Roberta Pernetti , Giorgia Stoppa , Corrado Lanera , Dolores Catelan , Enrico Oddone

Abstract

Objectives: Systematic reviews (SR) play a crucial role in synthesizing scientific literature for evidence-based decision-making, but traditional
Methods remain time-consuming and prone to inconsistencies. To enhance efficiency, we evaluated the feasibility of using GPT-based automated search techniques for retrieving occupational cancer-related studies from the PUBMED database.
Materials and Methods: The assessment was conducted across seven neoplastic sites (i.e. nasopharynx, lymphomas, bladder, larynx, ovary, breast and multiple myeloma) each involving a review of 100 articles using an AI-generated search prompt. The evaluation focused on title and abstract screening, leveraging automated classification to identify relevant studies on occupational exposures and cancer risks. Only case-control, cohort, cross-sectional studies, and meta-analyses indicating an association between occupational sector and neoplasm were included in the selection.
Results: The data extracted by GPT were subsequently reviewed by a human gold standard expert in occupational epidemiology. Compared to expert classification, GPT missed 5 out of 164 relevant studies (false negative rate: 3.0%) and flagged 69 irrelevant ones as relevant out of 536 true negatives (false positive rate: 11.4%), demonstrating the potential of AI-assisted literature screening in streamlining systematic reviews.

Conclusions: The findings suggest that GPT-based automated search techniques can effectively support the initial phases of systematic reviews by efficiently identifying relevant occupational cancer studies with a relatively low rate of false negatives. These results support the feasibility of using GPT-based tools for first-pass screening in occupational cancer SRs. While further refinement is needed to reduce false positives, this approach offers a promising balance between speed and sensitivity, with potential for broader integration into systematic review workflows

Xabier Irastorza

Abstract

Objective The European Agency for Safety and Health at Work (EU-OSHA) carried out an exposure survey to cancer risks factors, based on an adaptation of the Australian Workplace Exposures Study (AWES). The survey provides prevalence and semi-quantitative levels of occupational exposure, assessed with the Occupational Integrated Database Exposure Assessment System (OccIDEAS).
Material and Methods The survey was held with 24,402 respondents in six European countries. Almost 62% of the respondents were male workers, and 38% female. The unbalanced distribution by gender may be due to some extent to a limitation of the survey: many of the 24 cancer risk factors addressed by the survey are mainly relevant to male-dominated industrial jobs and sectors. Nevertheless, the survey data was weighted with the 2021 EU Labour Force Survey annual data as reference statistics, considering gender, to represent the working population of the six countries, namely 98.5 million workers.
Results Male workers are exposed more often than female workers to at least one cancer risk factor, to several of them, and to most of the single risk factors, with the exception of ionising radiation, ethylene oxide, acrylamide, o-toluidine, epichlorohydrin and leather dust, which are similar for both genders, but concerning fewer workers. The same applies to exposure at higher levels, except for ethylene oxide and trichloroethylene. When looking at specific sectors or occupations, there are some exceptions. For example, 48% of the female workers exposed to formaldehyde in the healthcare sector are exposed at a high level, compared to 31% of the male workers.
Conclusion Although the Workers’ Exposure Survey is not addressing a possible gender bias, it contributes to increasing awareness of some very relevant risk factors for female workers, such as formaldehyde, a wide-used chemical present in many applications and products in EU workplaces.

Rachel Louise Hasting, Jorunn Kirkeleit, Ronnie Babigumira, Leon A M Berge, Jan Ivar Martinsen, Sara Nafisi, Nita K Shala, Karina Undem, Marit B Veierød, Karl-Christian Nordby, Jo S Stenehjem,

Abstract

Objective: Offshore petroleum workers are exposed to various hazards through their work. We aimed to assess all-cause and cause-specific mortality among Norwegian offshore workers in two separate cohorts, with the working population and the general population as references.
Material and Methods: We examined workers first employed offshore during 1983–1998 in 1) the survey-based Norwegian Offshore Petroleum Workers (NOPW) cohort, comprising 25,142 workers (91% men), and 2) the national register-based Nor-Work cohort, comprising 60,096 workers (93% men). The cohorts were linked to the Cause of Death Registry for follow-up 1999–2020. We calculated calendar period- and age-standardized mortality ratios (SMR, 95% CI) for men with the working population (those who had at least one employment record during 1983–1998) as reference. SMRs for women and for the two cohorts with the general population as reference will also be calculated.
Results: Among men, when compared to the working population, all-cause mortality was reduced in both the NOPW cohort (SMR, 95%CI: 0.91, 0.86–0.98) and the Nor-Work cohort (0.48, 0.47–0.50). In both cohorts, death from diabetes was reduced (NOPW: 0.48, 0.22–0.90; Nor-Work: 0.32, 0.23–0.43). In NOPW, death from Parkinson’s disease (3.07, 1.68–5.15) and all cancers combined (1.12, 1.01–1.23) were elevated, while in Nor-Work, the corresponding estimates were reduced.
Conclusion: Reduced all-cause mortality among offshore workers compared to the working population was found for both cohorts. Comparisons to findings with longer inclusion periods and with the general population as reference may elucidate the impact of selection or information biases, including a healthy worker effect. Findings will contribute to a more thorough understanding of mortality patterns among Norwegian offshore workers.

Enrico Oddone, Luca D’Amato, Roberta Pernetti, Federico Sottotetti, Ilaria Campo, Giulia Maria Stella

Abstract

Objectives. To investigate potential germline mutations that may confer susceptibility to pleural mesothelioma (PM), with the goal of identifying individuals at increased risk despite similar levels of occupational or environmental asbestos exposure. This objective aims to shed light on the pathogenesis of PM, a rare and aggressive malignancy primarily linked to asbestos exposure and still lacking effective therapeutic options.
Materials and Methods. We conducted a case-control study involving two groups: (1) PM patients (n=16) with confirmed asbestos-related exposure, and (2) asbestos-exposed individuals (controls, n=32) who did not develop PM after a minimum follow-up period of 20 years. All participants were residents of the Pavia province (Lombardy, Italy), a region with elevated PM incidence due to both occupational and environmental asbestos exposure. Germline DNA samples underwent targeted Next-Generation Sequencing (NGS) using a gene panel focused on pathways related to inflammatory response, drug metabolism, and cancer susceptibility. Bioinformatic analyses were employed to identify and annotate relevant genetic variants.
Results. Germline variants were identified in several cancer susceptibility genes, including FBXW7 (75% of cases vs. 50% of controls), ATM (56% vs. 41%), BRCA2 (19% vs. 41%), PBRM1 (12% vs. 34%), and FAT1 (12.5% vs. 25%). Notably, a deletion in FBXW7 was observed in 62.5% of PM cases compared to 41% of controls.
Conclusion. Our preliminary findings highlight specific germline mutations that may contribute to increased susceptibility to PM following asbestos exposure. These results support the hypothesis that genetic predisposition plays a role in PM development alongside environmental and occupational risk factors. Further studies are warranted to validate these observations and explore their clinical relevance.

Will Mueller, Lucy Darnton, Mette W Christensen, Finlay Brooker, Henrik A Kolstad

Abstract

Objective According to the International Agency for Research on Cancer, styrene is probably carcinogenic for lymphohaematopoietic neoplasms, with insufficient evidence for other cancer sites. We compared mortality and cancer incidence (for the first time) in a UK cohort occupationally exposed to high levels of styrene to that of the general population of England and Wales.
Material and Methods The follow-up for mortality ran from 1969 to 2022, while the follow-up for cancer incidence ran from 1971 to 2020. Standardised mortality ratios (SMRs) and standardised incidence ratios (SIRs) were calculated for cancer and non-cancer outcomes. Additional analyses compared mortality and cancer incidence with respect to the median age at and time since first exposure.
Results A total of 1319 males contributed 53 687 person-years of follow-up in the all-cause mortality analysis. Mortality analyses did not indicate any clear increased risks. There was an indication of higher mortality of cancers of the trachea, bronchus or lung (SMR=1.30 (95% CI 0.99 to 1.70)). Mortality from lymphatic and haematopoietic neoplasms was elevated in those first exposed younger than 25 years of age (SMR=2.20 (95% CI 1.12 to 3.92)). The SIR analysis suggested reduced cancer incidence for all malignant neoplasms combined (SIR=0.85 (95% CI 0.76 to 0.96)). The incidence of lymphatic and haematopoietic neoplasms, especially myeloid proliferations and neoplasms, was elevated in those first exposed before 25 years old.
Conclusion This study provides some limited evidence in support of styrene being a cause of lymphohaematopoietic, particularly myeloid neoplasms and lung cancers. This cohort is contributing to an ongoing international study to help clarify these associations.

Tracy L Kirkham, Victoria H Arrandale, Tanya Navaneelan, Paul A Demers

Abstract

Objective Standardized occupation and industry classification systems of a job-exposure matrix (JEM) and study population may not match; crosswalks may be required for translating codes. Challenges in crosswalking between systems exist when there are multiple matches to a single occupation/industry code. Using crosswalks for exposure assessment and impacts on disease risk estimation are rarely discussed in the literature. This study investigates the effect of three crosswalk methods of the Diesel Exhaust in Canada Job-Exposure Matrix (DEC-JEM) on lung cancer risk in the Occupational Disease Surveillance System (ODSS).
Methods Ontario workers in the ODSS (~2.2 million identified through workers’ compensation claims (1983-2020)) were followed for cancer diagnoses through linkage with the Ontario Cancer Registry. Three methods were used to crosswalk DEC-JEM to the codes in the ODSS: (1) unexposed matches excluded, average of one-to-multiple matches, (2) unexposed matches included, average of one-to-multiple matches, (3) unexposed matched included, weighted average of one-to-multiple matches. Cox-proportional hazards models of lung cancer were run with DEC-JEM to estimate hazard ratios and 95% confidence intervals, adjusted for age, birth year, and sex. Analyses were run at four exposure thresholds: 5%, 25%, 50%, 75%.
Results DEC-JEM2 and DEC-JEM3 had similar case counts and exposure distributions for each exposure level and threshold (16-92% lower than DEC-JEM1, 25% exposure threshold). Increased lung cancer risk was observed using all methods (25% threshold). Differences in risk between methods were most noticeable for high exposed workers (HR range=1.12-1.73); little difference was observed amongst the low (HR range=1.28-1.35) and very high exposure (HR range=1.53-1.55) groups. DEC-JEM3 had the highest dose-response slope. Female workers had significant increased risk (all methods).
Conclusion Crosswalk decisions can change a JEM’s exposure distribution, determine case exposure status, and influence the slope of disease risk results. This study’s crosswalk methods provide opportunities to save resources while improving exposure assessment.

Saravanan SP

Abstract

Background: The tea industry is one of India’s oldest and most significant sectors, employing over one million workers, predominantly from scheduled castes, tribes, and ethnic minorities. Major tea-producing states include Assam, West Bengal, Kerala, and Tamil Nadu, with notable plantations also in Tripura and Himachal Pradesh. Tea plantation workers often live in socioeconomically disadvantaged conditions, with overcrowding, poor hygiene, and low literacy levels, predisposing them to communicable diseases and lifestyle-related health issues, including tobacco use and oral malignancies. This study aimed to assess the pattern of tobacco use and the prevalence of premalignant oral lesions and oral cancer among tea plantation workers in the Nilgiri Hills, Tamil Nadu, India.
Methods: A cross-sectional descriptive study was conducted among 400 tea plantation workers from five estates in the Nilgiri Hills. Data were collected using a pretested questionnaire covering demographic details, tobacco usage habits, frequency, and form. Oral examinations were conducted by a single trained examiner to identify premalignant and malignant lesions. The collected data were analyzed using SPSS version 15.
Results: Among the study population, 46% had no formal education, and 65% used indigenous Methods for oral hygiene. Oral mucosal lesions were identified in 52% of participants. The most common findings included leukoplakia (34%), tobacco pouch keratosis (42%), and malignant oral tumors (6%). The prevalence of oral lesions was significantly associated with tobacco usage and limited awareness of its health risks.

Conclusions: Tobacco use remains a leading preventable cause of morbidity and mortality. The high prevalence of oral mucosal lesions among tea plantation workers highlights the urgent need for targeted health education, tobacco cessation programs, and routine oral screening in this vulnerable population. Health professionals have a critical role in raising awareness and implementing preventive strategies to mitigate the health burden from tobacco use.

Zimbo S.R.M. Boudewijns, Antonio d’Errico, Anna Hatsagi, Pim N.H. Wassenaar, Maartje Brouwer, Myrna D. van de Burgwal, Eugene P. van Someren, Suzanne Spaan and Susan M. Peters

Abstract

Objective Although a wide variety of occupational exposure and health data are available online and within institutes and universities, these data sources are fragmented and hard to find for researchers working on prevention of occupational diseases. The Dutch LEXCES project aims to increase the usability of relevant occupational exposure and health data, including data that is not readily findable, by creating a comprehensive inventory.
Methods Data sources were inventoried based on consultation of relevant literature, internet search and interviews with researchers with a focus on datasets from The Netherlands. To facilitate findability and reuse, the data sources were described using a selection of relevant metadata elements from standard vocabularies. A catalogue was built to browse and search data sources, making the datasets findable for all relevant stakeholders.
Results The initial inventory yielded over 60 data sources relevant in the context of occupational exposure and health. With some overlap in domains, the majority of datasets were related to the characterization of hazardous substances (n=42), while data sources describing mechanism of effect (n=7), production and use (n=6), occupational exposure (n=8), occupational diseases (n=5) and individual and societal burden of disease (n=2) were more sparse. Metadata was not always sufficiently available to enable efficient evaluation of accessibility and usability of the data.
Conclusion The project shows that a large number of data sources is available for use within occupational exposure and health. However, for some domains only a few data sources are identified, e.g. with regard to data on occupational exposure, which is crucial for modeling disease risk. The catalogue will be publicly available and future efforts should be aimed at adding new data sources, for instance by inviting stakeholders to add relevant sources.

Daniel E Russ, Pabitra R. Josse, Leila Orszag, Jonas S. Almeida, Melissa C. Friesen

Abstract

Objective: Pooling studies increases the study power to evaluate occupational risk factors, but this often requires recoding them into a unified occupation coding system. Administrative crosswalks between classification systems may not directly exist and often have one-to-many relationships between codes. In this study, we describe a novel tool, SOCcerNET, that can use both the original free-text job description and occupation codes from other systems or versions to code jobs into US SOC2010.
Methods: SOCcerNET uses the free-text job title and job tasks and, if available, any previously assigned occupation code to classify English-language job descriptions to US SOC2010. Currently, SOCcerNET can utilize previously assigned US SOC1980 codes, Canadian NOC2011 and NOC2016 codes, and ISCO1988 codes. SOCcerNET incorporates administrative crosswalks and uses small language models that first converts (embeds) the free-text information to numbers; it then classifies using a dense classification neural network and provides a score for each of the 840 codes. We validated SOCcerNET using 11,943 jobs coded to SOC1980 (Set 1), 428 jobs coded to NOC2011 (Set 2), and 1500 jobs coded to ISCO1988 (Set 3); all sets were expert-coded to SOC2010.
Results: Compared to using only job title and task, incorporating the previous occupation coding improved SOCcerNET’s agreement (based on highest scoring code) with expert codes from 56.3% to 69.9% for Set 1, from 68.8% to 74.4% for Set 2, and from 44.7% to 46.5% for Set 3.
Conclusion: Using previously assigned occupation codes improved the ability of SOCcerNET to correctly identify the expert-assigned code versus using only the free-text responses, though the improvement was better for SOC1980 and NOC2011/2016 than for ISCO1988. In addition, the SOCcerNET score can help triage jobs for expert review. With additional training data, SOCcerNET can be extended to other coding systems. Acknowledgements: This work is funded by the Intramural Research Program of the US National Cancer Institute, Division of Cancer Epidemiology and Genetics.

Barbara Savary

Abstract

Objective: Occupational exposure limits (OELs) are often used to interpret workplace measurements to chemical agents. However little guidance is available on how to deal with agents without OELs. Therefore, we assessed the coverage and values of selected lists of OELs relative to those in France to develop guidance for assessing chemical risks in French workplaces
Material and Methods: We selected lists of predominantly health-based OELs published by four organizations – ACGIH TLVs and OARS-WEELs (USA), MAK (Germany), and JSOH (Japan) – along with the current list of French OELs comprising 557 agents. We first assessed the presence or absence of agents across each list. We then used linear models to compare the ratios of French OEL values to those in other lists, accounting for year of adoption of the French OEL (before or after 1990).
Results: Overall, OELs for 1096 agents were found, with 539 not present in France. While no agent featured simultaneously across all lists, 114 were present in four lists. WEELs had the highest proportion of agents not shared with any other list (73%). 32 entries were unique to France (e.g. 2-naphtylamine, benzidine) with OELs dating mostly from the 1980s. On average, French 8-hour OEL values adopted before 1990 were twice higher than those proposed by other institutions, whereas OELs adopted after 1990 tended to be similar. Spearman correlations in 8-hour OEL values between the lists ranged from 0.89 to 0.93.
Conclusion: The four lists of published OELs selected can provide valuable information for risk assessments for agents not covered by French regulations, and for agents with older OELs that do not reflect the current state of the literature. Sources of funding: Internal funding from the INRS

Jo S Stenehjem, Leon A M Berge, Ronnie Babigumira, Jan Ivar Martinsen, Niki Marjerrison, Nita K Shala, Sara Nafisi, Marcin Wojewodzic, Sven O Samuelsen, Magne Bråtveit, Jorunn Kirkeleit, Karl-Christian Nordby, , H Dean Hosgood, Paul A Demers, Roel C H Vermeulen, Hans Kromhout, Lawrence S Engel, Tom I L Nilsen, Olav Røise, Leiv Arne Rosseland, Debra T Silverman, Melissa C Friesen, Nathaniel Rothman, Qing Lan, Marit B Veierød, Tom K Grimsrud

Abstract

Objective: The lack of comprehensive personnel lists and work histories after the year 2000 has hampered epidemiological studies of recent exposure and risk of injuries, disease, and death in Norwegian offshore petroleum industry workers. The overarching purpose of the study is to assess hydrocarbon exposure, night shift work, and prescription drug use in relation to risk of injuries, cancer, cardiovascular-, neurological-, and respiratory diseases, psychological conditions, and death, in a combined cohort of Norwegian offshore petroleum workers and their offspring covering 1965–2023.
Materials and Methods: The Norwegian Offshore Petroleum Workers cohort (n=27,917, work histories 1965–1998), and the Heliport cohort (n=83,202, work histories 1980–2023), will be merged into a combined cohort (n=100,332) with work histories spanning 1965–2023. The combined cohort will be linked to the Medical Birth Registry of Norway for identification of the offshore worker’s offspring (n≈186,000). Exposures will be assessed through work histories linked to industry-specific job-exposure matrices, and two survey-questionnaires (from 1998 and 2023). The combined cohort will be linked to national registries for follow-up of injuries, disease, and death 1999–2023. Analysis and
Results*: Excess mortality and incidence will be assessed by calculation of standardized mortality and incidence ratios. Cause-specific analyses will be conducted by Cox regression or cumulative incidence from multistate models. Inverse probability of treatment weights will be used to estimate adjusted (weighted) cumulative incidence curves with death as a competing event.
Conclusion: Merging the NOPW and Heliport cohorts creates a uniquely comprehensive dataset with six decades of offshore work histories, detailed exposure and covariate data. High-quality outcome data from national registers enable a broad range of investigations including injuries, cancer and other non-communicable diseases, death and drug use. This will advance research on exposure-related risks in offshore workers and their offspring and facilitate disease prevention in the petroleum industry.

Sander Kurt Riemer van Zon, Raun van Ooijen, Sandra Brouwer

Abstract

Objective: With tightening labour markets and population ageing, maximizing labour potential has become a critical policy priority. While much research focused on the determinants of unemployment, a comprehensive overview of the factors associated with the broader concept of labour underutilisation is lacking. This study aims to explore the concept labour underutilisation and its associated factors.
Material and Methods: A scoping review was conducted following the Arksey & O’Malley’s framework. Academic and grey literature were searched across PubMed, MedLine, SocINDEX, PsychInfo, ERIC, Web of Science, and Scopus, and Dutch journals. Both quantitative and qualitative studies were considered. Experts in the field were consulted for additional key publications. Articles published between 2000 and 2024 from high-income countries were included. Factors related to labour underutilisation were mapped against the Social Determinants of Health (SDOH) framework.
Results: A total of 536 unique academic and 97 unique grey articles were identified. Of these, 14 academic and 28 grey articles met the selection criteria. The perspective on labour underutilisation shifted from a narrow economic to a broader welfare perspective. Predominantly, articles included time-related underemployment, unemployment and the potential labour force within the concept of labour underutilisation. Factors associated with labour underutilisation were found across all five SDOH-domains, though living/working conditions were least frequently considered. Key factors included: demographics (age, sex, ethnicity), health, family/social networks (marital status, children), living/working conditions (unpaid responsibilities, occupation) and socioeconomic conditions (labour market dynamics, social security systems).
Conclusion: Labour underutilisation is increasingly viewed through a broader welfare lens. Various factors are linked to labour underutilisation, but evidence is limited and primarily descriptive. The lack of longitudinal data limits understanding of its persistence, especially during key life phases (e.g., caregiving). Future studies should examine how labour underutilisation evolves, identify barriers within and across socio-demographic groups, and assess the role of unpaid activities.

Isabella Yu-Ju Hung , Tiffany Ting-Fang Shih , Bang-Bin Chen and Yue Leon Guo ,

Abstract

Objective Lumbar disc degeneration (LDD) has been related to heavy manual material handling. There are inconsistencies in findings regarding the relationship of occupational loading with spinal degeneration. The purpose of this study was to investigate the prevalence rate of LDD and the dose-response relationship between lifetime cumulative lifting load and LDD among male workers in Asian population.
Material and Methods This was a cross-sectional study. The participants were recruited from walk-in clinic patients and market workers who carry heavy loads. Every participant received assessments with an occupational questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disc degeneration from L1 to S1 lumbar disc level. The compression load was estimated by using a biomechanical software system, 3D SSPP (3D Static Strength Prediction Program).
Results A total of 252 male participants were entered the final analyze and categorized into tertiles by cumulative lifting load (ie, <5.4 × 105, 5.4 × 105 to 6.75 × 105, and ≥6.75 × 105 Nh). The risk of LDD increased with cumulative lifting load. The best dose-response relationships were found at the L5–S1 disc level, in which high cumulative lifting load was associated with elevated odds ratios statistically significant of 5.24 for disc protruding, 3.47 for disc height narrowing, 2.76 for annulus tear and 2.44 for dehydration compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 3.40 for disc protruding, 2.84 for disc height narrowing, 2.65 for annulus tear and 2.63 for dehydration compared with low lifting load.
Conclusion The
Results suggest a dose-response relationship between cumulative lifting load and LDD in Asian among male workers. The prevention to occupational heavy lifting load exposure is a crucial consideration in workplace for worker’s safety.

Jelizaveta Marčenko, Denīze Andrune, Andra Fernāte, Darja Kaļužnaja, Aleksandra Ķeizāne, Jana Mestalo, Marija Burčeņa, Vineta Silkāne, Ivars Vanadziņš, Kristīne Vende-Kotova, Jeļena Reste

Abstract

Objective: This paper explores the accuracy of different tools used to assess daily physical activity levels among office workers. The focus is on comparing objective accelerometer data with subjective self-report diaries.
Materials and Methods: 20 volunteers wore triaxial accelerometers (Axivity) for an average of 4.5 consecutive working days. Sensors were affixed to the neck C7-Th1 level paravertebrally. Accelerometers were configured at a sampling rate of 25 Hz ±4 g. Data was pre-processed using the OMGUI software and translated into activity levels using mathematical transformation steps. In parallel, participants manually completed daily activity diaries to provide subjective data. Statistical analysis of self-reported and accelerometer data was performed using Python. The study was funded by the framework of the Plan of the EU Recovery and Resilience Facility and the State budget (Nr. 5.2.1.1.i.0/2/24/CFLA/005), project “Multidisciplinary approach for the development of the sustainable habit of regular physical activity among sedentary workers”(Nr.RSU/LSPA-PA-2024/1-0013).
Results: Participants were majorly able to correctly identify sedentary activity level (89.3% of reported sedentary activity was confirmed by accelerometer readings), however, only 9% of self-reported moderate activity levels (walking in the park, etc) were reported correctly according to the sensor data. Moreover, none of the intense (intentional exercises, like gym or dance) was self-reported correctly, suggesting that either the location of the sensor was not fit for the purpose of identifying intense activity levels or that people who lead predominantly sedentary lifestyle tend to overestimate intensity of the undertaken activity majorly. Additionally, 10% of self-reported sedentary activity has been identified to be of moderate intensity, suggesting pacing or fidgeting that participants overlook.
Conclusion: Preliminary findings suggest that accelerometer-based measurements provide a more objective and consistent evaluation than self-reported data. Further research should clarify correlations between the tools and inform future workplace monitoring strategies.

Viviane Remy

Abstract

Objective: Musculoskeletal disorders are very common in bus drivers worldwide. This study aimed to develop a tool to allow investigating the contribution of bus-related ergonomic factors in the development and exacerbation of these disorders.
Methods: Drawing inspiration from the job-exposure-matrix approach, we developed a Bus-Ergonomics Matrix (BERM) to classify buses according to their ergonomics. A standardized protocol was used to evaluate 36 ergonomic parameters related to the driver’s workspace, including seat configuration, steering wheel, pedals, and dashboard layout. These parameters were weighted and combined to compute region-specific ergonomic scores (e.g., visual, biomechanical, shoulder girdle, back, upper and lower body) as well as an overall cabin ergonomics score. Scores range from zero to 100, with the higher the score, the more ergonomic the bus. Using Integrated Nested Laplace Approximation (INLA) and measurement data, we predicted ergonomic scores for 705 buses in the Swiss fleet, covering models manufactured between 1970 and 2022. We then assessed individual exposure to ergonomic constraints for 612 bus drivers (13% female, age=47.7 (SD=10.1) years, career duration=11.4 (SD=9.0) years). For this, we crossed-referenced their histories of driven buses with the BERM and estimated annual ergonomic scores.
Results: Drivers reported driving multiple bus models over time, with up to six different buses per year. Ergonomic scores of the Swiss bus fleet improved steadily from 1985 to 2010, especially for the ergonomics of shoulder girdle region. A flat point was reached then, with a negligible improvement over the last decade. Strong correlations were found between global and region-specific biomechanical scores, highlighting consistent exposure patterns across body regions.
Conclusion: The Bus-Ergonomics Matrix provides a unique, objective framework to assess ergonomic constraints in bus cabins, demonstrating improvements over time. Its international applicability makes it a valuable tool for improving drivers’ occupational health globally.

Alex Collie

Abstract

Objective: This study examines trends in adverse working conditions among Australian women in paid employment and identifies the factors associated with adverse working conditions.
Methods: Longitudinal population-based data from the Australian Longitudinal Study on Women’s Health, following a cohort of women aged 18-23 years at baseline (1996) through to ages 40-45 years (2018). Mixed-effect regression examined the factors associated with long working hours and shift work.
Results: The proportion of women working long hours increased from 23.7% in 1996 to 36.1% in 2018. By 2018, women had 1.77 times higher odds of working long hours compared to 1996 (95% CI: 1.58-1.97). Factors associated with long working hours included a degree/higher degree [AOR 1.91, 95%CI, 1.76-2.07] and being non-partnered [AOR 1.45, 95%CI, 1.37-1.53]. The proportion of women engaged in shift work declined from 24.9% in 1996 to 10.1% in 2018. By 2018, the adjusted odds of working shifts were significantly lower than in 1996 [AOR: 0.20 (95% CI: 0.16-0.24)]. Factors associated with a higher likelihood of shift work included blue-collar occupation [AOR 1.41, 95%CI, 1.06-1.33], and holding a degree/higher degree [AOR 1.27, 95%CI, 1.10-1.45].
Conclusion: Between 1996 and 2018, working conditions for a cohort of Australian women of reproductive age changed significantly. There was a notable decline in shift and night work, alongside a significant increase in long working hours. The
Results likely reflect a combination of modified working conditions, women’s career transitions and changes in personal/caring responsibilities. The potential health implications of long working hours require careful monitoring.

Fareed Ahmed

Abstract

There are several activities in supermarkets e.g. lifting products to shelves, stock packing and housekeeping. These repetitive activities can cause injuries including musculoskeletal disorders. The objective of the study was to study the association between work activities and the prevalence of MSDs in grocery stores. The
Results showed that job rotation, pressure during peak hour and prolonged standing showed significant differences between departments. The Deli department shows the highest prevalence of job rotation (79%) compared to other departments; Cashiers report the highest frequency of experiencing pressure during peak hours (60%). In association between work environment and MSDs; not adjusting shelf/storage heights to minimise reaching/stretching shows significant difference risk of leg/thigh pain in the past 7 days (3.189, 95%CI(1.162-8.750)), Task variation frequency to reduce the repetitive strain injuries show leg/thigh pain- past 7 days (3.312, 95%CI(1.170-9.376)); Feeling pressure to work quickly during peak hours caused upper back pain (3.273, 95%CI(1.291-8.299)), lower back pain (2.471, 95%CI(1.028-5.938)) and legs/thigh pain (5.100, 95%CI(1.823-14.267)) in the past 7 days. Feeling a lack of opportunities to take breaks during a shift showed risk of neck pain (3.231, 95%CI(1.130-9.237)) in the past 12 months. Using Step stools or ladders to reach high shelves could prevent neck pain (0.244, 95%CI(0.065-0.909)) in the past 7 days. Work environments present important factors causing risks of MSDs. The findings underscore the importance of tailored ergonomic interventions and workload management strategies to promote a healthier workplace environment. Health prevention strategies should be provided in the workplace to mitigate the risks or work-related injuries.

Stephanie Griemsmann; Ingolf Hosbach; Konstantin Wechsler; Britta Weber; Claudia Clarenbach; Jens Petersen; Birger Neubauer; Rolf Ellegast; Thomas Behrens

Abstract

Objective: This cross-sectional online study examined musculoskeletal pain (MSP) prevalence among German computer workers and its association with working from home (WFH) conditions.
Material and Methods: The online survey was conducted between September 2023 and April 2024 (t1). Current pain and pain experienced before the pandemic in early 2020 (t0, assessed retrospectively) were evaluated using the Brief Pain Inventory for various localizations. Symptoms of anxiety and depression were assessed by PHQ-4. A score for the ergonomic remote workstation equipment (WFH score) was established based on information about seating, table, and electronic workplace equipment. The relationship between WFH and newly developed MSP and worsening of MSP since the pandemic was modeled using logistic regression analyses and adjusted by several confounders.
Results: Data from 1,064 employees with at least four hours of daily computer work were analyzed. A total of 968 participants had worked from home (WFH employees), with a higher percentage at t1 compared to t0 (87% vs. 39%). According to the ergonomic WFH score, 74% of WFH employees had ergonomically well-equipped workstations. The highest MSP prevalence was observed for the lower back (42%) and neck (40%) at t1. WFH employees had a slightly higher risk than office workers for worsening of existing MSP (e.g., neck pain OR 1.62; 95% CI 0.83-3.19). Poorer workstation setups, longer daily screen time, or lack of regular participation in occupational health screenings were also risk factors for MSP. Additionally, more severe symptoms of anxiety or depression were associated with a higher risk of MSP (e.g., worsening low back pain OR 1.20; 95% CI 1.11-1.29).
Conclusion: To prevent MSP, employers should ensure that employees have the knowledge and equipment needed to set up and adjust their workstations according to ergonomic recommendations. They should also encourage regular participation in appropriate occupational health screenings.

Eva-Maria Backé, Michaela Prigge, Claudia Brendler, Carina Pfab, Martha Sauter

Abstract

Objective: Sitting at work contributes to daily sedentary time. Sedentary behavior and physical inactivity increase the risk for adverse health outcomes. Our aim was to systematically review the literature on the effects of working from home on sedentary behavior and physical activity.
Methods: The systematic review includes studies that examined the effects of working from home compared to working at the workplace on objectively measured or self-reported sedentary behavior and physical activity of employees on workdays or during working hours (Prospero: CRD42022349442). Studies identified in PubMed, Embase and SPORTDiscus until May 2024 were independently screened by two or more reviewers and assessed for risk of bias. Random-effects meta-analysis was performed when more than two studies reported
results for similar outcomes.
Results: We included 28 studies (31 publications) comprising 264,901 subjects comparing working from home to the usual workplace. We judged four studies as having a low risk of bias. Sedentary behavior was described in 18 studies and four studies were included in the meta-analysis of sitting time. During working hours, sitting time increased by 22 minutes (95% CI -1 to 45; I2 =55%) when working from home. Physical activity was described in 26 studies and the meta-analysis of four studies found a mean decrease in daily steps of -1660 (95% CI -3609 to 289; I2=87%) when working from home.
Conclusion: We found that sedentary time tended to increase and daily steps tended to decrease when working from home. Studies examining physical activity varied considerably regarding their outcome definitions and analyses. Few studies objectively measured sedentary time or physical activity. Also, pandemic conditions may have influenced the results of most of the studies (n=24). Nevertheless, workplace interventions aimed at reducing sedentary time and increasing movement should incorporate modifications to the home working environment.

Pieter Coenen, Sanja Kezic, Damien M. McElvenny, Faridi van Etten-Jamaludin, Henk F. van der Molen, Jan L. Hoving

Abstract

Objective: Occupational contact dermatitis arises from workplace exposure to irritants or allergens, causing irritant (ICD) or allergic contact dermatitis (ACD). Individual susceptibility, influenced by personal and lifestyle factors, may affect the risk of ICD and ACD. This study aims to identify these susceptibility factors and their impact on the association between work-related exposures and contact dermatitis (CD).
Methods: A scoping review following PRISMA-ScR guidelines was conducted using Medline, Embase, and CINAHL. Included study designs were cohort and case-control studies for all types of CD, and cross-sectional studies for ACD. Forest plots were used to summarize the influence of non-work-related susceptibility factors on the association between work-related exposures and CD.
Results: Twenty-one studies, primarily cross-sectional (n=18), investigated how 44 different individual susceptibility factors influenced the associations between 53 occupational exposures (from six exposure categories) and CD. The non-work-related susceptibility factors were categorized into five categories: demographic (i.e., sex), socioeconomic (i.e., income), personal/family atopic diseases (i.e., atopic dermatitis), lifestyle (i.e., smoking), and exposure outside work (e.g., wet work). Fifteen studies adjusted for concurrent work-related factors. Most studies adjusted for multiple non-work and work-related factors leading to either an increasing or decreasing association between work-related exposure and CD.
Conclusion: While susceptibility factors are often adjusted for, their impact on the association between work-related exposures and CD remains inconclusive, with some factors mitigating or amplifying the risk. The majority of studies account for various work- and non-work-related susceptibility factors, complicating the isolation of their individual contributions. Our review highlights the need for more research on individual susceptibility factors and their effects, harmonizing adjustment factors, and achieving consensus on differentiating ICD and ACD for effective prevention strategies.

Francesca Sellaro , Enrico Oddone , Roberta Pernetti , Giuseppe Taino , Marco Cravero , Davide Baldi , Rachele De Giuseppe , Hellas Cena , Matteo Manuelli , Elena Grignani , Paolo Sacco , Carlo Gaetano , Veronica Barbi , Mario Rotondi , Laura Croce , Francesca Coperchini , Stefano Massimo Candura

Abstract

Objective: Outdoor workers (OWs) in urban environments are chronically exposed to air pollutants during working hours, raising concerns about potential early biological changes and long-term health risks. Within the IDEA project—part of the National Biodiversity Future Center (NBFC)—this study aims to evaluate early inflammatory, metabolic, endocrine, and epigenetic effects of urban exposure in OWs compared with indoor administrative workers (IAWs), who are not occupationally exposed to outdoor pollutants.
Material and Methods: A total of 67 workers from Pavia, Italy, were enrolled: 21 OWs (municipal police officers) and 46 IAWs. Personal exposure to benzene, NO₂, and SO₂ was assessed using passive samplers (Radiello®) worn for five consecutive workdays. Blood samples were collected for routine biochemical analyses (including nutritional status), inflammatory cytokines (CCL2, CXCL8, CXCL10), and thyroid function (TSH, fT3, fT4, autoantibodies). Structured questionnaires gathered data on occupational history, lifestyle, and dietary habits.
Results: OWs showed higher mean benzene exposure (3.5 µg/m³) than IAWs (2.0 µg/m³), exceeding the 2030 EU target (3.4 µg/m³). NO₂ levels were slightly higher in IAWs (23.4 µg/m³) than in OWs (20.1 µg/m³), while SO₂ levels were low and comparable. Despite overall compliance with current regulatory limits, OWs exhibited significantly higher median values of erythrocytes, hemoglobin, hematocrit, vitamin B12, vitamin D, and fT3. Although within normal ranges, these differences may indicate early biological responses to outdoor occupational exposure. Inflammatory cytokine levels did not significantly differ between groups.
Conclusion: These preliminary
Results highlight the usefulness of an integrated exposomic approach combining personal monitoring and biomarker analysis. Ongoing recruitment and upcoming epigenetic analyses—including the epigenetic clock—will help estimate the impact of urban exposure on biological aging and chronic disease risk. Project funded by the European Union – NextGenerationEU under Italy’s NRRP, Mission 4, Component 2, Investment 1.4 (Call No. 3138/2021, Decree No. 3175/2021, MUR). Award: CN_00000033, Decree No. 1034/2022, CUP: F13C22000720007, “National Biodiversity Future Center – NBFC”.

Brad Alan Racette; Luis F Gonzales-Cuyar

Abstract

Background: Chronic exposure to manganese (Mn) has been associated with neurological dysfunction, but the neuropathological effects are not well understood. South Africa has 80% of the world’s Mn reserves and a large mining workforce exposed to Mn.

Objectives: We investigated differences in cell counts in the brains of deceased South African Mn-exposed and -unexposed mineworkers, and associations between cell counts and duration of exposure.
Methods: Postmortem brain tissue from 35 mineworkers from the Northern Cape province of South Africa (23 Mn-exposed, 12 -unexposed) was obtained with next-of-kin consent. Astrocytes and neurons in striatal regions (caudate, putamen, globus pallidus internus, and globus pallidus externus) were quantified using validated, reproducible stereological methods. Multiple linear regression analysis was used to compare cell counts between exposed and non-exposed mineworkers, and to assess the association between duration of Mn exposure and cell counts.
Results: Median age at death was 53 and 60 years for Mn-exposed and -unexposed mineworkers, respectively. Duration of employment (Mn exposure) ranged from 0.4 to 39.7 years (median 15.7 years) in the Mn mine workers. Astrocyte counts were significantly lower in the caudate of Mn-exposed than -unexposed mineworkers (p=0.025), with inverse associations between duration of Mn exposure and astrocyte counts. Neuronal counts showed similar trends. There was a strong inverse association between duration of Mn exposure and astrocyte count in the caudate (p=0.005) and a trend toward an inverse association in the putamen, globus pallidus internus, and globus pallidus externus. There was a strong trend toward lower neuronal cell count in the caudate, but not in the other striatal regions.
Conclusion: Mn exposure appears to be associated with region-specific reduced astrocyte and neuronal cell counts. These findings support the neurotoxic effects of occupational Mn exposure.

Florencia Harari, Klara Midander, Anneli Julander, Sandra Johannesson

Abstract

Objective: Lithium-ion batteries (LiB) are essential for electrification needed to achieve the climate goals, thus large-scale LiB manufacturing and recycling facilities are emerging globally. This pilot study aimed at characterizing metal exposure through air, skin and biomonitoring at a new recycling facility of LiB from electric vehicles.
Material and Methods: Biomonitoring (blood, plasma and urine) was performed in 16 employees at two time points: baseline (before start of production) and follow-up (four months later). Among these, five workers (from separation and sorting n=3, storage n=1, and maintenance n=1) were selected to perform exposure assessment through air using personal air samplers for inhalable dust, through skin by acid-wipe sampling, and biomonitoring (pre- and post-shift and pre-shift one day later). All samples were analyzed for lithium, nickel and cobalt, by inductively coupled plasma mass spectrometry.
Results: Airborne metal concentrations exceeded occupational exposure limits for all three workers in separation and sorting (work-shift averages, in µg/m3: lithium 17-78, nickel 85-351, cobalt 25-117). Direct reading particle instruments showed high peak exposures of dust during specific work tasks. Inhalable metal concentrations were low among storage and maintenance workers. Nickel (0.002-0.3 µg/cm2) and cobalt (0.001-0.1 µg/cm2) were detected on the hands of the five workers. Among the 16 workers, metal concentrations in blood, plasma and urine were low, similar to those found in the general population.
Conclusion: Low metal concentrations in biological samples among workers in sorting and separation, where metal dust was elevated, suggest effective use of powered air purifying respirators. Sensitizing metals were detected on skin of all workers, in some cases at ranges that trigger eczema in sensitized individuals. Efforts to reduce metal emissions at the sources are needed.

Patrick Hinton, Katherine Pullella, Joanne Kim, Daniel R. S. Middleton, Tracy Kirkham, Victoria Arrandale, Nathan DeBono

Abstract

Objective: Perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) are two perfluoroalkyl substances (PFAS) widespread in industrial applications and consumer products. However, evidence substantiating occupations with elevated exposure is limited. The recent IARC classification of PFOA as carcinogenic has prompted concern about occupational exposure to PFAS for cancer prevention, particularly among women. We investigated the association of occupation and industry of employment with serum PFOA and PFOS biomarker concentrations in a national survey of Canadian adults, with a specific focus on exposure in female workers.
Methods: We conducted a cross-sectional study of 5,795 participants in four cycles of the Canadian Health Measures Survey between 2007-2011 and 2016-2019. Linear regression models adjusted for demographic, diet, and environmental factors were used to estimate predicted geometric means (GM) and geometric mean ratios (GMR) of PFOA and PFOS concentrations among workers in 137 occupation and industry groups, overall and stratified by sex.
Results: PFOA and PFOS concentrations were higher among participants who were older, male, East/Southeast Asian, urban residents or seafood consumers. Concentrations declined in successive CHMS cycles. By occupation, PFOA was elevated among workers in health services (GMR-PFOA 1.25; 95%CI: 1.10–1.43); labourers in processing and manufacturing; front-line protection services; and harvesting and landscaping labourers. Among women, predicted PFOA levels were also elevated in electrical and construction trades; and technical health occupations. For PFOS, aside from health-related occupations,
Results were similar. By industry, concentrations were elevated among workers in ambulatory care services (GMR-PFOA 1.12; 95%CI: 1.02–1.24) and clothing manufacturing (GMR-PFOS 2.22; 95%CI: 1.39–3.57).
Conclusion: Occupational and sex-based differences in PFOA and PFOS exposure are evident, with elevated exposure identified for workers in specific occupations, including health and manufacturing. Further research will examine exposure to other PFAS as well as associations with cancer risk. This research was supported by the Canadian Cancer Society.

Valérie Bouchart, Yolaine Guérin, Stéphanie Lagadu, Claire Lopez-Piffet, Pierre Lebailly, Raphaël Delépée

Abstract

Objective: Occupational agricultural exposures have already been associated with numerous diseases in epidemiological studies involving large cohorts. More precisely, cancers such as prostate cancer and non-Hodgkin lymphomas are strongly linked to pesticides use, particularly in agricultural environments. However, although these exposures have been studied epidemiologically, the biological plausibility of the link between such exposures and cancer development has not been firmly established. One of the mechanisms proposed by the French national institute of health and medical research to explain cancer onset associated with occupational agricultural exposures involves epigenetic modifications. These modifications are also usually associated with other diseases and are known to be influenced by environmental exposures. The Objective of this project was therefore to investigate the biological plausibility of the association between occupational agricultural exposures and cancer onset by evaluating the effect of these exposures on epigenetic modifications of DNA derived from granulocytes.
Material and Methods: A quantification method for 5-methylcytidine (5mC) and 5-hydroxymethylcytidine (5hmC) by liquid chromatography coupled with tandem mass spectrometry was developed. This method allows the quantification of global scale DNA methylation and hydroxymethylation by quantifying 5-methyl-cytidine and 5-hydroxymethyl-cytidine. It was then applied to 539 samples from a French agricultural biobank. Accompanying questionnaires provided information on health determinants, psychosocial parameters, and agricultural exposures for each individual. Univariate analyses were performed on each parameter, followed by the construction of multivariate models.
Results: These models revealed the impact of various exposures on DNA methylation. Health determinants, psychosocial parameters and agricultural exposures both showed an impact on DNA global methylation. Concerning agricultural activities, pesticide use, agricultural equipment maintenance, milking, rodenticide use, and hormone use were shown affect global epigenetic modifications in individuals within the final multivariate models.
Conclusion: The highlighted occupational agricultural tasks were associated with an increased cancer risk in epidemiological studies, particularly AGRICAN.

Soumya, Roy & Joanna, Brooks

Abstract

Objective: Our Objective was to assess the preferences for Total Worker Health intervention modes to improve the health and well-being of workers in U.S. nursing homes.
Materials and Methods: In spring 2025, a census of nursing homes in four midwestern U.S. states, Kansas, Iowa, Nebraska, and Missouri, was taken. Information about the nursing homes, including those with fewer than 30 beds and those in rural areas, was used to survey Directors of Nursing using a multi-mode survey. The survey is in the field but will be completed by June 2025.
Results: Overall, DONs were responsive to the survey and reported levels of best practices for worker health and well-being. Results from the discrete choice experiment about intervention modes are forthcoming. Data analysis and the final survey contacts are ongoing.
Conclusion: Conclusions will be updated once the final data analysis is complete. Funding for this work was provided by the Healthier Workforce Center of the Midwest (NIOSH -U19OH008868).

Chiara Abela, Mattia Roberto Nocilla, Andrea Montagnani, Anna Bordignon, Stefano Mattioli, Angela Gambelunghe, Maria Grazia Gnoni, Diego De Merich, Stefania Curti

Abstract

Objective. Evaluating the effectiveness of preventive interventions is of paramount importance to set up efficient occupational safety and health (OSH) programs. Leading and lagging indicators can be used to monitor and improve health and safety at the workplace. The aim of this study is to provide a list of indicators for monitoring and evaluating the effectiveness of OSH interventions.
Material and Methods. This study is part of the project BRiC 2022–ID01 – funded by the National Institute for Insurance against Accidents at Work (INAIL, Italy) – which is aimed at developing a dashboard of indicators for preventing workplace injuries and illnesses. We will perform a scoping review of the literature (MEDLINE, Scopus, Web of Science), including peer-reviewed journal articles and grey literature (e.g., reports from agencies and conference proceedings). Leading and lagging indicators will be categorized according to type and predefined dimensions.
Results. Leading indicators measure events leading up to injuries, illnesses, and other incidents revealing emerging issues related to OSH. On the other hand, lagging indicators measure the occurrence of events in terms of number/rate of injuries, illnesses, and fatalities. Among others, leading indicators include the proportion of workers attending and completing safety training, the number of scheduled inspections and the types of hazards identified. Lagging indicators comprise a variety of metrics such as the number of near misses and the proportion of workdays lost due to occupational injuries/illnesses.
Conclusion. The combination of leading and lagging indicators can play a crucial role in preventing fatalities, injuries, and illnesses at work. The integration between proactive and reactive approach helps identifying critical areas and key factors for monitoring the effectiveness of OSH programs in the long term. Leading and lagging indicators are valuable tools that can be used to create a safe and sustainable workplace.

Esmee Bosma, Karin I. Proper, and Bette Loef

Abstract

Objective Despite the large body of research on interventions aimed at preventing sick leave, the evidence is scattered and a comprehensive overview is lacking. Therefore, this scoping review of reviews aimed to provide an overview of evidence-based interventions to prevent sick leave.
Material and Methods Embase and PsycInfo were systematically searched. A review was included when at least one of the included original intervention studies fulfilled three criteria: 1) target group was active workers not on sick leave, 2) sick leave was studied as outcome, and 3) the intervention was evaluated using a controlled design.
Results were descriptively summarized and grouped based on sick leave cause and intervention type. Furthermore, the effectiveness of the studied interventions in preventing sick leave was reported.
Results Twenty-eight reviews were included. Eight reviews focused on preventing sick leave due to physical health problems, ten on mental health problems, and ten on all-cause sick leave. Overall, the reviews identified a lack of effective interventions to prevent sick leave. However, multi-component interventions consisting of both individual and environmental components aimed at workers’ lifestyle and mental health were promising to prevent sick leave in the general working population).Certain specific interventions targeting workers at risk were effective, such as cognitive behavioral therapy programs for workers with anxiety and depression. Lastly, exercise programs were most effective in preventing sick leave due to physical health problems (e.g. low back pain prevention).
Conclusion This scoping review identified reviews on sick leave prevention across a broad scope of health problems, types of interventions, and target groups. Although a few types of effective interventions for preventing sick leave were identified, the included reviews indicate a limited availability of effective interventions. This partially stems from insufficient evidence, raising the need for more randomized controlled trials with long-term follow-up including sick leave as outcome.

Belackova L, Verbeek JH, Hoving JL, van der Molen HF, Gagliardi D, Curti S, Hulshof CTJ, Scheepers PTJ

Abstract

Introduction: Asbestos exposure can lead to asbestos-related occupational diseases. Two reviews were performed to evaluate risk reduction, namely legal banning (LB), and personal protective equipment (PPE).
Methods: For LB we searched MEDLINE, Embase and websites of the US and British Geological Survey as well as the International Ban Asbestos Secretariat. Time trend of production, import and export of asbestos among workers or the general population were compared before and after a partial or full asbestos ban. Included PPE studies measured asbestos concentration outside and inside PPE, considering outside concentration as a surrogate for no PPE.
Results: The effects of LB on asbestos consumption are heterogenous. The most consistent decrease occurred five years before introduction of a partial ban. There were only small changes after the implementation of a full ban. The effect sizes for LB decrease in later decades, e.g. the Dutch consumption to zero after full ban. Almost all types of studied respiratory PPE inside measurements complied with the current EU limit of 0.1 f/cm3 regardless of the asbestos concentration in the environment. Only respiratory protective equipment with a clean air supply reduce workers’ exposure to asbestos to below the proposed European occupational exposure limit of 0.01 fibres/cm3 air. Discussion: Both LB and PPE are potential effective preventive measures in terms of primary prevention. LB seems to mark the end of a period of anticipation on total asbestos banning and public discussion. However, the risk of bias was high for all countries because the introduction of the ban could not be separated from other factors that affected the time-series other than banning asbestos. To increase the confidence of the evidence in PPE effectiveness, there is a need for larger studies that also measure potential confounders such as risk perception and fit testing.

Chloé Charlotte Schröder, Stefanie K. Kösling, Uwe Rose, Peter Kujath, Manfred Giersig, Nina C. Reichelt, Janette Nestler, Heiko U. Käfferlein, Claudia Drossard

Abstract

Objective: Diisocyanates (DI) are crucial in producing polyurethane-based materials but can cause respiratory diseases like work-related DI asthma, affecting a four-digit range in the EU annually. In 2016, Germany proposed a new approach within the EU-wide regulation on chemicals (REACH), including mandatory training for employees on the safe handling of DI. The EU implemented this regulation in 2023 to enhance worker health and safety. To scientifically monitor and evaluate this new regulation an epidemiological study was planned.
Material and Methods: At first, a feasibility study was launched in 2018 as part of a large cooperative project involving various organisations. The aim was to recruit enough companies with approximately 1,500 DI-exposed employees (+ 200 non-exposed controls) but also to design the main study. Participating organizations, including accident insurance institutions and manufacturer associations, promoted involvement among companies. Interested companies were visited and further informed by conference calls, whereas the employees were informed through the company’s occupational health practitioner.
Results: Within the feasibility study 35 companies with >1,300 DI-exposed employees agreed to participate. A 5-year prospective cohort study will assess exposure to DI and related health effects while an embedded cluster-randomized trial with wait-listed control groups will test the effectiveness of the training measures in terms of exposure reduction. In 2022, 29 companies remained, of which 26 were randomised for the intervention. The field phase began in 2023 with 28 company sites visited since then, including 15 in the intervention part.
Conclusion: The preparatory phase, supported by institutional collaboration, successfully established a nationwide sample of isocyanate-using companies for a 5-year cohort study. The combination of interventional and observational study designs can answer research questions and exemplify for an evidence-based regulation in European chemical safety.

E.C. de Zoete, L. Kokai, H. Jilani, K.W. Binder-Olibrowska, D.A. Lucassen, M. Mensink, E.J.M. Feskens, H.M. Lammers-van der Holst,

Abstract

Introduction Night-shift work leads to disruption of an individual’s usual sleep-wake and light-darkness patterns leading to problems with maintaining healthy lifestyle behaviors and to circadian misalignment. Consequently, night-shift work is associated with increased BMI and a higher risk of (abdominal) obesity. Previous behavioral interventions in night-shift workers have shown modest improvements in health, but no combined lifestyle intervention (CLI) has yet been implemented for shift workers. Therefore, the SHAPE-study proposes an evidence-based CLI to promote behavior changes in four lifestyle domains (sleep, diet, physical activity, and stress management) amongst night-shift workers, in order to reduce and prevent obesity, and improve metabolic health.
Methods/
Results In this intervention study (pre-post design), 400 night-shift workers in Europe will undergo a 24-week CLI, following a run-in period. The CLI targets improvements in the four lifestyle domains mentioned above, and is grounded in the Integrated Behavior Change (IBC) model, which incorporates both volitional and automatic processes to support sustained behavior change. Participants will be randomly allocated into two groups, each having a different sequence of the lifestyle domains to control for possible ordering effects, where they receive lifestyle advice and behavioral change techniques throughout a mobile app and hybrid workshops to promote peer support. Measurements will be done at baseline and follow-up after 3, 6 and 12 months. The main expected outcomes are behavioral changes in sleep quantity, diet quality, physical activity, and perceived stress, which will analyzed with mixed models. Discussion/
Conclusion Night-shift work is prevalent and difficult to limit in our 24/7 society, yet there is currently limited evidence on effective combined lifestyle interventions to prevent negative health consequences in a real-life context. The SHAPE-study will contribute to this need by evaluating the effects of a promising evidence-based CLI aimed at behavior change to improve metabolic health amongst night-shift workers.

Lützen Portengen, Remko Houba* and Hans Kromhout

Abstract

Objective: Occupational exposure to respirable crystalline silica (RCS) is a well-established risk factor for lung cancer. Exposure to RCS however is still very prevalent and will not be easily phased-out. Though exposures are better controlled, health gain from these interventions remains unknown. To estimate the number of lung cancer cases prevented as a result of controlling exposure to RCS over two decades in an entire European industrial-sector.
Materials and Methods The Industrials Minerals Association Dust Monitoring Program (IMA-DMP) focused on lowering exposure to RCS. The IMA-DMP database was used to estimate cumulative RCS for the IMA cohort of approximately 75,000 workers. A simulation model was used to estimate the number of lung cancer cases for two scenarios: one without intervention with a Geometric Mean exposure of 14µg/m3 throughout the entire period and one where exposures declined over time (intervention).
Results Our study included 44,435 RCS measurements, for which we estimated a 4.5% decrease per year over the period 2002-2022. The estimated number of lung cancer cases prevented during this period totaled about 3 cases (2.4% of the total number of lung cancer cases attributable to silica exposure and 0.3% of the total number of lung cancer cases that would have occurred without the intervention). Estimated GM exposure levels in the cohort at the end of follow-up were estimated to be 60% lower than at the start, while GM cumulative exposures were 28% lower.

Conclusions The results show a relatively small number of prevented lung cancer cases resulting from an industry-wide dust monitoring program. This is likely to be due to the relatively young age of the cohort and the limited follow-up. However, given that there is no threshold below which lung cancer will not occur there is a need to continue the IMA-DMP and lower (future) workers’ cumulative exposure in order to preserve workers’ health and life.

Paulo Sergio Panse Silveira, Alberto Jose Niituma Ogata, Rodrigo Bornhausen Demarch, José Oliveira Siqueira

Abstract

Objective: To propose and test psychometric models that establish direct, cross-lagged, and reciprocal longitudinal relationships between burnout, depression, and anxiety among occupational physicians during the COVID-19 pandemic.
Methods: This short-term prospective cohort study employed repeated online questionnaires at three time points (T1: Oct 2020–Jan 2021; T2: May–Sep 2021; T3: Nov 2021–Jan 2022). A convenience sample of occupational physicians was recruited through professional networks and scientific associations. Instruments included a sociodemographic questionnaire, the Stanford Professional Fulfillment Index (PFI) and the Depression, Anxiety, and Stress Scale (DASS-21) questionnaires. Path analysis with Reciprocal Cross-Lagged Panel Models (RCLPM) was used to assess dynamic, bidirectional relationships among the psychological variables over time, controlling for age, sex, and years of practice. Three panel models were specified with burnout, anxiety, or depression as the central construct to determine which configuration provided the best fit to the observed data. IBM SPSS AMOS 24 was used for analysis.
Results: Of 540 participants, 124 completed all waves; 435 participated in wave 1, 220 in wave 2, and 265 in wave 3. Most participants were women, with similar age and work experience across waves. Burnout levels declined from T1 to T2 and remained stable in T3. Depression and anxiety scores showed a consistent decrease over time. The three panel models demonstrated significant reciprocal cross-lagged effects between variables, with feedback loops indicating mutual reinforcement across waves. Anxiety emerged as a particularly influential factor over time. Model fit indices supported the robustness of the models. Stability indices suggested a tendency toward psychological stabilization over time.
Conclusion: Burnout, depression, and anxiety are reciprocally interrelated and evolve dynamically over time among occupational physicians. Burnout appears central to these interactions. The findings highlight the need for integrated strategies addressing individual and organizational contributors to mental distress, especially in crisis contexts like the pandemic.

Mariem.Mersni, Imen Youssef, Najla Mechergui , Hanen Ben Said , Nesrine Chaouech, Dorra.Brahim, Ghada Bahri, Siwar Chemingui Mejda Bani, Nizar.Ladhari

Abstract

Introduction : Absenteeism due to psychiatric illness represents a major issue in the civil service sector, both in socio-professional and economic terms.
Methods: This was a retrospective descriptive study that included public service workers referred to the Commission Médicale de Contrôle de l’Absenteisme, implemented in the Occupational Medicine Department of the Charles Nicolle Hospital and composed of psychiatrists and occupational physicians. This study was carried out over the period from August 2022 to November 2024. The estimate of the direct cost of absenteeism linked to long-term sick leave for psychiatric reasons was based on the number of days of sick leave prescribed by the attending physician and on the average net monthly salary per professional categor
Results: We collated 1875 workers referred to the Medical Commission for the Control of Absenteeism. The mean age of the consultants was 46.1±16.96 years. The sex ratio (M/F) was 0.31. The majority (82.8%) worked in the health sector. The most common occupations were nurses (27.7%) and manual workers (19.8%). The average length of service was 16.96±10.34 years. The most common psychiatric illnesses were anxiety-depressive disorders (85.5%), bipolar disorders (5.8%) and schizophrenia (1.8%). The average number of days absent from work over the previous 12 months was 62.74±44.27 days. The factors leading to the decompensation of psychiatric illnesses were linked to a pathological state of health in 35.4% of cases, social factors in 33.4% and occupational factors in 29.9% of cases. The average overall cost of illness related to absenteeism was 1,692,606.09 $ (USD) with an average cost of 930.91$ (USD) per worker.
Conclusion : The direct cost of absenteeism was significant . Prevention, based on early detection of psychiatric illness and improved working conditions, is the best strategy for reducing expenditure.

Maël Quatrevaux, Thierry Rochereau, Isabelle Niedhammer

Abstract

Objective: Despite the abundant literature on the associations between psychosocial work factors and mental health outcomes, prospective studies using medico-administrative data are lacking. Our objective was to study the associations between various psychosocial work factors and subsequent psychotropic drug prescription.
Material and Methods: The study was based on data from the three waves (2010, 2012, 2014) of the French ESPS survey (Enquête Santé et Protection Sociale) linked to the national database of healthcare reimbursements. Each survey wave was conducted among a randomly selected national sample of people aged 18+, and a subsample was interviewed twice (2010 and 2014). A total of 8094 workers free of depression at baseline were included. Ten psychosocial work factors (quantitative demands, tensions with the public, freedom, possibilities for learning new things, colleague support, recognition, salary satisfaction, job insecurity, permanent/temporary contract, and redundancy plan) were assessed at baseline. The outcome was psychotropic drug prescription within the 2 following years. As 1086 of these workers participated twice, Cox regression models for clustered data were used to assess the associations between psychosocial work factors and psychotropic drug prescription, after adjustment for age, marital status, employee/self-employed worker, private/public sector, occupation, full/part‐time work, and survey wave.
Results: Most psychosocial work factors, except possibilities for learning new things, job insecurity, and permanent/temporary contract, were associated with subsequent psychotropic drug prescription. The number of psychosocial work factors increased the risk of psychotropic drug prescription. No gender interaction was found for these associations. Associations were observed for antidepressants, anxiolytics, and hypnotics/sedatives.
Conclusion: The findings support that poor psychosocial working conditions may increase the risk of psychotropic drug prescription. Funding: The French National Research Program for Environmental and Occupational Health of Anses (ANSES-23-EST-041)

Igor Portoghese , Sergio Pili , Alessandro Murru , Nicola Mucci , Marcello Campagna

Abstract

Objective: Total Worker Health Approach (TWH) recommends integrating prevention of occupational risk factors and active promotion of healthy behaviours. There is vast evidence showing that psychosocial working conditions, such as high job demands (JD) and work-family conflict (WFC) are associated with unfavourable lifestyle factors, such as physical inactivity. We tested a moderated mediation where the relationship between JD and physical activity is mediated by levels of WFC, while the relationship between JD and WFC is moderated by job control (JC), adjusted for age and job tenure.
Materials and Methods: a total of 927 workers of a military flight security company completed a survey composed of different measures: work family conflict (5 items); job demands (8 items); job control (5 items); level of physical activity performed (FIT index); personal and occupational data such as age, body mass index, job seniority and job tasks. To test the moderated mediation model, hierarchical regression analyses were performed using the PROCESS macro for SPSS software.
Results: The results showed that WFC significantly mediated the relationship between JD and physical activity. Job control showed a moderation effect on the relationship between JD and WFC. Furthermore, the indirect effect of JD on physical activity via WFC is weaker when JC is high rather than when it is low. Age, but not job tenure was significantly associated with physical activity (p=0.0001, p=0.089, respectively). While they have an opposite effect on WFC, that increases with age, (beta=0.081; p=0.014) but decreases with job tenure (beta=-0.062; p=0.047).
Conclusion: The results have implications for both management and organizations. The promotion of physical activity among workers should consider reducing job demands and facilitating work-life balance by enhancing job resources, such as job control. This TWH approach could provide a contribution to the reduction of physical inactivity and promote better health and wellbeing of workers.

Samir El Jaafari, Younes Filali-Zegzouti

Abstract

Objective: Burnout is a work-related stress syndrome resulting from chronic exposure to job stress which can interfere with dentists’ own wellbeing. This study aims to investigate burnout among dentists in the Fes-Meknes region, Morocco, and to identify associated factors using the Maslach Burnout Inventory (MBI).
Material and Methods: A questionnaire comprising sociodemographic information, professional experience and work-related stress factors was completed by 105 dentists. Burnout was measured using the French version of the Maslach Burnout Inventory. Chi-square tests examined associations between burnout dimensions and sociodemographic and occupational factors.
Results: Illegal dental practice (17.01%), management of complex cases (16.12%) and patient-dentist relationship (15.82%) were the primary sources of occupational stress reported by participants. 62.86% of our study population experienced burnout according to Maslach Burnout Inventory, of which 7.62% experienced high levels of burnout. Burnout level showed no significant association with gender, age, family situation, and work characteristics (years of experience, hours worked per day, number of patients seen per day). However, significant associations were found between specific dimensions of burnout as measured by the MBI and certain factors: depersonalization was significantly associated with dental laboratory-dentist relationship (X2 (2, N = 105) = 6.85, p = 0.032), emotional exhaustion with dental practice management (X2 (2, N = 105) = 8.66, p = 0.013), and personal accomplishment with years of experience (X2 (2, N = 105) = 7.14, p = 0.028).
Conclusion: This study provides valuable insights into the prevalence of burnout and work-related variables that increase the probability of suffering burnout among dentists in the Fes-Meknes region. Addressing these factors could potentially help in mitigating burnout and improving overall well-being among dentists. Further studies are needed to understand the specific mechanisms through which these factors contribute to burnout.

Elena Triantafillopoulou, Vaughan Parsons, Timothy Matthews, Louise Arseneault

Abstract

Concern around the health and economic impact of workplace loneliness has grown in recent years, with a recent report from the UK All Party Parliamentary Group on Tackling Loneliness and Connected Communities calling for employers to tackle loneliness within their organizations. While a recent systematic review has highlighted cross-sectional associations between workplace loneliness and poor wellbeing and occupational functioning (Bryan et al. 2023), no previous studies have directly investigated whether workplace conditions elevate or reduce a worker’s risk of feeling lonely. The health and occupational consequences of workplace loneliness are also not well established (Wright & Silard 2021). This study was conducted to identify work-related and individual risk factors for workplace loneliness and investigate the impact of loneliness on workers’ health and occupational functioning. In-depth semi-structured interviews with 31 UK based workers about experiences of social connection and loneliness at work. Participants from a broad range of occupations, ages and demographic backgrounds reported that loneliness was a significant part of their working life. A combination of individual factors and aspects of the work environment were described as eliciting or preceding feelings of loneliness. Participants also reported that workplace loneliness impacted their mental health, psychological wellbeing and performance at work. Overall, our findings highlight the impact of workplace loneliness on workers’ health and wellbeing. Our
Results also point to the role of the aspects of the work environment that increase risk of loneliness in staff, which can inform strategies to address workplace loneliness.

Merel Schuring, Helena Pardina Torner, Carlos Campos Rodriguez, Alex Burdorf.

Abstract

Objective: This systematic review aims to examine the effectiveness of self-management interventions and their components on mental, health-related, and work-related outcomes of workers with mild-to-moderate depressive symptoms across various work sectors and settings.
Material and Methods: Systematic review of randomized controlled trials of single and multiple component self-management interventions to assess their effects on depression, anxiety, health-related, and work-related outcomes among employees, conducted according to Cochrane guidelines. Work sectors included employees from the construction, public, and healthcare sectors, as well as employees from cross-sector settings and the information and technology industry. Intervention types were analysed across seven categories based on organisational and individual-level component descriptions. The seven categories included psychological interventions, mind-body therapy, lifestyle management, social environment, physical exercise, general education and information provision, and organisational and workplace modifications.
Results: A total of 32 single-component and 39 multi-component interventions were included out of 4450 records. Cognitive behavioral therapy components were found to be an essential component of effective multi-component interventions, followed by mind-body and lifestyle management components. Social environment, physical exercise, and general education components appear most useful as part of a multi-component intervention. Current research remains limited, offering little attention to the diversity of work sectors and the role of organisational or workplace modification components from the perspective of worker self-management.
Conclusion: Findings indicate that multi-component self-management interventions are more effective than single-component interventions. Future research should prioritize designing multi-component interventions that integrate effective components tailored to the self-management needs of employees across diverse work sectors.

Nancy Angeline Gnanaselvam; Bobby Joseph

Abstract

Background: Mental health at the workplace has less established causal models, especially for issues like depression, anxiety and stress at work.

Objectives: To assess the effect of the geographical location of the factory on depression, anxiety and stress of garment sector workers in South India. Methodology: An explanatory sequential approach mixed
methods study was conducted in garment factories located in 5 different districts of South India. A semi-structured questionnaire with socio-demographic details and the DASS-21 (Depression, Anxiety, Stress Scale) for mental health was developed for quantitative data collection. Inferential statistics was done with regression models. In-depth interviews were conducted among selected participants, and thematic analysis was done.
Results: A total of 1042 workers were interviewed. The geographical distribution of the study participants was 46% from Tirupur, 27% from Bengaluru, 10% from Krishnagiri – Hosur, 10% from Dindigul – Karur and 7% from Chennai. Prevalence of depression, anxiety and stress was 13.5%, 10.1% and 20.1%, respectively. Building a regression model for each of the mental health parameters with location as a predictor, adjusting for other variables and Bengaluru (better mental health) as a reference category, Chennai had 2.87 times the risk for Depression, 10.48 times the risk of Anxiety and 1.3 times the risk for Stress. The in-depth interviews resulted in 4 major reasons for the mental health issues concerning location: the presence of other factories in the vicinity as competition, more time in commute, lack of work throughout the year, and unavailability of other job opportunities.
Conclusion: Depression, Anxiety, and Stress prevalence vary across different cities of the factory location within South India. The geographical location, along with the various factors that characterise a city, plays a role not just in the business end of things but also in the employees’ mental health. Factors like clustering of factories, long commute, and unavailability of work throughout the year directly affect the mental health of employees. Funding: Primark under ABF – Associated British Foods, London, towards Mental Health programs in the supply chain

Emanuele Maria Giusti , Giovanni Veronesi , Rossana Borchini , Guido Grassi , Giancarlo Cesana , Marco Mario Ferrario

Abstract

Objective. To investigate the association between high job strain (high-JS) and all-cause and cardiovascular (CVD) mortality over a long period in Northern Italian population- and worker-based cohorts, overall and across occupational classes.
Material and Methods. We studied 9554 workers aged 30-59 years (55% females), recruited from 1986 to 1994 and followed-up for 25 years. Risk factors assessment followed WHO-MONICA protocols. Death certificates were retrieved to identify all-cause and CVD deaths. Occupational classes (OC) were aggregated as “managers/proprietors” (MP), “non-manual” (NW), and “manual” (MW) workers. The Job Content Questionnaire (JCQ) scores were used to classify workers for high-JS. Generalized linear models were used to estimate sex- and age-adjusted mortality rates, Cox proportional-hazards models to estimate sex-, age-, occupational class-, previous CVD-, and major CVD risk factors-adjusted Hazard Ratios (HR) for high-JS (non high-JS as reference) exposure overall and, based on interaction test, across OCs.
Results. A total of 794 all-cause and 176 CVD deaths occurred in a median follow-up of 23 years. All-cause mortality rates across JCQ categories ranged from 2.50 events/1000 py (active) to 3.31 (passive), CVD mortality rates from 0.51 (low-JS) to 0.71 (high-JS). In the adjusted Cox models, high-JS was not associated with all-cause mortality (HR; 95%CI: 1.06; 0.91-1.25) but showed a significant association with CVD mortality (1.46; 1.04-2.04). The OCs showed similar all-cause mortality rates (MP=3.50/1000 py, NW=2.37, MW=2.96; p=0.14) but different CVD mortality rates (MP=0.94/1000 py, NW=0.42, MW=0.60; p=0.04). The HRs for high-JS were consistent across OCs for CVD mortality: the interaction term was not significant (p=.66).
Conclusion. Exposure to high-JS has a long-term association with CVD mortality, going beyond the working period. This association is consistent across OCs. Interventions addressing workplace psychosocial stressors are warranted.

Renata Santos Tito, Henrique Gomes de Andrade, Patricia Campos Pavan Baptista

Abstract

Objective: To analyze the association between nursing workers’ perception of organizational support and the organizational climate in a specialized hospital setting.
Methods: This exploratory, cross-sectional study employed a quantitative approach and included 693 nursing professionals working at a cardiology-specialized hospital in São Paulo, Brazil. Data were collected through a Sociodemographic Questionnaire, the Organizational Climate Scale for Health Organizations, and the Organizational Support Scale. Statistical analyses included descriptive and inferential methods.
Results: The sample was predominantly female (85.3%) and relatively young (48.8% aged under 35). Over half of the participants (54.5%) had ten or fewer years of professional experience, and 65.5% worked day shifts. The overall organizational climate score had a mean of 3.49, indicating a fair to good evaluation. The dimensions with the lowest scores were Compensation (mean = 3.01; SD = 1.15) and Strategy (mean = 3.02; SD = 1.01). Regarding perceived organizational support, the overall mean was 2.90, suggesting a fair level of support. The lowest scoring items included: “the company is more concerned with profits than with employees” (mean = 2.51; SD = 1.26) and “the company shows willingness to expand its facilities to better utilize workers’ skills” (mean = 2.60; SD = 1.24). A strong and statistically significant positive correlation was identified between organizational climate and perceived organizational support (p < 0.001).
Conclusion: There is a strong, statistically significant positive correlation between perceived organizational support and organizational climate. These findings suggest that enhancing institutional support measures can contribute to more favorable perceptions of the organizational climate among nursing staff.

Andrew D. Ryan, Hyun Kim, Stephanie A. Hooker, Brian M. Zaidman, Katherine S. Drake, Nichole L. Sorenson, Bridget A. Bender, Allison L. Iwan, Bruce H. Alexander

Abstract

Objective: Rebuttable presumption legislation for work-related Post-Traumatic Stress Disorder (PTSD) designates work-relatedness for covered occupations in workers compensation. We compared outcomes of claims for PTSD in occupations covered and not covered by rebuttable presumption before and after a Minnesota law enacted in 2019.
Methods: Claims for PTSD in the workers’ compensation system were identified from nature of injury coding and key-word searches. The percentages of claims denied and claims receiving payments were calculated for the pre-law (2014-2018) and post-law (2019-2022) periods for presumption and non-presumption occupations. Payments were classified as regular claims or stipulations following appeal and legal proceedings. Log binomial regression models with an interaction variable for time period and presumption occupation tested differences in risk of the claim outcomes over time between presumption and non-presumption occupations adjusted for age, gender, job tenure, wage, and self-insured employer status.
Results: A total of 1,536 closed PTSD claims were identified. Initial claim denial rates increased from 91% in the pre-law period to 96% in the post-law period among presumption workers while decreasing among non-presumption workers (87% and 84%, respectively). The risk of receiving no payment for a denied PTSD claim from pre- to post-law among presumption workers was 49% lower compared to the change in risk among non-presumption workers (Relative Risk Ratio 0.51, 95% CI 0.39-0.67). In contrast, the increase in risk of receiving only stipulation payment from pre- to post-presumption law was two times greater among presumption workers than among non-presumption workers (RRR 2.00, 95% CI 1.40-2.86).
Conclusion: We observed limited effectiveness of a rebuttable presumption law in reducing initial denial rates for PTSD claims and subsequent litigation of denied claims. The root of this problem may be the structure of workers’ compensation systems not being compatible with a complex condition such as PTSD.

Marissa G Baker

Abstract

Experiences of discrimination have been shown to increase adverse mental and physical health outcomes. Prior research has examined individual-level predictors of perceived discrimination, few studies have evaluated the influence of occupational characteristics, including the gender composition of occupations. Evidence suggests that individuals working in occupations where they are the gender minority may report different patterns of exposure to discrimination, but nationally representative estimates are limited. The objective of this study is to evaluate the association between occupational gender composition and self-reported discrimination among U.S. workers and to assess modifying factors of this association. Using data from the 2023 National Health Interview Survey (NHIS) and US Bureau of Labor Statistics (BLS), a linear regression model was designed to estimate the relationship between occupational context and perceived discrimination. Gender composition was categorized by the gender-ratio for male- or female-dominated occupations as: low (under 25%), medium (25% – 75%), and high (more than 75%). Data analysis is still ongoing, but planned models will assess whether workers in male- or female-dominated occupations report higher levels of discrimination and whether associations differ across sociodemographic subgroups. This study will examine patterns of perceived discrimination in relation to occupational gender composition using a nationally representative dataset. Findings may inform future research on occupational exposures and psychosocial risk factors in workplace environments.

Caisa Laurell, Gunilla Rydenstrand, Frida Wiik, Maria Albin, Karin Broberg

Abstract

Objective: Disruption of circadian rhythms due to shift work is associated with an increased risk of diabetes and obesity. Adipose tissue plays a central role in metabolic processes related to lipid metabolism, endocrine signaling and energy regulation. The Objective of this study is to evaluate epigenetic changes in adipose tissue in relation to night-shift work.
Material and Methods: Day and night-shift workers from the Swedish health sector were recruited to the EPHOR Night Shift study. Participants filled in a questionnaire about lifestyle, medical history, sleep, diet, physical activity, psychosocial factors, and work conditions. Adipose tissue biopsies were collected from a subgroup of 13 day- and 17 night-shift workers. Adipose tissue DNA was analyzed using the Illumina Infinium MethylationEPIC v2.0 BeadChip array. Statistical analysis will include epigenome-wide association study, as well as bioinformatic analysis of circadian rhythms and key adipose pathways. Additionally, we will estimate the biological age in adipose tissue using different epigenetic clocks.
Results: Participants were all women except from one, and their mean ± SD BMI (kg/m2) was 26.6 ± 5.6 for day-shift, and 26.2 ± 4.1 for night-shift workers. None of the participants reported having diabetes. Our epigenetic analysis will be focused on epigenome-wide changes in relation to night shift work, differential DNA methylation in candidate pathways, such as circadian rhythm genes (CLOCK, BMAL1, CRY1, PER1, PER2 and ZFHX3), in pathways related to lipid metabolism (e.g. SREBF1), and adipogenesis (PPARG). We will compare epigenetic age acceleration between shift work groups to assess the impact of shift work on biological ageing.
Conclusion: To our knowledge, this is the first human study on epigenetic changes in adipose tissue in relation to night shift work. The findings will provide mechanistic evidence of whether night shift work can result in reprogramming of metabolic processes in target tissue of circadian disruption.

Kirsten Nabe-Nielsen, Anders Aagaard, Ann Dyreborg Larsen, Helena Breth Nielsen, Johnni Hansen, Åse Marie Hansen, Henrik Albert Kolstad, Jesper Medom Vestergaard

Abstract

Objectives Night work has been associated with a higher risk of injuries, but the extent to which the impact of different types of night work schedules influences the risk remains unclear. This study examines whether the risk of injuries differs between employees with permanent night work and those with other shift schedules, including rotating shift work with night shifts.
Methods We conducted a nationwide register-based cohort study using payroll data from the Danish Working Hour Database (DAD), which comprises day-by-day information about working hours among hospital employees. Based on the proportion of night, evening, and day shifts worked in the preceding 52 weeks, the following sic work schedules were applied: permanent day; permanent evening; permanent night; day/evening; day/night; evening/night, and day/evening/night. Injuries were identified using the Danish National Patient Register by use of a unique personal identifier applied to all residents. Poisson regression with generalized estimating equations (GEE) was applied with a running window of one day to estimate incidence rate ratios (IRRs) for injuries on the following day by work schedule. Main analyses were adjusted for sex, age, and job type.
Results Among 191,224 employees contributing 179 million observation days, permanent night workers had a lower injury risk compared with all other work schedules, except permanent day workers (IRR; CI). Compared to permanent night workers, the highest injury risk was observed among evening/night workers (IRR=1.38; 95% CI: 1.19–1.59) and day/evening/night workers (IRR=1.30; 95% CI: 1.19–1.42).
Conclusion Our results suggest that permanent night workers have lower injury risk than rotating shift workers with night shifts. Differences in work tasks, adaptation, and selection effects may contribute to this pattern. Funding The current project was funded by research grants from The Danish Working Environment Research Fund (23-2017-09) and the National Research Centre for the Working Environment. Denmark.

Esmee Bosma, Linda W. van Kerkhof, Karin I. Proper, Debbie van Baarle, Martijn E.T. Dollé

Abstract

Objective: In recent years, more research has been devoted to examining whether night-shift work negatively impacts immune system functioning and increases infection risk. However, an overview of the available evidence was lacking. Therefore, this review summarizes the evidence on the association between night-shift work and susceptibility to infectious diseases.
Methods: A systematic search was conducted in Embase and PsycINFO for studies published until September 2024. Eligible studies included a working population, a comparison between night-shift and non-shift workers, and an infectious disease outcome. The findings were descriptively summarized for common respiratory infections (flu and common cold), SARS-CoV-2 infection, and other infections. Random-effects meta-analysis was used to pool effect estimates.
Results: A total of 16 articles, covering 14 unique studies and involving 191,320 workers, met the inclusion criteria. Night-shift work was not statistically significantly associated with common respiratory infections (OR=1.11, 95% CI= 0.97–1.27; I²=65.8%, 4 studies). In contrast, night-shift workers had a higher risk of SARS-CoV-2 infection compared to non-shift workers (OR=1.31, 95% CI=1.09–1.58; I²=92.2%, 10 studies). For other types of infections, the number of available studies was insufficient to perform a meta-analysis. Overall, the certainty of the evidence was graded very low, mainly due to the limited number of prospective cohort studies and high heterogeneity between studies.
Conclusion: The findings of this systematic review and meta-analysis suggest that while night-shift workers are not at higher risk of common respiratory infections, they are at increased risk of SARS-CoV-2 infection. Given the very low certainty of the evidence, future research is needed that employs prospective designs, adjusts for confounding factors, and assesses night-shift work exposure more comprehensively.

Martie van Tongeren

Abstract

Objective Mendelian Randomisation (MR) is a research method that uses genetic markers, mainly single nucleotide polymorphisms (SNPs), as instrumental variables (IVs) to infer causality. MR requires three assumptions, one of which is that IVs must be independent of potential confounders. Several studies have been explored health effects from shift work as an exposure variable for MR.1-4 Conversely, body mass index and educational level are related to shift work in the MR analysis.5 This study shows the selection process of IVs for shift work and discusses its appropriateness.
Material and Methods For the ‘Job involves shift work’ question in the UK Biobank, we listed SNPs that are highly (p < 5×10-8) or moderately (p < 5×10-6) associated with the question. To assess potential association with confounders, each SNP was cross-referenced with trait associations (p < 1×10⁻⁶) from a wide database. In the created data frame, the data was listed based on specific keywords related to covariates (e.g., body mass index, education) to identify the frequency of occurrence for each keyword.
Results There were 55 SNPs associated with shift work with p < 5×10-8 and 446 SNPs with p < 5×10-6. After clumping, 2 and 39 SNPs remained, respectively. All 55 highly relevant SNPs for shift work were also associated with education. Of the 39 SNPs, 4 were associated with education and 6 with BMI. 25 SNPs had no association with other traits.
Conclusion Prior to using MR for occupational and environmental health research, a rigorous review of instrumental variables should be carried out to ensure that the assumptions of MR are not violated. To maintain methodological robustness, rather than attempting to establish a comprehensive causal relationship with shift work itself, we suggest that Mendelian Randomisation may be better suited for exploring specific biological mechanisms that may underlie its health effects.

Sylvia Rabstein , Thomas Kantermann , Céline Vetter , Rui Wang-Sattler , Martin Lehnert , Dirk Pallapies , Karl-Heinz Jöckel , Thomas Brüning , Thomas Behrens

Abstract

Objective Night-shift work is known to disrupt circadian rhythms, potentially leading to adverse health effects. This study investigated the relationship between sleep timing and cortisol secretion profiles among female hospital employees.
Material and Methods 89 female hospital workers (68 shift workers, 21 non-shift workers) were included in this cross-sectional study. Shift workers worked rotating shifts, including night shifts, whereas non-shift workers maintained regular day shifts. Shift workers provided salivary cortisol samples collected at multiple time points during two consecutive day shifts and three consecutive night shifts. Non-shift workers collected their samples across two consecutive day shifts. Sleep timing was assessed through polysomnography and sleep diaries. Using generalized additive mixed models, we estimated shift-specific cortisol curves, considering the non-linear relationship between time since waking up and logarithmized cortisol levels, adjusted for age, chronotype, menopausal status, contraceptive use, stress load, smoking status. Each cortisol curve was summarized by cortisol awakening response (CAR), peak-to-bed slope, and total cortisol output.
Results Shift workers on night shifts showed a flattened U-shaped cortisol profile after the post-awakening peak, with peak-to-bed slope close to zero (-0.02, 95%-CI = -0.82, 0.78). In the same women, a normal diurnal cortisol profile with a steep negative peak-to-bed slope after the post-awakening peak (-2.57, 95%-CI = -3.17, -1.98) was observed on day shifts. Day-shift cortisol curves were similar in shape for both, shift workers and non-shift workers, showing differences in mean cortisol levels at waking up (-0.41 log(nmol/L), 95%-CI = -0.79, -0.02) and in CAR (0.37 log(nmol/L), 95%-CI = 0.10, 0.63).
Conclusion This study in female shift workers showed night-work associated circadian misalignment between timing of sleep and cortisol rhythm. These findings highlight the importance of considering circadian biology in occupational health, particularly for professions requiring night work.

Sylvia Rabstein; Raimund Erbel; Lewin Eisele; Marina Arendt; Nico Dragano; Thomas Brüning; Karl-Heinz Jöckel; Thomas Behrens

Abstract

Objective Shift work is discussed as risk factor for cardiovascular diseases as it can disrupt the circadian system, which is involved in the regulation of cardiovascular functions. Here, we analyze associations between shift work and incident cardiovascular diseases (myocardial infarction, coronary heart disease, sudden cardiac death, stroke, transient ischemic attack).
Material and Methods Incident cardiovascular diseases were defined as fatal or non-fatal cardiac or cerebrovascular events, or interventional coronary revascularizations in the German prospective population-based Heinz Nixdorf Recall study. Lifetime shift work information was assessed retrospectively. We calculated incidence rate ratios (IRR) and 95% confidence intervals (CI) with log-linear Poisson regression models with the logarithm of person-years as offset for the effect of shift and night-shift work on incident cardiac and cerebrovascular events jointly and separately. Based on a directed acyclic graph, the models were adjusted for age, sex, educational years, and preferred midpoint of sleep as proxy for the chronotype. Stratified analyses by sex and chronotype were also performed.
Results We found no increased risk for cardiac and cerebrovascular events (N=3023; shift work for at least 1 year: IRR=0.87, 95% CI=0.68-1.10; night-shift work for at least 1 year: IRR=0.87, 95% CI=0.66-1.14). For women with night-shift work, we observed increased risk estimates (N=1438 with 91 night-shift workers; model for night-shift work for at least 1 year: IRR=1.56, 95% CI=0.76-3.22; model for duration of night-shift work: 1-<10 years: IRR=1.11, 95% CI=0.35-3.50; 10+ years: IRR=2.05, 95%CI=0.75-5.61). Stratification by preferred midpoint of sleep did not show increased risks in relation to chronotypes. The separate analysis of cerebrovascular events showed more pronounced risk estimates, but lower precision.
Conclusion Overall, we found no unambiguous associations between shift work and cardiovascular diseases. Slightly increased risk estimates for women indicate a vulnerable subgroup, but small case numbers limit the meaningfulness of our
Results.

Rahman Shiri , Aki Koskinen , Jenni Ervasti , Johnni Hansen , Mikko Härmä

Abstract

Objective Women with breast cancer should not work night shifts due to possible tumour recovery and other risks. However, little is known whether this recommendation is followed in practice. We investigated changes in night shift work and sickness absence before and after breast cancer diagnosis and compared these women to age-, organisation-, diagnosis year, and monthly number of night shift (≥1-2/≥3) matched female controls three years before and after the diagnosis.
Material and Methods We linked payroll register-based working hour and sickness absence data for 167 night shift working women (mean age 55.4 years) and their 673 matched controls (mean age 52.4 years) in the public sector with information on the timing of the first breast cancer diagnosis from the Finnish Cancer Registry (2008-2022). Unpaired two-sided two-sample t-tests were used to compare the night shift characteristics and sickness absence before and after the diagnosis.
Results The percentage and number of yearly night shifts decreased more among the cases than the controls (mean change 9.5% vs. 3.6%, P=0.0024 and 19.5 vs. 7.9 days, P=0.0003) after diagnosis. Although the percentage of >2 consecutive night shift spells decreased significantly more among the cases (13.5%) than controls (3.1%), the percentage of >4 consecutive night shift spells did not significantly differ (3.6% vs. 1.4%). The annual number of sickness absence days increased during the first and second years after the diagnosis among the cases compared to controls. All the differences in night shift characteristics and sickness absence between the cases and controls disappeared by the second or third follow-up year.
Conclusion Night shift work decreased and sickness absence increased after a breast cancer diagnosis, but differences between cases and controls diluted year by year, indicating that the recommendation to stop night work is not systematically followed. Funding and other acknowledgements Finnish Work Environment Fund

Xueqiong Weng; Natalie Hui Yu Tang; Cherry Wan, Yufei Liu; Feng Wang.

Abstract

Background: Shift work is a prevalent requirement for nurses, contributing to various health challenges, including obesity. The complexities involved in managing shift schedules make administrative changes difficult to implement. Understanding how environmental modifications can impact obesity among nurses is an area that requires further exploration.

Objectives: This study aims to evaluate individual exposure to environmental factors such as light, noise, green and blue spaces, and air pollution, and their associations with obesity indicators, including body mass index (BMI), waist circumference, hip circumference, waist-hip ratio, and body fat percentage.
Methods: We plan to recruit a total of 364 nurses. Data regarding environmental conditions were collected using a comprehensive questionnaire. Obesity indicators were assessed through direct measurements and standardized questionnaires. Multiple logistic regression analyses were conducted to investigate the relationships between environmental factors and obesity metrics.
Results: We have recruited 81 nurses so far. Preliminary data indicate that levels of satisfaction with workplace noise significantly correlated with obesity indicators: satisfaction with noise quality was associated with lower BMI (adjusted β: -0.192), waist circumference (adjusted β: -0.703), hip circumference (adjusted β: -0.454), waist-hip ratio (adjusted β: -0.004), and body fat percentage (adjusted β: -0.340). Other subjective environmental variables did not demonstrate statistically significant relationships with the obesity indicators.

Conclusions: These initial findings suggest that favorable environmental conditions, particularly in relation to perceived noise levels at work, may play a role in reducing obesity among nurses. Future publications from this ongoing research will provide further insights into the real-time monitoring of environmental factors and their impacts on obesity-related measurements. (Funding: GRF/RGC Ref.: 14609923; CUHK Ref.: E.C./2017/006, and SSFCRS Ref.: TL/SSFCRS2223/0953/ 23ww.)

Tara van der Grinten, Sylvia Jochems, Nina Berentzen, Flora van Leeuwen, Michael Schaapveld, Hans Kromhout, Roel Vermeulen, Jelle Vlaanderen, Susan Peters

Abstract

Shift work may impact headaches, significantly affecting quality of life and productivity. This study aims to investigate the relationship between shift work and headache occurrence among Dutch female nurses. Participants completed questionnaires in 2011 (N = 59,768) and in 2017 (N = 37,730) reporting on headaches, work history, sleep problems, lifestyle factors, among other factors. Logistic regression analysis was conducted to determine the association between shift work and headache/migraine, as well as the impact of changes in shift work status on headache outcomes. Shift work was associated with an increase in headache risk at both baseline (OR = 1.07, 95% CI: 1.02–1.12) and follow-up (OR = 1.07, 95% CI: 0.99–1.15). A similar trend was observed for migraine risk (baseline OR = 1.05, 95% CI: 0.99–1.13; follow-up OR = 1.19, 95% CI: 1.06–1.33). Stratification by shift work duration showed elevated headache risk for those with less than 20 years of shift work, but a reduced risk after 20 years (OR = 0.86, 95% CI: 0.78 – 0.95). Additionally, quitting shift work increased the odds of headache recovery (OR = 1.20, 95% CI: 1.04–1.38). The findings show a positive relationship between shift work and headache/migraine risk.

A.Kheder, N.Belhadj, H. Elmufti, T.Khalfallah, A. Mahfoudh

Abstract

Objectives: To determine the prevalence of anxiety and depression among healthcare workers (HCWs) and identify associated factors.
Methods: This descriptive cross-sectional study was conducted among HCWs at Taher Sfar Mahdia Hospital. Data were collected via a self-administered questionnaire capturing sociodemographic and professional characteristics. The “Hospital Anxiety and Depression scale” (HADS) was used to screen for anxiety and depression symptoms. The HADS includes 14 items scored from 0 to 3, with seven items assessing anxiety (HAD-A) and seven assessing depression (HAD-D), each subscale yielding a maximum score of 21. A score ≥11 indicates definite anxiety or depression symptoms.
Results: Of 197 HCWs who correctly completed the questionnaire, most were nurses (78.2%). Anxiety symptoms were reported by 49 HCWs (24.9%), and depressive symptoms by 53 (26.9%). HCWs on fixed night shifts had higher rates of anxiety (77.6% vs. 42.6%; p < 0.001) and depression (73.9% vs. 43.1%; p < 0.001) compared to those on other schedules. HCWs reporting alcohol consumption showed a higher prevalence of depressive symptoms (13.2% vs. 4.2%; p = 0.03). Multivariate analysis identified fixed night shift work as significantly associated with anxiety (OR = 4.513, p < 0.001; 95% CI [2.133; 9.55]). Fixed night shift work (OR = 3.54, 95% CI [1.76; 7.14], p < 0.001) and alcohol consumption (OR = 3.03, 95% CI [1.33; 9.95], p = 0.04) were associated with depressive symptoms. HAD-A and HAD-D scores were significantly correlated (Spearman, r = 0.572; p < 0.001).
Conclusion: This study highlights a significant prevalence of anxiety and depressive symptoms among HCWs, particularly linked to fixed night shift work. These findings emphasize the urgent need to address work organization by optimizing work schedules and implementing targeted interventions to prevent anxiety and depression in this vulnerable population.

Stéphanie Boini, Mathieu Dziurla, Michel Grzebyk, Céline Ribet, Jean Ferrières, Yolande Esquirol,

Abstract

Objective: To assess the cumulative dose-effect of night work exposure on the prevalence of cardiovascular risk factors (CVRF) among current and former night workers in France.
Material and Methods: Based on the Constances cohort, 52,234 workers were classified as exposed (permanent, rotating and former night work) or non-exposed (daytime) to night work throughout their working life. The duration of exposure to night work was assessed over the entire working career using a self-reported questionnaire. BMI, blood pressure, lipids, and glycaemia were measured in health screening centres. Generalized additive models were used to estimate the probability of being obese, having high blood pressure, lipid disorders, and type 2 diabetes (T2DM) as a function of the duration of exposure for each category of night workers. OR and 95% confidence intervals were estimated, and the reference group consisted of the daytime workers.
Results: The sample comprised 24,892 men and 27,342 women, with an average working career of 20 years. Identified among them were 685 permanent night workers, 915 rotating night workers and 2,972 former night workers. Among male permanent night workers, excess risks for obesity (+76%) and central obesity (64%) were noticed at 5-year exposure and for T2DM (+119%) at 10 years of exposure. Male rotating night workers showed excess risks at 5 years of exposure for obesity/central obesity (about +45%), and high triglyceridaemia (+52%). Female former night workers were at excess risk at 5 years of exposure for obesity/central obesity (about +45%), high blood pressure (+34%) and low-HDL-C (+35%).
Conclusion: The effects on cardiovascular risk factors varied according to the night work profiles and within gender groups. Some effects were observed after only 5 years of exposure. These results support the need for early and appropriate monitoring of cardiovascular risk factors among current and former night workers.

Barbara Harding , Jesse Thacher , Jelle Vlaanderen , Antonio D’Errico , Anastasiia Snigireva , Frida Wiik , Gunilla Rydenstrand , Roel Vermeulen , Anne Helene Garde , Kirsten Nabe-Nielsen , Karin Broberg , Maria Albin , Manolis Kogevinas

Abstract

Objective Circadian disruption, as experienced by night shift workers, increases the risk of cardiometabolic diseases. The aim of this study is to investigate metabolite alterations and their relation to cardiometabolic outcomes among night shift workers.
Material and Methods Data from exposure measurements, questionnaires including diet, clinical examination (anthropometry including BMI, blood pressure, waist and hip circumference), and biological samples after shift work were collected within the EPHOR-NIGHT project (N=860, day shift n=363, night shift =497) from Sweden, Spain and Denmark. Plasma metabolites (cholesterol, triglycerides, fatty acids, apolipoproteins, HbA1c and fasting blood glucose (the latter two only assessed in the Swedish sub-cohort n=156-169) were quantified by 1 H NMR Spectroscopy and routine clinical assays. Using adjusted linear regression models, including diet, we examined differences in plasma metabolite levels and their association with cardiometabolic risk factors among night shift workers compared with day shift workers.
Results No differences were found for total cholesterol, triglycerides, or apolipoproteins in the whole cohort, nor fasting glucose or HbA1c in the sub-cohort. Night-shift workers had lower fractions of PUFAs, both omega-3 (-0.22, 95% CI -0.38 to -0.07) and omega-6 (-0.56, -0.99 to -0.12), and total PUFAs (-0.78, -1.22 to -0.35). Conversely, they had higher fractions of mono-unsaturated (0.48, 0.11 to 0.84) and saturated fatty acids (0.31, 0.06 to 0.55). Lower fractions of PUFAs and higher fractions of mono- and saturated fatty acids metabolites fractions were in turn significantly associated with higher BMI and higher blood pressure. Further mediation and dose-response analyses will be presented at the conference.

Conclusions We found differences in potential metabolic pathways linking night shift work with cardiometabolic risk. Contributions from other e.g. behavioral and environmental factors cannot be ruled out and warrant further longitudinal investigation. Research funding from the EU Horizon project EPHOR, Swedish Research Council FORTE and AFA insurance.

Charlotte Juul Nilsson, Anne Helene Garde, Kirsten Nabe-Nielsen

Abstract

Objective Job demands in hospital environments may vary across shifts and work schedules. Identifying where demands are highest can help guide targeted prevention to reduce work strain and schedule-specific health risks. This study examined how perceived job demands differ by shift type and work schedule.
Material and Methods We used data from 966 employees in the 1001 nights-cohort – a study of female hospital workers in Denmark. Participants completed a baseline questionnaire and daily reports on working hours and physical, quantitative, and emotional demands (scale: 1–10). Analyses included participants with complete data on exposures and key covariates (age, education, Major Depression Inventory score, BMI, and shift duration). Mixed-effects models estimated differences in mean job demands across shift types (day or night) and work schedule-groups (permanent day, 2-shift without night, 2- or 3-shift with night, permanent night). Within-person analyses included participants with both day and night shift data.
Results On day shifts, 2-shift workers without night and 2- or 3-shift workers with night reported higher job demands compared to permanent day workers. The largest difference was observed in physical demands (+1.32, 95% CI: 0.93 to 1.71) among 2-shift workers without night. On night shifts, no differences were observed between permanent night workers and 2- or 3-shift workers. Within-person comparisons showed that night shifts were perceived as less demanding – both quantitatively (-0.28, 95% CI: -0.42 to -0.13) and emotionally (-0.51, 95% CI: -0.65 to -0.37) – than day shifts.
Conclusion 2- or 3-shift workers – with and without night – reported higher job demands on day shifts. Preventive measures may be more effective if tailored to specific shifts and work schedules. Further research should investigate whether differences in perceived job demands reflect actual job demands or are influenced by shift-related fatigue.

Rikke Harmsen, Jakob Møller Hansen, Dagfinn Matre, Anne Emily Saunte Fiehn Arup, Anne Helene Garde

Abstract

Objective To investigate the prevalence of headaches on days with night shifts compared with day shifts within the same individuals, accounting for work-related psychosocial stressors, physical job demands, and sleep duration and quality. This approach aimed to isolate the impact of circadian misalignment due to night work from other potential headache triggers.
Material and Methods We used data from the 1001 nights-cohort, comprising female employees from the Danish hospital sector. Participants completed 14-day diaries, providing daily information on working hours, sleep, emotional job demands, quantitative job demands, physical job demands, and headache occurrence (yes/no). Participants with data from at least one day shift and one night shift were included. In total, 522 participants contributed 3,348 measurement days (1,926 day shifts and 1,422 night shifts). We estimated prevalence ratios (PRs) for headache occurrence, accounting for repeated measures within individuals.
Results Headaches were reported on 21.5% of days with day shifts and 27.9% of days with night shifts. Night shifts were associated with a significantly higher headache prevalence (PR: 1.32; 95% CI: 1.15–1.51) compared with day shifts, independent of work-related psychosocial stressors, physical job demands, or sleep characteristics. Among consecutive night shifts, the second night showed the highest headache prevalence (PR: 1.20; 95% CI: 1.03–1.40), using the first night as the reference.
Conclusion This is the first study to assess headache occurrence on days with night shifts versus day shifts while accounting for both job-related and sleep-related factors. Neither work-related psychosocial stressors, physical job demands, nor sleep parameters explained the higher headache prevalence. These findings suggest that other mechanisms related to night work-induced circadian misalignment may be key drivers of headache risk in night shift workers. Funding The present study was funded by the Danish Working Environment Research Fund.

Dat Thien Tran; Susanne Strohmaier; Magdalena Żebrowska; Tianyi Huang; Kyriaki Papantoniou; Susan Redline; Richa Saxena; Martin K Rutter, Eva Schernhammer

Abstract

Aims Non-standard work schedules are becoming increasingly prevalent, with one in five workers participating in night shifts. Whether working night shifts is associated with cardiovascular-kidney-metabolic (CKM) outcomes, and whether chronotype or sleep duration modify this association, remains unclear.
Methods We utilized data from 96,365 UK Biobank participants (57% female, mean age 62 years), with information on employment history and tracked incidence of CKM (including cardiovascular diseases, chronic kidney diseases and/or type 2 diabetes) through 2022. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs), adjusting for a range of potential confounding factors.
Results Based on 5,967 incident CKM cases, participants with more than 20 years of night shift work history had a significantly higher rate of CKM (HR=1.32 [95% CI, 1.20-1.45]) compared to day workers, after adjusting for sex, age, ethnicity, and socioeconomic factors. Elevated rates were also observed among those working 8 or more night shifts per month (HR=1.32 [95% CI, 1.21-1.43]) and those with over 1,200 lifetime night shifts (HR=1.36 [95% CI, 1.25-1.48]) as compared to day workers; all Ptrend<0.001. The association between night shift work and CKM risk was significantly modified by sleep duration, with higher rates among short sleepers (<7 hours/night;Pinteraction= 0.009, 0.031, and 0.017 for night shift work duration, intensity, and cumulative number of nights worked, respectively). However, chronotype did not significantly modify this association.
Conclusion Our findings reveal a dose-response relationship between night shift work and CKM disease, which is further amplified by short sleep duration. Future studies should consider using CKM conditions as a composite outcome and investigate further how various sleep characteristics may modify the impact of night shift work.

Annett Dalbøge, Jens Peter Ellekilde Bonde, Anne Helene Garde, Johnni Hansen, Åse Marie Hansen, Ann Dyreborg Larsen, Sadie Costello, Morten Böttcher, Morten Fenger-Grøn, Henrik Albert Kolstad

Abstract

Objective To examine the exposure-response relations between cumulative evening and night shifts and incident myocardial infarction among hospital employed health care workers, including nurses, physicians, and others.
Materials and Methods This national register-based cohort study includes all newly hired health care workers ever working evening or night shifts with day by day payroll information on evening and night shifts, from 2008/2009 to 2020. In total, we included 137 184 health care workers (mean age 33.3 years at inclusion, 77% women) who were followed from first registered evening or night shift for an average of 6.4 years. First time hospital contacts for myocardial infarction were identified in national health registers. Incidence rates of myocardial infarction by cumulative evening and night shifts were estimated by Poisson regression adjusted for sex, age, calendar year, diabetes, obesity, hypertension, hypercholesterolemia, education, and family history of cardiovascular disease; and for a subset of 13 080 workers, additionally adjusted for self-reported smoking, body mass index, and alcohol consumption.
Results During follow-up, 477 workers (49% women) were diagnosed with myocardial infarction. Men and women showed overall incidence rates of 12.5 and 3.4 per 10 000 person years. No increasing incidence rates of myocardial infarction with cumulative number of evening or night shifts were observed.

Conclusions This study of health care workers found no exposure-response relation between cumulative evening or night shifts and incident myocardial infarction during up to 13 years after the first recorded evening or night shift.

Emmanuelle Brun, Pierre Berastegui

Abstract

Objective The European Agency for Safety and Health at Work (EU-OSHA) is carrying out a 3-year research activity focusing on cardiovascular diseases (CVDs) and Occupational Safety and Health (OSH). It will include several research projects implemented between 2025 and 2027. In this context, the present study consists of an analysis of quantitative data available in the EU on the types, extent and causes of work-related CVDs as well as on sectors, occupations and worker groups at risk. As the study is ongoing, the communication will present the aims, methodology, progress, preliminary findings and expected results.
Material and Methods The study will analyse quantitative data on work-related CVDs and occupational accidents related to CVDs collected at EU, Member State, regional, social partner, sectoral level or be implemented by key organisations or actors.
Results The analysis will give insights on the types and prevalence of work-related CVDs and occupational accidents related to CVDs, the underlying causes, occupational exposures, and risks as well as on the sectors, occupations and worker groups at risk. It will also seek to improve knowledge on multiple occupational exposures to combined occupational risk factors of work-related CVDs in the workplace. Finally, it will attempt a comparative qualitative analysis of the data provided by the various data systems and identify the data gaps, challenges and needs.
Conclusion The study will formulate conclusions and key policy pointers for the implementation of efficient collection systems, for the availability of comprehensive, reliable quality data, and for the effective prevention of work-related CVDs in the EU.

Esben Meulengracht Flachs, Regitze Sølling Wils, Ingrid Sivesind Mehlum, Jens Peter Ellekilde Bonde, Astrid Juhl Andersen, Hannah Nørtoft Frankel, Sandra Søgaard Tøttenborg, Karin Sørig Hougaard, Camilla Sandal Sejbaek

Abstract

Objectives To describe absence during pregnancy in the Danish workforce according to occupation, industry, and changes over time (1998-2018).
Methods The Danish register-based cohort DOC*X-Generation was used to identify all pregnancies among women (18-50 years) engaged in regular employment in Denmark from 1998 to 2018. The cohort holds individual-level data on occupations coded according to the Danish versions of the International Standard Classification of Occupations and of EU’s nomenclature, NACE rev. 2. Data on absence from work was retrieved from the Danish Register for Evaluation and Marginalization. The study population comprised 884,616 pregnancies in 547,870 women.
Results In 48% of the included pregnancies, the women had at least one week with registered absence with a median of eight weeks with absence (5-95% percentile; 1-27 weeks). The highest proportion of pregnancies with absence was observed among painters (75%) and women in the manufacture of meat products industry (68%). The lowest proportions were seen among professionals (physics, mathematics, engineering, architecture, 30%) and in the research and university education industry (32%). The difference between the lowest and highest number of cumulated weeks with absence was 9 weeks (5 to 14). From 1998-2018 the proportion of pregnancies with registered absence decreased, whereas the extent of absence per pregnancy increased.

Conclusions Absence during pregnancy was consistently high over time, but with vast differences across occupations and industries. A deeper understanding of underlying reasons for pregnancy-related absence is essential to develop targeted strategies for reducing absence, such as providing better opportunities for early adjustments or other tailored interventions.

Nantaka Sinthununsakul

Abstract

Objective: To analyze the burden associated with an incident involving varicella infections among healthcare workers (HCWs) in a tertiary hospital in northeastern Thailand, and to assess the operational and economic implications within a hospital setting.
Material and Methods: This descriptive report examined confirmed varicella cases among HCWs documented by occupational health and infection control units. Key metrics included number of cases, sick leave days, close contacts, and impact on hospital operations. Burden was evaluated using attack rate, workdays lost, estimated productivity loss, and Disability-Adjusted Life Years (DALYs), based on Global Burden of Disease parameters.
Results: Seven HCWs were diagnosed with varicella in 2025 among a total workforce of 2,980, resulting in an attack rate of 0.23%. Each case led to an average of 10 sick leave days, totaling 70 lost workdays. The estimated productivity loss was 105,000 THB. The total DALYs were estimated at 0.01 using a disability weight of 0.051. Additionally, 75 staff and 60 hospitalized patients were identified as close contacts, requiring multiple rounds of health monitoring and risk communication. Although no secondary cases occurred, the event placed a significant burden on occupational health resources and posed a potential risk of nosocomial transmission.
Conclusion: Even a limited number of varicella cases can generate measurable disruptions in hospital operations. The incident highlights the importance of routine immunity screening, targeted staff vaccination, and preparedness protocols to reduce institutional vulnerability to infectious disease incidents. Funding and Acknowledgements: No external funding was received. The authors thank Roi Et Hospital’s occupational health and infection control teams for their support.

Stefania D’Angelo, Georgia Ntani, Gregorio Bevilacqua

Abstract

Background Obesity is a growing public health burden associated with increasing healthcare costs. However, there is also evidence that obesity impacts work ability and reduces work productivity and participation, thereby increasing indirect costs. This longitudinal study investigated the impact of obesity on work participation amongst middle-aged adults and explored the mechanisms for these impacts.
Methods Data came from the Health and Employment After Fifty (HEAF) cohort study of adults aged 50-64 years at baseline. We used Cox proportional hazard models to explore the longitudinal effect of body mass index (BMI) on the risk of work exit because of health (HRJL). To test whether the association between BMI and HRJL was partly explained by depression and/or walking speed, we further adjusted estimates for these factors.
Results Amongst 5086 participants in paid work at baseline, 40% were overweight and 23.7% obese. Obesity and overweight showed a socio-economic gradient. After adjustment for sex, proximity to retirement, finances, educational attainment, smoking and physical activity, obesity and overweight were associated with increased risk of work exit on health grounds (HR 1.35, 95%CI 1.11-1.64 and HR 1.54, 95%CI 1.25-1.89 respectively). Depression and slow walking speed were independent risk factors for work exit which, when combined in the models with obesity, explained most of the effects. Discussion Obesity and overweight importantly impact work ability at older ages. However, most of their impact can be explained by depression and/or slow walking speed. Prompt diagnosis and treatment for depression, accompanied by mid-life recognition of functional impact on walking speed could facilitate prolonged working at older ages, resulting in economic benefits for individuals, employers and societies with reduced healthcare and indirect costs.

Stein Håkon Låstad Lygre, Kaja Irgens-Hansen, Carl Fredrik Fagernæs, Anje Christina Höper, Torgeir Storaas, Berit Elisabeth Bang, Kari Eilidh Mikkelsen, Gro Tjalvin

Abstract

Objective: Workers in the salmon processing industry are exposed to bioaerosols comprising proteins, including different allergens. Previous studies have suggested an increased risk of work-related rhinitis among these workers, but the pathophysiological mechanisms remain unclear. In this study we aimed to assess the prevalence of work-related nasal symptoms among workers in Norwegian salmon processing plants, and the prevalence of sensitization to salmon among exposed symptomatic workers.
Material and Methods: A cross-sectional study was performed among 518 workers in 9 Norwegian salmon processing plants. Questionnaire data comprised information about specific nasal symptoms during the workday. Skin prick tests (SPT) were performed using study-specific extracts from salmon: raw and cooked muscle, outer mucus and skin. Crude odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess possible differences in self-reported nasal symptoms between process line workers and office/administrative workers. In addition, the percentages of positive SPTs among process line workers with at least one nasal symptom were calculated.
Results: Process line workers (n=488) reported more work-related nasal symptoms than office/administrative workers (n=30); runny nose: 50.1% vs 24.1% (OR=3.2,CI:1.3-7.5), sneezing: 48.5% vs 23.3% (OR=3.1,CI:1.3-7.4), nasal congestion: 43.3% vs 26.7% (OR=2.1,CI:0.9-4.8), and itching: 37.2% vs 23.3% (OR=1.5,CI:0.8-4.6). Among 313 symptomatic process line workers, 7.2% had at least one positive SPT with reactions to raw muscle (5.8%), cooked muscle (1.3%), outer mucus (3.8%), and skin (0.3%).
Conclusion: Process line workers in the Norwegian salmon processing industry had a higher prevalence of work-related runny nose and sneezing than office/administrative workers in the same industry, suggesting a positive association with occupational exposure. The low prevalence of positive SPTs among symptomatic process line workers indicates that both non-allergic and allergic mechanisms may contribute to nasal symptoms among such workers.

Angel Louis-Baraud, Karima Senni, Annabel Desgrées du Loû, Camille Bergeret, Anne Gosselin

Abstract

Objective: Due to social inequality and spatial segregation, people living in deprived neighborhoods tend to suffer from a lack of access to health care in general and occupational health services in particular, even though they are employed in occupations that are more likely to be detrimental to their health and well-being. We aim to assess the awareness and utilization of occupational health services in deprived French neighborhoods.
Methods: In a participatory project involving an association whose salaried members reside in these neighborhoods, we conducted an innovative survey based on a door-to-door campaign in three neighborhoods in greater Paris in 2024. Data were collected through face-to-face questionnaires. The three primary outcomes were being aware of occupational medicine, ever having had an occupational health visit, and knowing how to declare a workplace accident. We further investigated their determinants using multivariate logistic regressions.
Results: The survey included 462 individuals, 53% of whom were women. Among the working population sub-sample, 17,3% had never heard of occupational health (64/370), 18,9% never had an occupational health visit (64/338 currently in activity), and 33,7% did not know how to declare a workplace accident (124/368). Preliminary
Results for all three outcomes show that individuals without stable housing (a proxy for the precariousness of living conditions), those who lack a neighborhood social network, and immigrants who live in France for less than 10 years had lower odds of awareness and use. Moreover, women, younger individuals, and individuals with lower formal education had lower odds of having heard of occupational health. Individuals working part-time were less likely to know how to declare a workplace accident.

Conclusions: Our findings support the implementation of community-based occupational health promotion interventions at the neighborhood level to reduce occupational health-related disparities in France.

Mo-Yeol Kang

Abstract

Objective: With increasing participation of older adults in the labor force, understanding the dynamics of health-related work limitations is critical for promoting sustainable employment. This study applies an age-period-cohort (APC) modeling framework to Korean longitudinal data, aiming to isolate the independent contributions of age, period, and birth cohort to changes in work capability. Recognizing the role of social stratification, we further stratified analyses by gender and educational level to identify vulnerable subgroups.
Material and Methods: This study utilized data from the Korea Labor and Income Panel Study collected between 1998 and 2023, comprising 7,811 adults aged 50–85. Health-related work limitation was assessed annually from 2003 onward. APC effects were examined using generalized additive mixed models (GAMMs), with subgroup analyses conducted by gender and educational level.
Results: The percentage of work-capable individuals declined with age but improved in recent periods. Stratified APC analyses revealed consistent age effects and modest period effects across all subgroups. The high-education groups—particularly men—showed the strongest cohort effects, exceeding age effects. In contrast, women exhibited greater cohort effects than men in the low and middle education groups.
Conclusion: Taken together, this study highlights the independent roles of age, period, and cohort effects in shaping work capability among older Korean adults. The pronounced cohort effects in highly educated men suggest accumulated social advantages over generations, while larger cohort improvements among less-educated women imply narrowing disparities. Strong cohort effects among the highly educated, irrespective of gender, suggest improved labor force sustainability in more educated cohorts. These findings underscore the need for forward-looking policies to support healthy and productive working lives in the context of ongoing educational expansion.

Peter Elias, Melissa C. Friesen, Olga Kononykhina, Stacey Marovich, Cheryl Peters, Daniel E. Russ, Malte Schierholz, Ellen Sweeney, Anil Adisesh

Abstract

Objectives: The goal of the International Partnership on Automatic Job Coding (IPAJC) is an interdisciplinary partnership aiming to enable and promote efficient collection, processing, and accessibility of job information through improvement of automatic coding tools.
Methods and
Results: Partners within IPAJC create and apply various automatic and semi-automatic coding tool using different
Methods. Examples include fuzzy matching and Boolean operators (e.g. CASCOT, University of Warwick), machine learning (ML) neural network (e.g. NIOCCS, US NIOSH), ML boosted decision trees (e.g. OccuCoDE, Ludwig Maximilian University, Munich; OPERAS, Utrecht University), ML ensemble classifiers (e.g. SOCcer ,US NCI and AUTONOC, University of New Brunswick/Dalhousie University), and large language models (e.g. TNO-AOC, TNO). Depending on the specific tool, free text job descriptions in different languages are converted into standardised occupation codes such as various versions of international ISCO, Canadian NOC, German KldB, UK SOC, and US SOC. Although most tools thus far focused on coding to standardised occupations, some tools for coding to standardised industries are also available (e.g. CASCOT; NIOCCS; SOCcer CLIPS).
Conclusion: The IPAJC continually seeks partners and job description data for development and validation of current and future automatic job coding tools. Our expertise on survey
Methods, occupation data collection, and occupation coding is improving job data collection and exposure assessment at scale in occupational health research.

Hira Tariq, Iqbal Azam, Uzma Rahim Khan, Asaad Ahmed Nafees

Abstract

Objectives We determined the prevalence of occupational injuries and disabilities, and their associated factors among textile workers in Karachi, Pakistan.
Methods We conducted a cross-sectional study among 400 workers from ten textile mills in Karachi using an interviewer administered questionnaire. Working conditions at each mill were assessed during walk through surveys, using an observation checklist. Occupational injury was defined as any physical injury or damage to the body structure during the past 12 months while working at the mill. Disability was assessed using the Washington Group Short Set on Functioning (WG-SS) – Enhanced Tool. Two-level mixed effects logistic regression was applied to assess associated factors of occupational injuries. Odds ratios with 95% confidence intervals (CIs) were calculated.
Results Study participants comprised 83% men and 17% women, with a median (IQR) age of 31 (25, 40) years and duration of employment in textile mills of 7 (3, 15) years. One-year prevalence of occupational injury was 27% (n=106; 95% CI: 22-31%) and of disability among injured workers was 5% (n= 4; 95% CI: 0.2-9.0%). The most common type of injury was ‘cuts/lacerations’ (53%), most common site was ‘fingers and/or nails’ (52%), and most common cause was ‘handling and working with machines or equipment’ (76%). We found that workers aged <30 years (AOR=1.7, 95% CI: 1.06-2.81), having a contractual employment status (AOR=2.0, 95% CI: 1.09-3.64), and working as a technician (AOR= 4.2, 95% CI: 1.23-14.36) exhibited greater odds of injuries.
Conclusion We found a high burden of occupational injuries and a low prevalence of disability among injured textile workers. Technicians, contractual workers and those aged <30 years were at an increased odd of injuries– our findings call for interventions targeted at both employee and employer level. Acknowledgement Supported by the Fogarty International Center of the NIH under Award Number D43TW007292, the AKU-TIRTP program

Michelle Turner, Sara Svensson, Maxime Turuban, Sara Stanulovic, Alex Burdof, Maria Albin, Manolis Kogevinas, Neil Pearce

Abstract

Background and Objective The transition to sustainable work practices and green jobs is reshaping European workplaces with profound implications for occupational health. The INTERCAMBIO Horizon Europe-funded project uniquely engages a broad European stakeholder community to define research priorities at the intersection of climate change, sustainable work, and health.
Material and Methods We mapped stakeholders across Europe using networks such as OMEGA-NET and other research collaborations, creating a multi-level community. A short online survey (via REDCap) was distributed to assess perceived climate-related occupational health risks and research needs. Analyses were restricted to complete responses (n=80) using STATA v.18. Findings will guide upcoming structured workshops applying concept mapping to reach consensus on priority research areas.
Results We identified over 500 stakeholders across Europe. In a first contact, 91 participants (23.4% response rate) completed the survey, mainly female researchers (72.1%), policymakers (11.6%), and representatives from other organizations (9.3%). Key disciplines among researchers included occupational health (65.5%), environmental health (17.2%), and social sciences (12.1%). Top concerns identified were heat exposure (76.0%), extreme weather events (59.5%), mental health impacts (48.1%), vulnerabilities among outdoor workers (77.2%) and precarious workers (66.7%), and recycling/waste management work (65.4%). Qualitative analysis revealed five major challenges: heat stress, extreme weather, occupational health and safety, mental health, and evolving work-climate dynamics. Participants stressed the importance of cross-sectoral collaboration, inclusive participation, knowledge exchange, and policy integration.
Conclusion This unique European stakeholder study highlights urgent needs for research on climate-driven occupational risks and strategies for sustainable, resilient work. Broader stakeholder representation and stronger multi-sectoral platforms are essential to shape a comprehensive European health research agenda addressing climate change and work-related health.

Celine Zind

Abstract

To prevent the risks associated with global warming, a public works company in the Paris region has been experimenting with the use of “heatstroke” detection bracelets, which alert if body temperature rises by 1.5°C, thus preventing sometimes fatal accidents. Objectives Understand the experience of employees who use the bracelets, and advise the company on the benefits of these bracelets for workers on outdoor sites. Method Questionnaire submitted to testing employees on the progress of the experiment, initial knowledge of the risks and measures to adopt, alerts received, changes in practices, prospects for use and extension of the equipment.
Results – 24 respondents out of 29 volunteers informed by their direct supervisor of the experiment, the use of the equipment and the preventive measures to take. – Bracelets worn consistently at first, forgotten after the holidays whereas weather was poor. – 3 age groups identified: 51 with equivalent distribution of pathologies and average Body Mass Index (NE 27.1). – Occupations: pipefitter’s assistant, pipefitter, HGV driver, road repairman, welder, machine operator or mason. – 2 operators reported wrist discomfort, including a skin reaction. – Alert triggered for 2 operators, one while working on the ground, the other while on vacation! – Increased vigilance on the part of users, colleagues and managers, notably to hydrate before thirst sets in, despite a 2024 summer with no real heatwave. – Everyone found the test useful, and wanted to wear the bracelet again, and suggest it to colleagues who had been exposed.
Conclusion Our feedback illustrates a secondary benefit to the alert, reinforcing vigilance and the correct application of instructions. This equipment, which met with near-unanimous approval, could be tested in other sectors where work is carried out in a hot environment.

Jasmin Bhawra, Kristian Larsen, Nektaria Nicolakakis, Paul Villeneuve, Michelle Lu, Cheryl Peters

Abstract

Rationale: Climate change-related extreme weather events are projected to intensify yet there has been little research into the effects of these events on the health of workers. Through a literature review, we identified extreme heat, floods, droughts, and wildfires as priorities for study in Canada. We aim to assess the risk of mental and physical health effects from climate change-related extreme weather events on workers across Canada.
Methods: Employing CAREX Canada methods, we collected data on occupations and industries at risk of the extreme weather events indicated above. We used data from multiple sources to identify the population at risk: 2021 Canadian census, published literature, CAREX Canada estimates, and Canadian occupation databases. These were combined with health impacts and climate change predictions to create risk assessments for each occupation and industry.
Results: Estimates on workers at risk of heat stress as a result of occupational exposure to extreme heat will be presented. Occupations at risk include outdoor workers, as well as indoor workers in settings with inadequate ventilation. Workers who participate in high activity occupations, don protective equipment, and have less autonomy over workplace activities will have a higher hazard score among those exposed.
Results will be presented by region in British Columbia, providing specific estimates for areas with greater exposure to extreme heat in the province, and nationwide by province. Interpretation: The results from this study enhance our understanding of the health risks of climate change-related extreme weather events on workers. These results can provide crucial data that can lead to better protection of workers as climate change-related weather events become more common. CAREX Canada has a history of successful knowledge synthesis campaigns that will inform the dissemination of these data and will get the results to the audiences that will be most impactful.

Yufei Liu, Natalie H.Y. Tang, Cherry C.M. Wan, Feng Wang, Wenzhen Li, Julie Y.T. Ma; Amy W.Y. Ho, C.S. Ho, Shelly L.A. Tse

Abstract

Introduction: Shift work frequently contributes to sleep disorders and mental health issues in nurses. Modifying environmental conditions may offer a strategy to mitigate these problems. This study investigates the initial relationships between aspects of environmental conditions, sleep patterns, and psychological well-being in nurses.
Methods: We plan to recruit 364 nurses. Data on environmental conditions (light, noise, green/blue spaces, air pollution) were gathered via questionnaire and real-time devices. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI), while anxiety and depression symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS), with higher scores indicating greater severity. Multiple linear regression analyses were employed to explore the associations between the environmental variables, sleep quality measures, and psychological health outcomes.
Results: To date, preliminary data from 81 recruited nurses are available. These findings indicate that 72.8% of participants reported poor sleep quality, and 59.3% experienced insomnia symptoms. Furthermore, 44.4% displayed signs of anxiety and depression. Increased satisfaction with workplace light quality was significantly associated with lower PSQI (adjusted β: -0.162) and ISI scores (adjusted β: -0.209). Similarly, higher satisfaction with workplace noise levels correlated significantly with lower PSQI (adjusted β: -0.196) and ISI scores (adjusted β: -0.252). Additionally, nurses satisfied with noise levels reported significantly reduced anxiety symptom scores (adjusted β: -0.227). Green/blue spaces and air pollution perceptions showed no significant associations in this preliminary stage.

Conclusions: These preliminary results suggest that specific environmental factors in the workplace, particularly lighting and noise, may be linked to sleep quality and mental health among nurses. Future publications will incorporate additional data, including real-time environmental monitoring, circadian rhythm metrics, and relevant biomarker data.

Constanza, Vielma; Joan Ballester

Abstract

Ambient temperatures and air pollution are considered as the most important environmental health risk factors causing more than half a million premature deaths every year in Europe alone. However, there is still an insufficient understanding of other short-term health impacts such as occupational health. Horizon Europe MSCA project OCCU-GUARD and OP JAC – MSCAfellow7_MUNI project ANThROPOCENE will analyse occupational accident risks associated with the joint exposure to ambient temperatures and air pollution in Europe, describe its modification by key socioeconomic factors, project the future temperature-related occupational accidents burden under different climate change scenarios, and develop a new generation of Pan-European multi-hazard occupational health early warning system accounting for real risks and impacts on the vulnerable workforce. Towards these aims, we already generated an enormous database with daily counts of occupational accidents disaggregated by sociodemographic vulnerable groups from nine European countries – namely, Austria, Belgium, Italy, Spain, Switzerland, Sweden, Czechia, Estonia, and Ireland. We are currently seeking to further expand the database. Detailed characterization of epidemiological models between temperatures and air pollution and occupational health records is ongoing. Data collection for further analysis of the effect of macroeconomic cycles and socioeconomic factors on these relationships started. Further, the projects will project future occupational accidents burden and will use above mentioned models to transform temperature and air quality forecasts into occupation health predictions representing the first Pan-European multi-hazard occupational health early warning system. ANThROPOCENE and OCCU-GUARD projects will largely contribute to the EU Strategic Framework on Health and Safety at Work because it will allow the activation of fit-for-purpose alerts and emergency plans directly targeting vulnerable groups, which is relevant information to key end-users such as industries concerned with workforce well-being, outdoor workers, trade unions, healthcare institutions, insurance companies and others.

Melissa Spröesser Alonso, Maria Cristina Pereira Lima, Adriano Dias, Hélio Rubens de Carvalho Nunes, Carlos Ruiz-Frutos, Juan Gómez-Salgado, João Marcos Bernardes

Abstract

Objectives: to identify the prevalence of psychological distress among workers in Brazil during the initial stage of the COVID-19 pandemic and to investigate its associated factors.
Materials and Methods: A cross-sectional study was conducted through an online questionnaire distributed to 2,903 Brazilian workers between April and May 2020 A cross-sectional study was conducted using an online questionnaire administered to 2,903 Brazilian workers between April and May 2020. The sample included 1,752 non-healthcare workers (NHCWs) and 1,151 healthcare workers (HCWs), recruited through snowball sampling. Statistical comparisons between NHCWs and HCWs were performed using the chi-square and Mann-Whitney tests, followed by effect size measurement. Multiple linear regression analyses, with the response variable following a Poisson distribution, were employed to examine factors associated with psychological distress.
Results: The prevalence of psychological distress was 72.6% (70.1-74.2%), with no statistically significant difference between HCWs and NHCWs. Although 32 variables differed significantly between the groups, only seven had clinical and epidemiological relevance, mainly related to job conditions. Work stress was a significant predictor of psychological distress (PR 1.04; 1.02–1.05), though its impact lessened when no family members had been infected with COVID-19. In contrast, a stronger sense of coherence served as a protective factor (0.99; 0.96–0.99), but its protective effect was also reduced in the absence of family infection.
Conclusion: The study revealed high psychological distress among Brazilian workers early in the pandemic, with work stress and sense of coherence as key factors. These findings highlight the need for targeted mental health strategies, particularly for those facing both work and family-related stress.

Igor Bukhtiyarov, Galina Tikhonova, Natalia Kostenko, Leonid Strizhakov

Abstract

Objective. Analysis of healthcare staff mortality from COVID-19 in comparison to general population of the Russian Federation
Materials and Methods. Based on information from the large corporative medical network (gender, age composition of staff and those who died from 01.01.2020 to 31.12.2022) and Russian population data for the same period, a comparative study of medical (doctors, secondary and junior medical staff) and non-medical staff mortality was performed. The number of person-years of follow-up was 25099 for male and 134208 for female group. 40 men and 73 women died. Analysis of mortality by the years based on age-standardized mortality rates for each occupational group was performed.
Results. Among men the risk of dying from COVID-19 was significantly higher than in the general population (SIR=1.86; 95%CI 1.05-3.31) mainly due to the high risk in the professional group of doctors (SIR=1.96; 95%CI 1.06-3.62). For female doctors SIR was 1.37 (95%CI 0.77-2.44). In all other female professional groups, the death rates were significantly lower than in population. Mortality rate from COVID-19 was particularly high in the first year of the pandemic. Male doctors had a 3.97-fold higher mortality rate than the population and female 3.6-fold. There was also a trend to increase of mortality rate in male secondary personnel. In other occupational groups mortality rates were significantly lower than in population. In 2021 and 2022 either in medical or non-medical healthcare staff mortality rates were significantly lower or did not differ from those in population.
Conclusion. In Russia’s largest corporative medical network a high risk of death compared to the population was registered among doctors of both sexes and male secondary staff in the first year of the pandemic. This raises the need for a further, more detailed study and for adaptation of the healthcare system to possible new challenges.

Feng Wang; Phoenix Kit Han Mo; Cherry Choi Miu Wan; Kin Fai Ho; Dong Dong; Samuel Yang-shan Wong.

Abstract

Background: Despite vaccination and booster shots proving more effective than workplace measures in controlling the COVID-19 pandemic, hesitancy towards compulsory booster shots remains. This study aimed to evaluate the effectiveness of an enhanced educational intervention program in improving the acceptance of COVID-19 booster shots and reducing breakthrough infections among non-healthcare workers in Hong Kong.
Methods: In this 9-month randomized controlled trial (RCT), workers were randomly allocated to either the intervention or control group. The intervention group received educational sessions at baseline and at 3- month, covering general health and evidence-based information on the efficacy and safety of COVID-19 vaccines and booster shots. The control group received only general health information. All participants were followed up for an additional 6 months. The primary outcomes were intention and acceptance of booster shots, as well as breakthrough infections. The DASS-21 scale was used to evaluate participants’ mental health status, and two-way mixed ANOVA to analyze the group effect. A difference of ≥ 5 % in booster uptake between the intervention and control group indicated a practical significance in infection control.
Results: Among 310 consenting workers, 282 (91.0 %) of them completed the trial. At recruitment, the booster uptake rate was similar between the intervention and control groups (62.0 % vs. 62.1 %). After the educational intervention sessions, the intervention group showed a higher booster uptake rate (76.1 % vs. 67.9 %). A lower rate of breakthrough infection was observed in the intervention group during the latest follow-up period (23.2 % vs. 29.5 %); however, no change in the intention to get booster shots were recorded for all subjects.
Conclusion: This enhanced educational intervention program significantly improves booster uptake rates and reduces COVID-19 breakthrough infection rates among non-healthcare workers. (Trial registration: ClinicalTrials.gov – NCT05197673). (Funding: HMRF Ref.: COVID190104, COVID1903008, and 18190471)

Lara Vendramini, Felipe Gabel, João Silvestre Silva-Junior

Abstract

Objective: To assess changes in depression and anxiety symptom scores among physicians working in occupational health services during the COVID-19 pandemic in Brazil.
Methods: This prospective cohort study collected data from 2020 to 2022. Participants completed the Brazilian short version of the Depression, Anxiety, and Stress Scale (DASS-21). The first wave included 435 participants and the second wave included 265, with 184 completing both assessments. The second data collection occurred approximately 365 days after the first participation. Due to the non-parametric distribution of the data, a generalized linear model was used to test the influence of age, gender, and collection phase on psychological symptom scores.
Results: In the first wave, 57.9% of participants were women; in the second, 56.2%. The mean age was 44.1 years in the first wave and 44.6 in the second. In the final statistical model, depression scores decreased by −5.2547 (95% CI: −5.8815 to −4.62788) in the second wave compared to the first. Gender, alone or in interaction with the phase, was not statistically significant. However, increasing age was associated with a decrease in depression scores of −0.0293 (95% CI: −0.0576 to −0.00101). In the anxiety model, there was a significant reduction over time of −3.3120 (95% CI: −3.7985 to −2.8256), with no effect of gender or age.
Conclusion: There was a significant reduction in depression and anxiety symptoms between the two data collection points, suggesting improved psychological well-being over time. Older participants reported fewer symptoms, but this effect was significant only in the depression model. No gender differences were observed either in isolation or over time. These findings highlight the importance of considering time and context in mental health assessments, especially among high-stress populations such as healthcare professionals.

Eva Madrid, Flor Rivera, Lorenzo Munar, Maria-Intí Metzendorf, Consol Serra, Marta Roqué

Abstract

Objective: To systematically evaluate the prevalence of work-related mental health problems in health and social care (HeSCare) professionals during the COVID-19 pandemic in the EU and investigate the initiatives undertaken to prevent and manage psychosocial risks and mental health in the sector.
Methods: A systematic review including cross-sectional studies reporting the prevalence of mental health problems assessed with validated scales in HeSCare workers (PROSPERO CRD42023473930). Bibliographic searches were conducted in Medline and EMBASE. Study quality was evaluated with the Joanna Briggs Institute Checklist for prevalence studies. Pooled prevalence estimates were obtained with random effects metanalyses, and sub-group analysis of workers potentially at increased risk conducted. In-depth grey literature searches and a Delphi survey allowed to identify interventions conducted during the pandemic in the sector, which were reviewed and classified.
Results: 113 studies from 2020 to July 2023 with 19,575 professionals were included, reporting data for 22 EU countries. HeSCare professionals showed high overall prevalence of anxiety, depression, acute stress, psychological distress, insomnia and burnout (37%, 22%, 44%, 46%, 36% and 38%). PTSD and suicidal thoughts were the least prevalent (24% and 11%). Evidence suggests higher prevalence rates of mental health problems in nurses, residents, aides, and emergency medical technicians, as well as in frontline and female workers. A significant degree of clinical and statistical heterogeneity was observed. In total, 134 reports of workplace interventions were evaluated, showing counselling (29.7%), mindfulness (17.4%), digital resources (14.5%), resting hubs (11.6%), organisational adjustments (10.9%), and psychoeducation (10.1%) as the most frequent, targeting largely healthcare professionals.

Conclusions: This review shows the burden of mental health problems in a critical sector and identifies categories of workers at higher risk, to inform targeted prevention. It provides a detailed analysis of interventions to safeguard workers wellbeing.

Georgia Ntani, Karen Walker-Bone

Abstract

Background The COVID-19 pandemic triggered widespread employment disruption, however studies on older workers are scarce. Undesired work changes at older ages may compromise long-term employment and health trajectories.

Objectives To explore the impact of employment changes since the onset of the COVID-19 pandemic on self-reported health of older workers.

Methods Data were drawn from the Health and Employment After Fifty (HEAF) study, a cohort of middle-aged individuals in England incepted in 2013-14. In February 2021 they reported on employment changes since March 2020 and perceived changes in mental and general health. Associations were analysed with Poisson regression, with robust standard errors, adjusting for age, sex, pre-pandemic self-rated health (SRH), pre-pandemic comorbidities, pre-pandemic financial position, and job type.

Results 2,469 participants responded to the online survey (53% response rate). After exclusion of participants already retired before the pandemic, 1,104 (48% men, mean age 63 years) were included. Only 33% retained the same employment, while 34% transitioned to home working, 15% were furloughed, 6% retired and 12% experienced another change. Compared with participants with unchanged employment, those who switched to home working (RR 1.59, 95%CI 1.09, 2.32) and those who retired (RR 2.07, 95%CI 1.14, 3.78) were more likely to perceive a SRH worsening. Recent retirees were also more likely to perceive a mental health worsening (RR 1.71, 95%CI 0.99, 2.97).

Conclusions Certain employment changes were associated with worsening of general and mental health. Some of the negative consequences of working from home during the peak of the pandemic may be explained by the shift to home working being sudden and forced. Health of the population should be monitored in the long term and support provided if needed.

Zipporah Iheozor-ejiofor, Mel Carder, David Fishwick, Ruth Wiggans, George McHale, Laura Byrne, Martie van Tongeren.

Abstract

Background The COVID-19 pandemic has changed many aspects of the way we interact with work and the subsequent risk of work-related ill-health (WRIH). With 5 years of post-COVID data, we may now start to investigate how trends in new cases of WRIH may have changed since 2020. Aim Using WRIH data reported to a UK-wide surveillance scheme, we investigated change in WRIH incidence trends in reporting post COVID-19 pandemic.

Method WRIH cases reported by physicians within The Health and Occupation Research (THOR) Network’s skin (called EPIDERM) and respiratory (called SWORD) schemes. Trends in WRIH incidence rates (since late 1990s) were evaluated using segmented (pre March 2020, Mar 2020 to 2024) time-series models within multilevel zero-inflated negative binomial models (ZINB). This allowed for investigation of post-pandemic trends in reporting of excess zeros (compared to pre-pandemic), and change in new cases of WRIH pre-pandemic.
Results Prior to the pandemic excess zero adjusted annual trends reported by THOR for skin and respiratory disease were decreasing by -3.4%(-3.8,-3.1) and -1.8%(-2.4,-1.2) per year respectively. The inflate proportion of the ZINB indicated an increase in number of excess zeros reported to EPIDERM in 2021 (OR=2.4(0.5,12.2)) and 2022 (4.0(1.4,11.3)). No such change occurred within SWORD. Both EPIDERM and SWORD reporting experienced decreases in trends of new cases reported post pandemic, with EPIDERM seeing nearly 60% (70%,50%) decrease whereas SWORD observed an 8% (10%,3%) decrease in new cases per year post pandemic.
Conclusion Early modelling of WRIH trends indicate new cases of skin and respiratory diseases may be declining at a faster rate than pre-pandemic. The potential reasons for these post pandemic differences are unclear, with additional data collection required to confirm these trends, and determine their future direction.

David Rees, Deepna Govind Lakhoo, Jill Murray

Abstract

Objective Lymph node silicosis may be diagnosed incidentally during investigations of lung and mediastinal diseases. This study explored the diagnostic accuracy of lymph node silicosis for pulmonary silicosis in deceased South African gold miners.
Methods Pathologist-diagnosed lymph node and pulmonary silicosis, and occupational histories of miners with exclusive gold mining service and who had an autopsy examination for compensation from 1975 to 2018 were selected from the Pathology Automation (PATHAUT) database. We calculated sensitivity, specificity, positive and negative predictive values (PPV and NPV) and summary diagnostic accuracy measures for lymph node silicosis overall and by employment duration, a surrogate for respirable crystalline silica (RCS) exposure. Pulmonary silicosis was the reference standard.
Results Of the 69 802 miners selected, 39.2% (n = 27373) had lymph node silicosis and 17.7% (n = 12345) had pulmonary silicosis. There were 10520 (15.1%) true positive, 1825 (2.6%) false negative, 40604 (58.2%) true negative and 16853 (24.1%) false positive pulmonary silicosis tests. Sensitivity was high (85.2%, 95% CI 84.6, 85.6) but specificity was lower (70.7%; 95% CI 70.3, 71.0). PPV was low (38.4%; 95% CI 37.9, 39.0) and NPV was high (95.7%; 95% CI 95.5, 95.9). Sensitivity increased with increasing years of employment.
Conclusion Our findings support previous studies suggesting that lymph node silicosis may occur at lower RCS exposures and precedes pulmonary silicosis. The detection of lymph node silicosis in a worker serves as warning of RCS exposures and as an early indicator of potential pulmonary silicosis. However, the low PPV indicates that lymph node silicosis has limitations as a diagnostic test for pulmonary silicosis. The detection of lymph node silicosis in workers should prompt further investigations for pulmonary silicosis detection, workplace RCS exposure assessments and implementation of control and prevention measures, as appropriate.

Hela Kamoun, Wiem Ayed, Hadhemi Rejeb, Hanen Smadhi, Leila Fekih

Abstract

Objective: Evaluating pulmonologists’ knowledge, attitudes, and practices in diagnosing occupational interstitial lung diseases (ILDs) and identify barriers to effective screening and referral.
Material and Methods: Descriptive cross-sectional study conducted from December 2024 to April 2025 using an anonymous online questionnaire via Google Forms. The survey targeted pulmonologists and covered demographics, knowledge of occupational exposures, diagnostic habits, and referral practices.
Results: Seventy-eight pulmonologists participated. Half were under 40 years old, and 75.8% had less than 10 years of experience. The sample included mainly residents (40.3%) and specialists (38.7%) Only 19.4% rated their knowledge of occupational ILDs as good or excellent, 30.6% as average, and 50% as poor or absent. The most recognized agents causing ILDs were asbestos and silica dust (93.5%), while fewer participants identified metallic dust (45.2%), sintered metals (35.5%), wood dust (35.5%), and cereal flours (40.3%). For extrinsic allergic alveolitis, the most cited causes were bird droppings (71%), isocyanates (69.4%), and moldy plant materials (43.5%). Occupational exposures linked to lung fibrosis included mining (79%), foundry work (77.4%), and welding (72.6%). Only 40.3% consistently took occupational histories in patients with ILDs. Just 14.5% recommended the correct six-month surveillance interval for exposed workers; 54.8% chose one year, and others opted for longer intervals. Only 43.5% frequently referred suspected occupational ILDs to occupational medicine. Motivations for referral included disease recognition (100%), exposure prevention (64.5%), and diagnostic clarification (61.3%). Main barriers were lack of training (80.6%), workload (80.6%), limited resources (77.4%), insufficient knowledge (72.6%), and low patient awareness (54.8%).
Conclusion: Significant gaps exist in pulmonologists’ knowledge and practices regarding occupational ILDs. Better collaboration with occupational health specialists is essential to improve early detection and care.

Fatma Ezzahra Boujmil, Nihel Khouja, Emna Baraketi, Khalil Grissa, Yasmine Tebourbi, Saloua Ismaïl, Jihène Hsinet, Aïda Benzarti

Abstract

Objective: To describe the socio-professional, clinical and etiological characteristics of occupational allergic rhinitis in Tunisia and to assess its impact on fitness for work.
Methods: A retrospective descriptive study of cases of occupational allergic rhinitis who consulted an occupational health department, known as a reference in occupational allergology in the northern region of Tunisia, over a period of 25 years.
Results: The total number of cases was 94. The mean age was 40.4±8.8 years, with a female predominance (sex ratio=0.77). They were mainly skilled (35.1%) or unskilled (58.5%) workers with 13.53±7.24 years’ professional experience, working in the automotive (23.4%), textile (20.2%) and healthcare (8%) sectors. Our population was non-smokers in 83% of cases and had no extra-professional activities. Family and personal atopy were reported in only 23.4% and 4% of cases respectively. Clinical symptoms were dominated by nasal pruritus (80.9%), rhinorrhoea (71.3%), sneezing (59.6%) and nasal obstruction (31.9%). It appeared on average 8.3±4.3 years after recruitment. The agents responsible were mainly isocyanates (25.5%), textile dusts (14%), moulds (7.4%), flour and cereals (5.3%) and formaldehyde (4.3%). Occupational rhinitis was isolated (76.6%) or associated with asthma (23.4%). Rhinitis was declared as a compensable occupational disease in 33% of cases and justified a modified workstation (65%) or a transfer to another workstation (34%), with a clear post-eviction improvement in 10% of cases and partial improvement in 78.7% of cases.
Conclusion: Occupational rhinitis affects both employees’ quality of life and their performance at work, which is why it is so important to step up preventive measures and encourage early detection.

Vanessa Zaat, Remko Houba

Abstract

In the food industry there is generally limited awareness for inhalation risk of food products for workers, more specific occupational allergies (rhinitis and asthma). Material Safety Data Sheets that point out potential allergic risks are mostly not available for food products. One of the sectors with low risk awareness is the milk industry. In our outpatient clinic several cases of occupational allergy to milk proteins have been diagnosed. In one patient occupational asthma was diagnosed for casein in a plant producing food ingredients. RAST tests were strongly positive for several products containing milk proteins and a workplace provocation test showed an increase of respiratory symptoms and a strong decline in lung function when working with powdered milk products. In a second patient occupational rhinitis was diagnosed for lactoferrin (a whey protein). This patient worked with lactoferrin in a cleanroom environment. Strong positive skin prick test was found for lactoferrin and a workplace provocation test showed an increase in nose symptoms. Individual cases of occupational milk powder allergy have been described in the literature and allergenicity of milk powder has also been shown in animal studies. Despite this information, milk proteins had not been recognized as a potential inhalation allergen in both companies. Patients should be considered as index cases and a strong signal that other exposed workers are also at risk for developing occupational allergy. Primary prevention to reduce exposure to milk powder and health surveillance for early identification of worker’s allergy on population level should be introduced in this industry. Based on a series of cases within this industry our
Conclusion is that milk powder allergy is an underestimated risk in the food industry that needs more awareness and prevention.

Jesper S. B. Frandsen,; Vivi Schlünssen; Ioannis Basinas; Anneli C. S. Bolund; Grethe Elholm; Signe Timm,; Øyvind Omland; Torben Sigsgaard,

Abstract

Objectives: To examine the connection between adult-onset asthma like symptoms and Alpha-1-antitrypsin (A-1-A) phenotype in farmers.
Methods: A 15-year follow up study of 917 Danish farming students and rural controls. Phenotypes of A-1-A phenotype and clinical examination were conducted at baseline and follow-up. At baseline A-1-A rare alleles wer found associated to non-specific bronchial responsiveness. We performed multiple Log regression assessing associations with adult-onset asthma. Asthma was defined as “definite or probable” according to the ECHRS algorithm previously employed in the baseline study and the ECRHS study.
Results: Among the young farmers 155 had new-onset asthma. Controlling for smoking, atopy, and upbringing at dairy farm risk for new onset asthma-like symptoms according to Alpha-1-phenotype (Pi) were compared to the wild type (MM); OR (95% CI) • MS : 0.55 (0,2 – 1.6) • MZ : 0.69 (0.3 – 1.8) • MX : 1.97 (0.2 – 20) • SS: 1.95 (0.2 – 24)
Conclusion: There is no direct effect of the different Pi-types on the risk of new asthma in adulthood. A sensitivity analysis showed no difference in the risk estimates when we included NSBR in the model. However, the study is too small ie. The power is low, and results should be appreciated with cautiousness.

Ryan F Hoy, Hore-Lacy Fiona, Tomic Dunya, Glass Deborah C and Walker-Bone Karen

Abstract

Objective Silicosis, a respiratory disease caused by inhalation of crystalline silica dust, is a major health concern among artificial stone benchtop workers worldwide. A health screening program funded by WorkSafe Victoria (Australia) showed had a high proportion of migrant workers (~50% born overseas) compared to general Australian workforce (30%). In this analysis we compared silicosis prevalence between migrant and non-migrant workers, with further analysis by interpreter use.
Material and Methods Data were extracted for persons attending screening between 2019–2024. Australian-born workers were classified as non-migrants and those born elsewhere as migrants. Interpreters were available for the assessment. Prevalence was compared between groups using Poisson regression with robust standard errors adjusting for age, smoking status and exposure duration, and we report risk ratios (RR) with the 95% confidence interval (CI).
Results There were 1080 workers, including 536 (50%) migrant workers and 24% of migrant workers used the interpreting service. Majority were men (93%) and median age was 33 (interquartile range (IQR) 27-42) and 39 years (IQR 31-47) among non-migrant and migrant workers, respectively. Silicosis prevalence was higher in migrant than non-migrant workers (23% vs 15%, RR=1.54, 95% CI 1.16–2.04). Prevalence among workers <45years was comparable but in those age ≥45years, prevalence was higher among migrant workers (RR=2.86, 95% CI 1.62-5.06). Migrant workers who used an interpreter had higher silicosis risk than those who did not (32% vs 13%, RR=2.24, 95% CI 1.61-3.10).

Conclusions This study showed disproportionate silicosis prevalence by migration status and interpreter use, the latter being a surrogate for language proficiency. It is therefore important for employers and workplace safety policymakers to seriously consider ways to overcome this disparity, and identify the optimum timing for intervening.

Tosca O.E. de Crom, Theresa Kynde, Wenxin Wan, Claudia Lissåker, Jenny Selander, Pernilla Wiebert, Henrik Kolstad, Jorunn Kirkeleit, Ingrid Sivesind Mehlum, Karina Undem, Svetlana Solovieva, Ioannis Basinas, Hans Kromhout, Michelle C. Turner-, Anjoeka Pronk, Vivi Schlünssen

Abstract

Objective: Chemical occupational exposures are established risk factors for chronic obstructive pulmonary disease (COPD), but most evidence comes from studies that overlook the potential impact of multiple co-exposures. The occupational exposome framework addresses this by capturing a broad range of occupational exposures across a career. We aimed to explore the association between the occupational exposome and COPD risk.
Material and Methods: We included individuals aged ≥40 years without COPD at baseline from four registry-based cohort studies: the Danish Occupational Cohort with eXposure data (DOC*X), the Swedish National Cohort on Work and Health (SNOW), the State of Labor Force in Finland (SLFF) cohort, and the Norwegian Nor-Work cohort. Participants were followed from cohort-specific start years between 1960 and 1990 through to 2022. Occupational histories were coded using the European version of the International Standard Classification of Occupations 1988 (ISCO-88 (COM)). Cumulative exposures were assigned via job-exposure matrices (EuroJEM, OAsJEM, Endo-JEM, ALOHA+ JEM, and DOM-JEM), collectively covering 52 chemical, psychosocial, and ergonomic factors. Incident COPD was identified from hospital records with a primary or secondary diagnosis of COPD (ICD-10 code J44) or emphysema (J43). In the ExWAS analysis, we used discrete-time hazard models to assess associations between individual exposures and incident COPD. Model 1 was adjusted for age, sex, and smoking status; model 2 included additional adjustment for education. These were followed by mutually adjusted LASSO regression to identify the most relevant exposures.
Results: Analyses are ongoing and are expected to reveal individual occupational exposures and co-exposure patterns associated with increased COPD risk.
Conclusion: This study is expected to improve our understanding of how complex occupational exposure patterns across working-life relate to COPD risk, offering insights that may inform future prevention strategies.

Adrienne Edwards, Amanda Eng, Alexandra Muthu, Frith Coolbear, Sally De-Boer, David Milne, Jeroen Douwes, Andrea ‘t Mannetje†and Margaret Wilsher.

Abstract

Objective: Engineered stone (ES) associated silicosis has killed young stonemasons around the world. In response, the New Zealand Accelerated Silicosis Assessment Pathway was implemented to ensure asymptomatic workers at risk of early disease are offered free health assessment and support to access services. We are conducting a study which aims to describe the exposure circumstances and health outcomes for all workers on the pathway including a case series of ES-associated silicosis in NZ diagnosed between 2019-24.
Material and Methods: For all pathway workers, the exposure and healthinformation will be analysed at a descriptive level and related to clinical outcome i.e. current silicosis (yes/no) and/or clinical abnormalities (yes/no), using lung-function, chest x-ray, CT scan, and blood biomarkers. Diagnoses of silicosis are made via a national Silica Multi-Disciplinary Meeting (MDM). To date, we have conducted descriptive analyses of a subset of MDM cases referred to Christchurch hospital since 2019 (reported here) with the full MDM case series being presented at the conference.
Results: From 222 workers entering the pathway (of ~1000 exposed workers), the majority were aged 25-59 years. About one quarter of these were referred to the MDM which resulted in 26 silica-related disease cases. The Christchurch subset (n=8)included four definite silicosis (one complicated progressive), three possible simple silicosis (with co-existing airways disease) and one silicolymphadenopathy. The age range at diagnosis was 32-62 years with an average duration of working with ES of 9 years (range 3-16; all dry cutting).Five were never smokers and 75% were born outside of NZ.. All but one had normal chest x-rays and spirometry at baseline and stability on CT thereafter.
Conclusion: This study will describe the first cases of engineered stone-associated silicosis in NZ and despite pathway uptake generally being poor, results will help answer key questions related to health outcomes of respirable crystalline silica exposure.

Zitong, Zhang; Moshe, Shapiro; Jonathan, Weber; John, T. Doucette; Juan, C. Celedón;

Abstract

Objective: In the Mount Sinai WTC General Responders’ Cohort on longitudinal health surveillance, about a third of participants who met the spirometric definition of chronic obstructive pulmonary disease (COPDspiro) have never smoked tobacco products, and we have observed less radiological emphysema. We examined the hypothesis that smoking-related COPDspiro is associated with accelerated longitudinal FEV1 decline.
Methods: All study subjects participated were diagnosed with COPDspiro based on post-bronchodilator FEV1/FVC<0.7. We examined differences between participants with ever vs. never smoking on longitudinal lung function trajectory based on our previous publication[PMC7605357] and defined those with an average decrease in FEV1 larger than 62.5ml/year as an accelerated decliner. We additionally compared the effect of bronchodilator response using and a five-category bronchodilator response grading strategy[PMC6956832]. We used multivariable logistic regressions to examine the odds of an accelerated FEV1 decline trajectory between ever- vs never smoking COPDspiro groups.
Results: Among the 504 subjects with COPDspiro, 181 (35.9%) never smoked. Compared with the ever smokers, nonsmokers were younger and more often of Latino/any race ethnicity. While the smokers had higher prevalence of high blood neutrophil count (>6000/mcl), the non-smokers had higher prevalence of self-reported asthma and evidence of bronchodilator responsiveness (BDR), and a higher proportion of subjects with marked BDR category (ΔFEV1>0.26 L or 26%). Smokers had 1.56 times higher odds (95%CI 1.01-2.42) of having dyspnea, and 1.74 times higher odds (95%CI 1.05-2.89) of having an accelerated FEV1 decline compared to non-smokers.
Conclusion: Among WTC responders, COPDspiro in smokers was associated with an accelerated FEV1 decline and shortness of breath compared to never smokers, while never smokers with COPD tended to have higher percentage of asthma diagnosis and a positive BDR. Funding: grant U01 OH011697 from CDC/NIOSH. The WTC GRC Data Center provided the data utilized for this study (CDC/NIOSH contract 75D30122C15187). The views expressed in this work are not necessarily those of the CDC/NIOSH.

Arroon Ketsakorn

Abstract

Fine particles are an undesirable phenomenon that affect human health and can lead to abnormal pulmonary function. The process of making Khit pillows is one of the processes that generates dust. The purpose of this study was to study association between abnormal respiratory function from exposure to fine particles in Khit pillow manufacturing informal workers, Thailand. The questionnaire survey was conducted between April and June 2024. Data collection involved questionnaires and levels of fine particles measurement. The questionnaires were asked about characteristics and work information, working area characteristics, work environment, knowledge, attitude and practice for preventing the workplace, risk perception and occupational disease prevention, and abnormal pulmonary function from exposure to fine particles. Spearman’s correlation and Pearson Chi-square’s correlation were used to analyze data. The results, 39.5% self-reported showed they had obstructive pulmonary disease symptoms from fine dust exposure; factors including age, frequency of smoking, concentration of fine particles, and knowledge about disease surveillance, prevention and control from dust, as tested using multiple regression analysis (p<0.05). Those risk factors should be considered for health prevention in the workers and to improve the workplace.