Development and validation of a multi-lingual online questionnaire for surveying the COVID-19 prevention and control measures used in global workplaces

Background Despite widespread COVID-19 vaccination programs, there is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to workers in diverse geographic and occupational settings. Methods A 44-item online survey was developed in English and validated for face and content validity according to literature review, expert consultation, and pre-testing. The survey was translated and piloted with 890 workers from diverse industries in Canada, Ireland, Argentina, Poland, Nigeria, China, the US, and the UK. Odds ratios generated from univariable, and multivariable logistic regression assessed differences in ‘feeling protected at work’ according to gender, age, occupation, country of residence, professional role, and vaccination status. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach’s alpha. Hypothesis testing using two-sample t-tests verified construct validity (i.e., discriminant validity, known-groups technique), and criterion validity. Results After adjustment for occupational sector, characteristics associated with feeling protected at work included being male (AOR = 1.88; 95% CI = 1.18,2.99), being over 55 (AOR = 2.17; 95% CI = 1.25,3.77) and working in a managerial position (AOR = 3.1; 95% CI = 1.99,4.83). EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach’s alpha ≥0.60). Hypothesis testing revealed differences in survey responses by country and occupational sector, confirming construct validity (p < 0.001), criterion validity (p = 0.04), and discriminant validity (p < 0.001). Conclusions The online survey, developed in English to identify the COVID-19 protective measures used in diverse workplace settings, showed strong face validity, content validity, internal consistency, criterion validity, and construct validity. Translations in Chinese, Spanish, French, Polish, and Hindi demonstrated adaptability of the survey for use in international working environments. The multi-lingual tool can be used by decision makers in the distribution of IPC resources, and to guide occupational safety and health (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.

Cancer incidence in a cohort of Swedish merchant seafarers between 1985 and 2011

Purpose Lung cancer, mesothelioma and several lifestyle-associated cancer forms have been reported more common in merchant seafarers. However, few studies reflect recent occupational settings and women seafarers are usually too scarce for meaningful analyses. We conducted a study on cancer incidence between 1985 and 2011 in a Swedish cohort consisting of male and female seafarers. Methods All seafarers in the Swedish Seafarers’ Register with at least one sea service between 1985 and 2011 and a cumulated sea service time of ≥ 30 days (N = 75,745; 64% men, 36% women; 1,245,691 person-years) were linked to the Swedish Cancer Register and followed-up until 31 December 2011. Standardized incidence ratios (SIR) were calculated with the general population as reference. Results There were 4159 cancer cases in total, with 3221 among men and 938 among women. Male seafarers had an increased risk of total cancer (SIR 1.05; 95% CI 1.01–1.09), lung cancer (SIR 1.51; 95% CI 1.35–1.67) and urinary bladder cancer (SIR 1.17; 95% CI 1.02–1.33). Several lifestyle-associated cancer forms were more common in men. Previous work on tankers was associated with leukaemia (SIR 1.41; 95% CI 1.00–1.86). The risk of cancer decreased with a start as a male seafarer after 1985, with a significant trend for total cancer (P < 0.001), lung cancer (P = 0.001) and, for tanker seafarers, leukaemia (P = 0.045). Women seafarers had an increased risk of lung cancer (SIR 1.54; 95% CI 1.23–1.87) but the risk of total cancer was not increased (SIR 0.83; 95% CI 0.78–0.89). Conclusions In this cohort of merchant Swedish seafarers 1985–2011, the risk of total cancer was increased in men but not in women compared to the general population. Lung cancer was increased in both genders. The risk of cancer seems to decrease over the last decades, but better exposure assessments to occupational carcinogens and longer observation times are needed.

Kidney Cancer Risk Associated with Historic Groundwater Trichloroethylene Contamination

Trichloroethylene (TCE) is a well-documented kidney carcinogen based on a substantial body of evidence including mechanistic and animal studies, as well as reports from occupational settings. However, the cancer risks for those in residential exposures such as TCE contamination in groundwater are much less clear. The objective of this study was to perform a detailed spatio-temporal analysis of estimated residential TCE exposure in New Hampshire, US. We identified kidney cancer cases (n = 292) and age-, gender-matched controls (n = 448) from the Dartmouth-Hitchcock Health System and queried a commercial financial database for address histories. We used publically available data on TCE levels in groundwater measured at contaminated sites in New Hampshire and then modeled the spatial dispersion and temporal decay. We overlaid geospatial residential locations of cases and controls with yearly maps of estimated TCE levels to estimate median exposures over the 5, 10, and 15-year epochs before diagnosis. The 50th–75th percentile of estimated residential exposure over a 15-year period was associated with increased kidney cancer risk (adjusted Odds Ratio (OR) 1.78 95% CI 1.05–3.03), compared to <50th percentile. This finding supports the need for groundwater monitoring of TCE contaminated sites to identify potential public health risks.

Pesticides as an Occupational Hazard Facts and Figures

The chapter gives insight into the harmful use of pesticides in different professional environments. It portrays the use of pesticides as the potential risks to the health of users and third parties and a danger to the environment. The use of pesticides has increased at a phenomenal rate. Pesticides and their threat to the biological world have reached almost hysterical proportions. Their residues are found everywhere, particularly those of the so-called “hard pesticides” or organochlorine compounds, DDT. Herein, an attempt has been made to reflect pesticide exposure in different occupational settings and their harmful effects on humans. Excess use of pesticide in agriculture has placed workers in this industry at risk of lethal exposure. Personnel working in domestic pest control service is also from continuous exposure to the pesticide. Further, the chapter highlights various corrective measures to be taken by the people working in different occupational settings to combat the dangerous effects of pesticides in everyday life.

Effect of Puffing Behavior on Particle Size Distributions and Respiratory Depositions From Pod-Style Electronic Cigarette, or Vaping, Products

The current fourth generation (“pod-style”) electronic cigarette, or vaping, products (EVPs) heat a liquid (“e-liquid”) contained in a reservoir (“pod”) using a battery-powered coil to deliver aerosol into the lungs. A portion of inhaled EVP aerosol is estimated as exhaled, which can present a potential secondhand exposure risk to bystanders. The effects of modifiable factors using either a prefilled disposable or refillable pod-style EVPs on aerosol particle size distribution (PSD) and its respiratory deposition are poorly understood. In this study, the influence of up to six puff profiles (55-, 65-, and 75-ml puff volumes per 6.5 and 7.5 W EVP power settings) on PSD was evaluated using a popular pod-style EVP (JUUL® brand) and a cascade impactor. JUUL® brand EVPs were used to aerosolize the manufacturers' e-liquids in their disposable pods and laboratory prepared “reference e-liquid” (without flavorings or nicotine) in refillable pods. The modeled dosimetry and calculated aerosol mass median aerodynamic diameters (MMADs) were used to estimate regional respiratory deposition. From these results, exhaled fraction of EVP aerosols was calculated as a surrogate of the secondhand exposure potential. Overall, MMADs did not differ among puff profiles, except for 55- and 75-ml volumes at 7.5 W (p &lt; 0.05). For the reference e-liquid, MMADs ranged from 1.02 to 1.23 μm and dosimetry calculations predicted that particles would deposit in the head region (36–41%), in the trachea-bronchial (TB) region (19–21%), and in the pulmonary region (40–43%). For commercial JUUL® e-liquids, MMADs ranged from 0.92 to 1.67 μm and modeling predicted that more particles would deposit in the head region (35–52%) and in the pulmonary region (30–42%). Overall, 30–40% of the particles aerosolized by a pod-style EVP were estimated to deposit in the pulmonary region and 50–70% of the inhaled EVP aerosols could be exhaled; the latter could present an inhalational hazard to bystanders in indoor occupational settings. More research is needed to understand the influence of other modifiable factors on PSD and exposure potential.

Development and Validation of a Multi-lingual Online Questionnaire for Surveying the COVID-19 Prevention and Control Measures used in Global Workplaces

Background Despite widespread COVID-19 vaccination programs, there is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to workers in diverse geographic and occupational settings. Methods A 44-item online survey was developed, translated, and validated for face, content, and cross-cultural validity according to literature review, expert consultation, and pre-testing. The survey was piloted with 890 workers from diverse industries in Canada, Ireland, Argentina, Poland, Nigeria, China, the US, and the UK. Odds ratios generated from univariable, and multivariable logistic regression assessed differences in ‘feeling protected at work’ according to gender, age, occupation, country of residence, professional role, and vaccination status. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach’s alpha. Hypothesis testing using two-sample t-tests verified construct validity (i.e., discriminant validity, known-groups technique), and criterion validity. Results After adjustment for occupational sector, characteristics associated with feeling protected at work included being male (AOR = 1.88; 95% CI = 1.18,2.99), being over 55 (AOR = 2.17; 95% CI = 1.25,3.77) and working in a managerial position (AOR = 3.1; 95% CI = 1.99,4.83). EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach’s alpha ≥ 0.60). Hypothesis testing revealed differences in survey responses by country and occupational sector, confirming construct validity (p < 0.001), criterion validity (p = 0.04), and discriminant validity (p < 0.001). Conclusions The online survey, developed to identify the COVID-19 protective measures used in diverse, international workplace settings, showed strong face validity, content validity, cross-cultural validity, internal consistency, criterion validity, and construct validity. It can be used by decision makers in the distribution of IPC resources, and to guide occupational safety and health (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.

Assessment of the Oxidative Potential and Oxidative Burden from Occupational Exposures to Particulate Matter

Oxidative potential (OP) is a toxicologically relevant metric that integrates features like mass concentration and chemical composition of particulate matter (PM). Although it has been extensively explored as a metric for the characterization of environmental particles, this is still an underexplored application in the occupational field. This study aimed to estimate the OP of particles in two occupational settings from a construction trades school. This characterization also includes the comparison between activities, sampling strategies, and size fractions. Particulate mass concentrations (PM4-Personal, PM4-Area, and PM2.5-Area) and number concentrations were measured during three weeks of welding and construction/bricklaying activities. The OP was assessed by the ascorbate assay (OPAA) using a synthetic respiratory tract lining fluid (RTLF), while the oxidative burden (OBAA) was determined by multiplying the OPAA values with PM concentrations. Median (25th–75th percentiles) of PM mass and number concentrations were 900 (672–1730) µg m–3 and 128 000 (78 000–169 000) particles cm–3 for welding, and 432 (345–530) µg m–3 and 2800 (1700–4400) particles cm–3 for construction. Welding particles, especially from the first week of activities, were also associated with higher redox activity (OPAA: 3.3 (2.3–4.6) ρmol min–1 µg–1; OBAA: 1750 (893–4560) ρmol min–1 m–3) compared to the construction site (OPAA: 1.4 (1.0–1.8) ρmol min–1 µg–1; OBAA: 486 (341–695) ρmol min–1 m–3). The OPAA was independent of the sampling strategy or size fraction. However, driven by the higher PM concentrations, the OBAA from personal samples was higher compared to area samples in the welding shop, suggesting an influence of the sampling strategy on PM concentrations and OBAA. These results demonstrate that important levels of OPAA can be found in occupational settings, especially during welding activities. Furthermore, the OBAA found in both workplaces largely exceeded the levels found in environmental studies. Therefore, measures of OP and OB could be further explored as metrics for exposure assessment to occupational PM, as well as for associations with cardiorespiratory outcomes in future occupational epidemiological studies.

O039 Differential effects of sleep deprivation and sleep restriction on error awareness

Introduction The ability to detect and subsequently correct errors is important in preventing the detrimental consequences of sleep loss. We report the first study to compare the effects of total sleep deprivation (TSD) and sleep restriction (SR) on error awareness. Methods Thirteen healthy adults (11F, age=26.8±3.4y) underwent a 34h TSD protocol, completing the Error Awareness Task (EAT: a combined Stroop/1-back/GoNogo task) at 4h and 27h post-wake. Twenty healthy adults (11F, age=27.4±5.3y) were studied both well-rested (WR: 9h sleep) and following SR (3 nights of 3h sleep), completing the EAT once/day (8-9h post-habitual wake). The EAT required participants to withhold responding to “nogo” stimuli and signal, via a button press, whenever they realised they made an error on these nogo trials. Results TSD did not significantly affect error rate (p=.712) or error awareness rate (p=.517), however, participants were slower to recognise errors after TSD (p=.004). In contrast, SR increased error rate (p&lt;.001), decreased error awareness (p&lt;.001), and slowed recognition of errors (p&lt;.01). Discussion Three nights SR impaired the ability to recognise errors in real-time, despite a greater number of errors being made. Thus, impaired error awareness may be one mechanism underlying increased sleep loss-related accidents and errors in occupational settings, as well as at home. Interestingly, 1-night TSD did not lead to more, or impaired recognition of errors. TSD participants were slower to recognise errors, which may be problematic in safety critical settings. Technological and/or operational solutions may be needed to reduce the risk of errors going unrecognised.