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Bland D, Evans R, Binesmael A, Wood S, Qureshi SP, Fearnley K, Small A, Strain WD, Agius R. Post-acute COVID-19 complications in UK doctors: results of a cross-sectional survey. Occup Med (Lond) 2024; 74:99-103. [PMID: 38078498 DOI: 10.1093/occmed/kqad120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND As a consequence of their occupation, doctors and other healthcare workers were at higher risk of contracting coronavirus disease 2019 (COVID-19), and more likely to experience severe disease compared to the general population. However, systematic information on post-acute COVID complications in doctors is very limited. AIMS This study aimed to determine the symptoms, perceived determinants, health and occupational impact, and consequent needs relating to post-acute COVID complications in UK doctors. METHODS An online cross-sectional survey was distributed to UK doctors self-identifying as having Long COVID or other post-acute COVID complications. RESULTS Of 795 responses, 603 fulfilled the inclusion criteria of being a UK-based medical doctor experiencing one or more post-acute COVID complications. Twenty-eight per cent reported a lack of adequate Respiratory Protective Equipment at the time of contracting COVID-19. Eighteen per cent of eligible respondents reported that they had been unable to return to work since acquiring COVID. CONCLUSIONS Post-acute COVID (Long COVID) in UK doctors is a substantial burden for respondents to our questionnaire. The results indicated that insufficient respiratory protection could have contributed to occupational disease, with COVID-19 being contracted in the workplace, and resultant post-COVID complications. Although it may be too late to address the perceived determinants of inadequate protection for those already suffering with Long COVID, more investment is needed in rehabilitation and support of those afflicted.
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Affiliation(s)
- D Bland
- Public Health and Healthcare Department, British Medical Association, London, UK
| | - R Evans
- Public Health and Healthcare Department, British Medical Association, London, UK
| | - A Binesmael
- Public Health and Healthcare Department, British Medical Association, London, UK
| | - S Wood
- Public Health and Healthcare Department, British Medical Association, London, UK
| | | | - K Fearnley
- Long COVID Doctors for Action, London, UK
| | - A Small
- Chest Heart and Stroke Scotland, Edinburgh, UK
| | - W D Strain
- British Medical Association Board of Science, University of Exeter Medical School, Institute of Clinical and Biomedical Science, Exeter, UK
| | - R Agius
- Council of the British Medical Association, The University of Manchester, Manchester, UK
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Agius R. COVID-19 in Workplace Settings: Lessons Learned for Occupational Medicine in the UK. Med Lav 2023; 114:e2023055. [PMID: 38060204 PMCID: PMC10731572 DOI: 10.23749/mdl.v114i6.15461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
This paper addresses lessons learned from the COVID-19 pandemic from a UK Occupational Medicine perspective to permit comparison with other national accounts. In spite of good prior research and statute, the necessary resources to protect workers' health were seriously lacking when the pandemic struck. Weak public health guidance, which did not recognise dominant airborne transmission, was applied to workplaces, leaving workers and others unprotected, especially in respect to Respiratory Protective Equipment (RPE). The Health and Safety Executive (HSE) as regulator was lacking, for example, in not producing guidance to protect HealthCare Workers (HCW) who were amongst the most at risk. The UK COVID-19 Public Inquiry should address shortcomings such as these, but recommendations must be accompanied by robust means to ensure appropriate implementation. These should range from substantial measures to improve indoor air quality, to a permanent pandemic management organization with adequate resources. The enforcing authority has to be obliged to publish more specific workplace guidance than the public health authorities. Occupational medicine as a discipline needs to be better prepared, and hence to assert its responsibility towards high standards of workers' health protection. Future research has to include investigating the best means of mitigation against airborne infection and the management of post-acute covid sequelae.
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Affiliation(s)
- Raymond Agius
- Professor Emeritus of Occupational and Environmental Medicine, The University of Manchester, UK.
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Agius R, Batistatou E, Gittins M, Jones S, McNamee R, Liu H, Rashid A, van Tongeren M, Oertzen GV, Wakeford R. An Epidemiological Study of Lung Cancer and Selected Other Cancers among Namibian Uranium Workers. Radiat Res 2023; 200:340-348. [PMID: 37590489 DOI: 10.1667/rade-23-00051.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
The Rössing Uranium Limited (RUL) open-cast uranium mine in Namibia has operated since 1976. Studies of underground uranium miners from Europe and North America have shown increased cancer risks (principally lung cancer). We explored the association between radiation doses and selected cancers in RUL mineworkers. Employees with at least one-year of continuous employment between 1976 and 2010 were included. Incident cancer cases [lung, extra-thoracic airways (ETA), leukemia, brain and kidney] occurring before the end of 2015 were identified from the Namibian and South African National Cancer Registries, and RUL's occupational health provider. Using a case-cohort design, data on exposure and confounding factors were collected for all cancer cases among the study cohort and a stratified random sample (sub-cohort) of the cohort, including cases. Radiation doses were estimated based on annual dose records held by RUL. In total, 76 cancer cases (32 lung, 18 ETA, 8 leukemia, 9 brain, 9 kidney) and a sub-cohort of 1,121 sampled from 7,901 RUL employees were included. A weighted Cox model, adjusted for available known confounders, produced a rate ratio (95% CI) for lung cancer of 1.42 (0.42, 4.77) and 1.22 (0.26, 5.68), respectively, for medium and higher cumulative lung dose categories compared to the lower category, and 1.04 (0.95, 1.13) for a dose increase of 10 mSv. This study faced considerable challenges with respect to case ascertainment, exposure estimates, and ensuring accuracy of key variables. Persuasive consistent evidence for elevated cancer risk was not found for radiation or other exposures studied at the Rössing uranium mine.
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Affiliation(s)
- Raymond Agius
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL United Kingdom
| | - Evridiki Batistatou
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL United Kingdom
| | - Matthew Gittins
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL United Kingdom
| | - Steve Jones
- Dalton Nuclear Institute, Pariser Building, Manchester, M13 9PL United Kingdom
- SJ Scientific Ltd. Summerhill, Cheddleton, Leek, Staffordshire, ST13 7DW, United Kingdom
| | - Roseanne McNamee
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL United Kingdom
| | - Hanhua Liu
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL United Kingdom
| | - Amir Rashid
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL United Kingdom
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL United Kingdom
| | | | - Richard Wakeford
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL United Kingdom
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Zhou AY, Hann M, Panagioti M, Patel M, Agius R, Van Tongeren M, Esmail A, Bower P. Exploring Associations between Stressors and Burnout in Trainee Doctors During the COVID-19 Pandemic in the UK. Acad Psychiatry 2022; 46:723-728. [PMID: 35661339 PMCID: PMC9165924 DOI: 10.1007/s40596-022-01660-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The authors examined associations between stressors and burnout in trainee doctors during the COVID-19 pandemic. METHODS An anonymous online questionnaire including 42 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory-Health Services Survey (MBI-HSS), was sent to 1000 randomly selected trainee doctors in North-West England. Main outcomes were burnout scores that were stratified into Emotional Exhaustion (EE), Depersonalisation (DP), and reduced Personal Accomplishment (PA) and associations between stressors and burnout using stepwise regression analysis. RESULTS A total of 362 complete responses were received giving a response rate of 37%. Mean scores for EE, DP, and PA derived from the MBI-HSS were 27.7, 9.8, and 34.3 respectively. Twenty-three stressors were found to be associated with burnout dimensions. "Increase in workload and hours due to COVID-19," "Poor leadership and management in the National Health Service," and "Not feeling valued" were found to have strong associations with burnout dimensions. Only "Not confident in own abilities" was found to be associated with all burnout dimensions. CONCLUSIONS Associations with burnout were found to be identified in a range of work, pandemic, and non-work-related stressors, supporting the need for multi-level interventions to mitigate burnout.
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Affiliation(s)
| | - Mark Hann
- University of Manchester, Manchester, UK
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Zhou AY, Hann M, Panagioti M, Patel M, Agius R, Van Tongeren M, Esmail A, Bower P. Cross-sectional study exploring the association between stressors and burnout in junior doctors during the COVID-19 pandemic in the United Kingdom. J Occup Health 2022; 64:e12311. [PMID: 35025106 PMCID: PMC8757574 DOI: 10.1002/1348-9585.12311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/26/2021] [Accepted: 12/19/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study aims to develop a comprehensive list of stressors relevant to junior doctors and will also report findings exploring the associations between burnout and stressors, which include work and non-work-related stressors as well as pandemic-related stressors. METHODS An anonymous online questionnaire was sent to 1000 randomly selected junior doctors in the North-West of England. The questionnaire included 37 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory Health Services Survey. The main outcomes of interest were junior doctor ratings of stressors and scores for burnout (emotional exhaustion [EE], depersonalisation [DP], and personal accomplishment [PA]). Stepwise regression analysis was undertaken to assess associations between stressors and burnout. RESULTS In total, 326 responses were collected (response rate = 33%). Of the top 10 stressors rated by junior doctors, 60% were related to the pandemic. Multiple stressors were found to be associated with the burnout dimensions. Fatigue (β = .43), pandemic-related workload increase (β = .33), and feeling isolated (β = .24) had the strongest associations with EE, whereas fatigue (β = .21), uncertainty around COVID-19 information (β = .22) and doing unproductive tasks (β = .17) had the strongest associations with DP. Working beyond normal scope due to COVID-19 (β = -.26), not confident in own ability (β = -.24) and not feeling valued (β = -.20) were found to have the strongest associations with PA. CONCLUSIONS Junior doctors experience a combination of general stressors and additional stressors emerging from the pandemic which significantly impact burnout. Monitoring these stressors and targeting them as part of interventions could help mitigating burnout in junior doctors.
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Affiliation(s)
- Anli Yue Zhou
- Division of Population Health, Health Services Research & Primary Care, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research & Primary Care, Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | | | - Raymond Agius
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Martie Van Tongeren
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Aneez Esmail
- Division of Population Health, Health Services Research & Primary Care, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
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Van Tongeren M, Iskandar I, Carder M, Seed M, Gittins M, Hoyle J, Agius R, Barradas A, Daniels S. Surveillance of Work-Related Occupational Respiratory Disease (SWORD): Three decades of data on occupational respiratory disease in the UK. Saf Health Work 2022. [DOI: 10.1016/j.shaw.2021.12.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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7
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Zhou AY, Panagioti M, Hann M, Agius R, Van Tongeren M, Esmail A, Bower P. Contributors to stress and burnout in junior doctors during the COVID-19 pandemic. Saf Health Work 2022. [PMCID: PMC8817298 DOI: 10.1016/j.shaw.2021.12.1672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lauriola P, Martín-Olmedo P, Leonardi GS, Bouland C, Verheij R, Dückers MLA, van Tongeren M, Laghi F, van den Hazel P, Gokdemir O, Segredo E, Etzel RA, Abelsohn A, Bianchi F, Romizi R, Miserotti G, Romizi F, Bortolotti P, Vinci E, Giustetto G, Santamaria M, Serafini A, Pegoraro S, Agius R, Zeka A. On the importance of primary and community healthcare in relation to global health and environmental threats: lessons from the COVID-19 crisis. BMJ Glob Health 2021; 6:bmjgh-2020-004111. [PMID: 33692145 PMCID: PMC7948151 DOI: 10.1136/bmjgh-2020-004111] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 12/05/2022] Open
Abstract
In the course of the COVID-19 pandemic, it has become clear that primary healthcare systems play a critical role in clinical care, such as patient screening, triage, physical and psychological support and also in promoting good community advice and awareness in coordination with secondary healthcare and preventive care. Because of the role of social and environmental factors in COVID-19 transmission and burden of disease, it is essential to ensure that there is adequate coordination of population-based health services and public health interventions. The COVID-19 pandemic has shown the primary and community healthcare (P&CHC) system’s weaknesses worldwide. In many instances, P&CHC played only a minor role, the emphasis being on hospital and intensive care beds. This was compounded by political failures, in supporting local community resilience. Placing community building, social cohesion and resilience at the forefront of dealing with the COVID-19 crisis can help align solutions that provide a vision of ‘planetary health’. This can be achieved by involving local well-being and participation in the face of any pervasive health and environmental crisis, including other epidemics and large-scale ecological crises. This paper proposes that P&CHC should take on two critical roles: first, to support local problem-solving efforts and to serve as a partner in innovative approaches to safeguarding community well-being; and second, to understand the local environment and health risks in the context of the global health perspective. We see this as an opportunity of immediate value and broad consequence beyond the control of the COVID-19 pandemic.
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Affiliation(s)
- Paolo Lauriola
- International Society of Doctors for the Environment (ISDE-Italy), Modena, Italy
| | | | - Giovanni S Leonardi
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Robert Verheij
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Michel L A Dückers
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Ferdinando Laghi
- International Society of Doctors for the Environment (ISDE-Int'l), Geneva, Switzerland
| | - Peter van den Hazel
- International Network on Children's Health, Environment and Safety (INCHES), Ellecom, The Netherlands
| | - Ozden Gokdemir
- Faculty of Medicine, Izmir University of Economics, Balçova/Izmir, Turkey
| | - Evelyn Segredo
- Uruguayan Society of Family and Community Medicine, Montevideo, Uruguay
| | - Ruth A Etzel
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Alan Abelsohn
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fabrizio Bianchi
- Istituto Fisiologia Clinica, Consiglio Nazionale della Ricerca (CNR-IFC), Pisa, Italy
| | - Roberto Romizi
- International Society of Doctors for the Environment (ISDE-Italy), Arezzo, Italy
| | - Giuseppe Miserotti
- International Society of Doctors for the Environment (ISDE-Italy), Piacenza, Italy
| | - Francesco Romizi
- International Society of Doctors for the Environment (ISDE-Italy), Arezzo, Italy
| | | | - Emanuele Vinci
- Health and Environment Working Group, National Medical Orders Federation, Rome, Italy
| | | | | | | | | | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Ariana Zeka
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Mason HJ, Carder M, Money A, Evans G, Seed M, Agius R, van Tongeren M. Occupational Asthma and Its Causation in the UK Seafood Processing Industry. Ann Work Expo Health 2021; 64:817-825. [PMID: 32491156 PMCID: PMC7543999 DOI: 10.1093/annweh/wxaa055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/23/2020] [Accepted: 05/13/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives The processing of seafood (fish and shellfish) for human consumption can lead to health consequences, including occupational asthma (OA). Several non-UK studies have reported both respiratory outcomes and airborne levels of major allergens in seafood processing. However, there is a paucity of such evidence in the UK land-based seafood processing sector, which employs some 20 000 workers. Methods University of Manchester’s Surveillance of Work-related and Occupational Respiratory Disease (SWORD) reporting system has been interrogated over the period 1992–2017 to define the incidence rate of OA cases that can be ascribed to the UK land-based processing sector, and the seafood species implicated. Airborne allergen monitoring data undertaken at Health and Safety Executive’s laboratory from 2003 to 2019 have also been collated. Results The estimated annual OA incidence rate in seafood processors was 70 [95% confidence intervals (CIs) 48.9, 91.1] per 100 000 workers compared with 2.9 (95% CIs 2.8, 3.1) in ‘all other industries’. The annual calculated percentage trend in OA (1992–2017) was −8.1% (95% CIs −15.9, 0.4) in seafood processing showing a similar trend to ‘all other industries’ (mean −7.0%; 95% CIs −7.8, −6.1). Prawns and salmon/trout were notably implicated by SWORD as causative species related to OA. There is a general paucity of available UK airborne allergen monitoring data, particularly concerning processing salmon or trout. Available airborne monitoring for salmon parvalbumin in seven processors ranged between the limit of detection and 816 ng m−3 (n = 64). Available air monitoring levels of the major shellfish allergen (tropomyosin) during processing of crabs and prawns ranged between 1 and 101 600 ng m−3 (n = 280), highlighting that high levels of exposure can occur. Conclusions These data show an excess incidence of OA in the UK seafood processing industry during 1992–2017, with limited airborne monitoring data for the processing of prawn, crab, and salmon suggesting that significant exposure to major seafood allergens can occur in this industry. Further investigation of current levels of respiratory ill-health and the sources of allergen exposure are warranted.
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Affiliation(s)
- Howard J Mason
- Health and Safety Executive Science and Research Centre, Biohazards Team, Harpur Hill, Buxton, UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Annemarie Money
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Gareth Evans
- Health and Safety Executive Science and Research Centre, Biohazards Team, Harpur Hill, Buxton, UK
| | - Martin Seed
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
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Le Guen M, Agius R, Panjo H, Moreau C. La « crise des pilules » en France : les femmes ont-elles davantage consulté un.e gynécologue afin d’accéder plus facilement au DIU ? Rev Epidemiol Sante Publique 2020; 68:347-355. [DOI: 10.1016/j.respe.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022] Open
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Affiliation(s)
- Raymond Agius
- Emeritus Professor of Occupational and Environmental Medicine, The University of Manchester, Manchester, UK
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12
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Zhou AY, Seed M, Carder M, Money A, Van Tongeren M, Agius R. Sentinel approach to detect emerging causes of work-related respiratory diseases. Occup Med (Lond) 2020; 70:52-59. [PMID: 31863117 DOI: 10.1093/occmed/kqz159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The world of work is continually changing, and this could result in new and emerging risks being introduced, including those that may cause work-related respiratory diseases (WRRD). AIMS To describe recently emerging and new cases of WRRD and the relevant methodology using data in a national occupational respiratory disease surveillance scheme in the UK. METHODS Incident cases of respiratory diseases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) between January 2015 and December 2017 were included. Potentially emerging respiratory hazards manifesting in SWORD data were identified with the following hierarchical approach: (i) new respiratory disease not previously associated with work, (ii) specific exposure/agent not previously associated with WRRD and (iii) industry and/or occupation not previously associated with WRRD. RESULTS A total of 1215 cases of WRRD were reported to SWORD between January 2015 and December 2017. No new WRRD were identified. Thirteen potentially emerging causes of occupational asthma were identified, including exposures to agents such as ninhydrin. Four potential new causes were identified for interstitial pneumonia, which included wood and brass dust. Two potentially emerging causes of WRRD were identified for inhalational accidents (green coffee and nitrocellulose), hypersensitivity pneumonitis (diphenylmethane diisocyanate and salami mould), rhinitis (morphine and Amaranthus quitensis) and sarcoidosis (prions and horses). CONCLUSIONS Continuous monitoring and reporting of any new work-related disease is a critical function of any occupational disease reporting scheme. Potential emerging causes of work-related health risks have been identified by using a simple and systematic way of detecting emerging causes of WRRDs.
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Affiliation(s)
- A Y Zhou
- Centre of Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester, UK
| | - M Seed
- Centre of Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester, UK
| | - M Carder
- Centre of Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester, UK
| | - A Money
- Centre of Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester, UK
| | - M Van Tongeren
- Centre of Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester, UK
| | - R Agius
- Centre of Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester, UK
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de Vocht F, Hidajat M, Martin RM, Agius R, Wakeford R. Ischemic Heart Disease Mortality and Occupational Radiation Exposure in a Nested Matched Case-Control Study of British Nuclear Fuel Cycle Workers: Investigation of Confounding by Lifestyle, Physiological Traits and Occupational Exposures. Radiat Res 2020; 194:431-444. [DOI: 10.1667/rade-19-00007.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 07/13/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Mira Hidajat
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Richard M. Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Raymond Agius
- Centre for Occupational and Environmental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, United Kingdom
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Abstract
IMPORTANCE Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non-workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better understanding of the most critical factors could help inform the development of targeted interventions to reduce burnout and stress. OBJECTIVE To estimate the association between different stressors and burnout/stress among physicians engaged in standard postgraduate training (ie, trainee physicians). DATA SOURCES Medline, Embase, PsycINFO, and Cochrane Database of Systematic reviews from inception until April 30, 2019. Search terms included trainee, foundation year, registrar, resident, and intern. STUDY SELECTION Studies that reported associations between stressors and burnout/stress in trainee physicians. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted the data and assessed the quality of the evidence. The main meta-analysis was followed by sensitivity analyses. All analyses were performed using random-effects models, and heterogeneity was quantified using the I2 statistic. MAIN OUTCOME AND MEASURES The main outcome was the association between burnout/stress and workplace- or non-workplace-related factors reported as odds ratios (ORs) and their 95% CIs. RESULTS Forty-eight studies were included in the meta-analysis (n = 36 266, median age, 29 years [range, 24.6-35.7 years]). One study did not specify participants' sex; of the total population, 18 781 participants (52%) were men. In particular, work demands of a trainee physician were associated with a nearly 3-fold increased odds for burnout/stress (OR, 2.84; 95% CI, 2.26-3.59), followed by concerns about patient care (OR, 2.35; 95% CI, 1.58-3.50), poor work environment (OR, 2.06; 95% CI, 1.57-2.70), and poor work-life balance (OR, 1.93; 95% CI, 1.53-2.44). Perceived/reported poor mental or physical health (OR, 2.41; 95% CI, 1.76-3.31), female sex (OR, 1.34; 95% CI, 1.20-1.50), financial worries (OR, 1.35; 95% CI, 1.07-1.72), and low self-efficacy (OR, 2.13; 95% CI, 1.31-3.46) were associated with increased odds for burnout/stress, whereas younger age and a more junior grade were not significantly associated. CONCLUSIONS AND RELEVANCE The findings of this study suggest that the odds ratios for burnout and stress in trainee physicians are higher than those for work-related factors compared with nonmodifiable and non-work-related factors, such as age and grade. These findings support the need for organizational interventions to mitigate burnout in trainee physicians.
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Affiliation(s)
- Anli Yue Zhou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Aneez Esmail
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Raymond Agius
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Martie Van Tongeren
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
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15
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Affiliation(s)
- Raymond Agius
- Emeritus Professor of Occupational and Environmental Medicine, The University of Manchester, Manchester, UK
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Zhou AY, Money A, Bower P, Van Tongeren M, Esmail A, Agius R. A Qualitative Study Exploring the Determinants, Coping, and Effects of Stress in United Kingdom Trainee Doctors. Acad Psychiatry 2019; 43:560-569. [PMID: 31290012 DOI: 10.1007/s40596-019-01086-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/31/2019] [Accepted: 06/24/2019] [Indexed: 05/14/2023]
Abstract
OBJECTIVES Evidence suggests United Kingdom trainee doctors are experiencing high levels of stress; however, little is known about what determinants contribute to stress, coping mechanisms to mitigate stress, and the effects of stress are in current trainee doctors. Hence, this study aims to explore the determinants, coping mechanisms as well as the effects of stress in this group. METHODS Focus groups were undertaken with trainee doctors in North West England to better understand the determinants, coping mechanisms, and effects of stress. Informed written consent was obtained and focus groups were recorded and transcribed. Transcriptions were analyzed using QSR NVivo v11. RESULTS A total of 44 trainee doctors participated in 11 focus groups. Respondents comprised UK graduates and international medical graduates, across all stages of training in a range of different specialties. Four main themes were identified as determinants: (1) Expectations and guilt, (2) Feeling undervalued, (3) Managing uncertainty and risk, (4) Work environment. Four main themes were identified as coping mechanisms: (1) Reflection and insight, (2) Work-life balance, (3) Work and training environment, (4) Development as a doctor. Two main themes were identified as effects of stress: (1) Negative outcome on wellbeing, (2) Outcome on career. CONCLUSIONS A range of determinants contributes to stress in trainee doctors and they utilize a range of mechanisms to cope. Stress in their working lives can also affect their wellbeing and careers. These findings could be used to improve the understanding of stress in trainee doctors and assist in the development of supportive interventions.
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Riddell A, Wakeford R, Liu H, O'Hagan J, MacGregor D, Agius R, Wilson C, Peace M, de Vocht F. Building a job-exposure matrix for early plutonium workers at the Sellafield nuclear site, United Kingdom. J Radiol Prot 2019; 39:620-634. [PMID: 31112514 DOI: 10.1088/1361-6498/ab1168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The potential for adverse health effects from internal exposure to Plutonium has been recognised since its discovery in the 1940s. However, in the absence of specific information, potential risks from Plutonium exposure have always largely been controlled through knowledge of radiation exposure risks in general, much of which comes from external radiation exposures. To try to obtain more direct estimates of potential internal exposure risks, epidemiological studies of Plutonium workers need to be conducted. Such epidemiological analyses require individual Plutonium exposure estimates that are as accurate and unbiased as possible. The UK Sellafield workforce includes one of the world's largest cohorts of Plutonium workers, which constitutes, by some considerable margin, the group of workers most comprehensively monitored for internal exposure to this alpha-particle-emitter. However, for several hundred workers employed at the start of Plutonium work at the facility, during the period from 1952 through to 1963, the historical urinalysis results available cannot provide sufficiently accurate and unbiased exposure assessments needed for use in epidemiological studies. Consequently, these early workers have had to be excluded from epidemiological analyses and this has significantly reduced the power of these studies. A promising quantitative methodology to overcome the issue of missing or deficient exposure data, is to use exposure data from other sources to estimate the average exposure a 'typical worker' would have received, and to collate this information for specific occupations and years. This approach is called a Job-Exposure Matrix (JEM). Work on a pilot study to construct a population-specific quantitative JEM for the early Plutonium workers at Sellafield during 1952-1963, for whom reliable urinalysis results do not exist, has shown the potential for a JEM approach to produce more reliable and useful exposure estimates for epidemiological research.
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Affiliation(s)
- Anthony Riddell
- Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Public Health England, Didcot, OX11 0RQ, The United Kingdom
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Kimber I, Agius R, Basketter DA, Corsini E, Cullinan P, Dearman RJ, Gimenez-Arnau E, Greenwell L, Hartung T, Kuper F, Maestrelli P, Roggen E, Rovida C. Chemical Respiratory Allergy: Opportunities for Hazard Identification and Characterisation. Altern Lab Anim 2019; 35:243-65. [PMID: 17559314 DOI: 10.1177/026119290703500212] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ian Kimber
- Syngenta Central Toxicology Laboratory, Macclesfield, UK.
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19
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Bhoyrul B, Lecamwasam K, Wilkinson M, Latheef F, Stocks SJ, Agius R, Carder M. A review of non-glove personal protective equipment-related occupational dermatoses reported to EPIDERM between 1993 and 2013. Contact Dermatitis 2019; 80:217-221. [PMID: 30430597 DOI: 10.1111/cod.13177] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Personal protective equipment (PPE) is defined as equipment that protects the wearer's body against health/safety risks at work. Gloves cause many dermatoses. Non-glove PPE constitutes a wide array of garments. Dermatoses resulting from these have hitherto not been documented. OBJECTIVES To determine the incidence and types of non-glove PPE-related dermatoses. PATIENTS/METHODS We analysed incident case reports from dermatologists of non-glove PPE-related dermatoses to a UK-wide surveillance scheme (EPIDERM) between 1993 and 2013. RESULTS The dermatoses associated with non-glove PPE accounted for 0.84% of all occupational skin disease. Of all PPE-related cases, 194 (9.2%) were attributable to non-glove PPE. Of these, 132 (68.0%) occurred in men, and the median age (both male and female) was 42 years (range 18-82 years). The non-glove PPE-related dermatoses were diagnosed as: allergic contact dermatitis (47.4%), irritant contact dermatitis (16.0%), friction (11.3%), occlusion (11.3%), unspecified dermatitis (8.8%), acne (3.1%), infections (1.5), and contact urticaria (0.52%). The industries most associated with non-glove PPE-related dermatoses were manufacturing (18.6%), public administration and defence (17.0%), health and social work (15.5%), and transport, storage, and communication (9.8%). CONCLUSIONS Clothing, footwear, facemasks and headgear need to be recognized as causes of dermatoses occurring at body sites less commonly associated with occupational skin disease.
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Affiliation(s)
- Bevin Bhoyrul
- Department of Dermatology, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - Kamalini Lecamwasam
- Department of Dermatology, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - Mark Wilkinson
- Department of Dermatology, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - Faheem Latheef
- Department of Dermatology, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - Susan J Stocks
- Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester, UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester, UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester, UK
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Vandenplas O, Rifflart C, Evrard G, Thimpont J, Seed M, Agius R. Occupational asthma caused by an epoxy amine hardener. Occup Med (Lond) 2019; 67:722-724. [PMID: 29040709 DOI: 10.1093/occmed/kqx151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe a 43-year-old epoxy floor layer who developed work-related asthma while exposed to an epoxy hardener based on isophorone diamine (IPDA). Challenge exposures to the curing of the epoxy resin system and subsequently to the polyfunctional amine hardener containing IPDA both elicited delayed asthmatic reactions. This report further indicates that exposure to epoxy hardeners containing polyfunctional amines should be considered as a potential cause of occupational asthma. Appropriate work hygiene measures should be implemented to minimize airborne exposure to these volatile compounds.
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Affiliation(s)
- O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Belgium.,Medical Department, Agence fédérale des risques professionnels (Fedris), Belgium
| | - C Rifflart
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Belgium
| | - G Evrard
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Belgium
| | - J Thimpont
- Medical Department, Agence fédérale des risques professionnels (Fedris), Belgium
| | - M Seed
- Centre for Occupational and Environmental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - R Agius
- Centre for Occupational and Environmental Health, School of Health Sciences, The University of Manchester, Manchester, UK
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Vocht FD, Riddell A, Wakeford R, Liu H, MacGregor D, Wilson C, Peace M, O'Hagan J, Agius R. Construction, Validation and Sensitivity Analyses of a Job Exposure Matrix for Early Plutonium Workers at the Sellafield Nuclear Site, United Kingdom. Radiat Res 2018; 191:60-66. [DOI: 10.1667/rr15177.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Anthony Riddell
- Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Public Health England, Didcot, OX11 0RQ, United Kingdom
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Hanhua Liu
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - David MacGregor
- Sellafield Approved Dosimetry Service, Sellafield Ltd, Cumbria, CA20 1PG, United Kingdom
| | - Christine Wilson
- Sellafield Approved Dosimetry Service, Sellafield Ltd, Cumbria, CA20 1PG, United Kingdom
| | - Mark Peace
- Sellafield Approved Dosimetry Service, Sellafield Ltd, Cumbria, CA20 1PG, United Kingdom
| | - Jacqueline O'Hagan
- Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Public Health England, Didcot, OX11 0RQ, United Kingdom
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, M13 9PL, United Kingdom
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Chamoux A, Lambert C, Vilmant A, Lanhers C, Agius R, Boutaleb M, Bonneterre V, Naughton G, Pereira B, Djeriri K, Ben-Brik E, Breton C, De Clavière C, Letheux C, Paolillo AG, Valenty M, Vandenberghe O, Aeschlimann MP, Lasfargues G, Lesage FX, Dutheil F. Occupational exposure factors for mental and behavioral disorders at work: The FOREC thesaurus. PLoS One 2018; 13:e0198719. [PMID: 29927960 PMCID: PMC6013225 DOI: 10.1371/journal.pone.0198719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 05/24/2018] [Indexed: 12/14/2022] Open
Abstract
Background Mental disorders in the workplace are a major public health problem. Knowledge of the impact of the psychosocial work environment on mental and behavioral disorders can assist occupational physicians in the identification and description of occupational risk situations, and help to define priority actions. However, no classification for occupational exposure factors is currently available. We aimed to build a thesaurus of “Organizational, Relational, Ethical and other Contributing Factors” (FOREC) linked with the onset of mental and behavioral disorders. Methods The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) initiated and supervised a multidisciplinary working group consisting of the representatives of the main French occupational and public health actors. All decisions were accepted on a consensus basis. This collaborative work led to the classification of occupational exposure factors for mental and behavioral disorders in the workplace. To test this thesaurus in clinical practice, a French multicenter study was implemented. Patients were workers referred to the Occupational Disease Centers for mental health issues at work. Factors contributing to mental and behavioral disorders among workers were identified and coded retrospectively from the worker’s point of view using the FOREC thesaurus. Results We recruited 323 workers, aged 44.9±9.2 years, of which 31.3% were men. The most commonly encountered disorders were generalized anxiety disorders (106 workers, 32.8%) and moderate depressive episodes (86 workers, 26.7%). We identified 1357 factors, i.e. an average of 4.2 factors per worker. Among them, 575 (42.4%) were relational and 515 (37.9%) were organizational. All factors identified during consultations were described in the thesaurus. Conclusions We built the first thesaurus of “Organizational, Relational, Ethical and other Contributing Factors” (FOREC) that may help to generate profiles of mental and behavioral disorders at work. Encoding and describing these exposure factors, as well as using a worldwide standardized and shared terminology, will help to identify specific workplace prevention programs.
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Affiliation(s)
- Alain Chamoux
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational Medicine, Clermont-Ferrand, France
| | - Céline Lambert
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational Medicine, Clermont-Ferrand, France
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Audrey Vilmant
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational Medicine, Clermont-Ferrand, France
| | - Charlotte Lanhers
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational Medicine, Clermont-Ferrand, France
| | - Raymond Agius
- University of Manchester, Institute of Population Health, Centre for Occupational and Environmental Health, Centre for Epidemiology, Manchester, United Kingdom
| | - Mounir Boutaleb
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational Medicine, Clermont-Ferrand, France
| | - Vincent Bonneterre
- CHU Grenoble, University Hospital of Grenoble, Occupational Medicine, Grenoble, France
| | - Geraldine Naughton
- Australian Catholic University, Faculty of Health, Melbourne, Victoria, Australia
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Khalid Djeriri
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational Medicine, Clermont-Ferrand, France
| | - Eric Ben-Brik
- CHU Poitiers, University Hospital of Poitiers, Occupational Medicine, Poitiers, France
| | - Christine Breton
- Regional Health Insurance Fund of Ile de France (CRAMIF), Prevention of Occupational Risks, Paris, France
| | - Caroline De Clavière
- CHU Créteil, University Hospital of Créteil, Occupational Medicine, Créteil, France
| | - Corinne Letheux
- Interdepartmental Center of Health and Occupational Medicine in Factories (Cisme), Paris, France
| | - Anne-Gaëlle Paolillo
- CHU Garches, University Hospital of Garches, Occupational Medicine, Garches, France
| | - Madeleine Valenty
- The French Institute for Public Health Surveillance (InVS), Paris, France
| | | | | | - Gérard Lasfargues
- Environmental and Occupational Health and Safety (ANSES), Maisons-Alfort, France
| | | | - Francois-Xavier Lesage
- University of Montpellier, CHU, Montpellier, France
- Epsylon, Univ Paul Valery Montpellier 3, Montpellier, France
- * E-mail:
| | - Frédéric Dutheil
- Australian Catholic University, Faculty of Health, Melbourne, Victoria, Australia
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Clermont-Ferrand, France
- University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, WittyFit, Clermont-Ferrand, France
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Cocco P, Agius R. The preventable burden of work-related ill-health. Occup Med (Lond) 2018; 68:327-331. [PMID: 29660035 DOI: 10.1093/occmed/kqy063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The fraction of ill-health overall attributable to occupational conditions has not been extensively evaluated, thus contributing to the perception of a lesser relevance of education and research in occupational health in respect to other fields of medical research and practice. Aims To assess the relevance of work-related conditions on the aetiology of human ill-health in different health domains. Methods We extracted the risk estimates associated with heritability and with occupational risk factors for chronic lymphocytic leukaemia (CLL), major depressive disorder (MDD) and long QT syndrome (LQTS) from 13 published international reports. The selection criteria for the eligible studies were: genome-wide studies, or studies of the occupational risk factors associated with one of the three diseases of interest. We calculated and compared the respective population attributable fraction for the combined occupational risk factors, and for heritability. Results We estimated that occupational risk factors would account for 12% (95% confidence interval (CI) 4-19) of CLL, 11% (95% CI 7-15) of MDD and 10% (95% CI 2-13) of LQTS burden in the general population. The corresponding figures for heritability would be 16% (95% CI 11-22), 28% (95% CI 20-5) and 17% (95% CI 7-27). Conclusions More efforts in capacity building and research in occupational health are warranted aiming to prevent ill-health and to preserve a productive life for the ageing work population.
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Affiliation(s)
- P Cocco
- Department of Medical Sciences and Public Health, Occupational Health Unit, University of Cagliari, Monserrato, Italy
| | - R Agius
- Centre for Epidemiology, Division of Population Health, School of Health Sciences, The University of Manchester, Manchester, UK
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Money A, Carder M, Noone P, Bourke J, Hayes J, Agius R. 309 Work-related ill-health: republic of ireland, northern ireland, great britain 2005–2016. Epidemiology 2018. [DOI: 10.1136/oemed-2018-icohabstracts.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kenning C, Lovell K, Hann M, Agius R, Bee PE, Chew-Graham C, Coventry PA, van der Feltz-Cornelis CM, Gilbody S, Hardy G, Kellett S, Kessler D, McMillan D, Reeves D, Rick J, Sutton M, Bower P. Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial. Public Health Res 2018. [DOI: 10.3310/phr06020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Penny E Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - David Reeves
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Joanne Rick
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Matthew Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Zhou AY, Carder M, Gittins M, Agius R. Work-related ill health in doctors working in Great Britain: incidence rates and trends. Br J Psychiatry 2017; 211:310-315. [PMID: 28935663 DOI: 10.1192/bjp.bp.117.202929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/23/2022]
Abstract
BackgroundDoctors have a higher prevalence of mental ill health compared with other professional occupations but incidence rates are poorly studied.AimsTo determine incidence rates and trends of work-related ill health (WRIH) and work-related mental ill health (WRMIH) in doctors compared with other professions in Great Britain.MethodIncidence rates were calculated using an occupational physician reporting scheme from 2005-2010. Multilevel regression was use to study incidence rates from 2001 to 2014.ResultsAnnual incidence rates for WRIH and WRIMH in doctors were 515 and 431 per 100 000 people employed, respectively. Higher incidence rates for WRIH and WRMIH were observed for ambulance staff and nurses, respectively. Doctors demonstrated an annual average incidence rates increase for WRIH and WRMIH, especially in women, whereas the other occupations demonstrated a decreasing or static trend. The difference in trends between the occupations was statistically significant.ConclusionsWRIH and WRMIH incidence rate are increasing in doctors, especially in women, warranting further research.
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Affiliation(s)
- Anli Yue Zhou
- Anli Yue Zhou, MBChB, MA, MRCP, Melanie Carder, PhD, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Matthew Gittins, PhD, Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Raymond Agius, MD, DM, FRCP, FRCPE, FFOM, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Melanie Carder
- Anli Yue Zhou, MBChB, MA, MRCP, Melanie Carder, PhD, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Matthew Gittins, PhD, Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Raymond Agius, MD, DM, FRCP, FRCPE, FFOM, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Matthew Gittins
- Anli Yue Zhou, MBChB, MA, MRCP, Melanie Carder, PhD, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Matthew Gittins, PhD, Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Raymond Agius, MD, DM, FRCP, FRCPE, FFOM, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Raymond Agius
- Anli Yue Zhou, MBChB, MA, MRCP, Melanie Carder, PhD, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Matthew Gittins, PhD, Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Raymond Agius, MD, DM, FRCP, FRCPE, FFOM, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Montgomery RL, Agius R, Wilkinson SM, Carder M. UK trends of allergic occupational skin disease attributed to fragrances 1996-2015. Contact Dermatitis 2017; 78:33-40. [DOI: 10.1111/cod.12902] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/21/2017] [Accepted: 09/03/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Rachel L. Montgomery
- Leeds Teaching Hospitals NHS Trust - Centre for Dermatology; Chapel Allerton Hospital; Leeds LS7 4SA UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health; University of Manchester; Manchester M13 9PL UK
| | - Stephen M. Wilkinson
- Leeds Teaching Hospitals NHS Trust - Centre for Dermatology; Chapel Allerton Hospital; Leeds LS7 4SA UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health; University of Manchester; Manchester M13 9PL UK
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Abstract
Background Evidence suggests that the medical profession is reluctant to report mental ill-health despite its high prevalence. Aims To compare differential reporting patterns in the incidence of work-related mental ill-health (WRMIH) affecting doctors with selected comparison occupational groups, as determined by surveillance by general practitioners (GPs), specialist psychiatrists and occupational physicians (OPs). Methods New cases of medically reported WRMIH were reported prospectively between 2006 and 2009 by GPs, psychiatrists and OPs as part of The Health and Occupation Research (THOR) network. For GP and psychiatry reporting schemes, incidence rates (IRs) for doctors, nurses, teachers, corporate managers and protective service workers were calculated using information from the Labour Force Survey as the denominator. In OP surveys, participating reporters provided denominator information to calculate IRs for doctors, nurses and teachers. Results Average annual IRs expressed per 100000 person/years employed as reported by GPs, psychiatrists and OPs, respectively, were: doctors (309, 971, 430), nurses (891, 208, 670), teachers (1040, 136, 210) and for GPs and psychiatrists, respectively, were: protective service workers (1432, 721) and corporate managers (428, 90). Psychiatrists reported a higher incidence of WRMIH in doctors, whereas GPs reported higher incidences of WRMIH in other occupations (chi-squared test, P < 0.001). Conclusions The distribution of the incidence of new cases reported across different schemes suggests a differential reporting pattern of WRMIH in doctors. The higher IR for doctors in psychiatrist-reported WRMIH could be due to factors such as disease severity and bypassing formal referral channels.
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Affiliation(s)
- A Y Zhou
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - M Carder
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - L Hussey
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - M Gittins
- Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - R Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
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Zhou AY, Dodman J, Hussey L, Sen D, Rayner C, Zarin N, Agius R. EELAB: an innovative educational resource in occupational medicine. Occup Med (Lond) 2017; 67:363-370. [DOI: 10.1093/occmed/kqx057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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. Lancet Respir Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Delaunay M, Van der Westhuizen H, Godard V, Agius R, Le Barbier M, Godderis L, Bonneterre V. Use of GIS in visualization of work-related health problems. Occup Med (Lond) 2016; 65:682-92. [PMID: 26503981 PMCID: PMC4661781 DOI: 10.1093/occmed/kqv152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Occupational health and safety (OHS) information is often complex, diverse and unstructured and suffers from a lack of integration which usually precludes any systemic insight of the situation. Aims To analyse to what extent the use of geographical information systems (GISs) can help to integrate, analyse and present OHS data in a comprehensive and communicable way relevant for surveillance purposes. Methods We first developed a ‘macro-approach’ (from national to local level), mapping data related to economic activity (denominator of active workers displayed by activity sectors), as well as work-related ill-health (numerators of workers suffering from work-related ill-health). The latter data are composed of compensated occupational diseases on the one hand and work-related diseases investigated by specialized clinics on the other hand. Then, a ‘micro-approach’ was worked out, integrating at a plant level, using computer-aided drawing, occupational risks data and OHS surveillance data (e.g. use of medication and sickness absence data). Results At the macro-level, microelectronics companies and workers were mapped at different scales. For the first time, we were able to compare, up to the enterprise level, complementary data showing different pictures of work-related ill-health, allowing a better understanding of OH issues in this sector. At the micro-level, new information arose from the integration of risk assessment data and medical data. Conclusions This work illustrates to what extent GIS is a promising tool in the OHS field, and discusses related challenges (technical, ethical, biases and interpretation) and research perspectives.
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Affiliation(s)
- M Delaunay
- Univ. Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525 (EPSP team: Environnement et Prédiction de la Santé des Populations), Grenoble F-38000, France, Univ. Paris 8/CNRS/Ladyss Laboratory UMR 7533 (Laboratoire Dynamiques sociales et recomposition des espaces), Saint-Denis F-93526, France, Modernet Network (Monitoring Occupational Diseases and new Emerging Risks in a NETwork, http://www.costmodernet.org/)
| | - H Van der Westhuizen
- Modernet Network (Monitoring Occupational Diseases and new Emerging Risks in a NETwork, http://www.costmodernet.org/), Cape Peninsula University of Technology/Faculty of Applied Sciences/Department of Environmental and Occupational Studies, Cape Town 8000, South Africa, Katholieke Universiteit Leuven, Centre for Environment and Health, 3000 Leuven, Belgium
| | - V Godard
- Univ. Paris 8/CNRS/Ladyss Laboratory UMR 7533 (Laboratoire Dynamiques sociales et recomposition des espaces), Saint-Denis F-93526, France
| | - R Agius
- Modernet Network (Monitoring Occupational Diseases and new Emerging Risks in a NETwork, http://www.costmodernet.org/), The University of Manchester/Faculty of Medical and Human Sciences/Institute of Population Health/Centre for Epidemiology/Centre for Occupational and Environmental Health (COEH), Manchester M13 9PL, UK
| | - M Le Barbier
- Modernet Network (Monitoring Occupational Diseases and new Emerging Risks in a NETwork, http://www.costmodernet.org/), ANSES (French Agency for Health Safety in Food, Environment and Work)/RNV3P, Maisons Alfort Cedex, F-94701, France
| | - L Godderis
- Modernet Network (Monitoring Occupational Diseases and new Emerging Risks in a NETwork, http://www.costmodernet.org/), Katholieke Universiteit Leuven, Centre for Environment and Health, 3000 Leuven, Belgium, Idewe, External Service for Prevention and Protection at Work, 3001 Heverlee, Belgium
| | - V Bonneterre
- Univ. Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525 (EPSP team: Environnement et Prédiction de la Santé des Populations), Grenoble F-38000, France, Modernet Network (Monitoring Occupational Diseases and new Emerging Risks in a NETwork, http://www.costmodernet.org/), CHU Grenoble (Grenoble Teaching Hospital)/Centre de Ressources de Maladies Professionnelles (Grenoble's Occupational Diseases Consultations Centre), Grenoble F-38000, France.
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Abstract
BACKGROUND Information on sickness absence (SA) duration in general practice is difficult to record. The duration of absence certified by general practitioners (GPs) can be viewed as a prognosis for return to work. The Health and Occupation Research network in General Practice (THOR-GP) collects SA information from GPs associated with cases of work-related ill-health. A sample of these cases is followed up 1 year retrospectively to gather information on the duration of absence. AIMS To examine the extent of the underestimation of SA in routinely reported data and to investigate how well GPs predict patients' return to work. METHODS THOR-GPs submit case and SA information using a web-based form. GPs who submitted selected cases were asked about the total number of days of SA and whether the patient had returned to work. RESULTS THOR-GPs' routine SA data collection underestimated absence duration by 61%. According to the retrospective data, a much larger proportion of periods of absence due to work-related mental ill-health developed into long-term SA (60%) than episodes attributed to musculoskeletal disorders (32%). In over half the reported cases, the return to work was longer than the GP initially predicted. CONCLUSIONS THOR-GP prospectively reported SA data underestimated the total length of absence; however, these data can examine the episodic rates of absence within different groups. More accurate longitudinal data can be collected retrospectively. GPs' ability to predict the length of time a patient will be away from work is important to enable treatment and rehabilitation planning in order to decrease the likelihood of a patient falling into long-term SA.
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Affiliation(s)
- L Hussey
- Centre for Occupational & Environmental Health, The University of Manchester, Manchester M13 9PL, UK
| | - K Thorley
- Centre for Occupational & Environmental Health, The University of Manchester, Manchester M13 9PL, UK
| | - R Agius
- Centre for Occupational & Environmental Health, The University of Manchester, Manchester M13 9PL, UK
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Barber CM, Wiggans RE, Carder M, Agius R. Epidemiology of occupational hypersensitivity pneumonitis; reports from the SWORD scheme in the UK from 1996 to 2015. Occup Environ Med 2016; 74:528-530. [PMID: 27919062 PMCID: PMC5520266 DOI: 10.1136/oemed-2016-103838] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/13/2016] [Accepted: 08/02/2016] [Indexed: 11/05/2022]
Abstract
Objective To estimate the reported incidence of occupational hypersensitivity pneumonitis (OHP) in the UK and to consider whether the pattern of attributed causation has changed over time. Methods All cases of OHP reported to the SWORD scheme between January 1996 and December 2015 were classified into 1 of 10 categories of the suspected agent. Cases were grouped into four 5-year time periods to examine any changing pattern in incidence or suspected causation. For each time period, the annual incidence was calculated using the estimated number of reported cases and the working population of the UK. Results Between 1996 and 2015, there were 202 actual cases of OHP reported to SWORD, equating to an estimated 818 cases, when adjusting for the sampling ratio. Over this period, the annual UK incidence was 1.4 per million workers. The mean (SD) age of reported cases was 52 (13) years, and cases were four-times more likely to be men than women. Over the study period, there was a fall in the proportion of cases reported to be due to agricultural exposures (44–12%), and an increase in cases due to metalworking fluids (MWFs, 2–45%). Conclusions Over the last 20 years, the incidence of OHP in the UK has been ∼1–2 cases per million workers per year. Working with water-based MWFs is now the most commonly suspected causative exposure for OHP cases reported to the SWORD scheme in the UK.
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Affiliation(s)
- C M Barber
- Health and Safety Laboratory, Centre for Workplace Health, Health and Safety Executive, Buxton, UK
| | - R E Wiggans
- Health and Safety Laboratory, Centre for Workplace Health, Health and Safety Executive, Buxton, UK
| | - M Carder
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | - R Agius
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
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Hidajat M, McElvenny D, MacCalman L, Alexander C, Cherrie J, Darnton A, Agius R, Vocht FD. P029 Lifetime cancer risk in the british rubber industry. a retrospective cohort with 45 year follow-up. Cancer 2016. [DOI: 10.1136/oemed-2016-103951.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Salomone A, Tsanaclis L, Agius R, Kintz P, Baumgartner MR. European guidelines for workplace drug and alcohol testing in hair. Drug Test Anal 2016; 8:996-1004. [PMID: 27402378 DOI: 10.1002/dta.1999] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 11/08/2022]
Abstract
Guidelines for Legally Defensible Workplace Drug Testing have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). They are based on the 2010 version published by Pascal Kintz and Ronald Agius (Guidelines for European workplace drug and alcohol testing in hair. Drug Test. Anal. 2010, 2, 367) and in concordance with the Society of Hair Testing guidelines (Society of Hair Testing guidelines for drug testing in hair. Forensic Sci. Int. 2012, 218, 20-24). The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing use these guidelines as a template for accreditation. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- A Salomone
- Centro Regionale Antidoping 'A. Bertinaria', Orbassano (TO), Italy.
| | - L Tsanaclis
- Cansford Laboratories, 1a Pentwyn Business Centre, Cardiff, UK
| | - R Agius
- Labor Krone, Bad Salzuflen, Germany
| | - P Kintz
- X-Pertise Consulting, Oberhausbergen, France
| | - M R Baumgartner
- Zurich Institute of Forensic Medicine, University of Zurich, Kurvenstrasse 17, 8006, Zurich, Switzerland
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Agius R, Bonneterre V, Carder M, Hussey L, Mcnamee R, Seed M, Stocks S. Tendances évolutives des maladies professionnelles, évaluation de l’efficacité des interventions préventives, et découvertes de nouveaux risques–le système de surveillance épidémiologique britannique THOR. ARCH MAL PROF ENVIRO 2016. [DOI: 10.1016/j.admp.2016.03.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Money A, Robinson C, Agius R, de Vocht F. Wishful Thinking? Inside the Black Box of Exposure Assessment. Ann Occup Hyg 2016; 60:421-31. [PMID: 26764244 PMCID: PMC4815939 DOI: 10.1093/annhyg/mev098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/25/2015] [Accepted: 12/12/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Decision-making processes used by experts when undertaking occupational exposure assessment are relatively unknown, but it is often assumed that there is a common underlying method that experts employ. However, differences in training and experience of assessors make it unlikely that one general method for expert assessment would exist. Therefore, there are concerns about formalizing, validating, and comparing expert estimates within and between studies that are difficult, if not impossible, to characterize. Heuristics on the other hand (the processes involved in decision making) have been extensively studied. Heuristics are deployed by everyone as short-cuts to make the often complex process of decision-making simpler, quicker, and less burdensome. Experts' assessments are often subject to various simplifying heuristics as a way to reach a decision in the absence of sufficient data. Therefore, investigating the underlying heuristics or decision-making processes involved may help to shed light on the 'black box' of exposure assessment. METHODS A mixed method study was conducted utilizing both a web-based exposure assessment exercise incorporating quantitative and semiqualitative elements of data collection, and qualitative semi-structured interviews with exposure assessors. Qualitative data were analyzed using thematic analysis. RESULTS Twenty-five experts completed the web-based exposure assessment exercise and 8 of these 25 were randomly selected to participate in the follow-up interview. Familiar key themes relating to the exposure assessment exercise emerged; 'intensity'; 'probability'; 'agent'; 'process'; and 'duration' of exposure. However, an important aspect of the detailed follow-up interviews revealed a lack of structure and order with which participants described their decision making. Participants mostly described some form of an iterative process, heavily relying on the anchoring and adjustment heuristic, which differed between experts. CONCLUSION In spite of having undertaken comparable training (in occupational hygiene or exposure assessment), experts use different methods to assess exposure. Decision making appears to be an iterative process with heavy reliance on the key heuristic of anchoring and adjustment. Using multiple experts to assess exposure while providing some form of anchoring scenario to build from, and additional training in understanding the impact of simple heuristics on the process of decision making, is likely to produce a more methodical approach to assessment; thereby improving consistency and transparency in expert exposure assessment.
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Affiliation(s)
- Annemarie Money
- 1.Centre for Occupational and Environmental Health, Institute of Population Health, Manchester Academic Health Sciences Centre, Centre for Epidemiology, The University of Manchester, Manchester M13 9PL, UK
| | - Christine Robinson
- 1.Centre for Occupational and Environmental Health, Institute of Population Health, Manchester Academic Health Sciences Centre, Centre for Epidemiology, The University of Manchester, Manchester M13 9PL, UK
| | - Raymond Agius
- 1.Centre for Occupational and Environmental Health, Institute of Population Health, Manchester Academic Health Sciences Centre, Centre for Epidemiology, The University of Manchester, Manchester M13 9PL, UK
| | - Frank de Vocht
- 2.School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Liu H, Wakeford R, Riddell A, O'Hagan J, MacGregor D, Agius R, Wilson C, Peace M, de Vocht F. A review of job-exposure matrix methodology for application to workers exposed to radiation from internally deposited plutonium or other radioactive materials. J Radiol Prot 2016; 36:R1-R22. [PMID: 26861451 DOI: 10.1088/0952-4746/36/1/r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Any potential health effects of radiation emitted from radionuclides deposited in the bodies of workers exposed to radioactive materials can be directly investigated through epidemiological studies. However, estimates of radionuclide exposure and consequent tissue-specific doses, particularly for early workers for whom monitoring was relatively crude but exposures tended to be highest, can be uncertain, limiting the accuracy of risk estimates. We review the use of job-exposure matrices (JEMs) in peer-reviewed epidemiological and exposure assessment studies of nuclear industry workers exposed to radioactive materials as a method for addressing gaps in exposure data, and discuss methodology and comparability between studies. We identified nine studies of nuclear worker cohorts in France, Russia, the USA and the UK that had incorporated JEMs in their exposure assessments. All these JEMs were study or cohort-specific, and although broadly comparable methodologies were used in their construction, this is insufficient to enable the transfer of any one JEM to another study. Moreover there was often inadequate detail on whether, or how, JEMs were validated. JEMs have become more detailed and more quantitative, and this trend may eventually enable better comparison across, and the pooling of, studies. We conclude that JEMs have been shown to be a valuable exposure assessment methodology for imputation of missing exposure data for nuclear worker cohorts with data not missing at random. The next step forward for direct comparison or pooled analysis of complete cohorts would be the use of transparent and transferable methods.
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Affiliation(s)
- Hanhua Liu
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, M13 9PL, UK
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Jabbour R, Turner S, Hussey L, Page F, Agius R. Workplace injury data reported by occupational physicians and general practitioners. Occup Med (Lond) 2015; 65:296-302. [PMID: 25883217 DOI: 10.1093/occmed/kqv014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Accurate workplace injury data are useful in the prioritization of prevention strategies. In the UK, physicians report workplace ill-health data within The Health and Occupation Research (THOR) network, including injury case reports. AIMS To compare workplace injury data reported by occupational physicians (OPs) and general practitioners (GPs) to THOR. METHODS Injury cases reported by OPs and GPs, reported to THOR between 2006 and 2012 were analysed. Demographics, industrial groups, nature of injury, kind of accident and site of injury were compared. Data on sickness absence for workplace injuries reported by GPs were investigated. RESULTS In total, 2017 workplace injury cases were reported by OPs and GPs. Males were more likely to sustain a workplace accident than females. Sprains and strains were reported most often, with the upper limbs being affected most frequently. Slips, trips and falls were identified as important causal factors by both OPs and GPs. Psychological injuries also featured in THOR reporting, with a higher proportion reported by OPs (21%) than by GPs (3%). The proportion of people classified as 'unfit' by GPs reduced following the introduction of the 'fit' note. CONCLUSIONS THOR reports returned by OPs and GPs provide a valuable source of information of workplace injury data, and complement other sources of information, such as the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations and the Labour Force Survey.
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Affiliation(s)
- R Jabbour
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester M13 9PL, UK
| | - S Turner
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester M13 9PL, UK
| | - L Hussey
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester M13 9PL, UK.
| | - F Page
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester M13 9PL, UK
| | - R Agius
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester M13 9PL, UK
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Urwin R, Warburton K, Carder M, Turner S, Agius R, Wilkinson SM. Methylchloroisothiazolinone and methylisothiazolinone contact allergy: an occupational perspective. Contact Dermatitis 2015; 72:381-6. [DOI: 10.1111/cod.12379] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/29/2015] [Accepted: 02/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Rachel Urwin
- Leeds Centre for Dermatology, Chapel Allerton Hospital; Leeds LS7 4SA UK
| | | | - Melanie Carder
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
| | - Susan Turner
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
- St Mary's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust; Manchester M13 9WL UK
| | - S Mark Wilkinson
- Leeds Centre for Dermatology, Chapel Allerton Hospital; Leeds LS7 4SA UK
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Abstract
BACKGROUND In 2010, the fit note replaced the sick note to help focus on what people are capable of doing, rather than signing patients 'off sick'. AIMS To compare proportions of work-related ill-health issued with sickness certification pre- and post-fit note introduction and assess sickness absence trends. METHODS General practitioners (GPs) report data on work-related ill-health and sickness absence via The Health and Occupation Research network in General Practice. The proportion of cases issued with sickness certification 4 years before and 3 years after the fit note introduction were compared. Changes in certification incidence rate ratios were measured over time. RESULTS Participating GPs reported 5517 cases of work-related ill-health. Pre-fit note introduction 50% of cases were certified sick. There was no change in the proportion of cases certified sick in the first year post-fit note, despite 13% of cases classified as 'maybe fit'. However, in the second year, the proportion of cases certified sick had reduced significantly (41%) and a larger proportion (19%) was advised on workplace adjustments. In the third year post-introduction, there was a slight rise in the proportion of cases certified sick; therefore, although there was a fall of 2% per annum in certification rates, this was not significant. CONCLUSIONS In the first year post-fit note introduction, modifications to work were recommended for people who would previously have been declared fit. Trends analyses showed a slight decrease in the certification rate, possibly indicating GPs will become more practised in advising on workplace adjustments.
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Affiliation(s)
- L Hussey
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK,
| | - A Money
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK
| | - M Gittins
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK
| | - R Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, The University of Manchester, Manchester M13 9PL, UK
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Warburton KL, Urwin R, Carder M, Turner S, Agius R, Wilkinson SM. UK rates of occupational skin disease attributed to rubber accelerators, 1996-2012. Contact Dermatitis 2015; 72:305-11. [DOI: 10.1111/cod.12356] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/13/2014] [Accepted: 12/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rachel Urwin
- Department of Dermatology; Leeds Teaching Hospitals NHS Trust; Leeds LS7 4SA UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
| | - Susan Turner
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, The University of Manchester; Manchester M13 9PL UK
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester M13 9WL UK
| | - S. Mark Wilkinson
- Department of Dermatology; Leeds Teaching Hospitals NHS Trust; Leeds LS7 4SA UK
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Cannon J, Fitzgerald B, Seed M, Agius R, Jiwany A, Cullinan P. Occupational asthma from tafenoquine in the pharmaceutical industry: implications for QSAR. Occup Med (Lond) 2015; 65:256-8. [PMID: 25663384 DOI: 10.1093/occmed/kqu193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We report occupational asthma and rhinitis in a formulation pharmacist, employed in the development of tafenoquine. Tafenoquine is a new anti-malarial drug in development; the pure drug substance has an asthma hazard index of zero and previously was not known to be a respiratory sensitizing agent. The implications of this finding for the refinement of quantitative structural analysis of asthmagenic chemicals are discussed.
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Affiliation(s)
- J Cannon
- Department of Occupational and Environmental Medicine, Royal Brompton and Harefield NHS Trust and Imperial College, London, UK,
| | - B Fitzgerald
- Department of Occupational and Environmental Medicine, Royal Brompton and Harefield NHS Trust and Imperial College, London, UK
| | - M Seed
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - R Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - A Jiwany
- Department of Occupational Health, GlaxoSmithKline, Brentford, UK
| | - P Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton and Harefield NHS Trust and Imperial College, London, UK
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Kwok C, Money A, Carder M, Turner S, Agius R, Orton D, Wilkinson M. Cases of occupational dermatitis and asthma in beauticians that were reported to The Health and Occupation Research (THOR) network from 1996 to 2011. Clin Exp Dermatol 2015; 39:590-5. [PMID: 24934913 DOI: 10.1111/ced.12367] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Beauticians are exposed to many potential allergens in their occupation. AIM To identify the sources of occupational skin and respiratory disease reported in beauticians, with an emphasis on acrylate chemicals, and to investigate the trends over time. METHODS We used the Health and Occupation Research (THOR) database to identify occupational disease in beauticians between 1996 and 2011. Trend analysis was carried out to look for any change in the allergens reported over this period. RESULTS In total, 257 cases of contact dermatitis (CD) in beauticians were identified, which were associated with 502 suspected agents. The most frequently cited source of allergic CD was acrylate chemicals. The trend analysis showed a small average annual percentage increase in work-related CD in beauticians for all agents (1.1%; 95% CI -2.5 to 4.9). There was a small decrease in cases in which acrylates were not cited (-1.7%; 95% CI -5.9 to 2.7), and a statistically significant increase when acrylates were cited (7.4%; 95% CI 0.9 to 14.4). There were 11 cases of occupational asthma. CONCLUSION We found an increase in cases of occupational dermatitis associated with acrylates in beauticians over a 15-year period, and describe other causes of occupational dermatitis.
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Affiliation(s)
- C Kwok
- Dermatology Department, Chapel Allerton Hospital, Leeds, UK
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Stocks SJ, McNamee R, van der Molen HF, Paris C, Urban P, Campo G, Sauni R, Martínez Jarreta B, Valenty M, Godderis L, Miedinger D, Jacquetin P, Gravseth HM, Bonneterre V, Telle-Lamberton M, Bensefa-Colas L, Faye S, Mylle G, Wannag A, Samant Y, Pal T, Scholz-Odermatt S, Papale A, Schouteden M, Colosio C, Mattioli S, Agius R. Trends in incidence of occupational asthma, contact dermatitis, noise-induced hearing loss, carpal tunnel syndrome and upper limb musculoskeletal disorders in European countries from 2000 to 2012. Occup Environ Med 2015; 72:294-303. [PMID: 25575531 DOI: 10.1136/oemed-2014-102534] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. METHODS OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. RESULTS Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries. CONCLUSIONS This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods.
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Affiliation(s)
- S Jill Stocks
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Roseanne McNamee
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Henk F van der Molen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christophe Paris
- Inserm U954, Vandoeuvre Les Nancy, France Occupational Diseases Department, University Hospital, Nancy, France
| | - Pavel Urban
- Centre for Occupational Health, National Institute of Public Health, Prague, Czech Republic Department of Occupational Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Giuseppe Campo
- Istituto Nazionale Assicurazione contro gli Infortuni sul Lavoro (INAIL) Research, Rome, Italy
| | - Riitta Sauni
- Finnish Institute of Occupational Health, Tampere, Finland
| | | | - Madeleine Valenty
- Département Santé Travail, Institut de veille sanitaire, Saint Maurice, France
| | - Lode Godderis
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium IDEWE, Heverlee, Belgium
| | - David Miedinger
- Department of Occupational Medicine & Department of Actuarial Science, Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland Medical Faculty, University of Basel, Basel, Switzerland
| | - Pascal Jacquetin
- Caisse nationale de l'assurance maladie des travailleurs salariés, Paris, France
| | | | - Vincent Bonneterre
- Département de Médecine et Santé au travail, Pôle Santé publique, CHU Grenoble, Grenoble, France
| | | | - Lynda Bensefa-Colas
- Occupational Diseases Department, University Hospital of Centre of Paris COCHIN, AP-HP, Paris, France Paris Descartes University, Sorbonne Paris Cité, EA 4064, Laboratoire Santé Publique et Environnement, Paris, France
| | - Serge Faye
- Agence Nationale de Sécurité Sanitaire (ANSES), Maisons-Alfort, France
| | | | - Axel Wannag
- Norwegian Labour Inspection Authority, Trondheim, Norway
| | | | - Teake Pal
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan Scholz-Odermatt
- Department of Occupational Medicine & Department of Actuarial Science, Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland Swiss Central Office for Statistics in Accident Insurance-SSUV, Lucerne, Switzerland
| | - Adriano Papale
- Istituto Nazionale Assicurazione contro gli Infortuni sul Lavoro (INAIL) Research, Rome, Italy
| | | | - Claudio Colosio
- Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
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49
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Abstract
BACKGROUND Both solar and non-solar exposures associated with occupation and work tasks have been reported as skin carcinogens. In the UK, there are well-established surveillance schemes providing relevant information, including when exposures took place, occupation, location of work and dates of symptom onset and diagnosis. AIMS To add to the evidence on work-related skin neoplasia, including causal agents, geographical exposure and time lag between exposure and diagnosis. METHODS This study investigated incident case reports of occupational skin disease originating from clinical specialists in dermatology reporting to a UK-wide surveillance scheme (EPIDERM) by analysing case reports of skin neoplasia from 1996 to 2012 in terms of diagnosis, employment, suspected causal agent and symptom onset. RESULTS The suspected causal agent was 'sun/sunlight/ultraviolet light' in 99% of the reported work-related skin neoplasia cases. Most cases reported (91%) were in males, and the majority (62%) were aged over 65 at the time of reporting. More detailed information on exposure was available for 42% of the cases, with the median time from exposure to symptom onset ranging from 44 (melanoma) to 57 (squamous cell carcinoma) years. Irrespective of diagnostic category, the median duration of exposure to 'sun/sunlight/ultraviolet light' appeared longer where exposures occurred in the UK (range 39-51 years) rather than outside the UK (range 2.5-6.5 years). CONCLUSIONS It is important to provide effective information about skin protection to workers exposed to solar radiation, especially to outdoor workers based outside the UK.
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Affiliation(s)
- S Turner
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK,
| | - S D Forman
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK
| | - R McNamee
- Centre for Biostatistics, University of Manchester, Manchester M13 9PL, UK
| | - S M Wilkinson
- Department of Dermatology, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - R Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK
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50
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Povey AC, McNamee R, Alhamwi H, Stocks SJ, Watkins G, Burns A, Agius R. Pesticide exposure and screen-positive neuropsychiatric disease in British sheep farmers. Environ Res 2014; 135:262-270. [PMID: 25462674 DOI: 10.1016/j.envres.2014.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 08/08/2014] [Accepted: 09/05/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Epidemiological evidence linking low dose pesticide exposure and chronic ill-health in UK sheep farmers is limited. Our aim was to examine whether neuropsychiatric disorders were associated with low dose chronic and/or more acute pesticide exposure in sheep farmers. METHODS A cohort of British farmers working in the 1970s was sent a screening questionnaire which asked about their health and work history. The prevalence of screen-positive depression, dementia, Parkinsonism and neuropathy was determined using a priori algorithms. Self-reported pesticide exposure was assessed by whether the participant had ever handled the pesticide concentrate (for low dose chronic exposure) or sought advice for pesticide poisoning (acute exposure) and participants categorised into those with only acute or chronic exposure, those with both acute and chronic exposure and those with neither acute nor chronic exposure. Associations between acute and chronic pesticide exposure, and screen-positive ill-health were determined after adjustment for demographic, lifestyle, occupation and somatic severity scores and other variables. RESULTS In those participants, who had never sought advice for pesticide poisoning, handling the pesticide concentrate for treating sheep was associated with elevated ORs for screen-positive neuropathy (ORadi 1.57 95%CI 0.97-2.54) and Parkinsonism (ORadj 1.56 95%CI 0.95-2.56) but not depression or dementia. In those participants who had handled the pesticide concentrate, seeking advice for pesticide poisoning was associated with screen-positive depression (Odds ratio, ORadj=9.97 95%CI 4.76-20.8 ), dementia (OR=6.94 95%CI 3.44-14.0), Parkinsonism (ORadj=4.77 95% 2.39-9.52), and neuropathy (ORadj=4.77 95%CI 2.39-9.52). Adjustment for somatic severity score modified little the associations with pesticide handling in those not acutely exposed but reduced the ORs for seeking advice for pesticide poisoning in those exposed chronically. Furthermore, stratification of results based upon somatic severity score indicated that the highest ORs for handling the pesticide concentrate associated with neuropathy and Parkinsonism were found in those participants whose somatic score was minimal. CONCLUSIONS Results are consistent with low-dose exposure to pesticides being associated with screen-positive neuropathy and Parkinsonism but the stronger associations between seeking advice for pesticide poisoning and screen-positive ill-health suggest that acute pesticide exposure remains an important determinant of ill-health. Further work is required to better delineate to what extent low dose exposures may contribute to ill-health in populations without acute exposures. Somatising tendency does not appear to play an important role in this population.
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Affiliation(s)
- Andrew C Povey
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester M13 9PL, United Kingdom.
| | - Roseanne McNamee
- Centre for Biostatistics, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, United Kingdom
| | - Haytham Alhamwi
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| | - S Jill Stocks
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Gillian Watkins
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, Faculty of Medical and Human Sciences, University of Manchester, United Kingdom
| | - Raymond Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
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