Stefano Porru

An etiologic prediction model incorporating biomarkers to predict the bladder cancer risk associated with occupational exposure to aromatic amines: a pilot study

BackgroundNo etiological prediction model incorporating biomarkers is available to predict bladder cancer risk associated with occupational exposure to aromatic amines.MethodsCases were 199 bladder cancer patients. Clinical, laboratory and genetic data were predictors in logistic regression models (full and short) in which the dependent variable was 1 for 15 patients with aromatic amines related bladder cancer and 0 otherwise. The receiver operating characteristics approach was adopted; the area under the curve was used to evaluate discriminatory ability of models.ResultsArea under the curve was 0.93 for the full model (including age, smoking and coffee habits, DNA adducts, 12 genotypes) and 0.86 for the short model (including smoking, DNA adducts, 3 genotypes). Using the “best cut-off” of predicted probability of a positive outcome, percentage of cases correctly classified was 92% (full model) against 75% (short model). Cancers classified as “positive outcome” are those to be referred for evaluation by an occupational physician for etiological diagnosis; these patients were 28 (full model) or 60 (short model). Using 3 genotypes instead of 12 can double the number of patients with suspect of aromatic amine related cancer, thus increasing costs of etiologic appraisal.ConclusionsIntegrating clinical, laboratory and genetic factors, we developed the first etiologic prediction model for aromatic amine related bladder cancer. Discriminatory ability was excellent, particularly for the full model, allowing individualized predictions. Validation of our model in external populations is essential for practical use in the clinical setting.

1603c Immunisation policies and practices in occupational health: evidence and options from the literature and the field

Introduction Exposure to biological agents occurs in many workplaces. Immunisation is a safe, cost-effective intervention for Vaccine Preventable Diseases (VPD). Although updated, evidence-based vaccination policies are available for the general population, overall there are few consensus recommendations for working populations apart from health care workers (HCWs). Methods To evaluate current trends and evidence-based options, we performed a literature review of main online databases from 1997 to 2017, websites of various public health organisations, and professional societies, focusing on vaccination policies and practices in occupational settings. Result Many vaccines are available for workers exposed to certain biological agents, while others are imminent. However, systematic, representative data on occupational immunisation policies, practices and coverage are lacking. Most pertain to HCWs, Influenza and HBV and coverage is sub-optimal. Variations exist by country and region for legislation, policies, schedules, groups requiring vaccination, implementation. Relevant issues include: access to vaccines; cost-effectiveness; immunisation coverage; identification susceptible of workers at-risk; fitness for work; involvement of all stakeholders. Discussion Immunisation is an additional preventive tool to conventional workplace interventions, very effective for biohazard containment. A specific immunisation policy and practice is a strategic priority for individual workers, different workforces and the public health system. The main Occupational Health Professionals’ (OHP) responsibilities are: individual, activity and area risk assessment; evaluation and provision of cost-effective vaccines; obtaining consent (or refusal) following counselling; managing non-responders and those who refuse vaccinations; career guidance; remaining updated. Mandatory immunisation should be explored in selected circumstances. OHP, employers and workers share the responsibility to implement the WHO Global Vaccine Action Plan to expand access to immunisation to all susceptible workers and strengthen routine immunisation. Policies and services should reside in the realm of Corporate Social Responsibility and be harmonised across industries, regions and countries with the ultimate goal to control and eradicate VPD in workplaces.

Management of Psychosocial Work Environment: Outline of a Multidisciplinary Preventive Intervention in a Large North Italian Municipality

There is a need of evidence-based multidisciplinary intervention studies to prevent work-related stress in municipality workforces. This study was carried out with the aim of improving management of psychosocial work environment in a large municipality. A steering committee of two occupational physicians and a psychologist designed the intervention, consisting of: preliminary meetings with management; comprehensive data collection (risk assessment, health surveillance, assessments from psychologists, educators, mediators; training activities; collection of sentinel events, data from focus groups); qualitative and quantitative data analysis to identify critical points. The 1730 workers are employed in 7 areas, 32 sectors and 74 services. Psychosocial risk assessment was carried out by questionnaires developed by national and international bodies. Risk assessment identified critical areas and sectors and needs update. Low response rate and non-comparability of data were critical issues. Health surveillance often reported stress related problems, but no structured intervention or integration with other municipality functions were noted. Internal transfer and mobility were critical issues too. Psychologists and consultants evaluated many cases and often suggested operative solutions. Focus groups were few, with no clear participation rate. Based on these data, the committee designed an intervention entailing: (a) formal municipality policy for work-related stress; (b) a multidisciplinary working group, managed by a psychologist, involving occupational physicians and consultants to evaluate single cases and general issues, as well as to elaborate, adopt and monitor specific interventions; (c) use of evidence based risk assessment and health surveillance tools; (d) implementation of good practice in transfer and mobility management.