2017-04-01 12:00 - Messages

Establishing a policy framework for the primary prevention of occupational cancer

A proposal based on a prospective health policy analysis
Background: Despite our knowledge of the causes of cancer, millions of workers are involuntarily exposed to a wide range of known and suspected carcinogens in the workplace. To address this issue from a policy perspective, we developed a policy framework based on a prospective health policy analysis. Use of the framework was demonstrated for developing policies to prevent cancers associated with diesel engine exhaust (DEE), asbestos, and shift work, three occupational carcinogens with global reach and large cancer impact.
Methods: An environmental scan of existing prospective health policy analyses was conducted to select and describe our framework parameters. These parameters were augmented by considerations unique to occupational cancer. Policy-related resources, predominantly from Canada, were used to demonstrate how the framework can be applied to cancers associated with DEE, asbestos, and shift work.
Results: The parameters of the framework were: problem statement, context, jurisdictional evidence, primary prevention policy options, and key policy players and their attributes. Applying the framework to the three selected carcinogens illustrated multiple avenues for primary prevention, including establishing an occupational exposure limit for DEE, banning asbestos, and improving shift schedules. The framework emphasized the need for leadership by employers and government.
Conclusion: To our knowledge, this is the first proposal for a comprehensive policy framework dedicated to the primary prevention of occupational cancer. The framework can be adapted and applied by key policy players in Canada and other countries as a guide of what parameters to consider when developing policies to protect workers' health.

Source: Veglia, A., Pahwa, M., & Demers, P. A. (2017). Safety and Health at Work, 8(1), 29-35.
http://doi.org/10.1016/j.shaw.2016.07.001

Behaviour of chemical respiratory allergens in novel predictive methods for skin sensitisation

Asthma resulting from sensitisation of the respiratory tract to chemicals is an important occupational health issue, presenting many toxicological challenges. Most importantly there are no recognised predictive methods for respiratory allergens. Nevertheless, it has been found that all known chemical respiratory allergens elicit positive responses in assays for skin sensitising chemicals. Thus, chemicals failing to induce a positive response in skin sensitisation assays such as the local lymph node assay (LLNA) lack not only skin sensitising activity, but also the potential to cause respiratory sensitisation. However, it is unclear whether it will be possible to regard chemicals that are negative in in vitro skin sensitisation tests also as lacking respiratory sensitising activity. To address this, the behaviour of chemical respiratory allergens in the LLNA and in recently validated non-animal tests for skin sensitisation have been examined. Most chemical respiratory allergens are positive in one or more newly validated non-animal test methods, although the situation varies between individual assays. The use of an integrated testing strategy could provide a basis for recognition of most respiratory sensitising chemicals. However, a more complete picture of the performance characteristics of such tests is required before specific recommendations can be made.

Source: Basketter, D., Poole, A., & Kimber, I. (2017). Regulatory Toxicology and Pharmacology.
http://doi.org/10.1016/j.yrtph.2017.03.002

History of knowledge and evolution of occupational health and regulatory aspects of asbestos exposure science: 1900–1975

The understanding by industrial hygienists of the hazards of asbestos and appropriate ways to characterize and control exposure has evolved over the years. Here, a detailed analysis of the evolution of industrial hygiene practices regarding asbestos and its health risks, from the early 1900s until the advent of the national occupational health and safety regulatory structure currently in place in the US (early-to-mid 1970s) is presented. While industrial hygienists recognized in the early 1900s that chronic and high-level exposures to airborne concentrations of asbestos could pose a serious health hazard, it was not until the mid-1950s that the carcinogenic nature of asbestos began to be characterized and widespread concern followed. With the introduction of the membrane filter sampling method in the late 1960s and early 1970s, asbestos sampling and exposure assessment capabilities advanced to a degree which allowed industrial hygienists to more precisely characterize the exposure–response relationship. The ability of industrial hygienists, analytical chemists, toxicologists, and physicians to more accurately define this relationship was instrumental to the scientific community's ability to establish Occupational Exposure Levels (OELs) for asbestos. These early developments set the stage for decades of additional study on asbestos exposure potential and risk of disease. This was followed by the application of engineering controls and improved respiratory protection which, over the years, saved thousands of lives. This paper represents a state-of-the-art review of the knowledge of asbestos within the industrial hygiene community from about 1900 to 1975.

Source: Barlow, C. A., Sahmel, J., Paustenbach, D. J., & Henshaw, J. L. (2017). Critical Reviews in Toxicology, 1-31.
http://dx.doi.org/10.1080/10408444.2016.1258391

Fire Simulation and Cardiovascular Health in Firefighters

Background: Rates of myocardial infarction in firefighters are increased during fire suppression duties, and are likely to reflect a combination of factors including extreme physical exertion and heat exposure. We assessed the effects of simulated fire suppression on measures of cardiovascular health in healthy firefighters.
Methods: In an open-label randomized crossover study, 19 healthy firefighters (age, 41±7 years; 16 males) performed a standardized training exercise in a fire simulation facility or light duties for 20 minutes. After each exposure, ex vivo thrombus formation, fibrinolysis, platelet activation, and forearm blood flow in response to intra-arterial infusions of endothelial-dependent and -independent vasodilators were measured.
Results: After fire simulation training, core temperature increased (1.0±0.1°C) and weight reduced (0.46±0.14 kg, P<0.001 for both). In comparison with control, exposure to fire simulation increased thrombus formation under low-shear (73±14%) and high-shear (66±14%) conditions (P<0.001 for both) and increased platelet-monocyte binding (7±10%, P=0.03). There was a dose-dependent increase in forearm blood flow with all vasodilators (P<0.001), which was attenuated by fire simulation in response to acetylcholine (P=0.01) and sodium nitroprusside (P=0.004). This was associated with a rise in fibrinolytic capacity, asymptomatic myocardial ischemia, and an increase in plasma cardiac troponin I concentrations (1.4 [0.8–2.5] versus 3.0 [1.7–6.4] ng/L, P=0.010).
Conclusions: Exposure to extreme heat and physical exertion during fire suppression activates platelets, increases thrombus formation, impairs vascular function, and promotes myocardial ischemia and injury in healthy firefighters. Our findings provide pathogenic mechanisms to explain the association between fire suppression activity and acute myocardial infarction in firefighters.

Source: Hunter, A. L., Shah, A. S., Langrish, J. P., Raftis, J. B., Lucking, A. J., Brittan, M., ... & Graveling, R. (2017). Circulation135(14), 1284-1295.
https://doi.org/10.1161/CIRCULATIONAHA.116.025711

Parkinson’s disease and occupational exposures

A systematic literature review and meta-analyses
Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of relevant risk factors for Parkinson's disease.
Methods: Our search identified 103 original publications on associations between work and Parkinson's disease. GRADE guidelines were used to ensure high scientific quality, and reliable guidelines were applied to classify the papers. Of the 103 articles, 47 fulfilled good scientific standards while 56 were methodologically deficient and thus excluded from our meta-analyses.
Results: A total of 23 publications concerned work exposure to pesticides. The weighted relative risk estimate was 1.67 (95% confidence interval 1.42–1.97). A funnel plot and bias test indicated that some publication bias concerning smaller studies might have been present. The risk estimate was not influenced by study design (case–control, cohort, or cross-sectional study) or gender. Higher estimates were found when there was a hereditary taint or onset below age 60. Studies on exposure to metals or electromagnetic fields did not show increased risk.
Conclusions: Using an elaborated quality protocol, there is now strong evidence that exposure to any pesticide involves a ≥50% increased risk for developing Parkinson's disease.

Source: Gunnarsson, L. G., & Bodin, L. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3641

La chimie en quête d'alternatives

Lors de toute démarche de prévention du risque chimique, lorsque celui-ci n'a pu être évité ou supprimé, la substitution des produits chimiques dangereux au profit d'autres produits ou de procédés moins dangereux doit être envisagée. Pour autant, elle se heurte bien souvent à des réalités complexes. Une démarche de substitution se conçoit comme un véritable projet. Elle nécessite la mise en commun de compétences internes et externes à l'entreprise, depuis l'analyse préalable jusqu'à la mise en oeuvre de solutions et à l'évaluation de leurs conséquences.

Source: https://kiosque.inrs.fr/alyas/view/news/lettre/114/html#suite

Epigenetics and chemical risk management in the workplace

Ce guide présente une introduction complète à l'épigénétique, la science émergente des mécanismes biologiques dans l'ADN qui peuvent modifier notre activité génétique sans changer le code génétique lui-même. La connaissance de l'épigénétique est importante pour les travailleurs car elle pourrait apporter des preuves rétrospectives d'exposition à des agents chimiques (néfastes) et permettre l'identification précoce des substances chimiques dangereuses sur les lieux de travail.

Source: http://www.etui.org/fr/Publications2/Guides/Epigenetics-and-chemical-risk-management-in-the-workplace

Guide de gestion des déchets du réseau de la santé et des services sociaux

Le réseau de la santé et des services sociaux du Québec produit chaque année une quantité importante de déchets de toutes sortes. Dans plusieurs municipalités, l'établissement de santé est l'employeur principal et
un des plus grands producteurs de matières résiduelles. Emballages, contenants divers, instruments médicaux jetables, déchets biomédicaux, matières dangereuses, résidus alimentaires et autres figurent sur la  longue liste des déchets des établissements.
Au cours des dernières années, de nombreux questionnements ont émané du réseau concernant plusieurs aspects de la gestion des déchets : contenants à utiliser, réglementation, catégorisation (ex. : déchets généraux vs biomédicaux), traitement, etc. La rédaction d'un document qui regroupe les connaissances et les bonnes pratiques actuelles en gestion des déchets pour les établissements de santé et de services sociaux québécois était nécessaire.
Le Guide de gestion des déchets du réseau de la santé et des services sociaux comporte trois chapitres importants : concepts de base, risques liés à la gestion des déchets et principes de gestion des déchets. Le premier chapitre présente un bref historique de la gestion des déchets, les catégories, la réglementation et les responsabilités liées à cette gestion. Ensuite, les principaux risques chimiques, biologiques ou infectieux, physiques et biomécaniques figurent au chapitre 2, et le chapitre 3 contient les étapes et les modalités de gestion des différentes catégories de déchets, et présente un aperçu des technologies d'avenir.

Source: http://publications.msss.gouv.qc.ca/msss/fichiers/2016/16-602-01W.pdf

A Review of Mercury Exposure and Health of Dental Personnel

Considerable effort has been made to address the issue of occupational health and environmental exposure to mercury. This review reports on the current literature of mercury exposure and health impacts on dental personnel. Citations were searched using four comprehensive electronic databases for articles published between 2002 and 2015. All original articles that evaluated an association between the use of dental amalgam and occupational mercury exposure in dental personnel were included. Fifteen publications from nine different countries met the selection criteria. The design and quality of the studies showed significant variation, particularly in the choice of biomarkers as an indicator of mercury exposure. In several countries, dental personnel had higher mercury levels in biological fluids and tissues than in control groups; some work practices increased mercury exposure but the exposure levels remained below recommended guidelines. Dental personnel reported more health conditions, often involving the central nervous system, than the control groups. Clinical symptoms reported by dental professionals may be associated with low-level, long-term exposure to occupational mercury, but may also be due to the effects of aging, occupational overuse, and stress. It is important that dental personnel, researchers, and educators continue to encourage and monitor good work practices by dental professionals.

Source: Nagpal, N., Bettiol, S. S., Isham, A., Hoang, H., & Crocombe, L. A. (2017). Safety and Health at Work, 8(1), 1-10.
http://doi.org/10.1016/j.shaw.2016.05.007

Risques biologiques en animalerie de recherche

La standardisation de la qualité sanitaire des animaux, l'évolution des métiers et des compétences des personnels et l'utilisation croissante des OGM ont modifié la caractérisation du risque biologique en animalerie de recherche.
Cet article fait le point sur ces notions nouvelles ainsi que sur les éléments utiles à l'évaluation des risques. Il détaille diverses mesures de prévention collective et individuelle à mettre en place et donne des éléments pour un suivi médical adapté.

Source: http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?ref=RST.TC%20157

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