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

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

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

We build a Bayesian hierarchical model for relating disease to a potentially harmful exposure, by using data from studies in occupational epidemiology, and compare our method with the traditional group-based exposure assessment method through simulation studies, a real data application, and theoretical calculation. We focus on cohort studies where a logistic disease model is appropriate and where group means can be treated as fixed effects. The results show a variety of advantages of the fully Bayesian approach and provide recommendations on situations where the traditional group-based exposure assessment method may not be suitable to use.

Irritant contact dermatitis (ICD) is common and poses a significant problem in high-risk populations. In most cases, ICD resolves despite continued exposure in a process known as 'hardening', allowing individuals to continue with their work. Those who cannot clear ICD develop chronic ICD, which is a significant source of emotional, physical, and financial distress for affected individuals. While hardening is well known among labourers and clinicians, its mechanism remains to be elucidated. Much can be learned from the study of self-healing processes like the hardening phenomenon. This overview briefly documents the pathogenesis of ICD, focuses on the latest advances pertaining to the hardening phenomenon in ICD, and then highlights potential avenues of productive research. A better understanding of the 'hardening' process in the skin will hopefully lead to advances for the treatment of ICD.

Background: Instrumental musicians are a risk group for a variety of skin conditions. Objectives: To determine the frequency and risk factors of instrument-related skin disorders in musicians. Method: We mailed an 11-item survey to 19 German universities of music and performing arts. Results: 412 musicians returned the completed questionnaire, of whom 21.6% (89/412) had an instrument-related skin disorder including callosities (52/89; 58.4%), contact dermatitis (CD; 17/89; 19.1%), fiddler’s neck (17/89; 19.1%), and erosion (3/89; 3.4%). Allergic CD (13/17; 76.5%) was most frequently reported in violinists and violists. Of 116 violinists and violists, 17 (14.7%) suffered from fiddler’s neck. String and plucking instrumentalists most frequently reported callosities (61/89; 68.5%) and skin problems (32/37; 86.5%). Instrument-related skin disorders were significantly associated with high practice frequencies (P = 0.022) and a professional status (P = 0.001). Conclusions: Callosities and CD were the most commonly reported skin changes in the respondents. Both callosities and skin problems such as CD and fiddler’s neck are significantly associated with high practice frequencies and professional status. Our data indicate that among those returning the questionnaires, string players and plucking instrumentalists seem to be at highest risk of developing skin problems when compared with players of other musical instruments.

We recently conducted a re-analysis [Gennaro et al. 2000] of two independent studies among oil refineries workers: an Italian cohort study [Gennaro et al., 1994,1995] and a Canadian case-control study [Finkelstein, 1996]. In the re-analysis we reported that maintenance workers (MW) experienced an asbestos-attributable risk (AR) of 96-100% for mesothelioma; the same subgroup of workers showed an asbestos AR for lung cancer of 49.2 (95% Confidence Interval (CI) = 26.4-72.4) in the Italian cohort study and an AR of 42.2 (95% CI=10.8-82.6) in the Canadian study. White collar workers (WCW), likely unexposed to asbestos, were considered the internal referent population in the Italian cohort study, while other workers were the comparison group in the Canadian study.

An important issue in epidemiology, often exploratory, is to compare the mortality of a certain cohort, exposed to some dangerous conditions, to that of a reference population. The main statistical tool to study relative mortality has long been the subject-years method. We propose a Bayesian version of the subject-years method, particularly suited to analyse the mortality of small cohorts. In particular, we employ the Bayes factor in order to test whether the mortality of a cohort exceeds that of a reference population. The methodology is applied to an occupational epidemiology study. The results are compared to those obtained from the classical one-sided tests on the same data.

Background We aimed to examine the association of objectively measured and self-reported sleep duration with carotid artery intima media thickness (IMT) among 257 police officers, a group at high risk for cardiovascular disease (CVD).

The variability of exposure has important implications for the design of occupational epidemiologic studies. To assess the influence of this variability in the rubber industry, the efficiency of different schemes for classification of exposure to particulates, cyclohexane-soluble contaminants, and solvents was assessed. Groupings based on job title, plant, factors affecting exposure, published classifications, and the International Standard Classification of Occupations of the International Labor Organization (ISCO-ILO) were compared. Statistical parameters for contrast in average exposure between groups and precision of average exposure within groups were developed to enable comparison of the efficiency of different classification schemes. Grouping of exposure to particulates and dermal exposure appeared to be less efficient than grouping of exposure to solvents. Grouping of solvent exposure using occupational title groups, existing classification schemes, and schemes based on factors affecting exposure showed comparable high resolution in exposure levels. Even the most detailed grouping schemes based on the combination of plant and occupational title group showed relatively modest resolution in particulate and dermal exposure levels. Groupings based on factors affecting exposure showed similar resolution for these exposures, but had higher precision due to having fewer groups. Application of optimal exposure grouping strategies will benefit new research on cancer among rubber workers. Eventually, this might resolve the situation in which a complete industry was included on the list of proven human carcinogens.

Quantitative assessment of exposure intensity is a difficult process, particularly for jobs held long ago. Despite difficulties, the use of this approach is growing in occupational epidemiology because it is hoped that the estimates will more closely approximate delivered dose than more traditional measures such as duration of exposure. If this assumption is correct, development and use of quantitative exposure estimates should reduce nondifferential exposure misclassification, sharpen exposure-response gradients, and enhance interpretation of study results. In this report, we used two methods to assess the value of quantitative exposure assessments in cancer epidemiology. In one, we surveyed the literature for investigations on occupational cancer that included assessments of both duration and intensity of exposure. The results of this survey indicated that exposure measures based on some measure of intensity of exposure yielded monotonically increasing exposure-response gradients and larger relative risks more often than those based on duration of exposure. Duration of exposure, however, occasionally provided the larger relative risks. In another approach, we found that different measures of exposure to formaldehyde classified subjects quite differently. For example, duration of exposure was unrelated to average exposure and was only weakly associated with exposure intensity or peak exposure. Because different measures of exposure may classify subjects quite differently and because quantitative estimates usually, but not always, yield larger relative risks and sharper exposure-response gradients than other measures of exposure, we believe that the prudent approach in epidemiologic investigations would be to develop quantitative estimates of exposure and to conduct analyses using several different measures of exposure, or combinations such as duration by intensity. Multiple comparisons would, however, increase chance findings. The value of such an approach is twofold. When a true association exists, use of several different measures decreases the chances of an unfortunate selection of an exposure measure that is poorly related to delivered dose, which would tend to produce negative results, and increases the chances of uncovering sharper exposure-response gradients. Use of several exposure measures in investigations that fail to exhibit an association between exposure and disease would be of value because such an approach would provide greater confidence that negative findings were not simply due to exposure misclassification.

Exposure data may be inadequate mainly for two reasons; they may not comply with a reasonable exposure-effect model or they may be biased. In the use of historical data it is essential to keep track of what the data were supposed to mean when collected in the first place. Most measurements of air contaminants in work places are probably carried out to establish compliance or non-compliance with limit values. Sometimes measurements are also made to evaluate control measures. Unfortunately, measurement data acquired in this way may have very little to do with the true average exposure of employees. The influence of trends and variations in production on the exposure level is substantial. This influence is similar and coincidental in widely different industries. In addition the variations attributed to production levels, there can be important variations due to season.

Much of the research and reviews on extremely low frequency (ELF) electric and magnetic fields (EMFs) have focused on magnetic rather than electric fields. Some have considered such focus to be inappropriate and have argued that electric fields should be part of both epidemiologic and laboratory work. This paper fills the gap by systematically and critically reviewing electric-fields literature and by comparing overall strength of evidence for electric versus magnetic fields. The review of possible mechanisms does not provide any specific basis for focusing on electric fields. While laboratory studies of electric fields are few, they do not indicate that electric fields should be the exposure of interest. The existing epidemiology on residential electric-field exposures and appliance use does not support the conclusion of adverse health effects from electric-field exposure. Workers in close proximity to high-voltage transmission lines or substation equipment can be exposed to high electric fields. While there are sporadic reports of increase in cancer in some occupational studies, these are inconsistent and fraught with methodologic problems. Overall, there seems little basis to suppose there might be a risk for electric fields, and, in contrast to magnetic fields, and with a possible exception of occupational epidemiology, there seems little basis for continued research into electric fields. Bioelectromagnetics 31:89–101, 2010. © 2009 Wiley-Liss, Inc.

Occupational health studies of agricultural workers have generally excluded migrant and seasonal farmworkers, and this population experiences a high degree of health risk from agricultural exposures. A survey of dermatologic disorders among migrant and seasonal farmworkers will be used to illustrate this point. Data from a recent field study are presented to illustrate epidemiologic approaches to studying dermatologic disorders in farmworkers and risk factors for dermatitis. This study suggests there is generally a high health risk to agricultural workers and this study also suggests methods to investigate other acute and chronic diseases among agricultural workers.

We are quite suprised by this request for explanation, since we think that our previous papers [Gennaro et al., 1994, 1995, 2000] already answered the questions raised. At the same time, we are pleased to have the opportunity to provide AJIM readers with additional information about how we have tried to demonstrate and explain the causal relationship between lung cancer and asbestos exposure among workers employed in the oil refinery industry, a relationship that, for various reasons, the epidemiologists of oil corporations do not see.

We appreciate the opportunity to respond to comments by Valentgas and colleagues regarding our report examining mortality among rubber chemical manufacturing workers [Prince et al., 2001]. Following are our responses to their comments, focusing on the authors' main points

This paper reviews the basic methods of analysis of data from case-control studies. The standard analytic methods are outlined first for a single stratum. The discussion is then extended to stratified analysis, multiple exposure levels, and analyses allowing for disease induction and latency periods. Finally, logistic regression is discussed as an extension of the more basic forms of analysis. The methods are illustrated with data from a study of lung cancer among asbestos textile plant workers.

Exposure information was evaluated for two large chemical manufacturing facilities and a research and development center in support of occupational health studies of employees assigned to these facilities. Methodology and rationale underlying the exposure categorization are provided, and descriptive exposure statistics are presented for a sample of 774 employees. Analysis of work patterns and exposure profiles revealed that 1) employee transfers among various production work areas did not follow a predictable pattern, 2) over 41% of the chemicals identified were present in multiple work areas, and 3) individuals exposed to one chemical of toxicologic interest were also likely to be exposed to other similarly toxic materials. The use of both work area and chemical-specific exposure measures is recommended, as each may be helpful in addressing etiologic questions regarding complex work environments.

Decisive for my long-term involvement in behavioral toxicology were the hours spent in interviewing and testing patients with occupational poisonings during the first years of my career as a clinical psychologist within the framework of occupational medicine. Important auxiliary factors were the innovative and inspiring scientific climate at our Institute, and the supportive kind of scientific education provided by this environment during the years. It has been rewarding and exciting to follow the international progress of behavioral toxicology. Advances in this special domain of research were and are partly related to advances in occupational epidemiology and toxicology, in neurotoxicology and other allied disciplines, as well as to advances in other branches of psychology. But the major challenge to behavioral toxicology during the first decades of its existence has been finding its place and role within these disciplines. Important challenges for the next decades are defining further the exposure-effect relationships as a basis for the standard setting, extending the surveillance of neurotoxic hazards to the developing countries, and searching for better understanding of the practical significance o neurobehavioral effects, eg, from the point of view of the afflicted individual. To realize these aims, further efforts are needed to coordinate the field of behavioral toxicology and to augment communication between those immediately involved.

Data from the 1978-1980 National Health Interview Survey smoking questionnaire were used to analyze prevalence and levels of cigarette smoking among groups of US workers. This information is valuable for indirect adjustment in occupational epidemiology studies as well as for describing smoking patterns of workers in a wide range of job settings. Although there was a higher percentage of current smokers among men than women in the general population, there were few differences in prevalence of smoking among men and women for specific occupations. Also, race and employment status had an influence on prevalence of smoking, where both the currently unemployed and blacks generally had a higher proportion of current smokers, although blacks generally had a higher proportion of current smokers, although blacks smoked fewer cigarettes. Industry also played a major role in the variation of smoking habits. For instance, the percentage of current smokers of a given occupation had as much as a 25% difference depending on the industry they were employed, such as 52% vs 26% for managers and administrators. Detailed data will be made available as microcomputer files for interested researchers.

Epidemiological studies relating occupational exposures of working women to spontaneous abortions and malformation are reviewed and some methodological considerations are presented. The reproductive epidemiology is less developed than epidemiology in general and seems to involve some specific problems. The ascertainment of exposure and of outcome may be problematic. The exposures may be reported differently by the women depending on the outcome of the pregnancy; thus confirmation of exposure from an independent data source would be an asset. The recognition of spontaneous abortions by women is variable and this should be considered in the study design. An access to medical records could provide objective data on the outcome, but it may introduce other types of asymmetries. The types of occupational exposures of the women, suggested to carry a risk of spontaneous abortions, include anesthetic agents, laboratory work, copper smelting, soldering, and chemical sterilization using ethylene oxide and glutaraldehyde. Maternal employment in laboratories and exposure to solvents has been linked to a risk of congenital malformations in the offspring in five studies. Data on the teratogenic effects of anesthetic gases has been conflicting. In one study, employment in copper smelting was associated with malformations in the offspring.