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Fritschi L, Driscoll TR, Nguyen H, Abdallah K, Carey RN. Occupational exposure to welding fume in Australia: An online survey. Aust N Z J Public Health 2024:100165. [PMID: 39039010 DOI: 10.1016/j.anzjph.2024.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/23/2023] [Accepted: 05/23/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE This survey aimed to investigate exposure to welding fume in Australian workplaces and the use of protective and control measures among workers. METHODS Data were collected via a cross-sectional online survey of workers and employers involved in welding in Australia. Survey questions focused on the determinants of exposure to welding fume, welding experience and qualifications, and use of control measures. RESULTS There were 634 respondents to the survey across Australia of whom 577 (91%) were assessed as being exposed to welding fume, most at high levels. Welders undertook a wide range of types of welding, and higher-risk welding such as in confined and restricted spaces was common. Most workplaces did not have any form of mechanical ventilation, and use of air-supplied respiratory protection was poor even when ventilation was not used. CONCLUSION Welders in Australia are exposed to several carcinogens, particularly welding fume, hexavalent chromium (CrVI) and nickel, and the use of control measures is sub-optimal. IMPLICATIONS FOR PUBLIC HEALTH Higher-order controls are the best way to reduce exposure to carcinogens in the workplace. The lack of use of these controls by Australian welders is concerning and needs to be a focus of attention by regulators and companies.
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Affiliation(s)
- Lin Fritschi
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Timothy R Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ha Nguyen
- Centre for Work Health and Safety, Sydney, New South Wales, Australia
| | - Kamil Abdallah
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Renee N Carey
- School of Population Health, Curtin University, Bentley, Western Australia, Australia.
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Kromhout H, Cherrie JW, van Tongeren M. Letter to the editor. ENVIRONMENT INTERNATIONAL 2023; 179:108107. [PMID: 37648641 DOI: 10.1016/j.envint.2023.108107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - John W Cherrie
- Institute of Occupational Medicine and Heriot-Watt University, Edinburgh, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
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3
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Friesen MC, Beane Freeman LE. Identifying occupational risk factors for cancer in women: a need for further action. Occup Environ Med 2023; 80:522-523. [PMID: 37429726 DOI: 10.1136/oemed-2023-108948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/26/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Melissa C Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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4
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Cavalin C, Lescoat A, Sigaux J, Macchi O, Ballerie A, Catinon M, Vincent M, Semerano L, Boissier MC, Rosental PA. Crystalline silica exposure in patients with rheumatoid arthritis and systemic sclerosis: a nationwide cross-sectional survey. Rheumatology (Oxford) 2023; 62:2707-2715. [PMID: 36458909 DOI: 10.1093/rheumatology/keac675] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/23/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Develop and validate a thorough exposure questionnaire to comprehensively explore crystalline silica (SiO2) exposure in the general population (gender-specific, occupational and non-occupational) and in patients with autoimmune diseases (rheumatoid arthritis (RA), systemic sclerosis (SSc)). METHODS Lifetime exposures to SiO2 in occupational and non-occupational settings were assessed using a thorough exposure questionnaire. The questionnaire was applied to a general population panel (n = 2911) sampled from the French rolling census, and to unselected patients with SSc (n = 100) and RA (n = 97). Global (GES), occupational (OES) and non-occupational (NOES) exposure scores were assessed in SSc and RA patients, and compared with up to four controls from the general population, matched by age group, sex and tobacco consumption. RESULTS Patients had higher GES than their matched controls (SSc: P = 0.001; RA: P < 0.0001) due to higher OES (P < 0.0001 for SSc and RA). Men had higher GES than women (SSc: P < 0.0001; RA: P = 0.002) due to higher OES (P < 0.0001 for SSc and RA). The NOES did not differ between men and women. In SSc patients: Men had higher GES than controls (P < 0.0001). Men and women with SSc had higher OES than controls (P < 0.0001). In RA patients: GES and OES were higher in both men (P = 0.00521; P < 0.0001) and women (P < 0.0001; P < 0.0001) than in their respective controls. Women had higher NOES than controls (P = 0.045). CONCLUSION The lifetime SiO2 exposure gap between RA and SSc patients and controls was substantially due to occupational exposure. In both diseases, men had higher exposure scores than women.
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Affiliation(s)
- Catherine Cavalin
- IRISSO, UMR CNRS-INRAE 7170-1427, Paris-Dauphine University, PSL, Paris, France
- Laboratory for Interdisciplinary Evaluation of Public Policies (LIEPP), Sciences Po,Paris, France
- Centre d'études de l'emploi et du travail (CEET, CNAM), Noisy-le-Grand, France
| | - Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Inserm, EHESP, Irset (Institute for Research in Health, Environment and Work) - UMR_S 1085, Rue du Thabor, France
| | - Johanna Sigaux
- Inserm U1125, Sorbonne Paris Nord University, Li2P, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Odile Macchi
- Investigation Department of the International Observatory of Prisons (OIP), Paris, France
- Centre for the Study of Social Movements (CEMS), École des Hautes Études en Sciences Sociales (EHESS), Paris, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Inserm, EHESP, Irset (Institute for Research in Health, Environment and Work) - UMR_S 1085, Rue du Thabor, France
| | | | | | - Luca Semerano
- Inserm U1125, Sorbonne Paris Nord University, Li2P, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Marie-Christophe Boissier
- Inserm U1125, Sorbonne Paris Nord University, Li2P, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
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5
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Beasley AB, Preen DB, McLenachan S, Gray ES, Chen FK. Incidence and mortality of uveal melanoma in Australia (1982-2014). Br J Ophthalmol 2023; 107:406-411. [PMID: 34880052 PMCID: PMC9985731 DOI: 10.1136/bjophthalmol-2021-319700] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/11/2021] [Indexed: 12/27/2022]
Abstract
AIMS We aimed to estimate the incidence and mortality of uveal melanoma (UM) in Australia from 1982 to 2014. METHODS Deidentified unit data for all cases of ocular melanoma were extracted from the Australian Cancer Database from 1 January 1982 to 31 December 2014. UM cases were extracted and trends in incidence and disease-specific mortality were calculated. Incidence rates were age-standardised against the 2001 Australian Standard Population. Mortality was assessed using Cox regression. RESULTS From 1982 to 2014, there were 5087 cases of ocular melanoma in Australia, of which 4617 were classified as UM. The average age-standardised incidence rate of UM was 7.6 (95% CI 7.3 to 7.9) per million. There was an increase (p=0.0502) in the incidence of UM from 1982 to 1993 with an annual percent change (APC) of +2.5%, followed by a significant decrease in the incidence of UM from 1993 to 2014 (APC -1.2%). The average 5-year survival from 1982 to 2011 did not significantly change from an average of 81%, with an average APC (AAPC) of +0.1%. A multivariate Cox regression revealed that residence in Western Australia (p=0.001) or Tasmania (p=0.05), age ≥60 years (p<0.001) and histological classification as mixed (p<0.001) or epithelioid cells (p<0.001) were significantly associated with reduced survival. CONCLUSION In conclusion, we found that the incidence of UM peaked in the 1990s. Although treatment for primary UM has improved in the last 30 years, overall survival did not change significantly in the last 30 years.
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Affiliation(s)
- Aaron B Beasley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Samuel McLenachan
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - Elin S Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia .,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Perth, Western Australia, Australia
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6
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Fenton S, Rydz E, Demers PA, Peters CE. Prevalence and Level of Occupational Exposure to Asbestos in Canada in 2016. Ann Work Expo Health 2022; 67:536-545. [PMID: 36383235 DOI: 10.1093/annweh/wxac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Objective
Asbestos use has decreased over time but occupational exposure still exists today due to the presence of asbestos in older buildings. The objective of this study was to update CAREX Canada’s prevalence of exposure estimate from 2006 to 2016, and to assess the level of occupational exposure by industry, occupation, province/territory, and sex.
Methods
Estimates by occupation, industry, province/territory, and sex were calculated using labor force data from the 2016 Census of Population and proportions of workers exposed by occupation and industry, which were previously developed for the 2006 estimates and updated here to reflect new knowledge and changes in exposures. Statistics Canada concordance tables were used to account for changes between the 2006 and 2016 job and industry coding systems. Expert assessment was used to qualitatively assign levels of exposure (low, moderate, or high) for each occupation and industry, with consideration of workers’ proximity and access to asbestos-containing material, and the condition and content of asbestos.
Results
Approximately 235 000 workers are exposed to asbestos on the job in Canada. The majority of Canadian workers exposed to asbestos are male (89%). Only 5% of all exposed workers are in the high-exposure category, while most workers are in the low (49%) or moderate (46%) exposure categories. The construction sector and associated jobs (e.g. carpenters, trades helpers and laborers, electricians) accounted for the majority of exposed workers.
Conclusions
Occupational exposure to asbestos continues to occur in Canada. Updating the prevalence of exposure estimate and adding exposure levels highlights the shift from high to lower-lever exposures associated with asbestos-containing materials remaining in the built environment.
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Affiliation(s)
- Shelby Fenton
- CAREX Canada, School of Population and Public Health, University of British Columbia , Vancouver, British Columbia V6T 1Z3 , Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Dr NW , Calgary, Alberta T2N 1N4 , Canada
| | - Ela Rydz
- CAREX Canada, School of Population and Public Health, University of British Columbia , Vancouver, British Columbia V6T 1Z3 , Canada
| | - Paul A Demers
- Occupational Cancer Research Centre (OCRC), Ontario Health , Toronto, Ontario M5G 1X3 , Canada
- Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario M5T 3M7 , Canada
| | - Cheryl E Peters
- CAREX Canada, School of Population and Public Health, University of British Columbia , Vancouver, British Columbia V6T 1Z3 , Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Dr NW , Calgary, Alberta T2N 1N4 , Canada
- Population and Public Health, British Columbia Centre for Disease Control , Vancouver, British Columbia V5Z 4R4 , Canada
- Prevention, Screening and Hereditary Cancer Program, BC Cancer , Vancouver, British Columbia V5Z 1G1 , Canada
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7
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Rai R, Fritschi L, Glass DC, Dorji N, El-Zaemey S. Comparison of agreement in asthmagen exposure assessments between rule-based automatic algorithms and a job exposure matrix in healthcare workers in Australia and Bhutan. BMC Public Health 2022; 22:2089. [DOI: 10.1186/s12889-022-14514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background:
Assessment of occupational exposures is an integral component of population-based studies investigating the epidemiology of occupational diseases. However, all the available methods for exposure assessment have been developed, tested and used in high-income countries. Except for a few studies examining pesticide exposures, there is limited research on whether these methods are appropriate for assessing exposure in LMICs. The aim of this study is to compare a task-specific algorithm-based method (OccIDEAS) to a job-specific matrix method (OAsJEM) in the assessment of asthmagen exposures among healthcare workers in a high-income country and a low- and middle- income country (LMIC) to determine an appropriate assessment method for use in LMICs for future research.
Methods:
Data were obtained from a national cross-sectional survey of occupational asthmagens exposure in Australia and a cross-sectional survey of occupational chemical exposure among Bhutanese healthcare workers. Exposure was assessed using OccIDEAS and the OAsJEM. Prevalence of exposure to asthmagens and inter-rater agreement were calculated.
Results:
In Australia, the prevalence was higher for a majority of agents when assessed by OccIDEAS than by the OAsJEM (13 versus 3). OccIDEAS identified exposures to a greater number of agents (16 versus 7). The agreement as indicated by κ (Cohen’s Kappa coefficient) for six of the seven agents assessed was poor to fair (0.02 to 0.37). In Bhutan, the prevalence of exposure assessed by OccIDEAS was higher for four of the seven agents and κ was poor for all the four agents assessed (-0.06 to 0.13). The OAsJEM overestimated exposures to high-level disinfectants by assigning exposures to all participants from 10 (Bhutan) and 12 (Australia) ISCO-88 codes; whereas OccIDEAS assigned exposures to varying proportions of participants from these ISCO-codes.
Conclusion:
There was poor to fair agreement in the assessment of asthmagen exposure in healthcare workers between the two methods. The OAsJEM overestimated the prevalence of certain exposures. As compared to the OAsJEM, OccIDEAS appeared to be more appropriate for evaluating cross-country exposures to asthmagens in healthcare workers due to its inherent quality of assessing task-based determinants and its versatility in being adaptable for use in different countries with different exposure circumstances.
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8
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Elbarazi I, El-Zaemey S, Saddik B, Ádám B, El Sadig M, Abdullahi AS, Fritschi L, Sheek-Hussein M. Estimate of Occupational Exposure to Carcinogens among Migrant Workers in the United Arab Emirates: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13012. [PMID: 36293617 PMCID: PMC9602412 DOI: 10.3390/ijerph192013012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
Occupational illnesses, such as cancer, cause more deaths each year than occupational accidents. Occupational carcinogens include physical, chemical, biological and organizational hazards. In the United Arab Emirates (UAE), migrant workers account for 80% of labor. Being sometimes employed as unskilled workers and more willing to work in demanding jobs, their vulnerability and exposure may be increased. This study aimed to estimate the prevalence of occupational exposure to workplace carcinogens among migrant workers in the UAE. A sample of employees working in construction, cleaning, dry cleaning, mechanic workshops and hair salons were recruited and interviewed. Using OccIDEAS (an online assessment tool), participants were asked questions about their demographics, work history and regular tasks. Exposure to various carcinogens was estimated using the in-built algorithms of OccIDEAS. A sample of 1778 workers was included. The sample consisted of workers from Bangladesh (19.2%), India (31%), Nepal (4.7%), Pakistan (29.9%) and the Philippines (4.8%), with the rest from other nationalities. Overall, the prevalence of probable exposure was considerable, with the highest among drivers (96%) and the lowest among laundry workers (52%). Moderate to high exposure was found to 20 different carcinogens. Self-rated health among those who were exposed to carcinogens was significantly lower than among those not exposed (AOR = 0.783, 95% CI [0.638-0.961]). Exposure to several different carcinogens is relatively common in the UAE among migrant workers. Further strengthening policies and the implementation of tailored interventions are needed to prevent exposure to occupational carcinogens and, consequently, to combat occupational cancer in the UAE.
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Affiliation(s)
- Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Sonia El-Zaemey
- School of Population Health, Curtin University, Bentley 6102, Australia
| | - Basema Saddik
- Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
- Sharjah Institute of Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Balázs Ádám
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Mohamed El Sadig
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Aminu S. Abdullahi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Lin Fritschi
- School of Population Health, Curtin University, Bentley 6102, Australia
| | - Mohamud Sheek-Hussein
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
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9
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Houot MT, Tvardik N, Cordina-Duverger E, Guénel P, Pilorget C. A 34-year overview of night work by occupation and industry in France based on census data and a sex-specific job-exposure matrix. BMC Public Health 2022; 22:1441. [PMID: 35906586 PMCID: PMC9336015 DOI: 10.1186/s12889-022-13830-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Night work has been increasing in the last decades due to new working arrangements for good and services production. Numerous studies have shown that night shift work causes disruptions in circadian rhythms that may affect health. In 2019, night shift work was classified as probably carcinogenic to humans by the International Agency for Research on Cancer, and may contribute to other health disorders. In this context, we assessed the number and proportion of workers exposed to night work today and investigated time trends by occupation and industry in France since 1982 in terms of prevention. Methods Using the data on work time schedules collected in the French Labour Force Surveys, sex- and period-specific job-exposure matrices (JEMs) to night work (working between midnight and 5 AM) were developed. After linkage of the JEMs with data of the national censuses of 1982, 1990, 1999, 2007 and 2015, the numbers and proportions of workers usually or occasionally exposed to night work were estimated. Results The number of night workers (usual and occasional) increased from 3.67 million in 1982 to 4.37 million in 2015 (15.8% vs 16.4%). Night work was more common in men than in women (e.g. 22.4% vs 10.0% in 2015), and usual night work largely increased after 2000 (4.4% in 1999, 7.2% in 2007). In 2015, 1.29 million men worked usually at night, including 882,000 workers in the service sector (63%) and 360,000 in the manufacturing and extracting industries (28%). For the same period, 581,000 women were usual night workers, most of them being employed in the service sector (90%). Among women, a 97% increase of usual night work was observed between 1982 and 2015. Conclusions This study shows that night work involves a growing number of workers in France, particularly in women in the service sector. These results raise concern about the public health impact of night work and particularly about the numbers of outcomes attributable to this exposure such as breast or prostate cancers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13830-5.
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Affiliation(s)
- Marie-Tülin Houot
- Santé publique France, The French Public Health Agency, 12 rue du val d'osne, 94415, Saint-Maurice, France.
| | - Nastassia Tvardik
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, Inserm, Université Paris-Saclay, Institut Gustave-Roussy, 94807, Villejuif, France
| | - Emilie Cordina-Duverger
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, Inserm, Université Paris-Saclay, Institut Gustave-Roussy, 94807, Villejuif, France
| | - Pascal Guénel
- Santé publique France, The French Public Health Agency, 12 rue du val d'osne, 94415, Saint-Maurice, France.,Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, Inserm, Université Paris-Saclay, Institut Gustave-Roussy, 94807, Villejuif, France
| | - Corinne Pilorget
- Santé publique France, The French Public Health Agency, 12 rue du val d'osne, 94415, Saint-Maurice, France
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10
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Rumchev K, Hoang DV, Lee A. Case Report: Exposure to Respirable Crystalline Silica and Respiratory Health Among Australian Mine Workers. Front Public Health 2022; 10:798472. [PMID: 35769775 PMCID: PMC9234445 DOI: 10.3389/fpubh.2022.798472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Occupational exposure to respirable crystalline silica (RCS) is common in a range of industries, including mining, and has been associated with adverse health effects such as silicosis, lung cancer, and non-malignant respiratory diseases. This study used a large population database of 6,563 mine workers from Western Australia who were examined for personal exposure to RCS between 2001 and 2012. A standardized respiratory questionnaire was also administered to collect information related to their respiratory health. Logistic regression analyses were performed to ascertain the association between RCS concentrations and the prevalence of respiratory symptoms among mine workers. The estimated exposure levels of RCS (geometric mean 0.008mg/m3, GSD 4.151) declined over the study period (p < 0.001) and were below the exposure standard of 0.05 mg/m3. Miners exposed to RCS had a significantly higher prevalence of phlegm (p = 0.017) and any respiratory symptom (p = 0.013), even at concentrations within the exposure limit. Miners are susceptible to adverse respiratory health effects at low levels of RCS exposure. More stringent prevention strategies are therefore recommended to protect mine workers from RCS exposures.
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Affiliation(s)
- Krassi Rumchev
- School of Population Health, Curtin University, Perth, WA, Australia
- *Correspondence: Krassi Rumchev
| | - Dong Van Hoang
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Andy Lee
- School of Population Health, Curtin University, Perth, WA, Australia
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11
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Carey RN, Whiteman DC, Webb PM, Neale RE, Reid A, Norman R, Fritschi L. The future excess fraction of cancer due to lifestyle factors in Australia. Cancer Epidemiol 2021; 75:102049. [PMID: 34710670 DOI: 10.1016/j.canep.2021.102049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Many cancers are caused by exposure to lifestyle, environmental, and occupational factors. Earlier studies have estimated the number of cancers occurring in a single year which are attributable to past exposures to these factors. However, there is now increasing appreciation that estimates of the future burden of cancer may be more useful for policy and prevention. We aimed to calculate the future number of cancers expected to arise as a result of exposure to 23 modifiable risk factors. METHODS We used the future excess fraction (FEF) method to estimate the lifetime burden of cancer (2016-2098) among Australian adults who were exposed to modifiable lifestyle, environmental, and occupational risk factors in 2016. Calculations were conducted for 26 cancer sites and 78 cancer-risk factor pairings. RESULTS The cohort of 18.8 million adult Australians in 2016 will develop an estimated 7.6 million cancers during their lifetime, of which 1.8 million (24%) will be attributable to exposure to modifiable risk factors. Cancer sites with the highest number of future attributable cancers were colon and rectum (n = 717,700), lung (n = 380,400), and liver (n = 103,200). The highest number of future cancers will be attributable to exposure to tobacco smoke (n = 583,500), followed by overweight/obesity (n = 333,100) and alcohol consumption (n = 249,700). CONCLUSION A significant proportion of future cancers will result from recent levels of exposure to modifiable risk factors. Our results provide direct, pertinent information to help determine where preventive measures could best be targeted.
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Affiliation(s)
- Renee N Carey
- School of Population Health, Curtin University, Kent Street, Bentley, Western Australia, Australia.
| | - David C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Penelope M Webb
- Department of Population Health, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Rachel E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Alison Reid
- School of Population Health, Curtin University, Kent Street, Bentley, Western Australia, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Kent Street, Bentley, Western Australia, Australia
| | - Lin Fritschi
- School of Population Health, Curtin University, Kent Street, Bentley, Western Australia, Australia
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12
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Carey RN, El-Zaemey S, Daly A, Fritschi L, Glass DC, Reid A. Are There Ethnic Disparities in Exposure to Workplace Hazards Among New Zealand Migrants to Australia? Asia Pac J Public Health 2021; 33:870-879. [PMID: 33847173 DOI: 10.1177/10105395211007648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Renee N Carey
- Curtin University, Bentley, Western Australia, Australia
| | - Sonia El-Zaemey
- Curtin University, Bentley, Western Australia, Australia.,BreastScreen Western Australia, Perth, Western Australia, Australia
| | - Alison Daly
- Curtin University, Bentley, Western Australia, Australia
| | - Lin Fritschi
- Curtin University, Bentley, Western Australia, Australia
| | | | - Alison Reid
- Curtin University, Bentley, Western Australia, Australia
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Olsson A, Kromhout H. Occupational cancer burden: the contribution of exposure to process-generated substances at the workplace. Mol Oncol 2021; 15:753-763. [PMID: 33544948 PMCID: PMC7931128 DOI: 10.1002/1878-0261.12925] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/25/2022] Open
Abstract
Respirable crystalline silica in mineral dust, wood dust, diesel engine exhaust emissions and welding fumes are among the most common process-generated substances to which millions of workers are exposed daily. The composition of process-generated substances can vary substantially, depending on the parameters of the underlying processes; for example, the composition and intensity of diesel motor emissions differs among the various generations of diesel engines and working environments (e.g. surface or underground mining). We illustrate how common these occupational exposures are and discuss challenges in estimating their global prevalence and their contribution to the burden of occupational cancer. Estimates of the number and proportion of workers exposed in most countries and on a global scale are generally scarce. A remarkable exception is based on the proactive bottom-up estimates generated within the European Network for Silica. Actions to reduce exposures and research to fill gaps in knowledge adapted to local settings are warranted to mitigate the occupational cancer burden, especially in under-researched settings including low- and middle-income countries.
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Affiliation(s)
- Ann Olsson
- International Agency for Research in Cancer (IARC)World Health Organization (WHO)LyonFrance
| | - Hans Kromhout
- Institute for Risk Assessment SciencesUtrecht UniversityThe Netherlands
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14
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Li N, Zhai Z, Zheng Y, Lin S, Deng Y, Xiang G, Yao J, Xiang D, Wang S, Yang P, Yang S, Xu P, Wu Y, Hu J, Dai Z, Wang M. Association of 13 Occupational Carcinogens in Patients With Cancer, Individually and Collectively, 1990-2017. JAMA Netw Open 2021; 4:e2037530. [PMID: 33599775 PMCID: PMC7893501 DOI: 10.1001/jamanetworkopen.2020.37530] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Occupational exposure to carcinogens has been shown to pose a serious disease burden at the global, regional, and national levels. Based on epidemiologic studies and clinical observations, working environment appears to have important effects on the occurrence of human malignant tumors; however, to date, no systematic articles have been published that specifically investigated cancer burden due to occupational exposure in an individual and collective manner. OBJECTIVE To estimate the degree of exposure and evaluate the cancer burden attributable to occupational carcinogens (OCs) individually and collectively by sex, age, year, and location. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study including data on 195 countries from the Global Burden of Diseases, Injuries, and Risk Factors Study from January 1, 1990, to December 31, 2017. Data were analyzed from June 24, 2020, to July 20, 2020. EXPOSURES Thirteen OCs (ie, arsenic, asbestos, benzene, beryllium, cadmium, chromium, diesel engine exhaust, formaldehyde, nickel, polycyclic aromatic hydrocarbons, silica, sulfuric acid, and trichloroethylene). MAIN OUTCOMES AND MEASURES The degree and change patterns of exposure as well as the attributable cancer burden, including deaths and disability-adjusted life years (DALYs), by sex, age, year, and location for 13 OCs. The calculation of the population-attributable fraction was based on past exposure in the population and relative risks. RESULTS Based on the GBD 2017 study, 13 OCs attributable to 7 cancer types were included. Most summary exposure values for the 13 OCs, particularly those of diesel engine exhaust (35.6% increase; 95% uncertainty interval [UI], 32.4%-38.5%) and trichloroethylene (30.3% increase; 95% UI, 27.3%-33.5%), increased from 1990 to 2017. Only exposure to asbestos decreased by 13.8% (95% UI, -26.7% to 2.2%). In 2017, 319 000 (95% UI, 256 000-382 000) cancer deaths and 6.42 million (95% UI, 5.15 million to 7.76 million) DALYs were associated with OCs combined, accounting for 61.0% (95% UI, 59.6%-62.4%) of the total cancer deaths and 48.3% (46.3% to 50.2%) of the DALYs. Among the 13 OCs, the 3 leading risk factors for cancer burden were asbestos (71.8%), silica (15.4%), and diesel engine exhaust (5.6%). For most OCs, the attributed cancer outcome was tracheal, bronchial, and lung cancer, which accounted for 89.0% of attributable cancer deaths. China (61 644 cancer deaths), the US (42 848), and Japan (20 748) accounted for the largest number of attributable cancer deaths in 2017; for DALYs, China (1.47 million), the US (0.71 million), and India (0.37 million) were the 3 leading countries. CONCLUSIONS AND RELEVANCE Results of this study suggest that although OC exposure levels have decreased, the overall cancer burden is continuously increasing.
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Affiliation(s)
- Na Li
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhen Zhai
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Zheng
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shuai Lin
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yujiao Deng
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Grace Xiang
- College of Arts and Sciences, New York University, New York
| | - Jia Yao
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Dong Xiang
- Celilo Cancer Center, Oregon Health Science Center Affiliated Mid-Columbia Medical Center, The Dalles
| | - Shuqian Wang
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Pengtao Yang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Si Yang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Peng Xu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ying Wu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jingjing Hu
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Zhijun Dai
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Meng Wang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Daly A, Reid A. Recruiting migrant workers in Australia for Public Health surveys: how sampling strategy make a difference in estimates of workplace hazards. BMC Res Notes 2020; 13:473. [PMID: 33028419 PMCID: PMC7542909 DOI: 10.1186/s13104-020-05320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives One third of the Australian work force are immigrants. Relatively little is known about working conditions for specific migrant groups. The objectives of this paper are to describe and compare the sampling strategies used to recruit migrant workers from specific migrant groups working in Australia into a cross-sectional study designed to produce population estimates of workplace hazards and self-reported health. Results Two cross sectional telephone surveys were conducted with immigrants currently working in Australia. Survey 1 used quota sampling from lists provided by a sample broker. Survey 2 used a combination of probability and non-probability sampling, including random sampling from telephone lists. Data from the surveys were weighted and comparisons made with unweighted data. While weighting adjusted for most differences across the sample sources, the likelihood of exposure to workplace hazards depended on exposure types and sampling strategies. We concluded that by using a combination of sampling strategies it is possible to recruit immigrants from specific migrant groups and provide a balanced view of working conditions, although no one strategy was best for all types of measures. Access to a robust sample source for migrants would enable a better perspective to migrant populations’ working conditions.
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Affiliation(s)
- Alison Daly
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Alison Reid
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
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McKenzie JF, El-Zaemey S, Carey RN. Prevalence of exposure to multiple occupational carcinogens among exposed workers in Australia. Occup Environ Med 2020; 78:oemed-2020-106629. [PMID: 32948666 DOI: 10.1136/oemed-2020-106629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/09/2020] [Accepted: 08/24/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Workers can be exposed to a range of different carcinogenic agents in the workplace. However, previous studies have often focused on prevalence of exposure to a single carcinogen, resulting in substantial knowledge gaps regarding the extent of multiple exposures in the workplace. This study aims to investigate the current prevalence of occupational exposure to multiple carcinogens among exposed workers in Australia. METHODS The data for this study come from the Australian Work Exposures Study, a nationwide cross-sectional telephone survey of Australian workers aged between 18 and 65. Information was collected about the respondents' current employment and numerous demographic factors using a web-based application (Occupational Integrated Database Exposure Assessment System) to conduct the interview, with predefined algorithms used to automatically assign exposures to carcinogens based on the respondents' job tasks. RESULTS The majority (81%) of exposed respondents were assessed as being probably exposed to more than one carcinogen, and 26% reported exposure to five or more carcinogens. We found that after adjusting for occupation, exposure to multiple carcinogens was more likely among male respondents, while older workers (aged between 55 and 65) were less likely to be exposed to multiple carcinogens. CONCLUSIONS This study provides information on the prevalence of exposure to multiple carcinogens in the general population that has not previously been reported. This information could be useful for the intervention and control of occupational exposures to the prioritised carcinogens identified in this study.
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Affiliation(s)
- Jennifer F McKenzie
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Sonia El-Zaemey
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Renee N Carey
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
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17
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Gosselin A, Daly A, El Zaemey S, Fritschi L, Glass D, Perez ER, Reid A. Does exposure to workplace hazards cluster by occupational or sociodemographic characteristics? An analysis of foreign-born workers in Australia. Am J Ind Med 2020; 63:803-816. [PMID: 32573821 DOI: 10.1002/ajim.23146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Disparities in exposure to occupational hazards may be linked to social position as well as the type of job a person holds. This study aimed to describe the prevalence of exposure to workplace hazards among three migrant worker groups and to assess whether social disparities in exposure for these groups remain after adjusting for occupational characteristics. METHODS Data were collected in 2017/2018 from 1630 Australian workers born in New Zealand, India, and the Philippines. Weighted estimated prevalence of exposure to 10 carcinogens and four psychosocial hazards (discrimination, job strain, vulnerability, and insecurity) was calculated for sociodemographics and occupation. Regression estimated the likelihood of exposure by sociodemographics after adjustment for occupational characteristics. RESULTS Exposure to workplace hazards ranged from 11.7% (discrimination) to 61.2% (exposed to at least one carcinogen). Compared with workers born in India, New Zealand born workers were over twice as likely to be exposed to diesel engine exhaust (adjusted odds ratio [aOR] = 2.60) and 60% more likely to be exposed to at least one carcinogen (aOR = 1.60) but less likely to be exposed to any psychosocial hazard. Social disparities by country of birth, sex, age, education, and number of years in Australia, as well as company size, employment type, and hours, worked remained associated with greater likelihood of reporting one or more workplace hazards after adjusting for occupational characteristics. CONCLUSION Examining sociodemographic as well as occupational characteristics helps to clarify groups most likely to be exposed to workplace hazards who can be hidden when examining occupational characteristics alone.
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Affiliation(s)
- Anne Gosselin
- Department of HealthFrench Collaborative Institute on Migration Paris France
- Social Epidemiology DepartmentIPLESP/INSERM Paris France
- SAGESUD Team, CEPED (Paris Descartes University—IRD)ERL Inserm SAGESUD Paris France
| | - Alison Daly
- School of Public HealthCurtin University Perth Western Australia Australia
| | - Sonia El Zaemey
- School of Public HealthCurtin University Perth Western Australia Australia
| | - Lin Fritschi
- School of Public HealthCurtin University Perth Western Australia Australia
| | - Deborah Glass
- School of Public Health and Preventive MedicineMonash University Melbourne Australia
| | - Elena Ronda Perez
- Public Health Research Group, Preventive Medicine and Public Health AreaUniversity of Alicante Alicante Spain
- Epidemiología y Salud PúblicaCIBERESP Madrid Spain
| | - Alison Reid
- School of Public HealthCurtin University Perth Western Australia Australia
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18
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Getu S, Shiferaw E, Melku M. Assessment of hematological parameters of petrol filling workers at petrol stations in Gondar town, Northwest Ethiopia: a comparative cross-sectional study. Environ Health Prev Med 2020; 25:44. [PMID: 32861244 PMCID: PMC7456503 DOI: 10.1186/s12199-020-00886-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background Petrol is the non-specific term for petroleum which is used for inside combustion of engines. Petrol filling workers are highly vulnerable to occupational exposure to these harmful substances which lead to hemato-toxicity and blood disorders such as leukemia, aplastic anemia, and dysplastic bone marrow. Thus, this study was aimed to assess hematological parameters of petrol filling workers in Gondar town, Northwest Ethiopia. Methods A comparative cross-sectional study was conducted from January to March 2019 in Gondar town, Northwest Ethiopia. A total of 110 study participants comprising 55 study groups and 55 controls group were recruited by a convenient sampling technique. Socio-demographic data were collected using a structured questionnaire, and 3 ml of venous blood was collected for the determination of hematological parameters. The data were entered into Epi info 7.2.0.1 and analyzed by SPSS version of 20. Mean, standard deviation, median, and interquartile ranges were used to present the data. Independent t test and Mann-Whitney U test were used to compare the mean or median difference between parametric and non-parametric hematological parameters, respectively. Moreover, Pearson product-moment and Spearman’s rank-order bivariable correlations analyses were used to describe the correlation between hematological parameters and duration of exposure to petrol. A P value of ≤ 0.05 was considered statistically significant. Results The study revealed that mean red blood cell count and hemoglobin level as well as the median hematocrit, mean cell hemoglobin concentration, platelet count, absolute lymphocytes count, and red cell distribution width values of petrol filling workers showed a significant increment compared with the control group. On the other hand, the mean cell hemoglobin value of petrol filling workers showed a significant decrement compared with healthy controls. Moreover, the duration of exposure to petrol showed a significant positive correlation with red blood cell count and mean cell hemoglobin concentration; however, a significant negative correlation was observed with mean cell volume. Conclusion This study showed that the majority of hematological parameters of petrol filling workers showed an increment compared with healthy controls which might be associated with exposure to petrol chemicals. However, further longitudinal study with a larger sample size should be conducted to explore the impact of petrol exposure on hematopoiesis.
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Affiliation(s)
- Sisay Getu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia. .,Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Elias Shiferaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abramson MJ, Murambadoro T, Alif SM, Benke GP, Dharmage SC, Glaspole I, Hopkins P, Hoy RF, Klebe S, Moodley Y, Rawson S, Reynolds PN, Wolfe R, Corte TJ, Walters EH. Occupational and environmental risk factors for idiopathic pulmonary fibrosis in Australia: case-control study. Thorax 2020; 75:864-869. [PMID: 32660982 DOI: 10.1136/thoraxjnl-2019-214478] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/08/2020] [Accepted: 06/10/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a lung disease of unknown cause characterised by progressive scarring, with limited effective treatment and a median survival of only 2-3 years. Our aim was to identify potential occupational and environmental exposures associated with IPF in Australia. METHODS Cases were recruited by the Australian IPF registry. Population-based controls were recruited by random digit dialling, frequency matched on age, sex and state. Participants completed a questionnaire on demographics, smoking, family history, environmental and occupational exposures. Occupational exposure assessment was undertaken with the Finnish Job Exposure Matrix and Australian asbestos JEM. Multivariable logistic regression was used to describe associations with IPF as ORs and 95% CIs, adjusted for age, sex, state and smoking. RESULTS We recruited 503 cases (mean±SD age 71±9 years, 69% male) and 902 controls (71±8 years, 69% male). Ever smoking tobacco was associated with increased risk of IPF: OR 2.20 (95% CI 1.74 to 2.79), but ever using marijuana with reduced risk after adjusting for tobacco: 0.51 (0.33 to 0.78). A family history of pulmonary fibrosis was associated with 12.6-fold (6.52 to 24.2) increased risk of IPF. Occupational exposures to secondhand smoke (OR 2.1; 1.2 to 3.7), respirable dust (OR 1.38; 1.04 to 1.82) and asbestos (OR 1.57; 1.15 to 2.15) were independently associated with increased risk of IPF. However occupational exposures to other specific organic, mineral or metal dusts were not associated with IPF. CONCLUSION The burden of IPF could be reduced by intensified tobacco control, occupational dust control measures and elimination of asbestos at work.
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Affiliation(s)
- Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tsitsi Murambadoro
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sheikh M Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Geza P Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Ian Glaspole
- Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Hopkins
- School of Medicine, University of Queensland, St Lucia, Queensland, Australia.,Lung Transplant Service, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Ryan F Hoy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sonja Klebe
- Department of Anatomical Pathology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Yuben Moodley
- School of Pharmacology and Respiratory Medicine, Lung Institute of Western Australia, University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory and Sleep Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Shuli Rawson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul N Reynolds
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tamera J Corte
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - E Haydn Walters
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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20
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Rai R, Fritschi L, Carey RN, Lewkowski K, Glass DC, Dorji N, El‐Zaemey S. The estimated prevalence of exposure to carcinogens, asthmagens, and ototoxic agents among healthcare workers in Australia. Am J Ind Med 2020; 63:624-633. [PMID: 32236973 DOI: 10.1002/ajim.23108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/07/2020] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Healthcare workers are occupationally exposed to various hazardous chemicals and agents that can potentially result in long-term adverse health effects. These exposures have not been comprehensively examined at a population level. The aim of this study was to examine occupational exposures to a wide range of asthmagens, carcinogens, and ototoxic agents among healthcare workers in Australia. METHODS Data were collected as part of the Australian Work Exposures Studies, which were computer-assisted telephone surveys conducted in 2011, 2014, and 2016 to assess the prevalence of occupational exposures to carcinogens, asthmagens, and ototoxic agents, respectively, among Australian workers. Using data on healthcare workers, the prevalence of exposures to these agents was calculated and associations of demographic variables and occupation groups with exposure status were examined. RESULTS The prevalence of exposure to at least one asthmagen, carcinogen, and ototoxic agent was 92.3%, 50.7%, and 44.6%, respectively. The most common exposures were to (a) cleaning and sterilizing agents in the asthmagen group; (b) shift work in the carcinogen group; and (c) toluene and p-xylene among ototoxic agents. Exposure varied by occupation, with exposure to carcinogens and ototoxic agents highest among personal carers and exposure to carcinogens most likely among nursing professionals and health and welfare support workers. CONCLUSION The results demonstrate that a substantial proportion of Australian healthcare workers are occupationally exposed to asthmagens, carcinogens, and ototoxic agents. These exposures are more common among certain occupational groups. The information provided by this study will be useful in prioritizing and implementing control strategies.
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Affiliation(s)
- Rajni Rai
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Lin Fritschi
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Renee N. Carey
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Kate Lewkowski
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Deborah C. Glass
- School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
| | - Nidup Dorji
- Faculty of Nursing and Public HealthKhesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan
| | - Sonia El‐Zaemey
- School of Public HealthCurtin University Bentley Western Australia Australia
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21
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Du M, Hall GL, Franklin P, Musk AB, Mullins BJ, de Klerk N, Elliott NSJ, Sodhi-Berry N, Brims F, Reid A. Association between diesel engine exhaust exposure and lung function in Australian gold miners. Int J Hyg Environ Health 2020; 226:113507. [PMID: 32160584 DOI: 10.1016/j.ijheh.2020.113507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/10/2020] [Accepted: 02/28/2020] [Indexed: 12/25/2022]
Abstract
Previous studies have reported that miners (and other workers) exposed to high levels of diesel engine exhaust (DEE) have an increased risk of lung function decline. The main objective of this study was to evaluate associations between exposure to different components associated with DEE in relation to lung function across a 12-h working shift. Eighty underground gold miners and twenty surface miners completed spirometry and questionnaires at the beginning and end of their 12 h work shift. Personal exposure to elemental carbon (EC), volatile organic compounds (VOCs), nitrogen dioxide (NO2), particle size and particle number were monitored during their shift. Multiple regression models were used to examine the associations between DEE and lung function, adjusting for a range of covariates. Underground miners were exposed to higher levels of EC, VOCs, NO2, and particle number and larger mean particle size than surface miners. Cross-shift reduction in Z-score value of FEV1/FVC in underground miners was statistically significantly greater than those of surface miners. The cross-shift change in Z-score value of FEV1/FVC was associated with exposure to higher concentration of EC and particle number, but not with VOCs, NO2 and particle size. Occupational exposure to diesel engine exhaust in current Australian gold mines is substantial. Exposures were higher in underground miners and had a negative association with their lung function over a single 12-h shift.
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Affiliation(s)
- Mengran Du
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Graham L Hall
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, Western Australia, Australia; School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - Peter Franklin
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Aw Bill Musk
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Benjamin J Mullins
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, Western Australia, Australia; School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Novak S J Elliott
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Nita Sodhi-Berry
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Alison Reid
- School of Public Health, Curtin University, Bentley, Western Australia, Australia.
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Global and regional burden of cancer in 2016 arising from occupational exposure to selected carcinogens: a systematic analysis for the Global Burden of Disease Study 2016. Occup Environ Med 2020; 77:151-159. [PMID: 32054819 PMCID: PMC7035689 DOI: 10.1136/oemed-2019-106012] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study provides a detailed analysis of the global and regional burden of cancer due to occupational carcinogens from the Global Burden of Disease 2016 study. METHODS The burden of cancer due to 14 International Agency for Research on Cancer Group 1 occupational carcinogens was estimated using the population attributable fraction, based on past population exposure prevalence and relative risks from the literature. The results were used to calculate attributable deaths and disability-adjusted life years (DALYs). RESULTS There were an estimated 349 000 (95% Uncertainty Interval 269 000 to 427 000) deaths and 7.2 (5.8 to 8.6) million DALYs in 2016 due to exposure to the included occupational carcinogens-3.9% (3.2% to 4.6%) of all cancer deaths and 3.4% (2.7% to 4.0%) of all cancer DALYs; 79% of deaths were of males and 88% were of people aged 55 -79 years. Lung cancer accounted for 86% of the deaths, mesothelioma for 7.9% and laryngeal cancer for 2.1%. Asbestos was responsible for the largest number of deaths due to occupational carcinogens (63%); other important risk factors were secondhand smoke (14%), silica (14%) and diesel engine exhaust (5%). The highest mortality rates were in high-income regions, largely due to asbestos-related cancers, whereas in other regions cancer deaths from secondhand smoke, silica and diesel engine exhaust were more prominent. From 1990 to 2016, there was a decrease in the rate for deaths (-10%) and DALYs (-15%) due to exposure to occupational carcinogens. CONCLUSIONS Work-related carcinogens are responsible for considerable disease burden worldwide. The results provide guidance for prevention and control initiatives.
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Florath I, Glass DC, Rhazi MS, Parent ME, Fritschi L. Inter-rater Agreement Between Exposure Assessment Using Automatic Algorithms and Using Experts. Ann Work Expo Health 2020; 63:45-53. [PMID: 30304470 DOI: 10.1093/annweh/wxy084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/19/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To estimate the inter-rater agreement between exposure assessment to asthmagens in current jobs by algorithms based on task-based questionnaires (OccIDEAS) and by experts. Methods Participants in a cross-sectional national survey of exposure to asthmagens (AWES-Asthma) were randomly split into two subcohorts of equal size. Subcohort 1 was used to determine the most common asthmagen groups and occupational groups. From subcohort 2, a random sample of 200 participants was drawn and current occupational exposure (yes/no) was assessed in these by OccIDEAS and by two experts independently and then as a consensus. Inter-rater agreement was estimated using Cohen's Kappa coefficient. The null hypothesis was set at 0.4, because both the experts and the automatic algorithm assessed the exposure using the same task-based questionnaires and therefore an agreement better than by chance would be expected. Results The Kappa coefficients for the agreement between the experts and the algorithm-based assessments ranged from 0.37 to 1, while the agreement between the two experts ranged from 0.29 to 0.94, depending on the agent being assessed. After discussion by both experts the Kappa coefficients for the consensus decision and OccIDEAS were significantly larger than 0.4 for 7 of the 10 asthmagen groups, while overall the inter-rater agreement was greater than by chance (P < 0.0001). Conclusions The web-based application OccIDEAS is an appropriate tool for automated assessment of current exposure to asthmagens (yes/no), and requires less time-consuming work by highly-qualified research personnel than the traditional expert-based method. Further, it can learn and reuse expert determinations in future studies.
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Affiliation(s)
- Ines Florath
- School of Public Health, Curtin University, Perth, Australia
| | - Deborah C Glass
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Lin Fritschi
- School of Public Health, Curtin University, Perth, Australia
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Fritschi L, Sadkowsky T, Glass DC. OccIDEAS: web-based assessment of occupational agent exposure. Int J Epidemiol 2020; 49:376-379. [DOI: 10.1093/ije/dyaa022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 01/04/2023] Open
Abstract
Abstract
Most epidemiological studies of disease aetiology do not consider potential risk factors at work. This may be because work is a complex exposure: people usually have a series of different jobs over their working lifetime; within each job there may be a range of different tasks; and there may be a variety of exposures in each job. Because of this complexity, many epidemiologists do not have the expertise or training to assess occupational exposures accurately. Our web-based application, OccIDEAS, manages the process of occupational agent assessment in epidemiological studies. The epidemiologist chooses the agents of interest for the study and OccIDEAS provides an online set of questionnaires that are tailored to those agents. The participant is asked specific questions about their job and evidence-based algorithms provide an assessment of exposure to each agent. OccIDEAS puts the world’s best occupational epidemiological expertise within reach of any researcher.
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Affiliation(s)
- Lin Fritschi
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Troy Sadkowsky
- School of Public Health, Curtin University, Perth, WA, Australia
- Data Scientists Pty Ltd, Brisbane, Queensland, Australia
| | - Deborah C Glass
- Monash Centre for Occupational & Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Ge CB, Friesen MC, Kromhout H, Peters S, Rothman N, Lan Q, Vermeulen R. Use and Reliability of Exposure Assessment Methods in Occupational Case-Control Studies in the General Population: Past, Present, and Future. Ann Work Expo Health 2019; 62:1047-1063. [PMID: 30239580 DOI: 10.1093/annweh/wxy080] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/22/2018] [Indexed: 11/14/2022] Open
Abstract
Introduction Retrospective occupational exposure assessment has been challenging in case-control studies in the general population. We aimed to review (i) trends of different assessment methods used in the last 40 years and (ii) evidence of reliability for various assessment methods. Methods Two separate literature reviews were conducted. We first reviewed all general population cancer case-control studies published from 1975 to 2016 to summarize the exposure assessment approach used. For the second review, we systematically reviewed evidence of reliability for all methods observed in the first review. Results Among the 299 studies included in the first review, the most frequently used assessment methods were self-report/assessment (n = 143 studies), case-by-case expert assessment (n = 139), and job-exposure matrices (JEMs; n = 82). Usage trends for these methods remained relatively stable throughout the last four decades. Other approaches, such as the application of algorithms linking questionnaire responses to expert-assigned exposure estimates and modelling of exposure with historical measurement data, appeared in 21 studies that were published after 2000. The second review retrieved 34 comparison studies examining methodological reliability. Overall, we observed slightly higher median kappa agreement between exposure estimates from different expert assessors (~0.6) than between expert estimates and exposure estimates from self-reports (~0.5) or JEMs (~0.4). However, reported reliability measures were highly variable for different methods and agents. Limited evidence also indicates newer methods, such as assessment using algorithms and measurement-calibrated quantitative JEMs, may be as reliable as traditional methods. Conclusion The majority of current research assesses exposures in the population with similar methods as studies did decades ago. Though there is evidence for the development of newer approaches, more concerted effort is needed to better adopt exposure assessment methods with more transparency, reliability, and efficiency.
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Affiliation(s)
- Calvin B Ge
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Melissa C Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Neurology, University Medical Centre Utrecht, Universiteitsweg, Utrecht, The Netherlands
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Qing Lan
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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26
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Rydz E, Arrandale VH, Peters CE. Population-level estimates of workplace exposure to secondhand smoke in Canada. Canadian Journal of Public Health 2019; 111:125-133. [PMID: 31489599 DOI: 10.17269/s41997-019-00252-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/25/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Secondhand smoke (SHS) is a known lung carcinogen that is also associated with cardiovascular disease and premature death. An important source of exposure to SHS is the workplace. In the past, efforts have been made to reduce workplace SHS exposure across Canada, with corresponding benefits to public health. This study estimated the number of workers exposed to SHS in Canada in 2006 and 2016 and their level of exposure. METHODS The proportion of workers exposed to SHS and the proportion of workers reporting specific workplace smoking restrictions by occupation and province, acquired from the 2007-2009 and 2010-2012 Canadian Tobacco Use Monitoring Surveys, were applied to 2006 and 2016 Canadian census data to estimate population-level exposure. Workers were assigned to exposure levels (possible, moderate, high) using workplace smoking restrictions. Only moderately and highly exposed workers were considered exposed. RESULTS The number of exposed workers decreased by 20% from 520,000 in 2006 to 418,000 in 2016. Workers were equally split between moderate and high exposure groups. Trades, transport and equipment operators, and workers in primary industry had the highest rates of overall exposure. The proportion of workers exposed varied by province, with the lowest rates in Ontario (approximately 2% in both years), and the highest in Saskatchewan in 2006 (6%) and Newfoundland in 2016 (4%). CONCLUSION Workplace SHS exposure persists. The findings can help prioritize high-risk groups for interventions and inform studies of the burden of occupational disease. Further characterization of exposure is needed to better inform enforcement and prevention.
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Affiliation(s)
- Ela Rydz
- CAREX Canada, Simon Fraser University, Vancouver, Canada. .,Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada.
| | - Victoria Helen Arrandale
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cheryl Elizabeth Peters
- CAREX Canada, Simon Fraser University, Vancouver, Canada.,Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
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27
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Sauvé JF, Friesen MC. Using Decision Rules to Assess Occupational Exposure in Population-Based Studies. Curr Environ Health Rep 2019; 6:148-159. [PMID: 31297745 PMCID: PMC6698417 DOI: 10.1007/s40572-019-00240-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Population-based studies increasingly link task-based occupational questionnaire responses collected from subjects to exposure estimates via transparent, programmable decision rules. We reviewed recent applications and methodological developments of rule-based approaches. RECENT FINDINGS Agent-specific decision rules require interviews incorporating work-task-based questions. Some studies have developed rules before the interviews took place, while others developed rules after the interviews were completed. Agreement between rule-based estimates and exposures assigned using job-by-job expert review were generally moderate to good (Kappa = 0.4-0.8). Rules providing quantitative intensity levels using measurement data or that integrate multiple independent exposure sources for the same job represent further advances to improve the characterization of occupational exposures in population studies. Decision rules have provided transparent and reproducible assessments, reduce job-by-job review, and facilitate sensitivity analyses in epidemiologic studies. Future studies should consider the development of decision rules concurrent with the questionnaire design to facilitate occupational exposure assessment efforts.
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Affiliation(s)
- Jean-François Sauvé
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Melissa C Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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28
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Fritschi L. OccIDEAS – occupational exposure assessment in community-based studies. Occup Med (Lond) 2019; 69:156-157. [DOI: 10.1093/occmed/kqy126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Lin Fritschi
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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29
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Koh DH, Park JH, Lee SG, Kim HC, Choi S, Jung H, Park JO, Park DU. Estimation of Lead Exposure Prevalence in Korean Population through Combining Multiple Experts' Judgment based on Objective Data Sources. Ann Work Expo Health 2019; 62:210-220. [PMID: 29342235 DOI: 10.1093/annweh/wxx106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/03/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Estimating carcinogen exposure prevalence is important for preventing occupational cancers. To develop the Korean version of CARcinogen EXposure (CAREX), a carcinogen surveillance system used in many countries, we estimated lead exposure prevalence in the Korean working population. Methods We used three Korean nationwide data sources to obtain objective database-derived prevalences of lead exposure across industries: airborne lead measurement data from the work environment measurement database (WEMD), blood lead measurement data from the special health examination database (SHED), and lead exposure prevalence computed using data from the work environment condition survey (WECS), which is a nationwide occupational exposure survey. We also asked a panel of 52 experts with ≥20 years of experience in industrial hygiene practice for their judgment about lead exposure prevalence across industries after they reviewed the database-derived prevalences computed from the three exposure databases. We developed and compared various estimation methods for combining the experts' judgments. The 2010 census was used as the reference population to estimate the number of lead-exposed workers in 228 industries by multiplying the exposure prevalence by the number of workers in each industry. Results The database-derived prevalences of lead exposure in the 228 industries were calculated using data collected between 2009 and 2011 from the WEMD and SHED and from the 2009 WECS. From the various estimation methods assessed, the median values of experts' responses were selected as our estimates of lead exposure prevalence in each industry. As a result, it was estimated that 129,250 Korean workers were exposed to lead in 2010. Conclusions Based on objective databases, we developed a method for estimating exposure prevalence for the CAREX system by combining experts' judgments. This work may offer an unbiased approach to the development process that accounts for the uncertainty in exposure.
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Affiliation(s)
- Dong-Hee Koh
- Department of Occupational and Environmental Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Ju-Hyun Park
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Sang-Gil Lee
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, Korea
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University, Incheon, Korea
| | - Sangjun Choi
- Department of Occupational Health, Catholic University of Daegu, Daegu, Korea
| | - Hyejung Jung
- Department of Occupational and Environmental Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Jae-Oh Park
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, Korea
| | - Dong-Uk Park
- Department of Environmental Health, Korea National Open University, Seoul, Korea
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30
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Counil E, Henry E. Is It Time to Rethink the Way We Assess the Burden of Work-Related Cancer? CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00190-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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El-Zaemey S, Carey RN. Variations in exposure to carcinogens among shift workers and non-shift workers. Am J Ind Med 2019; 62:352-356. [PMID: 30680755 DOI: 10.1002/ajim.22950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is limited information on whether the prevalence of exposure to workplace carcinogens varies among shift workers and non-shift workers. METHODS This analysis used data from the Australian Work Exposures Study-Cancer, a telephone survey which examined exposure to carcinogens in the workplace. Workers were classified as shift workers if they indicated that their usual roster ever included work between the hours of midnight and 5 am. Modified Poisson regression was used to estimate the adjusted prevalence ratios (aPRs) and 95% confidence internals (CIs). RESULTS Among the 5425 workers, 6.88% reported being exposed to shift work. Overall, shift workers were more likely to be exposed to any carcinogen (aPR = 1.16; 95% 1.06-1.26) and to specific carcinogens such as asbestos (aPR = 1.93; 95% 1.33-2.83) than non-shift workers. CONCLUSIONS Our study shows that there are differences in exposure to carcinogenic agents among shift and non-shift workers, and so there is a need for prevention programs in order to reduce these discrepancies.
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Affiliation(s)
- Sonia El-Zaemey
- School of Public Health; Curtin University; Bentley Western Australia Australia
| | - Renee N. Carey
- School of Public Health; Curtin University; Bentley Western Australia Australia
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32
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Varghese BM, Barnett AG, Hansen AL, Bi P, Hanson-Easey S, Heyworth JS, Sim MR, Pisaniello DL. The effects of ambient temperatures on the risk of work-related injuries and illnesses: Evidence from Adelaide, Australia 2003-2013. ENVIRONMENTAL RESEARCH 2019; 170:101-109. [PMID: 30579159 DOI: 10.1016/j.envres.2018.12.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The thermal environment can directly affect workers' occupational health and safety, and act as a contributing factor to injury or illness. However, the literature addressing risks posed by varying temperatures on work-related injuries and illnesses is limited. OBJECTIVES To examine the occupational injury and illness risk profiles for hot and cold conditions. METHODS Daily numbers of workers' compensation claims in Adelaide, South Australia from 2003 to 2013 (n = 224,631) were sourced together with daily weather data. The impacts of maximum daily temperature on the risk of work-related injuries and illnesses was assessed using a time-stratified case-crossover study design combined with a distributed lag non-linear model. RESULTS The minimum number of workers' compensation claims occurred when the maximum daily temperature was 25 °C. Compared with this optimal temperature, extremely hot temperatures (99th percentile) were associated with an increase in overall claims (RR: 1.30, 95%CI: 1.18-1.44) whereas a non-significant increase was observed with extremely cold temperatures (1st percentile, RR: 1.10 (95%CI: 0.99-1.21). Heat exposure had an acute effect on workers' injuries whereas cold conditions resulted in delayed effects. Moderate temperatures were associated with a greater injury burden than extreme temperatures. CONCLUSION Days of very high temperatures were associated with the greatest risks of occupational injuries; whereas moderate temperatures, which occur more commonly, have the greatest burden. These findings suggest that the broader range of thermal conditions should be considered in workplace injury and illness prevention strategies.
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Affiliation(s)
- Blesson M Varghese
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Adrian G Barnett
- School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Alana L Hansen
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Scott Hanson-Easey
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Jane S Heyworth
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Malcolm R Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, VIC, Australia
| | - Dino L Pisaniello
- School of Public Health, The University of Adelaide, Adelaide, Australia.
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Doubleday A, Baker MG, Lavoué J, Siemiatycki J, Seixas NS. Estimating the population prevalence of traditional and novel occupational exposures in Federal Region X. Am J Ind Med 2019; 62:111-122. [PMID: 30548877 PMCID: PMC10482507 DOI: 10.1002/ajim.22931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Federal Region X is an administrative region in the northwestern United States comprised of the states of Alaska (AK), Idaho (ID), Oregon (OR), and Washington (WA). Quantifying the number of workers in this region exposed to harmful circumstances in the workplace, and projected changes over time will help to inform priorities for occupational health training, risk reduction, and research. METHODS State data for WA, ID, OR, and AK were used to estimate number of workers by occupation, in 2014 and 2024. These data were merged with a Canadian job-exposure matrix (CANJEM) which characterizes chemical exposures, and O*NET, which ranks occupations with particular physical, ergonomic, and psychosocial exposures. RESULTS Of the exposures considered, psychosocial and ergonomic exposures were the most prevalent among the regional workforce, though traditional chemical exposures are still common and increasing. CONCLUSIONS Exposure surveillance will inform prioritization of risk reduction strategies, ultimately leading to a decrease in occupational injury and illness. Findings from this analysis will help to prioritize occupational health training and research in the region.
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Affiliation(s)
- Annie Doubleday
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Marissa G Baker
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Jérôme Lavoué
- University of Montreal Hospital Research Center, Montreal, Quebec, Canada
| | - Jack Siemiatycki
- University of Montreal Hospital Research Center, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Noah S Seixas
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
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Lingham G, Yazar S, Lucas RM, Walsh JP, Zhu K, Hunter M, Lim EM, Cooke BR, Mackey DA. Low 25-Hydroxyvitamin D Concentration Is Not Associated With Refractive Error in Middle-Aged and Older Western Australian Adults. Transl Vis Sci Technol 2019; 8:13. [PMID: 30697464 PMCID: PMC6348994 DOI: 10.1167/tvst.8.1.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/15/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose To investigate the association between serum 25-hydroxyvitamin D (25[OH]D) concentration and refractive error in a community-based cohort of adults aged 46 to 69 years. Methods Residents of the City of Busselton in Western Australia born between 1946 and 1964 were invited to participate. Participants underwent cycloplegic autorefraction and completed questionnaires on education, occupational sun exposure, and physical activity. Blood samples were collected and serum frozen at −80°C. Serum 25[OH]D concentration was measured by immunoassay. Data on 25[OH]D were deseasonalized and multivariate models built to analyze the association between 25[OH]D concentration and spherical equivalent and myopia, defined as spherical equivalent <−0.50 D. Results After exclusions, data were available for 4112 participants. Serum 25[OH]D concentration was not associated with spherical equivalent or myopia after adjustment for confounding factors (β = −0.01, 95% confidence interval [CI]: −0.03 to −0.008, P = 0.25, and odds ratio = 1.02, 95% CI: 0.99 to 1.05, P = 0.12, respectively). When participants were classified into 25[OH]D groups of lower (<50 nmol/L), medium (≥50 to <75 nmol/L), and upper (≥75 nmol/L), the upper group had slightly greater myopic refractive error than the medium group (P = 0.02) but not the lower group, after adjustment for confounders. Conclusions There was no substantial association between 25[OH]D levels and spherical equivalent or odds of myopia in this study. The association previously noted between low serum 25[OH]D level and myopia in younger Western Australians is not evident in later adulthood. Translational Relevance This study provides further evidence suggesting that vitamin D levels are unrelated to myopia risk in adults and thus not a suitable target for myopia intervention.
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Affiliation(s)
- Gareth Lingham
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Seyhan Yazar
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Robyn M Lucas
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - John P Walsh
- Medical School, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Ee Mun Lim
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia
| | - Brian R Cooke
- PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
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35
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Callahan CL, Locke SJ, Dopart PJ, Stewart PA, Schwartz K, Ruterbusch JJ, Graubard BI, Rothman N, Hofmann JN, Purdue MP, Friesen MC. Decision rule approach applied to estimate occupational lead exposure in a case-control study of kidney cancer. Am J Ind Med 2018; 61:901-910. [PMID: 30291640 DOI: 10.1002/ajim.22912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND We developed a systematic, data-driven approach to estimate metrics of occupational exposure to lead to aid in epidemiologic analyses in a case-control study of kidney cancer. METHODS Probability of exposure to ten lead sources was assigned using decision rules developed from an extensive literature review and expert judgement. For jobs with >50% probability of exposure, we assigned source-specific frequency based on subjects' self-reported task frequencies or means of subjects' job-groups and source-specific intensity estimates of blood lead (μg/dL). RESULTS In our study, 18.7% of employed person-years were associated with high (≥80%) probability of exposure to any lead source. The most common medium (>50%) or high probability source of lead exposure was leaded gasoline (2.5% and 11.5% of employed person-years, respectively). The median blood lead attributed to occupational exposure was 3.1 μg/dL. CONCLUSIONS These rules can aid in future studies after population-specific adaption for geographic differences and different exposure scenarios.
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Affiliation(s)
- Catherine L. Callahan
- Occupational and Environmental Epidemiology Branch; Division of Cancer Epidemiology Genetics; National Cancer Institute; Bethesda Maryland
| | - Sarah J. Locke
- Occupational and Environmental Epidemiology Branch; Division of Cancer Epidemiology Genetics; National Cancer Institute; Bethesda Maryland
| | - Pamela J. Dopart
- Occupational and Environmental Epidemiology Branch; Division of Cancer Epidemiology Genetics; National Cancer Institute; Bethesda Maryland
| | | | - Kendra Schwartz
- Department of Family Medicine and Public Health Sciences; Karmanos Cancer Institute; Wayne State University; Detroit Michigan
| | - Julie J. Ruterbusch
- Department of Family Medicine and Public Health Sciences; Karmanos Cancer Institute; Wayne State University; Detroit Michigan
| | - Barry I. Graubard
- Biostatistics Branch; Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda Maryland
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch; Division of Cancer Epidemiology Genetics; National Cancer Institute; Bethesda Maryland
| | - Jonathan N. Hofmann
- Occupational and Environmental Epidemiology Branch; Division of Cancer Epidemiology Genetics; National Cancer Institute; Bethesda Maryland
| | - Mark P. Purdue
- Occupational and Environmental Epidemiology Branch; Division of Cancer Epidemiology Genetics; National Cancer Institute; Bethesda Maryland
| | - Melissa C. Friesen
- Occupational and Environmental Epidemiology Branch; Division of Cancer Epidemiology Genetics; National Cancer Institute; Bethesda Maryland
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36
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Carey RN, Fritschi L, Driscoll TR, Peters S, Glass DC, Benke G, Reid A. Interventions to Reduce Future Cancer Incidence from Diesel Engine Exhaust: What Might Work? Cancer Prev Res (Phila) 2018; 12:13-20. [PMID: 30352840 DOI: 10.1158/1940-6207.capr-18-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/10/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022]
Abstract
Exposure to diesel engine exhaust (DEE) contributes appreciably to the burden of occupational cancer. This study aims to estimate the potential impact of a range of interventions on the future burden of cancer from occupational exposure to DEE in Australia. The future excess fraction method, a novel method based on the lifetime risk approach, was used to model changes in the future burden of cancer among the Australian working age population exposed to DEE at work in 2012 under various intervention strategies. The interventions modeled were based on the widely accepted hierarchy of control model. At baseline, 600 (0.4%) future bladder and 4,450 (0.6%) future lung cancer cases over the lifetime of the cohort were estimated to be attributable to occupational exposure to DEE in those exposed in 2012. Up to 2,000 of these cases were estimated to be avoidable through the use of various interventions. Exhaust hoses (engineering controls) were estimated to be particularly effective. This study provides an indication of which intervention strategies may be most useful in reducing the future burden of cancer associated with occupational DEE exposure. These results show the potential effect of changing current exposure, rather than focusing on past exposures, and thus provide relevant information for policy planning.
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Affiliation(s)
- Renee N Carey
- School of Public Health, Curtin University, Bentley, Australia.
| | - Lin Fritschi
- School of Public Health, Curtin University, Bentley, Australia
| | - Timothy R Driscoll
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Susan Peters
- School of Global and Population Health, University of Western Australia, Nedlands, Australia.,Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Deborah C Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Geza Benke
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alison Reid
- School of Public Health, Curtin University, Bentley, Australia
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37
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Soeberg M, Vallance DA, Keena V, Takahashi K, Leigh J. Australia's Ongoing Legacy of Asbestos: Significant Challenges Remain Even after the Complete Banning of Asbestos Almost Fifteen Years Ago. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020384. [PMID: 29473898 PMCID: PMC5858453 DOI: 10.3390/ijerph15020384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/28/2018] [Accepted: 02/13/2018] [Indexed: 11/17/2022]
Abstract
The most effective way of reducing the global burden of asbestos-related diseases is through the implementation of asbestos bans and minimising occupational and non-occupational exposure to respirable asbestos fibres. Australia’s asbestos consumption peaked in the 1970s with Australia widely thought to have had among the highest per-capita asbestos consumption level of any country. Australia’s discontinuation of all forms of asbestos and asbestos-containing products and materials did not occur at a single point of time. Crocidolite consumption ceased in the late 1960s, followed by amosite consumption stopping in the mid 1980s. Despite significant government reports being published in 1990 and 1999, it was not until the end of 2003 that a complete ban on all forms of asbestos (crocidolite, amosite, and chrysotile) was introduced in Australia. The sustained efforts of trade unions and non-governmental organisations were essential in forcing the Australian government to finally implement the 2003 asbestos ban. Trade unions and non-government organisations continue to play a key role today in monitoring the government’s response to Australian asbestos-related disease epidemic. There are significant challenges that remain in Australia, despite a complete asbestos ban being implemented almost fifteen years ago. The Australian epidemic of asbestos-related disease has only now reached its peak. A total of 16,679 people were newly diagnosed with malignant mesothelioma between 1982 and 2016, with 84% of cases occurring in men. There has been a stabilisation of the age-standardised malignant mesothelioma incidence rate in the last 10 years. In 2016, the incidence rate per 100,000 was 2.5 using the Australian standard population and 1.3 using the Segi world standard population. Despite Australia’s complete asbestos ban being in place since 2003, public health efforts must continue to focus on preventing the devastating effects of avoidable asbestos-related diseases, including occupational and non-occupational groups who are potentially at risk from exposure to respirable asbestos fibres.
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Affiliation(s)
- Matthew Soeberg
- Asbestos Diseases Research Institute, P.O. Box 3628, Rhodes, NSW 2138, Australia.
| | - Deborah A Vallance
- Australian Manufacturing Workers' Union, P.O. Box 160, Granville, NSW 2142, Australia.
| | - Victoria Keena
- Asbestos Diseases Research Institute, P.O. Box 3628, Rhodes, NSW 2138, Australia.
| | - Ken Takahashi
- Asbestos Diseases Research Institute, P.O. Box 3628, Rhodes, NSW 2138, Australia.
| | - James Leigh
- Asbestos Diseases Research Institute, P.O. Box 3628, Rhodes, NSW 2138, Australia.
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38
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Lewkowski K, McCausland K, Heyworth JS, Li IW, Williams W, Fritschi L. Questionnaire-based algorithm for assessing occupational noise exposure of construction workers. Occup Environ Med 2017; 75:237-242. [DOI: 10.1136/oemed-2017-104381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 10/27/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
ObjectivesOccupational noise exposure is a major cause of hearing loss worldwide. In order to inform preventative strategies, we need to further understand at a population level which workers are most at risk.MethodsWe have developed a new questionnaire-based algorithm that evaluates an individual worker’s noise exposure. The questionnaire and supporting algorithms are embedded into the existing software platform, OccIDEAS. Based on the tasks performed by a worker during their most recent working shift and using a library of task-based noise exposure levels, OccIDEAS estimates whether a worker has exceeded the full-shift workplace noise exposure limit (LAeq,8h≥85 dBA). We evaluated the validity of the system in a sample of 100 construction workers. Each worker wore a dosimeter for a full working shift and was then interviewed using the OccIDEAS software.ResultsThe area under the receiver operating characteristic curve was 0.81 (95% CI 0.72 to 0.90) indicating that the ability of OccIDEAS to identify construction workers with an LAeq,8h≥85 dBA was excellent.ConclusionThis validated noise questionnaire may be useful in epidemiological studies and for workplace health and safety applications.
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Abstract
PURPOSE OF REVIEW Burden of occupational disease estimation contributes to understanding of both magnitude and relative importance of different occupational hazards and provides essential information for targeting risk reduction. This review summarises recent key findings and discusses their impact on occupational regulation and practice. RECENT FINDINGS New methods have been developed to estimate burden of occupational disease that take account of the latency of many chronic diseases and allow for exposure trends and workforce turnover. Results from these studies have shown in several countries and globally that, in spite of improvements in workplace technology, practices and exposures over the last decades, occupational hazards remain an important cause of ill health and mortality worldwide. Major data gaps have been identified particularly regarding exposure information. Reliable data on employment and disease are also lacking especially in developing countries. Burden of occupational disease estimates form an important part of decision-making processes.
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Affiliation(s)
- Lesley Rushton
- Department of Epidemiology and Biostatistics, Imperial College London, MRC-HPA Centre for Environment and Health, Norfolk Place, London, W2 1PG, UK.
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40
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Hall AL, Demers PA, Astrakianakis G, Ge C, Peters CE. Estimating National-Level Exposure to Antineoplastic Agents in the Workplace: CAREX Canada Findings and Future Research Needs. Ann Work Expo Health 2017; 61:656-658. [PMID: 28595280 PMCID: PMC6824530 DOI: 10.1093/annweh/wxx042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/29/2017] [Accepted: 05/11/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Occupational exposure to antineoplastic agents occurs in various environments and is associated with increased cancer risk and adverse reproductive outcomes. National-level information describing the location and extent of occupational exposure to antineoplastic agents is unavailable in Canada and most other countries. CAREX Canada aimed to estimate the prevalence and relative levels of occupational exposures to antineoplastic agents across work setting, occupation, and sex. METHODS 'Exposure' was defined as any potential for worker contact with antineoplastic agents. Baseline numbers of licensed workers were obtained from their respective professional bodies. For unlicensed workers, Census data or data extrapolated from human resources reports (e.g., staffing ratios) were used. Prevalence was estimated by combining population estimates with exposure proportions from peer-reviewed and grey literature. Exposure levels (classified as low, moderate, and high) by occupation and work setting were estimated qualitatively by combining estimates of contact frequency and exposure control practices. RESULTS Approximately 75000 Canadians (0.42% of the total workforce) are estimated as occupationally exposed to antineoplastic agents; over 75% are female. The largest occupational group exposed to antineoplastic agents is community pharmacy workers, with 30200 exposed. By work setting, 39000 workers (52% of all exposed) are located in non-hospital settings; the remaining 48% are exposed in hospitals. The majority (75%) of workers are in the moderate exposure category. CONCLUSIONS These estimates of the prevalence and location of occupational exposures to antineoplastic agents could be used to identify high-risk groups, estimate disease burden, and target new research and prevention activities. The limited secondary data available for developing these estimates highlights the need for increased quantitative measurement and documentation of antineoplastic agent contamination and exposure, particularly in work environments where use is emerging.
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Affiliation(s)
- Amy L. Hall
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, B525 University Avenue, 3rd Floor, Toronto, Ontario M5G 2L3, Canada
| | - George Astrakianakis
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Calvin Ge
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM, Utrecht, The Netherlands
| | - Cheryl E. Peters
- Department of Health Sciences, Carleton University, 1125 Colonel By Dr., 5411 Herzberg Building, Ottawa, Ontario K1S 5B6, Canada
- CAREX Canada, Simon Fraser University, 105 - 515 W. Hastings St., Downtown Campus, Vancouver, British Columbia V6B 5K3, Canada
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41
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The future excess fraction of occupational cancer among those exposed to carcinogens at work in Australia in 2012. Cancer Epidemiol 2017; 47:1-6. [DOI: 10.1016/j.canep.2016.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/29/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
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42
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Driscoll T. Occupational health and safety in Oceania—current state and future priorities. Occup Med (Lond) 2017; 67:84-86. [DOI: 10.1093/occmed/kqw095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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43
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Varied exposure to carcinogenic, mutagenic, and reprotoxic (CMR) chemicals in occupational settings in France. Int Arch Occup Environ Health 2017; 90:227-241. [DOI: 10.1007/s00420-016-1191-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
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44
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Corrêa MJM, Santana VS. [Occupational exposure to benzene in Brazil: estimates based on an occupational exposure matrix]. CAD SAUDE PUBLICA 2016; 32:e00129415. [PMID: 28001208 DOI: 10.1590/0102-311x00129415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 04/06/2016] [Indexed: 02/07/2023] Open
Abstract
This study estimates the number of exposed workers and the prevalence of occupational benzene exposure in Brazil. Due to the lack of available local measurements for the study, data were used from an occupational exposure matrix, the Finnish National Job-Exposure Matrix (FINJEM), which covers proportions of individuals exposed to benzene, calculated as environmental measures. In Brazil, the 2010 Demographic Census identified 86,353,839 workers in the workforce and employed. Applying the FINJEM parameters, an estimated 7,376,761 (8.5%) belonged to potentially exposed occupational groups, while 770,212 were considered exposed to benzene, corresponding to an occupational group-weighted prevalence of 0.9%, higher in men (1.1%) than in women (0.6%). Exposed individuals were concentrated in the category of Machine and Motor Operators and Mechanics (62%). The number of exposed and prevalence of occupational exposure to benzene are high, even when compared to Finnish parameters, suggesting the need for monitoring and control of this carcinogen in Brazil.
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Affiliation(s)
| | - Vilma Sousa Santana
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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45
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Jomichen J, El-Zaemey S, Heyworth JS, Carey RN, Darcey E, Reid A, Glass DC, Driscoll T, Peters S, Abramson M, Fritschi L. Australian work exposures studies: occupational exposure to pesticides. Occup Environ Med 2016; 74:46-51. [DOI: 10.1136/oemed-2016-103723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 02/03/2023]
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46
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Whiteman DC, Webb PM, Green AC, Neale RE, Fritschi L, Bain CJ, Parkin DM, Wilson LF, Olsen CM, Nagle CM, Pandeya N, Jordan SJ, Antonsson A, Kendall BJ, Hughes MCB, Ibiebele TI, Miura K, Peters S, Carey RN. Cancers in Australia in 2010 attributable to modifiable factors: summary and conclusions. Aust N Z J Public Health 2016; 39:477-84. [PMID: 26437735 PMCID: PMC4606779 DOI: 10.1111/1753-6405.12471] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/01/2015] [Accepted: 07/01/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To estimate the numbers and proportions of cancers occurring in Australia in 2010 attributable to modifiable causal factors. METHODS We estimated the population attributable fraction (PAF) of cancers associated with exposure to 13 causal factors using standard formulae incorporating exposure prevalence and relative risk data. We also calculated the potential impact of changing exposure to some factors. RESULTS A total of 32% of all cancers diagnosed in Australia in 2010 (excluding keratinocyte cancers) were attributable to the 13 factors assessed (men 33%; women 31%). Leading factors were tobacco smoke (PAF all cancers: 13.4%), solar radiation (6.2%), inadequate diet (6.1%) and overweight/obesity (3.4%). Factors conferring highest PAFs differed by sex: highest PAFs for men were tobacco smoke (15.8%), solar radiation (7.1%) and alcohol (3.0%); while highest PAFs for women were tobacco smoke (10.1%), solar radiation (5.0%) and overweight/obesity (4.5%). Sites with the highest counts of potentially preventable cancers were lung (8,569), colorectal (7,404), melanoma of the skin (7,220) and breast (3,233). CONCLUSIONS At least one in three cancers in Australia is attributable to exposure to known modifiable factors. IMPLICATIONS Up to 37,000 cancers could be prevented in Australia each year if the population avoided exposure to 13 common factors known or strongly suspected to cause cancer.
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Affiliation(s)
- David C Whiteman
- QIMR Berghofer Medical Research Institute, Queensland.,School of Public Health, The University of Queensland
| | - Penelope M Webb
- QIMR Berghofer Medical Research Institute, Queensland.,School of Public Health, The University of Queensland
| | - Adele C Green
- QIMR Berghofer Medical Research Institute, Queensland.,School of Public Health, The University of Queensland.,Cancer Research UK, Manchester Institute and Institute of Inflammation and Repair, University of Manchester, United Kingdom
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Queensland.,School of Public Health, The University of Queensland
| | - Lin Fritschi
- School of Public Health, Curtin University, Western Australia
| | - Christopher J Bain
- QIMR Berghofer Medical Research Institute, Queensland.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australian Capital Territory
| | - D Max Parkin
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | | | - Catherine M Olsen
- QIMR Berghofer Medical Research Institute, Queensland.,School of Public Health, The University of Queensland
| | - Christina M Nagle
- QIMR Berghofer Medical Research Institute, Queensland.,School of Public Health, The University of Queensland
| | - Nirmala Pandeya
- QIMR Berghofer Medical Research Institute, Queensland.,School of Public Health, The University of Queensland
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Queensland.,School of Public Health, The University of Queensland
| | | | - Bradley J Kendall
- QIMR Berghofer Medical Research Institute, Queensland.,School of Medicine, The University of Queensland
| | | | | | - Kyoko Miura
- QIMR Berghofer Medical Research Institute, Queensland
| | - Susan Peters
- Occupational Respiratory Epidemiology, School of Population Health, The University of Western Australia
| | - Renee N Carey
- School of Public Health, Curtin University, Western Australia
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47
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Friesen MC, Lan Q, Ge C, Locke SJ, Hosgood D, Fritschi L, Sadkowsky T, Chen YC, Wei H, Xu J, Lam TH, Kwong YL, Chen K, Xu C, Su YC, Chiu BCH, Ip KMD, Purdue MP, Bassig BA, Rothman N, Vermeulen R. Evaluation of Automatically Assigned Job-Specific Interview Modules. ANNALS OF OCCUPATIONAL HYGIENE 2016; 60:885-99. [PMID: 27250109 DOI: 10.1093/annhyg/mew029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/29/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In community-based epidemiological studies, job- and industry-specific 'modules' are often used to systematically obtain details about the subject's work tasks. The module assignment is often made by the interviewer, who may have insufficient occupational hygiene knowledge to assign the correct module. We evaluated, in the context of a case-control study of lymphoid neoplasms in Asia ('AsiaLymph'), the performance of an algorithm that provided automatic, real-time module assignment during a computer-assisted personal interview. METHODS AsiaLymph's occupational component began with a lifetime occupational history questionnaire with free-text responses and three solvent exposure screening questions. To assign each job to one of 23 study-specific modules, an algorithm automatically searched the free-text responses to the questions 'job title' and 'product made or services provided by employer' using a list of module-specific keywords, comprising over 5800 keywords in English, Traditional and Simplified Chinese. Hierarchical decision rules were used when the keyword match triggered multiple modules. If no keyword match was identified, a generic solvent module was assigned if the subject responded 'yes' to any of the three solvent screening questions. If these question responses were all 'no', a work location module was assigned, which redirected the subject to the farming, teaching, health professional, solvent, or industry solvent modules or ended the questions for that job, depending on the location response. We conducted a reliability assessment that compared the algorithm-assigned modules to consensus module assignments made by two industrial hygienists for a subset of 1251 (of 11409) jobs selected using a stratified random selection procedure using module-specific strata. Discordant assignments between the algorithm and consensus assignments (483 jobs) were qualitatively reviewed by the hygienists to evaluate the potential information lost from missed questions with using the algorithm-assigned module (none, low, medium, high). RESULTS The most frequently assigned modules were the work location (33%), solvent (20%), farming and food industry (19%), and dry cleaning and textile industry (6.4%) modules. In the reliability subset, the algorithm assignment had an exact match to the expert consensus-assigned module for 722 (57.7%) of the 1251 jobs. Overall, adjusted for the proportion of jobs in each stratum, we estimated that 86% of the algorithm-assigned modules would result in no information loss, 2% would have low information loss, and 12% would have medium to high information loss. Medium to high information loss occurred for <10% of the jobs assigned the generic solvent module and for 21, 32, and 31% of the jobs assigned the work location module with location responses of 'someplace else', 'factory', and 'don't know', respectively. Other work location responses had ≤8% with medium to high information loss because of redirections to other modules. Medium to high information loss occurred more frequently when a job description matched with multiple keywords pointing to different modules (29-69%, depending on the triggered assignment rule). CONCLUSIONS These evaluations demonstrated that automatically assigned modules can reliably reproduce an expert's module assignment without the direct involvement of an industrial hygienist or interviewer. The feasibility of adapting this framework to other studies will be language- and exposure-specific.
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Affiliation(s)
- Melissa C Friesen
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA;
| | - Qing Lan
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA
| | - Calvin Ge
- 2.University of Utrecht, Utrecht, The Netherlands
| | - Sarah J Locke
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA
| | - Dean Hosgood
- 3.Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lin Fritschi
- 4.School of Public Health, Curtin University, Perth, Australia
| | - Troy Sadkowsky
- 5.Data Scientists Pty Ltd, Sunshine Coast, Queensland, Australia
| | - Yu-Cheng Chen
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA; 6.Environmental Health Research Center, National Health Research Institutes, Zhunan, Taiwan
| | - Hu Wei
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA
| | - Jun Xu
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA; 7.Division of Community Medicine and Public Health Practice, School of Public Health, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- 7.Division of Community Medicine and Public Health Practice, School of Public Health, The University of Hong Kong, Hong Kong
| | - Yok Lam Kwong
- 8.Bone Marrow Transplant Unit, Queen Mary Hospital, Hong Kong; 9.Division of Haematology, Oncology and Bone Marrow Transplantation, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Kexin Chen
- 10.Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Caigang Xu
- 11.Department of Hematology, Hematology Research Laboratory and Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yu-Chieh Su
- 12.Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; 13.School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Brian C H Chiu
- 14.Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Kai Ming Dennis Ip
- 7.Division of Community Medicine and Public Health Practice, School of Public Health, The University of Hong Kong, Hong Kong
| | - Mark P Purdue
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA
| | - Bryan A Bassig
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA
| | - Nat Rothman
- 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, North Bethesda, MD 20980, USA
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48
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Fritschi L, Chan J, Hutchings SJ, Driscoll TR, Wong AYW, Carey RN. The future excess fraction model for calculating burden of disease. BMC Public Health 2016; 16:386. [PMID: 27169472 PMCID: PMC4865002 DOI: 10.1186/s12889-016-3066-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/29/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Estimates of the burden of disease caused by a particular agent are used to assist in making policy and prioritizing actions. Most estimations have employed the attributable fraction approach, which estimates the proportion of disease cases or deaths in a specific year which are attributable to past exposure to a particular agent. While this approach has proven extremely useful in quantifying health effects, it requires historical data on exposures which are not always available. METHODS We present an alternative method, the future excess fraction method, which is based on the lifetime risk approach, and which requires current rather than historical exposure data. This method estimates the future number of exposure-related disease cases or deaths occurring in the subgroup of the population who were exposed to the particular agent in a specific year. We explain this method and use publically-available data on current asbestos exposure and mesothelioma incidence to demonstrate the use of the method. CONCLUSIONS Our approach to modelling burden of disease is useful when there are no historical measures of exposure and where future disease rates can be projected on person years at risk.
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Affiliation(s)
- Lin Fritschi
- School of Public Health, Curtin University, Perth, Australia.
| | - Jayzii Chan
- Department of Mathematics and Statistics, Curtin University, Perth, Australia
| | - Sally J Hutchings
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Tim R Driscoll
- School of Public Health, University of Sydney, Sydney, Australia
| | - Adrian Y W Wong
- Department of Mathematics and Statistics, Curtin University, Perth, Australia
| | - Renee N Carey
- School of Public Health, Curtin University, Perth, Australia
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49
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Fritschi L, Crewe J, Darcey E, Reid A, Glass DC, Benke GP, Driscoll T, Peters S, Si S, Abramson MJ, Carey RN. The estimated prevalence of exposure to asthmagens in the Australian workforce, 2014. BMC Pulm Med 2016; 16:48. [PMID: 27061283 PMCID: PMC4826519 DOI: 10.1186/s12890-016-0212-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/31/2016] [Indexed: 11/25/2022] Open
Abstract
Background There is very little information available on a national level as to the number of people exposed to specific asthmagens in workplaces. Methods We conducted a national telephone survey in Australia to investigate the prevalence of current occupational exposure to 277 asthmagens, assembled into 27 groups. Demographic and current job information were obtained. A web-based tool, OccIDEAS, was used to collect job task information and assign exposure to each asthmagen group. Results In the Australian Workplace Exposure Study – Asthma (AWES- Asthma) we interviewed 4878 participants (2441 male and 2437 female). Exposure to at least one asthmagen was more common among men (47 %) than women (40 %). Extrapolated to the Australian population, approximately 2.8 million men and 1.7 million women were estimated to be exposed. Among men, the most common exposures were bioaerosols (29 %) and metals (27 %), whilst the most common exposures among women were latex (25 %) and industrial cleaning and sterilising agents (20 %). Conclusions This study provides information about the prevalence of exposure to asthmagens in Australian workplaces which will be useful in setting priorities for control and prevention of occupational asthma. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0212-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lin Fritschi
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Julie Crewe
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Ellie Darcey
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Alison Reid
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Deborah C Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Geza P Benke
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tim Driscoll
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Susan Peters
- School of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Si Si
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Michael J Abramson
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renee N Carey
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
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Si S, Carey RN, Reid A, Driscoll T, Glass DC, Peters S, Benke G, Darcey E, Fritschi L. The Australian Work Exposures Study: Prevalence of Occupational Exposure to Respirable Crystalline Silica. ANNALS OF OCCUPATIONAL HYGIENE 2016; 60:631-7. [DOI: 10.1093/annhyg/mew007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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