Occupational safety and health considerations of returning to work after cancer

Increasing numbers of people undergo a return to work (RTW) after a cancer diagnosis and treatment. Although there is evidence available in relation to managing the RTW process, at the current time, there is limited information available in relation to any safety and health issues associated with this process. Using a systematic review and organisational case studies, this project aimed to understand the health and safety implications of returning to work or staying in work during treatment, to identify what employers can do to facilitate this process for cancer survivors and to develop guidance for IOSH from the work carried out. The systematic review identified that understanding the potential changes in individual capacity (both physical and mental) are essential, as are the role of the line manager, being able to offer flexibility in returning to work, and understanding that the process can be long term. The case studies aimed to identify good practice and found that different aspects can impact on the RTW or continuation to work, including using risk assessments of work tasks rather than job roles, and considering the impact of physical and psychological demands. Different factors need to be considered within the risk assessment, including the impact of fatigue, risks of infection, work planning and breaks in the working day, the inclusion of emergency planning, and flexibility in start times or workplace. The work has also highlighted a number of evidence gaps, including: the lack of an evidence base for safety, health or ergonomic interventions; a lack of information in relation to manual workers and their RTW needs; a lack of information on those who have had to change jobs or on their future employability; and a need for more in-depth, longer-term research. Content for an IOSH OH Toolkit on RTW after cancer was also produced as part of this work

Indoor exposure to selected air pollutants in the home environment : a systematic review

(1) Background: There is increasing awareness that the quality of the indoor environment affects our health and well-being. Indoor air quality (IAQ) in particular has an impact on multiple health outcomes, including respiratory and cardiovascular illness, allergic symptoms, cancers, and premature mortality. (2) Methods: We carried out a global systematic literature review on indoor exposure to selected air pollutants associated with adverse health effects, and related household characteristics, seasonal influences and occupancy patterns. We screened records from six bibliographic databases: ABI/INFORM, Environment Abstracts, Pollution Abstracts, PubMed, ProQuest Biological and Health Professional, and Scopus. (3) Results: Information on indoor exposure levels and determinants, emission sources, and associated health effects was extracted from 141 studies from 29 countries. The most-studied pollutants were particulate matter (PM2.5 and PM10); nitrogen dioxide (NO2); volatile organic compounds (VOCs) including benzene, toluene, xylenes and formaldehyde; and polycyclic aromatic hydrocarbons (PAHs) including naphthalene. Identified indoor PM2.5 sources include smoking, cooking, heating, use of incense, candles, and insecticides, while cleaning, housework, presence of pets and movement of people were the main sources of coarse particles. Outdoor air is a major PM2.5 source in rooms with natural ventilation in roadside households. Major sources of NO2 indoors are unvented gas heaters and cookers. Predictors of indoor NO2 are ventilation, season, and outdoor NO2 levels. VOCs are emitted from a wide range of indoor and outdoor sources, including smoking, solvent use, renovations, and household products. Formaldehyde levels are higher in newer houses and in the presence of new furniture, while PAH levels are higher in smoking households. High indoor particulate matter, NO2 and VOC levels were typically associated with respiratory symptoms, particularly asthma symptoms in children. (4) Conclusions: Household characteristics and occupant activities play a large role in indoor exposure, particularly cigarette smoking for PM2.5, gas appliances for NO2, and household products for VOCs and PAHs. Home location near high-traffic-density roads, redecoration, and small house size contribute to high indoor air pollution. In most studies, air exchange rates are negatively associated with indoor air pollution. These findings can inform interventions aiming to improve IAQ in residential properties in a variety of settings

Assessment of the fit and wearability of commercially available KN95 respirators for children in Indonesia and Nepal

The purpose of this study was to determine how well KN95 respirators, marketed for children, fit the faces of children aged 6–13 years old in two urban sites with elevated levels of air pollution: Kathmandu, Nepal and Bandung, Indonesia. The wearability of the tested respirators and the children's style preferences were also assessed.Sixty children, 30 in each country, were recruited and were fit tested with three different ear loop respirators in two combinations (with and without an additional adjustable ear loop clip worn around the head). The fit factor for each respirator was determined using a modified fit test protocol for filtering face piece respirators using a TSI PortaCount™ Respirator Fit Tester 8048. Facial dimensions were measured using callipers. The wearability of the respirators and children's style preferences were assessed through questionnaires administered after the fit tests.Most fit factors were less than 10, i.e. less than 90 % reduction in exposure. In both countries, using an additional ear loop clip was associated with increases in fit factor of 42 and 50 % for Indonesian and Nepalese respirators, respectively. There were no significant differences among the respirators for any of the perceptions: comfort, feeling hot, breathability, fit, embarrassment or appearance for either country. The appearance of the respirator was important to the children. Although the use of an additional ear loop clip improved the fit, the respirators were generally too large for the children's faces to achieve a good fit. Respirators marketed for children should be better designed to suit their facial dimensions

INTEGRA: From Global Scale Contamination To Tissue Dose

The objective of the INTEGRA project is to bring together all information necessary for assessing the source-to-dose continuum over the entire life cycle of substances covering an extensive chemical space through the use of QSARs. The major outcome of INTEGRA is a comprehensive computational platform that integrates multimedia environmental and micro-environmental fate, exposure and internal dose within a dynamic framework in time. The platform allows multimedia interactions across different spatial scales, taking into account environmental releases and related processes at global, regional and local scale, up to the level of personal microenvironment. Coupling seamlessly exposure models with refined computational tools for internal dosimetry transforms risk assessment of environmental chemicals since it allows risk characterization to be based on internal dosimetry metrics. In this way high throughput system data such as the ones generated by Tox21 in vitro testing can be used. This opens the way towards a higher level of assessment that incorporates refined exposure (tissue dosimetry) and toxicity testing (Biological Pathway Altering Dose – BPAD) associated to environmental contamination at different scales. The applicability of INTEGRA was tested on bisphenol-A. Tier 1 assessment (environmental releases based on production volumes, worst case exposure estimates and a Tolerable Daily Intake of 50μg/kg_bw/d) indicated that specific exposure scenarios (i.e. bottle fed neonates and premature infants hosted in intensive care units) are close to the legislative thresholds. The refined assessment incorporating probabilistic analysis, actual environmental release data, detailed consumer exposure modelling and the use of BPAD as risk characterization metric, resulted in increased margins of safety compared to conventional risk assessment

Factors Affecting Childhood Exposures to Urban Particulates (FACE-UP) WP2

The Factors Affecting Childhood Exposures to Urban Particulates (FACE-UP) project aims to reduce the lifetime vulnerability of urban children, particularly in Indonesia and Nepal, to noncommunicable diseases (NCDs) by reducing childhood exposure to particulate air pollution through suitable personal interventions (https://face-up-consortium.webspace.durham.ac.uk). This project contains the dataset from work package 2 which investigated how well KN95 respirators, marketed for children, fit the faces of children aged 6-13 years old in two urban sites with elevated levels of air pollution: Kathmandu, Nepal and Bandung, Indonesia. The wearability of the tested respirators and the children’s style preferences were also assessed

Exposure assessment of tetrafluoroethylene and ammonium perfluorooctanoate 1951-2002

Objectives: To develop a method to reconstruct exposure to tetrafluoroethylene (TFE) and ammonium perfluorooctanoate (APFO) in plants producing polytetrafluoroethylene (PTFE) in the absence of suitable objective measurements. These data were used to inform an epidemiological study being carried out to investigate possible risks in workers employed in the manufacture of PTFE and to study trends in exposure over time. Methods: For each plant, detailed descriptions of all occupational titles, including tasks and changes over time, were obtained during semi-structured interviews with key plant personnel. A semi-quantitative assessment method was used to assess inhalation exposure to TFE and inhalation plus dermal exposure to APFO. Temporal trends in exposure to TFE and APFO were investigated. Results: In each plant the highest exposures for both TFE and APFO occurred in the polymerisation area. Due to the introduction of control measures, increasing process automation and other improvements, exposures generally decreased over time. In the polymerisation area, the annual decline in exposure to TFE varied by plant from 3.8 to 5.7% and for APFO from 2.2 to 5.5%. Conclusions: A simple method for assessing exposure was developed which used detailed process information and job descriptions to estimate average annual TFE and APFO exposure on an arbitrary semi-quantitative scale. These semi-quantitative estimates are sufficient to identify relative differences in exposure for the epidemiological study and should good data become available, they could be used to provide quantitative estimates for all plants across the whole period of operation.</p

Occupational dermal exposure to nanoparticles and nano-enabled products:Part I − Factors affecting skin absorption

The paper reviews and critically assesses the evidence on the relevance of various skin uptake pathways for engineered nanoparticles, nano-objects, their agglomerates and aggregates (NOAA). It focuses especially in occupational settings, in the context of nanotoxicology, risk assessment, occupational medicine, medical/epidemiological surveillance efforts, and the development of relevant exposure assessment strategies. Skin uptake of nanoparticles is presented in the context of local and systemic health effects, especially contact dermatitis, skin barrier integrity, physico-chemical properties of NOAA, and predisposing risk factors, such as stratum corneum disruption due to occupational co-exposure to chemicals, and the presence of occupational skin diseases. Attention should be given to: (1) Metal NOAA, since the potential release of ions may induce local skin effects (e.g. irritation and contact dermatitis) and absorption of toxic or sensitizing metals; (2) NOAA with metal catalytic residue, since potential release of ions may also induce local skin effects and absorption of toxic metals; (3) rigid NOAA smaller than 45nm that can penetrate and permeate the skin; (4) non rigid or flexible NOAA, where due to their flexibility liposomes and micelles can penetrate and permeate the intact skin; (5) impaired skin condition of exposed workers. Furthermore, we outline possible situations where health surveillance could be appropriate where there is NOAA occupational skin exposures, e.g. when working with nanoparticles made of sensitizer metals, NOAA containing sensitizer impurities, and/or in occupations with a high prevalence of disrupted skin barrier integrity. The paper furthermore recommends a stepwise approach to evaluate risk related to NOAA to be applied in occupational exposure and risk assessment, and discusses implications related to health surveillance, labelling, and risk communication

Indoor Exposure to Selected Air Pollutants and Associated Health Effects: A Global Review

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