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Background Few studies have assessed depression in healthcare workers (HCWs) in Japan owing to the coronavirus disease 2019 (COVID-19) pandemic, and no studies have proposed effective interventions to help support their mental health. Aims To test the hypothesis that enhancing access to mental healthcare professionals helps to improve HCWs’ mental health. Methods This cross-sectional study assessed depressive symptoms in HCWs at three hospitals in Osaka prefecture between May and July, 2020. The survey obtained information on HCWs’ mental state and related situations/perceptions. Multivariable logistic regression analysis was performed to identify factors associated with depressive symptoms. Results Of the 3291 eligible HCWs, 1269 (39%) completed the survey. Of all HCWs, 87 (7%) were physicians, and 700 (55%) were nurses. A total of 181 (14%) HCWs had moderate-to-severe symptoms of depression. Being a frontline worker was not significantly associated with depressive symptoms (odds ratio: 0.86 [95% confidence intervals: 0.54–1.37], P = 0.50). The unwillingness to consult with anyone was significantly associated with more severe depressive symptoms (1.70 [1.10–2.63], P < 0.01). HCWs who had no opportunity to confide in family/friends (1.66 [1.10–2.52], P < 0.01) or colleagues/supervisors (3.19 [2.22–4.58], P < 0.001) were significantly more likely to have depressive symptoms. Conclusions Being a frontline HCW in a Japanese hospital treating patients with COVID-19 was not significantly associated with having depressive symptoms. The study highlights that encouraging daily communication with close persons (family, friends, colleagues and supervisors), rather than improving access to mental health professionals, might help to prevent depression in HCWs during the COVID-19 pandemic.

Background Providing frontline support places first responders at a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Aims This study was aimed to determine the anti-SARS-CoV-2 seroprevalence in a cohort of first responders (i.e. firefighters/paramedics), to detect the underascertainment rate and to assess risk factors associated with seropositivity. Methods We conducted a serological survey among 745 first responders in Germany during 27 November and 4 December 2020 to determine the anti-SARS-CoV-2 seroprevalence using Elecsys® Anti-SARS-CoV-2 immunoassay (Roche Diagnostics, Mannheim, Germany). As part of the examination, participants were asked to provide information on coronavirus disease 2019 (COVID-19)-like-symptoms, information on sociodemographic characteristics and workplace risk factors for a SARS-CoV-2 infection and any prior COVID-19 infection. Descriptive statistics and logistic regression analysis were performed and seroprevalence estimates were adjusted for test sensitivity and specificity. Results The test-adjusted seroprevalence was 4% (95% CI 3.1–6.2) and the underascertainment rate was 2.3. Of those tested SARS-CoV-2 antibody positive, 41% were aware that they had been infected in the past. Seropositivity was elevated among paramedics who worked in the emergency rescue team providing first level of pre-hospital emergency care (6% [95% CI 3.4–8.6]) and those directly exposed to a COVID-19 case (5% [95% CI 3.5–8.1]). Overall, the seroprevalence and the underascertainment rate were higher among first responders than among the general population. Conclusions The high seroprevalence and underascertainment rate highlight the need to mitigate potential transmission within and between first responders and patients. Workplace control measures such as increased and regular COVID-19-testing and the prompt vaccination of all personnel are necessary.

Aerosolization of SARS-CoV-2 by COVID-19 patients can put healthcare workers and susceptible individuals at risk of infection. Air sampling for SARS-CoV-2 has been conducted in healthcare settings, but methods vary widely and there is need for improvement. The objective of this study was to evaluate the feasibility of using a high-volume filter sampler, BioCapture z720, to detect SARS-CoV-2 in COVID-19 patient rooms in a medical intensive care unit, a dedicated COVID-19 ward, and at nurses’ stations. In some locations, the BioSpot-VIVAS, known for high efficiency in the collection of virus-containing bioaerosols, was also operated. The samples were processed for SARS-CoV-2 RNA with multi-plex nested polymerase chain reaction. One of 28 samples collected with the high-volume filter sampler was positive for SARS-CoV-2; all 6 samples collected with BioSpot-VIVAS were negative for SARS-CoV-2. The high-volume filter sampler was more portable and less intrusive in patient rooms than the BioSpot-VIVAS, but limits of detection remain unknown for this device. This study will inform future work to evaluate the reliability of these types of instruments and inform best practices for their use in healthcare environments for SARS-CoV-2 air sampling.

Objectives Elastomeric half-mask respirator (EHMR) use in healthcare increased significantly during the COVID-19 pandemic. Concern for potential release of infectious aerosols from EHMR exhalation valves prompted recommendations to cover them with surgical masks (SMs), thereby improving source control. The physiological and subjective effects of wearing a SM over the exhalation valve of an EHMR, however, are unknown. Methods Twelve healthy healthcare worker volunteers completed a 30-min series of simulated healthcare-related tasks, including resting, talking, walking, and bending, proning and supinating a weighted manikin, and performing cardiopulmonary resuscitation. This series recurred three times with different mask configurations—SM only, EHMR only, or EHMR with SM covering the exhalation valve. A transcutaneous sensor continuously measured carbon dioxide (tcPCO2), oxygen saturation (SpO2), and heart rate (HR) from each subject. Subjects scored their rates of perceived exertion (RPE) and levels of discomfort after each round. Physiological parameters and subjective scores were analyzed using mixed linear models with a fixed effect for mask type, activity, age, body mass index (BMI), and gender. Analysis also tested for interaction between mask type and activity. Results Physiological parameters remained within normal ranges for all mask configurations but varied by task. Statistically significant but small decreases in mean tcPCO2 (37.17 versus 37.88 mmHg, P < 0.001) and SpO2 (97.74 versus 97.94%, P < 0.001) were associated with wearing EHMR with SM over the exhalation valve compared with EHMR alone. Mean HR did not differ between these mask configurations. Wearing SM only was associated with lower RPE and level of discomfort compared with EHMR, but these subjective scores did not differ when comparing EHMR with SM to EHMR only. Age, BMI, and gender had no significant effect on any outcomes. Conclusions Wearing a SM over an EHMR did not produce clinically significant changes in tcPCO2, SpO2, or HR compared with uncovered EHMR during healthcare-related tasks. Covered EHMR use also did not affect perceived exertion or discomfort compared with uncovered EHMR use. Covering the exhalation valve of an EHMR with a SM for source control purposes can be done safely.

Purpose Medical masks have inferior filtration efficiency and fit to filtering facepiece respirators (FFRs) but are widely used in healthcare and the community. These masks are intended for disposal after use but in the event of mask shortage re-use after reprocessing may be an option. We investigated eight reprocessing methods that each involved washing or soaking in liquid, are likely to eliminate respiratory viruses, and are safe and available in most community and healthcare settings. Methods Three brands of EN 14683 standards-compliant commercial medical mask were each reprocessed 10 times by one of eight methods. We measured filtration efficiency for poly-dispersed sodium chloride particles and pressure differential. Results Compared with new medical masks, reprocessed masks had significantly reduced filtration efficiency. The reduction was mild-moderate (6.5–25.8%) after warm water wash, hot water soak or boiling water soak; and moderate-large (24.1–51.5%) after detergent, soap or laundry machine wash, or bleach soak. There were mixed and minor changes in pressure differential. Most reprocessed standards-compliant masks had better filtration efficiency than new non-standard commercial masks and then cotton and cotton-polyester mix fabric samples, even triple-layered fabrics. Conclusions High-quality commercial medical masks reprocessed 10 times by water immersion methods had better filtration efficiency than new non-standard masks and washable fabrics. These findings have particular relevance for community and low-resource healthcare settings.

Background The year 2020 was marked by the new coronavirus pandemic, resulting in millions of cases and deaths, placing healthcare workers at high risk of infection. Aims The aim of this study was to describe the role of an occupational health service during coronavirus disease 2019 pandemic in an oncologic hospital and characterize the most likely sources of viral infection. Methods The information of all healthcare workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from 11 March to 15 December 2020 was collected through an epidemiological survey conducted during contact tracing. The data extracted included gender, age, comorbidities, occupational group, source of infection, clinical presentation, duration of the disease, need for hospitalization and persistent or late symptoms after disease or upon returning to work. Results Out of a total of 2300 workers, 157 were infected, consisting of nurses (36%), nurse assistants (33%) and diagnostic and therapeutic professionals (10%). Physicians and administrative staff accounted for 8% each. The most frequently reported source of infection was occupational (43%), owing to worker-to-worker transmission (45%) and patient-to-worker transmission (36%). The most frequent moments of infection perceived corresponded to the removal of protective equipment during meals and moments of rest in the staff and changing rooms. Conclusions The study revealed that occupational transmission from patients and colleagues might be an important source of SARS-CoV-2 infection in healthcare workers. Spread between colleagues accounted for 45% of the occupational source infections reported. Implementing physical distancing measures and limiting the number of people in changing and rest rooms could significantly reduce infection and related absenteeism.

Objectives In veterinary settings, high exposures to animal allergens and microbial agents can be expected. However, occupational exposure levels are largely unknown. The objective of this study was to estimate the allergen, endotoxin, and β-(1,3)-glucan concentrations in small animal practices and in the homes of practice employees. Methods Dust samples were collected using electrostatic dust fall collectors in diverse rooms of 36 small animal practices, as well as in employees’ homes. Major animal allergens (Fel d 1, Can f 1, Ory c 3, Cav p 1, Equ c 1, Bos d 2), domestic mite (DM) allergens, and β-(1,3)-glucan levels were measured using enzyme immunoassays. Endotoxin was determined using the Limulus amoebocyte lysate assay. Influences on exposure levels were analyzed using multilevel models. Results The levels of Can f 1, Fel d 1, Ory c 3, and Cav p 1 were up to 30 times higher in practices compared with homes without animals, but significantly lower compared with the homes with the respective pet. Although horses were not treated in the practices, Equ c 1 was found in 87.5% of samples, with the highest concentrations measured in changing rooms. DM levels were significantly lower in practices than in all private homes, and endotoxin levels were similar to those in homes with pets. In the practice itself, exposure levels were significantly influenced by animal presence, type of the room, and area per employee; whereas, room volume and diverse cleaning measures had mostly no effect. Conclusions Exposure to animal allergens is high in veterinary practices, but it does not reach levels of households with pets. Domestic mite allergen and endotoxin exposure seem to be low for workers in veterinary practices. The high Equ c 1 detection rate strongly indicates dispersal of allergens, most likely through clothing and hair.

Background The first COVID-19-positive patient was identified in Ireland on 29 February 2020 (Department of Health, Government of Ireland; https://www.gov.ie/en/pressrelease/2f75fd-statement-from-the-national-public-healthemergency-team-sat-29-feb/). Healthcare worker (HCW) quarantining became a core intervention for those identified as ‘close contacts’ to reduce onward transmission within the workplace to patients and colleagues. Whether a quarantining strategy could be justified at a time when there was an increased demand for the services of HCWs remained unknown. Aims To establish whether quarantining staff away from a healthcare setting during a pandemic is justified. Methods This retrospective study examined close contacts of COVID-19-positive index cases (both residents and HCWs) in a community hospital over a 4-week period from 1 to 28 April 2020. Close contacts were identified in accordance with national guidelines. Zones of the hospital were examined to determine the number of COVID-positive index cases and their close contacts. A cumulative result for the hospital was recorded. Results While outcomes varied over time, per zone and per HCW category, the overall conversion rate from close contact to an index case was 30%. Conclusions This study vindicates the policy of quarantining close contact HCWs from their workplaces as they pose a significant threat to both their patients and fellow workers.

Background Hypersensitivity pneumonitis (HP) is caused by a variety of antigens and low-molecular-weight chemicals, often through occupational exposure. Making a diagnosis of HP and identifying a cause are challenging. Cryptogenic cases are frequently reported, and missing or incomplete exposure histories can cause misclassification. Aims To provide an evidence-based compendium of sources of exposure and causes of HP for the clinician, through systematic review of medical literature. Methods Articles related to HP causative agents and occupational exposure were searched from the databases OVID Medline (1946 to October 2020) and EMBASE (1974 to October 2020). Abstracts and full texts of articles were screened by two reviewers. Data on causative antigens, occupational source of exposure and any associated eponymous name were extracted and grouped according to source of exposure. Results A total of 1790 articles were identified, from which 305 articles met the inclusion criteria. An additional 22 articles were identified from citation lists of the selected review articles. Sources of exposure identified for HP were sorted into 14 categories of work (agricultural, plant matter processing, wood, animal-related, foodstuff, food processing, metal processing, polymers, other manufacturing, chemicals, aerosolized water, service, waste and sewage and wind instruments). Conclusions This work is a comprehensive list of occupational causative agents and exposures causing HP. Cases are grouped by source of exposure, allowing an immediately accessible compendium of causes for use during occupational exposure assessment, which could also form the basis for a clinical questionnaire.

ObjectivesThis systematic review aimed to evaluate the evidence for air and surface contamination of workplace environments with SARS-CoV-2 RNA and the quality of the methods used to identify actions necessary to improve the quality of the data.MethodsWe searched Web of Science and Google Scholar until 24th December 2020 for relevant articles and extracted data on methodology and results.ResultsThe vast majority of data come from healthcare settings, with typically around 6 % of samples having detectable concentrations of SARS-CoV-2 RNA and almost none of the samples collected had viable virus. There were a wide variety of methods used to measure airborne virus, although surface sampling was generally undertaken using nylon flocked swabs. Overall, the quality of the measurements was poor. Only a small number of studies reported the airborne concentration of SARS-CoV-2 virus RNA, mostly just reporting the detectable concentration values without reference to the detection limit. Imputing the geometric mean air concentration assuming the limit of detection was the lowest reported value, suggests typical concentrations in health care settings may be around 0.01 SARS-CoV-2 virus RNA copies/m3. Data on surface virus loading per unit area were mostly unavailable.ConclusionThe reliability of the reported data is uncertain. The methods used for measuring SARS-CoV-2 and other respiratory viruses in work environments should be standardised to facilitate more consistent interpretation of contamination and to help reliably estimate worker exposure.Key messagesWhat is already known about this subject?Low level contamination of air and surfaces in hospitals with SARS-CoV-2 RNA have been reported during the Covid-19 pandemic.Limited data have published from non-healthcare settings.What are the new findings?Typically, around 6% of air and surface samples in hospitals were positive for SARS-COV-2 RNA, although there is very limited data for non-healthcare settings.The quality of the available measurement studies is generally poor, with little consistency in the sampling and analytical methods used.Few studies report the concentration of SARS-CoV-2 in air or as surface loading of virus RNA, and very few studies have reported culture of the virus.The best estimate of typical air concentrations in health care settings is around 0.01 SARS-CoV-2 virus RNA copies/m3How might this impact on policy or clinical practice in the foreseeable future?There should be concerted efforts to standardise the methods used for measuring SARS-CoV-2 and other respiratory viruses in work environments.

Incidental ultrafine particles (UFPs) constitute a key pollutant in industrial workplaces. However, characterizing their chemical properties for exposure and toxicity assessments still remains a challenge. In this work, the performance of an aerosol concentrator (Versatile Aerosol Concentration Enrichment System, VACES) was assessed to simultaneously sample UFPs on filter substrates (for chemical analysis) and as liquid suspensions (for toxicity assessment), in a high UFP concentration scenario. An industrial case study was selected where metal-containing UFPs were emitted during thermal spraying of ceramic coatings. Results evidenced the comparability of the VACES system with online monitors in terms of UFP particle mass (for concentrations up to 95 µg UFP/m3) and between filters and liquid suspensions, in terms of particle composition (for concentrations up to 1000 µg/m3). This supports the applicability of this tool for UFP collection in view of chemical and toxicological characterization for incidental UFPs. In the industrial setting evaluated, results showed that the spraying temperature was a driver of fractionation of metals between UF (, This work was funded by SIINN ERA-NET (project id: 16), the Spanish MINECO (PCIN-2015-173-C02-01) and the French agency (Region Hauts de France). The Spanish Ministry of Science and Innovation (Project CEX2018-000794-S; Severo Ochoa) and the Generalitat de Catalunya (project number: AGAUR 2017 SGR41) provided support for the indirect costs for the Institute of Environmental Assessment and Water Research (IDAEA-CSIC). We acknowledge support of the publication fee by the CSIC Open Access Publication Support Initiative through its Unit of Information Resources for Research (URICI).

The British Occupational Hygiene Society (BOHS) COVID-19 Working Group developed a control banding matrix to provide guidance for employers and others to help assess the risks of COVID-19 infection during the pandemic. The matrix was based on occupational hygiene principles and the judgement of the occupational health practitioners involved; since objective data on workers’ exposure were unavailable. Users of the matrix identify one of five exposure categories based on generic job descriptions and example occupations, and these categories are linked to generic guidance on interventions at source, on the exposure pathway and for individual workers. The risk matrix was published on the BOHS website and the guidance has been downloaded more than 2000 times. The matrix has had limited evaluation for reliability, but the data suggest that the highest exposure ranked jobs were associated with higher age-standardized mortality in Britain during the pandemic. However, there was considerable variability in exposure assignments between assessors, which underlines the need for the control guidance to be precautionary. The BOHS calls on academic researchers to undertake further work to validate the reliability of the tool.

Silicosis is being increasingly reported among young stonemasons in the artificial stone (AS) benchtop fabrication and installation industry. Respiratory health screening, which included a job and exposure history, a chest X-ray (CXR), a respiratory health questionnaire, and gas transfer testing, were offered to stonemasons in Victoria, Australia. Workers typically reported a variety of tasks, including cleaning and labouring, which made exposure assessment complex. We estimated the relative respirable crystalline silica exposure intensity of each job from the proportion of time using AS and the proportion of time doing dry work (work without water suppression). The relative average intensity of exposure for up to five jobs was calculated. Cumulative exposure was calculated as the sum of the duration multiplied by intensity for each job. Installers and factory machinists (other than computer numeric control operators) were the most likely to report dry work with AS, and so had a greater average intensity of exposure. Exposure intensity and cumulative exposure were associated with increased odds of an ILO (International Labour Organisation) CXR profusion major category of ≥1 and with dyspnoea. Exposure duration was also associated with ILO profusion category. In multivariate analyses of health outcomes, only job type was associated with the ILO profusion category. For both most recent and longest-duration job types, when compared to the lowest exposure group, factory machinists were more likely to have an ILO category ≥1. This suggests that intensity of exposure estimated from the proportion of time dry cutting and proportion of time working on AS can predict the risk of adverse respiratory outcomes for workers in this industry.

Anaerobic digestion is an emerging technology producing energy from renewable resources or food waste. Exposure screenings, comprising hazardous substances and biological agents, at different workplaces are necessary for a comprehensive overview of potential hazards in order to assess the risk of employees in biogas plants. In order to analyse these parameters, workplace measurements were conducted in seven full-scale anaerobic digesters. Personal and stationary sampling was performed for inhalable and respirable particles, volatile organic compounds, ammonia, hydrogen sulphide, carbon monoxide, and carbon dioxide. Furthermore, concentrations of the total cell count, endotoxins, and fungi—down to species level—were determined in comparison to windward air. Sequencing of the 16S rRNA genes was utilized for the determination of the bacterial composition inside the biogas plants. Measurements of hazardous substances show hardly values reaching the specific occupational exposure limit value, except ammonia. An approximate 5-fold increase in the median of the total cell count, 15-fold in endotoxins, and 4-fold in fungi was monitored in the biogas plants compared with windward air. Specifying the comparison to selected workplaces showed the highest concentrations of these parameters for workplaces related to delivery and cleaning. Strikingly, the fungal composition drastically changed between windward air and burdened workplaces with an increase of Aspergillus species up to 250-fold and Penicillium species up to 400-fold. Sequence analyses of 16S rRNA genes revealed that many workplaces are dominated by the order of Bacillales or Lactobacillales, but many sequences were not assignable to known bacteria. Although significant changes inside the biogas plant compared with windward air were identified, that increase does not suggest stricter occupational safety measures at least when applying German policies. However, exposure to biological agents revealed wide ranges and specific workplace measurements should be conducted for risk assessment.

In occupational life, performing cognitive work tasks in between fatiguing physical work tasks may allow recovery and reduce stress without losing productive working time. The temporal pattern of such alternations is likely a determinant of the recovery effect, influencing both stress and fatigue; the difficulty of the cognitive task (CT) would also be a likely determinant. The aim of this study was to determine to what extent the temporal pattern of alternations between a repetitive physical task and a CT of different difficulties influenced perceived fatigability, performance fatigability, stress-related outcomes, and performance. Fifteen women performed four work sessions comprising 110 min of repeated bouts of a repetitive physical task (pipetting), alternating with a CT (n-back). Sessions differed in bout cycle time (short: 7 + 3 min versus long: 14 + 6 min) and CT difficulty (CTdiff; easy versus difficult). Fatigue was assessed from recordings of maximal voluntary contraction force in shoulder elevations and handgrip pre- and post-work, electromyography (EMG) from the right trapezius and right forearm extensors during work, and repeated self-ratings of fatigue and pain throughout the session. Stress was assessed using electrocardiography (heart rate variability), salivary alpha-amylase, and self-reports. Perceived fatigue increased significantly over time for all protocols and more in long-cycle than short-cycle conditions. EMG activity did not increase markedly over time in any condition. Neither objective nor subjective indicators suggested that stress increased over time, regardless of the temporal pattern. Pipetting performance remained stable in all conditions. Cognitive performance, measured by the proportions of correct positive and false positive answers, differed between CTdiff levels but remained stable over time, with no significant difference between temporal patterns. In summary, temporal patterns of alternating tasks influenced fatigue to some extent but had no obvious influence on stress indicators or performance. Thus, designing job rotation with alternating physical and cognitive work should consider the temporal patterns of alternations to minimize fatigue.

Objectives Increased use of small affordable alarm sensors with logging or network capabilities has improved the ability to monitor exposure. The large datasets generated from these monitors calls for development of a computer algorithm to assess these data. Methods We examined 88 time series of hydrogen sulphide (H2S) from wastewater works previously used for developing the exposure index. The time series covered 331 h, where 16 h had readings different from zero. Results The developed algorithm reproduced the manual assessed index almost perfectly (linear regression β = 1.02, R2 = 0.97, P < 0.001). Time-weighted average (TWA) values of the 88 time series showed a mean value of 0.04 ppm (range 0.0–0.9). The mean index value was 18 (range 0–337), with a good linear fit (β = 0.002, R2 = 0.93, and P < 0.001). The index gave us a better resolution and basis for risk assessment than the TWA, and managed to combine evaluation of TWA and exceedance of ceiling value in one number. Conclusions As long as peaks above ceiling value occur, we find alarm tools with an H2S sensor to be an essential personal protective equipment against H2S. The proposed method has been verified, and it removes some common human errors in graph evaluation. Use of the index is a possible way of quantifying risk level in exposure to H2S in one single number and provides better understanding of the risk of exposure, as it eases the analysis and evaluation of large numbers of time series.

Background Shift work may impact women more negatively than men due to the increased burden of coping with demanding work schedules while also undertaking more of the domestic chores, including childcare. Aims To examine whether the combination of shift working and caring for children affects the sleep, fatigue and work–family conflict experienced by women more than it affects men. Methods Using data from a survey of the Swedish working population, mixed linear regression models examined work schedule (daywork, shift work with nights, shift work without nights), gender and presence of children Results In fully adjusted models (N = 8938), shift work was associated with insufficient sleep (P < 0.01), disturbed sleep (P < 0.01), fatigue (P < 0.05) and work–family conflict (P < 0.001). Interactions in the analyses of sleep disturbance (P < 0.001) and work–family interference (P < 0.05) indicated that among participants with no children, females reported more disturbed sleep and more work–family conflict than their male counterparts, irrespective of schedule; while among participants with children, female dayworkers reported more disturbed sleep than their male counterparts, and females working shifts without nights reported more work–family interference. Conclusions Having young children did not exacerbate negative effects of shift work, in either men or women. This may reflect high levels of gender equality and childcare provision in Sweden.

Objectives Occupational exposure to wood dust can cause respiratory diseases, but few studies have evaluated the impact of declining exposure on health outcome. This study aimed to investigate whether a decline in wood dust exposure between two cross sectional studies performed in 1997–1998 and 2003–2004 was related to the prevalences of respiratory symptoms among woodworkers in a well-defined geographical area. Methods Two thousand and thirty-two woodworkers from 54 plants in study 1 and 1889 woodworkers from 52 plants in study 2 returned a questionnaire on respiratory diseases and symptoms, employment and smoking habits. Current individual wood dust exposure level was assessed from 2 study specific job exposure matrix’s based on task, factory size and personal passive dust measurements (2217 in study 1 and 1355 in study 2). Results The median (range) of inhalable dust was 1.0 mg/m3 (0.2–9.8), 0.6 mg/m3 (0.1–4.6) in study 1 and study 2, respectively. In study 2, the prevalence’s of self-reported asthma was higher and the prevalence’s of respiratory symptoms were lower compared to study 1. In adjusted logistic regression analyses using GEE methodology to account for clustering, dust exposure level could explain the differences in prevalence of coughing, chronic bronchitis and nasal symptoms between study 1 and study 2, while no effect was found for asthma. Conclusions A 40% decline in wood dust exposure in a 6 year period may serve as an explanation for the decline in most respiratory symptoms, but do not seems to impact the prevalence of self-reported asthma.

Background Healthcare workers (HCWs) accounted for a significant proportion of COVID-19 infections worldwide. Retrospective seroprevalence surveys are often used to screen for unidentified previous infection with SARS-CoV-2. However, the rate of humoral response in HCWs affected by COVID-19 is not well-defined. Aims To assess the specific IgG humoral response in symptomatic and asymptomatic SARS-CoV-2-infected HCWs and identify potential factors associated with humoral response. Methods We prospectively recruited 204 HCWs with RT-PCR-confirmed COVID-19 infection to evaluate SARS-CoV-2 humoral response. Serum-IgG antibodies against SARS-CoV-2 were analysed using two commercially available serological assays. A logistic regression was performed to identify independent factors associated with positive IgG serology test. Results Overall, the SARS-CoV-2 IgG seropositivity rate was 77%. This seropositivity rate was higher in symptomatic than in asymptomatic COVID-19 infection (83% versus 57%; P < 0.001) and in older HCWs.. The seropositivity rate did not diminish with time. In logistic regression, only a history of COVID-19 symptoms and age were identified as independent factors associated with the detection of anti-SARS-CoV-2 IgG antibodies. Conclusions SARS-CoV-2 IgG antibodies are found significantly more frequently in symptomatic and in older HCWs. The fact that not all COVID-19 HCWs develop detectable IgG is vital for the interpretation of COVID-19 seroprevalence surveys.

Objectives Diisocyanates are a chemical group that are widely used at workplaces in many sectors. They are also potent skin- and respiratory sensitizers. Exposure to diisocyanates is a main cause of occupational asthma in the European Union. To reduce occupational exposure to diisocyanates and consequently the cases of diisocyanate-induced asthma, a restriction on diisocyanates was recently adopted under the REACH Regulation in the European Union. Methods A comprehensive evaluation of the data on occupational exposure to the most important diisocyanates at workplaces was made and is reported here. The diisocyanates considered are methylene diphenyl diisocyanate (MDI), toluene diisocyanate (TDI), and hexamethylene diisocyanate (HDI), accounting for more than 95% of the market volume in the EU. The exposure assessment is based on data from Chemical Safety Reports (CSRs) of REACH Registration Dossiers, workplace air monitoring data from Germany, from the UK Health and Safety Executive (HSE), and literature data relevant for the EU, and the USA. Results Occupational exposure to diisocyanates is particularly relevant in: (i) C.A.S.E. applications (Coatings, Adhesives, Sealants, Elastomers), (ii) production of polyurethanes (PUs) (e.g. slab-stock foam), (iii) handling of partly uncured PU products (e.g. cutting, demoulding, spray application of foam), and (iv) when diisocyanates/PUs are heated (e.g. hot lamination, foundry applications/casting forms). Ranking of the reported data on inhalation to diisocyanate exposure at workplaces (maximum values) leads to following order: (i) HDI and its oligomers in coatings, (ii) MDI in spray foam applications, (iii) TDI in manufacture of foam, (iv) TDI in manufacture of PUs and PU composite materials, (v) TDI in adhesives, (vi) MDI in adhesives, (vii) MDI in manufacture of PUs and PU composite materials, (viii) TDI in coatings, (ix) MDI in manufacture of foam, and (x) HDI in adhesives.

There are several well-known risk factors for work-related musculoskeletal disorders (MSDs). Despite this knowledge, too many people still work in harmful conditions. The absence of occupational exposure limits (OELs) for physical workload impedes both supervision and preventive work. To prevent myalgia, tendon disorders, and nerve entrapments in the upper musculoskeletal system, we propose action levels concerning work postures, movement velocities and muscular loads recorded by wearable equipment. As an example, we propose that wrist velocity should not exceed 20°/s as a median over a working day. This has the potential to reduce the prevalence of carpal tunnel syndrome (CTS) in highly exposed male occupational groups by 93%. By reducing upper arm velocity in highly exposed female groups to the suggested action level 60°/s, the prevalence of pronounced neck/shoulder myalgia with clinical findings (tension neck syndrome) could be reduced by 22%. Furthermore, we propose several other action levels for the physical workload. Our ambition is to start a discussion concerning limits for physical workload, with the long-term goal that OELs shall be introduced in legislation. Obviously, the specific values of the proposed action levels can, and should, be discussed. We hope that quantitative measurements, combined with action levels, will become an integral part of systematic occupational health efforts, enabling reduction and prevention of work-related MSDs.

Background Work-related stress, anxiety and depression (WRSAD) are common, overlapping mental health problems burdened with major medical, occupational, institutional and societal implications. Current occupational health (OH) management of WRSAD is based on clinical and managerial guidelines and individual risk assessment. Aims The study sought to identify patterns of OH advice in WRSAD and the relationships between the OH advice, available evidence, experience and expertise of the OH doctors (OHDs). Methods A retrospective cross-sectional analysis of 101 first-time OH consultations for WRSAD by nine OHDs. Results The three most common OH interventions included follow-up OH consultations, adjusted duties and referrals for counselling. All OHDs preferred a light-touch approach but the less experienced and qualified OHDs were more proactive and prescriptive. Conclusions In the absence of a specific occupational medical guideline for the management of WRSAD, the OH interventions may be guided by clinical guidelines, individual risk assessment, the client’s circumstances or the experience, expertise and preferences of the OHDs. In the study group, OH interventions were under-utilized and not consistently applied. Our findings support the argument for OH guideline for WRSAD to improve the consistency and effectiveness of OH interventions. This is important given the scale of the problem and the recent increase in WRSAD during the COVID-19 pandemic.

Background Nurses who are one of the pivotal elements of countries’ strategic responses to COVID-19 are being exposed to COVID-19. Aims To investigate the underlying characteristics of nurses who died due to COVID-19. Methods On 1 September 2020, a grey literature search was conducted. Data obtained through Medscape, Google, PubMed, government and non-government websites. The search strategy was carried out using variants and combinations of keywords related to ‘nurse’ and ‘COVID-19’ in English. Abstracted data included age, gender, type of nurse, department of nursing, country, date of death and publication characteristics. Results Out of reported 1518 COVID-19-related nurse deaths, details of age, gender and department of nursing were available for 766 (50%), 945 (62%) and 153 (10%) of nurses, respectively. The median age of the nurses was 56 years. The majority of deaths were reported in the 46- to 65 (32%)-year age range. While the registered nurses had the highest number of deaths according to types of nurses (680/957; 71%), they are mental health nurses (42/153; 28%) in the department of nursing. The countries with the most reported nurse deaths were USA, South Africa, Mexico and Russia. Conclusions The predominance of deceased mental health nurses among nursing departments can be examined in future studies. Supportive health policies can be developed to increase the motivation of nurses.

Objectives The Fort McMurray fire in Alberta, Canada, devastated the townsite in May 2016. First responders were heavily exposed to smoke particles. Blood samples taken from firefighters in May and August/September 2016 were used to measure concentrations of inflammatory markers in plasma and the relation of these markers to exposures and respiratory ill-health. Methods Blood samples were drawn from firefighters from two fire services, who also completed questionnaires about tasks and exposures during their deployment to the fire and about respiratory symptoms. Plasma was analysed for 42 inflammatory markers in a multiplex assay. At Service A, samples were collected twice, within 19 days of the start of the fire (early sample) and again 14–18 weeks later (late sample). At Service B, only late samples were collected, at 16–20 weeks. Principal component (PC) scores were extracted from markers in plasma from the early and late samples and, at both time periods, the first two components retained. PC scores were examined against estimated cumulative exposures to PM2.5 particles, self-rated physical stressors during the fire, and time since the last deployment to an active fire. The relation of component scores and exposure estimates to respiratory health were examined, using self-ratings at the time of the blood draw, a validated respiratory screening questionnaire (the European Community Respiratory Health Survey [ECRHS]) some 30 months after the fire, and clinical assessments in 2019–2020. Results Repeat blood samples were available for 68 non-smoking first responders from Service A and late samples from 160 non-smokers from both services. In the 68 with two samples, marker concentrations decreased from early to late samples for all but 3 of the 42 markers, significantly so (P < 0.05) for 25. The first component extracted from the early samples (C1E) was unrelated to respiratory symptoms but the second (C2E) was weakly related to increased cough (P = 0.079) and breathlessness (P = 0.068) and a lower forced expiratory volume in one second/forced expiratory capacity (FEV1/FVC)(β = –1.63, 95% CI –3.11 to –0.14) P = 0.032. The first PC at 14–20 weeks (C1L) was unrelated to exposure or respiratory health but the second PC (C2L) from these late samples, drawn from both fire services, related to cumulative PM2.5 exposure. In a multivariate model, clustered within fire service, cumulative exposure (β = 0.19, 95% CI 0.09–0.30), dehydration (β = 0.65, 95% CI 0.04–1.27) and time since last deployed to a fire (β = –0.04, 95% CI –0.06 to –0.01) were all related to the C2L score. This score was also associated with respiratory symptoms of wheezing, chest tightness, and breathlessness at the time of the blood draw but not to symptoms at later follow-up. However, apart from the lower FEV1/FVC at 15–19 days, the marker scores did not add to regression models that also included estimated cumulative PM2.5 exposure. Conclusions Concentrations of persisting inflammatory markers in the plasma of firefighters deployed to a devastating fire decreased with time and were related to estimates of exposure. Although not a powerful independent predictor of later respiratory ill-health, they may serve as an indicator of previous high exposure in the absence of contemporary exposure estimates.

Objective To prevent occupational cancers, carcinogen exposure surveillance systems have been developed in many countries. This study aimed to develop a carcinogen exposure database specific to South Korea. Methods Twenty known human carcinogens were selected for this study. The International Standard Classification of Industry was used for a classification scheme of industries. Three nationwide occupational exposure databases, the Work Environment Measurement Database, the Special Health Examination Database, and the Work Environment Condition Survey, were used to calculate reference exposure prevalence estimates by carcinogen and industry. Then, 37 professional industrial hygienists with at least 19 years of field experience provided their own exposure prevalence estimates, after reviewing the abovementioned reference estimates derived from three data sources. The median value of the experts’ estimates was used as the final exposure prevalence. Finally, the number of exposed workers was computed by multiplying the final exposure prevalence by the number of workers extracted from the 2010 national census data by carcinogen and industry. Results The exposure prevalence and the number of exposed workers were calculated according to 20 carcinogen and 228 minor industrial groups, assuming year 2010 circumstances. The largest population was exposed to welding fumes (326 822 workers), followed by ultraviolet radiation (238 937 workers), ionizing radiation (168 712 workers), and mineral oil mist (146 798 workers). Conclusions Our results provide critical data on carcinogen exposure for the prevention of occupational cancers.

Objectives Several studies have demonstrated an increased risk of adverse health effects, including reduced lung function and lung cancer among asphalt pavers, which has been related to occupational exposure to contaminants during asphalt paving. Consequently, occupational exposure among asphalt pavers must be reduced. The aim of this study was to compare the impact of hot mix asphalt (HMA) and warm mix asphalt (WMA) paving on occupational exposure levels during road paving in field experiments. Asphalt temperatures when paving with WMA are usually lower than when paving with HMA due to differences in the asphalt’s composition and method of application. Methods On 11 different road sections, one lane was paved with WMA and one with HMA during the same work shift under approximately identical weather conditions. The weather conditions and asphalt surface temperature were monitored during paving. Fifty-seven samples of fumes and vapor, organic and elemental carbon, amines, and respirable, thoracic, and inhalable particulate matter (PM) fractions were collected by stationary sampling. In addition, 30 samples of fumes and vapor were collected by personal sampling Results Compared to paving with HMA, paving with WMA significantly (P < 0.05; paired Student’s t-test) reduced the geometric mean (GM) air concentration of asphalt vapor (0.04 versus 0.08 p.p.m.), organic carbon (OC; 0.09 versus 0.18 mg m−3), and respirable PM (0.12 versus 0.22 mg m−3). Additionally, the air concentration of OC correlated strongly with the respirable fraction of PM (Pearson’s correlation coefficient 0.83). Conclusions Measured airborne concentrations of respirable PM, OC, and asphalt vapor were lower when paving with WMA than with HMA. Because exposure to airborne contaminants generated during asphalt paving is believed to be responsible for the adverse health effects observed among asphalt pavers, paving with WMA rather than HMA may have health benefits.

BackgroundStaff working in intensive care units (ICUs) have faced significant challenges during the COVID-19 pandemic which have the potential to adversely affect their mental health.AimsTo identify the rates of probable mental health disorder in staff working in ICUs in nine English hospitals during June and July 2020.MethodsAn anonymized brief web-based survey comprising standardized questionnaires examining depression, anxiety symptoms, symptoms of post-traumatic stress disorder (PTSD), well-being and alcohol use was administered to staff.ResultsSeven hundred and nine participants completed the surveys comprising 291 (41%) doctors, 344 (49%) nurses and 74 (10%) other healthcare staff. Over half (59%) reported good well-being; however, 45% met the threshold for probable clinical significance on at least one of the following measures: severe depression (6%), PTSD (40%), severe anxiety (11%) or problem drinking (7%). Thirteen per cent of respondents reported frequent thoughts of being better off dead, or of hurting themselves in the past 2 weeks. Within the sample used in this study, we found that doctors reported better mental health than nurses across a range of measures.ConclusionsWe found substantial rates of probable mental health disorders, and thoughts of self-harm, amongst ICU staff; these difficulties were especially prevalent in nurses. Whilst further work is needed to better understand the real level of clinical need amongst ICU staff, these results indicate the need for a national strategy to protect the mental health, and decrease the risk of functional impairment, of ICU staff whilst they carry out their essential work during COVID-19.

ObjectivesAn estimated 125 million workers are exposed to asbestos worldwide. Asbestos is classified by the International Agency for Research on Cancer as a Group 1 carcinogen. The association between occupational asbestos exposure and kidney cancer is not well established however. This study aimed to determine the mortality and incidence of kidney cancer in workers who have been exposed to asbestos. We performed a systematic review and meta-analysis to evaluate the association between occupational asbestos exposure and kidney cancer.MethodsMedline, EMBASE, and Web of Science were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles on occupational asbestos exposure and kidney cancer. The studies reported the standardized mortality ratio (SMR) or standardized incidence ratio (SIR) of kidney cancer in workers exposed to asbestos. SMRs or SIRs with its 95% confidence interval (CI) were pooled using a fixed-effect model.ResultsForty-nine cohort studies involving 335 492 workers were selected for analysis. These studies included 468 kidney cancer deaths and 160 incident cases. The overall pooled-SMR of kidney cancer was 0.95 (95% CI: 0.86–1.05), with no significant heterogeneity (PQ = 0.09, I2 = 24.87%). The overall pooled-SIR of kidney cancer was 0.95 (95% CI: 0.79–1.11), with no significant heterogeneity (PQ = 0.68, I2 = 0.00%). Subgroup analysis did not find any increased association with occupational asbestos exposure. There was no evidence of publication bias with Egger’s test P values of 0.08 for mortality studies and 0.99 for incidence studies.ConclusionsThis systematic review and meta-analysis did not show evidence of association between occupational asbestos exposure and kidney cancer mortality or incidence.

Background In next fall and winter, SARS-CoV-2 could circulate in parallel with seasonal influenza. The dual epidemics will result in considerable morbidity and mortality; therefore, influenza vaccination may be essential. Recent studies found increased risk of coronavirus in individuals receiving influenza vaccination. Aims Our aim is to analyse the association between influenza vaccination and COVID-19 in a population of healthcare workers (HCWs). Methods IgG antibodies against SARS-CoV-2 were detected in 3520 HCWs at a large hospital in Northern Italy. For each participant, we collected data on flu immunization status for the last five flu seasons. Logistic regression was used to test associations between seasonal flu vaccination status and a positive serology tests for COVID-19. Results During the last five flu seasons, 2492 vaccinations were administered. Serology tests were negative for 3196 (91%) HCWs and residents and only 21 (1%) people had an equivocal test (12.0–15.0 AU/mL). Only 128 (4%) people received a diagnosis of COVID-19, with a positive swab test. No flu vaccinations for the last five flu seasons were specifically associated with diagnosis of COVID-19 or with positive results of serology tests. Conclusions Flu vaccinations did not appear to be associated with SARS-CoV-2 infection. Influenza vaccination should continue to be recommended for HCWs and for individuals at increased risk for severe illness from respiratory infection.

Background Healthcare workers (HCWs) are commonly infected by SARS-CoV-2 and represent one of the most vulnerable groups. Adequate prevention strategies are necessary to guarantee HCWs’ safety, as well as to prevent dissemination of the infection among patients. Aims To describe a case series of SARS-CoV-2-positive HCWs in a large public healthcare organization in Milan (Italy) during the most devastating weeks of the epidemic and analyse the sources, symptoms and duration of SARS-CoV-2 infection. Methods This study included 172 SARS-CoV-2-positive HCWs who were infected between the 25th of February and the 7th of April 2020. A nasopharyngeal swab (NPS) and RT-PCR were used to indicate. Results Initially, the most common sources of infection were other positive HCWs (49%). Medical doctors and nursing assistants were most frequently infected, with infection rates of 53/1000 and 50/1000, respectively. COVID-19 departments were less affected than internal medicine, surgery, intensive care, or emergency room. The most commonly reported symptom was mild cough, while loss of smell (anosmia) and loss of taste (ageusia) were reported as moderate and severe by 30–40% of HCWs. The time necessary for 50% of workers to recover from the infection was 23 days, while it took 41 days for 95% of HCWs to become virus-free. Conclusions HCWs are commonly infected due to close contacts with other positive HCWs, and non-COVID departments were most affected. Most HCWs were asymptomatic or subclinical but contact tracing and testing of asymptomatic HCWs help identify and isolate infected workers.

Background Fluid Resistant Surgical Masks have been implemented in UK personal protective equipment (PPE) guidelines for COVID-19 for all care sites that do not include aerosol-generating procedures (AGPs). FFP3 masks are used in AGP areas. Concerns from the ENT and plastic surgery communities out with intensive care units have questioned this policy. Emerging evidence on cough clouds and health care worker deaths has suggested that a review is required. Aims To test the efficacy of Fluid Resistant Surgical Mask with and without adaptions for respiratory protection. To test the efficacy of FFP and FFP3 regarding fit testing and usage. Methods A smoke chamber test of 5 min to model an 8-h working shift of exposure while wearing UK guideline PPE using an inspiratory breathing mouthpiece under the mask. Photographic data were used for comparison. Results The Fluid Resistant Surgical Mask gave no protection to inhaled smoke particles. Modifications with tape and three mask layers gave slight benefit but were not considered practical. FFP3 gave complete protection to inhaled smoke but strap tension needs to be ‘just right’ to prevent facial trauma. Facial barrier creams are an infection risk. Conclusions Surgical masks give no protection to respirable particles. Emerging evidence on cough clouds and health care worker deaths suggests the implementation of a precautionary policy of FFP3 for all locations exposed to symptomatic or diagnosed COVID-19 patients. PPE fit testing and usage policy need to improve to include daily buddy checks for FFP3 users

Objectives Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing public and occupational health concern. As transmission of MRSA can occur via contact with fomites, it is crucial to have sensitive methods for sampling of bacteria. The overall aim of this study was to obtain knowledge about methods and strategies for quantitative sampling Staphylococcus species on surfaces. Methods The study was designed as a comparative sampling experiment with different samplers [dipslide (two agar types), swabs (three brands, used wet and dry, and elution from swabs or plate diluted)] on smooth stainless steel surfaces spiked with MRSA and methicillin-sensitive S. aureus (MSSA). Furthermore, bacteria sampled from indoor surfaces with frequent or infrequent contact with hands were quantified and identified using matrix-assisted laser desorption-ionization time-of-flight (MALDI-TOF) mass spectrometry (MS). Results Pre-moistened swabs in combination with dilution plating and dipslides were more sensitive than dry swabs. For recovery of MRSA and MSSA from surfaces with eSwabs, at least 0.3–100 CFU MRSA cm−2 and 5.3–8.6 CFU MSSA cm−2 should be present. The sensitivities of pre-moistened eSwabs were approximately 10-fold higher than those of dipslides and pre-moistened viscose and cotton swabs. The variation in concentrations of Staphylococcus species in replicate sampling of adjacent squares on indoor surfaces was higher for surfaces frequently touched by hands than for surfaces infrequently touched. In total 16 different Staphylococcus species were identified, and S. aureus was found only in 2 of 66 surface samples. A considerable overlap was found between species in replicate sampling within an environment and between the air and surfaces within an environment. Conclusions Pre-moistened eSwabs in combination with dilution plating were found to be the best method for surface sampling of MSSA and MRSA. The method can be used for assessing the risk of exposure and transmission of MRSA from environmental surfaces. To obtain a reliable measure of concentrations and the presence of Staphylococccus species a higher number of samples should be taken from surfaces with hand contact than from surfaces dominated by sedimented bacteria.

Objectives The continuous supply of personal protective equipment (PPE) in the National Health Service (NHS) is paramount to reduce transmission of COVID-19 to patients, public, and staff. Methods A 16-question survey was created to assess the availability and personal thoughts of healthcare professionals regarding PPE supply in England. The survey was distributed via social media (Facebook© and Twitter©) to UK COVID-19 healthcare professional groups, with responses collected over 3 weeks in March 2020 during the beginning of the pandemic. Results A total of 121 responses from physicians in 35 different hospitals were collected (105 inpatient wards, 16 from intensive care units). In inpatient wards, eye and face protection were unavailable to 19% (20/105). Fluid-resistant surgical masks were available to 97% (102/105) whereas filtering facepiece class 3 (FFP3) respirator for 53% (56/105) of respondents. Gloves were accessible for all respondents (100%). Body protection was available primarily as a plastic apron 84% (88/105). All of respondents working in intensive care had access to full-body PPE, except FFP3 respirators (available in 88%, 14/16). PPE is ‘Always’ available for 30% (36/121) of all respondents. There was a statistically significant difference between London and non-London respondents that ‘Always’ had PPE available (44 versus 19%, P = 0.003). Conclusions Our survey demonstrated an overall lack of PPE volume supply in the UK hospitals during March 2020, demonstrating a lack of preparedness for a pandemic. PPE was more readily available in London which was the epicentre of the outbreak. Eye and full body protection are in most lack of supply.

With growing evidence of inhalation of small infectious particles as an important mode of transmission for SARS-CoV-2, workplace risk assessments should focus on eliminating or minimizing such exposures by applying the hierarchy of controls. We adapt a control banding model for aerosol-transmissible infectious disease pandemic planning to encourage the use of source and pathway controls before receptor controls (personal protective equipment). Built on the recognition that aerosol-transmissible organisms are likely to exhibit a dose–response function, such that higher exposures result from longer contact times or higher air concentrations, this control banding model offers a systematic method for identifying a set of source and pathway controls that could eliminate or reduce the need for receptor controls. We describe several examples for workers at high risk of exposure in essential or return to work categories. The goal of using control banding for such workers is to develop effective infection and disease prevention programs and conserve personal protective equipment.

Decisions on fitness for employment that entails a risk of contracting Covid-19 require an assessment of the worker’s personal vulnerability should infection occur. Using recently published UK data, we have developed a risk model that provides estimates of personal vulnerability to Covid-19 according to sex, age, ethnicity, and various comorbidities. Vulnerability from each risk factor is quantified in terms of its equivalence to added years of age. Addition of the impact from each risk factor to an individual’s true age generates their “Covid-age”, a summary measure representing the age of a healthy UK white male with equivalent vulnerability. We discuss important limitations of the model, including current scientific uncertainties and limitations on generalisability beyond the UK setting and its use beyond informing assessments of individual vulnerability in the workplace. As new evidence becomes available, some of these limitations can be addressed. The model does not remove the need for clinical judgement or for other important considerations when managing occupational risks from Covid-19.

Objectives Prisons in Scotland were one of the few workplaces exempt from the 2006 comprehensive smoking ban in indoor public places, excluding the prison workforce from the health benefits of smokefree workplaces. The November 2018 introduction of comprehensive restrictions on smoking in Scottish prisons aimed to protect prison staff and people in custody from the harmful impacts of second-hand smoke (SHS) exposure. This study presents SHS exposure data gathered after smokefree policy implementation and compares these with data gathered during and before policy development. Methods Dylos DC1700 monitors were used to measure concentrations of fine particulate matter (PM2.5) derived from SHS across Scotland’s 15 prisons. Six days of fixed-site monitoring (09.00 22 May 2019 to 09.00 28 May 2019) were conducted in residential halls in each prison 6 months post-smokefree policy implementation. Prison staff task-based measurements were conducted to assess concentrations of SHS in various locations (e.g. gyms and workshops) and during specific activities (e.g. cell searches, maintenance, and meal service). Utilizing the fixed-site monitoring data, typical daily PM2.5 exposure profiles were constructed for the prison service and time-weighted average (TWA) exposure concentrations were estimated for the typical shift patterns of residential staff pre- and post-smokefree policy implementation. Staff perceptions of changes to SHS exposure were assessed using online surveys. Results Analysis of both fixed-site and mobile task-based PM2.5 measurements showed the smokefree policy implementation was successful in reducing SHS exposures across the Scottish prison estate. Measured PM2.5 in residential halls declined markedly; median fixed-site concentrations reduced by more than 91% compared with measures in 2016 before policy announcement. The changes in the TWA concentrations across shifts (over 90% decrease across all shifts) and task-based measurements (89% average decrease for high-exposure tasks) provide evidence that prison staff exposure to SHS has significantly reduced. Following smokefree policy implementation, the majority of staff reported no longer being exposed to SHS at work. Conclusions To our knowledge, this is the first comprehensive international study to objectively measure SHS levels before, during, and after implementation of a smokefree policy across a country’s prison system. The findings confirm that such a policy change can be successfully implemented to eliminate occupational exposures to SHS. The results are highly relevant for other jurisdictions considering changes to prison smoking legislation.

It would be useful for researchers, practitioners, and decision-makers to anticipate the hazards that workers will face in the future. The focus of this study is a systematic review of published information to identify and characterize scenarios and hazards in the future of work. Eleven bibliographic databases were systematically searched for papers and reports published from 1999 to 2019 that described future of work scenarios or identified future work-related hazards. To compile a comprehensive collection of views of the future, supplemental and ad hoc searches were also performed. After screening all search records against a set of predetermined criteria, the review yielded 36 references (17 peer-reviewed, 4 gray, and 15 supplemental) containing scenarios. In these, the future of work was described along multiple conceptual axes (e.g. labor market changes, societal values, and manual versus cognitive work). Technology was identified as the primary driver of the future of work in most scenarios, and there were divergent views in the literature as to whether technology will create more or fewer jobs than it displaces. Workforce demographics, globalization, climate change, economic conditions, and urbanization were also mentioned as influential factors. Other important themes included human enhancement, social isolation, loneliness, worker monitoring, advanced manufacturing, hazardous exposures, sustainability, biotechnology, and synthetic biology. Pandemics have not been widely considered in the future of work literature, but the recent COVID-19 pandemic illustrates that was short-sighted. Pandemics may accelerate future of work trends and merit critical consideration in scenario development. Many scenarios described ‘new’ or ‘exacerbated’ psychosocial hazards of work, whereas comparatively fewer discussed physical, chemical, or biological hazards. Various preventive recommendations were identified. In particular, reducing stress associated with precarious work and its requirements of continual skill preparation and training was acknowledged as critical for protecting and promoting the health and well-being of the future workforce. In conclusion, the future of work will be comprised of diverse complex scenarios and a mosaic of old and new hazards. These findings may serve as the basis for considering how to shape the future of work.

Objectives There is limited knowledge of exposure to polycyclic aromatic hydrocarbons (PAHs) in wildland firefighters, or of the effectiveness of interventions to reduce this. This study of wildland firefighters assessed whether PAHs were present and considered respiratory protection and enhanced skin hygiene as possible interventions. Methods 1-Hydroxypyrene (1-HP) was measured in urine samples collected pre-shift, post-shift, and next morning from wildland firefighters in Alberta and British Columbia. Skin wipes, collected pre- and post-shift, were analysed for eight PAHs. Breathing zone air samples were analysed for 11 PAHs. As pilot interventions, participants were randomized to either normal or enhanced skin hygiene. A sample of volunteers was assigned to a disposable N95 mask or a half facepiece mask with P100 organic vapour cartridge. Participants completed a brief questionnaire on activities post-shift and respiratory symptoms. Results Non-smoking firefighters (66 male and 20 female) were recruited from 11 fire crews. Air sampling pumps were carried for the full shift by 28 firefighters, 25 firefighters wore masks (14 N95 and 11 P100); 42 were assigned to the enhanced skin hygiene intervention. Sixty had hot spotting as their main task. Air monitoring identified PAHs (benzo(b,j,k)fluoranthene in particulates, phenanthrene in the gaseous phase) for 6 of the 11 crews. PAHs (largely naphthalene) were found post-shift on 40/84 skin wipes from the hand and 38/84 from jaw/throat. The mean increase in 1-HP in urine samples collected after the shift (compared with samples collected before the shift) was 66 ng g−1 creatinine (P < 0.001) with an increase over the shift found for 76% of participants. 1-HP in next morning urine samples was significantly lower than at the end of shift (a reduction of 39.3 ng g−1: P < 0.001). The amount of naphthalene on skin wipes was greater at the end of the shift (post) than at the start (pre). The mean post–pre weight difference of naphthalene on skin wipes taken from the hand was 0.96 ng wipe−1 (P = 0.01) and from the jaw/throat 1.28 ng wipe−1 (P = 0.002). The enhanced skin hygiene intervention lead to a larger reduction in 1-HP between end of shift and next morning urine samples but only for those with naphthalene on skin wipes at the end of shift. The difference in 1-HP concentration in urine samples collected before and after the shift was reduced for those wearing a mask (linear tend P = 0.063, one-sided). In multivariable models, 1-HP at end of shift was related to gaseous phase phenanthrene, estimated from air sampling [β = 318.2, 95% confidence interval (CI) 67.1–569.2]. Naphthalene on hand skin wipes reflected work in hot spotting during the shift (β = 0.53, 95% CI 0.22–0.86). Conclusions This study provided evidence of PAHs in the air and on the skin of many, but not all, fire crew. Absorbed PAHs, reflected in 1-HP in urine, increased over the shift. Results from the pilot interventions suggest that enhanced skin hygiene would reduce absorption post fire where PAHs had been accumulated on the skin, and that masks could be effective in reducing PAH inhalation exposure. Interventions to reduce PAH absorption are supported by the pilot work reported here and warrant further evaluation across a full fire season.

Objectives The most pronounced occupational exposure routes for lead (Pb) are inhalation and gastrointestinal uptake mainly through hand-to-mouth behaviour. Skin absorption has been demonstrated for organic Pb compounds, but less is known about inorganic Pb species. Several legislative bodies in Europe are currently proposing lowering biological exposure limit values and air exposure limits due to new evidence on cardiovascular effects at very low blood Pb levels. In light of this, all exposure routes in occupational settings should be revisited to evaluate how to lower the overall exposure to Pb. Methods The aim of the study was to investigate the possible exposure routes in workers operating computer numerical control-machines in a brass foundry and specifically to understand if metal cutting fluids (MCFs) used by the workers could lead to skin absorption of Pb. The different bronze alloys at the facility may contain up to 20% Pb. After obtaining written informed consent from the workers (n = 7), blood, skin wipes, and personal air samples were collected. In addition, MCFs used on the day of exposure measurements were collected for in vitro skin absorption studies using stillborn piglet skin mounted in static Franz diffusion cells (n = 48). All samples were analysed for Pb content using inductively coupled plasma mass spectrometry. Results Pb air concentration ( Conclusions This case study shows that MCF may lead to skin absorption of inorganic Pb and contribute to a systemic dose (quasi-steady state). Furthermore, even though good hand hygienic measures were in place, the workers’ skin exposure to Pb is in all likelihood an important contributor in elevating blood Pb levels. Skin exposure should thus be monitored routinely in workers at facilities handling Pb, to help reducing unnecessary occupational exposure.

Objectives Childcare workers in Denmark have high prevalence of musculoskeletal pain (MSP) and sickness absence, but the existing knowledge of their physical work demands is limited, hampering preventive initiatives. This study aimed to assess the physical work demands with accelerometers and workplace observations of childcare workers handling children age 0–3. Methods Data collection consisted of an electronic survey, anthropometric measurements, accelerometer measurements providing information of physical activity types and postures with Acti4 software from five consecutive workdays, as well as 4-h visual workplace observation per childcare worker from 16 Danish nurseries. Results In total, 199 childcare workers were enrolled in the study. A total of 4181 working hours of accelerometer measurements and 722 h of workplace observations were carried out. Accelerometer measurements showed that they spent about half of the working day (44.8%) in sedentary postures, and the rest standing (22.8%), moving (13.0%), walking (14.6%), running (0.1%), and climbing stairs (0.7%), with 4.1% in knee straining postures (kneeling and squatting) and 4.3% forward trunk inclination >60°. Workplace observations showed that they carried children 1.8% of the working hours. Conclusions Physical work demands of Danish childcare workers are characterized by about half of the workday being sedentary, and the remaining of the workday being quite evenly distributed between standing and dynamic activities, with low exposures to carrying children. Their exposure to forward bending of the trunk and knee straining postures could impose a risk for MSP and sickness absence, and preventive initiatives should be considered.

Objectives The processing of seafood (fish and shellfish) for human consumption can lead to health consequences, including occupational asthma (OA). Several non-UK studies have reported both respiratory outcomes and airborne levels of major allergens in seafood processing. However, there is a paucity of such evidence in the UK land-based seafood processing sector, which employs some 20 000 workers. Methods University of Manchester’s Surveillance of Work-related and Occupational Respiratory Disease (SWORD) reporting system has been interrogated over the period 1992–2017 to define the incidence rate of OA cases that can be ascribed to the UK land-based processing sector, and the seafood species implicated. Airborne allergen monitoring data undertaken at Health and Safety Executive’s laboratory from 2003 to 2019 have also been collated. Results The estimated annual OA incidence rate in seafood processors was 70 [95% confidence intervals (CIs) 48.9, 91.1] per 100 000 workers compared with 2.9 (95% CIs 2.8, 3.1) in ‘all other industries’. The annual calculated percentage trend in OA (1992–2017) was −8.1% (95% CIs −15.9, 0.4) in seafood processing showing a similar trend to ‘all other industries’ (mean −7.0%; 95% CIs −7.8, −6.1). Prawns and salmon/trout were notably implicated by SWORD as causative species related to OA. There is a general paucity of available UK airborne allergen monitoring data, particularly concerning processing salmon or trout. Available airborne monitoring for salmon parvalbumin in seven processors ranged between the limit of detection and 816 ng m−3 (n = 64). Available air monitoring levels of the major shellfish allergen (tropomyosin) during processing of crabs and prawns ranged between 1 and 101 600 ng m−3 (n = 280), highlighting that high levels of exposure can occur. Conclusions These data show an excess incidence of OA in the UK seafood processing industry during 1992–2017, with limited airborne monitoring data for the processing of prawn, crab, and salmon suggesting that significant exposure to major seafood allergens can occur in this industry. Further investigation of current levels of respiratory ill-health and the sources of allergen exposure are warranted.

Detecting infectious aerosols is central for gauging and countering airborne threats. In this regard the Coriolis®µ cyclonic air sampler is a practical, commercial collector that can be used with various analysis methods to monitor pathogens in air. However, information on how to operate this unit under optimal sampling and biosafety conditions is limited. We investigated Coriolis performance in aerosol dispersal experiments with polystyrene microspheres andBacillus globigiispores. We report inconsistent sample recovery from the collector cone due to loss of material when sampling continuously for more than 30 min. Introducing a new collector cone every 10 min improved this shortcoming. Moreover, we found that several surfaces on the device become contaminated during sampling. Adapting a HEPA-filter system to the Coriolis prevented contamination without altering collection efficiency or tactical deployment. A Coriolis modified with these operative and technical improvements was used to collect aerosols carrying microspheres released inside a Biosafety Level-3 laboratory during simulations of microbiological spills and aerosol dispersals. In summary, we provide operative and technical solutions to the Coriolis that optimize microbiological air sampling and improve biosafety.

Background Disasters, crises and pandemics are emergencies which impact on businesses severely. The COVID-19 pandemic reached its peak in mid-April 2020 in the UK. During this period, NHS Occupational Health Services (OHS) were stretched to their limit along with other health services. OHS may have had to change their pattern of operation, operating times, services offered, etc. to cope with the pandemic. Data about business model modifications, services offered by the OHS businesses during the pandemic could help in better utilization of OHS resources in the future. Aims To understand the behaviour of OHS in different parts of the country during the COVID-19 pandemic. Methods An online survey link was sent to both accredited and unaccredited UK Occupational Health Physicians (OHPs). Results Sixty-two OHPs responded to the survey. In the current pandemic, 51% of the OHS (95% CI 0.38–0.62) offered weekend or out-of-hours (OOH) services, 21% had to employ extra staff (95% CI 0.13–0.33) and 54% had to change their working hours (95% CI 0.41–0.65). Ninety per cent of the OHS (95% CI 0.78–0.94) continued to offer routine services; however, there was a decline in offering vaccination services. Fifty-six per cent of the OHS (95% CI 0.42–0.67) offered a dedicated telephone line and 46% of the OHS (95% CI 0.32–0.56) started a dedicated COVID-19 queries inbox. Conclusions There was a change in the behaviour of the OHS to cope with the pandemic. Having a dedicated helpline to manage the crisis situation seemed a logical step whilst offering routine services.

The number of people infected with severe acute respiratory syndrome—coronavirus 2 (SARS-CoV-2), i.e. the virus causing coronavirus disease (COVID-19), is dramatically increasing worldwide to the size of a pandemic. At the time of writing Italy is ranking first among countries both in terms of number of COVID-19 confirmed cases and in terms of number of deaths. Such a wide spread of COVID-19 has led to concern among workers who are facing the risk of becoming infected during the execution of their duties. We believe it is useful to remark on the need for professional expertise in the field of Occupational Hygiene in this emergency context, in which the indications provided by national and international bodies, the available scientific literature and the legal provisions are constantly and rapidly evolving. It is of fundamental importance that there is an effective analysis of expert inputs, to provide essential guidance to Health, Safety and Environmental managers and other prevention managers in workplaces. In this regard, not only a constant update of the regulatory framework is needed, but also a development and circulation of operational guidance to all the stakeholders to translate general indications into clear operating procedures and implementation tools to be adopted in the workplaces. We believe that the scientific associations in the field of Occupational Hygiene play a crucial role in guiding and assisting prevention professionals. There is considerable expertise in the occupational hygiene and exposure science communities that can help employers and workers to contain and delay the spread of COVID-19. For this reason, the Italian Association of Industrial Hygienists (AIDII—Associazione Italiana degli Igienisti Industriali) published documents containing operational guidelines to provide correct and constantly updated information for: (i) workers employed in essential activities (with low and medium risk of contagion), (ii) health workers and other workers at high or very high risk of contagion, and (iii) for the correct use and handling of personal protective equipment for workers and for the population in general. It is worth pointing out that the documents produced are not intended to replace those produced by authoritative bodies, but to comply with and complete them by reporting an effective summary and further indications about the measures that should be taken in practice under the light of the Italian legislation. At present, the challenge is to produce scientifically sound knowledge, appropriate tools, and effective methodologies, by coordinating the initiatives of different scientific associations, with the final aim to effectively transfer them to employers and workers.

Background Recent investigations have demonstrated a significant prevalence of mental health disorders, including post-traumatic stress disorder (PTSD), and suicidal ideation, plans and attempts among Canadian public safety personnel, including police officers. What remains unknown is the relationship between mental disorders and suicide among sworn police officers, and the prevalence of both among civilian police workers. Aims To examine the relationship between suicidal ideation, plans and attempts and positive mental health screens for depression, anxiety, panic disorder, alcohol abuse and PTSD among Canadian sworn and civilian police employees. Methods Participants completed an online survey that included self-report screening tools for depression, anxiety, panic disorder, alcohol abuse and PTSD. Respondents were also asked if they ever contemplated, planned or attempted suicide. Between-group (Royal Canadian Mounted Police [RCMP], provincial/municipal police and civilians) differences on mental health screening tools were calculated using Kruskal–Wallis analyses. The relationship between mental disorders and suicidal ideation, plans and attempts was evaluated with a series of logistic regressions. Results There were 4236 civilian and sworn officer participants in the study. RCMP officers reported more suicidal ideation than other police and scored highest on measures of PTSD, depression, anxiety, stress and panic disorder, which were significantly associated with suicidal ideation and plans but not attempts. Relative to provincial and municipal police, civilians reported more suicide attempts and scored higher on measures of anxiety. Conclusions The results identify a strong relationship between mental health disorders and increased risk for suicidal ideation, plans and attempts among sworn and civilian Canadian police employees.

Objectives: Work and research with nanomaterials (NMs) has primarily focused on innovation, toxicity, governance, safety management tools, and public perceptions. The aim of this study was to identify academia and industry occupational safety and health (OSH) managers’ perceptions and handling of NMs, in relation to safety culture.Methods: Semistructured interviews were carried out with OSH managers at six academic institutions and six industrial companies. The interview statements were coded into five topics regarding NMs: risk comprehension, information gathering, actions, communication, and compliance. The statements were then coded according to a five-step safety culture maturity model reflecting increasing occupational safety maturity from passive, to reactive, active, proactive, and exemplary occupational safety.Results: The safety culture maturity of the academic institutions were primarily active and proactive, whereas the industry group were primarily active and reactive. None of the statements were rated as exemplary, with the majority reflecting an active safety culture. The topics varied from a passive approach of having no focus on NMs and regarding risks as a part of the job, to applying proactive measures in the design, production, application, and waste management phases. Communication and introduction to OSH issues regarding NMs as well as compliance provided challenges in both academia and industry, given the increasing cultural and linguistic diversity of students/staff and employees. Workplace leaders played a crucial role in establishing a legitimate approach to working safely with NMs, however, the currently available OSH information for NMs were described as insufficient, impractical, and inaccessible. There was an embedded problem in solely relying on safety data sheets, which were often not nanospecific, as this may have led to underprotection.Conclusions: There is a need for more structured, up-to-date, easily accessible, and user-friendly tools and information regarding toxicity and threshold limit values, relevant OSH promotion information, legislation, and other rules. The study underscores the need for politicians and engineers to collaborate with communication experts and both natural and social scientists in effectively framing information on NMs. Such a collaboration should allow for flexible deployment of multilevel and integrated safety culture initiatives to support sustainable nanotechnology and operational excellence.

Background Many public safety personnel (PSP) experience trauma directly or indirectly in their occupational role, yet there remain barriers to accessing care or seeking help. Aims To understand how PSP interpret different potentially traumatic events and how perceived eligibility for being traumatized is determined among PSP. Methods We analysed open-ended comments provided by over 800 PSP in a survey designed to assess the prevalence of post-traumatic stress injuries and other mental disorders. Results We found evidence that a trauma hierarchy may exist among PSP. Certain experiences may be interpreted as more traumatic, based on both the event and the PSP role in the actual event. For example, involvement in a shooting may be interpreted as more traumatic than arriving on the scene later. Similarly, a single event may be deemed more traumatic than an accumulation of events. The role of the individual and social context in shaping experiences and interpretations of trauma may be largely ignored in line with confirmation biases. Conclusions The role that individuals and social contexts play in shaping experiences and interpretations of trauma appear suppressed by perceptions of a trauma hierarchy, facilitating systematic discrediting or valuation of some experiences, therein evidencing that trauma is subjective and reinforcing barriers to care seeking. A trauma hierarchy may also propagate stigma and legitimize discrimination regarding mental health. We argue that recognizing, engaging with, and dismantling the perception of a trauma hierarchy may help create a respectful and open occupational culture supportive of mental health needs.

Background Drinking motivations within the UK military have not been studied despite the high prevalence of alcohol misuse in this group. Aims We aimed to characterize drinking motivations and their demographic, military and mental health associations in UK serving and ex-serving personnel. Methods Serving and ex-serving personnel reporting mental health, stress or emotional problems occurring in the last 3 years were selected from an existing cohort study. A semi-structured telephone interview survey examined participants’ mental health, help-seeking, alcohol use and drinking motivations. Results Exploratory factor analysis of drinking motivations in military personnel (n = 1279; response rate = 84.6%) yielded 2 factors, labelled ‘drinking to cope’ and ‘social pressure’. Higher drinking to cope motivations were associated with probable anxiety (rate ratio [RR] = 1.4; 95% confidence interval [CI] = 1.3–1.5), depression (RR = 1.3; 95% CI = 1.2–1.4) and post-traumatic stress disorder (RR = 1.4; 95% CI = 1.3–1.6). Higher social pressure motivations were associated with probable anxiety (odds ratio = 1.1; 95% CI = 1.0–1.1). Alcohol misuse and binge drinking were associated with reporting higher drinking to cope motivations, drinking at home and drinking alone. Conclusions Amongst military personnel with a stress, emotional or mental health problem, those who drink to cope with mental disorder symptoms or because of social pressure, in addition to those who drink at home or drink alone, are more likely to also drink excessively.

The effects of work and the conditions of employment on health behaviors and intermediate health conditions have been demonstrated, to the extent that these relationships should be addressed in efforts to prevent chronic disease. However, conventional health promotion practice generally focuses on personal risk factors and individual behavior change. In an effort to find solutions to the myriad of health challenges faced by the American workforce, the U.S. National Institute for Occupational Safety and Health (NIOSH) established the Total Worker Health® (TWH) program. Originally organized around the paradigm of integrating traditional occupational safety and health protections with workplace health promotion, TWH has evolved to a broader emphasis on workplace programs for enhancing worker safety, health, and well-being. Among the research programs and approaches developed by investigators at NIOSH Centers of Excellence for TWH and elsewhere, definitions of ‘integration’ in workplace interventions vary widely. There is no consensus about which organizational or individual outcomes are the most salient, how much to emphasize organizational contexts of work, or which program elements are necessary in order to qualify as ‘Total Worker Health’. Agreement about the dimensions of integration would facilitate comparison of programs and interventions which are self-defined as TWH, although diverse in content. The specific criteria needed to define integration should be unique to that concept—i.e. distinct from and additive to conventional criteria for predicting or evaluating the success of a workplace health program. We propose a set of four TWH-specific metrics for integrated interventions that address both program content and process: (i) coordination and interaction of workplace programs across domains; (ii) assessment of both work and non-work exposures; (iii) emphasis on interventions to make the workplace more health-promoting; and (iv) participatory engagement of workers in pivotal ways during intervention prioritization and planning to develop self-efficacy in addressing root causes, skill transfer, building program ownership, empowerment, and continuous improvement. Thus we find that integration requires organizational change, both to engage two managerial functions with different goals, legal responsibilities, and (often) internal incentives & resources, and also to orient the organization toward salutogenesis. Examples from research activity within the Center for the Promotion of Health in the New England Workplace illustrate how these criteria have been applied in practice.