Lesley Rushton

Purpose of Review Burden of occupational disease estimation contributes to understanding of both magnitude and relative importance of different occupational hazards and provides essential information for targeting risk reduction. This review summarises recent key findings and discusses their impact on occupational regulation and practice. Recent Findings New methods have been developed to estimate burden of occupational disease that take account of the latency of many chronic diseases and allow for exposure trends and workforce turnover. Results from these studies have shown in several countries and globally that, in spite of improvements in workplace technology, practices and exposures over the last decades, occupational hazards remain an important cause of ill health and mortality worldwide. Summary Major data gaps have been identified particularly regarding exposure information. Reliable data on employment and disease are also lacking especially in developing countries. Burden of occupational disease estimates form an important part of decision-making processes.

Cases of lymphohematopoietic cancer from three petroleum industry cohorts, matched to controls from the respective cohort, were pooled into single study. Average benzene exposure was quantitatively estimated in ppm for each job based on measured data from the relevant country, adjusted for the specific time period, site and job exposure characteristics and the certainty of the exposure estimate scored. The probability of dermal exposure and of peak exposure was also assessed. Before risk was examined, an exposure estimate comparison and rationalisation exercise was performed across the studies to ensure accuracy and consistency of approach. This article evaluates the final exposure estimates and their use in the risk assessments. Overall benzene exposure estimates were low: 90% of participants accumulated less than 20 ppm-years. Mean cumulative exposure was estimated as 5.15 ppm-years, mean duration was 22 years, and mean exposure intensity was 0.2 ppm. 46% of participants were allocated a peak exposure (>3 ppm at least weekly). 40% of participants had a high probability of dermal exposure (based on the relative probability of at least weekly exposure). There were differences in mean intensity of exposure, probability of peak, and/or dermal exposure associated with job category, job site, and decade of exposure. Terminal Operators handling benzene-containing products were the most highly exposed group, followed by Tanker Drivers carrying gasoline. Exposures were higher around 1940–1950 and lower in more recent decades. Overall confidence in the exposure estimates was highest for recently held jobs and for white-collar jobs. We used sensitivity analyses, which included and excluded case-sets on the basis of exposure certainty scores, to inform the risk assessment. The above analyses demonstrated that the different patterns of exposure across the three studies are largely attributable to differences in jobs, site types, and time frames rather than study. This provides reassurance that the previous rationalisation of exposures achieved inter-study consistency and that the data could be confidently pooled.

Background Occupational exposures are important and preventable causes of COPD. In a cross-sectional study of current occupation among over 220,000 workers in the UK Biobank cohort (over 500,000 subjects) we previously reported that 14 jobs were associated with increased COPD risk (De Matteis S, et al., OEM, 2016). To progress these findings we developed OSCAR, a new web-based tool for efficient self-reporting and automatic coding of job-histories in large population-based studies. Our aim was to identify the occupations at increased COPD risk taking into account lifetime job-histories in the UK general population. Methods We administered OSCAR to all UK Biobank participants with an available email address (n = 324,653) between June-February 2016. Paid jobs held for at least six months were collected and coded by OSCAR using the UK Standard Occupational Classification (SOC), v.2000. COPD was defined as FEV1/FVCResults Among the 116,375 participants who completed OSCAR (response rate: 34%), 94,551 had acceptable and repeatable spirometry data (according to ERS/ATS criteria) and smoking information and were included in the analyses. Taking into account individual lifetime job-histories, 19 jobs significantly increased COPD risk (e.g. ‘fishing and agriculture related occupations’: PR: 1.69; 95% confidence interval (CI): 1.18–2.42, and ‘food, drink and tobacco process operatives’: PR: 1.42; 95% CI: 1.02–1.97). The majority were also confirmed by positive exposure-response trends for cumulative years of employment in each job/lifetime. Conclusions Compared to our previous cross-sectional study, some jobs were confirmed (e.g. ‘food, drink and tobacco process operatives’, and ‘horticultural trades’) while others were not (e.g. ‘coal miners’), likely due to the few employed in these jobs among the OSCAR responders. OSCAR is still collecting job-histories in the UK Biobank cohort; further analyses on a larger sample, as well analyses restricted to never-smokers and never-asthmatics to investigate the possibility of residual confounding, are planned.

Hand dermatitis can be a serious health problem in healthcare workers. While a range of skin care strategies and policy directives have been developed in recent years to minimise the risk, their effectiveness and cost-effectiveness remain unclear. Evidence now suggests that psychological theory can facilitate behaviour change with respect to improved hand care practices. Therefore, we will test the hypothesis that a behavioural change intervention to improve hand care, based on the Theory of Planned Behaviour and implementation intentions, coupled with provision of hand moisturisers, can produce a clinically useful reduction in the occurrence of hand dermatitis, when compared to standard care, among nurses working in the UK National Health Service (NHS) who are particularly at risk. Secondary aims will be to assess impacts on participants’ beliefs and behaviour regarding hand care. In addition, we will assess the cost-effectiveness of the intervention in comparison with normal care. We will conduct a cluster randomised controlled trial at 35 NHS hospital trusts/health boards/universities, focussing on student nurses with a previous history of atopic disease or hand eczema and on nurses in intensive care units. Nurses at ‘intervention-light’ sites will be managed according to what would currently be regarded as best practice, with provision of an advice leaflet about optimal hand care to prevent hand dermatitis and encouragement to contact their occupational health (OH) department early if hand dermatitis occurs. Nurses at ‘intervention-plus’ sites will additionally receive a behavioural change programme (BCP) with on-going active reinforcement of its messages, and enhanced provision of moisturising cream. The impact of the interventions will be compared using information collected by questionnaires and through standardised photographs of the hands and wrists, collected at baseline and after 12 months follow-up. In addition, we will assemble relevant economic data for an analysis of costs and benefits, and collect information from various sources to evaluate processes. Statistical analysis will be by multi-level regression modelling to allow for clustering by site, and will compare the prevalence of outcome measures at follow-up after adjustment for values at baseline. The principal outcome measure will be the prevalence of visible hand dermatitis as assessed by the study dermatologists. In addition, several secondary outcome measures will be assessed. This trial will assess the clinical and cost effectiveness of an intervention to prevent hand dermatitis in nurses in the United Kigdom. ISRCTN53303171 : date of registration, 21 June 2013.

Objectives To estimate the number of new lung cancers cases in Canada attributable to occupational diesel engine exhaust (DEE), which IARC classified as a definite human carcinogen in 2012. This is part of a larger effort to estimate the current burden of occupational cancers in Canada. Method Relative risks were selected from two recent studies of miners and truckers with quantitative exposure-response. CAREX Canada estimates of exposure prevalence and level by detailed industry and occupation were supplemented by a literature search for DEE measurement data. For each exposure group, RRs were assigned based upon the estimated mean exposure. Employment trends of industries and occupations were based upon census data from multiple years. Annual Labour Force Survey data were used to attribute age- and tenure-distribution, as well as short-term turnover characteristics. Survival was adjusted to age at entry into the exposed cohort during the risk exposure period 1961–2001. The attributable fraction (AF) for DEE-related lung cancers will be calculated by province, sex, industry and occupation. Results Approximately 1.4 million workers were exposed to DEE during the risk exposure period. The initial estimated AFs for DEE-related lung cancers are: 4.92% for males, 0.29% for females, and 2.70% overall. Conclusions These burden estimates are somewhat higher than recent estimates from other groups (1.3–1.8%). They account for the most recent evidence for the risk of lung cancer from occupational DEE exposure, as well as detailed historical exposure assessment and labour force trends. Sensitivity analyses are underway to determine the influential assumptions.