Assessing the quality of evidence in studies estimating prevalence of exposure to occupational risk factors: The QoE-SPEO approach applied in the systematic reviews from the WHO/ILO Joint Estimates of the Work-related burden of disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) have produced the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). For these, systematic reviews of studies estimating the prevalence of exposure to selected occupational risk factors have been conducted to provide input data for estimations of the number of exposed workers. A critical part of systematic review methodology is to assess the quality of evidence across studies. In this article, we present the approach applied in these WHO/ILO systematic reviews for performing such assessments on studies of prevalence of exposure. It is called the Quality of Evidence in Studies estimating Prevalence of Exposure to Occupational risk factors (QoE-SPEO) approach. We describe QoE-SPEO's development to date, demonstrate its feasibility reporting results from pilot testing and case studies, note its strengths and limitations, and suggest how QoE-SPEO should be tested and developed further. METHODS: Following a comprehensive literature review, and using expert opinion, selected existing quality of evidence assessment approaches used in environmental and occupational health were reviewed and analysed for their relevance to prevalence studies. Relevant steps and components from the existing approaches were adopted or adapted for QoE-SPEO. New steps and components were developed. We elicited feedback from other systematic review methodologists and exposure scientists and reached consensus on the QoE-SPEO approach. Ten individual experts pilot-tested QoE-SPEO. To assess inter-rater agreement, we counted ratings of expected (actual and non-spurious) heterogeneity and quality of evidence and calculated a raw measure of agreement (Pi) between individual raters and rater teams for the downgrade domains. Pi ranged between 0.00 (no two pilot testers selected the same rating) and 1.00 (all pilot testers selected the same rating). Case studies were conducted of experiences of QoE-SPEO's use in two WHO/ILO systematic reviews. RESULTS: We found no existing quality of evidence assessment approach for occupational exposure prevalence studies. We identified three relevant, existing approaches for environmental and occupational health studies of the effect of exposures. Assessments using QoE-SPEO comprise three steps: (1) judge the level of expected heterogeneity (defined as non-spurious variability that can be expected in exposure prevalence, within or between individual persons, because exposure may change over space and/or time), (2) assess downgrade domains, and (3) reach a final rating on the quality of evidence. Assessments are conducted using the same five downgrade domains as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach: (a) risk of bias, (b) indirectness, (c) inconsistency, (d) imprecision, and (e) publication bias. For downgrade domains (c) and (d), the assessment varies depending on the level of expected heterogeneity. There are no upgrade domains. The QoE-SPEO's ratings are "very low", "low", "moderate", and "high". To arrive at a final decision on the overall quality of evidence, the assessor starts at "high" quality of evidence and for each domain downgrades by one or two levels for serious concerns or very serious concerns, respectively. In pilot tests, there was reasonable agreement in ratings for expected heterogeneity; 70% of raters selected the same rating. Inter-rater agreement ranged considerably between downgrade domains, both for individual rater pairs (range Pi: 0.36-1.00) and rater teams (0.20-1.00). Sparse data prevented rigorous assessment of inter-rater agreement in quality of evidence ratings. CONCLUSIONS: We present QoE-SPEO as an approach for assessing quality of evidence in prevalence studies of exposure to occupational risk factors. It has been developed to its current version (as presented here), has undergone pilot testing, and was applied in the systematic reviews for the WHO/ILO Joint Estimates. While the approach requires further testing and development, it makes steps towards filling an identified gap, and progress made so far can be used to inform future work in this area.

Exposure to SARS-CoV-2 at work and coronavirus disease (COVID-19): Survey with workers

IntroductionWith COVID-19 world dissemination, WHO declared a Public Health Emergency of International Relevance on March, 11th, 2020. In the face of absent effective treatment or vaccine for all, workers unable to comply with social distance were subjected to company health and security management policies. This study explored the knowledge on workspace safety measures.Methods2002 workers had accessed to self-reporting forms from December/2020 through March/2021. From these, over a thousand answered some of the questions, while 687 had filled most of the forms on the RedCap platform.ResultsFrom 687 workers distributed in 22 Units of Federation, the greater representation were SP (33%), RJ (30%) RS (19%) states. The majority belonging to health (22%), post office (11,3%), services (9,5%), education (9%) and extractive industry (9%). Participants were 54% women and 59% white. Among them, 24% were confirmed as positive for COVID-19. More than half (53%) believed contamination occurred at or during commute to work and 18% were undetermined. Regarding capacitation promoted by employers, 63% reported it as non-present or insufficient. The majority (70%) considered the collective space to address preventive measures as absent and/or insufficient, as well sanitary barriers use in employee and costumer distancing (2 m). 55% stated individual protection equipment were not supplied regularly and sufficiently since the beginning of pandemic.ConclusionThe findings in this study revealed deficiencies in contingency plans adopted by companies and workplace safety measures policy as well. Furthermore, inadequate protection equipment supply during COVID-19 pandemic was also reported. This situation increased insecurity and exposure risk to SARS-CoV-2 in workers, reducing preventive measures effectiveness to mitigate pandemic, turning workplace in an important locus for virus spread. Financial support: Vice-Presidency of Environment, Attention and Health Promotion of the Oswaldo Cruz Foundation and Public Ministry of Labor - 4th Region.