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Jacobsen G, Schaumburg I, Sigsgaard T, Schlünssen V. Wood Dust Exposure Levels and Respiratory Symptoms 6 Years Apart: An Observational Intervention Study Within the Danish Furniture Industry. Ann Work Expo Health 2021; 65:1029-1039. [PMID: 34087944 PMCID: PMC8577231 DOI: 10.1093/annweh/wxab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/11/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Occupational exposure to wood dust can cause respiratory diseases, but few studies have evaluated the impact of declining exposure on health outcome. This study aimed to investigate whether a decline in wood dust exposure between two cross sectional studies performed in 1997-1998 and 2003-2004 was related to the prevalences of respiratory symptoms among woodworkers in a well-defined geographical area. METHODS Two thousand and thirty-two woodworkers from 54 plants in study 1 and 1889 woodworkers from 52 plants in study 2 returned a questionnaire on respiratory diseases and symptoms, employment and smoking habits. Current individual wood dust exposure level was assessed from 2 study specific job exposure matrix's based on task, factory size and personal passive dust measurements (2217 in study 1 and 1355 in study 2). RESULTS The median (range) of inhalable dust was 1.0 mg/m3 (0.2-9.8), 0.6 mg/m3 (0.1-4.6) in study 1 and study 2, respectively. In study 2, the prevalence's of self-reported asthma was higher and the prevalence's of respiratory symptoms were lower compared to study 1. In adjusted logistic regression analyses using GEE methodology to account for clustering, dust exposure level could explain the differences in prevalence of coughing, chronic bronchitis and nasal symptoms between study 1 and study 2, while no effect was found for asthma. CONCLUSIONS A 40% decline in wood dust exposure in a 6 year period may serve as an explanation for the decline in most respiratory symptoms, but do not seems to impact the prevalence of self-reported asthma.
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Affiliation(s)
- Gitte Jacobsen
- Department of Occupational Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Finsensgade, Esbjerg, Denmark
| | - Inger Schaumburg
- Department of Public Health, Section of Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Alle, Aarhus C, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Section of Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Alle, Aarhus C, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Section of Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Alle, Aarhus C, Denmark.,National Research Centre for the Working Environment, Lersø Parkalle, Copenhagen Ø, Denmark
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Keefe AR, Demers PA, Neis B, Arrandale VH, Davies HW, Gao Z, Hedges K, Holness DL, Koehoorn M, Stock SR, Bornstein S. A scoping review to identify strategies that work to prevent four important occupational diseases. Am J Ind Med 2020; 63:490-516. [PMID: 32227359 DOI: 10.1002/ajim.23107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts. METHODS To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants. RESULTS We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity. CONCLUSIONS This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.
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Affiliation(s)
- Anya R. Keefe
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Cancer Care Ontario Toronto Ontario Canada
| | - Barbara Neis
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | | | - Hugh W. Davies
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Zhiwei Gao
- Department of Clinical Epidemiology, Faculty of MedicineMemorial University St. John's Newfoundland Canada
| | - Kevin Hedges
- Occupational Health Clinics for Ontario Workers Ottawa Ontario Canada
| | - D. Linn Holness
- Department of Medicine and Public Health SciencesSt. Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Mieke Koehoorn
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Susan R. Stock
- Division of Biological Risks and Occupational HealthInstitut national de santé publique du Québec (Quebec Institute of Public Health) Montreal Quebec Canada
- Department of Social and Preventive MedicineSchool of Public Health, Université de Montreal Montreal Quebec Canada
| | - Stephen Bornstein
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
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Henneberger PK, Patel JR, de Groene GJ, Beach J, Tarlo SM, Pal TM, Curti S. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev 2019; 10:CD006308. [PMID: 31593318 PMCID: PMC6781842 DOI: 10.1002/14651858.cd006308.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The impact of workplace interventions on the outcome of occupational asthma is not well understood. OBJECTIVES To evaluate the effectiveness of workplace interventions on occupational asthma. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); EMBASE(Ovid); NIOSHTIC-2; and CISILO (CCOHS) up to July 31, 2019. SELECTION CRITERIA We included all eligible randomized controlled trials, controlled before and after studies and interrupted time-series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. MAIN RESULTS We included 26 non-randomized controlled before and after studies with 1,695 participants that reported on three comparisons: complete removal from exposure and reduced exposure compared to continued exposure, and complete removal from exposure compared to reduced exposure. Reduction of exposure was achieved by limiting use of the agent, improving ventilation, or using protective equipment in the same job; by changing to another job with intermittent exposure; or by implementing education programs. For continued exposure, 56 per 1000 workers reported absence of symptoms at follow-up, the decrease in forced expiratory volume in one second as a percentage of a reference value (FEV1 %) was 5.4% during follow-up, and the standardized change in non-specific bronchial hyperreactivity (NSBH) was -0.18.In 18 studies, authors compared removal from exposure to continued exposure. Removal may increase the likelihood of reporting absence of asthma symptoms, with risk ratio (RR) 4.80 (95% confidence interval (CI) 1.67 to 13.86), and it may improve asthma symptoms, with RR 2.47 (95% CI 1.26 to 4.84), compared to continued exposure. Change in FEV1 % may be better with removal from exposure, with a mean difference (MD) of 4.23 % (95% CI 1.14 to 7.31) compared to continued exposure. NSBH may improve with removal from exposure, with standardized mean difference (SMD) 0.43 (95% CI 0.03 to 0.82).In seven studies, authors compared reduction of exposure to continued exposure. Reduction of exposure may increase the likelihood of reporting absence of symptoms, with RR 2.65 (95% CI 1.24 to 5.68). There may be no considerable difference in FEV1 % between reduction and continued exposure, with MD 2.76 % (95% CI -1.53 to 7.04) . No studies reported or enabled calculation of change in NSBH.In ten studies, authors compared removal from exposure to reduction of exposure. Following removal from exposure there may be no increase in the likelihood of reporting absence of symptoms, with RR 6.05 (95% CI 0.86 to 42.34), and improvement in symptoms, with RR 1.11 (95% CI 0.84 to 1.47), as well as no considerable change in FEV1 %, with MD 2.58 % (95% CI -3.02 to 8.17). However, with all three outcomes, there may be improved results for removal from exposure in the subset of patients exposed to low molecular weight agents. No studies reported or enabled calculation of change in NSBH.In two studies, authors reported that the risk of unemployment after removal from exposure may increase compared with reduction of exposure, with RR 14.28 (95% CI 2.06 to 99.16). Four studies reported a decrease in income of 20% to 50% after removal from exposure.The quality of the evidence is very low for all outcomes. AUTHORS' CONCLUSIONS Both removal from exposure and reduction of exposure may improve asthma symptoms compared with continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function compared to continued exposure. When we compared removal from exposure directly to reduction of exposure, the former may improve symptoms and lung function more among patients exposed to low molecular weight agents. Removal from exposure may also increase the risk of unemployment. Care providers should balance the potential clinical benefits of removal from exposure or reduction of exposure with potential detrimental effects of unemployment. Additional high-quality studies are needed to evaluate the effectiveness of workplace interventions for occupational asthma.
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Affiliation(s)
- Paul K Henneberger
- National Institute for Occupational Safety and HealthRespiratory Health Division1095 Willowdale RoadMorgantownWest VirginiaUSA26505
| | - Jenil R Patel
- University of Texas School of Public HealthDepartment of Epidemiology, Human Genetics and Environmental Sciences1200 Pressler ST#W1004aHoustonTexasUSATX 77030
- University of Arkansas for Medical SciencesDepartment of Epidemiology4301 W Markham St, Slot#820Little RockArkansasUSA72205
| | - Gerda J de Groene
- Coronel Institute of Occupational Health, Academic Medical CenterNetherlands Center of Occupational DiseasesPO Box 22660AmsterdamNetherlands1100 DD
| | - Jeremy Beach
- University of AlbertaDepartment of MedicineEdmontonABCanada
| | - Susan M Tarlo
- University of TorontoDepartment of Medicine, and Dalla Lana School of Public HealthToronto Western Hospital EW7‐449399 Bathurst StTorontoONCanadaM5T 2S8
| | - Teake M Pal
- Coronel Institute of Occupational Health, Academic Medical CenterNetherlands Center of Occupational DiseasesPO Box 22660AmsterdamNetherlands1100 DD
| | - Stefania Curti
- University of BolognaDepartment of Medical and Surgical SciencesUO Medicina del Lavoro ‐ Policlinico Sant'Orsola‐MalpighiVia Palagi 9BolognaItaly40138
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Oksa P, Sauni R, Talola N, Virtanen S, Nevalainen J, Saalo A, Uitti J. Trends in occupational diseases in Finland, 1975-2013: a register study. BMJ Open 2019; 9:e024040. [PMID: 31015267 PMCID: PMC6500243 DOI: 10.1136/bmjopen-2018-024040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The objective was to investigate trends in the incidence of recognized and suspected cases of occupational diseases in Finland from 1975 to 2013, including variations by industry - and describe and recognize factors affecting variations in incidence. DESIGN A register study. SETTING The data consisted of recognized and suspected cases of occupational diseases recorded in the Finnish Registry of Occupational Diseases (FROD) in 1975-2013. PARTICIPANTS Altogether 240 000 cases of suspected and recognized ODs were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES From the annual workforce statistics and FROD data, we calculated the incidence of ODs and suspected ODs per 10 000 employees. For time trends by industrial sector, we used a 5-year moving average and a Poisson regression analysis. RESULTS Annual average rates of ODs have varied from year to year. The total number was 25.0/10 000 employees in 1975 and 20.1/10 000 employees in 2013. Screening campaigns and legislative changes have caused temporary increases. When the financial sector was the reference (1.0), the highest incidence rates according to industrial sector were in mining and quarrying (9.87; 95% CI 8.65 to 11.30), construction (9.11; 95% CI 9.98 to 10.43), manufacturing (9.04; 95% CI 7.93 to 10.36) and agriculture (8.78; 95% CI 7.69 to 10.06). There is a distinct decreasing trend from 2005 onwards: the average annual change in incidence was, for example, -9.2% in agriculture, -10.3% in transportation and -4.7% in construction. The average annual decline was greatest in upper limb strain injuries (-11.1%). CONCLUSION This study provides a useful overview of the status of ODs in Finland over several decades. These data are a valuable resource for determining which occupations are at an increased risk and where preventive actions should be targeted. It is important to study long-term trends in the statistics of ODs to see beyond the year-to-year fluctuations.
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Affiliation(s)
- Panu Oksa
- Department of Occupational Health Services, Finnish Institute of Occupational Health, Tampere, Finland
| | - Riitta Sauni
- Department for Work and Gender Equality, Ministry of Social Affairs and Health, Tampere, Finland
| | - Nina Talola
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Simo Virtanen
- Department of Operations and Project Support, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaakko Nevalainen
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anja Saalo
- Department of Operations and Project Support, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland
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The Health and Occupation Research Network: An Evolving Surveillance System. Saf Health Work 2017; 8:231-236. [PMID: 28951798 PMCID: PMC5605884 DOI: 10.1016/j.shaw.2016.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022] Open
Abstract
Vital to the prevention of work-related ill-health (WRIH) is the availability of good quality data regarding WRIH burden and risks. Physician-based surveillance systems such as The Health and Occupation Research (THOR) network in the UK are often established in response to limitations of statutory, compensation-based systems for addressing certain epidemiological aspects of disease surveillance. However, to fulfil their purpose, THOR and others need to have methodologic rigor in capturing and ascertaining cases. This article describes how data collected by THOR and analogous systems can inform WRIH incidence, trends, and other determinants. An overview of the different strands of THOR research is provided, including methodologic advancements facilitated by increased data quantity/quality over time and the value of the research outputs for informing Government and other policy makers. In doing so, the utility of data collected by systems such as THOR to address a wide range of research questions, both in relation to WRIH and to wider issues of public and social health, is demonstrated.
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Cullinan P, Muñoz X, Suojalehto H, Agius R, Jindal S, Sigsgaard T, Blomberg A, Charpin D, Annesi-Maesano I, Gulati M, Kim Y, Frank AL, Akgün M, Fishwick D, de la Hoz RE, Moitra S. Occupational lung diseases: from old and novel exposures to effective preventive strategies. THE LANCET RESPIRATORY MEDICINE 2017; 5:445-455. [PMID: 28089118 DOI: 10.1016/s2213-2600(16)30424-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/22/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023]
Abstract
Occupational exposure is an important, global cause of respiratory disease. Unlike many other non-communicable lung diseases, the proximal causes of many occupational lung diseases are well understood and they should be amenable to control with use of established and effective approaches. Therefore, the risks arising from exposure to silica and asbestos are well known, as are the means of their prevention. Although the incidence of occupational lung disease has decreased in many countries, in parts of the world undergoing rapid economic transition and population growth-often with large informal and unregulated workforces-occupational exposures continue to impose a heavy burden of disease. The incidence of interstitial and malignant lung diseases remains unacceptably high because control measures are not implemented or exposures arise in novel ways. With the advent of innovative technologies, new threats are continually introduced to the workplace (eg, indium compounds and vicinal diketones). In developed countries, work-related asthma is the commonest occupational lung disease of short latency. Although generic control measures to reduce the risk of developing or exacerbating asthma are well recognised, there is still uncertainty, for example, with regards to the management of workers who develop asthma but remain in the same job. In this Review, we provide recommendations for research, surveillance, and other action for reducing the burden of occupational lung diseases.
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Affiliation(s)
- Paul Cullinan
- Department of Occupational and Environmental Medicine, Imperial College, London, UK; MRC-PHE Centre for Environment and Health, London, UK
| | - Xavier Muñoz
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron (CIBER de Enfermedades Respiratorias), Barcelona, Spain; CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Raymond Agius
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Surinder Jindal
- Department of Respiratory Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine, and Division of Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France; INSERM, Aix-Marseille Université, Marseille, France
| | - Isabella Annesi-Maesano
- Epidémiologie des Maladies Respiratoires et Allergiques, iPLESP INSERM et UPMC, Paris, France
| | - Mridu Gulati
- Section of Pulmonary, Critical Care, and Sleep Medicine, and Yale Occupational and Environmental Medicine Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Arthur L Frank
- Division of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Metin Akgün
- Department of Chest Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - David Fishwick
- Centre for Workplace Health, University of Sheffield, Sheffield, UK
| | - Rafael E de la Hoz
- Department of Preventive Medicine, Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Subhabrata Moitra
- Department of Respiratory Medicine and Allergology, Faculty of Clinical Sciences, Lund University Lund, Sweden; Department of Pneumology, Allergy and Asthma Research Centre, Kolkata, India.
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Stocks SJ, Bensefa-Colas L, Berk SF. Worldwide trends in incidence in occupational allergy and asthma. Curr Opin Allergy Clin Immunol 2016; 16:113-9. [PMID: 26844753 DOI: 10.1097/aci.0000000000000249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Recent improvements in the methods for analyzing trends in occupational health surveillance and the prospect of future improvements in the collecting and sharing of electronic data alongside increasing availability of linked datasets make this a good time to review the existing literature on trends in occupational allergy and asthma (OAA). RECENT FINDINGS There is a notable lack of reports of recent trends in OAA in the academic literature and much of the published work comes from European countries. The incidence of OAA appears to be declining based on physician-reporting or recognized compensation claims for the countries with published data. However, we need to be cautious in interpreting this as a decline in the 'true' incidence of OAA. Few of the studies adjusted appropriately for changes in the population at risk and one of the most robust study designs showed no change in the incidence of allergic contact dermatitis in contrast to the other studies. SUMMARY Many existing datasets have the potential to be used to examine trends, and studies from Canada show the potential of using linked databases for surveillance. We hope that this review will encourage improvements in the analysis, and more dissemination, of trends.
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Affiliation(s)
- Susan J Stocks
- aNIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK bOccupational Diseases Department, University Hospital of Centre of Paris HOTEL-DIEU, AP-HP cParis Descartes University, Sorbonne Paris Cité, Laboratoire Santé, Publique et Environnement, Paris, France dCollege of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
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Money A, Carder M, Hussey L, Agius RM. The utility of information collected by occupational disease surveillance systems. Occup Med (Lond) 2015; 65:626-31. [DOI: 10.1093/occmed/kqv138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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van der Molen HF, Stocks SJ, Frings-Dresen MHW. Exploring Study Designs for Evaluation of Interventions Aimed to Reduce Occupational Diseases and Injuries. Saf Health Work 2015; 7:83-5. [PMID: 27014496 PMCID: PMC4792913 DOI: 10.1016/j.shaw.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/18/2015] [Accepted: 09/03/2015] [Indexed: 01/17/2023] Open
Abstract
Effective interventions to reduce work-related exposures are available for many types of work-related diseases or injuries. However, knowledge of the impact of these interventions on injury or disease outcomes is scarce due to practical and methodological reasons. Study designs are considered for the evaluation of occupational health interventions on occupational disease or injury. Latency and frequency of occurrence of the health outcomes are two important features when designing an evaluation study with occupational disease or occupational injury as an outcome measure. Controlled evaluation studies—giving strong indications for an intervention effect—seem more suitable for more frequently occurring injuries or diseases. Uncontrolled evaluation time or case series studies are an option for evaluating less frequently occurring injuries or diseases. Interrupted time series offer alternatives to experimental randomized controlled trials to give an insight into the effectiveness of preventive actions in the work setting to decision and policy makers.
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Affiliation(s)
- Henk F van der Molen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Susan J Stocks
- Center for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Monique H W Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, The Netherlands
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Stocks SJ, Jones K, Piney M, Agius RM. Isocyanate exposure and asthma in the UK vehicle repair industry. Occup Med (Lond) 2015. [PMID: 26209793 PMCID: PMC4670911 DOI: 10.1093/occmed/kqv108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Organic diisocyanates are a common cause of occupational asthma, particularly in motor vehicle repair (MVR) workers. The UK Health & Safety Laboratory provides screening for urinary hexamethylenediamine (UHDA), a biomarker of exposure to 1,6-hexamethylene diisocyanate (HDI). The UK Surveillance of Work-related and Occupational Respiratory Disease scheme (SWORD) has collected reports of occupational asthma since 1996. Aims To compare trends in HDI exposure with trends in the incidence of work-related asthma attributed to isocyanates or paint spraying in MVR workers reported to SWORD. Methods Two-level regression models were used to estimate trends in UHDA levels and work-related asthma in MVR workers reported to SWORD. The direction and magnitude of the trends were compared descriptively. Results From 2006 to 2014, there was a significant decline in the number of urine samples with detectable levels of UHDA (odds ratio = 0.96; 95% confidence intervals 0.94–0.98) and minimal change in those over the guidance value (1.03; 1.00–1.06). Over the same period, there was a significant decline in all asthma cases attributed to isocyanates or paint spraying reported to SWORD (0.90; 0.86–0.94) and a non-significant decline among MVR workers (0.94; 0.86–1.02). Conclusions The simultaneous decrease in HDI exposure and incident cases of asthma reported to SWORD is temporally consistent with a reduction in exposure to airborne isocyanate leading to a reduction in asthma. Although this is not direct evidence of a causal relationship between the two trends, it is suggestive.
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Affiliation(s)
- S J Stocks
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK,
| | - K Jones
- Health & Safety Laboratory, Buxton, Derbyshire SK17 9JN, UK
| | - M Piney
- Health & Safety Executive, Bootle, Merseyside L20 7HS, UK
| | - R M Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
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Tarlo SM. Trends in incidence of occupational asthma. Occup Environ Med 2015; 72:688-9. [PMID: 25896329 DOI: 10.1136/oemed-2015-102852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/25/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Susan M Tarlo
- Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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Walters GI, Soundy A, Robertson AS, Burge PS, Ayres JG. Understanding health beliefs and behaviour in workers with suspected occupational asthma. Respir Med 2015; 109:379-88. [PMID: 25657173 DOI: 10.1016/j.rmed.2015.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/28/2014] [Accepted: 01/18/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Long delays from symptom onset to the diagnosis of occupational asthma have been reported in the UK, Europe and Canada and workers are often reluctant to seek medical help or workplace solutions for their symptoms. Reducing this delay could improve workers' quality of life, and reduce the societal cost of occupational asthma. This study aimed to explore reasons behind such delays. METHODS A purposive sample of 20 individuals diagnosed with, or under investigation for, occupational asthma (median age = 52; 70% male; 80% white British) undertook a single semi-structured interview. Interviews were transcribed verbatim and thematic analysis was undertaken in order to explore health beliefs and identify barriers to diagnosis. RESULTS Four themes were identified: (1) workers' understanding of symptoms, (2) working relationships, (3) workers' course of action and (4) workers' negotiation with healthcare professionals. Understanding of symptoms varied between individuals, from a lack of insight into the onset, pattern and nature of symptoms, through to misunderstanding of what they represented, or ignorance of the existence of asthma as a disease entity. Workers described reluctance to discuss health issues with managers and peers, through fear of job loss and a perceived lack of ability to find a solution. The evolution of workers' understanding depended upon how actively they looked to define symptoms or seek a solution. Proactive workers were motivated to seek authoritative help and negotiate inadequate healthcare encounters with GPs. CONCLUSION Understanding workers' health beliefs will enable policy makers and clinicians to develop better workplace interventions that may aid diagnosis and reduce delay in identifying occupational asthma.
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Affiliation(s)
- Gareth I Walters
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Andy Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alastair S Robertson
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - P Sherwood Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Jon G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Walters GI, Kirkham A, McGrath EE, Moore VC, Robertson AS, Burge PS. Twenty years of SHIELD: decreasing incidence of occupational asthma in the West Midlands, UK? Occup Environ Med 2015; 72:304-10. [PMID: 25608805 DOI: 10.1136/oemed-2014-102141] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Since 2000 a decline in the incidence of occupational asthma (OA) has been reported in the UK and Europe. We aimed to describe and account for trends in the incidence of OA in the West Midlands, UK using annual notification data from the SHIELD voluntary surveillance scheme over the period 1991-2011. METHODS All notifications to the SHIELD database between January 1991 and December 2011 were identified, along with patients' demographic data, occupations, causative agents and confirmatory tests. Annual notifications were scaled to give an annual count per million workers, giving a measure of incidence, and also standardised against those of bakers' asthma. Non-parametric analyses were undertaken between annual incidence and time (years) for common causative agents using (1) a negative binomial regression univariate model and (2) a logistic regression model calculating annual reporting ORs. A step-change analysis was used to examine time points at which there were marked reductions in incidence. RESULTS A decrease in annual incidence of OA was observed over the study period (incident rate ratio=0.945; 95% CI 0.933 to 0.957; p<0.0001), an effect that was lost after standardising for bakers' asthma. Decreases in incidence were seen for most common causative agents, with only cleaning product-related OA increasing over 21 years. Marked fall in incidence was seen in 2004 for isocyanates, and in 1995 for latex. Most notifications came from a regional specialist occupational lung disease unit, with notifications from other sites falling from 16 cases/million workers/annum in 1995 to 0 in 2004. CONCLUSIONS Reporter fatigue and increasing under-recognition of OA are both factors which contribute to the apparent fall in incidence of OA in the West Midlands. There is a future need for interventions that enable health professionals to identify potential cases of OA in the workplace and in healthcare settings.
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Affiliation(s)
- G I Walters
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | - A Kirkham
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, UK
| | - E E McGrath
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | - V C Moore
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | - A S Robertson
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | - P S Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
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van der Molen HF, Frings-Dresen MHW. Strategies to reduce safety violations for working from heights in construction companies: study protocol for a randomized controlled trial. BMC Public Health 2014; 14:541. [PMID: 24886440 PMCID: PMC4048537 DOI: 10.1186/1471-2458-14-541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/21/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Safety measures should be applied to reduce work-related fatal and non-fatal fall injuries. However, according to the labor inspectorate, more than 80% of Dutch construction sites violate safety regulations for working from heights. To increase compliance with safety regulations, employers and workers have to select, implement and monitor safety measures. To facilitate this behavioral change, stimulating knowledge awareness and personalized feedback are frequently advocated behavior change techniques. For this study, two behavior change strategies have been developed in addition to the announcement of safety inspections by the labor inspectorate. These strategies consist of 1) face-to-face contacts with safety consultants and 2) direct mail with access to internet facilities. The objective of this study is to evaluate the effectiveness of these two strategies on the safety violations for working from heights, the process and the cost measures. METHODS/DESIGN This study is a block randomized intervention trial in 27 cities to establish the effects of the face-to-face guidance strategy (N = 9), a direct mailing strategy (N = 9) and a control condition of no guidance (N = 9) on safety violations to record by labor inspectors after three months. A process evaluation for both strategies will be performed to determine program implementation (reach, dose delivered and dose received), satisfaction, knowledge and perceived safety behavior. A cost analysis will be performed to establish the financial costs for both strategies. The present study is in accordance with the CONSORT statement. DISCUSSION This study increases insight into performing practice-based randomized controlled trials. The outcome will help to evaluate the effect of two guidance strategies on safety violations. If these strategies are effective, implementation of these strategies through the national institute of safety and health or labor inspectorate can take place to guide construction companies in complying with safety regulations. TRIAL REGISTRATION NTR 4298 on 29-nov-2013.
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Affiliation(s)
- Henk F van der Molen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands
- Arbouw, P.O. Box 213, Harderwijk 3840 AE, the Netherlands
| | - Monique HW Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands
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