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Evaluations of gender equality initiatives in development programmes traditionally assess cognitive dimensions such as knowledge, attitudes, and awareness; and often rely solely on women’s perspectives. Leveraging story-based evaluation methods, this article explores the assessment of complex gender-transformations and focuses on effective question prompts to elicit significant and meaningful narratives of change from both women and men. In collaboration with a development programme in Cambodia, a staff assessment process led to a set of criteria for considering the quality of respondent stories and testing the efficacy of four different question prompts (n = 176): verb-, value-, sphere-, and theme-based. Highlighting aspects of embodiment, the study suggests that verb-based prompts were the most effective at eliciting stories that reflect diverse experiences of both women and men in processes of gender-transformation. Findings from our analysis can support evaluators in balancing simplicity and specificity of questions in assessing the unique experiences of individuals undergoing complex change.

ObjectiveByssinosis remains a significant problem among textile workers in low/middle-income countries. Here we share our experience of using different prediction equations for assessing ‘chronic’ byssinosis according to the standard WHO classification using measurements of forced expiratory volume in 1 s (FEV1).MethodsWe enrolled 1910 workers in a randomised controlled trial of an intervention to improve the health of textile workers in Pakistan. We included in analyses the 1724 (90%) men who performed pre-bronchodilator spirometry tests of acceptable quality. We compared four different equations for deriving lung function percentage predicted values among those with symptoms-based byssinosis: the third US National Health and Nutrition Examination Survey (NHANES-III, with ‘North Indian and Pakistani’ conversion factor); the Global Lung Function Initiative (GLI, ‘other or mixed ethnicities’); a recent equation derived from survey of a western Indian population; and one based on an older and smaller survey of Karachi residents.Results58 men (3.4%) had symptoms-based byssinosis according to WHO criteria. Of these, the proportions with a reduced FEV1 (1/forced vital capacity (FVC) ratio (ConclusionAccurate measures of occupational disease frequency and distribution require approaches that are both standardised and meaningful. We should reconsider the WHO definition of ‘chronic’ byssinosis based on changes in FEV1, and instead use the FEV1/FVC.

This article presents an historical and comparative analysis of the bargaining power and agency conferred upon migrant workers in Australia under distinct policy regimes. Through an assessment of four criteria – residency status, mobility, skill thresholds and institutional protections – we find that migrant workers arriving in Australia in the period from 1973 to 1996 had high levels of bargaining power and agency. Since 1996, migrant workers’ power and agency has been incrementally curtailed, to the extent that Australia’s labour immigration policy resembles a guest-worker regime where migrants’ rights are restricted, their capacity to bargain for decent working conditions with their employers is truncated and their agency to pursue opportunities available to citizens and permanent residents is diminished. In contrast to recent assessments that Australia’s temporary visa system is working effectively, our analysis indicates that it is failing to protect temporary migrants at work.JEL Codes: J24, J61, J83

ObjectivesThis study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study.MethodsThe GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors.ResultsIn 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39–1.68) million deaths and 76.1 (66.3–86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs.ConclusionsOccupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives.

ObjectiveTo quantify occupational risks of COVID-19 among healthcare staff during the first wave (9 March 2020–31 July 2020) of the pandemic in England.MethodsWe used pseudonymised data on 902 813 individuals employed by 191 National Health Service trusts to explore demographic and occupational risk factors for sickness absence ascribed to COVID-19 (n=92 880). We estimated ORs by multivariable logistic regression.ResultsWith adjustment for employing trust, demographic characteristics and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in ‘additional clinical services’ (care assistants and other occupations directly supporting those in clinical roles) (OR 2.31 (2.25 to 2.37)), registered nursing and midwifery professionals (OR 2.28 (2.23 to 2.34)) and allied health professionals (OR 1.94 (1.88 to 2.01)) and intermediate in doctors and dentists (OR 1.55 (1.50 to 1.61)). Differences in risk were higher after the employing trust had started to care for documented patients with COVID-19, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged COVID-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater.ConclusionsAfter allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for COVID-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. COVID-19 may meet criteria for compensation as an occupational disease in some healthcare occupations.Trial registration numberISRCTN36352994.

ObjectiveTo assess the association of lung function and respiratory symptoms with farming, particularly pesticide use, in an agricultural province in Thailand.MethodsWe undertook a cross-sectional survey of adults aged 40–65 in Nan province, Thailand, between May and August 2019. We randomly recruited 345 villagers and enriched the sample with 82 government employees. All participants performed post-bronchodilator spirometry and completed a questionnaire covering information on respiratory symptoms, farming activities, pesticide use and known risk factors for respiratory disease. Associations of respiratory outcomes with farming and pesticide exposures were examined by multivariable regression analysis.ResultsThe response rate was 94%. The prevalence of chronic airflow obstruction among villagers was 5.5%. Villagers had, on average, a lower percent predicted post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) than government employees (98.3% vs 100.3%; p=0.04). There was no evidence of association of lung function with farming activities, the use of specific herbicides (glyphosate and paraquat), insecticides (organophosphates and pyrethroids) or fungicides. The exceptions were poultry farming, associated with chronic cough and an increase of FEV1/FVC, and atrazine, for which duration (p-trend 1/FVC in an exposure–response manner. Cumulative hours (−280 mL/hour), low duration (−270 mL/year) and intensity (−270 mL/hour/year) of atrazine use were associated with lower FVC.ConclusionsChronic airflow obstruction is uncommon among villagers of an agricultural province in Nan, Thailand. Farming and pesticide use are unlikely to be major causes of respiratory problems there.

ObjectivesWe aimed to investigate whether there has been a geographic shift in the distribution of mesothelioma deaths in Great Britain given the decline of shipbuilding and progressive exposure regulation.MethodsWe calculated age-adjusted mesothelioma mortality rates and estimated rate ratios for areas with and without a dockyard. We compared spatial autocorrelation statistics (Moran’s I) for age-adjusted rates at local authority district level for 2002–2008 and 2009–2015. We measured the mean distance of the deceased’s postcode to the nearest dockyard at district level and calculated the association of average distance to dockyard and district mesothelioma mortality using simple linear regression for men, for 2002–2008 and 2009–2015.ResultsDistrict age-adjusted male mortality rates fell during 2002–2015 for 80 of 348 districts (23%), rose for 267 (77%) and were unchanged for one district; having one or more dockyards in a district was associated with rates falling (OR=2.43, 95% CI 1.22 to 4.82, p=0.02). The mortality rate ratio for men in districts with a dockyard, compared with those without a dockyard was 1.41 (95% CI 1.35 to 1.48, pConclusionFor most districts age-adjusted mesothelioma mortality rates increased through 2002–2015 but the relative contribution from districts with a dockyard fell. Dockyards remain strongly spatially associated with mesothelioma mortality but the strength of this association appears to be falling and mesothelioma deaths are becoming more dispersed.

ObjectivesThis paper presents detailed analysis of the global and regional burden of chronic respiratory disease arising from occupational airborne exposures, as estimated in the Global Burden of Disease 2016 study.MethodsThe burden of chronic obstructive pulmonary disease (COPD) due to occupational exposure to particulate matter, gases and fumes, and secondhand smoke, and the burden of asthma resulting from occupational exposure to asthmagens, was estimated using the population attributable fraction (PAF), calculated using exposure prevalence and relative risks from the literature. PAFs were applied to the number of deaths and disability-adjusted life years (DALYs) for COPD and asthma. Pneumoconioses were estimated directly from cause of death data. Age-standardised rates were based only on persons aged 15 years and above.ResultsThe estimated PAFs (based on DALYs) were 17% (95% uncertainty interval (UI) 14%–20%) for COPD and 10% (95% UI 9%–11%) for asthma. There were estimated to be 519 000 (95% UI 441,000–609,000) deaths from chronic respiratory disease in 2016 due to occupational airborne risk factors (COPD: 460,100 [95% UI 382,000–551,000]; asthma: 37,600 [95% UI 28,400–47,900]; pneumoconioses: 21,500 [95% UI 17,900–25,400]. The equivalent overall burden estimate was 13.6 million (95% UI 11.9–15.5 million); DALYs (COPD: 10.7 [95% UI 9.0–12.5] million; asthma: 2.3 [95% UI 1.9–2.9] million; pneumoconioses: 0.58 [95% UI 0.46–0.67] million). Rates were highest in males; older persons and mainly in Oceania, Asia and sub-Saharan Africa; and decreased from 1990 to 2016.ConclusionsWorkplace exposures resulting in COPD, asthma and pneumoconiosis continue to be important contributors to the burden of disease in all regions of the world. This should be reducible through improved prevention and control of relevant exposures.

ObjectivesThis study provides a detailed analysis of the global and regional burden of cancer due to occupational carcinogens from the Global Burden of Disease 2016 study.MethodsThe burden of cancer due to 14 International Agency for Research on Cancer Group 1 occupational carcinogens was estimated using the population attributable fraction, based on past population exposure prevalence and relative risks from the literature. The results were used to calculate attributable deaths and disability-adjusted life years (DALYs).ResultsThere were an estimated 349 000 (95% Uncertainty Interval 269 000 to 427 000) deaths and 7.2 (5.8 to 8.6) million DALYs in 2016 due to exposure to the included occupational carcinogens—3.9% (3.2% to 4.6%) of all cancer deaths and 3.4% (2.7% to 4.0%) of all cancer DALYs; 79% of deaths were of males and 88% were of people aged 55 –79 years. Lung cancer accounted for 86% of the deaths, mesothelioma for 7.9% and laryngeal cancer for 2.1%. Asbestos was responsible for the largest number of deaths due to occupational carcinogens (63%); other important risk factors were secondhand smoke (14%), silica (14%) and diesel engine exhaust (5%). The highest mortality rates were in high-income regions, largely due to asbestos-related cancers, whereas in other regions cancer deaths from secondhand smoke, silica and diesel engine exhaust were more prominent. From 1990 to 2016, there was a decrease in the rate for deaths (−10%) and DALYs (−15%) due to exposure to occupational carcinogens.ConclusionsWork-related carcinogens are responsible for considerable disease burden worldwide. The results provide guidance for prevention and control initiatives.

ObjectivesChronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey.MethodsPopulation samples aged 20–44 were randomly selected in 1991–1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations.Results8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides.ConclusionsOccupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation.

This article analyses the function of temporary sponsored skilled migrants in Australian hospitality, an industry with acute difficulties attracting and retaining skilled workers. Drawing upon survey data, the findings indicate that rather than utilising temporary sponsored skilled migration to source hard skills, as assumed within the extant literature, employers’ recruitment practices are motivated by a desire to source soft skills and labour perceived as relatively controllable, productive and reliable. In explaining these findings, the article develops new insights regarding the dependence of temporary sponsored skilled migrants on their employer sponsors and the industry effects of hospitality. These factors make these workers a relatively more attractive source of labour and shape the nature of employer demand.

The purpose of this investigation is to compute overall equipment effectiveness (OEE) in the small-scale industry. The novel approach is introduced to detect bottlenecks by which OEE can be improved. This study attempts to help small-medium enterprises in analyzing performance in a better way. The automotive industry was chosen for conducting the research. The present study is comprised of three phases. In the first phase, OEE was computed and compared with world-class manufacturing. The second phase included three-level of Pareto analysis followed by making fishbone diagram to mitigate the losses. The third phase conducted improved OEE in the industry. There are seven major losses present in the industry that adversely affect the effectiveness of machine in any industry. This approach can reduce these losses and improve the quality, asset utilization (AU), OEE, total effective equipment performance (TEEP) and productivity of the machine. The study exposes that Pareto analysis uncovers all the losses and works on the principle of 80/20 rule. The major losses were thoroughly explored with the help of the fishbone diagram and solutions were implemented at the shop floor. As a result, availability, performance, quality, OEE, AU, and TEPP show improvements by 4.6%, 8.06%, 6.66%, 16.23%, 4.16%, and 14.58%, respectively. The approach offers a good opportunity for both researchers and small-medium enterprises around the world to analyze the indicators of production losses, performance, and productivity in the manufacturing industry.

ObjectivesOccupational pesticide exposure is associated with a wide range of diseases, including lung diseases, but it is largely unknown how pesticides influence airway disease pathogenesis. A potential mechanism might be through epigenetic mechanisms, like DNA methylation. Therefore, we assessed associations between occupational exposure to pesticides and genome-wide DNA methylation sites.Methods1561 subjects of LifeLines were included with either no (n=1392), low (n=108) or high (n=61) exposure to any type of pesticides (estimated based on current or last held job). Blood DNA methylation levels were measured using Illumina 450K arrays. Associations between pesticide exposure and 420 938 methylation sites (CpGs) were assessed using robust linear regression adjusted for appropriate confounders. In addition, we performed genome-wide stratified and interaction analyses by gender, smoking and airway obstruction status, and assessed associations between gene expression and methylation for genome-wide significant CpGs (n=2802).ResultsIn total for all analyses, high pesticide exposure was genome-wide significantly (false discovery rate PRYR1, ALLC, PTPRN2, LRRC3B, PAX2 and VTRNA2-1, are genes previously linked to either pesticide exposure or lung-related diseases. Seven out of 31 CpGs were associated with gene expression levels.ConclusionsWe show for the first time that occupational exposure to pesticides is genome-wide associated with differential DNA methylation. Further research should reveal whether this differential methylation plays a role in the airway disease pathogenesis induced by pesticides.

BACKGROUND: We followed up, in 2013, the subjects who lived near the Athens International Airport and had participated in the cross-sectional multicountry HYENA study in 2004-2006.OBJECTIVE: To evaluate the association of exposure to aircraft and road traffic noise with the incidence of hypertension and other cardiovascular outcomes.METHODS: From the 780 individuals who participated in the cross-sectional study, 537 were still living in the same area and 420 accepted to participate in the follow-up. Aircraft and road traffic noise exposure was based on the estimations conducted in 2004-2006, linking geocoded residential addresses of the participants to noise levels. We applied multiple logistic regression and Cox proportional hazards models, adjusting for potential confounders.RESULTS: The incidence of hypertension was significantly associated with higher aircraft noise exposure during the night. Specifically, the OR for hypertension per 10 dB increase in Lnight aircraft noise exposure was 2.63 (95% CI 1.21 to 5.71). Doctor-diagnosed cardiac arrhythmia was significantly associated with Lnight aircraft noise exposure, when prevalent and incident cases were considered with an OR of 2.09 (95% CI 1.07 to 4.08). Stroke risk was also increased with increasing noise exposure but the association was not significant. Twenty-four-hour road traffic noise associations with the outcomes considered were weaker and less consistent.CONCLUSIONS: In conclusion, our cohort study suggests that long-term exposure to aircraft noise, particularly during the night, is associated with incident hypertension and possibly, also, cardiovascular effects.

Managers are in an influential position to make decisions that can impact on the mental health and well-being of their employees. As a result, there is an increasing trend for organisations to provide managers with training in how to reduce work-based mental health risk factors for their employees. A systematic search of the literature was conducted to identify workplace interventions for managers with an emphasis on the mental health of employees reporting directing to them. A meta-analysis was performed to calculate pooled effect sizes using the random effects model for both manager and employee outcomes. Ten controlled trials were identified as relevant for this review. Outcomes evaluating managers’ mental health knowledge (standardised mean difference (SMD)=0.73; 95% CI 0.43 to 1.03; p

Background and objectives We aimed to estimate credibility intervals for the British occupational cancer burden to account for bias uncertainty, using a method adapted from Greenland’s Monte Carlo sensitivity analysis. Methods The attributable fraction (AF) methodology used for our cancer burden estimates requires risk estimates and population proportions exposed for each agent/cancer pair. Sources of bias operating on AF estimator components include non-portability of risk estimates, inadequate models, inaccurate data including unknown cancer latency and employment turnover and compromises in using the available estimators. Each source of bias operates on a component of the AF estimator. Independent prior distributions were estimated for each bias, or graphical sensitivity analysis was used to identify plausible distribution ranges for the component variables, with AF recalculated following Monte Carlo repeated sampling from these distributions. The methods are illustrated using the example of lung cancer due to occupational exposure to respirable crystalline silica in men. Results Results are presented graphically for a hierarchy of biases contributing to an overall credibility interval for lung cancer and respirable crystalline silica exposure. An overall credibility interval of 2.0% to 16.2% was estimated for an AF of 3.9% in men. Choice of relative risk and employment turnover were shown to contribute most to overall estimate uncertainty. Bias from using an incorrect estimator makes a much lower contribution. Conclusions The method illustrates the use of credibility intervals to indicate relative contributions of important sources of uncertainty and identifies important data gaps; results depend greatly on the priors chosen.

Objectives: The epidemiological evidence for adverse health effects of long-term exposure to air and noise pollution from traffic is not coherent. Further, the relative roles of background versus near traffic pollution concentrations in this process are unclear. We investigated relationships between modelled concentrations of air and noise pollution from traffic and incident cardiorespiratory disease in London. Methods: Among 211 016 adults aged 40-79 years registered in 75 Greater London practices between 2005 and 2011, the first diagnosis for a range of cardiovascular and respiratory outcomes were identified from primary care and hospital records. Annual baseline concentrations for nitrogen oxide (NOx), particulate matter with a median aerodynamic diameterResults: The largest observed associations were between traffic-related air pollution and heart failure (HR=1.10 for 20 μg/m3 change in NOx, 95% CI 1.01 to 1.21). However, no other outcomes were consistently associated with any of the pollution indicators, including noise. The greater variations in modelled air pollution from traffic between practices, versus within, hampered meaningful fine spatial scale analyses. Conclusions: The associations observed with heart failure may suggest exacerbatory effects rather than underlying chronic disease. However, the overall failure to observe wider associations with traffic pollution may reflect that exposure estimates based on residence inadequately represent the relevant pattern of personal exposure, and future studies must address this issue.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Exposure to occupational hazards is an important preventable risk factor but the contribution of specific occupations to COPD risk in a general population is uncertain. Our aim was to investigate the association of COPD with occupation in the UK population.In 2006-2010, the UK Biobank cohort recruited 502 649 adults aged 40-69 years. COPD cases were identified by prebronchodilator forced expiratory volume in 1 s/forced vital capacitylower limit of normal according to American Thoracic Society (ATS)/ European Respiratory Society (ERS) guidelines. Current occupations were coded using the Standard Occupational Classification (SOC) 2000. Prevalence ratios (PRs) and 95% CIs of COPD for each SOC-coded job were estimated using a robust Poisson model adjusted for sex, age, recruitment centre and lifetime tobacco smoking. Analyses restricted to never-smokers and non-asthmatics were also performed.Of the 353 occupations reported by 228 614 current working participants, several showed significantly increased COPD risk. Those at highest COPD risk were seafarers (PR=2.64; 95% CI 1.59 to 4.38), coal mine operatives (PR=2.30; 95% CI 1.00 to 5.31), cleaners (industrial: PR=1.96; 95% CI 1.16 to 3.31 and domestic: PR=1.43; 95% CI 1.28 to 1.59), roofers/tilers (PR=1.86; 95% CI 1.29 to 2.67), packers/bottlers/canners/fillers (PR=1.60; 95% CI 1.15 to 2.22), horticultural trades (PR=1.55; 95% CI 0.97 to 2.50), food/drink/tobacco process operatives (PR=1.46; 95% CI 1.11 to 1.93), floorers/wall tilers (PR=1.41; 95% CI 1.00 to 2.00), chemical/related process operatives (PR=1.39; 95% CI 0.98 to 1.97), postal workers/couriers (PR=1.35; 95% CI 1.15 to 1.59), labourers in building/woodworking trades (PR=1.32; 95% CI 1.04 to 1.68), school mid-day assistants (PR=1.32; 95% CI 1.01 to 1.74) and kitchen/catering assistants (PR=1.30; 95% CI 1.10 to 1.53). Associations were similar in analyses restricted to never-smokers and non-asthmatics.Selected occupations are associated with increased COPD risk in a large cross-sectional population-based UK study. Further analyses should confirm the extent to which these associations reflect exposures still of concern and where strengthened preventive action may be needed.

Copyright Article author (or their employer) 2016. Background The association between lung cancer and occupational exposure to organic solvents is discussed. Since different solvents are often used simultaneously, it is difficult to assess the role of individual substances. Objectives The present study is focused on an in depth investigation of the potential association between lung cancer risk and occupational exposure to a large group of organic solvents, taking into account the well known risk factors for lung cancer, tobacco smoking and occupational exposure to asbestos. Methods We analysed data from the Investigation of occupational and environmental causes of respiratory cancers (ICARE) study, a large French population-based case–control study, set up between 2001 and 2007. A total of 2276 male cases and 2780 male controls were interviewed, and long-life occupational history was collected. In order to overcome the analytical difficulties created by multiple correlated exposures, we carried out a novel type of analysis based on Bayesian profile regression. Results After analysis with conventional logistic regression methods, none of the 11 solvents examined were associated with lung cancer risk. Through a profile regression approach, we did not observe any significant association between solvent exposure and lung cancer. However, we identified clusters at high risk that are related to occupations known to be at risk of developing lung cancer, such as painters. Conclusions Organic solvents do not appear to be substantial contributors to the occupational risk of lung cancer for the occupations known to be at risk. Ms Joëlle Fevotte for designing occupational questionnaires; all members of the MatGéné working group from the Institut de Veille Sanitaire and, Ms Brigitte Dananché and Mr Gwenaël GR Leday for his support in performing statistical analyses

Objectives In Italy, asbestos has been extensively used from 1945 to 1992. We evaluated the impact of exposure to asbestos on occurrence of malignant mesothelioma (MM) in the Lombardy Region, Northwest Italy, the most populated and industrialised Italian region. Methods From the Lombardy Mesothelioma Registry, we selected all incident cases of MM diagnosed between 2000 and 2012. We described sources of exposure to asbestos and examined time trends of MM rates. Using Poisson age-cohort models, we derived projections of burden of MM in the Lombardy population for the period 2013–2029. Results In 2000–2012, we recorded 4442 cases of MM (2850 men, 1592 women). Occupational exposure to asbestos was more frequent in men (73.6%) than in women (38.2%). Non-occupational exposure was found for 13.6% of women and 3.6% of men. The average number of cases of MM per year was still increasing (+3.6% in men, +3.3% in women). Incidence rates were still increasing in individuals aged 65+ years and declining in younger people. A maximum of 417 cases of MM (267 men, 150 women) are expected in 2019. We forecast there will be 6832 more cases (4397 in men, 2435 in women) in the period 2013–2029, for a total of 11 274 cases of MM (7247 in men, 4027 in women) in 30 years. Conclusions This study documented a high burden of MM in both genders in the Lombardy Region, reflecting extensive occupational (mainly in men) and non-occupational (mainly in women) exposure to asbestos in the past. Incidence rates are still increasing; a downturn in occurrence of MM is expected to occur after 2019.

BACKGROUND: We have conducted a population-based study of pleural mesothelioma patients with occupational histories and measured asbestos lung burdens in occupationally exposed workers and in the general population. The relationship between lung burden and risk, particularly at environmental exposure levels, will enable future mesothelioma rates in people born after 1965 who never installed asbestos to be predicted from their asbestos lung burdens. METHODS: Following personal interview asbestos fibres longer than 5 µm were counted by transmission electron microscopy in lung samples obtained from 133 patients with mesothelioma and 262 patients with lung cancer. ORs for mesothelioma were converted to lifetime risks. RESULTS: Lifetime mesothelioma risk is approximately 0.02% per 1000 amphibole fibres per gram of dry lung tissue over a more than 100-fold range, from 1 to 4 in the most heavily exposed building workers to less than 1 in 500 in most of the population. The asbestos fibres counted were amosite (75%), crocidolite (18%), other amphiboles (5%) and chrysotile (2%). CONCLUSIONS: The approximate linearity of the dose-response together with lung burden measurements in younger people will provide reasonably reliable predictions of future mesothelioma rates in those born since 1965 whose risks cannot yet be seen in national rates. Burdens in those born more recently will indicate the continuing occupational and environmental hazards under current asbestos control regulations. Our results confirm the major contribution of amosite to UK mesothelioma incidence and the substantial contribution of non-occupational exposure, particularly in women.

OBJECTIVES: First, we present a general analytical approach to estimating the association between medium-term changes in air pollution and health across small areas. As a specific illustration, we then applied the approach to data on London residents from a 4-year period to test whether reductions in traffic-related air pollution were associated with reductions in cardio-respiratory hospital admissions. METHODS: A binomial distribution was used to model change in admissions over time in each small area, which was measured as the proportion of admissions in 2003-2004 out of admissions over all study years (2001-2004). Annual average concentrations of nitrogen oxides (NO(x)) were modelled using an emissions-dispersion model. The association between change in NO(x) and change in hospital admissions was estimated using logistic regression and an instrumental variable approach. RESULTS: For some diagnostic groups, suggestive associations between reductions in NO(x) and reductions in admissions were observed, for example, OR=0.97 (95% CI 0.96 to 0.99) for an IQR decrease in NO(x) (3 microg/m(3)) and all respiratory admissions. Accounting for spatial dependence attenuated several of the associations; for respiratory admissions, the OR was 1.00 (95% CI 0.98 to 1.02), leaving only that for bronchiolitis significant (OR=0.91; 95% CI 0.84 to 0.99). In this particular illustration, the instrumental variable approach did not appear to add information. CONCLUSIONS: In this illustration, there was relatively limited power to detect an association between changes in air pollution and hospital admissions over time. However, the analytical approach could deliver more robust estimates of the health effects of changes in air pollution in settings with greater spatial contrast in changes in air pollution over time.

Text (excluding tables and references) 4833 ABSTRACT Objectives: The Runcorn area, north west England contains many pollution sources, the health effects of which have been under discussion for over a hundred years. Preliminary investigations revealed an excess risk of kidney disease mortality in people living nearest to several point sources of pollution, using distance as a proxy for exposure. Ongoing epidemiological investigations into the effect of ambient mercury exposure on dose and renal effect required a more refined assessment of exposure. Methods: Atmospheric dispersion modelling was used to assess mercury dispersion from three mercury emitting sources (including a large chlor alkali plant), based on knowledge of emissions, local meteorology and topography. Results: The model was sensitive to various input parameters, with different dispersion patterns and ground level concentrations, and therefore different exposed populations identified when different input parameters were defined. The different approaches to exposure assessment also had an impact on the epidemiologic findings. The model output correlated well with weekly monitoring data collected in the local area, although the model underestimated concentrations in close proximity to the chlor alkali plant. The model identified that one point source did not contribute significantly to ground level mercury concentrations, meaning inclusion of this source when using the distance as a proxy approach led to significant exposure misclassification. Conclusions: The model output indicates that assessment of ambient exposure should give consideration to the magnitude of emissions, point source characteristics, local meteorology and topography to ensure the most appropriate exposure classification is reached. Even if dispersion modelling cannot be undertaken, these data can be used to inform and improve the distance as a proxy approach, and improve the interpretability of the epidemiologic findings.

Runcorn has been a site of chemical industry activity for over a century, where tons of toxic chemicals are released annually to air and water. Excess kidney disease mortality (nephritis, nephrotic syndrome, and nephrosis) was found in the population living within 2 km of the industrial plants (standardised mortality ratio (SMR) in males 131 (95% CI 90 to 185) and females 161 (95% CI 118 to 214)) compared to a reference population (northwest England)). Risk of hospital admissions for kidney disease in Halton (comprising the towns of Runcorn and Widnes) was higher than in the less industrial, nearby town of Warrington. The standardised admission ratio (SAR) in Halton was 115 (95% CI 107 to 124) for males and 126 (95% CI 117 to 137) for females; and in Warrington 91 (95% CI 85 to 97) for males and 84 (95% CI 78 to 91) for females compared to the Warrington and Halton area as a whole. The excess risk of kidney disease in the Runcorn area requires further investigation.