Photoprotection in occupational dermatology.

Skin cancer has become a substantial matter of public health and in the workplace, accounting for a significant share of all reported occupational diseases. The most important external factor in the development of skin cancer is exposure to solar ultraviolet radiation. Outdoor workers have already been identified as a high-risk category. The need for interventions to improve the sun protection behavior of outdoor workers has recently been understood. Outdoor workers' risk perceptions and attitudes toward sun protection methods are likely to influence practical sun protection behavior at work, and despite the fact that many workers have expressed interest in improving their sun protection behavior, outdoor workers' unique needs are still neglected. Occupational dermatology is predicted to become more concerned with photoprotection in the decades ahead. Preventive action against the rapidly increasing number skin cancer cases is in great demand around the globe. In terms of preventive measures, the full range of available options should be used as needed to address the current difficulties in a goal-oriented way. This will almost certainly only be achievable if preventative efforts on a collective and individual level are successfully paired with support from policymakers to inspire long-term change.

Workplace exposure to UV radiation and strategies to minimize cancer risk.

BACKGROUND: Workplace exposure to solar ultraviolet (UV) causes malignant melanoma and non-melanoma skin cancer. The evidence for beneficial effects of solar UV exposure in reducing the risks for other cancers is increasing. The intensity of UV radiation at the Earth's surface is dependent on latitude, but even in northern European countries exposure can be high enough for outdoor work to cause skin cancer. GROWING POINTS: Awareness of the health risks and benefits of occupational solar UV exposure is poor. Actions to reduce the risk of skin cancer have been identified and employers should recognize their responsibility to actively manage these risks. There is evidence for reduced risks for breast, ovarian and colorectal cancer and possibly other cancers linked to solar UV exposure. SOURCES OF DATA: This narrative review draws on published scientific articles and material designed to assist identifying strategies to protect workers from solar UV exposure. AREAS OF AGREEMENT: Solar UV exposure can be harmful. Wavelengths in the UVB range are more effective in causing erythema and DNA damage. Solar UV is the main source of vitamin D for most people. Primary and secondary prevention for skin cancer can potentially eliminate these risks but the evidence for effectiveness is limited. AREAS OF CONTROVERSY: Potential health benefits of UV exposure, particularly for reduced cancer risk. Determining and communicating optimal exposure to maximize health benefits. The risk of non-melanoma skin cancers may be more than doubled for some workers in temperate latitudes. AREAS TIMELY FOR DEVELOPING RESEARCH: Exposure-response epidemiological studies; studies of the health benefits of occupational UV exposure; studies of the effectiveness of intervention strategies to prevent skin cancer. Use of low-cost UV sensors in workplaces.

Visualization of Dust Generation in Outdoor Workplaces Using A Wearable Particle Monitor and Global Navigation Satellite System.

We manufactured a wearable particle monitor (WPM), which is a simple and low-cost dust monitor. We aimed to evaluate the usefulness of the device by using it and location information of a Global Navigation Satellite System (GNSS) to measure dust generation in outdoor workplaces. We used nine WPMs and a particle counter KC-52 to measure in parallel the dust concentration diffusing standard particles in a dust exposure apparatus to evaluate the measurability of the WPM, and visualized dust generation in outdoor workplaces to evaluate its usability. We obtained location information using a GNSS in parallel with measuring with the WPM. The measured values of the WPM followed the measured values of the KC-52, with a strong correlation of the values between the KC-52 and each WPM. The discrepancy among devices tended to increase, however, because the measured values of the WPMs increased. For outdoor measurements, we could create a heat map of the relative values of dust generation by combining two data of the WPM and the GNSS. The methods of using the WPM could overview the conditions needed to produce dust emissions in dust-generating workplaces.

[Update on occupational skin cancer-basal cell carcinoma and solar UV exposure]. / Neues zum berufsbedingten Hautkrebs ­ Basalzellkarzinom und solare UV-Exposition.

BACKGROUND: Outdoor workers are occupationally exposed to significantly higher ultraviolet (UV) doses than the rest of the population. Recent data show a doubling of basal cell carcinoma (BCC) risk in outdoor workers with high occupational UV exposure. OBJECTIVES: To examine the stability and robustness of BCC risk estimators. METHODS: Sensitivity analyses to test model assumptions considering socioeconomic status, influence of matching procedure, gender and latency, regional differences (east/west), urban/rural cases/controls, and dual diagnoses (squamous cell carcinoma [SCC]/actinic keratoses grade III [AKIII]/Bowen disease [BD] and BCC) were performed. RESULTS: BCC risk was consistently higher for high occupationally UV-exposed individuals than for intermediate UV-exposed individuals, regardless of matching procedure, latency, regional differences (east/west), urban/rural recruitment of cases/controls, and dual diagnoses (SCC/AKIII/BD and BCC), sex, and socioeconomic status. CONCLUSION: The risk estimator for the association between exposure to solar UV radiation at work and the risk of developing BCC showed a high degree of stability and robustness for all variables investigated. The analyses support the recently published findings on the doubling of BCC risk in outdoor workers with high occupational UV exposure.

[Occupational risk related to natural optical radiation exposure and skin cancers]. / Rischio di tumore cutaneo da esposizione a radiazioni ottiche naturali.

SUMMARY: Skin tumors are the most frequent neoplasms worldwide in Caucasian subjects, and UV exposure is one of the most relevant risk factors in their etiology. Cumulative UV exposure is strongly associated with an increased occurrence of both basal and squamous cell carcinomas (i.e. Non melanoma skin cancers - NMSC), while for malignant melanoma the role of UV radiation as risk factors seems more related to intermittent and intense exposures, able to induce repeated sunburns, at young ages. Considering the occupational risk, currently UV radiation, part of the solar radiation (SR) spectrum, is one of the major risks in all jobs including outdoor activities (outdoor work - OW): many studies show high levels of solar UV exposure during OW, nevertheless to date the European, and Italian, legislation on occupational risks prevention does not include specific requirements for SR compleexposure at work, as occupational exposure limits values or workers' health surveillance. This is not coherent with the strong associations showed in scientific literature in particular between the occurrence of NMSC and a history of OW. Accordingly, considering the high exposure levels, the large number of outdoor workers and the strong associations with NMSC, we'd expect a relevant number of occupational skin cancers (OSC) to be reported every year to the national workers' compensation authorities in European countries. Nevertheless, in Italy, as in other European countries, the number of reported UV-induced OSC is much lower than the expected number of OSC, with less than 40 cases reported on average in Italy in last years compared to about a thousand of expected cases incident in outdoor workers per year. An increasing in the reporting of OSC would certainly be important, for the purpose of a better recognition of the real dimension of the phenomenon, and to stimulate the implementation of adequate preventive strategies, in order to guarantee an improved protection of outdoor workers and a more appropriate prevention of the adverse health effects related to solar UV exposure.

Photoaging and actinic keratosis in Danish outdoor and indoor workers.

BACKGROUND: The risk of photoaging and actinic keratosis caused by work related solar ultraviolet radiation exposure has not previously been investigated in Nordic countries. The objectives of this study were to describe the occurrence of photoaging, actinic keratosis, and keratinocyte cancer in a population of Danish outdoor and indoor workers, and investigate the association between these clinical findings and semi-objective measures of work related solar ultraviolet radiation exposure in the same population. METHODS: A clinical cross-sectional study of the occurrence of facial wrinkles, actinic keratosis, keratinocyte cancer, and melanocytic nevi in a population of Danish outdoor and indoor workers and associations with semi-objective measures of work related solar ultraviolet radiation exposure based on a combination of dosimetry and self-report. RESULTS: Work related solar ultraviolet radiation exposure was significantly positively associated with occurrence of facial wrinkles (α = 0.05). Actinic keratosis was associated to status as outdoor worker (OR = 4.272, CI [1.045-17.471]) and age (P < 0.001, CI [1.077-1.262]) and twice as common in outdoor workers (10.3% CI [0.05, 0.15]) compared to indoor workers (5.1% CI [0.00, 0.10]). Only two cases of keratinocyte cancer were diagnosed (<1%). Older age was negatively associated with occurrence of melanocytic nevi. CONCLUSION: Outdoor work in Denmark is associated with increased occurrence of facial wrinkles and actinic keratosis from solar ultraviolet radiation exposure, thus justifying sun safety at Danish workplaces from a clinical perspective.

Skin cancer in outdoor workers exposed to solar radiation: a largely underreported occupational disease in Italy.

BACKGROUND: Solar UV radiation (sUVR) is one of the main carcinogen exposures in occupational settings, and UV-induced skin cancers are the most frequent tumours in fair-skinned individuals worldwide. OBJECTIVES: According to this premise, we should expect a high number of occupational skin cancers reported to the national workers' compensation authorities each year, also considering that the incidence of skin cancers has been constantly increased in recent years METHODS: We examined the data on reported non-melanoma skin cancers (NMSC) and actinic keratoses (AK) to the Italian National Workers Compensation Authority (INAIL) from 2012 to 2017, and we compared the number of reported skin cancers for outdoor workers with the expected numbers, obtained from currently available NMSC incidence rates for the Italian population applied to the occupational sUVR-exposed workers estimated with the CAREX methodology in Italy in 2005. RESULTS: The cases of NMSC reported each year to INAIL in Italy are 34 per year on average, while for AK the mean number of reported cases is of only 15/year. We estimated a number of expected NMSC cases in Italy for solar UV-exposed workers ranging between 432 and 983, representing a proportion between reported vs. expected skin cancers of only 3.5-6.2%. CONCLUSIONS: Our study clearly shows that occupational skin cancers in Italy are largely underreported, and, accordingly, urgent initiatives should be taken to raise appropriate awareness to the problem of occupational sUVR-induced skin cancers, so that adequate preventive measures can be implemented rapidly.

Outdoor work and solar radiation exposure: Evaluation method for epidemiological studies.

BACKGROUND: The health risk related to an excessive exposure to solar radiation (SR) is well known. The Sun represents the main exposure source for all the frequency bands of optical radiation, that is the part of the electromagnetic spectrum ranging between 100 nm and 1 mm, including infrared (IR), ultraviolet (UV) and visible radiation. According to recent studies, outdoor workers have a relevant exposure to SR but few studies available in scientific literature have attempted to retrace a detailed history of individual exposure. MATERIAL AND METHODS: We propose a new method for the evaluation of SR cumulative exposure both during work and leisure time, integrating subjective and objective data. The former is collected by means of an interviewer administrated questionnaire. The latter is available through the Internet databases for many geographical regions and through individual exposure measurements. The data is integrated into a mathematical algorithm, in order to obtain an esteem of the individual total amount of SR the subjects have been exposed to during their lives. RESULTS: The questionnaire has been tested for 58 voluntary subjects. Environmental exposure data through online databases has been collected for 3 different places in Italy in 2012. Individual exposure by electronic UV dosimeter has been measured in 6 fishermen. A mathematical algorithm integrating subjective and objective data has been elaborated. CONCLUSIONS: The method proposed may be used in epidemiological studies to evaluate specific correlations with biological effects of SR and to weigh the role of the personal and environmental factors that may increase or reduce SR exposure. Med Pr 2016;67(5):577-587.

[Use of sunglasses in everyday life, at work, and during outdoor sports: current results from nationwide surveys]. / Die Nutzung von Sonnenbrillen im Alltag, im Beruf und bei Sport im Freien: aktuelle Ergebnisse bundesweiter Befragungen.

BACKGROUND: Ultraviolet (UV) radiation can increase the risk of eye damage. Therefore, wearing sunglasses is recommended to protect the eyes from UV rays. OBJECTIVE: To report the latest data on the use of sunglasses in everyday life in adults, children, at work, and during outdoor sports. MATERIAL AND METHODS: We used data from waves 2020 and 2021 from the representative National Cancer Aid Monitoring (NCAM). The use of sunglasses in everyday life was assessed in 4000 participants aged 16-65 years. Data on use during outdoor work were obtained from 486 outdoor workers and the use of sunglasses during outdoor sports from 2081 participants. Additionally, 554 adults living in a household with at least 1 child aged 1-10 years reported the use of sunglasses by children. Descriptive results and associations with demographic characteristics are reported. RESULTS: Overall, 50.6% of the general population, 31.0% of outdoor workers, 44.3% of those who reported being engaged in outdoor sports and 12.5% of children wore sunglasses always or often while being outside for more than 10 min in summer. The infrequent use of sunglasses was associated with a younger age, male sex, and lower school education. CONCLUSION: Because of the relatively low use of sunglasses further education in various settings (e.g., at the workplace, kindergartens, and schools) seems necessary. The general public should also be made aware of the risks of UV radiation for the eyes, especially against the background of climate change.

Sun Protection in German Outdoor Workers: Differences by Sex and Job-Related Characteristics.

BACKGROUND: Ultraviolet (UV) exposure during outdoor work increases the risk of developing skin cancer. Therefore, the uptake of recommended sun protection behaviors is important to prevent UV-related skin damage in the population of outdoor workers. To develop targeted prevention campaigns, information on the use of sun protection behaviors in different industries is needed. METHODS: A total of 486 outdoor workers were surveyed on the use of several sun protection measures as part of the 7th wave of the National Cancer Aid Monitoring. Furthermore, details on job-related characteristics, sociodemographics, and skin type were assessed. Descriptive analyses stratified by sex were conducted. RESULTS: In general, use of sun protection was insufficient (e.g. 38.4% used sunscreen on the face). Sun protection behavior differed between female and male outdoor workers with females being more likely to use sunscreen and males being more likely to wear sun protective clothes and headgear. For male outdoor workers, we revealed several associations with job-related characteristics. For instance, those who were employed full time were more likely to wear sun protective clothes (e.g. shoulder-covering shirt: 87.1% versus 50.0%, P < 0.001). DISCUSSION: We identified deficits in sun protection behavior in outdoor workers and differences by sex- and job-related characteristics. These differences offer starting points for targeted prevention measures. In addition, the findings may inspire qualitative research.

Evaluating the impact of ocular UV exposure for the development for pseudoexfoliation syndrome in a South Indian population.

CLINICAL RELEVANCE: Pathophysiology of pseudoexfoliation syndrome (XFS) can be influenced by environmental factors such as solar exposure/occupational factors and genetic factors. BACKGROUND: The study aims to assess the association of lifetime ocular UV exposure and its impact on the risk of development of XFS. METHODS: All eligible subjects underwent a comprehensive ocular examination. XFS was defined as precipitates on the pupillary border, cornea, and angle of anterior chamber or lens in at least one eye without any clinical signs of glaucoma. A standardised questionnaire was administered to assess the lifetime UV exposure. Conjunctival ultraviolet autofluorescence (CUVAF) photography was taken to detect the conjunctival changes with exposure to UV radiation. Ascorbic acid concentration in the aqueous humour was measured. RESULTS: A total of 404 subjects of which 274 (controls) and 130 (XFS cases) were studied. There were 204 males (50.5%) and 200 females (49.5%).Lifetime UV exposure (OR: 1.14, 95% CI: 1.02-1.30, p: 0.032), CUVAF damage (OR: 1.03, 95% CI: 1.01-1.06, p: 0.008) and outdoor worker (OR: 1.87, 95% CI: 1.18-3.00, p: 0.008) were positively associated with XFS. Usage of spectacles (OR: 0.63, 95% CI: 0.39-0.95, p: 0.030) and ascorbic acid concentration in aqueous (OR: 0.47, 95% CI: 0.23-0.99, p: 0.038) were found to be protective against XFS. CONCLUSION: Besides genetic factors, environmental factors such as lifetime ocular UV exposure and outdoor work are significantly associated with the risk of XFS. CUVAF can be used as a non-invasive tool to detect preclinical sun damage in outdoor workers.

UVR Exposure and Prevention of Street Construction Workers in Colombia and Germany.

(1) Solar ultraviolet radiation (UVR) poses a major risk factor for developing skin cancer after years of chronic exposure. The irradiation is strongly dependent upon the activity or occupation carried out, but also on the climate conditions at the workplace. Knowledge of both has been tested within the occupational group of road construction workers in Colombia and Germany. (2) The GENESIS-UV measurement system has been used at both locations for consistency. A number of workers in both countries wore an electronic data logging dosimeter for several months to deliver detailed information on UVR exposure. (3) It was found that in a tropical climate, UVR exposure remains constant throughout the year, while in a temperate climate seasonal effects are visible, superimposed by behavioural aspects e.g., in springtime. The daily distribution of the radiation shows a distinct dip, especially in the Colombian data. Derived data show the high fraction of working days exceeding a threshold set by the skin type. (4) Road construction work involves high UVR exposure. In both countries, preventive measures are required to reduce the personal exposure to a minimum. Exceedance of the minimal erythema dose (MED) suggests a possible enhancing effect, especially in fair skinned people. Intercomparison of UVR exposure at workplaces is possible between countries and climate zones, emphasizing efforts for global action against skin cancer.

Effects of Solar Radiation on the Eyes.

It is known that exposure to solar radiation (SR) can cause various harmful effects on one's health, most of which are related to the ultraviolet (UV) component of SR. A considerably high number of people around the world who work outside are constantly exposed to SR for the majority of their working lives. The eye is the primary organ affected by short-term and long-term exposure to solar radiation. According to an ever-growing body of research, cataracts, pterygium, and macular degeneration are all possible side effects of prolonged exposure. Despite this, the danger of SR exposure is presently underestimated, if not completely overlooked, as a component of occupational risk for employees who do their duties outside. SR exposure is impacted by a wide range of individual and environmental factors; nevertheless, occupational exposure is among the most significant. The scarcity of affordable and accepted methods to measure SR worker exposure, particularly long-term exposure, is one of the key obstacles that must be overcome before a more excellent knowledge of this risk and the development of more effective preventive strategies can be accomplished. This review was conducted with the primary objectives of providing a comprehensive overview of the SR exposure risk of outdoor workers, including UV exposure extents and the chief approaches recently proposed for short-term and cumulative exposure, as well as providing an update on the information presented regarding the most common adverse eye effects. In conclusion, this article will be presenting preventative steps that may be taken to reduce occupational risk.

New methods for assessing secondary performance attributes of sunscreens suitable for professional outdoor work.

BACKGROUND: Outdoor workers (OW) are highly exposed to solar ultraviolet radiation (UVR) and thus at increased risk for developing skin cancer. An essential part of an overall strategy to reduce workplace UVR-exposure to OW's skin is the usage of sunscreens. However, compliance with regular sunscreen usage seems to be low, as products are usually designed for recreational sun exposure and thus do not meet the requirements of physically active OW. To date, no standardized test procedures assess the suitability of sunscreens for professional use. The aim of this pilot study was to develop standardized methods of testing secondary performance attributes (PA) to represent real-life working conditions of outdoor work. METHODS: Ten sunscreen products, carefully selected after a detailed market survey of all relevant producers available on the German market, were evaluated regarding their suitability for professional outdoor work on 24 healthy volunteers in a newly designed test procedure. In addition to three standardized efficacy characteristics, i.e., sun protection factor, water-resistance, and UVA protection, we evaluated each PA involving parameters typically associated with outdoor workplaces. RESULTS: We developed standardized methods for objectifying the suitability of sunscreen products for professional outdoor work. The test procedures used are well feasible and appropriate for testing the PA because they represent practical working conditions in detail - although the degree of discriminability of single test methods varied. The claimed sun protection factor (SPF) of the products was confirmed; bio-stability of the SPF after physical activity was achieved in most cases. While most products hardly irritate the eyes and are quickly absorbed, the evaluation of the subjective skin feeling and non-slip grip is inconsistent. CONCLUSIONS: In this pilot study, for the first time secondary PA are defined and examined. Although further objectification of the PA assessment as well as the establishment of minimum standards should be sought, the new methods could already complement the so far mandatory labels and in this way provide a significant impetus for the current scientific and political focus on the improvement of occupational health in highly UVR-exposed OW.

Basal cell carcinoma risk and solar UV exposure in occupationally relevant anatomic sites: do histological subtype, tumor localization and Fitzpatrick phototype play a role? A population-based case-control study.

BACKGROUND: A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates. OBJECTIVES: To evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure. METHODS: Six hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age2, sex, phototype and non-occupational UV exposure were calculated. RESULTS: Participants with high versus no (OR 2.08; 95% CI 1.24-3.50; p = 0.006) or versus moderate (OR 2.05; 95% CI 1.15-3.65; p = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses. CONCLUSION: The risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.

Light Exposure during Days with Night, Outdoor, and Indoor Work.

OBJECTIVE: To assess light exposure during days with indoor, outdoor, and night work and days off work. METHODS: Light intensity was continuously recorded for 7 days across the year among indoor (n = 170), outdoor (n = 151), and night workers (n = 188) in Denmark (55-56°N) equipped with a personal light recorder. White light intensity, duration above 80, 1000, and 2500 lux, and proportion of red, green, and blue light was depicted by time of the day and season for work days and days off work. RESULTS: Indoor workers' average light exposure only intermittently exceeded 1000 lux during daytime working hours in summer and never in winter. During daytime working hours, most outdoor workers exceeded 2500 lux in summer and 1000 lux in winter. Night workers spent on average 10-50 min >80 lux when working night shifts. During days off work, indoor and night workers were exposed to higher light intensities than during work days and few differences were seen between indoor, outdoor, and night workers. The spectral composition of light was similar for indoor, outdoor, and night workers during days at and off work. CONCLUSION: The night workers of this study were during night hours on average exposed for a limited time to light intensities expected to suppress melatonin. The indoor workers were exposed to light levels during daylight hours that may reduce general well-being and mood, especially in winter. Outdoor workers were during summer daylight hours exposed to light levels comparable to those used for the treatment of depression.

Solar Radiation Exposure and Outdoor Work: An Underestimated Occupational Risk.

A considerably high number of outdoor workers worldwide are constantly exposed for the majority of their working life to solar radiation (SR); this exposure is known to induce various adverse health effects, mainly related to its ultraviolet (UV) component. The skin and the eye are the principal target organs for both acute and long-term exposure. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects, whereas in the eye pterygium, cataracts, and according to an increasing body of evidence, macular degeneration may be induced. Despite this, SR exposure risk is currently undervalued, if not neglected, as an occupational risk factor for outdoor workers. SR exposure is influenced by various environmental and individual factors, and occupation is one of the most relevant. For a better understanding of this risk and for the development of more effective prevention strategies, one of the main problems is the lack of available and adequate methods to estimate SR worker exposure, especially long-term exposure. The main aims of this review were to provide a comprehensive overview of SR exposure risk of outdoor workers, including the UV exposure levels and the main methods recently proposed for short-term and cumulative exposure, and to provide an update of knowledge on the main adverse eye and skin effects. Finally, we also outline here preventive interventions to reduce occupational risk.

Mortality and Morbidity during Extreme Heat Events and Prevalence of Outdoor Work: An Analysis of Community-Level Data from Los Angeles County, California.

Heat is a well-recognized hazard for workers in many outdoor settings, yet few investigations have compared the prevalence of outdoor work at the community level and rates of heat-related mortality and morbidity. This analysis examines whether heat-related health outcomes occur more frequently in communities with higher proportions of residents working in construction, agriculture, and other outdoor industries. Using 2005-2010 data from Los Angeles County, California, we analyze associations between community-level rates of deaths, emergency department (ED) visits, and hospitalizations during summer heat events and the prevalence of outdoor work. We find generally higher rates of heat-related ED visits and hospitalizations during summer heat events in communities with more residents working outdoors. Specifically, each percentage increase in residents working in construction resulted in an 8.1 percent increase in heat-related ED visits and a 7.9 percent increase in heat-related hospitalizations, while each percentage increase in residents working in agriculture and related sectors resulted in a 10.9 percent increase in heat-related ED visits. The findings suggest that outdoor work may significantly influence the overall burden of heat-related morbidity at the community level. Public health professionals and healthcare providers should recognize work and employment as significant heat risk factors when preparing for and responding to extreme heat events.

Trabalho a céu aberto: passado, presente e futuro sobre exposição ocupacional ao calor / Outdoor work: past, present, and future on occupational heat exposure

Resumo Considerando as mudanças climáticas e o impacto das temperaturas elevadas na saúde humana, especialmente devido ao aquecimento global, são relevantes as ações de prevenção ao calor voltadas aos trabalhadores que laboram a céu aberto. Neste ensaio, são apresentados resultados de recentes pesquisas, bem como destacadas inovações tecnológicas para monitoramento do calor no Brasil. Também são expostas reflexões sobre o futuro do trabalho a céu aberto diante das mudanças climáticas. O trabalho a céu aberto é em geral caracterizado por atividades pesadas, que geram elevado calor metabólico. Contudo, são escassos os esforços no campo da Saúde e Segurança do Trabalho para a busca de alternativas que minimizem ou eliminem os efeitos do calor para os trabalhadores. Além disso, as alternativas de proteção dos trabalhadores são reduzidas. O Monitor IBUTG é apresentado como inovação tecnológica de monitoramento remoto do calor em ambiente a céu aberto. Apesar das medidas de controle previstas em lei para proteção dos trabalhadores submetidos ao calor, em razão do aquecimento global, serão necessários intervenções inovadoras e controles especiais da exposição ao calor nos ambientes externos. Portanto, é desejável maior empenho na produção de conhecimento com vistas a fomentar a elaboração ou o aprimoramento de políticas públicas.

Abstract Given the current climate change and high-temperature impact on human health, especially due to global warming, actions for heat prevention focused on outdoor workers are relevant. This essay presents the results of recent research and highlights technological innovations for heat monitoring in Brazil. Also, it reflects on the future of outdoor work given climate change. Outdoor work is generally characterized as heavy, leading to higher metabolic heat production. However, Occupational Safety and Health have made few efforts to find alternatives to minimize or eliminate heat impact on workers. Moreover, the worker's protection alternatives are reduced. WBGT Monitor is presented as a technological innovation for remote heat monitoring in outdoor environments. Despite the control measures provided to workers subjected to heat, global warming demands innovative interventions and special exposure controls at outdoor workplaces. Thus, an increased commitment to knowledge production to elaborate or improve public policy is desirable.

Occupational Exposure to Solar Radiation at Different Latitudes and Pterygium: A Systematic Review of the Last 10 Years of Scientific Literature.

Pterygium is a chronic eye disease: among its recognized risk factors there is long-term exposure to ultraviolet (UV) radiation. The Sun is the main source of UV exposure: according to the World Health Organization, the Population Attributable Fraction of pterygium due to solar radiation (SR) is 42-74%. Outdoor work can deeply influence the eye exposure to solar UV rays, but, despite this, pterygium is currently not adequately considered as a possible occupational disease in this working category, at least in Europe. For this reason, we performed a systematic review of the scientific literature published in the last ten years (2008-2017) considering the role of outdoor work as a risk factor for pterygium, in order to give new support for the prevention of this UV related disease in workers. We identified 29 relevant papers. Our results show that pterygium prevalence highly increased with latitude and mean annual UV index, and outdoor work is one of the most relevant risk factors, as well as age and male sex, both in high risk and in moderate risk World areas considering the environmental UV levels. Accordingly, pterygium occurring in outdoor workers should be considered an occupational disease. Moreover, our findings clearly support the need of further research on more effective prevention of the occupational risk related to long-term solar radiation exposure of the eye.