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BackgroundTraumatic brain injury (TBI) is a public health concern that can occur in a range of contexts. Work-related TBI (wrTBI) is particularly concerning. Despite overall work-related injury claims decreasing, the proportion of claims that are wrTBI have increased, suggesting prevention and support of wrTBI requires ongoing attention.ObjectivesThis review aimed to provide updated information on the burden and risk factors of wrTBI among the working adult population.MethodsMedline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a combination of TBI, work, and epidemiology text words and medical subject headings. Two reviewers independently assessed articles for inclusion. Meta-analyses were conducted to estimate prevalence and mortality of wrTBI and a narrative synthesis was conducted to provide additional context.ResultsPooled proportions meta-analyses estimate that 17.9% of TBIs were work-related and 6.3% of work-related injuries resulted in TBI, with 3.6% of wrTBI resulting in death. Populations of wrTBI were predominantly male (76.2%) and were 40.4 years of age, on average. The most commonly reported industries for wrTBI were education and training, healthcare and social assistance, construction, manufacturing, and transportation. Falls, being struck by an object or person, motor vehicle collisions, and assaults were the most commonly reported mechanisms of wrTBI.ConclusionsA better understanding of the epidemiology of wrTBI can inform prevention and management strategies. This review highlights existing gaps, including a notable lack of sex or gender stratified data, to direct future investigation.PROSPERO registration numberCRD42020169642.

ObjectiveThis study was designed to reveal the relationship between the use and type of eye protection and the occurrence of work-related corneal and conjunctival foreign body injuries.MethodsThis is a retrospective cohort study of patients with work-related corneal and/or conjunctival foreign body injuries between 1 August 2017 and 31 July 2018. They were all diagnosed and treated at Jia Ding Hospital affiliated to the Shanghai University of Medicine and Health Sciences in Shanghai, China. All patients received a comprehensive eye examination and a face-to-face interview using a structured questionnaire by ophthalmologists.ResultsA total of 426 consecutive patients were included in the study. The majority of work-related eye injuries occurred in men (94.17%). Summer was the season that had the highest incidence of eye injuries, especially in July and August (38.03%). There were 290 patients (68.08%) that were injured more than once. The ratio of eye protection use to non-protection was 1:7 at the first time of eye injury. The ratio improved to 1:3 on subsequent injury. A majority of employers (79.11%) provided eye protection to employees. However, 19.95% of the workers were injured despite wearing a pair of protective spectacles. The causes of work-related eye injury were as follows: no eye protections provided (20.89%); unawareness of work safety (30.99%); defect of spectacles (47.18%).ConclusionsProtection use at work effectively prevents work-related eye injuries. Both employers and employees require improved awareness of workplace hazards and personal protection. Eye protection should be selected appropriately according to the work environment.

ObjectivesWork-related lung diseases (WRLDs) are entirely preventable. To assess the impact of WRLDs on the US transplant system, we identified adult lung transplant recipients with a WRLD diagnosis specified at the time of transplant to describe demographic, payer and clinical characteristics of these patients and to assess post-transplant survival.MethodsUsing US registry data from 1991 to 2018, we identified lung transplant recipients with WRLDs including coal workers’ pneumoconiosis, silicosis, asbestosis, metal pneumoconiosis and berylliosis.ResultsThe frequency of WRLD-associated transplants has increased over time. Among 230 lung transplants for WRLD, a majority were performed since 2009; 79 were for coal workers’ pneumoconiosis and 78 were for silicosis. Patients with coal workers’ pneumoconiosis were predominantly from West Virginia (n=31), Kentucky (n=23) or Virginia (n=10). States with the highest number of patients with silicosis transplant were Pennsylvania (n=12) and West Virginia (n=8). Patients with metal pneumoconiosis and asbestosis had the lowest and highest mean age at transplant (48.8 and 62.1 years). Median post-transplant survival was 8.2 years for patients with asbestosis, 6.6 years for coal workers’ pneumoconiosis and 7.8 years for silicosis. Risk of death among patients with silicosis, coal workers’ pneumoconiosis and asbestosis did not differ when compared with patients with idiopathic pulmonary fibrosis.ConclusionsLung transplants for WRLDs are increasingly common, indicating a need for primary prevention and surveillance in high-risk occupations. Collection of patient occupational history by the registry could enhance case identification and inform prevention strategies.

ObjectivesThe objective of this historical cohort study was to determine the claimant and prescriber factors associated with receiving opioids at first postinjury dispense compared with non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) in a sample of workers’ compensation claimants with low back pain (LBP) claims between 1998 and 2009 in British Columbia, Canada.MethodsAdministrative workers’ compensation, prescription and healthcare data were linked. The association between claimant factors (sociodemographics, occupation, diagnosis, comorbidities, pre-injury prescriptions and healthcare) and prescriber factors (sex, birth year, specialty) with drug class(es) at first dispense (opioids vs NSAIDs/SMRs) was examined with multilevel multinomial logistic regression.ResultsIncreasing days supplied with opioids in the previous year was associated with increased odds of receiving opioids only (1–14 days OR 1.62, 95% CI 1.51 to 1.75; ≥15 days OR 5.12, 95% CI 4.65 to 5.64) and opioids with NSAIDs/SMRs (1–14 days OR 1.49, 95% CI 1.39 to 1.60; ≥15 days OR 2.82, 95% CI 2.56 to 3.12). Other significant claimant factors included: pre-injury dispenses for NSAIDs, SMRs, antidepressants, anticonvulsants and sedative-hypnotics/anxiolytics; International Statistical Classification of Diseases and Related Health Problems, 9th Revision diagnosis; various pre-existing comorbidities; prior physician visits and hospitalisations; and year of injury, age, sex, health authority and occupation. Prescribers accounted for 25%–36% of the variability in the drug class(es) received, but prescriber sex, specialty and birth year did not explain observed between-prescriber variation.ConclusionsDuring this period in the opioid crisis, early postinjury dispensing was multifactorial, with several claimant factors associated with receiving opioids at first prescription. Prescriber variation in drug class choice appears particularly important, but was not explained by basic prescriber characteristics.

ObjectivesFour machine manufacturing facility workers had a novel occupational lung disease of uncertain aetiology characterised by lymphocytic bronchiolitis, alveolar ductitis and emphysema (BADE). We aimed to evaluate current workers’ respiratory health in relation to job category and relative exposure to endotoxin, which is aerosolised from in-use metalworking fluid.MethodsWe offered a questionnaire and spirometry at baseline and 3.5 year follow-up. Endotoxin exposures were quantified for 16 production and non-production job groups. Forced expiratory volume in one second (FEV1) decline ≥10% was considered excessive. We examined SMRs compared with US adults, adjusted prevalence ratios (aPRs) for health outcomes by endotoxin exposure tertiles and predictors of excessive FEV1 decline.ResultsAmong 388 (89%) baseline participants, SMRs were elevated for wheeze (2.5 (95% CI 2.1 to 3.0)), but not obstruction (0.5 (95% CI 0.3 to 1.1)). Mean endotoxin exposures (range: 0.09–28.4 EU/m3) were highest for machine shop jobs. Higher exposure was associated with exertional dyspnea (aPR=2.8 (95% CI 1.4 to 5.7)), but not lung function. Of 250 (64%) follow-up participants, 11 (4%) had excessive FEV1 decline (range: 403–2074 mL); 10 worked in production. Wheeze (aPR=3.6 (95% CI 1.1 to 12.1)) and medium (1.3–7.5 EU/m3) endotoxin exposure (aPR=10.5 (95% CI 1.3 to 83.1)) at baseline were associated with excessive decline. One production worker with excessive decline had BADE on subsequent lung biopsy.ConclusionsLung function loss and BADE were associated with production work. Relationships with relative endotoxin exposure indicate work-related adverse respiratory health outcomes beyond the sentinel disease cluster, including an incident BADE case. Until causative factors and effective preventive strategies for BADE are determined, exposure minimisation and medical surveillance of affected workforces are recommended.

IntroductionWorkplace violence carries a substantial economic loss burden. Up to 10% of all traumatic brain injury (TBI) admissions result from physical assault. There remains a paucity of research on assault as a mechanism of injury, taking into account sex, and its association with work re-entry.ObjectivesThe aim of this study was to characterise, by sex, the sample of workers who had sustained a work-related mild TBI (wr-mTBI) and to assess the independent influence of assault, as a mechanism of injury, on time away from work.MethodsA population-based retrospective cohort of workers’ compensation claimants in Australia (n=3129) who had sustained a wr-mTBI was used for this study. A multivariable logistic regression analysis assessed whether workers who had sustained wr-mTBI as a result of assault (wr-mTBI-assault) were more likely to claim time off work compared with workers who had sustained a wr-mTBI due to other mechanisms.ResultsAmong claimants who sustained a wr-mTBI, 9% were as a result of assault. The distribution of demographic and vocational variables differed between the wr-mTBI-assault, and not due to assault, both in the full sample, and separately for men and women. After controlling for potential confounding factors, workers who sustained wr-mTBI-assault, compared with other mechanisms, were more likely to take days off work (OR 2.14, 95% CI 1.53 to 2.99) within a 3-month timeframe.ConclusionThe results have policy-related implications. Sex-specific and workplace-specific prevention strategies need to be considered and provisions to support return-to-work and well-being within this vulnerable cohort should be examined.

Half of those recently surveyed by the BMA (43%) said that they were currently experiencing work related depression, anxiety, stress, burnout, emotional distress, or other mental health condition and that it was worse than it had been before the pandemic.1 Indeed, the recent General Medical Council survey of doctors in …

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access (PTA) to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA.

IntroductionWork-related musculoskeletal (MSK) pain is a highly prevalent condition and one of the main contributors to disability and loss of work capacity. Current approaches to the management and prevention of work-related MSK pain do not consistently integrate current evidence-based knowledge and seem to be outdated. The Prevent4Work (P4W) Project aims to collect and spread evidence-based information to improve the management and prevention of work-related MSK pain. P4W will longitudinally investigate (1) risk factors associated with the prevalence of work-related MSK pain, (2) predictive factors for new events of work-related MSK pain in the short term and (3) the modification of pain beliefs after participating in evidence-based e-learning courses.Methods and analysisThis project employs a mixed-methods design with international cohorts of workers from Spain, Italy and Denmark. All participants will be assessed using self-reported variables at baseline (ie, cross-sectional design) with follow-up after 3 and 6 months (ie, prospective–predictive design). Throughout the first phase (0–3 months), all participants will be offered to self-enrol in e-learning courses on work-related MSK pain. Changes in pain beliefs (if any) will be assessed. The dataset will include sociodemographic characteristics, physical and psychological job demands, lifestyle-related factors, MSK pain history and pain beliefs. At baseline, all participants will additionally complete the P4W questionnaire developed to detect populations at high risk of suffering work-related MSK pain.Descriptive statistics, binary logistic regression, and analysis of variance will be used to identify the significant factors that influence the history of work-related MSK pain, evaluate the short-term prediction capacity of the P4W questionnaire, and investigate whether workers’ participation in e-learning courses will modify their pain beliefs.Ethics and disseminationThe study received ethical approval from the Ethical Committee of San Jorge University (USJ011-19/20). The results will be made available via peer-reviewed publications, international conferences and P4W official channels.

The objective of this systematic review and meta-analysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the references of a systematic review performed for the period before 2009. Primary cross-sectional and longitudinal studies were included when outcome data were described in terms of clinically assessed soft tissue shoulder disorders and at least two levels of work-related exposure were mentioned (exposed vs less or non-exposed). Two authors independently selected studies, extracted data and assessed study quality. For longitudinal studies, we performed meta-analyses and used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the evidence for the associations between risk factors and the onset of shoulder disorders. Twenty-seven studies met the inclusion criteria. In total, 16 300 patients with specific soft tissue shoulder disorders from a population of 2 413 722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis of one case-control and six prospective cohort studies. This meta-analysis revealed moderate evidence for associations between shoulder disorders and arm-hand elevation (OR=1.9, 95% CI 1.47 to 2.47) and shoulder load (OR=2.0, 95% CI 1.90 to 2.10) and low to very low evidence for hand force exertion (OR=1.5, 95% CI 1.25 to 1.87), hand-arm vibration (OR=1.3, 95% CI 1.01 to 1.77), psychosocial job demands (OR=1.1, 95% CI 1.01 to 1.25) and working together with temporary workers (OR=2.2, 95% CI 1.2 to 4.2). Low-quality evidence for no associations was found for arm repetition, social support, decision latitude, job control and job security. Moderate evidence was found that arm-hand elevation and shoulder load double the risk of specific shoulder disorders. Low to very-low-quality evidence was found for an association between hand force exertion, hand-arm vibration, psychosocial job demands and working together with temporary workers and the incidence of specific shoulder disorders.

It has been suggested that certain types of work may increase the risk of common mental disorders, but the exact nature of the relationship has been contentious. The aim of this paper is to conduct the first comprehensive systematic meta-review of the evidence linking work to the development of common mental health problems, specifically depression, anxiety and/or work-related stress and to consider how the risk factors identified may relate to each other. MEDLINE, PsychInfo, Embase, the Cochrane Collaboration and grey literature databases were systematically searched for review articles that examined work-based risk factors for common mental health problems. All included reviews were subjected to a quality appraisal. 37 review studies were identified, of which 7 were at least moderate quality. 3 broad categories of work-related factors were identified to explain how work may contribute to the development of depression and/or anxiety: imbalanced job design, occupational uncertainty and lack of value and respect in the workplace. Within these broad categories, there was moderate level evidence from multiple prospective studies that high job demands, low job control, high effort-reward imbalance, low relational justice, low procedural justice, role stress, bullying and low social support in the workplace are associated with a greater risk of developing common mental health problems. While methodological limitations continue to preclude more definitive statements on causation between work and mental disorders, there is now a range of promising targets for individual and organisational-level interventions aimed at minimising mental health problems in the workplace.

ObjectivesThe healthy worker survivor effect (HWSE) usually leads to underestimation of the effects of harmful occupational exposures. HWSE is characterised by the concomitance of three associations: (1) job status–subsequent exposure, (2) job status–disease and (3) previous exposure–job status. No study has reported the coexistence of these associations in the relationship between psychosocial work-related factors and health. We assessed if HWSE is present when measuring the effects of cumulative exposure to psychosocial work-related factors on the prevalence of hypertension in white-collar workers.MethodsData were obtained from two timepoints (1991–1993 at baseline and 1999–2001 at follow-up) of a prospective cohort study. At baseline, the population was composed of 9188 white-collar employees (women: 49.9%) in Quebec City. Job strain as psychosocial work-related factor and blood pressure were measured using validated methods. Job status (retirees vs employees) at follow-up was self-reported. Multiple multilevel robust Poisson regressions were used to estimate prevalence ratios of hypertension and risk ratios of retirement separately by gender. We performed multiple imputations to control selection bias due to missing values.ResultsRetirement eliminated the subsequent exposure to job strain de facto and was associated with the reduction in the prevalence of hypertension in younger (−33%) and older (−11%) men and in older women (−39%). Job strain was associated with job status in younger men and in women of any age.ConclusionData showed the presence of HWSE in younger men and older women given the coexistence of the three structural associations.

Background:Current treatments for systemic sclerosis-associated interstitial lung disease (SSc-ILD) are characterised by different attributes such as mode of administration, adverse events (AE) and efficacy. Physicians and patients often have different perspectives on treatments, thus shared decision-making between patients and physicians is essential. An understanding of patients’ decision processes when weighing treatment attributes and the trade-offs they are willing to make is important for shared decision-making.Objectives:The study aimed to 1) identify relevant treatment attributes, 2) elicit patient preferences for these attributes and 3) quantify preference as relative attribute importance (RAI; a higher RAI indicates that more of the variability in patients’ responses may be explained by changes in the attribute); and maximum acceptable risk (MAR) of diarrhoea, nausea and/or vomiting (MAR is a trade-off measure that evaluates attributes in risk-equivalences as a unit of measurement).Methods:A discrete choice experiment (DCE) was created, based on a literature review, a patient advisory board, qualitative patient interviews, and a workshop involving SSc-ILD expert physicians. Seven SSc-ILD treatment attributes were identified: 1) mode of administration; 2) shortness of breath; 3) skin tightness; 4) cough; 5) tiredness; 6) risk of gastrointestinal tract (GIT) AEs; and 7) risk of serious and non-serious infections. The levels of AE risk were informed by frequencies observed in clinical trials and patient input during the interviews. The DCE was integrated into an online survey, which asked patients to make repeated choices between two alternatives described by varying levels of included attributes. Patients with SSc-ILD were recruited by physician referral from Switzerland, Norway, France, Germany and the USA. DCE data were analysed using a logit model, and RAI and MAR measures were calculated.Results:A total of 231 patients with physician-confirmed SSc-ILD (mean age 52.6±13.2 years; 54% diagnosed for >5 years) completed the survey. Patients with SSc-ILD mostly preferred twice-daily oral treatments (pPatients accepted an additional 21% risk (95% CI 13–29%) of GIT AEs if they could reduce the frequency of infusions from monthly to 6–12 monthly, or accepted an extra 15% (95% CI 7–23%) increase in risk if changing to an oral treatment twice daily. Among symptoms, an additional 28% (95% CI 20–36%) risk of GIT AEs was considered acceptable if the severity of patients’ persistent cough was reduced to a level that was easier to tolerate, even if it remained persistent. Similarly, a 37% (95% CI 28–46%) increase in the risk of GIT AEs was acceptable if it resulted in breathlessness during routine activities rather than breathlessness at rest. Finally, patients were willing to accept an additional 36% risk (95% CI 27–45%) of GIT AEs if it reduced their risk of non-serious infections from 30% to 15% and of serious infections from 10% to 5%.Conclusion:This is the first study to quantitatively elicit patients’ preferences for attributes of SSc-ILD treatments. Preferences were driven by safety, efficacy and technical considerations. Patients showed willingness to make trade-offs, providing a firm basis for shared decision-making in routine clinical practice.Disclosure of Interests:Cosimo Bruni Speakers bureau: Actelion, Consultant of: Eli Lilly, Grant/research support from: Gruppo Italiano Lotta alla Scleroderma (GILS), Fondazione Italiana per la Ricerca sull’Artrite (FIRA), New Horizon Fellowship, European Scleroderma Trial and Research (EUSTAR), Foundation for Research in Rheumatology (FOREUM)., Sebastian Heidenreich Consultant of: Sebastian Heidenreich, PhD is employed by Evidera Inc, a business unit of PPD. Evidera is a CRO that offers paid research services to pharmaceutical companies., Ashley Duenas Consultant of: Yes. I am an employee of Evidera which received funding from Boehringer Ingelheim for work related to this study., Anna-Maria Hoffmann-Vold Speakers bureau: Boehringer Ingelheim, Actelion, Roche, Merck Sharp & Dohme, Lilly, Consultant of: Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp & Dohme, ARXX, Lilly and Medscape, Grant/research support from: Boehringer Ingelheim, Armando Gabrielli Grant/research support from: Pfizer Bhering, Yannick Allanore Consultant of: Honorarium received from Boehringer, Medsenic,Sanofi, Menarini, Grant/research support from: Grants received from Alpine, Ose Immunogenetics, Emmanuel Chatelus: None declared, Jörg H.W. Distler Shareholder of: JHWD is stock owner of 4D Science, Consultant of: JHWD has consultancy relationships with Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB, Grant/research support from: JHWD has received research funding from Anamar, Active Biotech, Array Biopharma, ARXX, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB, Eric Hachulla: None declared, Vivian Hsu Speakers bureau: I am a speaker for Boehringer Ingelheim Pharmaceuticals, Consultant of: with Boehringer Ingelheim Pharmaceuticals, Grant/research support from: Principal Investigator for several clinical trials, currently with Genentech, Corbus Pharmaceutical, and EICOS, Nicolas Hunzelmann Speakers bureau: Boehringer, Roche, Sanofi, Dinesh Khanna Shareholder of: Eicos Sciences, Inc (less than 5%), Consultant of: Paid Consultant for: Acceleron, Actelion, Abbvie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead, Galapagos, Genentech/Roche, GSK, Horizon, Merck, Mitsubishi Tanabe Pharma, Sanofi-Aventis, and United Therapeutics, Grant/research support from: Research Grant support from: Immune Tolerance Network, Bayer, BMS, Horizon, Pfizer, Employee of: Leadership/Equity position – Chief Medical Officer, CiviBioPharma/Eicos Sciences, Inc – recieves a stipend for role as Chief Medical Officer, which would technically qualify as emplyoment., Marie-Elise Truchetet Speakers bureau: Abbvie, Lilly, Sobi, Boehringer, Paid instructor for: Lilly, Consultant of: UCB, Sobi, Abbvie, Grant/research support from: UCB, Gilead, Ulrich Walker Shareholder of: Bayer, NASDAQ, MSCI-World ETF’s, Speakers bureau: All companies producing pharmaceuticals used in AIDS, Paid instructor for: Roche, Abbvie, Novartis, Consultant of: All companies producing pharmaceuticals used in AIDS, Grant/research support from: Gilead, Abbvie, (in the last two years). Other companies in previous years., Margarida Alves Employee of: Boehringer Ingelheim, Nils Schoof Employee of: Employee of Boehringer Ingelheim International GmbH, Lesley Ann Saketkoo Speakers bureau: Boehringer Ingelheim, Actelion, Janssen, Mallinckrodt, United Therapeutics, Consultant of: Actelion, Boehringer Ingelheim, Bayer, Bristol Meyer Squibb, Corbus, EICOS, Janssen, Horizon, United Therapeutics, Inc, Grant/research support from: Mallinckrodt, United Therapeutics, Oliver Distler Speakers bureau: Boehringer Ingelheim, Medscape, IQone, Roche, Consultant of: OD has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years):Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: Kymera Therapeutics, Mitsubishi Tanabe

Background:EULAR recommendations emphasize the importance of suitable working conditions for people with Rheumatic diseases (RD). Thus, opportunities and choices at work need to be increased for people with rheumatic diseases. Conversely, the COVID-19 pandemic has challenged the working population and particularly those with chronic conditions, such as those with RD. However, there is still a lack of reliable data.Objectives:To depict contemporary real-life data regarding the work-related burden of disease among Greek patients with RD. To develop a White Paper with proposals to the State in order to facilitate people with rheumatic diseases to rejoin or be retained in the work force.Methods:A 24-item quantitative questionnaire was uploaded in the website and social media of REUMAZEIN to capture patients’ responses in respect to work life. The questionnaire was online accessible for a 45-day period (15/8-30/9/2020).Results:The responses of 503 adult people with RD (M/F/NA 94/408/1), were available for analysis. Their age was stratified in decades (18-20 0.6%,21-30 5.99%, 31-40 22.36%, 41-50 38.92%, 51-60 22.16% and over 60 9.58%); totally, 83.44% were in the “work-reproductive” period. The predominant RD types were RA 30.3%, SLE 22.8%, AS 20.2% and PsA 20.2%, respectively. Nearly 90% were on medication, namely 40% on biologics, 33% on methotrexate (as a monotherapy or combined therapy), 16.2% on steroids. A minority were either on alternative therapies (2.8%) or off medication (7.5%), respectively. Most of the people were still employed (72.9%) on a full-time schedule (57.7%) and 4.8% on a part-time one, due to their RD. The rest of them (27.1%) were out of work either due to RD (17%) or retirement (1.7%) or for unrelated to the RD reasons (8.4%). The main source of financial income was personal work (52.4%), followed by a family member support (31.1%), while 11% had either a state pension (8%) or a subsidy (3.2%). In respect to the daily house-keeping, half of them (59.3%) had a varying difficulty (mild 36.3%, severe 23%) and 0.8% considered themselves as “unable”. The diagnosis was mostly established (81%) prior to the work onset. Post-diagnosis, RD had not affected their working schedule in 47.2%, 17% continued to work with respective adaptations but 30% had quitted or resigned from their work 1-7 years later. RD was notified to the work environment by 85%. As for a compassionate work management, 46% reported no change, 28% an improved policy but 28% a worse one. The development of relative adaptations in the work setting (as chairs, devices, flexible schedule) were considered as favorite factors easing the work by 85%. 17% reported an employer’s knowledge on RD related working legislation, 43% the contrary and another 38.7% wished for a future employer’s awareness. Most of the participants (58.9%) had no personal information on this field but were eager to get it. The uneventful impact of RD on finding or keeping a job was registered by 77.4% and 66.9%, respectively. During COVID, most of the participants (53%) have not asked for an RD-related leave and only 24.2% chose to telework, a policy that raised mutual satisfaction in 19%. Of note, the working conditions have not mainly been altered (67%) after the end of the 1st quarantine.Conclusion:This study highlighted that although RD predominate in females, women are more willing to participate in such projects (F 90%). The financial income was mainly based on a personal or a family member work reimbursement (83%), while 11% depended on a state pension or subsidy. The majority has notified the RD to their work environment (85%) while another 85% considered as favorite factors easing the work, several adaptations in the work setting such as chairs, devices, flexible schedule etc. Interestingly, 60% of the participants were unaware of the beneficial legal work rights and nearly 70% of them believe that RD is an obstacle for employment or working maintenance. COVID has not dramatically impaired their work life although the use of teleworking should be strengthened.Disclosure of Interests:None declared.

Background This study evaluated the determinants of high fractional exhaled nitric oxide (FeNO; >50 ppb) and serial changes in FeNO over a 24-hour period in spice mill workers at risk of work-related allergic respiratory disease and asthma. Methods A cross-sectional study of 150 workers used European Community Respiratory Health Survey (ECRHS) questionnaires, Phadiatop, serum-specific IgE (garlic, chilli pepper, wheat; Phadia, ImmunoCAP), spirometry and FeNO. A hand-held portable nitric oxide sampling device (NIOX MINO, Aerocrine AB) measured FeNO before and after the 8-hour shift and after 24 hours from baseline. Results The mean age of workers was 33 years; 71% were male, 46% current smokers and 45% atopic. Among workers with garlic sensitisation, 13% were monosensitised and 6% were co-sensitised to chilli pepper. Baseline preshift FeNO geometric mean (GM=14.9 ppb) was similar to the mean change across shift (GM=15.4 ppb) and across the 24-hour period (GM=15.8 ppb). In multivariate linear models, smoking (β=−0.507) and atopy (β=0.433) were strongly associated with FeNO. High FeNO (>50 ppb) was significantly associated with asthma-like symptoms due to spice dust (OR=5.38, CI 1.01 to 28.95). Sensitisation to chilli pepper was more strongly correlated with FeNO (r=0.32) and FeNO>50 ppb (OR=17.04, p=0.005) than garlic. FeNO increase (>12%) across 24 hours demonstrated a strong association with elevated exposures to spice dust particulate (OR=3.77, CI 1.01 to 14.24). Conclusions This study suggests that chilli pepper sensitisation is associated with high FeNO (>50 ppb), more strongly compared with garlic, despite the low prevalence of sensitisation to chilli. Elevated inhalant spice dust particulate is associated with a delayed elevation of FeNO across the 24-hour period.

Background There is wide evidence that women present longer duration of sickness absence (SA) than men. Musculoskeletal disorders are influenced by gender due to the sexual division of work. Methods 354 432 episodes of non-work-related SA due to musculoskeletal disorders, which were registered in Catalonia between 2005 and 2008, were selected. The outcome variable was the duration of SA. Frailty survival models, stratified by sex and adjusted for explanatory variables (age, employment status, case management, economic activity and repeated episode), were fitted to study the association between each variable and the duration of SA, obtaining HRs. Results Women presented longer SA episodes than men in all variable categories. A trend from shorter to longer duration of SA with increasing age was observed in men, whereas in women, it had a fluctuating pattern. Analysing most frequent diagnostic subgroups from the sample, only ‘non-specific lumbago’ and ‘sciatic lumbago’ showed these age patterns. Frailty survival models applied to these 2 subgroups confirmed the described age patterns in SA duration. Conclusions Women have longer non-work-related SA due to musculoskeletal disorders than men. However, while men have longer absences as their age increases, in women some older groups have shorter absences than younger ones. These findings could be explained by gender differences in the interaction between paid work and family demands. Our results highlight the need for continued research on SA from a gender perspective, in order to improve management of SA in terms of clinical practice and public policies.

More than two fifths of doctors in the UK say that their mental health is now worse than before the pandemic, a BMA survey has found. The association received responses from 6610 doctors working across England to a snapshot survey it conducted in October. Of the 6550 doctors who responded to a question about their mental wellbeing, 43% said that they were currently experiencing work related depression, anxiety, stress, …

ObjectiveThe objective was to conduct an update of a previously published review and meta-analysis on the association between work-related psychosocial risk factors and stress-related mental disorders (SRD).DesignSystematic review and meta-analysis.Data sourcesMedline, Embase and PsycINFO were searched for articles published between 2008 and 12 August 2019 and references of a systematic review performed for the period before 2008 were included. Primary prospective studies were included when outcome data were described in terms of SRD assessment or a dichotomous outcome, based on a validated questionnaire, and at least two levels of work-related exposure were reported (exposed vs less or non-exposed). We used GRADE to assess the evidence for the associations between risk factors and the onset of SRD.ResultsSeventeen studies met the inclusion criteria. In total, a population of 73 874 workers from Belgium, Denmark, England, Finland, Japan, the Netherlands and Sweden were included in the meta-analysis of 14 prospective cohort studies. This meta-analysis revealed moderate evidence for associations between SRD and effort reward imbalance (OR=1.9, 95% CI 1.70 to 2.15), high job demands (OR=1.6, 95% CI 1.41 to 1.72), organisational justice (ORs=1.6 to 1.7, CIs 1.44 to 1.86), social support (ORs=1.3 to 1.4, CIs 1.16 to 1.69), high emotional demands (OR=1.6, 95% CI 1.35 to 1.84) and decision authority (OR=1.3, CI 1.20 to 1.49). No significant or inconsistent associations were found for job insecurity, decision latitude, skill discretion and bullying.ConclusionModerate evidence was found that work-related psychosocial risk factors are associated with a higher risk of SRD. Effort-reward imbalance, low organisational justice and high job demands exhibited the largest increased risk of SRD, varying from 60% to 90%.

Background:Many people with rheumatoid arthritis (RA) have comorbidities. However, there is limited research on the impact of multimorbidity on absenteeism (e.g. sick leave) and presenteeism (i.e. reduced productivity while at work due to ill health) in people with RA.Objectives:i) to explore the impact of comorbidities on absenteeism and presenteeism in patients with RA and ii) to evaluate the association between multimorbidity and employment status.Methods:A cross-sectional survey was conducted by the National Rheumatoid Arthritis Society (NRAS), UK, collecting information on: demographics, education, employment status (i.e. employed (Empl), stopped/retired early because of RA (Stop_RA), stopped/retired early because of other health issues (Stop_Health)), and disease related variables (e.g. symptom duration, rheumatoid arthritis impact of disease (RAID) questionnaire). Participants were asked to report whether they had or were treated for any of 15 predefined comorbidities (categorised into 0, 1, 2, 3, or ≥4 (Table)). Percentage of number of hours missed due RA (i.e. absenteeism) and presenteeism (10-point Likert scale) were assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI-RA). For the purpose of this study both absenteeism and presenteeism outcomes were dichotomized (no presenteeism/absenteeism versus any) and only patients aged Results:868 participants were included; 91.7% women with a median symptom duration of 8.3 years [IQR 4.4-13.7]. The average RAID score was 5.2 (SD 2.2). 80.4% were in paid employment, including those currently on sick leave, 16.9% stopped early because of their RA and 2.7% reported stopping early because of other health reasons. In those employed most commonly occurring comorbidities were: back pain (28.8%%), osteoarthritis (21.5%), depression (26.3%) and anxiety (22.6%). Compared to people with RA with no comorbidities, the odds associated with time off work due to RA increased from 1.7 up to 3.4 with increasing number of comorbidities (Table). Although a similar trend was observed for presenteeism, the effect sizes were smaller. Significant differences (pAbsenteeism (yes/no)Presenteeism (yes/no)Number of comorbiditiesNOR95%CIOR95%CI0206Ref.Ref.11741.701.06-2.711.661.00-2.7321361.771.08-2.921.991.13-2.863851.751.00-3.081.530.82-2.864-15max863.381.98-5.782.641.28-5.44OR=odds ratio; 95%CI=95% confidence interval; Comorbidities included: heart disease, blood pressure, lung disease, diabetes, ulcer or stomach disease, kidney disease, liver disease, anaemia or other blood disease, cancer, depression, anxiety, OA, back pain, osteoporosis and Sjögren. Bold figuresPConclusion:Although the study is cross-sectional and no temporal association can be determined, this study shows that not only personal and work related contextual factors should be considered when preventing worker productivity loss, but also other comorbidities.Disclosure of Interests:A. Bradshaw: None declared, Ailsa Bosworth Speakers bureau: a number of pharmaceutical companies for reasons of inhouse training, advisory boards etc., K. Walker-Bone: None declared, Laura Lunt: None declared, Suzanne Verstappen Grant/research support from: BMS, Consultant of: Celltrion, Speakers bureau: Pfizer

Background:One of the strongest known risk factors for the development of psoriatic arthritis (PsA) is psoriasis. A key question is whether treatment of psoriasis may prevent or delay onset of PsA.Objectives:To compare the incidence of PsA among patients with psoriasis treated with a biologic compared to those treated with a non-biologic therapy for psoriasisMethods:We performed a retrospective cohort study in the Optum de-identified Electronic Health Record dataset between 2006-2017. Patients with two or more ICD codes for psoriasis between the ages of 16 and 90, who were initiating an oral medication, a biologic therapy, or phototherapy (defined as no preceding codes for the therapy in the prior 12 months) were identified. Covariates at baseline were determined in the 12 months prior to therapy initiation. The outcome of interest was PsA as defined by one ICD code. The incidence of PsA was described overall and within each therapy group. We analyzed the data in two ways: a) a multivariable Cox model using a time varying exposure (once the patient was exposed to a biologic, they were considered always exposed) derived from automated stepwise regression and b) propensity score matching (greedy matching, caliper 0.1) between biologic-exposed patients and oral/phototherapy exposed patients.Results:Among 215,386 patients with psoriasis without PsA at baseline, 9,848 were excluded for prior biologic exposure, and among the remaining, 60,258 initiated phototherapy, oral or biologic therapy during follow up. Among 22,461 new biologic initiations, 29,121 oral therapy and 8,676 phototherapy initiations, the mean age was lower in the biologics group compared to the non-biologic groups (46.9 vs 50.8), with a similar proportion of females and Caucasians. Observational time was also similar. A total of 1,643, 1,813, and 122 new PsA cases occurred over 60,739, 85,670, and 28,528 person/years (PY) of follow up, respectively (incidence 27.1, 21.2 and 4.2 per 1,000 person years respectively). Using a traditional multivariable adjustment approach with time varying exposure, the age and sex adjusted and fully adjusted HR (95% CI) for biologic users were 1.01 (0.99-1.04) and 0.93 (0.91-0.95), respectively. However, after propensity score matching, the HR (95% CI) was 1.64 (1.51-1.77). Survival curves cross, however, at approximately 8 years (Figure 1) and most of the new diagnoses of PsA occurred shortly after therapy initiation (Figure 2).Conclusion:Confounding by indication or protopathic bias may explain the observed association of biologic therapy with the development of PsA among patients with psoriasis. Some patients may be receiving therapy because they have both psoriasis and early symptoms of PsA or their PsA diagnosis is not recorded appropriately. Given the directional discrepancy in the results between traditional modeling and propensity score analysis, further work is needed to understand the nature of this relationship.FigureFigure 3.Directed Acyclic Graphdescribing potential confounders in relationship between therapy prescription and diagnosis of PsADisclosure of Interests:Alexis Ogdie Grant/research support from: Pfizer, Novartis, Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Pfizer, Novartis, Thorvardur Love: None declared, Junko Takeshita: None declared, Joel Gelfand Grant/research support from: grants (to the Trustees of the University of Pennsylvania) from Abbvie, Boehringer Ingelheim, Janssen, Novartis Corp, Celgene, Ortho Dermatologics, and Pfizer Inc., Consultant of: BMS, Boehringer Ingelheim, Janssen Biologics, Novartis Corp, UCB (DSMB), Neuroderm (DSMB), Dr. Reddy’s Labs, Pfizer Inc., and Sun Pharma, Paid instructor for: received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly, Ortho Dermatologics and Novartis., Jose Scher Consultant of: Novartis, Janssen, UCB, Sanofi., Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood, Robert Fitzsimmons: None declared, Christopher T. Ritchlin Grant/research support from: UCB Pharma, AbbVie, Amgen, Consultant of: UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Joseph F. Merola Consultant of: Merck, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB Pharma, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and LEO Pharma

Background:The treatment of systemic lupus erythematosus (SLE) has improved over the last decades, however, absenteeism and work disability numbers remain higher than those observed in the general population (1). SLE has its onset between the ages of 20 and 40 years, and has a major burden on the lives of patients, both mentally and financially. A recent online survey amongst 2070 European SLE patients revealed that 69.5% of patients had their careers affected due to SLE (2).Objectives:To determine the magnitude of absenteeism and work disability in patients with SLE and to investigate the factors that might affect work participation in these patients in order to develop interventions to reduce the impact of the burden in the future.Methods:A systematic literature search was performed to identify published articles reporting on the prevalence of work related burden, as well as the relation of having SLE on employment status, sick leave and/or presenteeism. Full-text original articles (all languages) published before April 2019 were identified by literature search performed in MEDLINE, Cochrane, Embase and CINAHL.Results:In total, 2057 non-duplicate citations were screened after database searching and snowballing. Finally, 81 articles were included; most studies (n=59) had a cross-sectional design and the remaining 22 studies had a longitudinal design. Only 15 longitudinal cohort studies reported on associations, 6 studies described a longitudinal prediction model, 2 studies reported on associations and described a prediction model, and 3 studies had a longitudinal design but only reported on prevalences over time. In total, 3500 working patients were included in the studies reporting on associations or describing a longitudinal prediction model. In the association studies, the most frequently used outcome measures were respectively being employed/probability of being employed and work loss/job cessation. Other studies used loss of days from (non)workforce activities/sick leave days, work disability, productivity loss or work entry. Most associations with work outcome were found for demographic variables and two or three disease variables, like Systemic Lupus Activity Questionnaire (SLAQ) score and depressive symptoms. This was also the case in the prediction studies. Most studies did not assess work related variables as possible predictors for work outcome.Conclusion:A large heterogeneity was found in type of study design and outcome measures, which limits comparison with other studies. More longitudinal studies are needed to truly assess the impact of SLE on work participation, and to identify factors that could be influenced during interventions, in order to encourage work participation of these patients.References:[1]Bultink IE, Turkstra F, Dijkmans BA, Voskuyl AE. High prevalence of unemployment in patients with systemic lupus erythematosus: association with organ damage and health-related quality of life. J Rheumatol. 2008;35(6):1053-7.[2]Gordon C, Isenberg D, Lerstrom K, Norton Y, Nikai E, Pushparajah DS, et al. The substantial burden of systemic lupus erythematosus on the productivity and careers of patients: a European patient-driven online survey. Rheumatology (Oxford). 2013;52(12):2292-301.Disclosure of Interests:None declared

Objectives (1) To identify work-related fatal and non-fatal hospitalised injuries using multiple data sources, (2) to compare case-ascertainment from external data sources with accepted workers’ compensation claims and (3) to investigate the characteristics of work-related fatal and hospitalised injuries not captured by workers’ compensation. Methods Work-related fatal injuries were ascertained from vital statistics, coroners and hospital discharge databases using payment and diagnosis codes and injury and work descriptions; and work-related (non-fatal) injuries were ascertained from the hospital discharge database using admission, diagnosis and payment codes. Injuries for British Columbia residents aged 15–64 years from 1991 to 2009 ascertained from the above external data sources were compared to accepted workers’ compensation claims using per cent captured, validity analyses and logistic regression. Results The majority of work-related fatal injuries identified in the coroners data (83%) and the majority of work-related hospitalised injuries (95%) were captured as an accepted workers’ compensation claim. A work-related coroner report was a positive predictor (88%), and the responsibility of payment field in the hospital discharge record a sensitive indicator (94%), for a workers’ compensation claim. Injuries not captured by workers’ compensation were associated with female gender, type of work (natural resources and other unspecified work) and injury diagnosis (eg, airway-related, dislocations and undetermined/unknown injury). Conclusions Some work-related injuries captured by external data sources were not found in workers’ compensation data in British Columbia. This may be the result of capturing injuries or workers that are ineligible for workers’ compensation, or the result of injuries that go unreported to the compensation system. Hospital discharge records and coroner reports may provide opportunities to identify workers (or family members) with an unreported work-related injury and to provide them with information for submitting a workers’ compensation claim.

Child mortality has decreased substantially globally—from 12.6 million in 1990 to 6.3 million in 2013—due, in large part to of governments’ and organisations’ work, to prevent pneumonia, diarrhoea and malaria, the main causes of death in the postneonatal period. In 2012, the World Health Assembly adopted the Decade of Vaccines Global Vaccine Action Plan 2011–2020 as the current framework aimed at preventing millions of deaths through more equitable access to existing vaccines for people in all communities. The Global Alliance for Vaccines and Immunization (GAVI) plays a critical role in this effort by financing and facilitating delivery platforms for vaccines, with focused support for the achievements of improved vaccination coverage and acceleration of the uptake of WHO-recommended lifesaving new vaccines in 73 low-income countries. The GAVI Alliance has contributed substantially towards the progress of Millennium Development Goal 4 and to improving women's lives. By 2013, the GAVI Alliance had immunised 440 million additional children and averted six million future deaths from vaccine-preventable diseases in the world's poorest countries. The GAVI Alliance is on track to reducing child mortality to 68 per 1000 live births by 2015 in supported countries. This paper discusses the GAVI Alliance achievements related to Millennium Development Goal 4 and its broader contribution to improving women's lives and health systems, as well as challenges and obstacles it has faced. Additionally, it looks at challenges for the future and how it will continue its work related to reducing child mortality and improving women's health.

The past year has produced several new clinical guidelines germane to paediatric dermatology, as well as important work related to rheumatologic overlap disorders, psoriasis comorbidities, pigmented lesions and quality of life impact. This review highlights common diagnoses and treatments useful for the practicing paediatrician.

IntroductionEvidence indicates a bidirectional relationship between poor sleep and Alzheimer’s disease (AD). While AD may lead to disruption of normal sleep, poor sleep in itself may play a causal role in the development of AD by influencing the production and/or clearance of the amyloid-beta (Aβ) protein. This led to the hypothesis that extended periods (>10 years) of sleep loss could lead to Aβ accumulation with subsequent cognitive AD-related decline. This manuscript describes the methodology of the SCHIP study, a cohort study in maritime pilots that aims at investigating the relationship between prolonged work-related sleep loss, cognitive function and amyloid accumulation among healthy middle-aged maritime pilots, to test the hypothesis that prolonged sleep loss increases the risk of AD-related cognitive decline.MethodsOur study sample consists of a group of healthy middle-aged maritime pilots (n=20), who have been exposed to highly irregular work schedules for more than 15 years. The maritime pilots will be compared to a group of healthy, age and education-matched controls (n=20) with normal sleep. Participants will complete 10 days of actigraphy (Actiwatch 2, Philips Respironics) combined with a sleep-wake diary. They will undergo one night of polysomnography, followed by comprehensive assessment of cognitive function. Additionally, participants will undergo amyloid positron emission tomography-CT to measure brain amyloid accumulation and MRI to investigate atrophy and vascular changes.AnalysisAll analyses will be performed using IBM SPSS V.20.0 (SPSS). We will perform independent samples t-tests to compare all outcome parameters.Ethics and disseminationThe study protocol was approved by our institutional ethical review board (NL55712.091.16, file number 2016–2337) and will be performed according to Good Clinical Practice rules. Data and results will be published in 2020.

This hospital-based case-control study aimed to determine whether self-reports of musculoskeletal symptoms (MSS) were associated with the occurrence of work-related accidents. Study participants were recruited from the emergency department at Botucatu Medical School University Hospital. Cases were workers who suffered work-related accidents that required hospitalization, while controls were selected patients who suffered a non-work-related accident. Participants were interviewed using a standardized structured questionnaire with close-ended questions and a modified version of the Brazilian Portuguese Nordic Musculoskeletal Questionnaire. Associations between self-reports of MSS and work-related accidents were analyzed with two logistic regression models (one for symptoms that occurred in the 12 months period and the other for those that occurred in the previous 7 days). These analyses were performed in two steps: univariate and multiple model. Variables with a P-value ≤0.25 in the univariate analysis were included in the multiple models, using the forward stepwise selection procedure. In the multiple models two-sided P-values less than 0.05 were considered statistically significant. Altogether, 80 cases and 125 controls were included. The participants had a mean age of 36.9 years (SD = 11.4) and 72.2% were men. In the 12 months multiple logistic regression model, self-report of MSS in the upper limbs (OR 2.689 95% CI 1.357-5.326) was associated with increased odds of work-related accidents occurrence, while in the 7 days multiple logistic regression model, self-report of MSS in the upper limbs (OR 2.374 95% CI 1.083-5.201) and in the vertebral column (OR 2.154 95% CI 1.017-4.561) were associated. Thus, this case–control study suggests that MSS in the upper limbs and in the vertebral column are associated with increased odds of work-related accidents; and that the Nordic Musculoskeletal Questionnaire may be used as a complementary screening tool for identifying workers at risk for work-related accidents.

Background and objectivesMusculoskeletal discomforts (MSDs) attribute greatly to work-related disability, but the social distributions of MSDs in the general working population have seldom been investigated. Moreover, although ergonomic and psychosocial factors at work are known to contribute to musculoskeletal risks, their independent effects on specific sites of MSDs have not been well assessed. This study aimed to examine the social distributions of MSDs and the associations of ergonomic and psychosocial work factors with the risks of MSDs of different bodily sites in general employees of Taiwan.MethodsParticipants were representative employees aged 25–65 years from a nationwide survey of 2016. Self-administered questionnaires were used to obtain information concerning work-related ergonomic and psychosocial factors, employment conditions, and MSDs of different bodily sites over the past 12 months.ResultsA total of 5242 male and 4164 female employees was included. Workers who were older, with lower education levels, being manual skilled or low skilled workers, worked in the construction industry, and being employed in small-sized enterprises had higher risks for MSDs, and the most common bodily site were the neck/shoulders, low back, and wrists/hands. Psychological demands, workplace justice and ergonomic factors were significantly associated with MSDs. Furthermore, results of separate regression models performed for MSDs of different bodily sites showed that higher psychological demands and lower workplace justice were associated with MSDs of the neck/shoulders to a greater extent than other work-related factors, while whole-body-related ergonomic factors and hand-related ergonomic factors were more greatly associated with MSDs of lower back and wrists/hands, respectively.ConclusionsMSDs were more prevalent in workers with lower socioeconomic positions. Differential contribution of specific types of work-related ergonomic and psychosocial factors to the risks of specific types of MSDs should be taken into consideration in the management of MSDs in the workplace.

In New Zealand about 10% of workers are harmed every year, with approximately 2 00 000 claims made to Accident Compensation Corporation (ACC) to cover the cost of injury and illness. Work-related injury and illness outcomes differ between ethnic groups. M&_x0101;ori (indigenous population) workplace fatality rates are 19% higher by industry and 10% higher by occupation than for non-M&_x0101;ori. According to Statistics New Zealand from 2002–2017, M&_x0101;ori were more likely to have higher rates of work-related claims than non-M&_x0101;ori. This study currently underway has used the Integrated Data Infrastructure (IDI) to look at different injury types and explore injury distribution between M&_x0101;ori and non- M&_x0101;ori in terms of age, sex, industry and occupation. WorkSafe applied to Statistics New Zealand (Stats NZ) for access to microdata in the IDI in July 2018 and was granted access in September 2018. In this study, data for people with accepted work-related ACC claims has been linked to 2013 Census to identify the industry that ACC claimants have worked in and their occupations. This data has then been linked to data on sex, age and ethnicity as recorded for the IDI population. Confidentiality of data in this study has followed Stats NZ’s output rules including random rounding to base 3, suppression and aggregation.

The objective of this study was to estimate the economic burden of lung cancer and mesothelioma due to occupational and paraoccupational asbestos exposure in Canada.We estimated the lifetime cost of newly diagnosed lung cancer and mesothelioma cases associated with occupational and para-occupational asbestos exposure for calendar year 2011 based on the societal perspective. The key cost components considered were healthcare costs, productivity and output costs, and quality of life costs.There were 427 cases of newly diagnosed mesothelioma cases and 1904 lung cancer cases attributable to asbestos exposure in our reference year—calendar year 2011—for a total of 2331 cases. Our estimate of the economic burden is $C831 million in direct and indirect costs for newly identified cases of mesothelioma and lung cancer and $C1.5 billion in quality of life costs based on a value of $C100,000 per quality-adjusted life year. This amounts to $C356,429 and $C652,369 per case, respectively.The economic burden of lung cancer and mesothelioma associated with occupational and para-occupational asbestos exposure is substantial. The estimate identified is for 2331 newly diagnosed, occupational and para-occupational exposure cases in 2011, so it is only a portion of the burden of existing cases in that year. Our findings provide important information for policy decision makers for priority setting, in particular the merits of banning the mining of asbestos and use of products containing asbestos in countries where they are still allowed and also the merits of asbestos removal in older buildings with asbestos insulation.

IntroductionIn order to investigate the impact of work on health, we hypothesize that medication consumption registered in medical files of workers could serve as a proxy for work-related health problems. In this study, we describe variations in prevalence of specific medication groups between sectors, adjusting for age and gender. In addition, we investigated whether a change in job/sector can have an impact on medication use.MethodLogistic regression analysis is being performed to investigate the effect of occupational sector on the prevalence of specific medication groups, adjusted for year, age and gender. For this, an occupational surveillance dataset of 6 86 434 workers collected between 2011 and 2017 was used. Additionally, regarding the impact on job changes on medication use, analyses are currently being performed by comparing prevalence of specific medication groups in 2011 with 2017 for those employees who changed job during this time period.Results and discussionIn 2011 30,6% male and 49,8% female workers used medication. These figures roze to 43,1% and 67,3% respectively in 2017. The use of medication increased with age: in 2017 38,2% for workers=55 year. Big differences were observed between sectors. Medication use was highest in health care (67,1% in 2017), government and education. These differences remained after adjustment for age and gender. 9,8% and 9,1% of the workers were treated for respectively pain and neuropsychological disorders in 2017.ConclusionSignificant differences in workers’ medical consumption were observed between sectors. This information is now being used for the implementation of a sector-oriented health surveillance program.

BackgroundNZ’s workplace fatality record is high compared to similar countries, with a rate twice that of Australia and four times that of the UK. The reasons for NZ’s substandard performance are highly debated, and in-depth analysis to inform this debate is limited by a dearth of detailed fatality data. This study aims to inform work-related injury prevention efforts for NZ by: i) enumerating the fatal injury burden; and ii) identifying high risk groups and circumstances to prioritise and target preventive action.MethodsA dataset spanning forty-years of Coronial records was created by collecting data for the period 1995–2014 and appending this to existing data for 1975–1994. Data collection involved: 1) identifying possible cases aged 0–84 years from mortality records using injury external cause codes, 2) linking these to Coronial records 3) retrieving and reviewing records for work-relatedness, and 4) coding work-related cases. Work-related cases were classified as workers, bystanders, commuters or students. Work-related injury frequencies and rates per 1 00 000 workers for the most recent 20 year period were calculated by age, sex, employment status, occupation and industry.ResultsOf 17 658 injury fatalities reviewed for the period 1995–2014, 3766 (23%) were work-related, of which 1762 were workers. This corresponds to an overall rate of fatal injury of 4.7 (95% CI 4.5, 5.0) per 1 00 000 workers. Rates of fatal injury were highest for older workers aged 70–84 years (18.1, 95% CI 14.8, 21.8) and males (8.1, 95% CI 7.7, 8.5). The two industry groups with the highest burden of fatal injury were the Agricultural, Forestry and Fisheries and Transport, Postal and Warehouse.ConclusionsThis research demonstrates an innovative use of coronial data, and provides a rare example of the establishment of a continuous and comprehensive long-term coronial dataset. It will be used to generate knowledge for informing workplace preventive strategies in NZ.

BackgroundConsumption of alcohol and tobacco strongly increases risk of cancer of the tongue, mouth, pharynx, larynx, and oesophagus, and are established risk factors also for cancer of the liver, colon, and rectum. It is well documented that these habits are unequally distributed among occupational groups. Most occupational cohort studies do not have information on these potentially important confounders, and may therefore be prone to bias.AimThe aim of the study was to calculate standardized incidence ratios (SIRs) adjusted for alcohol and tobacco by occupation, and to compare to the unadjusted SIRs.Material and methodsThe study is based on the Nordic Occupational Cancer (NOCCA) database.We used confirmatory factor analysis models where the unobserved pattern of alcohol and tobacco consumption were considered a latent common factor, and the potential occupational variation on each cancer type latent site specific factors. Results were used to compute adjusted expected numbers of cancer from the reference rates and to calculate adjusted SIRs for the relevant cancer sites for each occupation.ResultsChanges of risk estimates from significantly high to significantly low and vice versa were seen. Among Nordic farmers, unadjusted SIRs for cancer of the mouth and oesophagus were 0.56 (95% confidence interval [CI] 0.51–0.61) and 0.67 (CI 0.63–0.70), respectively. After adjustment, estimates changed to 1.10 (CI 1.01–1.21) and 1.16 (CI 1.10–1.22). Unadjusted SIR for pharynx cancer among wood workers was 0.83 (CI 0.75–0.91), adjusted SIR was 1.14 (CI 1.03–1.25). For larynx cancer, results in the opposite direction were seen: unadjusted SIR for economically inactive was 1.38 (CI 1.31–1.46) while the adjusted SIR was 0.91 (CI 0.86–0.96).ConclusionAdjustment for the latent indicators of alcohol and tobacco consumption changed risk estimates for several occupations, and may guide in the identification of true risk factors and preventive strategies.

ObjectiveTo report data concerning the reality of work-related mental diseases (WRMD) in France, their acknowledgment as occupational diseases and some socio-economic data.MethodsData were collected from the French National Health Insurance Fund (NHIF) and from the database of the French national occupational surveillance and prevention network (rnv3p). Rnv3p collects data from French Occupational Disease Centers to identify and describe risks and/or emerging work-related diseases.ResultsData from NHIF indicate that the number of requests for acknowledgment of WRMD has increased significantly from 2012 to 2017 (200 to 1500). About 50% are acknowledged and compensated as occupational diseases. Within these affections, the share of depressions is the majority. Durations of work stoppages (more than 400 days on average) were much longer than for other occupational diseases.Mental disorders related to psychosocial risk factors may also be compensated as work injuries. In 2016, NHIF compensated over 10 000 mental disorders as work injuries, mostly caused by external events or inadequate working conditions. The proportion of people with permanent disability was 4.6%. Finally, the management of WRMD acknowledged will have represented € 230 million for the Work Injuries-Occupational Diseases branch of the NHIF.Rnv3p data are globally consistent with NHIF concerning compensated occupational mental diseases, highlighting the increase of WRMD in some sectors such as public administration, health and social action, retail business and education. Over 18000 WRMD (33% men, 67% women; mean age=46.0±8.9) were recorded in the database between 2010 and 2016, and 1833 cases of burnout situations currently non acknowledged as occupational diseases by the NHIF. Rnv3p data also illustrate the importance of under-reporting of WRMD as occupational diseases.ConclusionThen, RNV3P provides important data to assist in the acknowledgment of WRMD and to carry out preventive actions in the sectors and enterprises most concerned.

ObjectiveThe purpose of this study was to investigate whether firefighters’ exposure to work-related trauma events is related to work limitations that form part of social health.MethodsIn 2016, 618 firefighters from four cities in Gyeongsangnam-do participated in this study. They were analyzed using a health-related work limitations questionnaire, experience and type of work-related trauma, Korea Depression Scale, and the World Health Organization quality of life assessment instrument. The health-related work limitations consisted of three scales: ‘physical work demands,’ ‘psychosocial work demands,’ and ‘environmental work demands.’ The analysis was done by hierarchical logistic regression analysis.ResultsOf the subjects, 70.2% remembered traumatic experiences they had experienced during their job. The total work limitations were 21.5%; the limitation of physical work demands was 16.8%, that of psychosocial work demands was 15.5%, and that of environmental work demands was 13.8%. Logistic regression analysis of the final model 3 showed that, if firefighters have experience of their own risks and personal injury, physical (95% CI=1.169–9.405), psychosocial (95% CI=1.080–8.609), and environmental (95% CI=1.659–14.402), the total (95% CI=1.439–9.678) work limitation was significantly increased. When there was a memory of a terrible body or injury, the total work limitations increased significantly (95% CI=1.092–3.905).ConclusionsWhen firefighters are exposed to trauma events during their jobs, these have a negative impact on their work. In order to protect and improve the occupational functions of firefighters, effective prevention and management of work-related trauma incidents should be considered.

ObjectiveTo evaluate if the times of sick leave due to temporary disability related to a non-work-related illness (NWRI) depends on whether or not the workers have required a vocational rehabilitation.MethodHistorical cohort study of university workers in São Paulo, Brazil, between 2010 and 2015. Data were obtained from work institutional databases that recorded personal, occupation, physician’s examination and vocational rehabilitation data. The Charlson Comorbidity Index was obtained from medical history according to the most prevalent diagnoses in each physician’s assessment report and respective sick leave episode duration. Associations between variables were analyzed by simple and multiple Cox regression models.ResultsDepressive disorders, convalescences and back pain were responsible for 70% of all sick leaves due to non-work-related conditions that caused temporary disability. Follow-up time was decreased when the number of NWRI per worker increases, follow-up times until readaptation between 4 and 320 days and great variability within the same disease. The CCI weight was of 0 in 96.2% of sick leaves. In the Cox model, the number of physician’s examinations (HR=0.96), non-insulin-dependent diabetes mellitus (HR=0.40) and primary essential hypertension (HR=0.29) were found to be significant protective factor for sick leave duration until vocational rehabilitation. Recurrent depressive disorders (HR=1.5), conjunctivitis (HR=2.78), acute sinusitis (HR=4.99), skin conditions (HR=3, 80), back pain (HR=1.62), kidney and ureter calculus (HR=2.31), pelvic abdominal pain (HR=2.33) and falls at the same level (HR=3.71) were risk factors to longer sick leave duration until vocational rehabilitation.ConclusionWhen there was more medical assessment during the period of sick leave the times were reduced and some diseases such as upper airways, eyes and skin, pain and depression require longer times until vocational rehabilitation.

Ronald Clark (“Ron”) had a deep interest in nutrition and the metabolic response to acute disease and injury. He led research in this area for more than two decades as professor of surgery at the University of Sheffield (1971-93). Unusually for the 1970s, Clark’s research unit brought together trainee surgeons and postgraduate and postdoctoral biochemists, who worked collaboratively on glucose and salt metabolism. Much of his work related to life support in intensive care at a time when artificial nutrition was in its infancy. Brian Rowlands, now professor emeritus at the University of Nottingham, was Clark’s lecturer in surgery in the mid-1970s. He said that Clark took a holistic approach, which aimed to ensure that patients appeared in surgery well prepared and were looked after afterwards: “A lot of the concepts Ron espoused became essential building blocks on which successful modern intensive care units were built.” Clark’s career was similarly holistic. Aside from his research, he was a surgeon, teacher, and mentor; an effective manager who became dean of Sheffield University Medical School; and a longstanding member of the General Medical Council. He was pro vice chancellor of Sheffield University at a time of rapid expansion, and the first in its history to be asked to serve an extra year. Throughout it all, he was renowned for his patience and calm, along with the ability to come up with a well timed quip to liven up the dullest of meetings. His medical career is all the more remarkable as it almost didn’t happen at all. Clark was born in Aberdeen, the second child of George and Gladys Clark. He was educated at Aberdeen Academy and had a happy and mainly healthy childhood. He left school at 16 with no idea what he wanted to do; it was 1944 and, with …

Objective The aim of the study was to determine the prevalence and risk factors for allergic respiratory disease in spice mill workers. Methods A cross-sectional study of 150 workers used European Community Respiratory Health Survey questionnaires, Phadiatop, serum specific IgE (garlic, chili pepper), spirometry and fractional exhaled nitric oxide (FeNO). Personal air samples (n=62) collected from eight-hour shifts were analysed for inhalable particulate mass. Novel immunological assays quantified airborne garlic and chili pepper allergen concentrations. Results Mean dust particulate mass (geometric mean (GM)=2.06 mg/m 3 ), chili pepper (GM=0.44 mg/m 3 ) and garlic allergen (GM=0.24 mg/m 3 ) were highest in blending and were highly correlated. Workers’ mean age was 33 years, 71% were men, 46% current smokers and 45% atopic. Spice-dust-related asthma-like symptoms (17%) were common, as was garlic sensitisation (19%), with 13% being monosensitised and 6% cosensitised to chili pepper. Airflow reversibility and FeNO>50 ppb was present in 4% and 8% of workers respectively. Spice-dust-related ocular-nasal (OR 2.40, CI 1.09 to 5.27) and asthma-like (OR 4.15, CI 1.09 to 15.72) symptoms were strongly associated with airborne garlic in the highly exposed (>0.235 mg/m 3 ) workers. Workers monosensitised to garlic were more likely to be exposed to higher airborne chili pepper (>0.92 mg/m 3 ) (OR 11.52, CI 1.17 to 113.11) than garlic allergens (OR 5.08, CI 1.17 to 22.08) in this mill. Probable asthma was also more strongly associated with chili pepper than with garlic sensitisation. Conclusions Exposure to inhalable spice dust (GM >2.06 mg/m 3 ) containing garlic (GM>0.24 mg/m³) and chili pepper (GM >0.44 mg/m 3 ) allergens increase the risk of allergic respiratory disease and asthma.

ObjectivesTo examine how work-related mobility among female sex workers (FSWs) is associated with gender-based violence (GBV) in Iringa, Tanzania.DesignCross-sectional analyses were conducted on baseline data gathered between October 2015 and April 2016 from FSWs participating in Project Shikamana, a community empowerment-based combination HIV prevention intervention.SettingParticipants were recruited for the baseline study using venue-based time-location sampling in two communities in Iringa, Tanzania.ParticipantsFSWs were eligible for participation if they were 18 years or older and had exchanged sex for money within the past month. Four-hundred ninety-six FSWs participated in the baseline survey.Primary and secondary outcome measuresAny recent experience of GBV was examined by recent work-related mobility among FSWs. Any recent experience of GBV was also disaggregated by severity for analyses. All bivariate and multivariate binary and multinomial logistic regressions adjusted for intraclass correlations among women recruited from the same venues.ResultsForty per cent of participants experienced recent physical or sexual violence, and 30% recently experienced severe physical or sexual violence. Thirty-three per cent of participants recently exchanged sex for money outside of their district or region, and 12% were both intraregionally and inter-regionally mobile for sex work. Intraregionally and inter-regionally mobile FSWs had 1.9 times greater odds of reporting recent GBV (adjusted OR: 1.89; 95% CI: 1.06 to 3.38; p=0.031) compared with non-mobile FSWs and a 2.5 times higher relative risk for recent experience of severe GBV relative to no recent GBV (relative risk ratio: 2.51; 95% CI: 1.33 to 4.74; p=0.005).ConclusionsMobility for sex work may increase FSWs’ exposure to GBV, particularly more severe GBV. The vulnerability of mobile FSWs to violence, particularly severe forms, demands inclusive services that are accessible to mobile FSWs.

The European Medicines Agency has scaled back its landmark clinical trial data policies, the drug regulator has announced. Policy 0043, which granted public access to documents in the regulators’ archives, including clinical trial data, is now limited to EU citizens only, and work related to publishing new data packages under its clinical data publication policy (policy 0070) has been suspended. The agency said that the cutbacks were a response to an “excessive workload”1 and were part of its planning amid substantial staff loss as it prepared for Brexit.2 Transparency advocates have described it as a blow to critical transparency efforts with potential patient safety ramifications. “Deaths and other serious harms are much under-reported in published trials, and we therefore need unhindered and immediate access to clinical study reports and other relevant documentation that the EMA holds,” said Peter Gotzsche, director of the Nordic Cochrane Centre. Gotzsche is credited with “opening up” the EMA after his successful appeal to the European ombudsman over a denied request for data a decade ago.3 He said that the EMA’s announcements were “very …

Objective To characterise work-related fatal events that occurred in Chile in 2014 and 2015 in workers covered by the Occupational Accidents and Professional Disease No 16.744 Act. Design Cross-sectional on registries of the Chilean Worker’s Health and Safety National Information System, specifically focusing on the Fatal Work Accidents Registry of the Social Security Superintendence. Study population Secondary data analysis on all 815 cases of occupational injury-related deaths registered in 2014 and 2015 in Chile and that were accredited by the Social Security Superintendence up to March 2016. Outcome measures Variables relating to employer, workers and the events were analysed. Results The overall mortality rate for all injuries, both at work and during commuting, per 100 000 workers affiliated to the occupational social security system, was 7.2 for 2014 and 7.3 for 2015. For 2014, the highest mortality rates occurred in the transport and communications sectors (20.15) and the mining sector (18.17), while for 2015 the highest rates were found in the fishing industry (11.3) and in mining (12.1). Seventy-two per cent of cases occurred in small and medium-sized enterprises. Half of the companies that had work-related fatal injuries did not have a risk prevention department. Twenty-two per cent (121) of the companies had previous labour law infractions. The four activities most affected by workers’ deaths in the two study years were freight land transport, engineering works under construction, minor works under construction and construction of complete buildings or parts of buildings. Half of all fatal injuries occurred in workers who had been employed for less than a year in their company. Conclusions This descriptive study provides valuable insight into the current national registry on occupational deaths in Chile. While containing valuable information, the registry was not designed for epidemiological surveillance. Further efforts are needed to achieve a proper epidemiological integration of surveillance data.

To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in Victoria, 2001-6, an observational study of work-related deaths reported to the State Coroner's Office, Victoria, Australia was conducted. Case and postmortem forensic toxicology data were obtained from the National Coroner's Information System for work-related injury deaths with positive toxicology screens. Over 6emsp14;years there were 43 worker deaths in a total of 355 unintentional work-related injury deaths. The coroner mentioned the presence of alcohol/drugs in 22 of the 43 worker deaths with positive toxicology screens. Toxicology screens were positive for alcohol and/or drugs in 79 work-related deaths overall. Overall, alcohol was present in 26 (7%) work-related deaths and cannabis or amphetamines in 20 (6%). Incidents were mainly transport related. Alcohol and/or drugs were present in a significant portion of work-related deaths. Research is needed to determine the relative contribution of alcohol and drugs compared with other contributing factors to work-related deaths.

Background To explore time trends in deaths attributable to work in England and Wales, and identify priorities for prevention, we conducted a proportional analysis of mortality by occupation over a 22-year period. Methods Analysis was based on deaths in men aged 20–74 years during 1979–1980 and 1982–2000 with a recorded occupation. Proportional mortality ratios, standardised for age and social class, were calculated for pre-specified combinations of occupation and cause of death, for which excess mortality could reasonably be attributed to work. Differences between observed and expected numbers of deaths by cause and occupation were expressed as annual excess death rates. Results Mortality attributable to work declined substantially over the period of study, with total excess death rates of 733.2 per year during 1979–1990 and 471.7 per year during 1991–2000. The largest contributing hazards were chronic obstructive pulmonary disease and pneumoconiosis in coal miners, pleural cancer from asbestos, and motor vehicle accidents in lorry drivers. In contrast to most other hazards, there was no clear decline in excess mortality attributable to asbestos, or in deaths from sino-nasal cancer associated with exposure to wood dust. Conclusions The overall decline in mortality attributable to work is likely to reflect reduced employment in more hazardous occupations, as well as improvements in working conditions. It is imperative to ensure that occupational exposures to asbestos and wood dust are now adequately controlled. Further research is needed on accidents involving lorries with the aim of developing more effective strategies for the prevention of injury.

Introduction Most studies among sewage workers of wastewater treatment plants (WWTPs) have found a higher prevalence of gastrointestinal symptoms than among non-sewage exposed workers. Waterborne transmission of Helicobacter pylori (H pylori) has been hypothesised, as the bacteria can survive into an aqueous environment and has been detected in sewage. A health and hygiene questionnaire has demonstrated a higher prevalence of peptic ulcers among Belgian WWTP operators and maintenance workers than among non-sewage exposed colleagues. Objectives To assess the seroprevalence of H pylori infection in Belgian sewage workers at municipal WWTPs, and to determine whether sewage exposure is an important risk factor for acquisition of H pylori and the possible association with gastrointestinal symptoms. Methods A seroprevalence study of H pylori antibodies was conducted among 317 WWTP employees (operators, maintenance workers, laboratory personnel, other job). Information about demographic variables, possible H pylori risk factors, working history, and history of current gastrointestinal symptoms during last 3 months was obtained by a questionnaire. The presence of H pylori IgG was investigated with an ELISA. The results were compared with those of 250 employees of a pharmaceutical company (operators, maintenance workers, laboratory personnel). Results The prevalence of H pylori IgG antibodies among sewage workers was 16.7% (95% CI 12.6 to 20.8%) compared to 13.6% (95% CI 9.4 to 17.8%) among the control group. In a logistic regression model with controlling for age and educational levels, OR study/control group was 1.02 (95% CI 0.58 to 1.80 with p=0.93). No significant associations were found between the H pylori status and gastrointestinal symptoms, occupational exposures in different tasks, nor with hygienic practices. Conclusions Our results do not suggest that H pylori infection is a probable cause of part of gastrointestinal symptoms among Flemish municipal sewage workers of WWTPs.

Objectives To assess diagnostic agreement for occupational asthma, and to identify case and rater characteristics associated with this diagnosis. Methods Summaries of possible occupational asthma cases were sent to 104 occupational and respiratory physicians. Raters assigned likelihood scores (0–100%) of occupational asthma based on case histories (phase 1), and on histories plus investigative procedures (phase 2). Interclass correlation coefficients were calculated as statistical measures of reliability for occupational asthma scores. Comparisons between mean scores were assessed for statistical significance using tests based on multilevel models. RRs were calculated to summarise effects of raters9 demographics, and of supplying investigative procedures information. Results Occupational asthma scores showed limited agreement within each group of (occupational or respiratory) physicians, but scores were not systematically different. The difference between mean overall scores was 2.1% (52.1% occupational physicians; 50.0% respiratory physicians) in phase 1 (95% CI −2.6 to 6.8, p=0.37). In phase 2, mean overall scores were 46.1% (occupational physicians) and 41.5% (respiratory physicians); the difference in mean overall scores was 4.6% (95% CI −3.5 to 12.5, p=0.27). Raters with General Medical Council registration ≥1986 were more likely to give a positive occupational asthma diagnosis. In phase 2, male raters were more likely to label cases as occupational asthma than female raters (RR 4.5, 95% CI 3.3 to 6.0). Conclusions The RR of a positive occupational asthma diagnosis was unaffected by clinical speciality. Further work on why physicians consider cases to be occupational asthma will assist better diagnosis and prevention of this disease.

Background Health and injury surveillance data of the highest achievable quality are needed in order to appropriately allocate scarce resources at the local and national levels. Methods This is the first reported surveillance study of injury using a complete community sample in Viet Nam. Workplaces in Xuan Tien Commune most likely to benefit from intervention were identified and ranked by the magnitude of the problem (or highest injury count), the risk (highest incidence rates) and the burden (the effect of injuries on the livelihoods of workers). Results 591 injuries occurring in the month prior to survey administration were recalled, which satisfied the injury case criteria of this study (the annualised incidence rate (IR) was 681 per 1000 residents). 482 were attributed to work activities (82%), yielding an annualised IR of 1001/1000 full time employee equivalents (FTE). The highest number of injuries occurred in the manufacturing sector (n=299), followed by agriculture with far fewer injuries (n=70). The highest rate of injury was in the transport, storage and communications sector (annualised IR 1583/1000 FTE), followed by manufacturing (1235/1000 FTE) and agriculture (844/1000 FTE). Conclusion This study identified patterns of risk which, because data collection reflected work culture, are believed to be more reliable than those from previous studies. Interventions in the manufacture of machinery and equipment sector (the largest industry in the commune) would have the most impact in reducing occupational injuries. Despite the trend towards manufacturing, agriculture is still a high priority with a continuing substantial impact.

Objectives: This paper presents a dynamic population-based model for the development of sensitisation and respiratory symptoms in bakery workers. The model simulates a population of individual workers longitudinally and tracks the development of work-related sensitisation and respiratory symptoms in each worker. Methods: The model has three components: a multistage disease model describing the development of sensitisation and respiratory symptoms in each worker over time; an exposure model describing occupational exposure to flour dust and allergens; and a basic population model describing the length of a worker's career in the bakery sector and the influx of new workers. Each worker's disease state is modelled independently using a discrete time Markov Chain, updated yearly using each individual's simulated exposure. A Bayesian analysis of data from a recent epidemiological study provided estimates of the yearly transition probabilities between disease states. Results: For non-atopic/non-sensitised workers the estimated probabilities of developing moderate (upper respiratory) symptoms and progression to severe (lower respiratory) symptoms are 0.4% (95% CI 0.3 to 0.5%) and 1.1% (95% CI 0.6 to 1.9%) per mg/m3/year of flour dust, respectively, and approximately twice these for atopic workers. The model predicts that 36% (95% CI 26 to 46%) of workers with severe symptoms are sensitised to wheat and 22% (95% CI 12 to 37%) to α-amylase. The predicted mean latency period for respiratory symptoms was 10.3 years (95% CI 8.3 to 12.3). Conclusions: While the model provides a valuable population-level representation of the mechanisms contributing to respiratory diseases in bakers, it was primarily developed for use in quantitative health impact assessment. Future research will use the model to evaluate a range of workplace interventions, including achievable reductions in exposure and health surveillance. The general methodology is applicable to other diseases such as chronic obstructive pulmonary disease, silicosis and musculoskeletal disorders and could be particularly valuable for forecasting changes in long latency diseases.

Objective: In Spain, sick pay benefits for work-related sick leave episodes are higher than for non-work-related episodes. Our aim is to assess whether time to return to work is longer for higher paid sick leave episodes than for lower paid episodes. Methods: We used data from 62 376 work-related and 76 932 non-work-related sick leave episodes occurring among 338 226 workers from 56 099 companies in Spain in 2002. All episodes were followed for up to 18 months. Episodes were classified by a physician as being work- or non-work-related according to medico-legal judgments. The median episode duration and the 25th and 75th percentiles were calculated. The probability of remaining absent from work was estimated by a non-parametric estimator of the marginal survival function. The time ratio between both types of sick leave was estimated by a log-logistic regression model, using non-work-related episodes as the reference. Results: Median episode duration (25th–75th percentiles) was 11 (6–21) days for work-related episodes and 9 (4–29) days for non-work-related episodes. Time to return to work was longer for work-related episodes than for non-work-related episodes of less than 16 days (time ratio: 1.19 in men and 1.08 in women), while the opposite was observed for episodes of more than 15 days (0.58 in men and 0.40 in women). Conclusions: Sick pay benefits have a limited effect on time to return to work after a sick leave episode.

Objectives: To investigate the impact of temporary employment and job tenure on work-related sickness absence of 1 week or more. Methods: A longitudinal analysis was undertaken of the time to work-related sickness absence from the start of a job using the Canadian Survey of Labour and Income Dynamics. The sample consisted of 4777 individuals who experienced 7953 distinct job episodes and 167 absences. There were 114 488 person-job-month observational units. The major variables of interest in this study were a variable identifying whether the job was temporary or permanent, and tenure on the job. Results: Individuals in temporary jobs were as likely to have a work-related sickness absence as individuals in permanent jobs. Individuals with job tenure of 4–6 months were 64% less likely to have an absence than individuals with longer tenures. Individuals in a union were more likely to have an absence. Firm size was not associated with absence. Conclusions: Previous studies have suggested that temporary employment and job tenure are associated with work-related health risk exposures and the ability to take a sickness absence, but these studies have not considered the nature of the employment contract in a longitudinal framework. This analysis did not find temporary employment to be associated with differential absence rate after controlling for tenure, prior health status, and several other individual and job characteristics. Short tenure is negatively related to the probability of work-related sickness absence, union membership is positively related, and firm size is not related to this variable.

Objectives: The ability to measure temporal trends in disease incidence is important, but valid methods are needed. This study investigates UK trends during 1996–2005 in work-related skin and respiratory diseases including non-malignant pleural disease, asthma, mesothelioma and pneumoconiosis and the potential for bias when using surveillance systems for this purpose. Methods: The volunteer reporters in three surveillance schemes were specialist physicians for skin diseases, specialist physicians for respiratory diseases and occupational physicians, respectively, who provided monthly reports of new cases of disease which they considered work related. Poisson regression models were used to investigate variation by calendar year (trend), season and reporter characteristics. Separately, temporal patterns in the probabilities of non-response and zero reports were investigated. Annual changes in disease incidences were compared between reporter groups. Results: There was little evidence of change in incidences of non-malignant pleural disease, mesothelioma, skin neoplasia and urticaria, but falls were seen for contact dermatitis and pneumoconiosis. Although the directions of change were similar across reporter groups, the magnitude of annual change in incidence was often inconsistent: for occupational asthma, it was −1.9% (95% CI −5.2 to 1.4) and −12.1% (95% CI−19.5 to −4.1) using respiratory and occupational physician reports, respectively. Response rates were high (∼85%), but non-response increased slightly with membership time, as did the probability of a zero return in some groups. Adjustment of results for presumed reporting fatigue led to an upward correction in some calendar trends. Conclusions: As some estimated changes in incidence based on volunteer reporting may be biased by reporting fatigue, apparent downward trends need to be interpreted cautiously. Differences in the population bases of the surveillance schemes and UK health service capacity constraints may also explain the differences in trends found here.

Background: Isocyanates are the main cause of occupational asthma in most countries. Study of immunological markers of diisocyanate asthma may identify individuals at risk. Objectives: (1) To study changes in specific antibodies to hexamethylene diisocyanates (HDI); (2) to describe the incidence of work-related respiratory symptoms in relation to changes in specific antibody levels. Methods: Prospective study in 385 apprentice car-painters during their 18 months of training. Participants were assessed on entering and completing their training using questionnaires, methacholine challenges and measurements of HDI-specific immunoglobulin E (IgE), immunoglobulin G (IgG) and subclass 4 of IgG (IgG4) antibodies. Results: Complete data are available for 298 subjects. 13 subjects (4.4%) reported ⩾1 new work-related lower respiratory symptoms and 19 (6.4%), ⩾1 new work-related nasal symptoms. Increases in levels of specific IgE and IgG above the 97th and 95th percentiles were significantly associated with duration of exposure. Increase in specific IgG was inversely related to incidence of work-related lower respiratory symptoms (OR = 0.001, 95% CI 0.000 to 0.09) after adjusting for relevant covariates. The rise in specific IgG4 was significantly greater in those who did not develop work-related nasal symptoms (OR = 0.09, 95% CI 0.01 to 0.7). Conclusion: In this cohort of apprentice car-painters, a small proportion show increases in HDI-specific IgG and IgE after few months of exposure. Increases in specific IgG and IgG4 appear to have a protective effect on the incidence of work-related lower and upper respiratory symptoms, respectively. Assessment of specific antibodies to isocyanates may help identify subjects at risk of developing symptoms.