A number of epidemiological studies report an association between occupational noise exposure and arterial hypertension. Existing systematic reviews report conflicting results, so we conducted an updated systematic review with meta-analysis. We registered the review protocol with PROSPERO (registration no.: CRD 42019147923) and searched for observational epidemiological studies in literature databases (Medline, Embase, Scopus, Web of Science). Two independent reviewers screened the titles/abstracts and full texts of the studies. Two reviewers also did the quality assessment and data extraction. Studies without adequate information on recruitment, response, or without a comparison group that was exposed to occupational noise under 80 dB(A) were excluded. The literature search yielded 4583 studies, and 58 studies were found through hand searching. Twenty-four studies were included in the review. The meta-analysis found a pooled effect size (ES) for hypertension (systolic/diastolic blood pressure ≥140/90 mmHg) due to noise exposures ≥80 dB(A) of 1.75 (95% CI 1.46–2.10). There is no substantial risk difference between men and women, but data concerning this question are limited. We found a positive dose-response-relationship: ES = 1.21 (95% CI 0.78–1.87) ≤ 80 dB(A), ES = 1.66 (95% CI 1.24–2.22) > 80–≤85 dB(A), and ES = 3.38 (95% CI 1.37–8.35) > 85–≤90 dB(A). We found high quality of evidence that occupational noise exposure increases the risk of hypertension.

In the large-scale case-control study EPILIFT, we investigated the dose-response relationship between lifestyle factors (weight, smoking amount, cumulative duration of different sports activities) and lumbar disc disease.

There is evidence suggesting that occupational trauma leads to post-traumatic stress disorder (PTSD) and depression. However, there is a lack of high-quality reviews studying this association. We, therefore, conducted a systematic review with a meta-analysis to summarize the evidence of occupational trauma on PTSD and depression. After a database search on studies published between 1994 and 2018, we included 31 studies, of which only four had a low risk of bias. For soldiers exposed to wartime deployment, the pooled relative risk (RR) was 2.18 (95% CI 1.83–2.60) for PTSD and 1.15 (95% CI 1.06–1.25) for depression. For employees exposed to occupational trauma, there also was an increased risk for PTSD (RR = 3.18; 95% CI 1.76–5.76) and for depression (RR = 1.73; 95% CI 1.44–2.08). The overall quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was moderate; the evidence was high only for the association between workers after exposure to trauma and development of PTSD. The study results indicate an increased risk of PTSD and depression in soldiers after participation in war and in employees after occupational trauma.

Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4–41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases—particularly rotator cuff lesions—should be recognized as an occupational disease.

Zusammenfassung: In einem Meta-Review wurden 35 systematische Reviews zum Thema mit AMSTAR, ein Instrument zur Qualitätsbewertung von systematischen Reviews, beurteilt. 31 Reviews wiesen eine niedrige Qualität auf und hatten überwiegend Studien ohne eigene Kontrollgruppe einbezogen. Die 4 systematischen Reviews mit zumindest mittelgradiger Qualität zeigten ein signifikant erhöhtes Risiko von Soldaten nach Entsendung in einen Krieg für die Entwicklung einer posttraumatischen Belastungsstörung (PTBS) und einer Depression. Ferner zeigten sich Hinweise für ein deutlich erhöhtes PTBS-Risiko von Feuerwehrleuten und Rettungssanitätern.

We are grateful for the insightful comments in