Physicians' opinions about the causes of underreporting of occupational diseases

Framework for implementing collaborative TB-silicosis activities in India: insights from an expert panel

Tuberculosis (TB) treatment is more challenging for patients with silicosis, as it complicates the diagnosis of both diseases and increases mortality risk. Silicosis, an incurable occupational disease, confounds the diagnosis of TB and vice versa, making it more difficult to accurately identify and treat either condition. Moreover, TB appears to accelerate the progression of silicosis. Exposure to silica dust, a common cause of silicosis, can also trigger latent TB to become active TB. This correspondence outlines a proposed framework for implementing collaborative TB-silicosis activities in India, aimed at improving early diagnosis and management for both diseases. An expert panel of medical professionals developed this framework through online consultations in October and November 2022. The panel's goal was to establish a consensus on integrating TB-silicosis activities, with a focus on early detection and proper management. The framework suggests testing all patients with silicosis for active TB and screening workers exposed to silica dust for latent TB infection. It also recommends that patients with TB who have a history of occupational exposure to silica dust should be tested for silicosis. Reliable diagnostic tools, such as chest X-rays, are emphasized, providing guidance on their use for both diseases. The proposed collaborative TB-silicosis framework offers a structured approach to identifying and managing these two diseases, contributing to the global goal of eliminating silicosis by 2030 and aligning with the World Health Organization's targets for reducing TB incidence and mortality. It recommends specific strategies for implementation, including testing, referral systems, and workplace-based interventions. The framework also underscores the need for coordinated efforts among stakeholders, including the ministries of health, labor, industry, and environment. This correspondence provides valuable insights into how India can successfully implement collaborative TB-silicosis activities, serving as a model for other regions with similar challenges.

Silicosis as a predictor of tuberculosis mortality and treatment failure and need for incorporation in differentiated TB care models in India

BACKGROUND

Differentiated tuberculosis (TB) care is an approach to improve treatment outcomes by tailoring TB management to the particular needs of patient groups based on their risk profile and comorbidities. In silicosis-prone areas, the coexistence of TB and silicosis may exacerbate treatment outcomes. The objective of the study was to determine predictors of TB-related mortality, treatment failure, and loss to follow-up in a silicosis-prone region of western India.

METHODS

A retrospective cohort was conducted among 2748 people with TB registered between January 2006 and February 2022 in Khambhat, a silicosis-prone block in western India. Death, treatment failure, and loss to follow up were the outcome variables. The significant predictors of each outcome variable were determined using multivariable logistic regression and reported as adjusted odds ratios (aOR) with 95% confidence intervals (CIs).

RESULTS

In the cohort of 2,748 people with TB, 5% presented with silicosis, 11% succumbed to the disease, 5% were lost to follow-up during treatment, and 2% encountered treatment failure upon completion of therapy. On multivariable logistic regression, concomitant silicosis [aOR 2.3 (95% CI 1.5-3.5)], advancing age [aOR 1.03 (95% CI 1.02-1.04)], male gender [aOR 1.4 (95% 1.1-1.9)], human immunodeficiency virus (HIV) positive [aOR 2.2 (95% 1.02-4.6)], and previous TB treatment [aOR 1.5 (95% CI 1.1-1.9)] significantly predicted mortality among people with TB. Concomitant silicosis [aOR 3 (95% CI 1.4-6.5)], previous TB treatment [aOR 3 (95% CI 2-6)], and multi-drug resistant TB [aOR 18 (95% CI 8-41)] were the significant predictors of treatment failure on adjusted analysis. Advancing age [aOR 1.012 (1.001-1.023)], diabetes [aOR 0.6 (0.4-0.8)], and multi-drug resistance [aOR 6 (95% CI 3-12)] significantly predicted loss to follow-up after adjusting for confounders.

CONCLUSIONS

Controlling silicosis might decrease TB mortality and treatment failure in silicosis-prone regions. The coexistence of HIV and silicosis may point to an increase in TB deaths in silicosis-prone areas. Silicosis should now be acknowledged as a major comorbidity of TB and should be included as one of the key risk factors in the differentiated TB care approach. Primary care physicians should have a high clinical suspicion for silicosis among individuals diagnosed with TB in silicosis-prone blocks.

Challenges and opportunities for silicosis prevention and control: need for a national health program on silicosis in India

BACKGROUND

Silicosis has been one of the most serious occupational public health problems worldwide for many decades. The global burden of silicosis is largely unknown, although it is thought to be more prevalent in low and medium-income countries. Individual studies among workers exposed to silica dust in various industries, however, reveal a high prevalence of silicosis in India. This paper is an updated review of the novel challenges and opportunities for silicosis prevention and control in India.

MAIN BODY

The unregulated informal sector employs workers on contractual appointment thereby insulating the employers from legislative provisions. Due to a lack of awareness of the serious health risks and low-income levels, symptomatic workers tend to disregard the symptoms and continue working in dusty environments. To prevent any future dust exposure, the workers must be moved to an alternative job in the same factory where they will not be exposed to silica dust. Government regulatory bodies, on the other hand, must guarantee that factory owners relocate workers to another vocation as soon as they exhibit signs of silicosis. Technological advances such as artificial intelligence and machine learning might assist industries in implementing effective and cost-saving dust control measures. A surveillance system needs to be established for the early detection and tracking of all patients with silicosis. A pneumoconiosis elimination program encompassing health promotion, personal protection, diagnostic criteria, preventive measures, symptomatic management, prevention of silica dust exposure, treatment, and rehabilitation is felt important for wider adoption.

CONCLUSION

Silica dust exposure and its consequences are fully preventable, with the benefits of prevention considerably outweighing the benefits of treating patients with silicosis. A comprehensive national health program on silicosis within the public health system would strengthen surveillance, notification, and management of workers exposed to silica dust in India.

Analysis of the research subjects and hot topics of occupational diseases through the Web of Science from 1975 to 2021

A variety of studies have been conducted in Occupational diseases (ODs) and this makes it difficult for researchers to identify new areas of study. Therefore, the present study was conducted by examining Web of Science data to identify hot topics and research topics on ODs. This is a scientometric study performed using CiteSpace and Gephi software for statistical analysis. The published article in Web of Sciences was searched using the keywords "Occupational disease^*" OR "Occupational illness^*" OR "Industrial disease^*" OR "Industrial illness^*". Finally, the countries and institutions and their cooperation, the most important and main topics discussed, and the path of future progress in ODs was analyzed. Preliminary results of the study show that out of 5,947 articles. The results of important journals showed that the American Journal of Industrial Medicine with 233 articles (6.02%), Oxford Occupational Medicine, and International Archives of Occupational and Environmental Health with 86 (2.22%), and 83 (2.15%), respectively. The two producing countries are the United States and Germany, which published 628 and 419 articles, respectively. The results of hot topics showed occupational exposures, epidemiology, mental health, and respiratory diseases were the most important keywords used in these 45 years. It can be concluded that Germany, with its current development trend in the coming years, will surpass the United States based on the number of articles and gain the first rank. Also, future studies can be conducted on respiratory diseases as the most important ODs and health care work as the most important job during the past years.

Working Conditions of Occupational Physicians-A Scoping Review

Occupational physicians (OPs) offer a wide range of health support for employees and are confronted with varying job characteristics and demands. They monitor occupational health and safety and promote work(place)-related health measures and assessments. While helping employees to (re)gain a healthy status, their own job satisfaction as well as the investigation of their working conditions have earned limited research attention. Thus, this scoping review aims to summarize the current state of knowledge concerning OPs’ working conditions, i.e., work-related resources and stressors. PubMed, Web of Science and LIVIVO as well as grey literature were screened for relevant English or German articles until 10/2021. From a total of 1683 identified publications, we analyzed 24 full text articles that fulfilled all inclusion criteria. The overall study sample included 3486 male (54.6%), 2892 female (45.3%) and 5 diverse OPs, from which 1049 OPs worked in full-time (85.6%) and 177 in part-time (14.4%). The majority (72.4%) worked for the Occupational Health Service (OHS), 13% were self-employed, and 14.6% worked for a company/in-house service. The classification of stressors and resources was based on an inductively generated categorization scheme. We categorized 8 personal, relational and environmental resources and 10 stress factors. The main resources were support for personnel development and promotion, positive organizational policy, promoting work-life balance and other aspects of health. Key stressors were information deficits, organizational deficiency and uncertainty as well as socioeconomic influences and high professional obligations. The working conditions of OPs are still a topic with too little research attention. This scoping review reveals several starting points to maintain a healthy OP workforce and gives recommendations for action for the near future.

Skin cancer in outdoor workers exposed to solar radiation: a largely underreported occupational disease in Italy

Background

Solar UV radiation (sUVR) is one of the main carcinogen exposures in occupational settings, and UV‐induced skin cancers are the most frequent tumours in fair‐skinned individuals worldwide.

Objectives

According to this premise, we should expect a high number of occupational skin cancers reported to the national workers’ compensation authorities each year, also considering that the incidence of skin cancers has been constantly increased in recent years

Methods

We examined the data on reported non‐melanoma skin cancers (NMSC) and actinic keratoses (AK) to the Italian National Workers Compensation Authority (INAIL) from 2012 to 2017, and we compared the number of reported skin cancers for outdoor workers with the expected numbers, obtained from currently available NMSC incidence rates for the Italian population applied to the occupational sUVR‐exposed workers estimated with the CAREX methodology in Italy in 2005.

Results

The cases of NMSC reported each year to INAIL in Italy are 34 per year on average, while for AK the mean number of reported cases is of only 15/year. We estimated a number of expected NMSC cases in Italy for solar UV‐exposed workers ranging between 432 and 983, representing a proportion between reported vs. expected skin cancers of only 3.5–6.2%.

Conclusions

Our study clearly shows that occupational skin cancers in Italy are largely underreported, and, accordingly, urgent initiatives should be taken to raise appropriate awareness to the problem of occupational sUVR‐induced skin cancers, so that adequate preventive measures can be implemented rapidly.