[Analysis of the results of personal monitoring to ionizing radiation at workplaces]. / Analiza wyników rutynowego monitoringu narazenia personelu na promieniowanie jonizujace w miejscach pracy.

BACKGROUND: The paper presents the results of dosimetric measurements routinely performed by the Radiation Protection Department of the Nofer Institute of Occupational Medicine (NIOM) in Lódz in 2022 for people occupationally exposed to X and γ radiation. MATERIAL AND METHODS: The evaluation of the effective dose as part of individual dosimetry was provided using the film or thermoluminescent dosimetry (TLD). Additionally, based exclusively on the TLD method, measurements of the ambient dose equivalent H*(10) and personal dose equivalents Hp(0.07) and Hp(3) were performed. In 2022, the dosimetric service of the Radiological Protection Department of the NIOM covered >30 000 workers employed in >4500 laboratories (mainly health care departments). All measurements were performed in accordance with accredited research procedures (number AB 327). RESULTS: In 2022, the average annual dose of Hp(10) was equal to 0.26 mSv, whereas Hp(0.07) measured using ring and wrist dosimetry was equal to 0.63 mSv and 0.78 mSv, respectively. In turn, the average Hp(3) value was 0.21 mSv. In 2022, there was not a single case of exceeding the annual dose limit among people measured by the NIOM. CONCLUSIONS: The data collected in the "Dosimetry" database of the NIOM and a detailed analysis of annual doses received by people occupationally exposed to ionizing radiation indicate a well-functioning radiological protection system in Poland. Med Pr Work Health Saf. 2024;75(5).

Occupational exposure to arsenic and leukopenia risk: Toxicological alert.

Arsenic and its inorganic compounds affect numerous organs and systemic functions, such as the nervous and hematopoietic systems, liver, kidneys, and skin. Despite a large number of studies on arsenic toxicity, rare reports have investigated the leukopenia incidence in workers exposed to arsenic. In workplaces, the main source of workers' exposure is the contaminated air by the inorganic arsenic in mines, arsenic or copper smelter industries, and chemical factories. Erythropoiesis inhibition is one of the arsenic effects and it is related to regulatory factor GATA-1. This factor is necessary for the normal differentiation of early erythroid progenitors. JAK-STAT is an important intracellular signal transduction pathway responsible for the mediating normal functions of several cytokines related to cell proliferation and hematopoietic systems development and regulation. Arsenic inactivates JAK-STAT by inhibiting JAK tyrosine kinase and using the IFNγ pathway. The intravascular hemolysis starts after the absorption phase when arsenic binds to the globin of hemoglobin in erythrocytes and is transported into the body, which increases the oxidation of sulfhydryl groups in hemoglobin. So, this article intends to highlight the potential leukopenia risk via inhalation for workers exposed to arsenic and suggests a possible mechanism for this leukopenia through the JAK-signal transducer and activator of transcription (STAT) pathway inhibition.

Visualization of spatial dose distribution for effective radiation protection education in interventional radiology: obtaining high-accuracy spatial doses.

In recent years, eye lens exposure among radiation workers has become a serious concern in medical X-ray fluoroscopy and interventional radiology (IVR), highlighting the need for radiation protection education and training. This study presents a method that can maintain high accuracy when calculating spatial dose distributions obtained via Monte Carlo simulation and establishes another method to three-dimensionally visualize radiation using the obtained calculation results for contributing to effective radiation-protection education in X-ray fluoroscopy and IVR. The Monte Carlo particle and heavy ion transport code system (PHITS, Ver. 3.24) was used for calculating the spatial dose distribution generated by an angiography device. We determined the peak X-ray tube voltage and half value layer using Raysafe X2 to define the X-ray spectrum from the source and calculated the X-ray spectrum from the measured results using an approximation formula developed by Tucker et al. Further, we performed measurements using the "jungle-gym" method under the same conditions as the Monte Carlo calculations for verifying the accuracy of the latter. An optically stimulated luminescence dosimeter (nanoDot dosimeter) was used as the measuring instrument. In addition, we attempted to visualize radiation using ParaView (version 5.12.0-RC2) using the spatial dose distribution confirmed by the above calculations. A comparison of the measured and Monte Carlo calculated spatial dose distributions revealed that some areas showed large errors (12.3 and 24.2%) between the two values. These errors could be attributed to the scattering and absorption of X-rays caused by the jungle gym method, which led to uncertain measurements, and (2) the angular and energy dependencies of the nanoDot dosimetry. These two causes explain the errors in the actual values, and thus, the Monte Carlo calculations proposed in this study can be considered to have high-quality X-ray spectra and high accuracy. We successfully visualized the three-dimensional spatial dose distribution for direct and scattered X-rays separately using the obtained spatial dose distribution. We established a method to verify the accuracy of Monte Carlo calculations performed through the procedures considered in this study. Various three-dimensional spatial dose distributions were obtained with assured accuracy by applying the Monte Carlo calculation (e.g., changing the irradiation angle and adding a protective plate). Effective radiation-protection education can be realized by combining the present method with highly reliable software to visualize dose distributions.

Pattern of occupational lung disease among industrial workers attending a medical college of Eastern India.

Background: Occupational lung diseases (OLDs) contribute a significant proportion to the global burden of pulmonary morbidities but are grossly misdiagnosed due to the relative lack of attribution given to occupational exposures. Obstructive lung diseases are known to be associated with long-lasting disability and loss of earning capacity (LOEC) among workers in industrial setups, thus reducing nationwide productivity. Objective: In this context, the study aimed to find out the pattern of OLD and factors associated with the severity of it among patients in a tertiary care hospital. Materials and Methods: The study was a record-based secondary data analysis conducted in the Medical Records Department of a Medical College in Kolkata. A computerized database of patients attending Special Medical Board (SMB) examinations from the Department of Medical Records was utilized for data collection. A data abstraction format was constructed to collect information on pulmonary morbidity, occupational exposure, and sociodemographic and behavioral variables. Extracted data were analyzed in Microsoft Excel and Statistical Package for Social Sciences (SPSS) software. Results: After a review of records, it was shown that 62.3% (66 out of 106 people) of the study subjects had an obstructive type of OLD, the most common being Jute Byssinosis. A negative correlation (Spearman's ρ = -0.136) was found between pulmonary function (FEV1/FVC) and LOEC (%) in the study subjects. In the multivariable logistic regression, exposure to organic dust was found to be significantly associated with worsened lung function {adjusted-Odd's Ratio (95% Confidence Interval) =3.11 (1.1-8.8), P value = 0.03}. Conclusion: OLD is an understated health issue, especially in an industrial diaspora of developing countries, like India. Healthcare facilities should utilize their resources properly for the advancement of medical surveillance in industries where organic dust is produced. Health education of the stakeholders regarding the consequences of OLDs and the benefits of preventive primary approaches will go a long way in alleviating the burden of disease.

Cancer risk among air transportation industry workers in Korea: a national health registry-based study.

BACKGROUND: Flight attendants face various risk factors in their working environments, particularly occupational exposure to cosmic radiation. This study aimed to assess cancer risk among air transportation industry workers, including flight attendants, in Korea by constructing a cohort using national health registry-based data and analyzing cancer incidence risk. METHODS: We used the Korea National Health Insurance Service database from 2002 to 2021 to construct a cohort of 37,011 workers in the air transportation industry. Cancer incidence was defined using the tenth version of the International Classification of Diseases. We calculated the age- and sex-specific standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) by applying the cancer incidence rate of the general population between 2002 and 2019. RESULTS: Approximately 5% of the cohort developed cancer. Overall, the cancer incidence in the cohort was similar to or lower than that of the general population, with the SIRs for all cancers being lower. However, significantly higher SIRs were observed for nasopharyngeal cancer (SIR, 3.21; 95% CI, 1.71-5.48) and non-Hodgkin lymphoma (SIR, 1.57; 95% CI, 1.02-2.32) in male workers and breast and genital cancer (SIR, 1.51; 95% CI, 1.34-1.70) and thyroid cancer (SIR, 1.25; 95% CI, 1.05-1.47) in female workers. CONCLUSIONS: The lower overall cancer incidence among air transportation industry workers observed in this study could indicate the "healthy worker effect"; however, the incidences of certain cancers were higher than those in the general population. Given that these workers are exposed to multiple occupational and lifestyle-related risk factors, including cosmic radiation, further studies are necessary to determine radiation-induced cancer risk while considering potential confounding factors.

Short occupational exposure to glyphosate and its biomonitoring via urinary levels of glyphosate and metabolite AMPA (Amino-MethylPhosphonic acid), in Italian vineyard workers.

Glyphosate, an herbicide largely used in various contexts, can have adverse effects on human health. Although it is currently the most applied pesticide worldwide, few studies evaluated the extent of human exposure via biomonitoring. To expand such information, biological monitoring of exposure to glyphosate was conducted. The study has a before-and-after design to demonstrate the immediate impact of short-term interventions. Accordingly, the urine concentrations of glyphosate and its main biodegradation product (amino-methylphosphonic acid- AMPA) were measured before and the day after the single herbicide application in 17 male winegrowers. Urine samples were analyzed by high performance liquid chromatography coupled with a triple quadrupole mass spectrometer equipped with an electrospray ionization source. Glyphosate and AMPA were not detectable in pre-application urine samples (limit of quantification for glyphosate (LOQG) was 0.1 µg/L; limit of quantification for AMPA (LOQAMPA) was 0.5 µg/L). After application, glyphosate urinary levels were above LOQG in all workers. The median, min, and max values were 2.30, 0.51, and 47.2 µg/L, respectively. The same values were found for 50 %, 5 % and 95 % percentiles. After assigning numerical values, such as one half the LOQ, to each of the non-detects, the "z" of Wilcoxon matched-pairs signed-ranks test was -3.62 (p = 0.0003), suggesting the pre-application values being significantly lower than the post-application urinary glyphosate concentration. A similar analysis was not feasible with AMPA urinary levels, which were detectable only in 3 workers, after application. 12 (71 %) workers were significantly exposed to glyphosate, but adherence to the adoption of personal protective equipment was good: 14 (82 %) workers used gloves, 13 (76 %) used overalls and 13 (76 %) facial masks. Our data show that glyphosate can be absorbed by the workers after a single application and confirms the usefulness of biomonitoring in exposed workers. Further studies are needed in larger working populations and with multiple glyphosate applications, as well as to evaluate the correlations of glyphosate urine levels with exposure questionnaire data, in order to assess the actual relevance of risk and protection factors.

Association between relatively low blood lead levels and urinary δ-aminolevulinic acid concentrations among male workers at a Japanese battery factory.

OBJECTIVES: Whether the known positive association between blood lead (PbB) levels and urinary δ-aminolevulinic acid (ALAU) also exists at relatively low PbB levels (<40 µg/dL) remains unclear. We aimed to investigate this association at lower PbB levels. METHODS: We analyzed data from biannual medical examinations of workers at a Japanese factory from August 2013 to August 2023. We excluded records from female workers and those with missing data, resulting in a dataset consisting of 1396 records from 155 male workers. We employed mixed-effect linear regression models with a random intercept for workers and additional adjustments for age and smoking status. RESULTS: The median PbB level across all the analyzed records was 8 µg/dL (range: 1, 31 µg/dL). Significant positive associations were observed between PbB and ALAU, with a one-unit increase in natural logarithm-transformed PbB corresponding to a 10.0% increase in ALAU (95% CI: 2.7, 17.9%). Categorized PbB analyses showed a 23.8% increase in ALAU (95% CI: 2.7, 49.2%) for PbB levels at 20-24 µg/dL and an 83.1% increase (95% CI: 30.1, 157.7%) for PbB levels ≥25 µg/dL, compared to those <5 µg/dL. The exposure-response curve analysis indicated a plateau followed by an increasing trend. CONCLUSIONS: A positive and non-linear association between PbB and ALAU levels was observed at relatively low PbB levels.

A detailed methodology for estimating health-related hazards of workplace exposure to indoor formaldehyde vapours.

A comprehensive risk assessment method was applied to examine the risks associated with airborne formaldehyde occupational exposure among hospital laboratory staff. The method assessed exposure levels and health impacts by integrating area and personal air sampling, biological monitoring, and self-reported health data. Samples were collected from 74 workplaces across various departments using NIOSH method 3500 and were analyzed via UV-vis spectrophotometry. The data showed significant differences in exposure levels between departments (p≤0.05) and confirmed the efficacy of the method in identifying risk differences. Despite average personal exposure levels being measured lower than occupational limits, individual assessments indicated that some participants surpassed these limits, emphasizing the necessity of personal monitoring for workers with higher risks. The high prevalence of respiratory symptoms, such as cough and wheezing among staff, indicated the need for further investigation and targeted interventions. Although estimated cancer and non-cancer risks were within safe thresholds, the study emphasized the importance of continuous exposure monitoring and the implementation of effective control measures in hospital laboratory departments with formaldehyde emission. This integrated method improved the reliability and generalizability of formaldehyde exposure risk assessments and aided in the development of safe occupational health practices.•The method integrated personal and area sampling with advanced calibration for precise occupational exposure evaluation in laboratories.•The method used of biomarkers to assess formaldehyde absorption in the body estimating both cancerous and non-cancerous health risks associated with occupational exposure.•Addressed traditional method limitations and integrated risk components to improve data reliability for workplace safety and health risk management.

Prevalence of Non-communicable Disease Risk Factors Among Adults in a Rural Field Practice Area of a Tertiary Care Medical Center in Karnataka.

Background Non-communicable diseases (NCDs), also referred to as chronic diseases, typically have a long duration and arise from a combination of genetic, physiological, environmental, and behavioral factors. Each year, 17 million people under the age of 70 die from non-communicable diseases (NCDs), with 86% of these premature deaths occurring in low- and middle-income countries. Objectives To estimate the prevalence of NCD risk factors among adults (18-65 years) in a rural population. Methods A cross-sectional study was conducted by selecting 200 participants from 200 households using convenience sampling. Participants aged 18-65 years were included, and locked households were excluded. Sociodemographic profiles were assessed using semi-structured questionnaires, and NCD risk factors were assessed using a Community-Based Assessment Checklist (CBAC). Descriptive statistics and associations were analyzed. Results The majority of participants were men (53.5%), married (89.5%), and belonged to the class 2 socioeconomic classification. The prevalence of NCD risk factors was 17%, with smoking (12.5%), alcohol consumption (6%), and waist circumference (1.8% for men and 27.9% for women) being the most common risk factors. Older age, lower educational attainment, unemployment, and lower-income classes were associated with a higher risk of NCDs. Conclusion The study identifies key risk factors for non-communicable diseases (NCDs) as family history, waist circumference over 90 cm, daily alcohol consumption, and tobacco use, all significantly increasing the risk. Physical activity under 150 minutes per week and occupational exposure to crop residue showed no significant effect.

Dermal exposure assessment of formal e-waste dismantlers to flame retardants and plasticizers using passive sampling methodologies.

The recycling of e-waste can lead to the release of organic chemicals when materials containing additives are subjected to dismantling and grinding. In this context, the exposure of workers from a Catalonian e-waste facility to flame retardants and plasticizers (including organophosphate esters (OPEs), polybrominated diphenyl ethers (PBDEs), novel brominated flame retardants (NBFRs) and dechloranes) was assessed using T-shirts and wristbands as passive samplers. The study area includes an area exclusively dedicated to cathodic ray-tube (CRT) TVs dismantling, and a grinding area where the rest of e-waste is ground. All the families of compounds were detected in both T-shirts and wristbands, with the highest concentration levels corresponding to OPEs, followed by PBDEs, NBFRs, and dechloranes. The CRT area presented higher concentration levels than the grinding area. The compounds with higher concentrations in T-shirts were 2-ethylhexyl diphenyl phosphate (EHDPP), diphenyl cresyl phosphate (DCP) and triphenyl phosphate (TPHP), and the total concentration of all groups ranged between 293 and 8324 ng/dm2-h (hour). In the case of the wristbands, the most abundant compounds were DCP, TPHP, and BDE-209, with total concentrations between 188 and 2248 ng/dm2-h. The two sampling methods appear to be complementary, as T-shirts collect coarser particles, while wristbands also capture volatile compounds. Based on normalized surface and time concentrations, the estimated daily intake (EDI) through dermal contact was calculated and carcinogenic and non-carcinogenic risks (CR and non-CR) associated with this activity assessed. The results show median CR 29 and 16 times below the threshold in CRT and grinding areas respectively. The non-CR medians were 2 and 3 times below the threshold, although in the CRT area one exceptional value surpassed the threshold, suggesting that risk can exist for some workers in the facility.

Assessment of Occupational Exposure to Inhalable Aerosols in an Instant Powdered Food Manufacturing Plant in Norway.

Background: In the food manufacturing industry, exposure to inhalable aerosols contributes to respiratory illnesses such as occupational asthma and rhinitis. However, there is a lack of comprehensive exposure assessment studies. This study evaluated occupational exposure to inhalable aerosols in an instant powdered food manufacturing plant during work operations involving dried food and powders. Methods: In total, 50 workers from an instant powdered food manufacturing plant were recruited. Personal inhalable aerosol exposure measurements were taken for both full-shift and task-based activities. The concentrations of inhalable aerosols were analyzed to identify any variation within and across departments, as well as between seasons, handedness, and sex. Results: In total, 134 personal air samples were collected, and the particulate mass was determined gravimetrically. The concentrations of inhalable aerosols ranged from 0.1 to 27 mg/m3 for full-shift exposure measurements and 3.1 to 73 mg/m3 for task-based measurements. Statistically significant differences in mean aerosol concentrations were found across departments (A:B p < 0.001, A:C p < 0.05, B:C p < 0.001) and between seasons (p < 0.001). Conclusion: This study revealed high exposure to inhalable aerosols among workers, particularly those involved in manual weighing, mixing, and adding powders. The significant differences between departments highlight the specific activities contributing to increased inhalable aerosol concentrations. Seasonal variations were also evident, with autumn showing higher concentrations of inhalable aerosols in all departments compared with summer. These findings emphasize the importance of understanding the distribution of aerosol concentrations across different work tasks and departments, particularly during different seasons.

Occupational exposure protection and perioperative management of sudden infectious diseases from the perspective of COVID-19.

The coronavirus disease (COVID-19) SARS-CoV-2 virus epidemic continues to exhibit a sporadic onset trend due to the continuous variation of the novel coronavirus. However, the psychological impact of the pandemic persists. It is crucial to reflect on our experiences to better prepare for future large-scale infectious diseases. During outbreaks of infectious diseases, patients may still require orthopaedic surgery. It is crucial to prioritize the safety of medical staff and establish procedures to ensure their protection. However, with the implementation of a series of standardized operational protection procedures, orthopaedic surgeons can safely perform their duties without the risk of contracting COVID-19. There is no doubt that the orthopaedic occupational exposure protection process and perioperative management plan for global infectious diseases, such as COVID-19, require a standardized summarization process and a narrative review.

Urinary excretion of H2S methylation metabolites in oil refinery workers.

Hydrogen sulfide (H2S) is a toxic gas emitted through natural and anthropogenic activities. Chronic exposure to inhaled H2S at low sub-toxic levels is common among workers in oil refineries and may have important health implications. Inhaled H2S can be oxidized to thiosulfate or methylated to dimethylsulfide (DMS) which can be methylated to the novel human metabolite trimethylsulfonium (TMS) or oxidized to dimethylsulfoxide (DMSO) but the extent of methylation of inhaled H2S is currently unknown in humans. A total of 80 participants were recruited of which 40 were workers in an oil refinery in Kurdistan region, Iraq including those working in close contact with the facility area where H2S was measured at 1.5-5.0 mg m-3, and 40 controls living in a nearby city with no detectable H2S or perceptible odor (<0.1 mg m-3). A total of 240 urine samples were measured for multiple H2S-related metabolites. DMSO was consistently found in all urine samples with concentrations generally within the range of 1.0-10 µM. Although these concentrations were 10-100-fold higher than TMS urinary levels, clear correlation between DMSO and TMS was observed (rs 0.55, P < 0.0001), which supports DMS as common precursor. DMSO urinary levels were elevated in the oil refinery workers in close contact with the facilities (5.0 vs. 3.3 µM, P 0.03), but TMS was unaltered (0.13 vs. 0.14 µM, P 0.68). Overall, the results suggest that the investigated methylation metabolites are not sufficiently sensitive to low occupational exposure levels of inhaled H2S.

The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A systematic review of human observational studies - Part I: Most researched outcomes.

BACKGROUND: The objective of this review was to assess the quality and strength of the evidence provided by human observational studies for a causal association between exposure to radiofrequency electromagnetic fields (RF-EMF) and risk of the most investigated neoplastic diseases. METHODS: Eligibility criteria: We included cohort and case-control studies of neoplasia risks in relation to three types of exposure to RF-EMF: near-field, head-localized, exposure from wireless phone use (SR-A); far-field, whole body, environmental exposure from fixed-site transmitters (SR-B); near/far-field occupational exposures from use of hand-held transceivers or RF-emitting equipment in the workplace (SR-C). While no restrictions on tumour type were applied, in the current paper we focus on incidence-based studies of selected "critical" neoplasms of the central nervous system (brain, meninges, pituitary gland, acoustic nerve) and salivary gland tumours (SR-A); brain tumours and leukaemias (SR-B, SR-C). We focussed on investigations of specific neoplasms in relation to specific exposure sources (i.e. E-O pairs), noting that a single article may address multiple E-O pairs. INFORMATION SOURCES: Eligible studies were identified by literature searches through Medline, Embase, and EMF-Portal. Risk-of-bias (RoB) assessment: We used a tailored version of the Office of Health Assessment and Translation (OHAT) RoB tool to evaluate each study's internal validity. At the summary RoB step, studies were classified into three tiers according to their overall potential for bias (low, moderate and high). DATA SYNTHESIS: We synthesized the study results using random effects restricted maximum likelihood (REML) models (overall and subgroup meta-analyses of dichotomous and categorical exposure variables), and weighted mixed effects models (dose-response meta-analyses of lifetime exposure intensity). Evidence assessment: Confidence in evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS: We included 63 aetiological articles, published between 1994 and 2022, with participants from 22 countries, reporting on 119 different E-O pairs. RF-EMF exposure from mobile phones (ever or regular use vs no or non-regular use) was not associated with an increased risk of glioma [meta-estimate of the relative risk (mRR) = 1.01, 95 % CI = 0.89-1.13), meningioma (mRR = 0.92, 95 % CI = 0.82-1.02), acoustic neuroma (mRR = 1.03, 95 % CI = 0.85-1.24), pituitary tumours (mRR = 0.81, 95 % CI = 0.61-1.06), salivary gland tumours (mRR = 0.91, 95 % CI = 0.78-1.06), or paediatric (children, adolescents and young adults) brain tumours (mRR = 1.06, 95 % CI = 0.74-1.51), with variable degree of across-study heterogeneity (I2 = 0 %-62 %). There was no observable increase in mRRs for the most investigated neoplasms (glioma, meningioma, and acoustic neuroma) with increasing time since start (TSS) use of mobile phones, cumulative call time (CCT), or cumulative number of calls (CNC). Cordless phone use was not significantly associated with risks of glioma [mRR = 1.04, 95 % CI = 0.74-1.46; I2 = 74 %) meningioma, (mRR = 0.91, 95 % CI = 0.70-1.18; I2 = 59 %), or acoustic neuroma (mRR = 1.16; 95 % CI = 0.83-1.61; I2 = 63 %). Exposure from fixed-site transmitters (broadcasting antennas or base stations) was not associated with childhood leukaemia or paediatric brain tumour risks, independently of the level of the modelled RF exposure. Glioma risk was not significantly increased following occupational RF exposure (ever vs never), and no differences were detected between increasing categories of modelled cumulative exposure levels. DISCUSSION: In the sensitivity analyses of glioma, meningioma, and acoustic neuroma risks in relation to mobile phone use (ever use, TSS, CCT, and CNC) the presented results were robust and not affected by changes in study aggregation. In a leave-one-out meta-analyses of glioma risk in relation to mobile phone use we identified one influential study. In subsequent meta-analyses performed after excluding this study, we observed a substantial reduction in the mRR and the heterogeneity between studies, for both the contrast Ever vs Never (regular) use (mRR = 0.96, 95 % CI = 0.87-1.07, I2 = 47 %), and in the analysis by increasing categories of TSS ("<5 years": mRR = 0.97, 95 % CI = 0.83-1.14, I2 = 41 %; "5-9 years ": mRR = 0.96, 95 % CI = 0.83-1.11, I2 = 34 %; "10+ years": mRR = 0.97, 95 % CI = 0.87-1.08, I2 = 10 %). There was limited variation across studies in RoB for the priority domains (selection/attrition, exposure and outcome information), with the number of studies evenly classified as at low and moderate risk of bias (49 % tier-1 and 51 % tier-2), and no studies classified as at high risk of bias (tier-3). The impact of the biases on the study results (amount and direction) proved difficult to predict, and the RoB tool was inherently unable to account for the effect of competing biases. However, the sensitivity meta-analyses stratified on bias-tier, showed that the heterogeneity observed in our main meta-analyses across studies of glioma and acoustic neuroma in the upper TSS stratum (I2 = 77 % and 76 %), was explained by the summary RoB-tier. In the tier-1 study subgroup, the mRRs (95 % CI; I2) in long-term (10+ years) users were 0.95 (0.85-1.05; 5.5 %) for glioma, and 1.00 (0.78-1.29; 35 %) for acoustic neuroma. The time-trend simulation studies, evaluated as complementary evidence in line with a triangulation approach for external validity, were consistent in showing that the increased risks observed in some case-control studies were incompatible with the actual incidence rates of glioma/brain cancer observed in several countries and over long periods. Three of these simulation studies consistently reported that RR estimates > 1.5 with a 10+ years induction period were definitely implausible, and could be used to set a "credibility benchmark". In the sensitivity meta-analyses of glioma risk in the upper category of TSS excluding five studies reporting implausible effect sizes, we observed strong reductions in both the mRR [mRR of 0.95 (95 % CI = 0.86-1.05)], and the degree of heterogeneity across studies (I2 = 3.6 %). CONCLUSIONS: Consistently with the published protocol, our final conclusions were formulated separately for each exposure-outcome combination, and primarily based on the line of evidence with the highest confidence, taking into account the ranking of RF sources by exposure level as inferred from dosimetric studies, and the external coherence with findings from time-trend simulation studies (limited to glioma in relation to mobile phone use). For near field RF-EMF exposure to the head from mobile phone use, there was moderate certainty evidence that it likely does not increase the risk of glioma, meningioma, acoustic neuroma, pituitary tumours, and salivary gland tumours in adults, or of paediatric brain tumours. For near field RF-EMF exposure to the head from cordless phone use, there was low certainty evidence that it may not increase the risk of glioma, meningioma or acoustic neuroma. For whole-body far-field RF-EMF exposure from fixed-site transmitters (broadcasting antennas or base stations), there was moderate certainty evidence that it likely does not increase childhood leukaemia risk and low certainty evidence that it may not increase the risk of paediatric brain tumours. There were no studies eligible for inclusion investigating RF-EMF exposure from fixed-site transmitters and critical tumours in adults. For occupational RF-EMF exposure, there was low certainty evidence that it may not increase the risk of brain cancer/glioma, but there were no included studies of leukemias (the second critical outcome in SR-C). The evidence rating regarding paediatric brain tumours in relation to environmental RF exposure from fixed-site transmitters should be interpreted with caution, due to the small number of studies. Similar interpretative cautions apply to the evidence rating of the relation between glioma/brain cancer and occupational RF exposure, due to differences in exposure sources and metrics across the few included studies. OTHER: This project was commissioned and partially funded by the World Health Organization (WHO). Co-financing was provided by the New Zealand Ministry of Health; the Istituto Superiore di Sanità in its capacity as a WHO Collaborating Centre for Radiation and Health; and ARPANSA as a WHO Collaborating Centre for Radiation Protection. REGISTRATION: PROSPERO CRD42021236798. Published protocol: [(Lagorio et al., 2021) DOI https://doi.org/10.1016/j.envint.2021.106828].

The handling of hazardous medications by nurses and midwives: A retrospective cohort study.

BACKGROUND: Occupational exposure of healthcare workers to hazardous medications can be potentially harmful. Hazardous medications can be carcinogenic, developmentally toxic, reproductively toxic, genotoxic and/or toxic to organs at low doses. These hazardous medications can be used in many healthcare settings, but published research of occupational exposure has focused almost exclusively on cancer services. AIM: To identify the healthcare settings where nurses and midwives are responsible for the administration of hazardous medications. METHOD: A retrospective cohort study was undertaken of all medication administration events occurring during a two-week period at a public metropolitan health service in 2023. All medication administration events from six hospital sites were identified using the electronic (Oracle Health-Cerner-Millennium®) and paper (Chemotherapy Chart) medication administration records. From all of the medications administered, the subset of medications classified as hazardous were identified based on the Victorian Therapeutics Advisory Group Framework for Handling of Hazardous Medicines (2021) and other guidelines. Poisson regression modelling was used to explore associations between the number of hazardous medications and the healthcare area where they were administered (p < 0.001). RESULTS: Of the 121,567 administration events, 6054 (5.0 %) involved hazardous medications. The healthcare areas with the highest rate of hazardous medication administration events, as a proportion of all medication administration events, were outpatient cancer service (301/695, 43.3 %), birth suite (13/86, 15.1 %) and mental health (404/4011, 10.1 %) areas. During the two-week period, 6054 hazardous medication administration events occurred, involving 117 different medications. The greatest number of these events took place in the medical (1729/6054, 28.6 %) and geriatric (1579/6054, 26.1 %) inpatient healthcare areas. A total of 1258 nurses and midwives were directly involved in either administering, or checking and witnessing the administration of hazardous medications to 996 patients (25.2 % of the total 3958 patients). Most hazardous medications administered to patients were in an oral dosage form (5426/6054, 89.6 %). CONCLUSION: Hazardous medications were administered in all healthcare areas, with the exception of endoscopy services. Nurses and midwives were at risk of occupational exposure from hazardous medications.

Occupational exposure to radiofrequency electromagnetic fields and brain tumor risk: Application of the INTEROCC job-exposure matrix.

Radiofrequency electromagnetic fields (RF-EMF, 100 kHz to 300 GHz) are classified by IARC as possibly carcinogenic to humans (Group 2B). This study evaluates the potential association between occupational RF-EMF exposure and brain tumor risk, utilizing for the first time, a RF-EMF job-exposure matrix (RF-JEM) developed in the multi-country INTEROCC case-control study. Cumulative and time-weighted average (TWA) occupational RF-EMF exposures were estimated for study participants based on lifetime job histories linked to the RF-JEM using three different methods: (1) by considering RF-EMF intensity among all exposed jobs, (2) by considering RF-EMF intensity among jobs with an exposure prevalence ≥ the median exposure prevalence of all exposed jobs, and (3) by considering RF-EMF intensity of jobs of participants who reported RF-EMF source use. Stratified conditional logistic regression models were used, considering various lag periods and exposure time windows defined a priori. Generally, no clear associations were found for glioma or meningioma risk. However, some statistically significant positive associations were observed including in the highest exposure categories for glioma for cumulative and TWA exposure in the 1- to 4-year time window for electric fields (E) in the first JEM application method (odds ratios [ORs] = 1.36, 95% confidence interval [95% CI] 1.08, 1.72 and 1.27, 95% CI 1.01, 1.59, respectively), as well as for meningioma for cumulative exposure in the 5- to 9-year time window for electric fields (E) in the third JEM application method (OR = 2.30, 95% CI 1.11, 4.78). We did not identify convincing associations between occupational RF-EMF exposure and risk of glioma or meningioma.

Knowledge and safe handling practices affecting the occupational exposure of nurses and midwives to hazardous drugs: A mixed methods systematic review.

BACKGROUND: Hazardous drugs are inherently toxic and present a potential occupational exposure risk to nurses and midwives. Hazardous drugs require special handling to minimise the risk of exposure and adverse health effects. Although the use of hazardous drugs in oncology services is well recognised, they are also used in other healthcare areas where nurses and midwives may be unaware there is a risk. OBJECTIVE: To investigate what nurses and midwives know and do about their occupational exposure to hazardous drugs, and what factors affect their knowledge and practice. DESIGN: Mixed methods systematic review. METHODS: A systematic review was conducted, and studies were included if the authors described what nurses or midwives knew about hazardous drugs, or what they did in their clinical practice to reduce their risk of occupational exposure (PROSPERO registration CRD42024437493). The databases were searched for any year until the 26th of January 2024.Two independent reviewers extracted data using Covidence and assessed the risk of bias. The data were extracted into the categories of knowledge of risk and safe handling practices, attitude and factors affecting these, and activities that posed the greatest risk of exposure (preparation, administration, and disposal of hazardous drugs, cleaning hazardous drug spills, and handling excreta from patients who had recently been treated with hazardous drugs). RESULTS: Of the 2702 articles that were identified, 59 quantitative and 3 qualitative studies were included in this review. No studies reported on midwives handling hazardous drugs. Most studies investigated nurses working in oncology services. Nurses reported a lack of education about the risk and safe handling. They were often responsible for preparing hazardous drugs and there was inconsistency in their compliance when using personal protective equipment. Nurses did not always perceive that there was a real risk of exposure, were concerned about the effect of wearing personal protective equipment on their relationship with patients and perceived they lacked the time to don equipment. CONCLUSIONS: The risk of occupational exposure to hazardous drugs outside of oncology services was rarely investigated. There were no studies reporting what midwives knew and did about their risk of occupational exposure to hazardous drugs. When nurses were aware of the risks, this did not necessarily translate into the implementation of safe handling practices or the consistent use of personal protective equipment because of a perceived low risk, lack of personal protective equipment availability, and prioritising personal or patient comfort over safety measures. TWEETABLE ABSTRACT: Nurses and midwives are often unknowingly exposed to the toxic effects of hazardous drugs when they prepare and administer these drugs for patients, although knowledge does not always equal safe handling practices.

The SAM-Krom biomonitoring study shows occupational exposure to hexavalent chromium and increased genotoxicity in Denmark.

BACKGROUND: Hexavalent chromium (Cr(VI)) is a carcinogen. Exposure to Cr(VI) may occur in different industrial processes such as chrome plating and stainless steel welding. The aim of this study was to assess occupational exposure to Cr(VI) in Denmark. METHODS: This cross-sectional study included 28 workers and 8 apprentices with potential Cr(VI) exposure and 24 within company controls, all recruited from six companies and one vocational school. Use of occupational safety and health (OSH) risk prevention measures were assessed through triangulation of interviews, a questionnaire and systematic observations. Inhalable Cr(VI) and Cr-total were assessed by personal air exposure measurements on Cr(VI) exposed participants and stationary measurements. Cr concentrations were measured in urine and in red blood cells (RBC) (the latter reflecting Cr(VI)). Genotoxicity was assessed by measurement of micronuclei in peripheral blood reticulocytes (MNRET). RESULTS: At announced visits, a consistent high degree of compliance to OSH risk prevention measures were seen in 'chromium bath plating' for both technical devices (e.g. ventilation, plastic balls, sheet coverings) and in the use of personal protective equipment (e.g. gloves, respirators), yet a lesser degree of compliance was observed in 'stainless steel welding'. The geometric mean of the air concentration of Cr(VI) was 0.26 µg/m3 (95% confidence interval (CI): 0.12-0.57) for the Cr(VI)-exposed workers and 3.69 µg/m3 (95% CI: 1.47-9.25) for the Cr(VI)-exposed apprentices. Subdivided by company type, the exposure levels were 0.13 µg/m3 (95% CI: 0.04-0.41) for companies manufacturing and processing metal products, and 0.81 µg/m3 (95% CI: 0.46-1.40) for bath plating companies. Workers with occupational exposure to Cr(VI) had significantly higher median levels of urinary Cr (2.42 µg/L, 5th-95th percentile 0.28-58.39), Cr in RBC (0.89 µg/L, 0.54-4.92) and MNRET (1.59 ‰, 0.78-10.92) compared to the within company controls (urinary: 0.40 µg/L, 0.16-21.3, RBC: 0.60 µg/L, 0.50-0.93,MNRET: 1.06 ‰, 0.71-2.06). When sub-dividing by company type, urinary Cr (4.61 µg/L, 1.72-69.5), Cr in RBC (1.33 µg/L, 0.95-4.98) and MNRET (1.89 µg/L, 0.78-12.92) levels were increased for workers with potential Cr(VI) exposure in bath-plating companies, and when subdividing by work task, workers engaged in process operation had increased levels of urinary Cr (8.51 µg/L, 1.71-69.5), Cr in RBC (1.33 µg/L, 0.95-4.98) and MNRET (1.89 µg/L, 0.82-12.92) levels. CONCLUSION: This biomonitoring study shows that bath platers were highly exposed to Cr(VI), as suggested by relatively high levels of urinary Cr, Cr in RBC and increased levels of micronuclei. The urinary Cr concentrations were high when compared to the French biological limit value of 2.5 µg Cr/L, corresponding to the Danish occupational exposure limit of 1 µg/m3. This, in turn, indirectly suggests that additional exposure routes than via air may contribute to the exposure. For welders, no statistically significant increases compared to within company controls were observed, however, the observed urinary Cr levels were similar to the levels observed in a European study (HBM4EU), and were higher than the levels observed for welders in Sweden (SafeChrom). In spite of a high degree of self-reported and observed compliance to OSH risk prevention measures during announced visits, the biomarkers of exposure reflecting recent exposure (urinary Cr) or exposure during the last four months (Cr in RBC) may point to variation in compliance to OSH risk prevention measures in general. Reduced occupational exposure to Cr(VI) may be achieved by applying the hierarchy of controls in eliminating or substituting Cr(VI), and the use of more effective technical solutions (e.g. automation).

Comparison of radiation-shielding curtains for endoscopic retrograde cholangiopancreatography staff.

Occupational radiation exposure to the eye lens of medical staff during endoscopic retrograde cholangiopancreatography (ERCP) should be kept low so as not to exceed annual dose limits. Dose should be low to avoid tissue reactions and minimizing stochastic effects. It is known that the head and neck of the staff are exposed to more scattered radiation in an over-couch tube system than in a C-arm system (under-couch tube). However, this is only true when radiation-shielding curtains are not used. This study aimed to compare the protection radiation to the occupationally exposed worker between a lead curtain mounted on a C-arm system and an ERCP-specific lead curtain mounted on an over-couch tube system. A phantom study simulating a typical setting for ERCP procedures was conducted, and the scattered radiation dose at four staff positions were measured. It was found that scattered radiation doses were higher in the C-arm with a lead curtain than in the over-couch tube with an ERCP-specific lead curtain at all positions measured in this study. It was concluded that the over-couch tube system with an ERCP-specific lead curtain would reduce the staff eye dose by less than one-third compared to the C-arm system with a lead curtain. For the C-arm system, it is necessary to consider more effective radiation protection measures for the upper body of the staff, such as a ceiling-suspended lead screen or another novel shielding that do not interfere with procedures.