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Preventing SARS-CoV-2 transmission and protecting people from COVID-19 is the most significant public health challenge faced in recent years. COVID-19 outbreaks are occurring in workplaces and evidence is needed to support effective strategies to prevent and control these outbreaks. Investigations into these outbreaks are routinely undertaken by public health bodies and regulators in the United Kingdom (UK); however, such investigations are typically disparate in nature with a lack of consistency across all investigations, preventing meaningful analysis of the data collected. The COVID-OUT (COVID-19 Outbreak investigation to Understand Transmission) study aims to collect a consistent set of data in a systematic way from workplaces that are experiencing outbreaks, to understand SARS-CoV-2 transmission risk factors, transmission routes, and the role they play in the COVID-19 outbreaks. Suitable outbreak sites are identified from public health bodies. Following employer consent to participate, the study will recruit workers from workplaces where there are active outbreaks. The study will utilise data already collected as part of routine public health outbreak investigations and collect additional data through a comprehensive questionnaire, viral and serologic testing of workers, surface sampling, viral genome sequencing, and an environmental assessment of building plans, ventilation and current control measures. At each site, a detailed investigation will be carried out to evaluate transmission routes. A case-control approach will be used to compare workers who have and have not had SARS-CoV-2 infections during the outbreak period to assess transmission risk factors. Data from different outbreaks will be combined for pooled analyses to identify common risk factors, as well as factors that differ between outbreaks. The COVID-OUT study can contribute to a better understanding of why COVID-19 outbreaks associated with workplaces occur and how to prevent these outbreaks from happening in the future.

Reducing the burden of occupational cancers (OCs) is currently one of the most challenging Occupational Health (OH) issues. The European Union (EU) has made efforts to improve the existing legal framework and developed specific legislation aimed at reducing the burden of OC. However, available data suggest that OC are underreported. In August 2019, the European Association of Schools of Occupational Medicine (EASOM) adopted a statement that highlighted the importance of improving the education and training of Medical Doctors (MDs) to facilitate improvements in recognizing and reporting OC. To achieve this, EASOM proposes to promote OH education and training of MDs at undergraduate and postgraduate levels, foster harmonization of OH education and teaching standards and programs across EU countries, and enhance cooperation between universities and international scientific associations. Finally, we suggest that occupational data should be recorded in cancer and medical registers. By engaging MDs more fully in the debate about OCs, they will become more aware of the Occupational Physician's role in reducing the burden of OCs and, furthermore, embed consideration of occupation as a potential cause of cancer into their own practice. These interventions will help promote the implementation of policies and interventions aimed to reduce OC in the workplace. ispartof: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH vol:17 issue:7 ispartof: location:Switzerland status: published

Background: Never events (NEs) are serious preventable patient safety incidents and are a component of formal quality and safety improvement (Q&SI) policies in the United Kingdom and elsewhere. A preliminary list of NEs for UK general practice has been developed, but the frequency of these events, or their acceptability to general practitioner (GPs) as a Q&SI approach, is currently unknown. The study aims to estimate (1) the frequency of 10 NEs occurring within GPs' own practices and (2) the extent to which the NE approach is perceived as acceptable for use.\ud \ud Methods: General practitioners were surveyed, and mixed-effects logistic regression models examined the relationship between GP opinions of NE, estimates of NE frequency, and the characteristics of the GPs and their practices.\ud \ud Results: Responses from 556 GPs in 412 practices were analyzed. Most participants (70%-88%, depending on the NE) agreed that the described incident should be designated as a NE. Three NEs were estimated to have occurred in less than 4% of practices in the last year; however, two NEs were estimated to have occurred in 45% to 61% of the practices. General practitioners reporting that a NE had occurred in their practice in the last year were significantly less likely to agree with the designation as a NE compared with GPs not reporting a NE (odds ratio, 0.42; 95% CI = 0.36-0.49).\ud \ud Conclusions: The NE approach may have Q&SI potential for general practice, but further work to adapt the concept and content is required.

Vital to the prevention of work-related ill-health (WRIH) is the availability of good quality data regarding WRIH burden and risks. Physician-based surveillance systems such as The Health and Occupation Research (THOR) network in the UK are often established in response to limitations of statutory, compensation-based systems for addressing certain epidemiological aspects of disease surveillance. However, to fulfil their purpose, THOR and others need to have methodologic rigor in capturing and ascertaining cases. This article describes how data collected by THOR and analogous systems can inform WRIH incidence, trends, and other determinants. An overview of the different strands of THOR research is provided, including methodologic advancements facilitated by increased data quantity/quality over time and the value of the research outputs for informing Government and other policy makers. In doing so, the utility of data collected by systems such as THOR to address a wide range of research questions, both in relation to WRIH and to wider issues of public and social health, is demonstrated.

SummaryBackground Accelerators in rubber gloves constitute an important group of contact allergens, particularly in healthcare workers. Objectives To assess the efficacy of accelerator-free medical gloves in the secondary prevention of allergic contact dermatitis caused by rubber accelerators in healthcare workers. Methods Nine healthcare workers with hand eczema were advised to use accelerator-free rubber gloves after a diagnosis of allergic contact dermatitis caused by rubber accelerators. Results Switching from conventional medical single-use gloves containing accelerators to accelerator-free medical gloves led to improvement in all cases, and more than two-thirds of the patients were completely free of symptoms. Conclusion The use of accelerator-free medical gloves can be an effective alternative in healthcare workers who are allergic to rubber accelerators.

ObjectivesIn healthcare systems, practices and products of unproven value and cost-effectiveness can decrease value and increase waste. Using the management of complex wounds, this study investigates temporal trends in the use of antimicrobials dressings, places this in the context of available evidence and discusses the potential impacts on the UK National Health Service (NHS).DesignSecondary descriptive and interrupted time series (ITS) analysis of NHS prescription data.SettingPrescribing Cost Analysis (PCA) details all NHS prescriptions dispensed in the community in England.InterventionsAn ITS design was used to compare annual changes in the expenditure and use of antimicrobial and non-antimicrobial dressings before and after the publication of the ‘intervention’ of key evidence-based Scottish Intercollegiate Guidelines Network (SIGN) guidance in 2010.Primary and secondary outcome measuresTrends in use and expenditure of antimicrobial dressings in relation to published clinical guidance.ResultsThere was a large increase in the prescribing of, and expenditure on, antimicrobial wound dressings between 1997 and 2016. In 1997, the total number of dressings prescribed was 5 792 700; increasing to 11 447 102 in 2009 with expenditure increasing from £1 960 386 to £32 841 263. During the year of the SIGN intervention (2010), there was a significant drop in the use of silver but there was no consistent ongoing reduction from 2011 to 2015.ConclusionsPrescribing data can be used to identify products of unproven benefit, which also impose a significant financial burden. This study quantifies the huge increase in the use of antimicrobial wound dressings over a 20-year period despite the lack of compelling evidence to support their routine use. There is some suggestion, however that the use and expenditure decreased after the publication of key guidance. Routine data can be used to as part of more systematic efforts to increase value and reduce waste in health systems.

Policy interventions to address inappropriate prescribing of antipsychotic drugs to older people diagnosed with dementia are commonplace. In the UK, warnings were issued by the Medicines Healthcare products Regulatory Agency in 2004, 2009 and 2012 and the National Institute for Health and Care Excellence guidance was published in 2006. It is important to evaluate the impact of such interventions.We analysed routinely collected primary-care data from 111,346 patients attending one of 689 general practices contributing to the Clinical Practice Research Datalink to describe the temporal changes in the prescribing of antipsychotic drugs to patients aged 65 years or over diagnosed with dementia without a concomitant psychosis diagnosis from 2001 to 2014 using an interrupted time series and a before-and-after design. Logistic regression methods were used to quantify the impact of patient and practice level variables on prescribing prevalence.Prescribing of first-generation antipsychotic drugs reduced from 8.9% in 2001 to 1.4% in 2014 (prevalence ratio 2014/2001 adjusted for age, sex and clustering within practices (0.14, 95% confidence interval 0.12-0.16), whereas there was little change for second-generation antipsychotic drugs (1.01, confidence interval 0.94-1.17). Between 2004 and 2012, several policy interventions coincided with a pattern of ups and downs, whereas the 2006 National Institute for Health and Care Excellence guidance was followed by a gradual longer term reduction. Since 2013, the decreasing trend in second-generation antipsychotic drug prescribing has plateaued largely driven by the increasing prescribing of risperidone.Increased surveillance and evaluation of drug safety warnings and guidance are needed to improve the impact of future interventions.

Background Personal protective equipment (PPE) is defined as equipment that protects the wearer's body against health/safety risks at work. Gloves cause many dermatoses. Non-glove PPE constitutes a wide array of garments. Dermatoses resulting from these have hitherto not been documented. Objectives To determine the incidence and types of non-glove PPE-related dermatoses. Patients/methods We analysed incident case reports from dermatologists of non-glove PPE-related dermatoses to a UK-wide surveillance scheme (EPIDERM) between 1993 and 2013. Results The dermatoses associated with non-glove PPE accounted for 0.84% of all occupational skin disease. Of all PPE-related cases, 194 (9.2%) were attributable to non-glove PPE. Of these, 132 (68.0%) occurred in men, and the median age (both male and female) was 42 years (range 18-82 years). The non-glove PPE-related dermatoses were diagnosed as: allergic contact dermatitis (47.4%), irritant contact dermatitis (16.0%), friction (11.3%), occlusion (11.3%), unspecified dermatitis (8.8%), acne (3.1%), infections (1.5), and contact urticaria (0.52%). The industries most associated with non-glove PPE-related dermatoses were manufacturing (18.6%), public administration and defence (17.0%), health and social work (15.5%), and transport, storage, and communication (9.8%). Conclusions Clothing, footwear, facemasks and headgear need to be recognized as causes of dermatoses occurring at body sites less commonly associated with occupational skin disease.

OBJECTIVES: To estimate the frequency of patient-perceived potentially harmful problems occurring in primary care. To describe the type of problem, patient predictors of perceiving a problem, the primary care service involved, how the problem was discussed and patient suggestions as to how the problem might have been prevented. To describe clinician/public opinions regarding the likelihood that the patient-described scenario is potentially harmful.DESIGN: Population-level survey.SETTING: Great Britain.PARTICIPANTS: A nationally representative sample of 3975 members of the public aged ≥15 years interviewed during April 2016.MAIN OUTCOME MEASURES: Counts of patient-perceived potentially harmful problems in the last 12 months, descriptions of patient-described scenarios and review by clinicians/members of the public.RESULTS: 3975 of 3996 participants in a nationally representative survey completed the relevant questions (99.5%). 300 (7.6%; 95% CI 6.7% to 8.4%) of respondents reported experiencing a potentially harmful preventable problem in primary care during the past 12 months and 145 (48%) discussed their concerns within primary care. This did not vary with age, gender or type of service used. A substantial minority (30%) of the patient-perceived problems occurred outside general practice, particularly the dental surgery, walk in clinic, out of hours care and pharmacy. Patients perceiving a potentially harmful preventable problem were eight times more likely to have 'no confidence and trust in primary care' compared with 'yes, definitely' (OR 7.9; 95% CI 5.9 to 10.7) but those who discussed their perceived-problem appeared to maintain higher trust and confidence. Generally, clinicians ranked the patient-described scenarios as unlikely to be potentially harmful.CONCLUSIONS: This study highlights the importance of actively soliciting patient's views about preventable harm in primary care as patients frequently perceive potentially harmful preventable problems and make useful suggestions for their prevention. Such engagement may also help to improve confidence and trust in primary care.

Introduction If the occupational health (OH) information provided to workers is to be effective it must be responsive to the needs of the worker. To date little is known about how often workers access such information or their preferences on how to obtain such information, and their level of trust in the information accessed. Our aim is to identify these needs and preferences in the Spanish working population, and to compare them with the results observed in other countries. Methods 2268 workers attending for routine screening during a 3 month period in 2014 at the OH services in NHS hospitals and mutual societies in Galicia (Spain), were invited to complete a questionnaire. All workers had been provided with the legally-required OH information. The questionnaire was developed using French workers1 and subsequently modified and validated in the Spanish context. Results 1559 (69%) workers completed the questionnaire. Of these 1247 (80%) stated a need for more information on occupational hazards but only 686 (44% actually sought such information. For those seeking information, the internet was most frequently used (85%) despite low confidence in the quality of the information (21%). For personal advice workers preferred the family doctor (72%) and less frequently the occupational physician (19%) and information from the family doctor was considered more reliable (56% vs 43%). These observations are similar to those made in French and Dutch workers. Discussion Spanish workers expressed a substantial need for OH information yet many did not obtain this information. They often accessed resources they considered as less reliable such as the internet or had consulted with professionals lacking specialist expertise in OH. This study adds the Spanish perspective to that already measured in France and the NL and shows similar findings, possibly pointing towards the need for a European-wide strategy to tackle this problem.

ObjectivesTo design and pilot a survey to be used at the population level to estimate the frequency of patient-perceived potentially harmful preventable problems occurring in UK primary care. To explore the nature of the problems, patient-suggested strategies for prevention and opinions of clinicians and the public regarding the potential for harm.DesignA survey was codesigned by three members of the public and one researcher and piloted through public and patient involvement and engagement networks.SettingSelf-selected sample of the UK population.Participants977 members of the public accessed the online survey during October and November 2015.Primary outcome measuresRespondent feedback about the ease of completion of the survey, quality of responses in terms of review by clinicians and members of the public, preliminary estimates of the frequency and nature of patient-perceived potentially harmful problems occurring in the last 12 months.Results638 (65%) members of the public completed the survey and few respondents reported any difficulty in understanding or completing the survey. 132 (21%) respondents reported experiencing a potentially harmful preventable problem during the past 12 months and 108 (82%) of these respondents provided a description that was adequate for at least one clinician to form an opinion about the potentially harmful problem. Respondents were older than the UK generally, more likely to work or volunteer in the healthcare sector and tended to use primary care more frequently but their confidence and trust in their own general practitioner (GP) was similar to that of the UK population as measured by the annual English GP patient survey.ConclusionsThe survey was acceptable to patients and mostly provided data of sufficient quality for review by clinicians and members of the public. It is now ready to use at a population level to estimate the frequency and nature of potentially harmful preventable problems in primary care from a patient’s perspective.

ObjectivesTo identify the top 10 unanswered research questions for primary care patient safety research.DesignA modified nominal group technique.SettingUK.ParticipantsAnyone with experience of primary care including: patients, carers and healthcare professionals. 341 patients and 86 healthcare professionals submitted questions.Main outcomesA top 10, and top 30, future research questions for primary care patient safety.Results443 research questions were submitted by 341 patients and 86 healthcare professionals, through a national survey. After checking for relevance and rephrasing, a total of 173 questions were collated into themes. The themes were largely focused on communication, team and system working, interfaces across primary and secondary care, medication, self-management support and technology. The questions were then prioritised through a national survey, the top 30 questions were taken forward to the final prioritisation workshop. The top 10 research questions focused on the most vulnerable in society, holistic whole-person care, safer communication and coordination between care providers, work intensity, continuity of care, suicide risk, complex care at home and confidentiality.ConclusionsThis study was the first national prioritisation exercise to identify patient and healthcare professional priorities for primary care patient safety research. The research priorities identified a range of important gaps in the existing evidence to inform everyday practice to address primary care patient safety.

BACKGROUND: A previously developed quantitative structure-activity relationship (QSAR) model has been extern ally validated as a good predictor of chemical asthma hazard (sensitivity: 79-86%, specificity: 93-99%). AIMS: To develop and validate a second version of this model. METHODS: Learning dataset asthmagenic chemicals with molecular weight (MW)

Introduction The extent of preventable medication-related hospital admissions and medication-related issues in primary care is significant enough to justify developing decision support systems for medication safety surveillance. The prerequisite for such systems is defining a relevant set of medication safety-related indicators and understanding the influence of both patient and general practice characteristics on medication prescribing and monitoring. Objective The aim of the study was to investigate the feasibility of linked primary and secondary care electronic health record data for surveillance of medication safety, examining not only prescribing but also monitoring, and associations with patient- and general practice-level characteristics. Methods A cross-sectional study was conducted using linked records of patients served by one hospital and over 50 general practices in Salford, UK. Statistical analysis consisted of mixed-effects logistic models, relating prescribing safety indicators to potential determinants. Results The overall prevalence (proportion of patients with at least one medication safety hazard) was 5.45 % for prescribing indicators and 7.65 % for monitoring indicators. Older patients and those on multiple medications were at higher risk of prescribing hazards, but at lower risk of missed monitoring. The odds of missed monitoring among all patients were 25 % less for males, 50 % less for patients in practices that provide general practitioner training, and threefold higher in practices serving the most deprived compared with the least deprived areas. Practices with more prescribing hazards did not tend to show more monitoring issues. Conclusions Systematic collection, collation, and analysis of linked primary and secondary care records produce plausible and useful information about medication safety for a health system. Medication safety surveillance systems should pay close attention to patient age and polypharmacy with respect to both prescribing and monitoring failures; treat prescribing and monitoring as different statistical processes, rather than a combined measure of prescribing safety; and audit the socio-economic equity of missed monitoring. Electronic supplementary material The online version of this article (doi:10.1007/s40264-015-0304-x) contains supplementary material, which is available to authorized users.

Objective To estimate incidence and trends in incidence of occupational diseases (ODs) in the Dutch construction sector. Methods In a dynamic prospective cohort over a 5-year period (2010–2014), ODs assessed by occupational physicians (OPs) participating in a voluntary construction workers health surveillance (WHS) were reported to the Netherlands Centre for Occupational Diseases (NCOD). ODs were defined as a disease with a specific clinical diagnosis (International Classification of Diseases) that was predominantly caused by work-related factors as assessed by an OP. Annual incidences were determined for the total number of ODs and six frequently occurring OD groups. Trends in incidence were estimated using a multilevel negative binominal regression model. Results In 2014 the incidence of all OD was 12 964 per 100 000 workers and there was no significant change in incidence between 2010 and 2014 (3%; 95% CI −2% to +9%). Hearing loss (8125 per 100 000 workers) and musculoskeletal disorders (2081 per 100 000 workers) were the most frequently occurring ODs. Noise-induced hearing loss (+7%; 95% CI 1% to 13%) and contact dermatitis (+19%; 95% CI 6% to 33%) showed increasing trends. There was no statistically significant change in the incidence of low back pain, arthrosis, repetitive strain injuries, distress/burnout and chronic obstructive pulmonary disease/asthma. Conclusions In total, 13% of workers participating in WHS in the Dutch construction industry during 2014 had an OD diagnosed and reported by an OP. Over a 5-year period the annual incidence of reported ODs showed a statistically non-significant increase. Incidences in noise-induced hearing loss and contact dermatitis showed statistically significant increasing trends, 7% and 19%, respectively.

Effective interventions to reduce work-related exposures are available for many types of work-related diseases or injuries. However, knowledge of the impact of these interventions on injury or disease outcomes is scarce due to practical and methodological reasons. Study designs are considered for the evaluation of occupational health interventions on occupational disease or injury. Latency and frequency of occurrence of the health outcomes are two important features when designing an evaluation study with occupational disease or occupational injury as an outcome measure. Controlled evaluation studies-giving strong indications for an intervention effect-seem more suitable for more frequently occurring injuries or diseases. Uncontrolled evaluation time or case series studies are an option for evaluating less frequently occurring injuries or diseases. Interrupted time series offer alternatives to experimental randomized controlled trials to give an insight into the effectiveness of preventive actions in the work setting to decision and policy makers. Copyright (C) 2015, Occupational Safety and Health Research Institute. Published by Elsevier

Background The hospice has a well-established competency framework for Registered Nurses and Healthcare Assistants which guides staff progression. The importance of developing capabilities of the hospice workforce has been well documented (Help the Hospices, 2012). The hospice’s Nursing and Care Quality Forum recognised the importance of creating further growth opportunities for those who had achieved the most experienced level of competence whilst engaging staff in continuous practice development. Aims To ensure an engaged and motivated group of staff working together to progress practice development across the hospice. The programme formed the next stage in the cycle for those who had completed the competencies at the highest level for their role and recognised the need to embed continuous quality improvement whilst providing on-going career development. Methods A two-year programme was designed. The first year consisted of facilitated monthly sessions covering broad skills related topics. The second year required staff to work with colleagues on a particular project aimed at improving patient care and experience. Eleven Registered Nurses and 13 Healthcare Assistants have participated. In addition, participants attend regular facilitated sessions to ensure on-going support and engagement. Participants self-assessed their confidence and competence at the beginning of the programme to allow evaluation of its impact after completion. Results The second year has produced increased engagement from staff who have worked together on specific areas of practice development. The areas include: bowel assessment; shift patterns; feedback from service users of a telephone helpline; outcome measures; safer nursing toolkit; rehabilitative palliative care; dying phase implementation; record keeping and documentation; review of multi-disciplinary meeting. A planned event will celebrate the programme and share learning. Conclusions The two-year programme has strengthened team working and created a culture of curiosity and continuous improvement.

Objectives EU directives can lend themselves to evaluation through natural experiments because of the freedom regarding their implementation within individual countries. Natural experiments may be criticised because of the lack of direct casual evidence for a relationship between the intervention and the exposure or disease outcome. Such experimental designs could be strengthened by an a priori estimate of the impact of an intervention. Here we aim to predict the impact of EU Directive 2002/44/EC on VWF, CTS and sensorineural symptoms (HAVS). Methods Previously we described the development of a Markov chain Monte Carlo accelerated failure time model to predict the incidence and prevalence of HAVS. The model was developed using longitudinal data from Italian workers and validated using published data for Swedish and UK workers, and compensation data from the Czech Republic. For the next step we have used the exposure data from the Eurofound European Working Conditions Survey from 2000 to 2015 and population level demographic data to predict the impact of the directive on HAVS in Europe. Results The model predicted that a reduction in vibration exposure to 5 m/s2 (i.e. complete success of the directive) would result in a reduction in lifetime prevalence of VWF of around 25% in the UK. Predictions of the variation in impact according to differing reductions in exposure and across different age groups will be presented for the UK and other countries. Conclusion Future work will compare these estimates of the impact of the directive using routinely collected data in European countries.

Accelerators in rubber gloves constitute an important group of contact allergens, particularly in healthcare workers.To assess the efficacy of accelerator-free medical gloves in the secondary prevention of allergic contact dermatitis caused by rubber accelerators in healthcare workers.Nine healthcare workers with hand eczema were advised to use accelerator-free rubber gloves after a diagnosis of allergic contact dermatitis caused by rubber accelerators.Switching from conventional medical single-use gloves containing accelerators to accelerator-free medical gloves led to improvement in all cases, and more than two-thirds of the patients were completely free of symptoms.The use of accelerator-free medical gloves can be an effective alternative in healthcare workers who are allergic to rubber accelerators.

Background The prevalence of antidepressant prescribing in children and adolescents increased steadily in the United States and parts of Europe between 2005 and 2012 despite regulatory safety warnings. Little is known about the characteristics of those being prescribed antidepressants for the first time. Methods A longitudinal study of antidepressant prescribing in 3–17 year olds was carried out using data from the UK Clinical Practice Research Datalink (CPRD) between 2000 and 2015. Changes in the incidence of first ever antidepressant prescriptions and the characteristics of those being prescribed them was examined. Results Incidence of first ever prescriptions nearly doubled between 2006 and 2015 rising from 1.60 (95%CI: 1.51, 1.69) to 3.12 (3.00, 3.25) per 1000 person years. Only 21% of the 1721 patients with incident prescriptions in 2015 could be linked to a depression diagnosis, with an additional 22% of prescriptions linked to alternative indications. The incidence of prescriptions linked to a depression diagnosis increased between 2012 and 2015, with an adjusted incidence rate ratio of 1.46 (1.26, 1.70). Antidepressant prescribing for depression and other indications has been increasing most rapidly in 15 to 17 year old females. Limitations Diagnoses are not directly linked to prescriptions in CPRD, so linkage must be inferred by temporal proximity. Conclusions Antidepressant prescribing in children increased between 2006 and 2015. This is, at least in part, due to a rise in alternative uses of antidepressants, including the treatment of anxiety, chronic pain and migraines.

BACKGROUND: Epidemiological evidence linking low dose pesticide exposure and chronic ill-health in UK sheep farmers is limited. Our aim was to examine whether neuropsychiatric disorders were associated with low dose chronic and/or more acute pesticide exposure in sheep farmers. METHODS: A cohort of British farmers working in the 1970s was sent a screening questionnaire which asked about their health and work history. The prevalence of screen-positive depression, dementia, Parkinsonism and neuropathy was determined using a priori algorithms. Self-reported pesticide exposure was assessed by whether the participant had ever handled the pesticide concentrate (for low dose chronic exposure) or sought advice for pesticide poisoning (acute exposure) and participants categorised into those with only acute or chronic exposure, those with both acute and chronic exposure and those with neither acute nor chronic exposure. Associations between acute and chronic pesticide exposure, and screen-positive ill-health were determined after adjustment for demographic, lifestyle, occupation and somatic severity scores and other variables. RESULTS: In those participants, who had never sought advice for pesticide poisoning, handling the pesticide concentrate for treating sheep was associated with elevated ORs for screen-positive neuropathy (ORadi 1.57 95%CI 0.97-2.54) and Parkinsonism (ORadj 1.56 95%CI 0.95-2.56) but not depression or dementia. In those participants who had handled the pesticide concentrate, seeking advice for pesticide poisoning was associated with screen-positive depression (Odds ratio, ORadj=9.97 95%CI 4.76-20.8 ), dementia (OR=6.94 95%CI 3.44-14.0), Parkinsonism (ORadj=4.77 95% 2.39-9.52), and neuropathy (ORadj=4.77 95%CI 2.39-9.52). Adjustment for somatic severity score modified little the associations with pesticide handling in those not acutely exposed but reduced the ORs for seeking advice for pesticide poisoning in those exposed chronically. Furthermore, stratification of results based upon somatic severity score indicated that the highest ORs for handling the pesticide concentrate associated with neuropathy and Parkinsonism were found in those participants whose somatic score was minimal. CONCLUSIONS: Results are consistent with low-dose exposure to pesticides being associated with screen-positive neuropathy and Parkinsonism but the stronger associations between seeking advice for pesticide poisoning and screen-positive ill-health suggest that acute pesticide exposure remains an important determinant of ill-health. Further work is required to better delineate to what extent low dose exposures may contribute to ill-health in populations without acute exposures. Somatising tendency does not appear to play an important role in this population.

Background Regular exposure to hand-arm vibration can lead to hand-arm vibration (HAVS) and carpal tunnel (CTS) syndromes. EU Directive 2002/44/EC, which aims to improve surveillance and reduce exposure to vibration at work, defines exposure limits for hand-arm-vibration. The aim is to investigate whether the staged implementation of the directive since 2005 has been associated with a change in the incidence of HAVS or CTS in European countries. To model the range of potential outcomes of the intervention, we sought to define an exposure-risk relationship based on the best available prospective longitudinal data for exposed workers. Methods In a series of studies, which have been subject of previous publications, 1,2 forestry and stone workers were monitored at intervals of 1 to 5 years, on 1 to 4 occasions. Health status, annual hours of exposure and magnitude of vibration were recorded. In the present study, a novel analytical approach was applied to define a parametric survival function describing the incidence of HAVS as a function of various exposure metrics. Results Incidence of the vascular condition vibration-induced white finger was well described by a Weibull distribution with an increasing hazard rate. The resulting parametric equation reveals the role of duration of exposure and the vibration magnitude (m s-2) relative to a threshold magnitude. Conclusion The exposure-risk relationship, which differs in some respects from the exposure relationship described in current standards (e.g. ISO 5349-1, 2001), has a simple, mechanistically based form that can be easily applied to simulate the consequences of workplace interventions. References Bovenzi M. Int Arch Occup Environ Health 2008; 81 :401–408. doi:10.1007/s00420-007-0225-9 Bovenzi M. Int Arch Occup Environ Health 2010; 83 :259–272. doi:10.1007/s00420-009-0461-2

PURPOSE OF REVIEW: Recent improvements in the methods for analyzing trends in occupational health surveillance and the prospect of future improvements in the collecting and sharing of electronic data alongside increasing availability of linked datasets make this a good time to review the existing literature on trends in occupational allergy and asthma (OAA). RECENT FINDINGS: There is a notable lack of reports of recent trends in OAA in the academic literature and much of the published work comes from European countries. The incidence of OAA appears to be declining based on physician-reporting or recognized compensation claims for the countries with published data. However, we need to be cautious in interpreting this as a decline in the 'true' incidence of OAA. Few of the studies adjusted appropriately for changes in the population at risk and one of the most robust study designs showed no change in the incidence of allergic contact dermatitis in contrast to the other studies. SUMMARY: Many existing datasets have the potential to be used to examine trends, and studies from Canada show the potential of using linked databases for surveillance. We hope that this review will encourage improvements in the analysis, and more dissemination, of trends.

Objective Concerns over occupational exposures to blood-borne viruses resulted in increased protective glove use; consequentially latex allergy became a hazard for some occupational groups. Interventions aimed at managing this problem included substitution measures (eg, non-powdered/non-latex gloves), but such changes may not occur simultaneously across occupational sectors. This study evaluated whether the incidence of occupational dermatoses fell after interventions aiming to reduce exposure to ‘latex and rubber glove allergens’ (‘latex’) were introduced, and whether these interventions were more effective for healthcare workers (HCWs), compared with non-HCWs. Methods Incidence rate ratios (IRRs) comparing cases reported to EPIDERM (a UK-wide surveillance scheme) during post versus pre-intervention periods were calculated, both where ‘latex’ was cited and for cases associated with other exposures (‘controls’). Results Among HCWs, cases of contact urticaria and allergic contact dermatitis (ACD) where ‘latex’ was cited showed significant downward trends post-intervention, with IRRs of 0.72, 95% CI; 0.52 to 1.00 and 0.47, 95% CI; 0.35 to 0.64 respectively. For HCWs, this fall in ‘latex’ associated ACD was significantly greater (p=0.02) than for other exposures (‘controls’) IRR=0.85, 95% CI; 0.57 to 1.28, and greater than that among non-HCWs (IRR 0.75, 95% CI; 0.61 to 0.93). Increases over time were seen for irritant contact dermatitis (ICD) reporting for HCWs, both for cases associated with ‘latex’ (IRR 1.47, 95% CI: 1.02 to 2.13) and for other exposures (‘controls’) IRR 1.36, 95% CI 1.06 to 1.76, but not for non-HCWs. Conclusions A reduction in overall ACD, particularly in HCWs, coincided with interventions aimed at managing workplace contact dermatoses associated with ‘latex’ exposure. A coincidental rise in ICD reporting is also important, both for hand care and for infection control strategies.

This study outlines how mechanistic organic chemistry related to covalent bond formation can be used to rationalize the ability of low molecular weight chemicals to cause respiratory sensitization. The results of an analysis of 104 chemicals which have been reported to cause respiratory sensitization in humans showed that most of the sensitizing chemicals could be distinguished from 82 control chemicals for which no clinical reports of respiratory sensitization exist. This study resulted in the development of a set of mechanism-based structural alerts for chemicals with the potential to cause respiratory sensitization. Their potential for use in a predictive algorithm for this purpose alongside an externally validated quantitative structure-activity relationship model is discussed.

BACKGROUND: Self-reported work-related ill-health (WRI) statistics suggest that agricultural workers in the UK are at an increased risk of musculoskeletal disorders (MSD), skin and respiratory disease. However, there is little comprehensive medically reported information on WRI in the UK agricultural sector. METHODS: Cases of WRI within the UK from 2002 to 2008, as reported to The Health and Occupation Reporting (THOR) network by occupational physicians, clinical specialists and general practitioners, were analysed. Directly standardized incidence rate ratios (SRRs) for the agricultural sector versus all other sectors were calculated for dermatological, musculoskeletal, respiratory and psychological illness, using as the standard population the UK working population as estimated from the Labour Force Survey. RESULTS: During 2002-08, 471 cases within the agricultural sector were reported to THOR (2% of all cases). Based on reports by clinical specialists, male agricultural workers aged

Much of the current burden of long-latency respiratory disease (LLRD) in Great Britain is attributed to historical asbestos exposure. However, continuing exposure to other agents, notably silica, also contributes to disease burden. The aim of this study was to investigate the incidence of work-related LLRD reported by chest physicians in Great Britain, including variations by age, gender, occupation and suspected agent.LLRD incidence and incidence rate ratios by occupation were estimated (1996–2014). Mesothelioma cases by occupation were compared with proportional mortality ratios.Cases were predominantly in men (95%) and 92% of all cases were attributed to asbestos. Annual average incidence rates (males) per 100 000 were: benign pleural disease, 7.1 (95% CI 6.0–8.2); mesothelioma, 5.4 (4.8–6.0); pneumoconiosis, 1.9 (1.7–2.2); lung cancer, 0.8 (0.6–1.0); chronic obstructive pulmonary disease (COPD), 0.3 (0.2–0.4). Occupations with a particularly high incidence of LLRD were miners and quarrymen (COPD), plumbers and gas fitters (asbestosis), and shipyard and dock workers (all other categories). There was a clear concordance between cases of SWORD mesothelioma and proportional mortality ratios by occupation.Occupationally caused LLRD continues to contribute to a significant disease burden. Many cases are attributable to past exposure to agents such as asbestos and silica, but the potential for occupational exposures persists.Occupational long-latency respiratory disease contributes to a significant disease burden with ongoing exposure risk http://ow.ly/ahyF30gM9DK

To estimate incidence and trends in incidence of occupational diseases (ODs) in the Dutch construction sector.In a dynamic prospective cohort over a 5-year period (2010-2014), ODs assessed by occupational physicians (OPs) participating in a voluntary construction workers health surveillance (WHS) were reported to the Netherlands Centre for Occupational Diseases (NCOD). ODs were defined as a disease with a specific clinical diagnosis (International Classification of Diseases) that was predominantly caused by work-related factors as assessed by an OP. Annual incidences were determined for the total number of ODs and six frequently occurring OD groups. Trends in incidence were estimated using a multilevel negative binominal regression model.In 2014 the incidence of all OD was 12 964 per 100 000 workers and there was no significant change in incidence between 2010 and 2014 (3%; 95% CI -2% to +9%). Hearing loss (8125 per 100 000 workers) and musculoskeletal disorders (2081 per 100 000 workers) were the most frequently occurring ODs. Noise-induced hearing loss (+7%; 95% CI 1% to 13%) and contact dermatitis (+19%; 95% CI 6% to 33%) showed increasing trends. There was no statistically significant change in the incidence of low back pain, arthrosis, repetitive strain injuries, distress/burnout and chronic obstructive pulmonary disease/asthma.In total, 13% of workers participating in WHS in the Dutch construction industry during 2014 had an OD diagnosed and reported by an OP. Over a 5-year period the annual incidence of reported ODs showed a statistically non-significant increase. Incidences in noise-induced hearing loss and contact dermatitis showed statistically significant increasing trends, 7% and 19%, respectively.

Patient safety research has focused largely on hospital settings despite the fact that in many countries, the majority of patient contacts are in primary care. The knowledge base about patient safety in primary care is developing but sparse and diagnostic error is a relatively understudied and an unmeasured area of patient safety. Diagnostic error rates vary according to how 'error' is defined but one suggested hallmark is clear evidence of 'missed opportunity' (MDOs) makes a correct or timely diagnosis to prevent them. While there is no agreed definition or method of measuring MDOs, retrospective manual chart or patient record reviews are a 'gold standard'. This study protocol aims to (1) determine the incidence of MDOs in English general practice, (2) identify the confounding and contributing factors that lead to MDOs and (3) determine the (potential) impact of the detected MDOs on patients.We plan to conduct a two-phase retrospective review of electronic health records in the Greater Manchester (GM) area of the UK. In the first phase, clinician reviewers will calibrate their performance in identifying and assessing MDOs against a gold standard 'primary reviewer' through the use of 'double' reviews of records. The findings will enable a preliminary estimate of the incidence of MDOs in general practice, which will be used to calculate the number of records to be reviewed in the second phase in order to estimate the true incidence of MDO in general practice. A sample of 15 general practices is required for phase 1 and up to 35 practices for phase 2. In each practice, the sample will consist of 100 patients aged ≥18 years on 1 April 2013 who have attended a face-to-face 'index consultation' between 1 April 2013 and 31 March 2015. The index consultation will be selected randomly from each unique patient record, occurring between 1 July 2013 and 30 June 2014.There are no reliable estimates of safety problems related to diagnosis in English general practice. This study will lay the foundation for safety improvements in this area by providing a more reliable estimate of MDOs, their impact and their contributory factors.

Objectives Public and patient involvement (PPI) is required at all stages of research by many funding bodies such as the National Institute for Health Research (NIHR). Given the high priority of PPI within NIHR programmes and the associated costs, it is important that the process of involvement and impact of PPI on health services research is evaluated. We aimed to develop a tool to quantitatively evaluate the quality of PPI in research from a PPI participant9s perspective in order to inform the researchers about absolute level of quality (cross-sectional aspect) and changes in quality over time (longitudinal aspect). Setting A primary care patient safety translational research centre. Participants The 12 members of the Research User Group (RUG) of Greater Manchester Primary Care Patient Safety Translational Research Centre. Interventions By their own choice each RUG member supported a specific research theme. The level of involvement varied from commenting on documents through to designing their own research projects. Primary and secondary outcome measures planned Measure absolute score and change in score over time in a nine-point Likert score within individuals. Compare Likert scores before undertaking PPI with scores after PPI activities. Evaluate the usefulness of a questionnaire based on a theoretical framework of personal and research factors. Results The questionnaire had an acceptable to good level of internal consistency (Cronbach9s α 0.74–0.81). The majority of the individuals met their initial expectations (11/12) and scored high across all factors. There was no significant change over time in the aggregate score over all factors and all individuals, but there were differences within individuals and factors. A ceiling effect limited the questionnaire9s usefulness to measure increasing scores. Conclusions The questionnaire has been useful in evaluating the early stages of a PPI group and may be generalisable to another setting.

BACKGROUND: Reducing healthcare-associated infections (HCAI) has been a priority in the UK over recent decades and this has been reflected in interventions focussing on improving hygiene procedures. OBJECTIVES: to evaluate whether these interventions coincided with an increased incidence of work-related irritant contact dermatitis (ICD) attributed to hand hygiene or/and other hygiene measures in healthcare workers (HCW). METHODS: A quasi-experimental (interrupted time series) design was used to compare trends in incidence of ICD in HCW attributed to hygiene before and after interventions to reduce HCAI with trends in the same periods in control groups (ICD in other workers). Cases of ICD reported to a UK surveillance scheme from 1996 to 2012 were analysed. The time periods compared were defined objectively based on the dates of the publication of National evidence-based guidelines, the UK health act 2006 and the Cleanyourhands campaign. RESULTS: The reported incidence of ICD in HCW attributed to hygiene has increased steadily from 1996 to 2012 (annual incidence rate ratio; 95% confidence interval: hand hygiene only 1.10; 1.07 to 1.12, all hygiene 1.05; 1.03 to 1.07) whereas the incidence in other workers is declining. An increase in incidence of ICD in HCW attributed to hand hygiene was observed at the beginning of the Cleanyourhands campaign. CONCLUSIONS: The increasing incidence of ICD in HCWs combined with the popularity of interventions to reduce HCAI warrants increased effort towards identifying products and implementing practices posing the least risk of ICD. This article is protected by copyright. All rights reserved.

Working Group 2; Cost Action IS1002—Monitoring trends in Occupational Diseases and tracing new and Emerging Risks in a NETwork (MODERNET); International audience; Objectives: The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries.Methods: OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules.Results: Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries.Conclusions: This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods.

Introduction Pour prevenir les maladies attribuables au travail, il est important de s’appuyer sur des donnees epidemiologiques prevalence, incidence, ou tendances temporelles de l’incidence), d’evaluer les effets des interventions et, si possible, de predire de nouveaux risques. Objectifs Illustrer a travers le systeme THOR (The Health and Occupation Research Network) que la surveillance epidemiologique des maladies professionnelles et attribuables au travail permet de mettre en evidence les tendances temporelles de leur incidence, d’evaluer l’efficacite des interventions de prevention au niveau national ou international, ainsi que de decouvrir de nouveaux risques. Methodes Les donnees sur les nouveaux cas de maladies causees par le travail sont collectees de facon systematique par un echantillon de plus de mille medecins exercant en Grande Bretagne et en Irlande : medecins du travail, pneumologues et dermatologues hospitaliers, et medecins generalistes ayant recu une formation specifique en sante du travail. L’analyse statistique utilise les techniques de « Multi Level Modelling » MLM, modelisation a plusieurs niveaux) pour montrer les tendances. Ces methodes tiennent compte des changements dans les denominateurs et autres sources potentielles de biais. L’effet des interventions impliquant par exemple des modifications dans les expositions) sur les tendances d’incidence, sont evaluees par des methodes d’analyse de series temporelles intitulees « interrupted time series ». Les donnees suggerant de nouvelles causes soupconnees de sensibilisation des voies respiratoires ont ete corroborees par une methode explorant les relations entre structure chimique et effet physiologique, denommee QSAR (« Quantitative Structure Activity Relationships »). Resultats Les tendances montrent generalement une legere diminution de l’incidence de maladies telles que l’asthme et la dermatite professionnelle. Les analyses statistiques ont montre l’efficacite de differentes mesures de prevention prises au niveau national, telles que les limites d’exposition ou d’interdiction de certaines substances comme le latex ou le glutaraldehyde. Ceci a egalement ete demontre au niveau international, comme avec la directive europeenne 2003/53/CE portant diminution des concentrations de chrome hexavalent dans le ciment. En revanche, l’asthme cause par la farine ne diminue pas en frequence, et l’incidence des dermatites de contact chez les travailleurs des soins de sante s’est aggravee depuis la mise en place de certaines mesures visant a reduire le risque nosocomial. D’autres risques de dermatites se manifestent, comme par exemple celui attribue a la classe des isothiazolinones. Les analyses statistiques ont montre l’augmentation de l’incidence des maladies mentale et du « stress » en meme temps et dans le meme contexte que l’incidence des maladies musculo-squelettiques a diminue. Enfin, dans le cadre d’une collaboration internationale dans le reseau europeen MODERNET et avec l’utilisation de methodes complementaires QSAR) de nouveaux risques ont ete etudies, concernant notamment l’asthme professionnel. Conclusion L’utilisation de methodes valides permet d’obtenir des donnees mettant en evidence les tendances de l’incidence des maladies attribuees a l’activite professionnelle, l’effet preventif de certaines interventions par exemple, les directives europeennes), voire l’effet negatif d’autres mesures. Les collaborations internationales devraient permettre de decouvrir plus efficacement et plus rapidement des informations sur les nouveaux risques du travail pour la sante, et de rendre alors la prevention d’autant plus efficace.

Objective Hexavalent chromate (chromate) in cement is a well-recognised cause of allergic contact dermatitis (ACD). Consequently in January 2005, following European Union legislation (EU Directive 2003/53/EC), the use or supply of cement containing >2 ppm of chromate was prohibited in the UK (COSHH 2004). This analysis of work-related ill-health surveillance aims to evaluate the effectiveness of this legislation. Method Changes in the incidence of work-related ACD cases returned to The Health and Occupation Reporting network by dermatologists were analysed taking in to account attribution to chromate and occupation. Results There was a significant decline in the incidence of both ACD attributed to chromate (incidence rate ratio 0.48, 95% CI 0.36 to 0.64) and ACD not-attributed chromate (0.76, 95% CI 0.69 to 0.85) between the time period preceding the EU legislation (2002–2004) and the postlegislation period (2005–2009). However, the decline in ACD attributed to chromate was significantly greater (p=0.006). This decline was further increased in workers potentially exposed to cement (incidence rate ratio 0.37, p=0.001). The majority of the decline in incidence occurred during 2005. Conclusion The timing of this significant decline in the UK incidence of chromate attributed ACD, and the greater decline in workers potentially exposed to cement strongly suggests that the EU Directive2003/53/EC was successful in reducing exposure to chromate in cement in the UK.

Objective Self-reported work-related ill health (SWI) data show a high incidence of occupational ill health and a high burden of cancer attributable to occupational factors in the UK construction industry. However, there is little information on the incidence of medically reported work-related ill health (WRI) within this industry. This study aims to examine the incidence of WRI within the UK construction industry. Method Standardised incidence rate ratios (SRRs) were used to compare incidence rates of reports of medically certified work-related ill health returned to The Health and Occupation Reporting network (THOR) within the UK construction industry with all other UK industries combined. Results Male UK construction industry workers aged under 65 years had significantly raised SRRs for respiratory (3.8, 95% CI 3.5 to 4.2), skin (1.6, 1.4 to 1.8) and musculoskeletal disorders (MSD; 1.9, 1.6 to 2.2). These SRRs were further raised for those working within a construction trade. The increased SRRs for skin disease within male construction industry workers were due to contact dermatitis (1.4, 1.2 to 1.6) and neoplasia (4.2, 3.3 to 5.3). For respiratory disease, the increased SRRs were due to non-malignant pleural disease (7.1, 6.3 to 8.1), mesothelioma (7.1, 6.0 to 8.3), lung cancer (5.4, 3.2 to 8.9) and pneumoconiosis (5.5, 3.7 to 8.0), but the SRRs for asthma (0.09, 0.06 to 0.11) and mental ill health (0.3, 0.1 to 0.4) were significantly reduced. Conclusion The significantly raised SRRs for medically reported MSD and significantly reduced SRRs for mental ill health in construction workers confirm self-reported UK data. These SRRs provide a baseline of the incidence of WRI in the UK construction industry from which to monitor the effects of changes in policy or exposures.

Objective To investigate whether interventions implemented by the UK Health and Safety Executive addressing exposure to isocyanate-based spray paints in motor vehicle repair (MVR), flour dust in craft bakeries, rosin-based solder flux fume (RBSFF) in the electronics industry, metalworking fluids and wood dust coincided with a decline in incidence of work-related short latency respiratory disease (SLRD) or asthma in the target groups. Method Changes in the incidence of SLRD reported to a UK-based surveillance scheme were compared using a longitudinal, negative binomial regression model with β distributed random effects. An interrupted time series design was used and comparisons according to inclusion or exclusion in the target group were made by including a statistical interactions expressed as a ratio of incidence rate ratios (RIRRs) in the model. Results The incidence of SLRD attributed to flour dust significantly increased relative to all other agents (RIRR: 1.10; 95% CI 1.06 to 1.16) whereas SLRD attributed to RBSFF significantly declined relative to all other agents (0.94; 0.90 to 0.99). No significant changes in the incidence of SLRD attributed to wood dust (1.03; 0.91 to 1.16) or spray paints (1.03; 0.95 to 1.11) relative to all other agents were observed. A higher proportion of reports originated from the industries targeted by the intervention for RBSFF (65/107; 61%) than spray painting (27/93; 27%) or wood dust (16/42; 38%). Conclusions These data support a beneficial effect of interventions to reduce exposure to RBSFF but an increase in SLRD attributed to flour dust may indicate increased exposure or increased awareness of the problem.

Objective The 2004 amendment to the Control of Substances Hazardous to Health 2002 regulations (COSHH 2004) introducing workplace exposure limits (WELs) was enacted in the UK in 2005. This study aimed to determine whether introducing this legislation coincided with a reduction in the incidence of work-related short latency respiratory disease (SLRD) attributed to the agents with a WEL. The second objective was to determine whether changes in legislation, WELs and market forces coincided with a reduction in the incidence of SLRD attributed to glutaraldehyde and latex. Method Reports of SLRD made to the Surveillance of Work-related and Occupational Respiratory Disease scheme were used to estimate the change in incidence within reporters between two time periods (interrupted time series design) using a longitudinal, negative binomial regression model with β distributed random effects. A statistical interaction term was included in the model to make comparisons between the groups defined by suspected causal agent and/or occupation, essentially comparing two interrupted time series. Time periods were defined prospectively representing the changes in legislation or market forces. Results The introduction of the COSHH 2004 legislation in the UK coincided with a significant reduction in reports of SLRD attributed to agents with a WEL relative to those without a WEL (ratio of incidence rate ratios: 0.70; 95% CI 0.52 to 0.93) and a significant reduction in SLRD attributed to glutaraldehyde in healthcare workers (0.20; 0.07 to 0.57) and latex in all workers (0.37; 0.16 to 0.85). Conclusions These data are consistent with a beneficial effect of legislation aiming to reduce workplace exposures.

Objectives Recently the WHO estimated that up to 75% of emerging pathogens may be of zoonotic origin. Occupationally acquired zoonoses are of particular concern in food producing sectors because of the possibility of transmission through the food chain. We aim to investigate whether changes in incidence of occupationally-acquired zoonotic infections in agricultural and veterinary workers or food preparation and food retail workers are useful in predicting changes in the incidence of food-borne zoonotic infections in the wider population.Methods In the UK infectious disease consultants report cases of occupationally acquired infectious disease to the Surveillance of Infectious Diseases at Work (SIDAW) scheme. Cases reported to SIDAW will be analysed using a 2 level negative binomial regression model adjusted for changes in the size of occupational group at risk as described elsewhere1. Following a target set by the UK Health Protection Agency (HPA) in 2001 to reduce the incidence of salmonella in UK produced chicken there has been a declining trend in outbreaks of food-borne salmonellosis. In contrast there has been little change in the number of outbreaks of food-borne camphylobacteriosis reported to the HPA over the same time. These trends reported to the HPA will be compared with SWORD data.Results Between 1997 and 2010, 244 individual cases (209 outbreaks) of salmonellosis and 577 individual cases (522 outbreaks) of camphylobacterosis were reported to SWORD. Over the same time period 590 foodborne outbreaks of salmonellosis and 105 of camphylobacterosis were reported to the HPA. A simultaneous decline in the incidence of salmonellosis reported to SWORD and food-borne salmonellosis reported to the HPA was observed. These data will be analysed further to compare different occupational sectors.Conclusion Reporting of occupational infectious diseases in some sectors may be a useful marker for changes in incidence occurring in the wider population.

Objectives Over the past decade there has been increasing concern among the public and government about high rates of healthcare associated infections and low levels of hand hygiene compliance. In response the “Cleanyourhands” campaign was rolled out from 2004 in all acute NHS hospital trusts. A national level evaluation of this intervention found a substantial increase in the use of hand cleaning products in acute trusts between 2004 and 2008, which was associated with a reduction in meticillin resistant S aureus and C difficile infections1. This study aims to compare the increased usage of hand hygiene products1 in acute NHS trusts with changes in the incidence of CD attributed to hand washing in healthcare workers.Methods Reports of occupational CD to a surveillance scheme by dermatologists and occupational physicians (OPs) were analysed, using a prospective interrupted time series design with time periods matching those used in the evaluation of the “Cleanyourhands” intervention1. Comparisons were made between reports attributed to frequent hand washing and other causal agents, to mitigate bias arising from the voluntary nature of the reporting scheme.Results The incidence of CD attributed to hand washing was significantly increased relative to all other causes in healthcare workers following the “Cleanyourhands” campaign (statistical interaction;95% CIs: dermatologists 2.19; 1.62 - 2.96, OPs 2.44; 1.15 - 5.18). The increase reported by dermatologists was predominantly irritant CD (2.58; 1.74 - 3.81) rather than allergic CD (1.04; 0.38 - 2.84).Conclusion The increase in irritant CD reported by dermatologists, and all CD by OPs, is consistent with the increase in use of hand cleaning agents following the “Cleanyourhands” campaign. Attention should be paid to the adverse effects of frequent hand washing as well as prevention of infections.

In response to Upton, the Clinical Practice Research Datalink (CPRD) includes limited anonymised information on the characteristics of health professionals.1 2 Sex and role are available and information on consultation volumes can be extracted. Data on GP density, full time equivalents, or other staff characteristics are unavailable. Such data are available nationally but cannot be linked to the practices in CPRD, which are anonymous. In …

BACKGROUND: Construction workers are at increased risk of work-related ill-health (WRI) worldwide. AIMS: To compare the incidence of medically reported WRI in occupations within the UK construction industry according to job title. METHODS: We calculated standardized incidence rate ratios (SRRs) using WRI cases for individual job titles returned to The Health and Occupation Reporting network by clinical specialists and UK population denominators. We counted frequencies of reported causal exposures or tasks reported by clinical specialists, occupational physicians and general practitioners. RESULTS: We found significantly increased incidence of WRI compared with other workers in the same major Standard Occupational Classification, i.e. workers with similar levels of qualifications, training, skills and experience, for skin neoplasia in roofers (SRR 6.3; 95% CI: 3.1-13.1), painters and decorators (2.1; 95% CI: 1.2-3.6) and labourers in building and woodworking trades (labourers, 6.6; 95% CI: 3.2-13.2); contact dermatitis in metal workers (1.4; 95% CI: 1.1-1.7) and labourers (1.6; 95% CI: 1.1-2.3); asthma in welders (3.8; 95% CI: 2.8-5.0); musculoskeletal disorders in welders (1.7; 95% CI: 1.1-2.8), road construction operatives (6.1; 95% CI: 3.8-9.6) and labourers (2.5; 95% CI: 1.7-3.7); long latency respiratory disease (mesothelioma, pneumoconiosis, lung cancer, non-malignant pleural disease) in pipe fitters (4.5; 95% CI: 3.2-6.2), electrical workers (2.7; 95% CI: 2.4-3.2), plumbing and heating engineers (2.3; 95% CI: 1.9-2.7), carpenters and joiners (2.7; 95% CI: 2.3-3.1), scaffolders (12; 95% CI: 8-18) and labourers (3.3; 95% CI: 2.6-4.1). CONCLUSIONS: UK construction industry workers have significantly increased risk of WRI. These data in individual construction occupations can be used to inform appropriate targeting of occupational health resources.

The incidence and the causes of male infertility and male reproductive ill-health (in general) are important issues that remain poorly characterised. There does not appear to be a worldwide decline in semen quality but changes are more apparent in some regions than others. Furthermore, though the incidence of testicular cancer and congenital genital malformations had been increasing, the rate of increase has seemingly slowed over the past decade. Demographic data on UK fertility rates also provide scant evidence to suggest that infertility is increasing. Though this incidence data is reassuring, male infertility has been associated with an ever-increasing number of putative risk factors, including current exposures or parental exposures to occupational, lifestyle or environmental factors. It is currently unclear to what extent such risk factors (and others such as DNA damage) influence male infertility. Better characterisation of risk factors will aid our understanding of what is happening to male infertility. This brief review examines recent trends in male infertility and summarises the extent to which knowledge in this area has improved significantly.

Approximately one-third of IVF cases in the UK are attributed to male factor infertility and in the majority of cases the origin of male infertility is unknown. The integrity of sperm DNA is important both for the success of assisted reproduction and the implications for the off-spring. One type of DNA damage that has not been investigated with respect to fertility outcomes is the adduct N7-methyldeoxyguanosine (N7-MedG), a biomarker for exposure to alkylating agents. A prospective cohort of couples attending for IVF had their N7-MedG levels in sperm measured using an immunoslot blot technique to examine whether sperm N7-MedG levels are associated with male factor infertility, semen quality measures or assisted reproduction outcomes. Sufficient DNA for analysis was obtained from 67/97 couples and N7-MedG was detected in 94% of sperm samples analysed. Men diagnosed with male factor infertility had significantly higher mean levels of N7-MedG in their sperm DNA (P=0.03). Logistic regression analysis showed that N7-MedG levels were significantly negatively associated with the proportion of oocytes successfully fertilised irrespective of the method of fertilisation used (IVF or intra-cytoplasmic sperm injection; ICSI, P

Study question: What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices? Methods: A cross sectional study included all adult patients potentially at risk of a prescribing or monitoring error defined by a combination of diagnoses and prescriptions in 526 general practices contributing to the Clinical Practice Research Datalink (CPRD) up to 1 April 2013. Primary outcomes were the prevalence of potentially hazardous prescriptions of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives, and oestrogens and monitoring by blood test less frequently than recommended for patients with repeated prescriptions of angiotensin converting enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium, or warfarin. Study answer and limitations: 49 927 of 949 552 patients at risk triggered at least one prescribing indicator (5.26%, 95% confidence interval 5.21% to 5.30%) and 21 501 of 182 721 (11.8%, 11.6% to 11.9%) triggered at least one monitoring indicator. The prevalence of different types of potentially hazardous prescribing ranged from almost zero to 10.2%, and for inadequate monitoring ranged from 10.4% to 41.9%. Older patients and those prescribed multiple repeat medications had significantly higher risks of triggering a prescribing indicator whereas younger patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. There was high variation between practices for some indicators. Though prescribing safety indicators describe prescribing patterns that can increase the risk of harm to the patient and should generally be avoided, there will always be exceptions where the indicator is clinically justified. Furthermore there is the possibility that some information is not captured by CPRD for some practices—for example, INR results in patients receiving warfarin. What this study adds: The high prevalence for certain indicators emphasises existing prescribing risks and the need for their appropriate consideration within primary care, particularly for older patients and those taking multiple medications. The high variation between practices indicates potential for improvement through targeted practice level intervention. Funding, competing interests, data sharing: National Institute for Health Research through the Greater Manchester Primary Care Patient Safety Translational Research Centre (grant No GMPSTRC-2012-1). Data from CPRD cannot be shared because of licensing restrictions.

Background Prescribing safety indicators for use in UK general practice have been developed through expert consensus but have not been validated in a large UK-wide dataset. We aimed to quantify indicators describing hazardous prescribing patterns that could put patients at risk of harm (prescribing indicators) or repeat prescriptions without the appropriate monitoring tests (monitoring indicators) using the Clinical Practice Research Database (CPRD). We further investigated the relationship between patient and practice characteristics and the prevalence of the indicators and their usefulness for potentially distinguishing between practices. Methods The prevalence of individual and composite indicators addressing prescribing of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives (CHC) and oestrogens to patients with contra-indicating conditions or prescribing of angiotensin-converting-enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium and warfarin without appropriate monitoring was measured. Multilevel logistic regression models with random effects at the practice level were used to quantify the impact of patient and practice level variables on the indicator prevalence and the variation between practices. The variation between practices and the number of patients at risk were used to provide estimates of reliability for individual practices. Results 57,479 of 1,255 637 patients at risk triggered at least one prescribing indicator (4.58%; 95% CI: 4.54% to 4.61%) and 21,501 of 182,721 (11.8%; 11.2% to 11.9%) triggered at least one monitoring indicator. For individual prescribing indicators prevalence rates ranged from almost zero to 10.2%, and for monitoring indicators from 10.4% to 41.9%. Older male patients and those prescribed multiple repeat medications had significantly higher risk of triggering a prescribing indicator whereas younger female patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. A low prevalence of prescribing indicators did not predict a low prevalence of monitoring indicators or vice versa. Conclusion These findings highlight the hazards of prescribing multiple medications. Variation in the prevalence of prescribing and monitoring indicators between practices was high, even after adjusting for patient and practice level variables, presenting important targets to improve patient safety in primary care. These indicators can be used by primary care practitioners in their own practice and establish a baseline for investigating changes in prescribing safety over time.

BACKGROUND: Organic diisocyanates are a common cause of occupational asthma, particularly in motor vehicle repair (MVR) workers. The UK Health & Safety Laboratory provides screening for urinary hexamethylenediamine (UHDA), a biomarker of exposure to 1,6-hexamethylene diisocyanate (HDI). The UK Surveillance of Work-related and Occupational Respiratory Disease scheme (SWORD) has collected reports of occupational asthma since 1996. AIMS: To compare trends in HDI exposure with trends in the incidence of work-related asthma attributed to isocyanates or paint spraying in MVR workers reported to SWORD. METHODS: Two-level regression models were used to estimate trends in UHDA levels and work-related asthma in MVR workers reported to SWORD. The direction and magnitude of the trends were compared descriptively. RESULTS: From 2006 to 2014, there was a significant decline in the number of urine samples with detectable levels of UHDA (odds ratio = 0.96; 95% confidence intervals 0.94-0.98) and minimal change in those over the guidance value (1.03; 1.00-1.06). Over the same period, there was a significant decline in all asthma cases attributed to isocyanates or paint spraying reported to SWORD (0.90; 0.86-0.94) and a non-significant decline among MVR workers (0.94; 0.86-1.02). CONCLUSIONS: The simultaneous decrease in HDI exposure and incident cases of asthma reported to SWORD is temporally consistent with a reduction in exposure to airborne isocyanate leading to a reduction in asthma. Although this is not direct evidence of a causal relationship between the two trends, it is suggestive.