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Report prepared for Work Safe Victoria providing a theoretical and empirical background for the factors influencing return to work after injury.

The occupational disease skin No. 5101 ("severe or recurrent skin diseases that have forced the patient to refrain from all activities that were or could be the cause of the development, aggravation or resurgence of the disease") is the most frequently notified occupational disease in Germany. Since 1936, the medical-objective obligation to refrain from risky work activities, which has been necessary for the recognition of this occupational disease, was intended to delimit trivial diseases, facilitate the determination of occupational causality and promote prevention. The abolition of the legal obligation to refrain from risky work activities as a criterion for the recognition of the occupational disease 5101 as of 01.01.2021 has significant effects on the occupational dermatological care and expert assessment of this occupational disease. For less severe occupational skin diseases, however, the preventive dermatologist's procedure established since 1972 will continue to apply.

Background: Measles is an infectious disease and a major health concern worldwide. Among individuals with a higher risk of exposure to measles, there are the Health Care Workers (HCWs), who may transmit the virus to other people. According to the Italian National Plan for Immunization and Prevention, all HCWs should have presumptive evidence of immunity to measles (documented two doses of MMR vaccination) or serological evidence of protective antibodies. Aim: The study aims to evaluate the immunological status, the vaccine coverage, and the protective IgG antibody titre for measles in medical students of the teaching hospital PoliclinicoTor Vergata (PTV). Methods: IgG measles antibodies titre was evaluated in a sample of 461 medical students undergoing annual health surveillance visits from January 1st to May 31th, 2020. Results: 73.7% of medical students showed protective measles IgG antibody levels. The immunization rate was higher among subjects aged less than 25 years with respect to students aged over 25 years (77.4% vs. 66.4%; P P Conclusion: Our study shows a non-protective measles IgG antibody titre, especially among the older students. Therefore, it is essential to evaluate the serological levels, to vaccinate those subjects whose antibody level is not adequate, and promote the vaccination even in the general population.

Healthcare workers (HCWs) have an increased risk to be exposed to infectious diseases compared to the general population. For this reason, according to the National Immunization and Prevention Plan, all HCWs should have demonstrable evidence of immunity to measles, mumps, rubella, varicella and Hepatitis B. Earlier studies have already shown that a large percentage of Italian operators lacked immune protection for one or more of those pathogens. The aim of this study was to evaluate the immunization status for vaccine-preventable diseases of HCWs in a large Italian teaching hospital. We retrospectively evaluated clinical records and serological data of HCWs who followed the occupational health surveillance program between January 1 and December 31 2019. We reviewed the clinical records of 1,017 HCWs: 393 males and 624 females with a median age of 35.69 y (range: 19–67). Protective IgG antibody values were documented in the 88.0%, 75.7%, 90.3%, 87.4% and 85.7% of the HCWs screened, respectively, against measles, mumps, rubella, varicella and Hepatitis B. Age was significantly related to serological protection against measles, mumps and varicella but was not significantly related to protective IgG levels for rubella and HBV. Female gender was significantly related to a higher protection rate against Hepatitis B (87.8 vs 82.4%; p

This study investigated the challenges and facilitators of occupational epidemiology (OE) research in the UK, and evaluated the impact of these challenges. Semi-structured in-depth interviews with leading UK-based OE researchers, and a survey of UK-based OE researchers were conducted. Seven leading researchers were interviewed, and there were 54 survey respondents. Key reported challenges for OE were diminishing resources during recent decades, influenced by social, economic and political drivers, and changing fashions in research policy. Consequently, the community is getting smaller and less influential. These challenges may have negatively affected OE research, causing it to fail to keep pace with recent methodological development and impacting its output of high-quality research. Better communication with, and support from other researchers and relevant policy and funding stakeholders was identified as the main facilitators to OE research. Many diseases were initially discovered in workplaces, as these make exceptionally good study populations to accurately assess exposures. Due to the decline of manufacturing industry, there is a perception that occupational diseases are now a thing of the past. Nevertheless, new occupational exposures remain under-evaluated and the UK has become reliant on overseas epidemiology. This has been exacerbated by the decline in the academic occupational medicine base. Maintaining UK-based OE research is hence necessary for the future development of occupational health services and policies for the UK workforce.

This study protocol document outlines a proposed simulation study to understand the changing health impact of a series of exposure interventions under varying characteristics of a working life exposome. The scenario proposed is based on lung cancer and construction workers exposed to silica, asbestos, diesel, and wood dust.

Supervised by three or four medical doctors and one nurse in rotating shifts, the medical clinic in Costa Rica’s Moín Container Terminal is open 24/7 for visits from port workers. In our study, we aimed to identify the sociodemographic and clinical characteristics of a consecutive series of patients who attended the medical clinic for outpatient services during an 8-month period. Our descriptive study involved collecting patient records from the medical clinic during the first 8 months of 2021 (i.e., 1 January–31 August 2021), during which 3050 visits from 1301 port workers were registered. Terminal tractor drivers, crane operators, and stevedores were the most frequent job categories among the patients. Doping (i.e., ICD-10 Z03.6) was observed in 64% of the visits. The top ICD-10 codes among all other patients not observed to have engaged in doping (n = 469) were diseases of the musculoskeletal system (7.2%) and abnormal clinical and laboratory symptoms (6.2%). Problems with the musculoskeletal system were primarily back pain (36.0%), muscle contracture (30.1%), and secondary headache (25.2%). Two-thirds of the visits were due to screening for alcohol and drugs or doping; however, inconsistency in the coding system complicates the analysis of data, and a dropdown menu in the registration is therefore needed to prevent errors. Relative risk calculations are impossible due to a lack of data about the at-risk population but should be pursued under different circumstances in future studies. In the support chain of goods, the medical clinic in the port plays a key role in saving time in shipping, which means that the injured or sick employees in most cases can continue working. For the shipping industry, quick un- and offloading is very important to stay competitive in the market for transport.

Graphical abstract

This study determined the association of cold-related symptoms with workplace temperature and thermal insulation of clothing among Thai chicken industry workers. Three hundred workers were interviewed regarding cold-related symptoms, which were regressed on worksite temperature and protective clothing. In total, 80% of workers reported respiratory symptoms; 23%, cardiac symptoms; 62%, circulation disturbances; 42%, thirst; 56%, drying of the mouth; and 82%, degradation of their performance. When adjusted for personal characteristics, respiratory symptoms were 1.1‒2.2 times more prevalent at −22‒10°C than at 10‒23°C. At −22‒10°C, cardiac symptoms increased by 45%, chest pain by 91%, peripheral circulation disturbances by 25%, and drying of the mouth by 57%. Wearing protective clothing with at least 1.1 clo units was associated with marked reductions in symptom prevalence. Therefore, temperatures lower than 10°C increased prevalence of cold-related symptoms, which are largely preventable by appropriate clothing use.

This study explored the potential association between chronic exposure to pesticide mixtures including paraquat and respiratory outcomes among Colombian farmers. Sociodemographic and occupational data, respiratory symptoms and spirometric data were collected. Paraquat in spot urine samples were quantified with solid-phase extraction high-performance liquid chromatography. Multiple Poisson regressions with robust variance were used to determine factors associated with respiratory outcomes. Profiles of pesticide mixtures used were identified among 217 farmwork-ers, but profenofos and methamidophos-based mixtures were more frequent. Chronic paraquat exposure was slightly associated with self-reported asthma (PR: 1.06; 95% CI 1.00 to 1.13). Different pesticide mixtures were associated with flu, thoracic pain, allergic rhinitis, and obstructive pattern in spirometry. Although acute exposure to paraquat is low among Colombian farmers participating in the study, associations between respiratory outcomes and chronic pesticide mixtures exposure including profenofos, methamidophos or glyphosate require further specific studies. © 2020 National Institute of Occupational Safety and Health.

Health Care Workers (HCWs) have an increased risk of contracting contagious disease, including mumps. In January 2017 the Italian National Vaccine Prevention Plan 2017–2019, recommended the administration of a dose of MMR vaccine (Measles-Mumps-Rubella) to the Health Care Workers (HCWs) that, working in a risky environment, did not carry out the complete vaccination cycle of MMR or that are seronegative for at least one of the three vaccine viruses. In October of the same year, the Advisory Committee on Immunization Practices (ACIP) recommended a third dose of a vaccine containing Mumps Virus for people previously vaccinated with 2 doses, belonging to a group or to a population at increased risk of acquire mumps in the event of an epidemic. We analyzed the clinical records and values of mumps-specific IgG antibodies of 3032 HCWs (mean age 32.80 ± 10.75 years), that underwent occupational health surveillance between January 1st 2017 and March 31th 2018. The HCWs were also screened for measles, rubella, mumps using serological methods. 13% (405) was seronegative for mumps, especially among HCWs between 18 and 36 years. We calculated the cost-effectiveness of two-doses and three-doses MMR vaccination. The cost of vaccination without screening was significantly more expensive (cost difference: 99 712 € and 184 996 €) both in case of two-dose and three-dose MMR vaccination respectively. Our study suggests that, in HCWs, the assessment of the mumps antibody titer before vaccination may be a useful complement to vaccination itself, because it is more accurate and cost-effective than direct immunization of unvaccinated subjects.

Background A recent study of World Trade Center (WTC)-exposed firefighters and emergency medical service workers demonstrated that elevated thyroid cancer incidence may be attributable to frequent medical testing, resulting in the identification of asymptomatic tumors. We expand on that study by comparing the incidence of thyroid cancer among three groups: WTC-exposed rescue/recovery workers enrolled in a New York State (NYS) WTC-medical monitoring and treatment program (MMTP); WTC-exposed rescue/recovery workers not enrolled in an MMTP (non-MMTP); and the NYS population. Methods Person-time began on 9/12/2001 or at enrollment in a WTC cohort and ended at death or on 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. We used Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for MMTP and non-MMTP participants. NYS rates were used as the reference. To estimate potential changes over time in WTC-associated risk, change points in RRs were estimated using profile likelihood. Results The thyroid cancer incidence rate among MMTP participants was more than twice that of NYS population rates (RR = 2.31; 95% CI = 2.00-2.68). Non-MMTP participants had a risk similar to NYS (RR = 0.96; 95% CI = 0.72-1.28). We observed no change points in the follow-up period. Conclusion Our findings support the hypothesis that no-cost screening (a benefit provided by WTC-MMTPs) is associated with elevated identification of thyroid cancer. Given the high survival rate for thyroid cancer, it is important to weigh the costs and benefits of treatment, as many of these cancers were asymptomatic and may have been detected incidentally.

PurposeCurrent injury surveillance efforts in agriculture are considerably hampered by the limited quantity of occupation or industry data in current health records. This has impeded efforts to develop more accurate injury burden estimates and has negatively impacted the prioritization of workplace health and safety in state and federal public health efforts. This paper describes the development of a Naïve Bayes machine learning algorithm to identify occupational injuries in agriculture using existing administrative data, specifically in pre-hospital care reports (PCR).MethodsA Naïve Bayes machine learning algorithm was trained on PCR datasets from 2008–2010 from Maine and New Hampshire and tested on newer data from those states between 2011 and 2016. Further analyses were devoted to establishing the generalizability of the model across various states and various years. Dual visual inspection was used to verify the records subset by the algorithm.ResultsThe Naïve Bayes machine learning algorithm reduced the volume of cases that required visual inspection by 69.5 percent over a keyword search strategy alone. Coders identified 341 true agricultural injury records (Case class = 1) (Maine 2011–2016, New Hampshire 2011–2015). In addition, there were 581 (Case class = 2 or 3) that were suspected to be agricultural acute/traumatic events, but lacked the necessary detail to make a certain distinction.ConclusionsThe application of the trained algorithm on newer data reduced the volume of records requiring visual inspection by two thirds over the previous keyword search strategy, making it a sustainable and cost-effective way to understand injury trends in agriculture.

Background: A high level of occupational noise exposure has been noted in the fishing sector. Yet, less is known regarding other navigation groups, such as merchant seafarers, since a French study in the 1980s. This study assesses hearing impairment (HI) in a French merchant seafarers’ population. Methods: We collected data of all audiograms performed in 2018 and 2019 for French merchant seafarers. For each seafarer, hearing ability was measured in both ears using pure-tone audiometry at the following frequencies: 0.5, 1, 2, 3, 4, 6, and 8 kHz. Hearing threshold levels (HTLs), or the intensity of sound below which no sound is detected, were measured in decibels Sound Pressure Level (dB SPL) at each frequency and recorded in 5 dB increments. For HI, we used the validated definition of the American Speech–Language–Hearing Association (ASHA). Results: We were able to include statistical analysis results of 8308 audiograms. In a multiple logistic regression adjusted for age, experience, and class of navigation, we found that experience of more than 14 years Odds Ratio OR 1.28 (CI 95% 1.07–1.53), age 31–40 OR 2.2 (CI 95% 1.4–3.4), and >40 years OR 14, 3 (IC 95% 9.7–21) and marine engineers OR 1.26 (IC 95% 1.01–1.57) were still risk factors for HI. Conclusion: In 2018, Marine engineers were still the workers’ group with a higher risk of HI in merchant seafarers but, notch at 4 Hz, specific of noise-induced hearing loss, has improved. They have an HI close to the definition of socioacousis and mean deficit differences with deck and services’ merchant seafarers improved. Our results could be interpreted as a limitation of occupational noise exposure impact in a merchant seafarers’ population, needing an improvement in prevention measures and also encouraged to continue to improve onboard working conditions.

Increasing amount of waste concurrently increases the risk of exposure to hazardous materials among waste collectors. Vigorous exertion in the field intensifies the abundance of contaminated inspirable droplets. If left undetected and untreated, it may provoke significant pernicious health effects and redundant burdens to employees and employers. The purpose of this study is to determine the prevalence of respiratory symptoms and their associated factors among domestic waste collectors.A cross-sectional study was conducted in Kota Kinabalu, Sabah between January and April 2020. Data were collected using a validated questionnaire which encompasses details about sociodemographic, health status, environment, and employment characteristics.A total of 290 waste collectors with a mean age of 40 (±9) years old were participated in the study. Most of them were from Kadazan-Dusun-Murut ethnic origin with educational background till secondary school. The average monthly income of the workers was USD 298.45 (±171.9) per month, and they had been in service for 11 (±9.04) years. Respiratory symptoms were seen in 21% of the workers. The identified significant risk factors were determined as underlying chronic diseases (OR=2.34; 95% CI=1.054, 5.219) and contact with pets (OR=1.87; 95% CI=1.004, 3.288).Respiratory symptoms are prevalent amidst domestic waste collectors and related to their health and field activities.Artan miktarda atık, atık toplayıcılar arasında tehlikeli maddelere maruz kalma riskini de aynı zamanda artırır. Sahada aşırı çalışma, kontamine damlacıkların solunma sıklığını artırır. Tespit edilmezse ve tedavi olunmazsa, önemli zararlı sağlık sorunlarına, çalışanlar ve işverenler üzerinde yüklere neden olabilir. Bu çalışmanın amacı, evsel atık toplayıcıları arasında solunum semptomlarının yaygınlığını ve ilişkili etkenleri belirlemektir.Ocak-Nisan 2020 döneminde Kota Kinabalu, Sabah’da kesitsel bir çalışma gerçekleştiril-miştir. Veriler, sosyodemografik değişkenler, sağlık durumu, çevre ve istihdam özellikleri ile ilgili ayrıntıları içeren geçerliği sağlanmış bir anket kullanılarak toplanmıştır.Ortalama yaşı 40 (±9) olan toplam 290 atık toplayıcı araştırmaya katılmıştır. Çoğu ancak ortaokula kadar eğitimli olan, Kadazan-Dusun-Murut etnik kökenli kişilerdir. İşçilerin aylık ortalama geliri 298,45 ABD doları (±171,9) olup, 11 (±9,04) yıldır hizmet vermektedirler. So-lunum semptomlarının yaygınlığı %21 çıkmıştır. Araştırmada önemli risk faktörleri, altta yatan kronik hastalığı olma (OR=2.34; %95 CI=1.054, 5.219) ve evcil hayvanlarla temas (OR=1.87; %95 CI=1.004, 3.288) olarak belirlenmiştir.Solunum semptomları evsel atık toplayıcılar arasında yaygındır ve bunlar kişilerin sağlık durumları ve sahadaki etkinlikleri ile ilişkilidir.

Varicella is a potentially serious infectious disease caused by Varicella-Zoster Virus (VZV). In Italy childhood varicella vaccine have gradually introduced into national immunization program since 2003 and from 2017 a two-doses schedule has been stated nationally for all newborns and has become compulsory for school attendance. VZV exposures among healthcare workers (HCWs) and patients can be really dangerous and expensive. According to Centers of Disease Control and Italian national immunization plan health care, institutions should verify that all HCWs have clear evidence of immunity to VZV and should ensure that susceptible subjects will receive 2 doses of VZV vaccine. Currently, the vaccination of HCWs is not compulsory in Italy and the risk of varicella infection among these subjects is not well known. We evaluated the clinical records of 840 HCWs (256 male and 584 female) who underwent the annual occupational screening, from 1st January to 31st August 2018. HCWs were divided into three subgroups according to their age: 18–30, 31–40, and over 40 years old. We compared the mean values of IgG-specific antibodies between the age group through analysis of variance (ANOVA). A total of 784 (93.33%) HCWs were protected for VZV IgG antibodies level. There wasn’t a significant difference between male and female while was found between age group (P

The field of reproductive epidemiology has primarily focused on reproductive outcomes and gynaecologic cancers. The study of non-cancerous, gynaecologic conditions (eg, uterine fibroids, endometriosis) has not received serious treatment in existing epidemiology textbooks and reproductive epidemiology curricula. Further, these conditions do not neatly fit into the other common subdisciplines within epidemiology (eg, infectious disease, cardiovascular, injury and occupational epidemiology and so on). In this commentary, we identify and illustrate three critical challenges to advancing the epidemiologic research of non-cancerous, gynaecologic conditions. With greater investment and a patient-centred approach, epidemiology can advance knowledge about this critical area of human welfare.

International audience; Background - In occupational epidemiology, a male-centered perspective often predominates. We aimed to describe current research practices in terms of gender consideration at different stages of epidemiological studies. Methods - A systematic review of occupational lung cancer publications indexed in PubMed was conducted over the period 2003-2014. Articles were described according to the sex composition of their study sample. Results - In 243 studies, 7 (3%) were women-only, 101 (41%) were mixed, with a disproportionate men-to-women ratio (P50 = 3.5; P75 = 12.4). A shift was observed from mixed and unspecified source populations to men-only final samples. Our results also suggest implicit generalization of results from men-only studies, a lack of tests of interaction and often unjustified sex-adjustment for mixed studies. Conclusions - The lower proportion of women in studies cannot be fully explained by their under-representation in the target populations, since there were large numbers of women among both potentially exposed workers and patients diagnosed with lung cancer.

Context The greenspace sector includes a broad range of occupations: gardeners, landscapers, municipal workers, maintenance operators of public facilities, golf-course employees and other sports facilities, horticulturists, plant and tree nursery workers etc. The health impact of occupational pesticide exposure has mainly been studied among farmers. Other professionals such as greenspace workers are also extremely exposed, presenting specific exposure features (practices, types of pesticide used). The aim of this review was to summarize epidemiological literature that examine the relationship between pesticide exposure and the risk of cancer and long-term health effects in greenspace workers. Method Six main groups of greenspace workers were identified and examined through a systematic literature review based on PubMed and Scopus. The studies were then grouped according to their design, health outcomes and the type of population studied. Results Forty-four articles were selected among the 1679 identified. Fifteen studies were conducted exclusively among greenspace workers, while ten also studied these workers with other pesticide applicators. Six were cohorts from the general population in which greenspace workers were identified. Elevated risks were found in several studies for leukaemia, soft-tissue sarcoma, multiple myeloma, non-Hodgkin lymphoma and Parkinson's disease. Discussion The majority of studies used rough parameters for defining exposure such as job titles which could lead to the misclassification of exposure, with the risk of false or positive negative conclusions. Health outcomes were mainly collected through registries or death certificates, and information regarding potential confounders was often missing. Conclusion The review identified only 15 studies conducted exclusively among greenspace workers. Elevated risk was found for several sites of cancer and Parkinson's diseases. Further epidemiological research is needed, conducted specifically on these workers, to better characterize this population, its exposure to pesticides and the related health effects.

We are deeply saddened by the passing of Professor Pietro (Pier) Alberto Bertazzi, MD, MPH, who died on 15 September 2021. Pier (as he was called) graduated in medicine in 1971. His early interest in epidemiology is testified by a thesis on epidemiological methods in occupational health as postgraduate student in occupational health in 1973. He was postdoctoral fellow at the department of epidemiology of the University of North Carolina in 1979–1980, then he was a visiting scientist at the National Institute for Occupational Safety and Health in 1980. He attended epidemiology courses in Finland, the USA and at the International Agency for Research on Cancer (IARC). Pier had a seminal role in fostering epidemiology in Italy by implementing the first occupational epidemiology unit at the Clinica del Lavoro ‘Luigi Devoto’, in Milan. In 1987, he organised courses with Harvey Checkoway and Neil Pearce (occupational epidemiology) and with David Kleimbaum …

Background: Occupational accidents in developing countries like Pakistan are obvious due to poor occupational health safety infrastructure. Objective: This retrospective study aimed to analyze the industrial accidents in factories of Pakistan during 1993-2009. Methods and Material: An index value calculation method used to investigate the trends of occupational accidents. Accident rate (103), fatal accident rate (105), and non-fatal accident rate (103) were also calculated. Pakistan Statistical Year Books published by Pakistan Bureau of Statistics (PBS) used as data source.Results: Data of total 10330 industrial accidents analyzed and decreasing accident rate found with average 3.1 accident per 103 factory workers. Fatal accident increased with an average of 23 fatal accidents per 105 factories workers. Regarding the severity of industrial accidents, minor accidents found at 74% followed by serious (18%) and fatal accidents (8%). Decreased trends of index values and accident rates can associate with the increased human development index of Pakistan, but increased fatal accidents in factories and under-reporting are major areas of concern for safety stakeholders. Conclusions: Despite industrial accidents decreased in factories but more in depth studies with more recent data about the root causes of accidents can be useful to draw a true picture of occupational accidents in Pakistan. Improved social security system in Pakistan can be helpful to the exact recording of occupational accidents data.

Exposure assessment efforts in population-based studies are increasingly incorporating measurements. The published literature was reviewed to identify the measurement sources and the approaches used to incorporate measurements into these efforts. The variety of occupations and industries in these studies made collecting participant-specific measurements impractical. Thus, the starting point was often the compilation of large databases of measurements from inspections, published literature, and other exposure surveys. These measurements usually represented multiple occupations, industries, and worksites, and spanned multiple decades. Measurements were used both qualitatively and quantitatively, dependent on the coverage and quality of the data. Increasingly, statistical models were used to derive job-, industry-, time period-, and other determinant-specific exposure concentrations. Quantitative measurement-based approaches are increasingly replacing expert judgment, which facilitates the development of quantitative exposure-response associations. Evaluations of potential biases in these measurement sources, and their representativeness of typical exposure situations, warrant additional examination.

Work ability (WA) is an important concept in occupational health research and for over 30 years assessed worldwide with the Work Ability Index (WAI). In recent years, criticism of the WAI is increasing and alternative instruments are presented. The authors postulate that theoretical and methodological issues need to be considered when developing alternative measures for WA and conclude that a short uni-dimensional measure is needed that avoids conceptual blurring. The aim of this contribution is to validate the short and uni-dimensional WAI components WAI 1 (one item measuring &ldquo, current WA compared with the lifetime best&rdquo, ) and WAI 2 (two items assessing &ldquo, WA in relation to the [mental/physical] demands of the job&rdquo, ). Cross-sectional and 12-month follow-up data of two large samples was used to determine construct validity of WAI 1 and WAI 2 and to relate this to respective results with the WAI. Data sources comprise nurses in Europe investigated in the European NEXT-Study (Sample A, Ncross-sectional = 28,948 and NLongitudinal = 9462, respectively) and nursing home employees of the German 3Q-Study (Sample B) where nurses (N = 786, 339, respectively) and non-nursing workers (N = 443, 196, respectively) were included. Concurrent and predictive validity of WAI 1 and WAI 2 were assessed with self-rated general health, burnout and considerations leaving the profession. Spearman rank correlation (&rho, ) with bootstrapping was applied. In all instances, WAI 1 and WAI 2 correlated moderately, and to a similar degree, with the related constructs. Further, WAI 1 and 2 correlated with WAI moderately to strongly with &rho, ranging from 0.72 to 0.76 (WAI 1) and 0.70&ndash, 0.78 (WAI 2). Based on the findings and supported by theoretical and methodological considerations, the authors confirm the feasibility of the short measures WAI 1 and WAI 2 for replacing WAI at least in occupational health research and employee surveys.

Training in modern medicine aims at teaching not only the structure and function of the human organism in health and in disease, but also it aims at revealing the factors responsible for human health. The second field of teaching is based mainly on epidemiology. In undergraduate teaching, the epidemiological training should be introduced as early as possible in the curriculum and possibly divided into two parts, theoretical and practical. With the increasing awareness that the maintenance of health in populations is an ecological problem, there is also a growing need for professional epidemiologists who could assist in recognizing health risks, assessing and developing prevention strategies and in arranging of health services in a responsible way. The objectives of graduate teaching in epidemiology are different from those of undergraduate teaching. The graduate teaching should cover not only professional epidemiologists but also should be addressed to health services administrators, clinicians and graduates from other specialists and paramedical and auxiliary personnel. The needs and requirements for teaching epidemiology in undergraduate and postgraduate levels have been discussed against the background of currently available courses in Europe and local perception of environmental and occupational problems in European countries.

Background Exposure to aerosols from metalworking fluids (MWF) has previously been related to a series of adverse health outcomes (eg, cancer, respiratory diseases). Our present epidemiological study focuses on occupational exposures to MWF and a panel of exposure and effect biomarkers. We hypothesize that these health outcomes are caused by particle exposure that generates oxidative stress, leading to airway inflammation and ultimately to chronic respiratory diseases. We aimed to assess whether MWF exposure, in particular as characterized by its oxidative potential, is associated with biomarkers of oxidative stress and inflammation as well as genotoxic effects. Objective The ultimate goal is to develop exposure reduction strategies based on exposure determinants that best predict MWF-related health outcomes. The following relationships will be explored: (1) exposure determinants and measured exposure; (2) occupational exposure and preclinical and clinical effect markers; (3) exposure biomarkers and biomarkers of effect in both exhaled breath condensate and urine; and (4) biomarkers of effect, genotoxic effects and respiratory symptoms. Methods At least 90 workers from France and Switzerland (30 controls, 30 exposed to straight MWF and 30 to aqueous MWF) were followed over three consecutive days after a nonexposed period of at least two days. The exposure assessment is based on MWF, metal, aldehyde, and ultrafine particle number concentrations, as well as the intrinsic oxidative potential of aerosols. Furthermore, exposure biomarkers such as metals, metabolites of polycyclic aromatic hydrocarbons and nitrosamine are measured in exhaled breath condensate and urine. Oxidative stress biomarkers (malondialdehyde, 8-isoprostane, 8-hydroxy-2’-deoxyguanosine, nitrates, and nitrites) and exhaled nitric oxide, an airway inflammation marker, are repeatedly measured in exhaled breath condensate and urine. Genotoxic effects are assessed using the buccal micronucleus cytome assay. The statistical analyses will include modelling exposure as a function of exposure determinants, modelling the evolution of the biomarkers of exposure and effect as a function of the measured exposure, and modelling respiratory symptoms and genotoxic effects as a function of the assessed long-term exposure. Results Data collection, which occurred from January 2018 until June 2019, included 20 companies. At the date of writing, the study included 100 subjects and 29 nonoccupationally exposed controls. Conclusions This study is unique as it comprises human biological samples, questionnaires, and MWF exposure measurement. The biomarkers collected in our study are all noninvasive and are useful in monitoring MWF exposed workers. The aim is to develop preventative strategies based on exposure determinants related to health outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/13744

Little is known about the heart disease risks associated with occupational, rather than traffic-related, exposure to particulate matter with aerodynamic diameter of 2.5 µm or less (PM2.5). We examined long-term exposure to PM2.5 in cohorts of aluminum smelters and fabrication workers in the United States who were followed for incident ischemic heart disease from 1998 to 2012, and we addressed 2 forms of survivor bias. Left truncation bias was addressed by restricting analyses to the subcohort hired after the start of follow up. Healthy worker survivor bias, which is characterized by time-varying confounding that is affected by prior exposure, was documented only in the smelters and required the use of marginal structural Cox models. When comparing always-exposed participants above the 10th percentile of annual exposure with those below, the hazard ratios were 1.67 (95% confidence interval (CI): 1.11, 2.52) and 3.95 (95% CI: 0.87, 18.00) in the full and restricted subcohorts of smelter workers, respectively. In the fabrication stratum, hazard ratios based on conditional Cox models were 0.98 (95% CI: 0.94, 1.02) and 1.17 (95% CI: 1.00, 1.37) per 1 mg/m(3)-year in the full and restricted subcohorts, respectively. Long-term exposure to occupational PM2.5 was associated with a higher risk of ischemic heart disease among aluminum manufacturing workers, particularly in smelters, after adjustment for survivor bias.

I aimed to assess current practices and opportunities for addressing the problem of errors in exposure in occupational epidemiology. Occupational epidemiologists appreciate that errors in exposure are a concern, but almost none correct for these errors, although there are currently no theoretical and practical barriers for this inertia. The most serious barrier to change is a faulty belief that a well-conducted epidemiologic study suffers only non-differential exposure misclassification and that its sole impact is to attenuate risk gradients, causing a false negative. On the contrary, differential exposure misclassification is the most defensible model in occupational epidemiology, and errors in exposure increase chance of both false positive and negative results. Resistance to mathematical adjustment (correction) for errors in exposure is equivalent to denying the value of more valid exposure estimates and undermines the discipline’s relevance to protection of workers by informing workplace exposure limits.

Occupational epidemiology studies the distribution of health events and health related determinants and its relation to the working environment. Environmental epidemiology focuses on the involuntary exposure to physical and chemical factors in the indoor or outdoor environment that may affect health patterns. Occupational and environmental epidemiology use similar methodology although the conditions differ. The environmental epidemiology studies beyond the health effect of exposure to specific environmental factors and must consider the long-term impact of the ecosystems to nearby populations. Molecular technologies allow the detection of effects at the molecular level originated by very low levels of exposure. The concept of an exposome is a kind of database with information concerning environmental exposure measurements in a life time and corresponding biomarkers concentrations in different biospeciments, considering internal individual genetic characteristics.

To assess the state of Swiss occupational health (OH) research over the period 2008–2017. Two types of indicators were constructed, focused, respectively, on resources available for OH research and its output. Data for their assessment were gathered from specialized research institutions, professional associations, and the Swiss Federal Statistical Office. Thirty-two of 317 Ph.D./M.D.–Ph.D. theses delivered were in the field of OH. The number of OH physicians progressed substantially, but the density of OH professionals per number of active workers showed important variations between OH disciplines and geographical regions. The number of yearly peer-reviewed publications increased substantially but represented 6% of publications in public health in 2017. Psychological and respiratory health conditions were the most studied topics, while papers on cancers accounted for only 10%. This study suggests a limited place of OH research in the Swiss public health landscape and the need for a national research effort in OH. This requires an improved collaboration between regional and federal authorities and communication/coordination between public health authorities and OH executive institutions belonging to the economic sector.

Aims: Police have a high prevalence of musculoskeletal disorders. While physical factors contributing to this have been explored, little is known regarding the contribution of the psychosocial work environment. This study explores the association between elements of the JDC model, social support and multi-site musculoskeletal pain among Swedish police. Methods: In this cross-sectional study, responses from 4185 police were collected using a self-administered online survey. The survey included questions on the psychosocial work environment and musculoskeletal pain, as well as several potential confounding factors. Logistic regression analyses were performed to explore the degree of association between 1) the indices for job demands, job control, social support and multi-site musculoskeletal pain and 2) the four categories of the JDC model, social support and multi-site musculoskeletal pain. Results: The overall psychosocial work environment of Swedish police was characterised by low control and high social support. Police who reported active and high strain jobs were found to have an increase in the odds ratio for multi-site musculoskeletal pain (OR 1.45 (95% CI 1.08–1.94) and 1.84 (1.51–2.24), respectively). High demands, which is a component in the categories for active and high strain jobs, was also found to be associated with an increase in the odds ratio for multi-site musculoskeletal pain (OR 1.66 (1.45–1.91)). High social support was associated with a decrease in the odds ratio for multi-site musculoskeletal pain (OR 0.72 (0.57–0.86)). Conclusions: The psychosocial work environment should be considered when investigating factors related to the health and wellbeing of police.

BACKGROUND: Work history data often require major data management including handling of overlapping jobs to avoid overestimating exposure before exposure linkage to job-exposure matrices (JEMs) is possible. METHODS: In a case-cohort study of 1825 Norwegian offshore petroleum workers, 3979 jobs were reported (mean duration 2417 days/job; maximum 8 jobs/worker). Each job was assigned to one of 27 occupation categories. Overlapping jobs of the same category (1142 jobs) were collapsed and overlapping jobs of different categories (1013 jobs) were split. The resulting durations were weighted by a factor accounting for the number of overlapping jobs. RESULTS: Collapsing overlapping jobs within the same category resulted in 3295 jobs (mean 2629 days/job). Splitting overlapping jobs of different categories increased the number to 4239 jobs (mean 2043 days/job), while the total duration in days dropped with 10%. CONCLUSIONS: We demonstrated that overlapping employment data structures can be harmonized in a systematic and unbiased way, preparing work history data for linkage to several JEMs.

Background Flight attendants are an understudied occupational group, despite undergoing a wide range of adverse job-related exposures, including to known carcinogens. In our study, we aimed to characterize the prevalence of cancer diagnoses among U.S. cabin crew relative to the general population. Methods In 2014–2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their self-reported cancer diagnoses to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013–2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and the prevalence of selected cancers, using logistic regression and adjusting for potential confounders. Results Compared to NHANES participants with a similar socioeconomic status (n = 2729), flight attendants (n = 5366) had a higher prevalence of every cancer we examined, especially breast cancer, melanoma, and non-melanoma skin cancer among females. SPR for these conditions were 1.51 (95% CI: 1.02, 2.24), 2.27 (95% CI: 1.27, 4.06), and 4.09 (95% CI: 2.70, 6.20), respectively. Job tenure was positively related to non-melanoma skin cancer among females, with borderline associations for melanoma and non-melanoma skin cancers among males. Consistent with previous studies, we observed associations between job tenure and breast cancer among women who had three or more children. Conclusions We observed higher rates of specific cancers in flight attendants compared the general population, some of which were related to job tenure. Our results should be interpreted in light of self-reported health information and a cross-sectional study design. Future longitudinal studies should evaluate associations between specific exposures and cancers among cabin crew. Electronic supplementary material The online version of this article (10.1186/s12940-018-0396-8) contains supplementary material, which is available to authorized users.

Introduction Peak exposures, often characterised by short-term high intensities, are well established as major etiological contributors to acute adverse health outcomes. Associations between peak chemical exposures and risk of occupational cancers have been contrasted with observed effects related to more conventional metrics, cumulative exposure and exposure duration. However, the definitions of peak exposure have been highly idiosyncratic, which complicates data interpretation, risk assessment and ultimately setting occupational exposure standards. Thus, there is a need to develop a standardised epidemiologic framework for defining and assessing peak exposures in occupational epidemiology studies of chemical carcinogens, with consideration of underlying toxicological mechanisms, exposure assessment requirements, and policy implications. Methods We reviewed and contrasted cancer risk findings for peak and cumulative exposures from influential occupational epidemiology studies of benzene and formaldehyde, both classified by IARC as causes of lymphohematopoetic malignancies (LHM) in humans, and for some other possible chemical carcinogens. Results There is evidence for a strong association between high cumulative exposure to benzene and AML, but little support for an etiologic relation with peak exposure; in contrast, peak benzene exposure has been associated with risk of myelodysplastic syndrome. Peak, but not cumulative formaldehyde exposure has been associated with various LHM. For styrene, no relationship was seen between number of peaks and several cancers of interest. These patterns may be due to variable definitions of peak exposures or may reflect differences in toxicokinetic and carcinogenic mechanisms of these chemicals. Discussion A peak exposure should be defined quantitatively in terms of exposure intensity, duration, and frequency of occurrence. Future epidemiologic research should apply standardised definitions that can be applied to existing datasets and in newly initiated epidemiologic studies that are consistent with or shed light on the underlying disease processes.

Professors:1Leon Guo, 2Po-Chin Chu, 3R Mendes, 4O Dumas, 5AM Neophytou 1National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan 2Environmental and Occupational Medicine, National Taiwan University College of Medicine and NTU Hospital, Taipei, Taiwan 3National Association of Occupational Medicine (ANAMT), Sao Paulo – SP, Brazil 4INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches & University Versailles Saint-Quentin-en-Yvelines, Villejuif, France 5Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA

Prospective cohorts have played a major role in understanding the contribution of diet, physical activity, medical conditions, and genes to the development of many diseases, but have not been widely used for occupational exposures. Studies in agriculture are an exception. We draw upon our experience using this design to study agricultural workers to identify conditions that might foster use of prospective cohorts to study other occupational settings. Prospective cohort studies are perceived by many as the strongest epidemiologic design. It allows updating of information on exposure and other factors, collection of biologic samples before disease diagnosis for biomarker studies, assessment of effect modification by genes, lifestyle, and other occupational exposures, and evaluation of a wide range of health outcomes. Increased use of prospective cohorts would be beneficial in identifying hazardous exposures in the workplace. Occupational epidemiologists should seek opportunities to initiate prospective cohorts to investigate high priority, occupational exposures.

Objective This study examines asthma risk in facilities producing toluene diisocyanate (TDI). Methods A total of 197 workers were monitored from 2007 to 2012. TDI air concentrations were used to estimate exposures. Results The incidence of cases consistent with TDI-induced asthma was 0.009 per person-years (seven cases) or consistent with TDI-induced asthma or asthma indeterminate regarding work-relatedness was 0.012 (nine cases). Increased risk of cases consistent with TDI asthma was observed for cumulative (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.07 to 4.05) per logarithm parts per billion-years and peak TDI exposures (OR = 1.18, 95% CI 1.06 to 1.32) (logarithm parts per billion). There was a weak association with cumulative and peak exposures for decline of short-term forced expiratory volume in one second (FEV1). Asthma symptoms were associated with workers noticing an odor of TDI (OR 6.02; 95% CI 1.36 to 26.68). Conclusions There is evidence that cumulative and peak exposures are associated with TDI-induced asthma.

Background Flight attendants at Alaska Airlines reported health symptoms after the introduction of new uniforms in 2011. The airline replaced the uniforms in 2014 without acknowledging harm. To understand possible uniform-related health effects, we analyzed self-reported health symptoms in crew who participated in the Harvard Flight Attendant Health Study between 2007 and 2015, the period before, during, and after the introduction of new uniforms. Methods We calculated a standardized prevalence of respiratory, dermatological and allergic symptoms at baseline, as well as during and after uniform changes in 684 flight attendants with a varying number of surveys completed across each time point. We used Generalized Estimating Equations (GEE) to model the association between symptoms at baseline versus the exposure period after adjusting for age, gender and smoking status and weighting respondents for the likelihood of attrition over the course of the study period. Results We found the following symptom prevalence (per 100) increased after the introduction of new uniforms: multiple chemical sensitivity (10 vs 5), itchy/irritated skin (25 vs 13), rash/hives (23 vs 13), itchy eyes (24 vs 14), blurred vision (14 vs 6), sinus congestion (28 vs 24), ear pain (15 vs 12), sore throat (9 vs 5), cough (17 vs 7), hoarseness/loss of voice (12 vs 3), and shortness of breath (8 vs 3). The odds of several symptoms significantly increased compared to baseline after adjusting for potential confounders. Conclusion This study found a relationship between health complaints and the introduction of new uniforms in this longitudinal occupational cohort.

Background Sickness absence, work disability associated with illness or injury, is a major public health problem worldwide. Some studies have investigated determinants of sickness absence among workers with shorter job tenure, but have only focused on certain diagnostic groups. Although it is well established that job tenure has an inverse relationship with work injury rate, less is known about its association with sickness absence for other disorders. Therefore, this study aimed to investigate the risk factors for incidence and duration of sickness absence according to diagnosis over a 7-year period. A dynamic cohort consisting of all permanent civil servants hired from 2005 to 2011 by the Goiania municipality-Brazil. Data of certified sickness absences longer than 3 days were analyzed. The incidence density was calculated per 1000 person-years in each ICD-10 category. The association between sickness absence and socio-demographic and occupational characteristics was examined using negative binomial regression models. Results 18,450 workers, mean age of 32 years, accumulated 14,909 episodes of sickness absence. Overall, the incidence density was 234.6 episodes per 1000 person years. Diagnostic groups with the highest incidence density of sickness absences were injuries (49.1), musculoskeletal disorders (31.3) and mental disorders (29.2). Factors predicting any sickness absence were female gender, older age, low education, being a health professional, multiple jobs and full-time employment. Mental health disorders were more common among education professionals, musculoskeletal disorders among blue collar workers and injuries among inspection workers. Prolonged time on sick leave was associated with male gender, older age groups, low education and income, blue-collar workers, more than one job contract and full time employment. Conclusions These findings demonstrate a substantial sickness absentee burden and they provide relevant information for targeting prevention and health promotion policies to the most vulnerable occupational groups. Electronic supplementary material The online version of this article (10.1186/s13104-017-3116-5) contains supplementary material, which is available to authorized users.

Occupational exposures extending over a long working life can have complex relationships with health outcomes, as timing, duration, and intensity of exposure are all potentially relevant. Simple measures of cumulative, or average intensity of exposure typically considered in occupational studies may not fully capture these relationships. We applied distributed non-linear lag models to examine the association of crystalline silica exposures with mortality from lung cancer and non-malignant respiratory disease. We fitted Cox proportional hazard models for each cause of interest to data from a cohort study of 2342 California diatomaceous earth workers exposed to crystalline silica. Our models combined various functions for exposure-response and lag-response including linear, piece-wise constant and spline functions. Models with a spline function for exposure-response and a constant term for the lag-response appeared to have the best fit for lung cancer, while models with spline functions for both exposure-response and lag-response had the best fit for non-malignant respiratory disease. Hazard ratios (HR) from these best fitting models corresponding to average daily exposures of 275 µg/m3 during lag years 11–40 prior to the age of observed cases were 1.96 (95% confidence interval (CI) 0.95–4.06) and 2.01 (95% CI: 1.02–3.97) for the two outcomes respectively. HRs from simple models with linear exposure-response and constant lag-response terms for the same exposure scenario were 1.15 (95% CI: 0.88–1.49) and 1.21 (95% CI: 1.01–1.44) respectively. Occupational studies of longitudinal cohorts with detailed exposure histories could benefit from methods allowing for non-linearities and the disentanglement of intensity, duration and timing of exposure.

Objectives No study so far has combined register-based socioeconomic information with self-reported information on health, demographics, work characteristics and social environment in one study. The aim of this study is to investigate whether socioeconomic, health, demographic, work characteristics and social environmental characteristics independently predict working beyond retirement. Methods Questionnaire data from the Study on Transitions in Employment, Ability and Motivation was linked to data from Statistics Netherlands. A prediction model was built consisting of the following blocks: socioeconomic, health, demographic, work characteristics and social environment. First, univariate analyses were performed (p Results In the final model, only factors from the blocks health, work and social environmental characteristics remained. In the final model, better physical health, >2 days/week intensively physically active, higher body height and working in healthcare predicted working beyond retirement. If respondents had a permanent contract or worked in handcraft, or had a partner that did not like them to work until the official retirement age, they were less likely to work beyond retirement. Area under the curve was 73% (p Conclusion Health, work characteristics and social environment predicted working beyond retirement, but register-based socioeconomic and demographic characteristics did not independently predict working beyond retirement. This study shows that working beyond retirement is multifactorial.