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Objective: Within the scope of the Exposome Project for Health and Occupational Research on applying the exposome concept to working life health, we aimed to provide a broad overview of the status of knowledge on occupational exposures and associated health effects across multiple noncommunicable diseases (NCDs) to help inform research priorities., Methods: We conducted a narrative review of occupational risk factors that can be considered to have "consistent evidence for an association," or where there is "limited/inadequate evidence for an association" for 6 NCD groups: nonmalignant respiratory diseases; neurodegenerative diseases; cardiovascular/metabolic diseases; mental disorders; musculoskeletal diseases; and cancer. The assessment was done in expert sessions, primarily based on systematic reviews, supplemented with narrative reviews, reports, and original studies. Subsequently, knowledge gaps were identified, e.g. based on missing information on exposure-response relationships, gender differences, critical time-windows, interactions, and inadequate study quality., Results: We identified over 200 occupational exposures with consistent or limited/inadequate evidence for associations with one or more of 60+ NCDs. Various exposures were identified as possible risk factors for multiple outcomes. Examples are diesel engine exhaust and cadmium, with consistent evidence for lung cancer, but limited/inadequate evidence for other cancer sites, respiratory, neurodegenerative, and cardiovascular diseases. Other examples are physically heavy work, shift work, and decision latitude/job control. For associations with limited/inadequate evidence, new studies are needed to confirm the association. For risk factors with consistent evidence, improvements in study design, exposure assessment, and case definition could lead to a better understanding of the association and help inform health-based threshold levels., Conclusions: By providing an overview of knowledge gaps in the associations between occupational exposures and their health effects, our narrative review will help setting priorities in occupational health research. Future epidemiological studies should prioritize to include large sample sizes, assess exposures prior to disease onset, and quantify exposures. Potential sources of biases and confounding need to be identified and accounted for in both original studies and systematic reviews., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Objectives: The Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET) was set up to enable optimization of the use of industrial and general population cohorts across Europe to advance aetiological research. High-quality harmonized exposure assessment is crucial to derive comparable results and to enable pooled analyses. To facilitate a harmonized research strategy, a concerted effort is needed to catalogue available occupational exposure information. We here aim to provide a first comprehensive overview of exposure assessment tools that could be used for occupational epidemiological studies., Methods: An online inventory was set up to collect meta-data on exposure assessment tools. Occupational health researchers were invited via newsletters, editorials, and individual e-mails to provide details of job-exposure matrices (JEMs), exposure databases, and occupational coding systems and their associated crosswalks to translate codes between different systems, with a focus on Europe., Results: Meta-data on 36 general population JEMs, 11 exposure databases, and 29 occupational coding systems from more than 10 countries have been collected up to August 2021. A wide variety of exposures were covered in the JEMs on which data were entered, with dusts and fibres (in 14 JEMs) being the most common types. Fewer JEMs covered organization of work (5) and biological factors (4). Dusts and fibres were also the most common exposures included in the databases (7 out of 11), followed by solvents and pesticides (both in 6 databases)., Conclusions: This inventory forms the basis for a searchable web-based database of meta-data on existing occupational exposure information, to support researchers in finding the available tools for assessing occupational exposures in their cohorts, and future efforts for harmonization of exposure assessment. This inventory remains open for further additions, to enlarge its coverage and include newly developed tools., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

The International Agency for Research on Cancer (IARC) classifies firefighting as possibly carcinogenic to humans, and polychlorinated biphenyls (PCBs) as carcinogens with sufficient evidence for development of melanoma in humans. We present a case report of a firefighter with melanoma and history of 33 years of occupational exposure. Based on the available epidemiological and toxicological evidence of association between being a firefighter and developing melanoma, melanoma was recognized by the Norwegian Labour and Welfare Service as an occupational disease in our patient. In 2017, melanoma was acknowledged as an occupational disease in only 8 out of 28 surveyed European countries. Melanoma should be considered as a possible occupational disease among firefighters with a history of relevant exposure. Further recognition of the occupational exposures leading to increased risk of melanoma is still needed for preventive purposes., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Occupational Medicine.)

Objective: Ambient exposure to fine particles is associated with increased cardiovascular morbidity and mortality. Associations between occupational particulate matter (PM) exposure and cardiovascular disease have been studied less. The objective of this study was to examine associations between PM exposure and endothelial function among workers in Norwegian smelters., Methods: We examined endothelial function with Endo-PAT equipment after a working day (WD) and on a day off (DO) in 59 furnace workers recruited from three metal smelters in Norway. The difference in baseline pulse amplitude (BPA) and reactive hyperemia index (RHI) between the 2 days was analysed in relation to individual exposure to PM < 250 nm (PM 250 ) or the respirable aerosol fraction of particles, and adjusted for relevant covariates., Results: The exposure to PM 250 ranged from 0.004 to 5.7 mg/m 3 . The mean BPA was significantly higher on WD relative to DO (772 vs. 535, p = 0.001). This difference was associated with PM concentrations among participants ≥ 34 years, but not among the younger workers. Reactive hyperemia was significantly lower on workdays relative to days off (1.70 vs. 1.84, p = 0.05). This difference was observed only among participants above the age 34. No associations with PM exposure were observed., Conclusions: PM exposure was associated with higher BPA among participants older than 34 years. BPA reflects microvessel pulsatility. Our results may indicate an age-dependent cardiovascular susceptibility to PM exposure. Endothelial function measured by RHI was reduced on WD among participants 34 years and older, but we found no associations between PM exposure and RHI.

Objectives: To investigate the relationship between dust exposure and annual change in lung function among employees in Norwegian silicon carbide (SiC) plants using a quantitative job exposure matrix (JEM) regarding total dust., Methods: All employees, 20-55 years of age by inclusion (n=456), were examined annually for up to 5 years (1499 examinations). Spirometry was performed at each examination, and a questionnaire encompassing questions of respiratory symptoms, smoking status, job and smoking history, and present job held was completed. A JEM was constructed based on 1970 personal total dust exposure measurements collected during the study period. The association between lung function and total dust exposure was investigated using linear mixed models., Results: The annual change in forced expiratory volume (FEV) in one second per squared height, FEV1/height(2), per mg/m(3) increase in dust exposure was -2.3 (95% CI -3.8 to -0.79) (mL/m(2))×year(-1). In an employee of average height (1.79 m) and exposure (1.4 mg/m(3)) the estimated contribution to the annual change in FEV1 associated with dust was 10.4 mL/year. The annual change in FEV1/height(2) in current, compared with non-smokers was -1.9 (-7.2 to 3.4) (mL/m(2))×year(-1). The estimated overall annual decline in FEV1 among current and non-smokers in the highest exposed group was -91.2 (-124.3 to -58.1) (mL/m(2))×year(-1) and -49.0 (-80.2 to -17.8) (mL/m(2))×year(-1), respectively., Conclusions: Dust exposure, expressed by a quantitative JEM, was found to be associated with an increased yearly decline in FEV1 in employees of Norwegian SiC plants.

Objectives: An increased lung cancer risk associated with total dust exposure in the silicon carbide (SiC) industry has previously been reported. The aim of the present study was to examine the relative importance of specific exposure factors by using a comprehensive, historic job exposure matrix based on about 8000 measurements., Methods: Cumulative exposure to total and respirable dust, respirable quartz, cristobalite, and SiC particles and SiC fibres was assessed for 1687 long-term workers employed during 1913-2003 in the Norwegian SiC industry. Standardised incidence ratios for lung cancer, with follow-up during 1953-2008, were calculated stratified by cumulative exposure categories. Poisson regression analyses were performed using both categorised and log-transformed cumulative exposure variables., Results: The lung cancer incidence was about twofold increased at the highest level of exposure to each of the exposure factors (standardised incidence ratios 1.9-2.3 for all agents). Internal analyses showed associations between exposure level and lung cancer incidence for all investigated factors, but a significant trend only for total dust and cristobalite. In multivariate analyses, cristobalite showed the most consistent associations, followed by SiC fibres., Conclusions: The results indicated that crystalline silica in the form of cristobalite was the most important occupational exposure factor responsible for lung cancer excess in the Norwegian SiC industry. SiC fibres seemed to have an additional effect.

Purpose: We have investigated the association between respiratory symptoms and dust exposure among employees in 18 Norwegian smelters using a longitudinal design., Methods: All employees (N = 3,084) were examined annually for 5 years (12,996 health examinations). At each examination, the subjects reported if they had respiratory symptoms, coded as 1 (yes) or 0 (no), on a respiratory questionnaire. Symptom score was constructed as the sum of symptoms (0-5). Full-time workers in the production line were classified as line operators; subjects never exposed in the production line were regarded as non-exposed. The remaining individuals were classified as non-line operators. A job-exposure matrix regarding dust exposure was also available. Analyses of repeated measurements were performed using generalised linear mixed model with log-link (Poisson regression). Adjustments were made for overdispersion., Results: The mean age at inclusion was 39.0 years, and 89% were men. The median dust exposure in tertiles 1-3 was 0.19, 1.76 and 3.47 mg/m(3). The longitudinal analyses showed that the association between symptoms-score ratio (SSR) and job category was significantly stronger in dropouts compared with non-dropouts (p = 0.01). Among the dropouts, SSR was 1.61 (95% confidence interval: 1.27-2.05) and 1.39 (1.09-1.77) in line operators and non-line operators compared with non-exposed employees, respectively. The corresponding SSR for subjects who completed the study was 1.13 (1.01-1.27) and 1.12 (1.00-1.26), respectively. Similarly, among the dropouts, the SSR between the second and the first tertile was 1.28 (1.05-1.55) and 1.37 (1.13-1.66) between the third tertile and the first tertile., Conclusions: Line operators had more respiratory symptoms than non-exposed employees. This effect was significantly stronger in dropouts than in those who continued their jobs, indicating that there is a selection of subjects without respiratory symptoms in this industry.

The objective was to construct a retrospective job-exposure matrix (JEM) for the Norwegian silicon carbide industry. More than 3300 historical total dust measurements were available (1967-2005); however, there were few measurements of other agents. Total dust measurements were therefore used as the basis for the JEM, and a novel method was developed to estimate exposure to other agents. Multiple linear regression models were developed to describe historical exposure to total dust. Exposure estimates were extrapolated backward to periods without exposure data by adjustments for process and work-hour related changes. An exposure assessment study was performed where total dust was sampled in parallel with fibers or respirable dust. The respirable dust was analyzed for the content of quartz, cristobalite, and silicon carbide. Mixed-effect models were developed to estimate the exposure to these agents from total dust exposure, plant, and job group. Exposure to asbestos and polycyclic aromatic hydrocarbons was assigned qualitatively. Multiple linear regression models of total dust described historical exposure best in the furnace department (R(2) (adj) = 0.49-0.74). Models in the other departments explained less variance (R(2) (adj) = 0.12-0.32). Exposure determinants and total dust explained a substantial proportion of the between- (70-100%) and within-worker (8.0-54%) variance in the mixed-effect models. The relative bias between available historical measurements and the estimated exposure to dust components varied between -39% (fiber) and 40% (quartz). However, corrections were not considered necessary due to limitations in the historical data. The component-specific metrices were sufficiently different from each other (r(Pearson) < 0.7), with the exception of total and respirable dust (r(Pearson) = 0.84) and total dust and cristobalite (r(Pearson) = 0.72), and will enable component-specific epidemiologic analyses in the future. Improved and less correlated estimates of exposure levels for the different components in the dust were obtained with the updated exposure assessment. Due to limitations in the measurement data, assumptions had to be made, especially in the period before 1967. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file containing tables outlining multiple linear regression models for prediction of total dust exposure in the processing departments of Norwegian SiC producing plants, evaluation of the predictive abilities of the reduced total dust models, and mixed models for pedicting exposure to fibers and respirable quartz, cristobalite, non-fibrous silicon carbide and respirable dust from total dust exposure.].

Objectives: Increased mortality from asthma, chronic bronchitis and emphysema has previously been reported among workers in the silicon carbide (SiC) industry. The objective of the present study was to evaluate the influence of specific exposure factors on mortality from obstructive lung diseases (OLD), using a newly revised job-exposure matrix., Materials and Methods: 1687 long-term workers employed in 1913-2003 in the Norwegian SiC industry were characterised with respect to cumulative exposure to quartz, cristobalite, SiC particles and SiC fibres. Standardised mortality ratios (SMRs) for underlying causes of death, 1951-2007, were calculated stratified by category of cumulative exposure, and Poisson regression analyses of OLD were performed using cumulative exposure variables., Results: An increased total mortality (SMR 1.1, 95% CI 1.0 to 1.2) and increased mortality from cancer, non-malignant respiratory diseases and external factors, were observed. The SMR of OLD was increased at the highest level of cumulative exposure to all investigated exposure factors. In the internal analyses, a twofold increased risk of OLD was observed with increasing levels of cumulative exposure to SiC particles. In a multivariate model, SiC particles showed the most stable increased risk estimate when controlled for other exposure factors, among workers with less than 15 years of employment. Among workers with more than 15 years of employment, crystalline silica, primarily cristobalite, seemed to be the most important exposure factor., Conclusion: Exposure to SiC and crystalline silica may contribute to OLD development among SiC industry workers in different time windows, and possibly through different mechanisms.

Objectives: A previous study among workers in the Norwegian silicon carbide industry, followed until 1996, revealed an excess incidence of lung and total cancer. The present study adds nine years of follow-up and focuses on cancer risk among short- and long-term workers, based on the assumption that these two groups have different exposure and lifestyle characteristics., Methods: The total cohort for this study comprised 2612 men employed for >6 months between 1913 and 2003. The follow-up period for cancer was 1953-2005. Short-term workers were defined as having <3 years of total employment in the industry. We estimated standardized incidence ratios (SIR) using national rates as the expected values., Results: Among the short-term workers, we observed an overall excess incidence of cancer [SIR 1.4, 95% confidence interval (95% CI) 1.2-1.6], with an excess of lung cancer (SIR 2.6, 95% CI 1.9-3.5) as the most important contributing factor. The long-term workers also had an excess incidence of total cancer (SIR 1.2, 95% CI 1.1-1.3) and lung cancer (SIR 1.7, 95% CI 1.3-2.2). We also observed an increased risk of cancers at other sites, specifically among short-term workers., Conclusions: We observed an increased risk of cancer (especially in the lung but also at other sites) among both short- and long-term workers. Dust exposure in the silicon carbide industry may have contributed to the increased risk among long-term workers, whereas the increased risk among short-term workers may be due to a combination of occupational and lifestyle factors.

Aims To investigate the association between airflow limitation and occupational exposure and to compare a fixed limit with an age adjusted limit for airflow limitation. Methods 3924 employees in 24 Norwegian smelters and related workplaces were investigated annually over 5⇔…years (n=16?570) using spirometry and a respiratory questionnaire on smoking habits and job category. Employees working full time on the production line were classified as line operators; subjects who never worked on the production line were regarded as non-exposed. A job exposure matrix (JEM) was available in most smelters. Airflow limitation was expressed as (i) forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC ratio) <0.7 and (ii) FEV1/FVC ratio less than the lower limit of normal (LLN). Longitudinal analyses on the prevalence of airflow limitation were performed using a generalised linear mixed model. Results The prevalence of airflow limitation was stable during follow-up. The OR of airflow limitation during follow-up was 1.24 (95% CI 1.03 to 1.50) in line operators compared with unexposed subjects for FEV1/FVC ratio <0.7 and 1.44 (1.14 to 1.81) for FEV1/FVC ratio 1 was ⇔'77.5 (SD 99.9)⇔…ml/year in subjects with FEV1/FVC ratio <0.7 and ⇔'83.8 (114.2) ml/year in subjects with FEV1/FVC ratio 1/FVC ratio <0.7 and FEV1/FVC ratio 1. [ABSTRACT FROM AUTHOR]