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Objectives: The aim was to identify, appraise, and synthesize the scientific evidence of the relationship between potential occupational sensitizing exposures and the development of asthma based on systematic reviews., Methods: The study was conducted as an overview of systematic reviews. A systematic literature search was conducted for systematic reviews published up to 9 February 2020. Eligibility study criteria included persons in or above the working age, potential occupational sensitizing exposures, and outcomes defined as asthma. Potential occupational sensitizing exposures were divided into 23 main groups comprising both subgroups and specific exposures. Two reviewers independently selected studies, extracted study data, assessed study quality, and evaluated confidence in study results and level of evidence of the relationship between potential occupational sensitizing exposures and asthma., Results: Twenty-seven systematic reviews were included covering 1242 studies and 486 potential occupational sensitizing exposures. Overall confidence in study results was rated high in three systematic reviews, moderate in seven reviews, and low in 17 reviews. Strong evidence for the main group of wood dusts and moderate evidence for main groups of mites and fish was found. For subgroups/specific exposures, strong evidence was found for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals, whereas moderate evidence was found for 52 subgroups/specific exposures., Conclusions: This overview identified hundreds of potential occupational sensitizing exposures suspected to cause asthma and evaluated the level of evidence for each exposure. Strong evidence was found for wood dust in general and for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Introduction: The seafood industry is the largest industry in Greenland. Work-related diseases and accidents appear to constitute health risks in this sector. The aim was to describe the prevalence of work-related diseases and accidents among workers in the seafood industry in Greenland., Methods: Data from 311 workers included a questionnaire, lung function measurements, skin prick tests, blood samples, clinical examinations, personal inhalable dust samples and stationary dust measurements. Accident risk was evaluated by work site observations and safety walks. Statistical analyses included mean values and percentage distribution., Results: Exposure levels were highest in shrimp production; 16.1% were sensitised to snow crab, 10.1% to shrimp and 0.3% to fish; 5.2% had probable occupational asthma. Regarding accidents, the annual incidence rate per 100 workers was 10.3%., Conclusions: Workers in the seafood industry in Greenland have a high prevalence of sensitisation to work-related allergens and occupational asthma closely related to high exposures to shrimp and snow crab allergens. The rate of severe workplace injuries was high. Preventive measures are required., Funding: The Health Science Research Council; The Work Environment Council of Greenland; The Greenlandic Workers' Union; Greenland Business Association; Royal Greenland; Polar Seafood; The BANK of Greenland; The Danish Working Environment Research Fund., Trial Registration: The Scientific Ethical Committee for Greenland (2015-11317); The Danish Data Protection Agency, the Central Denmark Region (2012-58-006)., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Objectives: Due to the long lag-time for health outcomes, historical asbestos exposure measurements are valuable to support assessments of associated occupational health effects, and also to assess time trends and effects of preventive measures., Methods: Different sources of stored data were collated, assessed and refined to create a harmonized database on historical asbestos fibre concentrations measured in specific work tasks and different industries. The final database contains 9236 asbestos measurements from Danish workplaces collected from 1971 to 1997., Results: The geometric mean of asbestos concentrations in different occupations and tasks ranged from 0.003 to 35 fibres cm -3 . Highest concentrations were registered during handling of asbestos products in the construction services during the period 1981-1997. Although all the measured asbestos exposures without the use of respiratory equipment by the worker in the period of 1971-1997 exceeded the current 8-h time-weighted average exposure limit of 0.1 fibres cm -3 , the majority of samples collected in the earlier period of 1971 to 1980 did not exceed the exposure limit of 2 fibres cm -3 , which was in place at the time. All exposure data obtained from 1980 and onwards were found to be one seventh of the mean fibre concentrations in the previous measurement period. The impact of time shows a clear exponentially decreasing trend-line., Conclusions: Despite limitations in coverage of different occupations and tasks associated with the inventoried historical asbestos measurements, the data are helpful to identify specific work scenarios within an industry, where relatively high asbestos exposure levels may still occur or have occurred from 1971 to 1997.

Air force ground crew personnel are potentially exposed to fuels and lubricants, as raw materials, vapours and combustion exhaust emissions, during operation and maintenance of aircrafts. This study investigated exposure levels and biomarkers of effects for employees at a Danish air force military base. We enrolled self-reported healthy and non-smoking employees (n = 79) and grouped them by exposure based on job function, considered to be potentially exposed (aircraft engineers, crew chiefs, fuel operators and munition specialists) or as reference group with minimal occupational exposure (avionics and office workers). We measured exposure levels to polycyclic aromatic hydrocarbons (PAHs) and organophosphate esters (OPEs) by silicone bands and skin wipes (PAHs only) as well as urinary excretion of PAH metabolites (OH-PAHs). Additionally, we assessed exposure levels of ultrafine particles (UFPs) in the breathing zone for specific job functions. As biomarkers of effect, we assessed lung function, plasma levels of acute phase inflammatory markers, and genetic damage levels in peripheral blood cells. Exposure levels of total PAHs, OPEs and OH-PAHs did not differ between exposure groups or job functions, with low correlations between PAHs in different matrices. Among the measured job functions, the UFP levels were higher for the crew chiefs. The exposure level of the PAH fluorene was significantly higher for the exposed group than the reference group (15.9 ± 23.7 ng/g per 24 h vs 5.28 ± 7.87 ng/g per 24 h, p = 0.007), as was the OPE triphenyl phosphate (305 ± 606 vs 19.7 ± 33.8 ng/g per 24 h, p = 0.011). The OPE tris(1,3-dichlor-2-propyl)phosphate had a higher mean in the exposed group (60.7 ± 135 ng/g per 24 h) compared to the reference group (8.89 ± 15.7 ng/g per 24 h) but did not reach significance. No evidence of effects for biomarkers of systemic inflammation, genetic damage or lung function was found. Overall, our biomonitoring study show limited evidence of occupational exposure of air force ground crew personnel to UFPs, PAHs and OPEs. Furthermore, the OH-PAHs and the assessed biomarkers of early biological effects did not differ between exposed and reference groups., (© 2021. The Author(s).)

Occupational hand eczema (HE) has continuously been the most frequently recognised occupational disease, comprising > 95% of all recognised occupational skin diseases. Irritant contact dermatitis constitutes > 70%, where wet work is the main eliciting factor. Knowledge on the dose-response relationship between wet work and HE is pivotal concerning preventive interventions, job counselling and medico-legal regulations, which is summarised in this review. New findings indicate a significant risk of having HE at an exposure level of no more than 30 minutes of wet work per day.

Objective Prolonged seated immobility during long-distance flights is related to an increased risk of venous thromboembolism (VTE), but little, if anything, is known about the risk related to sedentary work. The objective of this paper was to examine the risk of VTE according to sitting posture at work. Methods This prospective study includes a total of 78 936 participants from the Copenhagen City Heart Study and the Copenhagen General Population Study, all without previous thromboembolic events and aged <65 years. An assessment of the number of hours spent in sitting position at work was assigned each participant at baseline using a job exposure matrix. VTE was identified through national patient registries. Survival analyses were performed to determine the risk of VTE according to sedentary position at work with adjustment for a range of known determinants including lifestyle and coagulation factors. Results During the follow-up period of 582 411 person years (mean follow-up, 7.4 years) 911 participants experienced their first VTE event. Multivariable adjusted analyses showed no difference in risk of VTE between occupational sitting ≥6.5 hours/day and occupational sitting ≤3.5 hours/day (hazard ratio 1.11, 95% confidence interval 0.92-1.34). Conclusion This study does not support the hypothesis that sedentary work is a risk factor for VTE in the general population. Whether certain occupations with particularly high exposure to immobilized sitting positions are associated with thromboembolic events is not addressed.

Purpose: The aim of this study was to create a job-exposure matrix (JEM) for wet work. A JEM is a tool used to assess exposure to potential health hazards in occupational epidemiological studies. It can be used when counselling concerning job change/job choice, as a medico-legal tool when recognizing diseases as occupational and when planning interventions regarding prevention of, in this case, occupational hand eczema., Methods: The study population was based on results from national surveys on working environment performed by the National Research Centre for the Working Environment in Denmark in 2000, 2005, and 2010 (National Research Centre for the Working Environment). We assessed responses on questions regarding wet hands, glove wear and total wet work. For the JEM a cutoff of 2 h total wet work/day was chosen as the exposure measurement. The proportion of responses of 2 h total wet work/day in each profession is illustrated as a number between 0 and 1 equal to 0-100% of the responses., Results: Total wet work was most frequent among cleaners (domestic, office, and hotel cleaning), butchers and fishmongers, cooks, beauticians (hairdressers, barbers, related work) and health care workers (home-based personal workers, dentists, dental assistants). Regarding differences between sexes we found that indifferent of age and profession, women had 78% higher odds of having wet work., Conclusion: We found that wet work as an exposure varies among professions depending on whether wet hands or glove wear is assessed. A JEM is a useful tool to assess the extent of the exposure, wet work, independent of prior perceptions of classical wet work professions.

Purpose: Wet work is the most important exposure leading to occupational hand eczema; however, the prevalence and character of wet work in various wet work professions remain not fully covered. Self-reported data are widely used in studies of wet work although the validity of these remains uncertain. The objective of the present study is to provide information on validity of self-reported wet work exposure in different professions by comparing work place observations with self-reported data., Methods: 114 workers from 15 various wet work professions were observed. The observations covered duration and frequency of wet work activities. The observed population as well as a non-observed population from each work place were given a questionnaire covering the same wet work activities., Results: Correspondence analysis between self-reported and observed wet work showed that misclassification was larger regarding duration than frequency. 29.2% overestimated and 23.9% underestimated total wet work with more than 2 h/day. Professions with high wet work prevalence overestimated duration of wet work activities, but underestimated frequency. Females overestimated frequency, but not duration. The observed group (45%) significantly more often, than the non-observed group (32%), reported having more than 2 h of wet work/day (OR 2.8, 95% CI 1.6-4.9). Sensitivity and specificity of the questionnaire regarding total wet work in the observed population showed 51% sensitivity and 59% specificity., Conclusion: Over- and underestimation of wet work were found to be equally distributed. The correspondence analyses illustrate a noticeable misclassification between the estimations and the observations on all wet work variables, but largest for total wet work.

Objective: Firefighters are exposed to numerous respiratory hazards, but large studies on the risk of pulmonary disease are scarce. The objective of this study was to examine incidence of asthma and chronic obstructive pulmonary disease (COPD) in a nationwide cohort of Danish firefighters., Methods: We used individual historical employment records on 11 968 Danish male firefighters primarily supplied by trade unions and fire agencies. Furthermore, we used the Supplementary Pension Fund Register to form an occupational reference group consisting of military employees. Information on respiratory incidence was retrieved from the nationwide Danish National Patient Registry. Age and calendar time standardised incidence ratio (SIR) and Poisson regression analyses (incidence rate ratio) were used for estimation of risks, including 95% CIs., Results: Compared with military employees, the overall age and calendar-time adjusted risk for asthma was significantly increased among full-time firefighters (SIR=1.58, 95% CI 1.32 to 1.88), but not among part-time/volunteer firefighters. Full-time firefighters' risk for asthma did not vary by duration of employment. No consistent evidence of an increased risk for chronic obstructive pulmonary disease was detected., Conclusion: Danish firefighters have an increased risk of asthma, but the causes, whether occupational or not, remain to be established., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Occupational exposure of firefighters involves a complex range of potential health threats from toxic chemicals, shift work, extreme heat, physical and emotional strain. The aim of this study is to examine overall and disease-specific mortality among Danish firefighters., Methods: Through systematic collection of personnel and membership records from employers and trade unions, past and present male Danish firefighters were identified (n = 11,775). Using the unique Danish personal identification number, information on additional employment, vital status and cause of death was linked to each member of the cohort from the Supplementary Pension Fund Register, the Danish Civil Registration System and the Danish Register of Causes of Death. Standardized mortality ratios (SMRs) were calculated for specific causes of death using rates for two reference groups, a random sample of the male working population (n = 262,168) and the military (n = 396,739), respectively., Results: Overall mortality was significantly reduced among the firefighters compared to both the sample of the working population and the military (SMR 0.74, 95% CI 0.69-0.78 and SMR 0.88, 95% CI 0.83-0.93). Further, the SMRs for endocrine diseases, mental disorders, non-traffic related accidents and other external causes were significantly lower against both reference groups. Death from stomach cancer was significantly increased among the full time firefighters, while part time/volunteer workers shared a significant increase in prostate cancer death compared to both references., Conclusions: Despite potential exposure to several occupational hazards, male Danish firefighters have a lower mortality than both the Danish working population in general and Danish military employees.

Firefighting is regarded as possibly carcinogenic, although there are few mechanistic studies on genotoxicity in humans. We investigated exposure to polycyclic aromatic hydrocarbons (PAH), lung function, systemic inflammation and genotoxicity in peripheral blood mononuclear cells (PBMC) of 22 professional firefighters before and after a 24-h work shift. Exposure was assessed by measurements of particulate matter (PM), PAH levels on skin, urinary 1-hydroxypyrene (1-OHP) and self-reported participation in fire extinguishing activities. PM measurements indicated that use of personal protective equipment (PPE) effectively prevented inhalation exposure, but exposure to PM occurred when the environment was perceived as safe and the self-contained breathing apparatuses were removed. The level of PAH on skin and urinary 1-OHP concentration were similar before and after the work shift, irrespective of self-reported participation in fire extinction activities. Post-shift, the subjects had reduced levels of oxidatively damaged DNA in PBMC, and increased plasma concentration of vascular cell adhesion molecule 1 (VCAM-1). The subjects reporting participation in fire extinction activities during the work shift had a slightly decreased lung function, increased plasma concentration of VCAM-1, and reduced levels of oxidatively damaged DNA in PBMC. Our results suggest that the firefighters were not exposed to PM while using PPE, but exposure occurred when PPE was not used. The work shift was not associated with increased levels of genotoxicity. Increased levels of VCAM-1 in plasma were observed. Environ. Mol. Mutagen. 59:539-548, 2018. © 2018 Wiley Periodicals, Inc., (Copyright © 2018 Wiley Periodicals, Inc.)

Background: Wet work is an important risk factor for occupational hand eczema., Objectives: To examine the effect of job change in workers with occupational hand eczema caused by wet work, and to evaluate the dose-response relationship between intensity of wet work and eczema., Method: The study is based on a subgroup (n = 954) from a descriptive, registry-based study including all participants with occupational hand eczema caused by wet work recognized by the Danish Labour Market Insurance Authority in 2010 and 2011. A follow-up questionnaire was sent out 4-5 years later (response 58%)., Results: Change of profession and being outside the labour market had a positive effect on healing and improvement of hand eczema. Inverse dose-response relationships were found between the amount of time spent with wet hands at work and healing (p = 0.001) and improvement (p < 0.001), and between the frequency of hand washing at work and healing (p = 0.013) and improvement (p < 0.001)., Conclusions: Leaving the profession has a positive effect on eczema; however, even minor changes in exposure to wet work were associated with healing and improvement. This information has implications with respect to advice given to patients with occupational hand eczema caused by wet work., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study investigated a number of biomarkers, associated with systemic inflammation as well as genotoxicity, in 53 young and healthy subjects participating in a course to become firefighters, while wearing personal protective equipment (PPE). The exposure period consisted of a 3-day training course where the subjects participated in various live-fire training exercises. The subjects were instructed to extinguish fires of either wood or wood with electrical cords and mattresses. The personal exposure was measured as dermal polycyclic aromatic hydrocarbon (PAH) concentrations and urinary excretion of 1-hydroxypyrene (1-OHP). The subjects were primarily exposed to particulate matter (PM) in by-stander positions, since the self-contained breathing apparatus effectively prevented pulmonary exposure. There was increased dermal exposure to pyrene (68.1%, 95% CI: 52.5%, 83.8%) and sum of 16 polycyclic aromatic hydrocarbons (ƩPAH; 79.5%, 95% CI: 52.5%, 106.6%), and increased urinary excretion of 1-OHP (70.4%, 95% CI: 52.5%; 106.6%) after the firefighting exercise compared with the mean of two control measurements performed 2 weeks before and 2 weeks after the firefighting course, respectively. The level of Fpg-sensitive sites in peripheral blood mononuclear cells (PBMCs) was increased by 8.0% (95% CI: 0.02%, 15.9%) compared with control measurements. The level of DNA strand breaks was positively associated with dermal exposure to pyrene and ƩPAHs, and urinary excretion of 1-OHP. Fpg-sensitive sites were only associated positively with PAHs. Biomarkers of inflammation and lung function showed no consistent response. In summary, the study demonstrated that PAH exposure during firefighting activity was associated with genotoxicity in PBMCs.

Background: Firefighters have increased risk of cardiovascular disease and of sudden death from coronary heart disease on duty while suppressing fires. This study investigated the effect of firefighting activities, using appropriate personal protective equipment (PPE), on biomarkers of cardiovascular effects in young conscripts training to become firefighters., Methods: Healthy conscripts (n = 43) who participated in a rescue educational course for firefighting were enrolled in the study. The exposure period consisted of a three-day training course where the conscripts participated in various firefighting exercises in a constructed firehouse and flashover container. The subjects were instructed to extinguish fires of either wood or wood with electrical cords and mattresses. The exposure to particulate matter (PM) was assessed at various locations and personal exposure was assessed by portable PM samplers and urinary excretion of 1-hydroxypyrene. Cardiovascular measurements included microvascular function and heart rate variability (HRV)., Results: The subjects were primarily exposed to PM in bystander positions, whereas self-contained breathing apparatus effectively abolished pulmonary exposure. Firefighting training was associated with elevated urinary excretion of 1-hydroxypyrene (105%, 95% CI: 52; 157%), increased body temperature, decreased microvascular function (-18%, 95% CI: -26; -9%) and altered HRV. There was no difference in cardiovascular measurements for the two types of fires., Conclusion: Observations from this fire extinction training show that PM exposure mainly occurs in situations where firefighters removed the self-contained breathing apparatus. Altered cardiovascular disease endpoints after the firefighting exercise period were most likely due to complex effects from PM exposure, physical exhaustion and increased core body temperature.

Background: Hairdressers are at risk of developing occupational contact dermatitis because of their intense contact with wet work in combination with chemicals., Objectives: To perform an analysis of a cohort study of hairdressers with occupational contact dermatitis recognized in the period 2006-2011, focusing on individual and environmental factors associated with the disease., Methods: The study was a descriptive, register-based survey including all hairdressers with recognized occupational contact dermatitis in Denmark in the period January 2006 to September 2011. Data were obtained from the Danish National Board of Industrial Injuries., Results: The study comprised 381 patients (373 women and 8 men). The median age was 25 years, 64.8% were apprentices, and 35.2% were fully trained hairdressers. The prevalence of atopic dermatitis was 36.0%, and was significantly higher among apprentices than among fully trained hairdressers (44.9% and 19.4%, respectively) (p < 0.001). Of the patients, 48.3% had their dermatitis recognized as occupational irritant contact dermatitis, 46.7% had their dermatitis recognized as as occupational allergic contact dermatitis or combined allergic and irritant contact dermatitis, and 5.0% were recognized as having occupational contact urticaria., Conclusion: The low median age, the high percentages of atopic dermatitis in apprentices and the fact that more apprentices than fully trained hairdressers had recognized occupational contact dermatitis underlines the importance of early prevention., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Skin diseases are the most commonly recognized occupational diseases in Denmark, and occupational contact dermatitis (OCD) comprises ∼95% of all cases., Objectives: To prevent occupational contact dermatitis, it is important to specifically identify exposures and work routines related to outbreak of the disease. The aim of this study was to give an overview of exposures for patients with occupational contact dermatitis in Denmark in 2010, and relate this to line of work and disease severity., Material and Methods: The study was a descriptive, register-based study including patients with recognized occupational contact dermatitis in Denmark in 2010. Data were obtained from the National Board of Industrial Injuries in Denmark, and comprised information about the skin disease as well as the occupation/industry of employment and exposures., Results: One thousand five hundred and four patients, 1020 women and 484 men, were included in the study. Irritant contact dermatitis accounted for 70% of all cases; 68% of these were caused by wet work. Forty-six per cent of all patients were employed either in the healthcare sector, in cleaning, or as kitchen workers. Among contact allergies, the most common were to rubber additives from gloves and epoxy in patients employed in the windmill industry., Conclusion: The data are important for planning preventive efforts in the future. The workers in the healthcare sector, kitchen workers and cleaners constitute almost half of all cases, and future preventive efforts should be directed at these occupations., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Skin cancer may, in some cases, be caused by occupational exposures. The aim of this study was to investigate the prevalence of and exposures leading to occupationally induced skin cancers in Denmark during a ten-year period., Material and Methods: The study is a descriptive, register-based study comprising all patients with recognized occupational malignant and premalignant skin conditions in Denmark in the 01/01 2000-31/12 2009 period. Data were obtained from The National Board of Industrial Injuries and comprise information about diagnosis, occupational and domestic exposure, anatomic localization, occupation, degree of permanent disability, age and sex., Results: A total of 36 patients were recognized as occupational skin cancer cases. The mean age was 61 years (44-75 years), 31 men and five women. The most frequent diagnosis was basal cell carcinoma followed by squamous cell carcinoma. No cases of malignant melanoma were recognized. The primary risk factor for development of occupational skin cancer was ultraviolet (UV) exposure during outdoor working., Conclusion: Data based on recognized cases of occupational skin cancer during a ten-year period in Denmark show that non-melanoma skin cancer was the most frequent diagnosis, while the primary risk factor was UV radiation in outdoor occupations. A total of 36 cases were reported over a period of ten years, and underreporting may be suspected. The purpose of the present study was to raise the awareness of occupational skin cancer, and on the basis of existing data to contribute to criteria for the diagnosis of occupational skin cancer., Funding: not relevant., Trial Registration: not relevant.

Objective: To investigate the interaction of smoking and history of long-term occupational exposure to organic solvents on the prevalence of chronic bronchitis (CB) among middle aged and elderly men., Methods: A questionnaire on health, lifestyle, and working conditions, and a clinical examination including measurements of height, weight, and peak-flow. Self-reported occupational solvent exposure for 5 years or more was compared to never exposed. Three thousand two hundred eight men aged 63 +/- 10 years were included., Results: Four hundred sixty one men had CB (14.4%). Current smoking and the interaction of smoking and long-term occupational exposure to organic solvents (> 5 years) were the factors most strongly associated with prevalence of CB. In the solvent exposed group odds ratio for CB was 7.0 (95% confidence interval [CI]: 3.4 to 14.5) comparing current smokers with non-smokers against only 3.7 (95% CI: 2.8 to 4.8) in the nonexposed group, also after control for potential confounders. Among nonsmokers only, long-term exposure to organic solvents was not associated with an increased prevalence of CB., Conclusion: Current or previous occupational exposure to organic solvents doubles the smoking related risk of CB, probably due to an additional irritative effect in the alveolar and bronchial mucosa.