Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017

BackgroundThe global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years.MethodsWe used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury.ResultsGlobally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change.ConclusionsWhile road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2.5 air pollution, 1990-2019 : An analysis of data from the Global Burden of Disease Study 2019

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2.5 air pollution, 1990-2019 : an analysis of data from the Global Burden of Disease Study 2019

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2.5 originating from ambient and household air pollution.Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2.5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure-response curve from the extracted relative risk estimates using the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2.5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2.5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals.Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2.5 exposure, with an estimated 3.78 (95% uncertainty interval 2.68-4.83) deaths per 100 000 population and 167 (117-223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13.4% (9.49-17.5) of deaths and 13.6% (9.73-17.9) of DALYs due to type 2 diabetes were contributed by ambient PM2.5, and 6.50% (4.22-9.53) of deaths and 5.92% (3.81-8.64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2.5.Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2.5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: A systematic analysis for the global burden of disease study 2017

© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings: In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), age-standardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation: Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. Funding: Bill & Melinda Gates Foundation

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe

Analysing Work Environment and Chemical Risk Factors for Occupational Exposure to Pesticides in Horticulture

Problem statement Exposure to pesticides in agriculture constitutes a major occupational and public health concern. Worldwide, it has been estimated that over a billion people work in agriculture, and most use pesticides to protect their crops from insects and other pests. Every year, occupational exposure to pesticides has been associated with more than 385 million poisoning cases, over 200,000 deaths, and a range of adverse health outcomes. Greenhouses are enclosed structures with unique work environment characteristics, and the implication of these factors for occupational exposure to pesticides is a major area of interest. The use of personal protective equipment (PPE) such as gloves is among the key interventions to minimise pesticide exposure in greenhouses. The selection of suitable gloves remains a challenge and the chemical protection performance of gloves may be dependent on work environment factors such as temperature, which is of increasing concern in a warming climate. Organophosphate (OP) insecticides are among the most widely used classes of pesticides and the skin is the primary route of occupational exposure in horticulture. Thus, there is a need to understand dermal exposure and the glove permeation potential of this class of pesticides. Dermal exposure assessments used for pesticide regulatory decisions have focused mostly on the active ingredients (AI), largely ignoring the fact that workers in real-life encounter commercially available formulated products and the potential role of formulation coingredients. Gap analysis The following four research gaps were identified through reviewing the literature evidence addressed in this research. 1. Greenhouses have some unique characteristics that set them apart from traditional open field farms. However, little is known about the implications of these greenhouse characteristics and the interactions therein on occupational pesticide exposure. 2. Although different chemical-resistant gloves are recommended for handling pesticides in horticulture, the comparative performance of these gloves in warm to hot conditions is understudied. 3. Apart from work environment factors, physicochemical and formulation attributes of the pesticide product itself may influence dermal exposure as well as permeation through chemical resistant gloves. However, the nature and extent of dermal exposure and the relevance of physicochemical properties and skin permeability models in predicting dermal absorption of pesticides from commercial formulations remain unclear. 4. Although pesticides are often complex mixtures of one or more AI and several coingredients, most in vitro dermal exposure assessment studies have only focused on the AI. Very little is known about the role of formulation co-ingredients on dermal absorption and glove permeation potential of the active insecticides. Purpose statement The overarching purpose of this research is to understand how work environment and chemical risk factors influence occupational exposure to pesticides in horticulture. There are two primary aims of this research: 1) A critical literature review attempts to examine how greenhouse characteristics influence occupational exposure to pesticides, and 2) A series of laboratory-based experimental studies set out to understand the nature and extent of dermal exposure and glove protection against OP insecticides as commercial formulations. General research questions 1) What is the evidence on the risk factors of occupational exposure to pesticides in greenhouse work environments? 2) What is the significance of temperature and pesticide formulation factors in determining the extent of dermal exposure and glove protection performance against OP insecticides? Methodology A combination of a critical literature review and a series of laboratory-based experimental studies were conducted to answer the above research questions. These are summarised below. Critical literature review (Study 1) The critical literature review followed the “Work”, “Worker” and “Workplace” conceptual framework. The search strategy, the screening, and appraisal processes identified 71 relevant literature sources for the review. These research articles were categorised into four groups based on what each studied. 1. Studies that described pesticide exposure scenarios in greenhouses (n=38), 2. Studies that analysed the effect of “Work”, “Worker” and “Workplace” factors on pesticide exposure (n=20) 3. Studies that investigated pesticide fate and behaviour in greenhouses (n=8) 4. Studies that compared exposure between greenhouses and open farms (n=5) Laboratory-based dermal exposure and glove permeation studies (Studies 2, 3, and 4) Permeation studies (in vitro human skin and test cell glove permeation) were performed using OP insecticides selected on the basis of their common use in Australia. For all experiments, permeation tests involved at least two concentrations of OP insecticides: Spray dilution strength and mixing concentrate strength. These experiments informed the following three discrete but related studies. Study 2: Effect of temperature on comparative protection performance of gloves - A glove permeation study - Three glove materials: polyvinylchloride (PVC), nitrile butadiene rubber (NBR), and nitrile/neoprene (NN) - Two OP insecticides formulations: dimethoate and malathion - A range of temperature conditions: 25-60°C. Study 3: Dermal absorption of OP insecticides as formulations - In vitro human skin permeation study - Four OP insecticide formulations: acephate, dimethoate, malathion, and diazinon - Three skin permeability models (Potts & Guy, Mitragotri, and IHSkinPerm) were evaluated. Study 4: The role of formulation co-ingredients in dermal exposure to OP insecticides - In vitro human skin and glove permeation study - One glove material: PVC - Two OP insecticides - Dimethoate: pure and two commercial formulations (one with xylene and the other without xylene) Omethoate: pure and two commercial formulations with the main difference being the presence of the co-ingredient propylene glycol methyl ether acetate (PGMEA). - Temperature conditions: 37°C for skin and 35°C for glove experiments Major findings This research analysed the risk factors for occupational pesticide exposure in horticulture and the main findings are broadly discussed in two parts. In part 1, the influence of Work Environment risk factors such as greenhouse characteristics and temperature on occupational exposure to pesticides and glove protection performance is discussed. Part 2 outlines how Chemical risk factors (i.e. physicochemical properties and formulation co-ingredient compositions of pesticides) influence dermal absorption and glove protection. PART 1-WORK ENVIRONMENT RISK FACTORS Greenhouse work environment and pesticide exposure The critical literature review revealed a number of exposure modifying factors in greenhouses, which are broadly discussed within the “Work”, “Worker”, and “Workplace” conceptual framework. Workplace The greenhouse work environment is characterized by its enclosed nature, tight space, dense plant arrangements, and controlled micro-climatic parameters including light, humidity, temperature, and ventilation. The critical literature review revealed two mechanisms in which these greenhouse Workplace factors influence pesticide exposure parameters. Firstly, Workplace factors directly influence pesticide exposure parameters such as the fate, distribution, and availability of pesticides in greenhouses, bodily distribution of pesticides, and penetration of pesticides through protective clothes and gloves. Secondly, Workplace factors alter how theWork is done (e.g. type of pesticides used, type of spraying techniques/equipment used, and the frequency of contact with contaminated surfaces), and how Workers behave (e.g. potentially poor safety procedures and inadequate PPE use compliance). Work The major exposure modifying Work factors in greenhouses were intense workload, quick reentry interval, and predominantly manual spraying techniques. These were shown to influence occupational exposure parameters such as the duration, frequency, and route of exposure, the body part contaminated, and PPE-use compliance. Worker The majority of the literature describes greenhouse workers as under-educated, poorly trained, and socioeconomically disadvantaged migrant workforce with precarious personal circumstances. Although these Worker characteristics may increase workers’ vulnerability for pesticide exposure and risk, a systematic understanding of how these characteristics contribute to pesticide exposure in greenhouses is still lacking. Overall, the evidence presented in the literature suggests that most of the pesticide exposure modifying greenhouse characteristics and interactions therein may not be apparent in traditional open field systems. Therefore, the two environments could have different pesticide exposure scenarios and may have different health risks as well. Glove permeation of OP insecticides and temperature The effect of temperature on permeation resistance of each chemical resistant glove was shown to be significant, particularly at high exposure concentrations. A comparison of the three gloves reveals that there was no significant difference in permeation resistance when tested against dilute forms of dimethoate (0.3 g/l and 1.6 g/l) and Malathion (1 g/l) at 25ºC. However, there was a significant difference in permeation resistance between glove materials under the “worst-case” exposure scenario of handling highly concentrated formulation products of dimethoate (400 g/l) and malathion (1150g/l), at elevated temperatures. PVC gloves afforded the highest permeation resistance, followed by NBR glove and lastly the single-use NN glove material. PART 2: CHEMICAL RISK FACTORS Pesticide formulations are often complex mixtures of active insecticides and co-ingredients. The analysis of Chemical risk factors for occupational exposure to pesticides was possible in this research because commercially available pesticide formulations were used in skin and glove permeation experiments. This part was informed by two studies. The first examined skin permeation of OP insecticides as formulations while the second investigates the role of formulation co-ingredients on permeation through the skin and PVC gloves. Skin permeation of OP insecticides as formulations The purpose of studying skin permeation of OP insecticides as formulations was to determine the relevance of physicochemical properties and selected Quantitative Structure-Permeability Relationship (QSPR) models in predicting skin permeability of OP insecticides as formulations. In terms of physicochemical properties, higher permeation flux was recorded at a higher applied concentration of OP insecticides for the hydrophilic AI (acephate and dimethoate), but not for the lipophilic ones (malathion and diazinon). The tested skin permeability models (Potts & Guy, Mitragotri, and IHSkinPerm) mostly over-predicted experimental outcomes by several orders of magnitude. Models were much less accurate in predicting permeation from highly concentrated emulsions of the lipophilic compounds. The model predictions were accurate only on two out of seven occasions, and only for the hydrophilic OP insecticides. The role of formulation co-ingredients in dermal exposure to OP insecticides The findings showed that the presence of xylene in dimethoate formulation and presence of PGMEA in omethoate formulation plays a critical role in the permeation of the respective OP insecticides through PVC gloves at high mixing concentration. The omethoate formulation without PGMEA content, showed 184-fold greater cumulative permeation and more than 16 fold shorter breakthrough (BT) time. The presence of xylene in dimethoate formulation increased the cumulative permeation (by 1.5 fold) and decreased BT time (by an hour) of dimethoate. The influence of these co-ingredients on skin uptake within the exposure timeframe was not statistically significant at both high and low OP insecticide concentrations which may be due to the high degree of variability with skin experiments. Novelty and strength In all glove and skin permeation experimental studies included in this thesis, commercially available pesticide formulations of OP insecticides were employed in the context of their use in horticulture. Thus, this research is the first to report empirical skin/glove permeation data for most of the OP insecticides studied. The two major strengths of this research are 1) framing of experimental studies around real-world exposure scenarios within the context of Australian horticulture, and 2) the use of fresh human donated skin, which is considered a gold standard for in vitro dermal absorption studies. Limitations This research is largely informed by laboratory-based experiments, hence it may not capture all the factors that would influence exposure in the field. Despite its limitation, it was supplemented by a critical review that captured the exposure modifying factors in greenhouses. Conclusions and recommendations This thesis combines multiple pieces of evidence from a critical literature review and a series of laboratory-based experimental studies to extend our knowledge of pesticide exposure risk in horticulture. Based on the findings the following conclusions can be made: Firstly, the exposure-modifying effect of the greenhouse work environment may set it apart from traditional open field farming in terms of pesticide exposure and its risks. This necessitates the need for the development of tailored guidelines for pesticide exposure control in greenhouses. Secondly, it was demonstrated that not all recommended gloves are equally protective. The findings underpin the importance of considering temperature-induced glove performance reduction in testing, selecting, using, storing, and replacing glove materials if used under hot working conditions. Thirdly, the findings from the skin permeation study support the notion that skin permeability models derived from experimental data on aqueous solutions have limited applicability in accurately predicting dermal absorption of OP insecticides from commercial formulations. Fourthly, the findings suggest that the presence and proportions of co-ingredients play a critical role in glove permeation potential of undiluted OP insecticides, which confirms the relevance of considering permeation data of co-ingredients in glove selection and recommendation. Based on the evidence from this research, the following recommendations have been made for various stakeholders: - Glove manufacturers should extend standard glove permeation test conditions to incorporate commercial pesticide formulations, in-use temperatures, and pesticide concentration conditions. - Pesticide manufacturers and suppliers should consider the role of formulation coingredients for dermal exposure when specifying glove materials and when developing pesticide formulations. Pesticide regulatory agencies should consider the implications of formulation coingredients in the process of reviewing exposure data as well as making product approval and registration decisions. - Horticulture growers and workers handling concentrated products at elevated temperature conditions, such as in greenhouses, should be aware of the increased exposure risk, the temperature-induced glove performance reduction, and the need for more frequent replacement. - Occupational hygienists and other risk assessors should take caution when using skin permeability models, developed for aqueous solutions, to predict dermal absorption of chemicals as formulations, particularly for highly concentrated lipophilic chemicals. Further research could assess the comparative health risk between greenhouses and open field horticulture, and the effects of glove reuse and pesticide concentrations on dermal exposure. Research into the feasibility of co-ingredient modifications to minimise dermal exposure would also be a fruitful area for further work.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 202

Temporal decline in serum PFAS concentrations among metropolitan firefighters: Longitudinal study on post-exposure changes following PFAS foam cessation

Firefighters are at a high risk of exposure to per- and polyfluoroalkyl substances (PFAS) due to their frequent use of PFAS-containing foams in training and emergency situations. This longitudinal study aimed to investigate the changes in serum PFAS levels among firefighters following cessation of their exposure to PFAS-containing foams. The study involved 130 firefighters from the South Australian Metropolitan Fire Services (SAMFS), and serum samples were collected at two time points: baseline in 2018–19 and follow-up in 2021–22. Along with the collection of samples, a survey questionnaire was administered to gather information on firefighters' employment and demographic characteristics. Regression models were employed to assess the association between these factors and the outcome variable (annual percentage change in serum PFAS concentration). The results indicated a decline in serum PFAS concentrations over time, with the main contaminants being perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorooctanoic acid (PFOA). The median and Interquartile Range (IQR) of total PFAS (∑PFAS) concentration reduced from 21.5 ng/ml (IQR: 11 to 53 ng/ml) at baseline to 15 ng/ml (IQR: 8 to 33 ng/ml) at follow-up. On average, there was an annual reduction of 13%, 7%, and 4.4% in serum concentrations of PFOS, PFHxS, and PFOA, respectively. Firefighters under the age of 55, those who used PFAS in the past ten years, or those who had little to no frequency of PFAS exposure in their previous employment, encountered a significantly higher annual percentage reduction (P < 0.05) in both ∑PFAS and PFOS concentrations. None of the independent variables analysed could significantly predict the annual percentage change in PFOA and PFHxS.This study provides evidence for a declining temporal trend in serum PFAS concentrations among metropolitan firefighters following workplace interventions that involved the removal of PFAS-containing foams

Prohibition of engineered stone: Literature review and gap analysis

In May 2023, Safe Work Australia commissioned the University of Adelaide to undertake a literature review and gap analysis of the scientific evidence to inform recommendations related to the three options for prohibition on the use of engineered stone in Australia.The report was independently peer reviewed by an expert from Monash University in June 2023.The final report was provided to Safe Work Australia in July 2023 and was used to inform the development of the Decision Regulation Impact Statement: Prohibition on the use of Engineered Stone.</p