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Donald K. Milton (1)
1. University of Maryland School of Public Health, College Park, MD, USA

Background

The toll of illness and death among healthcare and other “essential” workers during the COVID-19 pandemic and the overwhelming evidence for airborne transmission of SARS-CoV-2 created a wave of interest in non-pharmaceutical infection transmission controls – including PPE and engineering controls. The precautionary principle suggests that we should protect vulnerable workforces and populations against the possibility of airborne transmission. But recent policy changes indicate that we may be retreating rather than advancing control efforts.

Methods/Approach

We will start with a brief review evidence for aerosol inhalation as the dominant mode of transmission of coronaviruses and influenza viruses. Next, we will look at the so called “pragmatic” intervention studies of masks and respirators in healthcare and how the ubiquity of airborne viruses during epidemics complicates control. The “pragmatic” studies have been interpreted to essentially suggest that effective control cannot be achieved resulting in a policy of surrender.

Results

The well-known (in occupational health and hygiene communities) problems of reliance on PPE as first-line controls indicate that a new system of integrated infection protection and control policies is urgently needed. In the absence of data clearly demonstrating how to achieve effective control, advocates from labor and academia are losing the policy battles.

Conclusions

To move forward, we need to design specific, workable, and effective policies for specific work environments, and implement controlled studies that can test and refine them until we can demonstrate clearly what airborne infection control looks like, and that it works.

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Policy/Discussion

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Nsedu Obot Witherspoon (1); I. Leslie Rubin (2); Martha Berger (3)
1. Children's Environmental Health Network, Washington, DC USA
2. The Rubin Center for Autism and Developmental Pediatrics, Atlanta, GA USA
3. Climate Equity Collaborative, Merrifield, VA USA

Background

Climate change is a significant threat to human health as greenhouse gases accumulate, temperatures/sea levels rise, and extreme weather events become more intense and frequent. In communities throughout the world, those most often and severely affected by climate change are those with the least means to protect themselves and recover when disaster strikes. The effects of climate change on health are not the same for all. Children are vulnerable to the effects of climate change in ways that adults are not. They are sensitive to environmental threats in ways that adults are protected, and have fewer adaptive capacities. Studies of early life environmental exposures confirm that the effects of climate change on children and future generations will endure. While childhood is a uniquely vulnerable life stage for experiencing the health effects of climate change, not all children are affected the same. Children in marginalized or neglected communities suffer disproportionately. The need to take meaningful protective action is urgent.

Methods/Approach

The Climate Equity Collaborative (CEC) is a public private partnership launched with the Children’s Environmental Health Network in 2022 to center on youth education, health, career choices, and leadership in these under-resourced communities. Examples of key programs such as the Eco-Healthy Child Care program, Break the Cycle of Climate Change, and Global Children’s Environmental Health Network will be highlighted.

Results

Climate change is a multigenerational and intersectional issue. Focusing on the health of children provides solid and actionable information to ensure that today’s children can safely enter the world, learn, grow, and thrive into adulthood. Living with and potentially solving the climate crisis is not possible without considering the plight of those most vulnerable and affected.

Conclusions

Identification of the need to center children, justice, and climate change protections by considering them collectively as key drivers to systemic shift and needed child-protective policies.

Presenting author profile

Dr Amalia Laborde Garcia is Professor of Toxicology and founder of the Occupational and Environmental Toxicology area of the Toxicology Academic Unit of the Faculty of Medicine. She works in toxicology training, applied research and community interventions with residents, medical and public health students and engineers on environmental and occupational chemical exposures and health effects

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Research Data

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Raquel González (1); Fiorella Besses (1); Laura Tarán (1); Florencia del Cioppo (1); Simela de Varga (2); Mercedes Menéndez (2); Amalia Laborde Garcia (1)
(1) University of the Republic, Montevideo, Uruguay
(2) Clinical Hospital, Montevideo, Uruguay

Background

Glyphosate is the most applied herbicide in the South American region in both intensive and extensive farming. The main concern of glyphosate exposure is related to its long-term health effects. Considering the controversial estimations of its potential health impact, the widespread and great magnitude of use, there is a need to investigate the magnitude of human exposure.

Methods/Approach

Exploratory study was conducted on a convenience sampling of workers, in rural and urban population areas. ELISA Kit (Araxes®) immunoassay was used, for the quantitative detection of glyphosate in urine. The amniomethylphosphic acid (AMPA) metabolite was not measured.

Results

Glyphosate was detected in all urine samples. Agricultural workers showed a mean of 4.66 µg/L. The rural population mean was 3.03 µg/L ( 2.86 µg/L in adults and 3.50 µg/L in children) and the urban population showed a mean of 2.60 µg/L .

Conclusions

Results suggest that in any scenario of exposure, occupational or environmental, glyphosate levels in the studied population are in a higher range. Higher levels in children compared to adults have been also described by other research groups and is consistent with the particular vulnerability of children to chemicals exposures.
More research is needed to scale up results in order to understand the high risk scenarios of exposure in Uruguayan population. The immunofluorescence technique permitted us to find glyphosate levels with the expected differences according to the types of exposures. ELISA test must be considered as a tool for screening and bio monitoring in countries with low laboratory testing capacities.

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Policy/Discussion

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Janelle Rios (1)
1. The University of Texas Health Science Center at Houston, Houston, TX, USA

Background

As the frequency and severity of extreme weather events intensify, the ability to recover becomes increasingly important. We refer to this ability as resiliency. Some people and communities are more resilient than others. Why? What factors make workers vulnerable to (or better able to withstand) extreme weather events?

Hurricane Harvey, a category 4 storm that killed more than 100 people and devastated much of southeast Texas and western Louisiana in 2017, created a situation in which resiliency could be observed, in real people and in real time. At its peak, Hurricane Harvey attained winds of 130 miles per hour and, over four days, Hurricane Harvey dropped approximately 50 inches of rain in southeast Texas, flooding hundreds of thousands of homes and displacing more than 30,000 residents.

Methods/Approach

In this session, we will examine the resiliency of three of those residents, each with different backgrounds, educational levels, ethnicity, and income and resiliency levels. Our examination will follow the impact of Hurricane Harvey immediately after landfall. We will describe the factors that impacted the resiliency of these residents, including the influences that too often contribute to the vulnerability of individuals and communities, such as limited access to resources, inadequate social protection, low wages, and limited decision-making power.

Results

I will (1) describe the factors that contributed to the health (including mental health) and well-being of these residents and (2) illustrate the impact these factors had on the resiliency of these residents post Hurricane Harvey.

Conclusions

We will consider historical policies and then look towards the future to discuss potential methods to enhance the resilience of disproportionately impacted residents, including optimizing efforts to prepare for, respond to, and recover from climate impacts. Hopefully, this discussion will spark the development of strategies, policies, and systems that promote resiliency.

Presenting author profile

Dr. Baur is retired chair of the Occupational Department of the University of Hamburg, Gemany, and current president of the charity European Society for Environmental and Occupational Medicine, Berlin, Germany

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Xaver Baur (1); Joachim Schneider (2)
1. European Society for Environmental and Occupational Medicine, Berlin, Germany
2. University of Giessen, Giessen, Germany

Background

To estimate past asbestos exposure in the workplace some pathologists have analysed fibre counts in human lungs. However, such analyses are questionable because asbestos, especially chrysotile, undergoes translocation, clearance and degradation in the lungs.

Methods/Approach

We quantified the asbestos fibre and ferruginous (asbestos) body (FB) content in human lung tissue of 177 patients with various asbestos-related diseases (ARD)--28 with asbestosis, 105 with primary lung cancer due to asbestos, 44 with diffuse malignant pleural mesotheliomas)--and 46 controls.

Results

As shown in the figures, lung concentrations of chrysotile and amphibole fibres and of FBs depend on the year of examination and especially on the interim period since last exposure. As the interim increases, the asbestos fibre burden decreases. There was no relationship between FB and chrysotile asbestos fibre concentrations and only a weak correlation between FB and crocidolite fibre concentrations. FBs correlated poorly with the disease type and severity of asbestosis.

Conclusions

After an interim period of about 20 years, elevated chrysotile asbestos fibre concentrations cannot be detected in the lung tissue of chrysotile-exposed workers. We also show for the first time, that the more biologically stable amphibole (crocidolite) fibres are also subject to elimination kinetics. Therefore, false-negative results of lung fibre analysis must be expected for all asbestos types. Thus, a negative light or electron microscopic lung analysis is not capable of overturning a reliable occupational history of asbestos exposure.

Presenting author profile

Dr. Ngowi is retired Senior Lecturer, Muhimbili University of Health and Allied Sciences. She was Research scientist at Tropical Pesticides Research Institute. She was Chairperson for the Africa Stockpiles Programme, Tanzania Network of NGOs and CSOs. She led collaborative research with institutions in Eastern and Southern Africa, North America, Scandinavia, assessing the health hazards posed by pesticide handling, storage and use on large and small-scale farms and developing action on pesticide impact in Tanzania.

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Policy/Discussion

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Aiwerasia Vera Ngowi (1); Dorothy Ngajilo (2); Baldwina Olirk (3)
1. Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
2. Tanzania Association of Public, Occupational and Environmental Health Experts, Dar-es-Salaam, Tanzania
3. Muhimbili National Hospital, Dar-es-Salaam, Tanzania

Background

The use of pesticides in agriculture is growing in Tanzania, raising increasing concerns about their damaging effects on human health and the environment. Last year the government identified 44 highly hazardous pesticides (based on carcinogenicity and reproduction effects) on the market but has yet to ban or remove them from use. Over the last decades, Tanzania has developed agricultural policies favoring the use of chemical inputs, among which are pesticides.

Methods/Approach

New pesticide regulations and revamped institutions are an attempt to relax enforcement of control rules, and to establish clearer, quicker approved channels for pesticide sale. To loosen the control of pesticides makes them more accessible to people who are not competent on safe pesticide use. Today, there is evidence that the use of some pesticides causes long-term severe negative effects on human health and the environment. Health concerns associated with the handling and use of pesticides are greater in developing countries because farmers are often unable to read labels that are usually the only source of safety instructions and rely on pesticide retailers for advice.

Results

Although a transition away from exclusive reliance on chemical pesticides has gained critical importance in many countries, with support from international organisations such as FAO, WHO and UNEP, the pesticide industry has greater influence against such efforts inTanzania.

Conclusions

Building awareness of the hazards associated with pesticides as well as of the benefits of alternatives is an approach that is needed. It is also important to consider advocating for the amendment of regulations to prevent harmful effects as well as pushing for safer policies and regulations. To understand how public policies and regulations in Tanzania are designed to control pesticide trade and to what extent they effectively prevent the detrimental public health and environmental effects of those substances is presented.

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Policy/Discussion

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Lilian Corra (1)
1. International Society of Doctors for the Environment, Buenos Aires, Argentina

Background

In 2021 the United Nations Environment Assembly (UNEA) decided that a science-policy
panel should be established to contribute further to the sound management of chemicals
and waste and to prevent pollution.  Science is a central factor to strengthen informed
decision-making processes on the environment and health but scientific knowledge is not
easily accessible to policy makers.

Methods/Approach

UNEA stressed the urgent need for a multi-stakeholder participation to support and promote science-based local, national, regional and global action on the sound management of chemicals and waste and pollution prevention.

Results

According to UNEA: “Reaffirming that the sound management of chemicals and waste is
crucial for the protection of human health and the environment and that air pollution is the
single greatest environmental risk to human health, convinced that a science-policy panel
could support countries in their efforts to take action, including to implement multilateral
environmental agreements and other relevant international instruments, promote the
sound management of chemicals and waste, and address pollution by providing policy-
relevant scientific advice on issues, and that it could further support relevant multilateral
agreements, other international instruments and intergovernmental bodies, the private
sector and other relevant stakeholders in their work…”

Conclusions

In this presentation, opportunities for collaboration and involvement of the Collegium
Ramazzini (CR) under this new scenario will be analyzed, to increase the presence of the CR fellows in decision-making forums (both international, national and regional) on chemicals and waste and air pollution by fulfilling the natural commitment of the CR to protect health and quality of life, so well expressed in the phrase "Primun non nocere."

Presenting author profile

Dr. Ramos-Bonilla is Associate Professor at the Department of Civil and Environmental Engineering at Universidad de los Andes in Bogotá, Colombia. Since 2009 he has lead research efforts in Colombia aiming to understand the health risks associated with asbestos use at both the occupational and population levels.

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Policy/Discussion

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Juan Pablo Ramos-Bonilla (1); Margarita Giraldo (1); Daniela Marsili (2); Roberto Pasetto (2); Benedetto Terracini (3); Agata Mazzeo (4); Corrado Magnani (5); Pietro Comba (3); Benjamin Lysaniuk (6); María Fernanda Cely-García (1); Valeria Ascoli (7)

1. Universidad de Los Andes, Bogotá, Colombia
2. Istituto Superiore di Sanità, Rome, Italy
3. University of Torino and CPO-Piemonte, Torino, Italy
4. University of Bologna, Bologna, Italy
5. University of Eastern Piedmont, Novara, Italy
6. Institute for Sustainable Development (IRD), Aubervilliers, France
7. Sapienza University, Rome, Italy

Background

Asbestos has been extensively used in Colombia since the establishment of an asbestos-cement facility in Sibaté, Cundinamarca, in 1942, the country's first and largest facility, which manufactured corrugated sheets, pipelines, and water tanks. Despite hosting one of the largest asbestos industries in Latin America, Colombia lacks a reliable epidemiological surveillance system to monitor the health effects of asbestos exposure. An asbestos ban came into effect in Colombia on January 1, 2021, and the facility of Sibaté continues to operate with asbestos substitutes.

Methods/Approach

To study the potential health effects of asbestos use in Sibaté, an active surveillance strategy was implemented between 2015 and 2019, in the framework of an international collaboration that includes institutions from Colombia, Italy, and France. This included door-to-door structured interviews to identify asbestos-related diseases (ARDs), review by a panel of physicians of the medical records of mesothelioma cases identified following the criteria proposed by the Italian National Mesothelioma Register (ReNaM), and communication of findings to local, regional, and national authorities and the general population.

Results

The active surveillance strategy identified a mesothelioma cluster in Sibaté, composed of 15 cases diagnosed at really young ages. This implied the inadequacy of the existing health information system in monitoring ARDs. The study underscored the urgent need for Colombia to establish a reliable epidemiological surveillance system for ARDs, not only for Sibaté but also for all the additional regions where four asbestos-cement facilities, a friction products plant, and a chrysotile mine operated (i.e., Yumbo, Manizales, Barranquilla, Campamento and Bogotá).

Conclusions

The study demonstrated that active surveillance strategies could play a crucial role in identifying mesothelioma clusters and understanding the health effects of asbestos exposure. These strategies can be of critical importance in low- and middle-income countries with limited governmental institutions and resources.

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Amalia Laborde García (1)
1. University of the Republic, Montevideo, Uruguay

Background

There is an increasing body of evidence showing that agricultural practices based on intensive use of pesticides in South America (SA), should be a public health concern. Even though the per capita use of pesticides in the region is one of the most elevated, pesticides exposure research and health surveillance programs are practically nonexistent.

Methods/Approach

Rural families in SA are the most vulnerable group since they are usually poor, live with very limited services but have simultaneous occupational, para-occupational and environmental exposure. At the same time they represent the core group to manage actions not only for self-protection, but also for global food safety and environmental care.

Results

There have been different preventive programs as well as regulations proposed to reduce or minimize pesticides occupational and environmental exposure within the region. However, they have barely reached the rural workers and their families.

Conclusions

Public policies designed to the wellbeing of the rural population is key to their empowerment and involvement in agricultural practices that protect themselves, their families, and the general population from pesticides exposure.

Presenting author profile

Iman Nuwayhid, is a professor of Environmental and Occupational Health at the Faculty of Health Sciences at the American University of Beirut, where he served as dean (2008-2020). He is a Collegium Ramazzini Fellow and a co-editor of the landmark book on “Public Health in the Arab World” (2012). He served on the WHO-EMRO Commission on Social Determinants of Health and the Scientific Advisory Group for the World Report on Social Determinants of Health Equity.

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Iman Nuwayhid (1); Rima R Habib (1); Hani Mowafi (2)
1. American University of Beirut, Beirut, Lebanon
2. Yale University, New Haven, CT, USA

Background

In the wake of numerous protracted humanitarian crises in the Middle East and North Africa (MENA) region (e.g., armed conflicts, devastating natural disasters, socioeconomic collapse, mass displacements, climate change), the Global Environmental and Occupational Health Hub for Research and Training in the MENA region (GEOHealth-MENA) emerged to build capacity in environmental and occupational health (EOH) research and recommend an action plan to deal with these complexities.

Methods/Approach

Centered at the American University of Beirut (AUB), the GEOHealth-MENA Hub has adopted an ambitious agenda for research and training in collaboration with four US-based academic institutions: Yale University, the University of Iowa, the University at Buffalo, and the University of Washington.

The Hub’s research will examine the interplay between environmental, occupational, and social stressors in low-income communities. It will focus on the health impacts of pesticide exposure in Syrian refugee agricultural workers in Lebanon accounting for social stressors. The Hub’s research agenda also includes the health impacts of climate change, specifically exposure of agricultural workers to heat stress.

The GEOHealth-MENA’s training program includes offering four PhD and four MS Epidemiology scholarships at AUB to qualified professionals (Egypt:2, Lebanon:4, Sudan:2). The MS trainees are medical doctors who will pursue a clinical fellowship in Occupational Medicine. Furthermore, the program will offer focused short-term training in Agricultural Health and Safety addressed to farmers, workers, and health professionals.

Results

The Hub, with universities from across the MENA region (e.g., Egypt and Sudan), will develop a relevant regional EOH research agenda and will test low-cost tools for exposure assessment for use in low-income settings. Innovative approaches analyzing the interactions between environmental and social stressors, especially relevant in local contexts, will be adopted.

Conclusions

The Hub’s research will provide evidence-based solutions to inform policy in the agricultural sector.

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Policy/Discussion

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Timothy B. Erickson (1)
1. Harvard University Medical School, Boston, MA, USA

Background

The past indiscriminate use of chemical, biological, radiological, nuclear, or explosive (CBRNE) weapons in previous conflicts (WWI, WWII, Syrian War) and potential use in the current Russian-Ukraine War could trigger consequences that will reverberate globally and cause long-term human health effects and extensive environmental damage. In response, a team of subject-matter experts from the US and Ukraine developed a comprehensive hands-on CBRNE training program.

Methods/Approach

During 2022-2023, the team conducted 160 CBRNE and trauma courses over multiple deployments training over 4000 personnel in the key Ukrainian cities of Kyiv, Chernobyl, Zaporizhzhia, Dnipro, Kharkiv, and Odesa. The instructional team consisted of 20 international course leaders, supplemented by local translators and logisticians, and 45 Ukrainian nationals who completed CBRNE instructor courses. The objective was to evaluate the change in knowledge and skill confidence after implementation of a wartime CBRNE training course throughout Ukraine.

Results

Implications, successes, and challenges faced during the previous Syrian conflict and by our US/Ukrainian team in developing and delivering CBRNE training for frontline healthcare workers and civilians conducted during an active war will be discussed. The presentation will chart a path forward in building CBRNE, disaster, and emergency management capacity strategies and policies for Ukraine and bordering countries while also highlighting the human health and environmental impacts of CBRNE warfare.

Conclusions

We intend to use this model for future work in other countries and low resource, austere settings globally to address the growing threat of CBRNE weapons on human health and environmental consequences worldwide.

Presenting author profile

Dr. Rima R. Habib is a professor of Occupational and Environmental Health at the Faculty of Health Sciences at the American University of Beirut, Lebanon. Her research focuses on workers in marginalized communities, including refugees working in the agricultural sector. She conducted one of the largest studies on child labor including 3477 Syrian children working in agriculture in Lebanon. Dr. Habib is a Fellow of the Collegium Ramazzini.

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Rima R Habib (1); Iman Nuwayhid (1); Hani Mowafi (2)
1. American University of Beirut, Beirut, Lebanon.
2. Yale University, School of Medicine, New Haven, CT, USA

Background

This poster is provides further information linked to the session Panel session 'Calls for action in occupational and environmental health from the Global South'. Lebanon, a country of 4 million, face various economic and political challenges and hosts >1.5 million Syrians refugees. Most refugees work in agriculture and live in tented settlements. Syrian agricultural workers are exposed to high levels of pesticides and heat stress during summer.

Methods/Approach

As part of the Global Environmental and Occupational Health Hub for Research Training in the Middle East and North Africa Region (GEOHealth-MENA Hub) program, this research evaluates the pathways of pesticide exposure among greenhouse agricultural workers, association of such exposure with neurobehavioral outcomes, explores the role of social factors in this association, and assesses heat stress and health-related symptoms among these workers. Specific aims are:
1) build a cohort of 150 Syrian refugee greenhouse agricultural workers and 150 non-agricultural workers and quantify exposure to pesticides. A comprehensive exposure assessment of all participants will be conducted over two consecutive summers (2024, 2025), using three exposure assessment methods: field observation, quantitative environmental exposure using wearable individual passive samplers, and biological measures of urinary pesticide metabolites [TCPy for chlorpyrifos (organophosphate) and 3-PBA for pyrethroid exposures].
2) characterize workers’ social stressors and evaluate how they change over time and how they relate to pesticide exposure.
3) assess relationships between exposure to pesticides and neurobehavioral performance, focusing on temporal relationships (cross-sectional, over two waves, and dose-response) and explore the role of social stressors in these associations.
4) assess heat stress and heat-related physiological indicators and health symptoms among agricultural and non-agricultural workers.

Results

Agricultural workers worldwide are affected by pesticide exposure and heat stress, leading to impaired physical and cognitive function. Extreme temperatures are predicted to worsen and challenge population’s livelihoods.

Conclusions

Research findings will inform intervention/implementation science studies and agricultural health safety practices and policies.

Presenting author profile

Dr. Levy, an Adjunct Professor of Public Health at Tufts and a Past President of the American Public Health Association, has written and spoken extensively on the health impacts of war. He wrote the book “From Horror to Hope: Recognizing and Preventing the Health Impacts of War” and co-edited two editions of “War and Public Health” and 18 other books. He co-authored a New England Journal of Medicine paper on the war in Ukraine.

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Policy/Discussion

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Barry S. Levy (1)
1. Tufts University School of Medicine, Boston, MA, USA

Background

Russia’s invasion of Ukraine has caused profound impacts on health, human rights, and the environment. While the direct health impacts of the war are readily apparent, the indirect health impacts are less recognized and less frequently reported, but, based on data from many other wars, are likely to be occurring more frequently.

Methods/Approach

The indirect health impacts of war include malnutrition, communicable diseases, exacerbation and new onset of noncommunicable diseases, maternal and infant disorders, and mental and behavioral disorders. These impacts result largely from population displacement and damage to infrastructure, including food and water supply systems, medical care and public health facilities, and transportation, communication, and electricity networks. These impacts also result from and injuries and deaths of health care workers and other workers who support the health of populations. This presentation will review the indirect health impacts of Russia’s war in Ukraine.

Results

War causes profound, widespread, and long-lasting health impacts. The Collegium can play important roles in raising awareness about and reducing the occurrence of these impacts.

Conclusions

The Collegium should advocate for an end to Russian’s war in Ukraine and collaborate with Ukrainian scientists and policymakers to assess the health impacts of the war.

Presenting author profile

Dr. Amalia Laborde Garia is Professor of Toxicology at the School of Medicine of the University of the Republic in Uruguay. She established the occupational and environmental toxicology clinic at the University Hospital ,where she works with students , medical doctors, workers and community organizations in clinical care,training ,field interventions and research.

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Amalia Laborde García (1)
1.Universidad de la República, Montevideo, Uruguay

Background

Over the last decades, the globaly increasing turnover of electric and electronic products revealed a particularly complex health risk for vulnerable populations. More than 57 million tons of e-waste were produced globally in 2021. More than 80% of e-waste goes to landfills, dump sites or informal recycling made in poor communities. E- waste is dismantled and especially valuable elements such as gold and copper are captured through primitive recycling procedures as open cable burning, acid baths, and “cooking” circuit boards.

Methods/Approach

Adult workers, pregnant women and children are exposed to hundreds of chemicals contained in plastics and metallic materials. Many of them have been detected in water, air, and soil around recycling activities. A growing body of evidence confirms exposure for both workers and surrounding communities to heavy metals, POPs, complex particulate materials, dioxins and other combustion contaminants. Lead exposure has been associated with a significant impact on children’s health as a result of informal e-waste recycling.
Several chemicals from e-waste recycling are known to be neurodevelopmental toxicants, endocrine disruptors and carcinogens. Many of them have been associated with common non-communicable diseases.

Results

Countries on all continents have developed legal and regulatory frameworks for waste management, but less than 50% have specific legislation for e-waste. Scientists, governments, NGOs and the electric and electronic industry have driven initiatives for developing a framework of sustainable and socially equitable process to protect health and the environment.

Conclusions

Considering that informal activities are carried out by populations with higher social vulnerability, initiatives aimed at tackling this global environmental crisis need to be based on social inclusion, education and safer technologies availability.

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Bruce Rodan
United States Environmental Protection Agency
Office of Research and Development
Washington, DC. United States of America

Background

Similar to other problematic pollutants of the past, many of the beneficial commercial properties of PFAS also pose barriers to environmental degradation, necessarily to mineralization rather than just to shorter perfluorinated compounds.

Methods/Approach

The focus of this presentation is on US EPA drivers and considerations in prioritizing and conducting research on PFAS removal and destruction, and on latest research results. Drivers include environmental sources and occurrence, and the legal and policy mandates for action.

Results

Considerations focus on the commitment to address the totality of pathways and potential for transfer across media and locations – notably to not burden disadvantaged populations -- and the desire to achieve “complete” destruction without, for instance, emitting products of incomplete destruction (PIDs).

Conclusions

Research results will summarize latest information on removal and destruction technologies, and identify research underway along with the critical need for future collaborations on field testing at full-scale commercial facilities.

Disclaimer: The views expressed are those of the author and do not necessarily represent the views or policies of the U.S. Environmental Protection Agency. Any mention of trade names, products, or services does not imply an endorsement by the U.S. Government or the U.S. Environmental Protection Agency.

Presenting author profile

Philippe Grandjean is Professor of Environmental Medicine at the University of Southern Denmark and Research Professor at the University of Rhode Island, where he co-leads the STEEP superfund center that focuses on PFAS.

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Philippe Grandjean (1,2)
1. University of Southern Denmark
2. University of Rhode Island

Background

The PFASs illustrate key issues in public health where protection against adverse exposures relies on proper documentation. During the decades of PFAS production and dissemination, little research evidence was released. Only during the recent two decades has impartial documentation materialized, and regulatory limits have been lowered by a factor of about 1,000. The question to be asked today is whether we now have sufficient information to judge the true extent of PFAS toxicity or at least some of the most relevant aspects of it.

Methods/Approach

The relevance and quality of the epidemiological studies of course needs to be scrutinized, but the evaluation is not just a matter of, e.g., statistical power, or risk of bias. Given that PFASs can accumulate in the body over time and that vulnerability to PFAS toxicity is likely age-dependent, the assessment of PFAS exposure needs to be considered in the research design and in evaluating the study results. Likewise, the outcome parameters need to be carefully chosen and assessed.

Results

Regulatory agencies have prudently decided to focus the control on long-term exposures, and that PFASs are transferred from adults to the vulnerable next generation via the placenta and via human milk. This approach is innovative and allows the dose-dependent risks in early life be translated into limits for population exposures. The adverse outcome chosen is the decreased formation of specific antibody response to childhood vaccinations. Although this effect seems to occur at very low PFAS exposure levels and may therefore be considered critical, it is possible that other adverse effects, if represented by sensitive and continuous outcomes, may lead to lower limits. While carcinogenicity has been suggested, metabolic effects may also be a candidate.

Conclusions

Although recent epidemiological PFAS research therefore is supporting cautious interventions, critiques emphasize potential weaknesses and stress that correlations may not be causal.

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Brenda Jacklitsch (1)
1. National Institute for Occupational Safety and Health, Cincinnati, OH, United States

Background

Workers are disproportionately affected by climate, as they are likely to have more and greater exposure than the general public and employers may not be sufficiently informed or prepared to institute adequate risk management. In 2009, NIOSH authors published a framework that includes hazards or exposures and occupational health effects related to climate. This framework paper was subsequently updated in 2016 and 2023.

Methods/Approach

The framework’s seven occupational safety and health-related hazards and exposures include ambient temperature, air pollution, UV radiation, extreme weather, vector-borne diseases and expanding habitats, industrial transitions and emerging industries, and changes in the built environment. Additional cross-cutting topics were also identified including health equity, mental health, and economic burden.

Results

To address these climate-related impacts, priorities for action are needed, including those related to research, surveillance, risk assessment, and risk management.

Conclusions

NIOSH researchers are participating in climate and occupational safety and health activities, both internally and through external collaborations.

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Erin N. Haynes (1); Warren Jay Christian (1); Judy Westrick (2)
1. University of Kentucky, Lexington, Kentucky, USA
2. Wayne State University, Detroit, Michigan, USA

Background

On February 3, 2023, a freight train comprised of approximately 150 rail cars derailed and caught fire in the town of East Palestine, Ohio home to about 4,700 residents. Approximately 20 rail cars were listed as carrying hazardous materials, including vinyl chloride, butyl acrylate, ethylhexyl acrylate, and ethylene glycol monobutyl ether, which were released into the air, soil, and water; five rail cars of vinyl chloride were breached.

Methods/Approach

To address these exposure concerns, a community advisory board was formed, an on-line East Palestine Health Tracking Survey was launched to learn more about the experiences, health symptoms, and environmental health concerns of residents in the impacted area. A pilot study will take place in July 2023 to collect blood and urine on 20 adult participants living near the derailment site. Urine will be analyzed for metabolites of chemicals associated with the derailment, and blood will be processed for serum for clinical measures of kidney and renal function and multiple cytokine and chemokine biomarkers using the Luminex technology.

Results

Nearly 300 residents have completed the survey. Initial responses to the survey have demonstrated elevated levels of physical and mental health symptoms. Residents living within one mile of the train derailment reported cough (75%), headaches (89%), sinus irritation (75%) and rash (39%). A screening tool indicated 45% of all survey participants were at risk of post-traumatic stress disorder (PTSD). The mean score on the Perceived Stress Scale (PSS4) was 8.0; values above 6 are typically considered as high levels of stress. Urinary metabolites and clinical markers will be presented during the presentation.

Conclusions

Results from the survey are being shared broadly. Pilot study data and survey results will inform next steps by the research team and other researchers interested in assessing and improving health of those impacted by the disaster.

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Ian T Cousins (1)
1. Stockholm University, Stockholm, Sweden.

Background

In total, more than 200 use categories of PFAS were identified by Glüge et al. for more than 1400 individual PFAS. In further ongoing work, my research group is developing a database of alternatives for the identified uses of PFAS. For uses of PFAS in consumer products, safer and fit-for-purpose alternatives are often available. However, for some uses of PFAS, often industrial uses, it is claimed by industry that no alternatives to PFAS are currently available. Examples of uses of PFAS that are considered challenging to replace are fluorinated-gases (F-gases) used for refrigeration and the use of fluoropolymers in, for example, lithium ion batteries. It is not surprising that industry protects and defends the continued use of F-gases and fluoropolymers because these PFAS have by far the largest production volumes of any subgroup of PFAS within the PFAS class. Moreover, claims by industry regarding the lack of alternatives for F-gases and fluoropolymers are often overstated.

Methods/Approach

In this presentation, I will demonstrate that, even for these more challenging use cases, safer and fit-for-purpose alternatives are already available.

Results

The risks associated with fluoropolymers and F-gases are, on the other, understated by industry. Fluoropolymer manufacturing results in the emissions of a large number of PFAS into the environment and only a few of these PFAS are currently regulated. Modern F-gases such as hydrofluorolefins add to another environmental problem, namely they degrade to form trifluoroacetic acid (TFA). Although TFA is relatively non-toxic, it has been accumulating in the environment for decades so that regional precipitation levels can sometimes exceed German drinking water guidelines.

Conclusions

One effective solution to both these environmental problems is the phaseout of the many non-essential uses of fluoropolymers and F-gases. The essential uses of fluoropolymers and F-gases are far fewer than currently claimed by the PFAS manufacturing industry.

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Francesco Dondero (1)
1. Department of Science and Technological Innovation, Università del Piemonte Orientale, Alessandria, Italy.

Background

Per- and polyfluoroalkyl substances (PFAS) pose an unprecedented challenge to our society and future generations. Known as "forever chemicals," these compounds resist biodegradation and disperse globally, persisting indefinitely in the environment. Europe has experienced widespread PFAS contamination, including well-known cases like the Veneto Region in Italy, resulting in irreversible pollution of critical resources such as water, air, soil, and food. This contamination exposes individuals to unpredictable health risks and threatens ecosystem functioning.
To effectively address this challenge, we must prepare for PFAS mitigation. The H2020-SCENARIOS project serves as the basis for this presentation, focusing on three research pillars.

Methods/Approach

The first pillar develops user-friendly approaches for detecting PFAS in environmental matrices and human fluids. The second pillar embraces the One Health concept, recognizing the interconnectedness of human and environmental well-being. The third pillar aligns with the European Union's zero-pollution ambition by mitigating PFAS exposure risks.

Results

Significant progress is being made in sensor-based detection methods, such as electrochemical and Raman-based spectroscopic techniques, using PFOA as a test bed. Advanced in vitro 3D cellular models simulate human alveolar regions and intestine models with microbiomes, enhancing our understanding of PFAS effects. A systems toxicology framework categorizes and prioritizes 34 PFAS congeners based on their toxicological dynamics, enabling more sensitive risk assessments for populations near contamination hotspots.
For remediation and risk mitigation, Surface Activity Foam Fractionation shows promise by using air bubbles to strip PFAS to the air/water interface. This method achieves high removal efficiencies, exceeding 99% for legacy PFAS, and shows potential for short-chain PFAS with appropriate amendments.

Conclusions

By exploring these research pillars, the presentation aims to advance our understanding of PFAS, develop effective risk mitigation strategies, and contribute to a future with minimal PFAS pollution.

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Policy/Discussion

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Gretta Goldenman, Founder, Milieu Consulting, Belgium

Background

Regulatory efforts to control exposures to PFAS are gaining momentum in Europe, North America and other regions of the world. Until recent years, policies and regulations on PFAS focused primarily on PFOA and PFOS. But evidence of harmful impacts from other PFAS is growing also, and new approaches are being applied.

Methods/Approach

The presentation will outline the trend of using more comprehensive regulatory approaches to control exposures to PFAS, including consideration of PFASs as a class and how to control impacts over their entire life cycles. For example, the European Union’s drinking water standards include parameters covering groups of PFAS, including for total organic fluorine (TOF). Moreover, the EU is considering a far-reaching restriction under its framework REACH Regulation that will, if adopted, cover all uses of all PFAS, unless specific time-limited exemptions are agreed at EU level. In the United States, regulatory action on PFAS has been mainly at state level, with individual states setting health-based standards and restricting PFAS in certain products. Recently the federal government has stepped up, with USEPA proposing stringent enforceable standards for six PFAS in drinking water. In other regions with significant PFAS production, notably China, regulatory measures to address PFAS contamination and exposures are still lacking. For these middle- and low-income countries, the Stockholm Convention is important, but insufficient to address the thousands of PFAS on the global market.

Results

The various tools available to policymakers and regulators for limiting exposures to PFAS will be reviewed, including health-based quality standards and restrictions on emissions and uses, and their effectiveness analyzed.

Conclusions

The presentation will also discuss some of the challenges facing regulators of PFAS today, including the wide use of PFAS in industries working on the energy transition and the need for alternatives, to prevent lock-in of PFAS-dependent technologies in these areas.

Presenting author profile

Dr. Christiani is the Elkan Blout Professor of Environmental Genetics at the Harvard TH Chan School of Public Health, and Professor of Medicine at Harvard Medical School and Massachusetts General Hospital in Boston. He directs the Environmental and Occupational Medicine and Epidemiology Program at Harvard and has research environmental and occupational diseases with an emphasis on lung disorders.

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David C. Christiani (1,2,3)
1. Harvard TH Chan School of Public Health, Boston, MA, USA
2. Harvard Medical School, Boston, MA, USA
3.Massachusetts General Hospital, Boston, MA USA

Background

Electronic nicotine vaping is of growing concern among youth. In 2019, CDC reported that about 27.5% of US youth vaped; with a slight decline during the pandemic to 19.6%. The cancer causing potential of Electronic Vaping Devices (ENDS) is an area of active research.

Methods/Approach

This presentation will review recent data on the carcinogenic properties of ENDS exposures. Studies have detected a complex mixture of exposures that include a number of carcinogens, including formaldehyde, acetaldehyde, acrolein, benzene, solvents, and nitrosamines. Animal studies, in vitro studies and human biomarker studies are all producing results that will inform carcinogenic risk assessment of these products.

Results

1. Reduce cancer risk.
2, Reduce non-cancer associated toxicity.

Conclusions

Examples may include:
1. Fill knowledge data gaps on cancer risk.
2. Inform policies re restrictions in sales to youth.
3. Policies for warning labels.
4. Public health messaging regarding warnings not to start vaping if never exposed to nicotine products.
5. FDA regulation of all vaping products.
6. Counter tobacco industry claims regarding risk reduction and professed health benefits of ENDS.

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Tushar Kant Joshi (1); Govind Mawari (1); Naresh Kumar (1); M.M. Singh (1)

1. Department Centre for Occupational and Environment Health, Maulana Azad Medical College, New Delhi, India

Background

Controlling air pollution is an overriding priority of the Indian government. During the peak winter period the entire north India, mainly the Indo Gangetic plain, reels under appalling levels of PM 2.5, PM 10 and ozone. The government announced the Air Quality Index (AQI) with six categories in September 2014. Thereafter, a National Climate Action Plan, National Clean Air Programme (NCAP), revision of PM10, PM 2.5, and ozone standards followed.

Methods/Approach

The first Global Burden of Disease Study in 2019 claimed that 1.67 million deaths occurred due to air pollution (95% uncertainty interval 1·42–1·92) This represented 17·8% (15·8–19·5) of overall deaths in India. The significant fraction of these deaths was attributed to ambient particulate matter pollution (0·98 million [0·77–1·19]) and household air pollution due to biomass burning (0·61 million [0·39–0·86]).
Surprisingly, the death rate due to household air pollution were down by 64·2% (52·2–74·2) from 1990 to 2019, but the death rate caused by ambient particulate matter pollution increased by 115·3% (28·3–344·4) and was attributed to ambient ozone pollution which increased by 139·2% (96·5–195·8). Lost output from premature deaths and morbidity due to air pollution accounted for economic losses in 2019 of US$28·8 billion ($21·4–$37·4). The city of Delhi registered the highest per-capita economic loss due to air pollution.

Results

The Graded Response Action Plan (GRAP) implementation led to the improvement of AQI. This paper presents the strategy and its success and failures.

Conclusions

Delhi is the seat of power and a place from where India is administered. To protect the key functionaries and citizens Commission for Air Quality launched an innovative strategy of GRAP (Graded Response Action Plan).

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Nikki Pollo (1)
1. United Steelworkers Tony Mazzocchi Center, Pittsburgh, United States

Background

Workers and their communities face multiple hazards during and after human-made or natural disasters, leaving their health and safety at risk.

Methods/Approach

The United Steelworkers Tony Mazzocchi Center found that workers, which include union and worker center members, their management, day laborers, and their communities, needed more training to prepare for disastrous events. These conclusions were drawn after previous deployments and an interview project conducted during the COVID-19 pandemic. USWTMC’s team of Specialized Emergency Response Trainers (SERTs) have a mission to provide disaster preparedness and mental health awareness training to affected communities, and in the multitude of areas where disastrous events may occur, which lately is anywhere. This proactive focus allowed the SERTs to learn more about the hazards faced, but also to assist workers and communities in preparing for the inevitable next disaster or pandemic.

Results

Workers and communities are at risk for injury and illness caused by disastrous events. Preparedness training can mitigate the consequences. For example, it is imperative that someone who may experience a hurricane or flooding understands the long-term health effects from exposure to mold, as they are likely to be presented with it at their workplace or home. In the short-term, training on which chemicals to use when cleaning up mold and how to use personal protective equipment is necessary to prevent exposure to hazardous chemicals.

Mental health and resiliency training are important to those who have already experienced one or more disastrous events because they are likely to experience more during their lifetime.

Conclusions

Through awards from the National Institute of Environmental Health Sciences, the USWTMC SERTs team can continue their initiative, helping workers and communities with disaster preparedness and response, and mental health awareness. The team will continue to provide outreach and training in regions across the United States, Puerto Rico and Virgin Islands.

Presenting author profile

Dr. Frank, a Collegium Ramazzini Fellow, is a Professor of Public Health and Chair Emeritus of Environmental and Occupational Health and Professor of Medicine at Drexel University. He has studied asbestos related issues for more than 50 years and has more than 100 publications related to asbestos.

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Arthur L. Frank(1)
1. Dornsife School of Public Health of Drexel University, Philadelphia. USA

Background

Asbestos related diseases have been known for more than a century, yet this carcinogenic material is still in wide use around the world. This session will review past, current, and future issues regarding asbestos matters.

Methods/Approach

Still widely used, some countries have banned asbestos while others are attempting bans, and others continue to mine ,sell, and use this material. This set of presentations will review the history of use, past successes and science in dealing with bans, what still needs to be done, and what role law courts have and will yet play in such public health issues. Needed research until disease risks no longer exist will be discussed. Attached are the presentations of the other five presenters.

Results

Recent history has taught us that stopping the use of asbestos does indeed save lives.

Conclusions

There is still the need to have more countries ban the use of asbestos . There is also a continuing need to counter the false science that still too often makes its way into the scientific literature.

Presenting author profile

Since 2004, Linda Reinstein has been dedicated to preventing asbestos exposure and eliminating all asbestos-related diseases. As president and cofounder of Asbestos Disease Awareness Organization (ADAO), Linda leads global strategic educational efforts, engages with lawmakers, and established the influential "Asbestos: Art, Advocacy and Academia" project to drive significant change. ADAO's current focus is the passage of the Alan Reinstein Ban Asbestos Now Act, named after Linda's late husband, Alan, who tragically succumbed to mesothelioma.

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Linda Reinstein (1)
1.Asbestos Disease Awareness Organization, Redondo Beach, CA, USA

Background

Despite the known risks, United States (US) imports and uses asbestos in a number of industries including construction, automotive, and manufacturing. With 20 years of policy and regulatory experience, this presentation explores corporate defiance and its impact on public health, the use of asbestos in the US, and the importance of addressing this issue.

Methods/Approach

Using corporate documents from Borel v. Fiberboard Paper Products Corporation which established accountability and liability in the failure to warn, it will be discussed how misinformation was submitted to the government in attempts to legitimize asbestos imports, use, and negate liability. It will also discuss the role of public health advocacy within Congress and federal agencies. Using the drafting, enactment and implementation of the Lautenberg Chemical Safety Act to reform the Toxic Substances Control Act (TSCA) as an example, it will expose the 21st century corporate playbook, highlighting the obstacles and opportunities overcome through making asbestos a priority in the risk evaluation and management process. Also discussed will be three ADAO v. US Environmental Protection Agency legal wins to advance rulemaking and protection of public health, as will be the legislative efforts regarding the Alan Reinstein Ban Asbestos Now Act of 2023.

Results

These topics have had a profound impact on public health. The implications for this presentation are significant, as it highlights the urgent need for continued activism and regulation to address this issue. There will be a discussion of the best practices for raising public awareness , advocating for stronger regulations and safer alternatives to the use of asbestos, and corporate accountability.

Conclusions

There will be discussion of how to improve data, develop and implement stronger policies and regulations, disseminate educational materials to lawmakers, media, vulnerable communities, and the general public to prevent asbestos exposure to be able to prevent future all asbestos-related diseases.

Presenting author profile

Fernanda Giannasi is a Fellow of the Collegium Ramazzini and past Ramazzini Award recipient. She has been a leader in the fight to have asbestos banned in Brazil.

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Fernanda Giannasi (1)
1. Brazilian Association of the Asbestos-Exposed People (ABREA) / Associação Brasileira dos Expostos ao Amianto (ABREA), Sao Paulo, Brazil

Background

Brazil was, until recently, the third largest producer and exporter of asbestos and the fourth largest consumer of this carcinogen in the world. However, in November 2017, the Brazilian Supreme Court (STF), that had previously catered their decisions to corporate interests, prohibited the use of asbestos chrysotile, the only form still in use in Brazil, radically changing the jurisprudence adopted until then.

Methods/Approach

This presentation focuses on violation of the ban in the state of Goiás, site of Brazil’s last remaining asbestos mine. In total disregard of the court’s decision, the state legislature passed a law to ensure mining for export purposes that has yet to be struck down. This presentation argues this dynamic constitutes an immoral double standard that furthers environmental racism.

Results

There is an urgent need to improve the official Asbestos-Related Disease (ARD) statistics obscured by corporate subterfuge, including extrajudicial agreements and deliberate under-notification. Such maneuvers promote a vacuum or “epidemiological silence”, impeding the adoption of stronger public policy.

Conclusions

Several steps are necessary in the ongoing fight against asbestos in Brazil. First, the Goiás state law must be declared unconstitutional urgently. Second, medical professionals at all levels—from intake, to diagnosis, to palliative care must be better trained to treat and monitor those suffering from ARDs. This monitoring includes compulsory notification of the ARDs and improvement of morbidity and mortality records throughout Brazil. Finally, communities and policymakers must work together to fully decommission asbestos mining sites and remediate lands polluted by this ecological catastrophe promoted by the asbestos industry. These efforts toward environmental justice will only be possible if victims and families affected by asbestos consistently collaborate with watchdog groups to improve monitoring of likely illegal activity moving forward.

Presenting author profile

Dr. Markowitz is a physician specializing in occupational and environmental medicine and is Director of the Center for the Biology of Natural Systems and Professor of Environmental Sciences at Queens College, City University of New York. He currently directs the Worker Health Protection Program, a medical screening program for former Department of Energy workers. He is a Fellow of the Collegium Ramazzini.

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Steven Markowitz (1), Albert Miller (2)
1. Queens College City University of New York, New York, NY USA
2. Icahn School of Medicine at Mt. Sinai, New York, NY USA

Background

Asbestos causes lung and pleural fibrosis and lung, mesothelioma, laryngeal, ovarian, and likely selected gastrointestinal cancers. Prevention of exposure is paramount, but secondary prevention (early detection), tertiary prevention (limiting disease impact) and treatment are of great importance to the many people who have been exposed to asbestos in the past.

Methods/Approach

Randomized clinical trials of occupational disease, including those caused by asbestos, are few to none, necessitating the extrapolation of screening and treatment trials of other diseases or diseases with other causes to occupational diseases. Pirfenidone and nintedanib have been shown to lower functional progression in people with idiopathic pulmonary fibrosis (IPF), a rapidly progressive form of pulmonary fibrosis, but have only been used sporadically in people with asbestosis and other non-IPF pulmonary fibroses. Annual low dose chest computerized tomography (CT) scan is effective at detecting lung cancer at early stages with associated reduction in lung cancer mortality. Low dose chest CT scan is also more sensitive and specific than the chest x-ray in the assessment of asbestos-associated lung and pleural fibrosis. Further reduction in the radiation dose of chest CT scan, increasing availability of CT scanners, and price reduction may promote the periodic use (every 3 to 5 years) of low dose chest CT scan in the surveillance of asbestos-related fibrosis. Neither low dose chest CT scan nor blood, pleural fluid or exhaled breath biomarkers have emerged as valid means of early detection of malignant mesothelioma.

Results

Progress has been achieved in the surveillance and detection of selected asbestos-related diseases, especially its most common cause of mortality, lung cancer.

Conclusions

Identifying and enrolling asbestos-exposed populations in well-organized screening and surveillance programs that use periodic low dose chest CT scanning will reduce lung cancer mortality and promote improved identification of people with asbestos-related fibrosis.

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Miranda Dally (1)
1. University of Colorado, Aurora CO, USA

Background

Climate change has caused annual temperatures to rise worldwide resulting in higher incidence of heat-related illness in the workplace. This is especially true for agricultural workers who work long hours outdoors. Emerging evidence from Italy and Australia suggest that increasing temperatures may also rise occupational traumatic injury rates. These studies leave unresolved (1) the specific impact on agricultural workers in less temperate climates and (2) the specific physiological pathways underlying this relationship.

Methods/Approach

Occupational injuries recorded for the 2014/2015 to 2017/2018 harvest seasons were collected from a large agribusiness employing male sugarcane harvesters in Southwest Guatemala. Wet Bulb Globe Temperature (WBGT) for the same periods were calculated from the El Balsamo weather station in 15-minute increments. Using a Poisson generalized linear model we assessed the relationship between daily average WBGT and reported occupational injury rate. Logistic mixed effects models were used to test the association between average WBGT during hour of the workday and injury occurrence.

Results

We observed a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30°C (95% CI: -6%, 14%). Forty percent of injuries were recorded between 14:00 and 16:00 hours. There was no association between hourly average WBGT and injury occurrence (OR: 1.00; 95%CI: 0.94, 1.05).

Conclusions

In this setting agricultural workers are at an increased risk of occupational injury with increasing daily average outdoor temperatures. This study demonstrates that outdoor temperatures do not independently predict the complex epidemiology of occupational injuries. There is an urgent need to increase occupational injury surveillance, identify the correct measures of heat exposure, and understand the underlying pathways that generate the observed relationship between occupational heat exposure and traumatic injury.

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Miranda Dally (1); Mike Van Dyke (1); Karely Villareal Hernandez (1); Lyndsay Krisher (1), Marcela Tamayo y Ortiz (2), Jim Crooks (3); Diana Jaramillo (1); Lee S. Newman (1)
1. University of Colorado School of Public Health, Aurora, CO, USA
2. Mexican Institute of Social Security, Mexico City, Mexico
3. National Jewish Health, Denver CO, USA

Background

Recent research has suggested a relationship between climate change related increases in temperature and traumatic injuries in the workplace. A major limitation of the research is the ability to disentangle the complex epidemiology of traumatic injuries and elucidate the role of heat in the causal pathway. The Haddon Matrix is a commonly used tool to identify the causal factors related to injury. In this study we demonstrate how a modified Haddon Matrix can be utilized to identify causal factors of workplace injuries.

Methods/Approach

We conducted a mixed-methods analysis of five years of occupational injury records from an agribusiness operating in Veracruz, Mexico. Incidents were self-reported by workers and a narrative description of the accident was recorded by safety personnel. To qualitatively assess the data, we developed a codebook using inductive, data-driven content analysis with a modified Haddon Matrix as our framework. We allowed our codes to focus on causal factors related to human, object, environment, and organization levels that contributed to the injury.

Results

Injuries occurred at a rate of 3.9 per 100 FTE for the study period. The most common injury types were falls (0.7 per 100 full time equivalent (FTE)), entrapment (0.5 per 100 FTE), and extreme temperatures (0.4 per 100 FTE). Qualitative analysis suggested that impeded walkways and building conditions were common causal factors for falls. Extreme heat related injuries were often the result of insufficient use of PPE during welding, while fainting due to climatic conditions was also noted.

Conclusions

This study provides a comprehensive way to consistently collect and analyze data across multiple occupational surveillance systems. There is a need to develop a schematic that can be used as a set of guidelines when taking an occupational injury narrative to provide better insight into the impact climate change will have on occupational injury.

Presenting author profile

Prof. Magnani is an epidemiologist, formerly Professor of Medical Statistics and head of the Cancer Epidemiology Unit at the University of Eastern Piedmont at Novara and before that a researcher at the Cancer Epidemiology Unit at the University of Turin. He also trained in occupational medicine. He has been active in studying asbestos related disease patterns in Casale Monferrato area, in asbestos workers and in the general population.

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Corrado Magnani (1)
1. University of Eastern Piedmont, Novara, Italy

Background

An asbestos cement factory was active from 1907 to 1986, owned by Eternit in Casale Monferrato. Awareness of asbestos related neoplasms, especially mesothelioma in the area arose in the 1980s from clinical reports and epidemiological studies. Studies were conducted first by the Cancer Epidemiology Unit of the University of Turin and later by the University of Eastern Piedmont to investigate mortality and incidence of asbestos-related diseases in workers and their wives. Mesothelioma risk was investigated also in the general population. Mesothelioma incidence in the general population of Casale Monferrato in 2013 – 2017 was 54/100000 in men and 32/100000 (yearly rates, age adjusted over the EU population). Most studies were supported by local and regional administrations. No support, either financial or technical, was ever provided by Eternit.

Methods/Approach

The presentation will review the Casale Monferrato experience.

Results

Asbestos pollution effected not only the workforce but also the resident community at large. In 1986 an impressive remediation program was started. Now Casale Monferrato is a city with no residual asbestos contamination, as confirmed by repeated airborne measurement campaigns. The impressive number of incident mesothelioma cases (some 50 per year) forced the Local Health Authority to devise a specific organization for their diagnosis and treatment. The evidence of disaster and manslaughter led to several court trials.

Conclusions

Community involvement can bring about changes. The citizens of Casale Monferrato, the victims and their families, the Trade Unions and other associations, in close agreement with the City Mayor and the Piedmont region administration, were always determined to stop any attempts to restart asbestos cement production after Eternit closed. An association (AFeVA, Association of Families and Victims of Asbestos) was formed in 1988 and is active to promote awareness on asbestos related risks, demand resources for remediation and therapeutic treatment.

Presenting author profile

Mr. Hartley is an attorney practicing asbestos-related law for many years and currently his firm, of which he is a partner, only handles cases of mesothelioma. His work involves cases all over the United States.

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Christian Hartley (1)
1. Maune, Rachle, Hartley, French and Mudd Law Offices, Mount Pleasant, SC, USA

Background

The unique system of civil justice in the United States, based loosely on the legal premise that money can compensate for injuries, has had both positive and negative effects on the state of public health, both in the United States and worldwide. In addition to the systems for civil compensation, the United States (US) legal system has impacted the regulation of public health and the environmental regulations in positive and negative ways.

Methods/Approach

There will be a review of how science can influence public health.

Results

By its very nature, the US legal system and regulations relating to public health and the environment have trailed the development of medical and scientific knowledge. More recently, wealthy interests have sought to influence civil litigation and regulations through outcome-oriented publications in relation to a variety of exposure, including asbestos. The main issues are the carcinogenicity and potency of chrysotile asbestos for causing mesothelioma. This presentation focused on some positive and negative outcomes that illustrate the positive and negative developments resulting from the interaction between public health and the US legal system.

Conclusions

With honest science public health will be benefitted.

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Andrew Watterson (1)
1. University of Stirling, Stirling, Scotland

Background

Governments, the electronics industry, regulators, at times professionals and trade unions (TUs) have often failed to protect workers and communities in and around chip plants as earlier presentations in this session have demonstrated.

Methods/Approach

The focus is on global and local precautionary and preventive upstream and downstream measures available to better protect chip and other workers and communities along supply and disposal chains. Key principles of workplace and environmental justice are outlined with tools for use at different levels. Earlier successful examples of grassroots resistance to chip working conditions provide an effective downstream multi-pronged template for campaigns to guide us now. Workers, their families, TUs, NGOs, sympathetic occupational health professionals, scientists all played a part. Samsung workers and supporters showed how to hold transnational chip companies and their plants to account for workplace ill-health. Disseminating more information already gathered in Asia and US for example by NGOs and TUs on chips will also be critical.

Results

Workplace justice principles address occupational, health, safety, labour and environmental conditions in ILO and WHO reports and charters. These can underpin initiatives currently being developed by NGOs and TUs in the US and Europe. They will be strengthened by climate change and sustainability campaigns and IPCC and UNEP reports. Fine principles, however, change nothing in chip factories if they are ignored. Some of the most important tools we can adopt relate to those available to either build or further develop TU workplace organisation and community action. These may connect to effective national Fair Work and Toxics Use Reduction policies more detailed green chemistry research.

Conclusions

Opportunities now exist to build stronger alliances between SCI workers, community and environmental groups based on greater knowledge about industry impacts on water resources, air pollution, climate change and the threats from such chemicals as PFAS.

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Ockert Dupper (1)
1. International Labor Organization, Geneva, Switzerland

Background

Vision Zero Fund is a Group of Seven (G7) initiative and is administered by the ILO. The aim of the Fund is to reduce accidents, injuries, and diseases in global supply chains. In 2022, the G7 asked the VZF to address the impact of climate change on occupational safety and health in its project countries with a particular focus on climate change induced heat stress.

Methods/Approach

The Fund has adopted a 4-phased approach to develop, implement, and evaluate appropriate climate change adaptation measures. The first phase involves mapping, assessing, and identifying preventive and protective measures to be implemented by governments, employers, and workers; during Phase 2, the Fund facilitates a process of social dialogue with project stakeholders in line with its collective action approach; third, it supports the implementation of appropriate workplace adaptation measures and related policy and legal reform; finally, the Fund will adapt and expand the model to other countries and supply chains.

Results

The Fund’s work has the potential to protect the health of workers and communities globally through the implementation of appropriate policies, regulations, and workplace adaptation measures in line with international labor standards and with the active involvement of governments, employers, and workers.

Conclusions

It is recognized that there is no “one size fits all”. Policies and programs to address the impact of climate-change-induced heat stress on workers’ health and safety need to be designed in line with the specific conditions of countries, including their stage of development, economic sectors and types and sizes of enterprises. The Fund intends to use its convening power to bring global stakeholders together to reflect on lessons learned, facilitate knowledge exchange, and promote good practices.

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Shoji F. Nakayama (1); Tippawan Prapamontol (2)
1. National Institute for Environmental Studies, Tsukuba, Japan
2. Chiang Mai University, Chiang Mai, Thailand

Background

National Institute of Environmental Health Sciences of the United States (NIEHS) and the National Institute for Environmental Studies of Japan (NIES) have been collaborating to improve national and global capacity for disaster research response (DR2) to reduce the health impacts from disasters for at-risk populations. Wildfires, one of the common disasters all over the world, present threats not only to the public, but also to first responders, firefighters, farmers, and other exposed workers. NIES has been collaborating with the Chiang Mai University to elaborate the risk of smoke haze on community in northern Thailand.

Methods/Approach

During the smoke haze season, from February to April, people in the vicinity community have a special mission to volunteer to cope with the fires and are referred to as community fire fighters. A cross sectional study was conducted just after smoke-haze pollution on around May 2019. The fire fighters were recruited from 10 villages of northern Thailand. Questionnaires were used for data collection such as demographic status, firefighting and health status. Approximately 50 ml of a spot urine sample was collected at recruitment for oxidative stress biomarker (MDA) metabolite analysis. Particulate matter (PM) was analyzed for metals, polycyclic aromatic hydrocarbons, ions and oxidative potentials to perform source apportionment.

Results

Sixty participants including equal numbers of firefighters and non-firefighters were included in the study. Firefighters had a significantly higher prevalence of difficulty in breathing. PM2.5 and PM10 levels were associated with oxidative stress (MDA) among firefighters. The community was affected by the wildfires.

Conclusions

Community firefighters were affected by their work on wildfire fighting. The research led municipal officials to provide community volunteers with personal protection equipment. DR2 can be an effective tool to enable public officials to make evidence-based decisions.

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Mitchel A. Rosen (1); Janelle Rios (2)
1. Rutgers University, New Brunswick, NJ, USA
2. University of Texas Health Houston, Houston, TX, USA

Background

Climate change is a pressing global issue that significantly impacts aspects of work and disproportionately impacts some workers. Disproportionately impacted workers often face economic, social, and political disadvantages and are particularly susceptible to the adverse impacts of our changing climate.

Methods/Approach

Disproportionately impacted workers often respond to disasters caused by climate change. Increasing hurricanes, tornados, wildfires, and winter storms lead to devastation and destruction requiring significant person-power to respond and recover. These workers face known and unknown hazards with limited or no training to cleanup mold-infested homes, clear hazardous debris, and help recover from impacts of the disaster.

This presentation will discuss how climate change exacerbates existing inequalities, widening the gap between privileged and marginalized groups. Disproportionately impacted workers, such as those engaged in informal or low-wage sectors, are more likely to experience negative impacts due to limited access to resources, social protection, and decision-making power. They often work in sectors heavily influenced by weather conditions, such as agriculture, fisheries, and construction, making them more vulnerable to extreme weather events and rising temperatures, impacting health and well-being. Increased heat impacts physical health and mental cognition, increases illness and injuries, and spreads vector-borne diseases. Additionally, the psychological toll of climate-related disasters, displacement, and uncertainty about the future contribute to mental health issues among this population.

Results

Addressing the impacts of climate change on disproportionately impacted workers requires a comprehensive approach that integrates social, economic, and environmental interventions, including a focus on enhancing social protection measures, promoting sustainable and inclusive economic development, providing access to education and training, and ensuring meaningful participation and representation of disproportionately impacted workers in decision-making processes.

Conclusions

Utilizing examples of training materials, educational resources, and lessons learned developed by NIEHS Worker Training Program grantees, this discussion will assist others to develop strategies for protecting disproportionately impacted workers from climate impacts.

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Kevin Riley (1); Arturo Archilla (2)
1. University of California, Los Angeles, California, USA
2. United Steelworkers Union/Labor Institute, New York, New York, USA

Background

Changing climate patterns have led to increased temperatures and more severe weather events in many parts of the world, with migrant workers often among the populations at high risk for exposures to these environmental hazards.

Methods/Approach

This presentation will examine the impacts of climate-related hazards on migrant workers in the United States, many of whom face elevated climate-related occupational risks in the cleanup and rebuilding efforts by virtue of sociodemographic characteristics, work settings, and/or informal employment arrangements. We will consider how regulatory and policy measures can play a role in addressing the needs of these workers while protecting their rights. The presentation will highlight three policy models in the current U.S. context – OHS standards that establish requirements for employers to follow; access to training that informs workers about their rights and protections and focuses on specific high-risk hazards in the workplace around safety and health; and immigration reform measures extended to workers who experience violations of state and federal labor law. We will also discuss proposed measures for migrant communities that can support climate-displaced workers and just transition initiatives.

Results

The presentation helps to address some of the vulnerabilities and labor abuses including retaliation faced by migrant workers in the work settings and shares remedies provided to these workers. We will note the role that academic programs, community organizations and labor organizations can play in supporting these policy measures, focused on addressing the risks faced by workers when raising health and safety concerns in the workplace and the importance of required safety and health trainings to create awareness of workers’ rights and protections.

Conclusions

We will consider lessons learned from efforts with migrant climate workers in the United States that can be extended to other regions of the world.

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Panayiotis Kouis (1); Emmanouil Galanakis (2); Paraskevi Kinni (1); Eleni Michaelidou (2); Antonis Michanikou (1); Helen Demetriou (2); Souzana Achilleos (3); Pinelopi Anagnostopoulou (1); Konstantinos Pitsios (1); Stefania I. Papatheodorou (4); Petros Koutrakis (4); Panayiotis K. Yiallouros (1)

1. Medical School, University of Cyprus, Nicosia, Cyprus
2. Medical School, University of Crete, Heraklion, Greece
3. University of Nicosia Medical School, Nicosia, Cyprus
4. Harvard TH Chan School of Public Health, Boston, MA, USA

Background

Desert dust storms (DDS) are associated with reduced precipitation and are possibly increasing with climate change. Exposure to DDS is known to exacerbate childhood asthma. The MEDEA randomised trial assessed the impact of indoor air filtration and outdoor exposure reduction recommendations on control of childhood asthma during high DDS season in Cyprus and Greece.

Methods/Approach

Schoolchildren with asthma aged 6-11 years were randomised into three groups: (a) No Intervention (controls) (b) Outdoor Intervention (early warning dissemination, guidance to stay indoors and limit outdoor physical activity), (c) Combined Intervention (same as (b) in combination with indoor air purification in households and classrooms). Monthly asthma symptom control was quantified using the childhood Asthma Control Test (c-ACT), while lung function (FEV1, FVC) and Fractional exhaled Nitric Oxide (FeNO) were assessed at the start, middle and end of study period.

Results

A total of 182 children with asthma (mean age: 9.5 years) completed the study. Outdoor intervention significantly reduced time spent outside classrooms and homes, between non-DDS and DDS days by -62.4 min (p-value<0.001), in comparison to 37.2 min (p-value=0.098) in the control group. Indoor intervention led to significantly lower indoor PM2.5 and PM10 concentrations in comparison to the control group, for both the non-dust (PM2.5: 55% less, PM10: 48% less) and desert dust (PM2.5: 47% less, PM10: 40% less) days. By the end of the study period and compared to controls, the combined intervention group demonstrated significant improvement in cACT (β: 2.63, 95%CI: 0.61-4.65, p-value=0.011), FEV1% predicted (β: 4.26, 95%CI: 0.35-8.17, p-value=0.033) and FVC1% predicted (β: 3.88, 95%CI: 0.11-7.64, p-value=0.044), but no change in FeNO.

Conclusions

During high DDS season, exposure reduction recommendations, especially indoor air purification, have been proved effective to improve asthma control in children. This evidence can inform decision-making and strategic planning for mitigation of DDS health effects in Mediterranean Europe.

Presenting author profile

Dr. Lucchini is an MD, Professor of Occupational and Environmental Medicine at the University of Modena and Reggio Emilia, Italy, and Florida International University. His research interests are on the brain impacts from neurotoxicants across the life course. He investigates children, workers, elderly and patients with neuro-degenerative disorders residing in industrial areas of Italy, and the 9/11 responders who were impacted by the exposure to neurotoxic chemicals and intense psychological trauma.

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Roberto Lucchini (1, 2); Alessandra Patrono (3); Giuseppa Cagna (3); Stefano Renzetti (3); Marco Peli (3); Donatella Placidi (3)
(1) University of Modena and Reggio Emilia, Reggio Emilia, Italy
(2) Florida International University, Miami, FL, USA
(3) University of Brescia, Brescia, Italy

Background

The city of Taranto lies in the South of Italy and its port delivers raw material to the largest steel plant of Europe. Mixed exposure to neurotoxic metals measured in biomarkers and environmental media was associated to impaired neurodevelopmental functions in previous studies and is inversely related with distance from point sources.

Methods/Approach

Six hundred (600) children aged 6-15 years were examined with neurobehavioral testing assessing learning abilities, attention, behavior, socioeconomic status (SES), biomonitoring and environmental measures. The exclusion criteria included existing clinical diagnosis of neurodevelopmental disturbances. Nevertheless, the neuropsychological assessment revealed that 92 children (15.3%) exhibited borderline scores indicating potential for clinical diagnosis. The families were informed and referred to the children's neuropsychiatric department of the local public hospital for clinical evaluation.

Results

The clinical suspicion was confirmed for 63 cases (10.5%). Only 21 children were immediately examined with diagnostic protocols. For the remaining ones, the families avoided or delayed the clinical assessment for months, in some cases forced by the schools that reported the observation of disturbances. The majority of the 92 clinical cases are residing in the neighborhood closest to the point emissions that also show the lowest SES levels. Treatment conducted in the early stages resulted in substantial improvement and regression.

Conclusions

Clinical neurodevelopmental impacts associated to environmental exposure to neurotoxicants were observed in addition to evidence of early non-clinical changes. Unrecognized disturbances represent a major problem that must be approached with substantially increased communication and awareness about the need to recognize potential deficits, so that early treatment can be mostly effective. The interaction between exposure and SES data will be further analyzed to yield the most appropriate public health interventions.

Presenting author profile

Prof Joanna Jurewicz is the head of the Department of Chemical Safety, Nofer Institute of Occupational Medicine, Lodz, Poland

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Joanna Jurewicz (1), Małgorzta Kupczewska-Dobecka (1), Katarzyna Konieczko (1)
1. Nofer Institute of Occupational Medicine, Lodz, Poland

Background

Endocrine disrupting compounds are substances that have the ability to interact with the endocrine system by interfering with its proper functioning, leading to disorders in the synthesis, function and/or metabolism of hormones and may have a negative impact on health. These compounds belong to a broad group called in the English literature "endocrine disrupting chemicals" (EDCs). The increase in global industrial activity has led to increased exposure of people to a wide range of modern endocrine disrupting chemicals such as phthalates, bisphenol A, triclosan, polybrominated diphenyl esters and many others. Due to mass production, these compounds can be found in the work environment, but also commonly in the natural environment. Exposure occurs through contact with these compounds in food, water, air, through contact in the production of plastics, cosmetics or pesticides. Due to the fact that these are new compounds, which are to a small extent regulated by law, it becomes important to know their properties and their impact on health.

Methods/Approach

A review of epidemiological studies on the impact of selected EDCs on health in terms of occupational and environmental exposure will be presented. In addition, information on sources of exposure, occurrence, properties, registration, legal regulations and OEL values in Poland for these compounds has been collected.

Results

Knowledge about the impact of factors from the group of endocrine disrupting chemical is still limited. Only in the case of some of the chemicals we have data that unequivocally show a negative impact on human health.

Conclusions

Due to the widespread exposure, there is a need for a reliable risk assessment and the introduction of possible regulations regarding the use of these compounds.

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Albert. Manville (1); Blake Levitt (2); Henry C. Lai (3)
1. Johns Hopkins University, Washington DC Campus, United States
2. National Association of Science Writers, Berkeley, CA, United States
3. University of Washington, Seattle, United States.

Background

From 1980 to the present, we’ve witnessed at least a 70-fold increase in ambient nonionizing electromagnetic fields (EMF), and growing. While there is only limited field research on effects of nonionizing EMF on wildlife, including on birds and bats, many negative effects from EMF have been observed in laboratory research animal models. The results can be extrapolated as predictors to wildlife. The biological effects of EMF have been seen broadly across all taxa, including at low intensities. EMF exposures are growing exponentially, found in virtually all habitats from urban to rural to wilderness.

Methods/Approach

In a cutting-edge, 3-part paper published in 2021 by Levitt et al. in Reviews on Environmental Health, we summarize the key findings about impacts to birds and bats from nonionizing EMF, including next steps to begin addressing the impacts and ideally reversing some of the problems.

Results

While there is much yet to learn about effects of nonionizing EMF on wildlife, we already know much about radiation impacts, a subject of growing concern.

Conclusions

1. Continue to fill data gaps through peer-reviewed and rigorous scientific research — including in the field — and use the extensive amount of peer-reviewed, published information already available to the public to affect wildlife and environmental policy.
2. Get the U.S. Federal Communications Commission and all affected U.S. Federal agencies to conduct meaningful and rigorous scientific reviews of the known and suspected impacts of electromagnetic fields (EMF) on wildlife which could also improve human health and safety. These should include Environmental Impact Statements detailed under the U.S.'s National Environmental Policy Act.
3. Develop guiding principals for wildlife, especially for Threatened and Endangered/imperiled species and threatened habitats, that develop and implement human radiation safety standards "as low as reasonably achievable" (ALARA).

Presenting author profile

Dr Inoka Suraweera graduated from the Faculty of Medicine, University of Colombo, with second class honors. She holds Masters and Doctoral Degrees in Community Medicine from the University of Colombo. She had post-doctoral training at Monash Centre for Occupational and Environmental Health, Australia. She is currently Consultant Community Physician and technical head of the Environmental and Occupational Health Unit of the Ministry of Health and actively engaged in undergraduate and postgraduate medical education.

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Inoka Suraweera (1)
1. Ministry of Health, Colombo, Sri Lanka

Background

Proper management of healthcare waste is an essential component in the provision of quality patient care. Its mismanagement poses a significant threat to public and environmental health and Sri Lanka is no exception.

Methods/Approach

An assessment was conducted to understand the methods, challenges and the way forward in healthcare waste management in the health sector in Sri Lanka using desk reviews, focus group discussions, checklists, questionnaires and field visits.

Results

Healthcare waste management has been identified as a programme under the environmental health programme of the Ministry of Health. The Environmental and Occupational Health Unit provides technical guidance for national and sub-national level healthcare settings in this regard. Policy, guidelines, national and subnational level action plans are available for management of healthcare waste. Capacity building programmes, audits and reviews are being conducted.

Gaps have been identified in the areas of financial allocations for waste management, final disposal of infectious, sharps and mercury waste, healthcare waste management infra-structure, information management, inter-sectoral coordination, and complying with regulations pertaining to its management. Food waste, and inadequacies in sewerage and waste water management are identified as significant issues needing urgent attention.

Conclusions

Healthcare waste management should be considered a priority in the health sector. Every effort should be made to reduce the waste generation. Costs associated with its mismanagement should be calculated and presented to obtain the support for its management since it is considered a competing priority especially in resource poor settings.

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Eva Schernhammer, MD, DrPH (1,2,3)
1. Center for Public Health, Medical University of Vienna, Austria.
2. Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
3. Harvard T.H. Chan School of Public Health, Boston, MA

Background

Aspartame, which has been widely used as an artificial sweetener since the mid 1980s, has a long history of debate surrounding its potential carcinogenic effects.

Methods/Approach

Starting in 2022 and culminating in an expert meeting in Lyon, France, in June 2023, the International Agency of Cancer Research (IARC) set out to assess aspartame’s carcinogenicity as part of their Monograph program. As typical in these Monographs, the evaluation of a given exposure with potential carcinogenic effects, such as aspartame, was based on three main pillars: (1) evidence from animal studies, (2) from human studies, and (3) supporting mechanistic evidence.

Results

In this presentation, the processes and decisions underlying each of these three pillars will be discussed with a specific emphasis on human studies. Strength and limitations of the major contributing human studies, and surrounding considerations pertaining to the exposure definitions of the respective studies, along with the potential for bias in these observational studies aim at providing a succinct summary of the factors that led to the decisions reached during this Monograph meeting.

Conclusions

The presentation will conclude with recommendations for future studies addressing the association between aspartame use and cancer risk.

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Anna Longo (1), Laura Antonangeli (1), Vittorio Bordoni (1), Claudio Colosio (2)
1. Università degli Studi di Milano, Milano, Italy
2. University of Milano, and Saints Paolo and Carlo University Hospital, Milano, Italy

Background

During the COVID-19 pandemic the public health system became a source of renewed and modified occupational risks, not only biological, but also psychological, related to the very high burden of work affecting health care personnel. The goal of this study was to analyze the variables that influenced the development of the pandemic and its control, with particular attention to the role of occupational medicine in a university hospital of Milano.

Methods/Approach

We evaluated variation in the incidence, sources and severity of the infection in the workers of the Santi Paolo e Carlo Hospital of Milan considering the period between March 2020 and December 2021, describing the preventive measures adopted and their results.

Results

In the “first wave” the infection originated almost exclusively within the hospital, from worker to worker, whilst in the second wave the extra-hospital component progressively increased, due to factors such as greater availability of personal protective equipment, information/training initiatives for workers, screening programs and contact tracing. Finally, the introduction of the COVID-19 vaccination brought a significant reduction of the infection compared to the general population: risk and severity were higher outside the hospital. Since the beginning of the pandemic, our Occupational Health (OH) Unit created, together with the Psychological Unit, “Decompressing Rooms” where the workers had the possibility of relaxing, listening music and watching movies of landscapes and wild life. The possibility of having talks with the psychologist was also created.

Conclusions

Occupational medicine has actively participated in risk assessment and management in close collaboration with the hospital manager, the prevention and protection service and the psychological Unit. The pandemic was really a unique chance to show to the workers s substantial role of OH in health prevention instead of a bureaucratic role of only ascertainment of fitness to work of the employees according to law requests.

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Mark Sherlock (1); Martins Dada (1); Jean Christophe Dolle (1)

1. Médecins Sans Frontieres, Amsterdam, The Netherlands

Background

Médecins Sans Frontières (MSF) plays a crucial role in responding to infectious disease outbreaks, safeguarding the health and well-being of both their staff and the communities they serve. MSF has extensive experience in providing healthcare in challenging environments. This presentation focuses on MSF's duty of care approach and its significance in infectious disease outbreaks, with a specific focus on the Ebola virus.

Methods/Approach

This presentation examines the comprehensive duty of care framework implemented by MSF in the context of infectious disease outbreaks. It delves into the preventive, mitigation, and protective measures undertaken by MSF to support their collaborators exposed to work-related risks during their assignments. The content highlights the continuous monitoring of risks, raising awareness among staff, and managing risks within the organization's capacity.

Results

Infectious disease outbreaks pose significant threats to the health and safety of both humanitarian workers and the affected communities. The presentation discusses the specific health risks faced by MSF staff, including potential exposure to the virus, mental health challenges, and the impact of working in resource-constrained settings. The threats to the health of both staff and patients during these outbreaks emphasize the need for effective duty of care measures.

Conclusions

MSF's duty of care approach offers valuable insights into best practices for ensuring the health and safety of both staff and patients. This presentation contributes to the solution by highlighting the importance of continuous risk assessment, awareness raising, and risk management strategies. It emphasizes the need for balancing compliance with rules and regulations while maintaining an environment that enables informed risk-taking.

By examining MSF's duty of care approach in infectious disease outbreaks, this presentation aims to provide a comprehensive understanding of the challenges faced by humanitarian organizations and the measures taken to protect the health and safety of their staff and patients.

Presenting author profile

Dr. Robert Harrison is Clinical Professor of Medicine at the University of California, San Francisco where he has been teaching occupational specialists and designing and implementing health care worker safety and health programs.

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Robert Harrison (1)
1. University of California, San Francisco, CA, USA

Background

Airborne infection with COVID-19 from workplace exposure caused one of the largest occupational diseases in modern history, with thousands of workers infected and dying worldwide. Principles of worker protection with the hierarchy of controls were often inadequate or ignored by many employers, including necessary ventilation, respiratory protection, testing and paid sick time.

Methods/Approach

California is the largest State in the United States, ranking 6th in the global economy with over 18 million workers. The California Occupational Safety and Health Administration (Cal/OSHA) Aerosol Transmissible Diseases (ATD) standard was adopted in 2009 to protect employees who are at increased risk of contracting airborne infections due to their work activities. Starting in November 2020, California approved Cal/OSHA emergency temporary standards on COVID-19 infection prevention. These standards embody principles of worker protection with comprehensive employer duties to provide a workplace free from infectious diseases. In addition, labor standards provided for paid sick time for many workers.

Results

Although work-related COVID-19 outbreaks occurred throughout high-risk industries in California, the California ATD standard provided an important framework for improving worker protections and enforcing the employer duty of care. Specific workplace standards and guidance globally to prevent work-related infections should be a critical element of planning for the “next pandemic”.

Conclusions

Multiple gaps in workplace health programs were evident during the pandemic in California, including on-site trained industrial hygiene, nursing and medical personnel; free and accessible testing resources; data tracking systems for occupation and industry; and public health outbreak investigation teams. Enforceable ATD standards must be accompanied by robust government, academic, employer and worker capacity to reduce work-related infections and deaths.

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Roberta F. White (1)
1. Boston University, Boston, MA, USA

Background

Assessment of brain damage caused by exposures to toxicants has historically been a challenge, especially for subclinical or preclinical effects. However, understanding such effects is of great public health importance in protecting the central nervous system (CNS) health of children and adults. Assessment of exposure-related effects on brain structure and function has been greatly enhanced by the application of the knowledge and tools associated with cognitive neuroscience and its antecedent and associated fields These include behavioral neurology, neuropsychology, behavioral psychometric methodology, and neuroimaging.

Methods/Approach

This presentation provides an overview of the application of the methods developed by these fields to epidemiologic research into understanding neurotoxicant effects. We will begin with a brief overview of the evolution of the application of specific types of cognitive neuroscientific knowledge and methods to answer these questions. We will review the different but now converging methods applied to research on environmental exposures during neurodevelopment and occupational and environmental exposures in adults.

Results

These will include behavioral observations, psychometric testing, and various types of neuroimaging. These methods will be compared with regard to their sensitivity for etiologic research into the existence and structural brain determinants of neurotoxicant effects. In addition, clinical versus research applications will be compared.

Conclusions

Their utility for effective public health messaging concerning the dangers of neurotoxicant exposures will be considered. Finally, future directions for enhancement of cognitive neuroscience tools will be discussed.

Presenting author profile

Dr. David Prezant is the Chief Medical Officer for the Fire Department of the City of New York and the Special Advisor to the Fire Commissioner for Health Policy. Dr. Prezant received his BS from Columbia College and his Doctor of Medicine from the Albert Einstein College of Medicine. He continues as a Professor of Medicine at the Albert Einstein College of Medicine and a pulmonary physician at Montefiore Medical Center.

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David Prezant (1)
1. World Trade Center (WTC) Health Program; New York City Fire Department (FDNY) , Brooklyn, New York, USA

Background

Exposure to dust/smoke from the World Trade Center (WTC) attack caused increased rates of pulmonary and cancer illnesses in FDNY rescue and recovery workers. 10% of the cohort experience greater than twice the age-related decline in lung function (FEV1). We compared disease incidence and mortality rates in WTC-exposed FDNY firefighters with (1) similarly healthy, non-WTC-exposed/non-FDNY firefighters, and (2) the general population.

Methods/Approach

10,786 male WTC-exposed FDNY firefighters and 8,813 male non-WTC-exposed firefighters from other urban fire departments who were employed on 9/11/2001 (9/11) were included in the analyses. Only WTC-exposed firefighters received health monitoring via the WTC Health Program. Follow-up began 9/11/2001 and ended at the earlier of death date or 12/31/2016. Death data were obtained from the National Death Index, and demographics from the fire departments. We estimated standardized mortality ratios (SMRs) in each firefighter cohort vs. US males using demographic-specific US mortality rates. Poisson regression models estimated relative rates (RRs) of all-cause and cause-specific mortality in WTC-exposed vs. non-WTC-exposed firefighters, controlling for age and race.

Results

Between 9/11/2001-12/31/2016, both cohorts had reduced all-cause mortality compared with US males (SMR[95%CI]=0.30 [0.26-0.34] and 0.60 [0.55-0.65]) in WTC-exposed and non-WTC-exposed, respectively). WTC-exposed firefighters had lower rates of all-cause mortality (RR=0.54, 95%CI=0.49-0.59) and cancer-, cardiovascular- and respiratory disease-specific mortality compared with non-WTC-exposed firefighters. For WTC-exposed FDNY firefighters, those with FEV1 decline ≥64 ml/year had higher all-cause (HR=2.91; 95% CI=2.37-3.56) and cancer-cause mortality (HR=2.68; 95% CI=1.90-3.79).

Conclusions

Both firefighter cohorts had lower than expected all-cause and cancer-related mortality rates than the general population. Baseline and longitudinal lung function decline were associated with increased risk of all-cause and cancer-cause mortality. Further investigation is needed to define the pathways by which WTC-exposure, firefighting, the healthy-worker effect and greater access to free health monitoring/treatment interact to affect incidence and mortality rates.

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Alessandro Marinaccio (1)
1. Italian National Workers Compensation Authority, Rome, Italy

Background

Italy issued an asbestos ban in 1992 and a national mesothelioma registry has been progressively established for monitoring the occurrence of mesothelioma cases and conducting a case-by-case evaluation of asbestos exposure.

Methods/Approach

The Italian mesothelioma registry (ReNaM) is an epidemiological surveillance system, organized as a network of regional operating units (COR). The CORs actively search and register incident cases from healthcare services that diagnose and treat cases. Occupational history, lifestyle habits, and residential history are investigated using a standardized questionnaire. From ReNaM archives, all mesothelioma cases with occupational exposure as firefighters have been selected and analysed, focusing on the demographic, clinical and occupational characteristics.

Results

In ReNaM, 49 MM cases in firefighters are present (among the collected case-list of more than 30,000 mesotheliomas between 1993 and 2018). Median age at diagnosis is 64 years old and all cases are males and histologically confirmed). Almost all cases are in the pleural form (1 and 1 case for the peritoneal and pericardial forms).The modalities of exposure have been assessed qualitatively, by the means of a direct interview (36 cases, 73.5%) or of indirect interview (to a next of kin). The presence of asbestos in the protective suits and anti-fire overalls and blankets has been proven and extensively reported in the anamnestic analyses of the mesothelioma patients with an occupational period of work as firefighters. Gloves containing asbestos has been frequently in use until 1992.

Conclusions

The epidemiological mesothelioma surveillance is a fundamental tool for producing scientific knowledge, for supporting the effectiveness of the insurance and welfare systems, and for contributing to the asbestos exposure prevention policies in countries where asbestos has been banned. There is a need to improve the epidemiological surveillance of the asbestos related diseases in the countries where asbestos is still used.

Presenting author profile

Ellen Kessler, MD, MPH, FACP FACOEM is the past Medical Director of Inova Occupational Health Services in Fairfax County, Virginia. She brings more than 25 years of occupational health experience and directorship and is board certified in occupational medicine and internal medicine. Dr. Kessler received her medical and internal medicine residency training from Georgetown University. She completed an MPH and her occupational medicine residency at the Johns Hopkins Bloomberg School of Public Health.

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Ellen R. Kessler (1), MD, MPH, FACP, FACOEM

1. Inova Occupational Health Services, Ashburn, Virginia, USA

Background

Occupational exposure as a firefighter causes cancer, as recently determined by the International Agency for Research on Cancer. However, there are no uniform guidelines for cancer screening in firefighters. The US Preventive Services Task Force addresses cancer surveillance for the general population but has not directly acknowledged that the firefighter population warrants a more enhanced approach. As a result, the cost of screening for some cancers at an earlier age or employing more novel testing modalities will not typically be covered by the firefighter’s health insurance.

In the US, some jurisdictions have the financial resources to provide their members with enhanced cancer screening as part of a comprehensive annual physical. There are also companies that travel to the jurisdiction and provide targeted ultrasound imaging (Thyroid Ultrasound • Liver, Gall Bladder, Spleen, & Kidney Ultrasounds • Bladder Ultrasound • Pelvic Ultrasounds for Women (Ovaries and Uterus) • Prostate and Testicular Ultrasounds for Men). To date, the potential for false positive and false negative results have not been fully evaluated

Methods/Approach

Below are some jurisdictions with enhanced cancer screening and preliminary outcomes:
• Fairfax County, Virginia
• Phoenix, Arizona
• Boston, Massachusetts
• New York City, New York

Results

Inova is Northern Virginia’s leading nonprofit healthcare provider. The Inova Health System’s Occupational Medicine Department is working in partnership with the Hospital System’s Schaar Cancer Institute and its cancer wellness center (Saville Center) and firefighter cancer researchers to develop a tiered approach to firefighting cancer screening based upon family risk, years in service and age.

Conclusions

The screening is open to all career firefighters and funding will be via a combination of the firefighter’s private insurance, the use of available data from the annual firefighter exam and contributions from a private foundation. The number of enrollees is expected to be at least 200.

Presenting author profile

Dr. Hales is a senior medical epidemiologist with the CDC – NIOSH and a member of CDC’s emergency response team. For the past 10 years, Dr. Hales has been the Team Leader of the NIOSH Firefighter Program-Cardiovascular He received his BA from Stanford University, his MD from Case Western Reserve University in Cleveland, Ohio, and his MPH from University of California – Berkeley in epidemiology. He is board certified in internal medicine and occupational/environmental medicine.

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Thomas R. Hales (1)

1. National Institute for Occupational Safety and Health (NIOSH), Denver, Colorado, USA

Background

Between 2014 and 2020, the National Institute for Occupational Safety and Health (NIOSH) published three research papers examining the potential association of firefighter service and cancer. The most recent paper, published in 2020, updated the mortality experience of 29,992 urban career firefighters in the United States (US) compared with the US general population and examined exposure-response relationships within the cohort.

Methods/Approach

The vital status was obtained of firefighters from three large urban departments employed since 1950 and followed through 2016. The cohort mortality compared with the US population was evaluated via life table analyses. Exposure-response associations between select mortality outcomes and exposure surrogates (exposed-days, fire-runs and fire-hours) were analyzed using the Cox proportional hazards regression. Models were adjusted for a potential bias from healthy worker survivor effects by including a categorical variable for employment duration.

Results

Compared with the US population, mortality from all cancers, mesothelioma, non-Hodgkin's lymphomaand cancers of the esophagus, intestine, rectum, lung, and kidney were modestly elevated. Positive exposure-response relationships were observed for deaths from lung cancer, leukemia, and chronic obstructive pulmonary disease.

Conclusions

The 2020 update confirms previous NIOSH findings of excess mortality from all cancers and several site-specific cancers, as well as positive exposure-response relations for lung cancer and leukemia. These findings were reviewed by the IARC expert panel evaluating the carcinogenicity of occupational exposure as a firefighter.

Presenting author profile

Mr. Duffy has been involved with worker occupational health and safety issues for over 45 years. In January 2013, he retired from the International Association of Firefighters after 36 years of service. He was responsible for the all the IAFF’s activities addressing occupational medicine, safety and health. He holds BS degrees in environmental health and in business management from Davis and Elkins College and a MS in occupational and environmental health sciences from Hunter College.

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Richard Duffy (1)

1. International Association of Firefighters (retired). Washington, DC, USA

Background

The profession of firefighting is and has always been a hazardous occupation. Firefighter line-of-duty fatalities have ranked firefighting among other publicized hazardous occupations in the private sector. Every emergency situation encountered by a firefighter has the potential for exposure to carcinogenic agents. The list of potential carcinogenic agents to which firefighters can be exposed is almost as long as the list of all known or suspected carcinogens. Firefighters are exposed to toxic and carcinogenic substances at fire scenes as well as other emergencies such as hazardous chemical events. Further, they experience exposures to carcinogens in their fire stations as well as from their protective clothing. The long-term health effects of exposures may not be apparent to firefighters until after the memory of such incident or exposure. Despite the ominous risk of exposures, firefighters enter potentially toxic atmospheres without adequate protection or knowledge of the environment.

Methods/Approach

Firefighters continue to respond to the scene to save lives and reduce property damage without regard to the potential hazards that may exist. A fire emergency is an uncontrolled environment that is managed by firefighters using personal protective equipment that is often inadequate. The experience is not only physically demanding, but also involves exposures that are known to cause cancer. The nature of these exposures continues to be defined.

Results

We have assembled a group of experts that have defined the nature of many of these exposures and have assisted in the development of firefighter occupational health programs to address the firefighter cancer experience.

Conclusions

We have assembled a group of experts that have defined the nature of many of these exposures and have assisted in the development of firefighter occupational health programs to address the firefighter cancer experience.

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Jeffrey Stull (1)
1. International Personnel Protection, Inc., Austin, Texas, USA

Background

Firefighting and other forms of emergency response often involve a wide range of severe hazards under mainly uncontrolled, dynamic, and diverse exposure conditions. Over the last several decades, the personal protective equipment (PPE) items worn by fire fighters and other first responders have evolved with a changing focus on different requirements that address current and emerging threats, different mission responsibilities, and operational expectations. The priorities for protection have generally been established by successive versions of consensus standards that balance responder needs with available technology, but have become increasing complex as new hazards are given greater attention.

Methods/Approach

A short history of fire fighter PPE evolution in North America will be presented that shows how PPE technology has advanced through a series of significant changes based on what were perceived to be the principal protection needs and how current concerns related to minimizing exposure hazards leading to cancer and other serious health issues has now become one of the paramount issues facing emergency services. The specific impacts of selected research on PPE standards will be highlighted with insights as to how contemporary exposure concerns now warrant tradeoffs for balancing protection, functionality, and long-term health.

Results

The comprehensive revision of requirements in existing standards related to PPE manufacture, its selection and use, and overall care and maintenance is perceived to provide one of the best means to address contamination control. Part of this approach must entail a reanalysis of current criteria to better inform PPE design and performance that is coupled with practical, health-based operating practices that do not compromise protection from acute and chronic exposure threats.

Conclusions

A specific multi-step approach for revising standards is recommended to establish optimized forms of PPE that better account for cancer and disease causative factors.

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Brian Mason (1); Marissa Snapp (1)
1. Shoshone Paiute Tribes, Owyhee, NV, USA

Background

Often referred to as the “Green Economy,” extraction of minerals to fuel low-carbon energy can have negative effects on the rights of Indigenous Peoples. The Shoshone Paiute (Sho-Pai) Tribes have seen firsthand the impacts of mining dating back to the creation of the U.S. State of Nevada. This region is now ground zero for lithium extraction in the US. Lithium is critical for electric vehicle batteries and energy storage. Negative environmental and social impacts of the current Green Economy model are externalized to our homelands and Peoples.

Methods/Approach

The Sho-Pai advocate for recognition of the ways in which minerals have already impacted their environment, culture, and ways of life. The risks for further impacts soars. Development of a lithium mine at Peehee Mu’huh (Rotten Moon), also known as Thacker Pass, is the definitive example.

Results

Rotten Moon is the site of a massacre of Indigenous families by the US military in 1865 and is a sacred area. It is also now home to the largest known lithium deposit in the US. It was granted fast-track approval for mining, despite strong opposition by Tribes and environmental experts. In May 2023, the Biden Administration announced that the U.S. Bureau of Land Management has established mineral rights on the land adjacent to Thacker Pass, expanding further into our lands.

Conclusions

The Sho-Pai submitted a declaration to the United Nations Special Rapporteur on the Rights of Indigenous Peoples about the wave of ‘Green Colonialism,’ calling for immediate actions needed to address the crisis. First, governments must recognize Indigenous Peoples as decision makers regarding access to our territories and resources. Second, we require full and fair remuneration. Failure to do so violates international law and constitutes a perverse subsidy. Finally, governments must remove all environmentally harmful subsidies from mining, especially from lithium extraction, processing, and production.

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Fiorini Sara(1), Minacori Marco(1), Paglia Giuliano(1), Altieri Fabio(1), Eufemi Margherita(1), Natali Pier Giorgio(2).
1. Sapienza University of Rome, Italy
2. G. D’Annunzio University, Chieti, Italy

Background

The beta-isomer of hexachlorocyclohexane (β-HCH) is one of the most widespread and environmentally persistent organochlorine pesticides. It represents a potentially significant health hazard at contaminated sites. Epidemiological surveillance programs on a global scale demonstrated a high plasmatic concentration of β-HCH in exposed subjects, such as in the populations living in the Sacco Valley, SIN territory south of Rome. Previous cellular and molecular studies performed by our group on both normal and cancer human cell lines demonstrated that β-HCH activates a wide range of signaling pathways and act as an endocrine disruptor, promoting cellular processes related to carcinogenesis, tumor progression, and chemoresistance. In spite of its small size, β-HCH has a relevant impact on cellular homeostasis, making it necessary to explore defense strategies against its multifaceted biological effects. Our purpose is identifying a balanced combination of natural chemoprotective compounds to modulate β-HCH intracellular effects.

Methods/Approach

A screening of natural substances was carried out on the above-enlisted cell targets to test their capability to counteract β-HCH actions by performing viability assay, flow cytometry, and western blot analysis.

Results

Micronutrients from tomato and olive show a dose-dependent significant chemoprotective activity in cell lines by contrasting β-HCH induced intracellular responses such as anti-apoptotic and pro-metastasizing events, increase in ROS production, and DNA damage.

Conclusions

These experimental outcomes identified the chemoprotective effects of tomato and olive-derived micronutrients. Thus we hypothesize that these compounds could represent candidate for a "green therapy" approach as a system of remediation or prevention of the human organism against persistent organic pollutants (POPs). We are evaluating an experimental treatment scheme in populations living in Sacco Valley. We will measure changes of plasma markers indicative of POPs-induced toxicity, such as Sod, Catalase, Malondialdehyde in treated individuals compared to the control group.

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Claudia Thompson (1); Ashlinn Quinn (1)
1. National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA

Background

Nearly 3 billion people heat their homes and cook with solid biomass fuels contributing to deforestation, increasing atmospheric CO2 and PM, and polluting living spaces. Household air pollution is responsible for over 2.3 million premature deaths annually. Exposure to cookstove smoke is associated with many health problems, including respiratory and heart disease. In addition to the potential health consequences from cooking with biomass fuels, populations in low- and middle-income countries (LMICs) are also most vulnerable to the impacts of climate change. Evidence exists that shifting to cleaner fuels benefits both health and climate.

Methods/Approach

Over the past decade several intervention trials have been launched to assess the impact of cleaner fuels such as liquefied petroleum gas (LPG) on health. These include the Household Air Pollution Intervention Network (HAPIN), an international multi-center study located in Guatemala, India, Peru and Rwanda; and the Ghana Randomized Air Pollution and Health Study (GRAPHS). Findings demonstrate that LPG cookstoves were readily adopted and produced lower PM and black carbon emissions. Short-term health benefits from improved air quality, however, have been mixed and recent reports suggest that early life reduction in exposure can have longer term health benefits. Scalable and sustainable transitions to LPG or electrification in LMICs have the potential to reduce global climate temperatures and improve health but will require more research employing implementation science to understand effective strategies to achieve full transitions.

Results

Applying intervention trials and implementation science can provide the evidence-base for evaluating the effectiveness of switching to cleaner fuel alternatives for global climate and health related mitigation.

Conclusions

Understanding the complexity and time needed to implement and evaluate climate and health related interventions is vital to creating new evidence-based solutions to protect the most vulnerable populations from the effects of household air pollution and climate change.

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Fraser JH Brims (1,2,3); Chellan Kumarasamy (1); Jessica Nash (1,2); Edward JA Harris (1,2); Conor P Murray (4); Peter Franklin (5); Nola Olsen (5); Nick de Klerk (5)

1. Curtin University, Perth, WA, Australia
2. Sir Charles Gairdner Hospital, Perth, WA, Australia
3. Institute for Respiratory Health, Nedlands, WA, Australia
4. ChestRad Radiology, Nedlands, WA, Australia
5. University of Western Australia, Perth, WA, Australia

Background

Asbestos exposure increases lung cancer risk, especially in smokers. Low dose CT (LDCT) screening reduces lung cancer mortality. Of various proposed screening eligibility criteria, only the Liverpool Lung Project (LLP) model accounts for asbestos exposure. This study compares eligibility criteria for lung cancer screening in our asbestos-exposed population over a 10-year period.

Methods/Approach

Participants include former asbestos miners, former asbestos mining township residents, and anyone with >3 months cumulative occupational asbestos exposure. We set no age limits, and any smoking status was accepted. All participants had an annual LDCT scan with annual health questionnaire. Different criteria for lung cancer screening programs were analysed. Date of censoring 19 Aug 2022.

Results

11,834 LDCT scans were performed on 2,131 individuals of median age 70 years (IQR 63-75), 1,819 (85.4%) were male and 1,357 (63.7%) were ever-smokers. 52 lung cancers were diagnosed in 50 participants (2.3% of cohort). Median age at diagnosis was 78.2 years (IQR 71.5-82.3).
40/48 (83.3%) had stage 1 disease, and 37/48 (77.1%) participants underwent surgery or stereotactic radiotherapy with curative intent. Lung cancer was prevalent in 28 (53.8%) individuals. Of smoking-related cases (n=40), median pack year exposure was 30.5. At censoring date, 29 (55.8%) cases were alive, with median (IQR) survival of 707 (298-1495) days.
If alternative screening eligibility criteria were applied to our study population, including USPSTF2021, PLCOm2012 , LLPv2 or the proposed Australian criteria, only 5% to 40% of our study population would have been screened and only 4% to 50% of the lung cancers that we detected would have been detected.

Conclusions

LDCT screening is effective at diagnosing early-stage lung cancer in this population. Occupational exposure(s) should be considered when assessing risk for lung cancer, regardless of smoking status, and should be incorporated into future lung cancer screening programs.

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F. Delva (1); S. Gendarme (2); PY Brillet (2); P. Brochard (1); C. Paris (3); C. Chouaïd (2); O. Bylicki (4); V. Le Denmat (5;) B. Loddé (5); M. Belacel-Ouari (2); A. Roudil (1); M. Despagne (1; B. Clin (6); F. Gehanno (7); S. Mathoulin-Pélissier (8); F. Laurent (1; JC. Pairon (2)
1. CHU Bordeaux, Bordeaux, France
2. CHI Créteil, Créteil, France
3. CHU Rennes, Rennes, France
4. HIA Toulon, Toulon, France
5. CHU Brest, Brest France
6. CHU Caen, Caen, France
7. CHU Rouen, Rouen, France
8. Institut Bergonie, Bordeaux, France

Background

In 2015, clinical practice guidelines in France recommended a trial of low dose chest computed tomography (LDCT) for lung cancer screening in workers at high-risk of occupational lung cancer. The primary objective is to evaluate the performance of lung cancer screenings in a high risk population according to these clinical practice guidelines.

Methods/Approach

An interventional study in two French departments (Gironde and Val de Marne) targeted a population of smokers, aged from 55 to 74, with current or previous exposure to occupational lung carcinogens (IARC Group 1). The lung cancer relative risk of eligible subjects is estimated to exceed the risk of subjects in the National Lung Screening Trial. Trial steps included: 1) Identification of subjects aged 55 to 74 years (in the first phase, 65 to 74 years) with current or previous exposure to lung carcinogens and subsequent mailing of a screening invitation letter by health insurance funds; 2) Evaluation of occupational lung carcinogen exposure by specialized practitioners and verification of eligibility; 3) LDCT scans at baseline, years 1 and 2, in certified centers using NELSON Study criteria; and 4) Follow up of findings suspicious for lung cancer.

Results

In this initial stage, 236,000 letters were sent to subjects aged 65 to 74 years, of whom 9.1% (n=21,400) expressed interest in screening. Expert evaluation identified 509 (2.3%) people who were eligible, and 309 (60.7%) were screened. Screening was positive in 18 (5.8%) with 5 (1.6%) lung cancer diagnoses. LDCT screening was indeterminate in 70 (22.6%) subjects. Among participants with no evidence of lung cancer, 180 (58.2%) had coronary arterial calcification.

Conclusions

LDCT screening is feasible in a high risk population. Age at eligibility will be expanded to 55 to 74 years. For subjects with no occupational risk, smoking eligibility criteria of the NELSON study is under consideration.

Presenting author profile

Dr. Silveira is head of the Environmental Factors and Occupational Cancer Group from Molecular Oncology Research Center at Barretos Cancer Hospital where he has worked with population exposed to several carcinogens to better understand of carcinogenesis in the exposome context.

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Henrique C. S. Silveira (1); Rodrigo Sampaio Chiarantano (1); Leonardo Almeida (1); Larissa Cristina Ferreir (1); Maraisa Cristina da Costa (1); Ana Beatriz Oliveira (1); Bruna Gonçalves de Carvalho (1); Mauro Cardoso Júnior (1; Fabiana Lima Vazquez (1); Laércio Castilho Neto (1); Fernanda Gianassi (2); Rui Manuel Reis (1,3,4,)
1. Barretos Cancer Hospital, Barretos, São Paulo, Brazil
2. ABREA - Associação Brasileira dos Expostos ao Amianto, Osasco, São Paulo, Brazil
3. Medical School, University of Minho, Braga, Portugal
4. ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal

Background

In Brazil, the extraction and usage of asbestos was only recently banned. Therefore, cases of pulmonary fibrosis an asbestos-related malignancy are still expected to increase due to the long latency period of disease development. This scenario requires awareness and structured surveillance, but also access to medical screening and diagnostic methods, which are restricted and unequally available in Brazil. The Low Dose Computed Tomography (LDCT) is an effective tool to screen for malignancy in asbestos-exposed workers. We performed chest disease screening with a mobile LDCT unit in an undeserved population of former asbestos manufacturing workers.

Methods/Approach

In partnership with ABREA (Associação Brasileira dos Expostos ao Amianto) workers from Pedro Leopoldo, Minas Gerais, Brazil were offered LDCT screening in September 2019. Workers who had a history of direct or indirect asbestos exposure, regardless of exposure duration or respiratory symptoms, were offered a LDCT examination. Thoracic radiologists used a structured report to report pleural plaques or nodules, pleural effusions, parenchymal fibrosis, and lung nodules.. Pulmonary nodules were managed according to Lung Rads 1.1. Necessary supplementary diagnostic and treatment follow-up was p;rovided at a tertiary care oncology center.

Results

Two hundred and three men and twenty women, of whom 89% were directly engaged in asbestos manufacturing with median exposure time of 13.5 years, underwent LDCT screening. Median age was 57 years. Pleural plaques or nodules were identified in 19% of individuals. Five individuals had moderate or marked signs of pulmonary fibrosis, and one was diagnosed with an early stage pulmonary adenocarcinoma. None of these findings had been identified by usual health care.

Conclusions

Despite political interference that precluded full attendance of participants, proper treatment was guaranteed with the aid of Labor Prosecutor Office. The mobile LDCT unit successfully provided screening and increased awareness in this exposed and underserved worker population.

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Joachim von Braun (1,2)
1. Pontifical Academy of Sciences, Vatican City, Italy
2. Bonn University, Bonn, Bonn, Germany

Background

There is urgent need for more engagement and actions to overcome the growing number and intensity of food and humanitarian crises. It is imperative that we address the causes and consequences of these problems comprehensively and innovatively. The world is facing the highest number of violent conflicts since the Second World War. These conflicts are major triggers of humanitarian and food crises, causing livelihood and environmental destructions, reducing access to production factors, social safety nets and trade, and causing forced displacement. Under global climate change, extreme weather events have become a further important trigger of humanitarian and food crises worldwide. World food and water security and resilience is seriously threatened, partly due to climate disruption.

Methods/Approach

Resilience building must rest on three pillars: Mitigation, Adaptation & Transformation. The latter calls for change of lifestyle, transformation of society and ecosystems. This transformation is akin to an ecological conversion and must integrate actions on the triplet of crises: climate, biodiversity, and inequality. Science has an important role to play in addressing food and humanitarian crises, because they are problems of complexity.

Results

To prevent food and humanitarian crises, we need context-specific and appropriate international and regional engagement, local peacebuilding, and multilateral conflict resolution.

Conclusions

The structures, governance and management of humanitarian and food crises require comprehensive reform. Women’s roles and leadership in these contexts must be strengthened. We need increased and more flexible financial resources at an international level, along with redesigned emergency aid interventions. Without such reforms, we will continue to deal with symptoms rather than addressing the root causes.

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Vidhya Venugopal (1); M Yogeshwaran (1); PK Latha (1); S Rekha (1)
1. Sri Ramachandra Institute of Higher Education and Research, Chengalpattu, India.

Background

Despite heat mitigation efforts in the workplace, heat remains a significant health concern in Low- and Middle-Income Countries (LMICs), especially among informal workers. Numerous LMICs have implemented workplace and regional Heat Action Plans (HAPs) to reduce the heat burden.

Methods/Approach

In this presentation, we examine the challenges associated with implementing HAP policies in the workplace from the perspective of various stakeholders.

Results

For this qualitative study, we conducted in-depth interviews with approximately 500 stakeholders in 2022. Researchers on heat, policy advisors, policymakers, safety officers, workers, business owners, and supervisors were identified using purposeful sampling techniques. The interviews were conducted in either English or the native language. The data were evaluated through qualitative content analysis.

Conclusions

The participants identified four major types of obstacles to the implementation of HAPs and protective labor policies. Inadequate resources, a lack of trained personnel, ineffective supervision and mentoring of staff, and personnel turnover in the government are the first structural challenges. Second, the unilateral implementation of policies without input from stakeholders and oversight of enforcement. Thirdly, a lack of understanding of local sociocultural factors hindered the effective implementation of evidence-based and tested HAPs that were successful elsewhere. The fourth category, insufficiently informed policy development, involves a lack of channels to engage stakeholders and a top-down approach to policy design that affects worker and management acceptance. All policymakers must recognize that insufficient support for the policy objectives creates a gap execution. Thus, policy-making and implementation should be seen as holistic, interdependent and interactive processes. To overcome these difficulties and assist HAPs in LMICs, it is crucial to assess local implementation challenges for specific HAPs in order to transform them into opportunities.

Presenting author profile

Dr. Natali, Past President of the Italian Cancer Society and Director of the National Cancer Institute in Rome, Italy is Secretary General of MTCC an NGO founded in 2005 devoted to primary and secondary cancer prevention

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Pier Giorgio Natali (1)
1. Mediterranean Task Force for Cancer Control (MTCC), Rome, Italy

Background

Background: Although cancer knowledge is rapidly advancing, a paradoxical gap remains between what is known and what is implemented as best practices (2008 CR Statement, 2008). While cancer mortality is decreasing through primary/secondary prevention policies and therapeutic advancements, an increase in global cancer incidence is foreseen. Indeed, the widening of socio-economic, and cultural disparities is imputable for the rise in the incidence of hard-to-treat “advanced disease”, thus undermining the sustainability of cancer care even of “rich” healthcare systems.

Methods/Approach

Since 2005, MTCC has recognized that cost-effective prevention strategies remain not fully exploited. Also, general practitioners, who are key providers of cancer control services, are becoming an endangered species. Health and wealth are closely interconnected and MTCC has constantly advocated in the medical arena as well as at cultural, social, and political levels against misinformation disseminated through uncensored information.

Results

Since cancer “cannot be fought in solitude” (UNESCO: Chart of Paris, 2002), MTCC has pursued increasing networking with civilian and military medicine, governments, educators, families, religious centers, and charitable/cultural associations. New awareness strategies are explored. MTCC has developed multilingual messages free of “compassionate fatalism” and conducive to «aggressive optimism» and advocating “personal responsibility”.

Conclusions

At MTCC, we firmly believe that much can be done even with limited resources if we recognize that we have medical, ethical, and political obligations to prioritize public health beyond any disparity. In this framework, MTCC advocates that “health should be regarded as a safe space for dialogue between Countries of different cultures, faiths, economic strength having the power to unite because of common goals and challenges”.

Presenting author profile

Joseph LaDou MS, MD is Emeritus Clinical Professor and former Chief of the Division of Occupational and Environmental Medicine at UCSF.

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Joseph LaDou (1)

1. University of California, San Francisco, CA, USA

Background

Semiconductor chips have become the foundation of modern economic prosperity, military strength, and geopolitical power. Over the past half century, the US semiconductor industry exported most of its chip manufacture, primarily to Asia. The offshoring of chip production was in large part a result of the increasing costs of environmental regulation and enforcement in the United States. Environmental issues were simply transferred to other countries.

Methods/Approach

The most advanced chip research and design technology is dominated by the United States, Europe, and Japan. However, individual companies willing to invest in advanced technology are challenging industry leaders. Taiwan Semiconductor Manufacturing Company (TSMC) now produces 90 percent of the most advanced chips in the world. Advanced Semiconductor Materials Lithography (ASML), a Dutch firm, is the only company that produces and sells extreme ultraviolet lithography systems for chip production reduced to 5 nm and 3 nm. Taiwan’s TSMC and South Korea’s Samsung Electronics currently produce chips smaller than 5 nm, and they are engaged in a race to produce the 2-nm chip. The United States does not produce any of the highest-performance chips.

Results

The new chips will soon reform the computer industry. Quantum computers will have exponential increases in speed and capability. Cybersecurity with quantum computing will be a serious challenge to national security. Under intense pressure from the Department of Defense, the United States passed The CHIPS Act of 2022 to provide $52 billion to US semiconductor companies, to revitalize the country’s chip industry. As a result, many semiconductor companies will be making chips for the first time outside of Asia.

Conclusions

The European Union is advancing its own CHIPS Act to remain competitive. Korea and Japan are greatly expanding their chip industries. China has announced $143 billion in chip subsidies and support for domestic manufacturing to counter US export restrictions and curbs.

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Rodney Ehrlich (1)
1. University of Cape Town (UCT), Cape Town, South Africa

Background

Circular low-wage migrant labour is a global phenomenon. Perhaps nowhere have as many records been kept as on the low-wage migrant goldminers of Southern Africa and their triple burden of silicosis, tuberculosis and HIV. These records were kept by the state and industry in a racialised system in which the fate of migrants post-employment was largely unknown. Litigation, ex-miner organisation, and the work of historians and health researchers have enabled a critical perspective providing lessons for occupational health globally.

Methods/Approach

We inquired into the structural features maintaining the ill-health of migrant ex-goldminers in Southern Africa for so long.

Results

Features include roots in racially based colonial systems, inadequate control of work hazards, surveillance for productivity and contagion prevention rather than worker protection, externalization to home regions with limited surveillance and health care capacity, resistance of employers and host governments to responsibility for departing migrants, and the “healthy migrant” effect in research - a narrative influenced by employer and government interests and absence of migrant voice. The combined result is the gross understatement of the true burden of disease and injury. Most occupational health research and activism has been directed at the plight of working migrants in destination countries, but little on their life-course. There are numerous international/bilateral “instruments” designed to protect circular migrants’ rights and health, but with low levels of compliance.

Conclusions

As occupational health researchers we should adopt a whole-of-journey perspective which takes into account the externalisation of disease and injury to home countries. This will require historical and ethnographic inquiry into the roots of these systems and the migrant experience; support for home country researchers and health professionals in documenting the nature and burden of illness/injury in returning migrants; and political pressure on host and home countries for expansion and portability of social security benefits.

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Jeffrey Stull (1); Christina Stull (1, 2)
1. International Personnel Protection, Inc., Austin, Texas, USA
2. Dell Medical School, Austin Veterans Administration Clinic, Austin, Texas, USA

Background

The COVID-19 pandemic and prior serious virus outbreaks focused attention on a number of interventions for mitigating disease transmission in both the healthcare sector and for the general population. These events provided scrutiny for using PPE as an intervention approach and identified gaps in product designs, use strategies, and overall awareness of effectiveness, especially as adaptations were made in response to consequent disruptions in PPE availability.

Methods/Approach

The range of PPE used in major infectious disease events will be described in terms of its positioning for protection, particularly in addressing airborne respiratory hazards when contrasted with historically defined disease transmission modes used in infection control. Examples of studies for assessing PPE performance attributes will be cited as evidence of gaps in protection practice including frequent changes in PPE guidance. The recent case for rapidly creating a new face covering standard with potential workplace protection levels as a mitigation approach will also be highlighted. Specific recommendations will be presented for advancing PPE standards as applied to manufacturers and in addressing end user selection, use, and care that have lacked coordination and consistency.

Results

This presentation urges applying the lessons learned from the COVID-19 pandemic and other public health emergencies for developing appropriate PPE product and use requirements as an effective means for controlling disease transmission when coupled with other intervention strategies. An overarching strategy is also needed to educate healthcare workers and other affected individuals to maximize PPE effectiveness and allow for scale-up during future pandemics.

Conclusions

Global and national regulatory agencies must implement standards, practices, and surveillance programs for better governing appropriate PPE selection/use for both protection and infection control. This implementation should be directed to regulators, PPE manufacturers, and principal end user organizations and include elements of product conformity assessment and training.

Presenting author profile

Dr. Hryhorczuk is a Professor Emeritus of Environmental and Occupational Health Sciences and Epidemiology at the University of Illinois School of Public Health. He is an international member of the Ukrainian Academy of Medical Sciences and for the past 30 years has worked on research and capacity-building in environmental and occupational health in Ukraine.

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Daniel Hryhorczuk (1); Alex Hryhorczuk (2)

1. University of Illinois School of Public Health, Chicago, USA
2. Third Horizon Strategies, Chicago, USA

Background

Environmental harm during armed conflict can be an unintended consequence of military activity or part of a wartime strategy. Duties under International Humanitarian Law and International Human Rights Laws provide avenues to seek justice for widespread, long-term and severe damage to the environment.

Methods/Approach

The protection of the environment during wartime is governed by several international treaties, including the Geneva Conventions of 1949 and Additional Protocols of 1977, the Environmental Modification Convention of 1976, and the 1998 Rome Statute of the International Criminal Court (ICC). The prosecution of crimes against the environment during wartime is complicated by several factors, including issues of attribution, non-signatory states and balancing considerations of necessity and proportionality in wartime. The severe environmental damage inflicted on Ukraine by Russia’s invasion, including the destruction of Nova Kakhovka dam, likely presents a violation of the thresholds established by these international conventions.

Results

The severe and widespread environmental damage caused by Russia’s invasion has been well documented. While international law governing use of force inevitably falls short of its goal, it nonetheless plays an important regulatory role in holding bad actors accountable and preventing future atrocities. States have expressed clear intentions to expand the protection of the environment under international law. Russia’s unprovoked aggression may provide the collective political will to more comprehensively hold state and individual actors accountable for crimes against the environment.

Conclusions

The ICC limits its jurisdiction to “the most serious crimes of concern to the international community as a whole.” Given the interdependence of human and ecosystem health, advocates have proposed adding the crime of ecocide as the fifth international crime within the Court’s jurisdiction, both in times of war and peace.

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Homero Harari (1); Lukas McHugh (1); Ana Gonzalez (1); Josephine Dorsey (1); Daniel Aguilar (1); Sherry Baron (2); Gerald Mastroianni (1).
1. Icahn School of Medicine at Mount Sinai, NY, USA
2. Queen College, New York, USA

Background

Housecleaning work is precarious in the United States and widely performed by female immigrant workers. Housecleaners are exposed to chemical hazards due to the variety of cleaning chemicals and disinfectants (CP&D) in their jobs. The objective of this study was to 1) identify the most common cleaning chemicals and disinfectants used by Latinx housecleaners in New York and 2) quantify their inhalation and dermal exposures while performing common cleaning tasks.

Methods/Approach

As part of the Safe and Just study, we surveyed 402 Latinx housecleaners to identify the most common CP&D used in their job. Using the most common CP&D reported during common simulated bathroom and kitchen cleaning tasks; we assessed personal inhalation and dermal exposure to volatile organic compounds (VOCs) and quaternary ammonium compounds (QACs).

Results

Despite the large amount of CP&D available in the US market, our methodology allowed us to identify products commonly used by Latinx housecleaners. We found that some products and combinations of products exposed workers to higher levels of VOCs.

Conclusions

Latinx housecleaners in New York are exposed to mixtures of volatile chemicals. More language-appropriate training materials are necessary for immigrant workers and clients to increase awareness about health hazards related to chemical ingredients in CP&D. Increased policy efforts are needed to increase cleaning product transparent labeling.

Presenting author profile

Dr. Kurt Straif is Research Professor at Boston College, MA, USA and Associated Research Professor at ISGlobal, Barcelona, Spain. His research focus is on cancer prevention and more recently expanding to COVID-19 as well as climate crisis and health.

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

Background

In the early 1960s, after a long scientific debate, heavily undermined by BIG TOBACCO, several national committees finally reached a scientific consensus that tobacco smoking causes lung cancer. Since then, each re-evaluation of the carcinogenicity of tobacco smoking by the IARC Monographs Programme added more cancer sites with “sufficient evidence”, now encompassing a total of 16 cancer sites; also, second-hand smoke was classified as carcinogenic to humans. A similar pattern evolved for several multi-site carcinogens, such as ionizing radiation, human papilloma virus and alcohol consumption.

Methods/Approach

The SYNERGY project pooled 14 case-control studies to investigate joint effects of well-established occupational lung carcinogens, and the carcinogenicity of emerging risks; in addition, the developed quantitative job-exposure matrix SynJEM was applied to other pooling projects, such as INHANCE. Regarding occupational exposure to asbestos the NOCCA database was analysed for biliary tract cancer, and a systematic review was undertaken for gastro-intestinal cancers.

Results

Results from Scandinavian cancer registry data, pooling projects and systematic reviews on asbestos, silica and benzene and associations with lung, larynx and gastro-intestinal cancers will be presented.

Conclusions

Results demonstrate a similar pattern of expanding cancer risks of well-established occupational carcinogens to additional cancer sites. The increasing burden of occupational cancer calls for additional preventive efforts at all levels.

Presenting author profile

Dr. Kurt Straif is Research Professor at Boston College, MA, USA and Associated Research Professor at ISGlobal, Barcelona, Spain. His research focus is on cancer prevention and more recently expanding to COVID-19 as well as climate crisis and health.

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

Background

Consumer products are defined as products purchased for personal, family, or household use. Many agents that fall under this definition have been evaluated by the IARC Monographs programme or have been announced for re-evaluation in the near future. This presentation will focus on two relatively recent evaluations of consumer products that attracted some media attention.

Methods/Approach

In June 2023, the carcinogenicity of aspartame has been evaluated by the Volume 134 Working Group of the IARC Monographs programme. This presentation summarizes and discusses the conclusion of the WG and the related WHO/FAO JECFA dietary risk assessment, and presents results of a multi-cancer case-control study on aspartame and sugar consumption.
The second part focuses on the evaluations of processed meat and red meat by the Volume 114 Working Group of the IARC Monographs programme in October 2015 and puts it into the broader perspective of the climate crisis.

Results

Aspartame has been classified as “possibly carcinogenic to humans”, Group 2B, based on “limited evidence” in humans, in experimental animals and for selected key characteristics of carcinogens. The summary report in The Lancet Oncology noted an impressive list of statistically significantly increased cancers, in two species and two sexes of rodents. Based on these observations a not further qualified minority of the Working Group evaluated the carcinogenicity in experimental animals as “sufficient”. Further, detailed results of a recent case-control study will be presented and discussed in context of the conclusion of the IARC Working Group.
Processed meat and red meat have been classified as “carcinogenic to humans” (Group 1) and “probably carcinogenic” (Group 2A).

Conclusions

While there is no clear evidence on benefits of aspartame in terms of weight control, but an obvious nexus between meat production and the climate crisis, these consumer products are consumed by large proportions of the population and may cause cancer.

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Susan L. Teitelbaum (1); Jia Chen (1); Mary S. Wolff (1); Alfred I. Neugut (2); Regina M. Santella (2); Antonia M. Calafat (3);Hope L. Ettore (4); Marilie D. Gammon (6); Humberto Parada Jr (4)

1. Icahn School of Medicine at Mount Sinai, New York, New York, USA
2. Columbia University, New York, New York, USA
3. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
4. San Diego State University, San Diego, California, USA
5. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Background

Personal care products (PCPs) encompass a variety of items like facial cleansers, moisturizers, makeup, hair care products, deodorant, fragrances, nail care products, and personal hygiene products. Women typically use multiple PCPs each day, with estimates ranging from 5 to 15 products. Many PCPs contain endocrine disrupting chemicals (EDCs) such as phthalates, phenols, benzophenones, and parabens. Although many of these chemicals have a short half-life, women’s exposure is relatively consistent due the regular and continuous use of PCPs. Concerns about breast cancer risk associated with EDC exposure from PCPs are increasing.

Methods/Approach

To investigate this, the population-based case-control study, Long Island Breast Cancer Study Project, was conducted enrolling newly diagnosed breast cancer cases and frequency age-matched controls who were never diagnosed with breast cancer. Participants provided questionnaire responses during in-person interviews and donated blood and urine samples that were analyzed for EDCs by the CDC. Multivariable logistic regression analysis was used to estimate the associations between different EDC metabolites and breast cancer risk. Effect modification by body mass index (BMI) was also investigated.

Results

The highest (vs lowest) quintiles of urinary parabens showed associations with increased breast cancer risk (ORs ranging from 1.31 to 1.50). Associations were stronger among women with lower body mass index (BMI). In contrast, several phthalate metabolites were inversely associated with breast cancer risk.

Conclusions

Many environmental phenols as well as phthalates are known endocrine disruptors and are thus biologically plausible breast carcinogens. The study results suggest a potential positive association between paraben exposure and breast carcinogenesis, while phthalates did not show an increased risk. However, caution is needed due to the limitations of urine sample collection occurring after breast cancer diagnosis. Prospective studies are needed for confirmation. If confirmed, the findings have implications for the widespread use of these chemicals in personal care products.

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Hervé Raps (1), Philip Landrigan (1,2)
1. Centre Scientifique de Monaco, Monaco, MC
2. Boston College, Boston, MA, USA

Background

Ocean pollution is a growing threat to human health, both directly and through its impacts on ecosystem services. Climate change is a threat multiplier that worsens the health impacts of ocean pollution.

Methods/Approach

Ocean pollution has many sources: chemical pollutants (heavy metals, hydrocarbons), organic pollutants (phosphorus, nitrogen) and plastics. 80% of marine pollution originates on land and comes from human activities. Ocean pollution has worsening negative impacts on human health and well-being, both directly and indirectly through degradation of ecosystem services provided by the ocean (food, economic). Ocean pollution disproportionately affects the most vulnerable populations and communities.

Climate change acts as a threat multiplier for ocean pollution. It does so directly by increasing the intensity, frequency and geographical distribution of toxic algal blooms and accelerating the spread of Vibrio bacteria into previously uncontaminated waters through increasing sea surface temperature and changing salinity. Climate change also worsens ocean pollution indirectly by increasing extreme weather events and floods in coastal and riverine areas that can result in influx of pollution into the ocean, particularly if waste storage or treatment plants are submerged.

Results

The fight against climate change, with reductions in greenhouse gas emissions and the transition to renewable energy, must be accompanied by specific measures to reduce and control ocean pollution. Interventions that have proven effective include: the development of marine protected areas (MPAs), efficient wastewater and effluent treatment systems, protection of coastal waste treatment infrastructure areas against extreme events, and above all, the reduction of waste at source: agricultural release, industrial discharge and plastic pollution. .

Conclusions

National actions and support for international regulations, such as the Global Plastics Treaty now in development, is a guarantee of success of those measures

Presenting author profile

Sari Kovats is an Associate Professor in the Department of Public Health, Environments and Society in the Faculty of Public Health and Policy. She has been researching the effects of weather, climate and climate change on human health for more than 20 years. She has contributed to national and international assessments of the health impacts of climate change.

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Sari Kovats (1)
1. London School of Hygiene and Tropical Medicine, London, United Kingdom

Background

Flood risk to people from rivers, surface water and coastal flooding remains a significant current and future risk across all regions of the world. Climate change will increase risks of heavy rainfall and sea level rise and additional investment is needed. Countries are moving from a risk focused approach that relies on protection to a more holistic resilience based approach that recognises the need to live with water.

Methods/Approach

The presentation will discuss recent evidence for the impact of flooding on physical and mental health. Deaths may occur from drowning and physical injury through contact with flood waters. Mortality attributable to flooding can include hypothermia, and injuries associated with cleaning up (including carbon monoxide poisoning). Flood exposure is associated with long term burden of increased depression, anxiety, and post-traumatic stress disorder. Mental health outcomes are made worse by displacement, the extent of flood damage, a lack of warning and difficulties dealing with insurance. Methods for quantifying the health and social implications for flooding are discussed and how health research can be used to improve decision making.

Results

The costs of flooding on human health is increasing. Better quantification of the health impacts can be used to support the economic argument for flood defences and local interventions to address surface water flooding. Flood risk is exacerbated by poor planning decisions, ageing infrastructure and poor maintenance, coastal degradation, low uptake of property measures, loss of greenspace, and lack of effective and inclusive flood warnings.

Conclusions

Effective flood response requires coordinaton with health agencies. Robust measures to identify individuals at risk is needed, with better and more targeted advice for high risk persons for preparing for flooding. Investment in information systems to support surveillance of flood impacts on mortality, injuries and mental health, both in real time or to allow for research and evaluation retrospectively.

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Krishna Gopal Rampal (1)
1. University of Cyberjaya, Selangore, Malaysia.

Background

In 2019, the number of international migrant workers was 169 million. The world's migrant workers are distributed amongst the major regions with the majority in Europe and Central Asia (37.7%) and lowest in Africa (8.1%).

Methods/Approach

Migrant workers are employed in sectors and jobs which are dangerous, dirty, and demanding (3D) and least favoured by the local population. The sectors in which they work depends on the needs of the destination countries e.g. construction, manufacturing, services, plantation, agriculture as well as mining and quarrying. They are often exposed to high temperatures, loud noises and vibration, maintenance of an upright position for a long period of time, faster work rates and increased exposure to chemicals including pesticides.

Results

As a result of exposure to these hazards, there is a higher incidence of occupational injuries and diseases including mental health conditions. Migrant workers usually suffer from inadequate care and unstructured health surveillance services and struggle to access the health system. Migrant workers may also face discrimination, racism and unfair recruitment processes.

Conclusions

To address this the UN 2030 Sustainable Development Agenda has urged governments to protect labour rights and promote safe and secure working environments for all workers, including migrant workers. These are addressed in Sustainable Development Goal (SDG) 3, SDG 8 and SDG 10. The UN also endorsed the Global Compact for Safe, Orderly and Regular Migration in 2018. Migrant workers and members of their families are protected by the nine UN core international human rights instruments and ILO migrant specific standards. Noting that migrant workers have a higher incidence of occupational injuries and diseases, the following are recommended: promoting fair labour practices, improving health and safety training, and enhancing efforts by social media to call attention to abusive immigrant working conditions.

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Ian von Lindern (1); Simba Tirima (2)
1. TerraGraphics International Foundation (TIFO) NGO, Moscow, Idaho USA
2. Médecins Sans Frontières (MSF,) Abuja, Nigeria

Background

In the economically critical informal mining sector, ASM spans 80 countries employing 13 million people, equivalent to the global formal mining workforce. It supplies 20% of global gold, 80% of sapphire, 20% of diamond, 30% of cobalt, 25% of tin extraction, and significant contributions to critical electronics and energy transition metals. However, ASM's contributions are overshadowed by associated environmental, health, and human rights issues that intertwine opportunity and exploitation narratives.

Methods/Approach

This presentation examines two ASM human tragedies and attempted reform efforts in the context of the 2021 Collegium Ramazzini Statement. ASM is an essential income source for rural communities in 23 Sub-Saharan African countries. Despite this, the sector often lacks formal structure or legal recognition and is frequently marked by catastrophic health and human rights abuses. This reality is glaringly evident in the Democratic Republic of the Congo, where cobalt driven ASM flourishes. Workers, especially women and children, endure hazardous, exploitative, often brutal conditions. This situation highlights the disconcerting truth that one region's technological progress often hinges on another's suffering. In 2010, a lead poisoning crisis in Zamfara, Nigeria, led to the deaths of several hundred children. A subsequent halt to ore processing activities by Emirate leadership precipitated a collaborative response, aiming to treat the poisoned children, remediate the villages, and promote safer mining practices.

Results

In Nigeria, a decade-long reform effort culminated in a Presidential Executive Order to legalize and regulate ASM. The treatment/remediation/safer mining initiative led to an 89% reduction in environmental exposures and a decrease in mean blood lead levels from 149 µg/dl in 2010 to 15 µg/dl by 2013.

Conclusions

These communities continue to face significant challenges, including climate change, malnutrition, endemic disease, ethnic violence, terrorism, and other threats. Consequently, while ASM offers economic hope, it becomes a target for those seeking to exploit the population.

Presenting author profile

Carlos Santos-Burgoa is a Mexican Medical Doctor and Epidemiologist, former Dean and Professor at the School of Public Health of Mexico, Director General at the Ministry of Health, and Senior Advisor at PAHO/WHO. He is Director of the Global Health Policy program at the George Washington University School of Public Health. He is working with faculty and students on institutional capacity development of public health institutions, specifically focused on regulatory organizations.

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Carlos Santos-Burgoa (1); Maria Jose Talayero (1)
1. The George Washington University School of Public Health, Washington DC, USA

Background

A prolonged under-investment in public health systems, and lack of exercise public health authority has limited action on the causes of chronic diseases, the sound management of toxic chemicals, unsafe food and environment, and public health emergencies and crises, such as during the COVID-19 pandemic. Deficient knowledge translation in unequal benefits of science for health protection. Lack of transparency in decision-making fosters politicization and mistrust. A health system designed for health care foregoes public health functions.
Globally, the Public Health Protection function that tackles upstream causal factors, is the least developed of the PH functions, most notably in low and middle-income countries (LMICs). This impacts morbi-mortality, social and development inequities. We need to recognize its constraints, the universal deficiency of Public Health Regulatory Science and competencies, and innovate this field of knowledge and practice.
It is urgent to “Unlock” the potential of Public Health Protection and reimagine its health value.

Methods/Approach

We will present advances on the components of this project: conceptual reframing regulatory institutions, review of priority setting, and institutions case studies, and topics such as chemicals in food.

Results

We seek to establish a scholarly field of knowledge and organizational development. We aim to advance its conceptual framing and methodologic options, identify professional competencies, describe the distribution of public health authority in different settings, areas, and levels of government, and compare selected institutional organizational arrangements in model institutions and struggling areas. This initiative recovers from the procedural to the public health fora (no school of public health has a formal program), the actual organizational development challenges of these institutions and their social value.

Conclusions

We will outline the next steps in the initiative, outline the potential recommendations for implementation of changes in professional competencies, expansion of research, increase in transparency, and invite to innovate how we actually perform regulatory interventions.

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Pietro Comba (1)
1. Collegium Ramazzini, Carpi, Italy

Background

In the field of environmental health, a change of paradigm has taken place with respect to the interaction between scientists and the communities at study: Scientists provide not only scientific evidence about the specific issues at stake, but also a more general frame of the environmental health and social interface.

Methods/Approach

The case study concerns the discovery of fluoro-edenite, an asbestiform fibre contaminating the soil of Biancavilla, a city of about 20,000 residents close to Etna Volcano (Sicily). This discovery followed the observation of an excess of mortality from malignant pleural cancer, in the frame of a national epidemiological surveillance system of pleural mesothelioma in Italian Municipalities. IARC in 2014 recognized that fluoro-edenite was carcinogenic to humans (sufficient evidence). The Ramazzini Institute experiment that had proved in 2004 the carcinogenicity of fibrous fluoro-edenite in rodents, provided an excellent basis for designing a future development of Biancavilla based on prevention and precaution. Monitoring the occurrence of the fibre in a multiplicity of environmental and biological matrices is fundamental for detecting the priorities for environmental cleanup, also in view of the recent evidence of an excess risk of environmental fibrosis for Biancavilla residents corroborated by novel experimental findings of the Ramazzini Institute.

Results

An integrated analysis of contamination of different environmental matrices by fluoro-edenitic fibres, and epidemiologic data concerning mortality and morbidity due to mesothelioma and lung fibrosis provide a scientific approach to priority setting in environmental remediation.

Conclusions

Design and analysis of ad hoc etiologic studies will provide further epidemiologic evidence to detect subpopulations at risk, like those who were exposed unwillingly in their childhood. In order to prove effective, this procedure requires synergy between investigators, environmental and health authorities, social actors and the affected communities.

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Margaret Murray (1); Robert Harrison (2); Gina Solomon (1)
1. University of California, San Francisco; San Francisco, CA USA
2. California Department of Public Health, San Francisco, CA USA

Background

Firefighting in California (CA) is a hazardous occupation with exposure to fine particulates (PM2.5) and toxic chemicals associated with respiratory disease. Moreover lung function decline in firefighters is associated with a cumulative exposure over an occupational lifetime. Since 2000 the number of CA wildfires has increased, likely a manifestation of climate change. Now firefighters are frequently exposed to the wildland-urban interface, resulting in a cumulative higher level of exposure to particulate matter. Respiratory protection in CA wildland firefighters is considered impractical, due to the physical demands of the occupation. As the number of wildfires increase in CA, wildland firefighters will continue to be exposed to higher levels of carcinogens and PM2.5.

Methods/Approach

This policy analysis aims to analyze the risks and benefits of respiratory protection for these workers based on expert interviews and a comparative analysis on two policies for respiratory protection in other occupations with similar exposures.

Results

One benefit of protection is decreased exposure to the toxic chemicals and PM2.5, associated with respiratory diseases and decreased lung function. Powered air purifying respirators (PAPRs) ensure adequate protection against the exposures wildland firefighters typically encounter. Respiratory protection in this workforce faces administrative and physical constraints. Wildland firefighters are known to have an increased risk of heat-related illness compared to other workers due to the physical demands of their job. As temperatures continue to rise, this risk will increase. Finally wildland firefighters must accept these protective measures. Therefore collaboration with the firefighting community on safety regulations is necessary.

Conclusions

Overall there are multiple risks and benefits. An evaluation of the effectiveness and acceptance of respiratory protection in this workforce is necessary before any such regulation can be passed. To mitigate workers exposure to wildfire smoke both administrative controls and variation in type of respiratory protection are needed.

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Lieselot Bisschop (1)
1. Erasmus University, Rotterdam, the Netherlands

Background

In 1961 DuPont’s researchers raised concerns about the potential health effects of perfluorooctanoic acid (PFOA or C8), a heat-, water- and fat-resistant chemical discovered in the 1930s and used in many products. Its unbreakable bond makes it persistent and bio-accumulative. In 1998, PFAS contamination in Parkersburg, West Virginia (USA) led to an Environmental Protection Agency investigations, years of judicial proceedings and public debate. In the last eight years, and increasingly so in the last two, the pollution by forever chemicals emerged on the agenda in Europe, despite the presence of 20 PFAS production facilities and many more that use them. In this research we ask the question how the contamination emerged and how it was perpetuated.

Methods/Approach

Case study research about the PFOA- and GenX pollution by DuPont de Nemours/Chemours (‘Dordrecht Works’) in Dordrecht, the Netherlands, combining historical analysis of industry and government documents starting in 1967, observations of public meetings and expert interviews (municipalities, inspectorates, regulators, public prosecutors, police, civil society organizations, drinking water companies, scientists, journalists and chemical industry representatives).

Results

The emergence and perpetuation of PFAS pollution in and around Dordrecht resulted from the intersection of political and economic actions and interests, constituting a state-facilitated corporate crime. At the basis of the tardiness or even failure of governments to regulate PFAS emissions, lies a knowledge asymmetry between industry and regulators. Strategic behavior by companies challenged regulatory governance. Our study shows permits perpetuated the contamination, which can be explained by fragmented regulation and legal challenges.

Conclusions

In preventing social harms like PFAS pollution from occurring again, learning from past cases is essential. This requires looking beyond specific instances when public and private interests colluded and looking at how those instances were shaped throughout time. This is essential in addressing the historic pollution by PFAS around the world.

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Boris D. Lushniak (1)
1. University of Maryland School of Public Health, College Park, Maryland, USA

Background

Peace is amongst the fundamental conditions necessary for health promotion. War, therefore, presents a major challenge to the physical, mental, and social well-being of the population.

Methods/Approach

This presentation will initially focus on the definitions of health, public health, one health, and the elements of health promotion. Taking an approach of looking at war as a complex public health emergency, the top priorities of responding to such a public health emergency will be presented. These priorities include assessments, immunization, water and sanitation, food and nutrition, shelter and site planning, health care, public health surveillance, control of communicable diseases and epidemics, human resources and training, and coordination. Data from the war in Ukraine will be presented with a focus on specific assessments of impact and health care needs in the midst of this war.

Results

In a public health model, primary prevention of war is critical. However, once a war begins, the health of the population will be adversely affected and we can only resort on tertiary prevention which aims to reduce the effects of the disease (war in this model) once established in an individual (the population/society). Strategies of this tertiary prevention approach will be discussed.

Conclusions

Lessons learned from labelling war as a complex public health emergency will be presented. Most importantly is the implementation of complex emergency priorities in an active war time scenario. The ultimate goal is to protect, promote, and advance the health and safety of the population, even under the extreme circumstances of war.

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Arnaud Chaumot (1); Davide Degli Esposti (1); Olivier Geffard (1)
1. INRAE, UR RiverLy, Ecotox team, Villeurbanne, France

Background

Chemical exposure of aquatic communities and subsequent ecological impacts are still difficult to assess quantitatively. This limits our understanding of the consequences for the functioning of aquatic systems, and the implementation of effective management plans. This limitation is partly explained by the difficulty to translate present water contamination data into exposure levles of biological communities. With the French Biodiversity Agency and the Water Agencies, active biomonitoring assay with the crustacean Gammarus fossarum has been developed for the chemical contamination monitoring of the Water Framework Directive (WFD). Biota offers many advantages to quantify priority substances (metals, PAH, PCB, pesticides, PFAS…). Caging allows to control biological parameters of test organisms and the exposure duration, making it possible to reliably compare bioaccumulation data obtained between stations and over time.

Methods/Approach

This study proposed multi-contaminant indicators for characterizing chemical pressure in ecosystems based on bioaccumulation data recorded during in situ biotests implemented throughout the French river monitoring network. We also exploited ecological monitoring data (invertebrate inventories) collected in the same rivers for the regulatory implementation of the European WFD.

Results

We have been able to map bioavailable chemical contamination on a national scale, covering 218 rivers. We have identified a drop in sensitive invertebrates’ abundances due to contamination by specific compounds of the aquatic environment. We have also highlighted relationships between chemical pressure and macroinvertebrate diversity, with a decrease in species richness along a gradient of metal contamination, and the replacement of sensitive species by tolerant species that mainly compensate the loss of functional diversity between uncontaminated and contaminated sites.

Conclusions

This study demonstrates the value of the use of sentinel species to characterize the chemical pressure relying on biological communities. The main perspective is to consider measurements of toxic effects, which are today recorded at the national scale following the same in situ biotest methodology.

Presenting author profile

Dr. Pelclova is full professor at the Toxicological Information Centre of the Department of Occupational Medicine, Charles University and General University Hospital, focusing on occupational toxicology and pneumology, including nanoparticles.

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Daniela Pelclova (1); Zdenka Fenclova (1)
1. Charles University and General University Hospital in Prague, Prague, Czech Republic

Background

The first outpatient Department of Occupational Medicine in the Czech Republic was started in 1932 in Prague, when the president of the Republic signed the first List of Occupational Diseases with 25 items. In 1947, an in-patient department with 27 beds was opened; in 1999 it was comprised of 15 beds. In 2011, it became out-patient only. In 2011, the List of Occupational Diseases contained 85 items and in 2021 it was increased to 88.

Methods/Approach

Statistical data were searched from the publications and data of the Czech Institute of Health Information and Statistics, and State Institute of Public Health.

Results

The first complete statistical data from 1956 reported 3,111 occupational disease cases. The first peak was in 1962 with 4,658 cases, followed by gradual decline to 1,042 in 2013 and 1,222 in 2018. A second peak appeared in 2022, with a total of 7,439 with COVID-19 disease cases representing 91%. The structure of occupational diseases significantly changed over the 90 year period. Pneumoconioses decreased from 56% of cases in 1957 to 8% currently. Prior to COVID-19, the majority of disease cases (54%) were caused by overload of upper extremities. Illnesses from toxicants declined from 10% in 1973 to 3 cases in 2022. Most common causes of disease in the first few decades were poisonings from carbon monoxide, solvents, pesticides, and lead. In 1965-1968, 80 chemical workers developed “chloracne” and/or porphyria due to 2,3,7,8-tetrachlorodibenzo-p-dioxin, and consequently neuropsychological impairment, hyperlipidemia, and diabetes. In 1977-1989, about 50 rotogravure printers were exposed to excess toluene and experienced acoustic hallucinations and some developed chronic toxic encephalopathy.

Conclusions

The List of Occupational Diseases was gradually extended despite political pressure and enabled the technical preventive measures to lower life-threatening diseases in the country.

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Ruivo Raquel (1); Fonseca Elza (1); Sousa João(1,2); Oliveira Diogo(1,3), Correia da Silva Marta (1,3), Degli-Esposti Davide (2), Castro Luis Filipe(1,3), Santos Miguel Machado(1,3)

1. University of Porto, Matosinhos, Portugal
2. Unité de Recherche RiverLy, Villeurbanne, France
3. University of Porto, Porto, Portugal

Background

Deducing the potentially hazardous effects of chemicals relies on the extrapolation of physiological responses: from model species to the ecosystem scale. Yet, increasing evidence emphasises the need for adequate sampling of such responses across the metazoan tree. In fact, external stimuli may elicit both conserved and divergent physiological outcomes in animals, but the underlying genetic diversity is far from fully understood. This is particularly relevant for Nuclear Receptors (NRs), a family of transcription factors participating in crucial physiological processes throughout an organism’s life cycle: from development to the maintenance of adult endocrine systems. Importantly, NRs are mostly triggered by ligands and are thus often highjacked by environmental chemicals. Such susceptibility has been translated into tools with some NRs included in EPA and OECD test guidelines for endocrine-disrupting chemicals. Yet, despite their relevance in hazard assessment and monitoring, significant knowledge gaps still exist. First, NR gene repertoire is not stable across metazoan lineages; secondly, the presence of specific NRs does not strictly imply conserved responses. Additionally, the current vertebrate bias in NR-based testing likely impairs a metazoan-inclusive assessment.

Methods/Approach

Here, we use phylogenetic inference methods coupled to cell-based functional assays to explore the conserved and divergent sensitivities of selected metazoan NRs to exogenous compounds.

Results

Such phylogeny-informed case studies, allowed us to explore the applicability of NRs as decisive tools to understand the mechanisms of action of environmental chemicals, test their hazardous potential across species, or even contribute towards the screening of novel, and more environmentally friendly active compounds.

Conclusions

Our results corroborate the necessity of phylogeny-informed sampling of metazoan NRs, including functional characterization, to establish precision hazard assessment at an ecosystem scale.
Acknowledgements
FCT (Foundation for Science and Technology) Funding UIDB/04423/2020, UIDP/04423/2020, and PTDC/CTA-AMB/0853/2021.

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Hanna Majanen (1); Martins Dada (1)
1. Medecins Sans Frontieres (MSF), Amsterdam, The Netherlands

Background

On February 6, 2023, severe earthquakes struck southeast Turkey and northwestern of Syria in the early morning. The initial earthquake with an epicenter in the Pazarcik District of Kahramanmaras affected 11 provinces in Turkey, as well as the Idlib and Aleppo provinces in Syria. Despite downplayed official figures, the death toll is estimated at around 60,000 people. Almost 900,000 buildings were damaged or completely collapsed. Some 15 million people were affected in Syria and Turkey.

Methods/Approach

Five Medecins Sans Frontieres (MSF) sections responded in the earthquake-affected areas in Turkey and/or Syria. MSF Operational Centre Amsterdam (OCA) teams were able to initiate an exploratory team which arrived in Hatay within the first 24 hours after the earthquake. During the emergency response, MSF conducted activities in collaboration with local partners, mainly focusing on mental health, water, sanitation, and hygiene promotion activities, as well as distributions of items.

Results

Natural disasters, like the earthquake in Turkiye and Syria, can have a devastating impacts on populations. Clean water, healthcare, and transport are also often casualties in these disasters, making the immediate phase of the responses even more difficult. The adverse effects are the immediate deaths and injuries, as well as the trauma from losing homes, neighbors, and loved ones. These effects can overwhelm the entire populations long after the disaster.

Conclusions

A timely response is essential in natural disasters, such as earthquakes. Preparedness and the ability to mobilize quickly and adapt to different contexts and requirements using innovative approaches are needed for effective responses to save lives.

Presenting author profile

Dr. Robert Harrison is Clinical Professor of Medicine at the University of California, San Francisco where he has been teaching occupational specialists and designing and implementing health care worker safety and health programs.

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Robert Harrison (1)
1. University of California, San Francisco, CA USA

Background

Chemicals used in the manufacturer of semiconductors pose a risk to the health of workers and the community. Since the advent of the semiconductor industry more than 50 years ago, occupational and environmental exposures to chemical toxicants have increased the risk of many acute and chronic diseases. The use of chemicals in the global semiconductor manufacturing process has largely outpaced the resources, and authority of the scientific community, worker and community organizations to identify and prevent these diseases. Without the requirements to protect the safety and health of workers and the community from chemical exposure, the CHIPS Act of 2022 may cause a range of clinical and health problems.

Methods/Approach

The scientific evidence for acute and chronic diseases caused by chemical exposure in the semiconductor will be reviewed. In spite of challenges in conducting epidemiological studies in this industry, there is consistent evidence that a range of reproductive, neurological, respiratory and cancer health effects have occurred as a result of acute and long-term exposures to chemicals used in semiconductor manufacturing.

Results

The use of toxic chemicals in semiconductor manufacturing is not controlled or regulated in many parts of the world and continues to be a risk to the health of workers and the community. There are many examples of occupational and environmental health practices that can eliminate this threat.

Conclusions

It is imperative that worker and community health be considered as a human health cost as semiconductor manufacturing increases under the CHIPS Act. Investors and manufacturers should be required to establish, implement and fund comprehensive occupational and public health programs that include the monitoring and treatment of occupational diseases.

Presenting author profile

Dr Sen is working for OSH in Construction for over 35 years. Presently leading EHS Department of L&T Construction M&M SBH with over 200 OSH professionals in his team
He received “Safety Award” from the Institution of Engineers, Edgar Monsanto Queeny Safety Professional of the Year award from American Society of Safety Engineers and Distinguished Service Award from the Royal Society for the Prevention of Accidents.
He Chairs ICOH Scientific Committee in the Construction Industry.

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Krishna Nirmalya Sen (1); Gollapalli Muralidhar (1); Upasana Uniyal (1), Vinoth A (1)
1. Larsen & Toubro Limited M&M SBG, Kolkata, India

Background

Across the occupations, most vulnerable people are the migrant workers who mostly get engaged in construction and other informal jobs. Global migrant workers constitute around 4.9 % of the labour force of destination countries. Though certain ambiguity looms over the exact number of internal migrant workers; Some estimates suggests that there are over 194 million migrant workers in India. Majority of these migrants are associated with informal sector which employs around 89% of total Inidan labour force.

Methods/Approach

As per reports 9.6 % of labour are employed as informal workforce in construction works compared to Sub-standard working conditions, job security, poor understanding of workplace hazards and risks, lack of proper job skills, no formal training, unavailability/poor PPE, absence of emergency medical services are some of the common, yet serious issues faced by the migrant workers. 2.5% of formal workers, making construction majorly an unorganized industry.

Results

Owing to the typical intrinsic features of construction works they are subjected to heightened level of occupational health and safety risks such as physical fatigue, mental health issues, musculoskeletal disorders etc. To take care of safety, health, and welfare of these migrant workers in the construction and informal jobs, there is a definite need for multi-pronged approach. Other informal sectors too pose serious OSH concerns.

Conclusions

Legislative framework plays key role in improving OHS with “Vision Zero” for improving OSH culture by fostering leadership commitment and Implementation of control measures. As per the hierarchy of control, initiation of various steps such as improving working environment, welfare facilities, training and awareness on OSH, ensuring PPE etc. are crucial. Stringent monitoring and follow-ups could substantially improve the level of occupational health and safety standards in construction and informal jobs.

Presenting author profile

Dr. Casey Bartrem is Executive Director of TerraGraphics International Foundation, where she directs programs that address health issues related to mining and other hazardous industries. Her work and research focus on environmental assessment, human health risk assessment, and environmental health. Dr. Bartrem has led projects in Uzbekistan, Kyrgyzstan, Bangladesh, Nigeria, and the United States in close collaboration with local stakeholders, government representatives, humanitarian organizations, and other NGOs.

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Casey Bartrem (1); Kurbanov Murat (2); Dilmurod Rustamov (3); Amet Madreimov(4); Ian von Lindern (1); Brock Keller (1); Yvette Bonney (1); Margrit von Braun (1,5)

1. TerraGraphics International Foundation, Moscow, USA
2. Karakalpakstan Ministry of Health, Nukus, Karakalpakstan
3. Doctors Without Borders, Amsterdam, the Netherlands
4. Karakalpakstan Medical Institute, Nukus, Karakalpakstan
5. University of Idaho, Moscow, Idaho USA

Background

For decades, the rivers flowing into the Aral Sea in Central Asia were diverted to irrigate cotton fields. By the 1980s, the rivers no longer reached the sea and it rapidly began to reduce in size. Once the 4th largest inland body of water in the world, it is now 10% of its original size. The dramatic reduction in surface water and excessive use of agricultural chemicals resulted in severe environmental degradation and health impacts. The crisis is widely recognized as one of the world’s worst ecological disasters.

Methods/Approach

TerraGraphics International Foundation, Doctors Without Borders, and the Ministry of Health are assessing critical health issues related to the disaster. Partners are working in Karakalpakstan, a semi-autonomous region of Uzbekistan where salinization of drinking water, pesticide contamination, and airborne dusts are all likely contributors to elevated rates of cancer, kidney failure, respiratory disease, and other illnesses. In March-April 2023, partners collected 68 soil, 82 water, 23 sediment, and 27 air samples at 80 discrete locations throughout Karakalpakstan, analyzing samples for organochlorinated and organophosphorus compounds, as well as saline and heavy metal concentrations. Particulate air monitors were installed in three locations, and a weather station was installed in the capital city.

Results

Results from this study are being analyzed and will be presented in the context of identifying the most critical human health risks to both residents and agricultural workers.

Conclusions

Due to a complex geopolitical context, this investigation is providing the first set of comprehensive data from the region in more than 20 years. Environmental results will inform the development of a realistic and sustainable program that tackles health impacts by targeting exposure reduction for the most vulnerable and susceptible subpopulations.

Presenting author profile

Dr Maria Neira is WHO’s Director of Environment, Climate Change and Health. She was previously Vice-Minister, Health and Consumer Affairs, Spain and President, Spanish Food Safety and Nutrition Agency. She has worked in Mozambique, Rwanda, El Salvador, and Honduras, starting her career with Médecins Sans Frontières. Dr. Neira is a physician specialized in Endocrinology and Metabolic Diseases. She has received multiple awards, including the “Médaille de L’Ordre National du Mérite”, Republic of France.

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Maria Neira (1)
1. World Health Organization, Geneva, CH

Background

Climate change is already impacting human health in myriad ways, including death and illness from increasingly frequent extreme weather events, such as heatwaves, storms and floods; the disruption of food systems; increases in zoonoses, foodborne, waterborne, and vector-borne diseases; and mental health issues.

Methods/Approach

Climate change is undermining many of the social determinants for good health, such as livelihoods, equality and access to health care and social support structures. These climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, ethnic minorities, poor communities, migrants or displaced persons, older populations, and those with underlying health conditions.

Results

The health benefits of climate actions are well documented and offer strong arguments for transformative change. This is true across many priority areas for action, including adaptation and resilience, the energy transition, clean transport and active mobility, nature, food systems, and finance. The health sector and health community are a trusted and influential - but often overlooked - climate actors that can enable
transformational change to protect people and planet.
Climate interventions such as strengthening resilience and building adaptive capacity can lead to health benefits by protecting vulnerable populations from disease outbreaks and weather-related disasters, by reducing health costs and by promoting social equity.In addition, climate interventions are highly cost-effective with the public health and economic benefits resulting from ambitious mitigation efforts far outweighing their cost.

Conclusions

For all these reasons, there are no excuses for lack of action.

Presenting author profile

Philip J. Landrigan, MD, MSc is a pediatrician, epidemiologist, and occupational physician. He is a Professor at Boston College where he directs the Program for Global Public Health and the Common Good and the Global Observatory on Planetary Health. He recently chaired the Minderoo-Monaco Commission on Plastics and Human Health, which examined plastics’ negative impacts on human health, the environment and the economy across the plastic life cycle.

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Philip Landrigan (1,2), Sarah Dunlop (3), Hervé Raps (2)
1. Boston College, Boston, MA, USA
2. Centre Scientifique de Monaco, Monaco, MC
3. Minderoo Foundation, Perth, WA, Australia

Background

Plastics convey many benefits but also cause great harms. These harms have not been systematically examined.

Methods/Approach

To examine plastics’ harms to health across the entire plastic life cycle.

Results

98% of plastics are made from coal, oil and gas. They contain thousands of chemicals, mostly petrochemicals, and include carcinogens, neurotoxicants and endocrine disruptors. Production is increasing exponentially - from under 2 million tons in 1950, to 460 million tons today, and is on track to triple by 2060. Single-use plastics account for 40%. Recycling is ineffective, with rates below 10% globally. An estimated 22 million tons of plastic waste enters the environment each year. Much ends up in the ocean.

Plastic endangers human health across its entire life cycle – production, use, and disposal. Production workers, including coal miners, oil and gas workers, transport workers, chemical workers, and recyclers suffer excess cardiovascular, pulmonary, metabolic and neurologic diseases, and cancer. In use and disposal, plastics release microplastic particles and toxic chemicals. These materials increase risk for premature births, neurodevelopmental disorders, male reproductive birth defects, infertility, obesity, cardiovascular disease, renal disease, and cancer. Workers as well as children and environmental justice communities are especially at-risk.

Plastic production further endangers health by discharging nearly 2 gigatons of CO2 to the atmosphere annually – more than the contribution of Brazil.

The health-related costs of plastic production, including climate costs, exceed $250 billion globally. The costs of disease, disability and death caused by plastic chemicals exceed $920 billion annually in the USA alone.

Conclusions

The Minderoo-Monaco Commission supports urgent adoption of a legally binding Global Plastics Treaty, pursuant to the resolution of the 2022 United Nations Environment Assembly. A global cap on plastic production, bans on single-use plastics, comprehensive regulation of plastic chemicals, and Extended Producer Responsibility need to be core provisions of this Treaty.

Presenting author profile

Dr. Markowitz, MD is an occupational medicine physician and epidemiologist and directs the Barry Commoner Center for Health and the Environment at the City University of New York.

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Steven Markowitz (1); Amy Manowitz (1); Amaka OnyekeluEze (1); Jeffrey Miller (1), Albert Miller (1)
1. City University of New York, New York City, USA

Background

Background

Screening blue collar workers for lung cancer deserves high priority due to frequent exposure to occupational lung carcinogens and high rates of cigarette smoking. Implementation can be challenging.

Methods/Approach

Methods

Since 2000, in partnership with labor unions, we have applied low dose CT scan (LDCT) for early lung cancer detection to screen former and current nuclear weapons workers who were employed in previous decades by the U.S. Department of Energy (DOE). Eligibility criteria and program protocol have evolved over the program period. Since 2014, we have offered annual low dose CT (LDCT) screening to workers aged 50 to 80+ years, who smoked > 20 pack-years (with no limit on years since quitting) and worked > 2 years in production, maintenance, engineering, or science/laboratories at DOE facilities. Workers with asbestos-related pleural or parenchymal fibrosis were also eligible. Participants had to be free from terminal illness and sufficiently healthy to undergo treatment for lung cancer. The LDCT scans are offered free of charge at local CT scanning facilities.

Results

Results

We have screened ~14,000 DOE workers at 12 DOE sites, mostly in rural or non-metropolitan areas in the United States. We have detected 209 lung cancers, or 1.5% of all people screened at least once. 71% of detected lung cancers are early or limited stage [121 (60%) Stage I; 16 (8%) Stage II; 7 (4%) Limited small cell cancer; and 58 (29%) Stage III or IV].

Since mid-2014, when we began to offer annual LDCT screening, we have enrolled >65% of eligible people into screening and have achieved very good adherence from one year to the next, though the cumulative dropout proportion increases substantially over time.

Conclusions

Conclusion
LDCT-based lung cancer screening is endorsed by blue collar workers when offered free of charge by a trusted high quality program at a convenient location.

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Alessandra Patrono (1); Donatella Placidi (1); Stefano Renzetti (1); Giuseppa Cagna (1); Roberto G Lucchini (1,2)
1. University of Brescia, Brescia, Italy
2. Florida International University, Miami, FL, United States

Background

Neurodevelopmental disorders affect 15% of births. It is a priority to study the consequences of environmental pollutants and socio-economic status on cognitive functions. In this study of children in the industrialized area of Taranto, we investigated the trajectory of neurodevelopment of potentially healthy children to identify differences in cognitive functions based on the areas of residence at incremental distance from emissions and within the socio-economic context.

Methods/Approach

From 2014 to 2020 a total of 600 participants (ages 6 to 15) were involved in IQ assessments using the Wechsler Intelligence Scale for Children (WISC).The socio-economic data were collected through a questionnaire. To evaluate the influence of residential location, three areas at an increasing distance from the industrial source were considered.

Results

Cognitive indices with scores below the norm in the area closest to the industrial source compared to the area furthest away were as follows: verbal comprehension (33% v. 13%); visual-perceptual reasoning (33% v. 3%); working memory (42% v. 9%); machining speed (27% v. 4%). Although the screening phase included undiagnosed subjects, the following diagnostic profiles were collected among those who continued the evaluations: learning disorders; language disorders; intellectual disability. The results of the socio-economic survey showed that 74.2% mothers and 82.6% fathers have not completed post-secondary education; 66.1% have an annual income of less than €50,000; 51.4% of mothers were not formally employed.

Conclusions

Given the importance of early diagnosis, being able to grasp these factors quickly helped facilitate dispensatory methods. This had direct effects on the functional aspects and the emotional well-being profile. The aid measures should also be oriented according to the perception of the problem as functional or linked to difficulties in the socio-economic context.

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Praveen Kumar (1); Rajat Mishra (2); Sayli Shiradkar (2); Jayendran Venkateswaran (2); Chetan Solanki (2)
1. Boston College, Chestnut Hill, MA (USA)
2. Indian Institute of Technology Bombay, India

Background

Energy access in rural areas contribute to sustained well-being and economic development. Despite ubiquitous grid-based electricity infrastructure in rural India, the quality and reliability of electricity supply is below par. In rural and energy-poor areas, alternative technology solutions such as solar off-grid products, storage systems and energy-efficient devices can complement the unreliable electric grid to fulfil energy needs. This also contributes to the overall push to leapfrog to cleaner energy systems. Localized entrepreneurship in rural areas can play a significant role in increasing energy access. However, studies on the dynamics of rural entrepreneurship and low-cost energy access in poor households are scarce. This study explores local entrepreneurs' perception of social, economic, and technological factors that impact entrepreneurship dynamics in rural poor communities of India, and to identify strategies to help further improve the existing institutional support.

Methods/Approach

CBSD was used to engage participants in modelling their perspective of drivers and impacts of solar entrepreneurship. CBSD activities led to the development of a causal loop diagram that was subsequently translated into a stock-flow simulation model.

Results

Results indicate that training and subsequent experience in the project and business helped reinforce the entrepreneur's skills. Repair service and sales of energy products contributed in building trust and awareness in the community, thereby increasing demand for solar and energy-efficient products. The simulation-based scenario analysis shows the positive impact of better business practices, bulk procurement, and continued repair services on the income of the solar entrepreneurs.

Conclusions

Recent push to sustainable energy transition in the wake of reduction in carbon emissions has received a lot of traction. Thriving local markets and entrepreneurship in rural areas are crucial to for the energy transition in rural areas. Findings from this study can inform subsequent energy entrepreneurial development in rural Bihar.

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Mykola Prodanchuk (1)
1. Food and Chemical Safety Ministry of Health of Ukraine, Kyiv, Ukraine

Background

A peacetime Public health system must be prepared for the challenges of full-scale war. It must fully provide all disease prevention programs, especially vaccination, prevention of outbreaks and epidemics of infectious diseases, mass poisoning and radiation exposure.

Methods/Approach

This presentation focuses on the threats of chemical aetiology that arose in connection with the aggression of the Russian Federation against Ukraine. Among the chemical threats, in addition to the danger of using chemical weapons, the apparent consequences of hostilities were the impact of mixtures of highly toxic substances that are formed during the explosion of various types of ammunition (artillery shells, aerial bombs, cruise and ballistic missiles, attack drones), the use of phosphorous ammunition and riot control chemicals agents, oil storage combustion products, transformer oils, industrial process chemicals, agricultural chemicals and others. Similar situations in armed conflict zones in other countries will be analysed.

Results

In the public health model of Ukraine during the war, along with the need to provide tertiary prevention (first of all, closer to the front line), it is especially necessary to provide primary and secondary prevention of infectious diseases and poisoning in the rear. Without ensuring a stable epidemic situation in the rear, it is impossible to be sure of the stability of the front. Measures that the Public Health system should provide during martial law and after the end of the war will be discussed.

Conclusions

Proposals will be presented on models of tertiary prevention of the consequences of chemical stress to ensure diagnosis, treatment and rehabilitation of affected people and possible approaches to assessing the effects of chemical contamination of territories due to military actions.

Presenting author profile

Prof. Stephan Bose-O´Reilly, Senior Technical Director at Pure Earth /USA, is professor for Environmental and Public Health at the University Hospital, Ludwig-Maximilians-University (LMU), Munich. He is a pediatrician whose main interest is to prevent children from disease by helping to reduce their exposure to toxic substances, such as lead and mercury. His special interests are introducing micro-sampling methods, transferring knowledge and capacities, and training of scientists and experts to improve children’s environmental health.

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Stephan Bose-O'Reilly (1, 2), Aelita Sargsyan (1), Emily Nash (1), Sarah Berg (1), Gordon Binkhorst (1), Gabriel Sanchez Ibarra (1), Andrew McCartor (1)

1. Pure Earth, New York, NY USA
2. University Hospital, Munich, Germany

Background

Lead exposure can have serious consequences for the health of children. The neurological and behavioral effects of lead are believed to be irreversible. Young children are particularly susceptible to lead poisoning. In 2020, Pure Earth and UNICEF published “The Toxic Truth”, reporting that one in every three children has elevated blood lead levels above 5 µg/dL. Given that lead exposure sources can vary considerably by location, it is important to identify local sources of lead exposure, especially for young children and particularly within their homes.

Methods/Approach

To identify potential sources of exposure in low- and middle-income countries (LMICs), Pure Earth developed the “Rapid Market Screening” program. In 25 LMICs, Pure Earth collected and analyzed a total of more than 6,000 consumer products (metal cookware, ceramics, cosmetics, paint, toys, medicines), foods (starch, spices), and water and soil samples. The items were analyzed with a XRF locally, including quality control measurements with ICP-MS in the USA. The project was funded by Effective Altruism Global Health and Development Fund, GiveWell and Open Philanthropy.

Results

The final analysis is being performed at the time of the submission of this abstract. Preliminary results suggest several interesting trends. The well-known sources of exposure, like lead in paint and lead in ceramics are still an important source of lead exposure in some countries. Less known, but very important are lead in adulterated spices and lead in metal cookware. Toys and cosmetics showed high peak levels in several countries. Lead exposure of children is not limited to lead in paint, or lead-contaminated sites.

Conclusions

The exposure in LMICs can be diverse, and consumers in LMICs lack proper protection from avoidable lead sources. Rapid Market Screening is an innovative, simple and useful tool to identify the specific local pathways of lead exposure in children’s homes.

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Pietro Verzelloni (1); Teresa Urbano (1); Marco Vinceti (1,2); Tommaso Filippini (1,3)
1. University of Modena and Reggio Emilia, Modena, Italy
2. Boston University, Boston, MA, USA
3. University of California Berkeley, Berkeley, CA, USA

Background

Exposure to toxic metals in the environment is a major global public health concern due to its severe adverse effects on human health. Multiple studies have reported an increased risk of developing cardiovascular diseases (CVD), the leading cause of mortality in the developed world, associated with exposure to cadmium. The purpose of this meta-analysis is to assess the correlation between different levels of cadmium exposure and the risk of stroke and overall CVD.

Methods/Approach

To identify eligible articles, we searched three databases (PubMed, Web of Science, and Embase) from their inception up to July 24, 2023. We used MeSH terms and keywords related to 'cadmium', 'cardiovascular diseases', and 'stroke', while excluding reviews. The PECOS statement determined the criteria to include the adult population, varying levels of cadmium exposure from occupation, smoking, food, and water, as well as the risk of overall CVD and subgroups in observational studies (cohort, cross-sectional, or case-control) at increasing levels of cadmium exposure. We employed the one-stage approach with a random-effects model to conduct a dose-response meta-analysis.

Results

The current results indicate a clear link between higher levels of cadmium and increased prevalence, incidence, and mortality of CVDs and its specific outcomes. When assessing blood as a biomarker, a direct, positive correlation emerged between overall CVD risk, mortality, and cadmium exposure. When using urine as a biomarker, there was a positive but not entirely linear association for the same outcomes, with a plateau at high level of exposure. The only exception is the incidence of ischemic stroke, which showed no association. The analysis, even when stratified by sex, indicates a positive association.

Conclusions

These results highlight the need for implementing further measures to reduce environmental cadmium pollution, a significant factor associated with CVD.

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Palandri Lucia (1) , Lucaccioni Laura (2), De Pasquale Lisa (1), Lugli Camilla (1), Trevisani Viola (2), Righi Elena (1)
(1) University of Modena and Reggio Emilia, Modena, Italy
(2) University Hospital, Modena, Italy

Background

Phthalates are ubiquitous pollutants whose antiandrogenic effects have been widely studied. Therefore, their usage in toys, cosmetics and kitchenware manufacturing has been restricted to reduce exposure in susceptible populations such as infants. Understanding their phthalate exposure patterns might help shed light on the primary exposure sources.

Methods/Approach

Between 2019 and 2020, 197 mother-child couples were enrolled in a prospective cohort study at the
University Hospital of Modena (Italy). Urine samples were collected at birth, 3 and 6 months. 8 phthalates metabolites of 6 phthalates were analysed. Descriptive statistics, overall time trends and interclass correlation were calculated. Agglomerative hierarchical clustering was performed to assess exposure patterns in phthalate excretion. Risk assessment (Risk Quotients and Hazard Indices) was performed.

Results

Investigated phthalates were detected in all samples showing an increased trend over time. DnBP and BBzP were higher in newborns while DEHP was higher in 6-month-old infants. Samples collected at 3 months showed overall lower concentrations. Mothers and infants were interclass-correlated. Clustering analysis showed how 3- and 6-months infants had stricter clusters than their mothers. Most risk
quotient and hazard indices were below reference levels yet higher values than the threshold were detected at each follow-up visit.

Conclusions

Infants’ phthalate exposure in Modena is still high, even for those more toxic and strictly regulated.
Furthermore, our findings show how some mother-child pairs or infants tend to excrete higher levels of
metabolites than others. These findings suggest that different domestic exposure patterns exist and that
they tend to involve all family members. Finally, the results of the clustering analysis suggest that the
increase in environmental interactions may result in a loss in stricter patterns due to more widespread
environmental exposure. Public health campaigns addressing childbearing-age women about endocrine
disruptors and how to avoid their exposure should be considered.

Presenting author profile

During this roundtable, each participant will present an introduction of their involvement with aspartame research and the Collegium Ramazzini efforts.

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Knut Ringen (1); Morando Soffritti (2); Daniele Mandrioli (2); Linda Birnbaum (3); Kurt Straif (4, 5); Philip Landrigan (4)
1. CPWR - The Center for Construction Research and Training, Seattle, WA, USA
2. Ramazzini Institute, Bologna, Italy
3. National Institute of Environmental Health Sciences, Durham, NC USA (Retired)
4. Boston College, Boston, MA USA
5. ISGlobal, Barcelona, Spain

Background

The historical conflict over artificial sweeteners is long (110+ years!) and vicious, over the meaning of risk, in which different standards in chemical toxicology and food safety have been used to create confusion, and in which health science has been repeatedly attacked and brought into doubt by the chemical manufacturers, food industries and even the food safety regulators.

This struggle has been over a fundamental question: how much health risk should society accept from a product for which there is no observed evidence of health benefit?

When the Ramazzini Institute reported in 2006 and 2007 that aspartame (1) even at low exposure levels causes malignant tumors in in rats and mice, and (2) prenatal exposures caused increased malignancies in rodent offspring at lower doses than in adults, it set off a particularly vitriolic response.

Methods/Approach

This roundtable will discuss the struggle for scientific integrity and legitimacy by several CR fellows engaged in it.

Co-chairs: Morando Soffritti and Knut Ringen
Panel participants:
Daniele Mandrioli: Ramazzini Institute Perspective
Linda Birnbaum: National Institute of Environmental Health Sciences/National Toxicology Program Perspective
Kurt Straif: International Agency for Research on Cancer (IARC) Perspective
Philip Landrigan: Concluding Comments

Results

The scientists were attacked for their motives and the quality of their work. Yet, they persevered. After 15 years of struggle, their work triggered listing of aspartame as a high priority subject for evaluation by IARC). The IARC review panel concluded that based on the limited human epidemiology data available, aspartame is possibly carcinogenic to humans.

Conclusions

The outcome should be a framework for a Collegium Ramazzini Statement.

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Elisabeth Cardis (1,2,3); Elizabeth Diago Navarro (1,2,3); Roberto Lucchini (4,5)
1. Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
2. Pompeu Fabra University, Barcelona, Spain
3. Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
4, University of Modena, Modena, Italy
5. Florida International University, Miami, FL, USA

Background

Disaster preparedness and response has long been a scientific-technical issue with privileged involvement of experts and administrative bodies and siloing of hazards. The COVID-19 pandemic highlighted important gaps and difficulties in this approach to preparedness and response, at all levels. These are not unique to pandemics: similar challenges have been encountered following other types of crises: nuclear, chemical/industrial, natural hazards (including related to climate change), and wars.

Methods/Approach

We will briefly review lessons learnt from different types of crises, identifying commonalities and describing needs and challenges. These include the long-term indirect health and societal effects of the disasters and risk reduction measures; the acceptability of these measures; deficiencies in epidemiological intelligence systems; difficulties in identifying, tracking and adequately monitoring the impacted populations; challenges in real time exposure measurements; difficulties in communication and consequent loss of trust in authorities; fragmentation of response and resources leading to lack of coordination.

Results

The commonalities encountered suggest an all-hazards approach would be beneficial and more cost-effective. While such an approach is already taken in some countries, a more global application is needed.

Conclusions

This approach needs to be developed in peace time and requires multi-disciplinary and multinational collaborations and stakeholder engagement and the creation of an international network of subject matter experts to serve as a reference in case of crisis.
It would include in particular:
-Common core epidemiological protocols for environmental and public health crises, adaptable to particular crises;
-Development of needed processes and procedures to facilitate implementation of the protocols in emergency situations, addressing legal and ethics barriers to conducting research;
-Stakeholder engagement at all levels of actions to facilitate the integration of individual responsibilities;
-Improving communication and education strategies to efficiently communicate the best knowledge to date;
-Development of an all-hazards preparedness culture in peacetime;
-Adequate and sustainable political and financial support in the long run.

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Kristie L. Ebi (1)
(1) University of Washington, Seattle, WA, USA

Background

In recent decades, heatwaves worldwide increased in frequency, intensity, and duration. Heatwaves cause excess morbidity and mortality as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress also can reduce physical work capacity and motor-cognitive performances.

Methods/Approach

Statistical methods termed detection and attribution were used to determine the extent to which climate change increased the intensity of these events; some events were deemed virtually impossible without anthropogenic climate change.

Results

Projections under a range of climate and development scenarios indicate that greenhouse gas emissions from anthropogenic activities will likely make future heatwaves more extreme, with shorter return periods. The world will soon enter an era where climate change affects all heatwaves. Few regions are prepared for the heatwaves of today; even fewer are prepared for the more extreme events that are emerging.

Conclusions

Adverse health outcomes are potentially preventable with effective heat action plans that include sustainable cooling strategies at the level of individuals, communities, urban infrastructure, and landscape. Conducting stress tests of heat actions plans will help increase resilience to future, more extreme heatwaves, including compound heatwaves, heatwaves combined with wildfire smoke exposure, and other climate-related hazards. Projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase.

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Carl F. Cranor (1)
1. University of California, Riverside

Background

Most environmental health laws in the US are postmarket regulatory laws. Chemical products enter commerce with little or no toxicity data. To reduce or eliminate risky products, administrative agencies must satisfy a legal burden of proof with a postmarket, post-exposure, and (often) ambient exposure legal actions. This legal structure places near total risk bearing, plus cost and health externalities on the public, exemplifies moral hazards, and poorly protects the public. It also encourages companies to delay, foster scientific doubt with misleading studies, demand for “ideal” science for regulation, and (sometimes) cheat in studies or journal publications.

Methods/Approach

An “ideal” correction would be laws that approached premarket testing of new products and expedited testing of existing products. These need not replicate all details for premarket testing of pharmaceuticals. They could include a “tiered strategy” for reviewing toxic substances prior to commercialization (or those in commerce) to identify the most risky agents for greater review.

Results

We should modify postmarket laws to remove “protection time gaps” between identifying a toxicant and protecting the public.

Conclusions

In addition to wholesale premarket testing (above), the use of legal presumptions provides some ideas. Mimic aspects of the Vaccine Injury Compensation Program with charges on new chemicals used to assist compensation for injured parties and reduced legal barriers for redress. Or, mimic Presumptive Disability Decision-making Process for Veterans’ Compensation to ease legal proof burdens compared to tort law actions. In addition, agencies could make greater use of presumptions between toxicologically similar substances, e.g., epoxide and epoxide forming substances, or toxicity equivalency factors (for dioxin and dioxin-like compounds) to expedite regulatory steps. Developing group identification of substances also seems promising—substances with significant exposure potential as well as similar structures and functions. These suggestions could be explored to begin to address the shortcomings of postmarket laws.

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Adam M. Finkel (1)
1. University of Michigan School of Public Health, Ann Arbor, USA

Background

Much of the literature on how vested interests thwart regulation, and escape liability for past damages, has focused on the personal and financial dots connecting industries to “hired guns,” and less on the specific arguments made. Stepping back, I examine here two general lines of attack that are both superficially compelling and deeply misleading, and that are being used today to muddy attempts to control hazards as widespread and disparate as chemical pollutants in the workplace and the general environment, repeated head impact in contact sports and other occupations, and SARS-Cov-2.

Methods/Approach

I will dissect two common arguments against sensible regulation: (1) The claim that all dose-response functions have thresholds is now being misused to trivialize current and real exposures that should clearly be seen as intolerable regardless of whether hypothetical "lower" exposures might in fact be sub-threshold. This agenda also has a retrograde effect on science: it has delayed the mainstream recommendation that we modernize non-cancer risk assessment, and instead it has helped to “dumb down” the more scientific cancer risk assessment paradigm; and (2) new tests for “causality” are inappropriately offered as superior to face-value evidence from epidemiology and toxicology, again in order to cast doubt on policies that are likely (but not absolutely guaranteed) to provide substantial health and environmental benefits.

Results

We should continue to improve the science of risk assessment, but resist "manufactured hubris" and realize that inaction in the face of probable harms is a dangerous and value-laden action.

Conclusions

Regulatory agencies should promulgate guidelines for risk analysis that welcome new science but that are respectful of precaution, explicit in accounting for interindividual variability in susceptibility and exposure, and unwilling to discard sensible procedures in favor of unproven and illogical "innovations du jour."

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Jaime Butler-Dawson (1), Lyndsay K Krisher (1), Diana Jaramillo (1), Miranda Dally (1), John Adgate (1), Lee S Newman (1)

1. Colorado School of Public Health at University of Colorado, Aurora, CO, USA

Background

There is growing evidence that extreme heat stress and repeated dehydration is likely one of the contributors to the epidemic of CKDu. Many hypotheses regarding the disease’s cause have emerged including multiple occupational, environmental, and social factors—in particular, heat stress, dehydration, heavy metals, agrochemicals, and medications. Sugarcane workers, in affected communities, may be especially vulnerable to exposure to multiple nephrotoxicants, specifically particulate matter, heavy metals, and silica, which may exacerbate CKDu in addition to heat.

Methods/Approach

The Center for Health, Work and Environment (CHWE) partnered with a Guatemala sugarcane agribusiness to both investigate the etiology of CKDu and to develop enhanced preventive activities and interventions to protect sugarcane workers. Our interventions have included encouraging workers to drink electrolytes in addition to promoting water, rest, and shade; educating workers on ways to reduce heat stress and dehydration as well as avoiding anti-inflammatory medications, which are harmful to the kidneys when dehydrated; and performing enhanced kidney health surveillance and clinical monitoring for workers during the season.

Results

During our current study in Guatemala, we have collected two years of personal air samples from sugarcane workers as well as Individual-level biomonitoring of heat stress. We observed median breathing zone personal particulate matter exposure concentrations of nearly 450 µg/m3, levels that were up to 8 times higher local ambient levels and found amorphous silica in the air samples. We observed that almost half of the workers reached core body temperatures of 38.0 degrees Celsius during the work shift.

Conclusions

The results of our research are being used to inform interventions to reduce occupational and environmental exposures among workers populations in Latin America.

Presenting author profile

Dr. Lucchini is an MD, Professor of Occupational and Environmental Medicine at the University of Modena and Reggio Emilia, Italy, and Florida International University. His research interests are on the brain impacts from neurotoxicants across the life course. He investigates children, workers, elderly and patients with neuro-degenerative disorders residing in industrial areas of Italy, and the 9/11 responders who were impacted by the exposure to neurotoxic chemicals and intense psychological trauma.

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Roberto Lucchini (1, 2); Chip Hughes (3); Aubrey Miller (3); Leslie London (4); Iman Nuwayhid (5); Kurt Straif (6,7)
(1) University of Modena and Reggio Emilia, Italy
(2) Florida International University, USA
(3) USA National Institute of Environmental Health Sciences
(4) University of Cape Town, South Africa
(5) American University of Beirut, Lebanon
(6) Boston College USA
(7) ISGlobal, Barcelona, Spain

Background

Emergency preparedness of a variety of disasters is still largely suboptimal. In post-COVID19, emergency plans must be revised according to new and old lessons. A holistic approach to emergency preparedness, disaster management, and public health intervention is needed to anticipate and, where possible, prevent disasters and mitigate short and long-term impacts on responders and communities.

Methods/Approach

This statement considers the status of emergency and preparedness on a global scale, highlighting the suboptimal level of infrastructures that are available today. It is based on a review of major accidents and emergencies including infectious epidemics, nuclear, chemical and other accidents, disasters related to climate change, such as extreme weather events, wildfires and increased air pollution, and natural disasters including earthquakes, and volcanoes emissions. The analysis of various types of situations yields a constant process of lesson learning, and opportunities for improved policies and procedures at national and global levels.

Results

Immense negative consequences, especially for the vulnerable, arise from the inadequate response and management of disasters on population health and society’s development. Most impacts are all modifiable and can be significantly reduced by emergency and all-hazards preparedness plans.

Conclusions

Rigorous establishment and continuous curation of disasters databases shall contribute to improved and timely response guided by the incremental lessons learned from response analyses to new events when compared with the overall existing knowledge from different forms of disasters. Combined holistic approaches to disasters of different individual origin should lead to optimized resources and better coordination among agencies. Epidemiological surveillance will help identify physical and mental health impacts and yield personalized prevention and care. Disaster response plan must also recognize that there are large inequalities in resilience and social capital to address.

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Sotiris Vardoulakis (1)
1. Australian National University, Canberra, Australia

Background

Catastrophic wildfires, fuelled by climate change, have resulted in the direct loss of human and animal life, and the destruction of thousands of properties and habitats in Australia, Southern Europe, North Africa, Southeast Asia, and North and South America in recent years. For example, the unprecedented wildfires of the Australian Black Summer killed 34 people in 2019/2020, with millions more being exposed to hazardous bushfire smoke that lingered for weeks over large population centres.

Methods/Approach

This paper presents an overview of the health impacts of wildfires in Australia and internationally, and explores related communication tools, media and community engagement effort to protect human health. The Australian National University (ANU), in collaboration with other organizations involved in the HEAL National Research Network, have developed policy briefings, factsheets, infographics, media articles, interviews and podcasts on how we can protect the public’s physical and mental health from wildfires. The ANU factsheets have been translated into twelve languages and promoted through all media, reaching a very wide audience in Australia and overseas.

Results

This paper analyses and discusses approaches and challenges in public health communication, air quality reporting and health messaging in relation to wildfires. It also points to the need for greater public awareness of climate related health hazards, as well as of the need for health protective behaviours, adaptive infrastructure, and policy action to mitigate climate change.

Conclusions

Further work is currently ongoing to adapt the HEAL Network wildfire and air pollution communication materials for diverse audiences, such as First Nations, children, and patient and professional groups.

Presenting author profile

Morando Soffritti, MD, is the secretary General of the Collegium Ramazzini. He is also Honorary President of the Ramazzini Institute where he previously served as Scientific Director. His research focuses on the identification of the causes of cancers, particularly those of industrial and environmental origin. He is the author of more than 170 publications. In 2007 he was honored with the Irving Selikoff Award and in 2022 he was the Ramazzini Award Recipient.

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Morando Soffritti (1)
1. Ramazzini Institute, Bologna, Italy

Background

Aspartame is an intense artificial sweetener with a sweet taste approximately 200 times that of sucrose. It is an additive in more than 6,000 products including more than 500 pharmaceutical products for children.

Methods/Approach

Aspartame was invented by GD-Searle in 1965 and submitted for pre-marketing safety evaluation in early1980s. The studies conducted by GD-Searle to evaluate the potential carcinogenic risks of aspartame did not show any effect. Because of the wide commercial use of aspartame, in 1997 the Ramazzini Institute started a large experimental project on rodents to test the carcinogenic effects of aspartame. It involved the Institute's experimental model with more sensitive characteristics, namely a large number of rats and mice, start of the treatment from prenatal life, and observation until natural death. Overall, the project included the study of 2,270 rats and 852 mice starting the treatment from prenatal life or in mature age and lasting all life.

Results

These studies have shown that aspartame is a carcinogenic agent inducing a significant dose-related increased incidence of several types of malignant tumors, including hematological neoplasias and liver cancer. These effects have been confirmed by epidemiological studies. A comment on the recent evaluation by the International Agency for Research on Cancer of the carcinogenic potential of aspartame will be reported.

Conclusions

The results of the studies of the Ramazzini Institute on aspartame has opened a real front on the evaluation of health risks of artificial sweeteners and food additives in general. For industry, aspartame is an artificial sweetener to defend at all costs. Adequate long term carcinogenicity bioassays on other diffuse artificial sweeteners as acesulfame-k. sucralose, saccharine and others, including their blends, are urgently needed.

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Atsuko Ikeda (1,2); Yu Ait Bamai (1); Chihiro Miyashita (1); Rahel Mesfin Ketema (1); Reiko Kishi ()
1. Hokkaido University, Sapporo, Japan
2. WHO Collaborating Centre for Environmental Health and Prevention of Chemical Hazards, Sapporo, Japan

Background

The Hokkaido Study on Environment and Children’s Health is an ongoing study consisting of two birth cohorts of different sizes, the Sapporo cohort and the Hokkaido cohort, which were established in 2001.

Methods/Approach

Prenatal environmental exposure to chemicals such as polychlorinated biphenyls and dioxins, organochlorine pesticides, per-and polyfluorinated compounds (PFAS), and phthalates has been measured. Cord blood biomarkers, such as adiponectin, leptin, thyroid, and reproductive hormones were also measured. Information on physical growth, neurodevelopment, allergy and infections, and onset of puberty has been collected to analyze health outcomes. We have also conducted exposure measurements in children. Phthalate metabolites, bisphenols, and phosphate flame retardants metabolites in children’s urine collected at age of seven were examined. Recently, Electronic Magnetic Field around children has been also examined.

Results

In this presentation we focus on children’s exposure to plastic additives: phthalates, phosphate flame retardants and plasticizers (PFRs), bisphenols, and nonylphenol (NP). We have also examined the prevalence of asthma and allergies by ISAAC questionnaire. When comparing the levels of these chemicals in the urine collected from 2012 to 2017, increasing secular trend of PFRs and BPS was found, while decreasing trend in BPA and NP. The levels of legacy phthalates did not show any secular trends, whereas phthalate alternatives, DEHTP and DINCH show increasing trend. Single metabolite as well as mixture of phthalates were positively associated with increased risk of wheeze and eczema of 7 years old children.

Conclusions

Our study highlights the need for ongoing biomonitoring studies to closely monitor the increasing trends, investigate any potential health impacts, and enable prompt response if necessary. For further examination and life course approach, we are now conducting face-to face health check-up with blood and urine sample collections at one’s adolescence.

Presenting author profile

Dr Inoka Suraweera graduated from the Faculty of Medicine, University of Colombo, with second class honours. She holds Masters and Doctoral Degrees in Community Medicine from the University of Colombo. She had post-doctoral training at Monash Centre for Occupational and Environmental Health, Australia. She is currently Consultant Community Physician and technical head of the Environmental and Occupational Health Unit of the Ministry of Health. She is actively engaged in undergraduate and post graduate medical education

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Inoka Suraweera (1)
1. Environmental and Occupational Health Unit, Ministry of Health Sri Lanka

Background

Climate change has been producing and is expected to produce severe direct and indirect impacts on human health. It is considered the most significant health threat currently facing humanity. Sri Lanka, a tropical nation, is highly vulnerable to adverse impacts of climate change.

Methods/Approach

Desk review and key informant interviews were conducted to understand the activities performed by the health sector in Sri Lanka on climate adaptation and mitigation.

Results

The Sri Lanka health sector recognizes the importance of addressing climate-change-related health impacts in a systematic manner due to the nation’s great vulnerability. A focal unit has been identified in the health sector to work in this area.

The importance of climate adaptation as a key strategy has been recognized. A Health National Adaptation Plan 2016 -2025 has been developed and incorporated into the National Climate Adaptation Plan for Sri Lanka. Nationally Determined Contributions for health sector have been developed and being implemented. Advocacy, capacity building and awareness-raising are being carried out. Activities are ongoing to build the resilience of the health facilities to respond to climate related events.

Streamlining health care waste management, shifting to non-incineration techniques for infectious and sharps waste management, construction of solar panels are some of the activities done to reduce greenhouse gas emissions from health sector at national and sub national levels in Sri Lanka.

Conclusions

The health sector needs to take a lead role in addressing climate action. Vulnerability assessments should be conducted on a regular basis and health sector actions on adaptation and mitigation should be based on evidence. In-depth studies on traditional knowledge and experience to withstand climate threats should be conducted and used for planning adaptive measures.

Presenting author profile

*Dr. Zhang is an emeritus professor in toxicology at the Division of Environmental Health Sciences, School of Public Health, University of California at Berkeley, where she has worked for more than 30 years to understand the biological mechanisms of chemical exposure-related human cancer. The work presented conforms with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

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Iemaan Rana (1); Patton K. Nguyen (1); Gabrielle Rigutto (1); Allen Louie (1); Jane Lee (1); Martyn T. Smith (1); Luoping Zhang (1)
1. University of California, Berkeley, CA, U.S.A.

Background

Glyphosate was classified as a probable human carcinogen by IARC in 2015. Since then, numerous studies of glyphosate and its formulations (GBF) have emerged.Many of them can be evaluated for cancer hazard identification with the newly described approach of ten key characteristics (KC) of carcinogens.Our objective was to assess all human/mammal studies that compared exposure to glyphosate/GBF with low/no exposure counterparts for evidence of the ten KCs.

Methods/Approach

A detailed protocol (INPLASY202180045) with PRISMA guidelines was registered.Two blinded reviewers screened all mechanistic studies reporting any KC-related outcome available in PubMed. Studies that met inclusion criteria underwent data extraction conducted in duplicate for each KC outcome reported along with key aspects of internal/external validity, results, and reference information.These data were used to construct a matrix that was analyzed in program R to conduct strength of evidence and quality assessments.

Results

Of the 2537 articles screened, 175 articles met the inclusion criteria. Data analysis revealed strong evidence for five KCs, limited evidence for two KCs, and inadequate evidence for three KCs. Our in-depth quality analyses of genotoxicity (KC2) and endocrine disruption (KC8) revealed strong and consistent positive findings. For genotoxicity, we found studies conducted in humans provided stronger positive evidence than animal studies; GBF elicited a stronger effect in human/animal studies when compared to glyphosate alone; and the highest quality studies in humans consistently revealed strong evidence of genotoxicity. Our KC8 analysis indicated glyphosate’s ability to modulate hormone levels.The observed modulations provide clear evidence that glyphosate interacts with receptors, alters receptor activation, and modulates the levels and effects of endogenous ligands/hormones.

Conclusions

Our findings strengthen the mechanistic evidence that glyphosate is a probable human carcinogen and provide biological plausibility for previously reported non-Hodgkin lymphoma associations. We identified potential molecular interactions and subsequent key events that were used to generate a probable pathway to lymphomagenesis.

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Melissa J. Perry (1); Lauren B. Ellis (2); Karen Molina (3); C. Rebecca Robbins (4); Marlaina Freisthler (4); Daria Sgargi (5); Daniele Mandrioli (6)
1. George Mason University, Fairfax, VA, USA
2. Environmental Defense Fund, Arlington, VA, USA
3. National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
4. The George Washington University, Washington D.C., USA
5. University of Bologna, Bologna, Italy
6. Ramazzini Institute, Bologna, Italy

Background

Evidence of the negative impacts of contemporary use insecticides on sperm concentration has mounted over the last few decades but very few systematic reviews and meta-analyses of the epidemiologic evidence have been conducted.

Methods/Approach

Scientific and United States governmental databases and five non-governmental organization websites were searched for relevant primary epidemiology studies published in any language through August 11, 2022. Risk of bias and strength of evidence were evaluated according to validated systematic review methodology. Bias-corrected standardized mean difference values were calculated and pooled using a three-level, multivariate random-effect meta-analysis model with cluster-robust variance estimation.

Results

Across 20 studies, 21 study populations, 42 effect sizes, and 1,774 adult men, the standardized mean difference in sperm concentration between adult men more- and less-exposed to organophosphate (OP) and N-methyl carbamate (NMC) insecticides was -0.30 (95% CI: - 0.49, -0.10; PSatt < 0.01). Whereas the pooled association was affected by risk of bias, insecticide class, exposure and exposure and recruitment setting, negative associations persisted across all meta-analyses. The accumulated body of scientific information was found to have sufficient evidence of an association between adult OP and NMC insecticide exposure and reduced sperm concentration.

Conclusions

This comprehensive investigation found sufficient evidence of an association between OP and NMC insecticide exposure and reduced sperm concentration in adults. While mechanistic studies can fill data gaps, the strength of evidence strongly warrants reducing exposure to OP and NMC insecticides now to prevent continued male reproductive harm.

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Elliot M Berry, (1)
1. Hebrew University-Hadassah Medical School, Jerusalem, Israel

Background

BACKGROUND:
The current geo-political situation, following so soon after the COVID pandemic, has led to major food, energy, water and humanitarian crises for which the world is poorly prepared. The on-going war in the Ukraine shows how food and energy may be used as political weapons of war, prolonged by human choice and bystander indifference.

Methods/Approach

Both Poverty and War may be considered as epidemics leading to food insecurity and malnutrition in a world where one-third of food is wasted, yet there is enough food to feed everyone. Approximately, equal numbers (two billion) suffer from Under-nutrition and Over-nutrition, the latter a pandemic far greater than COVID. Unequal food distribution and economic interests are given higher priorities than equity and social justice.
However, this grave situation may be leveraged to produce positive responses at national and international levels to align food systems with the Sustainable Development goals. Operationally, a major re-thinking is required of the policies and science included in these multi-disciplinary activities. We discuss these challenges and suggest some new approaches using the sociotype framework.

Results

In practical terms, we do not need more recommendations but actions on the following points: 1) Responsibility: Food Security should be seen as a fundamental human right and a basic Government responsibility, providing access for all to affordable, safe and healthy food. 2) Prevention and Preparedness: Multi-disciplinary teams and partnerships, with defined leadership and dedicated budgets, are required to mitigate the next pandemic / crisis – which will surely come 3) Policies: Long-term SYSTEMIC policies must deal with Complex Adaptive Sustainable Food Systems. 4) Resilience building through the Sociotype Framework – at Individual, Societal and Institutional levels.

Conclusions

The goals are to eradicate hunger, prevent disease and promote well-being, with fewer conflicts in a more harmonious world - all crucial to combat malnutrition and food insecurity.

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Tommaso Filippini (1)(2); Teresa Urbano (1); Marco Vinceti (1)(3)
1. University of Modena and Reggio Emilia, Modena, Italy
2. University of California Berkeley, Berkeley, CA, USA
3. Boston University School of Public Health, Boston, MA, USA

Background

Nowadays, the majority of the world population live under light-polluted skies and are exposed to artificial light at night (ALAN). In addition, nearly 7-8% of the working population perform night work (any time between 9:00 pm and 08:00 am). Both ALAN and night-shift work have increased in recent years in developed and especially developing countries. ALAN exposure may occur both outdoors e.g. buildings with exterior lighting and streetlights, and indoors due to electronic devices related also to working activities. Both ALAN and night-shift work may disrupt the circadian rhythm, thus impairing several metabolic and hormonal system affecting human health.

Methods/Approach

We will present evidence from the scientific literature on adverse health effects from ALAN exposure and night-shift work on human health, focusing especially on vulnerable categories like women and children.

Results

Several reports indicate that ALAN and night shift work are associated with adverse effects on human health, including sleep problems, metabolic diseases including obesity and diabetes, cancer, especially breast cancer, and possibly cognition. Working at night is associated with higher risk of sleep deprivation, and decreasing alertness, also leading to higher risk of accidents, especially industrial environmental disasters. Some of the most devastating environmental health disasters occurred at night and have been partially related to performance failures during night working.

Conclusions

The widespread use of night lighting and 24/7 working activities should be considered a serious health concern, especially after the recognition of night-shift work as probable human carcinogen (Group 2A). Health policy should reconsider the economic and health benefits of 24/7 society, going one step back to go two steps forward.

Presenting author profile

Dr. Smith is Distinguished Professor of Microbiology and Environmental Toxicology at the University of California, Santa Cruz. He has worked with basic scientists, epidemiologists, and clinicians to better understand the causal relationship(s) between environmental neurotoxicant exposure and attentional and psychomotor disorders in children and adolescents, their underlying neural mechanisms, and the efficacy of therapeutics to ameliorate the executive function deficits.

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D.R. Smith (1); S. Beaudin (1); N. Santiago (1); S. Howard (1); D.J. Rowland (2); E. Fisher (1); B.J. Strupp (3)
1. University of California, Santa Cruz, CA, USA
2. University of California, Davis, CA, USA
3. Cornell University, Ithaca, NY, USA

Background

Attention deficit hyperactivity disorder (ADHD) and associated symptoms are associated with environmental risk factors. Developmental manganese (Mn) exposure is associated with deficits in attention, inhibitory response control, and psychomotor function in children and adolescents, though the causal relationship(s) between Mn exposure and these deficits, their underlying mechanisms, and efficacy of potential for therapeutic treatments are not known. Our objectives are to 1) demonstrate whether developmental Mn exposure causes lasting deficits in attention, impulse control, and sensorimotor function, 2) determine the mechanisms underlying the lasting Mn deficits, and 3) determine whether pharmacologic interventions with methylphenidate (MPH, Ritalin) ameliorates those deficits.

Methods/Approach

We used a rodent model of developmental Mn exposure, the 5-CSRTT and Montoya staircase tasks of attentional and sensorimotor function, catecholamine receptor-specific antagonists, raclopride PET imaging, in vivo microdialysis, and proteomics, transcriptomics, and methylomics to elucidate the neural mechanisms underlying the Mn deficits. Additionally, we determined the efficacy of MPH to ameliorate the Mn deficits.

Results

Developmental Mn exposure causes lasting impairments in attention, learning, and sensorimotor functions, and prolonged (but not acute) oral MPH treatment is efficacious in ameliorating these impairments. Antagonism of specific D1, D2, or α2A receptors does not alter the attentional impairment seen in the Mn animals, or the MPH efficacy to improve Mn-induced attentional dysfunction. The Mn deficits are associated with a proinflammatory cellular environment and a hypofunctioning catecholaminergic system (gene and protein expression, neurotransmitter release) in fronto-striatal regions. Disrupted mTOR and Wnt signaling is identified as a key regulatory pathway underlying the lasting catecholaminergic system deficits caused by developmental Mn exposure.

Conclusions

These findings significantly advance understanding of the causal relationship between developmental Mn exposure and lasting attentional and sensorimotor deficits and their underlying mechanisms, and they demonstrate that a clinically-relevant oral MPH regimen is fully efficacious in ameliorating these deficits.

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Elihu D. Richter (1)
1. Hebrew University, Jerusalem, Israel

Background

Failure to promote the core values of respect for human life and dignity is an ethical poverty. The big isms of the 21st century: Fascism, Communism, and Jihadism, are extreme examples of such a failure. A population-wide exposure to the motifs of these doctrinal ideologies has been shown to lead to mass murder, political violence, and genocide. Eugenics, Social Darwinism, racial selection, and Racial Hygiene led to Nazi Medicine and the Holocaust.

Methods/Approach

We review why incitement to genocide is an ethical poverty and make a case for action.

Results

The UN Convention of Genocide (1948) specifies that both genocide and its incitement are crimes against humanity. Incitement to genocide is a recognized early warning sign, marker, catalyst, and promoter of genocide. It includes Dehumanization, Demonization, Delegitimization, and support for extreme violence. The most pressing issues today are the rise of Antisemitism—including Iranian incitement—and the totalitarian war by Russia against Ukraine. In the latter case, there was a failure to recognize the early warning signs and act preemptively. This bystander indifference is an ethical poverty that makes genocide possible.

Conclusions

The precautionary principle (PP) is environmental medicine’s gift to genocide prevention. Respect for life and human dignity is the core ethical value and is essential to genocide prevention. The PP states that it is better to be safe than sorry. It shifts the burden of proof from those suspecting a catastrophic risk to those denying it. It advances the temporal locus of intervention from proof of intent after the event to predict and prevent before the event. We use the PP to prevent genocide by preventing incitement to genocide. Moral agency requires us to apply the PP to exercise human choice and overcome bystander indifference.

Presenting author profile

Dr. McDiarmid is a Professor of Medicine, Epidemiology and Public Health at the University of Maryland School of Medicine where she directs the Division of Occupational and Environmental Medicine. She studies the hazards of the health sector and their mitigation in both well-resourced and limited-resource settings.

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Melissa McDiarmid (1); Hanna LeBuhn (1)
1.University of Maryland School of Medicine, Baltimore, Maryland, USA

Background

Background: The duty of care principle has roots in both ethics and the law and is broadly defined as an obligation to conform to certain standards of conduct to protect others against unreasonable risk of harm. It appears in professional codes of ethics for health workers to provide care for their patients, including during pandemics. However, after the first severe acute respiratory syndrome (SARS) epidemic in 2003, with the notable loss of life among health workers, some authors raised the ethical need to consider the added risk workers assumed when gauging society’s expectations of their service. These authors suggested that employers had a reciprocal obligation to their employees to provide the needed training, work organization and protective equipment to make hazardous work as safe as possible.

Methods/Approach

A recent publication has suggested that the strong duty of care disposition of the Médecins Sans Frontieres (MSF) agency, compared to that of other responding agencies was a possible explanation for the dramatically lower Ebola Virus Disease incidence rate of MSF responders at 1.4/1000 persons versus 30-44/1000 persons depending on job title, for other agency-convened teams.

Results

MSF operationalized their duty of care commitment through four actions: performing risk assessments prior to deployment, organizing work and work practices to minimize exposure, providing extensive risk communication and training of staff and providing medical follow-up for staff exposures.

Conclusions

We will examine the overlap between these MSF actions with safety climate and safety behavior measures to argue that an organization’s duty of care commitment is an indicator of safer work during pandemic responses.

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June T. Spector (1,2)
1. Washington State Safety & Health Assessment & Research for Prevention (SHARP) Program, Tumwater, Washington, USA
2. University of Washington, Washington, USA

Background

Science is a key element that should be integrated into the development of occupational heat stress policies. Policymaking processes and requirements are different in different countries, jurisdictions, and organizations. However, there are several potential common opportunities and solutions for optimizing integration of science into heat stress policymaking processes, with the aim of reducing the burden of occupational heat stress.

Methods/Approach

This presentation will review potential entry-points and considerations for integration of science into heat stress policymaking, using local examples and solutions, but with consideration of broader generalizability. The importance of, and approach to, compiling and disseminating occupational heat stress research to stakeholders and diverse working populations in advance of policymaking will be described. Policy-relevant considerations for research on the burden of occupational heat stress, including quality and local applicability and relevance to specific working populations, will be discussed. The utility of intervention effectiveness research will be described in the context of other common policymaking aspects such as feasibility and economic considerations.

Results

Effective occupational heat stress policies have the potential to protect workers from heat stress. Depending on scope, purpose, implementation, and enforcement, these policies have the potential to contribute to reductions in adverse heat-related health outcomes, including heat-related illness, heat-related traumatic injuries, acute and chronic kidney disease, and exacerbations of underlying diseases such as cardiovascular disease.

Conclusions

Research on the relationship between heat stress and occupational health outcomes and intervention effectiveness research should be disseminated to stakeholders in advance of occupational heat stress policymaking to inform occupational heat stress policymaking processes. Evaluation research on the effectiveness of policies in reducing adverse health effects from occupational heat stress should also be conducted.

Presenting author profile

Dr. Miller is the Co-Chair of the NIH Climate Change and Health Working Group and serves as Deputy Director for the NIEHS Office of Scientific Coordination, Planning, and Evaluation, where he furthers the development and implementation of priority environmental health programs, as well as strategic planning and engagement with government agencies, academia, and other stakeholders.

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Aubrey Miller (1)
1. National Institute of Environmental Health Sciences, National Institutes of Health; Bethesda, MD, USA

Background

Climate drivers affect human health outcomes directly through weather events such as extreme heat, wildfires, droughts, storm surges, and floods, and indirectly through a series of exposure pathways such as air and water quality, food quality, and infectious diseases. Such direct and indirect impacts increasingly pose disproportionate impacts on workers who face growing health and safety risks associated with evolving exposures, hazards, and shifting work conditions. Important new efforts by health agencies, academia, and others to address the health consequences are forming but expanded collaborations on a global scale are needed.

Methods/Approach

While, the U.S. National Institutes of Health (NIH) has supported climate change and health (CCH)-relevant research for decades, efforts have greatly increased with the launch of the NIH Climate Change and Health Initiative (CCHI) in 2021. The CCHI is a unique NIH-wide effort led by seven institute directors and a working group of over 150 staff focused on furthering needed transdisciplinary research, capacity building and training, health equity, interventions, and partnerships to better understand and address the health consequences of climate change in the U.S. and globally. Newly evolving efforts to build a health-focused “community of practice” include research coordination, community engagement, and exploratory centers, as well as funding to spur needed areas of research (e.g., disaster response, adaptation research, predictive modeling) and broadening engagement by the health research community.

Results

Funding and leadership by NIH is an encouraging signal, however, given the immense and growing health challenges, additional investments and global collaborations are vital to creating the knowledge and evidence-based solutions and strategies that protect the health of workers and other disparate populations globally.

Conclusions

Stronger coordination, leadership, and partnerships between public and private sectors are needed to expand the scientific community, engage workers and at-risk communities, and inform policies to address adverse health outcomes and further impactful interventions.

Presenting author profile

Dr. Castleman has testified as an expert and worked with prosecutors in criminal cases against asbestos industry executives in Italy since 2010.

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Barry Castleman (1)

1. Environmental Consultant, Garrett Park, Maryland, USA

Background

Italy has considered death on the job a possible criminal matter and has prosecuted business executives for causing occupational cancer since the 1970s. Swiss Eternit Group operated "Eternit" asbestos-cement manufacturing plants in Italy and in many other parts of the world. Starting in 1976, the owner and CEO of Eternit was Stephan Schmidheiny. He has been convicted in four trial courts for creating an environmental disaster and aggravated manslaughter. He has been represented by able counsel but has never appeared in court in Italy. All three convictions for manslaughter are being appealed.

Methods/Approach

The evidence showing Schmidheiny directed a cover-up and the status of the appeals will be reviewed. Schmidheiny's rebranding as a "green" businessman, promoting "sustainable development," donating to the Rio 1992 Earth Summit in Brazil and receiving an honorary doctorate from Yale University in 1996 came just as Italian prosecutors were moving to charge the asbestos billionaire. Current Italian and alumni efforts to get Yale to return Schmidheiny's gifts and rescind the honorary degree will be discussed. Forbes magazine, which had praised Schmidheiny as a great philanthropist in 2009, reported on the verdict in 2023, when Schmidheiny was sentenced to 12 years in jail for the aggravated manslaughter of hundreds of people, employees and plant neighbors who died from mesothelioma.

Results

The criminal prosecution of corporate owners and executives has rarely been used in preventing occupational and environmental death and disease. Patently criminal conduct has been revealed in legal discovery of internal corporate documents and testimony. But in most cases, the corporate officials involved bear no personal responsibility for their business decisions. Humiliation and incarceration can add to the preventive efforts of information, regulation, and financial compensation.

Conclusions

Criminal prosecution of toxic corporate crime would make the world safer.

Presenting author profile

Dr. Fucic is a retired scientific advisor at the Institute for Medical Research and Occupational Health, with nearly 40 years of dedicated work in studying cancer risks related to radiochemical exposures in occupational settings. Throughout her career, she has focused on investigating the pathways of endocrine disruptor mechanisms in cancer development, as well as gender-specific health risks.

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Aleksandra Fucic (1)
1. Institute for Medical Research and Occupational Health, Zagreb, Croatia

Background

All cancer types are associated with disturbances in the estrogen/testosterone ratio, and their biology depends on estrogen and androgen receptor levels. As a result, cancer susceptibility exhibits gender specificity, with a higher incidence in men for cancer types associated with occupational exposure. The gender-specific cancer risks associated with environmental xenoestrogen exposure have been well-documented.

Methods/Approach

A significant portion of xenobiotics in occupational environments act as xenoestrogens such as metalloestrogens (aluminum, cadmium, chromium, cobalt, lead), some pesticides and PCBs while for example trichlorethylene and aniline disturb testosterone levels. Despite these facts, gender-specific susceptibility to exposure and gender-specific cancer risks are often overlooked in occupational health epidemiological studies or treated as anecdotal evidence. Moreover, it is important to emphasize that women working within the same industry but performing other activities than men may have different cancer risks than men due to the bimodal effects of endocrine disruptors as lower doses may have more pronounced effects than higher doses. The higher risk of cancer in men compared to women for cancer types associated with occupational health may stem from the inherent higher sensitivity of men to disturbances of estrogen/xenoestrogen levels. Current changes in the definition or personal expression of gender do not contradict the suggested approach, as brain gender specific lateralization during intrauterine development and body hormonal profiles may not necessarily align.

Results

Addressing gender-specific cancer risks in occupational health can aid in (a) developing targeted prevention strategies, (b) introduction of new biomarkers or their gender specific application and (c) improving workplace safety measures.

Conclusions

Recalculating cancer risk for men and women using available data could provide significant insights into whether cancer risk in occupational health should be presented separately for each gender.The increasing use of new hybrid materials (nano plastic/metal) and technologies in industry necessitates introduction of early evaluation of possible gender-specific cancer risks.

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William M. Ewing (1)
1. W.M. Ewing & Company LLC, Marietta, Georgia, USA

Background

In 1990 the Collegium Ramazzini convened a conference in New York City on "The Third Wave of Asbestos Disease: Exposure to Asbestos in Place." At that point effective asbestos control and abatement techniques had largely been developed and implemented. Some papers covered the emerging disease among maintenance and service personnel, but none considered the new class of asbestos abatement worker and their exposures. These abatement procedures did not erupt overnight but evolved over two decades. Many workers of the 1970s received heavy asbestos exposures which generally ebbed with improved work practices in the 1980s.

Methods/Approach

The early efforts to control exposures to in-place asbestos were largely adaptations of methods employed in mining, product manufacturing, and shipyards. Industrial sites such as power stations, refineries, foundries, and chemical plants began implementing controls during the 1970s. This was mostly in response to new OSHA and US EPA regulations. The rising concern over asbestos in schools during the early 1980s, publicity, insurance issues, and litigation prompted improved control measures. Work areas once roped off were now sealed with plastic barriers. An asbestos abatement industry emerged followed by state licensing and regulations. Organizations, including the National Asbestos Council (NAC) and the Association of the Wall and Ceiling Industries (AWCI) disseminated information through its courses, publications, and conferences. By the end of the 1980s these improved asbestos abatement practices were widely accepted and incorporated into new and revised federal and state regulations.

Results

The asbestos abatement techniques refined over the years are now being employed and adapted to control other hazards in buildings. Some are legacy hazards such as lead-based paint and PCBs.

Conclusions

Today we need to gather and disseminate exposure data representative of workers during the 1970s and 1980s.

Presenting author profile

Dr. Somkiat is a senior advisor on occupational and environmental health under the Department of Disease Control, Ministry of Public Health, Thailand. His current work focuses on the development of occupational and environmental disease surveillance systems, occupational and environmental health service systems, and public health preparation and response to occupational and environmental health hazards.

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Somkiat Siriruttanapruk(1); Hirunwut Praekunatham(1)
1. Ministry of Public Health, Nonthaburi, Thailand

Background

An airborne hazard, such as the COVID-19 virus, is one of the major public health problems worldwide including in Thailand. The aims of this presentation are to describe and review the policy and implemented measures from the Department of Disease Control (DDC) and other relevant agencies in Thailand for preparation and response to the COVID-19 infection from the beginning of the outbreak until now.

Methods/Approach

The DDC has one main function for preparation and response to all health hazards, including an airborne hazard, under the national Emergency Operation Center (EOC). The structure of EOC under DDC consists of an incident commander, strategic & information section, and operation & support section. Since the first outbreak of COVID-19 in China was detected, DDC had set up the EOC to prepare and respond to the disease. The main activities included development of policy and guidelines, disease surveillance and outbreak investigation, implementation of preventive and control measures, health risk communications and information sharing, provision of vaccine, and empowerment of health officers throughout the country. Specific control measures were also developed and supported for some specific groups such as the Bubble and Seal project for workers in enterprises, community isolation for rural communities, and suitable innovations for disease prevention among healthcare workers.

Results

Public health preparation and response to an airborne hazard is an important role for the public health authority in every country. The policy, infrastructure, technical know-how and resource support are essential components for prevention and control of the problem.

Conclusions

Despite the continuously improving COVID-19 situation, strengthening the health system, establishing collaboration of relevant agencies, and improving knowledge and capacity building among staff are still needed. Outcomes and lessons learned from our experiences should be shared and discussed for further development.

Presenting author profile

Dr. Ringen is the Senior Science Advisor to CPWR and the Principal Investigator for the Building Trades National Medical Screening Program (BTMed.org)

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Knut Ringen (1); John Dement (2); Marianne Cloeren (3); Kim Cranford (4); Janet Shorter (4),; Patricia Quinn (1)
1. CPWR - The Center for Construction Research and Training, Silver Spring, MD USA
2. Duke University Medical Center, Durham, NC, USA
3. University of Maryland, Baltimore, MD, USA
4. Zenith American Solutions, Tampa, FL, USA

Background

BTMed is a national medical screening program for older US construction trades workers with a 40% increase in lung cancer mortality over the general population. In 2011 BTMed started an early lung cancer detection (ELCD) program.

Methods/Approach

BTMed participants completed occupational and medical interviews, a physical examination, spirometry (PFT), and chest radiograph (CXR). Criteria for ELCD eligibility are age 50-79; 30 years of smoking and less than 15 years since quitting, or 20 years of smoking and 5 years of occupational exposures, or PFT (COPD) or CXR (fibrosis) findings. The screenings are provided by radiology centers of excellence. Abnormal findings are assessed by multi-disciplinary expert committees. Results are classified by ACR Lung-RADS.

Results

Over 7,700 BTMed participants were invited for ELCD with resultant enrollment of 2,000 (26%), receiving over 10,000 LDCT scans. The program has detected 54 (2.7% yield) lung cancers and one mesothelioma. In addition, it has detected 1,532 conditions referred for medical follow-up.

Conclusions

The detection rate for lung cancer in the BTMed population is higher than the 1.0-1.5% found in most lung cancer screening programs that follow the NLST criteria, although only 43.5% of BTMed ELCD participants met the NLST smoking criteria. Besides smoking, a CXR-based ILO profusion score of 1/0 was the strongest predictor of risk. These findings support inclusion of occupational risk factors to establish tailored eligibility criteria in well-defined populations, or for referral of individual patients. The use of community-based ELCD providers has strengths (participant familiarity; continuity of care) and weaknesses (maintaining consistency in quality; variable referral networks; finding providers outside urban centers; level of effort to manage and review performance). Adverse medical outcomes include two post-surgery deaths. There have been no radiation dose overexposures.

Presenting author profile

Celeste Monforton, Dr.PH, MPH is a lecturer in public health at Texas State University. Her research includes assessment of worker health and safety laws and policies, and their effectiveness in preventing injuries and illnesses. She has written about strategies used by business groups to manipulate evidence in order to delay regulatory protections. Her current projects include community-based research involving Latino day laborers in Houston, Texas and securing a United States ban on asbestos.

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Policy/Discussion

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Celeste Monforton (1); Mary Miller (2)
1. Texas State University, San Marcos, USA
2. University of Cape Town, Cape Town, South Africa

Background

United States (U.S.) employers are struggling to find people who will accept low paying jobs and working conditions as offered. Lawmakers have failed to adopt a humane immigration system which is a factor related to the labor shortage. In response, businesses are illegally hiring children to work in hazardous jobs and beyond the allowed hours of work. Simultaneously, efforts are underway to repeal U.S. child labor protections by business groups promoting the rollbacks.

Methods/Approach

Our poster will present information on these efforts and provide examples of the rhetoric used to persuade lawmakers to weaken child labor rules.

Results

Comprehensive child labor laws were adopted in the U.S. in 1938. The goal was to improve the health and well-being of children by requiring school attendance and limiting opportunities for work. It was meant to reduce educational disparities which are means to advance public health through greater equality and economic security. Children’s lives have been saved and health protected because of limits on legal age for work, work hours and prohibitions on employment in hazardous work. The first update of the safety protections for young farm workers was proposed in 2010 by the Obama administration. They abandoned the plan because of (misleading) claims that the regulations would destroy family farms. Use of rhetoric that invokes “American values” is prevalent in current efforts to scale back child labor and other protections for youth in the U.S.

Conclusions

Public health advocates need current data on the state of child labor in the U.S. The most recent comprehensive examination of U.S. employment trends for young workers and adequacy of child labor regulations was published 20 years ago. Systemic changes and updated policies are needed to improve jobs for adults and address implement humane immigration policies which influence the prevalence of child labor in the U.S.

Presenting author profile

Dr. Maffini is an independent consultant and Ramazzini fellow. Her research experience is in the fields of carcinogenesis, reproductive biology and endocrine disruption. For the past 13 years, she has conducted research and published on the U.S. food additive regulatory program, regulatory science and chemicals policy. Previously, she was a senior scientist with the Natural Resources Defense Council and The Pew Charitable Trust and a Research Assistant Professor at Tufts University School of Medicine.

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Klara Matouskova (1); Thomas G. Neltner (2); Maricel V. Maffini (3)
1. Independent consultant, Bethesda, MD, USA
2. Environmental Defense Fund, Washington DC, USA
3. Independent consultant, Frederick, MD, USA

Background

In the US, food chemical manufacturers are responsible for determining that the use of their products is safe. Food additives which include ingredients and chemicals indirectly entering food from packaging and generally recognized as safe (GRAS) substances mostly used as ingredients are legally defined: food additives must undergo approval by the U.S. Food and Drug Administration (FDA) and GRAS substances are exempted from pre-market approval. FDA created a voluntary program for manufacturers to submit their GRAS safety determination as a GRAS notice to FDA. They rely on their own employees, the employee of a hired firm or a panel of experts, known as GRAS panel, to review the safety information. FDA has published guidance for industry on best practices to convene GRAS panels to manage conflicts of interest and reduce biases that have plagued the process.

Methods/Approach

We performed a qualitative assessment of the compliance of GRAS panels with basic elements of FDA’s guidance. We assessed 403 GRAS notices filed by FDA between 2015-2020 and identified whether a GRAS panel was convened and by whom, its members, affiliations, and relationships between panelists and panel conveners. We compared this information against FDA’s recommendations.

Results

Manufactures relied on panels 57% of the time, 30% on their employee and 13% on consultant. Panels are populated from a small pool of professionals: 7 (out of 111) panel members occupied 46% of all available, and that they often serve together. Against guidance recommendations, ad‐hoc panels have been substituted by panels with recurring members in hired firms’ payrolls.

Conclusions

GRAS panels didn't adhere to FDA guidance. The widespread conflicts of interest, appearance of conflict and bias continue to put the health of families at risk and undermine confidence in the safety of food. FDA should require notice for all GRAS determinations including how conflicts and bias have been minimized.

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Policy/Discussion

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Ilana Belmaker (1); Noam van der Hal (2); Evelyn Anca (3); Anna Miodovnik (4); Hadas Magen-Molcho (5)
1. Faculty of Health Sciences of Ben-Gurion University of the Negev, Beer-Sheva, Israel
2. University of Haifa, Haifa, Israel
3. Plastic-Free Israel NGO, Israel
4. Israeli Plastic Pollution Prevention Coalition NGO, Israel
5. Center for Sustainability of Hebrew University, Jerusalem, Israel

Background

There is exponential increase in the manufacture and use of plastics worldwide. Most plastics are chemically inert and non-degradable, causing a huge problem of plastic waste. Plastic disintegrates into microplastics, which are widely dispersed throughout the environment, contaminating air, food, and water, thereby threatening the Web of Life. Microplastics have been found in many marine animals and in multiple organs of the human body. Chemical additives are added to the plastic during their manufacture, including Endocrine-Disrupting Chemicals (EDC), which have major adverse health effects.

Methods/Approach

We will present evidence from the scientific literature on adverse health effects from exposure to plastic, microplastics and their additives and propose policies that can help contain these threats.

Results

Since they are indestructible, microplastics that enter cells will remain there and accumulate over time as exposure increases. Additives can migrate out of the microplastic into tissues and the circulatory system. EDC additives threaten the basic biology of our reproductive system and are associated with increased risk of disorders of growth and development, obesity, diabetes and cancer. Populations suffering from poverty are more likely to suffer from adverse health effects from exposure to plastic.

Conclusions

The UN is leading the Intergovernmental Negotiating Committee for Plastics, with a goal to achieve a legally-binding treaty to end plastic pollution by 2040. The negotiators emphasis development of a circular economy for plastic. In parallel, nations and communities need to develop policies promoting reduction in use of plastic by reuse and replacement by safe alternatives. These activities are essential for the protection of future generations! It is our moral imperative to act now!

Presenting author profile

Florencia is Associate Professor at the School of Public Health and Community Medicine, University of Gothenburg, and Resident Physician at the Clinic of Occupational and Environmental Medicine at the Sahlgrenska University Hospital. Florencia obtained her MD in Ecuador in 2010 and her PhD degree at Karolinska Institutet. Florencia conducts research on occupational and environmental exposures and health effects in human populations, with special focus on metals, including those used in the production of lithium-ion batteries.

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Florencia Harari (1,2)
1. University of Gothenburg, Gothenburg, Sweden
2. Sahlgrenska University Hospital, Gothenburg, Sweden

Background

As a result of the global climate change crisis a so-called green transition is ongoing worldwide. To achieve climate neutrality within the coming decades, a rapid transition to a resource-efficient and circular economy is needed. Electrification of the vehicle fleet is one of the key measures to reduce traffic-generated air pollution and to phase out fossil fuels from the energy systems. Rechargeable lithium-ion batteries are the prominent technology used in electric vehicles which implies a considerably high demand for raw materials (mostly metals) globally.

Methods/Approach

At present, the metals used in the production of lithium-ion batteries are mostly extracted in countries outside Europe. An overview will be presented of the health risks of the metals involved in the production of lithium-ion batteries, ethical aspects of this part of the industrial green transition, as well as the knowledge gaps where more research is warranted.

Results

Metals are a limited natural resource. Mining of some of the metals needed to produce lithium-ion batteries has large socio-environmental impacts and are to some extent considered ethically problematic. Several gigafactories for manufacturing and recycling of lithium-ion batteries are underway in Europe, USA and Asia. In these novel workplaces, thousands of workers will be exposed to chemical health risks, including metals, in new, unknown occupational contexts. In addition to the technically challenging development of processes, this growing industry faces challenges regarding a healthy and safe working environment.

Conclusions

Responsible mining is needed to reduce the exposure of workers and communities to metals. At present, research on the working conditions and health risks associated to the production and recycling of lithium-ion batteries is scarce. Regulations for producers on taking the responsibility for the batteries from the very beginning till the end-of-life are needed.

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Boris D. Lushniak (1)
1. University of Maryland School of Public Health, College Park, MD, USA

Background

Duty of care, in the occupational setting, refers to being responsible for your people's health, safety and well-being. This usually means protecting the welfare of your team members while they are at their regular workplaces, or while they are on official business off-site and even abroad. This typically involves: providing and maintaining safe physical work environments; ensuring compliance with appropriate industry standards and statutory safety regulations; ensuring that people work a reasonable number of hours, and have adequate rest breaks; conducting work-based risk assessments; and, protecting people from discrimination, bullying, and harassment.

Methods/Approach

Infectious disease disasters present special challenges to protect responder’s health. This presentation will focus on the duty of care responsibilities in the midst of a very unique and dangerous work setting – within a field medical unit treating patients with ebola virus disease in a rural setting in Liberia. Specific challenges, successes, failures, and lessons learned will be presented from this real-life experience.

Results

Part of the responsibilities of leadership in such a setting includes providing individuals with clear job descriptions detailing their work responsibilities and the limits of their roles, providing appropriate training, and providing team members with opportunities to raise concerns and offer feedback.

Conclusions

Lessons learned in such a crisis response can be implemented in multiple other occupational settings. Most importantly is the implementation of duty of care activities from the theoretical to actual field settings. The ultimate goal is to protect, promote, and advance the health and safety of the working population.

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Ruth Amir (1)
1. Yezreel Valley College, Yezreel Valley, Israel

Background

Conscription and enlistment of child soldiers (C&E) is a war crime prohibited in several international and regional humanitarian and human rights treaties. It occurs in the poorest countries during internal and external conflicts. Child soldiers’ use devastates the lives of children, families, communities, and regions. These conflicts spill over to the region and the Global North through migration and refugee crises. Civil wars cost the annual Global North to South economic assistance; their longevity is fourfold compared to inter-state conflicts.

Methods/Approach

We will present evidence on the occurrence of C&E and direct and indirect adverse effects, map the deficiencies of the current legal mechanisms and policy tools, and propose policies to end this grave violation against children.

Results

Although the root causes of civil wars are severe economic inequalities and centralized hybrid or authoritarian political regimes, they are hardly addressed by current policies. The COVID-19 pandemic introduced new challenges and pinpointed the flaws of current policies. These deficiencies concern the narrow legal definition of the crime, incompatibility with other humanitarian law and human rights instruments, and lesser capabilities to deter non-state armed groups. Whereas criminalization and other current policies yielded some success with states, non-state armed groups continue C&E.

Conclusions

Reducing inequalities, poverty alleviation, and political reform would shift the focus from punishment to prevention, empower communities, and address old and new poverties.
A. Amend the legal definition of C&E to include children under 18.
B. Revise the definition of C&E to include all non-combat activities, such as sex slavery, kitchen duty, etc.
C. Ban arms sales to state and non-state parties using child soldiers and tight enforcement.
D. Empower communities through capacity building and the development of self-monitoring mechanisms.

Presenting author profile

Kenneth Olden, Ph.D. is the former Director of the National Institute of Environmental Health Sciences and the National Toxicology Program, National Institutes of Health, US Department of Health and Human Services (1991-2005). He was the founding dean of the School of Public Health at the Hunter College Campus of the City University on New York (2008-2012), and Director of the National Center for Environmental Assessment, US Environmental Protection Agency (2012-2016).

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Policy/Discussion

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Kenneth Olden (1)
1. Retired, Durham, NC USA

Background

The environmental conditions under which people are born, live, work and play—the so-called social determinants of health (SDOH)—play a significant role in the etiology of human diseases. For example, our social and economic policies determine who gets to breathe clean air, drink water free of lead and other toxic chemicals, acquire a good education, and earn a living wage.

Methods/Approach

Durable and environment-specific epigenetic modifications provide a plausible mechanism to explain how different SDOH exposures can become embedded with long-term, and even possibly transgenerational effects on human health. These epigenetic modifications can be reversed representing targets for precision medicine/public health.

Results

Socio-behavioral phenotypes and epigenetic signatures can be targeted based on potential to ameliorate risk posed by SDOH and incorporated into screening tools and stored in the electronic medical records. The SDOH factors can be used to develop a socio-behavioral profile or phenotype of the patient, and used to determine which SDOH is most likely to be effective in ameliorating specific health risks. Health equity is fundamentally a socioeconomic problem not caused by genetic variation, but by the cumulative effect of living in under resourced, polluted, stressful neighborhoods.

Conclusions

To achieve health equity, we should first, change our social and economic policies to ensure that all people have access to resources (e.g., nutritious food, safe housing, clean air and water, living wages, and health care) critical for human health and wellbeing and second, we should expand the Precision Medicine Initiative to include SDOH as actionable targets for use in the prevention or treatment of diseases and develop new tools and infrastructure to integrate SDOH into clinical medicine. For example, development and implementation of the social needs screening database and the social services referral system will require extensive collaborations and partnerships with local communities and public health agencies.

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Francesco Tovoli (1,2); Bernardo Stefanini (1); Daniele Mandrioli (3); Andrea Vornoli (3); Daria Sgargi (3); Fabiana Manservisi (3); Fabio Piscaglia (1,2); Luigi Bolondi (1)
1. University of Bologna, Bologna, Italy.
2. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
3. Ramazzini Institute, Bologna, Italy.

Background

Increasing evidence shows that environmental toxicants increase the risk of metabolic dysfunction-associated steatotic liver disease (MASLD). Studies about the potential contribution of the same chemicals to the progression of MASLD to advanced chronic liver disease (ACLD) or hepatocellular carcinoma (HCC) are virtually non-existent. Workers professionally exposed to toxicants represent an ideal population to detect potentially hazardous exposures and develop preventive strategies.

Methods/Approach

We conducted a hospital-based prospective study including 201 consecutive MASLD participants. Exposures to workplace toxicants were assessed using a structured questionnaire. The characteristics of ACLD/HCC patients were compared with those of patients with uncomplicated MASLD using logistic regression models. These models included crude estimates and inverse probability weighted (IPW) –based adjustment for confounders (age, sex, smoking status, diabetes, hypertension, and obesity).

Results

Increased rates of long-term exposures to workplace chemicals (especially metals, halogenated refrigerants, viscose, colourants, and fuels) were found amongst ACLD/HCC patients and confirmed after correction for confounders, with adjusted odds ratios (aORs) of 2.31 (95% CI 1.09-4.88, p=0.029) for 21-30 year-long exposures and 4.47 (95% CI 2.57-7.78, p<0.001) for > 30 year-long exposures. These effects were largely confirmed in study subgroups (Figure). Proximity to farms with probable use of pesticides was also more often referred by ACLD/HCC patients (aOR 4.66, 95% CI 2.36-9.19, p<0.001).

Conclusions

Patients with the most severe complication of MASLD (including ACLD and HCC) had an increased probability of > 20 years exposure to workplace toxicants. Our results warrant future multicenter confirmatory studies, as implementing prevention policies might reduce the risk of life-threatening liver diseases among exposed populations.

Presenting author profile

Dr. Etzel is a pediatrician, environmental epidemiologist, and courageous leader in bringing public attention to childhood environmental health hazards and working collaboratively towards prevention. She was elected to the Collegium in 2010. For speaking truth to power, she is known as an “inconvenient pediatrician”.

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Policy/Discussion

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Ruth A. Etzel (1)
1. The George Washington University, Washington, D.C.

Background

Each year, about 400,000 children develop cancer. The WHO website states “Childhood cancer cannot generally be prevented.” This is a misleading narrative.

Methods/Approach

Although several risk factors for childhood cancer have been identified, the dominant narrative results in little focus on primary prevention. In the U.S., all NIH funding is to study treatment of childhood cancer. In 2021 the National Cancer Institute received US$50 million for the Childhood Cancer Data Initiative and US$28 million for Childhood Cancer Survivorship, Treatment, Access, and Research Act. The Childhood Cancer Data Initiative facilitates a connected data infrastructure and integrates multiple data sources to make data work better for patients, clinicians, and researchers. The Childhood Cancer Survivorship, Treatment, Access, and Research Act of 2018 expands existing biorepositories for childhood cancer patients enrolled in clinical trials to collect and maintain relevant clinical, biological, and demographic information on children, and to continue to conduct pediatric cancer survivorship research. Neither NIH initiative funds primary prevention. In the U.S. CDC there is ongoing work to promote reducing children’s exposures to tobacco and ultraviolet light in order to prevent cancer in adulthood, but scant attention to preventing childhood cancer. Yet many childhood cancers are preventable. The first childhood cancer to be prevented was scrotal cancer. In Britain, the Chimney Sweepers Act was passed in 1788, forbidding master sweeps from employing children under 8 years old. (The age was raised to 14 in 1834 and to 16 in 1840.) Primary prevention of childhood cancer is not new, but it has been largely overlooked for more than 230 years.

Results

It is time to embrace primary prevention of childhood cancer.

Conclusions

The Collegium should develop a statement addressing missed opportunities for childhood cancer prevention.

Presenting author profile

Dr. Haryanto is a professor in the Department of Environmental Health, Faculty of Public Health, and chair of the Research Center for Climate Change at Universitas Indonesia where he has worked with residents in several areas to better understand and then adapt to address health impacts of climate crisis and environmental health.

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Budi Haryanto( 1); Fatma Lestari (1); Triarko Nurlambang (1)

1. Universitas Indonesia, Depok City, Indonesia

Background

Extreme weather events caused by climate change may destroy many components of the environment and facilities, and cause direct physical harm, loss of income, psychological stress, and other direct and indirect human health outcomes..

Methods/Approach

In Indonesia, disasters due to climate change during 1998-2018 were > dominated by flooding (39%), heavy wind/storm (26%), landslides (22%), and drought (8%). In 2017, there were 2,263 events and 198 of these events were considered a health crisis. There were 305,837 persons impacted; this included, major injuries to 2,314 persons, minor injury to 63,578 persons and 243,691 persons became refugees in 2017. By 2050, the annual cost of climate change to the Indonesian economy is estimated at Indonesian Rupiah 132 trillion, or United States $8.8 billion, with substantial variation both across sectors and across provinces. The United States Agency for International Development estimates the agriculture sector will account for the majority (53%) followed by health sector (34%) and sea level rise sector (13%).

Results

In particular, work that can consider the macroeconomic or multiplier implications of the loss of key urban infrastructure will be essential to set priorities for investments in adaptation or strategies to minimize the harm caused by such storms. The private sector must anticipate these problems as well; every company whose business relies on transportation through the harbor or airport should create plans for continuity of its operations in the face of such extreme storms.

Conclusions

It is suggested:
1. Re-orientation of the institutional arrangements for DRR and CCA
2. DRR and CCA activities needed to be stronger supported at the local level
3. Non-government organizations play a very important role in integrating DRR and CCA through community-based initiatives.
4. Reorient the institutional structure of the national government, strengthen technical and financial support to local governments, and recognize the importance of NGOs and community based initiatives.