Survey to assess the feasibility of establishing an international network for evidence synthesis in occupational safety and health.

BACKGROUND: Evidence synthesis in the field of occupational safety and health (OSH) has been continuously growing over the last two decades. With over 100 systematic reviews now published, the Cochrane Work Review group has played an important role in this development and the Cochrane Thematic Group 'Work & Health & Social Security' was established recently to combine evidence from both the OSH and insurance medicine fields. Worldwide, many organizations produce and synthesize evidence in OSH that can complement and support each other. We believe that a global network including Cochrane and others can collaborate on methods development and in the production, synthesis, use and dissemination of different types of evidence even more effectively. AIMS: To determine if establishing a global network for evidence synthesis in OSH is feasible. METHODS: We conducted a survey of international and national institutions between November 2022 and January 2023 using LimeSurvey. Participants included representatives of affiliated and sustaining members of the International Commission on Occupational Health, national institutes for OSH, academia and other international organizations. RESULTS: From 151 invitations, we received responses from 57 representatives of 54 organizations. Representatives reported that their organization will contribute financially on an annual basis (n = 1) or provide in-kind support (n = 10), and will probably be able to provide financial or in-kind support (n = 25). CONCLUSIONS: The feasibility criterion was met and an international network is being established.

Role of shift work in dietary changes among Danish nurses.

BACKGROUND: Research indicates that shift work is associated with dietary changes and the development of chronic diseases. AIMS: To assess if moving from day work into shift work is associated with dietary changes in Danish nurses. METHODS: Binary variables of changes in food consumption were created using data from the 1993 and 1999 surveys of the Danish Nurse Cohort. Analyses were carried out using multiple logistic regression in SPSS to assess how dietary practices changed in nurses who moved from day work into shift work compared with those who remained in day work. RESULTS: This study included 763 nurses who changed from Day to Shift work and 4022 nurses who continued to work days. Nurses who moved from day work into shift work were more likely to decrease their potato and vegetable intake odds ratio (OR) 1.31 (1.04-1.63). There was no difference in the frequency of coffee, milk or cheese consumption. New shift workers consumed more fatty meat OR 1.82 (1.23-2.69), sausages OR 1.37 (1.09-1.73) and cream/whipped cream/butter OR 1.61 (1.25-2.07) when they had avoided these foods in the past, compared to those who remained in day work. CONCLUSIONS: The majority of Danish nurses made little change to their diet as a result of moving into shift work, but some made dietary changes that were generally unhealthy compared with those who remained in day work. Employers of nurses should consider implementing health promotional activities, facilitating access and/or providing healthy eating options in nurses moving from Day to Shift work.

Factors associated with sickness absence in a large NHS Trust.

BACKGROUND: Sickness absence rates vary widely across a large acute NHS Trust, with the highest rates in some of the largest directorates. AIMS: This study was aimed to identify factors associated with sickness absence in teams and to inform interventions to improve staff health and well-being. METHODS: Using 2018 data from the electronic staff record and NHS Staff Survey, we examined variables associated with cost centre sickness absence rates, perceived abuse and staff engagement scores using multivariable linear regression. RESULTS: Data were available for 9362/15 423 (61%) of staff. Cost centre sickness absence was significantly positively associated with predominance of nursing and midwifery staff (ß = 0.28 [0.012-0.55]) and significantly inversely associated with predominance of medical and dental staff (ß = -0.94 [-1.2 to -0.65]) and proportion white (ß = -1.11 [-1.9 to -0.37]). Cost centre sickness absence was not significantly associated with staff engagement, reported abuse, age or higher headcount. Cost centre staff engagement was significantly positively associated with proportion white (ß = 0.98 [0.42-1.6]). Reported abuse by managers (ß = -13 [-22 to -4.2]) and by colleagues (ß = -24 [-35 to -12]) was significantly inversely associated with proportion white. Reported abuse by colleagues was significantly associated with predominance of medical and dental (ß = 7.6 [2.3-13]) and nursing and midwifery staff (ß = 9.1 [4.4-14]). CONCLUSIONS: These observed associations of sickness absence, staff engagement and perceived abuse with job mix and ethnicity should be further explored. Individual or team-level data, rather than cost centre-level data, might more meaningfully elucidate why sickness absence rates vary between groups of staff.

Lung cancer mortality in a cohort of UK cotton workers: an extended follow-up.

BACKGROUND: A recent systematic review and meta-analysis suggested that occupational exposure to endotoxins protects against lung cancer. To explore this hypothesis further, the follow-up of mortality of a cohort of 3551 workers, who were employed in the British cotton industry during 1966-1971, was extended by 23 years. METHODS: Subjects had originally been recruited to a survey of respiratory disease, which collected information about occupation and smoking habits. Cumulative exposures to endotoxins were estimated from data on endotoxin levels by work areas in cotton mills. Risks of lung cancer were estimated using survival modelling. RESULTS: During follow-up, 2018 deaths were recorded before the age of 90 years, including 128 deaths from lung cancer. After adjustment for smoking, hazard ratios (95% confidence intervals) for cumulative endotoxin exposures of ≤30,000, >30,000 and ≤200,000, >200,000 and ≤400,000, >400,000 and ≤600,000 and >600,000 endotoxin units (EU) m(-3) years were 1, 0.8 (0.5-1.6), 0.7 (0.4-1.3), 0.6 (0.3-1.0) and 0.5 (0.3-0.9), respectively (P for trend=0.005). CONCLUSION: Our findings strengthen the evidence that occupational exposure to endotoxins protects against lung cancer, and suggest that the effect depends on cumulative dose and persists after exposure ceases.

Mortality and cancer registration experience of the Sellafield workers known to have been involved in the 1957 Windscale accident: 50 year follow-up.

This paper studies the mortality and cancer morbidity of the 470 male workers involved in tackling the 1957 Sellafield Windscale fire or its subsequent clean-up. Workers were followed up for 50 years to 2007, extending the follow-up of a previously published cohort study on the Windscale fire by 10 years. The size of the study population is small, but the cohort is of interest because of the involvement of the workers in the accident. Significant excesses of deaths from diseases of the circulatory system (standardised mortality ratio (SMR) = 120, 95% CI = 103-138; 194 deaths) driven by ischaemic heart disease (IHD) (SMR = 133, 95% CI = 112-157, 141 deaths) were found when compared with the population of England and Wales but not when compared with the population of Northwest England (SMR = 105, 95% CI = 90-120 and SMR = 115, 95% CI = 97-136 respectively). When compared with those workers in post at the time of the fire but not directly involved in the fire the mortality rate from IHD among those involved in tackling the fire was raised but not statistically significantly (rate ratio (RR) = 1.11, 95% CI = 0.92-1.33). A RR of 1.11 is consistent with an excess relative risk of 0.65 Sv(-1) as reported in an earlier study of non-cancer mortality in the British Nuclear Fuels plc cohort of which these workers are a small but significant part. There was a statistically significant difference in lung cancer mortality (RR = 2.18, 95% CI = 1.05-4.52) rates between workers who had received higher recorded external doses during the fire and those who had received lower external doses. Comparison of the mortality rates of workers directly involved in the accident with workers in post, but not so involved, showed no significant differences overall. On the basis of the use of a propensity score the average effect of involvement in the Windscale fire on all causes of death was - 2.13% (se = 3.64%, p = 0.56) though this difference is not statistically significant. The average effect of involvement in the Windscale fire was - 5.53% (se = 3.81, p = 0.15) for all cancers mortality and 6.60% (se = 4.03%, p = 0.10) for IHD mortality though neither figure was statistically significant. This analysis of the mortality and cancer morbidity experience of those Sellafield workers involved in the 1957 Windscale fire does not reveal any measurable effect of the fire upon their health. Although this study has low statistical power for detecting small adverse effects, due to the relatively small number of workers, it does provide reassurance that no significant health effects are associated with the 1957 Windscale fire even after 50 years of follow-up.

Mortality among British asbestos workers undergoing regular medical examinations (1971-2005).

OBJECTIVES: The Great Britain Asbestos Survey was established to monitor mortality among workers covered by regulations to control occupational exposure to asbestos. This study updates the estimated burden of asbestos-related mortality in the cohort, and identifies risk factors associated with mortality. METHODS: From 1971, workers were recruited during initially voluntary and later statutory medical examinations. A brief questionnaire was completed during the medical, and participants were flagged for death registrations. Standardised mortality ratios (SMRs) and proportional mortality ratios (PMRs) were calculated for deaths occurring before 2006. Poisson regression analyses were undertaken for diseases with significant excess mortality. RESULTS: There were 15 496 deaths among 98 117 workers followed-up for 1 779 580 person-years. The SMR for all cause mortality was 141 (95% CI 139 to 143) and for all malignant neoplasms 163 (95% CI 159 to 167). The SMRs for cancers of the stomach (166), lung (187), peritoneum (3730) and pleura (968), mesothelioma (513), cerebrovascular disease (164) and asbestosis (5594) were statistically significantly elevated, as were the corresponding PMRs. In age and sex adjusted analysis, birth cohort, age at first exposure, year of first exposure, duration of exposure, latency and job type were associated with the relative risk of lung, pleural and peritoneal cancers, asbestosis and mesothelioma mortality. CONCLUSIONS: Known associations between asbestos exposure and mortality from lung, peritoneal and pleural cancers, mesothelioma and asbestosis were confirmed, and evidence of associations with stroke and stomach cancer mortality was observed. Limited evidence suggested that asbestos-related disease risk may be lower among those first exposed in more recent times.

Occupational exposure to asbestos and mortality among asbestos removal workers: a Poisson regression analysis.

The asbestos industry has shifted from manufacture to stripping/removal work. The aim of this study was to investigate early indications of mortality among removal workers. The study population consisted of 31 302 stripping/removal workers in the Great Britain Asbestos Survey, followed up to December 2005. Relative risks (RR) for causes of death with elevated standardised mortality ratios (SMR) and sufficient deaths were obtained from Poisson regression. Risk factors considered included dust suppression technique, type of respirator used, hours spent stripping, smoking status and exposure length. Deaths were elevated for all causes (SMR 123, 95% CI 119-127, n=985), all cancers including lung cancer, mesothelioma, and circulatory disease. There were no significant differences between suppression techniques and respirator types. Spending more than 40 h per week stripping rather than less than 10, increased mortality risk from all causes (RR 1.4, 95% CI 1.2-1.7), circulatory disease and ischaemic heart disease. Elevated mesothelioma risks were observed for those first exposed at young ages or exposed for more than 30 years. This study is a first step in assessing long-term mortality of asbestos removal workers in relation to working practices and asbestos exposure. Further follow-up will allow the impact of recent regulations to be assessed.

The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050.

The British mesothelioma register contains all deaths from 1968 to 2001 where mesothelioma was mentioned on the death certificate. These data were used to predict the future burden of mesothelioma mortality in Great Britain. Poisson regression analysis was used to model male mesothelioma deaths from 1968 to 2001 as a function of the rise and fall of asbestos exposure during the 20th century, and hence to predict numbers of male deaths in the years 2002-2050. The annual number of mesothelioma deaths in Great Britain has risen increasingly rapidly from 153 deaths in 1968 to 1848 in 2001 and, using our preferred model, is predicted to peak at around 1950 to 2450 deaths per year between 2011 and 2015. Following this peak, the number of deaths is expected to decline rapidly. The eventual death rate will depend on the background level and any residual asbestos exposure. Between 1968 and 2050, there will have been approximately 90,000 deaths from mesothelioma in Great Britain, 65,000 of which will occur after 2001.

Investigating and analysing workplace clusters of diseases: a Health & Safety Executive perspective.

BACKGROUND: Clusters of disease arising in workplaces cause concern among the management of the company, the workers affected and their families and friends. Chance is the most likely explanation for their occurrence, although a number of real workplace hazards have been identified through their observation and investigation. Employers have a duty to investigate such occurrences in order to assess whether some unknown or unidentified hazard is at work and to take the appropriate action. Several papers have been published over the last 15 years or so that set out a method for investigating workplace clusters of disease. Aims This paper presents the steps in the approach taken by the Health & Safety Executive in Great Britain. METHOD: An initial step identifies the relevant stakeholders at the outset, in order to maintain a realistic expectation of what the investigation can hope to achieve and to open a dialogue. The main steps in the assessment are: (1) identifying cases; (2) determining the other parameters of the investigation; (3) statistically assessing the cluster; (4) examining potential exposures and assessing their biological plausibility; and (5) determining the overall significance of the cluster. The approach is illustrated throughout by examples.

Update of the follow-up of mortality and cancer incidence among European workers employed in the vinyl chloride industry.

Although vinyl chloride is an established cause of liver angiosarcoma, the evidence is inconclusive on whether it also causes other neoplastic and nonneoplastic chronic liver diseases as well as neoplasms in other organs. Furthermore, the shape of the dose-response relation for angiosarcoma is uncertain. We have extended for approximately 8 years the mortality and cancer incidence follow-up of 12,700 male workers in the vinyl chloride industry in four European countries. All-cause mortality was lower than expected, whereas cancer mortality was close to expected. A total of 53 deaths from primary liver cancer (standardized mortality ratio 2.40, 95% confidence interval = 1.80-3.14) and 18 incident cases of liver cancer were identified, including 37 angiosarcomas, 10 hepatocellular carcinomas, and 24 liver cancers of other and unknown histology. In Poisson regression analyses we observed a marked exposure response for all liver cancers, angiosarcoma, and hepatocellular carcinoma. The exposure-response trend estimated for liver cancer in analyses restricted to cohort members with cumulative exposures of <1,500 parts per million-years was close to that estimated for the full cohort (relative risk of 2.0 per logarithmic unit of cumulative dose). No strong relation was observed between cumulative vinyl chloride exposure and other cancers. Although cirrhosis mortality was decreased overall, there was a trend with cumulative exposure.

Self-reported skin problems among physical processors in the chemical industry in Great Britain.

Contact dermatitis is common in the chemical industry. A cross-sectional study was conducted to investigate the prevalence of self-reported skin problems in employees involved in the drying, blending, milling, grinding and filling/bagging end of chemical manufacture in small- to medium-sized contract manufacturing/processing chemical companies in Great Britain. There were several secondary aims. Twenty-three per cent of the employees interviewed reported having had a skin problem in the previous 12 months. Of those reporting problems, 46% were always/nearly always involved in blending and 56% were always/nearly always involved in filling and bagging. These same processes were also more commonly associated with continuous or recurring skin problems. Seventy-five per cent reported a problem involving the upper limbs; most had more than one body area affected. Forty-three per cent had consulted a doctor (67% their general practitioner) and 9% took time off work as a result of their skin condition. Skin problems seemed to peak (34% employees) in those who had spent between 1 and 2 years in their current job. Solvents, known skin irritants, were the most frequent, single category of chemicals encountered in the study. Over 92% had been told how to avoid skin problems; 85% reported that they always/almost always wore protective clothing. Despite these measures, a significant number had reported having had a skin problem related to their work in the previous 12 months. Particular attention to control measures based on risk assessment is recommended for these physical processors in the chemical industry. Further research is also recommended into the whole area of personal protective clothing and the individual worker's perception of risks to health in the workplace.

Some practical issues in the design, monitoring and analysis of a sequential randomized trial in pressure sore prevention.

A sequential double blind (assessor and patient) triangular design was used to compare the incidence of pressure sores following elective major surgery among patients lying on a standard foam mattress with those on a dry visco-elastic polymer pad during their operation. A total of 446 patients were recruited into the trial between 1994 and 1996. Interim analyses were carried out after 181 patients were entered into the trial and then subsequently after approximately every 100 patients recruited. The trial unexpectedly reached a stopping boundary at the first interim analysis, however the Independent Data Monitoring Committee recommended continuation of the trial. They were concerned that there was a need for a larger definitive trial and about an apparent treatment by centre interaction. They required a substudy to be undertaken to further validate the subjective endpoint, and that further sensitivity analyses of the main trail endpoint should be carried out in the second interim analysis. The trial was stopped at the third interim analysis when again a stopping boundary was crossed indicating that the gel pad was associated with significantly fewer pressure sores than the standard mattress (log odds ratio -0.7, (95 per cent confidence interval (CI), -1.28, -0.11), p=0.02) (estimate CI, p-value adjusted for group sequential conduct). The design, monitoring and analysis of this trial will be presented as an example of the practical problems or non-problems encountered for the local hospitals, for the trials unit, for the data monitoring committee and for the funding committee.

Prognostic factors associated with pressure sore development in the immediate post-operative period.

The purpose of this study was to identify variables associated with post-operative pressure sore incidence. The data were derived from a sequential, double triangular, randomised, blinded, controlled trial of the intra-operative use of a visco-elastic polymer pad conducted at two centres. Of 446 surgical patients recruited the main endpoint was assessed for 416 patients of whom 65 (15.6%) had a post-operative pressure sore. Analysis determined that the probability of a patient developing a pressure sore was associated with increased number of hypotensive episodes and mean core temperature during surgery, and reduced mobility Day 1 post-operatively. The development of a probability equation illustrates the future potential of prognostic factor research in the development of risk assessment tools and their application within clinical settings.

Spontaneous abortion in the British semiconductor industry: An HSE investigation. Health and Safety Executive.

BACKGROUND: The UK Health and Safety Executive (HSE) conducted a study to examine the risk of spontaneous abortion (SAB) in British female semiconductor industry workers, following reports from the USA which suggested an association between risk of SAB and work in fabrication rooms and/or exposure to ethylene glycol ethers. METHODS: A nested case-control study based on 2,207 women who had worked at eight manufacturing sites during a 5-year retrospective time frame was established; 36 cases were matched with 80 controls. RESULTS: The overall SAB rate in the industry was 10.0%. (65 SABs/651 pregnancies) The crude odds ratio (OR) for fabrication work was 0.65 (95% CI 0.30-1.40). This was essentially unchanged after adjustment for a range of potential confounding factors in the first 3 months of pregnancy and was reduced to 0.58 (95% CI 0.26-1.30) after adjustment for smoking in the previous 12 months. There were no statistically significantly elevated ORs for any work group or any specific chemical or physical exposure in the industry. CONCLUSIONS: There is no evidence of an increased risk of SAB in the British semiconductor industry. Am. J. Ind. Med. 36:557-572, 1999. Published 1999 Wiley-Liss, Inc.

A sequential randomised controlled trial comparing a dry visco-elastic polymer pad and standard operating table mattress in the prevention of post-operative pressure sores.

Four hundred and forty-six general, vascular and gynaecological surgical patients were recruited to a two centre, double triangular sequential randomised controlled trial to compare the post-operative pressure sore incidence in patients positioned on the standard operating table mattress with those positioned on the dry visco-elastic polymer pad (Action Products Inc.). Two hundred and twenty two patients were randomised to the experimental group and 224 to the standard mattress. The main endpoint failure rate (a pressure sore) was found to be 11% (22/205) for patients allocated to the dry visco-elastic polymer pad and 20% (43/211) for patients allocated to the standard operating table mattress. There was a significant reduction in the odds of developing a pressure sore on the dry visco-elastic polymer pad as compared to the standard, [symbol see text] = 0.46 with 95% confidence interval of (0.26, 0.82), P = 0.010. The adjusted point estimates of the probability of developing a pressure sore on the dry visco-elastic polymer pad and the standard operating table mattress were 0.11 and 0.21 respectively.

Geographical distribution of preconceptional radiation doses to fathers employed at the Sellafield nuclear installation, West Cumbria.

OBJECTIVE: To examine whether the geographical distribution of births associated with preconceptional exposure of fathers to radiation at the Sellafield nuclear installation is consistent with the suggestion that this exposure explains the excess of childhood lymphoid malignancy in the adjacent village of Seascale. DESIGN: Retrospective birth cohort study. SETTING: Cumbria, West Cumbria health district, and Seascale civil parish. SUBJECTS: The 10,363 children born in Cumbria during 1950-89 to fathers employed at Sellafield. MAIN OUTCOME MEASURES: The doses of external whole body ionising radiation received by fathers at Sellafield in the total time and in the six months before conception of their children; the proportions of the collective doses associated with Seascale and the rest of West Cumbria. RESULTS: 9256 children were born to fathers who had been exposed to radiation before the child's conception. Of these, 7318 had fathers who were exposed in the six months before conception. Overall 7% (38 person-Sv) of the collective total preconceptional dose and 7% (3 person-Sv) of the collective dose for the six months before conception were associated with children born in Seascale. Of all the children whose fathers worked at Sellafield, 842 (8%) were born in Seascale. The mean individual doses before conception were consistently lower in Seascale than in the rest of West Cumbria. CONCLUSIONS: The distribution of the paternal preconceptional radiation dose is statistically incompatible with this exposure providing a causal explanation for the cluster of childhood leukaemias in Seascale.