Working Conditions Research Articles

Human-swine interface: is the hepatitis E virus a real risk for humans?

Abstract Background Hepatitis E virus (HEV) is the agent of hepatitis E, an emerging public-health infection with an increasing incidence in Europe. Due to the apparent lack of species barriers, HEV is considered a zoonotic agent, with swine as the main reservoir. This study investigated HEV prevalence in humans and domestic pigs in Northern Italy, a highly anthropic area with the highest pig farm density, to gain insights into the risk of HEV transmission from swine to humans. Methods A total of 508 blood samples were collected from blood donors (341 males and 167 females; from 18 to 66 years old) and from 1619 pigs in 40 different farms. Serological analyses were performed with ELISA to detect anti-HEV antibodies. In addition, 120 faecal pool samples collected from the pig farms with the highest seroprevalence and 69 salami produced in the same area were analysed to detect viral genome by Real-time PCR. Results In humans, HEV seroprevalence was 4.9% (CI95% 0.03-0.07); positive donors were mainly males, with seroprevalence increasing up to 12% (CI95% 0.09-0.15) in the 46-55 age group. Seroprevalence in swine was 53.00% (CI95% 0.50-0.55), with HEV detected in only 1% (CI95% 0.001-0.045) faeces. All food samples tested negative. Conclusions Even if the seroprevalence in pigs highlighted that HEV was actively circulating in the farms, the low seroprevalence in humans, the scarce HEV detection in swine faeces, and the absence in food products suggested that HEV transmission via faecal-oral or foodborne routes is unlikely, probably due to the implementation of severe biosecurity measures and high standards of hygiene in swine farms, and the continuous assessment of the critical points in the pig supply chain (from farm to fork). The serological surveillance of humans and the monitoring of farmed animals are needed to support the competent authorities in timely managing public health issues, improving human health and veterinary safety from a One Health perspective. Key messages • In the human-swine interface is important to monitor HEV presence. • The One Health approach is essential to control zoonotic diseases.

Navigating the AI Wave: Overcoming Barriers and Unleashing the Potential of Artificial Intelligence in Transforming European Public Health

Abstract Artificial Intelligence (AI) is not just a future promise but an urgent necessity for modern public health. By providing invaluable insights into disease patterns, therapeutic interventions, and overall public health management, AI has the potential to revolutionise healthcare. To tackle essential public health functions effectively, harnessing AI must become a top priority. However, there is an urgent need for a cohesive strategy across Europe. Currently, varying readiness levels among European nations regarding AI adoption in health result in uneven progress across the continent. This disparity must be addressed to ensure all countries benefit equally from AI advancements. Recognising this, the World Health Organization European Regional Office launched a regional report on digital health in 2023. The report evaluated the integration of big data and advanced analytics, including AI, in health systems. Findings revealed that while 60% of Member States have a national data strategy, only 35% have a policy regulating big data and AI in health, and 38% lack both. This highlights a critical gap that must be filled urgently. Our upcoming session will address these challenges head-on. Organised to provide visionary insights, practical applications, and a landscape view of artificial intelligence in public health, the presentations will be followed by a roundtable discussion in which panellists will delve into practical challenges surrounding AI adoption. They will reflect on the profound impact AI could have on the future of European health systems and offer pragmatic and responsible steps forward, culminating in achievable recommendations for public health professionals. To enhance the session, we will utilise existing Generative AI tools to provide a real-time summary of the plenary and reinforce the call to action in alignment with panellists’ recommendations. This approach ensures that the session discusses the urgent need for AI in public health and actively demonstrates its practical applications. Moderators Natasha Azzopardi Muscat Director, Division of Country Health Policies and Systems, WHO Regional Office for Europe Dimitra Panteli Programme Manager/Senior Health Systems Analyst, European Observatory on Health Systems and Policies Facilitator Stefan Buttigieg Vice-President, EUPHA Digital health section Speakers/Panellists Martin McKee Professor of European Public Health, London School of Hygiene & Tropical Medicine, UK Katharina Ladewig Director, Centre for Artificial Intelligence in Public Health Research, Robert Koch Institute, Germany Marco Marsella Director Digital, EU4Health and Health systems modernisation, Directorate-General for Health and Food Safety (DG SANTE), European Commission Keyrellous Adib Technical Officer Data Science and Digital Health, WHO Regional Office for Europe

Zibotentan in microvascular angina: a randomized, placebo-controlled, crossover trial

Abstract Background/Introduction Microvascular angina is a chronic condition characterized by abnormal myocardial blood flow leading to ischemic symptoms. Endothelin-1, a peptide secreted by endothelial cells, is a highly potent constrictor of the human coronary arterioles. Microvascular angina is associated with elevated circulating concentrations of endothelin-1, and prolonged exposure to ‘excess’ endothelin causes vasoconstriction and vascular remodelling. The chronic elevation of circulating endothelin-1 in microvascular angina may be influenced by genetic factors. Purpose Zibotentan, the most selective antagonist of the endothelin A receptor with no off-target binding to the endothelin B receptor, was evaluated in oncology trials and did not improve survival. We identified zibotentan as a potential disease-modifying therapy for patients suffering from microvascular angina. We hypothesized that zibotentan 10 mg daily for 12 weeks in addition to background medical therapy could be an efficacious and safe treatment for patients with microvascular angina. We further hypothesized that the SNP regulator of EDN1 gene expression, rs9349379 (G allele), could be a novel theragnostic biomarker. Methods The trial involved a prospective, multicentre, randomized, double-blind, placebo-controlled, sequential crossover design to assess the effects of zibotentan 10 mg or matched placebo, once daily for 12 weeks. The primary outcome was treadmill exercise duration (seconds) using the Bruce protocol. The secondary outcomes included exercise test parameters, health status questionnaires, safety (frequency and severity of severe adverse events (SAEs) and adverse events), feasibility (withdrawal rate), and biomarkers of efficacy (pharmacokinetics, pharmacodynamics). Results The study found no significant difference in exercise duration with zibotentan (-4.26 seconds; 95% CI: -19.60 to 11.06; P=0.5871). There was no effect on the secondary outcomes. However, for exploratory (mechanistic) outcomes, zibotentan increased plasma big endothelin-1, endothelin-1, and global myocardial blood flow, while reducing hemoglobin, diastolic, and systolic blood pressure (all p<0.001). Adverse events were more common during the zibotentan period (60.2%) compared to placebo (14.4%, p<0.001). Conclusion(s) In conclusion, daily administration of 10 mg zibotentan for 12 weeks did not enhance exercise duration and was commonly associated with adverse effects related to fluid retention. Further trials exploring lower zibotentan doses in combination with agents to mitigate fluid retention, and longer treatment durations, are warranted.

Preparedness and Public Health: an Italian Local Health Authority plan for a mass gathering in 2023

Abstract Issue Mass gatherings represent an important Public Health challenge. The increased number of people present in a specific area puts local health systems under stress (i.e.workload of emergency services, environmental health and food safety) and at the same time it rises the risks of a potential mass casualty incident. Effective planning and disaster preparedness have to be achieved through collaboration among local health authorities(LHA) and other stakeholders (event planners, law enforcement, local transportation services). Problem Every year, for 3 days, the Italian Alpine troops gather in a different city to remember First World War fallen. During those days, the city centre transit is not allowed to car (in specific areas even to emergency vehicles).In May 2023 this event occurred in Udine, a city in the North East of Italy with almost 100.000 inhabitants. For that year at least 300.000 participants were expected. LHA had to reorganize preparing itself to manage a temporary quadrupled catchment area. Results In the previous months, local authorities met local health representatives and other stakeholders in order to define a single emergency response plan. For healthcare services it was decided to: institute first aid points within the city; reorganise patients’ emergency transport system; increase hospitals’ treatment capacity (beds, life support equipment); increase healthcare professional availability; empower drugstores (opening times, drugs procurement); strengthen human and animal health surveillances;activate alternative communication systems. During the event, LHA updated other authorities involved three times a day about hospital and emergency system situation. At the end of the event,a multiprofessional debriefing meeting was held and no critical situations were reported. Lessons Preparedness requires a great commitment in terms of resources and time, but it is confirmed to be essential to guarantee adequate assistance even in extraordinary conditions. Key messages • Mass gathering s events put under stress all the main areas of public health system. • Public health preparedness cannot be effective without a strong involvement of other public and private stakeholders.

Based on Deep Learning Model and Flink Streaming Computing Short Term Photovoltaic Power Generation Prediction for Suburban Distribution Network

With the advancement of global energy internet construction, accurate prediction of new energy generation power such as photovoltaic is an important foundation for ensuring the safety and economic working of new power systems. A short-term photovoltaic power generation prediction method for suburban distribution networks based on deep learning model fusion and Flink flow calculation is proposed to address the challenges of complex power grids, diversified disturbance factors, and isolated monitoring points. This method uses Bi directional Long Short Term Memory(BiLSTM) to extract cross sequential nonlinear characteristic of photovoltaic power generation time series data. Compared with standard LSTM, BiLSTM can consider both historical and future information simultaneously, thus extracting richer extracted features from power generation time series data. This method also integrates attention mechanism to capture the importance distribution of historical temporal features for power generation prediction, effectively solving the problem of long-term temporal dependence in standard LSTM models. The Flink streaming computing framework embeds a trained BiLSTM-Attention photovoltaic power generation prediction model, enabling real-time prediction and monitoring analysis of photovoltaic power generation at various monitoring points in the suburban distribution network. This article uses a dataset of a suburban photovoltaic power station for validation, and trains the model with historical power generation data, meteorological factors, weather types, seasons, and other information as inputs. The BiLSTM-Attention fusion model studys the temporal characteristics of power generation, and has high accuracy in predicting short-term photovoltaic power generation in different scenarios. The Flink streaming computing platform can not only process high throughput predicted power data, but also has low time delay.

Protecting Electrical Workers in Conducting Locations with Restricted Movements

Conducting Locations with Restricted Movements (CLRs) pose unique electrical hazards due to the extensive presence of grounded conductive materials with which a person is likely to come into contact and the restricted freedom of movement of workers within these spaces. Extended physical contact is not solely a result of spatial constraints. It could also be associated with the specific tasks that workers need to execute. An example of this is work conducted on a transmission tower. This paper investigates the electrical safety measures necessary to protect operators in such environments. By examining the role of body resistance and the impact of different current pathways, this author highlights the inadequacy of the conventional disconnection of supply fault protection measure in CLRs. The paper discusses protective strategies, including supplementary equipotential bonding, use of double or reinforced insulation, electrical separation, and extra-low voltage systems. These measures are critical in mitigating the risk of electric shock and ensuring safety of workers in CLRs.

Unveiling mercury exposure sources in e-waste recycling with biomonitoring - A Portuguese case study

Abstract Background Mercury (Hg), a global pollutant, poses risks to both human and environmental health. The management and recycling of electrical and electronic waste (e-waste) is recognized as having the potential to promote workers’ exposure to this pollutant. Human biomonitoring (HBM) is a tool that can be used to evaluate exposure and monitor the health of workers. The objective of this study was to characterize exposure of workers from an e-waste recycling company and to analyze the relevance that HBM holds in the detailed characterization of exposure. Methods A cross-sectional observational study was conducted using data collected within the framework of the European Human Biomonitoring Initiative (HBM4EU). Data from environmental monitoring (settled dust) and biological monitoring (urine and hair) of 30 workers potentially exposed to Hg were analyzed in comparison with 12 unexposed workers from other occupational settings (controls). Results Exposed workers did not exhibit significantly higher concentrations of Hg in urine when compared to control workers. We found a significantly positive correlation between the concentration of Hg in urine (ρ = 0.688; p ≤ 0.001) and hair (ρ = 0.470; p ≤ 0.01) and the consumption of fish and shellfish. Conclusions Diet appears to be the most significant source of Hg in this context. These results suggest the importance of information and dietary habits to prevent mercury exposure. HBM stands out as an essential tool for identifying the most relevant exposure sources and risk management measures for workers and the general population. Key messages • Diet appears to be the most significant Hg source in workers from a Portuguese e-waste company. • HBM stands out as essential for identifying the most relevant exposure sources and risk management.

An integrated work health intervention among cleaners in Denmark

Abstract Introduction Work-related diseases are increasing and considered a global health challenge. Meanwhile, work-related risk factors and diseases are not equally distributed across occupational groups. Previous work health interventions have not succeeded in reducing the prevalence of work-related diseases. Therefore, integrated approaches combining prevention of disease and promotion of health in work health interventions have been developed. The aim of the Integrated Approach to Health, Wellbeing, and Productivity at Work (ITASPA) intervention was to prevent work-related injuries and diseases and promote the health, safety and wellbeing of cleaners. Methods The ITASPA intervention was implemented at two Danish workplaces among cleaners. At each workplace a committee of employees was established to develop their own initiatives to promote the health of the workers. By use of the British Medical research Council’s framework, a process evaluation was conducted. Qualitative data (focus group interview and field notes) and quantitative data (questionnaires) of participants evaluated the implementation. Results A total of 91 cleaners participated in health checks, and three workshops were held at each workplace. The development and implementation of activities was affected by mechanisms, such as lack of information about the intervention, new power dynamics, and lack of motivation for behavior changes, and contextual factors, such as many replacements, time pressure and absence of managers. Conclusions Integrated approaches in work health interventions among employees with short or no education may positively impact employees’ health, wellbeing and safety if comprehensively implemented. However, attention should be drawn to interventions that adapt a participatory design, as unintended power dynamics may occur when employees are given the tasks of implementing behavior changes among colleagues. The role of managers to obtain successful implementation should be highlighted.

Institutional Discrimination in Health Security Policies against Immigrants in South Korea

Abstract Background South Korea is poised to become Asia’s first mult-iethnic society with over 5% of its population, totaling more than 2.5 million, being immigrants. This demographic shift presents significant public health challenges linked to widespread, and even intensifying, institutional discrimination in healthcare services. Methods This study reviews discriminatory practices across ten essential health security programs, including National Health Insurance (NHI) system, disability assistance, occupational health services, maternal and child care services, national immunization program, health screening program, and assistance for catastrophic medical expenses. Government data and personal narratives were also reviewed to identify the discriminatory elements that can have significant consequences, including increased disease prevalence, higher incidence of occupational injuries, and broader socio-economic instability among migrants. Results Discriminatory elements were found in most programs, with the exception of emergency medical services. These programs commonly provide fewer benefits or impose stricter eligibility criteria for migrants compared to nationals. In particular, the Korean NHI system demands migrants to pay higher premiums and more rigorous maintenance requirements. Conclusions The findings emphasize the need for urgent reforms to equalize health insurance costs, simplify eligibility criteria for migrants, and broaden the scope of benefits to encompass all residency statuses. Implementing these changes will enhance public health infrastructure, improve occupational safety, and foster better integration of the diverse population, ultimately promoting social cohesion and a fairer health system for all. Key messages • A number of discriminatory elements against migrants have been identified in South Korea’s social security policies that can exacerbate health disparities. • Reforms are needed to expand benefits and relax eligibility criteria for migrants in key healthcare policies, including the National Health Insurance system.

Experts in promotion and prevention - The 100th Anniversary of Finnish public health nurse education

Abstract Issue/Problem Two key public health issues at present are mental health problems and obesity. Both typically begin before adulthood and once occurred, typically persist. Prevention would be important but also economically and humanely sensible. For this, competent experts in preventive work and health promotion are needed. Description of the problem Public health nurse education, originally known as health sister education, was initiated in Finland in 1924, by the Mannerheim League for Child Welfare. The six-month health sister education was targeted at nurses and began from the desire to focus not only on treating diseases but also on promoting health. In the 1940s, education was reformed and in the 1950s significantly expanded. In the 1970s, the professional title changed from ‘health sister’ to ‘public health nurse’. In 1987, the education was extended to 3 years, including the education of registered nurses. In 1992, the education was further extended to 3.5 years. By the beginning of the 21st century, education evolved into 4 years bachelor’s degree. Results In 2024, eighteen Universities of Applied Sciences provide public health nurse education in Finland. The 4-year Bachelor of Health Care in Public Health Nursing -degree (240 ECTS credits) also qualifies for a registered nurse. Nearly half of the education consists of clinical training. In addition, registered nurses can supplement their degrees by completing a one-year education (60 ECTS credits) that qualifies them as public health nurses. Lessons In Finland, approximately 700 new public health nurses graduate annually. They are trained to work independently as experts in preventive work, health promotion, and public health. Around 9,500 Finnish public health nurses work in settings such as maternity and child health clinics, school health services, occupational health care, and outpatient clinics. Key messages • Due to the overcrowding in many healthcare services providing treatment, educating experts in health promotion and disease prevention is crucial now and in the future. • By ensuring competent experts in health promotion and disease prevention, future healthcare services can continue to provide economically and humanely sensible and effective help for people.

Occupational Hazards: The Impact of Streptococcus suis Infections in Portuguese Pig Farming

Abstract Background In Portugal, the commensal and opportunistic bacteria Streptococcus suis is prevalent among pigs. Recognizing its public health significance, this systematic review investigates the relationship between occupational exposure in pig farming and the incidence of S. suis infections among workers. The importance of this study is to identify high-risk occupational activities and formulate effective public health interventions. Methods This review analyzed 20 scientific studies from 1986 to 2023 on human infections with S. suis in Portugal. The primary sources included articles in Portuguese from databases like MedLine, Scopus, and Pubmed. Studies were selected based on their focus on occupational exposure and the details provided on epidemiological context, clinical presentations, and outcomes. Results The review found that 85% of infection cases occurred in occupational settings, particularly among butchers (53%) and pig breeders or handlers (29%). Clinical manifestations predominantly included acute bacterial meningitis, with significant occurrences of neurosensory hearing loss as a sequelae. The average age of affected individuals was 44, predominantly male. Conclusions The study confirms a significant correlation between occupational exposure in pig farming and S. suis infections in humans. The findings underscore the need for stringent occupational health measures and integrated approaches encompassing human, animal, and environmental health under the One Health initiative. Innovations in public health interventions recommended include enhanced surveillance, improved workplace hygiene, and targeted health education for at-risk populations. Key messages • Occupational exposure in pig farming is a significant risk factor for S. suis infections in humans. • Integrative One Health approaches are essential for preventing S. suis infections in occupational settings.

“When the Bills Keep on Coming:” the Experiences of Seafood Processors During the COVID-19 Pandemic

ABSTRACT Essential workers were at increased risk during the COVID-19 pandemic, including seafood processors who are often rendered invisible within the public sphere. To examine the health and safety concerns of seafood processors, many who are low income or im/migrant workers on H-2B visas, our team conducted qualitative research with 44 participants. We found that in addition to high occupational health hazards that existed before the pandemic, COVID-19 increased workers’ financial risks, which put them in more dangerous health and safety positions, since they needed to work through physical and mental health illness. These financial risks can be seen through the themes of paid sick leave, mental health, economic duress, and primary care access. We conclude with three recommendations to the H-2B visa worker program, which will not only decrease health disparities for im/migrant workers, but also increase health equity across seafood worker populations.

Prevalence and treatment of chronic musculoskeletal pain focused on service gaps: a comparative analysis by age group and body part

Background Occupational health, grounded in occupational medicine, aims to enhance the well-being and labor productivity of the working population. Within this realm, there has been growing concern over the increasing instances of labor loss due to diminished physical capacity and the rise in musculoskeletal disorders. Chronic pain is also associated with musculoskeletal disorders. Another pressing issue related to chronic musculoskeletal pain was needed assistance services are underutilized, is referred to as a “service gap”. Understanding trends based on age and affected regions of the body is indispensable for developing strategies to address chronic musculoskeletal pain in workers. This study aimed to elucidate age-specific trends in the prevalence and number of pain sites in chronic musculoskeletal pain as well as the patterns of treatment during chronic musculoskeletal pain, categorized by age and affected site. Methods This study was conducted in December 2022 in contract to Cross Marketing Inc. The survey began on December 12, 2022 and ended on December 15, 2022. An online survey was administered to 1,946 participants (973 women and 973 men), and responses were collected, ensuring a roughly equal distribution of samples among men and women across six age groups ranging from their 20 to 70 s. The survey inquired about the presence of chronic pain in each of the eight body parts and the adoption of five different treatments when experiencing pain. Statistical analysis was performed using the chi-square test, with the measurement data categorized by age group and body part. Results The results indicated a significantly higher prevalence of chronic pain at three or more sites among individuals in their 30 s: the prevalence of pain at each of the eight body sites varied with age. Approximately half of the participants did not engage in specific treatments during episodes of chronic pain. The presence or absence of treatment showed no significant differences according to affected site or age group. This study revealed age- and body part-related relationships with chronic musculoskeletal pain in middle-aged patients and highlighted healthcare service gaps in its management in Japan.

Employees’ work ability during returning to work with common mental disorders: a mixed methods study

Abstract Background A main goal during the return to work (RTW) process after a long-term sickness absence due to common mental disorders (CMDs), is to restore and maintain an employees’ work ability to enable sustained work participation. To date, surprisingly little research has examined the concept of work ability during the RTW process with CMDs. To better understand how to restore employees’ work ability during RTW with CMDs, both quantitative and qualitative research is needed. The goal of this mixed methods study is to expand the understanding of restoring work ability during the RTW process with CMDs. Methods In this mixed methods follow-up study of N = 286 participants, work ability was quantitatively assessed with the Work Ability Score (WAS, range 0-10) at five measurement points (0, 6, 12, 18 and 30 months) during 30 months of follow-up. In a sub-sample, the qualitative work ability experiences of N = 32 participants were jointly analysed with their quantitative work ability ratings at 6 and 12 months. Results In the joint analysis, three groups of qualitative work ability experiences together with their respective quantitative work ability ratings emerged: Employees with (1) poor work ability (WAS 0-3), who did not RTW yet and described great difficulties in coping with everyday life; (2) moderate work ability (WAS 4-6), who mainly did RTW, but still showed a certain level of fragility; and (3) good to very good work ability (WAS 7-10), who mainly returned within 12 months and reported many individual and work accommodations to restore and maintain their work ability. Conclusions The joint evaluation of work ability ratings and experiences allowed a deeper understanding of restoring work ability during the RTW process. This knowledge may help occupational health professionals and other key RTW stakeholders to provide more tailored support during the RTW process and to promote a sustainable RTW for employees with CMDs. Key messages • Restoring and maintaining the work ability of employees with common mental disorders during the return to work process is crucial for their sustained work participation. • Achieving a good to very good work ability helps returning employees with common mental disorders to ‘stay and thrive’ at work again.

Periodontal conditions and salivary microbiota are potential indicators to distinguish silicosis: an exploratory study

BackgroundSilicosis has always been a serious global occupational health problem. Oral microbiota plays important roles in the development of lung disease. However, few studies have investigated the relationship between periodontal conditions, oral bacteria and silicosis disease.MethodA single-center and cross-sectional study was conducted in 2019 in Sichuan Province, China, including a small sample of silicosis patient group and healthy control group. Demographic data and periodontal examinations measured by clinical attachment loss (CAL), bleeding on probing (BOP) and periodontal pocket (PD) were collected from each participant. Phenotypic changes were detected by histopathological staining. Next-generation sequencing targeting 16S ribosomal RNA was targeted to decipher the salivary microbiome of the two groups. Random forest, Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression and multivariable logistic regression analysis were conducted to find potential indicators to distinguish silicosis.ResultsIn general, 29 male healthy controls and 24 male silicosis patients were included. The proportion of CAL ≥ 3 mm in silicosis group was greater than control group, while the proportion of BOP (+) and PD ≥ 4 mm was reduced in silicosis group. The α-smooth muscle actin and fibronectin expression increased in gingiva of patients. The composition of salivary microbiota exhibited significant differences between the two groups, with silicosis patients demonstrating a lower diversity of salivary microbiota. Genus of Aggregatibacter [odds ratio (OR) = 0.000, p = 0.003] and Catonella (OR = 0.000, p = 0.049) were identified as biomarkers to distinguish silicosis.ConclusionsThe silicosis group exhibited worse CAL, improved BOP and PD, which may be related to the gingival fibrosis found in this study. The composition of the oral microbiota underwent significant changes, accompanied by a decrease in diversity, in patients with silicosis. Our study indicates that respirable crystalline silica exposure affects oral health, and alterations of oral microbiota might be implicated in silicosis. We primarily identified Aggregatibacter and Catonella as the potential indicators to distinguish silicosis patients from healthy controls.

Assessing the return-to-work mode of Dutch precarious workers with mental health issues

Abstract Background Mental health issues are highly prevalent among precarious workers, often leading to sickness absence, work disability, and job loss. Return to work (RTW) is more challenging for these workers, as they often lack a job to return to and have limited access to occupational health care. Perceptions and attitudes about RTW are important determinants and can be categorized into three modes within the RTW process: a passive, an ambivalent and an active RTW-mode. To identify the RTW mode, we developed the RE-MODE tool. This study aimed to assess occupational health professionals’ agreement on the RTW-mode of sick-listed precarious workers with mental health issues using RE-MODE. Methods In a vignette study, 71 occupational health professionals from a Dutch social security institute viewed six videos of consultations between insurance physicians and precarious workers. They then used RE-MODE to assess the RTW mode and need for RTW-support. They also provided feedback on the tool’s validity and usability. We used a generalized linear mixed model to analyze inter-rater agreement, inter-item consistency, and the contribution level of each item. Additionally, we calculated the content validity index and the system usability scale. Results The agreement on the RTW mode with RE-MODE is high (ICC 0.86, 95% CI 0.64-0.95) and on the workers’ need for RTW-support moderate (0.61, 95% CI 0.31-0.84). Furthermore, the content-validity (Scale-CVI 0.83), usability (SUS 0.75), and inter-item consistency (Cronbach’s Alpha 0.70) show favorable results. We are currently analyzing the contribution of each item to the total score. The items with the best overall performance will be included in RE-MODE 2.0. Conclusions REMODE is a valuable tool for occupational health professionals to identify precarious workers with mental health issues at risk of long-term disability. Then they can arrange targeted RTW-support. Based on the study results, RE-MODE 2.0 is in development. Key messages • RE-MODE is a valuable tool for the assessment of the RTW-mode of precarious workers with mental health issues. • RE-MODE’s reliability, content-validity and usability is satisfactory.

Do shift-working nurses’ work-life quality relate to their physical health and diet quality?

Abstract Background Shift work negatively affects work-related quality of life and this situation causes significant labour force losses and decreased productivity in the society, especially health problems in nurses. This study was conducted to determine the relationship between work-related quality of life, physical health level and nutritional behaviours of nurses working in shifts. Methods This descriptive and relationship-seeking study was conducted with 312 nurses selected by quota sampling in Istanbul. Data were collected between December 2022 to July 2023 using the The Professional Quality of Life Scale (ProQOL), Physical Health Questionnaire and Food Consumption Frequency Questionnaire. Descriptive statistics and Pearson correlation tests were conducted on IBM SPSS 25.0. BeBIS 7.1 software were used for calculation diet index. Results Compassion Satisfaction (CS), Burnout (B) and Compassion Fatigue (CF) scores of nurses was examined, a relationship was found between CS score and B score (r=-0.39 p < 0.05) and between B score and CF score (r = 0.58 p < 0.05). CS score correlated with Cardiovascular Risk Level score (r=-0.15 p < 0.05) and diet index score (r = 0.15 p < 0.05). B score correlated with Gastrointestinal Risk Level score (r = 0.27 p < 0.05) and Cardiovascular Risk Level score (r = 0.38 p < 0.05). There was a correlation between the score of CF and Gastrointestinal Risk Level score (r = 0.25 p < 0.05) and Cardiovascular Risk Level score (r = 0.31 p < 0.05). Daily energy, fibre, vitamin B1 and C, folate, calcium and magnesium intakes of nurses were lower than the recommended. Conclusions Research results support that the gastrointestinal and cardiovascular systems have a direct relationship with stress and emotional states. In the policies to be developed within the scope of occupational health nursing practices, it is recommended to carry out studies to improve the physical health and nutritional behaviours of nurses in order to improve their work-related quality of life. Key messages • Nurses are a risky occupational group in terms of burnout. Protection studies should be prioritised to prevent burnout. • Gastrointestinal and cardiovascular system complaints of nurses should be paid special attention during recruitment and periodic examinations.

Heat-related risk in outdoor workers in the context of climate change: a systematic review

Abstract Background Climate change is one of the paramount challenges in the current global health setting. From an occupational health perspective, outdoor workers are amongst the most vulnerable populations to climate change and heat-related risk. A systematic review was performed, aiming to assess heat-related health outcomes in outdoor workers. Methods The research query was structured using the Population, Intervention, Comparison and Outcome (PICO) model, and including synonyms and Medical Subject Headings (MeSH) terms for the following keywords: “outdoor workers”, “climate change”, and “occupational risk”. The systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, screening three databases (PubMed, Web of Science, and Scopus). Results After duplicate removal and title and abstract screening, the final screening by full-text resulted in 10 included studies. The included studies were performed mostly on construction (included in 5 studies, 50.0%) and agriculture (in 5 studies, 50.0%) workers. Eight studies (80.0%) had a majority of male workers, while one (10.0%) had a majority of female workers, and one study (10.0%) did not report on the gender ratio. Four of the included studies (40.0%) reported a high prevalence of heat-related symptoms, ranging from 64.0% to 90.3% of workers. Three studies (30.0%) showcased a prevalence of heat-related symptoms in less than 50% of workers (ranging from 11.6% to 47.5%). Three studies (30.0%) evaluated odds ratio, highlighting an increased odds ratio of heat-related symptoms in outdoor workers. Conclusions This systematic review highlights heat-related stress in outdoor workers as an important occupational risk. Mitigation and prevention strategies should be developed and implemented at a company, national, and supra-national level, to ensure the safety and wellbeing of outdoor workers worldwide. Key messages • A systematic review was performed to assess risks related to climate change in outdoor workers. Heat-related symptoms were reported with a high prevalence, ranging from 64.0% to 90.3% of workers. • Mitigation and prevention strategies should be developed and implemented at a company, national, and supra-national level, to ensure the safety and wellbeing of outdoor workers worldwide.

Burnout as a multidimensional phenomenon: How can workplaces be healthy environments?

Abstract Purpose Burnout was already a significant problem before the pandemics, but in the aftermath became a serious concern and a public health and occupational health priority. This study had two aims. First, it investigated how different healthy workplace dimensions and other health individual-level variables are related to burnout. Second, it examined differences in terms of presentism, absenteeism, quality of life between employees who report burnout symptoms and those who do not. Methods Participants were 1702 Portuguese employees from various organizations. 69.68% were female, age ranged from 18 to 72 years (M = 43.25 years, SD = 10.40). Almost half of the participants (49.9%; 851 participants) reported having at least one burnout symptom. Results Participants reported that they have felt exhausted (43.7%), irritated (34.5%) and sad (30.5%) always or very often in the last 4 weeks. Regression analysis revealed that the global score on burnout symptoms was negatively related to leadership engagement, psychosocial work environment, personal health resources, health behaviours, and satisfaction with salary. In addition, the global score on burnout symptoms was positively related to worker involvement, enterprise community involvement, perceived stress, and screen time at work. Furthermore, females tend to report a higher level of burnout symptoms compared to males. In addition, burnout has an impact on sickness absenteeism, presentism, and quality of life. Conclusions Our findings have an important contribution to understanding and promoting a healthier work environment and reinforce the need for measures and policies to promote mental health, manage stress, and prevent burnout in the workplace. Key messages • What best explains the burnout symptoms is the workers’ perceived stress, followed by psychosocial risk factors at work. • There is a positive relationship between perceived stress and burnout: effective work stress management is one of the protective factors that prevents burnout.

Understanding labour exploitation as a social determinant of health in migrant populations – insights from the Danish population-based registers

Abstract Despite recent global events such as the COVID-19 pandemic and the Qatar world cup drawing attention to the significant loss of human lives of labour migrants in precarious working conditions, evidence on the comparative mortality of migrant workers remains sparse and inconsistent. Studying the comparative mortality of migrant workers with local workers is challenging for several reasons. Data on migrants’ employment conditions and health outcomes are often incomplete, and when available captured in separate databases. In addition, there is a need to disentangle the healthy migrant effect from the healthy worker effect, which presents challenges in the selection of reference populations and temporality when studying mortality of migrants. In view of such challenges, Denmark provides an ideal context to study labour migration and mortality. The Danish population-based registers offer linked longitudinal data on migrants’ employment history and mortality outcomes. Denmark’s migrant integration policy also has a history of weaving immigration and labour policies, and migrants in Denmark continue to be prone to labour exploitation in high-risk industries such as construction and agriculture. This presentation shall use Denmark as a case study to compare the mortality outcomes of migrant workers with Danish workers to better understand labour exploitation as a social determinant of health.