A call from 40 public health scientists for an end to the continuing humanitarian and environmental catastrophe in Gaza.

An under-recognised aspect of the current humanitarian catastrophe in Gaza is the impact of the war on the environment and the associated risks for human health. This commentary contextualises these impacts against the background of human suffering produced by the overwhelming violence associated with the use of military force against the general population of Gaza. In calling for an immediate cessation to the violence, the authors draw attention to the urgent need to rebuild the health care system and restore the physical and human infrastructure that makes a liveable environment possible and promotes human health and well-being, especially for the most vulnerable in the population. Environmental remediation should therefore form one of the most important parts of international efforts to assist reconstruction, through which we hope Palestinians and Israelis will achieve lasting peace, health, and sustainable development, all as part of accepted international human rights obligations.

Risk factors for leg ulceration in people who inject drugs: A cross-sectional study.

AIMS AND OBJECTIVES: The aim of this study was to assess, for the first time in a hard-to-reach population, the risk factors for leg ulceration among PWID, with the objective of making improvements to prevention and care. BACKGROUND: An estimated 4.8 million people globally inject drugs with potential for injecting-related harm. Skin and vein damage associated with drug injecting is increasing. Leg ulceration is a chronic condition which in the UK has a prevalence of 15% among people who have injected drugs (PWID) compared with 1% in the general population. Glasgow has the highest rate of problematic drug use in Scotland with approximately 13,900 individuals, about 50% of whom are thought to inject. However, the reasons for high prevalence of leg ulceration among PWID are unknown. To support improvements in prevention and care, the dearth of evidence around risk factors for leg ulceration in PWID needs to be addressed. DESIGN: A cross-sectional survey of 200 current and former injectors recruited from drug services in Glasgow, Scotland, to measure skin problems, leg ulceration and injecting habits is reported following STROBE guidelines. Logistic regression modelling examined whether demographics and injecting habits predicted leg ulceration. RESULTS: The likelihood of leg ulceration was increased for those who injected in the groin and the leg. Additionally, injecting in the groin and leg were associated with having a DVT. CONCLUSION: The primary risk factors for leg ulceration in PWID are injecting in the groin and the legs and these are clinically linked to deep vein thrombosis. Injecting into the femoral vein is increasingly common practice for PWID and healthcare practitioners should advise injectors of the increased risk of leg ulceration and DVT and discourage injecting into these areas.

The neglected millions: the global state of aquaculture workers' occupational safety, health and well-being.

A scoping project was funded by the Food and Agriculture Organization in 2017 on the health and safety of aquaculture workers. This project developed a template covering basic types of aquaculture production, health and safety hazards and risks, and related data on injuries and occupational ill health, regulations, social welfare conditions, and labour and industry activity in the sector. Profiles using the template were then produced for key aquaculture regions and nations across the globe where information could be obtained. These revealed both the scale and depth of occupational safety and health (OSH) challenges in terms of data gaps, a lack of or poor risk assessment and management, inadequate monitoring and regulation, and limited information generally about aquaculture OSH. Risks are especially high for offshore/marine aquaculture workers. Good practice as well as barriers to improving aquaculture OSH were noted. The findings from the profiles were brought together in an analysis of current knowledge on injury and work-related ill health, standards and regulation, non-work socioeconomic factors affecting aquaculture OSH, and the role of labour and industry in dealing with aquaculture OSH challenges. Some examples of governmental and labour, industry and non-governmental organisation good practice were identified. Some databases on injury and disease in the sector and research initiatives that solved problems were noted. However, there are many challenges especially in rural and remote areas across Asia but also in the northern hemisphere that need to be addressed. Action now is possible based on the knowledge available, with further research an important but secondary objective.

Occupational health: a world of false promises.

The response of the World Health Organization (WHO) to the Ebola outbreak in West Africa in 2015 demonstrated that the global health system is unprepared to address what should be its primary mission, control of disease epidemics while protecting health workers. Critics blamed WHO politics and its rigid culture for the poor response to the epidemic. We find that United Nations agencies, WHO and the International Labor Organization (ILO), are faced with the global problem of inadequate worker protections and a growing crisis in occupational health. The WHO and ILO are given monumental tasks but only trivial budgets, and funding trends show UN agency dependence on private donations which are far larger than funds contributed by member states. The WHO and ILO have limited capacity to make the necessary changes occupational health and safety demand. The UN could strengthen the national and global civil society voice in WHO and ILO structures, and by keeping conflict of interest out of policy decisions, ensure greater freedom to operate without interference.

Multi-factorial influences on sex ratio: a spatio-temporal investigation of endocrine disruptor pollution and neighborhood stress.

BACKGROUND: It is suggested the declining male birth proportion in some industrialized countries is linked to ubiquitous endocrine disruptor exposure. Stress and advanced parental age are determinants which frequently present positive findings. Multi-factorial influences on population sex ratio are rarely explored or tested in research. OBJECTIVES: To test the hypothesis that dual factors of pollution and population stress affects sex proportion at birth through geographical analysis of Central Scotland. METHODS: The study incorporates the use of Geographical Information Systems (GIS) tools to overlay modeled point source endocrine disruptor air emissions with "small-area" data on multiple deprivation (a proxy measurement of stress) and birth sex. Historical review of regional sex ratio trends presents additional data on sex ratio in Scotland to consider. RESULTS: There was no overall concentration in Central Scotland of low sex ratio neighborhoods with areas where endocrine disruptor air pollution and deprivation or economic stress were high. Historical regional trends in Scotland (from 1973), however, do show significantly lower sex ratio values for populations where industrial air pollution is highest (i.e. Eastern Central Scotland). CONCLUSIONS: Use of small area data sets and pollution inventories is a potential new method of inquiry for reproductive environmental and health protection monitoring and has produced interesting findings.

Prevalence of skin problems and leg ulceration in a sample of young injecting drug users.

BACKGROUND: Drug users suffer harm from the injecting process, and clinical services are reporting increasing numbers presenting with skin-related problems such as abscesses and leg ulcers. Skin breakdown can lead to long-term health problems and increased service costs and is often the first indication of serious systemic ill health. The extent of skin problems in injecting drug users has not previously been quantified empirically, and there is a dearth of robust topical literature. Where skin problems have been reported, this is often without clear definition and generic terms such as 'soft tissue infection' are used which lack specificity. The aim of this study was to identify the range and extent of skin problems including leg ulceration in a sample of injecting drug users. Definitions of skin problems were developed and applied to descriptions from drug users to improve rigour. METHODS: Data were collected in needle exchanges and methadone clinics across Glasgow, Scotland, from both current and former drug injectors using face-to-face interviews. RESULTS: Two hundred participants were recruited, of which 74% (n = 148) were males and 26% (n = 52) were females. The age range was 21-44 years (mean 35 years). Just under two thirds (64%, n = 127) were currently injecting or had injected within the last 6 months, and 36% (n = 73) had previously injected and had not injected for more than 6 months.Sixty per cent (n = 120) of the sample had experienced a skin problem, and the majority reported more than one problem. Most common were abscesses, lumps, track marks and leg ulcers. Fifteen per cent (n = 30) of all participants reported having had a leg ulcer. CONCLUSIONS: This is an original empirical study which demonstrated unique findings of a high prevalence of skin disease (60%) and surprisingly high rates of leg ulceration (15%). Skin disease in injecting drug users is clearly widespread. Leg ulceration in particular is a chronic recurring condition that is costly to treat and has long-term implications for drug users and services caring for current or former injectors long after illicit drug use has ceased.

The expansion of nurse prescribing in Scotland: an evaluation.

Medicine prescribing by community nurses commenced in the UK in 1996. By 2001, nurse prescribing was extended to include more nurses and to cover a wider formulary. This research project provides an evaluation of the extension of prescribing powers to nurses in Scotland, following the introduction of legislation in 2001. It aimed to evaluate the impact of nurse prescribing powers on patients, nurses, prescribers, and other stakeholders. A range of methods were used, including two public surveys, stakeholder interviews, postal questionnaires and case studies. The benefits of extended nurse prescribing include: improved patient access to treatment; enhanced patient care; enabled more effective use of medical staff time and greater professional satisfaction for nurses who used nursing skills; and built inter-professional working. Some obstacles existed, including organisational, institutional and resource factors that restricted the overall success of the extension of nurse prescribing. There are high levels of agreement between patients, the public, nurse prescribers, physicians and other health professionals about the benefits of nurse prescribing to patients. The extension of nurse prescribing has been largely successful, with some organisational and procedural areas that could be addressed.

Breast cancer risk in relation to occupations with exposure to carcinogens and endocrine disruptors: a Canadian case-control study.

BACKGROUND: Endocrine disrupting chemicals and carcinogens, some of which may not yet have been classified as such, are present in many occupational environments and could increase breast cancer risk. Prior research has identified associations with breast cancer and work in agricultural and industrial settings. The purpose of this study was to further characterize possible links between breast cancer risk and occupation, particularly in farming and manufacturing, as well as to examine the impacts of early agricultural exposures, and exposure effects that are specific to the endocrine receptor status of tumours. METHODS: 1005 breast cancer cases referred by a regional cancer center and 1146 randomly-selected community controls provided detailed data including occupational and reproductive histories. All reported jobs were industry- and occupation-coded for the construction of cumulative exposure metrics representing likely exposure to carcinogens and endocrine disruptors. In a frequency-matched case-control design, exposure effects were estimated using conditional logistic regression. RESULTS: Across all sectors, women in jobs with potentially high exposures to carcinogens and endocrine disruptors had elevated breast cancer risk (OR = 1.42; 95% CI, 1.18-1.73, for 10 years exposure duration). Specific sectors with elevated risk included: agriculture (OR = 1.36; 95% CI, 1.01-1.82); bars-gambling (OR = 2.28; 95% CI, 0.94-5.53); automotive plastics manufacturing (OR = 2.68; 95% CI, 1.47-4.88), food canning (OR = 2.35; 95% CI, 1.00-5.53), and metalworking (OR = 1.73; 95% CI, 1.02-2.92). Estrogen receptor status of tumors with elevated risk differed by occupational grouping. Premenopausal breast cancer risk was highest for automotive plastics (OR = 4.76; 95% CI, 1.58-14.4) and food canning (OR = 5.70; 95% CI, 1.03-31.5). CONCLUSIONS: These observations support hypotheses linking breast cancer risk and exposures likely to include carcinogens and endocrine disruptors, and demonstrate the value of detailed work histories in environmental and occupational epidemiology.

Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds.

BACKGROUND: Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds. OBJECTIVES: To determine whether pregnant women's perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006). DESIGN: A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009. SETTING/PARTICIPANTS: Cases were primigravida women from 'least deprived' (n=9) and 'most deprived' (n=12) geographical areas within one local authority in Scotland. ANALYSIS: Data were analysed using case study replication analysis. RESULTS: There was little difference in access to antenatal services between the 'least' and 'most' deprived groups. Perception of care differed in relation to the level of 'engagement' (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the 'least deprived' cases and almost none of the 'most deprived' cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making. CONCLUSION: In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non-engagement.

An Exploratory Study of Beryllium and UK Soft Touch Regulation: An Enduring Example of Weaknesses of UK Occupational Health and Safety Governance.

Smart regulation, better regulation, responsive regulation, business-friendly regulation and voluntary 'self-regulation' have their origins deeply embedded in UK policies in the 20th century. Their aim generally is to reduce workplace regulatory obligations on employers. This can overtly or covertly undermine efforts to improve working conditions. In the UK, the historical control and regulation of beryllium (a toxic metal used in industry) illustrates this problem, and as we illustrate through an exploratory analysis of original archival material and official publications. Soft touch regulation of the metal beryllium was developed within the UK semiconductor industry when tighter controls were proposed in the 1960s and 1970s. Historical industry, government and science responses to health and safety information about beryllium provide important lessons for current debates on occupational health and safety.

Privatization and Multi-Fatality Disasters: A Causal Connection Exposing Both Worker and Citizen Health and Safety Failures in the UK?

Although several countries have experienced large-scale privatization initiatives, relatively little is known about the impact of these initiatives on the health and safety of workers and resident populations. Examining data on technical (as compared to natural) multi-fatality disasters collected in the WHO's Emergency Events Database (EM-DAT) for the UK and a number of European comparator countries for recent decades, this paper shows that the incidence of these disasters and the number of deaths resulting from them rose significantly in the UK during the period from 1979 to 1991 when the country engaged in extensive and aggressive privatization campaigns which were supported by several consecutive Conservative governments. This observed UK blip or abnormal increase in multi-fatality disasters is apparent for the UK both in terms of a "within-country" comparison (i.e., when we compare the privatization period of 1979 to 1997 with other periods), as well as when viewed in terms of comparisons with the comparable European countries of Germany, France, and Italy for the same period (1979 to 1997). Contrary to previous analyses which suggested that there is no clear link between privatization and deterioration of health and safety, this paper concludes that the UK privatization experience (1979-1997) provides robust country-specific evidence of privatization initiatives leading to increases in the number of multi-fatality technological disasters as well as related fatalities. This evidence should be seen as a deterrent to similarly extensive and aggressive initiatives which, particularly in less developed countries, could result in similarly disastrous outcomes.

Artificial turf and crumb rubber infill: An international policy review concerning the current state of regulations.

Background: Although artificial turf fields are utilized widely around the world, sufficient research has not yet been conducted to assess the potential human and environmental health risks posed by the chemicals contained in the fields' fibers, backing, and often-used crumb rubber infill. Consequently, there is wide variation in governmental policies. Objective: Review the notable policies concerning artificial turf and crumb rubber infill in the European Union, United Kingdom, United States of America, Canada, China, Qatar, and the Global Stockholm Convention of the United Nations. Methods: Information was collected that included published papers, technical and policy reports, and grey literature. These were then analyzed by a collaborative group familiar with the environmental policies in their respective countries to extract the pertinent legislative or regulatory information. The group members were primarily identified through their involvement in publications pertinent to artificial turf and crumb rubber infill health research and included environmental health professors, active researchers, and governmental agency officials. Most information on direct policies was taken directly from reports provided to the public by various governmental agencies responsible for their countries' regulations, often available within the respective agency's online archives. Results: There are significant differences in the regulatory approaches adopted by the investigated countries with regards to artificial turf and its crumb rubber infill. Some regions, such as the European Union, have taken substantial steps to limit the fields' chemical components to which the public and environment are exposed. Other regions and countries have done far less to address the issue. Most policies relate directly to (i) the fields themselves, (ii) the microplastic components of crumb rubber infill, or (iii) the concentrations of harmful polycyclic aromatic hydrocarbons (PAHs), perfluoroalkyl and polyfluoroalkyl substances (PFAS), and heavy metals. Conclusion: While nearly every country acknowledges the potential health risks posed by heavy metals, microplastics, PAHs, and PFAS chemicals, very few have actually implemented artificial turf and crumb rubber infill regulations and/or established adequate surveillance measures to protect those regularly exposed to the fields.

COVID-19 in the UK and Occupational Health and Safety: Predictable not Inevitable Failures by Government, and Trade Union and Nongovernmental Organization Responses.

This commentary examines the occupational health and safety issues faced by the UK workers in the COVID-19 pandemic, against the background of government cuts in health care and in occupational health and safety budgets, and a deregulatory climate. The UK government has been obsessed, blinkered, and distracted by the desire to leave the European Union (Brexit). The state of knowledge about the virus, especially from international agencies that identified pandemic threats and strategies to combat it, is outlined. UK politicians, government bodies, medical and scientific advisors, and employers periodically ignored or abused that knowledge. Regulatory and ministerial inaction and errors on the workplace virus risks emerged. In contrast, several trade unions, health professional bodies, and nongovernmental organizations identified COVID-19 threats from poor personal protection equipment, working practices, and knowledge gaps and offered solutions for health care workers, social care workers, production workers, and service workers in "essential" occupations.

Lagging and Flagging: Air Pollution, Shale Gas Exploration and the Interaction of Policy, Science, Ethics and Environmental Justice in England.

The science on the effects of global climate change and air pollution on morbidity and mortality is clear and debate now centres around the scale and precise contributions of particular pollutants. Sufficient data existed in recent decades to support the adoption of precautionary public health policies relating to fossil fuels including shale exploration. Yet air quality and related public health impacts linked to ethical and environmental justice elements are often marginalized or missing in planning and associated decision making. Industry and government policies and practices, laws and planning regulations lagged well behind the science in the United Kingdom. This paper explores the reasons for this and what shaped some of those policies. Why did shale gas policies in England fail to fully address public health priorities and neglect ethical and environmental justice concerns. To answer this question, an interdisciplinary analysis is needed informed by a theoretical framework of how air pollution and climate change are largely discounted in the complex realpolitik of policy and regulation for shale gas development in England. Sources, including official government, regulatory and planning documents, as well as industry and scientific publications are examined and benchmarked against the science and ethical and environmental justice criteria. Further, our typology illustrates how the process works drawing on an analysis of official policy documents and statements on planning and regulatory oversight of shale exploration in England, and material from industry and their consultants relating to proposed shale oil and gas development. Currently the oil, gas and chemical industries in England continue to dominate and influence energy and feedstock-related policy making to the detriment of ethical and environmental justice decision making with significant consequences for public health.

Scoping Global Aquaculture Occupational Safety and Health.

Objectives: In 2017 the Food and Agriculture Organization (FAO) Committee on Fisheries committed to prioritize occupational safety and health issues in aquaculture (AOSH). An international team was established to synthesize OSH knowledge concerning more than 19 million, often vulnerable, aquaculture workers found globally.Methods: The study was conducted as a desktop scoping exercise using both peer-reviewed and gray literature and the knowledge and expertize of an international panel. Collated information used a standard proforma. Panel members developed draft national and regional AOSH profiles outlining occupational hazards contributing to occupational injuries, diseases, and known solutions. These were work-shopped and refined after gathering additional information and used to compile the first global scoping review report on AOSH.Results: Synthesized results revealed multiple hazards, significant global knowledge gaps and some successful and unsuccessful global, national and industry-specific AOSH policies, practices and standards along the primary supply chain, in marine and freshwater contexts. Some constructive initiatives by the International Labor Organization (ILO) and FAO, industry, labor and civil society groups in a range of employment and geographical settings and across diverse populations of workers were identified.Conclusion: Global commitment to AOSH should be given the same focus as product quality, biosecurity, food safety and environmental sustainability in the sector. This needs development and implementation of integrated AOSH actions appropriate for diverse settings especially in low and middle-income countries encompassing greater uptake of international codes, better risk assessment and OSH management, adoption of technological innovations, effective OSH regulation and enforcement, adequate resources, training and information.

An Online Survey of Occupational Hazards in Brazilian Aquaculture.

Information on occupational health and safety practices in Brazilian aquaculture is limited. This paper reports preliminary results from an online survey based on research questions to identify occupational hazards, risk assessment practices, and prevention measures adopted in Brazilian aquaculture. Data were collected through an online questionnaire, comprising 25 questions, on a voluntary and anonymous basis. Aquaculture stakeholders were invited to participate in the study through email and social media channels. The demographic data demonstrated that the majority of respondents were men (72%) and having a higher education (95%). Most respondents employed administrative controls and personal protective equipment (PPE) rather than substitution and other risk elimination measures to reduce exposure. The most commonly adopted measures were PPE use (87%), adequate handling of chemicals (86%), and imparting knowledge of risks (90%). However, only 12% of participants reported the presence of safety protocols at their workplace, and 17% had some form of immunization of workers. In this study, it was possible to identify a lack of hazard signage in the workplace and lack of occupational health and safety training. The results further indicate that risk management in aquaculture continues to be a challenge in low-income countries. Aquaculture farmers should be encouraged and supported in adopting measures and appropriate technologies to eliminate risks in Brazilian aquaculture.

Sex ratio changes as sentinel health events of endocrine disruption.

The production and widespread use of synthetic chemicals since the 1940s have resulted in ubiquitous contamination of fish, wildlife and human populations. Since the 1960s, observers have documented major damage to wildlife reproduction across the globe, and subsequently, damage to reproductive health in exposed humans as well. The sex ratio in human communities and populations can be readily measured to ascertain whether reproductive effects, such as subtle birth defects of the reproductive tract caused by exposures to chemicals, might be occurring. Male to female sex ratios appear to be declining in populations in several parts of the globe, possibly as a result of prenatal exposures to chemicals. Sex ratio data for communities with unusual occupational or environmental exposures can be compiled using traditional epidemiological techniques in pursuit of environmental justice. Local, regional and national population health researchers and occupational hygienists can use health statistics to examine sex ratios as sentinel health events that might portend patterns of subtle structural birth defects of the reproductive tract and functional deficits in neurodevelopment.