David Fishwick, Damn McElvenny, Laura Byrne, Martie van Tongeren

Abstract

Objective Even though South Korea has a significant history of asbestos use, there are fewer cases of malignant mesothelioma in South Korea than in the UK. The purpose of this study is to describe the occupational distribution of samples collected from mesothelioma cases in South Korea and the UK, where the incidence of mesothelioma appears to be different using different surveillant schemes.
Material and Methods The following three data sources were matched by unifying the occupational classification of cases reported as mesothelioma to a two-digit Standard Occupational Classification (SOC) code: UK Industrial Injuries Disablement Benefit (IIDB) mesothelioma SOC classification table from 2017 to the third quarter of 2020, cases with diagnosis code C45 reported by The Health and Occupation Research (THOR) network from 2017 to 2021, and KCOMWEL (Korea Workers’ Compensation & Welfare Service) occupational disease investigation cases with diagnosis code C45 during the same period. We compared the distribution of occupational groups by each source and calculated the standardised rate ratio (SRR) for each occupational group based on the population distribution by occupation surveyed in the UK in 1981 and South Korea in 1980.
Results In the SOC distribution, the three datasets showed differences in the distribution only in 81 (machine operators). The 53 (construction occupations) with the highest number reported cases had a high SRR in the UK. A statistically significant SRR was also reported in South Korea, but it was lower than in the UK.
Conclusion Surveillance data (THOR) shows a similar distribution to compensation data (IIDB). Mesothelioma may have been underreported among Korean construction workers, but this may be a diluted result due to the lack of detailed census data. Additional data is needed to estimate the number of construction workers in the 1980s for a more accurate comparison, especially in Korea.

Barbara Savary, Andrea Emili, Gautier Mater

Abstract

Objective: Nickel is a prevalent lung carcinogen and sensitizer with an estimated 100,000 workers exposed in France. We aimed to evaluate trends in occupational exposure levels to inhalable nickel in French workplaces since 1987.
Material and Methods: We sourced inhalable nickel measurements from the Colchic database, which contains exposure data collected in France for risk prevention purposes, restricted to personal samples with a sampling duration ≥2 hours. We used Bayesian hierarchical models to estimate relationships between nickel concentrations and sample year, accounting for censored data and repeated measurements within workplaces. We fit the models to all data and to industrial sectors (3-digit codes, ISIC revision 4) that had ≥20 measurements in each of the following time windows: 1987-1996, 1997-2006, 2007-2015, and 2016-2024.
Results: The whole dataset contained 8,230 measurements, with a median of 201 per year (range 68-482). Non-detects represented 29% of all measurements. Geometric mean concentrations by period ranged from 0.013 mg/m3 for 1987-1996 to 0.003 mg/m3 for 2016-2024. The proportion of samples exceeding the French exposure limit (0.1 mg/m3) decreased from 18% in 1987-1996 to 4% in 2016-2024. Overall geometric mean nickel concentrations decreased by 3.9% per year (95% credible interval 3.1-4.6%). Nine sectors had ≥20 measurements in all periods. All had trends of lower exposures over time, ranging from 3.3%/year (Manufacturing of other general machinery, n=267) to 9.1%/year (Manufacturing of medical and dental instruments and supplies, n=511).
Conclusion: Our analysis of historical inhalable nickel exposure data showed a generalized decrease in workplace concentrations across multiple sectors, although additional studies are needed to also assess trends in respirable nickel exposure. Sources of funding: Internal funding from the INRS

Fatima, Ali; Jeavana, Sritharan; Tanya, Navaneelan; Shannon, Halls; Nathan, DeBono; Paul, A, Demers

Abstract

Objectives: Several occupational exposures cause lung cancer, but few studies have examined sex-specific differences. We aim to investigate the independent exposure response effects of exposure to five carcinogens— asbestos, chromium VI, nickel, polycyclic aromatic hydrocarbons (PAHs), and silica— on lung cancer risk. Methods: A prospective open cohort of Ontario workers was followed for lung cancer diagnoses from 1983 to 2019 in the Ontario Cancer Registry. Exposures were assessed using the Canadian job-exposure matrix, including measures for exposure status (exposed/non-exposed), intensity of exposure (low, medium/high) and frequency of exposure (<8h/week, 8-40h/week, 40+h/week) for each carcinogen. Cox proportional hazards models estimated independent associations of carcinogen exposure and lung cancer risk overall, by sex, and by subtype. Models were adjusted for age, sex, and birth-year.
Results: Overall, 36,125 lung cancer cases were identified among 2,223,408 workers. Exposed workers had significantly higher lung cancer risks for all carcinogens (HR_chomium VI=1.12, 95% CI:1.06–1.18; HR_nickel=1.05, 95% CI: 1.01–1.10; HR_PAHs=1.18, 95% CI: 1.16–1.21; HR_silica=1.10, 95% CI: 1.06–1.14) except asbestos (HR_asbestos=1.00, 95% CI: 0.97–1.03). Females had higher risks than males for all carcinogens, ranging from 3% (Silica: HR_females=1.12, 95% CI: 0.96–1.31; HR_males=1.09, 95% CI: 1.05–1.13) to 28% (Nickel: HR_females=1.31, 1.10–1.56; HR_males=1.03, 95% CI: 0.99–1.08). Positive exposure-response relationships for exposure frequency and intensity were observed for all carcinogens, with stronger associations among females. Results were similar for adenocarcinoma, squamous cell, and small cell lung cancer.
Conclusion: The independent findings are consistent with previous research and highlight potential sex differences in lung cancer risk due to occupational exposure to five carcinogens.

Kenneth A. Mundt

Abstract

Objective: To quantify silicosis and lung cancer risks among 17,644 German porcelain workers occupationally exposed to respirable crystalline silica (RCS) after extending follow-up 15 years through Dec 31st, 2020.
Material and Methods: Porcelain workers enrolled in a mandatory medical surveillance program including triennial chest x-rays between 1985-1987 and alive at the end of the previous study follow-up (2005) were followed through 2020 for all-cause mortality and silicosis incidence. Cause of death was determined from death certificates. New silicosis cases were identified by re-reading x-rays of individuals included in the medical surveillance program and of individuals who filed insurance claims for silicosis. Cause-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were estimated by RCS exposure group based on work histories and about 8,000 industrial hygiene measurements. Cox proportional hazards ratios (HRs) were estimated by cumulative and average exposure groups.
Results: Deaths from all causes increased from 1,610 (9.1%) to 4,586 (26%). No statistically significant increased mortality risks were seen due to lung cancer, renal cancer, or non-malignant renal disease. Lung cancer mortality also was unrelated to RCS exposure. In contrast, silicosis risk was strongly and statistically significantly associated with average exposure intensity > 0.10 mg/m3 and cumulative exposure >3.0 mg/m3-years; however, exposures below these thresholds were not associated with increased silicosis risk.

Cheryl Peters, Disann Katende, Ela Rydz, Emma K Quinn, Raissa Shrestha, Sajjad S Fazel

Abstract

Objective: Understanding the demographic and job-related factors influencing the prevalence of new workers and their exposure to potential carcinogens is crucial for improving workplace safety and guiding policy interventions. We used the Labour Force Survey (LFS) to estimate the likelihood of being a new worker based on age, industry, occupation, season, and immigration status.
Material and Methods: Logistic regression was performed on the 2017 LFS; participants were categorized by sector and occupation using the North American Industry Classification System 2017 Version 1.0 and National Occupational Classification system 2016 Version 1.0. Finally, an exposures-per-worker metric was used to highlight the hazardous exposures new workers encounter in their jobs and industries.
Results: Individuals younger than 25 years had 3.24 times the odds of being new workers compared to those in the 25–39 age group (adjusted odds ratios (OR) = 3.24, 95% confidence interval (95% CI) = 3.18, 3.31). Recent immigrants (less than 10 years in the country) were more likely to be new workers than those with Canadian citizenship (OR 1.36, 95% CI: 1.32, 1.41). The total workforce exposures-per-worker metric using CAREX Canada data was 0.56. By occupation, new workers were the most overrepresented in jobs in natural resources and agriculture (20.5% new workers), where they also experienced a high exposures-per-worker metric (1.57).
Conclusion: Younger workers (under 25 years) and recent immigrants who had arrived 10 or fewer years prior were more likely to be new workers, and were overrepresented in jobs with more frequent hazardous exposures (Construction, Agriculture, and Trades).

Patrick Hinton , Laura A. Rodriguez-Villamizar , Philippe Prince , Tim Prendergast , Minh T. Do , Paul A. Demers , Cheryl E. Peters (,), Lydia B. Zablotska , and Paul J. Villeneuve

Abstract

Objective: Ionizing radiation is a human carcinogen, but there are uncertainties about cancer risks from long-term exposure at low-doses. Large-scale occupational studies provide opportunities to estimate these risks, yet to date, most have relied on mortality outcomes to do so. This study sought to characterize the risk of incident cancers in relation to cumulative occupational exposure to radiation among nuclear power plant workers in the recently extended follow-up of the Canadian National Dose Registry. Methods: This retrospective cohort study comprised 75,350 Canadians employed between 1945 and 2010. Record linkage to national cancer incidence and mortality registries was performed to identify incident cancers between 1969 and 2010. Annual whole-body doses to internal and external ionizing radiation, expressed as effective doses, were determined from personal dosimetry records. Standardized incidence ratios (SIRs) were calculated to compare site-specific cancer rates with the Canadian general population, while Poisson regression models estimated linear excess relative risks (ERR) per 100 millisieverts (mSv) of cumulative exposure.
Results: A total of 4,370 first primary cancers were identified during the follow-up. The mean cumulative effective dose was 12.0 mSv (SD = 30.42 mSv) at the end of follow-up. Elevated SIRs were observed for malignant melanoma, prostate, and colon cancer, while that for lung cancer incidence was less than one. The ERR estimates were positive, though not statistically significant, for prostate cancer (ERR/100mSv = 0.12; 95% CI: -0.05, 0.29) and melanoma (ERR/100mSv = 0.32; 95% CI: -0.23, 0.87), whereas an inverse association was exhibited for lung cancer. For prostate cancer, age at first exposure was found to modify the risk, with those first exposed from 55 years of age onwards most vulnerable.
Conclusion: Our findings provide some evidence that low-dose protracted ionizing radiation exposure increases the risk of prostate cancer and malignant melanoma. Funding: This project was funded by the Canadian Institutes of Health Research (Funding Application #: 487910).

Stoleski Sasho, Minov Jordan, Zdraveski David, Mijakoski Dragan

Abstract

Objective: This systematic review aims to identify, evaluate, and synthesize existing evidence about the association between occupational exposure and cancer in developing countries, to conduct risk of bias assessment (RBA), and to identify knowledge gaps to guide future research.
Material and Methods: A systematic review is currently conducted across three major databases—MEDLINE (via PubMed), EBSCO, and DynaMed—including studies published between 1990 and 2025. The search strategy was developed in accordance with the PICOs framework, using a combination of search terms, Medical Subject Headings (MeSH), and Boolean operators (AND, OR, NOT) to identify relevant studies. The ongoing first phase of this systematic review (MEDLINE database) initially identified a total of 1,759 records which were screened based on title and abstract. For the resulting 41 records, the full-text articles were assessed for eligibility. Following the exclusion criteria, four articles without an existing abstract and 28 review articles were removed. In accordance with the inclusion criteria, only original research articles were considered, resulting in 9 full-text articles being included for qualitative synthesis. Screening of EBSCO and DynaMed databases will be conducted in the next phase of the review. RBA was based on the criteria proposed by Shamliyana et al.
Results: Preliminary data showed that the most frequently analysed occupational carcinogens in developing countries were: asbestos, silica dust, pesticides, arsenic, and particulate matters. Mostly investigated cancer sites were: lung cancer, melanoma, leukaemia, and colo-rectal cancer. The RBA showed external and internal validity issues for most of the studies.
Conclusion: There is a clear need to improve evidence synthesis on occupational exposure and cancer in developing countries, where the burden could be greater but research is limited. Acknowledgements: The authors declare no funding or conflicts of interest.

Léa Guillemin , Gautier Defossez , Patricia Delafosse , Karima Hammas , Sandrine Plouvier , Isabelle Baldi , Jean-Yves Blay , François Le Loarer , Gonzague de Pinieux , François Gouin , Antoine Italiano , Alain Monnereau , Isabelle Pellegrin , Nicolas Penel , Isabelle Ray-Coquard , Maud Toulmonde , Françoise Ducimetière , Aude Lacourt , Simone Mathoulin-Pelissier , Brice Amadeo

Abstract

Introduction. Sarcomas are rare tumours of connective tissues whose aetiology is very poorly understood. Some studies suggested associations between sarcomas and some occupations, mainly in the agricultural population and among woodworkers, suspecting a role of pesticides in the occurrence of sarcomas. The main Objective of this study is to estimate the associations between occupations and soft tissue sarcomas (STS), viscera sarcomas (VS) and bone sarcomas (BS) separately. Methods. ETIOSARC is a French multicentric general population case-control study conducted between 2019 and 2024. Cases and controls were interviewed with a self-administered questionnaire and a face-to-face interview. Odds ratio and 95% confidence intervals adjusted for education level were estimated using a conditional logistic regression for each occupation held for at least five years separately in men and women.
Results. The number of cases included is 474 STS, 158 VS and 67 BS. Men are more represented in STS (56.1%) and women in VS (62.0%) whereas they are equally represented in BS. The mean age at diagnosis range from 57,4 for men with BS to 60,5 for men with VS and women with BS. Among men, heavy truck and lorry drivers and draughtspersons are significantly associated with STS (OR=3.60; 95% CI=1.23-10.52 and OR=2.53; 95% CI=1.03-6.20 respectively) and medical doctors with VS (OR=12.09; 95% CI=1.28-113.92). Among women, the risk of STS is significant for cleaners and helpers (OR=2.64; 95% CI=1.02-6.85). No significant association was found for BS in either men or women. A non-significant association was found between farmers and STS in men (OR=1.42; 95% CI=0.73-2.78).
Conclusion. This is the first study investigating the association between occupations and the site of the sarcoma by gender. This analysis identified new occupations associated with the occurrence of sarcomas, and a positive but non-significant strength of association among farmers who require further investigations.

Joachim Schüz, Evgeny Kovalevskiy, Hans Kromhout, Igor Bukhtiyarov

Abstract

Objective Investigate cancer mortality in workers of the world’s largest chrysotile mine and its enrichment factories in Asbest, Sverdlovsk region of the Russian Federation.

Materials and Methods The Asbest chrysotile cohort study includes 30 445 workers, whereof 32% are women, employed for at least 1 year between 1975 and 2010 and followed up until the end of 2015. Individual cumulative exposure to dust (and modelled conversion to asbestos fibres) was estimated based on workers’ occupational history linked to dust measurements systematically collected from the 1950s to 2010. Relative risks (RRs) by exposure were estimated as mortality rate ratios in Poisson regression models within the cohort, and standardized mortality ratios (SMRs) were calculated for selected cancer sites compared to the population of Sverdlovsk region for the years 1980-2015.
Results An exposure-response between cumulative dust and lung cancer mortality in men was observed with a RR 1.40, 95%-confidence interval (CI) 1.03-1.90 in the ≥150 mg/m3-years category and a p-value for trend of 0.02, while in women no clear association was seen but a modest increase in the highest category of exposure to fibres. Mesothelioma mortality was increased (RR 7.64, CI 1.18 to 49.5) in the highest exposure category to fibres (≥ 80 fibres/cm3-years). Comparing the cohort vs. Sverdlovsk region for lung cancer showed SMR 1.20, CI 1.10-1.30 in men and 1.35, CI 0.97-1.83 in women. No or no consistent associations were seen for stomach, colorectal, laryngeal, or ovarian cancer.
Conclusions This is the first international study to examine cancer mortality in the Russian chrysotile industry. We observed increased risks of mesothelioma and of lung cancer in men. Our comparison with the mortality of the region confirms the observed exposure-depended excess in lung cancer, especially in men.

Mieke Koehoorn, Hugh W. Davies, Paul Demers, Brianna Frangione, Hans Kromhout, Heather MacDonald, Christopher McLeod, Ann Olsson, Cheryl Peters, Laura Rodriguez-Villamizar, Leslie Stayner, Kyle Steenland, Kurt Straif, Paul J. Villeneuve

Abstract

Objective: Our Objective was to synthesize epidemiological findings on occupational exposure to respirable crystalline silica (RCS) and lung cancer, and to evaluate whether the relationship between RCS and lung cancer was modified by sex, histological type, adjustment for smoking, or study quality.
Methods: We conducted a systematic review and meta-analysis of cohort and case-control studies reporting risk estimates for lung cancer associated with occupational RCS exposure. Literature searches were applied across five databases with no restrictions on year, language, or region. A total of 1,783 studies were identified, of which 71 met the eligibility criteria. Meta-analyses were conducted in STATA using random effects models.
Results: Workers ever exposed to RCS had an increased risk of lung cancer (summary meta-risk estimate (mRE)=1.17; 95% CI: 1.07–1.28) relative to those not exposed. In higher quality studies, the risk was higher (mRE=1.19; 95% CI: 1.01–1.39). We found that RCS was associated with an increased risk of lung cancer in both men and women, although we lacked power to assess any differences as only 3 studies reported risks for women. Stronger associations were found for squamous cell carcinoma (mRE=1.41; 95% CI: 1.28–1.55), and among smokers (mRE=2.10, 95% CI: 0.86–5.14). Adjustment for smoking attenuated the summary risk estimate but it remained elevated. Exposure-response analyses are ongoing and will be presented.
Conclusion: These findings further corroborate the evaluations from past authoritative reviews that occupational exposure to RCS increases the risk of lung cancer. There remains an important need to conduct additional epidemiological studies to capture the risk more accurately in certain subgroups, particularly in women, and by histological type.

Tosca O.E. de Crom, Iris Eekhout, Ellian Lebbink, Caren Lanting, Susan Peters, Anjoeka Pronk

Abstract

Objective: It is well established that several occupational exposures have carcinogenic properties; the precise extent to which these exposures contribute to the recent cancer incidence in the Netherlands remains unclear. We estimated the annual cancer burden attributable to six occupational carcinogens in the Netherlands.
Material and Methods: We selected occupational exposures classified as Group 1 carcinogens by the International Agency for Research on Cancer (IARC) with high relevance to the Dutch working population. Selected exposures included asbestos, crystalline silica, diesel engine exhaust, and solar ultraviolet radiation (UV), as well as being employed as a welder or painter. Population attributable fractions (PAFs) were calculated using Levin’s equation for each exposure and associated cancer. Input data for the calculations included the proportions of the population exposed during the relevant exposure period (1971–2011) derived from Statistics Netherlands, and relative risks for each occupational exposure-cancer type combination obtained from existing literature. Cancer incidences from 2021, obtained from the Netherlands Cancer Registry, were combined with the PAFs to estimate the absolute numbers of attributable cases.
Results: Of 126,717 new cancer diagnosis in the Netherlands in 2021, 3,932 (3.1%) were attributable to the occupational exposures in our study. Occupational cancer burden in men (5.4%) were higher than in women (0.5%). Solar UV exposure resulted in the largest cancer burden (1720 basal cell skin cancers), followed by asbestos (925 lung cancers, 463 mesotheliomas, 10 ovarian cancers, and 9 laryngeal cancers), occupation as painter (156 lung cancers, 83 bladder cancers), occupation as welder (201 lung cancers, 11 ocular melanomas), crystalline silica (233 lung cancers), and diesel engine exhaust (187 lung cancers).
Conclusion: Occupational exposures contribute to thousands of cancer diagnosis in the Netherlands annually. Our estimates of cancer burden attributable to six important occupational carcinogens highlight areas for potential efforts for exposure and disease prevention.

Jan Ivar Martinsen ; Mieke C Louwe ; Marit B Veierød ; Marcin W Wojewodzic ; Jo S Stenehjem ; Tom K Grimsrud

Abstract

Objective: The green shift from fossil fuel to renewable energy depends on extensive use of batteries based on metals, whereof some are known or suspected carcinogens. Revisiting the effects of metal exposures on health outcomes, including cancer, is urgently needed. This study aims to provide new insight into low-grade or long-term exposure to air-borne nickel compounds (recognized human carcinogens) and cobalt (recently classified by the International Agency for Research on Cancer as probably carcinogenic).
Material and Methods: A cohort of Norwegian metal refinery workers (n=18,000) employed 1910–2018, will be linked to data from the Cancer Registry of Norway for follow-up 1953–2024. Department-time exposure matrices with average exposure to total nickel (1910–2018) or cobalt (1952–2018) will be linked to individual work histories. Data on total mortality will facilitate evaluation of competing risk adjusting for smoking by use of historical data. Internal comparisons among refinery workers will be conducted by regression methods and more advanced causal inference methods within a time-to-event analytic framework. Additionally, spatial data analysis and correlation statistics will be used for an ecological study of residents based on regional cancer rates and county-level cigarette consumption. A negative control outcome approach will address potential residual confounding.
Analysis and Results: Exposure-related cancer risks will be evaluated in the cohort analyses. We will evaluate spatial and temporal patterns of associations between metals measured in moss and ambient air, and county-level lung and sinonasal cancer. This is particularly relevant in the counties of Agder and Finnmark where emissions are assumed high due to nearby metal smelters or refineries.
Conclusion: The present study has an occupational component and an environmental component, both with high quality exposure and cancer data. This approach will attack the research questions from several angles and provide important insights both on the individual and aggregate level.

Marcin W. Wojewodzic, Herzke, Dorte; Langseth, Hilde; Haug, Line Småstuen; Marie Udnesseter Lie, Marianne Lauritzen, Jan Ivar Martinsen, Husøy, Trine;, Wojewodzic, Marcin W*,.

Abstract

Objective: Per- and polyfluoroalkyl substances (PFAS), also known as “forever chemicals”, have been widely used since the 1940s in industrial and consumer products such as non-stick cookware, waterproof coatings, fire suppression foams, and even cosmetics. PFAS are recognized as persistent and bioaccumulating, and are also possibly carcinogenic based on limited evidence for kidney and testicular cancer. Our aim is to assess the association between PFAS exposure and kidney and testicular cancer in a prospective cohort with historical serum samples.
Material and Methods: We are performing a nested case-control study of 1000 kidney cancer cases and 1000 matched controls, and 69 testicular cancer cases and 111 controls within the Janus Serum Bank (JSB) cohort. Cases and controls were matched by sex, birth-year, and residential county at blood draw. JSB enrollment questionnaires have been requested for the study population, including information on anthropometric and lifestyle factors. Levels of >24 PFAS in pre-diagnostic serum samples are being assessed using high-performance LC-MS/MS (limit of quantification: 0.015–0.2 ng/ml serum).
Statistical analysis: Logistic regression will be used to calculate adjusted odds ratios (95% CI) of the association between PFAS exposure and cancer risk. Serum samples from cases and controls are currently undergoing analysis for PFAS levels. Sources for high exposure, such as residential area or occupation, and the association between PFAS levels and kidney and testicular cancer risk, are being examined.

Noor Ul Huda and Muhammad Waseem Khan

Abstract

Diagnostic X-rays are the largest man-made source of radiation exposure. Although diagnostic X-rays provide great assistance, that their use involves some risk of adverse health effects is not commonly accepted. The exposure of individuals is rare and only prescription base. However, X-ray machine operators are exposed to these radiations on daily basis. In addition, the awareness of laboratory technicians about radiation exposure and associated adverse health effects is minimal. This research study is planned with the aim to assess combined carcinogenicity of X-rays and ELF MF in the form molecular mechanism i.e., DNA damage, disruption of antioxidant enzyme activities, and the generation of reactive oxygen species among X-rays technicians and their controls. The study participants will include healthy X-ray machine operators and their controls; matched with gender and age (± 5 years). Blood samples will be collected for the assessment of biological markers. Data about effect modifiers and other confounding factors i.e., smoking, socioeconomic status, etc., will be collected through a designed questionnaire. The data will be compared between the groups and analyzed using adjusted and un-adjusted regression analysis in R statistical software. Only a few studies have been conducted investigating the association between X-rays exposure of laboratory technicians and adverse health effects and no study has been conducted on the combined exposure of X-ray radiation in the laboratory workers and ELF MF, previously. The study results will be helpful both in assessing the adverse health effects of X-rays and in creating awareness amongst laboratory technicians, radiologists and other relevant health workers to keep the radiation exposure as low as possible. In addition, the study will be valuable for policy makers to prioritize occupational safety.

Hardy, Vanessa Amar, Derek Ruths, Nicholas B. King

Abstract

Objective: Industry-funded research is a threat to the validity of scientific inference on carcinogenic hazards. Scientists require tools to better identify industry-funded studies and minimize the influence of industry bias in evidence synthesis reviews. We applied a novel large language model (LLM)-based tool named InfluenceMapper to demonstrate and evaluate its performance in identifying industry sponsored research on the carcinogenicity of two occupational exposures of commercial interest by major industries, benzene and cobalt.
Materials and Methods: We identified all epidemiological, animal bioassay, and mechanistic studies included in systematic reviews on the carcinogenicity of benzene and cobalt conducted by the WHO/IARC Monographs Programme. InfluenceMapper extracted sponsoring entities disclosed in study publications and classified 40 possible relationship types between all entities and the study and each author. A human classified entities as industry or industry-funded. Positive predictive values described the extent of false positive relationships.
Results: Analyses included 1,520 studies for both agents. We identified 184 disclosed industry or industry-funded entities from InfluenceMapper output that were involved in 453 distinct study-entity and author-entity relationships. For each agent, between 4-8% of studies were funded by industry and 1-4% of studies had at least one author that disclosed receiving industry funding. Industry trade associations funded 19 studies published in 14 journals over a 37-year span. After funding, the most prevalent disclosed relationships with industry were receiving data, holding employment, paid consulting, and providing expert testimony. Industry sponsored research consisted predominantly of mechanistic studies. Positive predictive values were excellent (>98%) for study-entity relationships but declined for relationships with individual authors.
Conclusion: LLM-based tools can significantly expedite and bolster the detection of industry sponsored research in cancer prevention. Possible use cases include facilitating the assessment of bias from industry studies in evidence synthesis reviews and alerting scientists to the influence of industry on scientific inference about carcinogenic hazards.

Koehoorn M, Demers PA, Arrandale VH, Chen C, Davies HW, Dement J, Fan J, Macpherson R, Olsson A, Pahwa M, Peters CE, Stayner L, Straif K, McLeod CB

Abstract

Objective: To conduct an updated systematic review and meta-analyses of the exposure-response relationship between cumulative occupational asbestos exposure and the risk of lung cancer.
Materials and Methods: The search strategy was executed on five databases and by review of reference lists. A total of 32 cohort and case-control studies with risk estimates for cumulative, categorical asbestos exposure and lung cancer risk were included. The reported mean or midpoint of each cumulative asbestos exposure category was log-transformed and meta-analyzed using multi-level, random intercept, log-linear regression models. Analyses explored higher risk groups and sources of heterogeneity by exposure and study characteristics, including the quality of the exposure assessment. The investigators reached consensus on interpretation of the findings by emphasizing the consistency of the findings and study informativeness, and placing less emphasis on statistical significance in the meta-analyses of a significant occupational hazard.
Results: The predicted exposure-response curve, extrapolated from the overall meta-risk estimate (theta (θ)=0.13 (95% CI, 0.10, 0.16)), was nonlinear with a steeper rise in risk at the lower exposure range: the estimated RR was 1.21 (1.17, 1.26) at 5 f-yr/ml; 1.43 (1.33, 1.53) at 25 f-yr/ml; 1.52 (1.40, 1.63) at 50 f-yr/ml; 1.61 (1.47, 1.64) at 100 f-yr/m; and 1.71 (1.54, 1.87) at 200 f-yr/ml. Stronger exposure-response relationships were observed in studies with higher quality exposure assessment (e.g., RR from 1.32 to 2.07 across the same range of exposures), as well as in studies of asbestos production and manufacturing workers, particularly in North America. The results were robust to sensitivity analyses investigating sources of heterogeneity and analytic methods.
Conclusion: Increasing cumulative asbestos exposure is associated with higher lung cancer risk across the range of cumulative exposure, with a steeper rise in risk at the lower exposure range.

Andrew Curran

Abstract

Objective: This study examines the impact of the COVID-19 pandemic on workplace health and safety in England, identifying key lessons to strengthen preparedness for future public health emergencies.
Materials and Methods: The study draws on findings from 20 workplace outbreak investigations and an outbreak risk model based on national linked datasets. These were conducted as part of the COVID-OUT study under the UK PROTECT COVID-19 National Core Study. The analysis focused on transmission risks and control measures across various workplace settings and was complemented by a review of UK-based scientific literature on the broader effects of the pandemic on workers and workplaces.
Results: Workplaces were found to be significant settings for COVID-19 transmission. The study analyses outbreaks across several high-risk sectors, including manufacturing, storage and distribution, meat-processing, public order and safety, and public-facing offices, highlighting sector- specific challenges and the effectiveness of different control measures implemented in each setting. It emphasises the need for tailored infection prevention strategies, including regular testing in combination of local contact tracing, improved ventilation, use of face coverings, and financial support for workers to encourage self-isolation. The study advocates for a multi-layered approach to risk mitigation, combining physical, behavioural, and administrative interventions. It also stresses the need for strong data collection and analysis to identify high-risk settings and inform targeted response.
Conclusion: The COVID-19 pandemic highlighted the importance of infection-resilient workplaces to protect worker health and ensure business continuity. Future pandemic preparedness requires a holistic approach that integrates workplace health into broader national public health strategies. This includes establishing pre-approved emergency research protocols, enhancing international collaboration, and improving data systems with occupational data routinely collected for real-time insights and decision-making. A coordinated, system-wide approach is essential to ensure resilience and protect both the workforce and the broader community.

Helen Wahlkvist

Abstract

Objective: Eyelash extension is a beauty treatment established in recent years. Our hypothesis was that eyelash stylists would be professionally as well as personally affected by the conditions during the COVID-19 pandemic. The Objective was to survey changes in working conditions and work-related symptoms among Swedish eyelash stylists during the COVID-19 pandemic.
Material and Methods: A questionnaire with 20 questions about work-related respiratory and eye symptoms, eczema, and working conditions during the COVID-19 pandemic was sent by email to 154 eyelash stylists in June 2021. The eyelash stylists had previously participated in a survey with similar focus. In that study, the respondents had agreed to further contact. The study was approved by the Regional Ethical Review Board in Stockholm, Sweden.
Results: Thirty-six eyelash stylists responded to the survey (23% response rate). Among the respondents who had respiratory symptoms, hand eczema or eye symptoms previously, about 50%, 20% and 45%, respectively, reported that their symptoms had not changed. More than 80% reported that they had fewer customers than before the pandemic. Three respondents had stopped working as eyelash stylists because their businesses had closed due to COVID-19. About 50% of the respondents reported use of the same personal protection equipment as before the pandemic, whereas 45% reported that their protection was better than previously. Almost 60% reported concerns about getting infected with COVID-19 at work. More than 80% of the respondents were worried about their personal or their business’s finances and about 35% rated their mental health as ”poor”.
Conclusion: Despite the limited number of respondents, the
Results indicate that the main impacts of the COVID-19 pandemic were worries of getting infected, fewer customers and financial concerns among the eyelash stylists. We would like to acknowledge the eyelash stylists who responded to the survey. The study was supported by AFA Insurance.

Devan Hawkins

Abstract

Objective: This study seeks to determine whether there were declines in the percentage of suicides associated with financial and job problems following stimulus payments during the COVID-19 pandemic among working-age adults.
Methods: This study used data about suicides among working-age adults (16 to 64) for the years 2020 to 2021 from the National Violent Death Reporting System (NVDRS). We calculated the monthly percentage of suicides that were associated with either financial or job problems during this time period. Using interrupted-time series analysis, we examined changes in these percentages following the three stimulus payments issued during the pandemic.
Results: Following the first stimulus payment there was a statistically significant decline of 1.39% (p<0.001) in percentage of suicides associated with financial problems. While there was not a statistically significant decline in the percentage of suicides associated with job problems following the first stimulus payment there was a statistically significant decline in the monthly trend of suicides associated with job problems (change in trend= -0.07, p=0.049). There were also statistically significant declines in trends in suicides associated with financial problems (change in trend=-0.14, p<0.001) and job problems (change in trend=-0.13, p<0.001) following the second stimulus payment and a statistically significant decline in trends in suicides associated with job problems (change in trend=-0.16, p=0.016) following the third stimulus payment.
Conclusions: The three stimulus payments issued during the COVID-19 pandemic were linked with declines in the percentage of suicides associated with financial and job problems. The exact impact differed across the different stimulus payments. Further research should examine the impact that these stimulus payments may have had on the overall decline in suicides that occurred during the COVID-19 pandemic.

Allison Singier, Fabien Gilbert, Marie Zins, Laura Temime, Alexis Descatha

Abstract

Objective: This study aimed to develop and evaluate a job-exposure matrix (JEM) specific to healthcare workers and to compare estimates of known exposure-outcome associations using two exposure methods: the developed JEM and self-reported data.
Material and Methods: JEM SOIGNANCES was constructed using data from healthcare workers within the CONSTANCES cohort, according to job titles and sectors of activity, across 24 exposures covering organizational, psychosocial, physical, chemical and biological factors. The JEM was developed in a training dataset and its internal performance was assessed in a validation sample using AUC and Cohen’s Kappa. Association with relevant health outcomes (like pain, depressive symptoms, hypertension) were evaluated using logistic regression and compared to estimates obtained from self-reported exposure data as a reference.
Results: Of the 24 included exposures, 15 demonstrated satisfactory internal performance, with fair-to-moderate agreement with self-reported data, such as physical effort at work, ionizing radiation exposure, carrying heavy loads, shift work and formaldehyde exposure. The remaining exposures showed poor-to-moderate discriminatory power and poor agreement. Comparing association estimates, 10/16 associations based on JEM organizational exposures aligned with estimates based on self-reported data in direction and magnitude. For biomechanical exposures, 11/15 associations showed overlapping confidence intervals between the two methods. Other exposures generally underestimated associations.
Conclusion: JEM Soignances provided good internal performance, with good agreement with self-reported data for organizational and biomechanical exposures but not for psychosocial exposure. Further studies are needed to test its usage for research, though information tools could be developed based on it

Calvin B. Ge, Susan Peters, and Roel Vermeulen

Abstract

Background: Occupational exposure assessment is critical for understanding the health risks associated with chemical agents in epidemiological studies. While individual-level exposure measurements may be conducted in occupational cohorts, they are often impractical in general population-based studies. Job-exposure matrices (JEMs) provide a systematic approach to estimate exposures retrospectively based on job title, enabling exposure assessment in the general population. However, there is a notable lack of JEMs tailored to the Chinese context for common industrial solvents such as trichloroethylene (TCE), perchloroethylene (PCE), and formaldehyde. Objectives: This study aims to construct semi-quantitative JEMs for TCE, PCE, and formaldehyde exposure by integrating multiple data sources, demonstrating the principles and methodological considerations during the process. Methods: We synthesized data from published literature that reported occupational exposure levels, routine industrial hygiene monitoring datasets, existing international JEMs, and expert assessments to inform the exposure estimates. The final JEMs were structured across three dimensions: job title codes (3-digit and 4-digit ISCO-88), chemical agents (TCE, PCE, formaldehyde), and four calendar periods (≤1990, 1991–2000, 2001–2010, ≥2011). For each job title-chemical-period combination, estimates of exposure prevalence and level were assigned using a harmonized semi-quantitative scale.
Results: The resulting matrices covered over 500 job title codes and provided prevalence and level of occupational exposure with temporal resolution, enabling evaluation of exposure-response relationships for these exposures and disease outcomes in epidemiological studies.
Discussion: Despite the individual variations, the semi-quantitative JEMs balanced expert judgment and empirical data, enhancing reproducibility and applicability. These JEMs are essential resources for general population-based studies in China investigating the relationships between long-term occupational exposure and chronic health outcomes. Our experience and principles could serve as a model for future JEM development for other occupational exposures and in other geographic regions.

Jan-Willem Peters

Abstract

With the current alteration of the bitumen production process, it is not exactly known to which hazardous substances road pavers are exposed to. In an ongoing Dutch exposure survey ~70 exposure measurements are performed to 1) establish these components 2) find exposure determinants 3) evaluate the effect of control measures. Personal and stationary exposure measurements (15 different mixtures) were performed for volatile organic compounds, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, phtalates, formaldehyde, glutaraldehyde, and asphalt fumes. Similar exposure groups identified were asphalt paving operator, engine driver and asphalt laborer. Furthermore, an experimental set-up was designed to evaluate the effect of ventilation system to extract bitumen fumes. The results clarify that the exposure for some of the measured components cannot be classified as compliant according to the criteria mentioned in EN 689. Especially asphalt fumes, formaldehyde and glutaraldehyde were found for both the personal and stationary measurements. The highest exposure levels were found for the asphalt paving operator and the engine driver (20-35% OEL). Mixtures containing a higher percentage of newly added bitumen, high temperature asphalt, polymer modified bitumen and clear bitumen binders result in the highest exposure concentrations (factor 2-3 difference). Applying a ventilation unit to extract bitumen fumes results in a significant decrease at the surface where the asphalt is dispensed, but for personal exposure this reduction in exposure is not observed. More data will be available during the conference to provide data for optimizing technical control measures in order to reduce occupational exposure to carcinogenic asphalt fumes.

Tracy L Kirkham, Paul A Demers, Victoria H Arrandale

Abstract

Objective Job-exposure matrices (JEMs) based on expert judgement or measurement data are limited by the exposure information available at their development. Over time, more information about hazardous exposures is understood through additional measurements and peer-reviewed publications. This study presents a systematic approach to updating an existing diesel engine exhaust (DEE) JEM using published data.
Methods The literature was searched for occupational exposure studies that measured DEE as elemental carbon (EC) between January 2010-May 2022. Four-digit North American Industry Classification System (NAICS) 2002 and National Occupational Classification-Statistics (NOC-S) 2006 codes were assigned to each identified subgroup within the studies. EC exposures were categorized as low (0-10µg/m3), moderate (10-20µg/m3), or high (>20µg/m3). Weighted arithmetic means were calculated for each industry-occupation intersection (IOI) identified in the literature. These means were used to adjust, or retain, the exposure level within JEM cells using a decision-tree based on the number of studies, workplace locations, and pooled sample size of the weighted mean. Concordance was measured between the updated JEM (Diesel Exhaust in Canada JEM (DEC-JEM)), the previous JEM, and the Canadian Job-Exposure Matrix (CANJEM).
Results Thirty-seven studies were identified from the published literature reporting on 53 unique IOIs (20 NAICS, 34 NOC-S), including occupations in mining, construction, and transportation industries. Exposure levels for 66% of identified IOIs increased, most in construction. After the decision-tree’s
Results were expanded to the full DEC-JEM, the exposure level of 486 IOIs (12.5% of DEC-JEM) and 286,710 workers (15.8% of DEE-exposed workers) increased. There was significant correlation between qualitative exposure levels in DEC-JEM and CANJEM (Kendall’s tau=0.364, p<0.001).
Conclusion This study describes a systematic approach for updating an existing JEM to incorporate new scientific knowledge. DEC-JEM better reflects existing exposure knowledge in several industries, particularly construction. Future analyses include investigating its use as an exposure assessment tool in disease surveillance.

Saravanan SP

Abstract

Background: Fluoride, a naturally occurring mineral, is commonly found in drinking water. While low levels of fluoride are beneficial in preventing dental caries, chronic exposure to elevated levels has been linked to various health concerns, including potential neurotoxic effects. In developing countries like India, groundwater fluoride levels can exceed recommended limits, raising public health concerns. The aim was to assess the relationship between fluoride levels in drinking water and the intelligence of school-aged children in Tamil Nadu, India.
Materials and Methods: This cross-sectional study included 100 school children aged 10 to 15 years from two distinct regions (one urban and one rural) in Chennai, Tamil Nadu. Fifty children were selected from areas with low fluoride concentration in drinking water (<2 ppm), and 50 from high fluoride areas (≥2 ppm). Data were collected using a pretested structured questionnaire capturing demographic details, residential history, parental education, socioeconomic status, and medical history. Children’s intelligence was assessed using a standardized IQ test, and the
Results were categorized based on conventional intelligence grading. Statistical analysis was performed using the chi-square test to evaluate the association between fluoride exposure and IQ levels.
Results: A statistically significant reduction in IQ scores was observed among children exposed to high fluoride levels in drinking water compared to those from low fluoride areas. The findings suggest an inverse relationship between fluoride concentration and cognitive performance.
Conclusion: Exposure to elevated fluoride levels in drinking water is associated with reduced intelligence among children in Tamil Nadu. These results highlight the need for public health interventions to monitor and control fluoride levels in drinking water sources, particularly in vulnerable populations such as school-aged children. Further research with larger sample sizes and longitudinal design is recommended to validate these findings and explore potential underlying mechanisms.

Ioannis Sakellaris, Corinne Mandin, Emilie Pacheco Da Silva, Laurent Orsi, Pierre Bonnet, Valérie Siroux, Nicole Le Moual, Orianne Dumas

Abstract

Objective: Since the early 2000s, interest has grown in understanding the influence of poor Indoor Air Quality (IAQ) on respiratory disorders like asthma. Although exposure to inhaled pollutants including disinfectant and cleaning products is common in many workplaces, it remains poorly investigated, especially in daycare settings. The aim of this work is to investigate associations between IAQ and the respiratory health of daycare workers.
Material and Methods: In the French CRESPI cohort (2019-2022), concentrations of 67 volatile organic compounds (VOCs) and aldehydes were measured in 106 daycares during one day and concentrations were studied in 4 categories based on quartiles (Q1 to Q4). Using a self-administered standardized questionnaire, we evaluated asthma through the asthma symptom score, which consists of the sum of 5 asthma symptoms reported in the past 12 months: breathless while wheezing, woken up with chest tightness, attack of shortness of breath at rest, attack of shortness of breath after exercise and woken up by attack of shortness of breath. Cross-sectional associations between daycare VOC/aldehyde concentrations and the asthma symptom score (0 to 5) were estimated. Negative binomial models accounting for daycare effect, were adjusted for age, smoking status, body mass index and job type.
Results: This study included 300 women (mean age: 44 years; current smokers: 11%; job type: child-care: 69%, cleaning/cooking/washing: 7%, administration: 24%). Higher concentrations of hexamethylcyclotrisiloxane (D3) (Mean-Score Ratio Q4 versus Q1, 95% CI:1.74, 1.06–2.87; p-trend<0.01), octamethylcyclotetrasiloxane (D4) (2.24, 1.35-3.71; p-trend<0.01), and tetrachloroethylene (1.67, 1.03-2.73; p-trend=0.04) in daycare settings were associated with increased asthma symptom score. No significance remained after correction for multiple testing.
Conclusion: Workplace exposure to specific indoor air pollutants was associated with asthma symptoms in daycare workers. Further analysis is ongoing to investigate associations between multipollutant groups and asthma. These findings highlight the need to implement additional measures to reduce pollutant concentrations and control their sources in daycare environments.

Bjørg Eli Hollund, Marte Renate Thomassen, Miriam Grgic, Anje Christina Höper, Kaja Irgens-Hansen, Hans J Kromhout, Maja Karlausen, Kari Eilidh Mikkelsen, Anna Beathe Øvern Nordhammer, Hans Thore Smedbold, Gro Tjalvin, Berit Elisabeth Bang, Magne Bråtveit

Abstract

Objective: Workers in the salmon processing industry are at elevated risk of asthma and other respiratory illnesses. This study aimed to develop an industry-specific job exposure matrix (JEM) to assess exposure to inhalable total protein.
Materials and Methods: The JEM was developed based on 372 full-shift personal air samples collected in the breathing zones of 222 workers across nine salmon processing plants in Norway between 2001 and 2022. At the end of each shift, contextual data were gathered to classify each sample into one of four a priori exposure groups at each of the nine plants: slaughtering, filleting, miscellaneous processes, or assumed non-exposed. A linear mixed-effects model was used to estimate exposure levels. In these models, workers were treated as random effects and sampling time and exposure group within plant were treated as fixed effects, yielding 35 group-specific shift-long exposure estimates. The estimates were ranked and subsequently grouped into three exposure categories—low, medium, and high. Repeated modeling was conducted to estimate exposure levels for these three categories. Contrast in exposure was estimated as: between-group variance / (within-group variance + between-group variance).
Results: Estimated exposure levels for inhalable protein in the final JEM were 1.2 µg/m³ (low exposed), 2.3 µg/m³ (medium exposed), and 5.0 µg/m³ (high exposed). Reducing the number of exposure groups from 35 to 3 increased the contrast in exposure between groups from 0.60 to 0.70. The JEM will be further refined with the inclusion of an additional 390 measurements collected during a second sampling campaign in 2022–2023.
Conclusion: The JEM provides quantitative estimates of bioaerosol exposure which are essential for evaluating the exposure-response relationship between exposure and respiratory health outcomes in salmon processing workers. Such knowledge forms the basis for the establishment of health-based exposure limits, which are currently lacking in this industry.

Barbara Savary

Abstract

Objective: The death care sector encompasses many activities such as embalming, maintenance of cemeteries, cremation, and the manufacturing of caskets and tombstones. Several studies have assessed formaldehyde exposure among embalmers, but workers in other occupations can be exposed to a variety of chemical hazards. We aimed to describe exposure levels across jobs in the death care sector in France using existing measurement data.
Methods: We used personal and area measurements collected between 2002 and 2023 and stored in the Colchic database, which contains exposure data from research and prevention activities in France. We selected measurements associated with death care activities based on the reported industry and job titles, tasks, and establishment names.
Results: We identified 491 relevant exposure
Results to 31 chemical agents. Among personal samples, we found the highest prevalence of overexposure for wood dust in the manufacturing of caskets (9 out of 15 samples, 60%) relative to the French 8-hour occupational exposure limit (OEL8h) of 1 mg/m3. 30% of formaldehyde concentrations measured on workers handling or transporting the diseased, primarily embalmers, exceeded the OEL8h (0.37 mg/m3). Use of local exhaust ventilation was associated with a 64% reduction in geometric mean formaldehyde concentrations for this group. Lastly, 32% of quartz concentrations from the manufacturing of funeral monuments exceeded the OEL8h.
Conclusion: We found frequent overexposure in several activities in the death care industry in France. Additional exposure data is needed to assess risks in data-poor activities such as crematories. Sources of funding: Internal funding from the INRS

Scott Paine , Lin Fritschi, , Ha Nguyen , Renee Carey

Abstract

Background Welding is a common work activity in a wide variety of industries, including manufacturing, construction and mining. Many Australian workers are exposed to welding fume in the course of their work but there is little published information available on exposure levels and the use of control measures in regard to occupational exposure to welding fume in Australia. This study aimed to provide information on the level of exposure to welding fume in workplaces in Australia and the use of control measures in these workplaces.
Methods This was a cross-sectional study involving workers at a convenience sample of 20 workplaces in New South Wales. Personal and static samples of welding fume particulates and gases were collected whilst welding was being undertaken. Personal samples were taken from the breathing zone of 67 welders. Eighty-two static samples were also collected and personal real-time ozone monitoring was undertaken for a welder at each of 16 worksites. Observations of the workplace were recorded by study personnel.
Results The total welding fume particulate concentrations in the breathing zone were above the newly established workplace exposure standard for 61% of the welders. Peak concentrations of ozone were above the short-term exposure limit for most (75%) welders when they had their head over the welding area. Very few workplaces had active ventilation in place and functioning at the time of the worksite visits. The use of respiratory protective equipment was inconsistent; although 54% of welders used powered air-purifying respirators some of the time, about a fifth (22%) used no respiratory protection at all.
Conclusion This study provides the first comprehensive information on exposure to welding fume particulate and gases in Australian workplaces. The findings suggest there is considerable scope for improvement in the control of exposure to welding fume.

Eva Andersson, Håkan Tinnerberg and Sandra Johannesson

Abstract

Objective Accurate assessment of occupational exposure is of importance for epidemiological studies. Two factors affecting the accuracy are the number of measurements and their quality, which determines how much information the collected data can provide. One way to address both these factors is by using self-monitoring methods with a repeated sampling strategy. This strategy was used in the present study where the aim was to assess the exposure to soot among chimney sweeps, an occupation at high risk of many severe health outcomes related to their exposure to soot.
Material and Methods Exposure to soot was measured as black carbon. To assess the variation throughout a workday real-time monitoring instruments were used, micro-aethalometers (microAeth® model MA200 and AE51, AethLabs USA). Personal sampling (1-min average) was complemented with a diary specifying work task and duration. Personal samplings were performed for eight consecutive workdays for each of the 20 participants. The measurements were administrated by the sweeps themselves, except for the first sampling day when a trained occupational hygienist administrated and demonstrated the sampling procedure to each participant.
Results The mean exposure to black carbon for the group was 13.6 µg/m3, with a wide range (1.1-48.9 µg/m3) among the 20 participants. Daily mean exposures varied considerably (up to 49-fold) between the eight sampling days for an individual chimney sweep.
Conclusion We found a large variability in daily mean exposure to soot between the individual workers as well as between different days for an individual worker. The large within-worker variability suggests that repeated samplings on different days should be performed, to accurately assess the occupational exposure. Furthermore, we intend to evaluate how various determinants, such as different fuels, may affect the exposure to soot among chimney sweeps. Funding for this project was provided by AFA Insurance and the MSB Swedish Civil Contingencies Agency.

Mackenzie McKeown, Michael K. Lemke

Abstract

Objectives: The objectives of this study were to: 1) determine the average distance between truck stops in Canada; 2) describe the current state of truck stops; 3) compare the available amenities (e.g., number and type of restaurants) within walking distance of truck stops along major routes/highways; and 4) determine opportunities for truck stop improvement in Canada.
Material and Methods: For objectives 1 to 2, an environmental scan leveraged multiple data sources (e.g., books, websites) to collect data from over 700 truck stops in Canada. Data were collected on truck stop amenities (e.g., parking availability, nutrition options) and distance between truck stops. For objective 3, long-haul truck drivers (LHTD) were recruited from various provincial/federal trucking associations and trucking companies across Canada. A sample of 406 LHTD completed an online survey that consisted of questions on demographics, health conditions and behaviours, and preferences for truck stop amenities. Inferential data analysis was performed using SPSS; statistical significance was set at p ≤ 0.05.
Results: LHTD reported that parking, healthy and affordable foods, showers, washrooms, and exercise facilities with basic equipment are the most important amenities needed at truck stops. However, 33.3% of all truck stops are closed at night, only 13% have access to Wi-Fi, less than 50.0% have shower facilities, and more than half of truck stops do not provide healthy and affordable foods. The average distance between truck stops are 200-300 kilometers apart. Recommendations include investing in truck stop infrastructure to include additional parking, healthier food options, WiFi, and developing safety standards for truck stop services and amenities.
Conclusions: Improvements to truck stop environments are needed to support the health and wellness of LHTD. The findings show there are significant gaps between what truck drivers need versus what is often available.

Sylvia H.J. Jochems, Yvette Christopher-de Vries, Maartje Brouwer, Susan Peters, Frederieke Schaafsma, and Gilbert Wijntjens

Abstract

Background: Cardiovascular diseases (CVD) are the leading cause of mortality and morbidity worldwide. Emerging evidence suggests that exposure to nanomaterials and ultrafine particles (UFP) may alter cardiovascular function and contribute to the burden of CVD. Such exposures often occur in occupational settings involving nanomaterial production or high-energy processes like welding, printing, machining, and combustion. However, the cardiovascular effects of occupational exposure to nanomaterials and UFP remain poorly characterized, posing challenges for (occupational) health professionals. Objective: To summarize the existing evidence on cardiovascular health effects associated with occupational exposure to nanomaterials and UFP, identify commonly used biomarkers and diagnostic techniques, and highlight knowledge gaps requiring further investigation. Methods: A comprehensive search was conducted in MEDLINE, EMBASE, and Web of Science from inception to April 2024. Studies were eligible if they assessed health outcomes among workers exposed to nanomaterials or UFP in occupational settings. A total of 6020 unique records were screened, of which 66 studies met the inclusion criteria. Of these, 16 studies reported cardiovascular outcomes.
Results: The included studies employed various designs, with the majority being cross-sectional (n=11). Common workplace exposures included carbon nanotubes/fibers, titanium dioxide, and UFP from various industrial processes. The most frequently studied outcomes were cardiovascular inflammation and function. Reported biomarkers included elevated levels of VCAM-1, ICAM-1, endothelin-1, and hs-CRP. Some studies also reported changes in metabolic markers and vascular function; however, findings related to clinical measures such as blood pressure, heart rate variability, and autonomic function were inconsistent.
Conclusion: Occupational exposure to nanomaterials and UFP may be associated with early alterations in cardiovascular function. However, evidence on specific functional or structural disorders remains limited. This review highlights the need for longitudinal studies with detailed exposure assessment and standardized diagnostic tools to better understand causal pathways and inform occupational health policy.

Joseph Pyana Kitenge, Maria-Mirela Ani, Paul Musa Obadia, Evelyne Ngoy Kapoya, Celestin Banza Nkulu Lubaba, Jeroen Vanoirbeek, Mohamed Jeebhay, Steven Ronsmans, Radu-Corneliu Duca, and Benoit Nemery

Abstract

Objective: Little is known about occupational exposure to trace metals during industrial mining and processing in the African Copperbelt. We measured trace metals in blood and urine among workers from a large smelter processing historic slag from the copper industry to produce cobalt, copper, zinc and germanium.

Methods: In a cross-sectional study (July 2023-April 2024), we included, by exhaustive sampling, 292 workers from the smelter (“smelters”), and for comparison 144 workers from a mineral sampling company (“samplers”) and 358 brewery workers (“controls”). Twenty trace elements were measured by ICP-MS in blood and in urine (spot samples) in all participants from the two metal-exposed groups, and in 61 randomly selected controls. Urinary concentrations were corrected by urinary creatinine concentration, with exclusion of highly diluted samples (creatinine ˂0.3g/L). We compared groups using non-parametric tests.
Results: In blood, median (P25–P75) concentrations (µg/L) were higher for cobalt [0.82 (0.48–1.44)] and lead [190 (102–356)] in smelters than samplers [0.51 (0.29–1.08) and 48.8 (37.0–62.5, respectively] and controls [0.40 (0.29–0.51) and 56.1 (40.6–71.5)], respectively]; blood germanium was significantly higher in smelters [11.8 (11.0–13.0)] than samplers [11.0 (9.7–12.3)], but not different from controls [11.7 (11.0–12.6)]. Urinary concentrations (µg/g creatinine) were higher for cobalt [10.7 (6.64–18.5)], germanium [0.15 (0.04–0.39)] and lead [9.51 (4.08–23.3)] in smelters than samplers [0.83 (0.44–2.29), 0.009 (0.006–0.042) and 1.57 (0.99–2.18), respectively] and controls [0.46 (0.32–0.84), 0.023 (0.014–0.047) and 1.49 (1.15–-2.49), respectively].
Conclusion: We documented high trace metal concentrations (cobalt, germanium and lead) among workers from a smelting plant. The specific sources of excess exposures should be determined, and policies should be strengthened to protect workers’ health.

Andreas Hasse, Demian Langen, Anne Lotz, Dorothea Koppisch , Thomas Brüning, Thomas Behrens

Abstract

Objective: Welding fumes have been classified carcinogenic to humans by IARC in 2018, but current OELs are not always met at welding workplaces. Practical solutions are needed to reduce welders’ exposure to hazardous substances.
Materials and Methods: In an ongoing intervention study the effectiveness of technical measures to reduce exposure at real workplaces is evaluated. Repeated measurements of hazardous substances and biomonitoring (for chromium, nickel, and manganese) are carried out combined. Exposure determinants are comprehensively documented.
Results: So far, exposure was measured under baseline conditions in 53 welders, who applied gas metal arc welding (GMAW) in 13 companies. The median concentration of respirable particles was 1.38 mg/m³ in the welder’s breathing zone (measured in front of the welding hood). The German occupational exposure limit (OEL) for respirable particles (1.25 mg/m³) was exceeded at every second workplace. The highest concentration was 12 mg/m³. For respirable manganese (MnA), the German OEL (0.02 mg/m³) was exceeded at 50 of 53 workplaces (94%); with a median value of 0.10 mg/m³. At baseline 35 welders (66%) wore helmets with powered air purifying respirators (PAPR). The OEL for respirable manganese (MnA) was exceeded in 40 % of the stationary fume measurements in the near field of the welding workplaces. The OEL for respirable particles was never exceeded here.
Conclusion: Compliance with the OEL during GMAW is a challenge. Personal protective equipment, such as PAPRs, is often required to ensure adequate health protection. The individual workplaces are currently being examined by expert teams for possible interventions. The focus is on the alloys of the welding wires, the mixture of process gases, innovative welding process variants and adjustments to local extraction systems. Once measures have been implemented, their effectiveness will be evaluated.

Chih-Fu Wei, Ping-Ju Hsieh, Nien-Wei Lee

Abstract

Introduction: Agricultural workers may expose to multiple different metals due to frequent contact with pesticides, water, and soil. But few studies examined the role of personal protective equipment (PPE) and behavioral factors on metal exposure in this population. Methods: We analyzed data from 577 participants in the ongoing Cohort for Occupational Health among Farmers in Taiwan (COH-FIT). Information on personal behaviors and PPE use was collected via structured questionnaires. Urinary and blood concentrations of different metals were measured using mass spectrometry as biomarkers of exposure. Spearman correlation coefficients were used to assess relationships between different metals. Generalized linear models were applied to test the associations between PPE use, behavioral factors, and metal concentrations.
Results: Elevated total arsenic concentrations were found among some participants, though inorganic arsenic levels were not elevated. Significant correlations were found among certain metals and metalloids. Smoking and betel nut chewing were associated with higher levels of non-essential metals. Use of cloth masks during pesticide application was linked to increased non-essential metal concentrations, whereas the use of detoxifying masks was associated with lower levels of non-essential metals and higher zinc concentrations.
Conclusion: This study identified multiple behavioral and occupational factors influencing metal exposure among agricultural workers in Taiwan. Smoking and betel nut chewing were related to elevated non-essential metal levels, which warranted more behavioral interventions. Also, using appropriate PPE may play a protective role in reducing harmful metal exposure. These findings can inform precision occupational health strategies to minimize metal exposure among agricultural workers.

Fateme, Kooshki ; Annabel, Zhang ; Sara, Vaezafshar (, ); Joseph, Okeme ; Nikhil, Rajaram (,); Roel, Vermeulen ; Miriam, L, Diamond ; Paul, A, Demers ; Victoria, H, Arrandale

Abstract

Background: Organophosphate esters (OPEs) are a group of chemicals used in many industries due to their dual flame retardant and plasticizing properties. OPEs have been associated with some cancers in humans and other adverse effects. Firefighters are potentially exposed to OPEs in protective equipment and paramedics may be exposed to OPEs in vehicle components to meet flammability standards. This study aims to characterize external and internal OPE exposure among firefighters, paramedics and office-workers in Ontario, Canada.
Methods: Participants wore a wristband for 24-hours and provided two urine samples (0h and 24h). Twelve urinary metabolites (mOPEs) and 13 OPEs from wristbands were quantified; those detected in >50% of wristbands and urine (0h and 24h) are reported here. Urinary mOPEs and wristband OPEs were described and between-group differences examined using ANOVA.
Results: In total 40 firefighters, 12 paramedics and 13 office-workers participated (78% male; mean age=41years). Eight wristband OPEs and six urinary mOPEs had >50% detection. Wristband triphenylphosphate (TPhP) (GM=258.6ng/wristband [GSD=2.72]) and urinary diphenyl phosphate (GM-0h=1.09 µg/g-creatinine [GSD=2.4]; GM-24h=1.20µg/g-creatinine [GSD=2.2]) had the highest levels. TPhP levels were significantly higher among firefighters (GM=395.6ng/wristband [GSD=2.43]) and paramedics (GM=230.1ng/wristband [GSD=2.2]) than office-workers. OPE concentrations tended to be higher among paramedics, while mOPE levels tended to be higher among firefighters, though differences were not always significant. Office-workers had significantly higher tris(2-chloroethyl) phosphate levels (GM=141.1ng/wristband [GSD=2.13]) than firefighters (GM=61.3ng/wristband [GSD=2.3]).
Conclusion: OPE exposure is widespread among the studied occupations. Firefighters tended to have higher urinary mOPE levels than other groups, but this was not consistent with their external (wristband) exposure, suggesting multiple exposure routes. Research is needed to identify exposure pathways driving these differences. Subsequent analysis will explore how work-related activities contribute to exposure. Future research will examine a broader Canadian workforce to identify additional high-exposure groups.

Abstract

BACKGROUND Several industrial chemicals with harm to reproductive function and foetal development have been identified. Whether chemical exposures at workplaces in fact constitute a problem for reproduction could be assessed if all substances with ability to harm reproduction were identified, alongside exposure levels at which effects are induced, number of workers exposed and actual exposure levels. Exposure data is however poor and incomplete and most chemicals are under-assessed for reproductive toxicity. Objective To initiate assessment of the potential for impact of chemicals on worker reproductive health, by estimating 1) use of chemicals classified as reproductive toxicants, 2) level of knowledge on reproductive and developmental toxicity on any chemical used. Denmark was used as case.
Materials and Methods Use of chemicals by companies in Denmark was retrieved from the Danish Product Registry in 2022. Reproductive and developmental toxicants were identified by classification in category 1A/1B/2 under EU’s Classification and Labelling Regulation. Standard information on reproductive toxicity required for registration under REACH, according to tonnage, was used as proxy for knowledge level on reproductive and developmental toxicity.
Results 222 substances had harmonised classifications for harm to fertility and 327 for harm to the unborn child (Annex VI to the CLP Regulation); 59 were registered with use in quantities >1 ton/year by companies in Denmark. Appox. 5700 chemicals had notified classifications for reproductive toxicity (C&L Inventory); hereof 227 with use >1 ton/year by companies in Denmark. Of all chemicals registered with use in Denmark, REACH standard information requirement on reproductive toxicity would have been comprehensive for 68%, medium for 18%, slight for 18% and absent for 7%.
Conclusion There is significant possibility of encountering reproductive toxicants or chemicals untested for this in the Danish work environment. Whether workers are in fact exposed and fertility and the unborn child affected, remains to be identified.

Tosca O.E. de Crom, Youchen Shen, Bernice Scholten, Eugenio Traini, Koen van der Sanden, Boris Kingma, Floris Pekel, Manosij Ghosh, Hilde Notø, Michelle C. Turner-, Miguel Angel Alba Hidalgo, Lisa Klous, Maria Albin, Henrik A. Kolstad, Jenny Selander, Calvin Ge, Anjoeka Pronk

Abstract

Objective: Climate change is making occupational heat stress an increasing concern, even in mild-climate countries like the Netherlands. This study estimated the annual hours of occupational heat stress among Dutch workers from 2020 to 2023.
Material and Methods: We used data from the National Employment Survey (NEA), completed annually by a random sample of Dutch workers. Respondents reported their occupation, coded using the International Standard Classification of Occupations (ISCO). Each respondent was assigned a weighting factor reflecting how many people in the population they represent, allowing estimation of the total number of workers per occupation in the Netherlands. Exposure was estimated using a heat job exposure matrix (Heat-JEM) based on the wet bulb globe temperature (WBGT) framework defined by the International Organization for Standardization (ISO). The Heat-JEM integrates metrological data with job-specific information on time spent indoors versus outdoors, physical activity, work clothing, and the presence of local heat or cooling sources.
Results (preliminary): Between 2020 and 2023, Dutch workers (~3.9 million women, ~4,1 million men) experienced 0 to 1,260 hours of occupational heat stress annually, with an average of 24 hours (11 for women, 36 hours for men). Over 10% of the Dutch workforce was exposed to ≥24 hours per year. Among the most common occupations, cooks were the largest exposed group, with women averaging 1,242 heat stress hours annually (n = 22,487) and men 1,243 hours (n = 50,780). For women, the next largest exposed groups were bakers, pastry-cooks and confectionery makers (725 hours, n = 7,830) and police officers (136 hours, n = 9,843). Among men, bakers, pastry-cooks and confectionery makers (727 hours, n = 10,682), and chemical-heat-treating-plant operators (741 hours, n = 9,104) were most affected. Heat stress in these occupations was mostly caused by local heat sources like ovens.
Conclusion: A substantial number of Dutch workers are affected by occupational heat stress.

Sandra H. van Oostrom , Hendrika P. Zijlstra , Johannes R. Anema , Karin I. Proper

Abstract

Purpose. A stepped-care approach, beginning with a low-intensity e-Health program followed by a high-intensity Participatory Approach led by a return-to-work (RTW) coordinator is a promising intervention to promote RTW of employees on sick leave with distress. As this approach is new, determinants of its successful implementation remain unknown. This study aimed to identify the potential facilitators and barriers for a stepped-care approach to promote RTW of employees with distress, from the perspective of employees, employers and occupational physicians. Methods. A qualitative study was performed consisting of individual semi-structured interviews with 10 employees, 5 supervisors and two focus groups with 15 occupational physicians. The verbatim transcripts were inductively thematically coded. The Consolidated Framework for Implementation Research (CFIR) was applied to classify themes within its domains.
Results. Themes were constructed belonging to either the implementation or the content of the stepped-care approach, falling within the CFIR domains “innovation”, “outer setting”, “inner setting” and “characteristics of the individual”. From all three stakeholder groups, identified facilitators were the tailored program, enabling task adjustments and the RTW-coordinator to stimulate a good communicative relationship between employee and supervisor. Barriers identified were the timing of the stepped-care approach, integrating the approach in the current RTW system, and low digital skills.
Conclusion. Both facilitators and barriers were found for the implementation of the stepped-care approach. This underlines the importance of an adaptive implementation strategy, that takes into account workplace dynamics and tailored approaches to support the stakeholder groups’ needs.

Marwân-al-Qays BOUSMAH; Sarah DEMICHEL-BASNIER; Annabel DESGREES DU LOU; Angel LOUIS-BARAUD; Karima SENNI; Camille BERGERET

Abstract

Objective. Nonstandard working hours (early, evening, night, weekend) have increased in the last decade among workers in lower-qualification occupations. Although they may be more affected by this increase, persons living in deprived neighbourhoods could be under-represented in surveys because of participation biases. Our study aims at describing the level of nonstandard working hours and its association with mental health in three deprived neighbourhoods in greater Paris area, according to gender.
Material and Methods. Our participatory project involves researchers and a community-based organisation (VoisinMalin). A survey was conducted in 2024 by inhabitants trained in outreach and questionnaire administration. We described the study population by sociodemographic and occupational characteristics, nonstandard working hours and mental health (WHO5) according to gender. We further investigated the determinants of poor mental health using multivariate logistic regressions.
Results. A total of 462 persons participated in the survey, 53% of whom where women. Among the working population sub-sample, 73.4% had at least one type of non-standard working hour (78.3% among men, 67.5% among women). Poor mental health was 19.7% among men and 29.6% among women. Among men, night work was associated with poor mental health. Among women, non-standard working hours were associated with better mental health. In multivariate analysis, this association remained among women (aOR non-standard working hours=0.29, p<0.016). Another protective factor was neighbourhood network (aOR=0.32, p<0.016). A low level of education and lack of work-personal life conciliation tended to be associated with a higher probability of poor mental health.
Conclusions. We found different associations of nonstandard working hours on mental health according to gender. Further analysis should investigate whether the association between mental health and nonstandard working hours is due to better work-personal life conciliation. Funding: Agence Nationale de la Recherche; Agence Régionale de Santé Ile de France

Wenzhen Li; Feng Wang; Cherry Wan; Samuel Yeung-shan Wong.

Abstract

Objective: This study aims to explore the association of greenspace exposure (PGE) with quality of life (QoL) and mental health among non-healthcare workers. Methods: We conducted a cross-sectional survey on occupational and environmental influences on QoL of non-healthcare workers in Hong Kong during 12/2023 – 12/2024. Information on demographics, lifestyle behaviors, occupational history and perceived environmental factors was collected by online questionnaires. We measured PGE using self-reported questionnaires about greenspace abundance, visibility, access and usage near participants’ homes/workplace. We assessed relationships between PGE and QoL using multiple linear models and logistic regression models.
Results: Totaling 547 (39.6%) from 1380 participants were male, the mean physical composite scores (PCS) of 46.1 and the mean mental composite scores (MCS) of 50.6. 300 (21.7%) participants were found with stress symptom, 512 (37.1%) with anxiety symptom and 419 (30.4%) with depression symptom. Positive relationships between MCS and PGE3 (0.54, 95%CI: 0.11-0.96) were observed. Significant negative associations of anxiety and depression with PGE3 were also observed (odds ratio [OR]=0.93, 95% CI: 0.87-0.99 for anxiety; 0.93, 0.87-0.998 for depression). Subgroup analyses showed that PGE played different roles on workers with different genders and ages.
Conclusion: This study suggests that PGE plays a vital role in enhancing the quality of life and promoting mental health. (Funding: HMRF Ref.: COVID190104, COVID1903008, and 18190471)

Sibel Kiran , Erdem Erkoyun, Sezer Uguz, Evangelia Nena, Çigdem Çaglayan, Maria Katsaouni, Ingrid Sveshim Mehlum, Ewan Macdonald

Abstract

Background: Topic modelling is a valuable approach for identifying interdisciplinary trends in large-scale textual data. This study applies topic modelling to analyse research patterns in occupational health literature over the decade preceding the COVID-19 pandemic (2010–2020). Methods: We searched SCOPUSⓇ using keywords related to labour force and employment relations, identifying 162,652 publications. Latent Dirichlet Allocation (LDA) was used for topic modelling. Topics were identified and labelled through expert consensus, based on the coefficients of terms extracted from titles, abstracts, and keywords. Each topic was assessed by frequency, citation count, funding status, journal distribution, and annual trends. Prevalence ratios were calculated using the topic with the lowest publication count as the reference, comparing 2020 outputs to the cumulative counts of previous years. Linear trends across the decade were also estimated.
Results: Eighteen distinct topics were identified. The most prevalent topics were population characteristics and social inclusion (7.5%), social policy models (7.4%), and psychosocial factors (7.3%). The most highly funded topics were indices of exposure (9.9%), environmental exposure (8.9%), and health estimates (7.5%). In 2020, occupational health and safety (OHS) management showed the highest prevalence ratio, while interventions and occupational health outcomes showed the lowest. The steepest positive trends were observed in social policy models, psychosocial factors, and population characteristics and social inclusion.
Conclusion: Topic modelling serves as an effective exploratory method for secondary analysis, enabling the assessment of thematic and temporal patterns within occupational health literature. The observed trends underscore a growing emphasis on employment-related issues, particularly in psychosocial risk management and systems-level OHS governance. Key Messages: 1. Topic modelling is a valuable approach for secondary analysis, offering insights into research trends and interdisciplinary themes in occupational health. 2. The rise of topics such as psychosocial risks and OHS governance highlights the need to align future research and policy priorities with evolving global challenges.

Sandrine Bertrais, Thierry Rochereau, Isabelle Niedhammer

Abstract

Objective: The objective was to explore dose-response associations between the frequency and number of psychosocial work factors and psychological distress.
Material and Methods: The ESPS survey (Enquête Santé et Protection Sociale) was a periodical French national survey among the general population in which households were selected randomly and all individuals of these households were surveyed. This study had a cross-sectional design and included 11,018 workers surveyed in 2010 or 2012. Psychological distress was assessed using MHI-5 and defined by a score below 52. Ten psychosocial work factors (quantitative demands, tensions with the public, freedom, possibilities for learning new things, colleague support, recognition, salary satisfaction, job insecurity, temporary contract, and redundancy plan) were studied using frequency categories and dichotomized into exposed/non-exposed. The associations between psychosocial work factors and psychological distress were studied using modified Poisson regression models with cluster-robust standard errors. All analyses were stratified by gender and adjusted for age, marital status, employee/self-employed worker, public/private sector, occupation, full/part-time work, and survey wave. Gender-related interactions were tested.
Results: The prevalence of psychological distress was higher in women (20.7%) than in men (13.3%). Studied as binary variables, all psychosocial work factors, except temporary contract, were associated with psychological distress. There were linear trends between the frequency and number of psychosocial work factors and psychological distress. The associations with psychological distress were stronger in men than in women for the frequency of half of psychosocial work factors.
Conclusion: Our study showed dose-response associations between psychosocial work factors and psychological distress. Reducing the frequency and number of psychosocial work factors could help to improve mental health at work. Funding: The French National Research Program for Environmental and Occupational Health of Anses (ANSES-23-EST-041)

Małgorzata Kowalska

Abstract

Objective Medical students face numerous demands during their education, which can significantly impact their quality of life (QoL) and overall health. High levels of stress, deteriorating health status, and unhealthy habits are particularly noticeable among students in the early years of their studies. The POLLEK project (pol. POLski LEKarz – eng. Polish Physician) aims to longitudinally assess medical students’ quality of life and health status.
Material and Methods POLLEK is a prospective cohort study among medical students at the Medical University of Silesia in Katowice. It was conducted at two time points: during their first year of study in the 2019/2020 academic year (T1) and their fifth year in the 2023/2024 academic year (T2). Data were collected using an integrated research tool that included WHOQOL-BREF, AUDIT, GHQ-28 questionnaires, and authorial questions identifying lifestyle, diet, health, and socio-demographic factors. Blood pressure, body weight, and height were also measured.
Results In the first year of observation (T1), 560 students participated, while in the fifth year (T2), 204 students. The analysis revealed a statistically significant increase in quality of life (QoL) during the fifth year of study, encompassing both the overall assessment of QoL and its specific domains: physical, psychological, social, and environmental. Key determinants of QoL common to both T1 and T2 included self-assessed health status, current financial situation, and risky alcohol consumption.
Conclusions Medical students exhibited a lower quality of life in their first year of study, with an improvement observed by the fifth year. The obtained
Results indicate the need for comprehensive programs supporting the mental and physical health of medical students, particularly during periods of heightened stress, such as the early years of education. Additionally, regular monitoring of alcohol use and educational interventions may help reduce risky health behaviors and related health risks.

Maël Quatrevaux, Thierry Rochereau, Sandrine Bertrais

Abstract

Objective: The objective was to examine the cross-sectional associations between psychosocial work factors and depression using baseline data of a prospective study.
Material and Methods: The study was based on the data of the national ESPS survey (Enquête Santé et Protection Sociale), a population-based periodical survey in France, whose data were collected in 2010, 2012 and 2014. The sampling design relied on a random selection of households and the inclusion of all persons within each selected household. The studied sample included 15,833 workers. Depression was assessed using one self-reported item related to depression within the last 12 months. Psychosocial work factors included ten factors and the number of exposure to these factors. Logistic regression models with cluster-robust standard errors were performed to study the associations between psychosocial work factors and depression, for men and women, and before and after adjustment for covariates (age, marital status, employee/self-employed worker, public/private sector, occupation, full/part time work, and survey wave).
Results: The 12-month prevalence of depression was higher among women than among men (5.6% versus 2.7%). Quantitative demands, tensions with the public, low freedom at work, low possibilities for learning new things, low support from colleagues (men only), low recognition at work, low satisfaction with salary, job insecurity, and redundancy plan (men only) were associated with depression. Some associations were stronger among men than among women. The higher the number of psychosocial work factors, the stronger the association with depression.
Conclusion: The study showed cross-sectional associations, including dose-response associations, between psychosocial work factors and depression. Forthcoming
Results will investigate the prospective associations of psychosocial work factors with various mental health outcomes. Funding: The French National Research Program for Environmental and Occupational Health of Anses (ANSES-23-EST-041)

Manon Truchon, Mahée Gilbert-Ouimet

Abstract

Objective While psychosocial risks at work (PRW) are known to negatively impact health and productivity, their interrelations and cumulative effects remain poorly understood. This study aims to test an integrative explanatory model—grounded in both the Job Demands-Resources model and the theory of Psychosocial Safety Climate (PSC)—to better understand how PRW interact and influence outcomes. By modeling the interrelations between PRW, this study seeks to identify key risks that act as amplifiers or triggers, offering organizations evidence-based guidance on which PRW to address first to maximize impact.
Material and Methods In October-November 2024, 3000 French-speaking workers from a demographically diverse populational panel completed the French-language Questionnaire on Psychosocial Risks, Well-being, and Health at Work (QRBEST), a validated instrument measuring 22 PRW and 12 outcomes of well-being, health, and productivity. Structural equation modeling will be used to assess the fit and plausibility of the proposed explanatory model, where six latent factors (demands, resources, violence/harassment, PSC, health, and productivity) are expected to interact. Confirmatory factor analyses will first validate the factor structure; if needed, theory- and data-driven adjustments will be made. Once the measurement model is satisfactory, the structural model will be tested to evaluate the hypothesized pathways among factors.
Results Preliminary analyses show good to excellent internal consistency for all QRBEST dimensions (α>.75). The factorial structure is supported by confirmatory factor analyses. Upcoming analyses will examine the model’s fit and hypothesized pathways and identify key PRW linked to adverse outcomes; findings will be ready for presentation at EPICOH.
Conclusion This research will advance understanding of how various PRW interact to influence well-being, health, and productivity. The findings might support the development of more targeted and effective prevention strategies across diverse organizational contexts, especially those with limited occupational health resources. Funding: Fonds institutionnel de recherche de l’Université du Québec à Rimouski.

Elaine Reis, Tania Maria de Araújo

Abstract

Objective: To analyze the association between exposure to moral harassment and violence at work and Common Mental Disorders (CMT) in healthcare workers in Brazil.
Material and Methods: Cross-sectional study with 1,005 public healthcare workers, active in primary and secondary care in three municipalities of Bahia, located in northeastern Brazil, in 2021. The SRQ-20 was used for CMT assessment, and a specific self-reported questionnaire on direct victimization was used for the analysis of violence at work in the last 12 months. Exposure to moral harassment was assessed by the self-labelled method with specific validated questions. A structured questionnaire and validated instruments were used to assess sociodemographic, behavioral, and psychosocial factors. Odds ratios and 95% confidence intervals were estimated using multiple Logistic Regression.
Results: The overall prevalence of CMT among the workers was 40.3%. Regarding moral harassment, 8.4% reported being victims, and 11.4% experienced violence. Exposure to moral harassment and workplace violence was associated with 2.5 (OR = 2.47; 95% CI 1.56 – 3.91) and 2.9 (OR = 2.92; 95% CI 1.95 – 4.37) times higher odds of CMT, respectively, compared to those not exposed. After adjustments for confounding factors, those who experienced moral harassment and violence still showed 1.6 (OR = 1.59; 95% CI 0.95 – 2.67) and 2.1 (OR = 2.09; 95% CI 1.32 – 3.31) times higher odds of having CMT compared to those not exposed, respectively.
Conclusion: The findings indicate a high prevalence of CMT and show that both moral harassment and violence at work are independent health risks. Interventions in organizational/structural processes in healthcare work, aiming to reduce harassment and violence, are viable strategies to mitigate the burden of diseases related to CMT. This approach requires policies and strategies for decent conditions and stable employment relationships.

Bridget Bryan, PALM Team

Abstract

Longitudinal studies are a powerful research tool that have the potential to answer pressing questions about human health and wellbeing. However, longitudinal data have been underused because they can be difficult to find, and their data difficult to access. Improving the discoverability of longitudinal data is an essential step towards increasing the outreach and impact of these valuable data resources. The Atlas of Longitudinal Datasets is an interactive online platform that aims to maximise the uptake of longitudinal data by improving the discoverability of over 2,000 longitudinal datasets from around the world, including many occupational cohorts and health surveillance studies. The Atlas shares metadata about each dataset, including information about their location, sample and unique features, as well as detailed information about data collection methods, mental health, neuroimaging, linkage, qualitative data, and data access policies. Users can explore datasets, filter their searches, compare features of datasets and save their favourite datasets to return to. Current expansion of the Atlas includes adding detail about occupational and environmental exposure data, including pollution, dust and radiation. The Atlas aims to provide a resource for users of longitudinal data planning new research projects, as well as data custodians in maximising the discoverability of their data. The Atlas can also facilitate the development of collaborations and be a resource for funders to identifying areas for enrichment. This presentation will introduce the Atlas, share insight into how it has been developed, and showcase its use as a free-to-access tool. Specifically, it will highlight the usefulness of the Atlas to occupational health researchers and demonstrate how it can be used to discover datasets covering populations of workers from around the world.

Seth Addo, Abid Lashari, Per Gustavsson, Carolina Bigert, Jenny Selander, Emma Brulin

Abstract

Objective: To investigate the associations between shift work and the risk of psychotropic medication prescriptions (PMPs), specifically, neuroleptics, sedatives, hypnotics, and antidepressants, among nursing staff in Region Stockholm.
Materials and Methods: Using register-based data, 32,275 nurses and nursing assistants employed for at least one year by Region Stockholm between 2008 and 2019 were included. Exposures were obtained from a computerised employee register while PMPs were obtained from a pharmaceutical register. With one year follow-up, discrete time proportional hazard models were used to estimate hazard ratios (HR), adjusting for covariates.
Results: Increased risks of PMPs were recorded among those who only worked night shifts (HR 1.14, 95 % CI 1.08–1.20) compared to those who worked day shifts, and those who worked night shift frequently (>121 times) compared to those who never worked nights (HR 1.04, 95 % CI 1.02–1.05) in the preceding year. Among night workers, increased risks were recorded for those who worked 3 or more consecutive nights 13-21 times and >21 times (HR 1.04, 95 % CI 1.02–1.07, and HR 1.08, 95 % CI 1.06–1.11 respectively) compared to those with none. Night workers who had quick returns from night shift (69 times recorded an increased risk compared to those who had 0-9 times (HR 1.06, 95 % CI 1.04–1.09). Lastly, decreased risks were recorded for quick returns from afternoon (49 times (HR 0.94, 95 % CI 0.92–0.95, HR 0.94, 95 % CI 0.92–0.95, and HR 0.98, 95 % CI 0.96–0.99 respectively) compared to day shift only.
Conclusion: Exclusive night work is associated with a small but statistically significant increase in risk of PMPs compared to day work. However, day work only is associated with increased risks compared to afternoon shift.

Delepee Raphael – Lebailly Pierre

Abstract

Epidemiological studies have already established a link between occupational agricultural exposures and cancers. However, despite extensive epidemiological study, the biological plausibility of the link between these exposures and cancer development has not been definitively confirmed. The aim of this study were i) to determine the effect of current smoking on DNA damage in blood cells and ii) the effect of various agricultural exposures including pesticides in a French agricultural cohort. Blood samples were collected from n=375 farmers, with 97 were current smokers, 97 former smokers and 185 never smokers. The alkaline comet assay version was applied on cryopreserved isolated lymphocytes isolated to evaluate DNA damage levels, evaluated by scoring a mean 800 nuclei per sample, classified in four categories by an AI Yolo recognition algorithm using a neural network developed in the laboratory. Socio-demographic information including smoking related questions, livestock and crop production of the farm and pesticide application schedule were collected by face-to face questionnaires. Univariate linear and logistic regression tests and multivariate analysis were performed. the initial
Results on smoking status show no clear difference in any of the qualitative criteria considered in our population. Smoking status should not be considered as a major cofounding factor in occupational studies using the alkaline comet assay. The 168 different molecules listed in the treatment schedules will be considered individually and grouped by Mode of Action (MoA), and farmers will be considered individually and clustered by treatment types of cultures and livestock activities All of this data will be correlated with the levels of DNA damage estimated by the comet assay. With very little literature evaluating genotoxic damages linked with agricultural activities, this study tends to be an exploratory study. We hope to find specific agricultural activities or treatment patterns links to an increase of DNA damages evaluated by comet assay.

Johan Ohlander; Marine Renier; Isabelle Baldi; Laura Beane Freeman; Pierre Lebailly; Karl-Christian Nordby; Joachim Schuz; Hans Kromhout

Abstract

Objective: Several pesticides have endocrine disrupting properties, but few studies have examined breast cancer risk in relation to specific active ingredients. Existing studies consider exposure from application or mixing (“use”), which is less common for female farmers, but none account for exposure from entering sprayed crops to carry out farming tasks (“re-entry”). This prospective analysis examines exposure to 71 pesticide active ingredients and the risk of breast cancer.
Material and Methods: We used data from three cohorts participating in an international consortium of agricultural cohorts (AGRICOH): the French Agriculture and Cancer Cohort (AGRICAN, 2005-2017), Cancer in the Norwegian Agricultural Population (1993-2022), and the US Agricultural Health Study (AHS, 1993-2021). The total population includes ~197,000 female farmers and farmers’ wives. Lifetime exposure to specific active ingredients via personal use and re-entry tasks was estimated from crop-exposure matrices, self-report, or both. Cohort-specific adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer (overall, pre-, and post-menopausal) will be estimated using Cox regression and combined using random effects meta-analysis.
Results: Analyses are ongoing. Preliminary
Results for AHS and AGRICAN indicate 4326 incident breast cancers among the 87,090 combined population. Among the 66 active ingredients examined so far, the median numbers of exposed cases were 51 (IQR: 30-91) in AHS and 21 (IQR: 11-30) in AGRICAN. The most commonly used pesticides in AHS were carbaryl, glyphosate, and malathion, while diazinon and parathion were the most common in AGRICAN.
Conclusion: This is the largest prospective analysis of specific pesticide active ingredients and breast cancer risk. Strengths include assessment of re-entry exposure, which have largely been ignored in pesticide-cancer analyses, and additional study power from meta-analysis. Cohort heterogeneity presents challenges. Our findings will be relevant to future evaluations of the carcinogenicity of pesticides.

Carine Nassar, Séverine Tual, Mathilde Bureau, Yannick Lecluse, Isabelle Baldi, Pierre Lebailly, Bénédicte Clin

Abstract

INTRODUCTION Few occupational exposures are definitely associated with kidney cancer. Because of its role in blood detoxication, the study of chemical exposure is of particular interest for this cancer. In the agricultural workplace, chemical risk is represented in particular by pesticides, yet studies of the links between kidney cancer and pesticides are rare. Succinate dehydrogenase-inhibiting (SDHI) fungicides exert their action by interfering with cellular respiration, and succinate dehydrogenase deficiency has been identified in some rare cases of kidney cancer. The aim of our study is to investigate the associations between exposure to SDHI fungicides and the risk of kidney cancer.

METHODS Pesticide use and the type of crops concerned were assessed using questionnaire data from the AGRICAN cohort, a large prospective French cohort including ~180,000 people, ~135,000 of them were farmers, set up between 2005 and 2007. The questionnaire also provided data on potential confounding factors: smoking, BMI, hypertension. Data from the PESTIMAT crop-exposure matrix were used to determine which pesticide active ingredients may have been used, depending on the year and crop. Exposure scores were established, considering the probability, frequency, intensity of use and duration for each active ingredient. Kidney cancer cases were identified via cancer registries. Cox models with attained age as the time scale were used and subjects followed up to December 31st 2017.
Results The analyses are currently in progress. We identified 654 renal cancer cases overall, and 14 active substances from the SDHI family likely to have been used in France. Of these, 5 were introduced before the 2000s (carboxin, oxycarboxin, mepronil, fenfuram, flutolanil). Analyses are being conducted separately for men and women, as pesticide exposure patterns and circumstances differ according to gender. DISCUSSION Ten SDHI are still authorized: our results will be discussed with regard to their implications for further research and occupational health policies.

Marine Renier , Juliette Hippert , Mathilde Bureau , Nicolas Vigneron , AGRICAN group, Isabelle Baldi , Pierre Lebailly ,

Abstract

Objective: Prostate cancer is the second most common and the 5th cause of cancer death among men worldwide. Several meta-analyses have linked the incidence of prostate cancer to agriculture and pesticide use. Among these, organophosphate insecticides are a large family that has been widely used throughout the world for decades and have been seldom studied. We assessed association between occupational exposure to 26 organophosphate insecticides and prostate cancer risk in the Agriculture and Cancer cohort (AGRICAN).
Material and Methods: The PESTIMAT crop-exposure matrix was used to assess exposure to the 26 organophosphates studied, based on the probability, frequency and intensity of their use. A Cox regression model with age as the time scale was used to estimate the hazard ratio with 95% confidence intervals among men enrolled from 2005 to 2007 in the AGRICAN cohort, with follow-up until 31st December 2017.
Results: With a total of 4,102 incident cases of prostate cancer out of 80,038 men, an increased prostate cancer risk was observed with duration and/or exposure score for the following 12 organophosphates: diazinon, malathion, dichlorvos, parathion-ethyl, chlorpyrifos ethyl, fonofos, phorate, terbufos, azinphos, mevinphos, parathion-methyl and trichlorfon. We also observed some inverse association with prostate cancer risk for a few molecules such as methidathion and oxydemeton-methyl. No confounding effects were detected in the relationship between exposure to each organophosphate and prostate cancer risk.
Conclusion: Our study provides new informations about exposure to organophosphates and prostate cancer risk. Consideration of data from follow-up questionnaire will enable us to complete and refine the
Results.

Riku Perhoniemi

Abstract

Objective: Monitoring sickness absence trends across different population and diagnostic groups is essential for detecting emerging health and disability patterns. The aim of this study is to examine recent diagnosis-specific sickness absence trends in the Finnish working-age population by sex and age group.
Material and Methods: Data was collected from national registers covering all non-retired 16–67-year-old residents in Finland from 2010 to 2023 (annual N > 3.1 million persons). Sickness absence was defined as receipt of sickness allowance, a benefit provided after 10 days of absence. Annual sickness absence prevalences (%) were calculated by diagnostic group across five 10-year age groups, separately for women and men.
Results: The relative importance of different diagnostic groups causing sickness absence changed significantly during the study period. While sickness absence due to somatic diagnoses – primarily musculoskeletal diseases and injuries – generally declined, sickness absence due to mental disorders increased markedly from 2016 to 2023, particularly among women. This increase was most pronounced in younger age groups (16–25, 25–34 and 35–44 years). By the end of the study period, mental disorders had become the leading cause of sickness absence in most age and sex groups. Only among men aged 45–54 and among women and men aged 55–67 did musculoskeletal diseases remain the primary cause of sickness absence also at the end of the study period.
Conclusion: The rise in sickness absence due to mental disorders across all demographic groups, particularly younger women, is concerning and requires urgent intervention. Simultaneously, the decline in sickness absence due to musculoskeletal diseases is a positive trend that should be maintained.

Adriano Dias; Helio Rubens Nunes; Carlos Ruiz-Frutos; Juan Gómez-Salgado; Melissa Sproesser Alonso; João Marcos Bernardes; Juan Ramon Lacalle-Remigio

Abstract

Objectives: The aims were to investigate whether changes in the main cause of the sick leaves and the presence of mental health illnesses are associated with return to work with readaptation.
Materials and Methods: A historical cohort study was carried out with non-work-related illnesses suffered by statutory workers of university campuses in a medium-sized city in the state of São Paulo, Brazil. Two exposures were measured: (a) changes, throughout medical examinations, in the International Classification of Diseases (ICD-10) chapter regarding the main condition for the sick leave; and (b) having at least one episode of sick leave due to mental illness, with or without change in the ICD-10 chapter over the follow-up period. The outcome was defined as return to work with adapted conditions. The causal model was established a priori and tested using a multiple logistic regression (MLR) model considering the effects of several confounding factors and then compared with the same estimators obtained using Targeted Machine Learning.
Results: Among workers in adapted conditions, 64% were health professionals, 34% had had changes in the ICD-10 chapter throughout the series of sick leaves, and 62% had diagnoses of mental health issues. In addition, they worked for less time at the university and were absent for longer periods. Having had a change in the illness condition reduced the chance of returning to work at another function by more than 30%, whereas having had at least one absence because of a cause related to mental and behavioral disorders more than doubled the chance of not returning to work in the same activity as before.
Conclusion: These
Results were independent of the analysis technique used, which allows concluding that there were no advantages in the use of targeted maximum likelihood estimation (TMLE), given its difficulties in access, use, and assumptions.

Claus Bogh Juhl-, Bibi Gram, Inge Brosbøl Iversen

Abstract

Objective: Previous studies have found that obesity are associated with reduced work ability as well as increased sickness absence and a lower likelihood of employment. However, body mass index (BMI) estimations in these studies have been based on self-reported weight and height, which may be inaccurate. This study aims to investigate the impact of obesity on work ability and workforce participation in the South Danish Obesity Initiative (SDOI) cohort using objective measurements of height and weight.
Material and Methods: The SDOI cohort includes approximately 1100 cases with obesity (BMI≥30kg/m2), 100 controls with overweight (BMI 25-29.9) and 100 controls with normal weight (BMI 18.5-24.9), who have undergone an extensive health examination including measurements of weight and height and screening for obesity-related diseases. Furthermore, participants completed questionnaires on pain, job characteristics and work ability based on the Work Ability Index questionnaire. Data on employment and welfare benefits are available for all participants in the Danish DREAM database. In a cross-sectional study, we will assess work ability and labour market outcomes, including sickness absence and likelihood of employment, for all cases compared to controls as well as for higher compared to lower BMI subgroups among cases. We will also examine the impact of obesity-related diseases, self-reported pain and job characteristics such as shift work and active versus sedentary work.
Results: The study will generate results regarding the impact of obesity on work ability and workforce participation.
Conclusion: The results of this study can strengthen existing evidence on the impact of excess body weight on work ability and workforce participation, thereby contributing to a better understanding of potential weight-related social inequalities in the labour market. Furthermore, this study may lead to identification of risk factors for reduced work ability and workforce participation, supporting the development of targeted preventive strategies.

Seong-Sik Cho; Dong-Wook Lee; Jaesung Choi; Mo-Yeol Kang

Abstract

Objective: Unmet healthcare needs (UHNs) have been associated with adverse health outcomes, yet their impact on labor-related variables remains underexplored. This study examines the association between UHNs and health-related productivity loss (HRPL), work ability, and work engagement among Korean workers.
Material and Methods: We utilized data from the Korean Work, Sleep, and Health Study, a nationwide panel survey conducted from 2022 to 2024. UHNs were assessed based on self-reported experiences of forgoing necessary medical care. HRPL was measured using the Work Productivity and Activity Impairment Questionnaire, while work ability and work engagement were evaluated using the Work Ability Index and Utrecht Work Engagement Scale-3, respectively. Generalized estimating equation models were applied to analyze the association between UHNs and labor-related outcomes, adjusting for sociodemographic factors.
Results: A total of 6,633 participants were included in this study. Workers with UHNs exhibited significantly higher HRPL (mean difference, 9.517 percentage points; 95% confidence interval [CI], 8.355–10.679 percentage points) and were more likely to report poor work ability (odds ratio [OR], 3.348; 95% CI, 2.696–4.158) and low work engagement (OR, 1.506; 95% CI, 1.357–1.670) compared to those without UHNs. When participants were stratified according to the reported causes of their UHNs, similar associations were observed for both financial constraints and time constraints. However, the associations between UHNs and higher HRPL, poor work ability, and low work engagement were more pronounced when financial constraint was identified as the cause of the UHNs.
Conclusion: Addressing UHNs is not only a public health priority but also an economic necessity, as inadequate healthcare access can reduce workforce productivity and organizational performance. Policymakers and employers should consider integrated healthcare strategies, workplace health programs, and expanded insurance coverage to mitigate the negative consequences of UHNs on labor outcomes. This work was supported by the National Research Foundation of Korea (NRF-2022R1F1A1066498).

Antonio d’Errico , Sewon Lee , Max J . Oosterwegel

Abstract

Objective: Open access (OA) publishing allows research to be freely available to readers, whilst costs are usually transferred to authors, funders, or institutions. This study explores OA indexing and publication costs among occupational health journals.
Material and Methods: We queried the Ulrichsweb database (a comprehensive catalog for academic and non-academic publications) for publications under the subject “occupational health and safety”. Filters were applied to restrict the search to active peer-reviewed journals with either print or online formats. After deduplication, journals were searched for indexing in the Directory of Open Access Journals (DOAJ). Data on OA status, article processing charges (APC), and author copyright retention were retrieved from DOAJ. The DIAMAS criteria (persistent identification, scholarly journal, OA with licenses, no fees, open to all authors, and community-owned) were used to define diamond OA journals when all criteria were met. Publishers were labelled as commercial or non-commercial by reviewing publishers’ websites and stock exchange listings. APC were compared by type of publisher (commercial/non-commercial) with the Mann-Whitney U-test. A p < 0.05 was considered statistically significant.
Results: Out of the 107 journals analyzed, 33 (30.8%) were fully OA and 15 (14%) were diamond OA journals. In the subset of fully OA journals, 6 (18.2%) were owned by commercial publishers and 27 (81.8%), non-commercial. Journals owned by commercial publishers charged higher APC (median: 1532.5 EUR, IQR: 671.25 – 1745) than non-commercial (median: 0 EUR, IQR: 0 – 421, p = 0.02). Fifteen (14%) OA journals allowed authors to retain copyright of their works.
Conclusion: Nearly one third of occupational health journals in Ulrichsweb are fully OA and less than 2 in 10, diamond OA. Those owned by commercial publishers charge higher APC. Existing occupational health journals could evaluate transitioning to non-commercial or diamond OA models, while new diamond OA journal initiatives could be encouraged.

Stavroula Leka, Miguel Munoz Harrison, Claire Hardy, Kay Greasely

Abstract

Objective: Occupational safety and health (OSH) services play a critical role in preventing work-related injuries and illnesses, supporting worker well-being, and enabling sustainable economic productivity. Yet despite their recognised importance, an estimated 75% of the global workforce lacks access to OSH services. Significant disparities persist between high-income countries and low- and middle-income countries, where implementation remains fragmented and inequitable, and among workers in small and medium-sized enterprises and informal sectors. This study explores the facilitators and barriers of OSH service delivery across diverse countries, with a focus on positioning OSH as a universal fundamental right at work. Materials & Methods: 25-30 online semi-structured interviews are being conducted via Microsoft Teams with stakeholders across high-, middle-, and low-income countries. Participants include experts in occupational health, occupational safety, and related fields such as sustainability and human or labour rights. Data will be later analysed using a thematic analysis, which will be concluded before the presentation of this paper.
Results: Findings will be categorised according to key facilitators and barriers identified during the initial literature review phase. The study is expected to reveal both shared and context-specific patterns across countries. As such, facilitators and barriers will include, but are not limited to, governance structures, regulatory frameworks, financing mechanisms, workforce capacity, integration with primary healthcare systems, and access for vulnerable worker populations.
Conclusion: This study will generate insights into the conditions that enable or hinder OSH service delivery worldwide. Drawing on stakeholder perspectives and existing literature, it will inform an updated conceptual model focused on positioning OSH as a universal fundamental right. Findings will guide actionable recommendations to improve access, equity, and integration of OSH services. Funding and Acknowledgements: This research is funded by the Institution of Occupational Safety and Health (IOSH) and conducted in collaboration with the International Commission on Occupational Health (ICOH).

Harald Hannerz, Esben Meulengracht Flachs, Marie Pedersen, Sandra Søgaard Tøttenborg, Jens Peter Bonde, Luise Mølenberg Begtrup, Camilla Sandal Sejbaek, Karin Sørig Hougaard

Abstract

Objective: We aim to examine the associations between maternal occupation during pregnancy and risk of preterm birth, low birth weight and major congenital malformations of the offspring.
Material and Methods: We identified our study population of live singleton births from April 1, 2004 to December 31, 2018 using the DOC*X-Generation Cohort, which was created by linking several national registers with detailed information on employment and birth outcomes and covers all residents in Denmark. We will estimate relative risks for the adverse birth outcomes by occupation and industry. Additionally, we will estimate excess fractions, defined as the proportion of adverse birth outcomes that would not have occurred if each occupation and industry group had the same risk as the lowest-risk group, after adjusting for relevant covariates and within-group random variation. Logistic regression will be used, firstly, to test the null-hypotheses and, secondly, to estimate group-specific expected numbers of cases under the null-hypotheses of no risk inequalities. Excess fractions will be estimated using Monte Carlo simulation.
Results: We plan to share the results for all three outcomes. For now, job codes have been grouped into 37 occupational groups based on the Danish version of ISCO-88 and 36 industrial groups using the Danish Working Environment Authority’s classification. Out of the included study populations of approximately 630.000 pregnancies, we have identified 29.624 cases of preterm birth, 6.106 cases of low birth weight among term births and 27.636 cases of major congenital malformations.
Conclusion: The analyses will show if there are disparities in these adverse birth outcomes across maternal occupations and industries registered for pregnant women giving birth in Denmark, 2004-2018. Findings can provide updated valuable insights into how specific occupations and industries affect pregnancy and health in a high-income society with relatively high occupational health standards. Funding: Working Environment Research Fund (Project J.nr. 20225100773).

Alana Ponte Correia, Jéssica Iracema Diogo Luís, Ivan Dieb Miziara, João Silvestre Silva-Junior

Abstract

Objective: To quantify the number of work disability benefits granted due to dizziness without an identified etiological diagnosis in Brazil between 2022 and 2024.
Material and Methods: Dizziness is defined as the sensation of disturbed bodily balance and is often accompanied by recurrent falls. These falls can lead to fractures and even more serious consequences, such as the inability to perform basic activities of daily living and work, resulting in significant impacts on both the individual and society. This ecological study analyzed data from the Social Security Statistical Yearbook on work disability benefits related to the diagnosis of “Dizziness and Giddiness” (ICD-10 R42) from 2022 to 2024. The benefits were stratified by type (work-related) and disability duration (temporary/ or permanent).
Results: A total of 1,963 work disability benefits were granted during the study period, of which 11 (0.57%) were classified as work-related and 1,952 (99.43%) as non-work related. Regarding the duration of benefits for work-related diseases, almost all were for temporary disability, with only one for permanent disability. For non-work-related benefits, 1,906 were temporary, and 46 were permanent. The number of benefits increased 98% over time: 457 in 2022, 601 in 2023, and 905 in 2024.
Conclusion: Most of the benefits granted for dizziness were temporary and of non-occupational origin and were approved despite the absence of a defined etiological diagnosis. This suggests that dizziness alone can lead to work disability, particularly in occupations where it may pose a significant safety risk, such as operating machinery, working at heights, handling sharp instruments, or driving. Although the dataset lacks occupational detail, the findings support the need for targeted prevention and rehabilitation strategies to reduce the individual, social, and economic burden associated with dizziness-related work disability.

Najla Mechergui , Samia Ben Sassi , Saloua Fray , Mariem Mersni , Ghada Bahri , Nizar Ladhari

Abstract

Introduction : Multiple sclerosis (MS) is a neurodegenerative disease that affects young people and can have an impact on their socio-professional life. The aim of our study was to evaluate work capacity in workers with MS .

Methods : Bicentric cross-sectional study including patients with MS followed up at the neurology consultations during the period of one year . Work ability was assessed using the Work Ability Index (WAI) questionnaire.
Results: We included 146 patients with a mean age of 39.9±9.6 years and a gender-ratio (M/F) of 0,52. The WAI assessment was poor in 40.6% of cases, resulting in mean absenteeism of 127 days over the previous 12 months (p=10-3). Impairment of work capacity was associated with personal psychiatric history (10-3) , professional seniority of more than 17 years (p=0,006), , exposure to chemical neurotoxins (p=0,023), occupational constraints of accessibility to the company (p=10-3), prolonged walking (p=0,002), manual precision (p=0,016) and cognitive constraints (p=0,005). Work disability were also associated with the secondary progressive form (p=0,019) and the cognitive (p=10-3), motor (p=0,008) and bladder-sphincter (p=0,01) clinical signs. In multivariate analysis, the factors associated with work incapacity were cognitive l signs (OR=10,184; p=0,002), high days absence (OR=1,007; p=0,003), taking medication for comorbidities (OR=6,968; p=0,002), company accessibility constraints (OR=4,850; p=0,040) and high EDSS score (OR=1,786; p=0,002).
Conclusion : According to our study , a close collaboration between the neurologist, occupational physician and employer is essential to remain patients with multiple sclerosis in work.

Hélène Attali, Régine Codron, Pierre-Yves Montéléon, Ibrahim Mounchetrou Njoya, Magali Noyé, Oren Semoun, Caroline Wargon, Céline Zind

Abstract

Objective: This study focuses on occupational strain, a key element in national health and work plans in France, aiming at preserving employee health by preventing harmful exposures. The Objective is to gather data on employees’ perceptions of their occupational strain, protective strategies, and career outlook.
Material and Methods: A cross-sectional study was conducted from February 5 to May 27, 2024, using an online questionnaire accessed via a QR code, among employees followed by a French intercompany occupational health and prevention service. The data, analyzed using SPSS®, focused on the physical, psychological, and relational challenges employees face at work, the links between health and working conditions, and difficulties in sustaining work obligations on the long-term.
Results: A total of 2,121 responses were collected, with an average age of 40 years and 52% women. Key findings (p<0.001) include: • A higher proportion of employees reporting physical fatigue as they age, from 27% in those under 26 to 48% in those over 56. • Increased stress levels among women, supervisors, and managers, while manual and clerical workers reported more physical strains. • Employees facing demanding work situations reported poorer health and struggled to balance work life balance. • Those who believe they cannot remain in their job for more than five years often lack support from colleagues or management, rely on personal strategies, and face demanding physical, mental, or interpersonal situations.
Conclusion: The study indicates that occupational strain starts early in one’s career and worsens overtime. It highlights the importance of early prevention through individual monitoring of work-related health indicators. Multidisciplinary teams of the intercompany occupational health and prevention service, in collaboration with employers and social partners, can implement targeted primary prevention actions to support employee health and employment longevity.

Sanja Kezic, Florentine de Boer, Ivone Jakasa, Thomas Rustemeyer

Abstract

Contact dermatitis (CD), also known as contact eczema, is one of the most common occupational skin diseases, resulting from direct exposure to irritants or allergens. CD is generally classified as either irritant contact dermatitis (ICD) or allergic contact dermatitis (ACD). Occupational ICD is most frequently caused by wet work, which is highly prevalent among healthcare workers, hairdressers, construction workers, cleaners, and food industry employees. Common occupational allergens include preservatives (e.g., isothiazolinones), rubber additives, metals such as nickel and chromium, acrylates, epoxy resins, and hair dyes. Professions at highest risk for ACD include hairdressers, dentists, metalworkers, and healthcare workers. Due to overlapping clinical features, distinguishing between CD subtypes remains challenging. Accurate diagnosis is crucial for effective treatment, prevention strategies, and eligibility for compensation. This study aimed to identify biomarkers that differentiate between ICD and ACD. We analyzed a broad panel of immune and skin barrier mediators in patients with CD who underwent patch testing with allergens and irritants as part of routine diagnostics, as well as in workers with hand dermatitis. Skin samples were collected using tape stripping, a simple and non-invasive method. Preliminary findings suggest that while ICD and ACD share many immune markers, certain Th-cell mediated markers appear more specific to ACD. Skin barrier biomarkers, especially cholesterol derivatives and filaggrin breakdown products (natural moisturizing factors), showed distinct profiles between the two, likely reflecting irritant-induced damage, which is less pronounced in ACD. We hypothesize that integrating immune and skin biomarkers will improve the ability to distinguish CD subtypes more effectively than using single markers alone. A predictive model will be developed using machine learning and validated in samples from workers with hand dermatitis.

Daniel E. Russ, Leila Orszag, Nicole Gerlanc, Jonas Almeida, Laura E. Beane Freeman, Melissa C. Friesen

Abstract

Objective: Coding free-text job descriptions is time-consuming and expensive. We evaluated the use of the SOCcer auto-coding tool to help participants self-code their occupations in an online questionnaire of the population-based Connect for Cancer Prevention Study.
Materials and Methods: We used SOCcer to provide participants with a list of the four best-fitting occupation categories based on self-reported job title. Participants were asked to select the best category or “none of the above” (v1). In a second version of the questionnaire, we incorporated answers to a work task question and expanded the list to six suggestions (v2). An expert coded 1,000 randomly selected “none of the above” jobs from each version to the 6-digit level where possible, blind to SOCcer’s suggestions. We examined the frequency of selecting a SOCcer-suggested code. We also evaluated the expert’s ability to code the “none of the above” jobs and compared the expert’s assigned code to SOCcer’s suggested list.
Results: V2 modifications reduced the selection of “none of the above” from 17% of 23,699 v1 jobs to 14% of 12,060 v2 jobs. The “none of the above” jobs had lower median SOCcer scores (v1=0.15; v2=0.16) than the participant-coded jobs (v1=0.53; v2=0.56). For these “none of the above” jobs, incorporating task increased the proportion of jobs the expert could code to 6-digits from 68% in v1 to 95% in v2 and decreased un-codable jobs from 16% to 3%; the remainder were assigned a less detailed code. The expert-assigned code was within the SOCcer-suggested list 27% and 54% of the time in v1 and v2, respectively.
Conclusion: Participants successfully self-coded most jobs, with improved performance observed when we added work tasks and expanded the list of suggested occupations. Incorporating task also improved the expert’s ability to assign the “none of the above” jobs to a detailed occupation code.

José Rodolfo Tenório Lima, Felipe Seiti Sekiya, Rodrigo Pereyra de Sousa Coelho

Abstract

Objective: To analyze the incidence and characteristics of temporary disability benefits among workers in the Brazilian sugarcane agroindustry, comparing manual and mechanized labor processes. Methods: This ecological study analyzed secondary data from 2012 to 2021. Formal labor data were obtained from the Annual Social Information Report (RAIS) database, and data on social security benefits were sourced from the Smartlab platform. Workers were categorized into two groups: manual laborers (e.g., sugarcane field workers) and mechanized workers (e.g., machine operators). The incidence rates of temporary disability benefits (B31 – non-work-related and B91 – work-related) were calculated. Relative risk (RR) was used to compare groups, and causes of disability were classified using ICD-10.
Results: During the period, 70,339 temporary disability benefits were granted in the sector, 75% to manual workers and 25% to mechanized ones. The average annual incidence was 28.8 per 1,000 for manual labor and 25.3 per 1,000 for mechanized labor. The overall RR for disability was 1.14, indicating a 14% higher risk for manual workers. The B91-specific RR was 1.71. Musculoskeletal disorders (MSDs) were more prevalent among manual workers, accounting for 33.7% of cases vs. 24.6% among mechanized workers. Among B91 cases, dorsalgia (M54) was the leading cause in manual workers (19%), while wrist/hand fractures (S62) predominated in mechanized roles (13%). Three of the five leading B91 causes in manual workers were MSDs, compared to only one in mechanized jobs.
Conclusion: Despite a general decline in benefit concessions, significant inequalities remain. Manual workers face a higher burden of MSDs, while mechanized workers are more affected by severe traumatic injuries. The persistent high incidence of work-related benefits underscores the link between job conditions and health outcomes. Addressing these disparities requires stronger enforcement of labor standards, broader application of NR-31, enhanced training and safety measures, and policies tailored to the realities of rural labor in Brazil’s sugarcane sector.

Sigita Skrastina, Madara Kivleniece, Kristine Krumina, Jelena Reste

Abstract

Background: This study analyzes muscle synergy patterns during maximal-effort upper limb testing. The aim was to examine neuromuscular coordination and identify hidden compensatory activations that could inform ergonomic and rehabilitative strategies for preventing work-related upper limb disorders (WRULDs).
Material and Methods: Surface electromyography (sEMG) was recorded from six pairs of upper limb muscles: the deltoids, biceps brachii, brachioradialis, triceps brachii, wrist flexors, and wrist extensors. Twenty-three healthy adults (median age 24.69±4.13) underwent a standardized series of classic isolated manual strength tests for each muscle group, performed at maximal effort. For each trial, the muscle showing the highest sEMG amplitude was identified as the dominant contributor and compared to the intended target. Statistical analyses were performed using Jamovi, including chi-square tests and Cohen’s Kappa to assess agreement.
Results: Across 276 trials, the intended muscle was dominant in 72% of cases. In the remaining 28%, a different muscle produced the highest activation, indicating frequent synergistic compensation. The biceps brachii failed to dominate in 65% of its own tests, with the deltoid or brachioradialis often taking over. The deltoid was the dominant muscle in 26% of all trials. In contrast, triceps and deltoid tests showed high isolation success (98–100%). Concordance between tested and dominant muscles was moderate (Cohen’s κ ≈ 0.66; χ² p < 0.001, statistically significant). No consistent side-dominance patterns were observed.
Conclusions: Even in standardized strength testing, healthy individuals frequently recruit alternate muscles. Persistent synergy patterns may contribute to WRULD development over time. Identifying such patterns could enable earlier ergonomic interventions, more targeted rehabilitation, and refinement of muscle testing protocols.

Nihel Khouja¹, Emna Baraketi¹, Mamoun Alaoui Belhassan², Yasmine Tebourbi¹, Saloua Ismaïl¹, Chiraz Jemli Chammakhi² ,Jihen Hsinet¹, Aida Benzarti¹

Abstract

Objectives: This study aimed to evaluate the prevalence of musculoskeletal disorders (MSDs) among Tunisian radiologists, identify occupational risk factors associated with these disorders in this professional group, and assess their functional impact. Methods: A cross-sectional survey was conducted using a questionnaire via Google Forms. It included four sections: sociodemographic and professional data; the Nordic Musculoskeletal Questionnaire (NMQ); the Roland-Morris Disability Questionnaire; and items related to predictive factors.
Results: A total of 73 radiologists participated in the study. They were predominantly aged between 36 and 55 years (70.8%), with 56.9% were women. The mean work seniority was 13,23 years. Most reported working 6 to 7 hours per day (77.8%) and using multiple imaging modalities: ultrasound (100%), computed tomography (100%), conventional radiology (90.3%), MRI (86.1%), and interventional radiology (54.2%). The majority (80.6%) reported working primarily in a seated position while 19.4% alternated between sitting and standing throughout their workday. Over the past 12 months, the most frequently reported sites of MSDs were the right shoulder (83.3%), neck (63.9%), and lower back (61.1%). Recent pain (past 7 days) was commonly reported in the lower back (52.8%) and upper back (27.8%). Functional limitations due to pain were reported in the lower back (13.9%) and right wrist/hand (47.2%). Regardind the Roland-Morris Disability Questionnaire; main impacts were fatigue (50.7%) and anxiety (49.3%). To relieve pain, most participants reported changing posture frequently (82.6%) and taking breaks (71%). A majority expressed interest in training and awareness programs (93%), ergonomic workstation assessments (83.1%), and preventive exercises (63.4%).
Conclusion: MSDs are prevalent among Tunisian radiologists and significantly affect their physical and psychological well-being. There is a critical need for targeted ergonomic interventions, structured training programs, and workplace adjustments to prevent and manage MSDs in this population.

Mathias Moselund Rønnow , Marianne Kyndi , Søren Mose (,), Dorte Rytter , Jeremy Labrecque , Jesper Medom Vestergaard , Annett Dalbøge , Esben M Flachs , Alex Burdorf , Johan Hviid Andersen

Abstract

Study Objective: To estimate the effect of cumulative occupational lifting on the risk of lumbar spine disc herniation. Purpose of abstract/presentation: To discuss different methods for assessing the effect of cumulative occupational lifting on the risk of lumbar disc herniation.
Material and Methods: In this nationwide register-based cohort study, we included Danes aged 18–25 years in 1995, corresponding to ~570,000 individuals with up to 31 years of follow-up. Cumulative lifting was estimated annually using job exposure matrices (JEMs) linked to occupational registers, whereas lumbar disc herniations and covariates were obtained from registers. We performed a pooled logistic regression with time-varying exposure adjusted for the following baseline and time-varying confounders: calendar year, age, sex, education, industry, family income, and marital status. PRELIMINARY
Results: The pooled logistic regression model yielded the following HRRs (95%CI): 6000 ton 1.59(1.46-1.72)
Conclusion: Preliminary results showed an increased risk of lumbar disc herniation with increasing cumulative lifting. However, these results require very strong assumptions to be considered causal and are likely influenced by exposure-confounder feedback (e.g. healthy worker biases). We are currently performing a target trial emulation, where we emulate an RCT evaluating different lifting thresholds (e.g. “lift below 750 tons”). Each individual is cloned to seven lifting threshold arms, where the clone is censored when the observed exposure exceeds the assigned threshold. Inverse probability of censoring weights account for the selection bias introduced by censoring, and for baseline and time-varying confounding, and exposure-confounder feedback. The final
Results, including the target trial emulation, will be presented at EPICOH. We thank “the Danish Working Environment Research Fund” and “NIDO | Centre for Research and Education” for their financial support.

Alexis Descatha, Marc Fadel, Ryan Colvin, Ann Marie Dale, Céline Ribet, Annette Leclerc, Bradley Evanoff

Abstract

Background. Knee meniscus disorders represent a significant cause of work absence and work disability, and often result in surgical intervention. We aimed in a large-scale general population study to assess knee meniscus disease associated with cumulative workplace exposures over the working lifetime .
Material and Methods Participants in a large prospective study (CONSTANCES) were surveyed. The survey included self-reported history of current and past jobs, allowing estimation of past and current workplace physical exposures using an existing job exposure matrix (JEM). meniscus surgery cases were ascertained through matching the surveys to national health insurance data. Poisson regression analyses (controlling for age, Body Mass Index, and sex) computed the relative risks (RR) of future meniscus surgery associated with standing, kneeling/squatting, carrying loads > 25kg, and computer use. Eleven exposures including physical force, repetition, posture, and keyboard use were categorized into quartiles. Models included different time periods of exposure and/or different exposure lag times.
Results. More men than women had meniscus surgery (1,062 men vs. 541 women). Cumulative years of work in a job above the 75th percentile of population exposures to standing, kneeling/squatting, and carrying loads > 25kg were associated with statistically significant higher risks of meniscus surgery among men (RR per ten years of exposure 1.06-1.09), while years of computer work were associated with a lower risk of surgery (RR=0.93). Years of standing was associated with higher risk of surgery among women (RR=1.11). Placing a 5 year lag on exposures had minimal effects on the associations.
Conclusion Our study found that working long hours standing, carrying heavy loads, and kneeling and squatting increased the risk of knee meniscus surgery among men during the working life. Time spent on computers was linked to a lower risk of future meniscus surgery.

Isabella Ferreira Valentini Ferreira; Jéssica Iracema Diogo Luis; Ivan Dieb Miziara;João Silvestre Silva-Junior

Abstract

Objectives: Fibromyalgia is a chronic pain syndrome that affects quality of life and work ability. This study aimed to describe the frequency and characteristics of disability benefits granted due to fibromyalgia in Brazil between 2014 and 2024. Methods: Ecological study using public data from the Brazilian Social Security Statistical Yearbook (2014 – 2024). Including all disability benefits granted under the ICD-10 code M79 (Other Soft Tissue Disorders, Not Elsewhere Classified), which includes fibromyalgia (ICD M79.7). Benefits were analyzed by type (work-related or non-work-related), duration (temporary or permanent), and sex.
Results: Between 2014 and 2024, 100,113 disability benefits were granted: 4,093 (4.1%) work-related and 96,020 (95.9%) non-work-related. Among work-related cases, 3,994 (97.6%) were temporary and 99 (2.4%) permanent. For non-work-related cases, 94,166 (98.0%) were temporary and 1,854 (2.0%) permanent. Most benefits (80.0%) were granted to women. Numbers peaked in 2024 (27,776) and 2023 (12,952), together accounting 40.6% of the total. From 2014 to 2019 and 2021 to 2022 numbers remained relatively stable (mean: 7,255; SD: 1,091). In 2020, there was a sharp decline (2,881; -60.3%) due to COVID-19 pandemic and suspension of in-person medical assessments at the Brazilian Social Security Institute (INSS). Activities resumed later that year, and in 2023, a new online document-based evaluation system was introduced.
Conclusions:Most disability benefits due to fibromyalgia were temporary, non-work-related, and to women. The low rate of permanent benefits reflects fibromyalgia’s fluctuating course, with symptom exacerbation and remission without physical sequelae. Establishing an occupational link is complex, which may explain the small proportion of work-related benefits. These findings underscore the need to prevent work disability in people with fibromyalgia—especially women—by adapting occupational demands through physical, cognitive and organizational ergonomic strategies individually.

Jantine M. Maarleveld (-), Pieter Coenen (,), Johannes R Anema , P Paul F M Kuijer (,), Erwin M Speklé

Abstract

Objective: To evaluate the effectiveness of a computer-assisted reintegration protocol designed for occupational health professionals to facilitate a fast reintegration of employees on sick leave due to musculoskeletal disorders. We will also explore the duration until first consultation with an occupational health professional.
Material and Methods: Since 2020, a computer-assisted protocol is used by occupational health professionals of a large occupational health service in the Netherlands for the reintegration of employees at risk for long-term sick leave due to musculoskeletal disorders. A main characteristic of this protocol is an early consultation. In this study, we used register data of employees on sick leave due to musculoskeletal disorders working at organizations receiving reintegration according to the protocol and at organizations receiving usual care. We used descriptive statistics to explore the duration until first contact with an occupation health professional. We will use Cox regression analyses to investigate the effectiveness of the protocol on sick leave duration.
Results: Between January 2020 and July 2023, 28,796 employees (median age: 51.7 years; 38% female) on sick leave were diagnosed with a musculoskeletal disorder. Of these employees, 1,970 (median age: 51.8 years; 54% female) were at risk of long-term sick leave and received guidance according to the reintegration protocol. Preliminary
Results show that the median duration until first consultation was 21 days in this group compared to 26 days in employees receiving guidance according to usual care.
Conclusion: In line with a main aspect of the computer-assisted reintegration protocol, preliminary
Results indicate an early consultation with an occupational health professional for employees guided according to this protocol. Further analyses have to provide insights into the effectiveness of the new protocol on sick leave duration of employees with musculoskeletal disorders. Funding: This study is financed by Arbo Unie BV. Other acknowledgements: Jantine Maarleveld is a visiting researcher at Arbo Unie BV. Erwin Speklé is employed by Arbo Unie BV.

A. Carlien Straat, Jantine M. Maarleveld, Judith A.F. Huirne, Gino M.M.J. Kerkhoffs, Johannes R. Anema, P. Paul F.M. Kuijer.

Abstract

Objective: There is little guidance on return to daily life activities, including work and sport, after a knee replacement surgery. Personalized eHealth programs could provide perioperative guidance to patients, facilitating recovery. We evaluated whether personalized eHealth care enhances return to daily life activities compared to usual care among working-age patients receiving a knee-replacement surgery in the Netherlands.
Material and Methods: We conducted the multi-centre randomized controlled ACTIVE trial in eleven medical centres across the Netherlands. Patients were included if they were from working age, on the waiting list for knee-replacement surgery, employed 8 hours/week, and willing to return to work. Patients were randomized the either the usual care group or a group receiving an eHealth care program in addition to usual care. The program included an eHealth application with activity tracker, goal attainment scaling and a one-time case-manager consultation. The primary outcome was time from surgery to return to six out of eight self-selected daily life activities, using the PROMIS-Physical Functioning questionnaire. Kaplan-Meier curves and multi-level Cox proportional hazard modelling were used for analyses.
Results: We randomized 145 patients in the intervention group (54% female, mean age 58 years) and 142 in the control group (51% female, mean age 59 years). Median time to resume self-selected daily life activities was 52 days (IQR 32–84) in the intervention group and 75 days (IQR 36-137) in the usual care group (HR 1.6, 95%CI 1.3–2.0).
Conclusion: The personalized eHealth care program reduced time to return to self-selected daily life activities by 23 days compared to usual care. Given the worldwide rising prevalence of knee osteoarthritis, especially among working-age patients, this intervention could enhance perioperative care to support personalized medicine.

Yifei Liu, Min Zhao, Jing Liao, Peixin Li, Yuxi Wang, Jing Li, Huimin Huang, Peifang Liu, Jing Wu, Yu Jiang

Abstract

Objectives: Shift work affects approximately 30% of the global workforce and may lead to cognitive impairment. This study explores the impact of shift work on cognitive function and involves the potential mechanisms of the cholinergic pathway. Methods: We recruited 1,025 manufacturing workers (Fuzhou, China) with ≥1 year of employment, retaining 677 after exclusions. Data collection included: 1) Shift work patterns (questionnaires); 2) Cognitive assessment using the Montreal Cognitive Assessment (MoCA); and 3) ELISA-measured circadian (BMAL1, CLOCK, PER1/2, CRY1/2) and cholinergic markers (ACh, AChE, ChAT, ChT, VAChT). Statistical analyses assessed cognitive outcome and cholinergic alterations.
Results: Among shift workers (58.1%), cognitive impairment prevalence was 37.9%. Cognitive impairment rates significantly differed by shift work duration groups. Shift work disrupted circadian regulation, with decreased BMAL1/CLOCK and increased PER/CRY levels (P<0.05), negatively correlating with shift duration. MoCA revealed deficits in visuospatial/executive function, attention, and abstraction among long-term shift workers. Logistic regression identified prolonged shift work as an independent risk factor for cognitive impairment. Cholinergic dysregulation in impaired shift workers included elevated AChE and reduced ChAT, VAChT, ChT, and ACh (P<0.05). Significant negative correlations emerged between shift work duration and peripheral cholinergic factor expression.
Conclusion: Shift work is a significant risk factor for cognitive impairment, with prolonged exposure increasing severity. Cognitive impairment was associated with circadian disruption and cholinergic dysfunction (elevated AChE, suppressed ACh synthesis/transport), suggesting cholinergic pathways may mediate the cognitive effects of shift work. Interventions targeting circadian and cholinergic systems may help mitigate these risks.

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

Abstract

Objectives: To determine the prevalence and associated factors of irritable bowel syndrome (IBS) among paramedical professionals (PPs) at Taher Sfar Mahdia hospital, Tunisia.
Materials and Methods: A cross-sectional study was conducted among PPs of Taher Sfar Mahdia Hospital. Data were collected via a self-administered questionnaire capturing socio-demographic and occupational characteristics. IBS was diagnosed using the Rome IV Diagnostic Questionnaire for Adult FGIDs and anxiety/depression symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS).
Results: Of 261 PPs included in the study, 197 provided complete questionnaires. IBS prevalence was 15.7% (n=31), with 66% of cases among females. A higher IBS prevalence was found among PPs working fixed night shifts than those with variable schedules (93.5% vs. 43.4%, p <0,001). The average number of monthly shifts was significantly higher in PPs with IBS (11.9 ± 4.8 vs. 6.1 ± 7.1, p <0,001). Anxiety (87.1% vs 54.8%, p=0.001) and depression (87.1% vs 57.8%, p=0.002) were significantly more frequent in PPs with IBS. Multivariate analysis identified associations between IBS and body mass index (BMI) (OR=1.115, 95% CI [1.013-1.226], p=0.026), fixed night shifts work schedules (OR=13.589, 95% CI [3.078-29.991], p=0.001) and anxiety symptoms (OR=3.675; 95% CI [1.155; 11.694], p=0.028).
Conclusion: IBS was identified in 15.7% PPs, with significant associations with fixed night shifts, higher BMI, and anxiety. The strong link with night shifts suggests that disrupted circadian rhythms and sleep quality exacerbate IBS. The high prevalence of anxiety among affected PPs highlights the role of psychosocial stressors in functional gastrointestinal disorders. These findings highlight the need for improved shift scheduling, early screening for mental health issues, and targeted interventions to reduce occupational stress and enhance PPs’ well-being in high-demand hospital settings.

CheongHee, Yu

Abstract

Objectives: A significant number of workers in logistics centers engage in fixed night shifts. Due to higher wages associated with night shift allowances compared to day shifts, many workers prefer night work over day shifts. However, night work, combined with the high labor intensity of logistics centers and the lack of protection from extreme cold or heat, has made workers’ health vulnerable. The number of workers who perform fixed night shifts for more than 20 days per month is increasing. This study aimed to investigate the working conditions and health status of fixed night shift workers in logistics centers. Methods: The working conditions, environment, and health status of logistics center workers engaged in fixed night shifts were assessed through surveys and interviews.
Results: A total of 270 fixed night shift workers in logistics centers responded to the survey, and the responses were analyzed. On average, the workers worked 9.4 hours per day, with meal breaks totaling 52 minutes and rest breaks averaging 55 minutes daily. Respondents reported experiencing sleep disorders, fatigue, weight loss, vision impairment, and gastrointestinal issues after working at logistics centers. The labor intensity of fixed night shift workers in logistics centers was high. There was a slight tendency for lower prevalence rates of most diseases among fixed night shift workers with long tenure, which was attributed to the healthy workers survivor effect.
Conclusion: The physical and mental health of fixed night shift workers in logistics centers was poor. Although the workers recognized that fixed night shifts were detrimental to their health, they exhibited a strong tendency to continue working night shifts. The primary reason was economic, as night shifts provided higher wages, and there were limited options for earning comparable wages during daytime shifts.

Magdalena Zebrowska, Jing Zhang, Thien Dat Tran, Tala El Ghoul, Susanne Strohmaier, Eva Schernhammer,

Abstract

Objective: Circadian rhythms regulate key physiological functions and are influenced by environmental, behavioral, and genetic factors. We conducted a genome-wide association study (GWAS) of the Circadian Imbalance Index (CII)—a composite phenotype incorporating eveningness, abnormal sleep duration, high neuroticism, atypical caffeine intake, and low vitamin D levels—to identify genetic variants associated with circadian disruption, particularly relevant for night shift workers.
Material and Methods: We analyzed 308,211 UK Biobank participants of European ancestry. The CII (range 0–5) was derived from self-reported and biomarker data. GWAS was adjusted for age, sex, assessment center, genotyping batch, and 20 principal components of ancestry. Variants with MAF <1% and imputation quality R² <0.7 were excluded. Functional annotation and enrichment analyses were conducted using FUMA and MAGMA.
Results: GWAS identified 190 genome-wide significant SNPs (p<5×10⁻⁸), mapping to 57 lead variants in 27 genomic loci. Seventy-two mapped genes were associated with circadian regulation and pleiotropic traits spanning psychiatric, metabolic, and cardiovascular domains. Enriched expression was found in brain regions including the cerebellum, frontal cortex, and nucleus accumbens. Gene set enrichment implicated vitamin D metabolism and the Nikolsky breast cancer amplicon gene set.
Conclusion: The CII is a heritable, polygenic trait reflecting shared genetic risk for circadian disruption and related health conditions. Identified pathways, particularly those involving vitamin D metabolism and neuropsychiatric regulation, offer insights into the biological underpinnings of circadian misalignment. These findings are especially relevant to night shift workers, who are at elevated risk of circadian-related health issues. Understanding genetic susceptibility can inform interventions to mitigate risks in this population.

Johanneke E. Oosterman, Suzan Wopereis, Martijn E.T. Dollé, Alex Burdorf, Linda W.M. van Kerkhof , Heidi M. Lammers-Van der Holst

Abstract

Objective Shift work disrupts sleep-wake rhythms, causing poor sleep, circadian misalignment, sleepiness, and reduced performance. This study evaluated the effect of personalized sleep and nutrition strategies on sustained attention in night shift workers. Methods In this 12-week intervention, 57 healthy male shift workers (18–60 years) were allocated to a personalized sleep (n=25), nutrition (n=22), or control (n=10) arm. The sleep group received guidance on sleep timing and strategic napping; the nutrition group received meal plans with timed calorie and macronutrient distribution. At baseline, early intervention (first shifts post-advice), and end of intervention, participants completed 5-minute Psychomotor Vigilance Tests (NASA PVT+ app) at the start and end of two consecutive shifts. Attentional lapses (reaction time >500 ms) was the primary outcome. Negative binomial mixed models included participant and shift as random intercepts, adjusted for age, chronotype, and household composition.
Results Baseline lapse rates did not differ between groups. Across all groups and timepoints, lapse rates were over twice as high at shift end vs. start (Rate Ratio = 2.19, 95% CI [1.84, 2.61]). In controls, lapse rates increased from baseline to the early (RR = 2.19 [1.37, 3.49]) and end of the intervention (RR = 2.43 [1.45, 4.07]), with a similar pattern in the nutrition group. However, the sleep intervention mitigated this increase. The sleep group had 51% fewer lapses than controls during early intervention (RR = 0.49 [0.28, 0.88]); and this protective effect persisted at the end of the intervention (RR = 0.53 [0.28, 1.00]).
Conclusion The sleep intervention reduced attentional lapses during night shifts relative to control and nutrition groups. While sustained attention declined in the other groups, the sleep group remained stable over time. These findings support integrating personalized sleep strategies into occupational health policy to improve safety and reduce error risk in 24-hour operations.

Alex Collie

Abstract

Objective: This study aimed to fill this gap by examining the association between pre-term birth and two key occupational risk factors: long working hours and shift work. Methods: This study analysed data from the Australian Longitudinal Study on Women’s Health. A total of 2241 women employed during pregnancy, who reported 2522 singleton births between 1996 and 2018 were included in analysis. Mixed effects logistic regression was used to address potential dependencies among births from the same women.
Results: Long working hours were associated with increased pre-term birth risk after adjusting for socio-demographic factors (AOR:1.61, 95%CI: 1.02-2.55), but this association became non-significant after further adjustment for obstetric and general health-related factors (AOR 1.21, 95% CI: 0.76-1.92). Shift work was not associated with preterm birth in either crude or adjusted regression models (AOR 0.59, 95%CI: 0.31-1.13). Women having year 12 or below education (AOR 1.86, 95%CI: 1.04-3.31), current smokers (AOR 2.48, 95%CI: 1.17-5.25), gestational hypertension (AOR 2.75, 95%CI: 1.32-5.23), primiparity (AOR 2.02, 95% CI: 1.13-3.63), past history of asthma (AOR 2.01, 95%CI: 1.05-3.84) and without private health insurance (AOR 1.86, 95%CI: 1.14-3.05) had significantly increased odds of preterm birth.
Conclusion: This study initially found an association between working more than 40 hours per week and preterm birth after adjusting for socio-demographic factors. However, this association became non-significant after further adjustment for obstetric and general health-related factors. The findings suggest that comprehensive policies addressing chronic disease prevention and social inequalities are crucial for reducing preterm birth.

Alana Correia, Isabella Valentini, Ivan Dieb Miziara, João Silvestre Silva-Junior

Abstract

Objective: To describe the profile of reported cases of occupational noise-induced hearing loss (NIHL) among drivers in the state of São Paulo, Brazil, from 2010 to 2022. Methods: This descriptive study was based on data from the Notifiable Diseases Information System (SINAN), available through the Brazilian public health database (DATASUS). Notifications of NIHL between 2010 and 2022 were filtered using the Brazilian Occupation Classification (CBO) 7825, referring to drivers. Variables analyzed included year of notification, age group, specific occupation, and duration of occupational noise exposure.
Results: A total of 70 cases of NIHL in drivers were reported during the study period, with an average of 5 cases per year. The highest number of notifications occurred in 2015 (14 cases). The most affected age group was 50–64 years (54%), followed by 35–49 years (24%), 65–79 years (19%), and 80 years or older (3%). The CBO code 782510 (truck drivers) accounted for 51% of the cases. The average duration of occupational noise exposure was 25 years, with a minimum of 7 years.
Conclusion: The analysis of NIHL notifications in drivers highlights the relevance of occupational health surveillance and the need for effective preventive strategies. While NIHL does not inherently result in work incapacity, it can lead to functional limitations that require individualized assessment and workplace adaptations to support worker rehabilitation and retention.

None

Abstract

Objective: Our Objective was to assess the prevalence of best practices to support worker safety, health, and well-being under the Total Worker Health framework in U.S. nursing homes. A validated measure of Total Worker Health practices was used for the survey.
Materials and Methods: The first survey wave was done in 2018-2019, and a follow-up contacting original respondents was completed in 2024. All nursing homes caring for adults with at least 30 beds in California, Ohio, and Massachusetts were eligible for the original sample. The original mixed-mode survey had a 23.8% response rate (N=569), but subsequent analysis found no differential response based on observable characteristics. The follow-up survey had a lower response rate, 11.7% (N=63 of 537 remaining nursing homes). Directors of Nursing were the intended respondents in each organization as they have the requisite skills and knowledge to complete the survey on behalf of the organization.
Results: Overall, DONs reported relatively high levels of best practices for worker health and well-being. There was remarkable stability in the average and median scores for the five domains: leadership commitment; participation; policies program and practices that foster supportive working conditions; comprehensive and collaborative strategies; and adherence to federal and state regulations and ethical norms. These
Results held true even when using the entire sample average from 2019 rather than only the matched nursing homes. DONs also reported a slightly easier time recruiting and retaining qualified employees. However, the same $20 incentive resulted in a much lower response rate.
Conclusion: A 5-year follow-up survey found no significant changes in the manager-reported working conditions of U.S. nursing homes. Survey incentives for DONs might need to be increased to obtain response rates similar to previous surveys.

Evgeny Zibarev, Anna Bessonova, Natalia Zabrodina, Evgeny Kovalevskiy

Abstract

Objective. To assess the mortality rates of retired civil aviation pilots in comparison with the Russian male urban population.
Materials and Methods. Mortality of 38016 civil aviation pilots retired from 1990 to 2018 was studied. Age-specific mortality rates for 5-year age groups calculated using pilots’ vital status data from Social Fund of Russia and mortality data for male Russian population for years 2019-2023.
Results. By the end of the observation period 6649 pilots died, while 31367 stayed alive. A total of 176500 person-years of observation were obtained. The average retirement age was 52,9±11,4 years. Pilots had a significantly lower risk of death from all causes compared to the urban male population – OR 0.80 (95%CI 0,78-0,81), i.e. the risk of death in male pilots was 20% lower compared to the urban male population. However, in the 55-59 age group the mortality rate for pilots was 1.3 times higher than in 45-49 age group, whereas in the population it was 0.9 times higher; in the 60-64 age group the mortality rate for pilots was 3.0 times higher, and the population – 1.8 times. Higher rates of increase of the mortality rate in pilots’ group can be traced in all age groups.
Conclusion. The lower risk of death in pilots could be explained by effective and high-quality professional selection and high levels of their socio-economic support, however, the age-related mortality rates in pilots are increasing at a faster rate, especially in retirement period due to the influence of occupational risk factors. Important evidence of the adverse impact of working conditions on pilots is increase of their mortality rate compared to the population of the Russia with increasing age, despite the fact that the start of a pilot career excludes any chronic diseases.

Monica O’Dwyer; Ryan Hoy; Deborah Glass; Natasha Kinsman;

Abstract

Background Construction work is associated with a range of health and safety issues. Whilst regulators have placed a great deal of attention in this area, there continue to be concerns around musculoskeletal injury, mental health and the risk of respiratory diseases such as silicosis. However, this is a hard-to-reach group of workers. We carried out a feasibility study to assess several aspects of health and investigate recruitment. Methods We developed an on-line questionnaire that was easy to use and asked questions about demographic factors, respiratory health, musculoskeletal pain, hearing, mental health and attendance for health surveillance. The research team attended 5 pre-shift briefings to publicise the research and engage with potential participants.
Results In total, 104 workers visited the survey of whom 75 responded. The majority were men with peak age 30-40 years. Average duration in construction was 17 years. 19% reported poor self-rated health. 25% were current smokers and over half had ever smoked regularly. 15% worked > 50 hours/week and almost half worked shifts. 21% commuted more than two hours/day. They reported a wide range of high-risk exposures including dust, diesel, noise and asbestos. Workers had low recognition of health surveillance or its importance. One third reported that their employer was sent their
Results from health surveillance. Musculoskeletal pain was common as was self-reported hearing loss. 10-20% fulfilled criteria for sever depression according to their screening questionnaires.
Conclusion A large-scale study is feasible and will be undertaken, aiming at >1000 workers. Workers are interested in their health but are most interested in being able to work. They have limited knowledge of the risk of their work or the importance of health monitoing/surveillance.

Leo D. Westbury , Trish Davey , Joanne L. Fallowfield , Kate Harrison , Elaine M. Dennison

Abstract

Objective Stress fractures (SF) occur more frequently in military recruits than in the general population, causing morbidity, training delays, and costly rehabilitation. We aimed to report the incidence of SFs and identify characteristics associated with SF in male Royal Marines recruits
Material and Methods We studied 1,815 male RM recruits (aged 16-33 years) starting a 32-week training programme at the Commando Training Centre Royal Marines, UK, between November 2017 and March 2020. Baseline exposures included age, weight, body mass index (BMI), waist circumference, waist-to-height ratio, smoking status, estimated maximum oxygen consumption (VO2max), and physical fitness measures (sit-ups, press-ups, pull-ups). Incident SFs were determined through radiography or MRI. Associations between baseline exposures and SF were examined using univariate logistic regression.
Results The median age at entering training was 21 years. Baseline cardiorespiratory fitness was high (median VO₂max of 52.2 mL/kg/min), and mean BMI was 24.5 kg/m2. Most recruits (85.6%) had healthy central adiposity (waist-to-height ratio: 0.4–0.49), with none classified as high (≥0.6), and 10.4% were smokers. The incidence of SF was 5.6%, with 102 recruits sustaining at least one; the highest rate was among those aged 16–18 years (7.2%). The highest quintiles of BMI (odds ratio 0.16, 95% CI 0.06-0.42, p<0.001), weight (0.50, 0.26-0.95, p=0.036), waist circumference (0.40, 0.19-0.83, p=0.014), and waist-to-height ratio (0.37, 0.18-0.78, p=0.009) demonstrated significantly lower odds of SF compared to respective lowest quintiles. No other baseline exposures were associated with SF risk.
Conclusions SFs were common in Royal Marines recruits, especially those who were less skeletally mature. Higher BMI appeared protective against SF risk, and we hypothesise that greater BMI is likely related to reduced SF risk via greater muscle mass rather than greater adiposity. Further validation in other cohorts is planned.

Samir El Jaafari, Younes Filali-Zegzouti

Abstract

Objective: Many studies have reported the prevalence of occupational hazards in dentistry and their adverse health effects in different countries. In Morocco, data about occupational exposure to health hazards in dentistry is scarce. Therefore, the present study aims to generate evidence on the prevalence of occupational hazards among Moroccan dentists.
Material and Methods: 105 dentists working in the private sector in the Fes-Meknes region in Morocco were asked to complete a self-administered questionnaire inquiring about demographic characteristics, prevalence of occupational problems, and preventive measures.
Results: Professional experience ranged from 1 to 45 years. Musculoskeletal problems were prevalent, with 89.52% of dentists reporting issues including lower back (17.37%), neck (16.13%), and arm (15.14%) pain. Latex allergies were reported by 9.52% of respondents. Eye injuries were mainly caused by chemicals (22%). Ear complaints included tinnitus (24.76%) and hypoacusis (17.14%). 46.67% of participants reported being exposed to infectious diseases, primarily SARS-CoV-2, (50.63%), influenza (15.19%), and HIV (10.13%), while 42.42% of participants had incomplete or no vaccination against hepatitis B. Accidental exposure to blood (AEB) was high at 81.37%, yet only a third (33.33%) received post-exposure prophylaxis. Overall, compliance with personal protective equipment was strong, with 98.10% using gloves and 95.24% using masks. In terms of radiation protection, the preferred methods were standing two meters away from the source (63.81%) and standing behind a protective barrier (26.67%). Finally, only 52.94% of respondents reported handling medical waste through specialized companies.
Conclusion: These findings highlight the pressing challenges in dental practice safety and occupational health. Addressing these issues requires continuing education and targeted interventions to empower dentists in recognizing, managing, and mitigating occupational hazards. Additionally, further research into factors influencing occupational hazards is warranted to enhance prevention strategies.

Fatma Ezzahra Boujmil¹, Nihel Khouja¹, Emna Baraketi¹, Mohamed Ouerdiane², Oussema Haj Salem², Yasmine Tebourbi¹, Khalil Grissa¹, Saloua Ismaïl¹, Jihène Hsinet¹, Aïda Benzarti¹

Abstract

Objective: To describe the characteristics of occupational injuries (OI) among paramedical staff in public hospitals and to analyse their impact on the quality of care provided to patients. Methods: Cross-sectional descriptive study conducted in April 2025 among paramedical staff at La Rabta Hospital in Tunis who had suffered at least one OI during their professional career, using an anonymous self-administered questionnaire.
Results: A total of 79 cases were collected. The mean age was 30.4 ± 7.6 years, with a female predominance (sex ratio: 0.68). Nurses accounted for 73% of the workforce, with a median seniority of 6 years. The departments most affected were cardiology (20%) and medical emergencies (19%). A number ≥2 OI were reported in 43% of cases, the most significant of which occurred less than a year ago in 51% of cases. The most frequent accidents were blood exposure accidents (48%), skin injuries (33%) and verbal aggression (13%). Medical treatment was provided in 77.3% of cases, but was deemed insufficient in 27%. OI were reported to the authorities in 85% of cases, but 15% did not receive any compensation. Sixteen victims were left with physical after-effects (scars, joint limitations), nine of whom reported discomfort in their daily tasks. Psychological after-effects included anxiety (70%) and depression (23%), 10% of which required psychiatric treatment. Professional consequences included reduced motivation (68%), concentration (69%), self-confidence (58.3%) and quality of care (72%), with 19% of errors attributed to a lack of vigilance. Verbal aggression was associated with anxiety (p=0.015) and psychiatric referral (p=0.05). Impaired quality of care was statistically associated with anxiety (p=0.002), depression (p=0.005), and reduced concentration or motivation (p < 0.001).
Conclusion: Prompt and appropriate medical and psychological management of work-related accidents is essential to limit their repercussions and preserve the quality of care in hospitals.

Merlyn Joseph, Bobby Joseph

Abstract

Objectives: In India’s garment sector, 60% of the workforce is female, with males often in supervisory or co-worker roles. Understanding menstrual issues and fostering empathy for female colleagues is crucial. Our study assessed the knowledge, attitudes, and perceptions of male garment factory workers in India regarding menstruation and their role in supporting women during this time.
Materials and Methods: A cross-sectional study was conducted among 178 male workers aged 18 years and above in 8 garment factories across various states in India. A structured interview schedule was used to assess their knowledge of menstruation, menstrual problems, role of men in menstruation, and the associated stigma. Few open-ended questions explored the reasons behind men’s perceptions and behaviours regarding menstruation.
Results: The average age of workers was 34.5±9.8 years, 80% completed secondary education with average income of INR 12722.69±3295.59. Most (76%) were married and 34% were migrants. While 70% had good awareness of menstrual cycle, knowledge about menstrual symptoms and sanitary pad disposal was low. About 13% believed in restricting water and certain foods during menstruation. Most workers (80%) helped their wives with household chores during periods and 70% openly discussed menstruation. However, only 25% had spoken to their children about it, citing reasons like shyness and the topic would be better discussed by their wives. Nearly half felt empathetic when their wife discussed menstruation, while others felt uncomfortable, irritated, or disgusted. Stigma among male workers was due to lack of knowledge, viewing menstruation as a woman’s issue, and reluctance to discuss it.
Conclusion: Our study found that while workers had good knowledge about menstruation, attitudes and perceptions still showed stigma, making it a taboo topic. Based on these findings, we conducted health education sessions in these factories for male workers and supervisors to break the stigma and create a period-friendly workplace.

Tessa Keegel, Monica O’Dweyer, Janneke Berecki-Gisolf

Abstract

Objective Work-related injuries occur in about 4% of the Australian working population and many injured persons end up in the hospital emergency department(ED). A fifth of ED visits are injury-related, with 10% being work-related. International studies shown increased injury rates among migrant workers, but this information is missing for Victoria, a multicultural society with a diverse workforce. This study compared occupational injury rates by country of birth in patients presenting to EDs in Victoria, Australia.
Materials and Methods Data were derived from the Victorian Emergency Minimum Dataset(VEMD, 01/07/2019–30/06/2023) which is collected by Victoria’s Department of Health and housed by the Victorian Injury Surveillance Unit. Work-related injury presentations for persons aged 15-69years were identified using diagnoses codes, activity when injured and workers’ compensation indicators. Injury rates were calculated using Australian Bureau of Statistics’ 2021 Labour Force data, stratified by age group, sex and country of birth.
Results There were 111717 ED presentations with work-related injuries, a rate of 9 per 1000 employed persons. The highest rates were for persons born in Sudan (26 per 1000), Afghanistan (23 per 1000), Samoa (21 per 1000), Tonga (18 per 1000) and Cook Islands (17 per 1000) workers. The rates among Australia- and New Zealand-born workers were similar, 11 per 1000 workers, whilst for workers born in India and China 4.3 and 3.8 per 1000, respectively. The injury presentation rates were further compared by age, sex, case severity and injury type.
Conclusions ED presentations for work-related injuries varied substantially by country of birth, calling for further explorations to understand these discrepancies. It is noteworthy that not all persons with work-related injuries present to ED. Hence consideration of health-seeking behaviour patterns by migrant status is imperative.

Will Mueller, Fiona S Carson, Finlay Brooker, Ioannis Basinas, Martie van Tongeren

Abstract

Background  Evidence is growing that former professional athletes, in particular association footballers, are at an increased risk of neurological disorders compared with the general population.  A study of over 7,000 former professional footballers in Scotland found a 5-fold relative risk of mortality from Alzheimer’s disease compared to the general population RR 5.07 (95% CI: 2.92-8.82).  Similarly, an increased risk of Alzheimer’s disease was reported in a study in Sweden containing around 6,000 former footballers: HR 1.62 (1.47-1.58).  A French study examined mortality from dementia in around 6,000 former professional footballers and found a RR 3.38 (2.49-4.46).  We aimed to carry out a similar study in England.

Materials and Method  Mortality rates of this cohort are being compared to those of the general population.  Additionally, the effects of the length of a player’s professional career is being investigated.  We are using an exposure matrix https://www.sciencedirect.com/science/article/pii/S1438463923001268) developed for a cross-sectional study of cognition in former professional footballers to estimate footballers’ lifetime history of heading footballs and other head-related impacts during training and playing.  This is allowing an internal analysis where we can compare the neurological mortality in those who headed footballs more with those that headed them less.

Results  We have identified a cohort of over 22,000 former professional footballers in England from http://barryhugmansfootballers.com/ and have supplemented missing player career details using other sources.

Conclusions  This study is more powerful than the previous three studies combined and for the first time will incorporate an exposure assessment for heading footballs and other head impacts into its analysis.

Devy L. Elling; Bodil J. Landstad,; Josefina Peláez-Zuberbuhler,; Malin Sjöström; Emelie Thern

Abstract

Objective: The aim is to examine the association between substance use and the risk of i) all-cause medically certified sickness absence (ACMCSA), ii) self-reported short-term sickness absence (SRSSA), and iii) whether the associations are moderated by burnout complaints and depressive symptoms, among healthcare workers in Sweden.
Material and Methods: This longitudinal cohort study used data from the Swedish Longitudinal Study of Work Environment and Health in Healthcare (LOHHCS), collected in 2022 and 2023, linked to a nationwide register (N=10,319). ACMCSA (≥14 days) data was obtained from a nationwide register, while SRSSA (<14 days) was gathered from the survey. Substance use was self-reported, measured as problem drinking (PD) and use of other illicit drugs (IDU). Important covariates included sociodemographic characteristics (sex, age). Moderators were burnout complaints and depressive symptoms collected from the survey. Regression models were employed to examine the risk of first occurrence of ACMCSA and SRSSA, presented as odds ratios (OR) with 95% confidence intervals (CI).
Results: Preliminary results show that neither PD nor IDU were associated with ACMCSA. Compared to non-PD, PD was associated with a higher risk of SRSSA (OR 1.24; 95% CI 1.03, 1.48). No statistically significant association was found between IDU and SRSSA. Burnout complaints and depressive symptoms did not seem to moderate any of the associations.
Conclusion: Among healthcare workers in Sweden, substance use did not seem to increase the risk of long-term sickness absence. However, those who reported PD were more likely to have shorter spells of sickness absence. The findings highlight the importance of addressing repeated periods of short-term sickness absence among healthcare workers, particularly in the context of alcohol-related issues.