The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden. Several hundred occupational agents, mainly allergens but also irritants and substances with unknown pathological mechanisms, have been identified as causing work-related asthma. The essential message of these guidelines is that the management of work-related asthma can be considerably optimised based on the present knowledge of causes, risk factors, pathomechanisms, and realistic and effective interventions. To reach this goal we urgently require greatly intensified primary preventive measures and improved case management. There is now a substantial body of evidence supporting the implementation of comprehensive medical surveillance programmes for workers at risk. Those workers who fail surveillance programmes need to be referred to a clinician who can confirm or exclude an occupational cause. Once work-related asthma is confirmed, a revised risk assessment in the workplace is needed to prevent further cases. These new guidelines confirm and extend already existing statements and recommendations. We hope that these guidelines will initiate the much-needed research that is required to fill the gaps in our knowledge and to initiate substantial improvements in preventative measures.
Smoking and occupational exposure to welding fumes are both associated with an increased risk of CB.
Objectives Many women experience absence periods from work during pregnancy. Several single risk factors for absence are identified, whereas the impact of multiple concurrent exposures has been sparsely studied. We hypothesized that the presence of multiple occupational exposures would be associated with an increased risk of absence from work during pregnancy. Methods We included women from the Danish National Birth Cohort (1996-2002), pregnant with one child and working ≥30 hours/week at interview (mean gestational week 17 (standard deviation 4.0); N=50 142). Information about five occupational exposures (job demands, job control, work posture, work shift, lifting) were retrieved from the interview, each assigned values of 0/1, and summed into an index (0-5). The woman's first absence from work (both regular and related to pregnancy) after the interview was available from a nationwide administrative register. We analyzed data with Cox regression using gestational age as the underlying time-variable. Results Few women experienced none of the occupational exposures (3.6%) and most experienced two exposures (34.7%). Only 24.3% of the women were absent from work before gestational week 31. The number of occupational exposures was associated with an increasing risk of absence. The adjusted hazard ratio for absence increased from 1.3 [95% confidence interval (CI) 1.1-1.5] for one exposure to 2.9 (95% CI 2.5-3.3) for four to five exposures compared to no occupational exposure. Conclusion The higher the number of potentially adverse occupational exposures pregnant women experienced, the higher the risk for absence from work during pregnancy.
We found substantial agreement between job-exposure-matrix-derived exposure estimates according to DISCO-88 codes based on self-reported job-titles and registered in the Danish Occupational Cohort with eXposure data (DOC*X), with respect to airborne, mechanical, and physical exposures. Substantial agreement was also found between the two sets of DISCO-88 codes. The results are promising with respect to future studies based on the DOC*X.
Objective To assess whether exposure can be reduced by providing feedback to the farmers concerning the levels of dust that they are daily exposed to in their farm. Methods The personal dust levels of farmers in 53 pig and 25 dairy cattle farms were evaluated in 2 measurement series performed approximately 6 months apart. Detailed information on technical parameters and farm characteristics were also registered. Participating farms were a priory randomly divided into a control (n = 39) and an intervention group (n = 39). Shortly after the first visit, farm owners in the intervention group received a letter with information on the measured dust concentrations on their farm together with some general advises on exposure reduction strategies (e.g. use of respirators during certain tasks). Relationships between measured dust concentrations and intervention status were quantified by means of linear mixed effect analysis, with farm id as a random effect. Season, type of farming, visit, intervention status and their two-way interactions were tested as fixed effects. Results After adjustment for season and farm type we found no effect by intervention status. There was no interaction by type of farm, but measured dust levels on the second visit were significantly lower than during the first visit. Similar results were observed in models stratified by type of farming, where the effects of visit were most clearly observed among pig farms. Conclusion These preliminary findings suggest no interventional effects on the levels of exposure; though, the presence of the investigation itself seems to reduce the levels of exposure. By June 2013, the authors intend to present the above results along with those from further analysis addressing potential changes in working patterns and hygienic parameters during the second exposure evaluation.
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