Occupational Exposure to Ultrafine Particles and Placental Histopathological Lesions: A Retrospective Study about 130 Cases

Ultrafine particles (UFPs) are particles smaller than 100 nanometers that are produced unintentionally during human activities or natural phenomena. They have a higher biological reactivity than bigger particles and can reach the placenta after maternal exposure. One study has shown an association between maternal occupational exposure to UFPs and fetal growth restriction. Yet few studies have focused on the effects of UFP exposure on placental histopathological lesions. The aim of this study was to investigate the association between maternal occupational exposure to UFPs and histopathological lesions of their placenta. The analyses were based on data from the ARTEMIS Center. A job-exposure matrix was used to assess occupational exposure to UFPs. The histopathological placental exam was performed by two pathologists who were blinded to the exposure of each subject. The examination was conducted in accordance with the recommendations of the Amsterdam consensus. The study sample included 130 placentas (30 exposed, 100 unexposed). Maternal occupational exposure to UFPs during pregnancy is significantly associated with placental hypoplasia (the phenomenon affected 61% of the exposed patients and 34% of the unexposed ones, p < 0.01). Further research is needed to explain its pathophysiological mechanisms.

Developing a company-specific job exposure matrix for the Asbest Chrysotile Cohort Study

ObjectivesExposure assessment for retrospective industrial cohorts are often hampered by limited availability of historical measurements. This study describes the development of company-specific job-exposure matrices (JEMs) based on measurements collected over five decades for a cohort study of 35 837 workers (Asbest Chrysotile Cohort Study) in the Russian Federation to estimate their cumulative exposure to chrysotile containing dust and fibres.MethodsAlmost 100 000 recorded stationary dust measurements were available from 1951-2001 (factories) and 1964–2001 (mine). Linear mixed models were used to extrapolate for years where measurements were not available or missing. Fibre concentrations were estimated using conversion factors based on side-by-side comparisons. Dust and fibre JEMs were developed and exposures were allocated by linking them to individual workers’ detailed occupational histories.ResultsThe cohort covered a total of 515 355 employment-years from 1930 to 2010. Of these individuals, 15% worked in jobs not considered professionally exposed to chrysotile. The median cumulative dust exposure was 26 mg/m3 years for the entire cohort and 37.2 mg/m3 years for those professionally exposed. Median cumulative fibre exposure was 16.4 fibre/cm3 years for the entire cohort and 23.4 fibre/cm3 years for those professionally exposed. Cumulative exposure was highly dependent on birth cohort and gender. Of those professionally exposed, women had higher cumulative exposures than men as they were more often employed in factories with higher exposure concentrations rather than in the mine.ConclusionsUnique company-specific JEMs were derived using a rich measurement database that overlapped with most employment-years of cohort members and will enable estimation of quantitative exposure–response.

Wissen über berufsbedingte inhalative Noxen bei Beschäftigten im Gesundheitsdienst und der Wohlfahrtspflege

Zusammenfassung Hintergrund Das Einatmen von beruflich bedingten Noxen (Dämpfe, Gase, Stäube, Rauche) kann zu unterschiedlichsten Gesundheitsproblemen führen. Beschäftigte aus dem Gesundheitsdienst und der Wohlfahrtspflege sind bei ihrer Tätigkeit z. B. Inhalationsanästhetika, Desinfektionsmitteln und -reinigern und chirurgischen Rauchgasen ausgesetzt. Fragestellung In dieser Untersuchung soll ermittelt werden, inwieweit sich Beschäftigte im Gesundheitsdienst und der Wohlfahrtspflege ihrer berufsbedingten Exposition gegenüber inhalativen Noxen bewusst sind. Material und Methoden Aus der 10.000er Baseline-Stichprobe der HCHS (Hamburg City Health Study) wurden alle Probanden selektiert, die beruflich im Gesundheitsdienst und der Wohlfahrtspflege tätig waren. Die subjektiven Fragebogenangaben zu einer arbeitsplatzbezogenen Exposition von Dämpfen, Gasen, Stäuben und Rauchen wurden mit Daten einer Job-Exposure-Matrix (JEM) abgeglichen. Ergebnisse Die Stichprobe (N = 1176) bestand zu 78 % aus Frauen, das Durchschnittsalter lag bei 61 Jahren. Probanden, die in der Arzt- und Praxishilfe (60,5 %) beschäftigt waren, machten die größte Berufsgruppe aus. Die Übereinstimmung zwischen subjektiven Expositionsangaben und JEM war gering (Cohens Kappa: 0,18). Die Sensitivität der subjektiven Angaben zu inhalativen Noxen im Vergleich zur JEM lag bei 49,5 %, die Spezifität bei 81,7 %. Ein Underreporting zu inhalativen Noxen war ausschließlich bei Beschäftigten in der Reinigung und der Körperpflege zu beobachten. Diskussion Die Ergebnisse zeigen, dass rund 50 % der exponierten Beschäftigten dieser Stichprobe sich ihrer Exposition nicht bewusst sind. Dies betrifft speziell Beschäftigte in der Reinigung und der Körperpflege. Das Underreporting von inhalativen Noxen am Arbeitsplatz gibt einen Hinweis für einen erhöhten Präventionsbedarf in dieser Branche. Demgegenüber stehen die existierenden Regeln und Vorschriften des Arbeitsschutzsystems. Abzuklären bleibt, inwieweit Wissensvermittlung sowie Präventionsregeln hinsichtlich inhalativer Noxen am Arbeitsplatz in Betrieben tatsächlich umgesetzt werden.

1067Annual changes in job strain and risk of coronary heart disease in Denmark

Background We examined the association between annual changes in job strain and incident coronary heart disease (CHD) in a population-based cohort study in Denmark. Methods We studied all workers residing in Denmark in 2000, aged 30-59 years with no prevalent CHD (N = 1,660,150). Using a job exposure matrix (JEM) with annual updates, we assessed changes in job strain from 2000-2009. Incident CHD was identified in hospital and death registers from 2001 to 2010. Using Cox regression, we calculated hazard ratios (HR) and 95% confidence intervals (CI) for the association between annual changes in job strain and incident CHD. Results During 16.1 million person-years (mean time of follow-up: 9.7 years), we identified 24,159 CHD cases (15.0 per 10,000 person-years). Compared to persistent no job strain, persistent job strain (HR 1.07, 95% CI 1.03–1.10), onset of job strain (HR 1.20, 95% CI 1.12–1.29) and removal of job strain (HR 1.20, 95% CI 1.12–1.28) were associated with higher CHD incidence. Conclusions Persistent and onset of job strain was associated with a higher risk of CHD. Removal of job strain was also associated with a higher risk, which might be due to health selection. Our results suggest that job strain contributes to risk of CHD in the Danish workforce. Key messages Implementing JEM in a population-based cohort of more than 1.6 million workers enabled us to demonstrate associations between annual changes in job strain and risk of incident CHD.

1510Development and validation of a Job Exposure Matrix for work related risk factors for COVID-19

Background Studies have shown a higher mortality due to COVID-19 amongst certain professions. The risk of becoming infected with SARS-CoV-2 and the occupational conditions associated with this, have not been studied extensively. This study aimed to develop and validate a Job Exposure Matrix (JEM) to assess the risk of COVID-19 in the workplace. Methods Researchers from three European countries defined six dimensions (four transmission determinants, two mitigation measures) to classify occupational risk. A combination of national statistics and expert judgement was used to classify ISCO-08 codes in no, low, elevated, or high risk for each dimension. Two data driven aspects of precarious work were also included and classified in four categories. The JEM was translated to SOC2010-codes and validated by comparing it to UK infection survey data and ONS estimates of exposure based on ONET data. Results A slightly increasing proportion of COVID-19 cases was observed with increasing risk scores in each dimension of the JEM. There was a high correlation between the JEM and the ONS estimates for physical proximity (r = 0.71) and exposure to COVID-19 or SARS-CoV-2 infection (r = 0.80) Conclusions Successful development and initial validation of this JEM has resulted in a useful tool for risk assessment of COVID-19 in the workplace. Further validation exercises will continue. Key messages This publicly available JEM can play a key role in the essential assessment of occupational contribution to the total burden of the COVID-19 pandemic.

Evaluation of Work-Related Symptoms by Job Exposure Matrix in Chronic Pulmonary Diseases - A Cross-sectional Study

Background: Despite the high prevalence of occupational airway disorders, they are usually underestimated by physicians. This study designed to study the prevalence of work-related symptoms (WRS) and their association with occupational exposure in outpatient pulmonary clinics. Methods: Adults with more than one year of lower respiratory symptoms were included. Retired patients, housewives and those unable to perform spirometry were excluded. Demographic, anthropometric and medical data were documented. The Persian version of National institute for health and safety respiratory questionnaire was used to classify job titles. WRS were defined as 2 (or more) positive questions with improvement of symptoms on days off work. Job exposure matrix (JEM) was used for classifying the type of occupational exposure into one of three categories: high molecular weight (HKW), low molecular weight (LMW) and mixed. Results: A total of 250 patients (69% male) with mean (±SD) age of 40 (±11.6) years, 178 cases of asthma and 59 chronic obstructive pulmonary disease (COPD) cases entered. Occupational exposure was seen in 51.2% of patients (26, 51 and 51 cases with HMW, LMW and mixed, respectively). WRS were lower in those who exercised regularly (24.6% vs. 39.4%) and higher in those with eczema (62.5% vs. 33.6%). Eczema had an odds ratio (OR) of 4.13 (95% CI 1.3 to 12.9, P = 0.01). Exposure to LMW almost tripled the risk of WRS (OR: 2.9, 95% CI: 1.4 to 5.9, P = 0.003) in our patients. Conclusion: Pulmonologists are firmly advised to take their patients’ occupational and vocational exposures into consideration for treatment plans, especially in those with positive history of eczema and exposure to LMW.

Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies

ObjectivesTo examine the association between cognitively stimulating work and subsequent risk of dementia and to identify protein pathways for this association.DesignMulticohort study with three sets of analyses.SettingUnited Kingdom, Europe, and the United States.ParticipantsThree associations were examined: cognitive stimulation and dementia risk in 107 896 participants from seven population based prospective cohort studies from the IPD-Work consortium (individual participant data meta-analysis in working populations); cognitive stimulation and proteins in a random sample of 2261 participants from one cohort study; and proteins and dementia risk in 13 656 participants from two cohort studies.Main outcome measuresCognitive stimulation was measured at baseline using standard questionnaire instruments on active versus passive jobs and at baseline and over time using a job exposure matrix indicator. 4953 proteins in plasma samples were scanned. Follow-up of incident dementia varied between 13.7 to 30.1 years depending on the cohort. People with dementia were identified through linked electronic health records and repeated clinical examinations.ResultsDuring 1.8 million person years at risk, 1143 people with dementia were recorded. The risk of dementia was found to be lower for participants with high compared with low cognitive stimulation at work (crude incidence of dementia per 10 000 person years 4.8 in the high stimulation group and 7.3 in the low stimulation group, age and sex adjusted hazard ratio 0.77, 95% confidence interval 0.65 to 0.92, heterogeneity in cohort specific estimates I2=0%, P=0.99). This association was robust to additional adjustment for education, risk factors for dementia in adulthood (smoking, heavy alcohol consumption, physical inactivity, job strain, obesity, hypertension, and prevalent diabetes at baseline), and cardiometabolic diseases (diabetes, coronary heart disease, stroke) before dementia diagnosis (fully adjusted hazard ratio 0.82, 95% confidence interval 0.68 to 0.98). The risk of dementia was also observed during the first 10 years of follow-up (hazard ratio 0.60, 95% confidence interval 0.37 to 0.95) and from year 10 onwards (0.79, 0.66 to 0.95) and replicated using a repeated job exposure matrix indicator of cognitive stimulation (hazard ratio per 1 standard deviation increase 0.77, 95% confidence interval 0.69 to 0.86). In analysis controlling for multiple testing, higher cognitive stimulation at work was associated with lower levels of proteins that inhibit central nervous system axonogenesis and synaptogenesis: slit homologue 2 (SLIT2, fully adjusted β −0.34, P<0.001), carbohydrate sulfotransferase 12 (CHSTC, fully adjusted β −0.33, P<0.001), and peptidyl-glycine α-amidating monooxygenase (AMD, fully adjusted β −0.32, P<0.001). These proteins were associated with increased dementia risk, with the fully adjusted hazard ratio per 1 SD being 1.16 (95% confidence interval 1.05 to 1.28) for SLIT2, 1.13 (1.00 to 1.27) for CHSTC, and 1.04 (0.97 to 1.13) for AMD.ConclusionsThe risk of dementia in old age was found to be lower in people with cognitively stimulating jobs than in those with non-stimulating jobs. The findings that cognitive stimulation is associated with lower levels of plasma proteins that potentially inhibit axonogenesis and synaptogenesis and increase the risk of dementia might provide clues to underlying biological mechanisms.

Night shift work undertaken by women and fertility treatment interact to increase prevalence of urogenital anomalies in children

ObjectiveTo investigate the role of maternal night shift work in occurrence of urogenital anomalies in offspring, considering a possible interaction with mode of conception.MethodsA population-based cohort comprising births in South Australia (1986–2002) was produced via linkage of fertility clinic records, perinatal and birth defects data. This study concerned first births to women in paid employment (n=98 103). Potential exposure to night shift was imputed by applying a job-exposure matrix to recorded occupation. Associations were examined using logistic regression, first for nurses and other night shift workers separately, then combined. An interaction term for night shift work and mode of conception was included in all models, while adjusting for covariates.ResultsAssociations were similar for nurses and other night shift workers, although only statistically significant for the former when considered separately. A multiplicative interaction was supported: for natural conceptions, maternal night shift work was not associated with offspring urogenital anomalies (OR=0.99, 95% CI 0.84 to 1.15); where a birth arose from fertility treatment, urogenital anomalies were significantly higher among births to all night shift workers compared with day workers (OR=2.07, 95% CI 1.20 to 3.55). This was not due to differences in the type of fertility treatment received.ConclusionsWomen in occupations that probably involved night shift did not have offspring with increased prevalence of urogenital anomalies if they conceived naturally. When night shift workers conceived with fertility treatment, the prevalence of urogenital anomalies was elevated. Possibly these women had the greatest exposure to night shift work, or least tolerance for this work schedule, or heightened sensitivity to hormonal aspects of fertility treatment.