[Silicosis]. / Silicose.

BACKGROUND: Silicosis is a potentially severe but preventable occupational lung disease caused by inhalation of silica particles. There is a wide application in the usage of silica especially in lesser known industries. This disease has yet not been eradicated due to insufficient application of protective measures. CASE DESCRIPTION: A 57-year-old patient presents to the pulmonary outpatient clinic with progressive dyspnea d'effort. The professional history states that he worked as a sandblaster 10 years ago. The accompanying protective measures were not properly followed by the patient at the time. The CT chest showed a nodular interstitial lung disease and silica particles were detected in the bronchial lavage conforming the diagnosis of silicosis. CONCLUSION: Early detection of silicosis is essential to prevent further lung damage and silicosis associated complications. The occupational history and radiological diagnostics are essential to confirm the diagnosis. There is no specific treatment for silicosis. Therefore prevention is better than cure.

Work-related and personal risk factors for occupational contact dermatitis: A systematic review of the literature with meta-analysis.

The objective of this review is to identify work-related and personal risk factors for contact dermatitis (CD), and assess their association with this frequently occurring occupational disease. A systematic review of the literature from 1990 to June 2, 2020, was conducted using Medline and Embase. Prospective cohort and case-control studies were included, and meta-analyses were conducted when feasible. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Twenty-nine studies were identified, comprising 26 study populations and with a total of 846 209 participants investigating 52 risk factors for CD. Meta-analyses were performed for five risk factors, all of them for irritant contact dermatitis (ICD). Moderate-quality evidence was found for associations between wet work and ICD (OR: 1.56, 95%CI: 1.21-2.01). High-quality evidence was found for the association between atopic dermatitis and ICD (OR: 2.44, 95%CI: 1.89-3.15). There was no evidence for an association between ICD and sex or history of hand dermatitis, respiratory and mucosal atopy. In conclusion, several work-related and personal risk factors associated with CD were identified. Our data emphasize the need for the assessment of both, work-related and personal, risk factors to prevent occupational CD.

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review.

BACKGROUND: The objective was to update the 2011 Cochrane systematic review on the effectiveness of workplace interventions for the treatment of occupational asthma. METHODS: A systematic review was conducted with the selection of articles and reports through 2019. The quality of extracted data was evaluated, and meta-analyses were conducted using techniques recommended by the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Data were extracted from 26 nonrandomized controlled before-and-after studies. The mean number of participants per study was 62 and the mean follow-up time was 4.5 years. Compared with continued exposure, removal from exposure had an increased likelihood of improved symptoms and change in spirometry. Reduction of exposure also had more favorable results for symptom improvement than continued exposure, but no difference for change in spirometry. Comparing exposure removal to reduction revealed an advantage for removal with both symptom improvement and change in spirometry for the larger group of patients exposed to low-molecular-weight agents. Also, the risk of unemployment was greater for exposure removal versus reduction. CONCLUSIONS: Exposure removal and reduction had better outcomes than continued exposure. Removal from exposure was more likely to improve symptoms and spirometry than reduction among patients exposed to low-molecular-weight agents. The potential benefits associated with exposure removal versus reduction need to be weighed against the potential for unemployment that is more likely with removal from exposure. The findings are based on data graded as very low quality, and additional studies are needed to generate higher quality data.

Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis.

OBJECTIVE: The objective was to conduct an update of a previously published review and meta-analysis on the association between work-related psychosocial risk factors and stress-related mental disorders (SRD). DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase and PsycINFO were searched for articles published between 2008 and 12 August 2019 and references of a systematic review performed for the period before 2008 were included. Primary prospective studies were included when outcome data were described in terms of SRD assessment or a dichotomous outcome, based on a validated questionnaire, and at least two levels of work-related exposure were reported (exposed vs less or non-exposed). We used GRADE to assess the evidence for the associations between risk factors and the onset of SRD. RESULTS: Seventeen studies met the inclusion criteria. In total, a population of 73 874 workers from Belgium, Denmark, England, Finland, Japan, the Netherlands and Sweden were included in the meta-analysis of 14 prospective cohort studies. This meta-analysis revealed moderate evidence for associations between SRD and effort reward imbalance (OR=1.9, 95% CI 1.70 to 2.15), high job demands (OR=1.6, 95% CI 1.41 to 1.72), organisational justice (ORs=1.6 to 1.7, CIs 1.44 to 1.86), social support (ORs=1.3 to 1.4, CIs 1.16 to 1.69), high emotional demands (OR=1.6, 95% CI 1.35 to 1.84) and decision authority (OR=1.3, CI 1.20 to 1.49). No significant or inconsistent associations were found for job insecurity, decision latitude, skill discretion and bullying. CONCLUSION: Moderate evidence was found that work-related psychosocial risk factors are associated with a higher risk of SRD. Effort-reward imbalance, low organisational justice and high job demands exhibited the largest increased risk of SRD, varying from 60% to 90%.

Workplace interventions for treatment of occupational asthma.

BACKGROUND: The impact of workplace interventions on the outcome of occupational asthma is not well understood. OBJECTIVES: To evaluate the effectiveness of workplace interventions on occupational asthma. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); EMBASE(Ovid); NIOSHTIC-2; and CISILO (CCOHS) up to July 31, 2019. SELECTION CRITERIA: We included all eligible randomized controlled trials, controlled before and after studies and interrupted time-series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and risk of bias, and extracted data. MAIN RESULTS: We included 26 non-randomized controlled before and after studies with 1,695 participants that reported on three comparisons: complete removal from exposure and reduced exposure compared to continued exposure, and complete removal from exposure compared to reduced exposure. Reduction of exposure was achieved by limiting use of the agent, improving ventilation, or using protective equipment in the same job; by changing to another job with intermittent exposure; or by implementing education programs. For continued exposure, 56 per 1000 workers reported absence of symptoms at follow-up, the decrease in forced expiratory volume in one second as a percentage of a reference value (FEV1 %) was 5.4% during follow-up, and the standardized change in non-specific bronchial hyperreactivity (NSBH) was -0.18.In 18 studies, authors compared removal from exposure to continued exposure. Removal may increase the likelihood of reporting absence of asthma symptoms, with risk ratio (RR) 4.80 (95% confidence interval (CI) 1.67 to 13.86), and it may improve asthma symptoms, with RR 2.47 (95% CI 1.26 to 4.84), compared to continued exposure. Change in FEV1 % may be better with removal from exposure, with a mean difference (MD) of 4.23 % (95% CI 1.14 to 7.31) compared to continued exposure. NSBH may improve with removal from exposure, with standardized mean difference (SMD) 0.43 (95% CI 0.03 to 0.82).In seven studies, authors compared reduction of exposure to continued exposure. Reduction of exposure may increase the likelihood of reporting absence of symptoms, with RR 2.65 (95% CI 1.24 to 5.68). There may be no considerable difference in FEV1 % between reduction and continued exposure, with MD 2.76 % (95% CI -1.53 to 7.04) . No studies reported or enabled calculation of change in NSBH.In ten studies, authors compared removal from exposure to reduction of exposure. Following removal from exposure there may be no increase in the likelihood of reporting absence of symptoms, with RR 6.05 (95% CI 0.86 to 42.34), and improvement in symptoms, with RR 1.11 (95% CI 0.84 to 1.47), as well as no considerable change in FEV1 %, with MD 2.58 % (95% CI -3.02 to 8.17). However, with all three outcomes, there may be improved results for removal from exposure in the subset of patients exposed to low molecular weight agents. No studies reported or enabled calculation of change in NSBH.In two studies, authors reported that the risk of unemployment after removal from exposure may increase compared with reduction of exposure, with RR 14.28 (95% CI 2.06 to 99.16). Four studies reported a decrease in income of 20% to 50% after removal from exposure.The quality of the evidence is very low for all outcomes. AUTHORS' CONCLUSIONS: Both removal from exposure and reduction of exposure may improve asthma symptoms compared with continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function compared to continued exposure. When we compared removal from exposure directly to reduction of exposure, the former may improve symptoms and lung function more among patients exposed to low molecular weight agents. Removal from exposure may also increase the risk of unemployment. Care providers should balance the potential clinical benefits of removal from exposure or reduction of exposure with potential detrimental effects of unemployment. Additional high-quality studies are needed to evaluate the effectiveness of workplace interventions for occupational asthma.

Workplace interventions for treatment of occupational asthma.

BACKGROUND: The impact of workplace interventions on the outcome of occupational asthma is not well-understood. OBJECTIVES: To evaluate the effectiveness of workplace interventions on the outcome of occupational asthma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; NIOSHTIC-2; CISDOC and HSELINE up to February 2011. SELECTION CRITERIA: Randomised controlled trials, controlled before and after studies and interrupted time series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and trial quality, and extracted data. MAIN RESULTS: We included 21 controlled before and after studies with 1447 participants that reported on 29 comparisons.In 15 studies, removal from exposure was compared with continued exposure. Removal increased the likelihood of reporting absence of symptoms (risk ratio (RR) 21.42, 95% confidence interval (CI) 7.20 to 63.77), improved forced expiratory volume (FEV1 %) (mean difference (MD) 5.52 percentage points, 95% CI 2.99 to 8.06) and decreased non-specific bronchial hyper-reactivity (standardised mean difference (SMD) 0.67, 95% CI 0.13 to 1.21).In six studies, reduction of exposure was compared with continued exposure. Reduction increased the likelihood of reporting absence of symptoms (RR 5.35, 95% CI 1.40 to 20.48) but did not affect FEV1 % (MD 1.18 percentage points, 95% CI -2.96 to 5.32).In eight studies, removal from exposure was compared with reduction of exposure. Removal increased the likelihood of reporting absence of symptoms (RR 39.16, 95% CI 7.21 to 212.83) but did not affect FEV1 % (MD 1.16 percentage points, 95% CI -7.51 to 9.84).Two studies reported that the risk of unemployment after removal from exposure was increased compared with reduction of exposure (RR 14.3, 95% CI 2.06 to 99.16). Three studies reported loss of income of about 25% after removal from exposure.Overall the quality of the evidence was very low. AUTHORS' CONCLUSIONS: There is very low-quality evidence that removal from exposure improves asthma symptoms and lung function compared with continued exposure.Reducing exposure also improves symptoms, but seems not as effective as complete removal.However, removal from exposure is associated with an increased risk of unemployment, whereas reduction of exposure is not. The clinical benefit of removal from exposure or exposure reduction should be balanced against the increased risk of unemployment. We need better studies to identify which interventions intended to reduce exposure give most benefit.