Description: The year 2016 has seen some major events and unexpected results on the international stage, such as the ‘Yes’ vote for Brexit in the UK, the Syrian refugee crisis in Europe and the US Presidential election. It is not yet clear what impact these results could have on worker health, but anticipated changes to international trade and immigration could impact on the health and well-being of workers, especially those in unskilled and semiskilled, lower paid and more precarious jobs. The past year has also seen some important changes at Occupational and Environmental Medicine ( OEM ). In June, we were pleased to discover that the impact factor for OEM had increased from 3.215 to 3.745, its highest value ever. While the impact factor for OEM has been consistently above three over the past 6 years, over the past couple of years there have been stepwise increases to its current level. While we...

Description: In this issue of Occupational and Environmental Medicine ( OEM ), Leach et al 1 review the evidence that workplace bullying is associated with suicidal thoughts and behaviours. This is a rapidly developing area of enquiry, as it should be. In most Organisation for Economic Co-operation and Development (OECD) countries, suicide is a leading cause of mortality, particularly for men, who comprise on average of 3/4 of completed suicides. 2 While only a fraction of those experiencing suicidal thoughts will go on to self-harm, attempt suicide, or die by suicide, suicidal thoughts are a key upstream indicator of suicide risk and an appropriate target for prevention and control efforts. Finding strategies to reduce suicidality is a public health imperative. Leach et al identified a dozen studies meeting their inclusion criteria. Eight of these studies (including 1 of ours) reported on the association between workplace bullying and suicidal ideation or...

Description: Introduction Shift work is a common working arrangement with wide-ranging implications for worker health. Organisational determinants of shift work practices are not well characterised; such information could be used to guide evidence-based research and best practices to mitigate shift work's negative effects. This exploratory study aimed to describe and assess organisational-level determinants of shift work practices thought to affect health, across a range of industry sectors. Methods Data on organisational characteristics, shift work scheduling, provision of shift work education materials/training to employees and night-time lighting policies in the workplace were collected during phone interviews with organisations across the Canadian province of British Columbia. Relationships between organisational characteristics and shift work practices were assessed using multivariable logistic regression models. Results The study sample included 88 participating organisations, representing 30 700 shift workers. Long-duration shifts, provision of shift work education materials/training to employees and night-time lighting policies were reported by approximately one-third of participating organisations. Odds of long-duration shifts increased in larger workplaces and by industry. Odds of providing shift work education materials/training increased in larger workplaces, in organisations reporting concern for shift worker health and in organisations without seasonal changes in shift work. Odds of night-time lighting policies in the workplace increased in organisations reporting previous workplace accidents or incidents that occurred during non-daytime hours, site maintenance needs and client service or care needs. Conclusions This study points to organisational determinants of shift work practices that could be useful for targeting research and workplace interventions. Results should be interpreted as preliminary in an emerging body of literature on shift work and health.

Description: There is increasing evidence that shift work, an occupational exposure affecting about one-fourth of the working population, increases the risk of major chronic disease outcomes, such as cardiovascular disease and cancer. 1–4 Currently, there is an open discussion on whether shift work should be included in national lists of occupational hazards for compensation purposes. Denmark was the first (and to date only) country to consider breast cancer an occupational disease in shift workers, and to compensate women with over 20 years of night work who developed breast cancer. Chronic disease risk reduction and prevention in shift workers is an emerging field, which points to the need for more intervention studies. Whether and how companies or governments translate existing evidence into real-world policy or preventive actions currently remains largely unknown. The study by Hall et al 5 is a unique effort and first...

Description: Objective The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs. Methods Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated. Results Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p〈0.10). Stress at home and stress over finances were predictive of higher and lower costs of claims, respectively (p〈0.05). Conclusions The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims.

Description: Objectives Exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) has inconsistently been associated with a decreased sex ratio of the offspring (number of male births divided by total births). We conducted a study among men and women who were employed in a New Zealand phenoxy herbicide production plant between 1969 and 1984, to study their offspring sex ratio in relation to their back-calculated TCDD serum concentrations determined in 2007/2008. Methods A total of 127 men and 21 women reported that 355 children were conceived after starting employment at the plant. The association between their lipid-standardised TCDD serum concentrations back-calculated to the time of their offspring's birth and the probability of a male birth was estimated through logistic regression, adjusting for the age of the exposed parent at birth, current body mass index and smoking. Results The overall sex ratio was 0.55 (197 boys, 158 girls). For fathers with serum TCDD concentrations ≥20 pg/g lipid at time of birth, the sex ratio was 0.47 (OR 0.49; 95% CI 0.30 to 0.79). The probability of a male birth decreased with higher paternal serum TCDD at time of birth (〈4; 4–20; 20–100; ≥100 pg/g lipid), with ORs of 1.00 (reference); 1.00 (95% CI 0.50 to 2.02); 0.52 (95% CI 0.29 to 0.92); 0.45 (95% CI 0.23 to 0.89), p trend 0.007. For exposed mothers, the sex ratio was not reduced. Conclusions This study indicates that paternal serum TCDD concentrations in excess of an estimated 20 pg/g lipid at time of conception are associated with a reduced sex ratio.

Description: Objectives We investigated the relationship between 4,4’-methylene-bis(2-chloroaniline) (MBOCA) exposure and micronucleus (MN) frequency, and how this association was affected by genetic polymorphism of the cytochrome P450 enzyme (CYP3A4). Methods We divided the study population into an exposed group (n=44 with total urine MBOCA ≥20 μg/g creatinine) and a control group (n=47 with total urine MBOCA 〈20 μg/g creatinine). Lymphocyte MN frequency (MNF) and micronucleated cell (MNC) frequency were measured by the cytokinesis-block MN assay method. MNF reported as the number of micronuclei in binucleated cells per 1000 cells, and MNC reported as the number of binucleated cells with the presence of MN per 1000 cells. CYP3A4 alleles were measured by PCR-based restriction fragment length polymorphism (PCR-RFLP). Results The mean MNF (6.11 vs 4.46 MN/1000 cells, p〈0.001) and MNC (5.75 vs 4.15 MN/1000 cells, p〈0.001) in the exposed workers was significantly higher than that in the controls. The CYP3A4 polymorphism A/A+A/G influenced the difference in the mean MNF (5.97 vs 4.38 MN/1000 cells, p〈0.001) and MNC (5.60 vs 4.15 MN/1000 cells, p〈0.001) between the MBOCA-exposed and control groups. After adjusting risk factors, the MNF level in the MBOCA-exposed workers was 0.520 MN cells/1000 cells (p〈0.001) higher than the control group among the CYP3A4 A/A+A/G genotype. Similarly, the MNC level in the MBOCA-exposed workers was 0.593 MN/1000 cells (p〈0.001) higher than the control group among the CYP3A4 A/A+A/G genotype. However, the difference in adjusted MNF and MNC between the exposed and control groups was not significant for the CYP3A4 polymorphism with the G/G genotype. Conclusions We recommend that lymphocytes MNF and MNC are good indicators to evaluate MBOCA genotoxicity. Individuals with the CYP3A4 polymorphism A/A and A/G genotypes appear to be more susceptible to MBOCA genotoxicity.

Description: Background Pesticides are widely used in some occupational settings. Some pesticides have been classified as carcinogens; however, data on the number of workers exposed to pesticides are not available in Australia. The main aim of this study was to estimate the current prevalence of pesticide exposure in Australian workplaces. Methods The analysis used data from the Australian Work Exposures Study, a series of nationwide telephone surveys which investigated work-related prevalence and exposure to carcinogens and asthmagens, including pesticides, among current Australian workers. Information about the respondents’ current job and various demographic factors was collected in a telephone interview using the web-based tool OccIDEAS. Workers were considered exposed to pesticides if they reported applying or mixing pesticides in their current job. Results Of the 10 371 respondents, 410 (4%) respondents were assessed as being exposed to pesticides in the workplace, with exposure being more likely among males, individuals born in Australia, individuals with lower education level and those residing in regional or remote areas. Glyphosate was the most common active ingredient used by workers. Conclusions This is the first study to describe the prevalence of occupational pesticide exposure in Australia and one of the few recent studies internationally.

Description: Objectives The use of genetically engineered enzymes in the synthesis of flavourings, fragrances and other applications has increased tremendously. There is, however, a paucity of data on sensitisation and/or allergy to the finished products. We aimed to review the use of genetically modified enzymes and the enormous challenges in human biomonitoring studies with suitable assays of specific IgE to a variety of modified enzyme proteins in occupational settings and measure specific IgE to modified enzymes in exposed workers. Methods Specific IgE antibodies against workplace-specific individual enzymes were measured by the specific fluorescence enzyme-labelled immunoassay in 813 exposed workers seen in cross-sectional surveys. Results Twenty-three per cent of all exposed workers showed type I sensitisation with IgE antibodies directed against respective workplace-specific enzymes. The highest sensitisation frequencies observed were for workers exposed enzymes derived from α-amylase (44%), followed by stainzyme (41%), pancreatinin (35%), savinase (31%), papain (31%), ovozyme (28%), phytase (16%), trypsin (15%) and lipase (4%). The highest individual antibody levels (up to 110 kU/L) were detected in workers exposed to phytase, xylanase and glucanase. In a subgroup comprising 134 workers, detailed clinical diagnostics confirmed work-related symptoms. There was a strong correlation (r=0.75, p〈0.0001) between the symptoms and antibody levels. Workers with work-related respiratory symptoms showed a higher prevalence for the presence of specific IgE antibodies against workplace-specific enzymes than asymptomatic exposed workers (likelihood ratio 2.32, sensitivity 0.92, specificity 0.6). Conclusions Our data confirm the previous findings showing that genetically engineered enzymes are potent allergens eliciting immediate-type sensitisation. Owing to lack of commercial diagnostic tests, few of those exposed receive regular surveillance including biomonitoring with relevant specific IgE assays.

Description: Objectives Our aim was to develop a job-exposure matrix (JEM) to assess occupational exposure to alkylphenolic compounds in epidemiological research, considering changes in their use over time, and including exposure probabilities in the assessments. Methods We consulted multiple sources of information, and performed interviews with 9 key people from industry and academia. 3 hygienists coded frequency (minority or majority of workers involved) and intensity of exposure (including dispersive processes, with shaking, or aerosol generation, or otherwise) to alkylphenolic compounds for all the 390 International Standard Classification of Occupations (ISCO)-88 job titles by period of time. Intensity and frequency of exposure were combined in a single score as follows: unlikely=0, occasionally+low intensity=1, occasionally+high intensity=2, frequent+low intensity=2, and frequent+high intensity=3. Results We identified 54 (13.8%) of the 390 ISCO-88 job titles with potential exposure to alkylphenolic compounds. In 6 of jobs deemed as exposed, exposure depended on the economic sector of the occupation. Nonylphenol ethoxylates were the compounds most commonly involved (30 job titles, 55.6% of the exposed). Variations in alkylphenolic compounds use varied greatly over time; while they are still used in the plastic and rubber industry, in domestic cleaning agents their use began to decline before 1995. Conclusions We built a JEM to assess exposure to alkylphenolic compounds, taking into account changes in use over time, different types of alkylphenolic compounds and different scenarios of exposure, which can be a valuable tool for exposure assessment in epidemiological research on the health effects of these chemicals.