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Presenting author profile

Oladele (Dele) Ogunseitan holds the title of Distinguished Professor in the Departments of Global Health & Biobehavioral Sciences, and Environmental & Occupational Health at the University of California, Irvine. He co-directs the World Institute for Sustainable Development of Materials (WISDOM) and is a partner of the Institute for Sustainable Process and Resources Convergence for Critical Materials (SPARC).

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Oladele A. Ogunseitan (1); Julie M. Schoenung (2); Seth Mehalic (2)
1. University of California, Irvine, California, USA
2. Texas A&M University, College Station, Texas, USA

Background

High Entropy Alloys (HEAs) are revolutionizing healthcare due to their exceptional biocompatibility, corrosion and wear resistance, and bone-mimicking properties. By strategically selecting non-toxic components, HEAs can replace flawed materials such as titanium alloys. Comparative assessment of the potential sustainability of complex materials including mixtures and alloys requires methodologies that appropriately distinguish between additive and non-additive material properties. Current approaches apply uniform weighted-average calculations across all sustainability criteria, which inadequately captures the complex, synergistic behaviors exhibited by toxicity and other non-additive indicators in alloys and other multi-component materials. This study develops and applies an improved methodology for criteria assessment in sustainability evaluation that explicitly distinguishes between additive criteria (e.g., cost, embodied energy) and non-additive criteria (e.g., human health damage, human and labor rights pressures).

Methods/Approach

We developed a toxicity-weighted scoring system that accounts for the disproportionate influence of highly toxic constituents through non-linear weighting functions. The methodology is applied to binary alloys (Fe-Ni, Fe-Mo), dilute alloys (Fe-based stainless steel, Ni-based superalloys), and HEA compositions (transition metal, refractory, and light-weight systems). Human health damage scores for individual metallic elements, derived from a published dataset, are used to calculate alloy-level scores as a function of alloy composition.

Results

The new methodology significantly influences materials selection options, with differences between the conventional and improved assessment ranging from 1 to 28 points (out of 100 possible points) in alloy-level human health damage scores. Alloying elements such as molybdenum and tantalum, with high individual elemental scores and known toxicity burdens, cause significant increases in alloy-level scores even when present in low concentrations. Reducing nickel content from >50% in superalloys to 20% in HEAs is advantageous due to nickel’s known carcinogenicity.

Conclusions

The study advances sustainability-informed materials selection for complex multi-component systems where empirical data remain unavailable, with implications extending beyond HEAs to other mixtures, formulations, compounds, and multi-material products.

Presenting author profile

Professor Dingani Moyo is an Associate Professor of Occupational Medicine at the National University of Science and Technology in Zimbabwe and the University of the Witwatersrand in South Africa. He has served two terms as a Board Member of the International Commission on Occupational Health (ICOH). He is the Executive Director of Baines Occupational Health Services. He has researched and published extensively on occupational lung diseases.

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Dingani Moyo (1,2,3); Anil Chuturgoon (1); Rajen Naidoo (1)
1. University of Kwa-Zulu Natal, Durban, South Africa
2. University of the Witwatersrand, Johannesburg, South Africa
3. National University of Science and Technology, Bulawayo, Zimbabwe

Background

Silicosis is a progressive, irreversible occupational lung disease caused by inhalation of respirable crystalline silica dust. It remains highly prevalent among artisanal and small-scale miners, particularly in low- and middle-income countries. Current screening methods, including chest radiography, have limited sensitivity for detecting early silicosis, highlighting the need for reliable, non-invasive biomarkers.

Methods/Approach

A case–referent study was conducted among 146 artisanal and small-scale miners at mining sites in Kwe Kwe district in Zimbabwe. The study included cases with radiologically confirmed silicosis cases （ILO profusion ≥1/1） and those without silicosis (ILO 0/0), who were recruited during outreach services. Demographic, occupational and clinical data were collected using a structured questionnaire, while chest radiographs were classified according to the International Labour Organization （ILO） classification system. Blood samples were analysed for serum miRNA-27a, miRNA-27b, miRNA-145, TNF-α, IL-1β and IL-6 using microarray, quantitative reverse transcription polymerase chain reaction (qRT-PCR) and ELISA techniques. Associations between biomarker expression and radiological silicosis were evaluated using multivariable logistic regression, with statistical significance set at p<0.05.

Results

Laboratory analyses of serum miRNA-27a, miRNA-27b, miRNA-145, TNF-α, IL-1β and IL-6 expression profiles have been completed, and statistical analyses are currently underway. Preliminary data cleaning, quality assurance procedures and radiological classification have been finalized. The final results will quantify the associations between selected serum biomarkers and radiological silicosis severity among artisanal and small-scale miners and will be available for presentation at the conference.

Conclusions

This study represents one of the first investigations of serum miRNA-27a, miRNA-27b and miRNA-145 as potential biomarkers of silicosis among artisanal and small-scale miners in Africa. The findings are expected to provide novel evidence on the utility of circulating microRNAs and inflammatory cytokines for the early detection and characterization of silicosis.
Completion of this study will enable evaluation of the diagnostic and prognostic potential of the selected biomarkers.

Presenting author profile

Dr. Smith is a Distinguished Professor Emeritus and Interim Vice Provost of Graduate Studies at the University of California Santa Cruz, where he has studied environmental metal exposures and neurotoxic outcomes in humans and animal models for over three decades.

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Don Smith (1)
1. University of California, Santa Cruz, California, USA

Background

In January 2025, the Vistra Battery Energy Storage System (BESS) in California, the largest BESS in the US, experienced thermal run-away and caught fire. A majority of the ~100,000 lithium ion batteries in the facility burned, potentially contaminating surrounding communities with toxic metals. Initial findings from state and local agencies suggested no cause for concern, though environmental and human exposure assessments were limited or non-existent.

Methods/Approach

We engaged community members to collect Ghost Wipe surface dust (February-March 2025), and subsequently Cyclone surface dust samples (October–December 2025) over a broad area surrounding the Vistra BESS facility for metal analyses. Additionally, 63 community volunteers provided hair samples for metal analyses to assess past (distal hair segment) and recent (proximal segment) human exposures. All samples were analyzed for metals by magnetic sector inductively coupled plasma mass spectrometry.

Results

Findings show highly elevated dust levels of lithium (Li), cobalt (Co), manganese, and nickel (Ni) within 3-8 miles of the Vistra facility. Metal levels in dust collected ~10 months after the fire were ~100-times lower than levels within 1 month of the fire, suggesting dispersion of contamination over the ~9-month between sample collections; dust samples with the highest levels of nickel, cobalt, and manganese exhibited a Ni:Co ratio of ~2.3:1, consistent with composition of Li-NMC 532 batteries. There were substantial differences in hair metal levels between the human volunteers, supporting individual differences in metal exposure and metabolism. Overall, distal hair segments were significantly higher than corresponding proximal hair samples for cobalt, nickel, manganese, but not the other metals, consistent with elevated exposures to Li-battery associated metals.

Conclusions

These findings raise significant concerns regarding environmental and human exposure risk to toxic metals from lithium ion BESS facilities that experience thermal runaway fire, and they highlight the inadequate human exposure/health risk assessment efforts by local and state public health agencies.

Presenting author profile

Kurt Straif is a Research Professor at Boston College and Research Associate at ISGlobal, where he focuses his work on research and policy on topics including global cancer prevention and climate change and health.

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Kurt Straif (1,2)
1. Boston College, Boston, Massachusetts, USA
2. ISGlobal, Barcelona, Spain

Background

The international health community advocates for bringing health arguments to the international climate negotiations, with the strategic perspective that anticipated health co-benefits would support more ambitious climate negotiations.

Methods/Approach

Starting with a brief history of health at climate change negotiations, important health-related updates from the period of 2025/26 will be reported. In the context of the Global Goal on Adaptation (GGA) experts were tasked to develop a list of 100 indicators, including 10 health indicators. This is the first time that “health” was discussed at official negotiations. However, parties at the Conference of Parties (COP30) agreed on only 59, less stringent indicators (including 8 health indicators), with a vague perspective on their implementation. During the following mid-term meeting of Subsidiary Bodies (SB64) in Bonn, Parties could not agree on the terms of reference of an Indicator Task Group.
To overcome the disappointing outcomes of COP30, 1) a COP30 Presidency Roadmap on Transitioning away from Fossil Fuels was launched and promising progress was reported at SB64; 2) In a parallel process, a “Coalition of the Willing” met in Santa Marta, Colombia, and started the development of a roadmap for transitioning away from fossil fuels.
The International Court of Justice Advisory Opinion (ICJAO), and the Intergovernmental Panel on Climate (IPCC) Change, and particularly its 7th Assessment Report may provide additional opportunities to strengthen the health argument.

Results

Enhancing the health expertise on official COP delegations and strengthening the health arguments in climate change negotiations can be enablers of climate change mitigation and climate action.

Conclusions

Initiation of a Climate Change and Health Committee of interested Fellows to continuously analyze negotiations and prepare Collegium Ramazzini contributions to international climate conferences.

Presenting author profile

Dr. Michaels is an epidemiologist and professor at the George Washington University Milken Institute School of Public Health. He served as Assistant Secretary of Labor for Occupational Safety and Health 2009 - 2017, the longest serving administrator in OSHA's history. He also was Assistant Secretary of Energy for Environment, Safety and Health 1998-2001, with responsibility for protecting the health and safety of workers, neighboring communities and the environment surrounding the nation's nuclear weapons facilities.

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David Michaels (1); Robert Harrison (2); Steven Markowitz (3)
1. George Washington University, Washington DC, USA
2. University of California San Francisco, San Francisco, California, USA
3. Queens College, City University of New York, Queens, New York, USA

Background

Workers exposed to respirable crystalline silica released in the fabrication and installation of “engineered stone” or “quartz” countertops containing crystalline silica are at greatly increased risk of silicosis. These cases are notable for their relatively young age at diagnosis, short duration of exposure, severity and rapid progression of disease.
In the few decades since this engineered stone product was first developed, thousands of cases have been reported in Israel, Spain, Italy, UK, Australia, China, Taiwan, US, and elsewhere. Traditional industrial hygiene-based regulatory approaches, including US OSHA’s strengthened silica standard have failed. Recognizing this, in 2024 Australian authorities prohibited the use, supply, and manufacture of quartz countertops composed of >1% crystalline.

Methods/Approach

A safer alternative, made from amorphous silica (crushed or recycled glass), is widely available. Global manufacturers of slabs from which countertops are fabricated now market this alternative in Australia and elsewhere, although they continue to sell the more dangerous product where it is not prohibited. Engineered stone containing significant amounts of respirable crystalline silica remains the most popular choice in many locations.

Results

As long as countertops are fabricated and installed by small shops that employ workers with little ability to demand safe working conditions, it will be virtually impossible to eliminate silicosis in this industry. A global ban on the manufacture and fabrication of countertops and related materials containing >1% respirable crystalline silica is the best solution to preventing this global epidemic.

Conclusions

A Collegium Ramazzini Statement calling for a global ban would make an important contribution to stopping this tragic epidemic.

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David Prezant (1,2,3); Rachel Zeig-Owens (1,2); David Goldfarb (1,2); Micheal Weiden (1,3); Anna Nolan (1,3); Krystal Cleven (1,2); Theresa Schwartz (1,2); Madeline Cannon (1,2); Charles Hall (1,2); Jaeun Choi (1,2); Brandon Vaeth (1,2); Ankura Singh (1,2); Alexandra Mueller (1,2); Julia Sese (1,2); Tyrone Moline (1,2); Yang Lui (4)
1. World Trade Center Health Program at Fire Dept of City of New York, New York, USA
2. Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York, USA
3. New York University (NYU) Langone Medical Center, New York, New York, USA
4. Fire Department of City of New York, New York, USA

Background

The September 11, 2001 (9/11) World Trade Center (WTC) disaster resulted in large scale exposure to the tragedy including the respirable particulate matter and combustion byproducts among responders and community survivors. Compassion driven advocacy mobilized philanthropic and governmental resources to provide medical monitoring. Data driven advocacy led to long-term funding under the federally mandated WTC Health Program, providing medical monitoring and treatment of WTC-qualifying conditions and supporting WTC health-related research.

Methods/Approach

Nearly all Fire Department of City of New York (FDNY) responders were present within 48 hours and remained on-site for months. FDNY’s pre-existing occupational health infrastructure enabled immediate initiation of post-exposure monitoring and facilitated comparisons with pre-WTC data. This review synthesizes findings from numerous studies involving FDNY firefighters and EMS responders, including analyses of respiratory, cancer, autoimmune, cardiovascular, sleep-related, and cognitive disorders.

Results

Long-term follow-up confirmed elevated rates of accelerated lung function decline, upper and lower respiratory diseases, sarcoidosis, PTSD and sleep apnea. Cancer surveillance detected modest excess incidence, (SIR) of 1.10 (95% CI 0.98–1.25) for all cancers compared with US males, and relative rates (RR) between 1.19 and 1.32 when WTC-exposed firefighters were compared to non-exposed firefighters with site-specific cancer elevations for melanoma, thyroid, prostate and lymphoma. Autoimmune outcomes showed those highly exposed having ~7.7 excess cases relative to background rates. Based on growing epidemiologic evidence, submitted petitions to the federal government seeking expansion of program coverage to include autoimmune, cardiovascular, and cognitive conditions.

Conclusions

Continued long-term surveillance remains essential for characterizing conditions with multi-decade latency. Future research will focus on identifying biomarkers that could assist in early diagnosis, potentially leading to improved outcomes. For future disaster responses, lessons learned from the WTC attack underscore the importance of pre-existing occupational health systems, standardized data, early cohort establishment, biomarker collection, and structured longitudinal follow-up in future disaster responses.

Presenting author profile

Dr. McPhaul is a researcher in the Department of Global, Environmental, and Occupational Health at the University of Maryland School of Public Health where she addresses improving understanding of airborne infections and environmental mitigations in indoor spaces.

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Kathleen M. McPhaul (1); Melissa Thomas (1); Sulakkhana de Saram (1)
1. University of Maryland School of Public Health, College Park, Maryland, USA

Background

Working in patient care exposes clinicians, direct caregivers, and ancillary staff to infectious airborne pathogens. A systematic literature review included tuberculosis, SARS-CoV-1 and 2, and influenza demonstrated the significant occupational exposures to healthcare workers (HCW) globally. The literature focused on controlling transmission, whether from patient to HCW or HCW to patient, via the standard infection control paradigm. With the exception of California’s Airborne Transmission Disease standard, the literature included minimal guidance for indoor ventilation and air disinfection. Instead, the literature generally recommended guidance used for community and healthcare-associated infections (HAIs) exposures.

Methods/Approach

Failing to prevent airborne infections to health workers and patients was well documented during the COVID-19 pandemic. Engineering controls, in the form of ventilation, air filtration, and air disinfection, were not been widely implemented nor emphasized as hazard controls in our literature review. In recent years, there was increased adoption of N-95 respirators over surgical masks to protect against airborne hazards. While this change meaningfully advanced occupational infection control practice, PPE still ultimately sits at the bottom of the hierarchy of controls. Given the risk to healthcare workers globally, we must move beyond a focus on PPE toward environmental controls like ventilation, filtration, and air disinfection through germicidal ultraviolet (GUV).

Results

Airborne infections are important occupational exposures to HCW’s resulting in significant morbidity, increasing costs, and destabilizing healthcare systems through absenteeism and workforce turnover. These occupational risks leave countries ill-prepared for seasonal airborne infections and future pandemics. Preservation of the global healthcare workforce is critical to sustainable development and human progress.

Conclusions

The Collegium Ramazzini should consider investigating the extent of this problem together with the evidence for effectiveness of engineering controls and develop a policy statement to communicate the urgency of a paradigm shift toward protecting healthcare workers using engineering controls in addition to infection control measures.

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Sara Colazzo (1); Angela Contri (1); Alberto Modenese (1); Simone Mosconi (2)
1. University of Modena and Reggio Emilia, Modena, Italy
2. Confindustria Ceramica, Sassuolo, Italy

Background

Respirable crystalline silica (RCS), when generated by work processes, is recognized in Europe as a substance subject to occupational restrictions under EU-Directive 2017/2398; however, there is no harmonized hazard classification for this substance under Regulation (EC) No 1272/2008 on the classification, labelling and packaging of substances and mixtures. In the ceramic sector, exposure assessment is complex due to the coexistence of multiple production phases where silica-containing materials are processed.
A multi-stakeholder initiative involving regional health authorities, industry associations, trade unions, and manufacturers was established in Emilia-Romagna (Italy): shared evaluation criteria were developed to identify production phases associated with exposure to RCS generated by work processes, based on material transformation and dust generation.

Methods/Approach

A total of 610 RCS measurements were reviewed to characterize exposure conditions: the average working-day RCS concentration was 0,024 mg/m³; > 60% of measurements were below ACGIH-TLV (0,025 mg/m3), 95% were <0,05 mg/m³, and 99% complied with the EU-OEL (0.1 mg/m³).
The multi-stakeholder group developed two criteria for identifying ‘work involving exposure to RCS dust generated by a work process’: i) there is a modification of the material’s form, appearance, and function, through mechanical and/or chemical and/or thermal transformation during the process; ii) there is a production of RCS dusts not previously present in the workplace environment through the operational activities required by the job task. On the basis of the criteria identified, the Directive apply only to dry milling, dry cutting and dry squaring/grinding operations.

Results

The proposed evaluation framework provides harmonized criteria for the ceramic sector to identify work processes associated with airborne RCS exposure to be considered for the application of the EU-Directive 2017/2398.

Conclusions

Looking ahead, updating exposure data and systematically collecting health-related information may prove useful in assessing the effectiveness of the measures adopted to ensure ever-improving protection for ceramic workers.

Presenting author profile

Dr Tibaldi is the Head of the Pathology Unit at the Cesare Maltoni Cancer Research Center, Ramazzini Institute. Her work is focused on pathology involved in screening of slides to perform diagnosis and conducting peer review of histopathology for all in vivo studies.

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Tibaldi Eva (1); Simona Panzacchi (1); Francesca Truzzi (2); Roberta Noferini (1); Laura Falcioni (1); Daria Sgargi (1); Rita Giovannini (1); Martina Iuliani (1); Marco Manservigi (1); Isabella Manzoli (1); Ilaria Menghetti (1); Sara Nanni (1); Valentina Strollo (1); Luana De Angelis (1); Fiorella Belpoggi (1); Daniele Mandrioli (1)
1. Cesare Maltoni Cancer Research Center, Ramazzini Institute, Bologna, Italy
2. Alma Mater Studiorum University of Bologna, Bologna, Italy

Background

The organ toxicity and genotoxicity associated with pure glyphosate or its formulations is a central issue in the scientific and regulatory debate. Increases in micronuclei, a known marker of genotoxicity, have been previously reported in vitro and in vivo. The Global Glyphosate Study is an integrated project in Sprague-Dawley (SD) rats designed to test pure glyphosate and two commercial formulation Roundup Bioflow and RangerPro (GBHs), at doses considered as safe under current regulations, to provide independent results on various outcomes. Here presented are the preliminary results from the the 13-week prenatal sub-chronic toxicity study on the bone marrow genotoxicity and an in-depth analysis of histopathological lesions observed in liver and kidney.

Methods/Approach

Pure glyphosate or the 2 GBHs were administered to SD rats in water at 0.5 (the EU acceptable daily intake, or ADI), 5 and 50 (the EU no observed adverse effect level, or NOAEL) mg/kg body weight per day, from prenatal life until 13 weeks after weaning. All tissues were histopathologically evaluated and bone marrow smear was analyzed for the micronuclei assessment, preliminarily in the highest doses and control groups, using the May-Grunwald-Giemsa stain. Micronuclei count was performed manually on digital images analyzed with software Image J. The procedure was carried out according to OECD guideline TG 474.

Results

Preliminary results from the bone marrow micronucleus tests revealed a statistically significant increase compared to the control group, at least at the highest doses (NOAEL) and homogeneous among glyphosate and formulations. Non-neoplastic histopathological lesions in the liver and kidneys were morphologically analyzed.

Conclusions

Our preliminary results on micronuclei assessment confirm the in vivo genotoxic potential in SD rats treated at dose equal to the current EU NOAEL of glyphosate and GBHs related. Liver and kidney histopathological analyses provide important insights on the toxicity of glyphosate and GBHs.

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Raja Singh (1,2,3); Rohit Kumar (1,2); Mukesh Nagar (1,2); Narendra Singh Rathore (4); Akhil Kapoor (5,6,7); Shiv Rajan (8); Chunwei Xu (9); Saman Iddagoda (10); Rima Dada (11); Monika Gaur (12); Nilesh Gawde (13); Qian Wang (14); Ajay Kumar Verma (15); Priyanka Roy (16); Yue Hao (17); Tarang Patel (18); Richard Fuller (19,20); Arthur L Frank (21)
1. Safdarjung Hospital, New Delhi, India
2. Vardhman Mahavir Medical College, New Delhi, India
3. Pure Earth, New York, New York, USA
4. Rabindranath Tagore Medical College, Udaipur, India
5. Mahamana Pandit Madan Mohan Malviya Cancer Centre, Varanasi, India
6. Homi Bhabha Cancer Hospital, Varnasi, India
7. Tata Memorial Centre, Varanasi, India
8. King George’s Medical University, Lucknow, India
9. Chinese Academy of Sciences, Hangzhou, China
10. National Hospital for Respiratory Diseases, Welisara, Sri Lanka
11. All India Institute of Medical Sciences, New Delhi, India
12. Government Medical College, Pali, India
13. Tata Institute of Social Sciences, Mumbai, India
14. Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
15. Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
16. Government of West Bengal, Kolkata, India
17. Chinese Academy of Sciences Zhejiang Cancer Hospital, Hangzhou, China
18. All India Institute of Medical Sciences, Rajkot, India
19. Columbia University, New York, New York, USA
20. Global Toxics Research Initiative, Nyack, New York, USA
21. Drexel University, Philadelphia, Pennsylvania, USA

Background

Mesothelioma cases are recorded by cancer registries. International organisations such as the International Agency for Research on Cancer (IARC) rely largely on data from national cancer registries. This reliance assumes that national registries maintain comprehensive and accurate records for their respective countries. However, this assumption may not always hold true, particularly in the developing world, where challenges include a lack of appropriate legislation, inadequate enforcement, and the lack of full geographical area coverage. Further issues may arise from underreporting and incorrect/missed diagnoses. Inadequate history-taking may also lead to misleading conclusions regarding disease etiology.

Methods/Approach

This commentary examines the current status of cancer record-keeping in selected countries in the developing world, including India, Sri Lanka, and China. The coverage of cancer registries, existing gaps, and potential challenges are examined using government sources and other studies that highlight deficiencies in cancer registration within these countries. The commentary also highlights multi-center studies demonstrating how comprehensive history-taking may provide a fuller understanding of causative factors that might otherwise remain obscured, be forgotten, or simply not be investigated.

Results

Policymakers and global organisations rely on international sources of information, which may present a misleading picture when underlying national data are incomplete. A lack of data should not be interpreted as a lack of disease. Rather, inefficient record-keeping mechanisms may result in a substantial disease burden remaining unrecognised. Consequently, a high incidence of disease and opportunities for appropriate preventive or corrective interventions may be overlooked.

Conclusions

Opening up opportunities for detailed, multi-center studies at the global level to obtain more accurate estimates of the incidence and etiology of mesothelioma to strengthen existing cancer registries. Calling for extensive questionnaires that enable comprehensive history-taking and accurate record-keeping for patients with mesothelioma. Developing dedicated mesothelioma registries in settings where a comprehensive overhaul of national cancer registry systems may not be feasible.

Presenting author profile

Dr. Blanc, Professor Emeritus, served as the Chief of the Division of Occupational, Environmental and Climate Medicine at the University of California San Francisco (UCSF) from 1994 through 2023. Dr. Blanc is the author of "How Everyday Products Make People Sick" (2007) and "Fake Silk: The Lethal History of Viscose Rayon" (2016).

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Paul D. Blanc (1)
1. University of California, San Francisco, California, USA

Background

Biography should play a balanced role in the history of occupational medicine. Hagiography obscures a clear understanding of the past, but missing relevant biographic details impairs a nuanced reading of the historical record.

Methods/Approach

Building the St. Louis Bridge led to the most important outbreak of caisson disease in the nineteenth century. The core medical findings of this epidemic were documented with great erudition by Dr. Louis Antoine Alphonse Jaminet in his 1871 work, Physical Effects of Compressed Air. Jaminet systematically assessed workers’ symptoms and outcomes; subjected himself to the high-pressure environment, experiencing an episode of painful paralysis that resolved; and instituted key preventive measures (decreased exposure times and slower decompression). Although Jaminet’s work is cited routinely in reviews of caisson disease, little has been reported of even his basic biographic details.

Results

Jaminet was educated as a physician in France. Documentation of his training is scant beyond service as an externe at the Hôpital de la Charité where he was recognized for caring to the wounded of the revolution of 1848. He had a dual career, taking over his father’s work as a fountain-maker and being recognized for hydraulic inventions related to water filtration. He emigrated to Missouri, USA, in 1851, established a clinical presence, published in journals, was a Civil War house surgeon at St. Louis General Hospital (1862-63), and went on to successful private practice.

Conclusions

Jaminet’s biography illuminates that he was ideally suited to be a leader in understanding and preventing caisson disease. Trained in the Paris school of medical practice, the numerical method was reflected in his treatise on compressed air. His engineering familiarity with hydraulics was directly applicable to an understanding of mechanics of pressurized caissons. His own background as a fountain-maker’s son and his engagement in 1848 are consistent with empathy for the working man.

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Maria Ferri (1,2); Giulia Piazza (1); Simonetta Cimino (3); Loretta Casolari (2); Gabriele Donati (2); Roberto Lucchini (1,4); Alberto Modenese (1)
1. University of Modena and Reggio Emilia, Modena, Italy
2. Modena University Hospital, Modena, Italy
3. AUSL di Modena, Modena, Italy
4. Florida International University, Miami, Florida

Background

Chronic Kidney Disease (CKD) is a growing global public health burden. Beyond metabolic and vascular determinants, environmental and occupational exposures are increasingly recognized as potentially modifiable contributors. CKD was the ninth leading cause of death worldwide in 2023 and is projected to rank fifth by 2040.

Methods/Approach

CKD is classified according to estimated glomerular filtration rate and albuminuria. In the CARHES survey, the prevalence of advanced CKD (stages 3–5) in Italy was 2.89%. In Modena Province, we found a prevalence of 5.64% in 2023, almost twice the national estimate and higher among women than men (6.19% vs 5.07%). Since 2017, Modena has recorded the highest incidence of dialysis initiation in Emilia-Romagna, reaching 196 cases per million population in 2023, compared with 167 regionally, together with longer dialysis duration. This persistent excess is not readily explained by a single clinical or genetic determinant. Employment in industry is substantially higher in Modena Province than nationally (42% vs 27%): over 60,000 workers are employed in metalworking/mechanical engineering and ceramic activities. Notably, excess end-stage kidney disease has previously been reported in both sectors (Rapiti et al., 1999; Shrestha et al., 2022). Other locally relevant exposures may include heat stress, inadequate hydration, heavy physical workload, nephrotoxic metals, agrochemicals and silica. Migrant workers may be particularly vulnerable: in 2022, they represented over 18% of the local hemodialysis population and initiated dialysis younger than Italian-born patients.

Results

Modena’s excess CKD and dialysis burden constitutes a persistent epidemiological signal. Integrated research linking clinical and registry data with occupational histories, environmental monitoring, socioeconomic conditions, migration-related vulnerabilities and heat exposure is urgently needed.

Conclusions

Collaboration among nephrology, occupational medicine and public health could strengthen surveillance, prevention and early detection of kidney dysfunction in high-risk populations.

Presenting author profile

Dr. Juan Pablo Ramos-Bonilla is an Associate Professor of Civil and Environmental Engineering at Universidad de los Andes, Bogotá, Colombia. Trained in civil engineering, environmental management, and public health, he has over twenty years of experience in environmental health research, policy, and practice. He leads the Bogotá research program on occupational asbestos exposure behind this study, focusing on asbestos-related disease and prevention in low- and middle-income countries. He is an elected Fellow of Collegium Ramazzini.

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Juan Felipe Gualdrón Hernández (1); María Fernanda Cely-García (1); Carlos Valencia (1); Juan Pablo Ramos-Bonilla (1)
1. Universidad de los Andes, Bogotá, Colombia

Background

Counting airborne fibers is central to assessing occupational asbestos exposure, which causes lung cancer, mesothelioma, and other diseases. Phase-contrast microscopy (PCM) is the standard, low-cost method but cannot distinguish asbestos from non-asbestos fibers. Transmission electron microscopy (TEM) provides asbestos-specific identification but is costlier and often unavailable for historical records. Prior conversion factors, derived in different occupational settings (mining, milling, manufacturing), vary substantially. We developed new conversion models, validated them, and compared their performance with published models using a common external dataset.

Methods/Approach

We analyzed paired PCM (National Institute for Occupational Safety and Health [NIOSH] Method 7400) and TEM (NIOSH Method 7402) measurements from personal air samples collected in brake repair shops (BRS) and transmission repair shops (TRS) in Bogotá, Colombia. Of 641 BRS and 88 TRS samples, 375 and 68 met inclusion criteria. Weighted least-squares (WLS), generalized linear, and linear mixed-effects models were fitted to BRS data. These and published conversion models were evaluated in the independent TRS dataset using mean squared error (MSE) and mean absolute error (MAE).

Results

The WLS model (TEM = 0.034 + 1.907 × PCM) produced the lowest MSE (0.069), whereas a previously published factor (Verma and Clark; TEM = 1.9 × PCM) produced the lowest MAE (0.139); performance was nearly identical. Larger factors performed substantially worse. Shop, worker, laboratory, and asbestos type did not improve prediction.

Conclusions

Developed from one of the largest paired PCM–TEM databases reported, the WLS model (brake repair) matched the Verma and Clark factor (asbestos milling), supporting broader applicability when sampling and analytical methods are comparable. The equations can strengthen retrospective exposure reconstruction, occupational epidemiology, and policy evaluation where only PCM records remain. Next steps include validation across additional industries, regions, laboratories, and asbestos types.

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Liliana Tenney (1); Carol Brown (1); Joelle Wedel (1); Lee Newman (1,2); Cathy Bradley (3)
1. Colorado School of Public Health, Aurora, Colorado, USA
2. University of Colorado School of Medicine, Aurora, Colorado, USA
3. University of Colorado (CU) Cancer Center, Aurora, Colorado, USA

Background

The purpose of the Well-Being and Cancer at Work (WeCanWork) study was to develop and evaluate a referral pathway for oncology clinics to refer cancer survivors to receive an occupational medicine (OM) consultation to discuss their work-related concerns to benefit both patients’ care and workability.

Methods/Approach

We built a referral pathway for oncology teams to connect patients with an OM provider. The new referral was approved as a Quality Improvement (QI) service. OM providers are trained to help patients address work related needs, including assessment of impairment, return-to-work recommendations, and assistance in navigating employer systems. We identified and executed implementation strategies, including educating oncology shareholders about OM, generating buy-in, and addressing implementation barriers to enhance adoption and fidelity of the referral across multiple oncology clinics in the system.

Results

As of August 2026, a total of 155 referrals occurred between oncology and OM. 62 OM consultations have been completed, with 26% of patients attending a second consultation. Interviews with providers from OM and oncology have shown high levels of intervention engagement and acceptability, with agreement that the consultation provided a needed resource to patients and is feasible to implement. Facilitators to adoption included planning with OM experts on advising team, understanding needs of both patients and clinical teams, support of nurse navigators, and expanding OM consult options to offer greater availability to scheduling consults faster. Barriers to implementation included challenges with customizing OM referral in electronic health records, high attrition due to mechanics of telehealth option, and OM scheduling and tracking due to outside usual clinic workflow.

Conclusions

Oncology and occupational medicine practices value having a referral pathway for working cancer survivors. Opportunities for improvement include streamlining referrals and identifying pathways for expansion and sustainability.

Presenting author profile

Dr. Baur is Professor Emeritus. He chaired Occupational Medicine at the Universities of Hamburg and Bochum and was director of the Occupational (and Maritime) Institutes at these Universities from 1990 until his retirement in September 2012. He is the initiator and current president of the charity European Occupational and Environmental Medicine (EOM) Society, whose major aim has been to support independent medical research for diagnostics and prevention of occupational diseases and related sociopolitical issues.

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Presenter - Research Data

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Xaver Baur (1)
1. European Society for Environmental and Occupational Medicine, Berlin, Germany

Background

Lead poisoning (plumbism or saturnism) is caused by high lead loads of the human body. Currently, occupational lead poisoning is rare in high income countries.

Methods/Approach

Case report: Presentation of occupational and clinical findings.

Results

A recent case of a worker machining bronze or brass molds which contained about 1.4 % lead, rarely also pure lead, over a period of 6 years is reported. Safety conditions were almost non-existing and eating and drinking occurred at the dusty workplace. The patient developed fatique, musculoskeletal and abdominal pain, headache, insomnia, irritability, speech disorder, cognitive problems, intellectual impairment, and mild anaemia. Lead blood level was high (138 µg/l) and the renal function slightly impaired. During a period of sick leave of 5 months followed by change of workplace all symptoms largely subsided and the lead blood level normalised.

Conclusions

Metal poisoning can still occur in metalworking companies if industrial hygiene is poor and occupational safety regulations are disregarded.

Format

Presenter - Policy Discussion

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Arthur L. Frank (1); Linda Reinstein (2); Christian Hartley (3)
1. Drexel University, Philadelphia, Pennsylvania, USA
2. Asbestos Disease Awareness Organization, Manhattan Beach, California, USA
3. Maune Raichle Hartley French & Mudd, LLC, Mount Pleasant, South Carolina, USA

Background

Despite possessing the world’s most extensive scientific and clinical records on asbestos-related disease, the United States remains among the few industrialized nations without a comprehensive asbestos ban. This presentation examines the gap between scientific consensus and public health policy and the factors that have limited the translation of evidence into effective action.

Methods/Approach

Using a policy-analytic framework, this presentation examines the scientific record established through Dr. Irving Selikoff’s epidemiologic studies and its translation into judicial proceedings, including Borel v. Fibreboard Paper Products Corp. (1973). Drawing on two decades of engagement in asbestos policy, the analysis identifies structural factors limiting the participation of physicians and scientific institutions in policymaking. Recent EPA actions illustrate progress and continuing gaps. In 2024, EPA finalized its TSCA Part 1 risk management rule addressing chrysotile asbestos, while development of the Part 2 rule addressing legacy asbestos has been delayed despite EPA’s determination that legacy uses present an unreasonable risk. The bipartisan Senate reintroduction of the Alan Reinstein Ban Asbestos Now Act of 2026 offers an opportunity to translate scientific evidence into comprehensive public health policy and protection. Three findings emerge: scientific consensus has not produced comprehensive prevention policy; regulatory action has remained incremental despite decades of evidence; and scientific expertise has not been consistently integrated into policymaking.

Results

The U.S. experience demonstrates that scientific consensus is insufficient to achieve effective asbestos prevention. Translating scientific evidence into public health policy and protection requires engagement by physicians, scientists, and public health experts throughout the regulatory, legislative, and administrative policymaking process.

Conclusions

The Collegium Ramazzini is uniquely positioned to strengthen the translation of science into prevention by fostering collaboration between scientific experts and policymakers. Participation by physicians and scientific institutions can help advance evidence-based asbestos policy and public health protection in the United States and in jurisdictions where asbestos bans remain unresolved.

Presenting author profile

Lee Newman, MD, MA, FACOEM, FCCP, F. Collegium Ramazzini is a Distinguished University Professor of Public Health and Medicine and Director of the Centers for Health, Work & Environment in the Colorado School of Public Health, University of Colorado. He co-directs a NIOSH-supported Total Worker Health (TWH) Center of Excellence in the U.S. where he applies TWH research principles in agricultural settings in Latin America.

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Presenter - Research Data

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Lee S. Newman (1)
1. University of Colorado, Aurora, Colorado, USA

Background

The prevalence of chronic kidney disease and other non-communicable diseases in Guatemala has been rising. Chronic kidney disease of non-traditional origin (CKDnt) has been identified among occupational cohorts and linked to heavy workloads in hot environments. This presentation’s objective is to describe a systems-based community participatory approach to OSH and relate this Total Worker Health® approach to those in other countries.

Methods/Approach

Over the last 10 years, we have partnered with an agribusiness, including leaders, supervisors and workers in Southwest Guatemala, to address the health, safety, and well-being concerns of workers, especially in relation to CKDnt and other safety issues. This case study presents the Total Worker Health® approach used to develop, implement, and evaluate interventions to address potential causes of CKDnt. The results of these interventions are presented using the Consolidated Framework for Implementation Research and RE-AIM.

Results

As demonstrated by changes in organization policies, practices, and reduced rates of kidney injury in this workforce a Total Worker Health (TWH) approach, addressing both transactional and transformational organizational behavior change, can be successfully implemented to reduce the incidence of reduced kidney function. Our findings highlight the need for collaborative approaches to the development and implementation of strategies to adapt to climate change in the workplace. The sustainability of interventions needs constant re-evaluation to adapt to changing contexts.

Conclusions

This case study illustrates a practical, evidence-based TWH approach to address the immediate impacts of heat stress and nephrotoxins on the kidney health of sugarcane workers in Guatemala. It also illustrates the importance of multi-modal interventions implemented and evaluated in a dissemination and implementation science framework informed by the community that is at risk. The principles underlying our approach may have applicability and generalizability to less extreme circumstances, and beyond those with heat-associated kidney disease.

Presenting author profile

Prof. Dr. med. Stephan Böse-O'Reilly is a specialist in pediatrics and environmental medicine and Professor of Public and Environmental Health at LMU University Hospital Munich, where he heads the Research Group on Global Environmental Health and Climate Change. For over two decades, his research has addressed the health consequences of environmental pollution for children in low- and middle-income countries, working with WHO, UNIDO, the World Bank, and Pure Earth.

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Presenter - Research Data

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Stephan Bose-O’Reilly (1)
1. Ludwig-Maximilians University (LMU) Hospital, Munich, Germany

Background

ASGM employs an estimated 16.8 million people across 37 SSA countries. Mercury amalgamation remains the dominant gold recovery method, exposing miners, families, and communities to toxic mercury vapor, often in enclosed, unventilated spaces without protective equipment. Despite the scale of this exposure, the disease burden has been systematically undercounted and the economic costs remain absent from national accounts.

Methods/Approach

Updated Disability-Adjusted Life Year (DALY) estimates for chronic metallic mercury vapor intoxication (CMMVI) were calculated for all 37 SSA countries using the Steckling et al. (2017) methodology, applying a disability weight of 0.368 for moderate CMMVI and two prevalence scenarios (23.7% and 34.3%) to fully updated 2026 miner population data. Economic costs were quantified using two frameworks: (1) a cost-per-gram-of-gold model monetising mercury-attributable IQ loss and lifetime cognitive impairment; and (2) a DALY-based human capital model estimating productivity losses from disability and premature morbidity.

Results

The annual DALY burden from CMMVI among active miners in SSA is estimated at approximately 1.79 million (range: 1.46–2.12 million), comparable to lead poisoning and neonatal sepsis regionally, yet receiving a fraction of the policy attention. These figures cover only active miners with moderate intoxication; the true burden, including severe cases, former miners, and community members, is considerably higher. Both economic models converge: the cost of mercury-related health damage in SSA's ASGM sector is large, quantifiable, and currently invisible in national accounts. The cost-per-gram framework reveals substantial losses embedded in every gram of gold produced; the human capital model shows productivity destruction from CMMVI dwarfs the investment required for prevention.

Conclusions

CMMVI constitutes one of SSA's largest preventable occupational disease burdens. Measured in both healthy life years lost and economic costs, the impact is enormous, and the case for intervention, biomonitoring, mercury-free technologies, and regional health infrastructure, is compelling and actionable within existing policy mandates.

Presenting author profile

Stephan Bose-O’Reilly is a professor of Environmental and Public Health at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Germany. He works as a consultant for the World Bank on projects tackling mercury exposure and e-waste in five African countries.

Format

Presenter - Policy Discussion

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Stephan Böse-O’Reilly (1); Johann Wilhelm Weidringer (2); Ursula von Gierke (3)
1. Ludwig-Maximilians University (LMU) Hospital, Munich, Germany
2. Wackler Holding SE, Munich, Germany
3. International Study Group on Self-organization, Munich, Germany

Background

Health care is a major consumer of resources and source of emissions, yet clinicians rarely see environmental stewardship and clinical quality as aligned. In Munich alone, nearly 23,000 physicians make daily decisions, in hospitals, private practices, and medical care centers (MCCs), that carry both health and environmental consequences.

Methods/Approach

This article argues that sustainable health care arises not from sacrifice but from structurally improved decision quality: sustainability as a co-benefit of good medicine.

Results

Failing to act perpetuates avoidable harm and waste. Desflurane, an inhalation anesthetic, is roughly 2,500 times more damaging to the climate than carbon dioxide (CO₂), yet it offers no clinical advantages. In older patients, it increases the risk of delirium. The use of desflurane has already been phased out in the EU. It is estimated that 20–30% of medical services in high-income countries are of little or no benefit. This exposes patients to harmful anesthetics, unnecessary radiation, side effects, and costs. Antibiotic overuse drives antimicrobial resistance (AMR) and releases pharmaceutical residues into water and soil. Conversely, addressing these issues protects patients directly while reducing emissions, waste, and expenditure.

Conclusions

We identify five evidence-based, guideline-concordant levers implementable today without new resources.
-replacing desflurane (roughly 2,500 times more climate-damaging than carbon dioxide (CO₂) while offering no clinical advantage and, in older patients, a higher delirium risk) with sevoflurane, regional anesthesia, or total intravenous anesthesia (TIVA), consistent with the revised European Union Fluorinated Gas Regulation (EU F-Gas);
-reducing low-value diagnostics via “Choosing Wisely” and validated decision rules; rational prescribing through Antibiotic Stewardship (ABS) and polypharmacy reduction;
-prevention, including the EAT-Lancet Planetary Health Diet, physical activity, heat protection, and vaccination;
-life-cycle-based procurement of reusable materials, but with hygiene as a priority. Interdisciplinary “Green Teams” sustain change, persuading through patient safety and quality rather than moralizing, with environmental benefit as the welcome side effect.

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Presenter - Research Data

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Liliana Tenney (1); Lee S. Newman (1); Rebeca Velasco Reyna (2); Ivo Iavicoli (3)
1. University of Colorado, Aurora, Colorado, USA
2. Instituto Mexicano del Seguro Social, Mexico City, Mexico
3. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

Background

Although evidence supporting Total Worker Health® (TWH) continues to grow, fewer studies describe how organizations successfully adopt and implement TWH in real-world settings. Since 2013, the Health Links® program at the Centers for Health, Work and Environment has partnered with more than 1,000 employers representing diverse industries, organizational sizes, and geographic regions to assess workplace policies and practices, build organizational capacity, and support implementation of evidence-based TWH strategies.

Methods/Approach

Health Links uses a structured implementation model centered on the Healthy Workplace Assessment, an organizational assessment aligned with six benchmarks of healthy workplaces: organizational support, health and safety, work-life integration, employee engagement, policies and benefits, and community engagement. Employers receive benchmarked feedback, tailored recommendations, advising, training, and recognition through a continuous quality improvement process. Assessment data collected over more than a decade have been used to evaluate implementation, characterize organizational needs, identify predictors of successful adoption, and refine implementation strategies.

Results

More than 1,000 employers, representing over 1 million workers across public, private, and nonprofit sectors, have participated in one or more Health Links activities, creating one of the largest organizational datasets examining TWH implementation in the United States. Findings demonstrate substantial variation in TWH maturity by employer size, industry, and organizational characteristics. Longitudinal assessment data show that repeated measurement, tailored advising, and sustained engagement support incremental improvements in workplace policies and practices while generating implementation evidence to inform continuous program refinement.

Conclusions

Scaling TWH requires implementation strategies that are practical, data-driven, and responsive to organizational context. The Health Links model demonstrates how assessment, technical assistance, and organizational partnerships can accelerate employer adoption of integrated worker health, safety, and well-being practices while advancing implementation science.

Presenting author profile

Mitchel Rosen, PhD, is a Professor Rutgers University School of Public Health (RUSPH) Department of Environmental and Occupational Health and Justice. He has nearly 40 years of experience in OSH. Nationally recognized for his leadership in workforce development and continuing education, his work focuses on public health practice and preparing current and future professionals. As Director of the RUSPH Center for Public Health Workforce Development, he oversees programs that train thousands of practitioners each year.

Format

Presenter - Policy Discussion

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Joseph 'Chip' Hughes (1); Mitchel A. Rosen (2)
1. MDB, Inc., Washington DC, USA
2. Rutgers School of Public Health, Piscataway, New Jersey, USA

Background

The NIEHS Worker Training Program’s technical workshop series has begun examining Artificial Intelligence (AI) deployment in the workplace, alongside its growing role in training and education. Workshops reveal AI is transforming how work is organized, monitored, and performed, creating both opportunities and emerging risks for worker health and safety. Occupational Safety and Health (OSH) experts must examine AI through an occupational health lens, exploring how AI functions as workplace hazard, protective tool, and agentic actor making/executing decisions with diminishing human review. AI-related concerns must be assessed to understand AI’s full impact on workers.

Methods/Approach

AI-related occupational risks may contribute to increased psychosocial stress, erosion of privacy, inequitable impacts on vulnerable worker populations, diminished worker agency, and unsafe decision-making from inaccurate or biased AI outputs. Uncritical adoption may shift responsibility for system failures onto workers while outpacing evidence-based safeguards in ways existing OSH frameworks do not resolve. Workshop evaluation data surface an evidentiary gap: presenter messaging about AI’s occupational impact can outpace the data supporting it, undermining the credibility governance depends on. Conversely, proactive management of AI-related risks can prevent injuries, reduce hazardous exposures, strengthen worker participation, and support healthier workplaces.

Results

A worker-centered AI approach must clarify whether it is building worker-safety capacity or worker-power and enforcement. It adapts established OSH frameworks to AI-specific hazards. Existing precedents, such as data-training prohibitions and disciplinary firewalls negotiated in worker agreements, demonstrate that enforceable protections are achievable. AI-enabled robotics, predictive hazard detection, and tailored training tools remain promising applications for reducing exposures.

Conclusions

Developing AI principles paired with enforceable implementation mechanisms, advancing foundational AI literacy calibrated to workers’ current understanding, incorporating AI considerations into training development and evaluation, and expanding research on AI’s occupational health impacts. Continued collaboration among workers, trainers, researchers, employers, and policymakers remains essential to ensure AI advances worker well-being while minimizing harm.

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Presenter - Research Data

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Marco Manservigi (1), Isabella Manzoli (1), Roberta Noferini (1), Valentina Strollo (1), Rita Giovannini (1), Luana De Angelis (1), Martina Iuliani (1), Laura Falcioni (1), Daria Sgargi (1), Simona Panzacchi (1), Eva Tibaldi (1)
1. Cesare Maltoni Cancer Research Center, Ramazzini Institute, Bologna, Italy

Background

Caffeine is a food and pharmaceutical ingredient that is widely used and consumed; the population's high level of exposure makes evaluating its carcinogenic potential important for public health. Based on the available studies, the IARC concluded that the evidence of carcinogenicity in experimental animal is inadequate. This study, initiated by Professor Cesare Maltoni and currently ongoing, aims to evaluate the effects of chronic caffeine exposure in Sprague-Dawley rats.

Methods/Approach

A total of 800 Sprague-Dawley rats were equally divided into four experimental groups and treated with caffeine dissolved in drinking water at the doses of 0, 150, 750, and 1500 ppm. Administration began at 8 weeks of age and continued for 104 weeks, followed by monitoring until natural death. Body weight, food and water consumption, and survival were preliminarily analyzed by comparing the highest treatment group with the control group. Histopathological analysis has also been performed on these two groups.

Results

Caffeine treatment resulted in a significant reduction in body weight in both sexes and increased survival, which was statistically significant in females. Histopathological analysis revealed changes in the incidence of neoplastic diseases in various organs following high-dose caffeine exposure. Notably, a significant reduction in the incidence of mammary gland neoplasms was observed in treated females, supporting a potential onco-protective effect of caffeine. Conversely, males exposed to the highest dose showed an increased incidence of hepatic and gastrointestinal neoplasms compared to controls. Various nonneoplastic liver lesions were also observed; in particular, caffeine appeared to reduce biliary duct fibrosis.

Conclusions

These initial results suggest that caffeine may exert different effects depending on the target organ, in particular displaying onco-protective properties in the mammary gland but a possible pro-carcinogenic effect in the liver, glandular stomach, and intestine of male rats exposed to high doses.

Format

Presenter - Policy Discussion

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Christian H. Hartley (1)
1. Maune Raichle Hartley French & Mudd, LLC, Mount Pleasant, South Carolina, USA

Background

Legal actions in the civil justice system in the United States have played a significant role in reducing asbestos use in the United States.

Methods/Approach

This presentation will briefly compare and contrast the U.S. regulatory and civil justice systems with systems in other nations with an eye toward understanding their implications on public health as it relates to asbestos disease. The pros and cons of the U.S. framework will be discussed with specific examples.

Results

The civil justice system in the U.S. has effectively greatly reduced exposure to asbestos, despite long-term opposition to a complete ban via regulations. A strong civil justice system, such as in the United States, is an important adjuvant to strict regulation and can help improve public health while also assigning the costs of injury to those responsible.

Conclusions

U.S. policy makers should consider more stringent regulations of asbestos. Penalties for violation of more stringent regulations should be more onerous. Policy makers in countries with less developed civil justice systems should consider enacting laws to support civil remedies similar to those in the U.S.

Presenting author profile

Dr. Frank, a Collegium Ramazzini Fellow, has been studying asbestos related activities for more than 50 years and has more than 100 related publications. His work has taken him to many countries around the world.

Format

Presenter - Policy Discussion

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Arthur L. Frank (1)
1. Drexel University, Philadelphia, Pennsylvania, USA

Background

Asbestos has been known for more than a century to be a hazardous material. causing both non-malignant and malignant diseases., To date some 70 countries have banned its use.

Methods/Approach

Although banned in many places, but not fully in the USA, its continued use is about one million tons per year, with India replacing China as the largest user country and Russia now the leading producer. Most use continues in Asian countries with some use in Africa, and supposedly no use in the EU and limited us in the USA. Unfortunately, there is still under or unregulated importation of asbestos containing materials in many places where it is nominally banned, especially with the use of talc products and children's sand filled toys. There is also the issue of continuing use of asbestos cement water distribution pipes, and former use of asbestos has left millions of tons in place.

Results

Unfortunately, many countries with bans in place seem to care little about the continuing hazards that still exist, and often downplay existing hazards as well. Those industries that have or still use asbestos still carry great sway in allowing exposure to the public.

Conclusions

What is still needed is a combination of better public education, grass roots activism, and continued legal action to not only stop new uses of asbestos but to better deal with what is already in place, and how to properly dispose of those materials.

Presenting author profile

Dr. Etzel is a pediatrician and environmental epidemiologist and the Editor of Pediatric Environmental Health, published by the American Academy of Pediatrics.

Format

Presenter - Policy Discussion

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Ruth A. Etzel (1)
1. Georgetown University, Washington D.C., USA

Background

Scientific findings in children’s environmental health often generate divergent views. Public health officials may welcome the findings and use them to implement prevention programs, while affected industries may implement the 5 D’s of the typical industry playbook (Deny, Distort, Distract, Delay, and Doubt).

Methods/Approach

In recent years, some government leaders have taken steps to roll back regulations that protect children’s health, ignoring scientific findings about which there is perceived doubt. This threatens to put more children in harm’s way. Also, the industry has attacked scientists themselves, using tactics ranging from harassment to facilitating removal from their positions, making it difficult for the scientists to pursue next steps in their research.

Results

In his address at Ramazzini Days 1999, Dr. Maltoni said of the Collegium "Its raison d’être is rather to pursue the lesson of truth, to be the house and the forum for those who spend their lives in the name of truth, and to give solidarity to those who, in pursuing the truth, are attacked and humiliated.”

Conclusions

The stories of attacks and humiliation on children’s environmental health scientists will serve as a springboard for a discussion about what can be done by the Collegium Ramazzini to better assist scientists under attack. Steps include a proposal for a new statement describing a structured approach to provide support to scientists under siege. The Collegium, however, must go further than individual statements of support; we must build strong alliances with constituencies that depend on publicly generated knowledge, such as child health advocacy groups and communities where children are exposed to environmental degradation. The session will include a discussion of how to build solidarity.

Presenting author profile

Dr. Frank is an Emeritus Professor at Drexel University and a Collegium Ramazzini Fellow. He has been studying asbestos related activities for more than 50 years and has more than 100 related publications. His work has taken him to many countries around the world.

Format

Panel Organizer

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Arthur L. Frank (1); Linda Reinstein (2); Christian Hartley (3)
1. Drexel University, Philadelphia, Pennsylvania, USA
2. Asbestos Disease Awareness Organization, Manhattan Beach, California, USA
3. Maune Raichle Hartley French & Mudd, LLC, Mount Pleasant, South Carolina, USA

Background

Asbestos is still widely used around the world, and even finds its way into countries with bans. About a million tons per year still are produced and while about 70 countries have banned its use the USA still only has a partial ban, and many countries still use it around the world. The passage of regulations banning future use does not deal with issues of materials still in place or how to safely dispose of same.

Methods/Approach

As a presenter, Dr. Frank will discuss medical issues about exposure and how it still makes its way into countries with bans. As a presenter, Ms. Reinstein will discuss the situation in America and the on-going fight for a total ban. Her organization is actively involved in litigation. Mr. Hartley will discuss the role the law courts have played in bringing about changes in workplaces and elsewhere. He has litigated numerous cases and deals with many issues which complicate litigation.

Results

There will be education of those present as to what works and what may be less successful in getting asbestos banned, and the difficulty faced by activists in taking on this issue.

Conclusions

Those present will gain knowledge as to how to proceed in their own settings in addressing the banning of asbestos. How the Collegium Ramazzini and its Fellows can help protect those engaged in bans around the world will be clearer.

Presenting author profile

Lee Newman, MD, MA, FACOEM, FCCP, F. Collegium Ramazzini is a Distinguished University Professor of Public Health and Medicine and Director of the Centers for Health, Work & Environment in the Colorado School of Public Health, University of Colorado. He co-directs a NIOSH-supported Total Worker Health (TWH) Center of Excellence in the U.S. where he applies TWH research principles in agricultural settings in Latin America.

Format

Panel Organizer

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Lee S. Newman (1); Liliana Tenney (1); Ivo Iavicoli (2,3); Gabriel Alejandro Real Ornelas (4)
1. University of Colorado, Aurora, Colorado, USA
2. Catholic University of the Sacred Heart, Rome, Italy
3. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
4. Mexican Social Security Institute (IMSS), Mexico City, Mexico

Background

Over 15 years, U.S. National Institute for Occupational Safety and Health (NIOSH) Total Worker Health® (TWH) has ‘come of age.’ We have witnessed adoption and adaptation of the framework across academic, industry, and labor organizations. Governments have begun incorporating TWH concepts into occupational safety and health policy to address workforce challenges including mental health, chronic diseases, substance use, fatigue, injury prevention, and climate-related impacts on workers. Businesses focused on sustainability and workforce retention are embracing TWH to improve worker safety, well-being, productivity, and organizational resilience, while labor unions are applying the concepts to promote psychological safety without sacrificing the primacy of hazard prevention and worker protection.

Methods/Approach

This session includes presentations and a panel discussion examining how the paradigm-shifting concept —that work should be both safe and healthful—is becoming integrated and applied internationally across policy, practice, and research settings. Prof. Newman is Panel Organizer and will present on TWH research implementation in Guatemala. Dr. Tenney is Panel Co-Organizer and will present on a decade of implementing TWH in the U.S. Prof. Iavicoli will present on the TWH approach as an integrated model for occupational risk prevention and promotion in Italy. Dr. Real will present on Mexico's approach to promoting workplace safety, health, productivity and quality.

Results

Outcomes include understanding 1) how TWH frameworks are incorporated in national policies, business practices, and prevention strategies; 2) how organizational values, economic drivers, workforce pressures, injury costs, and the distribution of financial responsibility between employers, workers, and public systems influence adoption and sustainability of TWH; 3) comparative lessons related to voluntary versus mandated approaches to worker well-being and prevention, highlighting how policy context shapes implementation outcomes and organizational behavior.

Conclusions

Follow-up will include development of a peer-reviewed publication and dissemination of TWH best practices toward policy recommendations addressing both worker well-being and injury prevention.

Format

Presenter - Research Data

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Angela Contri (1); Sara Scilli (1); Sara Colazzo (1); Dagllas Alushi (1); Giulia Piazza (1); Alberto Modenese (1); Fabriziomaria Gobba (1)
1. University of Modena and Reggio Emilia, Modena, Italy

Background

Confined spaces, generally defined as enclosed or partially enclosed environments with restricted access and not designed for continuous human occupancy, present multiple and complex occupational hazards. Accidents are a well-recognized risk, potential long-term adverse health effects remain poorly investigated, as do individual conditions that may increase susceptibility to adverse health effects. To our knowledge, no systematic reviews addressing these topics are available. Furthermore, in several countries, Occupational Health and Safety (OHS) legislation on confined space work remains incomplete, creating challenges for an effective risk prevention, including the organization of health surveillance (HS).

Methods/Approach

We are conducting a PROSPERO-registered systematic review following PRISMA guidelines. We searched PubMed and Scopus databases without language or date restrictions. Studies were selected according to a Population–Exposure–Outcome framework: workers; confined space exposure; adverse health outcomes. Two independent reviewers screened titles and abstracts and assessed eligible full-text articles using Rayyan; a third reviewer resolved conflicts. Methodological quality will be assessed using Joanna Briggs Institute critical appraisal tools, and certainty of evidence will be evaluated using the GRADE approach. A narrative synthesis will be performed, with meta-analysis of proportions where heterogeneity permits (I² <75%).

Results

The search yielded 10,873 records. Preliminary findings indicate a broad spectrum of adverse outcomes, including asphyxiation, toxic poisoning, hypoxia-induced tachycardia, and other cardiovascular alterations. Neurological and neurobehavioral symptoms include impaired judgment, delayed reactions and increased accident risks. Confined spaces may also severely exacerbate pre-existing cardiopulmonary conditions and contribute to psychological stress.

Conclusions

This systematic review will provide the first comprehensive synthesis of adverse health outcomes among confined-space workers. By identifying potentially reliable physiological and subclinical indicators (e.g., SpO₂, heart rate, carboxyhaemoglobin), the findings will support occupational physicians in developing evidence-based HS protocols and fitness-to-work assessments. Acquired knowledge may also contribute to the development of more effective prevention and regulatory legislation for confined-spaces work.

Presenting author profile

Alberto Modenese is Chair of the Residency School in Occupational Medicine at the University of Modena and Reggio Emilia (UniMoRe). He is a Professor of Occupational Medicine and occupational physician at the UniMoRe Department of Biomedical, Metabolic and Neural Sciences in Modena, Italy. He holds a PhD in Clinical and Experimental Medicine and his main research interests are the evaluation and prevention of health risks related to occupational exposure to ionizing and non-ionizing radiations.

Format

Presenter - Policy Discussion

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Alberto Modenese (1)
1. University of Modena & Reggio Emilia, Modena, Italy

Background

An estimated 1.6 billion outdoor workers (OW) worldwide are cumulatively exposed to solar ultraviolet radiation (UVR). Keratinocyte cancers (KC), mainly basal and squamous cell carcinomas, are clearly associated with cumulative UVR exposure, are particularly frequent in fair-skinned individuals, and are recognized as occupational diseases in many countries. Their occupational burden is substantial, particularly among ageing workforces with long exposure histories and inadequate workplace protection. Until recently, less agreement existed regarding the occupational origin of cutaneous melanoma, traditionally associated mainly with intermittent intense UVR exposure and sunburn, especially during childhood.

Methods/Approach

In 2018, the WHO identified specific melanoma subtypes, including lentigo maligna melanoma (LMM) and some superficial spreading melanomas, as related to cumulative solar damage (CSD). A 2022 WHO/ILO systematic review also reported an increased relative risk of LMM among OW. More recently, the Italian Workers’ Compensation Authority proposed criteria for recognizing CSD-related melanomas as occupational diseases in workers chronically exposed to solar UVR.

Results

Current evidence indicates that not only KC but also specific cutaneous melanoma subtypes arising in chronically sun-exposed areas should be considered potentially occupational in workers with cumulative solar UVR exposure, particularly when exposure has occurred for many years without adequate protection. Both KC and melanoma remain substantially under-reported, under-recognized, and under-compensated. Appropriate health surveillance (HS) is essential for early detection and treatment and often requires collaboration between occupational physicians and dermatologists.

Conclusions

Occupational UVR-related skin cancers are largely preventable through measures reducing cumulative exposure among OW. Effective prevention requires adequate risk recognition and improved identification of these common occupational diseases. Occupational skin cancers, including CSD-related melanoma subtypes, should be reported to health authorities and workers’ compensation institutions. Physicians should be encouraged to report eligible cases, while procedures should be simplified. Robust reporting and surveillance data are needed to inform policymakers and support stronger workplace protection, including appropriate occupational HS.

Format

Presenter - Research Data

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Enrico Barbolini (1); Angela Contri (1); Rebecca Gasparini (1); Federica Zampieri (1); Alberto Modenese (1)
1. University Of Modena & Reggio Emilia, Modena, Italy

Background

Outdoor workers (OW) are chronically exposed to solar ultraviolet radiation (UVR). WHO identified lentigo maligna melanoma (LMM) as related to cumulative solar damage (CSD), and a WHO-ILO review showed increased LMM risk in OW. The Italian Workers' Compensation Authority (INAIL) indicated CSD-related melanomas can be recognized as occupational diseases when specific criteria are met. Adequate health surveillance and research on occupational UV-induced melanomas need to consider histotype, site, lifetime job history, and non-occupational risk factors. We aimed to evaluate the association between occupational UVR exposure and melanoma, focusing on identification of occupational cases.

Methods/Approach

We conducted a hospital-based case-control study at the University Hospital of Modena, Italy (2025–2026). Cases had new histologically confirmed melanoma; controls had benign lesions. A structured questionnaire collected lifetime occupational history, non-occupational UVR exposure, and phenotypic traits. Occupational UVR exposure was estimated using the quantitative European job-exposure matrix (Würtz et al., 2025), expressed as cumulative Standard Erythemal Doses (SED). INAIL criteria were systematically applied to all cases.

Results

Preliminary data from 160 participants (84 controls, 73 non-occupational melanoma cases, 2 occupational cases) are presented. Non-occupational cases had lower cumulative SED than occupational cases (mean: 6258.8 ± 4802 vs 10027.3 ± 5179.0 SED-years). Conversely, the non-occupational melanoma risk score (Fortes et al., 2010) was higher in non-occupational cases (25.79 ± 15.75) than in occupational cases (17.56 ± 3.58). All occupational cases were located on chronically photo-exposed sites and classified as LMM, consistently with CSD-related subtypes.

Conclusions

Selected melanoma can be recognized as occupational diseases in OW when subtype, site and exposure history are coherent with CSD. The combination of higher occupational UVR exposure and lower phenotypic risk score in occupational cases supports the role of work-related cumulative exposure. Multidisciplinary criteria can reduce under-reporting, support compensation, and strengthen prevention, health surveillance, and early diagnosis.

Format

Presenter - Research Data

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Ivo Iavicoli (1,2)
1. Catholic University of Sacred Heart, Rome, Italy
2. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

Background

Total Worker Health® (TWH) integrates occupational risk prevention with policies and practices promoting worker health and well-being. In Italy, an occupational health and safety system and a public health framework oriented toward One Health approaches support TWH implementation. The National Prevention Plans 2020–2025 and 2026–2031 recognize TWH as a framework for addressing occupational health challenges, while the National Strategy for Occupational Health and Safety 2026–2030 links it to public health, innovation, sustainability, and Vision Zero for occupational injuries and diseases. However, its broader application remains in the early stages.

Methods/Approach

A conceptual and policy-oriented analysis was conducted to examine how the TWH framework could be adapted to the Italian occupational prevention system. Attention was paid to institutional assets, implementation barriers, and governance mechanisms.

Results

TWH implementation in Italy is supported by a regulatory and technical tradition in occupational health and safety, a structured prevention system and professional expertise. These conditions support integrating risk prevention with organizational well-being, psychological health, chronic disease management, and quality of work. However, fragmented responsibilities, regional disparities, limited multidisciplinary skills and resource constraints, especially in smaller enterprises, hinder adoption. A compliance-focused prevention culture may overlook broader organizational determinants of health. Clear operational guidance and scalable models supported by sectoral or territorial networks are therefore needed. National and regional institutions, prevention services, and social partners could support this process through coordination, training, technical tools, incentives and shared evaluation frameworks.

Conclusions

TWH should not replace existing occupational prevention, but integrate organizational, psychosocial, environmental, and individual determinants of health within a coherent framework. Key priorities include national guidance, adaptable models for smaller enterprises, multidisciplinary training, active worker participation, and shared tools to assess implementation, equity, and effectiveness.

Presenting author profile

Prof. Filippini is Associate Professor in Public Health at the Department of Biomedical, Metabolic and Neural Sciences at University of Modena and Reggio Emilia where he works in the study of health effects of environmental and dietary risk factors, specifically regarding risk of chronic diseases as neurodegenerative diseases and cancer.

Format

Presenter - Research Data

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Tommaso Filippini (1,2); Christian Fiorini (1); Jessica Mandrioli (1,3); Andrea Cherubini (4); Asia Sarti (1); Carlotta Malagoli (1); Giuseppe Maffeis (4); Marco Vinceti (1,5)
1. University of Modena and Reggio Emilia, Modena, Italy
2. University of California School of Public Health, Berkeley, California, USA
3. University Hospital of Modena, Modena, Italy
4. TerrAria, Milan, Italy
5. Boston University School of Public Health, Boston, Massachusetts, USA

Background

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by the degeneration of upper and lower motor neurons. Although most ALS cases are sporadic, increasing evidence suggests that environmental exposures may contribute to disease development. This study investigated the association between residential exposure to vehicular traffic pollutants and ALS risk in the Emilia-Romagna region, Italy

Methods/Approach

We conducted a population-based case–control study including 387 incident ALS cases and 1536 matched controls from the provinces of Modena and Reggio Emilia. We estimated residential exposure to traffic-related benzene and particulate matter with diameter ≤10 μm (PM10) using the CALINE4 atmospheric dispersion model and calculating median annual and maximum pollutant concentrations. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression models, matched by age, sex and province, and adjusting for co-exposure to the other pollutant. We performed sex-stratified analyses and restricted cubic spline regression models investigate effect modification and potential non-linear exposure–response relations

Results

Higher residential exposure to benzene was associated with an increased risk of ALS. Participants in the highest exposure category showed increased risk for both median (OR=1.72, 95% CI: 1.06-2.80) and maximum (OR=2.01, 95% CI: 1.20–3.34) annual benzene exposure, with substantially stronger association in males. In contrast, we observed no meaningful association between PM10 exposure and ALS risk. Restricted cubic spline analyses supported a progressive increase in ALS risk with increasing benzene concentrations, whereas no dose–response relation emerged for PM10.

Conclusions

Residential exposure to traffic-related benzene was associated with an increased risk of ALS, particularly among males, whereas PM₁₀ did not show an association. These findings support a potential role of traffic-related pollutants in ALS pathogenesis and highlight the need to clarify underlying mechanisms, inform environmental prevention strategies and promote further reduction of traffic-related air pollution.

Presenting author profile

Drs. Etzel and Mandriole are Fellows of the Collegium Ramazzini.

Format

Panel Organizer

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Ruth A. Etzel (1); Daniele Mandriole (2)
1. Georgetown University, Washington D.C., USA
2. Collegium Ramazzini, Bologna, Italy

Background

The topic of this panel is not new. For hundreds of years, innovative scientific findings and the scientists who promote them have been the subject of attacks. Copernicus’s statement that the earth revolved around the sun was a revolutionary idea at the time it was proposed, about 500 years ago. Galileo’s publications on heliocentrism a hundred years later angered Church authorities and he was found “vehemently suspect of heresy” and sentenced to house arrest. Almost 200 years ago Charles Darwin’s theory of evolution by natural selection led to fierce public backlash. Around the same time, Semmelweis taught that handwashing could prevent infection, but this idea contradicted the miasma theory of disease. His ideas met with ridicule and rejection from medical authorities. About 50 years ago Prusiner’s identification of prions as a possible cause of neurological diseases challenged the prevailing dogma that only organisms with genetic material could transmit disease and he, too, encountered criticism and ridicule.
Hundreds of years ago the Church was typically the institution that was threatened by new scientific ideas, but in today’s society, commercial interests are often threatened. When environmental health scientists publish findings that document health concerns from chemicals, these special interests can create, test, and disseminate disinformation to undermine these scientific findings, shape public opinion, and sometimes prevent regulation. The commercial interests may also target individual scientists in an effort to undermine their credibility.

Methods/Approach

This panel will include presentations by three environmental health scientists who have been subjected to attacks.
Ruth Etzel, United States (Presenter)
Daniele Mandriole, Italy (Presenter)
Fernanda Giannasi, Brazil (Presenter)

Results

The expected outcome of this panel is to generate discussion about what can be done by the Collegium to better assist scientists under attack.

Conclusions

The Collegium will formulate a new statement about providing assistance to threatened scientists.

Presenting author profile

Professor Antonio Giordano is President of the Sbarro Health Research Organization (SHRO) and Vice President of Section IV – One Health of the "Consiglio Superiore di Sanità". An internationally recognized physician-scientist, he is renowned for his pioneering contributions to molecular oncology, cancer biology, and translational medicine. His research has significantly advanced precision medicine and the One Health approach, fostering interdisciplinary collaborations that bridge human, animal, and environmental health to address health challenges.

Format

Presenter - Research Data

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Giovanna Liguori (1,2); Stefano Ruga (3); Roberto Bava (3); Clementina Sansone (4); Adriana Basile (5); Salvatore Cortellino (2,6); Canio Martinelli (1); Antonio Giordano (1,7)
1. Temple University, Philadelphia, Pennsylvania, USA
2. Sbarro Health Research Organization ETS, Candiolo, Italy
3. Magna Graecia University of Catanzaro, Catanzaro, Italy
4. Stazione Zoologica Anton Dohrn, Naples, Italy
5. University of Naples Federico II, Naples, Italy
6. Scuola Superiore Meridionale (SSM), Naples, Italy
7. University of Siena, Siena, Italy

Background

Environmental contamination by trace elements represents a persistent threat to ecosystem integrity and human health. Conventional environmental monitoring often measures contaminant concentrations but may fail to capture biologically relevant exposure and bioavailability. Within the One Health framework, sentinel wildlife species can provide integrated information on environmental contamination and potential risks for human populations. Peregrine falcons (Falco peregrinus), as apex predators, accumulate contaminants across food webs and may serve as effective early warning indicators of environmental hazards.

Methods/Approach

Trace element accumulation was evaluated in peregrine falcons from areas with high environmental impact (HEI) and low environmental impact (LEI) in Italy using a multi-matrix biomonitoring approach. Feathers, faeces, blood, and seminal fluid were analysed and integrated with environmental measurements from soil and groundwater. Concentrations of trace elements were compared across matrices and study areas to assess long-term accumulation, recent exposure, systemic burden, and potential reproductive effects.

Results

A clear contamination gradient was observed between HEI and LEI sites, consistent with environmental measurements. Feathers showed higher concentrations of mercury, lead, and other toxic elements in falcons from HEI areas, reflecting chronic dietary exposure. Feces provided complementary information on recent exposure, whereas blood and seminal fluid reflected systemic distribution and potential reproductive toxicity. Among the biological matrices, feathers demonstrated the strongest agreement with environmental contamination patterns.

Conclusions

These findings demonstrate that peregrine falcons are sensitive sentinels of terrestrial environmental contamination and support the application of multi-matrix wildlife biomonitoring within One Health surveillance systems. Integrating sentinel species into environmental and public health monitoring could improve early detection of hazardous exposures, complement conventional environmental assessments, and strengthen evidence supporting preventive policies, including implementation of the European Water Framework Directive and the proposed Soil Monitoring Law.

Format

Presenter - Policy Discussion

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Ian von Lindern (1); Sierra Brantz (2); Casey Bartrem (1); Margrit von Braun (1)
1. TerraGraphics International Foundation (TIFO) NGO, Moscow, Idaho, USA
2. TerraGraphics International Foundation (TIFO) NGO, Arlington, Virginia, USA

Background

Children are especially vulnerable to environmental carcinogens and neurotoxins due to developing organ systems and limited ability to control their environments. Environmental health regulations and cancer risk assessment methodologies are intended to limit these exposures through health-protective standards. Recent changes in U.S. environmental policy altered regulatory priorities, scientific guidance, and oversight, influencing how states implement environmental health protections. This poster examines Idaho’s decreasing pediatric health protections in the context of national and international regulatory changes using a policy surveillance framework to track environmental health policy.

Methods/Approach

Lobbying from chemical, agriculture, mineral, pharmaceutical, and nuclear industries has resulted in historic U.S. policy changes and delegation of key authorities to state governments, highlighting the importance of regulatory tracking. The state of Idaho is particularly vulnerable to the mineral industry because it is a major producer of precious, critical, and strategic minerals. Moreover, Idaho state law prohibits the adoption of regulations more stringent than federal requirements. Together with revisions to the Idaho cancer risk assessment methodology during the Stibnite Gold Project’s permitting process, this new precedent could allow 100-to 1000-fold increases in children's carcinogenic exposures, reducing protections for other vulnerable populations. If adopted, Idaho’s precedent could also encourage similar regulatory approaches in other states and internationally.

Results

Weakening environmental health protections increases children's exposure to environmental carcinogens, undermining primary prevention of pediatric cancer. In previous years, the U.S. has been a leader in progressively more protective standards but now faces a period of historic deregulation and a greater need for international collaboration and advocacy.

Conclusions

Systematic policy surveillance, transparent scientific evaluation of regulatory changes, and international advocacy can increase awareness of these emerging trends and support evidence-based decision-making. Together, these efforts can help preserve pediatric health standards in the U.S. and internationally by preventing one jurisdiction from setting a dangerous precedent that others may follow.

Presenting author profile

Fernanda Giannasi worked as a Federal Labor Inspector at the Ministry of Labor and Employment for thirty years. Currently, she is the coordinator of the Citizen Virtual Network for the Prohibition of Asbestos for Latin America and founder of the Brazilian Association of People Exposed to Asbestos (ABREA). Since 2013, after retiring from public service, she has worked as an expert witness in legal proceedings related to asbestos, nuclear and other toxic chemicals.

Format

Presenter - Policy Discussion

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Fernanda Giannasi (1)
1. Brazilian Association of People Exposed to Asbestos - ABREA, São Paulo, Brazil

Background

For 50 years, Brazil was one of the world's largest producers and exporters of asbestos. Two large multinational companies, French and Swiss-Belgian, controlled mineral production, distribution, and the manufacture of asbestos-cement products from the late 1930s onwards.
With the growing prohibition of asbestos use in European countries, starting in the 1980s, industries rushed to lobby the Brazilian government to regulate the ILO Asbestos Convention, 1986 (No. 162), concerning safety in the use of asbestos, which led to the formation of a powerful business lobby, joined by national manufacturers, forming a veritable cartel. This lobby brought together academics from prestigious universities, politicians, union leaders, and other members of civil society around the so-called "controlled use of asbestos" thesis in the uncompromising defense of the carcinogenic mineral, creating, among others, the IBC-Brazilian Chrysotile Institute, modeled after its Canadian sister organization.
In the mid-1980s, I created the GIA-Interinstitutional Asbestos Group at the Ministry of Labor in the state of São Paulo, the most industrialized in the country, with the objective of inspecting asbestos-cement companies, which represented 85% of the mineral's consumption, and pressing for the gradual replacement of the raw material.
From this point on, asbestos stakeholders, including from abroad, began their efforts to remove me from my position as a Labor Inspector, using physical, psychological and legal threats in their attempts to demoralize and criminalize our work. This lasted until 2017, when the Brazilian Supreme Court banned the use of asbestos in the country.

Methods/Approach

Resisting the threats of the asbestos industry

Results

Greater support for the continuation of the national and international fight to eradicate asbestos, considered the health catastrophe of the 20th century.

Conclusions

This experience will serve as a springboard for a discussion about what might be done by the Collegium to assist scientists under attack.

Format

Presenter - Research Data

All authors and affiliations

Gabriel Alejandro Real Ornelas (1); Rebeca Velasco Reyna (1); Ricardo Alonso Rivera Beltrán (1); Claudia Gorian Montealegre (1); Marco Antonio Gutierrez Escamilla (1); Nitgard Giomar Roman Ramos (1)
1. Instituto Mexicano del Seguro Social, Mexico City, Mexico

Background

During the COVID-19 pandemic, 10 million workers were identified as vulnerable due to inadequate health surveillance. An occupational safety and health needs analysis revealed a crisis: non-communicable diseases were depleting the workforce, with 8.6 million adults suffering from diabetes, 15.2 million from hypertension, and 75.2% being overweight or obese. Regarding occupational injuries, hand and ankle accidents exceeded 165,000 cases, generating over 4 million temporary disability days, while back musculoskeletal disorders generated over 50,000 disability days. The economic burden was estimated at up to 3.94% of gross domestic product (GDP). In response, the Instituto Mexicano del Seguro Social (IMSS) launched Safe and Healthy Work Environments (ELSSA) in May 2022.

Methods/Approach

Using the Total Worker Health paradigm, ELSSA, a voluntary, non-punitive program, tackled these challenges massively through digital resources (courses, guides, infographics, risk assessment tools, disability dashboards), technical advice, and a recognition program. It is operationally complemented by the Annual Plan for the Prevention of Occupational Accidents (PAPAT) and the National Program for Toxicological and Environmental Surveillance (PRONAVT).

Results

This tripartite integration achieved massive impact. ELSSA enrolled 18,105 businesses and benefited over 5 million workers, delivering 206,366 consultations, 26,681 ELSSA emblems, and 975 "Zero Accidents" emblems. PAPAT intervened in 1,282 critical companies, reducing occupational accidents by 7.6% year over year. PRONAVT documented that 90.4% of evaluated workstations now operate below 50% of the occupational exposure limit, reducing the median inhalable toxic load from 75.1 to 1.2 mg/month. Furthermore, biological monitoring identified emerging risks, showing 59% of blood samples exceeded manganese reference values, prompting targeted medical surveillance.

Conclusions

ELSSA will increase technological resources to enable the massive scale-up of the program and promotion to continue enrolling companies. PRONAVT will expand its analytical offer in environmental and biological samples, while PAPAT will be extended to new economic sectors to consolidate a national prevention culture.

Format

Presenter - Research Data

All authors and affiliations

Paul T.J. Scheepers (1); Kirsten Lassing (1,2); Martien H.F. Graumans (1); Sander H.P. Driessen (1); Antzelina Gkintsev (1); Ioanna Konstantinou (1); Valérie Leermakers (1); Hilde Onstek (1); Maxime Sulter (1); Lotte van den Oord (3); Chariya van Dolder (1); Hendrik Jan Jansen (4); Emilie M. Hardy (5); Radu Corneliu Duca (5,6); Ad Ragas (1); Frans G.M. Russel (2); Thomas Rustemeyer (4)
1. Radboud University, Nijmegen, The Netherlands
2. Radboud University Medical Center, Nijmegen, The Netherlands
3. Leiden University Medical Center, Leiden, The Netherlands
4. Amsterdam University Medical Center, Amsterdam, The Netherlands
5. Laboratoire National de Santé, Dudelange, Luxembourg
6. Health Directorate, Strassen, Luxembourg

Background

Healthcare workers' safety when using ethanol-based hand-disinfectant products is controlled only by restricting airborne levels. Are these workers sufficiently protected from uptake via dermal absorption? This study aimed to determine the dermal route's contribution to total ethanol uptake.

Methods/Approach

A laboratory-controlled study of 25 sequential alcohol-based-hand-rubs (ABHRs), each followed by glove use, was conducted in seven healthcare workers. We compared two exposure conditions: hands and forearms placed inside a laboratory fume hood to prevent inhalation (skin-only condition) and the same procedure outside the fume hood to allow inhalation (default condition). The disinfection product contained 84% ethanol, and 1% ethanol-d6 was added to confirm the exogenous origin of ethanol. We measured inhalation exposure by personal air sampling. We collected blood at baseline, during exposure, and during a post-exposure wash-out period and analyzed it for ethanol and ethanol-d6 by HS-GC-MS. We assessed the contribution of dermal uptake by comparing the area-under-the-curve (AUC) of blood ethanol concentrations in the skin-only condition with that in the native condition within each study participant.

Results

Inhalation exposure in the breathing zone was (mean±sd): 5.3±3.6 mg/m3 in the skin-only condition and 120±7 mg/m3 in the default condition. The corresponding AUCs for blood ethanol concentrations were 1400±1100 and 3300±2300 (mg/L)*min (p=0.014), respectively, indicating that the dermal route contributed 43±28 % to total absorption (N=7). For ethanol-d6 these values were 17±4 and 48±17 (mg/L)*min (p=0.064), respectively, with a contribution of dermal uptake of 40±16% (N=3).

Conclusions

High-frequency ABHRs significantly increase dermal ethanol absorption. To protect workers at the current risk level, reduce the occupational exposure level by 50%. For exposure surveillance, air monitoring is not sufficient. Exposure should be assessed by breath or blood analysis

Format

Presenter - Policy Discussion

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Muchtaruddin Mansyur (1)
1. Universitas Indonesia, Jakarta, Indonesia

Background

Occupational exposure to hazardous chemicals remains a major contributor to preventable disease and premature mortality among workers, particularly in industries that routinely handled metals, solvents, pesticides, and other toxicants. In addition, nutritional status may also influence toxicant absorption, metabolism, oxidative stress, immune response, and recovery after exposure. This presentation highlights occupational nutrition as an integrated strategy to strengthen biological resilience and reduce health risks associated with chemical exposure.

Methods/Approach

The evidence indicates a bidirectional relationship between nutritional status and occupational chemical exposure. Deficiencies in protein, minerals, and antioxidant vitamins may increase the absorption, retention, and toxicity of hazardous metals such as lead and cadmium. Toxicants may also enter the body through contaminated food chains when hazardous substances accumulate in soil, water, crops, livestock, or aquatic products, creating an additional exposure pathway that intersects with occupational and environmental health risks. Conversely, chemical exposure may disrupt nutrient metabolism, reduce nutrient uptake, and intensify oxidative and inflammatory pathways, increasing susceptibility to chronic disease. Nutrient deficiencies may impair toxicant metabolism, weaken immune function, and delay recovery from chemical-induced tissue injury. Evidence from lead-exposure studies in Indonesia suggests that socioeconomic disadvantage, environmental contamination, household conditions, and nutritional vulnerability are associated with elevated blood lead levels and adverse outcomes, including neurodevelopmental impairment, cardiovascular disease and metabolic dysfunction.

Results

Workplace nutrition interventions, including balanced nutrition, antioxidant-rich foods, micronutrient supplementation, hydration, and nutrition education, may improve nutritional status, support toxicant metabolism, immune function, and repair mechanisms, and, in turn, enhance recovery capacity while also supporting productivity and well-being.

Conclusions

Occupational nutrition should be considered an integrated component of occupational safety and health systems rather than a partial health program. Integrating nutrition-based interventions with established hazard-control measures may strengthen worker resilience, reduce vulnerability to non-communicable diseases, and improve long-term workforce health.

Presenting author profile

Daniele Mandrioli, MD, PhD, is the Secretary General of the Collegium Ramazzini. Dr. Mandrioli’s independent research work included in vitro and in vivo toxicological assays, epidemiological studies, systematic reviews of the evidence in environmental and occupational health on hundreds of chemical and physical agents including pesticides, fibers, plastics, food additives, nanomaterials, ionizing and non-ionizing radiation.

Format

Presenter - Policy Discussion

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Daniele Mandrioli (1)
1. Collegium Ramazzini, Bologna, Italy

Background

Attacks on scientists are on the rise globally and Collegium Ramazzini Fellows have been increasingly targeted for their independent scientific work. This worrisome trend is putting at risk the very existence of genuine scientific work, aiming to isolate and silence independent voices, while fostering conformed and mercenary practices.

Methods/Approach

Cases and examples of attacks on scientists will be presented. The deafening silence of science could affect billions of lives. Many scientists have experienced it, particularly in underprivileged communities and in low- and middle-income countries, but high-income countries are increasingly affected, too.

Results

Reverting this trend is a priority and the Collegium Ramazzini should adopt strategies to support Fellows under attack and that will ultimately help to prevent the burden of occupational and environmental health diseases and death caused by a science under siege.

Conclusions

The ongoing “scientists hunt”, where egregious conflicts of interest are at play and billions of lives are at stake, likely represents the current most relevant threat to public health worldwide. A Collegium Ramazzini Statement will represent an important step to support Fellows in need and highlighting strategies that might also be adopted by scientists globally.

Presenting author profile

Dr. Homero Harari is an Associate Professor in Environmental Medicine at the Icahn School of Medicine at Mount Sinai. He is the head of the Occupational and Environmental Hygiene Laboratory at the Selikoff Centers for Occupational Health.

Format

Presenter - Policy Discussion

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Homero Harari (1); Amalia Laborde (2); Florencia Harari (3); Melissa McDiarmid (4); Daniele Mandrioli (5); Denny Dobbin (6)
1. Icahn School of Medicine at Mount Sinai, New York, New York, USA
2. Universidad de la Republica, Montevideo, Uruguay
3. Sahlgrenska University Hospital, Gothenburg, Sweden
4. University of Maryland School of Medicine, Baltimore, Maryland, USA
5. Collegium Ramazzini, Bologna, Italy
6. National Institute of Environmental Sciences (NIEHS) (ret.), Chapel Hill, North Carolina, USA

Background

The Collegium Ramazzini, together with Fellows in Quito (2006) and Montevideo (2012 and 2026), organized scientific conferences on occupational and environmental health for practitioners throughout Latin America. At the 2006 conference in Quito, a declaration was adopted to guide future efforts. This declaration was renewed and expanded at the 2026 conference in Montevideo to address emerging hazards in the region. Here, we report on the 2026 Montevideo meeting and present the updated Montevideo Declaration.

Methods/Approach

The Declaration was developed through discussions among participants and subsequently signed by 160 attendees from nine countries at the 3rd Latin American Conference on Environmental and Occupational Health, held in Montevideo in April 2026. The conference featured 39 speakers, including 19 Collegium Ramazzini Fellows. A pre-conference training session addressed topics related to maternal and child health, as well as occupational health.

Results

The conference focused on issues most relevant to addressing current challenges in Latin America and highlighted the latest scientific findings. Topics included, but were not limited to, pediatric lead exposure, pesticide exposures in adults and children and their role as endocrine disruptors, arsenic exposure in Argentina, chemotherapy drug exposure among healthcare workers, microplastic exposures, and toxicological emergencies in Latin America.

Conclusions

The Collegium Ramazzini should continue to support the Montevideo/Quito Declaration and plan for a 4th Conference in Latin America within the next decade. The Conference and Declaration may inform future Collegium Ramazzini satellite conferences.

Format

Presenter - Policy Discussion

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Sibel Kiran (1); Dumitru Cheptea (4); Özgür Bilek (2,3); Raisa Deleu (4); Esra Nur Güner (1); Serghei Cebanu (4)
1. Koç University, Istanbul, Turkey
2. Provincial Health Directorate, Mardin, Turkey
3. Mardin Artuklu University, Mardin, Turkey
4. Nicolae Testemitanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova

Background

Occupational health systems develop within different historical, institutional and resource contexts, creating opportunities for mutual learning. The Türkiye–Moldova collaboration, supported by the TÜBİTAK–NARD 2530 Programme (Project No. 121N796), combined implementation experience, locally generated evidence and methodological capacity to identify context-relevant pathways for strengthening occupational health practice.

Methods/Approach

Within the jointly planned research and capacity-building program, Koç University teams exchanged methodological and implementation experience, supported researcher development, and used modified Delphi, stakeholder-oriented research and global occupational health webinars to explore locally identified needs. Moldova-led work addressed International Labor Organization (ILO) Convention 161 (Occupational Health Services Convention, 1985)) implementation, awareness, legislation, professional training and curricula, alongside adaptation of research methodologies. Türkiye reassessed occupational health services and professional development needs within its longer implementation experience. Building on these activities, the Türkiye team also developed a pilot individualized learning pathway and a collaborative research and capacity-building initiative to support continued application and development of the approach. Acknowledgement: We gratefully acknowledge TÜBİTAK and NARD for their support.

Results

The project experience suggests that the principles underpinning ILO Convention 161 can provide a durable foundation for occupational health services across diverse national contexts, while their translation into practice requires context-responsive solutions. Collaboration enables countries with different resources, structures and implementation experience to examine alternative approaches, share expertise and generate locally relevant evidence, strengthening professional networks for mutual learning and context-sensitive problem solving.

Conclusions

Follow-up should focus on widening the collaborative research and capacity-building approach through new funded partnerships. Planned work includes curriculum enrichment and modular applications addressing research capacity, nutrition at work and new ways of working. Integration with complementary occupational-health research initiatives may broaden international testing and shared learning, while helping identify which elements are transferable, which require contextual adaptation, and how the approach can sustainably strengthen preventive occupational health practice across diverse settings.

Format

Presenter - Policy Discussion

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Ibrahim Issah (1,2); Serwaa A. Bawua (1,2); Spendylove Addai Nkrumah (2); Julius N. Fobil (1,2)
1. University of Ghana School of Public Health, Legon-Accra, Ghana
2. College of Health Sciences, Legon-Accra, Ghana

Background

Human biomonitoring (HBM) reference values are essential for interpreting internal exposure to environmental contaminants and informing clinical, regulatory, and public health decision-making. However, Africa has limited region-specific HBM reference values, forcing researchers and practitioners to rely on reference values derived largely from European and North American populations, which may not reflect the continent’s genetic diversity, environmental conditions, occupational exposures or socioeconomic realities. This commentary examines the scientific and public health implications of this gap and argues for establishing an African biomonitoring framework.

Methods/Approach

We synthesized evidence to show that Africa's rapidly changing environmental landscape, including informal e-waste recycling, artisanal mining, intensive agriculture, industrialization, urbanization, and climate-related hazards, create exposure profiles that differ substantially from those in high-income countries.

Results

Continued reliance on external reference values risks exposure misclassification, inaccurate clinical interpretation, underestimation of environmentally related disease burdens, and ineffective environmental health policies. Vulnerable populations working in the informal sector, who experience disproportionately high exposure and remain inadequately represented in global biomonitoring initiatives, are of particular concern.

Conclusions

We propose key priorities for establishing African HBM reference values, including coordinated continental biomonitoring programs, harmonized analytical methods, investment in laboratory and research capacity, community engagement, and the integration of biomonitoring data into environmental and occupational health policies. Regionally derived reference values would strengthen exposure assessment, improve risk characterization, support regulatory decision-making, and promote environmental justice, while contributing to Sustainable Development Goals related to health, environmental protection, and sustainable development.
Keywords: Human biomonitoring; Reference values; Environmental health; Occupational health; Africa

Format

Presenter - Policy Discussion

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Sibel Kiran (1); Nick Pahl (2)
1. Koç University, Istanbul, Turkey
2. Society of Occupational Medicine, London, UK

Background

Research and innovation increasingly reshape technologies, organisations and the world of work, yet worker-health implications may remain peripheral when occupational health is not the primary research focus. Fields such as climate, cancer, digitalisation and health systems can transform working life even when workers are not the primary study population.

Methods/Approach

Across fields—from cancer and medicines to climate and digitalisation—translation into practice relies on workers and can reshape working life even when workers are not the study population. Healthy and sustainable work should therefore be an integral dimension of responsible research and innovation. A proportionate Worker Health Relevance Statement is proposed as a cross-cutting consideration for research and innovation proposals. Rather than a simple declaration, it would prompt applicants to consider potential implications for worker health, working conditions and workforce sustainability and, where relevant, seek appropriate occupational-health expertise or include proportionate assessment and implementation measures.

Results

An upstream worker-health lens could embed occupational health across research design, innovation, implementation and real-world translation while complementing downstream responses. It would expose the interconnectedness of occupational health, positioning it not as a niche but as an enabling contributor to responsible innovation, prevention and societal impact. This could identify harms and inequities earlier, strengthen health promotion and preparedness, support workforce well-being and resilience, and align progress with healthy, equitable and sustainable working lives.

Conclusions

The Collegium Ramazzini could convene a working group to refine a Worker Health Relevance Statement—potentially broadened into a Healthy Working Lives Statement—define minimum principles and materiality criteria, and guide integration into funding calls, proposal review, ethics and implementation. It could be piloted with Horizon Europe and occupational-health networks. Evaluation could recognise proportionate integration supported by occupational-health expertise, worker involvement and dedicated tasks or work packages where relevant.

Format

Presenter - Policy Discussion

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Trish Creech¹
1. United Steelworkers Tony Mazzocchi Training Center, Pittsburgh, PA, USA

Background

Workers often recognize emerging hazards and unsafe conditions through direct experience before those concerns appear in formal assessments, incident data or organizational safety systems. Despite recognition of the importance of worker participation, worker knowledge is often treated as anecdotal rather than an important source of information for identifying and preventing occupational hazards. This discussion examines how worker knowledge can be systematically recognized and used alongside scientific and technical evidence to strengthen prevention.

Methods/Approach

This discussion will examine the gap between worker knowledge and information captured through formal occupational health and safety systems. It will explore meaningful worker participation in hazard identification, exposure assessment, incident investigation, risk assessment, management of change and development of controls. Examples from occupational health and safety practice will illustrate how worker observations can identify persistent or emerging hazards and provide context not apparent through traditional data sources. Barriers to incorporating worker knowledge, including organizational culture, fear of retaliation, limitations of reporting systems and lack of meaningful follow-up, will also be examined.

Results

Meaningful worker participation should extend beyond consultation to include the systematic collection, evaluation and use of worker knowledge in occupational health and safety decision making. Worker observations should be considered alongside scientific, exposure and injury data when identifying hazards and developing prevention strategies. Recognizing worker knowledge as a complementary source of evidence can strengthen risk assessment, improve controls and identify hazards before they result in serious injury or illness.

Conclusions

Organizations should evaluate whether existing systems effectively capture and respond to worker concerns. Occupational health professionals and researchers should engage workers in identifying research priorities and evaluating workplace hazards. The Collegium could support collaboration and guidance on meaningful worker participation and integrating worker-generated information with scientific and technical evidence.

Presenting author profile

Dr. Daniela Pelclová is working for almost 50 years at Toxicological Information Centre for the Czech Republic and for 22 years was the head of the Department of Occupational Medicine, First Medical Faculty, Charles University in Prague. She has been a Collegium Ramazzini Fellow since 2003 and served on the Executive Committee 2017-2023. She has also been a Fellow of European Association of Poison Centres and Clinical Toxicologists since 2014.

Format

Presenter - Research Data

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Daniela Pelclová (1,2)
1. Charles University, Prague, Czech Republic
2. General University Hospital, Prague, Czech Republic

Background

The number of occupational intoxications in the Czech Republic is decreasing. While effective prevention may be a contributing factor, underreporting may also play a role.

Methods/Approach

Statistical data were obtained from the National Registry of Occupational Diseases and from inquiries to the Toxicological Information Centre (TIC).

Results

The total number of acknowledged occupational intoxications has gradually declined from a peak of 440 cases in 1956 to 175 cases in 1980, 88 cases in 1989, 8 cases in 2024, and 3 cases in 2025.
Conversely, total inquiries to the TIC increased sharply from 9,975 in 2006 to 30,451 in 2025. Over the past 20 years, the number of job-related inquiries has remained relatively stable, with annual mean of 125.6±32.6.
Among the total of 2,511 subjects, 66.3% were male and 33.7% were female. Inquiries originated most frequently from physicians (67.6%), followed by the patients themselves (20.1%), family or friends (7.7%), and workplaces (4.6%). The most frequent routes of exposure were inhalation (73.4%), skin contact (11.3%), eye contact (4.5%), accidental ingestion/aspiration (2.7%), injuries caused by syringes or animals (1.6%), and combined exposure (6.5%). The most frequent exposures involved disinfectants, solvents, cleaning agents, pesticides, fuming gases, ozone, ammonia, chlorine, acetic acid, hydrofluoric acid, and metallic dusts.

Conclusions

Occupational intoxications in the Czech Republic are declining, reaching a record low in 2025. Nevertheless, the number of inquiries regarding workplace toxic exposures remains stable. Key reasons for underreporting include misconceptions among patients who believe they would not receive compensation, and a lack of insurance coverage among self-employed individuals. Continuous monitoring of new cases through the TIC remains crucial for identifying emerging occupational risks. Acknowledgements: Cooperatio 207041-3

Presenting author profile

Dr. McDiarmid is the Director of the Division of Occupational and Environmental Medicine in the Department of Medicine and the University of Maryland School of Medicine where she is a researcher and thought leader in the safe handling of hazardous drugs.

Format

Presenter - Research Data

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Melissa McDiarmid (1); Kathryn Barry (1); Tsion Girmay (1)
1. University of Maryland School of Medicine, Baltimore, Maryland, USA

Background

The DNA damaging effects of treatment with hazardous, anti-cancer drugs (HD) resulting in therapy-related leukemia and other cancers are well recognized. These findings have also driven health concerns for cancer caregivers handling these drugs. Because there is no US national cancer registry and state registries do not obtain occupational data when documenting new cancer cases, the true impact of work exposure on cancer risk is unknown.

Methods/Approach

To assess this risk, we have established a national exposure registry for oncology workers which collects drug exposure history, safety practices, a complete health history, and a self-reported cancer history for validation by state registries. After piloting with nursing and pharmacy participants, a ‘soft roll-out’ began in 2026 through multiple channels supported by oncology professional organizations. Preliminary data are presented here.

Results

221 survey respondents provided informed consent with 83 (39.3%) completing the survey. The 83 were primarily female (93%) with a median age of 43 years; 93% were of non hispanic or latino origin and 85% had a bachelor’s degree or above. The majority, 57, were currently handling hazardous drugs in a clinical setting (81%) with about 90% in the nursing role and 10% in pharmacy. For these 57 respondents, 77% reported a designated area for HD preparation in their facilities, with 63% stating those were negative pressure areas. 19% reported use of closed-system transfer devices. Eight of 83 full respondents (~10%) reported a total of 9 cancers including 3 breast cancers, two non-melanoma skin cancers and one each of: pancreatic, liver, thyroid and synovial sarcoma.

Conclusions

An exposure registry offers a unique opportunity to obtain a structured exposure and safety practice history together with health information for a targeted occupational group at high risk for cancers, supplying key exposure data that current cancer registries do not routinely capture.

Presenting author profile

Prof. Joachim von Braun, is distinguished Professor at Center for Development Research (ZEF) of Bonn University, Germany. He is President of the Pontifical Academy of Sciences, The Vatican. His research is on social, economic, technology, health and environmental issues related to low-income contexts. He studies related issues at macro and local community levels.

Format

Presenter - Policy Discussion

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Joachim von Braun (1)
1. University of Bonn, Bonn, Germany

Background

Export-oriented agriculture - especially coffee, horticulture, tea, and groundnuts - remains a cornerstone of economic growth, foreign exchange earnings, and rural livelihoods in East Africa. However, a substantial share of these gains relies on unpriced environmental, health, and social costs, including pesticide exposure, reduced school participation, and health effects of hazardous child labor, as well as land and water degradation. These externalities are systemic rather than marginal.

Methods/Approach

Evidence highlights three central policy insights: most externalities originate at the production stage, making farm-level interventions the most effective leverage point; no single instrument is sufficient: effective responses require balanced policy mixes combining regulation, incentives, voluntary standards, and enforcement; and third, fair cost-sharing along value chains is critical. Smallholders cannot bear transition costs alone; downstream actors and consumers must contribute through pricing, contracts, and co-investment. True Cost Accounting emerges as a practical policy tool to make trade-offs explicit, prioritize interventions, and design development-sensitive regulations. While not all externalities can be eliminated, many—particularly hazardous child labor and pesticide-related health risks—are preventable at relatively low cost.

Results

Priority actions include: integrating sustainability incentives, regulation, certification, and digital traceability into national agricultural and trade policies; sharing compliance costs through fair contracts and long-term sourcing commitments by private-sector actors;

Conclusions

Strengthening farmer organizations to reduce certification and compliance costs, providing subsidies and technical support for sustainable practices and ensuring sustainability regulations in consumer markets are development-sensitive.