ObjectiveThe COVID-19 pandemic is demanding for occupational medicine and for public health. As healthcare workers (HCWs) fight impacts of SARS-CoV-2 on front lines, we must create safe work environments through comprehensive risk assessments, evaluation and effective implementation of counter-measures. We ask: ‘What does current literature report on health risks at workplaces regarding COVID-19?’ and ‘What do current studies report on the effectiveness of enacted preventative recommendations?’MethodsAs a snapshot of early HCW research, on 26 April 2020, we conducted a rapid systematic literature search in three databases (PubMed, Web of Science and PsycInfo) for COVID-19-related health outcomes and preventive measures in healthcare-associated workplaces.Results27 studies were identified as relevant for exploring the risk of infection, 11 studies evaluated preventive measures. The studies described that SARS-CoV-2 impacts significantly on HCW’s health and well-being, not only through infections (n=6), but also from a mental health perspective (n=16). 4 studies reported indirect risks such as skin injuries, one study described headaches to result from the use of personal protective equipment. Few studies provided information on the effectiveness of prevention strategies. Overall, most studies on health risks as well as on the effectiveness of preventive measures were of a moderate-to-low quality; this was mainly due to limitations in study design, imprecise exposure and outcome assessments.ConclusionsDue to widespread exposure of HCW to SARS-CoV-2, workplaces in healthcare must be as safe as possible. Information from HCW can provide valuable insights into how infections spread, into direct and indirect health effects and into how effectively counter-measures mitigate adverse health outcomes. However, available research disallows to judge which counter-measure(s) of a current ‘mix’ should be prioritised for HCW. To arrive at evidence-based cost-effective prevention strategies, more well-conceived studies on the effectiveness of counter-measures are needed.
Experimental studies indicate that perinatal light may imprint the circadian timing system, subsequently affect later life physiology, and possibly disease risk. We combined individual time-of-year of birth and corresponding latitude to determine perinatal photoperiod characteristics for UK Biobank participants (n = 460,761) and tested for associations with diabetes mellitus (DM, the pathophysiology of which is often linked with circadian disruption) and chronotype (a trait co-governed by the circadian timing system) prevalence in a cross-sectional investigation. The UK Biobank is a population-based cohort with a 5.5% participation rate (~9.2 million individuals were invited into the study between 2006 and 2010). We defined three groups based on photoperiods experienced in the 3 rd trimester of pregnancy and first 3 months post-birth time windows: (1) those who exclusively experienced non-extreme photoperiods (NEP, 8-16 hours), (2) those who experienced at least one extreme short photoperiod (ESP, <8 hours), and those who experienced at least one extreme long photoperiod (ELP, >16 hours). For individuals in each group and time window, mean daily photoperiod and relative photoperiod range (relative = relative to the mean) were calculated. Inclusion of relative photoperiod range adds dispersion information (relative change of photoperiods) to statistical models. Multivariable and multinomial logistic regression analyses were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Increased 3 rd trimester relative range was associated with decreased odds of DM (OR 0.63 95%CI 0.49-0.81) in the NEP group, but increased odds of DM were detected for the ESP (OR 1.34, 95%CI 0.96-1.86) and ELP groups (OR 1.32, 95%CI 0.78-2.22). Increased 3 rd trimester relative range was associated with increased odds of being a "Morning" (OR 1.20, 95%CI 1.02-1.41) or "Evening" (OR 1.43, 95%CI 1.21-1.69) chronotype in the NEP group, but this was not observed in other groups. Additionally, different effect sizes and directions of association with DM were observed in different strata of ethnicity and chronotype and statistically significant odds ratio modifications were detected. In conclusion, perinatal photoperiod associations with DM and chronotype prevalence are detected in the UK Biobank. NEP, ESP, and ELP differences are speculated to be caused by a non-linear dose-response to photoperiods from 0-24 hours or by confounding due to artificial light playing a dominant role in ESP individuals and seeking darkness in ELP individuals. Ethnicity and chronotype may be important effect modifiers of perinatal photoperiod associations with DM. Potential for selection biases due to low UK Biobank participation rate disallows stating conclusions too strongly. Overall, further studies are needed to confirm different perinatal photoperiod associations with DM and chronotype. Further investigations into the hypothesized imprinting mechanism are also warranted.
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