OBJECTIVES:To examine the associations of sleep disturbances and sleep duration with working life expectancy (WLE; the estimated number of years an individual is expected to be in the workforce) from age 50 to 68. METHODS:Data of individuals ≥50 years were drawn from two cohort studies: the Finnish Public Sector (FPS) study involving public sector employees in 2000-2016 (n=70 339, 80% women) and the Health and Social Support (HeSSup) study in 1998-2013 initially representing the general working age population in Finland (n=6071, 54% women). Participants reported sleep disturbances (none, moderate, severe, only in FPS) and usual sleep duration (short: <7 hours, mid-range: 7-8.5 hours, long: ≥9 hours). WLE from age 50 to 68 was estimated using multistate life table models. RESULTS:Reporting no sleep disturbances predicted a WLE of 13.4 years (95% CI 13.4 to 13.5), moderate sleep disturbances a WLE of 13.0 years (95% CI 13.0 to 13.1) and severe sleep disturbances a WLE of 12.8 years (95% CI 12.7 to 12.8) at 50 years of age. Short sleep duration predicted a WLE of 13.2 years (95% CI 13.1 to 13.2), mid-range sleep duration a WLE of 13.2 years (95% CI 13.1 to 13.2) and long sleep duration a WLE of 12.4 years (95% CI 12.3 to 12.6). The findings on sleep duration were more pronounced in HeSSup. CONCLUSIONS:Severe sleep disturbances and long sleep duration were associated with a reduction of approximately 8-9 months in WLE compared with no disturbances or mid-range sleep duration. To promote older adults' participation in working life, supporting sleep of recommended length and good quality may be required.
OBJECTIVES:To investigate whether employment characteristics and psychosocial work factors are associated with the development of severe menopausal symptoms among working women. METHODS:We longitudinally analysed 648 working women aged 35-55 years without menopausal symptoms interfering with daily life at baseline (2012-2014). Employment characteristics included employment status, managerial position, shift work and working hours. Psychosocial work factors included workload, job control, job strain and effort-reward imbalance. At follow-up (2018-2020), women in the menopausal transition or postmenopause who reported menopausal symptoms that interfered with daily life during follow-up were classified as having developed severe menopausal symptoms. Associations between baseline work factors and the development of severe menopausal symptoms were examined using modified Poisson regression adjusted for age, follow-up duration, body mass index, smoking, drinking and educational attainment. Symptom domains (vasomotor, psychological and physical) were also evaluated. RESULTS:During 5.3±0.5 years of follow-up, 68 women (10.5%) developed severe menopausal symptoms. Per 1-SD increase, higher workload (risk ratio (RR) 1.34, 95% CI 1.04 to 1.73), job strain ratio (RR 1.30, 95% CI 1.10 to 1.54) and effort-reward ratio (RR 1.23, 95% CI 0.99 to 1.51) were associated with a higher risk, whereas higher job control was protective (RR 0.78, 95% CI 0.63 to 0.97). Results were similar after additional adjustment for menopausal, marital and parental status. Domain-specific analyses showed similar associations across symptoms, strongest for physical symptom severity. CONCLUSIONS:Psychosocial work factors, particularly high workload, low job control and high job strain, were associated with the development of severe menopausal symptoms. These findings highlight the importance of psychosocial work environments in supporting women during the menopausal transition.
OBJECTIVES:Despite declining incidence rates for some cancers, the ageing workforce and improved survival have increased the number of workers with a history of cancer. Cancer treatment can affect strength, balance and bone health, thereby increasing fall risk among cancer survivors. However, an association between a history of cancer and occupational falls has not been reported. We aimed to investigate whether a history of cancer was associated with occupational falls and fall-related fractures among workers in Japan using prospective data. METHODS:We analysed two-wave panel data from the Japan COVID-19 and Society Internet Survey, a nationwide web-based survey with 1-year follow-up. Cancer history, including active treatment or remission, was assessed at baseline, and occupational falls and fall-related fractures were assessed at the 12- month follow-up. Poisson regression was used to estimate relative risks (RRs) and 95% CIs, adjusting for baseline covariates. RESULTS:Among 11 733 participants (mean age: 42.6 years), 8.0% reported at least one occupational fall in the past 12 months, and 3.7% reported a fall-related fracture. Compared with participants without a history of cancer, occupational fall risk was higher among those in remission (RR 1.90; 95% CI 1.50 to 2.41) and those receiving active treatment (RR 2.38; 95% CI 1.79 to 3.18). Similar associations were observed for fall-related fractures. CONCLUSIONS:Workers with a history of cancer had a higher risk of occupational falls and fall-related fractures. Occupational injury prevention strategies should address the needs of workers with a history of cancer.
OBJECTIVES:Research on the association between occupational noise and incident depression is limited. We investigated whether long-term occupational noise was associated with depression risk, both independently and in combination with other stress-related factors. METHODS:In a Danish nationwide register-based cohort of 2 424 542 workers aged 25-64 years, individual-level occupational histories were linked to noise exposure using a job exposure matrix. Noise exposure was aggregated as 5-year running means. During follow-up from 2000 to 2017, 142 370 women and 119 900 men developed incident depression, identified through hospital and prescription registers. HRs were estimated using Cox models with adjustment for individual and area-level factors. Subgroup analyses assessed effect modification by stress-related factors. RESULTS:A 10 dBA higher 5-year mean occupational noise (≥65 dBA) was associated with HRs (95% CIs) of 1.09 (1.07 to 1.12) for women and 1.13 (1.10 to 1.15) for men aged 25-39 years and 1.09 (1.04 to 1.14) for women aged 40-64 years. Higher risks were mainly observed among workers with low education, low to median income, blue-collar jobs or financial stress. Among men aged 40-64 years, the corresponding HR was 0.98 (0.97 to 1.00), with inverse associations mainly observed among those with high income, white-collar occupations and no financial stress. CONCLUSIONS:Long-term exposure to occupational noise seemed associated with higher depression risk among women as well as men younger than 40 years. Associations were mainly observed among workers of low socioeconomic status, suggesting that noise reduction may be particularly relevant for prevention in vulnerable worker groups.
Objective To systematically review the evidence on the association between occupational exposure to pesticides and the risk of amyotrophic lateral sclerosis (ALS). Methods A systematic search, conducted in eight bibliographic databases for publications between 1990 and 2025, identified observational studies estimating the risk of ALS after occupational pesticide exposure. Study quality was assessed using the WHO Risk of Bias (RoB) assessment instrument for systematic reviews, with the ROBINS-E (RoB in non-randomised studies of exposure) tool domains of bias. Pooled risk estimates were produced using random-effects models with restricted maximum likelihood, heterogeneity was assessed with I² statistics, and meta-regressions and publication bias explored with funnel plots and Egger’s test. Results Eight case-control studies (1734 cases) were retained for meta-analysis from 767 initially screened articles. ‘Ever’ occupational exposure to pesticides was associated with an increased risk of ALS (n=6 studies, pooled OR (pOR)=1.6; 95% CI 1.1, 2.2; I²=57%), for combined sexes. The risk for exposure to herbicides was slightly greater (pOR=1.7, I 2 =0.0%) than for exposure to insecticides or fungicides (pORs=1.6, I 2 =0.0%). Based on three studies, ever exposure to high levels of pesticides was associated with a higher risk (pOR=2.7; 95% CI=1.4, 5.0) than exposure to low levels (pOR=1.9; 95% CI=1.0, 3.7). Self-reported exposure assessment methods and older publication dates (<2015) were statistically significant predictors of the effect size. Conclusion Despite the small number of studies and some heterogeneity, our results add to the evidence suggesting that occupational exposure to pesticides may increase the risk of ALS.
OBJECTIVE:Preventing farmers' exposure to pesticides is a major public health issue. However, research on farmers' practices, particularly in high-income countries, rarely explores the combined role of sociodemographic, occupational and psychosocial factors or considers behaviours beyond the use of personal protective equipment. This study investigated pesticide risk prevention behaviours among French farmers, focusing on agricultural specialisation (ie, the main production on the farm), individual characteristics and key psychosocial determinants. METHODS:A comprehensive telephone survey conducted among French winegrowers or grower-breeders probed their pesticide knowledge, psychological constructs (attitudes and perceptions, social norms and control) and individual and occupational factors. Associations with three preventive behaviours were studied separately by logistic regression. RESULTS:162 male farmers were surveyed (median age 50, 74% with high school education), including 99 grower-breeders and 63 winegrowers, with differences in farm size, labour structure and employment status. Preventive measures were not implemented systematically: 59% wore gloves, 65% washed their hands and 45% read hazard information on labels. Agricultural specialisation was a major factor influencing behaviour as well as psychosocial determinants (self-efficacy, perceived barriers and social norms). In contrast, sociodemographic factors and knowledge levels had little effect. CONCLUSION:The adoption of pesticide risk prevention behaviours remains limited over time, even in high-income countries. Our study demonstrates that (1) behaviours relying on distinct determinants should be analysed separately, (2) agricultural specialisation is a major factor influencing behaviours and (3) psychosocial variables play a predominant role in behaviour adoption. This appraisal is crucial for designing an appropriate intervention targeting French farmers.
Objectives Brick kiln workers in Nepal face high exposure to respirable silica but are not required to use personal protective equipment (PPE). We sought to understand factors influencing PPE use, design and pilot a PPE training and distribution intervention and assess its feasibility. Methods We used a human-centred design approach guided by the Discover, Design, Build, Test framework and conducted four pre-intervention workshops (36 participants), a 21-day randomised controlled trial (RCT) and three post-intervention workshops (19 participants) at a kiln in Bhaktapur, Nepal. Workers and leadership aged ≥18 years were purposively sampled for workshops and randomly selected for the RCT (20 intervention, 20 control). Intervention participants received PPE training, weekly reminders and free N95 respirators and eyewear. Control participants received counselling and information on where to purchase PPE. Results Pre-intervention workshops revealed barriers to PPE use, including cost, discomfort and work efficiency concerns. Workers preferred expert-led, hands-on PPE training. We identified high feasibility (mean Feasibility of Intervention Measure, 4.6±0.5 points) among workers; leadership rated feasibility lower due to cost concerns. Observed N95 use was higher in the intervention group (78.9%, 71/90 visits) compared with none in the control group (0%, 0/93 visits; p<0.001). Post-intervention feedback showed workers felt N95s reduced dust exposure and respiratory symptoms without impacting efficiency, but eyewear needed adaptation for sustained use. Conclusions With worker-centred training, N95 respirators are feasible to reduce silica exposure in this setting. However, broader adoption may depend on improving the affordability and accessibility of PPE through advocacy and policy changes. Trial registration number NCT06090370 .
OBJECTIVE:While adverse respiratory health effects of exposure to disinfectants and cleaning products (DCPs) are well-documented in cleaners/healthcare workers, no study has investigated their impact on daycare workers. We evaluated cross-sectional associations between occupational exposures to DCPs, considering them as a mixture of chemical compounds and asthma in CRESPI daycare workers. METHODS:Use of DCPs in daycares was assessed using a smartphone application. We retrieved their chemical compounds, classifying them as irritants, sensitisers, quaternary ammonium compounds and biocides. Latent class analysis (LCA) was conducted to identify exposure profiles for the weekly used DCPs/compounds. We assessed associations of the identified exposure profiles with the asthma symptom score (0-5) using negative binomial regressions, adjusted for age, smoking status and body mass index and accounted for daycare centre. RESULTS:Analyses included 311 women (43 years, people who smoke: 11%). The LCA identified three exposure profiles: no weekly use of DCPs (LC1 prevalence: 24%), weekly use of a moderate number of irritants (LC2: 37%), weekly use of a high number of irritants, respiratory sensitisers and biocides (LC3: 39%). Women in LC2 and LC3 had a higher risk for asthma symptoms compared with those in LC1. The association was borderline statistically significant for LC3 (mean score ratio (MSR)=1.56; 95% CI 0.99 to 2.46) and weaker for LC2 (MSR=1.34 95% CI 0.85 to 2.13). CONCLUSION:Our results show positive associations between weekly occupational use of numerous DCPs and those with multiple types of chemical compounds in daycares and asthma symptoms in daycare workers.
OBJECTIVES:To develop and evaluate different deep learning (DL) models for clinically relevant screening and classification of pneumoconiosis based on chest radiographs. METHODS:This retrospective study used B-reader labelled pneumoconiosis lung images from US workers. After pre-processing the images, DL models were trained and evaluated for four classification tasks: (1) parenchymal abnormalities present versus absent, (2) parenchymal and/or pleural abnormalities present versus absent, (3) small parenchymal opacities grade 1 versus grade 0 and (4) progressive massive fibrosis versus simple pneumoconiosis versus no pneumoconiosis. RESULTS:A total of 2968 lung images were divided as follows: 2294 for training, 287 for validation, 287 for independent in-distribution testing and 100 for out-of-distribution testing from a separate scanner manufacturer dataset. On the in-distribution testing data set, the DL models achieved an accuracy of 0.93 (SD=0.01), 0.92 (SD=0.02) and 0.91 (SD=0.02) for task 1, 2 and 3, respectively. DL had comparable or better performance compared with certified B-readers who had average accuracies of 0.9 (SD=0.11), 0.91 (SD=0.10) and 0.77 (SD=0.21). For task 4, the DL model achieved an accuracy of 0.83 (SD=0.02), which is similar to B-readers' performance (average accuracy of 0.86 (SD=0.12)). Performance was markedly lower on the out-of-distribution test set, with reduced accuracy and AUC. CONCLUSIONS:On independent, in-distribution test images, DL models performed comparably to certified B-readers for tasks 1-4, supporting their potential to augment pneumoconiosis screening and classification. Reduced performance on challenging out-of-distribution cases warrants further study to improve generalisation.
OBJECTIVES:The 2011 Fukushima Daiichi Nuclear Power Plant accident involved approximately 20 000 emergency workers. Given the scale and nature of the accident, concerns have been raised regarding the long-term health of the emergency workers. This study presents the first 10 year overview of mortality among these workers. METHODS:We analysed the mortality data for 19 358 male emergency workers (mean age in 2012: 45.5 years; SD: 11.3) from 2012 to 2021. Mortality data were monitored through linkage to national vital statistics, including the dates and causes of death. Standardised mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated using the general male population in Japan as a reference, standardised by calendar year and attained age (5 year age groups). RESULTS:During 190 700 person-years of follow-up, 708 deaths were identified. The overall SMR was 0.86 (95% CI 0.80 to 0.93). SMRs for all solid cancers and radiation-associated solid cancers and leukaemia were below 1.0 during 2012-2014, approached 1.0 during 2015-2017 and exceeded 1.0 during 2018-2021, suggesting marginal excess mortality (both P values for trend <0.05). In contrast, the increasing trends were less evident for neoplasms excluding radiation-associated solid cancers and leukaemia. No elevated SMR for suicide was observed. CONCLUSIONS:The overall mortality among Fukushima emergency workers was lower than expected based on general population rates, likely reflecting the healthy-worker effect. However, marginal elevations in SMRs for all solid cancers and for radiation-associated solid cancers and leukaemia emerged during later follow-up, highlighting the importance of continued health monitoring in this population.
BACKGROUND:Musculoskeletal pain (MSP) is a major occupational health challenge and a leading cause of disability and economic burden worldwide. However, prospective evidence on how pain intensity across multiple body regions affects long-term labour market participation and production losses remains limited. This study quantifies working-life expectancy (WLE) and working years lost (WYL) associated with multisite MSP among senior workers and introduces a novel method to estimate its related economic burden. METHODS:The study includes 23 071 Danish employees aged 50-66 years from the SeniorWorkingLife study (2018 and 2022), linked to national labour-market registers through 2024. Self-reported pain intensity (low, moderate, high) in four body regions was examined. WLE and WYL were estimated using the expected labour market affiliation method, and economic costs were calculated from individual wage data. RESULTS:Moderate-to-high pain in two body regions was associated with reduced WLE and higher production losses. Employees with high back and leg pain had mean annual losses of €8167 per person (€58.8 million total), with 38% attributable to sickness absence. Total losses linked to back and leg pain were estimated at €2.0 billion (0.5% of Denmark's GDP). CONCLUSION:MSP in senior workers, particularly when affecting multiple body regions, imposes a substantial economic burden through reduced WLE and increased sickness absence. Targeted interventions are needed to manage MSP and sustain employment among older workers.
OBJECTIVE:To assess the association between parental occupational pesticide exposures at birth and adult testicular germ cell tumour (TGCT) by histological subtype and the agreement between two pesticide job-exposure matrices (JEM). METHODS:TGCT cases (n=454) and matched controls (n=670) aged 18-45 years were recruited from 20 French university hospitals into the TESTIS national case-control study. Paternal and maternal jobs at birth were obtained from interviews of participants and their mothers/relatives and coded into official nomenclatures (International Standard Classification of Occupations, French nomenclature of activity-1999). Two complementary JEMs, ALOHA+ and FRIJEM, assessed occupational exposure to all pesticides, herbicides, insecticides, fungicides with ALOHA+ for each parent by linking job titles to JEM-derived probability and intensity estimates (no/low/high). Cohen's Kappa coefficient (κ) assessed their agreement. ORs and 95% CIs comparing exposure and levels of exposure with no exposure were estimated using conditional logistic regression adjusted for literature-based covariates statistically associated with TGCT and stratified by histological subtypes. RESULTS:Agreement between ALOHA+and FRIJEM was moderate to substantial (κ 0.52-0.80). A statistically non-significant higher TGCT risk was observed for high paternal occupational pesticide exposure with ALOHA+ (OR 1.95, CI 0.98 to 3.84) and FRIJEM (OR 1.70, CI 0.88 to 3.28). With ALOHA+, statistically significant positive associations were seen for high paternal occupational exposure to herbicides (overall: OR 4.23, CI 1.75 to 10.22; seminomas: OR 4.78, CI 1.79 to 12.77; non-seminomas: OR 3.53, CI 1.21 to 10.3) and fungicides (overall: OR 2.09, CI 1.05 to 4.18; seminomas: OR 2.31, CI 1.02 to 5.23). No statistically significant associations were observed for other levels of paternal exposure or pesticide groups nor for maternal exposure. CONCLUSION:Only high paternal occupational exposure to pesticides at birth, especially herbicides and fungicides, was positively associated with TGCT.
OBJECTIVE:Inhalation of crystalline silica dust causes lung cancer, although evidence assessing risk at low levels of exposure is needed. We sought to estimate the association between cumulative silica exposure and lung cancer risk in a cohort of miners in Ontario, Canada. METHODS:A cohort of 48 772 hard rock miners enumerated from a medical surveillance programme was followed for lung cancer diagnoses in the Ontario Cancer Registry from 1964 through 2022. Silica dust exposure was estimated using a linear prediction model based on 12 325 personal sampling measurements from Ontario mines. Exposure-response associations were estimated, with adjustments for uranium mining, arsenic dust and screening CXR. Probabilistic bias analysis was used to evaluate differential outcome misclassification due to loss to follow-up using a known bias parameter. RESULTS:3218 lung cancer cases were diagnosed during a median of 44 years of follow-up. Positive associations between cumulative silica exposure and incident lung cancer rates were observed in all categories of exposure, with 0.5-2.0 mg/m3-years of exposure associated with 1.33 times (95% CI 1.06 to 1.66) the adjusted rate of lung cancer compared with<0.5 mg/m3-years. The positive exposure-response association remained after excluding known silicotics and increased in magnitude when excluding radon-exposed uranium miners. Bias adjustment for outcome misclassification increased the monotonicity and slope of the exposure-response relationship, but attenuated the IRR in the 0.5-2.0 mg/m3-year category to 1.08. CONCLUSION:Silica exposure was positively associated with lung cancer risk at low levels of cumulative exposure in a universally exposed population of miners. Findings were robust to suspected sources of bias.
Introduction The risks to lung health from workplace hazards remain incompletely understood and may still be overlooked by workers, employers and healthcare professionals. We used an online tool to collect European population-based data relating to workplace exposures, training and lung health. Methods A targeted industry-specific digital tool, enquiring about the link between respiratory symptoms and work, was made accessible online over a 24-month period. Results 22 393 individuals (mean age 43.6 years) responded; 55.7% were female, 46.7% completed in English, 19.9% in Portuguese, 17.8% in French, 10.5% in Dutch and 5% in German. 47% reported nasal symptoms, 42% cough, 21% chest tightness and 20% wheeze. 8412 (37.6%) reported at least one work-related symptom. The use of workplace training (11%) and guidance (17%) to prevent respiratory ill health was uncommon. 980 (5.9%) had changed their job because it had affected their breathing. Increasing age (OR 1.02 per year age increase), completion language (English (OR 0.66), French (OR 0.39)), workplace (bakery (OR 1.64), mine (OR 1.91), sports centre (OR 3.03) and farm (OR 1.77)) and workplace training (OR 0.71) were significantly associated with this outcome. These workers also had more work-related symptoms (p<0.001) and complained of more wheeze (p<0.001) and nasal symptoms (p<0.001). 919 (5.6%) workers with a more likely diagnosis of occupational asthma were more female, had less workplace guidance and training and had co-workers with health complaints. Conclusion This tool has reached real-world working populations and these findings identify the need for further awareness raising, education and social media interventions.
OBJECTIVES:Smoking remains a major preventable cause of lung and cardiovascular disease. This randomised controlled trial evaluated EILA, a mobile application using artificial intelligence, for promoting smoking cessation among hospital workers. METHODS:A randomised controlled trial was conducted. Hospital workers (n=43) were recruited from a German university hospital from May 2022 to March 2023. Inclusion criteria comprised age ≥18, Fagerström score ≥3 or 10 cigarettes per day, ownership of a suitable smartphone, motivation to quit smoking and no addiction to other psychoactive substances. Participants were randomised by sealed envelopes to EILA intervention (n=25) or a wait-list control (n=18) receiving a primary care-style intervention, with crossover after 3 months. The primary outcome was the cessation rate. Secondary outcomes comprised nicotine dependence, mental health and cardiovascular risk, all measured using validated questionnaires. RESULTS:At the 6-month follow-up, the relative risk for continued smoking was reduced to 0.91 (n=51, 95% CI 0.7 to 1.2), and nicotine dependence, measured by the Fagerström Test, decreased significantly from 4.41±1.93 to 3.32±2.69 (n=19, p=0.014). PROCAM score for cardiovascular risk was reduced from 35.22±12.47 to 31.9±13.24 (n=36, p=0.008). CONCLUSION:The digital health application EILA was linked to increased smoking cessation rates, although without achieving statistical significance. Nevertheless, the results indicate reductions in nicotine dependence and cardiovascular risk, supporting EILA as a scalable and flexible intervention for promoting health in hospital workers.
Occupational and environmental risk factors for salivary gland cancer (SGC) are largely unrecognised. This systematic review is the first to characterise the relationship between employment in specific industries or occupations and risk of SGC, as well as exposure to key occupational and environmental hazards.Studies published up to September 2023 were collected from three electronic databases and systematically screened. The Health Assessment Workplace Collaborative programme was used to tag studies based on pre-established inclusion and exclusion criteria. Studies eligible for inclusion (n=24) underwent an in-depth review to extract key study characteristics and findings, including effect estimates and 95% CIs. Studies were evaluated for influence of key biases. To identify priority sectors and hazards for intervention, effect direction plots were created to analyse the number and quality of studies reporting elevated rates of SGC across industry, occupation and exposure groups.24 articles were included for analysis. Exposure misclassification and confounding bias were a common concern across studies. Industry and occupation groups with the strongest relationship to SGC included cleaning services, material handling, food services, rubber/plastics production, engineering and construction/painting. Exposures with the strongest relationship to SGC included silica dust, cement dust, chlorinated solvents, formaldehyde and white spirits.Several occupational exposures were associated with an elevated risk of SGC, whereas environmental evidence was more limited. Additional research involving larger cohorts with quantitative exposure data is needed to further establish relationships between occupational and environmental exposures and often-overlooked rare cancers like SGC.PROSPERO registration number: CRD42023468037.
OBJECTIVES:The US Environmental Protection Agency has determined that formaldehyde presents an 'unreasonable risk of injury to human health'. Occupational inhalation exposure is associated with short- and long-term damage to the respiratory, female reproductive and nervous systems, and is also carcinogenic. The European Union (EU) has recently introduced formaldehyde work exposure limits (WELs) lower (long-term 0.3 ppm; short-term 0.6 ppm) than those currently applied in the UK (long-term 2 ppm; short-term 2 ppm). UK regulation additionally requires exposure to carcinogens to be reduced to as low as is reasonably practicable. We evaluated formaldehyde airborne concentrations in National Health Service (NHS) cell pathology departments to assess the adequacy of exposure controls. METHODS:Using the UK Freedom of Information Act (2000), we requested 12 months (2024-2025) of formaldehyde airborne monitoring data collected by cell pathology departments across 122 NHS Trusts in England (n=102), Scotland (n=10), Wales (n=6) and Northern Ireland (n=4). Results were evaluated empirically and using EN 689:2018 statistical methods to assess exposure variability, estimate upper-bound concentrations and determine the likelihood of adequate exposure control when benchmarked against EU WELs. RESULTS:A total of 1 715 516 formaldehyde airborne monitoring results were disclosed by 117 NHS cell pathology departments. Monitoring was infrequent, with 73% of sites measuring formaldehyde airborne concentrations once weekly or less. The EU long-term WEL was exceeded regularly at 70% of sites (95th percentile >0.3 ppm), and the EU short-term WEL was exceeded regularly at 43% of sites (95th percentile >0.6 ppm). The 95th percentile upper tolerance limit (UTL95,70) exceeded the EU short-term WEL at 68% of sites. Only 11% and 17% of departments demonstrated frequent (once daily or more) formaldehyde airborne monitoring with 95th percentiles below the EU long- and short-term WELs, respectively. CONCLUSIONS:Formaldehyde exposure is infrequently monitored and inadequately controlled in NHS cell pathology departments.
OBJECTIVES:Asbestos exposure raises the lung cancer risk and has supra-additive synergy alongside tobacco exposure. Lung cancer screening (LCS) is effective when high-risk populations are targeted. This study examined the utility of various LCS eligibility and risk prediction models in an asbestos-exposed population. METHODS:The Western Australia Asbestos Review Program (ARP) consists of individuals with known exposure to asbestos. All participants underwent annual review with low-dose CT screening. The performance of the Prostate, Lung, Colorectal and Ovarian (PLCO)m2012, PLCOm2014 and PLCOocc models, Liverpool Lung Project V.2 (LLPv2) and Bach models, together with the United States Preventive Services Task Force (USPSTF)2021 and Australian LCS eligibility criteria were validated on the ARP. RESULTS:The cohort consisted of 2126 participants of which 85.4% were male with a median (IQR) age of 70 (63-75) years old. Former smokers comprised 55.1% (n=1172) and never smokers 36.2% (n=769) of the cohort. Median smoking and cessation duration were 24 years (IQR: 13-72) and 32 years (IQR: 22-41), respectively. Lung cancer was diagnosed in 51 (2.4%) participants.When applying the risk models to the ARP cohort, the area under the curve for all models was modest, ranging from 0.602 to 0.675. All models underestimated risk in this cohort during calibration assessment, with the exception of the LLP V.2, which overestimated risk. CONCLUSIONS:In an asbestos exposed population, current LCS eligibility criteria and risk models mostly underestimate the risk of lung cancer, reflecting the need for improved risk prediction models that adequately account for asbestos exposure.
