bluuebunny/crossref_metadata_2025 huggingface dataset:
Implications of the use of mechanical thrombectomy on outcome in large vessel occlusion following the 2015 landmark trials
Authors: Kuybu Okkes , Javalkar Vijayakumar , Amireh Abdallah , Kaur Arshpreet , Kelley Roger E , Cuellar-Saenz Hugo H , Sharma Pankaj
Published: May 2020

Background

The effectiveness of mechanical thrombectomy (MT) was demonstrated in five landmark trials published in2015.Mechanical thrombectomy is now standard of care for acute ischemic stroke and has been growing in popularity after publication of landmark trials.

Objective

To analyze outcomes and trends of the use of MT and intravenous thrombolysis (IVT) in patients with acute ischemic stroke in US hospitals before and after publication of these trials.

Methods

Patients discharged with a diagnosis of ischemic stroke between 2012 to 2017 were diagnosed using ICD codes from the National Inpatient Sample. Thereafter, patients given acute stroke treatment were identified using the corresponding procedure codes for IVT and MT. The primary clinical outcomes of in-hospital mortality and disability were then compared between two time periods: 2012–2014 (pre-landmark trials) and 2015–2017 (post-landmark trials). Binary logistic regression and Χ2tests were used for statistical analysis.

Results

A total of 57 675 patients (median age 68.9 years (range 18-90), 50.1% female) were identified with acute procedures. Of these patients, 57.6% were from the post-landmark trials time period. Despite an increased number of cases, the rate of IVT decreased from 84.3% to 75.9% and the rate of IVT+MT decreased from 7.1% to 6.3%. After publication of the pivotal trials in 2015, the rates of MT increased from 8.7% to 17.8%. Significant reductions of in-hospital mortality (7.1% vs 8.7%, p<0.001) and disability (64% vs 66.2%, p<0.001) were noted.

Conclusion

The analysis showed a significant increase in the proportion of patients receiving MT after 2015. This has translated into reduction of in-hospital mortality and improvement in disability.
O5A.1 Definition of case management for return-to-work in the approach of workers with musculoskeletal disorders: an update using a scoping review
Authors: Font Mercè Soler , Maria Ramada Rodilla José , Maria Gonzalez José , Sanchez Francisco Palencia , Pujadas Consol Serra
Published: May 2020

Purpose

We aim to identify the elements and functions that define the case management in the individual approach of workers with musculoskeletal disorders for return to work and to propose an updated definition.

Methods

Relevant articles were identified through a computerized search up to 1 December 2017 in the bibliographic databases PubMed, Web of Science, Scopus, Cochrane Library, IBECS, EMBASE, and LILACS. Language filter (English and Spanish) was included in the search. The inclusion criteria were working age population with musculoskeletal disorders, studies that described or evaluated case management interventions, and return to work interventions. Military personnel, and rheumatic and surgical pathologies were excluded. Independent pairs reviewed all cites and articles and extracted data, and narrative synthesis was carried out.

Results

Our searches identified 1950 possible relevant articles, of which 27 were included for data extraction. Of these, 15 papers included definitions of case management, and 14 common elements were identified. Twenty two explained the role of case manager and in 18 a description of tasks was found. In 25 articles referral services were mentioned. The most common defining elements were ‘return to work intervention’, ‘multidisciplinary assessment’ and ‘interdisciplinary intervention’ (53.8%). The 40% of the articles emphasized the ’coordination’, ‘to influence multiple factors’ (33.3%) and ‘individual approach’ (26.7%). The tasks included ’to establish goals and plan the rehabilitation for return to work’ (50%), and ’supervise or coordinate return to work process and to offer/refer the employee to services/adaptations or therapeutic workplaces’ (36.4%) The most common offered services were mental health (64.0%), and rehabilitation (48.0%).

Conclusions

Despite the increase in the number of published articles dealing with case management, usually it is not clearly defined. This scoping review emphasizes the need to define case management and its organizational characteristics, and proposes an extended and updated definition.
O5A.6 Objectively assessed arm elevation and the course of neck and shoulder pain during a 2-year follow-up: a compositional approach
Authors: Merkus Suzanne , Lunde Lars-Kristian , Koch Markus , Knardahl Stein , Veiersted Kaj Bo
Published: May 2020

Purpose

To use a compositional data analysis approach and objective exposure assessments to study the association between the duration of arm elevation and the course of neck and shoulder pain (NSP) during a 2-year follow-up in physically demanding occupations.

Methods

Construction (n=59) and healthcare (n=59) employees wore accelerometers on the dominant upper-arm during a full working day at baseline. Objective assessments using accelerometers addresses biases found in previous studies that estimate duration of arm elevation with self-reports. At baseline and every 6 months for two years, participants reported on NSP (scale 0–3). Duration of arm elevation within predefined ranges (<30°; 30–60°; ≥60) formed the parts of the composition. Compositional data analysis is a new statistical analysis method within occupational health and it is the correct way of analysing data with a compositional nature. The associations between the relative importance of the duration within the levels of arm elevation and the course of NSP during the 2-year follow-up were estimated with compositional linear mixed models, adjusted for confounders.

Results

In non-adjusted analyses, only duration arm elevation <30° was associated with NSP at baseline (β = 0.37; p=0.015). Duration arm elevation <30° had a tendency to be associated with an improvement in NSP over the 2-year follow-up (<30°*time (β=-0.07; p=0.089)). Neither duration 30–60° nor ≥60 were associated with the course of NSP during follow-up. After adjusting for confounders, none of the durations of arm elevation were associated with the course of NSP over the 2-year period (<30° and NSP (β = 0.20; p=0.126); <30°*time (β=-0.06; p=0.097)).

Conclusion

Among construction and healthcare personnel, duration of working in awkward arm elevation postures was not associated with the course of NSP over a 2-year period. Arm elevation alone, without considering force exertion, may not be sufficient to influence the course of NSP.
O5D.3 Methods of estimating lifetime occupational exposure in the general population, based on job-exposure matrices
Authors: Houot Marie , Homère Julie , Goulard Hélène , Garras Loïc , Delabre Laurène , workgroup Matgéné , Pilorget Corinne
Published: May 2020

Objectives

To estimate proportion of pathologies attributable to occupational exposure, lifetime occupational exposure prevalence (LOEP) and relative risk are necessary. LOEP estimates are commonly used but often estimated with different methods. The method choice and the impact on estimates are rarely discuss in the literature. This study present and discuss the most widely used means of estimating LOEP and their respective impacts on estimates.

Methods

A sample of individuals representative of the French population from 2007 was linked with four Matgéné job-exposure matrices: flour dust, cement dust, silica dust and benzene. LOEP and the 95% confidence interval were estimated using five methods: the maximum exposure probability during the career (Method 1), four using individual exposure probabilities, three of which subdivide careers into job-periods (Methods 2–4) and one which subdivides them into job-years (Method 5). To quantify differences between methods, percentage of variation were calculated for prevalence values on Methods 2 to 5 versus Method 1.

Results

For each agent, LOEP estimated from the maximum probability during the career (Method 1) was consistently lower than prevalence taking account of job-periods or job-years. LOEP on Method 1 for flour dust, cement dust, silica dust and benzene were respectively 4.4%–95% CI [4.0–4.7], 4.3% [3.9–4.6], 6.1% [5.7–6.5] and 3.9% [3.6–4.2]. Percentage of variation ranged from 0% to 25.0% for flour dust, from 11.6% to 55.8% for cement dust, from 11.5% to 49.1% for silica dust and from 0% to 53.8% for benzene.

Conclusions

The present study provides a description of several LOEP estimation methods in the general population based on job-exposure matrices. It specifies the strong and weak points of each of the five chosen methods. For health monitoring purposes, LOEP should be reported as intervals, with low and high estimates obtained on different methods using job-periods (Methods 2–4).
O5D.5 Construction of finnish ISCO-88 job exposure matrix: examination of dataset with two different classification of occupations in consecutive censuses
Authors: Sallmén Markku , Uuksulainen Sanni
Published: May 2020

Finnish Job exposure matrix (FINJEM) assesses occupational exposure for 84 factors in 311 FINJEM occupations. Finnish version of ISCO-88 International Standard Classification of Occupations 1988 (F-ISCO-88) occupational codes (n=445), used in population censuses from 1995 to 2009, often split into more than one FINJEM code. We describe the construction of a crosswalk between F-ISCO-88 codes and FINJEM codes and the resulting F-ISCO88 job exposure matrix (F-ISCO-88-JEM).

In total, we found 1144 conversion candidate pairs from two sources: 1) Statistics Finland crosswalks from three sequential classification of occupations (2001–1997, 1997–1987, 1987–1980) combined with crosswalk between the classification of occupations in 1980 and FINJEM, and 2) preliminary expert judgement-based conversion of F-ISCO-88–FINJEM.

We counted frequencies for all 9900 F-ISCO88 (in 1995) and FINJEM (1990) occupational code pairs from a study of neurodegenerative disease (n=103,969). Correctness of every candidate pair and prevalent non-candidate pairs was checked using occupational coding manuals of FINJEM and F-ISCO88, including occupational titles. Final list of accepted pairs was agreed by the authors.

The number of verified F-ISCO-88–FINJEM conversion pairs was 835, including 88 pairs from non-candidates. In total, 397 (34.7%) candidate pairs were incorrect. We could solve FINJEM occupation for 84 252 (81.0% from total population) persons with direct conversions or verified conversion pairs. Occupation of the remaining 19 717 persons changed between 1990 and 1995. Direct conversions totaled 27 716 (26.6%) solutions and split F-ISCO-88 codes 56 536 (54.4%) solutions. The resulting F-ISCO-88–JEM comprises original FINJEM exposure estimates for direct conversions and estimates for split F-ISCO-88 codes, calculated using proportions of corresponding FINJEM codes as weights.

A quarter of F-ISCO-88 codes can be converted to FINJEM codes in data with F-ISCO-88 occupational codes. This proportion could be tripled in a dataset including FINJEM and F-ISCO88 codes in consecutive censuses, resulting in more accurate exposure estimates.
O5E.1 Data on acknowledgment and costs of work-related mental diseases in france
Authors: Lasfargues Gérard , Jacquetin Pascal , Vongmany Nathalie , Chauvet Claire , Durand-Moreau Quentin
Published: May 2020

Objective

To report data concerning the reality of work-related mental diseases (WRMD) in France, their acknowledgment as occupational diseases and some socio-economic data.

Methods

Data were collected from the French National Health Insurance Fund (NHIF) and from the database of the French national occupational surveillance and prevention network (rnv3p). Rnv3p collects data from French Occupational Disease Centers to identify and describe risks and/or emerging work-related diseases.

Results

Data from NHIF indicate that the number of requests for acknowledgment of WRMD has increased significantly from 2012 to 2017 (200 to 1500). About 50% are acknowledged and compensated as occupational diseases. Within these affections, the share of depressions is the majority. Durations of work stoppages (more than 400 days on average) were much longer than for other occupational diseases.

Mental disorders related to psychosocial risk factors may also be compensated as work injuries. In 2016, NHIF compensated over 10 000 mental disorders as work injuries, mostly caused by external events or inadequate working conditions. The proportion of people with permanent disability was 4.6%. Finally, the management of WRMD acknowledged will have represented € 230 million for the Work Injuries-Occupational Diseases branch of the NHIF.

Rnv3p data are globally consistent with NHIF concerning compensated occupational mental diseases, highlighting the increase of WRMD in some sectors such as public administration, health and social action, retail business and education. Over 18000 WRMD (33% men, 67% women; mean age=46.0±8.9) were recorded in the database between 2010 and 2016, and 1833 cases of burnout situations currently non acknowledged as occupational diseases by the NHIF. Rnv3p data also illustrate the importance of under-reporting of WRMD as occupational diseases.

Conclusion

Then, RNV3P provides important data to assist in the acknowledgment of WRMD and to carry out preventive actions in the sectors and enterprises most concerned.
O5E.3 Occupational diseases among workers in different socioeconomic positions
Authors: van der Molen Henk , Vries Sanne de , Sluiter Judith
Published: May 2020

Introduction

To determine differences between workers in lower and higher socioeconomic positions (SEP) in: i) incidence, trends and type of occupational disease (OD) and ii) incapacity for work due to ODs. It is hypothesized that workers in lower and higher SEP still differ in health disparities from an occupational perspective.

Methods

From a Dutch cohort of occupational physicians (OPs), ODs assessed by OPs were retrieved over a seven year period (2010–2016) for lower and higher SEP groups. Incidence and type of OD and incapacity for work were determined for the total number of ODs and six frequently occurring ODs. Trends in incidence were estimated using a multilevel negative binominal regression model.

Result

In total, 54 per 100,000 workers in elementary occupations, machine operating and assembly jobs, as well as managerial and intellectual jobs during 2016 had an OD diagnosed and reported by an OP, from which 98 per 100,000 were for lower SEP, and 36 per 100,000 for higher SEP. Among the lower SEP, musculoskeletal disorders (37%) and noise-induced hearing loss (NIHL) (32%) comprised two-thirds of the OD diagnoses. Among the higher SEP, distress/burnout comprised 60% of the OD diagnoses, with an increasing trend (6%; 95% CI: 3%-8%). Incapacity for work due to work-related low back disorders (69% vs 9%) and shoulder-, arm- and wrist disorders (89% vs 47%) differed significantly between workers in lower compared to higher SEP.

Discussion

Occupational diseases occur at a 2.7 higher incidence rate for workers in lower SEP compared with higher SEP. Incapacity for work due to work-related musculoskeletal disorders are higher for workers in lower SEP compared with higher SEP, suggesting fewer opportunities to modify work tasks and working circumstances for lower SEP. Psychosocial risk factors constitute the greatest problem for workers in higher SEP, resulting in distress/burnout, accompanied by incapacity for work.
O5E.4 Bridging the gap between clinical cases and epidemiological evidence
Authors: Godderis Lode , Bakusic Jelena , Pauwels Sara , Molen Henk Van der , Lenderink Annet
Published: May 2020

One of the current gaps in the prevention of work-related diseases (WRDs) is the missing link between the assessment of occupational hazards introduced at the workplace, clinical alerts, epidemiological studies and policy actions. Alert systems aim to bridge this gap, by collecting information on diseases and exposures to raise alerts to different stakeholders and trigger timely prevention.

This project started with a review of international alert systems to identifying good practices and learning about prerequisites, drivers and obstacles to implement alert and sentinel systems. Next, the findings led to the implementation of an integrated approach consisting of alert systems on three levels in the Belgian context:

Signal detection and assessment: suspected clinical cases of new WRDs (new exposure–disease combinations) can be reported though an online platform called ‘SIGNAAL’. Each reported case is followed by an extensive assessment of exposure– and work–relatedness performed by clinical experts. Since the start, 22 cases have been reported to the platform.

Signal strengthening though a network of occupational health physicians. This sentinel approach has been introduced though the PROBE system, in which 47 occupational physicians participated. During the periodic health examinations of workers, the physicians filled in a web survey regarding occupational exposure of a random sample of workers to 22 selected hazardous chemicals during the last working week. Results of the first study showed that 47% of workers were exposed to at least one chemical product from the list, with diesel exhaust being the most frequently reported substance (n=91; 14% of workers).

Alerts to public health authorities are mainly communicated though collaboration with Federal Public Services and Federal Agency for Occupational Risks.

These agencies provide support in the maintenance of systems and in turn, data from the systems is used as input for potential preventive strategies on company and societal level.
O6C.1 Ischaemic heart disease and occupation: a linkage between two new zealand surveys and the integrated data infrastructure
Authors: Corbin M , Barnes L , Denison HJ , Eng A , Mannetje A , McLean D , Ellison-Loschmann L , Jackson R , Douwes J
Published: May 2020

Background

Associations between ischaemic heart disease (IHD) and occupation are poorly understood. We linked two previously conducted New Zealand workforce surveys with routinely collected health data to assess occupational risk factors of IHD in New Zealand.

Methods

Two probability-based sample surveys of the general New Zealand adult population (2004–2006; n=3003) and of the New Zealand indigenous peoples (M&_x0101;ori; 2009–2010; n=2107), for which occupational history was collected, were linked with health data up to the end of 2017 using Statistics New Zealand individual-level microdata. Incident IHD events were identified using hospitalisations, prescriptions and deaths. The odds ratios associated with ever being employed in occupational groups were estimated by logistic regression adjusting for age, smoking and socio-economic status separately for males and females in each cohort.

Results

A total of 282 IHD cases were identified in both surveys. Statistically significant elevated IHD risks were observed for male clerks in the general survey (OR=1.60, 95%CI=1.02–2.49) and agriculture and fishery male workers in the M&_x0101;ori survey (OR=1.70, 95%CI=1.02–2.82). Among females, the odds ratios for agriculture and fishery workers were 1.69 (95%CI=0.81–3.51) and 1.49 (95%CI=0.81–2.75) in the general survey and the M&_x0101;ori survey, respectively. A statistically significant increased risk was observed for female plant and machine operators and assemblers in the M&_x0101;ori survey (OR=1.87, 95%CI=1.05–3.31). In the general survey, male plant and machine operators and assemblers had an odds ratio of 1.26 (95%CI=0.81–1.95). We also identified borderline increased odds ratios for trades workers among males in the general survey (OR=1.39, 95%CI=0.92–2.12, p-value=0.12) and among females in the M&_x0101;ori survey (OR=2.26, 95%CI=0.98–5.21, p-value=0.06).

Conclusion

This study identified associations between several occupational groups and IHD in the New Zealand population. Further analyses will be conducted to assess specific occupational exposures associated with IHD risk.
O6C.3 The association between long-term exposure from heavy physical work load and coronary heart disease in middle aged men
Authors: Hemmingsson Tomas , Selander Jenny , Kjellberg Katarina
Published: May 2020

Objectives

Previous studies have shown conflicting results concerning the association between heavy physical work load and risk of coronary heart disease (CHD). The aim of this study was to investigate the association between long-term exposure to heavy physical work load in middle age and risk of CHD among Swedish men during almost 20 years of follow-up.

Methods

The study is based on a cohort of around 40 000 Swedish males, born 1949–51, with census information on occupation in 1985 and 1990 (at ages 34–41). Aspects of physical workload was estimated from job exposure matrices based on questions concerning heavy lifting, strenuous work postures, and physically strenuous work from the Swedish Work Environment Surveys 1989–97. Mean values for each physical exposure variable were assigned to over 300 occupational titles from the censuses conducted in 1985 and 1990. Only those 29 530 subjects who were in the same quintile of exposure both years were included in the analyses. Information on smoking behavior and body mass index (BMI) was collected at compulsory conscription for military training in 1969/70 (at 18–20 years of age), and follow up data on CHD (1457 cases) between the years 1991–2009.

Results

An increased relative risk of CHD were found among workers in the quintiles with medium low (HR=1.36 CI95%=1.14–1.62), medium (HR=1.46 CI95%=1.23–1.74), medium-high (HR=1.62 CI95%=1.36–1.91), and high (HR=1.45 CI95%=1.22–1.71) exposure to heavy lifting at work compared with those in the quintile with low exposure to heavy lifting. After adjustment for smoking and BMI the risk estimates were somewhat lower but still significantly increased. Risk estimates of the same magnitude were seen for a number of other aspects of the physical work environment.

Conclusion

There was an association between long-term exposure from heavy physical work load and CHD even after adjustement for smoking and BMI.
O6D.1 Inflammatory markers in the plasma of firefighters heavily exposed to particulates
Authors: Galarneau Jean-Michel , Cherry Nicola
Published: May 2020

Introduction

In 2016 firefighters from Alberta, Canada deployed to a catastrophic fire in Fort McMurray. In the first few days, firefighters experienced heavy smoke exposures during greatly extended work shifts. Blood samples were collected to determine whether inflammatory markers might constitute a useful biomarker of exposure. In first responders exposed during the Word Trade Center disaster, inflammatory markers in serum samples collected within 6 months post-event were associated with poor recovery from exposure-related lung disorders.

Methods

Blood samples were collected at two fire services. At Service A, first samples were drawn two weeks from the start of the fire and second samples after 3–4 months. At Service B samples were collected over 4 weeks, starting 4 months from the first exposure. Samples were immediately centrifuged and the plasma stored at −80C before being evaluated for 42 cytokines or chemokines using a multiplex assay. A principal component analysis was carried out to reduce the number of correlated outcomes. Exposure to particulates was estimated for each firefighter using environmental PM2.5, total hours exposed, tasks carried out and the use of respiratory protection. Respiratory symptoms immediately before the fire, immediately post fire and at 4 months were collected using visual analogue (VA) scales.

Results

Inflammatory markers were assayed for 242 plasma samples from 175 firefighters. Six components were extracted of which only one, labelled the inflammatory marker component (IMC) was related to estimated exposure (p<0.001): values decreased with time since last exposure (p<0.001). All respiratory symptoms post-fire were greater in those with higher estimated PM2.5. IMC scores were independently related to cough and wheeze at 4 months, but the biomarker did not contribute to models for these endpoints that also included PM2.5.

Conclusions

Inflammatory markers were related to exposure but did not improve prediction of symptoms in the first months post fire.
O6E.1 Self-report occupational exposures and mnd in new zealand
Authors: Chen Grace , Mannetje Andrea ’t , Douwes Jeroen , Berg Leonard van den , McLean Dave , Pearce Neil , Kromhout Hans , D´Souza Wendyl , McConnell Melanie
Published: May 2020

Background

We have reported previously the results on a New Zealand population based case-control study evaluating occupations as risk factors for MND. The aim of this study was to investigate the associations between 11 different occupational exposure groups and the risk of MND by using self-reported job-related exposures.

Methods

We recruited 321 cases through the New Zealand Motor Neurone Disease Association and hospital discharges records, and 605 population controls from the Electoral Roll between 2013 and 2016. A standardized questionnaire was used to obtain information on personal and demographic details, lifestyle factors and a full occupational history with detailed workplaces exposures. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals for MND. Analyses were adjusted for age, gender, ethnicity, socioeconomic status, education and smoking.

Results

Significantly elevated risks for MND were observed for self- reported job related exposures to Fibres (OR=1.39, 95% CI 1.00–1.93); Fumigants (OR=2.44, 95% CI 1.35–4.23); Animal and Animal Products (OR=1.41, 95% CI 1.03–1.92); Other Chemicals (OR=1.53, 95% CI 1.14–2.05) and Fungicides/Insecticides/Herbicides/Timber Preservatives (OR=1.44, 95% CI 1.05–1.99)

Conclusions

Our study shows various occupational related exposures with increased odds of MND. While study results need to be interpreted cautiously given the lack of direct exposure measures, these results, in particular exposure to Fumigants, Fungicides/Insecticides/Herbicides/ Timber Preservatives which were consistent with our previous results on agriculture occupations and MND risk. Future studies will have a particular focus on exposures specific for certain job tasks and dose-response relationships.
O7B.5 Trajectories of psychosocial working conditions as predictors of later life physical function
Authors: Nilsen Charlotta , Andel Ross , Darin-Mattsson Alexander , Kåreholt Ingemar
Published: May 2020

Objectives

The demographic shift towards an aging society has made it important to understand underlying life course trajectories of later life health and function. The aim was to investigate if psychosocial working conditions are associated with later life physical function.

Method

Two individually linked longitudinal Swedish surveys were used (n=803). A psychosocial job exposure matrix was used to measure psychosocial working conditions in the first occupation and at ages 25, 30, 35, 40, 45, and 50 - based on work history - and current occupation at baseline (1991). Physical function was measured in 2014. Random effects growth curve models were used to calculate within-person change. Random effects growth curve models were used to calculate intraindividual trajectories of working conditions, analyzed in relation to functional impairment with ordered logistic regression.

Results

Having a more active job at baseline was associated with decreased odds of functional impairment in old age (OR 0.87, CI 0.76–0.99). Having a more high strain job at baseline was associated with increased odds of functional impairment in old age (OR 1.33, CI 1.04–1.70). Having a high starting point and upward trajectory of job strain throughout working life were associated with increased odds of functional impairment in old age (OR 3.16, CI 1.73–5.80).

Discussion

Promoting a healthy workplace by reducing chronic stress and inducing intellectual stimulation, control, and personal growth, may not only improve the health of workers. It may also lower the cost of health and social care by improving health and function of the older population. Hence, investing in a healthy workplace should be seen as a double-win investment for society.
O7C.4 Use of control measures among construction workers when performing dusty work
Authors: Khieu Trang , Daubé Jacob
Published: May 2020

Respirable dust, including respirable crystalline silica (RCS), is a common risk to health for construction workers. New Zealand and international literature has shown that construction workers are likely exposed to high levels of dust in the performance of their work. However, very little is known about the prevalence of controls used to minimise the dust exposure. An on-site survey of 250 construction workers was undertaken in Hamilton, New Zealand. Respondents were asked how frequently they completed any of six common high-risk activities for dust exposure: [1] cutting or drilling concrete, [2] grinding or polishing concrete, [3] jackhammering, [4] crushing concrete, [5] cutting or sanding wood, [6] cutting or sanding plasterboard or fibre cement board. For each activity completed more than once a month, workers were asked about the controls they used to minimise exposure to dust and their consideration of the risks to their health. Low levels of controls were reported across the high-risk activities. The majority of workers did not usually use water suppression when jackhammering (79.6%) or crushing concrete (56.3%). Nearly two thirds (62.8%) of workers did not use dry dust extraction when cutting or sanding wood, and over a quarter of respondents used neither water suppression nor dry dust extraction when cutting/drilling concrete (30.1%) or grinding/polishing concrete (25.0%). Half of the workers (50%) often or always wore respirators when performing dusty work but fewer than half of ever-wearers were fit-tested or clean-shaven. Younger workers (<25 years) were significantly less likely to consider risks to their health or wear a respirator compared to older workers (≥25). This study provides an insight into the use of dust controls in the construction industry in New Zealand. Future work should investigate how to encourage or enable uptake of stronger dust controls.
O7E.1 Solutions to prevent occupational health and productivity effects of heat
Authors: Fluoris Andreas , Bogataj Lucka Kajfez , Kjellstrom Tord , Morris Nathan , Nybo Lars
Published: May 2020

In the context of global warming and rising workplace temperatures, the European Commission funded HEAT- SHIELD project is creating a sustainable inter-sectoral framework to prevent heat- induced health effects in working people and improve quality and productivity of important industries (i.e. manufacturing, construction, transportation, tourism and agriculture). Strengthened occupational epidemiology services is an essential component of this framework.

The project is producing a series of outcomes including: (i) implementation of appropriate technical and biophysical solutions to counter the heat- induced risk to workers’ health for key industries; (ii) development of an online open access service to anticipate and warn about extreme heat events; (iii) dissemination of scenario-specific guidelines aimed at maintaining workers’ health, well-being and productivity in spite of global warming; (iv) assessment of the health, social, and economic benefits of implementation of such guidelines and their impact on reducing inequalities. This paper at EPICOH will present up-to-date results of the analysis of preventive solutions and their testing.

For example, in order to ensure agricultural workers, remain healthy and productive the following steps should be followed:

Have a plan for how to deal with heat stress

Give workers training on signs and symptoms of heat strain

Pay attention to weather forecasts.

In hot weather give workers time to physiologically acclimatize

Reschedule physically demanding work to cool times

Provide short breaks every 30 min in cool areas

Hydration: make sure workers drink 500 ml (2 glasses) of water before the work shift starts and when the work shift end, further encouraging them to drink plenty in the evenings. Also, make sure workers have access to water throughout the day.

Workers should wear light, breathable, light–coloured, loose fitting clothing unless special protective clothing is needed.
O8C.2 Is chronic kidney disease of unknown cause (CKDU) an occupational or an environmental disease?
Authors: Pearce Neil
Published: May 2020

Chronic Kidney Disease of undetermined cause (CKDu) is affecting agricultural communities in Central America, South Asia, and possible other parts of the world. Various possible causes have been suggested, including heat/dehydration, pesticides, infections, and water contamination/heavy metals. In particular, it has been suggested that CKDu is an occupational disease caused by various working conditions (heat stress, pesticides), and that there is a global epidemic. The debate has become increasingly polarised, since most of the various protagonists are arguing in a data-deficient vacuum. We still don’t know, at least on a global level, who gets this disease, or if the disease is the same in different parts of the world. However, evidence is beginning to emerge, based on studies that we are conducting in Nicaragua, Peru, Malawi, India, and Sri Lanka. These new findings indicate that: (i) the disease does not exist globally, but appears at this stage to be confined to Central America and South Asia (India, Sri Lanka) – there are other regions of the world which are also hot and use large amounts of pesticides where the disease does not occur; (ii) it is more common in agricultural areas, but is not confined to sugar cane workers, and also occurs in women, albeit at a lower rate; (iii) there is a very clear distinction between community members who experience marked declines in kidney function and those who do not. Taken together, this emerging evidence indicates that CKDu may be an environmental rather than an occupational disease, and that the environmental cause(s) are unknown at this time. This has important implications in terms of what research we do next to try and find the cause(s) of this condition.
K-02 The evolution of occupational epidemiology
Authors: Pearce Neil
Published: May 2020

In this talk, I review the evolution of occupational epidemiology over the last 40 years. Methodologically, the field is almost unrecognizable compared to what was ‘standard practice’ 40 years ago. Methodological changes include the use of new study design and statistical methods, such as counterfactual theory, directed acyclic graphs (DAGs), IPW, g-estimation, g-computation, multiple imputation for missing values, sensitivity analysis, and bootstrapping. Biomarkers and various molecular and omics measures are increasingly used for exposure assessment, and exploration of mechanisms. The exposures and outcomes under study have also evolved, e.g. with increased consideration of psychosocial factors, work organisation, musculoskeletal problems, mental health and neurological disease. Despite all of these changes, many of the fundamentals of occupational epidemiology remain the same. Thediscoveryof new causes of occupational disease continues to be lead by astute observers (including astute clinicians and astute workers), rather than by ‘bigdata’ or ‘omics’ methods. The strategy forinvestigationof possible occupational causes of disease continues to require a variety of study designs and approaches, including ‘descriptive’ studies, and triangulation across study designs and populations (albeit while utilising new molecular biology and statistical techniques). Thecausal assessmentof occupational exposures and their health effects continues to require a wide variety of types of evidence in humans and animals, as well as mechanistic evidence. Forty years later, the Bradford-Hill considerations have been augmented but not been replaced, and the IARC ‘rules’ for combining various types of evidence remain the state-of-the-art. Reports of the death of ‘traditional epidemiology’ (and its replacement by ‘modern epidemiology’ and ‘causal inference’ methods) have been exaggerated.
O8D.7 The effect of right truncation bias on biomechanical factor risk estimates for CTS
Authors: Harris-Adamson Carisa , Eisen Ellen , Rempel David , Gerr Fred , Bao Stephen , Hegmann Kurt , Kapellusch Jay , Meyers Alysha
Published: May 2020

Carpal tunnel syndrome (CTS) is a potentially disabling occupational illness with high incidence rates in certain occupations. Prospective workplace studies have identified associations between personal, psychosocial and biomechanical factors and incident CTS. However, biased estimates of association due to the healthy worker survivor effect (HWSE) have not been fully investigated. The HWSE results in left truncation bias when affected workers are lost from the population of more highly exposed workers before study participants are sampled. Right truncation bias occurs when affected workers are lost disproportionately from higher exposure strata after enrollment in a prospective cohort study. This study evaluated the effects of right truncation bias on risk estimates for biomechanical factors.

Between 2001 and 2010 five research groups in the US conducted coordinated prospective studies of incident CTS among workers from various industries. Hazard ratios (HR) were estimated using Cox proportional regression analyses with adjustment for personal and workplace psychosocial factors. Inverse probability censoring weight (IPCW) values were created using a cross-validated approach analogous to the lasso method for variable selection and parameter regularization. The weighting model predicted the probability of exit from the cohort in the next 3 months.

The final models included 2520 workers and 166 incident CTS cases. IPCW models with adjustment for right truncation bias were used to predict incident CTS. Effect size estimates for the workplace biomechanical factors of Peak Force, HAL Scale, Forceful Repetition Rate and the ACGIH TLV for HAL increased by 11% to 71% in comparison to models without adjustment for right truncation bias. After adjusting for right truncation bias the predicted incidence of CTS in highly exposed workers increased up to 3-fold.

Bias from symptomatic workers disproportionately leaving the workplace was identified in this cohort. Adjusting for this bias has likely produced more accurate dose-response relationships than those previously reported.
P.1.01 A nationwide, longitudinal study of crohn’s disease among korean workers exposed to toluene
Authors: Ahn Yeon-soon , Yoon Jin-Ha , Lee Jeong-Ha
Published: May 2020

The pathogenesis of inflammatory bowel diseases (IBD) probably involves an interaction between genetic and environmental factors. Recent studies have shown that air pollution and PFOA (perfluorooctanoic acid) are associated with IBD. It is presumed to be related to inflammatory response. Immunoreactivity and inflammatory response are known to be major important mechanisms that causes toluene induced toxicity. So we evaluated the Crohn’s disease morbidity among Korean workers exposed to toluene.

Methods

Data were collected from toluene-associated specialized medical check-up 2000 and 2004 in Korea. The number of workers admitted to hospital because of clinically diagnosed Crohn’s disease was analyzed in male workers exposed to toluene (n=149,183). As a control reference population, 2% of Korean men were randomly selected and their hospital admission data were analyzed. For toluene exposed workers, Standardized admission ratios (SARs) for Crohn’s disease, as determined by ICD-10 classifications, were estimated in reference to the control population.

Results

During follow up, 46 workers admitted because of Crohn’s diseases. Occupational exposure to toluene (5 63 852 person-years) was significantly associated with the SAR of Crohn’s disease (SAR: 1.60, 95% CI: 1.17–2.13), in particular, SARs of workers with 3rd quartile hippuric acid level was significantly increased (SAR: 1.95, 95% CI: 1.21–2.99).

Conclusion

In conclusion, toluene-exposed workers exhibited significantly elevated SARs for Crohn’s disease, especially workers with high level of hippuric acid, compared to the age-matched reference population, suggesting a relatedness with toluene exposure. This work was supported by Korea Environmental Industry and Technology Institute (KEITI) through ‘The Chemical Accident Prevention Technology Development Project’ funded by Korea Ministry of Environment (MOE) (2017001970001).
P.1.24 The development and impact of policies and research for preventing and recognizing overwork-related cardiovascular disease in taiwan
Authors: Lin Ro-ting
Published: May 2020

Introduction

Overwork-related cardiovascular and cerebrovascular disease (CVD) is an emerging occupational and public health issue in East Asian societies with a substantial impact on workers’ rights and labor standards. To eliminate exposure to work-related risk factors and prevent overwork-related CVD, establishing national policy is a key step. We investigated the development and impact of policies and research regarding overwork-related CVD in recent years in Taiwan.

Methods

We collected information regarding government policies that aimed to prevent and recognize overwork-related CVD. Among the risk factors, long working hours have been widely adopted as a quantitative measure to recognize CVD as overwork-related or not. We also collected data on the number of overwork-related CVD cases and average working hours for each industry from 2006 to 2017.

Results

In Taiwan, overwork-related CVD 79% of all deaths due to occupational diseases in 2017, although it accounted for 13% of all cases of occupational diseases. Taiwanese workers have long working hours compared to those in other countries, but Taiwan did not have official criteria for recognizing overwork-related diseases until 1991, and it did not recognize its first case until 2006 after several onsets of CVD reported on the news. Our estimation showed an under-recognition problem in less severe outcomes (i.e., illness). We also found variations in CVD risks across industries, with the higher risk in transportation and information.

Conclusions

National policy changes for preventing overwork were pushed by insightful scholars, labor unions, nongovernmental organizations, and legislators. Clear criteria for recognizing overwork-related CVD can help occupational physicians and industrial hygienists to assess the workers’ working characteristics more objectively. Although Taiwanese government has adopted the criteria for recognizing overwork-related CVD from Japan, the underreporting of less severe outcomes and industry disparities warrants further research to explore causal mechanisms and policies to narrow the gaps.
P.1.26 Biomarkers of health effects in nanomaterials workers: updated status of nanoepidemiology
Authors: Liou Saou-hsing , Li Wei-Jin , Wu Wei-Te
Published: May 2020

The first article ‘Epidemiological Study of Health Hazards among Workers Handling Engineered Nanomaterials.’ was published on J Nanopart Res in 2012, and the first review article ‘Assessing the first wave of epidemiological studies of nanomaterial workers’ was published on J Nanopart Res in 2015. Until now, 29 epidemiological studies were published in peer-reviewed scientific journal. In addition, 5 epidemiological studies were traced but unpublished in the peer-reviewed journal, including 1 PhD. thesis and 4 conference abstracts. Most of these studies involved single nanomaterial exposure, for example, 8 articles for carbon nanotubes (MWCNT), 7 articles for titanium dioxide, 1 article for iron oxides, nano calcium carbonate, nano zinc oxide, and nanocomposite, but 6 studies from Taiwan involved multiple exposures. Two studies did not mention the specific components of nanoparticles. Most of these studies were done in Europe (14), followed by Asia (10), USA (2) and Australia (1).

Generally, biomarkers were used as the outcomes variables to elaborate the health hazards of nanomaterials, except for 1 study surveyed work-related symptoms and diseases worsen by work. Exhaled breath condensate (EBC) and serum were the most frequently used biospecimen. All 26 cross-sectional studies and 1 six-month longitudinal panel study showed positive relationship between nanomaterials exposures and various biomarkers. Positive health effects include: 1. elevation of lung fibrosis markers and lung inflammation markers; 2. elevation of cardiovascular injury markers and abnormal HRV; 3. elevation of EBC nucleic acid, lipid and protein oxidative markers; 4. Increased immune markers; 5. changes in the ncRNA and mRNA expression, reduced global methylation, and specific gene methylation.

This review provides some insight into potentially adverse effects that might be related to nanomaterial exposures and provides a foundation for future work. We expect more longitudinal studies with repeated measurements to explore chronic and cumulative effects of nanomaterial exposure.
P.1.31 Limit values for metals: discrepancies between derivation from animal experiments and epidemiological studies/workplace observations without effects at higher exposures
Authors: Pallapies Dirk , Welge Peter , Bruening Thomas
Published: May 2020

Risk assessment/limit value setting for metals at the workplace is often based primarily on animal data. Epidemiological data providing information on quantitative exposure-response relationships is rarely available, but should be used preferentially if of sufficient quality, as in the case of chromium(VI). In Germany, the Committee of Hazardous Substances has derived an assessment criterion for chromium(VI) of 1 µg/m³ reflecting a tolerable risk of 4 additional cancer cases in 1000 workers exposed over their whole working life. For various metals human data is less informative. Thus, for cobalt, a tolerable concentration of 5 µg/m³ (respirable fraction) as been calculated based on inhalation studies in rats and mice which developed lung tumors after exposure to more than 1 mg/m³. However, recently published epidemiological studies among more than 30 000 hardmetal and cobalt production workers do not provide any evidence for carcinogenicity in humans at exposures in the range from 10–100 µg/m³ - between the tolerable concentration based on animal data and the concentration used in the animal experiments. The implications for risk assessment will be discussed also taking into account additional epidemiological data addressing potential inflammatory or fibrogenic effects with impairment of lung function at higher workplace exposures. Copper is another compound for which in Germany a limit value has been proposed by the MAK (maximal workplace concentration) commission based on animal data. Based on a 28 day rat inhalation study with copper(I) oxide which demonstrated inflammatory effects at concentrations starting around 200 µg/m³ a MAK value of 10 µg/m³ (respirable fraction) has been derived. However, copper has been used at workplaces for centuries at concentrations even in the mg range without observation of clear health effects. Potential explanations for these discrepancies as well as requirements of additional health data will be presented.