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Despite the constantly growing exposure to psychosocial hazards as well as their health and occupational consequences, research on psychosocial risks among musicians is exceptionally scarce. Moreover, previous studies on psychosocial risks and occupational stress among professional musicians have used a wide variety of measurement methods. The questionnaire we have developed assesses both the occurrence and stressfulness of particular work demands. Thus, it includes the “potential harm” caused by particular work aspects, described in the World Health Organization definition of psychosocial risks. Our questionnaire allows for measuring the general index of the occurrence and stressfulness of psychosocial risks in musicians’ work places, but also the occurrence and stressfulness of eight distinct categories of psychosocial risks: Job Content, Work Environment, Work-Home Interference, Relationships, Lack of Stability, Development Possibilities, Home-Work Interference, and Tools. The Psychosocial Risks Questionnaire for Musicians (PRQM) has satisfactory reliability (Cronbach’s alpha for the whole scale is 0.89 and from 0.74 to 0.86 for particular subscales). The PRQM correlates significantly with self-assessed work demands and stress symptoms (positive relationships) as well as with self-assessed physical and mental condition, control at work and coping ability (negative relationships).

International audience; In the context of a new annual eye lens dose limit for occupational exposure equal to 20mSv, European Radiation Dosimetry Group (EURADOS) organized an intercomparison dedicated to eye lens dosemeters, including photon and beta radiations. The objective was to complete the first intercomparison recently organized by EURADOS for photons and to update the overview of eye lens dosemeters available in Europe. The dosemeters provided by the 22 participants coming from 12 countries were all composed of thermoluminescent detectors. The dosemeters were irradiated with photon and beta fields defined in relevant standards. The results, provided by participants in terms of Hp(3), were compared to the reference delivered doses. Results are globally satisfactory for photons since 90% of the data are in accordance to the ISO 14146 standard requirements. The respective values for betas stress the fact that dosemeters designed for Hp(0.07) are not suitable to monitor the eye lens dose in case of betas. © The Author(s) 2018.

An association between low socioeconomic status (SES) and lung cancer has been observed in several studies, but often without adequate control for smoking behavior. We studied the association between lung cancer and occupationally derived SES, using data from the international pooled SYNERGY study. Twelve case-control studies from Europe and Canada were included in the analysis. Based on occupational histories of study participants we measured SES using the International Socio-Economic Index of Occupational Status (ISEI) and the European Socio-economic Classification (ESeC). We divided the ISEI range into categories, using various criteria. Stratifying by gender, we calculated odds ratios (OR) and 95% confidence intervals (CI) by unconditional logistic regression, adjusting for age, study, and smoking behavior. We conducted analyses by histological subtypes of lung cancer and subgroup analyses by study region, birth cohort, education and occupational exposure to known lung carcinogens. The analysis dataset included 17,021 cases and 20,885 controls. There was a strong elevated OR between lung cancer and low SES, which was attenuated substantially after adjustment for smoking, however a social gradient persisted. SES differences in lung cancer risk were higher among men (lowest vs. highest SES category: ISEI OR 1.84 (95% CI 1.61-2.09); ESeC OR 1.53 (95% CI 1.44-1.63)), than among women (lowest vs. highest SES category: ISEI OR 1.54 (95% CI 1.20-1.98); ESeC OR 1.34 (95% CI 1.19-1.52)). SES remained a risk factor for lung cancer after adjustment for smoking behavior. Funding: This study was supported by the German Social Accident Insurance, grant number FP 271. Grant sponsors of the individual studies were the Canadian Institutes for Health Research and Guzzo-SRC Chair in Environment and Cancer, National Cancer Institute of Canada, Canadian Cancer Society, Occupational Cancer Research Centre, Workplace Safety and Insurance Board, Canadian Cancer Society, and Cancer Care Ontario; Grant sponsor: European Commission’s INCO Copernicus program; Grant number: IC15-CT96-0313; Grant sponsor: European Union Nuclear Fission Safety Program; Grant number: F14P-CT96-0055; Grant sponsors: French Agency of Health Security (ANSES), Fondation de France, French National Research Agency (ANR), National Institute of Cancer (INCA), Fondation pour la Recherche Medicale, French Institute for Public Health Surveillance (InVS), Health Ministry (DGS), Organization for the Research on Cancer (ARC), and FrenchMinistry of work, solidarity, and public function (DGT); Grant sponsor: Federal Ministry of Education, Science, Research, and Technology; Grant number: 01 HK 173/0); Grant sponsor: Federal Ministry of Science; Grant number: 01 HK 546/8; Grant sponsor: Ministry of Labour and Social Affairs; Grant number: IIIb7-27/13; Grant sponsor: Research Grants Council of the Hong Kong Special Administrative Region, China; Grant number: CUHK4460/03M; Grant sponsors: Environmental Epidemiology Program of the Lombardy Region, INAIL, Italian Association for Cancer Research, Region Piedmont, Compagnia di San Paolo, Lazio Region, Health Research Council of New Zealand, New Zealand Department of Labour, Lottery Health Research, Cancer Society of New Zealand; Grant sponsor: Polish State Committee for Scientific Research; Grant number: SPUB-M-COPERNICUS/P-05/DZ-30/99/2000; Grant sponsors: Instituto Universitario de Oncologia, Universidad de Oviedo, Asturias, Fondo de Investigacion Sanitaria (FIS) and Ciber de Epidemiologia y Salud Publica (CIBERESP), Swedish Council for Work Life Research and Swedish Environmental Protection Agency, Dutch Ministry of Health, Welfare and Sports, National Institute of Public Health and the Environment, and Europe Against Cancer Program, Roy Castle Foundation, and Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland.

Non-small cell lung cancer is the most common type of lung cancer. Both environmental and genetic risk factors contribute to lung carcinogenesis. We conducted a genome-wide interaction analysis between single nucleotide polymorphisms (SNPs) and smoking status (never-versus ever-smokers) in a European-descent population. We adopted a two-step analysis strategy in the discovery stage: we first conducted a case-only interaction analysis to assess the relationship between SNPs and smoking behavior using 13 336 non-small cell lung cancer cases. Candidate SNPs with P-value

Objectives: According to current research, patient handling is not universally taught in academic nursing programs in Europe. Miscellaneous patient handling education may expose students and novice health care workers to occupational hazards, especially if the evidence-based contents of safe patient handling are not recognized. Health care workers deal with high physical workloads daily, which points out the importance of evidence-based curricula contents from the early phases of education. The aim of this study was to describe the patient handling education and to analyse the differences in curricula among higher education institutions (HEIs) in Europe. Material and Methods: The study used a cross-sectional design and was conducted in HEIs educating health care professionals in Europe. The data was collected through a Webropol questionnaire consisting of structured and open-ended questions. Results: Only 68.4% of the respondents stated that they have a framework that guides the patient handling education. Additionally, some answers referred to guidelines that are not adequate to be referred to as evidence-based guidelines on patient handling. There is variation in emphasizing workplace safety and risk assessment issues in the curricula, and variation in teaching of assistive aids. Conclusions: Currently the patient handling education in the studied HEIs does not meet the requirements of evidence-based practice. The establishment of a European-wide framework, including both theoretical and practical training for safe patient handling is needed. The inclusion of risk assessment and workplace safety issues is essential to improve the risk management knowledge and skills and further avoid work-related musculoskeletal disorders.

Dysphonia; Neutrophilic inflammation; Occupational asthma Disfonía; Inflamación neutrofílica; Asma ocupacional Disfonia; Inflamació neutròfila; Asma ocupacional

German Social Accident Insurance (DGUV) between 2007 and 2011, Olsson A, Guha N, Bouaoun L, Kromhout H, Peters S, Siemiatycki J, Ho V, Gustavsson P, Boffetta P, Vermeulen R, Behrens T, Brüning T, Kendzia B, Guénel P, Luce D, Karrasch S, Wichmann HE, Consonni D, Landi MT, Caporaso NE, Merletti F, Mirabelli D, Richiardi L, Jöckel KH, Ahrens W, Pohlabeln H, Tardón A, Zaridze D, Field JK, Lissowska J, Świątkowska B, McLaughlin JR, Demers PA, Bencko V, Foretova L, Janout V, Pándics T, Fabianova E, Mates D, Forastiere F, Bueno-de-Mesquita B, Schüz J, Straif K

Supplemental Digital Content is available in the text., Background: Evidence is limited regarding risk and the shape of the exposure–response curve at low asbestos exposure levels. We estimated the exposure–response for occupational asbestos exposure and assessed the joint effect of asbestos exposure and smoking by sex and lung cancer subtype in general population studies. Methods: We pooled 14 case–control studies conducted in 1985–2010 in Europe and Canada, including 17,705 lung cancer cases and 21,813 controls with detailed information on tobacco habits and lifetime occupations. We developed a quantitative job-exposure-matrix to estimate job-, time period-, and region-specific exposure levels. Fiber-years (ff/ml-years) were calculated for each subject by linking the matrix with individual occupational histories. We fit unconditional logistic regression models to estimate odds ratios (ORs), 95% confidence intervals (CIs), and trends. Results: The fully adjusted OR for ever-exposure to asbestos was 1.24 (95% CI, 1.18, 1.31) in men and 1.12 (95% CI, 0.95, 1.31) in women. In men, increasing lung cancer risk was observed with increasing exposure in all smoking categories and for all three major lung cancer subtypes. In women, lung cancer risk for all subtypes was increased in current smokers (ORs ~two-fold). The joint effect of asbestos exposure and smoking did not deviate from multiplicativity among men, and was more than additive among women. Conclusions: Our results in men showed an excess risk of lung cancer and its subtypes at low cumulative exposure levels, with a steeper exposure–response slope in this exposure range than at higher, previously studied levels. (See video abstract at, http://links.lww.com/EDE/B161.)

Background: Early-life respiratory tract infections might affect chronic obstructive respiratory diseases, but conclusive studies from general populations are lacking. Our objective was to examine if children with early-life respiratory tract infections had increased risks of lower lung function and asthma at school age. Methods: We used individual participant data of 150 090 children primarily from the EU Child Cohort Network to examine the associations of upper and lower respiratory tract infections from age 6 months to 5 years with forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow at 75% of FVC (FEF75%) and asthma at a median (range) age of 7 (4-15) years. Results: Children with early-life lower, not upper, respiratory tract infections had a lower school-age FEV1, FEV1/FVC and FEF75% (z-score range: -0.09 (95% CI -0.14- -0.04) to -0.30 (95% CI -0.36- -0.24)). Children with early-life lower respiratory tract infections had a higher increased risk of school-age asthma than those with upper respiratory tract infections (OR range: 2.10 (95% CI 1.98-2.22) to 6.30 (95% CI 5.64-7.04) and 1.25 (95% CI 1.18-1.32) to 1.55 (95% CI 1.47-1.65), respectively). Adjustment for preceding respiratory tract infections slightly decreased the strength of the effects. Observed associations were similar for those with and without early-life wheezing as a proxy for early-life asthma. Conclusions: Our findings suggest that early-life respiratory tract infections affect development of chronic obstructive respiratory diseases in later life, with the strongest effects for lower respiratory tract infections. A comprehensive list of grant funding is available on the ALSPAC website (www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). BAMSE: BAMSE was funded by the Swedish Research Council, the Swedish Heart Lung Foundation, ALF Region Stockholm and SFO Epidemiology Karolinska Institutet. E. Mélen is supported by a European Research Council grant (TRIBAL, 757919). BiB (Born in Bradford): BiB is only possible because of the enthusiasm and commitment of the children and parents in BiB. We are grateful to all the participants, practitioners and researchers who have made BiB happen. The BiB study presents independent research commissioned by the National Institute for Health Research Collaboration for Applied Health Research and Care (NIHR CLAHRC) and the Programme Grants for Applied Research funding scheme (RP-PG-0407-10044). Core support for BiB is also provided by the Wellcome Trust (WT101597MA). BILD: This study was funded by the Swiss National Science Foundation (320030_163311). CoNER: Funds were obtained from the special programme (Programmi speciali – Art.12 bis, comma 6 D.lgs.229/99 Sanitaria e della Vigilanza sugli Enti) funded by the Italian Ministry of Health. Approval for the study was obtained from the Ethics Committee of the S. Orsola-Malpighi Teaching Hospital in April 2004 (52/2004/U/Tess). COPSAC 2000 and COPSAC 2010: All funding received by COPSAC is listed on www.copsac.com. The Lundbeck Foundation (R16-A1694), Ministry of Health (903516), Danish Council for Strategic Research (0603-00280B) and Capital Region Research Foundation have provided core support to the COPSAC research centre. We express our deepest gratitude to the children and families of the COPSAC 2000 and COPSAC 2010 cohort studies for all their support and commitment. We acknowledge and appreciate the unique efforts of the COPSAC research team. DNBC (Danish National Birth Cohort): The authors would like to thank the participants, the first Principal Investigator of DNBC, Jørn Olsen, the scientific managerial team and DNBC secretariat for being, establishing, developing and consolidating the DNBC. The DNBC was established with a significant grant from the Danish National Research Foundation. Additional support was obtained from the Danish Regional Committees, Pharmacy Foundation, Egmont Foundation, March of Dimes Birth Defects Foundation, Health Foundation and other minor grants. The DNBC Biobank has been supported by the Novo Nordisk Foundation and Lundbeck Foundation. Follow-up of mothers and children has been supported by the Danish Medical Research Council (SSVF 0646, 271-08-0839/06-066023, O602-01042B, 0602-02738B), Lundbeck Foundation (195/04, R100-A9193), Innovation Fund Denmark 0603-00294B (09-067124), Nordea Foundation (02-2013-2014), Aarhus Ideas (AU R9-A959-13-S804), University of Copenhagen Strategic Grant (IFSV 2012) and Danish Council for Independent Research (DFF-4183-00594, DFF-4183-00152). A. Pinot de Moira is funded by a Lundbeck Foundation grant (R264-2017-3099). EDEN: We thank the EDEN mother–child cohort study group (I. Annesi-Maesano, J.Y. Bernard, J. Botton, M.A. Charles, P. Dargent-Molina, B. de Lauzon-Guillain, P. Ducimetière, M. de Agostini, B. Foliguet, A. Forhan, X. Fritel, A. Germa, V. Goua, R. Hankard, B. Heude, M. Kaminski, B. Larroque†, N. Lelong, J. Lepeule, G. Magnin, L. Marchand, C. Nabet, F. Pierre, R. Slama, M.J. Saurel-Cubizolles, M. Schweitzer and O. Thiebaugeorges). We thank all funding sources for the EDEN study (not allocated for the present study but for the cohort): Foundation for Medical Research (FRM), National Agency for Research (ANR), National Institute for Research in Public health (IRESP: TGIR cohorte santé 2008 programme), French Ministry of Health (DGS), French Ministry of Research, INSERM Bone and Joint Diseases National Research (PRO-A) and Human Nutrition National Research Programs, Paris-Sud University, Nestlé, French National Institute for Population Health Surveillance (InVS), French National Institute for Health Education (INPES), the European Union FP7 programmes (FP7/2007-2013, HELIX, ESCAPE, ENRIECO, MeDALL projects), Diabetes National Research Program (in collaboration with the French Association of Diabetic Patients (AFD)), French Agency for Environmental Health Safety (now ANSES), Mutuelle Générale de l'Education Nationale complementary health insurance (MGEN), French national agency for food security, and French speaking association for the study of diabetes and metabolism (ALFEDIAM). The funding source had no involvement in the conception of the present study. FLEHS: This study was conducted within the framework of the Flemish Centre of Expertise on Environment and Health, funded by the Dept of the Environment of the Flemish Government, Flemish Agency of Care and Health, and Flemish Dept of Economy, Science and Innovation. GASPII: The GASPII cohort was funded by the Italian Ministry of Health (2001), the research leading to these results has received funding from the European Community's Seventh Framework Program under grant agreement 261357 (MeDALL). Generation R: This study was funded by Erasmus MC Rotterdam, Erasmus University Rotterdam and the Netherlands Organisation for Health Research and Development. V.W.V. Jaddoe received a grant from the European Research Council (ERC-2014-CoG-648916). L. Duijts received funding from cofunded ERA-Net on Biomarkers for Nutrition and Health (ERA HDHL), Horizon 2020 (696295; 2017), the Netherlands Organisation for Health Research and Development (ZonMw; 529051014; 2017), Science Foundation Ireland (SFI/16/ERA-HDHL/3360), and European Union (ALPHABET project). The project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, 733206, 2016; EUCAN-Connect 824989; ATHLETE, 874583). The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of data or writing of this report. Generation XXI: Generation XXI was supported by the European Regional Development Fund (ERDF) through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology (FCT), Portuguese Ministry of Science, Technology and Higher Education, and by the Unidade de Investigação em Epidemiologia – Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (UIDB/04750/2020), Administração Regional de Saúde Norte (Regional Dept of Ministry of Health) and Fundação Calouste Gulbenkian. A.C. Santos is founded by FCT Investigator contracts IF/01060/2015. GINI: The GINIplus study was mainly supported for the first 3 years by the Federal Ministry for Education, Science, Research and Technology (interventional arm) and Helmholtz Zentrum München (former GSF) (observational arm). The 4- and 6-year follow-up examinations of the GINIplus study were covered from the respective budgets of the five study centres (Helmholtz Zentrum München (former GSF), Research Institute at Marien-Hospital, Wesel, LMU Munich, TU Munich and from 6 years onwards also from IUF – Leibniz Research Institute for Environmental Medicine at the University of Düsseldorf). HUMIS: We thank all mothers for participating in the HUMIS study. HUMIS was funded by a grant from the Norwegian Research Council (226402). The HUMIS study was approved by the Norwegian Data Inspectorate (2002/1398) and by the Regional Ethics Committee for Medical Research in Norway (S-02122), and the specific use in the current study was approved by the Ethics Committee as well (2010/1259/REK sør-øst). INMA: Gipuzkoa: This study was funded by grants from Instituto de Salud Carlos III (FIS-PI09/00090, FIS-PI18/01142 including FEDER funds), CIBERESP, Dept of Health of the Basque Government (2013111089) and annual agreements with the municipalities of the study area (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia and Beasain). Menorca: This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041; 97/0588; 00/0021-2, PI061756; PS0901958, PI14/00677 including FEDER funds), CIBERESP, Beca de la IV convocatoria de Ayudas a la Investigación en Enfemerdades Neurodegeneratives de La Caixa, and EC contract QLK4-CT-200-00263. Sabadell: This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041; PI041436; PI081151 including FEDER funds), Generalitat de Catalunya-CIRIT 1999SGR 00241 and Fundació La marató de TV3 (090430). ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. M. Casas holds a Miguel Servet fellowship (CP16/00128) funded by Instituto de Salud Carlos III and cofunded by the European Social Fund “Investing in your future”. Valencia: This study was funded by grants from the European Union (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), Spain: Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041; FIS-FEDER: PI03/1615, PI04/1509, PI04/1112, PI04/1931, PI05/1079, PI05/1052, PI06/1213, PI07/0314, PI09/02647, PI11/01007, PI11/02591, PI11/02038, PI13/1944, PI13/2032, PI14/00891, PI14/01687, PI16/1288, PI17/00663; Miguel Servet-FEDER CP11/00178, CP15/00025, CPII16/00051), Generalitat Valenciana: FISABIO (UGP 15-230, UGP-15-244, UGP-15-249), and Alicia Koplowitz Foundation 2017. Isle of Wight: This study was funded by grants from the National Institutes of Health USA (R01HL082925), Asthma UK (364), Isle of Wight NHS Trust and the British Medical Association. KOALA: The collection of data relevant for this study was funded by grants from the Netherlands Organisation for Health Research and Development (ZonMw; 2100.0090) and the Netherlands Asthma Foundation (3.2.03.48, 3.2.07.022). The researchers are independent from the funders. The funders had no role in the study design, data analysis, interpretation of data or writing of this report. We thank the children and parents for their participation in the KOALA study. LRC (Leicestershire Respiratory Cohorts): This study was funded by grants from the Swiss National Science Foundation (SNF: 320030-182628, 320030-162820, 3233-069348, 3200-069349) and Asthma UK 07/048. Lifeways Cross-Generation Cohort Study: This study was funded by the Health Research Board, Ireland, and the Irish Dept of Health and Children's Health Promotion Policy Unit. LISA: The LISA study was mainly supported by grants from the Federal Ministry for Education, Science, Research and Technology and in addition from Helmholtz Zentrum München (former GSF), Helmholtz Centre for Environmental Research – UFZ, Leipzig, Research Institute at Marien-Hospital Bad Honnef for the first 2 years. The 4-, 6-, 10- and 15-year follow-up examinations of the LISA study were covered from the respective budgets of the involved partners (Helmholtz Zentrum München (former GSF), Helmholtz Centre for Environmental Research – UFZ, Leipzig, Research Institute at Marien-Hospital Wesel, Pediatric Practice, Bad Honnef, IUF – Leibniz Research Institute for Environmental Medicine at the University of Düsseldorf) and in addition by a grant from the Federal Ministry for Environment (IUF Düsseldorf, FKZ 20462296). Further, the 15-year follow-up examination of the LISA study was supported by the Commission of the European Communities, the Seventh Framework Program: MeDALL project. This project has received funding from the European Research Council under the European Union’s Horizon 2020 research and innovation programme (949906). LucKi: LucKi is supported by Child and Youth Health Care Zuyderland, Public Health Service South Limburg and Maastricht University. We thank all parents and children for their participation in LucKi. LUKAS: This study was funded by research grants from the Academy of Finland (139021, 287675, 296814, 296817, 308254); Juho Vainio Foundation; EVO/VTR funding; Päivikki and Sakari Sohlberg Foundation; Farmers’ Social Insurance Institution (Mela); Finnish Cultural Foundation; Foundation for Pediatric Research; European Union QLK4-CT-2001-00250; and Finnish Institute for Health and Welfare, Finland. MAS-90: This study was funded by grants from the German Federal Ministry of Education and Research (MBMF; 07015633m 07ALE27, 01EE9405/5, 01EE9406) and the German Research Foundation (DFG; KE1462/2-1). Millennium Cohort Study: This study was funded by the Economic and Social Research Council and a consortium of UK government funders. We are grateful to the participating families and the Centre for Longitudinal Studies (CLS), UCL Institute of Education, for the use of these data and to the UK Data Service for making them available. However, neither CLS nor the UK Data Service bear any responsibility for the analysis or interpretation of these data. This work was supported by the Welcome Trust (187389/B/08/Z). MoBa: The Norwegian Mother, Father and Child Cohort Study is supported by the Norwegian Ministry of Health and Care Services and Ministry of Education and Research. We are grateful to all the participating families in Norway who take part in this ongoing cohort study. This research was supported by the Research Council of Norway through its Centres of Excellence funding scheme (262700). NINFEA: The authors are grateful to all the participants of the NINFEA cohort. The NINFEA study was partially funded by the Compagnia San Paolo Foundation. This research was partially funded by the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, 733206). PELAGIE: We are grateful to the families who participated and continue to participate in the study. The cohort is supported by INSERM and received funding from the French National Research Agency, Fondation de France, French Agency for Food, Environmental and Occupational Health & Safety, National Institute for Public Health Surveillance (InVS), French Ministry of Labour, and French Ministry of Ecology. PIAMA: This study was funded by the Netherlands Organisation of Health Research and Development, Netherlands Organisation for Scientific Research, Netherlands Asthma Fund, Netherlands Ministry of Spatial Planning, Housing and the Environment, and Netherlands Ministry of Health, Welfare and Sport. REPRO_PL: This study was funded by the National Science Center Poland (DEC-2014/15/B/N27/00998). Rhea: This study was funded by the European Union Social Fund and the Hellenic Ministry of Health (“Program of prevention and early diagnosis of obesity and neurodevelopment disorders in preschool age children in the prefecture of Heraklion, Crete, Greece”; MIS 349580, NSRF 2007–2013). Additional funding from the National Institute of Environmental Health Sciences (NIEHS) supported L. Chatzi (R01ES030691, R01ES029944, R01ES030364, R21ES029681, R21ES028903, P30ES007048). STEPS: This study was funded by the University of Turku, Abo Akademi University, Turku University Hospital, Academy of Finland (123571, 140251, 277535) and Foundation for Pediatric Research Finland. SWS: This study was funded by the Medical Research Council, British Heart Foundation, Arthritis Research UK, Food Standards Agency, NIHR Southampton Biomedical Research Centre and the European Union's Seventh Framework Programme (FP7/2007–2013), project EarlyNutrition (289346), and the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, 733206). WHISTLER: The WHISTLER birth cohort was supported with a grant from the Netherlands Organisation for Health Research and Development (2001-1-1322) and by an unrestricted grant from GlaxoSmithKline Netherlands. GlaxoSmithKline had no role in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the report for publication. WHISTLER-Cardio was supported with an unrestricted strategic grant from the University Medical Center Utrecht (UMCU).

International audience; Background: In sepsis, neutrophil respiratory bursts participate in endothelium damage, the first step to multiple organ failure. In plasma two antioxidant selenoenzymes, which protect the endothelium, decrease: selenoprotein-P, and to a lesser extent glutathione peroxidase (GPX3). Sodium selenite (Na2SeO3) is a Se donor, but also an oxidant chemotherapy drug depending on its concentration. In a previous published study, Na(2)SeO(3 )continuous infusion in septic shock patients at a pharmacological dose of 4 mg1 Se/day on day-1, followed by a high nutritional dose of 1 mg Se/day during 9 days, showed no beneficial effect on weaning of catecholamine nor on survival. In this ancillary study, we report clinical and biological effects of such continuous infusion of Na2SeO3. Methods: This was a multicenter, placebo-controlled, double-blind study on 60 patients. Na(2)SeO(3)or placebo in continuous infusion as described above. Evolution with time of plasma Se, selenoprotein-P, GPX(3), Organ dysfunction (sequential organ failure assessment SOFA scores, including PaO2/FiO(2), for respiratory failure, and plasma lactate) and quality of life at 6 months (by SF36 scores) were analyzed using two-way (time, treatment) non-parametric repeated-measures analysis of variance (Friedman test). Main Results: At baseline, plasma Se was about a quarter of reference values. From baseline to day-4 plasma Se, selenoprotein-P and GPX(3) significantly increased by 3.9, 2.7 and 1.8 respectively in the Na(2)SeO(3 )group as compared with placebo and remained elevated by 2.3, 2.7 and 2.1 at day-14 respectively (p < 0.001). Na(2)SeO(3 )did not affect global and organ by organ SOFA Scores and plasma lactate concentration at day-1 and later up to day-14. The evolution of PaO2/FiO(2) until day-14 was similar in the two groups. Quality of life in the surviving patients at 6 months was similar between the two groups. Conclusion: Continuous infusion of Na(2)SeO(3 )at 4 mg Se at day-1 seems to have neither beneficial nor toxic effect at day-1 or later and induces a late increase of selenoprotein-P at day-4. Preclinical studies are required to confirm the use of Na(2)SeO(3 )as a cytotoxic drug against neutrophils and protection of the endothelium by sele-noprotein-P.

BackgroundThe Coronavirus disease 2019 (COVID‐19) has evolved as a pandemic infectious disease transmitted by the severe acute respiratory syndrome coronavirus (SARS‐CoV‐)2. Allergists and other health care providers (HCPs) in the field of allergies and associated airway diseases are in the front line, taking care of patients potentially infected with SARS‐CoV‐2. Hence, strategies and practices to minimize risks of infection for both HCPs and treated patients have to be developed and followed by allergy clinics.MethodThe scientific information on COVID‐19 was analyzed by a literature search in Medline, Pubmed, national and international guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), the Cochrane Library and the Internet.ResultsBased on diagnostic and treatment standards developed by EAACI, on international information regarding COVID‐19, on guidelines of the World Health Organization (WHO) and other international organizations as well as on previous experience, a panel of experts including clinicians, psychologists, IT experts and basic scientists along with EAACI and the “Allergic Rhinitis and its Impact on Asthma (ARIA)” inititiative have developed recommendations for the optimal management of allergy clinics during the current COVID‐19 pandemic. These recommendations are grouped into nine sections on different relevant aspects for the care of patients with allergies.ConclusionsThis international Position Paper provides recommendations on operational plans and procedures to maintain high standards in the daily clinical care of allergic patients whilst ensuring necessary safety in the current COVID‐19 pandemic.

Background Germline genetic variation contributes to lung cancer (LC) susceptibility. Previous genome-wide association studies (GWAS) have implicated susceptibility loci involved in smoking behaviors and DNA repair genes, but further work is required to identify susceptibility variants. Methods To identify LC susceptibility loci, a family history-based genome-wide association by proxy (GWAx) of LC (48 843 European proxy LC patients, 195 387 controls) was combined with a previous LC GWAS (29 266 patients, 56 450 controls) by meta-analysis. Colocalization was used to explore candidate genes and overlap with existing traits at discovered susceptibility loci. Polygenic risk scores (PRS) were tested within an independent validation cohort (1 666 LC patients vs 6 664 controls) using variants selected from the LC susceptibility loci and a novel selection approach using published GWAS summary statistics. Finally, the effects of the LC PRS on somatic mutational burden were explored in patients whose tumor resections have been profiled by exome (n = 685) and genome sequencing (n = 61). Statistical tests were 2-sided. Results The GWAx–GWAS meta-analysis identified 8 novel LC loci. Colocalization implicated DNA repair genes (CHEK1), metabolic genes (CYP1A1), and smoking propensity genes (CHRNA4 and CHRNB2). PRS analysis demonstrated that these variants, as well as subgenome-wide significant variants related to expression quantitative trait loci and/or smoking propensity, assisted in LC genetic risk prediction (odds ratio = 1.37, 95% confidence interval = 1.29 to 1.45; P Conclusions This study has expanded the number of LC susceptibility loci and provided insights into the molecular mechanisms by which these susceptibility variants contribute to LC development.

RationaleSevere fetal malnutrition has been related to an increased risk of respiratory diseases later in life, but evidence for the association of a suboptimal diet during pregnancy with respiratory outcomes in childhood is conflicting. We aimed to examine whether a pro-inflammatory or low-quality maternal diet during pregnancy was associated with child's respiratory health.MethodsWe performed an individual participant meta-analysis among 18 326 mother–child pairs from seven European birth cohorts. Maternal pro-inflammatory and low-quality diets were estimated by energy-adjusted Dietary Inflammatory Index (E-DII) and Dietary Approaches to Stop Hypertension (DASH) scores. Preschool wheezing and school-age asthma were measured using questionnaires and lung function by spirometry.ResultsAfter adjustment for lifestyle and sociodemographic factors, we observed that a higher maternal E-DII score (a more pro-inflammatory diet) during pregnancy was associated only with a lower forced vital capacity (FVC) in children (z-score difference −0.05, 95% CI −0.08– −0.02, per interquartile range increase). No linear associations of the maternal E-DII or DASH score with child's wheezing or asthma were observed. In an exploratory examination of the extremes, a very low DASH score (ConclusionThe main results from this individual participant data meta-analysis do not support the hypothesis that maternal pro-inflammatory or low-quality diet in pregnancy are related to respiratory diseases in childhood.

Not only employees in industrial plants but also consumers, by using finished products, are exposed to chemical substances. Therefore, consumer exposure assessment is also important. To assess the risk for the consumer, the exposure magnitude is needed but measuring these values in residential conditions of consumers is usually impossible. ConsExpo has been designed to facilitate the exposure assessment to substances in consumer products. It is available in English as a free web application at www. consexpoweb.nl. The ConsExpo Web tool, developed by the Netherlands National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu), contains a set of models that help in the assessment of exposure to the substances in consumer products. These are mathematical models with increasing complexity, describing exposure by inhalation, dermal and oral routes. Available models are described in this work. ConsExpo is also equipped with a products database with defined exposure scenarios and default values, which could be a starting point for the models. The aim of this work was to review the literature regarding ConsExpo and to present the application to Polish users through the description of the models contained therein and by providing assessments examples. The review was based on databases of scientific journals. ConsExpo is a commonly known tool, and one of its applications is exposure estimation in comparative studies and the development of new models. For lower-tier analyses ConsExpo can be used by less advanced users. The most favorable for Polish users would be the creation of the Polishlanguage version of the ConsExpo application or a detailed Polish-language instruction manual. Med Pr. 2019;70(6):747-62.Na substancje chemiczne narażeni są nie tylko pracownicy zakładów w szeroko pojętym przemyśle, ale również konsumenci korzystający z gotowych produktów. Dlatego oprócz oceny narażenia pracowników równie ważne jest szacowanie narażenia konsumentów: potrzebne są do tego wielkości narażenia, których zmierzenie w warunkach domowych konsumentów najczęściej nie jest możliwe. Aplikację ConsExpo Web (w artykule dla ułatwienia zwaną ConsExpo) zaprojektowano, by ułatwiać szacowanie narażenia na substancje zawarte w produktach konsumenckich. Dostępna jest ona nieodpłatnie w języku angielskim pod adresem www.consexpoweb.nl. Narzędzie ConsExpo, opracowane przez Narodowy Instytut Zdrowia Publicznego i Środowiska w Holandii (Rijksinstituut voor Volksgezondheid en Milieu), zawiera zestaw modeli pomocnych w ocenie narażenia na substancje w produktach konsumenckich. Są to modele matematyczne, opisujące narażenie drogą inhalacyjną, dermalną i pokarmową. ConsExpo umożliwia – dla tych dróg narażenia – korzystanie z modeli o rosnącej złożoności: od pierwszego rzędu do bardziej szczegółowych, które opisano w tej pracy. Aplikacja zawiera również bazę danych o produktach, dla których zdefiniowano scenariusze narażenia, posiadającą zestaw wartości domyślnych używanych jako parametry wejściowe modeli. Celem pracy było dokonanie przeglądu piśmiennictwa dotyczącego ConsExpo oraz przybliżenie aplikacji polskiemu użytkownikowi poprzez opisy zawartych w niej modeli i zamieszczenie przykładowych szacowań. Przeglądu dokonano na podstawie baz czasopism naukowych. ConsExpo jest narzędziem powszechnie znanym, a jednym z jego zastosowań jest szacowanie narażenia na produkty konsumenckie w badaniach porównawczych i przy opracowywaniu nowych modeli do szacowania narażenia. Przez mniej zaawansowanych użytkowników może być z powodzeniem używana do analiz niższego szczebla i w połączeniu z bazami danych ConsExpo. Najkorzystniejsze dla polskich użytkowników byłoby utworzenie polskojęzycznej wersji aplikacji ConsExpo lub instrukcji użytkowania w języku polskim. Med. Pr. 2019;70(6):747–762.

Long-term exposure to hypercholesterolemia is the cause of atherosclerosis, which in turn causes cardiovascular and cerebrovascular events. In developed countries, including Poland, vascular diseases are the main cause of death. They affect an ever younger part of the population, including the working population. The authors address the problem of epidemiology of cardiovascular diseases, unsatisfactory detection and treatment, economic consequences for the health care system, and the possibilities of using occupational medicine services in the prevention of this health problem. Due to the fact that the early detection of diseases caused by high blood cholesterol levels is relatively low in Poland, obligatory occupational medicine examinations seem to be a key element of the second-line prevention. Therefore, it seems natural to consider the idea of extending the scope of obligatory examinations and introducing tests that allow lipid disorders to be detected at an early stage. This can contribute to a general improvement of the health of the population, and to economic benefits, such as a decrease in the costs of treatment of the disorders that have been detected too late. Broadening the scope of occupational examinations is also important from the perspective of public health and epidemiology of cardiovascular diseases, thus being an element of prevention of civilization diseases. It means improving health and building health awareness, and it should translate into regular health examinations. The performance of these examinations should result not only from the obligation, but also from the patient's conviction about the importance of early detection of disorders, including lipid disorders, for an effective therapy. Int J Occup Med Environ Health. 2019;32(6):865-72.

The aim of the literature review was to describe the environments where the presence of airborne Staphylococcus aureus was confirmed and to catalogue the most often used methods and conditions of bioaerosol sampling to identify the bacteria. The basis for searching of studies on S. aureus in the bioaerosol in different environments was PubMed database resources from the years 1990–2019 (May). The review included studies which were carried on in selected environments: hospitals and other health care facilities, large-scale animal breeding, wastewater treatment plants, residential areas, educational institutions, and other public places. The highest concentrations and genetic diversity of identified S. aureus strains, including MRSA (methicillin-resistant S. aureus), have been shown in large-scale animal breeding. The role of the airborne transmission in dissemination of infection caused by these pathogens is empirically confirmed in environmental studies. Commonly available, well-described, and relatively inexpensive methods of sampling, identification, and subtyping guarantee a high reliability of results and allow to obtain fast and verifiable outcomes in environmental studies on air transmission routes of S. aureus strains.

Road accidents are among the main fatalities worldwide and drowsy driving is a significant cause of road deaths where drivers are at fault. There are well known diseases which impair sensory and cognitive functions and can cause sleepiness during driving. Such diseases can be an important contraindication to driving because they may have an adverse effect on its safety. Thus, medical examinations for drivers should also be directed at identifying any possible conditions posing risks for driving safety. Occupational medicine specialists should look for symptoms of locomotor and sleep-related breathing disorders as these are medical conditions which could preclude a person from driving. In this case report, the authors describe a professional driver with chest deformity and present a pioneering attempt at assessing his medical fitness to drive. It is also explained why scoliosis can impair driving ability and how it should be diagnosed and treated. Finally, the authors describe how they used driving simulator tests as part of their diagnosis and suggest a relevant treatment regimen. Int J Occup Med Environ Health. 2019;32(5):735-45.

Experimental studies have shown cardiovascular effects of electromagnetic fields (EMF) emitted by mobile phones (e.g., prolonged QTc interval and abnormal blood pressure [BP] values). Also, stress may have an impact on the cardiovascular function. However, there are practically no data regarding the joint effect of exposure to stress and EMF, with both factors pertaining, e.g., to employees of mobile network operators.Out of 208 subjects who had taken part in survey research, 55 workers agreed to undergo resting ECG, 24-h ECG and ambulatory blood pressure monitoring (ABPM). Their health condition, occupational and life-stress levels and EMF exposure were also assessed.Among the workers using mobile phones for more than 60 min daily, the systolic BP values in office measurement and at night-time in ABPM were significantly higher than among the workers spending less time talking on mobile phones (p = 0.04 and p = 0.036, respectively). The workers with the highest level of occupational stress showed significantly higher systolic 24-h BP (p = 0.007) and at day-time (p = 0.002), both during work (p = 0.010) and after work (p = 0.005), and higher diastolic BP values at day-time (p = 0.028). Cardiovascular response was strongly gender-related: males showed more BP abnormalities while females displayed more impairments in ECG records. The heart rate from 24 h was significantly correlated with the level of occupational stress, after adjusting for gender, life-stress and EMF.The findings obtained thus far have indicated the need to conduct in-depth studies on the impact of stress and EMF emitted by mobile phones on the health effects, in order to clarify the observed gender-related differences in cardiovascular response to the combined exposure to stress and EMF. Med Pr. 2019;70(4):411-24.W badaniach eksperymentalnych zaobserwowano wpływ korzystania z telefonu komórkowego na pracę serca, m.in. wydłużenie odstępu QTc oraz zmiany w wartościach ciśnienia tętniczego. Także stres może wywoływać zmiany w układzie krążenia. Brak jednak badań uwzględniających jednoczesne oddziaływanie stresu i pola elektromagnetycznego (PEM). Oba czynniki dotyczą m.in. pracowników sieci komórkowych.Spośród 208 badanych we wcześniejszych etapach metodą ankietową 55 osób wyraziło zgodę na udział w dalszych badaniach [EKG spoczynkowe, 24-godzinna rejestracja EKG i ciśnienia tętniczego (W przypadku osób rozmawiających przez telefon komórkowy ponad 60 min dziennie ciśnienie skurczowe w pomiarze jednorazowym i ciśnienie skurczowe z nocy w badaniu ABPM były istotnie wyższe niż u rozmawiających krócej (odpowiednio, p = 0,04 i p = 0,036). Badani, u których stwierdzono najwyższy poziom stresu zawodowego, charakteryzowali się istotnie wyższym ciśnieniem skurczowym w okresie doby (p = 0,007) i dnia (p = 0,002), zarówno w pracy (p = 0,010), jak i po niej (p = 0,005), oraz wyższym ciśnieniem rozkurczowym w okresie dnia (p = 0,028). Reakcja układu krążenia była istotnie zależna od płci. U mężczyzn dominowały zaburzenia ciśnienia tętniczego, a u kobiet – zaburzenia przewodzenia w EKG. Częstość skurczów serca w okresie doby z uwzględnieniem wpływu płci, stresu ogólnego i PEM była istotnie skorelowana z poziomem stresu zawodowego.Uzyskane dotychczas wyniki wskazują na potrzebę dalszych badań w celu wyjaśnienia przyczyn różnej u kobiet i mężczyzn odpowiedzi układu krążenia na działanie stresu i PEM emitowanego przez telefony komórkowe. Med. Pr. 2019;70(4):411–424.

Every year in Poland almost 5 million prophylactic examinations (PEs) are carried out by occupational medicine specialists (OMPs) among workers, for the purposes envisaged in the Polish Labour Code. The aim of this study was to collect workers' opinions on the possible extension of these check-ups in the field of prophylaxis and prevention of civilization diseases (CivDs), focusing also on the "healthy lifestyle" recommendations.The study group comprised 325 employees who filled out an anonymous questionnaire containing questions about the possible extension of the PE scope for CivD and cancer prophylaxis. During medical check-ups, evaluation of the incidental glucose (IG) and total cholesterol (TCh) levels, waist circumference measurement and electrocardiography (ECG) were proposed. The respondents were asked about the most interesting issues for discussing with OMPs.Screening tests for some cancers (69.5%) and risk factors for CivDs (61.5%) were indicated as the most interesting topics to discuss with OMPs. The possibility for evaluating the levels of IG and TCh during PEs was approved by approx. 94.8% and 95.3% of the respondents, respectively. Almost 96% accepted having ECG and 80% agreed to waist circumference measurement. As many as 89.5% of the respondents supported the idea of organizing physical activities at their workplaces, and 77.8% were eager to learn about "healthy lifestyles" during training sessions conducted at their workplaces.Restricting the aim of PEs just to certifying the ability to work, or identifying certain medical contraindications, means losing a chance for implementing the prophylaxis and prevention of diseases' development among active working subjects. The kinds of activities proposed by the authors of this publication have been approved by the employees. Med Pr. 2019;70(4):425-33.Każdego roku w Polsce wykonuje się w celach przewidzianych w Kodeksie pracy prawie 5 mln badań profilaktycznych osób pracujących. Celem badania przeprowadzonego przez autorów artykułu było uzyskanie opinii pracowników na temat celowości poszerzenia zakresu tych badań o profilaktykę chorób cywilizacyjnych (m.in. działania edukacyjne dotyczące zdrowego stylu życia).Anonimową ankietę na temat rozszerzenia opieki o działania profilaktyczne dotyczące chorób cywilizacyjnych i nowotworowych wypełniło 325 pracowników. Zaproponowano uzupełnienie badań przeprowadzanych w celach przewidzianych w Kodeksie pracy o oznaczenie we krwi pobranej z opuszki palca glikemii przygodnej i cholesterolu całkowitego oraz wykonanie pomiaru obwodu brzucha i zapisu elektrokardiograficznego (EKG). Zapytano o najbardziej interesujące tematy, które powinien omówić lekarz służby medycyny pracy (SMP).Jako interesujące tematy najczęściej wskazywano badania przesiewowe w kierunku chorób nowotworowych (69,5%) oraz czynniki ryzyka chorób cywilizacyjnych (61,5%). Rozszerzenie zakresu badania profilaktycznego o EKG zaakceptowało 95,7% osób, pomiar stężenia cholesterolu całkowitego − 95,3%, oznaczenie glikemii przygodnej − 94,8%, pomiar obwodu brzucha − 80%. Aż 89,5% ankietowanych poparło organizację zajęć sportowych w miejscu pracy i/lub dofinansowanie przez pracodawcę dostępu do obiektów sportowych, a 77,8% badanych wyraziło chęć uczestniczenia w szkoleniach nt. zdrowego stylu życia w miejscu pracy.Ograniczenie badań lekarskich wskazanych w Kodeksie pracy do certyfikowania zdolności lub istnienia przeciwwskazań zdrowotnych do wykonywania określonej pracy skutkuje utratą szansy na wdrożenie profilaktyki schorzeń u osób aktywnych zawodowo, które mają poczucie pełnego zdrowia. Zaproponowane przez autorów publikacji rodzaje działań spotkały się z aprobatą pracowników. Med. Pr. 2019;70(4):425–433.

The aim of this work was to assess the awareness among both downstream users and distributors of chemicals in Poland, as regards legal regulations applicable to chemicals (i.e., the Regulation on Registration, Evaluation, Authorisation and Restriction of Chemicals - REACH, and the Registration on classification, labelling and packaging - CLP), and to identify on this basis the needs for training and information campaigns addressed to these professional groups, by means of a questionnaire survey.The SurveyMonkey Internet survey software was selected for this purpose. Two groups of respondents were surveyed - downstream users (DU) and distributors (D) of chemicals, and consumers.Responses were obtained from 65 downstream users and distributors of chemicals, and from 98 consumers. As many as 23% of the respondents did not know the obligations imposed on their company by REACH and CLP. Over 59% of the DU/D respondents did not have the opportunity to participate in chemical safety management (CSM) training in the last 5 years. Eighty percent of the respondents were interested in participating in free courses that would enable them to broaden their knowledge of the classification, labeling and marketing of chemicals.Despite the 10 years of the application of REACH and CLP, many people working for chemical enterprises still do not know their company's obligations set out in these regulations. The percentage of people positively assessing their competences increases with the size of the enterprise. The results of the survey indicate the need to organize continuous training for people using chemicals in their professional activity and for distributors. It is very important to ensure training at the basic level of chemical distributors. Such training should provide them with elementary knowledge on the hazards posed by chemicals, which could then be passed to consumers in an understandable manner. Med Pr. 2019;70(4):435-44.Celem pracy było przeprowadzenie oceny świadomości dalszych użytkowników i dystrybutorów chemikaliów w Polsce na temat obowiązujących regulacji prawnych [rozporządzenia dotyczącego rejestracji, oceny i udzielania zezwoleń w zakresie chemikaliów (iRegistration, Evaluation, Authorisation and Restriction of Chemicals/i− REACH) i rozporządzenia w sprawie klasyfikacji, oznakowania i pakowania (iclassification, labelling and packaging/i− CLP)] w zakresie chemikaliów oraz określenie na tej podstawie potrzeby szkoleń i akcji informacyjnych skierowanych do tych grup zawodowych za pomocą badania ankietowego.Do przeprowadzenia ankiety wybrano internetowe oprogramowanie SurveyMonkey. Badaniami objęto 2 grupy respondentów. Pierwszą grupę osób, do których skierowano ankietę, stanowili dalsi użytkownicy i dystrybutorzy substancji chemicznych i ich mieszanin, 2 grupę – konsumenci.Uzyskano odpowiedzi od 65 dalszych użytkowników i dystrybutorów chemikaliów oraz od 98 konsumentów. Aż 23% respondentów nie znało obowiązków, jakie nakładają na ich przedsiębiorstwo rozporządzenia REACH i CLP. Ponad 59% badanych (dalszych użytkowników i dystrybutorów) nie miało możliwości uczestniczenia w szkoleniach dotyczących zarządzania bezpieczeństwem chemicznym w ostatnich 5 latach. Osiemdziesiąt procent respondentów było zainteresowanych uczestnictwem w nieodpłatnych kursach umożliwiających poszerzenie wiedzy z zakresu klasyfikacji, oznakowania i wprowadzania chemikaliów do obrotu.Pomimo 10 lat obowiązywania REACH i CLP wiele osób pracujących w przedsiębiorstwach nadal nie zna obowiązków swojej firmy określonych w tych rozporządzeniach. Odsetek pracowników pozytywnie oceniających swoje kompetencje rośnie wraz z wielkością przedsiębiorstwa. Wyniki badania ankietowego wskazują na potrzebę organizowania ustawicznych szkoleń dla osób stosujących chemikalia w działalności zawodowej oraz dla dystrybutorów. Bardzo istotne jest przeszkolenie na podstawowym poziomie dystrybutorów chemikaliów. Szkolenia powinny zapewnić im elementarną wiedzę na temat zagrożeń stwarzanych przez chemikalia, tak aby mogli te informacje w przystępny sposób przekazać konsumentom. Med. Pr. 2019;70(4):435–444.

Professional drivers are exposed to a number of factors that have a negative influence on their health status. These include vibrations, noise, the lack of fresh air in the car cabin, shift work (frequently at night), monotony resulting from permanent repetition of certain actions, static loads due to immobilization in a sitting position, stress resulting from the need to ensure safety in heavy traffic, as well as air pollution (dust, volatile organic substances, nitrogen and sulfur oxides, polycyclic aromatic hydrocarbons, heavy metals, dioxins, furans and others). Factors associated with the specificity of the profession of a driver, including exposure to chemical substances, result in an increased risk of the development of many diseases, i.e., obesity, diabetes, heart disease, hypertension, extensive genitourinary pathology experienced by taxi drivers, lung cancer and other forms of cancer. In the case of drivers, especially those covering long distances, there are also actual difficulties related to ensuring a proper diet. Although attempts at interventional research that would change the principles of nutrition, as well as ensure physical activity and weight reduction, have been made, their results have not been satisfactory. The paper focuses on the discussion on the role of a diet and dietary phytochemicals in the prevention of adverse health effects of such chemicals as a mix of chemicals in the polluted air, benzo(a)pyrene, benzene and metals (lead, cadmium, chromium, nickel), which are the main sources of exposure in the case of transport workers. Int J Occup Med Environ Health. 2019;32(4):441-64.

OBJECTIVES: This study aimed at assessment of the perceived barriers and motivators to smoking cessation among socially-disadvantaged populations in Poland. It is hypothesized that different factors can be considered depending on the level of smoking addiction. Therefore, a comparison between light and heavy smokers was performed. MATERIAL AND METHODS: Data collected during the second wave of a cross-sectional study carried out in the Piotrkowski District in October 2016 - February 2017 among 1668 socio-economically disadvantaged persons constituted the source of information for the present study. Barriers and motivators to smoking cessation among daily smokers were identified via face-to face interviews. RESULTS: About one-third of the studied population admitted to being current daily smokers, almost 75% of whom were heavy smokers. The most common barriers to quitting smoking were related to difficulties in quitting (62%), the lack of willingness to quit (56%), as well as addiction and withdrawal symptoms (craving cigarettes [65%], habit [56%], stress and mood swings [55%]). A significantly higher proportion of such barriers was noted among heavy smokers compared to light smokers (p < 0.05). The following motivations to quit were pointed out by the respondents: available pharmacotherapy (47%), access to a free-of-charge cessation clinic (40%), and encouragement and support provided by their doctor (30%), with no differences between various levels of smoking addiction (p > 0.05). CONCLUSIONS: Developing effective interventions targeted at unique deprived populations requires understanding the barriers and motivators to quitting smoking. Social support and financial issues, including free-of-charge pharmacotherapy and cessation clinics, as well as doctor's encouragement and support, are crucial for successful smoking cessation in this vulnerable population

The paper presents the state of workplace health promotion in Poland as of December 2017.Standardized computer-assisted personal interviews (CAPI) were conducted on a representative sample of 1000 companies employing over 50 people.Few companies (37%) actually know the health needs of their employees, whereas 25% admit that they care about health more than it is required by law, and declare their increased involvement in that area. At the same time, 55% of companies sponsor sports tickets, and 52% cover the costs of medical care. Every second company supports physical activity in other ways and improves the working environment. Every third offers medical prophylaxis, takes care of stress reduction and healthy eating habits, or solves the problems of alcohol consumption. The main reasons for such activities are the company's image (79%), good social atmosphere (72%) and employee's work performance (69%), while the prevention of health problems is rarely indicated (43%). The effects of workplace health promotion measures include improved productivity (50%), a better health condition (49%) and an increased identification with the company (47%). As for the obstacles, these is a shortage of financial resources (53%), the lack of favorable fiscal and legal solutions (48%), low interest among employees (45%), the lack of skilled people to manage health promotion (42%) and low awareness of its benefits (37%). Companies that are consciously involved in health promotion and monitor the actual health needs implement more activities, evaluate them more often, recognize their positive effects, and are able to better motivate their employees.There is a need to develop systemic solutions that foster health promotion in companies, to disseminate knowledge about the benefits associated with it, and to train the staff responsible for employee health management. Med Pr. 2019;70(3):275-94.W artykule przedstawiono stan promocji zdrowia w zakładach pracy w Polsce na grudzień 2017 r.W reprezentatywnej próbie 1000 firm zatrudniających powyżej 50 osób wykorzystano standaryzowane wywiady osobiste wspomagane komputerowo (Niewiele zakładów pracy (37%) zna potrzeby zdrowotne swoich pracowników. Co czwarty przyznaje jednak, że dba o ich zdrowie bardziej, niż wymaga tego prawo, oraz deklaruje wzrost zaangażowania w działania prozdrowotne. Jednocześnie 55% organizacji sponsoruje pracownikom abonamenty sportowe, a 52% opiekę medyczną. Co druga firma wspiera ich aktywność fizyczną w inny sposób oraz doskonali środowisko pracy. Co trzecia promuje profilaktykę medyczną, dba o redukcję stresu i zdrowe odżywianie się pracowników, rozwiązuje problemy konsumpcji alkoholu. Wskazywane powody takich działań to przede wszystkim troska o wizerunek firmy (79%) i dobrą atmosferę społeczną (72%) oraz efektywność zawodową pracowników (69%), a niestety rzadko – profilaktyka problemów zdrowotnych (43%). Efekty przedsięwzięć promujących zdrowie w miejscu pracy to poprawa wydajności (50%) i stanu zdrowia pracowników (49%) oraz zwiększenie ich deklarowanej identyfikacji z firmą (47%). Przeszkody w prowadzeniu takich działań to niedobór środków finansowych (53%), brak sprzyjających rozwiązań fiskalno-prawnych (48%), małe zainteresowanie pracowników (45%), niedostatki kadrowe osób przygotowanych do zarządzania promocją zdrowia (42%) oraz niewielka wiedza na temat korzyści ich wdrożenia (37%). Firmy świadomie zaangażowane w promocję zdrowia i monitorujące potrzeby zdrowotne pracowników realizują więcej, niż ogół zakładów pracy, tego rodzaju działań, częściej je ewaluują, dostrzegają ich pozytywne efekty oraz potrafią lepiej motywować zatrudnionych.Istnieje potrzeba wypracowania rozwiązań systemowych sprzyjających promocji zdrowia w firmach, upowszechniania wiedzy o związanych z nią korzyściach oraz przeprowadzania szkoleń dla zarządzających zdrowiem personelu. Med. Pr. 2019;70(3):275–294.

Objectives In the contemporary Western culture, working population health issues, stressed in various publications, have been perceived as a crucial part of public health. To deal with occupational health issues properly, occupational health services (OHS), aiming at the protection of the workers' health, are organized in many countries. The survey was to find the differences in occupational health systems that the European Economic Area countries use in order to execute prophylactic activities focused on diseases of affluence and how the OHS are used for health promotion actions. Material and methods The survey was conducted with the use of an on-line expert questionnaire. No deep statistical analysis was performed as for the designed aims of the study simple statistics were sufficient. Results All the reviewed countries have organized OHS. The funding mechanisms are based mainly on the financial involvement of employers. In the majority of countries, the main goal of the OHS is certification of the ability to work. Workplace surveillance aiming at the occupational risk assessment and health promotion activities that focus on work-related and/or occupational diseases are the most popular services provided within national systems. Conclusions Occupational health professionals are well placed to perform actions directed at health promotion and prophylactics of a wide range of diseases - not only occupational/work-related, but also non-communicable, particularly life-style-related diseases of affluence. The engagement of the occupational medical services (OMS) in prevention of the non-work-related health issues would be valuable. However, it would be inevitable for employers to finance a wider range of services to a greater extent. Int J Occup Med Environ Health. 2019;32(3):353-61.

The shift work system may affect the temporal distribution of eating and diet quality. The paper aimed at reviewing a body of research examining the associations between night shift work and dietary habits among nurses. Data from the PubMed and Google Schoolar databases, as well as references lists in selected papers were searched. The authors used the following keywords: nurses, shift work, diet, nutrition. Papers published in English or Polish were selected for the review, and as many as 19 papers published in 2000-2017 were eventually identified. The studies varied greatly with respect to the study size, subjects' age and the duration of night shift work. The major problem was the heterogeneity of the tools used for dietary assessment. Self-administered questionnaires were used and analyses were rarely adjusted for confounders. Alcohol consumption was the most frequently analyzed aspect (N = 8 studies), followed by the total energy (N = 7), protein, fat (N = 6), and carbohydrate intake, coffee and fruit consumption (N = 5). The results showed quite a consistent association of night work with higher coffee (caffeine) consumption, as well as lower alcohol, and fruit and vegetables consumption. Few studies also reported more frequent snacks consumption, later time of the last meal, eating at night, meals irregularity, and a poorer diet quality among night shift nurses when compared to the reference. The review showed some poor nutritional habits among nurses working night shifts. However, the topic warrants further attention, owing to the relatively small number of the studies performed so far, and their numerous methodological limitations. Med Pr. 2019;70(3):363-76.The shift work system may affect the temporal distribution of eating and diet quality. The paper aimed at reviewing a body of research examining the associations between night shift work and dietary habits among nurses. Data from the PubMed and Google Schoolar databases, as well as references lists in selected papers were searched. The authors used the following keywords: nurses, shift work, diet, nutrition. Papers published in English or Polish were selected for the review, and as many as 19 papers published in 2000−2017 were eventually identified. The studies varied greatly with respect to the study size, subjects’ age and the duration of night shift work. The major problem was the heterogeneity of the tools used for dietary assessment. Self-administered questionnaires were used and analyses were rarely adjusted for confounders. Alcohol consumption was the most frequently analyzed aspect (N = 8 studies), followed by the total energy (N = 7), protein, fat (N = 6), and carbohydrate intake, coffee and fruit consumption (N = 5). The results showed quite a consistent association of night work with higher coffee (caffeine) consumption, as well as lower alcohol, and fruit and vegetables consumption. Few studies also reported more frequent snacks consumption, later time of the last meal, eating at night, meals irregularity, and a poorer diet quality among night shift nurses when compared to the reference. The review showed some poor nutritional habits among nurses working night shifts. However, the topic warrants further attention, owing to the relatively small number of the studies performed so far, and their numerous methodological limitations. Med Pr. 2019;70(3):363–76.

Cytostatics not only induce significant side-effects in patients treated oncologically but also pose a threat to the health of occupationally exposed healthcare workers: pharmacists, physicians, nurses and other personnel. Since the 1970s numerous reports from various countries have documented the contamination of working areas with cytostatics and the presence of drugs/metabolites in the urine or blood of healthcare employees, which directly indicates the occurrence of occupational exposure to these drugs. In Poland the significant scale of occupational exposure to cytostatics is also confirmed by the data collected in the central register of occupational carcinogens/mutagens kept by the Nofer Institute of Occupational Medicine. The assessment of occupational exposure to cytostatics and health risks constitutes employers' obligation. Unfortunately, the assessment of occupational risk resulting from exposure to cytostatics raises a number of concerns. Provisions governing the problem of workers' health protection are not unequivocal because they derive from a variety of law areas, especially in a matter of hazard classification and safety data sheets for cytostatics. Moreover, no legally binding occupational exposure limits have been set for cytostatics or their active compounds, and analytical methods for these substances airborne and biological concentrations are lacking. Consequently, the correct assessment of occupational exposure to cytostatics, the evaluation of health hazards and the development of the proper preventive strategy appear difficult. The authors of this article described and discussed the amendments to the European provisions concerning chemicals in the light of employers' obligations in the field of employees' heath protection against the consequences of exposure to cytostatics. Some modifications aimed at a more effective health protection of workers occupationally exposed to cytostatics were also proposed. Int J Occup Med Environ Health. 2019;32(2):141-59.

Objectives The objective of this study was to evaluate the association between breastfeeding duration and child neurodevelopment based on the Polish Mother and Child Cohort Study. Material and Methods The current analysis included 501 mother–child pairs. The analysis evaluating the association between the length of breastfeeding and child neurodevelopment considered the following variables: maternal age and body mass index, weight gain during pregnancy, parental level of education, marital status, socioeconomic status, child gender, birthweight, type of delivery, preterm delivery, pre- and postnatal exposure to tobacco constituents and child day care attendance. Psychomotor development was assessed in 1-year-olds on the Bayley Scales of Infant and Toddler Development . Results The length of breastfeeding correlated positively with maternal age at delivery (ρ = 0.13), maternal and paternal level of education (ρ = 0.2 and ρ = 0.14 respectively), birthweight (ρ = 0.1) and marital status (ρ = 0.16) (p < 0.05). A negative correlation between the length of breastfeeding and maternal smoking status during the first year after delivery (ρ = –0.19) and weight gain during pregnancy (r = –0.1) was observed (p < 0.05). The association between the duration of breastfeeding and child development was not statistically significant in the model with the inclusion of confounding variables. A significant association between language development and maternal level of education (p = 0.004), gender of the child (p = 0.0007) and maternal weight gain during pregnancy (p = 0.01) was found. A negative association between cognitive development and maternal salivary cotinine during pregnancy (p = 0.03) and a negative association between motor development and maternal smoking status during the first year after delivery (p = 0.007) were also found. Conclusions This study found no significant association between the duration of breastfeeding and child development after adjustment for confounders. Int J Occup Med Environ Health. 2019;32(2):175–84

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of deaths and disability-adjusted life years from cardiovascular disease attributable to exposure to occupational noise, to inform the development of the WHO/ILO joint methodology. Objectives: We aim to systematically review studies on exposure to occupational noise (Systematic Review 1) and systematically review and meta-analyse estimates of the effect of occupational noise on cardiovascular diseases (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework, conducting both systematic reviews in tandem and in a harmonized way. Data sources: Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science and CISDOC. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand search reference list of previous systematic reviews and included study records; and consult additional experts. Study eligibility and criteria: We will include working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State, but exclude children (

Objectives The aim of the study was to establish whether the driver's visual strategy may influence a driver's behavior to avoid a crash in a high-risk situation. Any published papers on drivers' visual strategies just before a crash were not found. Material and methods Tests were performed using a high-tech driving bus simulator. Participants comprised 45 men drivers, aged 43.5±7.9 years old, seniority as a bus driver of 13.3±8.6 years. The tests were preceded by medical examinations: general, neurological and ophthalmological. Each participant drove the same city route for approximately 40 min (entire route - ER). In the final phase, a collision situation was simulated (a phantom car blocked the participant's right of way). Driver's visual strategy was analyzed using the FaceLab device with 2 cameras during ER and just before collision. The field-of-view covered by camera 1 was divided into 8 regions, by camera 2 into 10 regions. The distribution of gazes in regions was a criterion of visual strategy. Results Thirty-five drivers completed the simulated driving test, 14 escaped the collision, 21 crashed. These groups differed only in resting systolic blood pressure before the test. The analysis of covariance, after adjusting to this factor, indicated that during the ER visual strategy recorded by camera 1 did not differ between groups, in camera 2 the drivers in the crash group fixed their gaze more frequently (p = 0.049) in region 3 (close part of the road in front of the windshield). Just before the collision drivers who escaped the collision fixed their gaze significantly more often in region 6 (left side of the road) in camera 1 and in region 6 (in front of the windshield,) and region 10 (right side) in camera 2. Conclusions The visual strategy has an impact on the road safety. The analysis of visual strategies may be a useful tool for the training of drivers. Int J Occup Med Environ Health. 2019;32(2):161-74.

Objective: Evidence on the impact of leisure time physical activity (LTPA) in pregnancy on birth size is inconsistent. We aimed to examine the association between LTPA during early and late pregnancy and newborn anthropometric outcomes.Design: Individual level meta‐analysis, which reduces heterogeneity across studies.Setting: A consortium of eight population‐based studies (seven European and one US) comprising 72 694 participants.Methods: Generalised linear models with consistent inclusion of confounders (gestational age, sex, parity, maternal age, education, ethnicity, BMI, smoking, and alcohol intake) were used to test associations between self‐reported LTPA at either early (8–18 weeks gestation) or late pregnancy (30+ weeks) and the outcomes. Results were pooled using random effects meta‐analyses.Main outcome measures: Birth weight, large‐for‐gestational age (LGA), macrosomia, small‐for‐gestational age (SGA), % body fat, and ponderal index at birth.Results: Late, but not early, gestation maternal moderate to vigorous physical activity (MVPA), vigorous activity, and LTPA energy expenditure were modestly inversely associated with BW, LGA, macrosomia, and ponderal index, without heterogeneity (all: I2 = 0%). For each extra hour/week of MVPA, RR for LGA and macrosomia were 0.97 (95% CI: 0.96, 0.98) and 0.96 (95% CI: 0.94, 0.98), respectively. Associations were only modestly reduced after additional adjustments for maternal BMI and gestational diabetes. No measure of LTPA was associated with risk for SGA.Conclusions: Physical activity in late, but not early, pregnancy is consistently associated with modestly lower risk of LGA and macrosomia, but not SGA.Tweetable abstract: In an individual participant meta‐analysis, late pregnancy moderate to vigorous physical activity modestly reduced birth size outcomes.

Noise in entertainment industry often reaches high sound pressure levels. Nevertheless, the risk of hearing loss in this sector is insufficiently recognized. The aim of this study was the assessment of the relationship between noise exposure and temporary threshold shifts (TTS) for people working as bartenders at a variety of entertainment venues.The study comprised a total of 18 bartenders (mean age was 25±7 years old) employed at a music club (N = 8), pub (N = 5) and discotheque (N = 5). Personal dosimeters were used for determining noise levels and frequency characteristics. Hearing was evaluated by pre- (before work) and post-exposure (up to 15 min after the end of work) pure tone audiometry. Hearing tests were carried out for bartenders during 2 or 3 sessions while working on weekends.The mean personal noise exposure level normalized to a nominal 8-hour working day was 95 dBA, above 4 times higher than the accepted legal limit. The TTS values (10 dB HL or more) were significant at 4 kHz for both ears for 77% of bartenders.People working as bartenders represent a professional group with an increased risk of hearing loss. Raising awareness of this fact and implementing hearing protection programs in this group of workers is urgently needed, in line with the European Commission Directive (EU Directive 2003/10/EC). Med Pr. 2019;70(1):17-25.W przemyśle rozrywkowym hałas często osiąga wysokie poziomy ciśnienia akustycznego, jednak ryzyko uszkodzenia słuchu w tym sektorze nie zostało jeszcze dokładnie ocenione. Celem pracy była ocena związku między ekspozycją na wysoki poziom dźwięku a czasowym przesunięciem progu słuchu u osób pracujących na stanowisku barmana w lokalach rozrywkowych.Badaniem objęto 18 barmanów (średni wiek: 25±7 lat) zatrudnionych w klubie muzycznym (N = 8), pubie (N = 5) i dyskotece (N = 5). Poziomy dźwięków oraz charakterystyka częstotliwościowa hałasu były określane za pomocą dozymetrii indywidualnej. Progi słuchu oceniano za pomocą audiometrii tonalnej przeprowadzanej przed rozpoczęciem dnia pracy oraz bezpośrednio (do 15 min) po jego zakończeniu. Badania słuchu przeprowadzono u barmanów w czasie 2 lub 3 sesji badawczych podczas pracy w weekendy. Uzyskano 92 audiogramy przed- i poekspozycyjne.Uśrednione równoważne poziomy dźwięku odniesione do 8-godzinnego dnia pracy w ocenianych 3 lokalach muzycznych wynosiły 95 dBA, przekraczając ponad czterokrotnie dopuszczalne prawnie normy. U 77% badanych osób wykazano przynajmniej w 1 sesji pomiarowej czasowe przesunięcia progów słuchu ≥ 10 dB HL dla częstotliwości 4 kHz.Osoby pracujące na stanowisku barmana stanowią grupę zawodową o podwyższonym ryzyku utraty słuchu. Niezbędne jest zwiększanie świadomości tego faktu oraz wdrażanie u tych pracowników programów ochrony słuchu, zgodnie z dyrektywą Komisji Europejskiej (EU 2003/10/WE). Med. Pr. 2019;70(1):17–25.

Funding Information: BSreports personal fees from Allergopharma, during the conduct of the study; grants from National Health Programm, grant, personal fees from Polpharma, ASTRA, personal fees from Mylan, Adamed, patient ombudsman, national Centre for Research and Development, Polish Allergology Society. Funding Information: NGP reports personal fees from Novartis, Nutricia, HAL, MENARINI/FAES FARMA, SANOFI, MYLAN/MEDA, BIOMAY, AstraZeneca, GSK, MSD, ASIT BIOTECH, Boehringer Ingelheim, grants from Gerolymatos International SA, Capricare. Funding Information: CA reports grants from Allergopharma, grants from Idorsia, Swiss National Science Foundation, Christine Kühne‐Center for Allergy Research and Education, European Commission's Horison's 2020 Framework Programme, Cure, Novartis Research Institutes, Astra Zeneca, scibase, advisory role in Sanofi/Regeneron, grants from Glakso Smith‐Kline, advisory role in scibase. Funding Information: MJTreports grants from European Commission, SEAIC, ISCIII, personal fees from Diater laboratory, Leti laboratory, Aimmune Therapeutics. Funding Information: LK reports grants and personal fees from Allergopharma, MEDA/Mylan, LETI Pharma, Sanofi, grants from Stallergenes, Quintiles, ASIT biotech, grants from ALK Abelló, Lofarma, AstraZeneca, GSK, Inmunotk, personal fees from Allergy Therapeut., HAL Allergie, Cassella med; and Membership: AeDA, DGHNO, Deutsche Akademie für Allergologie und klinische Immunologie, HNO‐BV, GPA, EAACI. Funding Information: DPreports grants and personal fees from GlaxoSmithKline, personal fees from Menarini, Pliva, Belupo, AbbVie, Novartis, MSD, Chiesi, Revenio, personal fees and non‐financial support from Boehringer Ingelheim, non‐financial support from Philips. Funding Information: OP reports grants and personal fees from ALK‐Abelló, Allergopharma, Stallergenes Greer, HAL Allergy Holding B.V./HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Lofarma, ASIT Biotech Tools S.A., Laboratorios LETI/LETI Pharma, Anergis S.A., Glaxo Smith Kline, grants from Biomay, Circassia, Pohl‐Boskamp, Inmunotek S.L., personal fees from MEDA Pharma/MYLAN, Mobile Chamber Experts (a GA2LEN Partner), Indoor Biotechnologies, Astellas Pharma Global, EUFOREA, ROXALL Medizin, Novartis, Sanofi‐Aventis and Sanofi‐Genzyme, Med Update Europe GmbH, streamedup! GmbH, John Wiley and Sons, AS. Copyright: Copyright 2021 Elsevier B.V., All rights reserved. publishersversion published

International audience; Systemic mastocytosis (SM) is a hematologic neoplasm with abnormal accumulation of mast cells in various organ systems such as the bone marrow, other visceral organs and skin. So far, only little is known about epigenetic changes contributing to the pathogenesis of SM. In the current article, we provide an overview of epigenetic changes that may occur and be relevant to mastocytosis, including mutations in genes involved in epigenetic processes, such as TET2, DNMT3A and ASXL1, and global and gene-specific methylation patterns in neoplastic cells. Moreover, we discuss methylation-specific pathways and other epigenetic events that may trigger disease progression in mast cell neoplasms. Finally, we discuss epigenetic targets and the effects of epigenetic drugs, such as demethylating agents and BET-targeting drugs, on growth and viability of neoplastic mast cells. The definitive impact of these targets and the efficacy of epigenetic therapies in advanced SM need to be explored in future preclinical studies and clinical trials.

Background Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes, but its contribution to the global epidemic of childhood obesity has not as yet been definitively characterized. We investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity. Methods We harmonized and pooled individual participant data from 16,295 mother-child pairs in seven European birth cohorts. Maternal pre-, early-, late-, and whole-pregnancy (any time during pregnancy) dietary quality and inflammatory potential assessed with the Dietary Approaches to Stop Hypertension (DASH) score and the energy-adjusted Dietary Inflammatory Index (E-DII™) score, respectively. Primary outcome was childhood overweight and obesity (OWOB) (age-and-sex-specific BMI z-score > 85th percentile). Secondary outcomes were sum of skinfold thickness (SST), fat mass index (FMI) and fat-free mass index (FFMI). We used multivariable regression analyses (adjusting for maternal lifestyle and sociodemographic factors) to assess the associations of maternal DASH and E-DII scores with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effect meta-analyses. Results The study mothers had a mean (SD) age of 30.2 (4.6) years and a mean BMI of 23.4 (4.2) kg/m2. Higher early-pregnancy E-DII scores (more pro-inflammatory diet) tended to be associated with a higher odds of late-childhood [10.6 (1.2) years] OWOB [OR (95% CI) 1.09 (1.00, 1.19) per 1-SD E-DII score increase], whereas an inverse association was observed for late-pregnancy E-DII score and early-childhood [2.8 (0.3) years] OWOB [0.91 (0.83, 1.00)]. Higher maternal whole pregnancy DASH score (higher dietary quality) was associated with a lower odds of late-childhood OWOB [OR (95% CI) 0.92 (0.87, 0.98) per 1-SD DASH score increase]; associations were of similar magnitude for early and late-pregnancy [0.86 (0.72, 1.04) and 0.91 (0.85, 0.98), respectively]. These associations were robust in several sensitivity analyses and further adjustment for birth weight and childhood diet did not meaningfully alter the associations and conclusions. In two cohorts with available data, a higher whole pregnancy E-DII and lower DASH scores were associated with a lower late-childhood FFMI in males and a higher mid-childhood FMI in females (P interactions Conclusions A pro-inflammatory, low-quality maternal antenatal diet may adversely influence offspring body composition and OWOB risk, especially during late-childhood. Promoting an overall healthy and anti-inflammatory maternal dietary pattern may contribute to the prevention of childhood obesity, a complex health issue requiring multifaceted strategy.

The German Social Accident Insurance supported this study (grant number FP 271)., Hovanec J, Siemiatycki J, Conway DI, Olsson A, Guenel P, Luce D, Jöckel KH, Pohlabeln H, Ahrens W, Karrasch S, Wichmann HE, Gustavsson P, Consonni D, Merletti F, Richiardi L, Lorenzo S, Fortes C, Parent MÉ, McLaughlin JR, Demers P, Landi MT, Caporaso N, Fernández-Tardón G, Zaridze D, Świątkowska B, Pándics T, Lissowska J, Fabianova E, Field JK, Mates D, Bencko V, Foretova L, Janout V, Kromhout H, Vermeulen R, Boffetta P, Straif K, Schüz J, Casjens S, Pesch B, Brüning T, Behrens T.

International audience; The SCCS concludes the following: 1.In light of the new data provided, does the SCCS consider Aluminium safe when used in lipsticks up to a maximum concentration of 14%? In the event that the estimated exposure to Aluminium from lipsticks of cosmetic products is found to be o concern, SCCS is asked to recommend safe concentration limits. In the light of the new data provided, the SCCS considers that the use of aluminium compounds is safe at the following equivalent aluminium concentrations up to: 6.25% in non-spray deodorants or non-spray antiperspirants10.60% in spray deodorants or spray antiperspirants2.65% in toothpaste and14% in lipstick2.Does the SCCS have any further scientific concerns regarding the use of Aluminium substances in cosmetic products taking into account the newly submitted information on aggregate exposure from cosmetics? The SCCS considers that the systemic exposure to aluminium via daily applications of cosmetic products does not add significantly to the systemic body burden of aluminium from other sources. Exposure to aluminium may also occur from sources other than cosmetic products, and a major source of aluminium in the population is the diet. This assessment has not taken into account the daily dietary intake of aluminium.

International audience; Although the need for non-animal alternatives has been well recognised for the human health hazard assessment of chemicals in general, it has become especially pressing for cosmetic ingredients due to the full implementation of testing and marketing bans on animal testing under the European Cosmetics Regulation. This means that for the safety assessment of cosmetics, the necessary safety data for both the ingredients and the finished product can be drawn from validated (or scientifically-valid), so-called "Replacement methods". In view of the challenges for safety assessment without recourse to animal test data, the Methodology Working Group of the Scientific Committee on Consumer Safety organised a workshop in February 2019 to discuss the key issues in regard to the use of animal-free alternative methods for the safety evaluation of cosmetic ingredients. This perspective article summarises the outcomes of this workshop and reflects on the state-of-the-art and possible way forward for the safety assessment of cosmetic ingredients for which no experimental animal data exist. The use and optimisation of "New Approach Methodology" that could be useful tools in the context of the "Next Generation Risk Assessment" and the strategic framework for safety assessment of cosmetics were discussed in depth.

"SCCS OPINION on Benzophenone-3 (CAS No 131-57-7, EC No 205-031-5)"SCCS/1625/20 - Preliminary OpinionU. Bernauer, L. Bodin, Q. Chaudhry, P.J. Coenraads, M. Dusinska, J. Ezendam, E. Gaffet, C. L. Galli, B. Granum, E. Panteri, V. Rogiers, Ch. Rousselle, M. Stepnik, T. Vanhaecke, S. Wijnhoven, A. Koutsodimou, W. Uter, N. von GoetzThe SCCS adopted this document by written procedure on 15 December 2020 (77 pages)Mise en ligne le 21 Décembre 2020https://ec.europa.eu/health/sites/health/files/scientific_committees/consumer_safety/docs/sccs_o_247.pdfConclusion of the opinion:(1) In light of the data provided and taking under consideration the concerns related to potential endocrine disrupting properties of Benzophenone-3, does the SCCS consider Benzophenone-3 safe when used as a UV-filter in cosmetic products up to a maximum concentration of 6% and up to 0.5% in cosmetic products to protect product formulation?On the basis of safety assessment, and considering the concerns related to potential endocrine disrupting properties of benzophenone-3 (BP-3), the SCCS has concluded that:a. The use of BP-3 as a UV-filter up to a maximum concentration of 6% in sunscreen products, either in the form of body cream, sunscreen propellant spray or pump spray, is not safe for the consumer.b. The use of BP-3 as a UV-filter up to a maximum concentration of 6% in face cream, hand cream, and lipsticks is safe for the consumer.c. The use of BP-3 up to 0.5% in cosmetic products to protect the cosmetic formulation is safe for the consumer.(2) Alternatively, what is according to the SCCS the maximum concentration considered safe for use of Benzophenone-3 as a UV-filter in cosmetic products?In the SCCS’s opinion, the use of BP-3 as a UV filter in the following sunscreen products is safe for the consumer up to a maximum concentration of:a. 2.2% in body creams, in propellant sprays and in pump sprays, provided that there is no additional use of BP-3 at 0.5% in the same formulation for protecting the cosmetic formulation.b. Where BP-3 is also used at 0.5% in the same formulation, the levels of BP-3 used as UV filter should not exceed 1.7% in body creams, in propellant sprays and in pump sprays.(3) Does the SCCS have any further scientific concerns with regard to the use of Benzophenone-3 in cosmetic products?It needs to be noted that the SCCS has regarded the currently available evidence for endocrine disrupting properties of BP-3 as inconclusive, and at best equivocal. This applies to all of the available data derived from in silico modelling, in vitro tests and in vivo studies, either considered individually or taken together. The SCCS considers that, whilst there are indications from some studies to suggest that BP-3 may have endocrine effects, the evidence is not conclusive enough at present to enable deriving a specific endocrine-related toxicological point of departure for use in safety assessment.________________________________________Keywords:SCCS, scientific opinion, Benzophenone-3, UV filter, Regulation 1223/2009, CAS Number 131-57-7, EC No 205-031-5________________________________________Opinion to be cited as:SCCS (Scientific Committee on Consumer Safety), Opinion on Benzophenone-3 (CAS No 131-57-7, EC No 205-031-5), preliminary version of 15 December 2020, SCCS/1625/20.

Background: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. Objective: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. Methods: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure-response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. Results: We obtained 2005-2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11.7 μg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0-23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. Discussion: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures. https://doi.org/10.1289/EHP4495. This work was funded by the EU Seventh Framework Programme EXPOsOMICS Project (grant agreement no. 308610), Human Genetics Foundation agreement 17-080 ISG, and CIBER Epidemiología y Salud Pública (CIBERESP). ISGlobal is a member of the Centres de Recerca de Catalunya (CERCA) Programme, Generalitat de Catalunya. We would like to thank the members of the European Programme for Intervention Epidemiology Training (EPIET) Alumni Network (EAN) for their assistance in identifying appropriate national focal points in specific countries. We would also like to thank the people from the national and local authorities and universities for the provision of THM data: Sofie Dewaele (Leefmilieu Brussel-BIM/Bruxelles Environnement–IBGE Afd. Inspectie en verontreinigde bodems, Dpt. Geïntegreerde controles, Brussels, Belgium), Steven Vanderwaeren (Team Watervoorziening-en gebruik, Vlaamse Milieumaatschappij, Afdeling Operationeel Waterbeheer, Brussels, Belgium), Jurica Štiglić (Croatian National Institute of Public Health, Zagreb, Croatia), Outi Zacheus (National Institute for Health and Welfare, Kuopio, Finland), Carmelo Massimo Maida (University of Palermo, Italy), Anna Norata (Agenzia di Tutela della Salute Citta’ Metropolitana Milano, Italy), Marco Chiesa (Agenzia di Tutela della Salute della Val Padana-Sede Territoriale di Mantova, Italy), Vincenzo Clasadonte (Agenzia di Tutela della Salute della Val Padana-Sede Territoriale Cremona, Italy), Emilia Guberti (Local Health Authority, Bologna, Italy), Cinzia Govoni (Local Health Authority, Ferrara, Italy), Paolo Pagliai (Local Health Authority Romagna, Italy), Daniela de Vita (Local Health Authority, Reggio Emilia, Italy), Danila Tortorici (Regional Health and Social Agency, Emilia Romagna, Italy), Marco Schintu (University of Cagliari, Italy), Paolo Montuori (University of Napoli Federico II, Italy), Audrius Dedele (Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania), Stefan Cachia (Water Services Corporation, Malta), Roel C.H. Vermuelen (Institute of Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands), the Chief Sanitary Inspectorate (Poland), Luís Simas (Water Quality Department, Entidade Reguladora, Dos Serviços De Águas e Resíduos, Lisboa, Portugal), and Christina Forslund (Food Control Department, National Food Agency, Uppsala, Sweden). Finally, we would like to thank Charles F. Lynch (University of Iowa, USA), Sylvaine Cordier (Université de Rennes, Inserm, École des hautes études en santé Publique (EHESP), Rennes, France), Will D. King (Queen’s University, Kingston, Ontario, Canada), and Kenneth P. Cantor (National Cancer Institute, National Institutes of Health, Bethesda, USA) for allowing us to use the dose–exposure data from their study. We are grateful to Xavier Basagaña (ISGlobal) for statistical assistance.

Objectives 1-Methylnaphthalene (1-MN) is a constituent of polycyclic aromatic hydrocarbons, the chemicals that have become ubiquitous in the environment as result of natural and industrial process. This paper reports a study on the distribution and excretion of 1-MN in rats after single and repeated inhalation exposure to 1-MN vapor. Material and Methods Male Wistar rats were exposed to 1-MN vapor at nominal concentrations of 50 mg/m 3 or 200 mg/m 3 in the dynamic inhalation chambers (TSE Systems Head Nose Only Exposure) for 6 h (single exposure) or 5 days (6 h/day, repeated exposure). Blood, urine and tissue samples were collected during and after the exposure. Blood, urine and tissue concentrations of 1-MN were estimated by gas chromatography using the headspace technique. Results The elimination of 1-MN from blood followed an open 2-compartment model. The concentration in rat tissues was dependent on the magnitude and time of exposure. After repeated exposure, the concentration 1-MN in tissue decreased in comparison to single exposure. The elimination of 1-MN with urine after single and repeated exposure to 1-MN occurred mainly in the samples collected during the first day of collection. Conclusions 1-Methylnaphthalene was rapidly eliminated from the blood and tissues of animals exposed by inhalation to 1-MN. In repeated exposure, there was probably a significant increase of 1-MN metabolism in rats exposed to low and high 1-MN doses. Under conditions of repeated 1-MN exposure, no significant systemic 1-MN accumulation could be observed. Int J Occup Med Environ Health 2018;31(6):763–770

The etiology of cancer is multifactorial. Malignant tumors caused by factors occurring in the work environment, classified as carcinogenic in humans, can be recognized as an occupational disease. Analysis of epidemiological data indicates a significant underestimation of occupational cancer, mainly due to long latency period of these diseases. This publication provides guidance to certify occupational etiology of malignant tumors, based on the reviews of existing legislation and medical literature, as well as on the experience of their authors. The publication presents the epidemiology of cancers, including occupational cancers, risk factors, occupational carcinogens and presents the principles of occupational cancer certification. Med Pr 2018;69(1):93-108. Etiologia chorób nowotworowych jest wieloczynnikowa. Nowotwory złośliwe powstałe w następstwie działania czynników występujących w środowisku pracy, uznanych za rakotwórcze dla ludzi, mogą być rozpoznane jako choroba zawodowa. Analiza danych epidemiologicznych wskazuje na istotne niedoszacowanie nowotworów zawodowych, czego główną przyczyną jest długi okres latencji tych schorzeń. Publikacja zawiera wytyczne do orzekania o zawodowej etiologii nowotworów złośliwych przygotowane na podstawie obowiązujących aktów prawnych, publikacji medycznych i doświadczeń własnych autorów pracy. W publikacji przedstawiono epidemiologię chorób nowotworowych, w tym pochodzenia zawodowego, czynniki ryzyka chorób nowotworowych i czynniki rakotwórcze w miejscu pracy. Podano też zasady orzekania o nowotworach zawodowych. Finansowanie / Funding: projekt pn. „Paszport zdrowej kobiety w profilaktyce chorób nowotworowych” nr IS-2/94/NCBR/2015, finansowany przez Narodowe Centrum Badań i Rozwoju w ramach programu Innowacje Społeczne (II konkurs). Wartość projektu: 798 419,43 zł, wartość dofinansowania: 725 000 zł. Kierownik projektu: dr hab. n. med. Marta Wiszniewska, prof. IMP.

The aim of the article was to summarize the results offered in the research on occupational functioning of women with endometriosis. We followed PRISMA guidelines. Database search was done in November 2017 using EBSCO. In the review were included the articles clearly referring to the relationships between endometriosis and work or any aspect of work (e.g., work productivity, work ability, absenteeism). Eight papers were included in the final review. Seven studies were cross-sectional, 1 retrospective. The majority of researchers used standardized research measures, such as Work Ability Index, Work Productivity and Activity Impairment Questionnaire or Health Related Productivity Questionnaire. Only in 2 studies the reference group was considered, one of them consisted of healthy women. The results clearly indicate that endometriosis is a disease that causes major disturbance in occupational functioning of the suffering women. In the future the researchers should search for individual and organizational correlates of the improvement of occupational functioning in this group of patients. The methodology of the existing studies has been evaluated and the methodological cues for future research has been given. Med Pr 2018;69(6):663-671. The aim of the article was to summarize the results offered in the research on occupational functioning of women with endometriosis. We followed PRISMA guidelines. Database search was done in November 2017 using EBSCO. In the review were included the articles clearly referring to the relationships between endometriosis and work or any aspect of work (e.g., work productivity, work ability, absenteeism). Eight papers were included in the final review. Seven studies were cross-sectional, 1 retrospective. The majority of researchers used standardized research measures, such as Work Ability Index, Work Productivity and Activity Impairment Questionnaire or Health Related Productivity Questionnaire. Only in 2 studies the reference group was considered, one of them consisted of healthy women. The results clearly indicate that endometriosis is a disease that causes major disturbance in occupational functioning of the suffering women. In the future the researchers should search for individual and organizational correlates of the improvement of occupational functioning in this group of patients. The methodology of the existing studies has been evaluated and the methodological cues for future research has been given. Med Pr 2018;69(6):663–671.

Objectives Welding processes that generate fumes containing toxic metals, such as hexavalent chromium (Cr(VI)), manganese, and nickel (Ni), have been implicated in lung injury, inflammation, and lung tumor promotion in animal models. Bronchiolar epithelium Clara cells/club cells, coordinate these inflammatory responses. Clara cells secretory protein (CC16) with ant-inflammatory role. Material and methods The pulmonary toxicity of welding dust (WD) was assessed for Wistar rats exposed to 60 mg/m3 of respirable-size welding dust (mean diameter 1.17 μm for 1 and 2 weeks (6 h/day, 5 days/week)) or the aerosols of soluble form (SWD) in the nose-only exposure chambers. Additionally the effect of antiinflammatory betaine supplementation was assessed. Clara cells secretory protein, differential cell counts, total protein concentrations and cellular enzyme (lactate dehydrogenase - LDH) activities were determined in bronchoalveolar lavage fluid, and corticosterone and thiobarbituric acid reactive substances (TBARS) and prolactin concentrations were assessed in serum. Histopathology examination of lung, brain, liver, kidney, spleen was done. Additionally slices of brain and lung were exanimated in laser ablation inductively coupled plasma mass spectrometry. Results Both WD and SWD exposure evoked large bronchiolar infiltration shoved in histopathology examination. In this study, TBARS inversely correlated with a significant decrease of CC16 concentration that occurred after instillation of both WD and SWD indicating decreased anti- inflammatory potential in the lung. In WD exposed rats prolactin correlated with nuclear factor-kappa B (NF-κB), LDH, TBARS and serum levels Cr, Ni and inversely with c-Jun. In SWD exposed rats prolactin correlated with CC16 indicated effect of prolactin on the population of epithelial cells. Conclusions In the current study, deleterious effects of repeated inhalation stainless steel welding dust form on club (Clara) cell secretory protein (CC16) were demonstrated. Clara cells secretory protein relation with prolactin in exposed rats to welding dust were shown and explored whether the NF-κB and c-Jun/activator protein 1 related pathway was involved. Int J Occup Med Environ Health 2018;31(5):613-632.

Paper presents the intentional use of biological agents for industrial, diagnostic and research purposes in enterprises in Poland.The source of data is the National Register of Biological (in Polish KRCB) - the type of the database that gathers data about the intentional use of biological agents at work in Poland. The analysis includes tabular summaries of the data as of December 2017.Notifications were sent by 598 enterprises for: diagnostic - 67.5%, research - 25% and industrial purposes - 75%. Those mostly were hospital diagnostic laboratories - 36%, entities other than hospitals - 32% and higher education and research units - 13%. In total, 4477 workers (91.3% women, 8.7% men) were exposed to biological agents. Agents from 2nd and 3rd group of risk were used in 581 and 106 enterprises, respectively.The network organization, legal base and central nature cause that the KRCB is a unique database that allows for diagnosis of the situation and tracking of dynamics in the context of occupational exposure to biological agents used intentionally in enterprises in Poland. Med Pr 2018;69(4):413-424.Publikacja prezentuje zamierzone użycie czynników biologicznych w celach przemysłowych, diagnostycznych oraz naukowo- badawczych w przedsiębiorstwach w Polsce według stanu na grudzień 2017 r.Dane pochodzą z Krajowego Rejestru Czynników Biologicznych (KRCB) – bazy danych, w której gromadzone są informacje o celowym użyciu czynników biologicznych w procesach pracy w Polsce.Od 598 polskich przedsiębiorstw uzyskano zgłoszenia użycia czynników biologicznych w celach: diagnostycznych – 67,5%, naukowo-badawczych – 25% i przemysłowych – 7,5%. Najwięcej zgłoszeń przesłały laboratoria diagnostyczne przyszpitalne – 36% i inne niż przyszpitalne – 32% oraz szkoły wyższe i jednostki naukowo-badawcze – 13%. Ogółem wskazano 4477 narażonych pracowników (91,3% kobiet, 8,7% mężczyzn). Czynniki z 2. i 3. grupy zagrożenia stosowało odpowiednio 581 i 106 zakładów. Najczęściej wykorzystywano bakterieSposób organizacji, umocowanie prawne oraz centralny charakter powodują, że KRCB stanowi unikalną bazę danych, umożliwiającą diagnozę sytuacji oraz śledzenie dynamiki w czasie w kontekście zawodowej ekspozycji na szkodliwe czynniki biologiczne celowo stosowane w zakładach pracy w Polsce. Med. Pr. 2018;69(4):413–424.

Cadmium (Cd) is regarded as a potential endocrine disruptor. However, the exact mechanism by which this metal may interfere with the reproductive system has not yet been elucidated. The present study aimed to investigate the effect of subacute Cd oral administration at daily doses of 0.09, 1.8, and 4.5 mgCd/kg b.w. and the impact of Cd on sex hormones (estradiol (E2) and progesterone (P)) in the plasma and uterus, as well as on estrous cyclicity and histopathological changes in uterine and ovary in female rats after terminating the exposure and after a prolonged observation period (3 months). Moreover, Cd bioaccumulation in the uterine and brain tissue of rats was analyzed. The study revealed that oral Cd exposure induced changes in the plasma levels of steroid hormones: decrease in E2 and increase in P after the highest dose of Cd. Probably, for the first time, it was evidenced that circulation sex hormone disturbances in Cd-exposed rats caused irregular estrous cycle, persisting for 3 months after exposure termination; no alterations in these hormone levels in uterine tissue were noted. Cd did not induce estradiol-like hyperplasia of endometrium, but resulted in endometrial edema irrespective of the dose, and caused damage of the ovaries after the highest dose. In summary, subacute oral exposure of female rats to Cd may lead to long-term disturbances in reproductive system.

Morphine and related drugs, which are the most effective analgesics for the relief of severe pain, act through activating opioid receptors. The endogenous ligands of these receptors are opioid peptides which cannot be used as antinociceptive agents due to their low bioactivity and stability in biological fluids. The major goal of opioid research is to understand the mechanism of action of opioid receptor agonists in order to improve therapeutic utility of opioids. Analgesic effects of morphine are mediated mostly through activation of the mu opioid receptor. However, in the search for safer and more effective drug candidates, analogs with mixed opioid receptor profile gained a lot of interest. Recently, the concept of biased agonists able to differentially activate GPCR downstream pathways, became a new approach in the design of novel drug candidates. It is hypothesized that compounds promoting G-protein signaling may produce analgesia while β-arrestin recruitment may be responsible for opioid side effects. In this report we showed that replacement of the tyrosine residue in the mu-selective ligand Tyr-c[d-Lys-Phe-Asp]NH2 with 2',6'-dimethyltyrosine (Dmt) produced a cyclopeptide Dmt-c[d-Lys-Phe-Asp]NH2 with mu/delta opioid receptor agonist profile. This analog showed improved antinociception in the hot-plate test, probably due to the simultaneous activation of mu and delta receptors but also significantly inhibited the gastrointestinal transit. Using the bioluminescence resonance energy transfer (BRET) assay it was shown that this analog was a mu receptor agonist biased toward β-arrestin. β-Arrestin-dependent signaling is most likely responsible for the observed inhibition of gastrointestinal motility exerted by the novel cyclopeptide. This work was supported by the Polpharma Scientific Foundation grant (11/XIII/2014 to KG) and grants from the Medical University of Lodz (No 503/1-156-02/503-11-002 and 502-03/1-156-02/502-14-301) and from the University of Ferrara (FAR grant to G.C.). KG is recipients of the Polish L’Oréal UNESCO Awards for Women in Science.