Christoph Oberlinner

Health and safety protection for chemical industry employees in a rotating shift system: program design and acute injury and illness experience at work.

Objectives: To describe a comprehensive health protection program for rotating shift employees and evaluate the program effectiveness in injury and illness prevention. Methods: For 14,128 shift and 17,218 day wage employees, occupational medical records were linked to job assignment records and studied over an 11-year period. Results: Between 1995 and 2005, initiatives directed to shift employees contributed to their 59% and 100% greater participation in medical examinations and health seminar days, respectively, compared to day wage employees. Injury rates declined over time and with increasing employee age and were not elevated among rotating shift compared to day wage employees. Clinic visit rates for acute illnesses were generally higher for day than shift work employees. Conclusion: Coupling of active medical monitoring with additional health and safety initiatives appears to mitigate the expected adverse physiological and psychosocial stresses of shift work.

Occupational stress perception and its potential impact on work ability

OBJECTIVE To examine perceived stress across employees with different occupational status, to investigate the impact of stress on work ability and to derive conclusions regarding health promotion activities. PARTICIPANTS AND METHODS A comprehensive survey combining questionnaire and medical examination was offered in one division in BASF Ludwigshafen. Among 867 voluntary participants, 653 returned complete questionnaires. The questions were directed at perception of safety at the workplace, self-rated health status, frequency of stress symptoms, unrealistic job demands, time pressure and maladjustment of work life balance. The outcome of interest was self-estimated health measured by the Work Ability Index (WAI). RESULTS Occupational stressors were perceived differently across occupational status groups. Frontline operators had more health concerns due to workplace conditions, while professional and managerial staff reported higher frequencies of perceived tension, time pressure, and maladjustment of work life balance. After adjustment for occupational status, demographic and lifestyle factors, perceived stress was associated with a modest to strong decline in WAI scores. CONCLUSION While perceived occupational stress had an apparent impact on WAI, and WAI has been demonstrated to be predictive of early retirement, more intensive and employee group-specific stress management interventions are being implemented beyond traditional strategies of routine occupational medical surveillance.

Chromosomal alterations in exfoliated urothelial cells from bladder cancer cases and healthy men: a prospective screening study

BackgroundChromosomal instability in exfoliated urothelial cells has been associated with the development of bladder cancer. Here, we analyzed the accumulation of copy number variations (CNVs) using fluorescence in situ hybridization in cancer cases and explored factors associated with the detection of CNVs in tumor-free men.MethodsThe prospective UroScreen study was designed to investigate the performance of UroVysion™ and other tumor tests for the early detection of bladder cancer in chemical workers from 2003–2010. We analyzed a database compiling CNVs of chromosomes 3, 7, and 17 and at 9p21 that were detected in 191,434 exfoliated urothelial cells from 1,595 men. We assessed the accumulation of CNVs in 1,400 cells isolated from serial samples that were collected from 18 cancer cases up to the time of diagnosis. A generalized estimating equation model was applied to evaluate the influence of age, smoking, and urine status on CNVs in cells from tumor-free men.ResultsTetrasomy of chromosomes 3, 7 and 17, and DNA loss at 9p21 were the most frequently observed forms of CNV. In bladder cancer cases, we observed an accumulation of CNVs that started approximately three years before diagnosis. During the year prior to diagnosis, cells from men with high-grade bladder cancer accumulated more CNVs than those obtained from cases with low-grade cancer (CNV < 2: 7.5% vs. 1.1%, CNV > 2: 16-17% vs. 9-11%). About 1% of cells from tumor-free men showed polysomy of chromosomes 3, 7, or 17 or DNA loss at 9p21. Men aged ≥50 years had 1.3-fold more cells with CNVs than younger men; however, we observed no further age-related accumulation of CNVs in tumor-free men. Significantly more cells with CNVs were detected in samples with low creatinine concentrations.ConclusionsWe found an accumulation of CNVs during the development of bladder cancer starting three years before diagnosis, with more altered cells identified in high-grade tumors. Also, a small fraction of cells with CNVs were exfoliated into urine of tumor-free men, mainly exhibiting tetraploidy or DNA loss at 9p21. Whether these cells are preferentially cleared from the urothelium or are artifacts needs further exploration.

Combined effect of back pain and stress on work ability

BACKGROUND Back pain and occupational stress are known risk factors for absenteeism and presenteeism. In addition, the relationship between back pain (BP) and psychosocial stressors has been examined in numerous studies. AIMS To examine the prevalence of BP and perceived stress among employees of different occupational status and to investigate their combined impact on work ability. METHODS A comprehensive survey combining questionnaire data and medical examination offered in one division of a major chemical company in Germany. Self-rated health and work ability were assessed using the Work Ability Index (WAI). A synergy index was used to assess a potential interaction between both exposures under an additive model. RESULTS Of 867 voluntary participants, 653 returned complete questionnaires on BP and job stress perception. Although occupational stressors were perceived differently, there was no difference in the prevalence of BP between the occupational groups. Back pain and stress perception are correlated with each other and both are negatively associated with work ability. After adjustment for occupational status, demographic and lifestyle factors, we found a synergy effect of BP and stress perception with a modest to strong impact on declining WAI. CONCLUSIONS Corporate health promotion interventions to reduce the impact of BP and stress perception on work ability should target both physical and psychological dimensions. Such interventions may be initiated in the context of regular (occupational) medical examinations.

Pregnant Employee Protection Program in a Large Chemical Company.

Objectives: To assess whether a structured employee protection program for pregnant workers at a chemical company has an impact on pregnancy outcomes. Methods: Reported pregnancies (n = 1402) between 2003 and 2010 and their outcomes were documented using questionnaires at the time of pregnancy report, end of pregnancy, and 1 year later. Potential maternal exposures were assessed using job histories, workplace inspections, and questionnaires. Results: Participation was 86% overall and was consistently high across subgroups. Pregnancy losses (10.9%), pregnancy complications, and preterm births (8.1%) were in agreement with rates in the general population and were independent of type of work and maternal exposure category. Conclusions: Pregnancy complication rates in this chemical company are not statistically elevated than that in the general population, as suggested in a previous study. The protection program may play a role in preventing complications that may have occurred.

140 Sociodemographic and health-related factors associated with temporary work disability in a large german chemical company: results of a cross-sectional study

Introduction With the present study, we aimed to determine the occurrence of temporary work disability within 12 months in a large German chemical company. Furthermore, we assessed the association of sociodemographic and health-related factors with work disability. Methods We used cross-sectional data, surveyed in occupational health checks-ups between January 2011 and December 2014 at the Ludwigshafen site (Germany). A blood sample, physical examination, anamnesis by a physician and a written questionnaire were part of the health check-up. Work disability in the year prior to participation was assessed using a single (categorical) item from the Work-Ability-Index. We used partial proportional odds models for ordinal response variables to assess the association of sociodemographic and health-related factors with work disability. Results Altogether, 17 351 employees participated in the voluntary health check-up. Excluding 386 persons with missing information and trainees, a final sample of 16 965 persons was yielded. Respondents were on average 43.7 (SD: 9.7) years old and predominantly male (79.0%). About one third (32.8%) did not miss a single day, 40.8% up to nine days, 18.5% 10–24 days, 6.8% 25–99 days, and 1.1% 100 days or more. The proportion of respondents being unable to work for ≥10 days in the last 12 months was comparatively high for older persons (31.8%; 50+years) vs younger persons (22.6%; <30 years), manual workers (40.1%) vs managerial staff (8.3%), rotating shift workers (38.9%) vs day workers (21.9%), obese (38.1%) vs non-obese people (19.6%), and smokers (35.3%) vs non-smokers (20.6%). In multivariable analyses, missing ≥10 days was significantly more likely for older respondents, females, manual workers and skilled/supervisory workers (vs. managerial staff), rotating shift workers, obese people, and for smokers and former smokers (vs. non-smokers). Conclusion The findings of the present study could be considered a starting point for the implementation of targeted preventive measures to reduce work disability.

253 The association of age and chronotype in day and rotating shift workers of a large german chemical company

Introduction The aim of the present study was to evaluate the association between chronotype and age in day and rotating shift workers. Methods The present cross-sectional study was carried out between October 2012 and February 2015 in a large German chemical company. Employees participating in a regular voluntary occupational health check-up were requested to complete a written questionnaire, which included items on sleeping behaviour extracted from the Munich Chronotype Questionnaire. Inclusion criteria comprised a fully completed questionnaire, not having used an alarm clock on free days, and being employed either as a day or rotating shift worker. Senior executive managers, trainees and interns were excluded. We used univariable and multivariable linear regression analyses to assess the association between age and chronotype (in minutes) in the whole sample and stratified by shift status. Result Altogether 10 348 persons completed the questionnaire, of which 4040 (39.0%) met the inclusion criteria. Participants were on average 41.8 years old (SD: 10.2), mainly male (75.4%) and engaged in day work (82.3%). Mean chronotype was 03:23 (SD: 54 min.) in the total sample, 03:16 (SD: 55 min.) in day and 03:57 (SD: 35 min.) in rotating shift workers. With increasing age, chronotype declined from 04:00 (≤29 years) to 03:08 (≥50 years) in the whole sample, and from 03:54 to 02:59 in day and 04:25 to 03:45 in rotating shift workers. Univariable and multivariable linear regression analyses correspondingly showed a significant decline of chronotype with age in both, day and rotating shift workers. Discussion While day workers could benefit from a chronotype decrease, rotating shift workers could build up an intolerance regarding night work with increasing age. Shift workers might benefit from specific targeted prevention programs including sleep hygiene trainings.

0243 Rotating shift work and prevalence of diabetes mellitus and prediabetes in male employees of a large german chemical company: results of a cross-sectional study

Purpose The aim of the study was to investigate the association between rotating shift work (RSW) and prevalence of diabetes and prediabetes in male employees of a large chemical company. Methods We used cross-sectional data, surveyed in health checks between January 1st2011 and December 31st2014 at BASF SE in Ludwigshafen (Germany). A blood sample, physical examination and anamnesis by a medical officer as well as a written questionnaire were part of the health-check. Diabetes status (no diabetes, prediabetes, diabetes) was assessed via HbA1c-value and information provided by employees themselves. Shift status was surveyed using company records. Partial proportional odds models for ordinal response variables were applied to assess the association of RSW with diabetes status. Results Data on 9765 male employees (40.4% rotating shift workers) with a mean age of 44.3 years (SD: 9.6) could be used for analyses. Prevalence of diabetes and prediabetes in rotating shift workers were 6.4% and 14.2% respectively. Corresponding figures for day workers were 3.6% and 11.5% (p<0.001). Unadjusted analyses yielded an Odds Ratio of 1.85 (95%-CI: 1.53–2.22) for RSW (comparing diabetes with prediabetes/no diabetes). The effect attenuated in the fully adjusted multivariable model (aOR: 1.38; 95% CI: 1.11–1.70) but remained significant. The association between RSW and diabetes status varied by BMI and occupational status. The association was stronger in skilled/supervisory workers and respondents with a BMI <30 kg/m². Conclusions The present study found a significant association between RSW and diabetes which differed by BMI and occupational status. Declaration of potential conflict of interest: All authors are employees of BASF SE.

0153 Risk of bladder cancer in a cohort of chemical workers

Objective Bladder cancer is the fourth most frequent cancer among men in Germany. Aromatic amines can cause bladder cancer and therefore cancerogenic aromatic amines have been banned a long time ago from workplace, but a long latency can still increase the risk of former exposed workers. In this study, we will assess the risk of bladder cancer in a cohort of chemical workers with earlier use of aromatic amines compared to the general population. Methods In the prospective cohort study UroScreen, 1800 former chemical workers exposed to aromatic amines were offered to participate in an early detection of bladder cancer by means of tumour markers. In 2003–10, 1609 people were examined at least once. The exposure to aromatic amines was determined by means of questionnaires. The observed bladder cancer incidence was compared with the expected incidence in the general population. Bladder cancer risk was estimated as standardised incidence ratio. Results Nine incidence urinary bladder carcinoma occurred during the study. Eight cases were ex-smokers and one case was non-smoker. All cases were exposed for at least 10 years, including six cases longer than 20 years. Compared to the general population, the risk of bladder cancer was 2.94 (95% CI 1.35–5.59). Conclusions Since almost all cases have both smoked and were highly exposed, reliable risk detection is difficult. Nevertheless, in view of a threefold increased risk, the early detection of urinary bladder carcinomas were promising.

Job duration as a surrogate measure of exposure to shiftwork in relation to mortality

Objectives Human evidence of carcinogenicity concerning shiftwork is inconsistent. In a previous study, we found no effect on mortality in relation to ever / never working nightshift. The present analyses examined the dose-response-relationship between mortality outcomes and job duration as a surrogate of cumulative exposure. Methods The cohort consisted of male production workers (14 037 shift and 17 095 day), employed for at least 1 year between 1995 and 2006. Vital status was followed from 2000 to 2009. Cause-specific mortality was obtained from death certificates. While lifetime job history was not available, job duration in the company was derived from personal data, which was then categorised at the quartiles. Cox proportional hazard model was used to adjust for potential confounders. The effect estimates were calculated as hazard ratio (HR) with 95% CI. Results Comparing to never shiftwork, the lower quartile of shift exposure (<18 yrs) was not associated with all-cause mortality after adjustment for age at entry in the study, job level and smoking (HR=1.05, 95% CI 0.81-1.37). In the upper three quartiles (18–23; 24–29; ≥30 years) we found non-significantly lowered hazard ratios with no significant trend (P=0.24). Similar patterns were found regarding cancer (P=0.40) and non-cancer mortality (P=0.24). Conclusions The present analyses did not suggest a positive dose-response-relationship between shift duration and the risk of cancer or non-cancer mortality. Potential sources of bias will be discussed.