulfate with placebo and quadriceps muscle exercises. Arthritis Rheum. 1992;35(9):1053–61.CrossRef

62.

Magrans-Courtney T, Wilborn C, Rasmussen C, et al. Effects of diet type and supplementation of glucosamine, chondroitin, and MSM on body composition, functional status, and markers of health in women with knee osteoarthritis initiating a resistance-based exercise and weight loss program. J Int Soc Sports Nutr. 2011;8(1):8.CrossRef

63.

Mata J, Cabrera S, Sanchis P, et al. Electro-acupuncture for treatment of knee pain from osteoarthritis and the possible endocrinology changes: a study protocol for a randomized controlled trial. Trials. 2015;16:248–015–0766-2. https://doi.org/10.1186/s13063-015-0766-2.CrossRefPubMedPubMedCentral

64.

Möller I, Pérez M, Monfort J, et al. Effectiveness of chondroitin sulphate in patients with concomitant knee osteoarthritis and psoriasis: A randomized, double-blind, placebo-controlled study. Osteoarthr Cartil. 2010;Suppl 1:S32–40.CrossRef

65.

Mazzuca SA, Page MC, Meldrum RD, Brandt KD, Petty-Saphon S. Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis. Arthritis Rheum. 2004;51(5):716–21. https://doi.org/10.1002/art.20683. CrossRefPubMed

66.

Pavelka K Jr, Sedlackova M, Gatterova J, Becvar R, Pavelka KS. Glycosaminoglycan polysulfuric acid (GAGPS) in osteoarthritis of the knee. Osteoarthr Cartil. 1995;3(1):15–23.CrossRef

67.

Pincus T, Koch GG, Sokka T, et al. A randomized, double-blind, crossover clinical trial of diclofenac plus misoprostol versus acetaminophen in patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2001;44(7):1587–98.CrossRef

68.

Sanghi D, Mishra A, Sharma AC, et al. Does vitamin D improve osteoarthritis of the knee: A randomized controlled pilot trial. Clin Orthop Relat Res. 2013;471(11):3556–62. https://doi.org/10.1007/s11999-013-3201-6. CrossRefPubMedPubMedCentral

69.

Schauss AG, Stenehjem J, Park J, Endres JR, Clewell A. Effect of the novel low molecular weight hydrolyzed chicken sternal cartilage extract, BioCell collagen, on improving osteoarthritis-related symptoms: a randomized, double-blind, placebo-controlled trial. J Agric Food Chem. 2012;60(16):4096–101.CrossRef

70.

Segal NA, Toda Y, Huston J, et al. Two configurations of static magnetic fields for treating rheumatoid arthritis of the knee: a double-blind clinical trial. Arch Phys Med Rehabil. 2001;82(10):1453–60.CrossRef

71.

Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369(26):2515–24. https://doi.org/10.1056/NEJMoa1305189. CrossRefPubMed

72.

Singer BJ, Silbert PL, Song S, Dunne JW, Singer KP. Treatment of refractory anterior knee pain using botulinum toxin type a (dysport) injection to the distal vastus lateralis muscle: a randomised placebo controlled crossover trial. Br J Sports Med. 2011;45(8):640–5.CrossRef

73.

Taverner MG, Ward TL, Loughnan TE. Transcutaneous pulsed radiofrequency treatment in patients with painful knee awaiting total knee joint replacement. Clin J Pain. 2010;26(5):429–32. https://doi.org/10.1097/AJP.0b013e3181d92a87.CrossRefPubMed

74.

van der Weegen W, Wullems JA, Bos E, Noten H, van Drumpt RA. No difference between intra-articular injection of hyaluronic acid and placebo for mild to moderate knee osteoarthritis: A randomized, controlled, double-blind trial. J Arthroplast 30(5):754–7. 2015;30(5):754–7. https://doi.org/10.1016/j.arth.2014.12.012.CrossRef

75.

Zhao SZ, McMillen JI, Markenson JA, et al. Evaluation of the functional status aspects of health-related quality of life of patients with osteoarthritis treated with celecoxib. Pharmacotherapy. 1999;19(11):1269–78.CrossRef

Title: Work-related outcomes in randomized, double blind, placebo-controlled trials in osteoarthritis – are they adequately reported in journal publications? A systematic review
Authors: Daniel Sowah
Flora Balat
Sebastian Straube
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Occupational Medicine and Toxicology / Issue 1/2018
Electronic ISSN: 1745-6673
DOI: https://doi.org/10.1186/s12995-018-0215-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Work-related outcomes in randomized, double blind, placebo-controlled trials in osteoarthritis – are they adequately reported in journal publications? A systematic review

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Indoor concentrations of VOCs in beauty salons; association with cosmetic practices and health risk assessment

Food offerings on board and dietary intake of European and Kiribati seafarers - cross-sectional data from the seafarer nutrition study -

Occupational exposure to ultrafine particles in police officers: no evidence for adverse respiratory effects

Cotton dust exposure and self-reported respiratory symptoms among textile factory workers in Northwest Ethiopia: a comparative cross-sectional study

Employment status and changes in working career in relation to asthma: a cross-sectional survey

Association of plasma PCB levels and HbA1c concentration in Iran