Progressive Massive Fibrosis Identified at Federally Funded Black Lung Clinics in the US.

This study of US Black Lung Clinics (established to treat coal miners) reports the prevalence of progressive massive fibrosis identified through June 2023.

Noise risk assessment practices of four South African manufacturing and utilities companies.

BACKGROUND:  The South African Noise Induced Hearing Loss (NIHL) Regulations, mandates employers to conduct a noise risk assessment, which records specific variables for determining the status of exposure and the need for implementation of control measures. OBJECTIVES:  The study evaluated company noise risk assessment practices for alignment with legal requirements and specific risk assessment guidelines. METHOD:  Convenience sampling was used to select the four manufacturing and utilities companies that participated in the study. The participating companies submitted latest noise risk assessment records for evaluation through the READ approach. RESULTS:  The noise risk assessment records of three of the four companies omitted the recording of factors such as the reasonable deterioration in or failure of control measures, adequate control and formalisation of hearing conservation programmes (HCPs). When evaluated against the South African National Standard 31000 Risk Assessment guidelines, the risk assessment processes of the respective companies were lacking in addressing aspects related to establishing communication and consultation, evaluation, adapting, continually improving, leadership and commitment, and integration. CONCLUSION:  The recorded information on the noise risk assessment reports from the four participating companies were incomplete, negatively affecting subsequent HCP management processes and decision-making. Future studies should investigate other aspects such as the implementation status of recommended noise controls as well as their effectiveness as recorded in the noise risk assessment records.Contribution: This study provided firsthand insights of company noise risk assessment practices, specifically identifying functional and technical areas requiring improvement to enhance current efforts directed towards the minimisation of NIHL within HCPs. The study highlighted that the current practices on recording noise risk assessment information remain incomplete, adversely diminishing the impact of the assessment as an important decision-making tool. The identified technical issues specifically, when addressed, will increase trust on the decisions derived from noise risk assessments.

Concept of health surveillance programme for workers exposed to respirable crystalline silica at present and in the past.

In the paper authors present general assumptions of health surveillance programme concept for workers employed in respirable crystalline silica (RCS) exposure at present and in the past. There is no effective treatment for silicosis thus disease prevention is of paramount significance. For decades efforts of World Health Organization (WHO) and International Work Organization (ILO) have been focused on eliminating silicosis globally. Unfortunately silicosis is still one of the most lethal occupational diseases and the preventative programmes have not yet been successful. The authors identify main steps to complete an overview of RCS exposure and suggest lines of actions to be taken before launching the health surveillance programme. Introduction of the health surveillance programme would increase awareness of harmful health effects of the RCS exposure, emphasize the significance of preventive medical check-ups and early diagnostics of occupational diseases as well as the importance of using appropriate protective equipment. The programme development on a national level might be carried out with the cooperation of multiple backgrounds and institutions. This would allow for detailed planning, implementation, monitoring and effective evaluation of its results. Having a better and updated knowledge of silicosis epidemiology, early diagnostics, the possible sources of RCS occupational exposure and evaluation of undertaken preventive actions are crucial factors in disease prevention. The programme introduction would be of educational significance for all the stakeholders and the groups engaged in the project implementation, which would contribute to high effectiveness of the preventive activities and their improvement in the future. Med Pr Work Health Saf. 2023;74(4):341-6.

Validity of "OfficeCheck": A self-musculoskeletal assessment tool for screening work-related musculoskeletal disorders in office workers.

BACKGROUND: Early self-assessment for work-related musculoskeletal disorders (WMSDs) is crucial in preventing severe symptoms and long-term consequences. Accessible tools are necessary for proactive management. OBJECTIVE: To validate the OfficeCheck web application as a screening tool to classify office workers as capable of self-management for specific symptoms of WMSDs or requiring professional consultation. METHODS: This study was conducted to determine the criterion-related validity of OfficeCheck using physical therapy assessment as the reference standard. In total, 223 office workers who work with a computer more than two hours a day with or without symptoms of WMSDs participated in this study. All of them were classified by self-assessment on the OfficeCheck process flow (Kappa = 0.841) and physical therapy assessment, respectively. For statistical analysis, classification numbers were calculated for sensitivity, specificity, false positive rate (FPR), false negative rate (FNR), positive predictive value (PPV), and negative predictive value (NPV). RESULTS: A total of 223 workers with a mean age of 38.9±9.0 years and mean body mass index (BMI) of 24.3±5.2 kg/m2 were illustrated. The most common areas of complaint were neck/upper back and lower back/hip. The results indicated that OfficeCheck had high sensitivity (95.1%), low specificity (42.0%), low PPV (38.0%), and high NPV (95.8%). The FPR was 58.0% and the FNR was 4.9%. CONCLUSION: OfficeCheck was found to have high sensitivity to classify office workers as capable of self-management for specific symptoms of WMSDs or requiring professional consultation. The use of OfficeCheck is thus recommended for self-detection and management to stop the consequences of WMSDs.

[COVID-19 as an insurance case of the statutory accident insurance: occupational disease or occupational accident : Relevant knowledge for the (general and abdominal) surgeon]. / COVID-19 als Versicherungsfall der gesetzlichen Unfallversicherung: Berufskrankheit oder Arbeitsunfall : Relevantes Wissen für den (Allgemein­/Viszeral­)Chirurgen.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in many infections with the virus and sickness due to coronavirus disease 2019 (COVID-19). Therefore, there was a dramatic increase in the number of reported and recognized occupational diseases (Berufskrankheit, BK) and occupational accidents (Arbeitsunfall, AU) at the German Social Accident Insurance Institutions (BG) and accident insurance funds (Unfallkassen).The publication aims to show the differences between BK and AU and to review the current data on occupational diseases. It deals with the definitions of BK and AU, the differences in the conditions for recognition as BK or AU. Furthermore, the claims for benefits are presented. Finally, statistical key figures of the BK according to No. 3101 and the AU are presented.Results (key points)- According to § 7 SGB VII, AU and BK are insured events of the statutory accident insurance.- In surgery, like specifically in the rest of the healthcare system, the relevance of the SARS-CoV­2 infection with post-COVID in personnel for occupational medical prevention and as a case to be recognized by the statutory accident insurance (BK or AU) becomes clear.- Relevant for the recognition are the duration and the intensity of the contact (local proximity) and the SARS-CoV­2 occupational health and safety rule of 20 August 2020 essentially recognizes a contact duration of at least 15 min at a spatial distance of less than 1.5-2 m (further aspects: more intensive shorter contacts, number of verifiably infected persons in the closer activity environment or the usual personal contacts, spatial situation, work route, special constellations).- No case numbers can be elicited for the detailed presentation of the surgery setting.- There are still immense problems and challenges in the assessment of COVID-19 consequences or post-COVID as occupational disease, as numerous uncertainty factors, such as insufficiently secured knowledge about the further long-term course over the years or the widely varied symptom spectrum complicates the medical assessment of the consequences of this disease.Conclusion: the SARS-CoV­2 pandemic is a special challenge for surgery with intensive patient contact and for the entire healthcare system. This caused long-lasting changes and the adequate health care as well as insurance law processing of the (case-specific) consequences might still require considerable efforts and resources.

Self-reported musculoskeletal disorders questionnaire for agriculturists: An online self-assessment tool development.

The musculoskeletal disorders (MSDs) severity and frequency questionnaire (MSFQ) has been used with agriculturists. Although it frequently appears in the literature, it does not periodically reflect the levels of MSDs. This study aimed to develop a MSDs assessment tool for agriculturists via an online database. The four hospitals that were assigned to the development and tryout group received a random selection of participants from 33 health promoting hospitals. In the development phase, 55 agriculturists (from two hospitals) completed the structured interview questionnaire. The MSFQ document for the analysis of MSDs symptoms among agriculturists was concentrated on the frequency and severity of symptoms. The online MSFQ was checked by using intraclass correlation coefficients (ICC) in a one-way random-effects model. In the tryout phase, a group of 44 agriculturists (from another two hospitals) completed a similar online MSFQ. Cronbach's alpha was used to test the reliability of the online self-reported MSDs questionnaires. A Likert rating scale, used to measure the satisfaction of users, was divided into three categories: information, program design, and benefits. The development phase showed an ICC = 0.99 with a 95% CI = 0.98-0.99. More than 65 percent of agriculturists were female, aged from 41-50 years old. A large number of them were engaged in self-cultivation. Their main crops were rice and cassava. In total, 50% reported that they had experienced mild MSDs levels. The shoulder, knee-calf, and hip-thigh areas were the top three parts of the body where agriculturists had experienced MSDs from cultivation. Excellent reliability of online MSFQ was found after the tryout. The agriculturists were very satisfied overall (information, program design, and benefits). Developments to the MSFQ and online administration did not diminish its reliability for obtaining information about the level of MSDs of agriculturists' musculoskeletal symptoms. This self-reported MSDs questionnaire was appropriate to be used among agriculturists.

[Occupational cancer of the urinary tract-incidence, reporting behavior, and administrative procedures]. / Berufsbedingte Tumoren der ableitenden Harnwege ­ Häufigkeit, Meldeverhalten und administratives Vorgehen.

Tumors of the urinary tract are among the most common types of occupational cancer. A significant proportion of about 5-15% may be of occupational etiology. Suspicion of an occupational genesis is subject to mandatory reporting. However, epidemiological analyses show that the number of reports received by accident insurance companies and employers' liability insurance associations is significantly lower than expected. Finally, the economic and administrative effort in surveying a patient's occupational history hinders adequate reporting. By routinely and systematically using a structured questionnaire as part of clinical routine in our hospital, a significantly improved detection of justified suspected cases (from about 4.8% to about 67% of the theoretically expected value) has been achieved since about 2006. In addition to improved medical care and adequate compensation for recognition as an occupational disease, disease-related care is subject to extra-budgetary remuneration in Germany (UV-GOÄ).

Carcinogenic risk assessment and changes in Spirometric indices in casting and welding workers exposed to Metal fumes.

INTRODUCTION: The aim of this study was to investigate exposure to dust, and metal fumes, changes in pulmonary function indices among industrial workers to estimate the carcinogenic and non-carcinogenic risk of exposure to occupational metal fume.

Methods: This cross-sectional study was performed on 98 workers exposed to metal fumes. Air sampling was performed according to the NIOSH 0500 method and was analyzed by gravimetry and metal levels were analyzed by atomic absorption spectrometry. Spirometric results for 2010-2016 were collected. Carcinogenic and non-carcinogenic risk assessments were performed according to the US Environmental Protection Agency guidelines. Data were analyzed by SPSS 20 software. RESULTS: The mean occupational exposure of the subjects to workplace dust and iron fumes was 15.95 ± 6.65 mg/m3 and 13.18 ± 3.06 mg/m3 respectively. During these 6 years, the FVC (P=0.04), PEFR (P=0.04), and FEV1 (P=0.03) indices decreased significantly among welders, but there was no significant difference between FEV1/ FVC indexes. Also, the mean of FEV1 and PEFR decreased significantly amongst casting workers, but FVC and FEV1/ FVC had no significant difference. Multivariate regression showed that in both jobs, BMI and work history were related to pulmonary function indices. The mean total excess ifetime carcinogenic risk (ELCR) of hexavalent chromium in the study population was 0.708 per 1000 people and the mean non-carcinogenic risk of hexavalent chromium was HQ = 19.62. CONCLUSIONS: The results showed that exposure to metal fumes in casting and welding jobs reduces pulmonary function indices. Although the average occupational exposure to hexavalent chromium is lower than the recommended limit and the risk of carcinogenesis is within an acceptable range, the risk of non-carcinogenic effects among workers is significant Therefore, it is important to prevent this problem, by adequate ventilation and using respiratory masks.

A Work-Related Musculoskeletal Disorders (WMSDs) Risk-Assessment System Using a Single-View Pose Estimation Model.

Musculoskeletal disorders are an unavoidable occupational health problem. In particular, workers who perform repetitive tasks onsite in the manufacturing industry suffer from musculoskeletal problems. In this paper, we propose a system that evaluates the posture of workers in the manufacturing industry with single-view 3D human pose-estimation that can estimate the posture in 3D using an RGB camera that can easily acquire the posture of a worker in a complex workplace. The proposed system builds a Duckyang-Auto Worker Health Safety Environment (DyWHSE), a manufacturing-industry-specific dataset, to estimate the wrist pose evaluated by the Rapid Limb Upper Assessment (RULA). Additionally, we evaluate the quality of the built DyWHSE dataset using the Human3.6M dataset, and the applicability of the proposed system is verified by comparing it with the evaluation results of the experts. The proposed system provides quantitative assessment guidance for working posture risk assessment, assisting the continuous posture assessment of workers.

[Health hazards and hearing loss risk assessment of workers exposed to noise in an automobile manufacturing enterprise].

Objective: To investigate the current situation of occupational exposure to noise among noise workers in an automobile manufacturing enterprise in Tianjin, understand the impact of noise on workers＇ nervous system and hearing, and assess the risk of hearing loss among noise workers. Methods: In May 2021, 3516 workers in an automobile manufacturing enterprise were investigated by using a self-made questionnaire＂Noise Workers Questionnaire＂ and cluster sampling method. The occupational noise hygiene survey and occupational hazards detection were carried out in their workplaces. They were divided into noise exposure group and non-noise exposure group according to whether they were exposed to noise or not. The general characteristics, hearing and nervous system symptoms of the two groups of workers were compared, and the risk of hearing loss was assessed. Results: There were 758 workers in the noise exposure group, aged (26±5) years old, with a working age of 3.0 (2.0, 6.0) years exposed to noise. 2758 workers in the non-noise exposure group, aged (25±6) years old, with a working age of 2.0 (1.0, 4.0) years. There were statistically significant differences in the distribution of workers＇education level, working age and memory loss between the two groups (χ(2)=37.98, 38.70, 5.20, P<0.05). The workers in the noise exposure group showed a decreasing trend of insomnia, dreaminess, sweating and fatigue with the increase of working age (χ(2trend)=6.16, 7.99, P<0.05). The risk classification of binaural high-frequency hearing loss for workers in all noise positions until the age of 50 and 60 was negligible, the risk of occupational noise deafness was low for workers in stamping and welding noise positions until the age of 60. Conclusion: The occupational noise exposed to automobile manufacturing workers may cause certain harm to their nervous and auditory systems. Noise protection measures should be taken to reduce the risk of hearing loss and occupational noise deafness.

Usefulness of the Rapid Office Strain Assessment (ROSA) tool in detecting differences before and after an ergonomics intervention.

BACKGROUND: Most ergonomics studies on office workstations evaluate the effects of an intervention only by subjective measures such as musculoskeletal pain and discomfort. Limited evidence has been provided regarding risk factor reduction in office environments through standardized methods assessments. The Rapid Office Strain Assessment (ROSA) tool can provide an estimation of risk factor exposure for office workers as a means by which the outcome of interventions can be quantified. PURPOSE: The aim of the study was to evaluate if ROSA scores reflect changes in risk factors after an ergonomics intervention among office workers. METHODS: Office workers (n = 60) were divided into two groups. The experimental group received a workstation intervention and the control group received no intervention. Changes in ROSA scores were compared before and after the intervention in both groups. RESULTS: Statistically significant reductions in the ROSA final and section scores occurred after the intervention in the experimental group with (mean reduction of 2.9, 0.8 and 1.6 points for sections A, B and C, respectively). In contrast, no differences were detected in the control group (mean increase of 0.1 point for sections A and C and mean reduction of 0.1 point for Section B). CONCLUSIONS: These findings show that ROSA scores reflect changes in risk factors after an ergonomics intervention in an office environment. Consequently, this tool can be used for identifying and controlling risk factors among computer workers, before and after interventions.

Retrospective assessment of occupational disease trends in Russian Arctic apatite miners.

For many years in Russia, apatite ore mining has been associated with high levels of occupational morbidity. The aim of the study was to retrospectively assess occupational disease trends in Russian Arctic apatite miners. We analysed data from routine health screening of 2 649 underground apatite miners in 2007 and data of social-hygienic monitoring "Working conditions and occupational morbidity" in 2008-2020. In 2007, according to the results of routine health screening, 6 778 chronic diseases were diagnosed in 2 649 miners, the most prevalent being musculoskeletal (34.4%) and eye (16.0%) diseases. In the next 13 years, 572 occupational diseases were first diagnosed in 300 (11.3%) miners, most prevalent being musculoskeletal diseases (47.2%). The risk of developing occupational diseases in tunnellers exceeded that in all other miners, including timber-men (RR = 1.56; CI 1.06-2.30), vibration-loading machine operators (RR = 1.67; CI 0.99-2.80), drillers (RR = 1.51; CI 1.08-2.11) and blasters (RR = 2.12; CI 1.55-2.84). We conclude that ongoing modernisation of ore mining processes and medical preventive measures should include more effective health-improving interventions for underground apatite miners. Findings from the analysis of data can be used by health professionals and policy makers to address these problems.

Waiting time from identification to recognition an occupational disease in Spain.

OBJECTIVE: To estimate the waiting time since a suspected an occupational disease (OD) is identified, notified and recognized in Spain. METHOD: A series of 34 patients attended at Occupational Diseases Unit (ODU) of Hospital del Mar in Barcelona were follow up since their identification until final resolution by the National Institute of Social Security (INSS). Median, and 25 and 75 percentiles (interquartile range [IQR]) were calculated in weeks by total time (n=27), ODU time (n=34), patient time (n=31) and INSS time (n=27). RESULTS: Total time was 51 weeks (IQR: 33.6 and 122.6), of which 42 weeks (17.6-99.5) corresponded to the waiting period at the INSS. CONCLUSIONS: The disproportionately long waiting time since INSS receives a case could impact on the under-recognition of OD. Urgent improvement of the administrative process is needed to reduce the patient waiting time for the recognition of OD.

Development of modified rapid entire body assessment (MOREBA) method for predicting the risk of musculoskeletal disorders in the workplaces.

BACKGROUND: Rapid Entire Body Assessment (REBA) technique is one of the tools developed for predicting the risk of musculoskeletal disorders based on the effective risk factors. This method has several limitations. The present study was aimed to develop the Modified Rapid Entire Body Assessment (MOREBA) method to more accurately predict the risk of musculoskeletal disorders. MATERIALS: This cross-sectional study was performed on 300 male workers of a steel factory with a variety of job tasks in Iran. Then, the information related to the various physical risk factors was extracted through observation of their duties and conversation with them. Also, the subjects were asked to complete the Persian version of Cornell musculoskeletal discomfort questionnaires (CMDQ). Then, a theoretical model was drawn in AMOS software. Computed coefficients were used to develop the MOREBA equation. In the end, the final scores were categorized by ROC curves, and the validation of the novel method was investigated using linear regression analysis. RESULTS: The parameters evaluated in the MOREBA method included contact stress, rapid and sudden movement, throwing motion, hand-arm vibration, whole-body vibration, temperature, and work-rest cycle in addition to the parameters of the REBA method, including awkward posture, coupling, force, load, static activity, and repetitive activity. The results showed that the strain produced by the physical risk factors with the total effect coefficient of 0.783 could significantly affect the musculoskeletal symptoms. The computed coefficients of the risk factors were applied to develop a novel index. The final score of the MOREBA method was categorized into four levels by optimal cut-off points of 12.37, 16.51, and 24.35. Based on the results, the MOREBA and REBA methods could justify 67 and 55% of the variations of musculoskeletal symptoms, respectively. CONCLUSIONS: The results revealed that modifications conducted in the REBA method were effective, and the MOREBA method can provide a more accurate prediction of the risk of musculoskeletal disorders.

Prevalence of Intestinal Parasite Infections and Their Associated Factors among Food Handlers Working in Selected Catering Establishments from Bule Hora, Ethiopia.

Intestinal parasites are responsible for one of the major health problems like food contamination with socioeconomic effects in the world with a prevalence rate of 30-60%, in developing countries that lie within tropical and subtropical areas. They pose a reasonable public health burden, particularly in low- and middle-income countries, including Ethiopia. Globally, due to intestinal parasitic infections, around 3.5 billion people are affected and more than 200,000 deaths are reported annually. Around 50000 deaths yearly are caused by intestinal parasites in Ethiopia. As such, intestinal parasites perceived global and local burdens to various countries. The risk of food contamination depends largely on the health status of the food handlers, their hygiene, knowledge, and practice of food hygiene. Food handlers with poor personal hygiene and sanitation conditions are the major potential sources of intestinal helminthes and protozoa worldwide. The proposed study was aimed at evaluating prevalence of intestinal parasitic infections and their associated factors among food handlers working in selected catering establishments. A cross-sectional study was conducted in Bule Hora Town from March to April 2020. A total of 136 catering establishments were selected using a systematic sampling technique. Data analysis was done using SPSS version 20. The prevalence of intestinal parasites in this study was 46.3%. Entamoeba histolytica was the most predominant parasite (33.3%, i.e., 21/63) while Giardia lamblia was the least (11.1%, i.e., 7/63). Consumption of vended or borehole water and hygienic practices such as hand washing before eating, after using toilet, before cooking and trimming of finger nail and wearing proper working clothes and shoes were statistically significant with intestinal parasitic infection (P < 0.05). Generally, the prevalence of intestinal parasitic infection in this study was high and contributed by low socioeconomic status and poor environmental and personal hygiene. Measures including education on personal hygiene, environmental sanitation, drinking water supply, regular medical checkups, and treatment should be taken into account to reduce the prevalence of intestinal parasites.

Work-related asthma.

Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.

Effect of reminder letters after health checkups on the consultation behavior of participants with possible hypertension, hyperglycemia, and dyslipidemia: A retrospective cohort study using administrative claims data in Japan.

OBJECTIVES: Prevention of and early treatment for noncommunicable diseases such as hypertension, hyperglycemia, and dyslipidemia are important, as these diseases are asymptomatic in early stages but can lead to critical conditions such as macro- and microvascular disorders later on. While screening is conducted worldwide, low rates of hospital visits after screening is a common issue. We aimed to investigate the effect of reminder letters on the consultation behavior of screened participants. METHODS: We used administrative claims data from a database managed by JMDC Inc for participants of health checkups in 2014, 2015, 2016, and 2017, who belonged to a health insurance society. Reminder letters were sent regularly 6 months after checkups to improve participant consultation behavior. Participants who screened positive for hypertension, hyperglycemia, and dyslipidemia, and who were not taking medication for any of these diseases at the time of health checkups, were included in the analyses. RESULTS: A total of 1739 participants in 2014, 1693 in 2015, 2002 in 2016, and 2144 in 2017 were included in the analysis for hypertension. The cumulative proportion of hospital visits gradually increased over the course of 12 months after checkups in all years. After 2015, spikes, albeit very small ones, were observed at 6 months after checkups in accordance with the timing of reminder letters. Similar trends were observed for hyperglycemia and dyslipidemia. CONCLUSIONS: Sending reminder letters is a potentially effective approach to increase hospital visits, but further improvements (ie, multiple reminders) may be necessary to affect enhancements in participant consultation behavior.

[Update of the AWMF S2k Guideline "Diagnostics and Assessment of Occupational Asbestos-Related Diseases" - What's New?] / Update der AWMF-S2k-Leitlinie "Diagnostik und Begutachtung asbestbedingter Erkrankungen" ­ Was gibt es Neues?

The S2k guideline "Diagnostics and assessment of occupational asbestos-related diseases" was updated in November 2020. This article summarizes the most important changes. There is a new reference to the risk of potentially high exposures to asbestos fibers when renovating plaster, fillers and adhesives containing asbestos.Biomarkers such as mesothelin and calretinin should currently only be used in the context of research. The "asbestos airways disease", which can only be diagnosed histologically, is included in the guideline as an early form of asbestosis. Since the UIP pattern is not characteristic of asbestosis, computed tomography cases with UIP patterns alone cannot be assigned reliably to asbestosis without the simultaneous detection of pleural plaques. With regard to the evaluation of the functional damage, attention is drawn to the importance of flow volume curve, whole-body plethysmography, diffusion capacity and exercise testing. If available, the reference values ​​according to GLI are the basis of the assessment. The guideline contains specific recommendations on prevention, medical treatment and, for the first time, on the importance of outpatient rehabilitation and training therapy. There are also references to the assessment of the new occupational disease ovarian cancer after occupational exposure to asbestos.

Metal additive manufacturing and possible clinical markers for the monitoring of exposure-related health effects.

Additive manufacturing (AM) includes a series of techniques used to create products, in several different materials, such as metal, polymer or ceramics, with digital models. The main advantage of AM is that it allows the creation of complex structures, but AM promises several additional advantages including the possibility to manufacture on demand or replacing smaller worn parts by directly building on an existing piece. Therefore, the interest for and establishment of AM is rapidly expanding, which is positive, however it is important to be aware that new techniques may also result in new challenges regarding health and safety issues. Metals in blood and possible clinical effects due to metal exposure were investigated in AM operators at one of the first serial producing AM facilities in the world during two consecutive years with implementation of preventive measures in-between. As comparison, welders and office workers as control group were investigated. Health investigations comprised of surveys, lung function tests, antioxidant activity and vascular inflammation as well as renal- and hepatic function analysis. AM operators had significantly reduced nickel levels in blood (10.8 vs 6.2 nmol/L) as well as improved lung function (80 vs 92% of predicted) from year 1 to year 2. This is in line with previously published results displaying reduced exposure. Blood cobalt and nickel levels correlated with previously reported urinary levels, while blood chromium did not. Multivariate modelling showed that blood cobalt, antioxidant/inflammatory marker serum amyloid A1/serum paraoxonase/arylesterase 1 activity and the hepatic markers aspartate transaminase, alanine transaminase, and alkaline phosphatase were higher in AM operators compared to controls. The study show that the selected clinical analyses could function as a complement to metal analyses in biological fluids when investigating exposure-related health effects in AM operators. However, validation in larger cohorts is necessary before more definite conclusions could be drawn.