Women's labour force participation often declines after childbirth, but the role of sick leave during pregnancy and after childbirth in sustained employment remains unclear. This study examined: (1) the association between sick leave during pregnancy and/or within 2 years after childbirth and sustained labour force participation, (2) whether sick leave during pregnancy predicts sick leave within 2 years after childbirth, (3) demographic and employment-related factors associated with sick leave length and labour force participation. Prospective cohort study including 261 171 women in the Netherlands who applied for maternity benefits in 2020 or 2021. A subset also received sick leave benefits during pregnancy or after childbirth. Logistic regression assessed associations between sick leave timing and sustained labour participation. General linear models examined determinants of the total length of sick leave during pregnancy and within 2 years after childbirth. Sick leave during pregnancy was associated with higher odds of sustained labour force participation (OR 1.20, 95% CI 1.17 to 1.23), whereas sick leave within 2 years after childbirth was associated with lower odds (OR 0.65, 95% CI 0.62 to 0.67). Sick leave during pregnancy strongly predicted sick leave within 2 years after childbirth (OR 3.63, 95% CI 3.53 to 3.74). Employment sector, contract type, residential area and age were associated with sick leave length and labour participation. Sick leave within 2 years after childbirth was associated with reduced sustained labour force participation, whereas sick leave during pregnancy was not negatively associated. Employment characteristics were strongly associated with both sick leave patterns and sustained labour force participation.

We investigated associations between maternal occupations and a diagnosis of autism spectrum disorder (ASD) in offspring. We obtained data for 1702 ASD cases born between 1973 and 2012 from the Danish National Patient Registry and matched each case to up to 100 population based controls based on sex and birth year (n=110 234). Mothers' employment histories were obtained from the Danish Pension Fund Registry. Conditional logistic regression models were used to test associations between occupations held ever, 1 year before conception, during pregnancy and during infancy, adjusting for the mother's age and history of neuropsychiatric disorders, parity and residential location. There were increased odds of having a child with ASD for mothers who were employed before conception up to infancy in ground transportation (adjusted OR (aOR) 1.24, 95% CI 1.08 to 1.42; q=0.036), public administration (aOR 1.20, 95% CI 1.07 to 1.35; q=0.018) and military/defence occupations (aOR 1.59, 95% CI 1.39 to 1.82; q<0.001). Associations for judicial occupations and military/defence service were also apparent 1 year before conception and during pregnancy. We observed sex differences, with significant associations in male children for employment in ground transportation and defence occupations. Associations between certain maternal employment categories with high toxicant or psychosocial stress exposure suggest future studies should focus on examining specific toxicant exposures common in those occupations and neurodevelopment in offspring. This is of particular concern for associations seen for occupations held several years before conception.

To report estimates of cancer incidence (1982-2016) and mortality (1980-2020) in the Health Watch cohort after four decades of follow-up. Health Watch is a prospective cohort study of 18 040 (16 666 men, 1374 women) employees recruited between 1981 and 2000.Personal data were linked to national and state cancer and death registries. Standardised mortality ratios (SMRs) and standardised incidence ratios were calculated using national population rates adjusted for age, sex and calendar period. All-cause mortality was reduced compared with Australian population rates (men: SMR 0.79, 95% CI 0.77 to 0.82; women: SMR 0.70, 95% CI 0.59 to 0.83). Lower mortality likely reflects the healthy worker effect. Persistent excesses of mesothelioma, melanoma and prostate cancer may reflect ongoing occupational risks warranting targeted prevention and surveillance. In particular, melanoma risk underscores the need to minimise both occupational and recreational ultraviolet exposure.

Hexavalent chromium (Cr(VI)) is a human carcinogen. It is unclear whether Cr(VI) can cause cancer of the small intestine, oral cavity, pancreas, prostate and urinary bladder. We performed a systematic review and meta-analyses of epidemiological studies on occupational exposure to Cr(VI) and incidence and mortality of these cancer sites.A comprehensive review of human studies on Cr(VI) and cancer was performed in Embase and Scopus. 131 potentially relevant epidemiological studies were identified. Study quality was assessed using the Newcastle-Ottawa Scale. 29 publications including 81 observations for meta-analyses were based on cohort or case-control studies with exposure assessment of sufficient quality. Site-specific random-effects meta-analyses were done separately for incidence and mortality. Sensitivity analyses focused on the studies with the highest quality scores.No indications for an association between Cr(VI) exposure and oral or small intestine cancer were found. Incidence of pancreatic cancer was not associated with Cr(VI) exposure (meta-relative risk (RR) 1.04; 95% CI 0.85 to 1.28) while for specific mortality RR was 1.41 (95% CI 0.96 to 2.08) with moderate heterogeneity (I2=41%) and an asymmetric funnel plot (Egger's test; p=0.002). For incidence of prostate cancer meta RR was 1.16 (95% CI 0.99 to 1.37) while the RR for mortality was 1.03 (95% CI 0.84 to 1.25). For bladder cancer, RR was 1.04 (95% CI 0.91 to 1.20) for incidence and 1.76 (95% CI 1.20 to 2.60) for mortality.This comprehensive meta-analysis of epidemiological studies did not provide sufficient evidence that occupational Cr(VI) exposure may cause cancer of the oral cavity, small intestine, pancreas, prostate or the urinary bladder in humans.

Lymphoid neoplasms are a diverse group of cancers derived from lymphocytes, with classification recently updated by the 5th edition of the WHO Classification of Haematolymphoid Tumours (WHO-HAEM5). Benzene, a well-known carcinogen, is widely used in industries and environmental exposures vary; however, its association with specific lymphoid neoplasm subtypes remains unclear due to historical classification challenges. This study aimed to clarify the risk of lymphoid neoplasms related to benzene exposure using the updated WHO-HAEM5 framework.A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies were comparative human studies evaluating benzene exposure and lymphoid neoplasm risk, with sufficient data for risk estimates. Inclusion criteria specified study designs, participants, exposures and outcomes based on clinical diagnoses. Data were independently extracted by multiple reviewers. The main outcome was risk of lymphoid neoplasms and subtypes analysed by random-effects meta-analysis with heterogeneity and bias assessments.From 1488 records, 95 studies met criteria (65 occupational and 30 environmental exposure). Benzene exposure significantly increased overall lymphoid neoplasm risk (RR 1.26; 95% CI 1.18 to 1.35). B-cell neoplasms showed elevated risk (RR 1.26; 95% CI 1.16 to 1.37), including mature B-cell neoplasms, Hodgkin lymphoma and plasma cell neoplasms. T-cell and natural killer cell neoplasm risk was not significantly increased overall. Occupational exposures conferred higher risks with lower heterogeneity than environmental exposures.Benzene exposure is strongly associated with increased risk of lymphoid neoplasms, particularly B-cell subtypes, supported by the refined WHO-HAEM5 classification reducing heterogeneity. This study underscores the importance of biologically informed disease classification and the need for targeted occupational safety and environmental health policies.The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration ID: CRD420251063844).

Firefighters are continuously exposed to hazardous conditions including smoke, chemicals, stress, long work shifts and exhaustion, which may lead to a higher risk for chronic conditions and reproductive health issues. However, there is limited research looking at the association between parental firefighting with adverse birth outcomes. This cross-sectional study aimed to determine whether female or male firefighting was associated with adverse birth outcomes. Arizona birth certificates for the years 2006-2013 were used to compare firefighters with teachers, law enforcement officers and all other occupations while stratifying by sex. Logistic regression models estimated ORs and 95% CIs. We included 720 686 births, 5490 paternal firefighters and 376 maternal firefighters. Maternal firefighting was associated with increased odds of preterm birth compared with teachers (OR: 1.46, 95% CI 1.06 to 1.97) and all other occupations (OR: 1.41, 95% CI 1.02 to 1.88). Higher odds for neonatal intensive care unit admission were observed when compared with teachers (OR: 1.77, 95% CI 1.22 to 2.48), law enforcement officers (OR: 1.74, 95% CI 1.07 to 2.81) and all other occupations (OR: 1.84, 95% CI 1.30 to 2.56). Paternal firefighting was statistically significantly associated with decreased caesarean section and low birth weight. Female firefighters may have higher odds of adverse birth outcomes. Further research should aim on understanding the biological mechanism behind these associations and ways to mitigate the risk in this population.

This study assesses potential exposure-response relationships between diesel engine exhaust (DEE) and lung and bladder cancers, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) in Ontario workers in the Occupational Disease Surveillance System. Approximately 2.3 million workers were identified through workers' compensation claims (1983-2019) and followed for cancer through linkage with the Ontario Cancer Registry (1964-2019). COPD and IHD cases were identified using hospital discharges (2006-2020), emergency department visits (2006-2020) and physician billing records (1999-2020). Exposure was assessed using the Diesel Exhaust in Canada Job-Exposure Matrix, a semiquantitative job-exposure matrix based on expert assessment and published measurement data. Cox-proportional hazards models were used to estimate HRs and 95% CIs, adjusted for age, birth year and sex by exposure status (exposed/unexposed) and for increasing exposure level (unexposed, low, moderate, high and very high). Trend tests were run using exposure category midpoints (µg/m3 elemental carbon). Overall, 39 743 incident lung cancer, 12 528 bladder cancer, 77 124 COPD and 302 876 IHD cases were identified. Among exposed cases (all outcomes), the majority (90%) were assigned low exposure. Significant increased risks of lung cancer (HR=1.33, 95% CI 1.29 to 1.37), bladder cancer (HR=1.19, 95% CI 1.13 to 1.26), COPD (HR=1.34, 95% CI 1.31 to 1.37) and IHD (HR=1.15, 95% CI 1.13 to 1.16) were observed among exposed workers compared with unexposed workers. Exposure-response relationships were observed (all outcomes) although increases in risk were non-monotonic. Trend tests suggested increased risk (p trend <0.001). This study improves understanding of DEE-related diseases. These results could be used to improve prevention efforts and workers compensation practices for DEE-related occupational diseases.

The effect of occupational irritants on IgE sensitisation remains unknown. We investigated the association between occupational exposure to irritants and IgE sensitisation. The study included a cross-sectional analysis of 924 adult participants to the first follow-up of the Epidemiological study of the Genetics and Environment of Asthma (EGEA2) and a longitudinal analysis of 271 children recruited at EGEA1 and followed up to adulthood (EGEA2). Allergen-specific IgE sensitisation to 162 allergens was assessed by microarray technology. Lifetime occupational exposure to irritants was evaluated by the occupational asthma-specific job-exposure matrix. Adjusted regression models were performed to evaluate (1) cross-sectional associations between irritant exposures with the number and cluster-based profiles of sIgE sensitisation and (2) longitudinal associations between childhood sIgE sensitisation and occupational irritant exposures in adulthood to assess a potential 'healthy hire effect'. Among adult-onset asthma participants, occupational exposure to irritants was associated with a lower number of sIgE sensitisation (adjusted mean ratio=0.63 (95% CI 0.39 to 1.02), p=0.06) and a lower risk of exhibiting house dust mite predominant and pollen/animal predominant sIgE sensitisation profiles (p=0.02 and 0.06 respectively). No association was observed in participants without asthma or with childhood-onset asthma. The longitudinal assessment showed no association. This study, showing fewer sIgE sensitisations associated with occupational exposure to irritants in participants with adult-onset asthma but not in those with childhood-onset or no asthma, highlights the need to further explore the non-immunological mechanisms associated with exposure to respiratory irritants at work.

Beekeepers are frequently exposed to bee venom and combustion smoke, leading to risks of systemic allergic reactions and respiratory hazards. This study assesses the prevalence of systemic allergic symptoms among beekeepers in Northeastern Italy and describes current management practices. Additionally, it characterises inhalation exposures to combustion smoke during apiary maintenance. A cross-sectional survey collected data on sting exposure, allergic symptoms and smoke use practices. Combustion smoke exposure assessment was performed using Fourier transform infrared spectroscopy (Gasmet DX-4030) coupled with an ultrafine particle classifier (DiSCmini) to characterise emissions from commonly used fuels. Among 553 beekeepers surveyed, 21.3% reported systemic allergic reactions after bee sting, mostly males (66.7%). Of these (n=118), only 31.4% were confirmed sensitised to Apis mellifera and prescribed epinephrine autoinjector; 16.1% received venom immunotherapy, while others had no specific allergological assessment. Multivariate analysis showed that allergic symptoms during apiary work and extended local reactions increased the likelihood of systemic reactions fivefold. Almost all participants used smoke during inspections, with 39.1% frequently inhaling smoke; only 0.9% used respiratory protective equipment. Environmental monitoring detected multiple volatile organic compounds-including formaldehyde exceeding at different time points the threshold limit value-short term exposure limits-and high concentrations of ultrafine particles, particularly from hay and pellet combustion. Systemic allergic reactions to bee venom are common but often undertreated in beekeepers. Combustion smoke is a significant respiratory hazard. Targeted interventions are needed to improve health outcomes and safety in this occupational group.

Although ultrafine particles are suspected to contribute significantly to occupational exposure to crystalline silica, they have not yet been definitively identified in workplaces or human tissues. Particles were generated in three 60-minute tests in a glove box: cutting kerb or granite pavement, drilling solid cinder block. The particle concentrations per cm3 of air in the box and their mean size were analysed online and using transmission electron microscopy and energy dispersive X-ray analysis (EDX). 17 mediastinal lymph node (MLN) samples from construction workers who underwent lung cancer surgery were examined by Fourier transform infrared spectroscopy (FTIR) and 8/17 by scanning electron microscopy (SEM) with EDX analysis. The particle concentration was high when cutting kerb or granite pavement (10 000-20 000 cm-3 and 50 000-160 000 cm-3, respectively), while below 1000 cm-3 for drilling cinder block. The aerosol consisted mainly of submicron emissions with a nanometric fraction (ie, <100 nm), showing two main modes: 351 nm to 16 nm for kerb, 407 nm to <16 nm for granite pavement and 310 nm to 17 nm for cinder block processing. Ultrafine silica particles were only identified in kerb and granite cutting samples.Analysis using FTIR revealed an Si signal in 15/17 of the MLN samples and SEM and EDX analysis detected geometric particle deposition with Si spectra, particularly nano-sized particles, in the eight analysed samples. Ultrafine silica particles are produced in conditions that mimic typical construction work processes, but the quantity produced varies according to the task. Similar characteristics were observed in ultrafine silica particles in both MLN samples and experimental aerosols.