Implications of applying cumulative risk assessment to the workplace

What occupational risk factors significantly affect miners' health: Findings from meta-analysis and association rule mining

INTRODUCTION

The workplace's health hazard remains a significant concern to workers in the mining industry, where miners are continually exposed to various kinds of exposure sources.

METHOD

First, the determinants of miners' health were systematically extracted from 259 publications, comprising chemical, physical, ergonomic, and psychosocial stressors, vulnerability factors, and common health outcomes. Then, 16 meta-analyses were performed to ascertain the epidemiological evidence for associations between four stressors and three health outcomes. The seven top contributing factors affecting miners' health were identified through 166 available prospective studies. Finally, based on the classic and domestic measurement scales, a cross-sectional survey of 559 Chinese miners was conducted to determine the core psychosocial predictors. In addition to the traditional mechanisms, complex interactive networks among the antecedents and consequences and the reversed effects of consequences were also obtained, where 379 strong association rules were yielded via the Apriori algorithm.

RESULTS

The results showed that occupational dust, NO2, heavy metals, heat, vibration, awkward posture, and job stress are significant risk factors associated with individuals' health conditions. Psychological capital, coping style, job demand, social support, organizational support, justice, and culture are core psychosocial predictors of miners.

CONCLUSIONS

This study presents a case for identifying the most significant occupational risk factors related to individuals' health, which could be extended and applied to other industries, as working populations around the world are suffering from various chemical, physical, ergonomic, and psychosocial stressors.

PRACTICAL APPLICATIONS

Identifying the significant occupational risk factors affecting workers' health conditions is essential for comprehensive occupational health risk assessment and management. Therefore, this study could be important for health management in mines and other industries.

Cumulative risk assessment for combinations of environmental and psychosocial stressors: A systematic review

With the growing awareness of stressors, cumulative risk assessment (CRA) has been proposed as a potential method to evaluate possible additive and synergistic effects of multiple stressors on human health, thus informing environmental regulation and protecting public health. However, CRA is still in its exploratory stage due to the lack of generally accepted quantitative approaches. It is an ideal time to summarize the existing progress to guide future research. To this end, a systematic review of the literature on CRA issues dealing with combinations of environmental and psychosocial stressors was conducted in this study. Using typology and bibliometric analysis, the body of knowledge, hot topics, and research gaps in this field were characterized. It was found that research topics and objectives mainly focus on qualitative analysis and community settings; more attention should be paid to the development of quantitative approaches and the inclusion of occupational settings. Further, the roles of air pollution and vulnerability factors in CRA have attracted the most attention. This study concludes with views on future prospects to promote theoretical and practical development in this field; specifically, CRA is a multifaceted topic that requires substantial collaborations with various stakeholders and substantial knowledge from multidisciplinary fields. This study presents an overall review as well as research directions worth investigating in this field, which provides a historical reference for future study. Integr Environ Assess Manag 2024;20:602-615. © 2023 SETAC.

Cumulative risk assessment of dietary exposure to phthalates in pregnant women in Beijing, China

Diet is an important exposure route for phthalates, such as di-iso-butyl phthalate (DiBP), dibutyl phthalate (DBP), bis(2-ethylhexyl) phthalate (DEHP), and benzyl butyl phthalate (BBP). In this study, we aimed to estimate phthalate exposure in the diet of pregnant women and assess the health risk. A total of 517 pregnant women in the first trimester were recruited, and food frequency questionnaires were collected. A simple distribution assessment method was used to estimate daily exposure, and the hazard index (HI) method was used to assess cumulative risk. The maximum daily dietary exposure to DEHP, DBP, DiBP, and BBP was 5.25, 3.17, 2.59, and 0.58 μg/kg bw/day, respectively, and did not exceed the safety limit values. Cereals and vegetables were the main sources of the estimated daily intake (EDI) of phthalates in the diet. The cumulative risk assessment, based on the European Food Safety Authority tolerable daily intake (TDI) and the US Environmental Protection Agency reference dose (RfD), did not exceed the threshold of 1. DiBP, DBP, and DEHP had higher hazard quotient (HQ) values for cumulative health risk than BBP. In conclusion, a low health risk was posed by the cumulative dietary exposure to phthalates for pregnant women in Beijing.

Pilot study and cumulative risk framework to advance long-haul driver health

Commercial drivers are essential to the economic recovery, yet their work exposes them to many health and safety hazards. Research to improve driver health should be designed with an understanding of both the complex occupational environment and the risk management context. We present results from a small pilot study of driver health concerns and behaviors to illustrate concepts and frameworks from human health risk assessment and management that may assist in the design and translation of driver and other worker health research. The pilot study surveyed 18 long-haul truck drivers at a truck stop using an instrument adapted from the International Physical Activity Questionnaire and a transient community needs assessment developed for the US Antarctic Program Recreation and Wellness Survey. Respondents' characteristics and health concerns reflect existing literature: mostly male of older age with musculoskeletal and chronic health conditions. The two most common barriers to physical activity were lack of time and physical limitations. Applying cumulative risk assessment and risk-based decision-making frameworks, we suggest that preventive health management opportunities can be improved for these transient workers through actions of employers, truck stop owners and their communities. Considering lessons learned in implementing the pilot, cumulative risk assessment, and risk-based decision making in research design can facilitate holistic research considering co-exposures, risk factors and mitigators across multiple domains of health to inform worker protection.

Risk management in occupational safety: A systematic mapping

BACKGROUND

Occupational safety risk management is a systemic process capable of promoting technical engineering solutions, considering a wide range of predictable, unexpected and subjective factors related to accident occurrences. In Brazil, the behavior of managers in relation to risk management tends to be reactive, and facilitates access to information for crucial practical and academic purposes when it comes to changing the attitude of managers, so that their actions become increasingly more proactive.

OBJECTIVE

To identify, classify, analyze, and discuss the existing literature related to the topic, produced from 2008 to 2020, besides contributing to a broader understanding of risk management in occupational safety.

METHODS

We did a systematic literature mapping. The research process was documented starting by the planning stage. Afterwards, the focus was on research conduction and information synthesis.

RESULTS

Knowledge systematization and stratification about OHS risk management through various perspectives to identify, analyze and manage risks in the workplace. Were identified 37 tools for identifying and analyzing risks, management-related practices and future research trends.

CONCLUSIONS

The set of tools and management practices identified can be used as a support for decision making in the selection process of tools and practices to reduce risks and improve occupational safety. Also, the results can help target future research.

COVID-19 Stressors on Migrant Workers in Vietnam: Cumulative Risk Consideration

This study explored the impact of COVID-19 on migrant workers in Vietnam, using a cumulative risk assessment (CRA) framework which comprises four domains (workplace, environment, individual and community). A cross-sectional study was conducted. Data were collected in 2020 through a self-administered questionnaire with 445 domestic migrant workers in two industrial zones in two northern provinces (Bac Ninh and Ninh Binh) in Vietnam. The majority of migrant workers were female (65.2%), aged between 18 and 29 years old (66.8%), and had high school or higher education level qualifications. Most migrant workers had good knowledge about preventive measures (>90%) and correct practices on COVID-19 prevention (81.1%). Three health risk behaviors were reported: 10% of participants smoked, 25% consumed alcohol and 23.1% were engaged in online gaming. In terms of workplace, occupational working conditions were good. Noise was the most commonly reported hazard (29%). Regarding environment, about two-thirds of migrant workers lived in a small house (<36 m2). Most participants (80.4%) lived with their families. About community domain, many reported low salary or losing their job during January-July, 2020. Most migrants received information about COVID-19. The migrant workers suffered from poor health and low occupational safety, fear of job loss and income cut, poor housing and living conditions and limited access to public services. The holistic approach to address stressors is recommended to improve health and safety of migrant workers.

Identification of public health priorities, barriers, and solutions for Kuwait using the modified Delphi method for stakeholder consensus

The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.

COVID-19 infection across workplace settings in Qatar: a comparison of COVID-19 positivity rates of screened workers from March 1st until July 31st, 2020

INTRODUCTION

COVID-19 transmission was significant amongst Qatar's working population during the March-July 2020 outbreak. The study aimed to estimate the risk of exposure for COVID-19 across various workplace settings and demographics in the State of Qatar.

METHODS

A cross-sectional study was conducted utilizing surveillance data of all workplaces with 10 or more laboratory-confirmed cases of COVID-19. These workplaces were categorized using a mapping table adapted from the North American Industry Classification System (NAICS) codes, 2017 version. The data was then analyzed to estimate and compare the positivity rate as an indicator of the risk of developing COVID-19 infection across various workplace settings in the State of Qatar.

RESULTS

The highest positivity rate was reported amongst the Construction & Related (40.0%) and the Retail & Wholesale Trade sectors (40.0%), whereas, the lowest positivity rate was attributed to the healthcare workplace setting (11.0%). The highest incidence of COVID-19 infections occurred in South Asian nationalities and in the male gender. The private funded sector employees have seen higher positivity rate than employees of the governmental funded sector.

CONCLUSION

The elevated risk of infection in Construction and Retail & Wholesale Trade is probably due to environmental and educational vulnerabilities. The predominant labor force of those workplace categories is South Asian craft and male manual workers. Alternatively, the better containment of the healthcare workplace setting can be attributed to the enforcement of infection control and occupational safety measures. These findings imply the importance of using preventive and surveillance strategies for high-risk workplace settings appropriately.

Cumulative Risks from Stressor Exposures and Personal Risk Factors in the Workplace: Examples from a Scoping Review

Protecting worker and public health involves an understanding of multiple determinants, including exposures to biological, chemical, or physical agents or stressors in combination with other determinants including type of employment, health status, and individual behaviors. This has been illustrated during the COVID-19 pandemic by increased exposure and health risks for essential workers and those with pre-existing conditions, and mask-wearing behavior. Health risk assessment practices for environmental and occupational health typically do not incorporate multiple stressors in combination with personal risk factors. While conceptual developments in cumulative risk assessment to inform a more holistic approach to these real-life conditions have progressed, gaps remain, and practical methods and applications are rare. This scoping review characterizes existing evidence of combined stressor exposures and personal factors and risk to foster methods for occupational cumulative risk assessment. The review found examples from many workplaces, such as manufacturing, offices, and health care; exposures to chemical, physical, and psychosocial stressors combined with modifiable and unmodifiable determinants of health; and outcomes including respiratory function and disease, cancers, cardio-metabolic diseases, and hearing loss, as well as increased fertility, menstrual dysfunction and worsened mental health. To protect workers, workplace exposures and modifiable and unmodifiable characteristics should be considered in risk assessment and management. Data on combination exposures can improve assessments and risk estimates and inform protective exposure limits and management strategies.

Risk of cardiovascular disease is driven by different combinations of environmental, medical and behavioral factors: Building a conceptual model for cumulative risk assessment

The U.S. Environmental Protection Agency (EPA) and National Institute of Environmental Health (NIEHS) held a workshop in 2012 to discuss principles and applications of cumulative risk assessment (CRA). The workshop organizers chose cardiovascular disease (CVD) as an example health outcome for which cumulative risk considerations could illuminate environmental and health management strategies. To guide discussions, we developed a series of conceptual models illustrating factors influencing CVD. The CVD conceptual model represents complex processes across varying space and time scales, different causal pathways, and multiple chemical and non-chemical stressors and factors. It includes causal influences of environmental exposures and lifestyle choices, in the context of genetics and medical factors. The representation of cumulative risk as a network of interrelated nodes and arrows helps define and organize the problem and available information, determine the scope and scale, and creates a platform for analysis. It provides an interface for discussing how different entities (e.g., environmental versus health-driven organizations) can work together on different parts of the problem, and facilitates relative risk ranking and management triage. Color coding is used to distinguish categories of stressors and possible oversight responsibility. This work informs guidelines for CRA planning and assessment of factor combinations affecting real-world risk.

Are There Ethnic Disparities in Exposure to Workplace Hazards Among New Zealand Migrants to Australia?

Disparities in exposure to workplace hazards exist between Māori and non-Māori workers in New Zealand, with Māori workers generally incurring poorer conditions. This study aimed to determine if these ethnic disparities are similar after migration to Australia. A national cross-sectional telephone survey asked participants what tasks they undertook in their job to assess exposure to carcinogens as well as whether they experienced ethnic discrimination, bullying, job precariousness, or job strain. A total of 389 New Zealand Caucasians and 152 Māori/Pasifika workers were recruited. After adjustment, 79% of Māori/Pasifika compared with 67% of New Zealand Caucasian workers were assessed as being exposed to at least one carcinogen at work (adjusted prevalence ratio [aPR] = 1.2, 95% confidence interval [CI] = 1.1-1.4). Māori/Pasifika workers were also more likely to report ethnic discrimination (aPR = 6.9, 95% CI = 2.6-18.3) and fair or poor current health (aPR = 1.9, 95% CI = 1.1-3.2) than New Zealand Caucasians. Some ethnic disparities in exposure to workplace hazards in New Zealand are apparent after migration to Australia.

Cabin crew health and fitness-to-fly: Opportunities for re-evaluation amid COVID-19

Aircrew fitness-to-fly is among the elements that make aviation the safest form of long-distance transport. The health of cabin crew is a crucial determinant in carrying out safety-related duties. 'Fitness-to-fly' is associated with defined workplace conditions, for which airlines have a legal duty to ensure fitness for employment. We explored the literature on fitness-to-fly to obtain a pragmatic assessment of the challenges for aeromedical examinations. Regulations promulgated by aviation regulatory authorities and airline-internal policies have similar status and meaning, yet there is no harmonised approach internationally, and an inability to conform periodic medical assessments to actual operational fitness. The COVID-19 pandemic has highlighted the need to better understand fitness-to-fly criteria. Fitness-to-fly measures are mainly based on self-reported data and there is a need for a 'safety' factor for self-reports. Aeromedical evaluations should evolve from meeting medical standards to include pandemics as an element of the overall risk of aircraft operations. Re-evaluating criteria for fitness-to-fly assessment will further the goal of linking research to the actual needs of public health decisionmakers. If airlines are to resume operations at pre-pandemic levels, they must demonstrate to the public and public health agencies that fitness-to-fly assessment is appropriate and effective.

A Risk Assessment Tool for Resumption of Research Activities During the COVID-19 Pandemic

RATIONALE

The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk.

OBJECTIVES

In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial, we developed a framework to assess the risk of each trial activity and to guide protective measures. Our goal is to maximize integrity of reseach aims while minimizing infection risk based on the latest understanding of the virus.

METHODS

We drew on a combination of expert consultations, risk assessment frameworks, institutional guidance and literature to develop our framework. We then systematically graded clinical, behavioral, laboratory and field environmental health research activities in four countries for both adult and child subjects using this framework.

RESULTS

Our framework assesses risk based on staff proximity to the participant, exposure time between staff and participants, and potential aerosolization while performing the activity. One of of four risk levels, from minimal to unacceptable, is assigned and guidance on protective measures is provided. Those activities which can potentially aerosolize the virus are deemed the highest risk.

CONCLUSIONS

By applying a systematic, procedure-specific approach to risk assessment for each trial activity, we can compare trial activities using the same criteria. This approach allows us to protect our participants and research team and to uphold our ability to deliver on the research commitments we have made to our participants, local communities, and funders. The trial is registered with clinicaltrials.gov (NCT02944682).

A Cumulative Risk Perspective for Occupational Health and Safety (OHS) Professionals

Cumulative risk assessment (CRA) addresses the combined risk associated with chemical and non-chemical exposures. Although CRA approaches are utilized in environmental and ecological contexts, they are rarely applied in workplaces. In this perspectives article, we strive to raise awareness among occupational health and safety (OHS) professionals and foster the greater adoption of a CRA perspective in practice. Specifically, we provide an overview of CRA literature as well as preliminary guidance on when to consider a CRA approach in occupational settings and how to establish reasonable boundaries. Examples of possible workplace co-exposures and voluntary risk management actions are discussed. We also highlight important implications for workplace CRA research and practice. In particular, future needs include simple tools for identifying combinations of chemical and non-chemical exposures, uniform risk management guidelines, and risk communication materials. Further development of practical CRA methods and tools are essential to meet the needs of complex and changing work environments.

Cancer Risk Assessment for Workers Exposed to Pollution Source, a Petrochemical Company, Iran

Background:

Air pollution have led to severe problem of adverse health effect in the world. This study aimed to conduct the health risk assessment, cancer risk analysis, and non-cancer risk for exposure to volatile organic compounds (VOCs) and hydrogen sulfide (H ₂ S) in petrochemical industry.

Methods:

In this cross-sectional research, 123 samples were collected in the ambient air in Iran during winter 2016. For sampling and analysis of VOCs and H ₂ S, 3 methods (numbers 1500, 1501, and 6013) presented by the National Institute of Occupational Safety and Health (NIOSH) were used. For determination of risk assessment of chemical pollutants, semi-quantitative method presented by the Occupational Safety and Health Division, Singapore was used. Finally, for calculation of cancer risk analysis, Chronic Daily Intake (CDI) and calculation of non-cancer risk, Exposure Concentration (EC) were used.

Results:

Average concentration of benzene (2.12±0.95) in breathing zone of workers were higher than the Threshold Limit Values-Time Weighted Average (TLV-TWA) (P<0.05). Among chemical substance, benzene had very high rank of risk in petrochemical industry. Rank of risk for H ₂ S, toluene, and xylene present in the breathing zone of workers was low. The mean cancer risk for workers exposed to benzene was estimated 8.78×10^−3, in other words, 8.7 cancer per 1000 i.e. higher than the acceptable standard of 10⁻⁶. In our study, non-cancer risk for BTX was higher than the acceptable standard of 1.

Conclusion:

In particular, overall cancer and toxic risk can be associated with long term exposure to benzene.

COVID-19 stressors on migrant workers in Kuwait: cumulative risk considerations

As a marginalised subpopulation, migrant workers often fall short from protection by public policies, they take precarious jobs with unsafe working and living conditions and they grapple with cultural and linguistic barriers. In light of the current COVID-19 pandemic, migrant workers are now exposed to additional stressors of the virus and related responses. We applied a comprehensive qualitative cumulative risk assessment framework for migrant workers living in Kuwait. This pandemic could be one of the few examples where the stressors overlap all domains of migrant workers' lives. No single intervention can solve all the problems; there must be a set of interventions to address all domains. Local authorities and employers must act quickly to stop the spread, ensure easy access to testing and treatment, provide adequate housing and clear communication, encourage wide social support, safeguard financial protection and mental well-being and continuously re-evaluate the situation as more data are collected.