Occupational Causes Research Articles

Contemporary Concise Review 2023: Environmental and occupational lung diseases.

Air pollutants have various effects on human health in environmental and occupational settings. Air pollutants can be a risk factor for incidence, exacerbation/aggravation and death due to various lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis or pneumonia (HP), pulmonary fibrosis such as pneumoconiosis and malignant respiratory diseases such as lung cancer and malignant pleural mesothelioma. Environmental and occupational respiratory diseases are crucial clinical and social issues worldwide, although the burden of respiratory disease due to environmental and occupational causes varies depending on country/region, demographic variables, geographical location, industrial structure and socioeconomic situation. The correct recognition of environmental and occupational lung diseases and taking appropriate measures are essential to their effective prevention.

Prevalence and Risk Factors Associated with Chronic Occupational Low Back Pain among Healthcare Professionals Working at Hospitals: Exploratory Survey Study.

Objective This study aimed to describe the methodological process for developing a questionnaire to identify the prevalence and risk factors for chronic occupational low back pain in healthcare professionals working at hospitals. Method An exploratory crossectional survey study was carried out in Belo Horizonte, MG, Brazil, and its metropolitan region, in two stages. Initially, the authors prepared a questionnaire based on the Roland Morris disability questionnaire and sent it to a committee of low back pain specialists for validation using the Delphi technique. The second stage consisted of sending the final questionnaire to health professionals working in a hospital environment for at least 2 years and presenting chronic low back pain for at least 3 months. Results Validation occurred in two rounds of questionnaire adjustments by a panel consisting of physical therapists and physician experts in the field (orthopedists with more than 3 years of experience). Both rounds had 13 participants. The questionnaire initially consisted of 27 items, and, after validation, it had 19 items. The study included 65 subjects, with an average age of 40.91 years old and an average time working at a hospital of 40 hours per week. The total sample had 76.9% of physicians, 10.8% of physical therapists, and 12.3% of nurses or nursing technicians. Most (52.3%) subjects reported staying in uncomfortable positions affecting the lower back for 5 to 10 hours per day. Conclusion We developed and validated, using the Delphi technique, a questionnaire on the prevalence and risk factors associated with chronic occupational low back pain among healthcare professionals working at hospitals. This unprecedented tool can benefit the population studied since the questionnaires currently used to evaluate chronic low back pain are not specific for investigating the occupational cause of this condition.

Associations between tobacco smoking status and patch test results-A cross-sectional pilot study from the Information Network of Departments of Dermatology (IVDK).

Earlier studies suggested a potential association between tobacco smoking and nickel sensitization, but little is known about other contact allergens. To investigate the association of smoking status and contact sensitizations as well as subtypes of dermatitis, and to analyse the sensitization profiles of tobacco smokers. Within the Information Network of Departments of Dermatology (IVDK), we performed a cross-sectional multicentre pilot study comprising 1091 patch-tested patients from 9 departments, comparing 541 patients with a history of cigarette smoking (281 current and 260 former smokers) with 550 never-smokers. We could not confirm the previously reported association between nickel sensitization and tobacco smoking. Moreover, sensitizations to other allergens, including colophony, fragrance mix I, Myroxylon pereirae and formaldehyde, were not increased in cigarette smokers compared with never smokers. Hand dermatitis (50.6% vs. 33.6%) and occupational cause (36.2% vs. 22.5%) were significantly more frequent among cigarette smokers compared with never-smokers as shown by non-overlapping 95% confidence intervals. Although our study does not allow a firm conclusion on whether smoking status contributes to certain contact sensitizations, it confirms an association of smoking with hand dermatitis and occupational cause.

The OCCHLTH Mnemonic-Construction and Content of a Tool for Increasing Awareness of Occupational Illness and Injury.

Unidentified or nonmitigated occupational illnesses and injuries can complicate disease management. The "occupational health" (OCCHLTH) mnemonic aims to raise awareness of work-related exposures and associated illnesses and injuries. Occupational safety and health history-taking elements were combined with peer-reviewed information [from the PubMed database (first review January 1, 2000, to February 8, 2016; updated to February 8, 2021)] about workplace exposure-outcome associations to create the mnemonic. Seven components constitute the OCCHLTH mnemonic. Literature results support its categories and subcategories. Three components represent symptom onset and health conditions. Four represent occupational exposures. Evaluating published occupational illness cases explored mnemonic applicability. Awareness of occupational risk factors can affect clinical decision-making. The OCCHLTH mnemonic encourages consideration of occupational causes of illness and injury to optimize patient care. Further evaluation of the utility of the OCCHLTH mnemonic is needed.

118 Occupational causes of respiratory cancers: Current and emerging trends and promoting prevention

118 Occupational causes of respiratory cancers: Current and emerging trends and promoting prevention

Environmental Causes of Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF), the most common and severe of the idiopathic interstitial pneumonias, is a chronic and relentlessly progressive disease, which occurs mostly in middle-aged and elderly males. Although IPF is by definition "idiopathic", multiple factors have been reported to increase disease risk, aging being the most prominent one. Several occupational and environmental exposures, including metal dust, wood dust and air pollution, as well as various lifestyle variables, including smoking and diet, have also been associated with an increased risk of IPF, probably through interaction with genetic factors. Many of the predisposing factors appear to act also as trigger for acute exacerbations of the disease, which herald a poor prognosis. The more recent literature on inhalation injuries has focused on the first responders in the World Trade Center attacks and military exposure. In this review, we present an overview of the environmental and occupational causes of IPF and its pathogenesis. While our list is not comprehensive, we have selected specific exposures to highlight based on their overall disease burden.

Investigation and Analysis on Occupational Exposure Causes and Mental Status of Infectious Diseases in Pre-Hospital Emergency Medical Personnel.

We aimed to probe into the occupational exposure causes and mental status of infectious diseases in pre-hospital emergency medical personnel. Forty medical personnel with occupational exposure to infectious diseases who participated in pre-hospital emergency work in 120 emergency center of The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China were selected as respondents from February 2018 to February 2021. The occupational exposure modes, exposure degrees, exposure sites, exposure sources and exposure causes of infectious diseases were summarized, and the mental status of emergency medical personnel after occupational exposure to infectious diseases was analyzed. In the occupational exposure modes of infectious diseases, needle stick injuries were overtly higher than mucosal pollution, hematic and humoral pollution and incised wound by glass (P<0.05). In exposure degrees, slight bleeding was notably higher than excessive bleeding, bleeding and no bleeding (P<0.05). The hand was distinctly higher than the eye in exposure sites (P<0.05). In exposure sources, hepatitis B virus was visibly higher than hepatitis C virus, HIV, syphilis, intravenous drug, hemorrhagic fever and unknown cause (P<0.05). The scores of somatic symptoms, anxiety, depression, fear, interpersonal sensitivity, hostility, compulsion and paranoia in medical personnel were clearly higher than the norm in Chinese adults after occupational exposure to infectious diseases (P<0.05), with no statistical significance in the comparison of psychotic scores. The occupational exposure risk of infectious diseases among pre-hospital emergency medical personnel is high. It is necessary to strengthen pre-job training and education and improve standardized management for protection.

Global Trends in Occupational Lung Disease

Lung diseases caused by workplace exposure are too often mis- or underdiagnosed due in part to nonexistent or inadequate health surveillance programs for workers. Many of these diseases are indistinguishable from those that occur in the general population and are not recognized as being caused at least in part by occupational exposures. More than 10% of all lung diseases are estimated to result from workplace exposures. This study reviews recent estimates of the burden of the most important occupational lung diseases using data published by United Nations specialized agencies as well as the Global Burden of Disease studies. We focus on occupational chronic respiratory disease of which chronic obstructive lung disease and asthma are the most significant. Among occupational cancers, lung cancer is the most common, and is associated with more than 10 important workplace carcinogens. Classic occupational interstitial lung diseases such as asbestosis, silicosis, and coal workers' pneumoconiosis still comprise a substantial burden of disease in modern industrial societies, while other occupational causes of pulmonary fibrosis and granulomatous inflammation are frequently misclassified as idiopathic. Occupational respiratory infections gained prominence during the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, eclipsing influenza and tuberculosis and other less common workplace infectious agents. The most significant risks are workplace exposures to particulate matter, gases, and fumes as well as occupational carcinogens and asthmagens. We present data on the burden of disease measured by deaths attributable to occupational respiratory disease as well as disability-adjusted years of life lost. Where available, prevalence and incidence data are also presented. These diseases are unique in that they are theoretically 100% preventable if appropriate exposure controls and workplace medical surveillance are implemented. This remains a continuing challenge globally and requires steadfast commitment on the part of government, industry, organized labor, and the medical profession.

Chronic Obstructive Pulmonary Disease and Work: The Continuing Narrative

It has long been recognized that harmful inhaled workplace exposures can contribute to the development of chronic obstructive pulmonary disease (COPD). This article, intended for the clinician, summarizes some of this evidence and some areas of controversy. Current estimates based on pooled epidemiological analyses of population-based studies identify that approximately 14% of the burden of COPD (and 13% of the burden of chronic bronchitis) is attributable to such exposures. In addition to these approaches, various studies implicate specific exposures as contributing. Certain of these relating to cadmium, coal, and respirable crystalline silica are discussed in more detail. Despite this amassed evidence to date supporting associations between COPD and workplace exposures, there have been surprisingly few studies that have attempted to assess the attribution by experts of an occupational cause in cases of COPD. One study, using hypothetical cases of COPD, noted that while expert physicians were willing to make such an occupational link, this was only likely in cases with light smoking histories and a priori defined heavy occupational exposures. Relatively recent data relating to computed tomography (CT) scan appearances may give the clinician a further guide. Several studies from populations have now linked potentially harmful occupational exposures specifically with the presence of emphysema on CT scanning. It will be of interest to see if this finding, along with other clinical attributes of cases such as smoking and family histories, exclusion of asthma, genetic data, and the nature of workplace exposures, will increase the future diagnosis by clinicians of occupational COPD. In the interim, while better diagnostic approaches are developed, we suggest that consideration of an occupational cause is an important part of the clinical investigation of cases of COPD. Finally, we suggest that evidence-based workplace preventive strategies for occupational COPD should be informed by knowledge of which exposures are most important to reduce, and whether and when intervention to reduce exposure at an individual worker level is warranted.

Occupational Cancers among Employed Women: A Narrative Review.

The facts that occupational cancer in women is under-investigated, with few in-depth analyses are well known. In recent decades the workforce has changed, with an increasing number of women employed. Therefore, the inclusion of women in occupational cancer studies has become more urgent and feasible than in the past decades. The difficulties to evaluate occupational causes of female gynecologic tumors in most past cohorts and the potential variation in outcome responses between men and women must be taken into consideration. This narrative review discusses women's occupational cancer as a current area of research, focusing on three groups of workers characterized by peculiar exposure to occupational carcinogens and where women are often employed: beauticians and hairdressers; farmers; and healthcare workers. We discuss the most relevant cancers in each working category, with a particular focus on female breast cancer. In the three industries reviewed in detail, there are some risk factors which may affect primarily women, inducing breast cancer and cervical cancer, as well as risk factors that are carcinogenic in both genders, but whose effects are less well known in women.

Risk of adverse pregnancy outcomes by maternal occupational status: A national population-based study in South Korea.

This study examined the association between maternal occupational status and adverse pregnancy outcomes in the general South Korean population. We analyzed 1825 845 employed and non-employed women with a diagnostic code for pregnancy in the National Health Insurance Service (NHIS) database (2010-2019) of South Korea. Based on their employment status and type of occupation, we calculated risk ratios for three adverse outcomes: early abortive outcomes (miscarriage, ectopic pregnancy, and molar pregnancy), stillbirth, and no live birth (diagnosis of pregnancy with no record of live birth thereafter, which include early abortive outcomes and stillbirth) with adjusting for covariates. Overall, 18.0%, 0.7%, and 39.8% ended in early abortive outcomes, stillbirths, and no live births, respectively. The risk of early abortive outcomes and stillbirths was higher in non-employed women than in employed women, while no live births were more frequent in employed women. Those in the health and social work industry showed the highest risk of no live births. Manufacturing jobs (1.030, 95% CI: 1.013, 1.047) and health/social work (1.029, 95% CI: 1.012, 1.046) were associated with an increased risk of early abortive outcomes compared with financial and insurance jobs. Consistently higher risks of no live births were observed in the manufacturing, wholesale/retail trade, education, health/social work, and public/social/personal service occupation. Employment during pregnancy and several occupation types were associated with a higher risk of pregnancy loss. Additional research using detailed job activity data is needed to determine specific occupational causes of adverse pregnancy outcomes.

Contact dermatitis

Contact dermatitis is a common skin condition, in which an inflammatory reaction occurs in response to an irritant or allergen. It can be subdivided into irritant (non-immune modulated) and allergic (immune modulated) contact dermatitis. Both forms can exist together. A detailed history and examination are essential to aid diagnosis. The hands are most commonly affected. There is an increased prevalence of contact dermatitis among those with occupational risks, females and those with a history of atopy. Affected skin becomes erythematous, and pruritic with vesicles or bullae. Lichenification and fissuring can occur in chronic cases. Treatment involves the avoidance of causative agents, the use of emollients, soap substitutes, and topical steroids. In severe cases, oral steroids may be necessary. Patch testing and onward dermatology referral to should be considered in cases that fail to respond to topical treatments, when the causative agent remains unknown or an occupational cause is suspected.

Respiratory Tract Cancer Incidences across Industry Groups: A Nationwide Cohort Study with More Than 70 Million Person-Years of Follow-Up.

The number of cases and incidence rates of laryngeal and lung cancers have been increasing globally. Therefore, identifying the occupational causes of such cancers is an important concern for policymakers to prevent cancers and deaths. We used national health insurance service claims data in Korea. We included 10,786,000 workers aged between 25 and 64 years. In total, 74,366,928 total person-years of follow-up were included in this study with a mean follow-up of 6.89 years for each person. The standardized incidence ratio (SIR) and 95% confidence intervals (CIs) referenced with the total workers were estimated. For laryngeal cancer, increased SIRs were observed in the land transportation industry among male workers (SIR [95% CI]: 1.65 [1.02-2.53]). For lung cancer, elevated SIRs were observed in the industries including animal production (1.72 [1.03-2.68]), fishing (1.70 [1.05-2.60]), mining (1.69 [1.22-2.27]), travel (1.41 [1.00-1.93]), and transportation (1.22 [1.15-1.30]) among male workers. For female works, healthcare (2.08 [1.04-3.72]) and wholesale (1.88 [1.18-2.85]) industries were associated with a high risk of lung cancer. As an increased risk of respiratory tract cancers has been identified in employees associated with certain industries, appropriate policy intervention is needed to prevent occupational cancers.

Asbestos danger in central Europe is not yet over - the situation in the Czech Republic

In the Czech Republic, asbestos has been classified as a known human carcinogen since 1984. The use of asbestos-containing products was limited to scenarios where the use of other materials was not possible. Since 1997, the manufacture of asbestos materials has been forbidden, and in 1999, the import, manufacture and distribution of all types of asbestos fibres was legally banned by Act No. 157/1998 Coll. Although the use of asbestos is forbidden, the risk of exposure still exists given the ongoing demolition and reconstruction of buildings in which asbestos has been used. In addition, a novel risk has arisen through the quarrying of asbestos-containing aggregates and their subsequent use. The aim of this paper was to describe and evaluate asbestos in terms of history, legislation, current risk of occupational exposure and its health consequences in the Czech Republic over the last three decades. This retrospective descriptive study used the collected data on occupational exposure and occupational diseases. The counts of workers occupationally exposed to asbestos were obtained from the Registry of Work Categorization; the numbers and structure of occupational diseases caused by asbestos were taken from the Czech National Registry of Occupational Diseases. Data on the total number of mesothelioma cases recorded in the Czech National Cancer Registry was provided by the Institute of Health Information and Statistics of the Czech Republic. A total of 13,112 subjects were registered as occupationally exposed to asbestos during the period 2001-2020. A total of 687 cases of asbestos-related occupational diseases were reported in the period 1991-2020 in the Czech Republic, comprising 178 cases of asbestosis, 250 cases of pleural hyalinosis, 168 cases of pleural or peritoneal mesothelioma, 90 cases of lung cancer, and one case of laryngeal cancer. The data from the Czech National Cancer Registry, available for a shorter period (1991-2018), reveal 1,389 cases of mesothelioma, of which only ~11% were recognised as occupational, despite the fact that the occupational causality of mesotheliomas is estimated to be up to 90% of mesotheliomas. Moreover, the latency of mesotheliomas since the last occupational exposure reached up to 50 years and this trend is still slightly increasing, unlike asbestosis, where a high cumulative dose of inhaled asbestos is needed. The real proportion of occupational lung cancers may obviously be even higher, especially in smokers, where occupational causes including asbestos are not suspected by most physicians. Czech data on asbestos-related occupational diseases, especially cancers, are grossly underestimated, which is most apparent through the low proportion of mesotheliomas diagnosed as occupational. Asbestos materials in older buildings remained in situ and may represent a danger during reconstruction works. The current source of exposure appears to be quarrying of asbestos-containing aggregate and its subsequent use. Awareness of the professional community is therefore crucial, not only for the possibility of compensating those affected, but also for the early detection of the diseases through the dispensary of exposed persons.

The Proportion of Occupationally Related Cholangiocarcinoma: A Tertiary Hospital Study in Northeastern Thailand.

Simple SummaryNortheastern Thailand has the world’s highest incidence rate of cholangiocarcinoma (CCA), whereas a consequence, approximately 14,000 patients die annually. In most cases, the causal factors are identified, but, for some, they remain unknown. Legally imported industrial chemicals such as 1,2-dichloropropane (1,2-DCP), dichloromethane (DCM), and asbestos fibers are defined as occupational causes of CCA. An investigation into these vis-à-vis the diagnosis of occupationally related CCA in Thailand has not been conducted, but is important for understanding the potential magnitude of the problem. The current study found that the proportion of occupationally related CCA was approximately 5.5%, as well as a lower proportion of occupational history taken by treating physicians. Improving physician skills and developing an assistive tool for exploring occupational history might improve the documentation of work-related conditions.Northeastern Thailand registers the highest worldwide incidence of cholangiocarcinoma (CCA). Most of the cases are associated with liver flukes, while unknown causes comprise approximately 10–30% of cases, and these could be due to occupational exposures. Our aim was to determine the magnitude of occupational causes of CCA in a tertiary hospital in northeastern Thailand. We conducted a cross-sectional study with a sample of 220 patients between March and November 2021. Descriptive statistics were used to analyze the findings. Clinical information and telephone interviews were used to explore significant occupational histories. An occupational consensus meeting was held with two occupational physicians, an industrial hygienist, and a hepatobiliary surgeon to decide on the final diagnosis. The response rate was 90.9% (200/220). Based on the medical records and telephone interviews, researchers found that 11 participants had significant exposure. After occupational consensus, it was agreed that the eleven had possible occupational causes, 5.5% (11/200)–54.5% (6/11) being due to asbestos fibers, 45.5% (5/11) due to dichloromethane, and 9.1% (1/11) due to 1,2-dichloropropane. Only 4% (8/200) had occupational histories collected by their treating physicians. Taken together, occupationally related CCA appears to have been underestimated, so improving occupational history taking is needed to properly identify and classify work-related CCA—both for patient treatment and occupational hazard prevention.

Occupational COPD-The most under-recognized occupational lung disease?

Chronic obstructive pulmonary disease (COPD) is caused by exposure to noxious particles and gases. Smoking is the main risk factor, but other factors are also associated with COPD. Occupational exposure to vapours, gases, dusts and fumes contributes to the development and progression of COPD, accounting for a population attributable fraction of 14%. Workplace pollutants, in particular inorganic dust, can initiate airway damage and inflammation, which are the hallmarks of COPD pathogenesis. Occupational COPD is still underdiagnosed, mainly due to the challenges of assessing the occupational component of the disease in clinical settings, especially if other risk factors are present. There is a need for specific education and training for clinicians, and research with a focus on evaluating the role of occupational exposure in causing COPD. Early diagnosis and identification of occupational causes is very important to prevent further decline in lung function and to reduce the health and socio‐economic burden of COPD. Establishing details of the occupational history by general practitioners or respiratory physicians could help to define the occupational burden of COPD for individual patients, providing the first useful interventions (smoking cessation, best therapeutic management, etc.). Once patients are diagnosed with occupational COPD, there is a wide international variation in access to specialist occupational medicine and public health services, along with limitations in workplace and income support. Therefore, a strong collaboration between primary care physicians, respiratory physicians and occupational medicine specialists is desirable to help manage COPD patients' health and social issues.

The National Occupational Respiratory Disease Registry (NORDR): it is time to learn from failure.

The National Occupational Respiratory Disease Registry (NORDR): it is time to learn from failure.

Occupational causes of chronic obstructive pulmonary disease: an update.

This brief narrative review aims to highlight relevant recent updates on occupational causes of chronic obstructive pulmonary disease (COPD). The most recent literature has been searched for any new relevant association between occupational exposures and COPD. Only large epidemiological studies of high quality have been included. Beyond the more traditional exposures, such as mineral or organic dusts, new chemicals have emerged as potential occupational causal agents for COPD. In particular, pesticides and cleaning products, including disinfectants, that have shown also positive exposure-response trends. For cleaning products, some specific chemicals have been identified, but for pesticides the identification of specific causal compounds is more challenging. The biological underlying mechanisms are still under study. In the recent literature, occupational exposure to pesticides and cleaning products has emerged as potential cause of COPD. Awareness on occupational causes of COPD should increase among all stakeholders, from health professionals to public to prevent the associated public health burden. More studies on identifying the specific causal agents and mechanisms are needed to focus preventive strategies.

Evidence for marked underutilization of insurance billing in malignant pleural mesothelioma in Finland.

BackgroundSubstantial variation in health care costs for malignant pleural mesothelioma (MPM) has previously been identified.Materials and MethodsWe analyzed the changes in health care costs in MPM in Finland during 2002–2012. Finland has low‐threshold public health care and a mandatory Workers' Compensation scheme that covers all occupational‐related disease expenses. The costs include treatment costs for inpatients, hospice care, medication costs, rehabilitation costs, and travel costs. All costs are expressed in 2012 prices, adjusted using the consumer price index.ResultsA total of 907 MPM patients were included in the study. Mean duration of inpatient episodes increased 7% per year from 2002 to 2012, correlating with total costs (R2 = 0.861, p < 0.05). The annual total costs for treatment increased from 1.7 to 4.3 m€ during the study period and the cost per patient from 27 000 to 43 000 €. The overall costs increased progressively by the number of procedures performed. In patients who had been compensated for occupational cause by Workers' Compensation Center, only 36% of the overall care costs were billed from the insurance company. Billing of inpatient costs was 86% in these patients.ConclusionDuring the study period, we found that the costs of MPM increased more than the average health care costs. This may be because of advanced diagnostic workup or more costly treatment (e.g., pemetrexed). Moreover, only one‐third of all health care costs are charged to Workers' Compensation Insurance.

Low-level radon exposure and lung cancer in the Pooled Uranium Miners Analysis (PUMA)

BACKGROUND AND AIM: Radon, a ubiquitous gas, and its progeny are a leading environmental and occupational cause of lung cancer. To better inform radiation protection standards by estimating risk, we assembled an international cohort study of workers employed in uranium mining in Canada, the Czech Republic, France, Germany, and the United States. METHODS: We focus on miners employed during the more contemporary period of the uranium mining industry when radon exposures tended to be comparatively low, and individual exposure data are available. A cohort of 56,614 male uranium miners first employed in 1960 or later was assembled and followed to ascertain causes of death. Estimates of excess relative rate (ERR) per working level month (WLM) of cumulative radon progeny exposure for mortality from lung cancer were derived by internal Poisson regression. RESULTS:In the follow-up period a total of 1217 lung cancer deaths occurred, accumulating 1.9 million person-years at risk. The relative rate of lung cancer increased in a linear fashion with cumulative exposure to radon progeny, lagged 5 years (ERR/100 WLM=1.34; 95% CI: 0.89, 1.89). Attained age was a clear modifier of this association, showing a decrease in ERR/WLM with increasing attained age. Further potential modifiers are age at exposure or time since exposure and exposure rate. CONCLUSIONS:PUMA provides the most precise and informative estimates to-date of the association between low-level exposure to radon progeny and lung cancer mortality. The results strengthen the basis for radiation protection standards for radon and its progeny. KEYWORDS: Ionizing radiation, Occupational exposures, Risk assessment,International collaboration