Occupational Health (ICOH) ENVIRONMENTAL IMPACT ON WORKER HEALTH€¦ · Occupational Health (ICOH)...

32nd Triennial Congress of theInternational Commission onOccupational Health (ICOH)

Dublin, Ireland, 29th April to 4th May 2018

Opening Keynote Session

1759 THE IARC MONOGRAPHS AND THE BURDEN OFOCCUPATIONAL CANCER

1,2Kurt Straif. 1Section of Evidence Synthesis and Classification; 2International Agency forResearch on Cancer, WHO, Lyon, France

10.1136/oemed-2018-ICOHabstracts.1

This presentation will be about the triad of historicalinsights, scientific evidence and preventive action. By way ofintroduction, the history of chemical carcinogenesis (fromPott’s soot to the IARC evaluation of benzo[a]pyrene as aGroup 1 carcinogen based on a mechanistic upgrade) show-cases the important role of occupational carcinogens inunderstanding the causes of cancer and related paradigmshifts, primarily over the last century. Similarly, the historyof radiation carcinogenesis has significantly learned fromoccupational exposures and served as a foundation of envi-ronmental epidemiology.

The IARC Monographs programme is not only the longestrunning program of cancer hazard identification, it is also onthe cutting edge of the latest scientific developments. A shorthistory of the evolution of the program with a focus oncausal inference and changing contributions from the differ-ent scientific domains (cancer bioassays, epidemiology andtoxicology) will be followed by the latest developments interms of systematic review, key characteristics of carcinogens,high through-put/high content data, and quantitative riskcharacterisation. The integration of evidence streams into anoverall evaluation will be illustrated with a selectedcarcinogen.

The Monographs’ evaluations often serve as the basis forthe estimation of the burden of occupational cancer. Impor-tant milestones in burden estimates (from Doll and Peto,1981, to the ongoing joint WHO/ILO undertaking) will bepresented. These results are not for debates in an ivory towerof science, but here to inform public health actions, and par-ticularly a vision of zero occupational cancers. Data on theadverse economic impact of occupational cancer together withevidence that out-phasing of occupational carcinogens likeasbestos does not have negative economic impact will furthersupport implementation of control measures and should beemployed more often.

Finally, the presentation will name significant challenges onour roadmap, such as the need for better exposure data andexposure assessment, shift of funding to prevention researchincluding occupational cancer prevention, access to data forresearch and management of conflict of interests.

Plenary Sessions

1773 ENVIRONMENTAL IMPACT ON WORKER HEALTH –HONG KONG EXPERIENCE

1,2Tse Lap Ah (Shelly). 1Division of Occupational and Environmental Health, the Jockey ClubSchool of Public Health and Primary Care, the Chinese University of Hong Kong, Hong KongSAR, China; 2Center for Occupational and Environmental Health Studies, Faculty ofMedicine, Chinese University of Hong Kong, China


Worker health is determined not only by occupational hazardsbut also by environmental factors. Chronic diseases, such as car-diovascular diseases, cancer, chronic respiratory diseases and dia-betes are the leading causes of mortality worldwide, accountingfor almost two-thirds of all deaths. Chronic diseases have a mul-tifactorial etiology, such as only 10% of overall lung cancer inmen and 5% in women are attributable to occupational hazards,while a majority of etiology comes from smoking and otherenvironmental exposures. Many environmental exposures ofchronic diseases are common in workers, while some of themare related to job nature and working schedule, and these mayhave a large impact on worker health.

This presentation focuses on some common environmentalrisk factors among workers and discusses their impacts on bur-dens of chronic diseases based on Hong Kong experience, cover-ing the following topics (1) tobacco smoking and workplaceenvironmental tobacco smoke and health impacts (e.g., lung can-cer, metabolic syndromes); (2) environmental exposure tobisphenol A and health impacts (e.g., metabolic syndromes, pros-tate cancer); (3) changed sleep and diet patterns related to shiftwork schedule/long working hours and the health impacts basedon our ongoing prospective shift worker cohort in China andHong Kong breast cancer study. This presentation also empha-sizes the importance of integrating the prevention of chronic dis-eases and improving worker health with the promotion of ahealthy environment beyond the workplace.

1747 WHEN OCCUPATIONAL HEALTH BECOMES PUBLICHEALTH: OCCUPATIONAL LUNG DISEASE IN MINERS

Rodney I Ehrlich. School of Public Health and Family Medicine, University of Cape Town,South Africa


Despite a century of surveillance of silicosis and tuberculosisin the South African gold mining industry, black gold minerswere afflicted with a triple epidemic of silicosis, tuberculosisand HIV at the turn of the 21 st century. Fertile ground forthis new co-epidemic was provided by a migrant labour sys-tem that linked rural areas in South Africa and surroundingcountries with the gold mining industry. A surge in theemployment of miners and the stabilisation of employmentcontracts from the 1970s shifted the cumulative service curve,and hence silica exposure, upwards. Despite the availability oftreatment for tuberculosis, elevated rates of tuberculosis had

Abstracts

Occup Environ Med 2018;75(Suppl 2):A1–A651 A1

persisted in the industry, while the known relationshipbetween silica and tuberculosis had faded from memory. Thearrival of HIV, another cofactor for tuberculosis, in the 1980sfound a large population of men living in single sex accom-modation far from their families.

Understanding of this co-epidemic was also limited by themigrant labour system, which had resulted in two subpopulationsnumbering in the millions in dynamic association with each other.The first were those employed and thus under radiological, clinicaland post-mortem surveillance for lung disease, and subject to healthselection into and out of the industry. The other were ex-miners,dispersed through remote rural areas with poorly developed econo-mies and health services, to which the burden of mining relatedlung disease was shifted and whose health experience remained hid-den. The Southern African experience of silicosis and tuberculosisand related disorders holds lessons for other countries with activeand growing extractive industries. More generally it should alsodirect our attention to areas of the world dependent on large num-ber of migrant workers employed under harsh conditions, whosework related ill health is ‘externalised’ in various ways. Occupa-tional health needs to regain its public health perspective.

1748 THE IMPORTANCE OF WORKERS’ HEALTH TO ADVANCETHE UNITED NATIONS SUSTAINABLE DEVELOPMENTAGENDA

Gerry Eijkemans. Head of Country Office, Pan American Health Organisation/World HealthOrganisation, Mexico


Introduction The 2030 Agenda embraces the three dimensionsof sustainability – economic, social and environmental. It wasadopted by world leaders at the United Nations in September2015. The 2030 Agenda for sustainable development putspeople and planet at its centre and gives the internationalcommunity the impetus it needs to work together to tacklethe formidable challenges confronting humanity, includingthose in the world of work and for improved health for all.Discussion WHO has recognised that addressing social determi-nants of health – the conditions in which people are born, grow,work, live, and age, and the wider set of forces and systems shap-ing the conditions of daily life- are key for the creation of health;employment conditions are essential in this context.

When examining the situation and role of workers´ health inthe SDGs, we see that over the last years limited progress has beenmade; The latest ILO figures show that work-related fatal injuriesand diseases have increased from 2.3 million to 2.78 million peryear, increasing the global cost of the failure to adequately addressoccupational safety and health concerns to an estimated 3.94% ofglobal GDP per year, or 2.99 trillion US dollars. Roughly half theworld’s population still lives on the equivalent of about US$2 aday, and in many places, having a job does not guarantee the abil-ity to escape from poverty. This slow and uneven progress requiresus to rethink and retool our economic and social policies aimed ateradicating poverty.

The 2030 agenda seeks to reduce poverty and to increasingequity. Some specific SDG objectives are achieving UniversalHealth Coverage (still only 15% of workers worldwide haveaccess to specialised occupational health services) and achiev-ing full and productive employment and decent work for allwomen and men.

These are very ambitious goals; but they are essential and theyare feasible. But in order to meet those goals, the world needs to

focus on people, by implementing public policies that improveemployment conditions and health of workers, through a veryclose coordination among government agencies responsible forhealth, labour, social security and economic development,together with employers and workers´ organisations.

1749 CONNECTED WORKPLACE HEALTH, SAFETY ANDWELLBEING IN AN IRISH CONTEXT

John Gallagher. University College Hospital and University College, Cork


Irelands industrial heritage is often overlooked. Though not of thesame scale as our closest neighbour Ireland has a significant indus-trial past. The famine not only led to depopulation particularly ofrural areas but also to urban drift and the growth of factory labour.Early health and safety legislation focused on extractive, manufac-turing and transport industries. Modern Irish legislation has encom-passed the terms health, safety and welfare from its inception in1989. The practical focus has been on the safety component, areflection of preceding legislation. Over the last 10 years there hasbeen an increased focus on health and welfare and a move towardthe concept of wellness. The concept of Total Worker Healththough more established overseas and particularly in the UnitedStates, is a new arrival in Ireland. This approach attempts to inte-grate the functions of occupational health, health promotion, andhealth protection programs with the aim of improving employeehealth, minimising work-related injuries and illnesses, and reducingemployee health care-related costs. It has been embraced to varyingdegrees by different organisations and with varying levels of success.Prof Gallagher will discuss the reasons behind this and will look atsome recent evidence and case examples in Ireland. He will addresswhere occupational medicine fits into the concept of total workerhealth and how this may develop in the future. This has implica-tions for the discipline of occupational medicine which he will alsoaddress. Finally he will look at the challenges and opportunities ofconnected health approaches.

1683 PSYCHOSOCIAL CONDITIONS AFTER OCCUPATIONALINJURY

1,2,3Leon Guo, 4Judith Shiao, 1,2,3Weishan Chin. 1Environmental and OccupationalMedicine, National Taiwan University College of Medicine and Hospital; 2National Instituteof Environmental Health Science, National Health Research Institutes, Taiwan; 3OccupationalMedicine and Industrial Hygiene, National Taiwan University College of Public Health;4School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan


Introduction Annually in the world, more than 300 million nonfa-tal occupational accidents occur requiring at least 4 days ofabsence from work. Elevated psychiatric disorders and psychologi-cal symptoms are reported after occupational injuries. In addition,those with poorer psychological conditions had lower probabilityof returning to work, and those who with a disability of the upperor lower extremity tended to have higher mortality from self-harm in later life than did the general population. In cases ofsevere injury, a proportion of workers spent the rest of their lifesuffering from psychological ailments.Methods Using the available information on incidence rates ofoccupational injuries, and related psychological and psychiatricailments after occupational injuries, overall psychosocial

Abstracts

A2 Occup Environ Med 2018;75(Suppl 2):A1–A651

impacts as a result of occupational injuries are estimated,including psychiatric diseases, psychological symptoms, disabil-ity from work, and suicides.Result Psychiatric diseases worldwide are caused directly orindirectly by occupational injuries. The less severe forms ofmental consequences are psychological symptoms or preclinicalpsychiatric conditions. Significant percentage of permanent dis-abilities are caused by psychiatric conditions related to injuries.In addition, delayed return-to-work, i.e., longer duration oftemporary disability is found among injured workers with psy-chological symptoms. A special form of psychological/psychiat-ric condition, suicides and suicidal ideation are increasedamong injured workers. There are still limitations in this anal-ysis due to a great varieties of psychological outcomesobtained, and to lacking of epidemiological assessment ofthese conditions after occupational injuries.Discussion Generally, the psychosocial impacts of occupationalinjuries are greater than generally understood. In addition topreventing occupational injuries, secondary and tertiary pre-vention to minimise psychosocial impacts are warranted.

1755 ‘VISION ZERO’ – FOR A WORLD OF WORK WITHOUTFATAL AND SERIOUS ACCIDENTS

Hans-Horst Konkolewsky. International Social Security Association (ISSA) based in Geneva,Switzerland


There is a growing international consensus that efforts todevelop a global prevention culture should be reinforced inorder to reduce the unacceptably high number of work acci-dents and occupational diseases worldwide. It is at the sametime recognised that business performance is highly dependingon a healthy and motivated workforce.

The ISSA has on this background developed a new preven-tion concept, called ‘Vision Zero’, which is based on thebelief that all accidents and diseases at work can be prevented.The ISSA’s Vision Zero approach is flexible and can beadjusted to any workplace, company or industry.

A global Vision Zero campaign was launched at the XXIWorld Congress for Safety and Health at Work in September2017 in Singapore, which aims to mobilise business leaders tointegrate safety, health and well-being at work in their coremanagement function as well as company culture.

To this end the ISSA has developed a Vision Zero Guidethat outlines a roadmap with 7 Golden Rules to help improvea company’s safety and health performance as well as practicalchecklists and training materials.

More than 700 Companies and OSH-organisations frommore than 90 countries have since its launch joined the cam-paign as Vision Zero Companies or Partners.

1766 GENE-ENVIRONMENT INTERACTION: PROMISES ANDPITFALLS OF MOLECULAR EPIDEMIOLOGY ANDTOXICOLOGY IN OCCUPATIONAL HEALTH

A Mutti*. University of Parma, Parma, Italy


Most Gene x Environment (G×E) studies focused on poly-morphic variants in metabolism genes affecting metabolic

function of proteins that activate or detoxify exogenous andendogenous toxins. Examples include members of the cyto-chrome P-450 (CYP) superfamily of proteins, N-acetyltransfer-ase 2 (NAT2), and glutathione S-transferases (GSTs) that areimplicated in cancer, Parkinson disease (PD), and Alzheimerdisease. For example, long before the first familial PD genewas identified, the ‘poor metabolizer’ enzymatic phenotype ofthe cytochrome P450 2D6 (CYP2D6) gene was the first PDcandidate gene because the enzyme is active in the brainregion linked to PD, metabolises relevant endogenous neuralcompounds, and inactivates neurotoxins known to cause Par-kinsonism in animal models and humans. Many populationstudies have shown an increased risk of PD for CYP2D6 poormetabolizers compared with all other metabolizer types, andsome PD studies that include pesticide exposures also observedG×Es for poor-metabolizer variants of CYP2D6.

Incorporating individual susceptibility in risk assessment hasbeen a challenging endeavour as there is the problem of low statis-tical power when testing for G×E in studies designed to uncovermain effects of variables. There is also the problem of the com-plexity of measuring environmental exposures and the difficulty inassigning temporality, especially in case-control studies.

Other problems include the limited range of genetic and/orenvironmental variation, the redundancy of metabolic pathways,the limited scope of minor biotransformation reactions, scaledependence in the definition of statistical interaction, and a lack ofbiological data on the health impact of many genetic variants.

Risk management implying priority setting and soundresource allocation should rely on risk characterisation, whichin turn requires deep understanding of mechanisms of actionof individual risk factors and relevant dose-response relation-ships. Most often, however, primary prevention aimed at elim-inating exposure and hence also GxE remains the mostpragmatic approach and perhaps the most effective one.

1736 MIGRATION, WORK AND OCCUPATIONAL HEALTH ANDSAFETY

Alison Reid. School of Public Health, Curtin University


The number of people leaving their homes and crossingnational borders has increased in recent decades. Today, thereis an estimated 232 million migrants globally, half of whomwork, and this number is anticipated to continue to increase.The migrant workforce is mixed, containing young unskilledworkers, highly skilled and educated workers, and latterlyfemales. Migrant workers from developing countries have atendency to segment into jobs at the bottom and top of theoccupational hierarchy, whereas professional migrants habitu-ally move from one wealthy country to another. The literatureis mixed about whether migrant workers experience morework -related injuries than their native-born counterparts andlittle is known about their exposure to carcinogens and/orother workplace hazards and whether that varies with that oftheir native-born counterparts. Drawing on the findings fromthe international literature and several studies comparing expo-sure to workplace hazards between migrant and native-bornworkers in Australia, I will address why and how migrantworkers are vulnerable to adverse working conditions andhow this impacts on their occupational health and safety.

Abstracts


1761 TOTAL WORKER HEALTH1,2Bonnie Rogers. 1North Carolina Education and Research Centre and Occupational healthNursing Program; 2University of North Carolina, School of Public Health, Chapel Hill, NorthCarolina, USA


As defined by the U.S. National Institute for OccupationalSafety and Health, Total Worker Health

®

is defined as policies,programs, and practices that integrate protection from work-related safety and health hazards with promotion of injuryand illness prevention efforts to advance worker well-being.

Traditional occupational safety and health protection pro-grams have and continue to focus efforts on ensuring thatwork is safe and that workers are protected from work-relatedhazards and working conditions that arise from work itself.The Total Worker Health (TWH) approach seeks to improveworker well-being for the benefit of workers and employersby protecting safety and enhancing health and productivity. Asevidenced in research, work-related hazards and unhealthywork environments can contribute to or aggravate healthproblems experienced by workers such as, sleep disorders,stress, depression, and cardiovascular conditions.

The TWH approach integrates workplace interventions thatprotect worker safety and health with activities that advancethe overall well-being of workers through the establishmentand implementation of policies, programs, and practice. Thisincludes, for example, addressing hazard prevention and con-trol, work organisation and environmental supports, effectiveleadership, changing work and worker communities, fair andsupportive policies, and worker advocacy.

1760 CLIMATE VARIABILITY IMPACTS ON OCCUPATIONALHEALTH – RESEARCH EVIDENCE AND FUTURE STEPS

Vidhya Venugopal. Department of Environmental Engineering, Faculty of Public Health, SriRamachandra Medical College and Research Institute, Porur, Chennai, India


Introduction High-heat exposures at workplaces have particu-larly increasing adverse occupational health consequencesacross the globe, which will be an increasing problem as cli-mate change progresses. Working people with moderate orheavy work intensity in hot environments are at particularrisk especially in middle- and low-income tropical and sub-tropical regions, where protective workplace policies/optimalcontrols are not in place. This lecture presents evidence onoccupational heat stress in the context of climate change,reviews the current global status, and reflects on the healthimplications, presents an overview of the outcomes and thevery important next steps.Methods Epidemiological evidence from author’s seasonal stud-ies with workers engaged in moderate to heavy labour in~35 Indian workplaces collected over a 8 year period onoccupational heat exposures(n=~3500), self-reported heat-related health symptoms/productivity losses and physiologicaldata(n=~2000) were analysed to understand the level andextent of heat stress impacts.Results A significant number of workers (~82%) had heatexposures higher than the recommended WBGT (Avg.WBGTof 28.7°C±3.1°C). Workers exposed to chronic high-heat hadsignificant higher odds of adverse-health outcomes (OR=2.43,

95% CI: 1.88 to 3.13, p-value£0.0001) and productivity losses(OR=1.79, 95% CI: 1.32 to 2.4, p-value=0.0002). Abovenormal sweat rates, urinary specific gravities, rise in CoreBody Temperature and moderate dehydration were common,with compromised renal health prevalence high amongexposed workers in certain occupations. Climate Projectionsshow that future temperature rise to impose additional healthand productivity risks for workers, especially in hot seasons.Conclusion Current workplace exposure standards must berevisited and optimised for tropical settings and be consistentwith the approach of protecting workers against adverseeffects to health. In-depth research investigations on healthimplications of heat stress are an urgent need. Though reduc-ing workplace heat stress by interventions has multiple bene-fits, adaptation and mitigation measures including policychanges are imperative to tackle heat stress at workplaces inthe Climate Change future.

Semi – Plenary Sessions

1744 NOVEL DELIVERY MODELS FOR OCCUPATIONALHEALTH: RESPONDING TO THE HEALTHCARE WORKERSHORTAGE

1,2William G Buchta. 1American College of Occupational and Environmental Medicine;2Logistics Health, Inc. La Crosse, Wisconsin, USA


As healthcare becomes a recognised human right across theglobe, there is a commensurate demand for healthcare workersin all fields, including occupational health. However, currentmodels of healthcare delivery are not scalable to meet theneed, either in terms of funding or availability of healthcareworkers. In this semi-plenary presentation, we will confrontthe problem and explore existing and potential solutions tomeet that need, particularly the preventive services, surveil-lance, diagnostics, and treatment afforded to the working pop-ulation in all countries and cultures.

843 EMERGING PSYCHOSOCIAL WORK HAZARDS ANDEVOLVING POLICY ACTIONS: EXPERIENCES OF TAIWANAND OTHER EAST ASIAN COUNTRIES

Yawen Cheng*. Institute of Health Policy and Management, College of Public Health,National Taiwan University, Taipei, Taiwan


Psychosocial work hazards including prolonged working hours,heavy workloads, irregular work shifts, workplace bullying andviolence, precarious employment and income insecurity havebeen emerging occupational health concerns worldwide. Theseissues appear to be significant in the East Asian region, wherelong working hours are commonplace and extreme cases ofstress-related events such as sudden deaths, cardiac attacks andsevere mental disorders including depression and suicide haveplagued the workplace. In the first part of the talk, I will brieflyreview the development of work stress as a major policy concernin this region, and summarize epidemiologic findings concerningthe prevalence, social distribution and trends of major psychoso-cial work hazards as well as their safety and health consequences

Abstracts


for workers. Some culture-specific coping behaviors to combatwork-related fatigue such as the use of betel nuts, alcoholicenergy drinks and substances will be addressed. In the secondpart, I will describe policy-level intervention strategies whichhave been adopted in response to work stress in Taiwan andcompare that with policy actions adopted in other East Asiancountries. Unique features in terms of the nature of psychosocialwork environment and social attitudes and reactions towardwork stress from an international perspective will be explored.

1587 PREVENTION OF SLEEP DISORDERS AMONG SHIFTWORKERS AND DRIVERS

Pierluigi Cocco. Department of Medical Sciences and Public Health, University of Cagliari,Cagliari, Italy


Introduction Sleep is a vital function regulated by a circadianrhythm. Its restriction results in daytime sleepiness, which dis-rupts social life and affects behaviours that have survivalvalue, particularly for occupations requiring a high level ofalertness, such as shift workers and drivers.Methods Data from published reports and unpublished pre-liminary results will be used to illustrate the genetics of thesleep/wake cycle and the mechanisms underlying the healthconsequences of sleep loss.Result Shift-work can alter the sleep/wake cycle and the circa-dian rhythm of biological functions, which results in daytimesleepiness and disruption of social life. About 10% shift work-ers complain daytime sleepiness or insomnia, impairment intheir performance, and cardiovascular, digestive and neuro-psychiatric symptoms. Polymorphisms in genes expressing theproteins that regulate the circadian functions result in differentchronotypes with diverse capability of adapting to shift rota-tion schedules. Circadian genes also regulate the maintenanceof energy balance; sleep loss is a contributor to the develop-ment of metabolic disorders, which min turn, are a major riskfactor for obstructive sleep apnea syndrome (OSAS). Day timesleepiness is frequently consequent to OSAS, a major cause ofdeadly road accidents, and an occupational hazard for driversof commercial and public transport vehicles and commuters towork, but also for the general public. Early detection ofOSAS symptoms shall be part of health surveillance protocolsof workers in commercial and public transport trades.Discussion Several approaches are suggested to detect andmonitor daytime sleepiness and OSAS among shift workersand long haul drivers, including specific questionnaires, andbiomonitoring the salivary concentration of melatonin and cor-tisol level at a specific day time. A carefully designed biomoni-toring protocol would help to reduce the health burden ofsleep disorders and to save lives.

1588 EMERGENCY IN OCCUPATIONAL HEALTH: FROMPREPAREDNESS AND RESPONSE TO WELL-BEING?

1,2,3Alexis Descatha. 1AP-HP, EMS (Samu92), Occupational Health Unit, University hospitalof Poincare site, Garches, France; 2University Versailles St-Quentin, Versailles, France;3Inserm, UMS 011 UMR1168, F-, Villejuif, France


Many occupational practitioners have to face emergencies inoccupational setting, from life-threatening emergencies to cur-rent urgent care. Actually, workplace emergencies have singu-larities that usual emergency teams are not aware of – likeuse of hazardous substances, dangerous working conditions.Furthermore, responders and emergency professionals have toface to major hazards requiring prevention.

In the context of a new scientific committee created inICOH in 2015 about Emergency Preparedness and Responsein Occupational Health (EPROH), we aimed to take differentexamples to illustrate the importance for workers and popula-tion health and well-being, including emergency responders.Perspectives and challenges for next decades will be discussed.

1592 WORK STRESS, CAPITALISM AND THE IDEA OFPSYCHOSOCIAL SAFETY CLIMATE PSYCHOSOCIALSAFETY CLIMATE: CAUSES AND COSTS OFPSYCHOSOCIAL RISKS AT WORK

Maureen F Dollard. Asia Pacific Centre for Work Health and Safety, University of SouthAustralia, A World Health Organisation Collaborating Centre in Occupational Health,Adelaide, Australia


Introduction The driving beat of most modern societal struc-tures is economic rationalism under capitalism. Relentlessdemands for increased profits, performance and productivitycoupled with reduced resources, predispose workers to poorquality work conditions. In turn, poor quality work conditionscan lead to mental and physical ill-health, with significantcosts to organisations such as high rates of sickness absenceand reduced performance, and costs to society such as loss ofpotential labour supply and high rates of unemployment.Organisations characterised by a good psychosocial safety cli-mate (PSC) offer a point of resistance to these pressures.

Psychosocial safety climate concerns the value and prioritygiven to worker psychological health compared to productivityimperatives likely achieved through economic rationalistapproaches such as downsizing and lean structures. Far fromundermining productivity we expect that pro-social optionsembodied in high PSC organisations that value worker psycho-logical health will lead to better quality work options,increased meaningfulness, increased possibility for creativityand innovation, and reduced productivity costs associated withsickness absence and presenteeism. This presentation respondsto a public health priority and a call from the OECD to pre-vent and manage mental ill-health and promote health andwell-being by drawing attention to the connexion betweenwork and mental health.Methods Multilevel evidence from around the globe will bepresented to show that PSC precedes work quality (demands,resources) and the social-relational aspects of work (harass-ment and bullying, social support). Evidence supporting theexpansion of work stress theories to include national (e.g.,culture, legislation and regulation, corrupt values, welfareregimes, union representation), organisational (e.g., PSC) andteam level factors will be explored. International researchshowing the impact of PSC on working conditions, health andproductivity; cost estimates for improving PSC at work; PSCbenchmarks for job strain and depression; and implications forwork systems improvements will be discussed.

Abstracts


Results Evidence supports PSC as a ‘cause of the causes’ ofwork stress, and a theoretical precursor to many job design-based work stress theories.Discussion This presentation will discuss contemporary eco-nomic policies, work stress issues, PSC theory and evidence-based implications for organisations and national level, policy,practices and procedures for worker psychological health. Thepresentation will highlight how PSC affects working condi-tions, employee health and well-being, and organisational out-comes, with evidence from around the globe.

1726 FROM FRAGMENTATION TO A HOLISTIC VIEW OF THEWORKING LIFE: CHALLENGES, POSSIBILITIES ANDSOLUTIONS

Pauli Forma. Keva, Helsinki, Finland


The working life is changing significantly especially due totechnological development. Among the most important techno-logical drivers are digitalization, development of artificial intel-ligence and increasing role of the platform economy. Thesetrends have substantial impact on the different areas of theworking life. Entire industries will be under disruption, skillsand competencies needed in different occupations are going tochange and totally new occupations and job functions will becreated. The development also has many consequences to theoccupational safety and health. Improving occupational safetyand health has always been based on data and cumulatedknowledge. However, technological development and changingworking life is going to change the utilisation of the data.Challenges as well as possibilities can be identified here.When it comes to challenges, first, the relevant data is frag-mented. At the national level, different institutions, organisa-tions and authorities have data concerning some part of theworking life. Different data-sets can include information onwork disability, work accidents, occupational health or well-being at work. Due to this fragmentation, the picture concern-ing the working life is incomplete. The second challenge isthat the traditional data and classifications may be inadequate.For example, new categories of employment (e.g. platformworkers) are created and traditional datasets do not provideinformation on their risks, work ability and wellbeing. Wemight even need a totally new segmentation model for theoccupational safety and health. Third, we lack data concerningthe new risks on occupational safety and health due to digital-ization and other aspects of the changing working life.

However, possibilities can also be identified. Because of thedigitalization, data is produced in almost every action we takebefore, during and after the working day. This data can berelated for example to working hours, productivity, wellbeing,health, stress and recovery. In a way, the entire ‘digital work-ing day’ can be measured and this information can be used toimprove occupational safety and health. Sources for this typeof data can be HR-systems, registers, platforms and employ-ees’ own devices (My Data). Thus, in addition to traditionaldata-sources we have to use also new sources of data onoccupational safety and health. It is also evident that due todigitalization we have more tools to analyse the data. When itcomes to solutions, the Finnish project ‘National Working LifeIndicators’, which tries to overcome these challenges and ben-efit these possibilities, will be demonstrated. The aim of the

project is to provide near online information concerning theFinnish working life and occupational safety and health. Inthe project, relevant data focusing on different aspects of theworking life will be collected to one data-base. Both tradi-tional data-sources and big data will be used. Based on thedata, key-indicators describing development of the Finnishworking life will be identified. The data-base will include tra-ditional data (e.g. survey-data and registers) as well as ‘bigdata.’ The portal makes it possible for the different stakehold-ers to access the data through the dashboard. The aim of thedatabase is to support decision-making, research and improv-ing occupational safety and health.

1764 THE ROLE OF EDUCATION AND TRAINING TO SUSTAINAND DEVELOP AN OCCUPATIONAL HEALTHWORKFORCE FOR THE BENEFIT OF WORKING PEOPLE

1,2John Harrison. 1National School of Occupational Health, Health Education England,London, UK; 2Business School, Brunel University, Uxbridge, London, UK


Introduction The world of work in the twenty-first centurypresents a number of challenges to occupational health practi-tioners. Why should organisations invest in occupationalhealth provision? What are the political, economic and socialdrivers and how will changes in technology and the environ-ment influence the competencies and composition of futureoccupational health workforces? Education and training mustprepare practitioners for practice that is relevant and market-able to improve the reach and efficacy of occupational health,as well as underpinning attractive careers. This talk willreview work that is on-going to address these issues.Methods Consideration of different initiatives globally, withparticular reference to work in the United Kingdom regardingthe development of a multidisciplinary occupational healthworkforce.Discussion Education and training must address structural dif-ferences in occupational health provision, as described in thebasic occupational health services model. Future occupationalhealth workforces will be multidisciplinary and viewed holisti-cally as part of a public health provision. Wellbeing at workis contingent on assessing and meeting a hierarchy of work-place and organisational needs and practitioners will need therequisite competencies to meet market demands. Considerationis necessary as to how established training provision will adaptto deliver accessible, timely, affordable and effective educa-tional resources.

1738 NATIONAL SURVEY OF WELLBEING OF HOSPITALDOCTORS IN IRELAND

1,2Blanaid Hayes. 1Dean, Faculty of Occupational Medicine, Royal College of Physicians inIreland, Dublin, Ireland; 2Consultant Occupational Physician, Beaumont Hospital, PO Box1297, Dublin, Ireland


Introduction Doctors’ wellbeing is increasingly attracting theattention of researchers. It is of interest of itself and becauseof its potential impact on the health of others. In the wakeof the global recession of the past decade, Ireland dramaticallycut its healthcare expenditure resulting in significant staff

Abstracts


shortages at a time of growing population, more challenginghealthcare delivery and increased societal expectation. This hascreated a highly challenging psychosocial environment forhealthcare workers. Consultants feel undervalued and are con-cerned about the quality of care they provide. They perceivecare to be thwarted by managers being reactive and notfocused on longterm planning. As well as feeling undervalued,trainees too have concerns about the quality of care they pro-vide and they struggle to manage both service and trainingdemands.Method Utilising validated questionnaires, a national cross-sec-tional survey of hospital doctors, undertaken in 2014, soughtresponses from consultants and trainees working in the sector.The response rate was 55%.Results Hospital doctors in Ireland had higher levels of psy-chological distress than elsewhere. They also had significantsymptoms of depression and anxiety as well as high levels ofburnout and occupational stress. Self-stigma in relation tomental illness was more common in doctors than in the gen-eral population. However, current desire to practice remainedhigh.Discussion The high levels of personal and workplace distressidentified in this study suggest that much needs to be done tohighlight the importance of doctors’ wellbeing in this country.Self-stigmatisation is likely a barrier to early identification andtreatment of mental health problems. Post-graduate trainingbodies have already begun to address these issues with traineeand trainer members. Occupational health services have a keyrole to play in ensuring appropriate access to care and indetermining necessary workplace restrictions and/or supportsfor this group.

1756 OCCUPATIONAL HEALTH AND EPIDEMIOLOGICALMETHODS RESEARCH: CHALLENGES ANDOPPORTUNITIES

Jain Rajiv Kumar. Vice President, Association of Environmental and Occupational Health-Delhi


Purpose It is widely accepted that there is definite need forstrengthening research in developing, validating and refiningepidemiological methods for application in OccupationalHealth, if preventive strategies have to be devised on actualevidence. There is need to further identify and manage thechallenges and also diffuse the opportunities available for col-laboration in conducting research in Epidemiological Methodsfor Occupational Health.Review and discussion Developing improved methods for expo-sure assessment, statistical analysis, studying migrant workersand other vulnerable populations, the use of biomarkers, andnew hazards provide challenges and opportunities.

Issues of challenges due to lack of validated statistical tools,complexity of ethical considerations, lack of training in occu-pational epidemiological methods, non-clarity in methods foraccurate determination of proportion of disease/diseases attrib-utable to occupation, shifting of hazardous industries fromdeveloped to developing countries, lack of collaboration mech-anisms with veterinary epidemiologists, lack of participatoryresearch, effective and appropriate communicating tools, pre-ventability paradox and maintaining public health perspectiveto ensure proper population perspective, shall be discussed.

Conclusion and outcome Opportunities for developing, nurtur-ing, financing and implementing local, regional and global col-laboration through fair, transparent, democratic andparticipative consortiums/forums/alliances of people, civil soci-ety and public and private institutions and Governments, inthe field of epidemiological methods research shall beexplored and discussed. A case for germinating an Institute ofOccupational Health Metrics and Evaluation in a developingcountry environment shall be built upon.

46 DEVELOPMENT OF OCCUPATIONAL HEALTH NURSINGASSESSMENT TOOLS FOR INDIVIDUAL AND GROUP/ORGANISATION

Keiko Kono. Research Centre for Occupational Health Nursing, Yokkaichi Nursing andMedical Care University/Japan


Introduction In order to provide high quality activities inoccupational health (OH) nursing, it is essential to assess theworker and the group/organisation. However, these kind oftools have not been available until we developed the OHnursing assessment tools. Methods we have developed theassessment tools for both individual and group/organisation bythe task force consisting of 17 OH nurses from 2000 through2014. In the development of the tool for Individual, we basedon the frame work of North American Nursing DiagnosisInternational (NANDA I), and for group/organisation wereferred to the Community as Partner Model by Andersonand the Hanasaari Conceptual Model which was developed inthe 1 st International Symposium on OH Nursing Educationin Finland in 1988.Results The tool for Individual has been divided into 13domains with a face sheet. By using the face sheet, we cancapture work/life style history of individual effectively. The 13domains consist of Health Promotion, Nutrition, Elimination,Activity/Rest, Perception/Cognition, Self-Perception, Role Rela-tionships, Sexuality, Coping/Stress Tolerance, Life Principle,Safety/Protection, Comfort and Growth/Development. The toolfor group/organisation has been comprised 8 core items (Com-pany Outline, Organisation Outline, Constitution of theWorker, Human Resources/Labour Management/Education,Culture, Labour Condition, Health Status and Safety/Health),which directly related with the worker belonging to thegroup/organisation, and 5 sub-items (Administration, Economy,Environment, Social Resource and Traffic), which will be indi-rectly related with the worker.Conclusion These tools are useful to catch the informationabout workers and their surroundings including labour stand-point. As the result, currently many OH nurses in Japan uti-lise these tools in daily work that can help them to assess theworker holistically and to assess the group/organisation com-prehensively and systematically.

1732 KNEE ARTHROPLASTY AND THE UNFORESEEN IMPACTON WORK

Paul FM Kuijer. Academic Medical Centre, University of Amsterdam, Coronel Institute ofOccupational Health, People and Work Outpatient Clinic, Amsterdam Public Health researchinstitute, Amsterdam, the Netherlands


Abstracts


Introduction Total knee arthroplasty (TKA) is increasinglybeing performed among working patients suffering from kneeosteoarthritis. As the retirement age is rising and more work-ers are being overweight or obese, a further increase isexpected in the upcoming decade. Unfortunately, limited disor-der-specific evidence is available for clinicians to support thesepatients in return to work (RTW). This semi-plenary providesan interactive overview, using quiz-questions, of what weknow now and how to guide these workers to secure a timelyand sustainable RTW.Methods Questions that will be addressed are: how manypatients do RTW after TKA?, which TKA patients should bereferred to work-directed care?, which work-related knee-demanding activities improve most after TKA?, what do work-ers expect from TKA before surgery?, do orthopaedic sur-geons and occupational physicians provide the same answersregarding prognosis for RTW?, and what kind of vocationalrehabilitation is effective for RTW?.Result Two quiz-questions are already answered.

First, based on a systematic review, 71%–83% of TKApatients in working age returned to work: so 2 to 3 out of 10did not. The average time varied from 8 to 12 weeks althoughlarge differences were noted. Second, the Work, Osteoarthritisor joint-Replacement Questionnaire (WORQ) was used to assessthe self-perceived difficulty performing 13 work-related kneedemanding activities like kneeling, lifting, and working withhands below knee height. Patients who benefitted most fromTKA are those whose work involved operating a vehicle or whohave a job which requires periods of standing or walking onlevel ground.Discussion In the upcoming decade, more TKA patients will haveto RTWafter surgery, and expect sound advice and guidance fromtheir physician. Given the limited evidence available and the largegroup of workers involved, effective interventions to secure atimely and sustainable RTW should be developed.

1734 UTILISING DIGITAL MEDIA: WHERE ARE WE NOW,WHERE ARE WE GOING AND WHY SHOULD WE CARE?THE GOOD, THE BAD AND THE REALLY UGLY

MR Lum. National Institute for Occupational Safety and Health, Washington, DC, USA


This presentation will address the following key factors: Howdo we best use the new digital technology to deliver ourOSH information for engagement and impact?; What techni-ques and strategies actually work and how do we know?;What might the future look like and how are we adapting?Digital Media is at the very heart of the Fourth IndustrialRevolution, changing our approach to communication andincreasing the delivery of information with exceptional speedto our audiences. Digital technology is evolving faster thanorganisations can adapt. It is a fate that challenges mostorganisations in almost every industry. Digital technology hasexploded and is being continually modified especially since thenew millennium. We find ourselves skyrocketing into anentirely new world of communication and information sharing.We now reach out and connect to our friends, family and co-workers virtually instantaneously with the touch of a few but-tons. This new constant connexion has fundamentally changedthe way we interact with each other and our target audiences.Because of continual digital modifications we must be agile

and alert to utilising better strategies and techniques to deliverinformation to improve decision making by our citizens intheir working environment not only for today but also for theunforeseeable future.

This presentation using globally derived data will discuss theuse of a variety of the most popular digital communication plat-forms from Facebook and Twitter to Wikipedia, their internationaleffect on Search Engine Optimisation (SEO) and their potentialimpact for extending the global reach of our OSH health informa-tion and expanding the engagement with both health professionalsand the general public. This presentation has been organised tohighlight the good, and the not so good challenges we face in theadvanced digitization environment.

The good:

. The promise of Increased reach of our information withminimal cost and effort;

. The opportunity for closer global collaboration ofinformation generation;

. Easy to use digital impact and engagement measures; and

. A proven mechanism to reach the ever increasingindependent work force.

The not so good:

. A lack of imagination and strategy, coupled withunpredictability and poor data quality:

. A lack of agility and insufficient encouragement towardsinnovation: and

. A lack of pertinent competencies and insufficient strategies toovercome consolidation by information generators whosealgorithms tend to favour sensationalism over science,fabricated news over facts and are increasingly monetized adsover meaningful content.

These challenges will be addressed by a selection of casestudies which highlight mechanisms and strategies to overcometransformational barriers in the digital environment.

1763 THE DEVELOPMENT OF A STATE-WIDE FRAMEWORKFOR THE PREVENTION AND MANAGEMENT OF WORK-RELATED MUSCULOSKELETAL DISORDERS: A WESTERNAUSTRALIAN EXPERIENCE

J Mangharam, ES Chew, L Coubrough. Human Factors and Ergonomics Team, Work Safe,Western Australia, Australia


Introduction In Australia, work-related musculoskeletal disor-ders (WMSD) is a workplace condition that has been priori-tised to be addressed at state and national levels. The costand burden associated with musculoskeletal disorders workers’compensation claims in Western Australia (WA) as a result ofbody stressing and slips, trips and falls is high and accountsfor approximately 60% of claims. Time trends have demon-strated that on average, each WMSD claim has become moreexpensive and led to longer periods off work.

Preventing and managing WMSDs are complex, owing tothe interaction of multiple risk factors, including workplacephysical, workplace psychosocial and individual risk factors.An array of primary, secondary and tertiary prevention levelinterventions such as ergonomic intervention, risk manage-ment, wellness programs, early and appropriate clinical inter-vention and return to work rehabilitation programs have been

Abstracts


tested. Wide scope public health influencers exist in severalforms, including education, stakeholder partnership and legisla-tion. Collectively, the complexity of this problem indicates thatpublic health strategies for this condition require a multidiscipli-nary and multifaceted approach that should be sustained over aperiod of time. Musculoskeletal models of care and frameworksthat have been developed by multiple stakeholders at statewidelevels have been shown to be of value. This talk will describe theprocess of developing such a framework through surveys andfocus groups for the state of Western Australia.Methods Key stakeholders for WMSDs in WA were initiallyidentified and placed in a network database. These comprisedof government agencies, employer and employee groups, spe-cial interest groups, professional bodies, key academics, indus-try peak bodies and the insurance sector. Surveys and focusgroups were held across Western Australia over a 3 monthperiod. The primary aim of the qualitative data collection wasto gain an understanding of the views of key stakeholders inrelation to the prevention and management of work-relatedmusculoskeletal, particularly their believes of the risk factors,facilitators and barriers for success and their views of currentpolicy and legislation associated with this condition.Results Information collected demonstrated that a high propor-tion of key stakeholders viewed this as a significant state-wideissue. The views of key stakeholders in relation to risk factors,barriers and facilitators for the prevention and management ofthis condition varied across the stakeholder groups and trendscould be identified within and between stakeholder groups.Results show the interconnection between these stakeholdergroups and the potential value of systematic and organisedinformation sharing and staged collaborative intervention.Conclusion The development of a state-wide framework forWMSDs requires an understanding of the evidence behind themultifaceted interventions, and a staged and consultativeapproach to achieve ownership and confidence in the stake-holders and implementers of the framework.

1743 HEALTH OF WORKING CHILDREN: BEYOND WORKPLACEHAZARDS

Iman Nuwayhid. Professor and Dean, Faculty of Health Sciences, American University ofBeirut, Beirut, Lebanon


Introduction Globally, hundreds of millions of childrenyounger than 18 years of age are reported to be working indangerous jobs and worst forms of child labour with exposureto a myriad of hazards. However, in our assessment of thehealth and wellbeing of these children, we invariably tend todismiss the factors that have pushed these children in the firstplace to work, especially in hazardous occupations. This pre-sentation puts child labour in perspective and explores hazardsbeyond the workplace.Methods A review of the relevant literature on exposures andhealth of working children and a reflection on my personal experi-ence and observations of the issue of child labour in Lebanon.Results Many papers have been published on the exposure ofworking children to physical, chemical, biological, safety, andpsychological hazards at the workplace. There is a dearth ofresearch in the health domain on the complexity of childlabour and its social and political determinants, especially inthe context of war and conflicts.

Discussion Are we realistic about our goals and targets in thejourney to eliminate or control child labour? Who are ourpartners on this path? How do we deal with child labour inthe context of refugees and conflicts?

51 GLOBAL WARMING AND OCCUPATIONAL HEAT ANDHOT ENVIRONMENT STANDARD IN THAILAND

Wantanee Phanprasit, Kannikar Rittaprom, Vorakamol Boonyayothin. Dept. of OccupationalHealth and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand


Introduction The current occupational exposure to heat andhot environment standard of Thai law was issued in 2006.The wet bulb globe temperature (WBGT) index was definedfor 3 workload levels without a work-rest regimen. To assessheat exposure according to the law, workload and WBGT ismonitored for 2 hours during the hottest period of the day insummer. As has been predicted, global warming could signifi-cantly impact labour capacity and productivity in SoutheastAsian countries. Thus, this study aimed to explore whetherthe occupational standard could protect outside workers focus-ing on construction workers in Thailand.Methods This cross-sectional study included 18 medium andsmall construction sites and involved 90 heat acclimatised con-struction workers. Most wore cotton long sleeve shirts andpants. Heart rate (HR) and Aural (tympanic) temperature ofthe participants were recorded continuously for 2 hours.Exposure data comprised relative humidity, wind velocity andWBGT, including dry bulb, wet bulb and globe temperatures,were monitored and the participants’ workloads were esti-mated, simultaneously with the collection of physiological andenvironmental data, i.e. March to June. In addition a ques-tionnaire was used to collect data of the participants.Result WBGT ranged from 24.35–34.18°C, and 47 participantswere exposed to WBGT exceeding the standard. Average airvelocity and RH were 1.11 m/s and 35.77%, respectively. Therange of average core body temperature and HR for 3 levelsof workload were 36.60–39.4°C, 70–97 bpm, 36.62–39.58°C,80–126 bpm and 37.04–40.08°C, 82–127 bpm respectively.Core body temperature of 29 of 47 participants exposed toheat above the standard exceeded 38°C, among these 11 hadsymptoms of heat related illness. In all, 18 participants wereexposed to heat below the standard but their core body tem-peratures were higher than 38°C.Discussion The weather was hot and dry with occasional goodair movement. However, 32% of construction workers workedin high risk conditions (WBGT above the standard). Further-more, 18 (20%) participants worked in an environment belowthe standard but their body core temperatures exceeded 38°C.Thus, this group of workers was not protected by thestandard.

973 HEALTHY AGEING, HEALTHY WORK: A GLOBALPERSPECTIVE ON THE HOME CARE WORKFORCE

Margaret Quinn. University of Massachusetts Lowell, Lowell, USA


Introduction By 2030 one billion people worldwide will be 65years of age or older. While populations in industrially-

Abstracts


developed countries are ageing rapidly, the most dramaticincreases are occurring in developing countries. Because mostelders prefer to be cared for at home, these profound demo-graphic shifts are driving a global need for home care (HC)at an unprecedented rate. As a result, HC aide jobs areamong the fastest growing occupations and yet their occupa-tional safety and health (OSH) experience is nearly invisible.The Safe Home Care Project at the University of Massachu-setts, Lowell USA, funded by the US National Institute forOccupational Safety and Health, was established to protectand promote the OSH of the HC workforce.Methods We used mixed methods ranging from focus groupsto large scale OSH questionnaire surveys, microbiology fieldstudies, and laboratory experimental studies of chemical, bio-logic, and biomechanical hazards. These studies were per-formed among HC aides and elders who are HC recipients.Results HC aides experience numerous OSH hazards similarto hospitals and nursing homes: back injuries from patient lift-ing; needlestick injuries; respiratory irritant exposures fromcleaning and disinfecting; and serious encounters with violencefrom patients or family members. Aides also experience haz-ards not seen in institutional settings: exposure to second-hand smoke, risk of fire from patients smoking cigaretteswhile on oxygen, patients re-using needles for injections andstoring them improperly, and lack of medical equipment forpatient lifting. Overall, we found that high quality care deliv-ery depends significantly on HC aide safety.Discussion HC aides need OSH protections. Despite OSHchallenges, the great majority of aides report high job satisfac-tion due to meaningful relationships with patients and familiesand to the relative autonomy compared to institutional carework. Interventions should enhance these beneficial aspects ofHC work as well as improve OSH.

1765 SEED SAFETY AND HEALTH WHEN RUSHING TO HELP1,2,3Michael Riediker, 4Magda Stepanyan. 1IOM (Institute of Occupational Medicine)Singapore, Singapore, Singapore; 2School of Materials Science and Engineering, NanyangTechnological University, Singapore, Singapore; 3Institut universitaire romand de santé autravail, University of Lausanne, Epalinges, Switzerland; 4The Risk Society, Den Hague, TheNetherlands


Introduction Helping local populations develop economic inde-pendence is an important aspect of international developmentprogramming, and can be critical for longer-term resiliencebuilding after major natural disasters. When teaching newskills and methods, one needs to make sure that:

1. those teaching the skills stay healthy while on site, and2. that the new workforce learns about the essential elements of

workplace safety and health (WSH) so that they stay healthywhile becoming economically more stable.

Methods The principle to keep both, trainers and trainees safeand healthy during a training and later on is universal. How-ever, many of these interventions happen in ill-controlled sit-uations with many other concerns such as security andadministrative challenges related to the exceptional situation.Furthermore, many well-intending teams perceive the situa-tions as ‘emergency’. Combined with the hesitance to be ‘bet-ter treated’ than the locals, this can lead to them acceptingand taking more risks than they would accept at home.

Result Trainers need to plan how to recognise and teach goodsafety and health practices in situations where they don’t haveaccess to sophisticated or expensive measures. They can set anexample to the local population by using WSH methods thatare adapted to the specific risks of the solutions. They needto be simple and cheap so that they can later be applied bythe locals. Trainers need to emphasise the importance of WSHto prevent the creation of long-term health problems.Discussion Once development partners and emergency respond-ers understand these WSH-challenges, they can plan for them. It isimportant to train all stakeholders in how to include WSH aspects.Also donors need to understand the importance of WSH so thatthey can accept, if not even demand that WSH is given importancealso from a perspective of value for money.

1591 MY TRUTH IS BETTER THAN YOURS – HOW TO FIGHTBACK IN THE AGE OF ALTERNATIVE FACTS

Jani Ruotsalainen. Cochrane Work Review Group, Finnish Institute of Occupational Health inKuopio, Finland


Apparently we live in the time of post-truth and alternativefacts. However, we do not have to take this lying down.What we, the scientific community, can offer is a viable alter-native, meaning real facts. There are two things that are crit-ical in this: what to do when faced with outright lies oropinions parading as facts and what to offer in their place.The key to both issues is bias. Alternative facts consciouslyignore biases and their effects. Somehow a personal gut feel-ing just trumps scientific reasoning. The best thing we can dois to accept the existence of biases and to try and minimisetheir effects in what we do. One way to do this is by meansof systematic review. It is a means of abstracting a higherlevel of truth from multiple scientific studies that each exam-ine a similar issue. Whilst synthesising their results and formu-lating overall conclusions, one explicitly displays the biasesaffecting both the existing research (what others have done)and the process of synthesis (what you do to combine theresults of the studies in one conclusion).

For example, a Cochrane review found high quality evi-dence that the use of blunt needles appreciably reduces therisk of exposure to blood and bodily fluids for surgeons andtheir assistants over a range of operations. High quality evi-dence means that the finding is not significantly affected bybiases in the evidence or in the process to combine theirresults. Future research is unlikely to change this conclusion.Conversely another Cochrane review found very low qualityevidence that bullying behaviours may be prevented in theworkplace. Future research is very likely to change this con-clusion. Know thyself and be open about your failings. Thatis a sound basis for true facts.

1590 THE ROLE OF EPIDEMIOLOGICAL RESEARCH IN THEPREVENTION OF OCCUPATIONAL ILL HEALTH

Lesley Rushton. Imperial College London, London, UK


Introduction Concerns about occupationally-related diseasesthat are rare in the general population have provided an

Abstracts


impetus for the development of epidemiological research (thestudy of the distribution and causes of disease in human pop-ulations) into the adverse health effects of the workplace.Methods There are numerous epidemiological studies of spe-cific industries, occupations and workplace ‘exposures’, fromchemical, physical and biological agents to ergonomic factorsand psychosocial stressors. These are usually observational indesign and ‘classical’ intervention studies are much rarer.Occupational epidemiology plays an important role in identify-ing and quantifying risks and understanding the aetiology ofdisease and makes important contributions towards

i. risk and health impact assessment,ii. setting standards/limits in workplaces and the general

environmentiii. provision of evidence for compensationiv. estimation of the burden of occupational disease to society.

Results Epidemiological studies of current risks from pastexposure have directly informed strategic workplace riskreduction programmes and campaigns and production of guid-ance and practical interventions for stakeholders. Togetherwith mechanistic information they contribute to occupationalexposure limit (OEL) setting. More recent studies illustrateprediction modelling of the impact of reduction of OELs andr strategies such as improving compliance. Results from epide-miological studies are also incorporated into economic evalua-tions of risk options and this in turn has been important indecision making e.g. in the choice of EU OELs. Internationalepidemiological studies can demonstrate important differencesacross nations in workplace exposures, resulting health conse-quences and use/lack of prevention measures.Discussion Occupational epidemiology thus plays a vital rolein increasing awareness of occupational disease and enumerat-ing the impact of adverse working conditions and exposures.The occupational health community should continue to pushfor increased education on occupationally related ill-health,encourage routine collection of occupational data and, ofcourse, persuade organisations to fund appropriate research.

1589 INFECTIONS IN THE WORKPLACE: IDENTIFYINGPROBLEMS AND APPLYING RESEARCH TO PREVENTION

Mary Ross. School of Public Health, University of the Witwatersrand, Johannesburg, SouthAfrica


Introduction Infections are the only occupational diseases that canbe transmitted from one worker to another. Although workplaceand community-acquired infections have a long history of affect-ing health and productivity, from miners’ ‘consumption’ and sea-farers’ plague to influenza and Ebola, occupational infections havebeen under-recognised, under-reported and under-researched. Inmost workplace settings, infectious diseases have not received thesame attention as physical, chemical and psychosocial challenges.Similarly, workplaces have generally been underutilised in the pre-vention and control of infections. However, epidemics in the 21 stcentury have evoked attention not only from the occupationalhealth fraternity, but also from employers, workers and the mediaseeking policies and procedures to prevent and manage infectionin the workplace.Methods Selected infections and their impact in various occu-pational settings are explored to illustrate the challenges of

their identification and management, as is the interfacebetween public health and occupational health surveillance,research and interventions. The unique nature of infectiousagents as an occupational hazard is considered, while long-standing and new public health research and strategies for pre-vention are evaluated in an occupational context.Discussion A major challenge for research and prevention ismeasuring occurrence, morbidity or mortality from occupation-ally-acquired infections, especially when exposure in the work-place is not always recognised. Primary preventioninterrupting the transmission cycle of micro- organisms com-prises a variety of interventions that are implemented concur-rently rather than in a hierarchy of control, while secondaryprevention for affected individuals, becomes effective primaryprevention for others. To date, even for health care workers,who dominate global research and interventions related tooccupational infections, success has been somewhat limited tobetter resourced workplaces. It is vital for the focus to extendbeyond the workplace in collaboration with public health careto promote research, recognition, prevention and managementof infectious diseases for all workers.

1730 WORKING TOO MUCH, ANYWHERE AND AT ALL TIMES– WORKERS’ HEALTH IN OUR CONTEMPORARYCOMMUNICATION SOCIETY

Lucia Rotenberg. Fiocruz, Oswaldo Cruz Institute, Laboratory of Health and EnvironmentalEducation, Rio de Janeiro, Brazil


The advancement of information and communication technolo-gies (ICT) has changed spatial and temporal dimensions ofwork. Currently, in several occupations, there is a blurring ofthe boundaries between professional and private life, thus pro-viding access to workers at any time of the day or night. Thispresentation will deal with consequences of ICT to workers’health and well-being, including the supplemental work fromhome, intensification of work, and the intrusion of work intoindividuals’ personal life, affecting work life balance. Besides,the presentation will focus the phenomenon of constant con-nexion and its relation to a general feeling of time scarcity,also with implications to well-being. The view of organisationsthat care about working conditions, such as the Eurofoundand the International Labour Office, will also be addressed, aswell as policies to protect workers, such as the so-called ‘rightto be disconnected’ recently implemented in France.

1746 OVERVIEW OF THE CURRENT STATE OF KNOWLEDGEABOUT THE HEALTH EFFECTS OF NANOMATERIALS

Paul A Schulte, Charles L Geraci, Eileen D Kuempel. National Institute for OccupationalSafety and Health, Cincinnati, OH, USA


Introduction It has been close to 20 years that engineerednanomaterials have entered commerce. There are tens of thou-sands of types of nanomaterials that have been produced andthe hazard potential varies across them. Some may be hazard-ous and some not. The last decade of research has begun toidentify important determinants of ENM toxicity but there isstill much uncertainty about hazard potential. It is useful to

Abstracts


attempt to sort out what currently is known and not abouthazards of ENMs.Methods The scientific literature from 2000–2017 was assessedusing keywords and environmental scanning techniques to cap-ture information about the health effects of ENMs. The focuswill be on high volume ENM.Result The extent of research health effects that have beenidentified for various high volume ENMs will be described.While many nanomaterials have been developed there are alimited number that are widely used in commerce. Commondeterminants of toxicity will be identified.Discussion Assessing the hazard potential of ENM is a com-plex task since there are so many combinations of physio-chemical parameters that may lead to ENMs having differen-tial toxicity. The implications of this will be discussed as wellthe research needed to address the hazard potential of engi-neered of nanomaterials that are or could be in commerce.

1745 AIR PNEUMO: AN ACADEMIA-BASED QUALITYASSURANCE OF PHYSICIANS’ PROFICIENCY IN READINGCHEST RADIOGRAPHS OF PNEUMOCONIOSIS

Narufumi Suganuma. Department of Environmental Medicine, Kochi Medical School, KochiUniversity, Nankoku, Japan


Introduction Early detection of the disease, by routine standardchest X-ray, is one of the essential measures for secondary preven-tion. ILO has provided the guideline for radiographs reading forpneumoconioses according to the ILO classification to support themedical screening test and clinical purposes. The aim of this articleis to describe the history and concept of the AIR Pneumo.Methods Asian Intensive Reader of Pneumoconioses (AIRPneumo) is a quality assurance program to train and certifyphysicians who works for prevention of pneumoconises, whichis one of the major occupational health problems worldwide.The system is useful for epidemiological research, screeningand surveillance of high-risk workers, diagnosis and compensa-tion. Because of variability of reading by physicians, someorganisation, e.g., US NIOSH, has developed the certificationtesting, called B –reader.Result Since its first Bangkok workshop in 2006, AIR Pneumohas conducted 17 workshops 6 times in Thailand, 4 times inBrazil, twice in Japan, and one in each in Philippines andIndia. As Bangkok workshops invited international participants,most of physicians from ASEAN countries and D.R. Congohas attended the workshops.Discussion The classification system holds its uniqueness inpossessing standard radiographs that show profusion 0 to 3for each types of small opacities, large opacities and pleuralabnormalities. By using standard radiograph side-by-side to thesubject radiographs that physicians are reading and classifying,higher inter reader agreement can be achieved. Understandingand using the classification properly demands certain amountof training. In accordance with WHO/ILO Global Programmefor Elimination of Silicosis, ILO has been encouraging GPESparticipating nations to educate physicians to increase profi-ciency of reading radiographs of pneumoconioses. The AIRPneumo, an academia based quality assurance of physiciansproficiency in reading pneumoconiosis radiographs is sustain-able approach with active involvement of local experts inGPES participant nations.

39 APPLYING HUMAN FACTORS TO PROMOTE A POSITIVESAFETY CULTURE

Anna-Maria Teperi. Finnish Institute of Occupational Health, Helsinki, Finland


Introduction Safety management has traditionally been based ontechnical solutions and regulations. Although these traditionalsafety methods are still needed, they do not necessarily raise realsafety levels. A prerequisite for improving safety is proper safetymanagement, implemented by people who create and maintainsafety through vigilance, competence, communication and groupwork, if the organisational structures around them support thishuman success. In this review, I summarise the research anddevelopment processes implemented in 2000–2017 to improvethe safety, efficiency and well-being of organisations, from theaspect of human factors (HF) with safety critical domains.Methods In 2000–2017, we conducted interviews, questionnairesand interventions among operative personnel, management andexperts in the nuclear industry and the aviation, railway, and mari-time sectors. Both business and authorities were represented. TheHF tool was designed and modified for each field and the userexperiences are presented here. The HF tool consists of a singletool, material for HF training, techniques for analysing cases atwork, and proceedings for corrective actions. Its aim is to promotea positive safety culture.Result The HF interventions helped the organisations handleincidents more transparently, giving way to more open discus-sions on demanding situations at work. The HF tool becamemore of a philosophy, with which to highlight and understandhuman performance at the individual, work, group and organ-isational level, also taking successes into account. It helpedconcreticise cognitive, work and organisational psychology as afacilitator of safety.Discussion The HF tool promoted Safety-II thinking, whichhas recently been actively discussed as a safety paradigm shift,but has lacked the concrete tools to transform it from scien-tific debate to practice.

1758 6TH EUROPEAN WORKING CONDITIONS SURVEY: JOBQUALITY IN EUROPE

Agnès Parent-Thirion, Isabella Biletta, Jorge Cabrita, Oscar Vargas, Greet Vermeylen,Alksandra Wiczynska, Mathijn Wilkens. Eurofound, Dublin, Ireland


Introduction The Union and Member states shall have as theirobjectives improved living and working conditions (article 151of the TFEU). More and better job is an important policyobjective for the European Union.Methods Statistical analysis of the 6th European Working Condi-tions Survey. In 2015, the Sixth European Working Conditions Sur-vey interviewed almost 44 000 workers in 35 European Countries.Result Seven job quality indices are produced which at thelevel of the job, gathers these characteristics of work andemployment that have been associated in positive or negativewith health and wellbeing of workers. The job quality indicesare: physical environment, social environment, work intensity,working time quality, skills and discretion, prospects and earn-ings. They are presented and discussed. Each index is associ-ated with a positive experience of working life in health andwell being, work life balance, engagement and motivation,financial security. The job quality indices are pooled together

Abstracts


to create cluster of jobs in Europe on the basis of the jobquality: high flyers, smooth running, active manual, underpressure, poor quality. They are presented and discussed.Discussion Results support the importance of monitoring jobquality in Europe and in the world. How can they be improved?

1723 WORKERS’ COMPENSATION AND SOCIAL SECURITYSYSTEM AND OCCUPATIONAL INJURIES

JU Won. Yonsei University College of Medicine, Seoul, Korea


Worker’s compensation is different for each country accordingto their histological and cultural background and socioeco-nomic status. The number of workers and the kind of diseasescovered by worker’s compensation differs for each countrydepending on approval criteria and degree of worker’scompensation.

It has close relationship with social security system of eachcountry. Therefore, it is important to understand various situa-tions when using worker’s compensation statistics or compar-ing with other countries. We compared and analysed worker’scompensation and social security systems of South Korea,Japan, Germany and US, and studied the correlation betweensocioeconomic status and worker’s compensation statistics ofOECD countries. Occupational injury rate of South Korea isnot high compared to Japan, Germany or US, but fatal injuryrate is significantly high. This is presumably related to under-reporting and the under- reporting is in relation with socialand political situations of Korea. US shows very high ratio ofmusculoskeletal diseases including sprains and strains, whileGermany shows lower ratio. This seems to be related withpaid sick leave of each country. South Korea, Japan and Tai-wan have almost identical approval criteria for cerebrovasculardiseases, but approval rate is exceptionally high in SouthKorea. This is because of high application ratio due to thefact that the all cerebral haemorrhage cases during work werecompensated as occupational diseases in South Korea in thepast. For developing countries trying to benchmark othercountries’ worker’s compensation system, should consider notonly the workers’ compensation system, but also other socialsecurity systems and the socioeconomic status.

44 THE QUALITY AND GOVERNANCE OF OCCUPATIONALHEALTHCARE SERVICES IN SOUTH AFRICA: WHATLESSONS FOR UNIVERSAL HEALTH COVERAGE?

1,2Karen E Michell, 2Laetitia Rispel. 1Concept Safety Systems cc, Johannesburg, South Africa;2School of Public Health, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa


Introduction The 2015 United Nations sustainable develop-ment goals have underscored the importance of universalhealth coverage (UHC), a healthy, well-educated workforceand compliance with international occupational health andsafety standards. This paper draws on key findings of a doc-toral research study to explore the [dis] connexions betweenquality, governance and models of occupational health service(OHS) delivery in South Africa. Within the context of UHC,

the paper will highlight key recommendations emerging fromthe study.Methods The Human Research Ethics Committee providedethics approval. The research used a combination of methods,which included a review of occupational health (OH) legisla-tion and policy documents; in-depth interviews with 12 keyinformants; 11 focus group discussions in three South Africanprovinces, and a web based survey of OHS practitioners. Weused thematic content analysis to analyse the qualitative dataand STATA to analyse the web based survey.Results The study found diverse models of OHS delivery inSouth Africa, of varying quality, with an excessive focus onphysical examinations to achieve legal compliance. Further-more, OHS occupy a relatively low priority on the healthreform agenda and are delivered in a fragmented and complexlegislative framework. These quality and governance problemsare exacerbated by a perceived lack of employer emphasis onOH, insufficient human and financial resources, and lack ofspecific quality of care standards for OH. The survey foundthat external assessment of OHS is associated with improvedcompliance with relevant legislation.Discussion Improvement in the quality and governance of OHSdelivery is essential to realise South Africa’s quest for UHC. Whilethe exact nature and form of external assessment needs to bedetermined, there is need for nationally agreed upon standards forthe delivery of OHS, implemented through a cohesive structurewhich is cost effective, sustainable, and mandatory without mar-ginalising small to medium service providers.

1772 PROMOTING A POSITIVE PSYCHOSOCIAL WORKENVIRONMENT: INDIVIDUAL, ORGANISATIONAL ANDSOCIETAL BENEFITS

1,2Stavroula Leka. 1Centre for Organizational Health & Development, University ofNottingham; 2ICOH Scientific Committee ‘Work Organization & Psychosocial Factors’


The psychosocial work environment underpins every organiza-tion's operations and concerns psychological and social dimen-sions of the work environment relevant to aspects of workorganization, design and management, and interpersonal rela-tionships. Despite often viewing the psychosocial work environ-ment as something new, the way we organise our work and howwe work with others are issues that are as old as work itself.What has brought about an increased focus on the psychosocialwork environment is the accumulating evidence on the negativeoutcomes of poor management in terms of potential harm toemployee health, safety and well-being, poor organizational per-formance with associated negative societal impacts.

Efforts have been made over the past decades to promote a pos-itive psychosocial work environment and mental health and well-being in the workplace. These include interventions both at thepolicy and at the organizational level. This presentation will con-sider the action framework so far implemented to address the psy-chosocial work environment across the world. It will discussdifferences across countries and highlight priorities to beaddressed. It will showcase successes and good practice examples.

Taking the overall state of the art in this area into considera-tion it will identify necessary actions both in relation to policyand practice for necessary progress to be achieved. These willspecifically consider evolution in knowledge, technology, andsociety that has brought about inevitable changes in our working

Abstracts


practices and experiences. It is important to develop systems thatallow us to forecast and document these changes and enable usto implement appropriate actions to respond and adapt appro-priately to these changes, learning from past experiences. It willalso be highlighted that it is important to promote comprehen-sive approaches that address not only potential negative impactsbut also positive outcomes and synergistic effects across severalpolicy and organizational interventions.

9 OCCUPATIONAL HEALTH ASPECTS OF EMERGINGINFECTIONS – SARS OUTBREAK AFFECTINGHEALTHCARE WORKERS

1,2David Koh*. 1Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam;2National University of Singapore, Singapore


Introduction The risk of occupationally acquired infectionsamong healthcare workers (HCWs) has been recognized forhundreds of years. Examples include HCWs managing patientswith infections and infestations ranging from tuberculosis toscabies. In the past two decades, HCWs have faced an esca-lated threat of deadly emerging infections such as SevereAcute Respiratory Syndrome (SARS), Avian Influenza, MiddleEast Respiratory Syndrome (MERS) and Ebola.Methods This presentation will cover first-hand experiencesgained during the SARS outbreak in 2003 in Singapore. Asurvey of 15,025 HCWs was conducted in Singapore duringthe outbreak, to study perceptions of the risk of SARS infec-tion and work-related as well as non-work related problemsfaced by HCWs as a result of the outbreak.Results Worldwide, over 8,422 cases and 916 deaths werereported from 29 countries, and HCWs comprised 21% of cases.In Singapore, HCWs managed 238 cases of SARS and accountedfor about 40% of the cases. A total of 10,511 HCWs in Singapore(70%) responded to the survey. There was fear of the deadly dis-ease and HCWs faced both work as well as non-work relatedproblems as a result of SARS outbreak.Discussion Among the insights gained during the SARS out-break were the following:

1. SARS was a grim reminder that health care work can behazardous;

2. the effects of SARS extended beyond the infection, to impactcolleagues and families of HCWs;

3. General principles for prevention and infection control wereeffective against SARS; and

4. SARS posed both a public health and an occupational healththreat.

Given these perspectives gained and lessons learnt, weshould hopefully be better prepared when faced with similarscenarios in the future.

21 UNDERSTANDING ADMINISTRATIVE REGULATION ONOCCUPATIONAL HEALTH IN CHINA

Zhijun Zhou*. Department of Occupational Health and Toxicology, School of Public Health/MOE Key Lab for Public Health Safety, Fudan University, Shanghai, China


Introduction With the explosive economic growth and socialdevelopment, China has caught the worldwide attention.Under such high speedy industralization, more internationalprofessionals start to pay close attention to occupational man-agement system. This article tries to give some information inthis aspect.Methods The laws, regulations and standards related to occu-pational health in China were collected in the official web-sites, specifically at web of National Health and FamilyPlanning Commission (NHFPC, the former Ministry ofHealth, www.nhfpc.gov.cn) and the web of State Administra-tion on Work Safety (SAWS, www.chinasafety.gov.cn). Themajor contents of these laws or regulations and current practi-ces were introduced.Results The two important laws in China are the Law on Pre-vention and Control of Occupational Diseases and the WorkSafety Law, in which the responsibility of employer, employee,the governmental agencies, the authorized occupational healthservice agency and other stakeholder have been described.NHFPC and SAWS, jointly with other related Departments,issued two important classified catalogues, namely, the Cata-logue of Occupational Hazards; and the Classification andCatalogue of Occupational Diseases. Except for ensuring thesafety and health workplaces, more work on both workingenvironment monitoring/evaluation and health surveillance arerequired for employers. NHFPC and SAWS have issued a ser-ies of regulations and standards to ensure these work areproperly implement. However, the occupational health prob-lem in China seems still serious, not all enterprises did followthe requirements and the level of occupational hazards atsome workplaces was not compliant with OELs, even theworking environment is very poor in small-scale industries.Conclusion The Chinese government should take great effectto enforce the employers to observe the laws and regulations.There is needed improvement of the Integrity and the system-aticness of occupational health management system, while theeconomic is growing and governmental administrative structureand function is reforming.

Accident Prevention

1718 ACCIDENT PREVENTION IN PRACTICE OR RI

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