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Comparing the use of an online expert health network against common information sources to answer health questions.

Background Many workers have questions about occupational safety and health (OSH). It is unknown whether workers are able to find correct, evidence-based answers to OSH questions when they use common information sources, such as websites, or whether they would benefit from using an easily accessible, free-of-charge online network of OSH experts providing advice. Objective To assess the rate of correct, evidence-based answers to OSH questions in a group of workers who used an online network of OSH experts (intervention group) compared with a group of workers who used common information sources (control group). Methods In a quasi-experimental study, workers in the intervention and control groups were randomly offered 2 questions from a pool of 16 standardized OSH questions. Both questions were sent by mail to all participants, who had 3 weeks to answer them. The intervention group was instructed to use only the online network ArboAntwoord, a network of about 80 OSH experts, to solve the questions. The control group was instructed that they could use all information sources available to them. To assess answer correctness as the main study outcome, 16 standardized correct model answers were constructed with the help of reviewers who performed literature searches. Subsequently, the answers provided by all participants in the intervention (n = 94 answers) and control groups (n = 124 answers) were blinded and compared with the correct model answers on the degree of correctness. Results Of the 94 answers given by participants in the intervention group, 58 were correct (62%), compared with 24 of the 124 answers (19%) in the control group, who mainly used informational websites found via Google. The difference between the 2 groups was significant (rate difference = 43%, 95% confidence interval [CI] 30%–54%). Additional analysis showed that the rate of correct main conclusions of the answers was 85 of 94 answers (90%) in the intervention group and 75 of 124 answers (61%) in the control group (rate difference = 29%, 95% CI 19%–40%). Remarkably, we could not identify differences between workers who provided correct answers and workers who did not on how they experienced the credibility, completeness, and applicability of the information found (P > .05). Conclusions Workers are often unable to find correct answers to OSH questions when using common information sources, generally informational websites. Because workers frequently misjudge the quality of the information they find, other strategies are required to assist workers in finding correct answers. Expert advice provided through an online expert network can be effective for this purpose. As many people experience difficulties in finding correct answers to their health questions, expert networks may be an attractive new source of information for health fields in general.

Information and feedback to improve occupational physicians’ reporting of occupational diseases: a randomised controlled trial

PurposeTo assess the effectiveness of supplying occupational physicians (OPs) with targeted and stage-matched information or with feedback on reporting occupational diseases to the national registry in the Netherlands.MethodsIn a randomized controlled design, 1076 OPs were divided into three groups based on previous reporting behaviour: precontemplators not considering reporting, contemplators considering reporting and actioners reporting occupational diseases. Precontemplators and contemplators were randomly assigned to receive stage-matched, stage-mismatched or general information. Actioners were randomly assigned to receive personalized or standardized feedback upon notification. Outcome measures were the number of OPs reporting and the number of reported occupational diseases in a 180-day period before and after the intervention.ResultsPrecontemplators were significantly more male and self-employed compared to contemplators and actioners. There was no significant effect of stage-matched information versus stage-mismatched or general information on the percentage of reporting OPs and on the mean number of notifications in each group. Receiving any information affected reporting more in contemplators than in precontemplators. The mean number of notifications in actioners increased more after personalized feedback than after standardized feedback, but the difference was not significant.ConclusionsThis study supports the concept that contemplators are more susceptible to receiving information but could not confirm an effect of stage-matching this information on reporting occupational diseases to the national registry.

Online reporting and assessing new occupational health risks in SIGNAAL

BACKGROUND Changes in work and working conditions continuously give rise to new work-related health risks. Without sufficient knowledge of these, opportunities for prevention and intervention may be missed. AIMS To develop, implement and evaluate an online tool called SIGNAAL for reporting and assessment of new work-related health risks by occupational health physicians and experts in the Netherlands and Belgium. METHODS Development and implementation of SIGNAAL to allow both easy and sufficient detailed reporting by occupational health physicians and structured and transparent assessment by occupational health experts. A new work-related health risk is defined as a work-related disease due to specific exposure in a specific work setting not described in the literature before. RESULTS The online reporting and assessment tool proved to be a feasible means of reporting possible new combinations of health problems and exposures in the work situation. Eleven of the 15 cases reported until October 2014 were fully assessed: one was an entirely new work-related disease, four were known but uncommon work-related diseases, five were known but new in the reported work situation and one was a well-known work-related disease. CONCLUSIONS An online reporting system used in an occupational health setting can provide insight into new work-related health risks by creating a structured way to gather, report and assess new combinations of health problems and exposure in the workplace.

Can online networks provide quality answers to questions about occupational safety and health

Objectives To assess whether experts can provide high-quality answers to occupational safety and health (OSH) questions in online Question & Answer (Q&A) networks. Methods The authors evaluated the quality of answers provided by qualified experts in two Dutch online networks: ArboAntwoord and the Helpdesk of the Netherlands Center for Occupational Diseases. A random sample of 594 answers was independently evaluated by two raters using nine answer quality criteria. An additional criterion, the agreement of answers with the best available evidence, was explored by peer review of a sample of 42 answers. Reviewers performed an evidence search in Medline. Results The median answer quality score of ArboAntwoord (N=295) and the Netherlands Center for Occupational Diseases Helpdesk (N=299) was 8 of 9 (IQR 2). The inter-rater reliability of the first nine quality criteria was high (κ 0.82–0.90, p<0.05). A question answered by two or more experts had a greater probability of a high-quality score than questions answered by one expert (OR 4.9, 95% CI 2.7 to 9.0). Answers most often scored insufficient on the use of evidence to underpin the answer (36% and 38% for the networks, respectively) and on conciseness (35% and 31%, respectively). Peer review demonstrated that 43%–72% of the answers in both online networks were in complete agreement with the best available evidence. Conclusions OSH experts are able to provide quality answers in online OSH Q&A networks. Our answer quality appraisal instrument was feasible and provided information on how to improve answer quality.

Finding ‘new’ occupational diseases and trends in ‘old’ ones

Strategies for the reduction of risk to the health of workers, as well as the population in general, rely on the collection, analysis and interpretation of valid data to study work-related ill-health in relation to its determinants. In the developed world, through advances in occupational medicine and changing societal attitude reflected in legislation, the scourges of many occupational diseases such as those caused by asbestos, coal dust and silica have abated significantly. However, the risks of these diseases and many other categories of occupational ill-health ranging from noise-induced hearing loss to musculoskeletal and mental disorders still persist globally. It is clearly essential for all stakeholders including policy makers, occupational health professionals as well as employees, employers and the public to have reliable information on the trends in incidence of these conditions so as to intervene and achieve reductions in risk through legislation, enforcement and education [1]. In order to evaluate policy and its implementation, the results of these interventions can and should also be evaluated using corresponding reliable measurements of frequency of disease [1,2]. However, the challenges that hinder such reliable measurements should not be underestimated especially when potentially flawed, and in any case diverse, methods of data collection exist across national systems. To achieve better comparability of figures between countries, it is necessary to harmonize definitions and methods of recording of occupational diseases. However, the availability of reliable and integrated occupational health indicators to guide policymaking is hampered by societal, economic, financial and cultural differences between countries. Thus, Eurostat (the statistical office of the European Union) has curtailed publication of its previous range of occupational health statistics prompting a search for alternative approaches [2]. Another, arguably even bigger challenge, arises from the need for the early identification, or even the prediction of ‘new’ or emerging diseases arising from novel hazards, changing circumstances of occupational exposure, or evolution in modes of employment. In essence, new or emerging risks may result from completely novel physical, chemical or biological agents, from known risks associated with the introduction of changes in work conditions or from unforeseen methods of uptake of, or exposure to, previously recognized hazardous entities. In occupational health and safety, considerable effort can be invested in risk assessment in order to manage hazards and their risks. The risk assessment process can be viewed as a deductive method starting with established premises. However, for new risks, these premises are not known and consequently an inductive method might be more appropriate to discover and quantify previously unknown risks. Moreover, the existing ‘registries’ for occupational diseases are usually less suitable for the detection of ‘new’ occupational of work-related diseases, since they are aimed primarily at already known and established conditions. There is an urgent need to develop and study consistent methods that can improve the re cognition, validation and sharing of information about new occupational health risks [3]. The European Agency for Safety and Health at Work has used techniques such as literature reviews, interviews and expert consultations to help identify and predict new and emerging occupational health risks [4]. Notwithstanding such laudable initiatives, direct observation through sentinel reporting or surveillance schemes accompanied by expert interpretation is vital to demonstrate early signals of these new hazards and emerging risks [1,5]. Once a suspicion of a new hazard is raised, targeted ‘case-finding’ may be warranted to generate a hypothesis for further research and appropriate and timely protection of workers’ health [6]. The ‘holy grail’ is to aim towards ‘ideal prevention’ by pre-empting hazards to health even before they become manifest as disease. While no system could ever promise zero-risk, it nevertheless behoves all concerned to learn from the past to achieve a better future. Strategies need to be further developed in order to utilize extant data to best advantage by predicting potential new hazards and taking steps to protect workers and consumers before any health damage is manifest. Thus, techniques such as Quantitative Structure Activity Relationships (QSARs) have been applied to a variety of potential toxicants ranging from carcinogens, mutagens and reprotoxic agents to skin sensitizers. QSARs advocated and developed for occupational asthmagens [7] and for nanoparticles [8] aim to effectively forecast unknown hazards from those which are known. For the purposes of investigating trends in the incidence of work-related ill-health as well as to identify new or emerging health risks arising from work, an international consortium entitled MODERNET (Monitoring trends in Occupational Diseases and tracing new and Emerging Risks in a NETwork) was founded in 2008 [9]. MODERNET is a collaboration between academic centres investigating occupational disease and work-related ill-health incidence

Time trends and blind spots: what employers, employees and policy-makers want to know about occupational diseases

Abstract Occupational illnesses and accidents impose a heavy burden on both workers and employers and represent enormous economic costs. This burden could be substantially reduced through preventive measures. This paper reports on a Dutch survey to investigate what information employers, employees, policy-makers and other stakeholders need to prevent occupational diseases and how these information needs can best be met. Our survey consisted of two rounds of interviews. In the first round, we interviewed 11 key stakeholders from employers organisations, employees organisations, the Dutch government and labour inspectorate, the EU authorities and the Dutch Society of Occupational Physicians. In the second, we asked 14 disease registration experts to comment on the results of the first round and to give their opinion on what they thought was the best way of meeting stakeholders information needs. Between them, the experts represented six European countries. From the first round of interviews, we deduced five categories of information that stakeholders need: time trends of occupational diseases for setting policy priorities cases of new occupational diseases for early preventive action disease patterns in specific occupational groups for focused prevention measures consequences of occupational diseases and resulting measures for policy evaluation purposes blind spots to reveal areas where more investigation is needed. The interviews with experts revealed that it is wise to rely on several instruments and findings to meet the comprehensive information needs of stakeholders, such as sentinel surveillance, epidemiological studies and case tracing. In addition, the experts indicated that linking registration to prevention requires closer communication between providers of occupational disease statistics and stakeholders.

1498 Basic typology of sentinel and alert approaches to identify new and emerging work-related diseases

Objective Changes in working conditions give rise to new occupational health risks and work-related diseases (WRDs). Monitoring these new WRDs is essential for their early recognition and prevention and requires a comprehensive approach, using several complementary methods. The aim of this review is to provide an overview and basic typology of different approaches to detect new/emerging WRDs. Methods We conducted an extensive scientific literature search combining terms for the following three concepts: surveillance/reporting systems; occupational/work–related diseases; and new or emerging risks. In addition, a grey literature search was performed of both grey literature databases and relevant EU and research institute websites for additional resources. Results We identified a total of 75 surveillance systems from 26 different countries. We set up a basic typology of these systems dividing them into four main groups. Compensation-based systems (n=22) were designed to gather data for compensation purposes and are insurance-driven. Non-compensation-related systems (n=34) were created with the aim of improving the collection and analysis of data to measure trends in occupational and work-related diseases. Sentinel systems (n=12) were specifically designed to provide a warning signal that will initiate health interventions and preventive actions. Finally, public health surveillance systems (n=7) aim to monitor the health of the general population, but can also be used for work-related surveillance. These four main types further differed in terms of disease coverage, means of data collection, evaluation of work-relatedness, follow-up of new/emerging risks, link with prevention etc. Conclusion Sentinel systems seem to have the most suitable approach to detect and alert to new/emerging WRDs. Nevertheless, systems identified in the other three groups can also contribute to identifying new/emerging WRDs, despite being primarily designed for other purposes.

New and emerging risks of chemical carcinogens: detection and prevention.

© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com EDITORIAL

Werkgerelateerde kanker in maat en getal

SamenvattingWerkgerelateerde kanker is kanker die mede is ontstaan als gevolg van blootstelling aan kankerverwekkende factoren tijdens de uitvoering van het werk. Hiermee is het een breder begrip dan de term beroepskanker. Bij beroepskanker moet namelijk vastgesteld zijn dat werk de belangrijkste oorzaak van de kanker is.1

Manganisme of Parkinson

SamenvattingDe ziekte van Parkinson is in Nederland met minstens 40.000 patiënten geen zeldzame ziekte. De ziekte begint meestal op wat latere leeftijd, vooral tussen 50 en 60, maar 10% van de patiënten is jonger dan 40 jaar. De ziekte van Parkinson ontstaat door celverlies in bepaalde delen in de hersenen, met name in de substantia nigra. Het verlies van deze cellen leidt tot een tekort aan dopamine in de hersenen, hetgeen leidt tot de symptomen van de ziekte van Parkinson. De oorzaak van de zogenaamde idiopathische ziekte van Parkinson is niet bekend. Algemeen wordt ervan uitgegaan dat sprake is van een combinatie van genetische en omgevingsfactoren. In 5-10% van de gevallen is de ziekte van Parkinson een erfelijke ziekte, (familiaire Parkinson) en op dit moment zijn er ongeveer zes genen bekend die de ziekte van Parkinson kunnen veroorzaken, terwijl een aantal andere het risico verhogen. In een klein percentage van de gevallen zijn omgevingsfactoren waarschijnlijk van doorslaggevend belang. Er is relatief veel bewijs voor een relatie met blootstelling aan bepaalde bestrijdingsmiddelen (zoals rotenon, paraquat, organochloorverbindingen) en aan chloorhoudende oplosmiddelen (trichloorethyleen, perchloorethyleen). Minder sterk, maar wel aanwezig is het verband met blootstelling aan PCB’s; met metalen, lood, kwik, mangaan; met vervuilde lucht; bepaalde infecties en herhaald hoofdletsel.1