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Presenting author profile

Budi Haryanto is a Professor of Environmental Health at Universitas Indonesia and Director of its Research Center for Climate Change. He is on the board of directors of Pacific Basin Consortium on Environment and Health, and a Collegium Ramazzini Fellow. He has published more than 100 papers and book chapters on environmental epidemiology, health impacts of climate change, and air pollution.He has presented scientific research at COP15 (Copenhagen); COP21 (Paris); COP22 (Marrakech) and EWC (Honolulu).

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Budi Haryanto(1); Indang Trihandini(1); Fajar Nugraha(1); Fitri Kurniasari(1)
1. Universitas Indonesia, Jakarta, Indonesia

Background

Air pollution, including PM2.5, has been suggested as one of the primary contributors to COVID-19 fatalities worldwide. Jakarta, the capital city of Indonesia, recognized as one of the ten most polluted cities globally. Additionally, the incidence of COVID-19 in Jakarta surpasses that of all other provinces in Indonesia. However, no study has investigated the correlation between PM2.5 concentration and COVID-19 fatalities in Jakarta. The study aims to investigate the correlation between short-term and long-term exposure to PM2.5 and COVID-19 mortality in the greater Jakarta area.

Methods/Approach

An ecological time-trend study was implemented. The data of PM2.5 ambient concentration was obtained from Nafas Indonesia and the National Institute for Aeronautics and Space (LAPAN)/National Research and Innovation Agency (BRIN). The daily COVID-19 death data was obtained from the City’s Health Office.

Results

Our study unveiled an intriguing pattern: while short-term exposure to PM2.5 showed a negative correlation with COVID-19 mortality, suggesting it might not be the sole factor in causing fatalities, long-term exposure demonstrated a positive correlation. This suggests that COVID-19 mortality is more strongly influenced by prolonged PM2.5 exposure rather than short-term exposure alone. Specifically, our regression analysis estimate that a 50 µg/m3 increase in long-term average PM2.5 could lead to an 11.9% rise in the COVID-19 mortality rate.

Conclusions

Our research, conducted in one of the most polluted areas worldwide, offers compelling evidence regarding the influence of PM2.5 exposure on COVID-19 mortality rates. It emphasizes the importance of recognizing air pollution as a critical risk factor for the severity of viral respiratory infections.

Presenting author profile

Hae-Kwan Cheong, professor emeritus of Sungkyunkwan University, is an environmental epidemiologist and a fellow of Collegium Ramazzini since 2007. Since the 1990s, he has been involved in many environmental health issues in Korea, including carbon disulfide, oil spills, humidifier disinfectants, and climate change. He had been a chair of the national committee on humidifier disinfectant-related health hazard review and presents recent developments on the carcinogenicity of this multipotent toxin.

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Mina Ha (1); Jongin Lee (2); Hong Lee (3); Ju-Han Lee (3); Ha Ryong Kim (4); Kyoung-Nam Kim (5); Byungmi Kim (6); Jungyun Lim (7); Sol Yu (7); Yong-Wook Baek (7); Younghee Kim (7); Kyu Hyuck Chung (8)(9); Hae-Kwan Cheong (10); Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects

1. Dankook University College of Medicine, Cheonan, Republic of Korea
2. The Catholic University of Korea, Seoul, Republic of Korea
3. Korea University College of Medicine, Ansan, Republic of Korea
4. Korea University, Seoul, Republic of Korea
5. Yonsei University College of Medicine, Seoul, Republic of Korea
6. National Cancer Center Graduate School, Koyang, Republic of Korea
7. National Institute for Environmental Research, Incheon, Republic of Korea
8. Sungkyunkwan University, Suwon, Republic of Korea
9. Kyungsung University, Busan, Republic of Korea
10. Sungkyunkwan University School of Medicine, Suwon, Republic of Korea

Background

Humidifier disinfectants, designed to remove water scale from humidifiers, have been manufactured and sold in South Korea since 1994 and were used before recall by the government in 2011. It has induced various respiratory illnesses, such as upper and lower respiratory tract inflammation, asthma, pneumonia, interstitial lung disease, bronchiectasis, and chronic obstructive pulmonary disease. Carcinogenesis of polyhexamethylene guanidine phosphate (PHMG-p)-containing products, the main component of the exposure, was evaluated as a long-term health effect, and recent progress was reviewed.

Methods/Approach

A study evaluated the long-term effect of PHMG-p exposure in rat models and human pulmonary alveolar epithelial cells. Epidemiological studies were conducted using the claimants' data compared with national controls.

Results

In rat models, CT scans and lung tissue pathology 54 weeks after respiratory exposure to PHMG-p in rats revealed a significant discovery-lung cancer occurred even in the low-dose group, with a higher incidence in the high-dose group. PHMG was found to promote lung carcinogenesis by enhancing necroptotic and MAPK signaling, inhibiting apoptosis, and interfering with DNA damage repair mechanisms in a human cell model in a time-dependent manner. In ongoing epidemiological studies, claimants for humidifier disinfectant damage had significantly higher standardized incidence ratios of lung cancer compared to the general Korean population. They also showed an increased risk of lung cancer according to exposure duration in a dose-response manner and exhibited a significantly higher risk compared to propensity score-matched controls from the National Health Insurance Service data. The PHMG-p was recommended as a high 5 in the IARC Monographs Advisory Group Meeting 2024 based on the experimental evidence.

Conclusions

This finding was brought to the attention of the public and environmental health experts, as it necessitates immediate action. It is equally important to stress the need for further research to fully understand this study's implications and develop effective strategies for prevention.

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Jane C. Fazio (1,2); Fernanda Florez (3); Amy Heinzerling (3); Sheiphali A. Gandhi (4); Nader Kamangar (1,2): Robert J. Harrison (3,4); Kristin J. Cummings (3)
1.UCLA Medical Center, Sylmar CA, USA
2.University of California Los Angeles, Los Angeles, CA, USA  
3.California Department of Public Health, Richmond, CA, USA 
4.University of California San Francisco, San Francisco, CA, USA 

Background

Silicosis is a preventable, progressive, fibrotic lung disease caused by exposure to respirable crystalline silica, reported among engineered stone countertop fabricators in several countries. We aim to describe work practices and silica dust mitigation strategies of countertop workers in Los Angeles County (LAC).

Methods/Approach

We recruited countertop fabrication workers November 2023-June 2024 through targeted public health outreach and included current workers with ≥2 years tenure, residing in LAC, and ≥18 years old. Participants completed a 30-minute telephone survey on demographics, occupational characteristics, medical history, and symptoms.

Results

Twenty-eight individuals completed the questionnaire. All were male, median age of 44 years (Interquartile range [IQR] 40-51), and work tenure of 18 years (IQR 13-23). Twenty-five (89%) were employees and three were independent contractors. Twenty-seven (96%) were Spanish-speaking. All fabricated engineered and natural stone, but 22 (79%) used engineered stone >50% of the time. The most common job tasks were: cutting with handheld tools (86%), polishing (86%), and shaping/grinding/finishing (89%). Seventeen (61%) participants reported frequently or always dry cutting, however, all worked near someone dry cutting. Twenty-five (89%) reported frequently using respiratory protection: half-face respirators (n=13, 46%); disposable N95s (n=8, 29%); and surgical masks (n=4, 14%); 2 denied respirator use altogether. Eighteen (64%) had never received respirator training and only 5 (18%)had been fit tested. Twenty-four (86%) had used compressed air for cleaning. Seventeen (56%) reported having at least one respiratory symptom, but only 1 had a previously diagnosed respiratory condition. 

Conclusions

Countertop fabrication workers in LAC commonly engage in high-risk dust-generating activities without controls such as wet methods and adequate respiratory protection. Therefore, employers need to make changes to comply with California’s recent prohibition of dry cutting and full-face powered air-purifying respirator requirement. These results highlight the need for promotion of improved practices in this industry.

Presenting author profile

In 1990, Joseph "Chip" Hughes began a 35 year federal career as program administrator with the US government, directing the NIEHS Worker Training Program in the Department of Health and Human Services, designing training programs for vulnerable workers in high risk occupations, and more recently as Deputy Assistant Secretary for U.S. Occupational Safety and Health Administration (OSHA) for Emergency Response in the U.S. Department of Labor.

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Joseph Hughes, Jr. (1,2)

1 Michael D. Baker (MDB), Inc., Washington, D.C., USA
2. National Institute of Environmental Health Sciences, Washington, D.C., USA

Background

Artificial Intelligence (AI) has increasingly become an integral part of the modern workplace, revolutionizing industries and transforming how tasks are performed. Its applications range from automating routine processes to enhancing sophisticated data analysis. While the benefits of AI in terms of efficiency, productivity, and innovation are undeniable, its integration into the workplace also raises significant concerns regarding worker protection and the creation of new technology-based safety and health risks.

Methods/Approach

AI-augmented work poses risks such as reduced worker autonomy, diminished job quality, embedded biases in decision-making, lack of transparency, and potential job displacement. As AI technology advances, a risk that the OSH benefits will not be equitably distributed exists, which may aggravate existing occupational health inequities for certain segments of the workforce. There are significant barriers to achieving OSH equity through AI deployment. Privacy and confidentiality concerns arise from the increased surveillance that some AI systems bring, potentially disadvantaging workers if safeguards on data use are not implemented.

Results

The integration of AI into the workplace presents substantial risks to worker protection, including job displacement, skills gaps, privacy concerns, algorithmic bias, and psychological impacts. Addressing these risks requires a multifaceted approach involving regulatory frameworks, organizational policies, and a commitment to ethical AI practices. These concerns can be mitigated through transparent power structures, algorithmic audits, and multidisciplinary participatory approaches to AI design, implementation, maintenance, and evaluation.

Conclusions

By investing in workforce development, implementing ethical AI guidelines, fostering supportive work environments, ensuring data privacy, and promoting fairness and inclusion, organizations can harness the potential of AI while safeguarding the rights and well-being of workers in numerous industrial settings. Through collaborative efforts of the Collegium Ramazzini, a focus on responsible AI integration through a policy statement or an international convening can create safer working conditions that can benefit both employers and workers.

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Iris Maria Forte (1), Viviana Maresca (2), Marianna Tomeo (1), Anna Sfera (3), Francesco Pagano (1), Alessia Postiglione (2), Adriana Basile (2) and Antonio Giordano (3,4).

1.Istituto Nazionale Tumori, IRCCS, Naples, Italy
2. University of Naples Federico II, Naples, Italy
3. University of Siena, Siena, Italy
4. Sbarro Health Research Organization at Temple University, Philadelphia, PA, USA

Background

This study investigates the use of bioindicators as a means to assess air quality to provide a comprehensive overview of ecosystem health. In particular, we focused on a region of Italy (Campania), which represent a dramatic example of a polluted area (Land of Fires). We evaluated the air levels of toxic heavy metals by using two different bioindicators: moss, S.circinatum and the honeybee, Apismellifera. The use of both indicators improve the quality of the measurements because the first is a fixed element while the latter is mobile. We tested the efficacy of these bioindicators to monitor the presence and the biological effects of potentially toxic elements (PTEs) in the Land of Fires.

Methods/Approach

The moss was placed near apiaries in two locations:1) a natural place (Carditello), and 2) high industrial and anthropogenic pollution location (outskirts of Giugliano). We also selected two places as control sites. We first evaluated the bioaccumulation of PTEs, and then, the ultrastructural and biochemical effects in both organisms.

Results

As expected, the control sites showed the absence of heavy metal pollution. Surprisingly, comparable pollution levels were observed in the two sites characterized by different environmental conditions. Our data indicated that both bioindicators had a greater bioaccumulation capacity. Ultrastructural observations confirmed the data on bioaccumulation.

Conclusions

Our preliminary data suggest that toxic fumes mainly give the contribution to the presence of heavy metals in the air while that due to the degree of anthropization is negligible. In addition, although our results must be improved, they open the "view" on a disturbing panorama relating to the fact that environments which present a situation of low anthropization and high care of the territory, can present an extremely worrying degree of environmental pollution from metals, if there are "toxic fumes" or other sources of pollutants released into the air.

Presenting author profile

Dr Sen is the Head of the Department of Environment, Health and Safety in L&T Construction, M&M Strategic Business Group. On an average, over 25,000 construction workers are deployed by the particular strategic business group.

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Krishna Nirmalya Sen (1); Gollapalli Muralidhar (1)
1. Larsen & Toubro Limited, Minerals & Metals SBG, Kolkata, India

Background

In India, the construction industry is the second largest sector in terms of employment with around 74 million workers and contributes nearly 9 to 11% of the country's GDP. Construction workers are often exposed to various high level occupational health risks. As per the recent global estimates, 88% of work-related deaths, were attributed to work-related diseases. Moreover, less than 5% workers are employed by large construction organizations. The balance workers are mostly unregulated.

Methods/Approach

Occupational health related risk factors are often ignored at workplaces, and construction industry in India is no exception. This can be attributed to lack of awareness, and chronic nature of health effects. Construction workers are highly susceptible to various occupational health risks owing to the intrinsic characteristics, constantly evolving workplaces, introduction of new materials/equipment and processes. Occupational risk factors include MSDs, vibration, noise, chemicals, heat-related illnesses and air contaminants like silica dust, asbestos, fumes, and gases. In addition, introduction of new machinery/equipment and materials with nano technology are presenting novel risks to construction workers.

Results

A majority of construction workers are migrant workers. They hail from economically weak areas. Many of them come to construction work as they do not find any alternatives. Since they do not have any permanent employer, obtaining compensation for their adverse health becomes difficult. Hence it is important to focus on prevention and put in place policies to strengthen the existing mechanisms so that adverse occupational health outcomes are avoided or minimized.

Conclusions

Limited epidemiological data related to occupational health in the construction industry needs attention. Experience of occupational health challenges faced in global construction industries should be used to develop strategies for prevention while local data and remedial measures are developed.

Presenting author profile

Dr. Pelclova is full professor and emeritus head at 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); Vladimir Zdimal (2); Pavlina Klusackova (1); Tomas Navratil (3); Miroslav Pohanka (4); Stepanka Vlckova (1); Andrea Rossnerova (5)

1. Charles University and General University Hospital, Prague, Czech Republic
2. Institute of Chemical Process Fundamentals of the Czech Academy of Sciences, Prague, Czech Republic
3. J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic
4. University of Defense, Hradec Kralove, Czech Republic
5. Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czech Republic

Background

Researchers exposed to nanocomposites were examined and their exposures monitored to study the trends in oxidative stress (OS) from a 5 year perspective. Biomarkers of OS and/or antioxidant capacity were analyzed in exhaled breath condensate (EBC), plasma, and urine.

Methods/Approach

Researchers’ exposure to nanoparticles was measured using online and off-line instruments during machining of geopolymer samples and epoxide resin with nanoSiO2 filler, and metal surfaces welding. Additionally, in the last 2 years, personal nanoparticles samplers (PENS) were used. Markers of oxidation of lipids, nucleic acids and proteins were analyzed both pre-exposure and post-exposure using HPLC/MS/MS in researchers and controls in 2016-2018 (malondialdehyde, aldehydes C6-C13, 8-isoProstaglandinF2α, 8-hydroxy-2-deoxyguanosine, 8-hydroxyguanosine, 5-hydroxymethyl uracil; o-tyrosine, and 3-nitrotyrosine). In 2019 and 2020, thiobarbituric acid reactive substances (TBARS) were measured and antioxidant status was assessed by glutathione (GSH) and ferric-reducing antioxidant power (FRAP), all using spectrophotometry.

Results

On average 20 researchers were examined yearly (aged 40±5 years, exposure 14±3 years). Median particle number concentrations dropped from 4.8x104/cm3-5.4x105/cm3 in 2016-2018 to 4.6 x103/cm3-15.0x103/cm3 in 2019-2020. In contrast to 2016-2018, all markers of OS were elevated in researchers´ EBC and plasma, TBARS, corresponding to malondialdehyde, were increased in 2019-2020 in pre-exposure EBC only (p<0.05). Finally, biomarker of antioxidant capacity, GSH was elevated in plasma both pre- and post-exposure (p<0.01), as compared to controls.

Conclusions

Positive effect of reducing nanoparticles exposure by more than one order of magnitude, but also adaptation of long-term exposed researchers may give plausible explanations. Therefore, verification of OS biomarkers using highly sensitive HPLC/MS/MS in stored samples is needed.
Acknowledgements: Cooperatio 207041-3 Charles University and GACR 22-08358S
Bibliography
1. Pelclova D, Zdimal V, Komarc M, et al. Three-Year Study of Markers of Oxidative Stress in Exhaled Breath Condensate in Workers Producing Nanocomposites, Extended by Plasma and Urine Analysis in Last Two Years. Nanomaterials (Basel). 2020;10:2440.

Presenting author profile

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

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Xaver Baur (1); Arthur L. Frank (2) 
1. European Society for Environmental and Occupational Medicine, Berlin, Germany
2. Environmental & Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA

Background

Numerous papers document that pulmonary function impairment after exposure to asbestos can precede radiographic changes, either by chest X-ray or CT scan. This has significant implications for compensation, with some workers in the past being denied compensation with such findings.

Methods/Approach

Literature search and review

Results

A review of the scientific literature reveals many papers documenting that pulmonary function can be altered after exposure to asbestos, e.g. from traditional workplace exposures such as at shipyards or from exposure to contaminated vermiculite from Libby, MT (Ohlson, Rydman et al. 1984; Wang, Wang et al.2010; Clark, Flynn et al. 2017). These changes can occur in the absence of smoking, although smoking increases the amount of change in such individuals.
When considering persons with asbestos exposure but no radiographic changes, our literature search has shown that pulmonary function changes can still be ascribed to the asbestos exposure. These effects are less than in those with asbestos-related pleural abnormalities or asbestosis or with both (Kilburn and Warshaw 1991; Dujic, Tocilj et al. 1992; Kilburn and Warshaw 1994; Wilken, Velasco Garrido et al. 2011). (Fig. ).

Conclusions

Our findings indicate that even sensitive chest CT scanning cannot provide exact lung function data and replace specific pulmonary tests. Although the issue of compensation being denied individuals whose only clinical abnormality following asbestos exposure is impaired pulmonary function has been discussed in the published literature, increasing numbers of studies addressing the issue document that such alterations in pulmonary function can occur and that there is therefore an inappropriate denial of benefits to some. Proper assessment of the literature would support fairer results in such cases and provide a more accurate framework for evaluation of asbestos-exposed individuals going forward.

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M. Silvestri(1), R. Gasparini(1), F. Gobba(1), A. Modenese(1)
1 Residency School of Occupational Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia (UniMoRe), Modena, Italy

Background

The international multi-centric study “Connecting European Cohorts to Increase Common and Effective Response to SARS-CoV-2 Pandemic” (ORCHESTRA) was funded by the EU Horizon2020 program to identify better preventive strategies to reduce the COVID-19 risk.

Methods/Approach

We used the ORCHESTRA self-reported questionnaire to assess the utilization rate of different types of personal protective pquipment (PPE) in cases of SARS-CoV-2 infections reported by resident physicians from the UniMoRe medical residency schools. Questionnaires were collected between July and September 2022.

Results

271 residents (40% male, average age 30 years) responded: 24% worked, at least for a period between March 2020 and September 2022, in “COVID departments”. Of the subjects who reported at least 1 SARS-CoV-2 infection episode, 65% worked in “COVID departments” while 55% worked in “non-COVID departments”. The PPE availability during March-May 2020 was judged as inadequate by 5% of respondents from the first group and 4% from the second. In the first group >74% of respondents reported often/always wearing PPEs (surgical masks, filtering face piece (FFP) 2 respirators, eye protections, aprons, gloves). In the second group, only the 35% reported often/always using all the available PPEs, including FFP2 respirators, as there was no indication for their continuous use in “non-COVID departments”. Considering PPEs and SARS-CoV-2 infections, among those who never tested positive 80% reported often/always using gloves; 43%, eye protections; 54%, disposable gowns; 85%, surgical masks; 79% FFP2, and 7% FFP3, respirators. Among those who reported ≥1 infections, the PPEs utilization rates were similar, except for gloves, utilized in 77% of the cases.

Conclusions

This study highlights differences in the frequency of PPEs utilization between medical residents in COVID vs non-COVID departments, with the former showing higher utilization rates. No relevant difference was observed for the type of PPEs utilized in relation to SARS-CoV-2 infections.

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Francesco Enrico Zagariello (1); Rebecca Gasparini (1); Jorge Barroso Dias (2,3); Marilia Silva Paulo (4); Claudine Strehl (5); Marc Wittlich (5); Fabriziomaria Gobba (1); Roberto Giuseppe Lucchini (1, 6); Alberto Modenese (1)

1. University of Modena & Reggio Emilia, Modena, Italy
2. Municipal de Lisbon, Lisbon, Portugal
3. Portuguese Society of Occupational Medicine, Lisbon, Portugal
4. Universidade NOVA de Lisbon, Lisbon, Portugal
5. Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), Sankt Augustin, Germany
6. Florida International University, Miami, FL, USA

Background

The Project “Measuring solar ultraviolet radiation (UVR) in outdoor workers in Lisbon: From measuring to assessing risks and developing a digital health platform for workers’ guidance” (MEAOW@SolarUV), launched in 2023, is aimed to evaluate solar UVR exposure in outdoor workers (OW) in Portugal using prolonged personal monitoring. OW from Lisbon municipality engaged in different activities are involved.

Methods/Approach

Six different groups of OW were included: gardeners, graveyard workers, pavers, sanitation workers, street construction workers and sailors. GENESIS-UV dosimeters, worn on the upper left arm for about one month, were used to monitor UVR exposure.

Results

The preliminary results obtained in 4 graveyard workers of a Lisbon cementery, monitored from mid April/beginning of May to mid-August 2023 are presented here. The average daily solar UVR exposure, resulting from an average number of 64,5 working days (minimum 57, maximum 74) ranged from 1,8 to 3,7 SED (1 SED = 100 J/m² erythemal weighted irradiance): these values are among the highest recorded in these groups.

Conclusions

Our data unexpectedly show an high individual solar UVR exposure in graveyard workers, a group not frequently considered in the OW lists, as the one recently provided by the Irish Health Safety Executive. During the four-months observation period, graveyard workers received an individual average daily dose largely sufficient to cause sunburn, a main acute adverse health effect of UVR. Furthermore, sunburns are potentially mutagenic and are recognized risk factors for UV-related skin cancers. Studies like the one presented here are fundamental for a proper recognition of the group of workers at a higher risk, such as graveyard workers, in order to properly implement preventive interventions, including adequate health surveillance programs, and for a proper occupational disease recognition.

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Enrico Barbolini (1); Stefano Renzetti (2): Donatella Placidi (2); Margherita Caci (4);Manuela Oppini (5); Roberto Lucchini (1,3)

1 University of Modena & Reggio Emilia (UniMoRe), Modena, Italy
2 University of Brescia, Brescia, Italy
3 Florida International University, Miami, FL, USA
4 PSAL ATS, Brescia, Italy
5 Servizio del Medico Competente Azienda Socio-Sanitaria Territoriale del Garda, Italy

Background

It is known that occupational and environmental exposure to various chemicals is associated with an increased risk of Parkinson’s Disease (PD) and Parkinsonism (P). The aim of this study is to identify methods for a Retrospective Exposure Assessment (REA), based on reliable assessments of chemical exposure, and therefore suitable to provide accurate information on occupational exposure to neurotoxic agents/substances.

Methods/Approach

A previous study applying the Job Exposure Matrix (JEM) ALOHA by Renzetti et al.2022, observed an association between cumulative occupational exposure to metals and pesticides and a significant increased risk of P and PD in the province of Brescia, Italy. This JEM was based on self-reported job history and experts classification but did not provide information on the specific type of chemical responsible for the association with the neurological impacts. Therefore, we considered a recent systematic review of Borghi et al.2020 to identify a more appropriate method for occupational REA when assessing long-term neurological effects.

Results

Among the methods considered in the review, we found of particular interest the study by Vermeulen et al.2010, who developed a REA for the assessment of miners exposed to diesel fumes. The study by Bello et al. 2017 identified a REA for various chemicals in ex-military personnel. Finally, Mester et al. 2011 developed a JEM for the exposure to endocrine disrupting chemicals in the automotive sector.

Conclusions

Based on the methods identified, we are planning a review of the work history collected among 430 P and PD cases and 446 age- and sex-matched controls of our first study by Lucchini et al., 2020. We will apply the identified REA methods and compare them to assess the variations in exposure-disease associations. We believe that using different methods to reconstruct job exposure to neurotoxic chemicals is key to identify more accurately the occupational determinants of chronic neurodegenerative diseases.

Presenting author profile

Dr. Juan Pablo Ramos-Bonilla is an Associate Professor in the Department of Civil and Environmental Engineering at Universidad de los Andes. He has investigated the occupational and environmental health impacts of asbestos in Colombia. Since 2015, he has led an ongoing investigation into the health impacts of asbestos in Sibaté, a municipality where the asbestos industry began operations in Colombia in 1942.

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Margarita Giraldo (1); Juan Pablo Ramos-Bonilla (1,2); Laura Bedoya (1); Cristian Vargas (1); Benjamin Lysaniuk (3); María Fernanda Cely-García (1); Pietro Comba (2); Francesco Turci (4); Milena Maule (4); Corrado Magnani (2)
(1) University of los Andes, Bogotá, Colombia
(2) Fellow Collegium Ramazzini
(3) CNRS, Paris, France
(4) University of Turin, Turin, Italy

Background

The operation of asbestos manufacturing facilities has been linked to asbestos-related-disease clusters, affecting workers and the general population. Sibaté, home to an asbestos-cement facility since 1942, has Colombia's first reported mesothelioma cluster. Weak legal enforcement and inadequate communication from environmental authorities have resulted in a lack of detailed information about the facility's operations and environmental performance. This study aims to investigate the facility's operations, including its production processes, stages involved, and the potential production and release of residues, as well as assess its environmental impacts on the population.

Methods/Approach

Former workers were interviewed to obtain information on the production process, plant layout, asbestos control measures, and waste management. Asbestos concentrations associated with different production activities of the facility were sourced from the scientific literature. Additionally, regulatory compliance documents from the regional environmental authority (CAR) were reviewed. Thirteen records (ten permissive and three non-compliance) were analyzed to evaluate adherence to regulations on industrial wastewater treatment, hazardous waste management, and air emissions.

Results

Thirteen factory workers that were employed between 1967 and 2010 were interviewed, providing detailed information about the production process. Flow charts were constructed, identifying activities with high asbestos fiber release potential. Environmental authority records, available since 1980, revealed incomplete data on wastewater and hazardous waste management. Untreated discharges into the El Muña reservoir occurred until 1999. Hazardous waste, mainly sludge and asbestos-containing materials (ACM), were frequently disposed of in Sibaté and the region, with the knowledge of the environmental authority. Local testimonies confirmed the frequent disposal of asbestos residues in urban Sibaté.

Conclusions

The asbestos-cement facility in Sibaté, which remains operational with asbestos substitutes, repeatedly violated environmental regulations, resulting in persistent asbestos contamination and significant health risks for the local population. The methodology employed in Sibaté may serve as a model for assessing similar risks in other low- and middle-income countries.

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Rebecca Gasparini (1); Andrea Bogi (2); Giovanni Calcagnini (3); Federica Censi (3); Rosaria Falsaperla
(4); Fabriziomaria Gobba (1); Roberto Giuseppe Lucchini (1, 5); Eugenio Mattei (3); Matteo Silvestri
(1); Cecilia Vivarelli (3); Alberto Modenese (1)

1.University of Modena & Reggio Emilia, Modena, Italy
2. Public Health Laboratory of the Local Health Authority of South East Tuscany, Siena, Italy
3. Italian National Institute of Health, Rome, Italy
4. Italian Workers’ Compensation Authority, Rome, Italy
5. Florida International University, Miami, FL, USA

Background

The risk of interference with Active Implanted Medical Devices (AIMD) and Active Wearable Medical
Devices (AWMD) shall be assessed at any level of exposure to electromagnetic fields (EMF). For
instance, EMF can interfere with cardiac pacemaker (PM) or implantable cardioverter-defibrillator
(ICD), causing an inappropriate stimulation or affecting the sensing function or the setting of the
devices.

Methods/Approach

The diffusion of AIMD/AWMD among EMF-exposed workers was explored through a survey
conducted among Occupational Physicians (OPs) in charge of the workers’ health surveillance in
several Italian hospitals and companies. A 15-item online survey was collected, focusing on nine
types of devices, including AIMD (PMs, ICDs, loop-recorders, cochlear implants and auditory
brainstem implants, central nervous system/peripheral nerve stimulators) and AWMD (active
prosthesis, wearable pumps for drugs/hormones, hearing aids). The study is funded by the Italian
Workers’ Compensation Institute (i.e. INAIL) within the project BRiC22 ID36.

Results

A total of 131 OPs, in charge of the health surveillance for an overall population of ~170,000,
responded. Preliminary results of the survey indicate that the most common devices were: i) hearing
aids (79% reported at least 1 worker with the device in the last year), ii) drug/hormone infusion
pumps (76%), iii) ICDs (64%) and iv) PMs (61%).

Conclusions

Considering the overall population of workers followed by the OPs and the reported proportions of
subjects with AIMD/AWMD, we estimated that >700 individuals, i.e., 0.5% of the total workers
followed, utilize AIMDs (mainly PMs and ICDs), while >900 have AWMD (mainly hormone/drug pumps and hearing aids). Therefore, based on our estimates, approximately the 1-1.5% of the working population can be at risk for interference to medical devices from EMF exposure at the workplace. Adequate health surveillance and fitness-for-work evaluation of these workers must be carefully implemented to reduce this risk. Device manufacturers should be consulted in
specific situations.

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

Background

The demands to provide humanitarian aid to a population that until now has been incited and indoctrinated to carry out mass murder and atrocities pose ethical questions. How do you go about doing this?

Methods/Approach

Humanitarian aid must be delivered. It should be accompanied by strong indoctrination and education programs, as well as legislation and political changes. These measures aim to shape embedded mindsets, beliefs, attitudes, and modes of behaviors that cause hatred, dehumanization, and demonization. The role model for such changes comes from the denazification programs of the US, British, and French imposed on Nazi Germany after WW2. These programs aimed to eliminate deeply embedded mindsets in heavily indoctrinated populations. These programs were accompanied by public health measures such as supplying water, food, shelter, basic security, sanitation, vaccination, and health care.

Results

It is suggested that these models apply to the deradicalization of any extremist population or movement intent on terrorism, including combatants and non-combatants. All these groups and their followers are indoctrinated top-down using motifs of dehumanization, demonizing, and glorification of violence. This indoctrination is population-wide, from cradle to grave, and can be intergenerational. Child soldiers are a special risk group.

Conclusions

There is a need for a unified field theory and model to apply to all the above scenarios. As with denazification, deradicalization requires command and control approaches top-down as well as community-based approaches reaching far and deep into community life. There is a parallel need for strong public health programs, especially where infrastructure has been greatly destroyed. Deradicalization must be local, regional, and global. The core value is to choose life.

Presenting author profile

Iman Nuwayhid and Rima R Habib are professors of environmental and occupational health at the Faculty of Health Sciences at the American University of Beirut.

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Iman Nuwayhid (1); Rima R. Habib (1)
1. American University of Beirut, Beirut, Lebanon

Background

Israel has targeted hospitals and primary health centers in the on-going war in Gaza (starting on October 7, 2023), rendering two thirds of those dysfunctional, and killed more than 500 health professionals. In addition, schools and universities have been destroyed, WASH facilities have been damaged, and the environment has been heavily polluted from detonated explosives, fire combustion products, and rubble. To address this catastrophic health crisis, we argue for a public health approach for the rebuilding of Gaza’s health.

Methods/Approach

A public health approach transcends the focus on hospitals, medical care, and physical injuries to encompass a broader spectrum of mental and social health, including social inequalities. Driven by its core values of equity and social justice, and in collaboration with other sectors, this approach prioritizes community health workers, equipped with knowledge of the local context, to address the social (e.g., lack of schools and education, food insecurity, malnutrition, loss of loved ones, broken social networks), environmental (e.g., limited access to water, poor water quality, poor sanitation and hygiene, overcrowding), economic (e.g., destroyed economic sectors, limited jobs, child labor), and political (e.g., security, neighborhood safety) conditions that will impact people’s health and wellbeing for many generations.

Results

It is a moral imperative to strive towards a future where the people of Gaza can live in peace, dignity, and self-determination. The international public health community must provide urgent and unequivocal support to the people of Gaza, guided by locally-identified community-based needs and solutions. However, justice, freedom, end of occupation, and the dismantling of structural racism are pre-requisites for the sustainability of the health and wellbeing of people in Gaza.

Conclusions

Public health professionals, including fellows of the Collegium Ramazzini, can actively engage in the training of public and environmental health human resources in Gaza and the health and environmental rehabilitation of Gaza.

Presenting author profile

Prof. Sim is an Emeritus Professor in the School of Public Health and Preventive Medicine at Monash University. He was previously Head of the Centre for Occupational and Environmental Health before retiring in 2021. He has been very actively involved in research into the accelerated silicosis epidemic in Australia and providing policy and practice advice to the Australian Government to reduce the burden of this disease.

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Malcolm R Sim (1)
1. Monash University, Melbourne, Australia

Background

Artificial stone can contain up to 96% crystalline silica and a variety of resins, pigments and other additives. Its use has rapidly increased in Australia and many other countries over the past two decades. Cases of accelerated silicosis among stonemasons working with artificial stone in Australia continued to rise dramatically since the first case report in 2015.

Methods/Approach

Due to concern about this dramatic increase of silicosis cases, a national dust disease taskforce was established in 2019. The taskforce made several recommendations in June 2021 to improve working conditions and reduce respirable crystalline silica (RCS) dust exposures among stonemasons. It recommended that a ban on artificial stone be introduced if control measures did not result in a measurable improvement. There was considerable media coverage of this issue leading to increased public awareness. The main construction trade unions also began a campaign to ban work with this material.

Results

In 2023 the Australian Workplace OHS Ministers met and asked Safe Work Australia (SWA), the national OHS policy body, to review the effectiveness of control measures and to evaluate future options, including a ban on artificial stone. In 2022 the published number of cases had risen to 579. The SWA report in August 2023 concluded that the existing regulatory framework was ineffective in protecting workers from silicosis and recommended a total ban. The OHS Ministers subsequently decided to ban artificial stone from 1 July 2024. An important implication of this was the need to identify alternative safer materials.

Conclusions

This has important implications for policies in other countries where artificial stone is being used in the construction industry. An important contributor to policy development is establishing high quality screening programs, including sensitive tools such as low dose CT scans, to detect silicosis at an early stage.

Presenting author profile

Prof. Modenese is an Occupational Physician, Associate Professor and Director of the Residency School of Occupational Medicine of the University of Modena and Reggio Emilia (UniMoRe). He is the Chair of the Scientific Committee "Radiation and Work" of the International Commission on Occupational Health (ICOH). He has 15-years of experience in clinical, teaching and research activities in Occupational Medicine, with a particular focus on risk prevention practices related to non-ionizing radiation exposures at work.

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

Background

Occupational exposure to solar ultraviolet radiation (UVR) involves 1.6 billion workers worldwide, with a burden of ~19,000 deaths and 0.5 million disability-adjusted life years (DALY) for non-melanoma skin cancers (NMSC). Nevertheless, UVR-inflicted occupational skin cancers are extremely under-reported to worker compensation authorities.

Methods/Approach

It is time to globally improve the prevention of occupational risks related to solar UVR exposure of outdoor workers, considering that:
1) The risk is preventable: SunSafety campaigns e.g. in Australia showed positive effects, with a reducing trend in melanoma incidence for subjects <55 years).
2) There are collective technical and organizational protective measures (e.g., covering/shielding structures, avoiding open-field work with high UV-index) to be applied at the workplaces, even if current risk evaluation and specific workers' trainings are lacking.
3) Personal Protective Equipment (UV-filtering glasses and clothing, UV-protecting hats/helmets) are available, even if not rigorously worn by the workers. Moreover, sunscreens are fundamental individual protections, but it is difficult to have them directly provided by the employers.
4) Occupational health surveillance is fundamental for the prevention of UV-related effects, and can require collaboration with specialists such as dermatologists. In case of diagnoses of NMSC, the diseases need to be reported to the workers' compensation authorities.

Results

Improvement of the prevention of solar UVR risk at workplaces on a global scale will result in a reduction of extremely frequent, but under-recognized, occupational diseases, such as NMSC. It should be noted that recent data indicate that specific subtypes of melanoma are associated with cumulative solar UVR at work.

Conclusions

Actions urgently recommended on a global scale in outdoor workplaces are:
1) Rigorous adoption of UVR-prevention programs, including occupational health surveillance.
2) Improvement of the notification of work compensation claims for UVR-inflicted diseases.
4) Definition of a reliable occupational exposure limit, to support risk evaluation and specific norms.

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Kathleen McPhaul (1)
1. University of Maryland, College Park, Maryland, USA

Background

Ultraviolet-C, or UVC, inactivates infectious pathogens in water, on surfaces, and in air. Pandemic preparedness and occupational health practice demand improved technology to protect essential workers from novel infectious respiratory particles (IRP's); we must also protect all workers from endemic respiratory infections. Businesses experience absenteeism due to seasonal infections and also become unwitting spaces for transmission of IRP's to the public. Engineering controls are available but underutilized for IRP's. We analyze the policy barriers to using UVC as an engineering control for IRP's in the workplace.

Methods/Approach

UVC has a long history of safe use in schools and tuberculosis wards to prevent transmission of IRP's. It is increasingly installed in restaurants, airports and hospitals. Yet the science for human safety does not meet the threshold for IARC and ICNIRP; the ACGIH, however, has recently updated its TLV's for UVC in the workplace and NIOSH has specific, detailed guidance for safe installation of 254-UVC. Yet, there is no effort to integrate public-facing informational websites across US federal agencies and the World Health Organization (WHO) to guide occupational health practitioners and employers for the safe use of UVC in the workplace.

Results

The occupational risks to workers from UVC can be controlled which means that employers and workers can enjoy the benefits of reducing illness and absenteeism due to IRP's. Yet, the lack of credible, integrated information is a barrier and, we argue, that this barrier creates a vacuum which allows for the proliferation of misinformation.

Conclusions

Occupational medicine must advocate for plain language guidance for workers and employers while providing expertise and recommendations to policy makers on the need for strategic use of GUV in workplaces. We must also consider the need for medical surveillance protocols, work accommodations when reasonable, and preventive health education in workplaces.

Presenting author profile

Roberto Lucchini is a professor of Occupational and Environmental Health with research interest in metal neurotoxicity. He conducted human cohort studies on workers, children, Parkinsonian patients, and controls, focusing on neurodevelopmental and neurodegenerative impacts. His work provided scientific evidence for risk assessment and identification of protective standards for manganese, lead, and mercury. In 2023 he started a collaborative scientific effort in the Amazon, by leading a panel of experts in occupational and environmental health.

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Roberto G Lucchini (1,2)
1. University of Modena and Reggio Emilia, Modena, Italy
2. Florida International University, Miami, Florida, USA

Background

Gold mining is the anthropogenic activity that contributes the most to mercury contamination in the Amazon, enhanced by deforestation and climate stressors that pose additional threats to human health and ecosystems. The Indigenous people are significantly impacted, raising the need for intervention to eliminate inequalities. The Amazon may become a degraded ecosystem, as recognized at the high-level summit held in Belém, Brazil in August 2023. The eight Amazonian countries agreed on a protection plan for the forest illustrated in the Belem Declaration. The implementation of this plan is highly dependent on scientific data supporting and guiding this concerted governmental action.

Methods/Approach

Considering these premises, a workshop was planned with the patronage of Collegium Ramazzini at the Annual Conference of Global Health for the Americas, held by FIU in Cartagena, Colombia, in September 2023. Experts from FIOCRUZ, Brasil, Universidad de Cartagena, Colombia, Universidade Federal do Para, Belem, Brasil, Centro de Innovación Científica Amazónica, Puerto Maldonado, Perú, Instituto Nacional de Salud, Lima, Perú, Ministério dos Povos Indígenas, Brasil, reported updates on exposure-related health impacts, genetic predispositions, and co-exposures between mercury, microplastics and agrochemicals introduced by deforestation and mining.

Results

This presentation illustrates the current experience in the Amazon research and the needs to enhance and strengthen specific partnership focused on the environmental crisis in this key area of Latin America. To avoid fragmentation of scientific efforts, unified cohorts should be created to gain epidemiological (and political) power to address the complexity of exposomic and social stressors affecting human's health in this region.

Conclusions

The CR statement of 2021, "Reducing disease and death from artisanal small-scale mining" included recommendations for governments, employers and mineral purchasers that need to be applied locally. These inputs should be conveyed to the new Intergovernmental Science Panel for the Amazon established by the Declaration of Belem.

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Mitia Stiscia (1), Rebecca Gasparini (1), Enrico Barbolini (1), Fabriziomaria Gobba (1), Alberto Modenese(1)

1. University of Modena & Reggio Emilia, Modena, Italy

Background

A novel job exposure matrix (JEM) combining personal solar ultraviolet radiation (UVR) measurements and expert ratings is under development by an international research group (Wurtz et al. Saf Health Work 2022).

Methods/Approach

A UniMoRe expert participated with other nine experts in the assessment of probability and duration of outdoor work for all ISCO-88 (International Standard Classification of Occupations) codes. To integrate objective measures in the JEM, we re-analyzed solar UVR data collected with personal dosimeters in 7 fishermen of the North-Adriatic Sea (Modenese et al. 2019). We grouped them according to the ISCO88 fishermen codes 6152 ‘Inland and coastal waters fishery workers,’ and 6153 ‘Deep-sea fishery workers.'

Results

Based on the experts’ estimates, fishermen were the highest exposed group for both probability and duration. Our measurements showed that the 6152 group, formed by two workers conducting sea snail and cuttlefish fishing on small boats with no possibility of shielding from sunlight, received a daily UVR dose ranging from 0,8 to 5,4 Standard Erythema Doses (SED). Group 6153 included five fishermen who were mussels fishing and trawling on medium-sized boats, partially shielded from sunlight, and received a daily UVR dose between 0,3 and 2,1 SED.

Conclusions

Fishermen with the ISCO88 codes 6152 and 6153 were classified by experts in the highest level group of UVR exposure. In our re-analysis, coastal fishermen received, at least in one of the two days, >1 Standard Erythema Dose (SED) (maximum= 5,4 SED). Deep sea fishermen received lower UVR doses; nevertheless, 3 out of 10 measurements resulted >1 SED, (maximum= 2,1), i.e., twice the energy needed for sunburns. Notably, measurements were collected during cloudy mornings in spring. Our data, matched with the expert assessment, is a significant contribution to the development of an innovative solar UVR JEM.

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Stefan Rakete (1), Viet Do (1), Razan Wibowo (1), Caroline Quartucci (1,3), Stephan Bose-O’Reilly (1,3)
1. LMU University Hospital, LMU Munich, Munich, Germany
2. Bavarian Health and Food Safety Authority, Munich, Germany
3. University for Health Sciences, Medical Informatics and Technology, University in Hall in Tirol, Austria

Background

Due to climate change, hot days and heat waves will occur more frequently. As a consequence, indoor air temperatures may also rise, especially in non-air-conditioned rooms. A survey has shown that this particularly affects nursing staff in Germany. The aim of the presented study is the investigation of the influence of increased indoor temperatures and the use of personal protective equipment (PPE) on the thermal stress of health care workers.

Methods/Approach

The study was divided into two parts. In the first part, 18 test subjects were exposed to standardized test conditions in a climate chamber: 1) 22 °C without PPE, 2) 27 °C without PPE, 3) 22 °C with PPE and 4) 27 °C with PPE. The second part of the study took place in a hospital ward at temperatures below 22 °C or above 27 °C. In both studies, physiological parameters were monitored with wearable sensors and subjective well-being was assessed using a questionnaire.

Results

For the climate chamber experiment, both heat and PPE showed significant effects on physiological parameters and the subjective well-being. The combination of heat and PPE showed the strongest effects. While PPE had no effect on core body temperature, skin temperature was increased by wearing PPE. Perceived physical strain increased with heat and PPE, as did exertion and water consumption. For the hospital ward experiment, increased temperatures had a significant effect on physiological parameters and lead to a decline of subjective well-being.

Conclusions

Although this study does not indicate any acute health risk from elevated temperatures or the use of PPE, we observed a negative influence on the well-being and performance of healthcare workers. The experimental design and the resulting data can be used be used to investigate mitigation strategies, e.g., using cooling vests.

Presenting author profile

Dr. Juan Pablo Ramos-Bonilla is an Associate Professor in the Department of Civil and Environmental Engineering at Universidad de los Andes. He has investigated the occupational and environmental health impacts of asbestos in Colombia. Since 2015, he has led an ongoing investigation into the health impacts of asbestos in Sibaté, a municipality where the asbestos industry began operations in Colombia in 1942.

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Juan Pablo Ramos-Bonilla (1)(2); Pietro Comba (2); Benjamin Lysaniuk (3); María Fernanda Cely-García (1); Benedetto Terracini (2)(4); Daniela Marsili (5); Roberto Pasetto (5); Agata Mazzeo (6); Margarita Giraldo (1); Corrado Magnani (2)(7); Milena Maule (8); Francesco Turci (8)

(1) University of los Andes, Bogotá, Colombia
(2) Fellow Collegium Ramazzini, Bologna, Italy
(3) CNRS, Paris, France
(4) University of Turin and CPO-Piemonte, Turin, Italy
(5) Istituto Superiore di Sanità, Rome, Italy
(6) University of Bologna, Bologna, Italy
(7) University of Eastern Piedmont, Novara, Italy
(8) University of Turin, Turin, Italy

Background

On 2015, Universidad de los Andes (Uniandes, Bogotá, Colombia) began investigating asbestos-related disease (ARD) cases in Sibaté, Colombia, following residents' complaints. In 2019, a mesothelioma cluster was reported in Sibaté associated with local asbestos-cement production, thanks to collaboration with researchers from Colombia, Italy, and France. This groundbreaking research has had significant policy implications. This presentation outlines the establishment of this collaboration, key factors for its success, ongoing work, and future challenges.

Methods/Approach

The Sibaté study was initiated by Uniandes on 2015, and by the summer of 2016, over 350 door-to-door surveys indicated a major public health problem. With these preliminary results and through networking by researchers from the Italian Istituto Superiore di Sanità, collaboration with renowned asbestos researchers from Italy and France was established in Rome in September 2016. Over three years, a network of 12+ researchers described a mesothelioma cluster in Sibaté, extensive asbestos contamination, and several mesothelioma cases diagnosed at a young age, suggesting childhood asbestos exposure. The collaboration now includes academic institutions from Italy (University of Turin and University of Eastern Piedmont), a dual-degree doctoral student studying in Italy and Colombia, collaboration with the French CNRS, and the presentation of grant proposals.

Results

The international collaboration was crucial for uncovering the public health crisis in Sibaté. Factors contributing to its success included:
1. Shared interest in understanding asbestos impact.
2. Researchers dedicated to rigorous scientific methods.
3. Integrating complementary knowledge.
4. A common goal of influencing public policy.
5. The time and intellectual generosity of renowned international researchers sharing their expertise.

Conclusions

Despite the mesothelioma cluster being reported in April 2019 and a national asbestos ban being approved the same year, governmental authorities have done little to address the crisis in Sibaté. Funding shortages have also hindered the investigation. However, the investigation continues with the commitment and dedication of all the collaborators involved.

Presenting author profile

Roberto Lucchini, is a professor of Occupational and Environmental Health with research interest in metal neurotoxicity. He conducted human cohort studies on workers, children, Parkinsonian patients, and controls, focusing on neurodevelopmental and neurodegenerative impacts from metal exposure. His work has provided scientific evidence for risk assessment and identification of protective standards for manganese, lead, and mercury exposure. He documented dose-response relationships that yielded more accurate estimates of population health risks for manganese exposure.

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Roberto G Lucchini (1,2); Donald R Smith (3)
1. University of Modena and Reggio Emilia, Modena, Italy
2. Florida International University, Miami, Florida, USA
3. University of California, Santa Cruz, California, USA

Background

Exposome research is rapidly evolving by encompassing biomolecular omics-based techniques. This constantly refining approach provides increasing opportunity to assess causation and to inform precision medicine and population health. Mixed exposure sciences are key in the exposome quantification, as shown by the growing number of new exposure mixture models. This expanding complexity also creates challenges for risk assessment of the individual mixture components.

Methods/Approach

Essential elements like copper, iron, manganese, selenium, zinc are part of the exposure mixtures examined in human and experimental research. Exposure to mixtures is mostly based on biomarkers, which can accurately reflect exposure to non-essential purely toxic elements but not to essential elements. This is due to highly efficient physiologic mechanisms devoted to maintaining the homeostatic range. Therefore, mixtures cannot effectively include the role, or ‘weight’ in statistical terms, of essential individual components. As a result, the health effect of mixtures may be underestimated, and the role of each mixture component identified by models like Benchmark Kernel Machine Regression can be misinterpreted. Manganese is a good example of this, where blood manganese is not a reliable exposure proxy, especially at environmental non-occupational levels; when utilized in mixed exposure models, blood manganese levels misrepresent the real toxic effects, which can be evident when using environmental exposure metrics of airborne particulate, deposited dust or soil.

Results

Mixed exposure approaches in exposomic research can negatively impact risk assessment by underestimating the toxicity of individual essential elements. This may yield unrealistic revision of protective standards, or simply to non-compliance with existing ones. The growing demand of individual elements for EV batteries and other uses must be strictly controlled to avoid health consequences on exposed workers and communities.

Conclusions

We propose to combine biomarkers with multimedia environmental measurements in mixed exposure sciences, especially for essential elements that may not be adequately represented by biomarkers.

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

Background

Several South East Asian (SEA) countries are facing changes in the proportion of their population, leading to a large proportion of working age and some countries becoming an ageing society with high prevalence of communicable and non-communicable diseases and occupational diseases and accidents. The practice of occupational medicine in occupational health and workers' health services is important to increase access to and quality of health services for achieving a high level of national productivity.

Methods/Approach

SEA countries have made significant progress in occupational health and safety by integrating technology into training programmes. The COVID-19 pandemic accelerated the process. These technologies not only make education more accessible but also enhance the learning experience and allow trainees to practice real-life scenarios in a controlled environment. Collaboration and knowledge exchange among SEA countries play an important role in advancing occupational medical education (OME). Student exchanges, faculty exchanges, and international partnerships in research will be ways to harmonize through sharing experiences, research findings, and best practices.

Results

Such collaboration fosters a global perspective on both challenges and solutions. Through collaboration, it is possible to develop harmonization of OME and training and create equity and equal distribution of quality occupational health services. Therefore, building collaboration and harmonization of OME and training in SEA is needed. Strong occupational medicine professionals will strengthen the occupational health services and workers’ health and productivity. The arrangement of ASEAN Diagnostic Criteria for Occupational Diseases after five meetings in Thailand and once in Malaysia is an initial milestone in the harmonization of occupational health and medicine in SEA countries.

Conclusions

Seminars and workshops are needed to build this collaboration and harmonize OME at institutions in SEA. Benchmarking to the other countries which have more advanced occupational health service training and programs will enhance the better standardized OME and training in SEA.

Presenting author profile

Daniel Hryhorczuk is a Professor Emeritus at the University of Illinois School of Public Health in Chicago.

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Daniel Hryhorczuk (1)
1. University of Illinois at Chicago, Chicago, IL, USA.

Background

War and the preparation for war create profound and extensive adverse impacts on the environment and on environmental health.

Methods/Approach

Armed conflicts, including the wars in Ukraine and Gaza, can cause severe, widespread, and/or long-lasting damage to the environment, which can meet the definition of ecocide. This environmental damage can increase the risk of related acute and chronic adverse health effects. Systematic comprehensive assessment of the environmental damage and related health impacts, likely difficult until conflict ends, is necessary to document damage and plan remedial measures. It is also necessary to provide further support for local responses and global preventive measures, including development of an international convention declaring ecocide as a crime against humanity.

Results

International law proscribing military crimes against the environment has evolved over the past five decades, but enforcement is often complicated by issues of attribution, non-signatories to international treaties, and other factors. In addition to possible treaty obligations, attacks on the environment fall under the protection and authority of customary international law, including principles of humanity. There is a strong movement to more explicitly define environmental protections under international law and to build on existing law that governs the way in which warfare is conducted. There are needs for investigating the environmental consequences of all armed conflicts and for implementing more effective measures to protect the environment during war, including holding accountable those responsible for damaging the environment during war and those who instigate war. However, the only way to prevent the environmental impacts of war is to prevent war itself, by preventing conflicts from becoming violent, by addressing the underlying causes of war, and by strengthening the infrastructure for peace.

Conclusions

The Collegium should consider drafting a statement supporting current efforts to include ecocide as the fifth crime against humanity in times of both war and peace.

Presenting author profile

Naresh Gupta, MD, is president of the Health Environment Foundation, and former Director-Professor at Maulana Azad Medical College, New Delhi, India.

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Naresh Gupta (1)
1. Health Environment Foundation, New Delhi, India

Background

Solid cookfuel pollution is the largest energy-related health risk globally and most important cause of ill-health for Indian women and girls. With 700 million people cooking with open biomass chulhas, the Indian population exposed has not changed in several decades, in spite of hundreds of programs to make the “available clean”, i.e., to burn biomass cleanly in advanced stoves. In May 2016, the government of India launched an ambitious project to provide free liquefied petroleum gas (LPG) connections to deprived and poor women in 80 million households, surpassing an incremental target of 96 million by 2022.

Methods/Approach

Naresh Gupta - Session Chair, organizer and coordinator
Arthur Frank- Session Co-Chair
TK Joshi - Presenter, "The evolution of women’s health in India kitchens vis-à-vis household environment"
Mukesh Khare - Presenter, "Household air quality before and after the introduction of liquefied petroleum gas in kitchens in India under project mode"
GC Khilnani - Presenter, "Health impacts and lessons learned from the kitchens LPG (Liquefied Petroleum Gas) project in India”

Results

Challenges to accessing and using cleaner fuels in three middle-income countries, including India have been highlighted by Kapsalyamova Z, Mishra R et. al. 2021. With protean impact of fuel pollutants on human health and non-communicable diseases (NCDs), the multiplier benefits on women's health - from a young age through childbearing years - will likely have long term impacts on society, national economy and its millennium development goals.

Conclusions

1. Our regular National Family Health Surveys (NFHS) should document cumulative trends/ benefits, along with data from 700 medical schools and other public health institutions

2. For the long term, such myriad and generational population health benefits should stimulate more basic research.

3. Research is needed to ways to improve adoption of cleaner fuels in resource-constrained settings

Presenting author profile

Daniel Hryhorczuk is a Professor Emeritus at the University of Illinois School of Public Health and has conducted research on the impacts of war on the environment in Ukraine.

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Daniel Hryhorczuk (1); Donna Mergler (2)
1. University of Illinois School of Public Health, Chicago, USA
2. University of Quebec, Montreal, Canada

Background

The war in Gaza has created a humanitarian crisis with over 40,000 people killed, 92,000 wounded, and over 1.9 million people displaced. In addition to the humanitarian crisis, the war has led to extensive destruction of the natural and built environment.

Methods/Approach

This panel will address the public health and environmental damage caused by the war. Dr. Daniel Hryhorczuk from the University of Illinois will discuss the impact of war on the natural and built environment and the limitations of current international law in addressing the crime of ecocide. Drs Rima Habib and Iman Nuwayhid from the American University of Beirut will discuss a public health approach to rebuilding public health and health infrastructure in Gaza. Dr. Mazi Qumsiyeh from the University of Bethlehem will discuss the environmental damage in Gaza that has resulted from the war.

Results

The international public health community must provide urgent and unequivocal support to the people of Gaza, guided by locally-identified community-based needs and solutions.

Conclusions

The environmental and human health impacts of the war in Gaza need to highlighted in public discourse. Public health professionals, including fellows of the Collegium Ramazzini, can actively engage in the training of public and environmental health human resources in Gaza and the health and environmental rehabilitation of Gaza.

Presenting author profile

Mukesh Khare, C. E, Ph.D. (UK) is Professor Emeritus in Environmental Engineering, Civil Engineering Department, Indian Institute of Technology (IIT) Delhi, New Delhi, India where he worked in the public, academic and research arenas.

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Mukesh Khare (1)
1. Indian Institute of Technology, Delhi, India

Background

Indoor air pollution poses a significant and growing health risk in India. Primary pollutants of concern in biomass fuel generated household air pollution are particulate matters (PM10, PM2.5, PM1.0), NOx, SOx, and CO.

Methods/Approach

The Pradhan Mantri Ujjwala Yojana (PMUY), launched in 2016, has significantly impacted indoor air quality in India. Before the scheme, many rural and underprivileged households relied on solid fuels like firewood, cow dung, and crop residues for cooking. These traditional fuels produced high levels of indoor air pollution, leading to severe health issues such as respiratory diseases and low birth weights, especially affecting women and children.

After the implementation of PMUY, which provided free liquefied petroleum gas (LPG) connections to economically disadvantaged households, there has been a notable improvement in indoor air quality. The availability of cleaner cooking fuel through PMUY has also empowered women by reducing the time and effort required to collect traditional fuels and improving overall household health.

Results

Studies show that indoor PM2.5 concentrations in households using LPG were nearly two times lower during cooking hours compared to those using traditional chulhas. By 2019, the PMUY helped prevent 1.8 million tonnes of PM2.5 emissions and reduced indoor air pollution deaths by 13%. This equated to the prevention of approximately 150,000 pollution-related premature deaths in that year alone.

Conclusions

Despite these improvements, challenges remain in ensuring consistent LPG use among beneficiaries and extending the benefits to all eligible households. The target coverage under the Pradhan Mantri Ujjwala Yojana (PMUY) has been expanding ever since its launch. However, in 2021-2022, 9.6% of beneficiaries took no refills, 11.3% took only one refill, and 56.5% took four or fewer refills of LPG.

Presenting author profile

Prof. Naesinee Chaiear is chair of MSc program in Occupational Medicine and Occupational Health Program and also the founder of Occupational Health and Safety Section of Srinagarind Hospital.

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Naesinee Chaiear (1);
1. Khon Kaen University, Khon Kaen, Thailand

Background

Over the past 20 years, occupational medicine in Thailand has significantly addressed gaps in workers' health by training occupational health (OH) specialists, who have become pioneers and leaders in developing comprehensive occupational health services. One notable achievement is the establishment of occupational health service systems for healthcare workers. Additionally, the ASEAN Diagnostic Criteria for Occupational Diseases, developed through five meetings in Thailand and one in Malaysia, marks a key milestone in improving the quality of occupational disease diagnoses in Southeast Asian countries. Similarly, Malaysia has made great strides in developing and enforcing national guidelines for occupational health services, a direct result of contributions from the field of occupational medicine. This panel discussion aims to explore the strategic development of occupational health services, education, and safety management for health personnel in ASEAN countries, focusing on Indonesia, Malaysia, and Thailand.

Methods/Approach

This panel includes presentations by OH leaders in occupational medicine education and training and occupational safety and health (OHS) programs in South East Asia, including the panel chair Naesinee Chaiear, Thailand, and Muchtaruddin Mansyur, Indonesia and Abu Hasan Samad, Malaysia.

Results

Through collaboration, Indonesia can harmonize occupational medical education and training, ensuring equitable and high-quality health services. In Malaysia, an effective regulatory environment, which involves regularly updating regulations and developing new ones. In Thailand, effective occupational health and safety management for health personnel has been implemented by meeting HR management requirements. A case study of this success should support nationwide implementation, with thorough monitoring from internal and external audits.

Conclusions

Indonesia will be benchmarking against other countries. In Malaysia, OSH practitioners, play a significant role and can collectively contribute to the development of new OHS Regulations. In Thailand, the adoption of the Thailand Healthcare Standard as a guide to protect health personnel will be key and should be followed up.

Presenting author profile

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

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Pietro Verzelloni (1); Vincenzo Giuliano (1); Lauren A. Wise (2); Teresa Urbano (1); Claudia Baraldi (1); Marco Vinceti (1)(2); Tommaso Filippini (1)(3)
1. University of Modena and Reggio Emilia, Modena, Italy
2. Boston University School of Public Health, Boston, MA, USA
3. University of California Berkeley, Berkeley, CA, USA

Background

Exposure to environmental toxic metals represents a significant global public health concern. Many studies have found that exposure to cadmium (Cd) increases the risk of developing hypertension. Since the shape of the relation between Cd exposure and hypertension has not been well characterized, we assessed it by performing systematic review and dose-response meta-analysis of human studies.

Methods/Approach

We searched the literature for eligible articles using keywords related to Cd, hypertension, and blood pressure (BP). Eligible criteria for the studies were: observational design, adult population, assessment of exposure using Cd biomarkers, and availability of exposure category-specific risk estimates for hypertension. We performed a dose-response meta-analysis of the findings yielded by the eligible studies.

Results

We included 18 articles in both qualitative and quantitative analyses published between 2006-2024, with most (n=14) having a cross-sectional design. Cd was measured in whole blood and/or urine in almost all studies, whereas only two assessed the concentration in serum. Dose-response meta-analysis showed an almost linear relation between urinary Cd concentrations and hypertension risk with RR=1.18, 95%CI 1.02-1.37 at 2.0 µg/g creatinine compared with null exposure. Conversely, the association between blood Cd and hypertension risk was non-linear, with a more steep risk increase at Cd concentrations above 2 µg/L, and a RR of 1.48 (95%CI 1.17-1.86) at 2.0 µg/L compared with null exposure. We found similar trends in studies limited to Asian populations, while when considering studies from North America hypertension risk seemed to increase above 1.0 µg/g creatinine.

Conclusions

The positive association between Cd exposure and risk of hypertension, based on a validated biomarker as blood Cd, was non-linear while the association was almost linear for urinary Cd, possibly related to the different timing of exposure assessed by blood (short-term) and urine (long-term) concentrations. Further lowering Cd exposure is confirmed as a public health priority for chronic disease prevention.

Presenting author profile

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

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Tommaso Filippini (1)(2); Sofia Costanzini (1); Annalisa Chiari (3); Teresa Urbano (1); Francesca Despini (1); Manuela Tondelli (1)(3); Roberta Bedin (1)(3); Giovanna Zamboni (1)(3); Sergio Teggi (1); Marco Vinceti (1)(4)
1. University of Modena and Reggio Emilia, Modena, Italy
2. University of California Berkeley, Berkeley, CA, USA
3. University Hospital of Modena, Modena, Italy
4. Boston University School of Public Health, Boston, MA, USA

Background

A few studies have suggested that exposure to lighting during night hours, i.e. light at night (LAN), may increase the risk of dementia. In this study, we aimed to evaluate the association between exposure to outdoor artificial LAN and risk of conversion to dementia in an Italian cohort of subjects with mild cognitive impairment (MCI).

Methods/Approach

We recruited subjects with a diagnosis of MCI at the Cognitive Neurology Clinic of Modena Hospital in the period 2008-2014, and we followed these subjects up to 2021 for conversion to dementia. We collected their residential history and we assessed LAN exposure at subjects’ residences using satellite imagery data available from the Visible Infrared Imaging Radiometer Suite (VIIRS) for the period 2014-2022. Using a Cox-proportional hazards model adjusted for relevant confounders, we computed the hazard ratio (HR) of dementia with 95% confidence interval (CI) according to increasing LAN exposure through linear, categorical, and non-linear restricted-cubic spline models.

Results

Out of 53 recruited subjects, 34 converted to dementia of any type including 26 Alzheimer’s dementia. In linear regression analysis, LAN exposure was positively associated with dementia conversion (HR 1.03, 95% CI 1.00-1.06 for 1-unit increase). Using as reference the lowest tertile, subjects at both intermediate and highest tertiles of LAN exposure showed increased risk of dementia conversion (HRs 2.26, 95% CI 0.88-5.85, and 2.89, 95% CI 1.10-7.58). In spline regression analysis, the risk linearly increased up to a LAN exposure of 30 nW/cm2/sr, above which a plateau seemed to be reached. Results were almost confirmed when limited to conversion to Alzheimer’s dementia, except for an almost linear relation.

Conclusions

Our findings suggest that exposure to outdoor artificial LAN may increase conversion from MCI to any type of dementia, especially above 30 nW/cm2/sr, while such relation appears to be almost linear for Alzheimer’s dementia.

Presenting author profile

G C Khilnani is Professor and Head of the Department of Pulmonary Medicine and Sleep Disorders, AIl India Institute of Medical Sciences, New Delhi, teaching and training in pulmonary medicine. He has pioneering research on occupational lung diseases.

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Gopi C Khilnani (1)
1. PSRI Hospital, New Delhi, India

Background

Cooking activities release millions of particles (~106 particles/cm3) by burning wood, oil and other similar sources, many of which are ultra-fine particles. Residents' health may be negatively impacted by these particles spreading not just to the kitchen but also to other parts of the building. Almost 40% of Indian households still use solid fuels including wood, charcoal, leaves, cow dung cake, among others.

Methods/Approach

The Kitchens LPG Project, under the Pradhan Mantri Ujjwala Yojana (PMUY) launched in 2016 by the Government of India, aims to mitigate these health hazards. The target was to release 8 crore (80 million) Liquefied Petroleum Gas (LPG) connections to the deprived households by March 2020. Under the union budget for financial years 2021-22, provision for release of an additional 1 crore (10 million) LPG connections under the PMUY scheme was made. There is also extension of PMUY for release of 75 lakh (7.5 million) LPG connections over three years from financial year 2023-24 to 2025-26. As of 1st March 2024 there are 10.27 crore (102.7 million) PMUY beneficiaries.

Results

The benefits of the program are:
1. Reduction in health risks: Switching to LPG significantly reduces the emission of harmful pollutants, leading to lower respiratory and cardiovascular diseases.
2. Improved quality of life: Access to LPG saves time spent on gathering biomass fuels, allowing women to engage in other productive activities and improving their overall quality of life.
3. Environmental benefits: Reduced reliance on biomass fuels decreases deforestation and environmental degradation, contributing to forest conservation and climate change mitigation.
4. Economic benefits: Healthier individuals contribute more effectively to the economy. The LPG industry also creates job opportunities, stimulating economic growth.

General benefits expected are health improvements, reduction in mortality rates and environmental and social Impacts.

Conclusions

The potential follow-up issues involve addressing accessibility and affordability, supply chain, behavioral change, and monitoring and evaluation.

Presenting author profile

Not applicable

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Florencia Harari (1); Denny Dobbin (2); Homero Harari (3)
1. University Hospital and University of Gothenburg, Gothenburg, Sweden.
2. NIEHS (retired), Research Triangle Park, NC, USA
3. Icahn School of Medicine at Mount Sinai, New York City, New York, USA

Background

This scientific session aims at advancing occupational and environmental health in Latin America by examining lessons learned from previous successful international collaborative efforts. This session also aims at encouraging next steps for the Collegium toward continuing to strengthen collaborative work for developing a future path forward for its programs in Latin America. The session will also honor and remember our dear Fellow Raúl Harari (1 August 1948 – 30 May 2022), his life, legacy, and achievements. This session is of importance for the Collegium because it aims at increasing scientific knowledge on environmental and occupational health in Latin America and to transmit this knowledge to decision-makers and the global public to protect public health. Such knowledge is of special interest considering that the economy in the region involves agriculture and mining where poor working conditions are common and lead to dangerous exposures for workers, their families and the society in general.

Methods/Approach

Introduction to the session. Florencia Harari (co-chair)

Collaborations between Italy–Ecuador and Italy–Colombia. Francesco Forastiere and Pietro Comba (presenters)

The Path Forward in Latin America:
- Uncovering Asbestos-Related Health Risks in Sibaté: A Successful International Ongoing Collaboration: Juan Pablo Ramos-Bonilla (presenter)
- Ongoing research efforts in the Amazon Basin: Roberto Lucchini (presenter)
- The Uruguayan perspective: Amalia Laborde (presenter)

Open discussion and closing remarks. Homero Harari (co-chair, moderator)

Results

This session will highlight lessons from programs started in Ecuador together with examples from Colombia, Uruguay and the Amazon Basin, in order to start a discussion of future efforts throughout the Latin American region and guide the Collegium Ramazzini in its next steps in the region.

Conclusions

We will propose a follow-up session at the Sunday morning, 2024 October 27th, Ramazzini Days planning session to build on ideas that evolve from the discussions in this session for next steps.

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Lucia Palandri (1,); Cristiana Rizzi (1); Vittoria Vandelli (1); Tommaso Filippini (1,2); Alessandro Ghinoi (1); Giuliano Carrozzi (3); Gianfranco De Girolamo (3); Isabella Morlini (4); Paola Coratza (3)' Enrico Giovannetti (1); Margherita Russo (1); Mauro Soldati (3); Elena Righi (1)

Affiliations:
1.University of Modena and Reggio Emilia, Modena, Italy
2.University of California Berkeley, Berkeley, CA, USA
3.Local Health Authority of Modena, Modena, Italy
4.Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy

Background

Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse often-contrasting associations with COVID-19 spread or severity. Most studies used large-scale, aggregated data focused more on viral spread than severe outcomes, with limited adjustment for individual factors. Evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analyse their collective impact on an individual level.

Methods/Approach

Our population-based retrospective cohort study aimed to assess the comprehensive role in individual COVID-19-related risk of hospitalization and death played by exposure variables belonging to four different domains: Environmental, climatic, socio-economic, and non-pharmacological interventions (NPI). We analysed data from all patients (n=68472) who tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021.
Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios.

Results

Several significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes.

Conclusions

Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities, taking into account our findings, could result in significant benefit to potentially affected populations.

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Wen-Yi Lee (1); Ching-Chun Lin (2); Pau-Chung Chen (2)
1. National Health Research Institutes, Miaoli, Taiwan
2. National Taiwan University, Taipei, Taiwan

Background

COVID-19 infection and mortality risk varies among occupations. Many studies have focused on the occupational hazards for healthcare workers. However, the risks for occupations other than healthcare workers are still unclear. In Taiwan, a guideline called “New Pandemic-safe Life”, was released after the first outbreak of COVID-19. It is important to know how workers in other occupations conduct relevant hygiene behaviors and how the policy works to affect those behaviors.

Methods/Approach

A cohort for investigation of New Pandemic-safe Life was established with multi-stage cluster sampling controlled by age, gender, and city distribution in Taiwan. The semi-constructed survey was conducted during July 2020 to September 2020, asking people for their behaviors and attitudes about the pandemic. A total of 4,775 participants older than 20 were recruited for the survey. The odds ratios were estimated by logistic regression models adjusted for potential confounders: age, gender, education, city level, smoking status and drinking status.

Results

Among all the occupations, students were at highest risk for failure to perform most of the hygiene behaviors frequently. With the exception of students, there was no difference between healthcare workers and other occupations in the odds of keeping social distancing and avoiding going to crowded public areas.

Conclusions

Hygiene behaviors vary among occupations. Health education on hygiene behaviors for students needs to be improved.

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Muchtaruddin Mansyur (1); Stephan Bose-O'Reilly (2)
1. Universitas Indonesia, Jakarta, Indonesia
2. University Hospital LMU Munich, Munich, Germany.

Background

Children are a vulnerable population group to the effects of lead exposure. Lead exposure can occur directly from the child's daily environment and indirectly due to contact with their lead-exposed working fathers. This study explores factors related to blood lead levels (BLL) in children, the results of which can be used as a basis for prevention and control strategies for lead exposure and its health effects.

Methods/Approach

This study used a cross-sectional design involving 324 children from exposed sites and 240 from control sites, aged 12 to 59 months in five areas of Java Island, Indonesia. 137 fathers were randomly selected based on their children's BLL exceeding 10 micrograms. Children's BLL from fingertips blood were measured using LeadCare II Analyzer. This study used ICP-MS to measure fathers' BLL from venous blood.

Results

The proportion of BLL of ≥3.5 μg/dL showed a similar proportion (>95%) based on gender and socioeconomic level. Besides that, the percentage of children's BLL of ≥3.5 μg/dL in controlled areas showed a proportion of 93.3% which was slightly lower than children's BLL in exposed areas (97.8%).
The BLLs in fathers/guardians (N = 137) displayed a median (Q1 – Q3) of 6.63 (4.71–12.23 g/dL). Intriguingly, among fathers with BLL ≥20 μg/dL, 90% of their children also manifested BLL ≥20 μg/dL. Children whose father's/guardian's BLL was ≥20 μg/dL exhibited a sixfold higher risk of having elevated BLL, compared to children with parents whose BLL was lower than 20 μg/dL (OR=6.0; 1.3–27.3, p < 0.01)

Conclusions

Children with high BLL should promptly receive access to appropriate medical intervention, coupled with vigilant health monitoring, particularly if they exhibit symptoms and are experiencing delays in their growth and developmental milestones. The personal hygiene of working fathers should be improved to minimize the children's lead exposure from their fathers.

Presenting author profile

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

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

Background

This presentation presents a short history, recent achievements and future needs and opportunities on the global nexus on climate change and health.

Methods/Approach

At COP26 in Glasgow in 2021 health topics were only discussed at the Health Pavilion or some off-side events. Last year, COP28 in Dubai hosted the first ever official Health Day at COP negotiations with 140+ health ministers and senior representatives of health ministries signing a Declaration on Climate Change and Health. This milestone achievement was enabled by many activities of the health community (such as The Lancet Countdown, The Lancet Pathfinder; various statements including from editors-in-chief of major journals, and observer organisations, like the Global Climate Health Alliance; and scientific societies). This momentum has been taken forward to the WHO-ATACH committee and the WHO World Health Assembly resolution on Climate Change and Health, and will be implemented through WHO’s GPW14. Most recently, the annual mid-year preparatory Subsidiary Body (SB60) meetings in Bonn, Germany provided an opportunity to further support health topics at the forthcoming COP discussions in Baku, Azerbaijan.

Results

Important opportunities for engagement include the preparation of the IPCC 7th Assessment Report (specifically the inclusion of health topics), and the support of countries in developing the next round of Nationally Determined Contributions (NDC 3.0), with strong pledges on health-related actions, and the development of a consensus on health indicators to be adopted by the COP.

Conclusions

The presentation wants to stimulate discussion and sustained action by the Collegium, such as an active committee on climate change and health, the development of a Collegium Statement and an efficient strategy to bring health to the COP negotiations, embedded in the overall idea that the trusted voices of the health community may support more ambitious COP negotiations and offer better public health as co-benefits of successful climate mitigation.

Presenting author profile

Dr. Alberto Caban-Martinez is a board-certified physician-scientist, Professor (tenured) of Public Health Sciences, Deputy Director of the MD-MPH Program, and Associate Vice-Provost for Research Integrity, Regulatory Affairs, and Assessment at the University of Miami. He serves as the Deputy Director of the Firefighter Cancer Initiative. He has published over 200 peer reviewed publications on a wide range of occupational health and safety topics. He is a Fellow of the Collegium Ramazzini since 2021.

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Alberto J. Caban-Martinez (1); Addison C. Testoff (1); Damena Gallimore-Wilson (1); Ashley Gray (1); Natasha Schaefer Solle (1); and Erin N. Kobetz (1).
1. University of Miami, Miami, Florida, USA

Background

Firefighters are exposed to per- and polyfluoroalkyl substances (PFAS) through aqueous film forming foam and protective turnout gear. PFAS bioaccumulates in nature and resists environmental degradation leading to long-term contamination of fire training sites and adjacent ecosystems. Serum PFAS levels are linked to adverse health effects, including carcinogenicity, immune dysfunction, endocrine disruption, and dyslipidemia. Despite the known health effects, biomonitoring of serum PFAS levels among firefighters is limited. In the present study, we evaluated the feasibility, acceptability and implementation of an at-home PFAS test kit and describe serum PFAS levels in a national sample of firefighter workforce.

Methods/Approach

Health survey, employment, occupational exposure and blood PFAS data were collected as part of an at-home firefighter PFAS feasibility testing study launched in June 2023. A volumetric absorptive microsampler was mailed to each firefighter to measure 45 different PFAS types and concentrations in capillary whole blood. Total blood PFAS levels were calculated and classified using National Academies of Sciences PFAS guidance on PFAS testing and health outcomes. Feasibility, acceptability and implementation metrics were derived from the operational processes of administering the PFAS kits to firefighters and evaluating their perspectives on use.

Results

Among 268 firefighter participants 86.4% were male, 95.5% white, and 90.2% non-Hispanic with a group mean age of 47.44 years. Geometric mean serum levels of key PFAS congeners in µg/L for all firefighters were: total PFOS (5.03), total PFOA (0.76), PFHxS (1.71), PFNA (0.21), PFHpS (0.09), PFUnA (0.04), PFBS (0.03), PFDA (0.02), PFDS (0.006), NMeFOSAA (0.005), PFOSA (0.002), PFDoA (0.001), and PFTrDA (0.0005). The at-home PFAS test protocol met study criteria on feasibility, implementation, and acceptability among study participants.

Conclusions

At-home PFAS testing kits provide an accepted approach to PFAS biomonitoring among fire service personnel. Legacy and emerging PFAS congeners were detected in serum samples in a national sample of firefighters.

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Chia-Jung Tung (1); Dr. Jia-Hwa yang (2); Ching-Chun Lin (1); Chia-Yang Chen (1)); Wu-Shiun Hsieh (3,4); Mei-Huei Chen (2,3); Pau-Chung Chen (1,2 5)

1.. National Taiwan University College of Public Health, Taipei, Taiwan
2. National Health Research Institutes, Miaoli, Taiwan
3. Taiwan University College of Medicine and Hospital, Taipei, Taiwan
4. Cathay General Hospital, Taipei, Taiwan
5. National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

Background

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants with potential adverse health effects. This study investigates the relationships between 11 types of PFAS and children's behavioral performance

Methods/Approach

This study recruited participants from the Taiwan Birth Panel Study II (TBPS II), encompassing a cohort of 448 children aged 6-8 years. Behavioral performance was evaluated using the Conners' Kiddie Continuous Performance Test, 2nd Edition (K-CPT 2). Both linear regression and quantile g-computation (QGC) analyses were employed to assess the results.

Results

The study included 448 children with an average age of 7.0 years; 58.8% had a normal BMI. PFBS (6.538 ng/mL), PFOS (5.493 ng/mL), and PFOA (3.047 ng/mL) had the highest concentrations, while PFDoDA had the lowest. PFBS and PFHxA showed negative scores for boys and positive for girls across five K-CPT 2 indicators. PFBA showed positive scores for boys and negative for girls. PFOA consistently showed positive results for girls. Significant gender differences indicated that PFBS and PFBA affected males more, while PFHxA impacted females.

Conclusions

The study found significant gender differences in the impact of short-chain PFAS on children's neurobehavioral development and attention. Future research can further identify more accurate risk factors and targeted interventions based on gender differences, better protecting children's health and development from the adverse effects of exposure to short-chain PFAS substitutes.

Presenting author profile

Don Smith is a Distinguished Professor of Microbiology and Environmental Toxicology with over 30 years of experience in environmental health research in rodent animal models and human studies, with an emphasis on exposures and neurotoxicology of environmental agents, including the introduction, transport and fate of metals and natural toxins in the environment, exposure pathways to susceptible human populations such as children, the metabolic disposition and elimination of toxicants.

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Don Smith (1); Izzy Thiara (1); Simona Panzacchi (2); Ilaria Menghetti (2); Marco Manservigi (2); Daniele Mandrioli (2)
1. University of California, Santa Cruz, CA, USA
2. Ramazzini Institute, Bologna, Italy

Background

Environmental and occupational glyphosate exposure is associated with a variety of adverse health and neurobehavioral effects in children and adults, though the causal nature of these relationships remains uncertain.

Methods/Approach

We used a rodent model of transgenerational environmental glyphosate exposure via formulations of glyphosate, RoundUp, or RangerPro at doses or 0, 0.5, 5, or 50 mg/kg/d starting on gestational day 6 in F0 pregnant dams and continuing in F1 generation postnatally through pregnancy and postnatally in the F2 generation through 1 year of age until behavioral testing in an open field test of behavioral reactivity, balance beam test of gross motor coordination, grip strength test of fore- and hindlimb neuromuscular tone, and passive avoidance test of short term memory.

Results

Findings show that all three formulations altered behavioral reactivity and open field exploration consistent with increased anxiety in a dose-response fashion, though the RoundUp and/or RangerPro formulations caused greater anxiety-like behaviors than glyphosate alone, and when sex-based differences were present, males were more affected than females. There was evidence that RoundUp and/or RangerPro, but not glyphosate alone altered gross motor coordination and neuromuscular tone, but there were no effects of any formulation on short term memory to avoid an aversive stimulus in the passive avoidance test.

Conclusions

These results demonstrate that trans-generational glyphosate exposure, particularly in the commercially available formulations of RoundUp and RangerPro produces significant neurobehavioral impairments and increased anxiety-like behaviors, substantiating concerns for the adverse health effects of environmental applications of this commonly used herbicide.

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Inga Iamandii (1); Riccardo Mazzoli (1); Lisa De Pasquale (1); Tommaso Filippini (1, 2); 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

Exposure to Fluoride (F), a common natural element, occurs primarily through drinking water. F can have adverse effects on human health, including dental and skeletal fluorosis, altered thyroid function and neurodevelopment. To understand its effects on bone health, particularly bone density and fracture risk, we carried out a systematic review and meta-analysis, using a novel statistical approach to characterize the shape of the relationship between exposure and effects.

Methods/Approach

Three authors reviewed titles, abstracts and full-text files, retrieved via an online literature search of PubMed, Embase and Web of Science databases, for original human studies reporting risk estimates (relative risk, hazard ratio, odds ratio or mean difference) on the relationship between fluoride exposure and bone density or fracture risk. Next, we performed a meta-analysis of the selected studies, using both a restricted maximum likelihood random effects model, which compares the highest versus lowest fluoride exposure categories, and a one-stage dose-response model, which assesses the shape of the association.

Results

We included 28 articles on bone fracture risk and 12 on bone density in the quantitative analyses, from those initially found in the literature search (1052 and 1201, respectively). Most focused on adults in Western countries, and assessed fluoride exposure through its concentrations in drinking water, urine, serum, toenail or dietary intake. Our initial dose-response analyses showed positive associations between fluoride exposure in drinking water and fracture frequency and bone mineral density (BMD), from 1.5 mg/L and <0.5 mg/L, respectively.

Conclusions

Further stratified analyses are currently underway, focusing on gender, bone site and risk of bias influence. Overall, the risk of bone fractures appears to increase with exposure to F in drinking water. Greater attention should therefore be paid to F levels in water regarding potential adverse effects on bone health.

Presenting author profile

Prof. Dr. Med. Stephan Böse-O´Reilly is a professor of environmental and public health at the University Hospital, LMU in Munich, Germany. He is a pediatrician and his main interest is to prevent children from disease by helping to reduce their exposure to toxic substances, such as lead and mercury.

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Stephan Bose-O'Reilly (1)
1. Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Munich, Germany

Background

Artisanal and small-scale gold mining (ASGM) is widespread in low and middle income countries (LMICs).The widespread use of mercury is highly neurotoxic. Over the past two decades, by measuring mercury levels in the urine, blood, hair, and breast milk, we have conducted a comprehensive assessment of the health impacts on miners. Our research has identified significant health needs, the deficiencies in workplace health and safety standards, and the substantial burden of disease associated with these mining practices. What tangible impact had this research on the situation of ASGM miners?

Methods/Approach

After years of pandemic restrictions, ASGM continues with considerable activity. Extracting ore from small tunnels, processing it with rudimentary ball mills and using mercury to create amalgams containing both gold and mercury, involves many young miners, including a significant number of women and children. The amalgams are then heated to release toxic mercury vapors, leaving behind gold that provides minimal financial return per miner. Young and female miners and their children are subjected to unhealthy living conditions in makeshift camps, exposed to constant noise, dust and mercury fumes. The driving force behind these conditions is deepening poverty. It appears that our research has not led to the reduction and replacement of mercury in many ASGM sites.

Results

The combined effects of poverty, exacerbated by the pandemic, the lack of alternative employment opportunities and the urgent need for income have driven individuals to engage in small-scale mining. It’s likely that some decision-makers in more affluent areas of a country have benefited from this crisis. Widespread mercury exposure, combined with arid and unhealthy living conditions, affects children in particular. This scenario is a contemporary manifestation of Dante's Inferno - an existence marked by unrelenting suffering, hopelessness and no apparent escape.

Conclusions

It’s time to rethink strategies to improve environmental and health conditions in ASGM areas.

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Natasha Schaefer Solle (1); Lilli Resto (1); Cynthia Beaver (1); Ashley Gray (1); Erin N. Kobetz (1); and Alberto J. Caban-Martinez (1)

1. University of Miami, Miami, FL, USA

Background

Women in the United States fire service workforce represent a critical and increasing demographic within an historically male-dominated profession. They are routinely exposed to a myriad of hazardous substances, including carcinogens, endocrine disruptors, and other toxic chemicals released during fires and from fire suppression activities. Despite these exposures, little research has been done to evaluate reproductive health risk from exposures encountered during fire and emergency medical response. In the present study, we examine the association of miscarriages and fertility markers (anti-mullerian hormone (AMH)) in a sample of women firefighters.

Methods/Approach

Women firefighters participating in a statewide cohort study, Health Exposure Reproduction (HER) of Florida Women Firefighters, completed a baseline health survey and provided a whole blood sample to examine fertility and hormone markers. A binary logistic regression model with the outcome of yes/no for miscarriage was used in data analysis.

Results

Among 95 women firefighter participants, 32.3% reported miscarriage. Of these, most were 40-49 years old (48.4%), Caucasian (83.9%), non-Hispanic (87.7%), married (64.5%), and college graduate (51.6%). Forty percent were healthy weight and 67.7% had children. Self-reported miscarriage was significantly higher among company officers (36.7% vs 19.4%), women with firefighting tenure 11-20 years (41.9%), and those having given birth (67.7% vs 29.7%) compared to firefighters who did not miscarry. Low serum levels of AMH were observed more commonly in 60.7% of firefighters who miscarried compared to 34.4% those who did not (p-value=0.013).

Conclusions

Our findings highlight the reproductive health challenges faced by women firefighters, particularly those in leadership roles, those with longer firefighting tenures, and those who have given birth. The significant association between low AMH levels and miscarriage underscores the importance of regular reproductive health monitoring and fertility support for women in the fire service. Future research should focus on identifying causal relationships between firefighting exposures and reproductive health outcomes.

Presenting author profile

Dr. Naesinee Chaiear is a Prof of Occupational Medicine of Thailand. She ran the MSc program of Occupational Medicine and Occupational Health and the OM residency training.

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Naesinee Chaiear (1);
1. Srinagarind Hospital Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Background

In Thailand occupational physicians contribute not only clinical practice but also lead the development of occupational safety and health management system (OH&SMS) in healthcare setting.

Methods/Approach

In 2003, the Srinagarind Hospital set up the Safety, Health, and Environment (SHE) Committee and in 2006 established the governing bodies of OH&SMS, including the office of OH&S and other committees. The office comprises a safety officer and an occupational physician as chief. Six years later, two registered nurses were added. The OH&S committee are responsible for OH&S policy preparation, the regular monthly meeting, strategic planning, budgeting plan development, goal achievement, management evaluation and review, and continual improvement. The recently launched patient and personnel safety goals (2P Safety Goals) uses the Srinagarind OH&SMS as a model for the development of the Goals guideline and more details of OH&S added in the Hospital and Healthcare Standard where this standard is enforced at all hospital levels in Thailand.

Results

Thailand hospitals follow the hospital and healthcare standard and 2P Safety Goals, OH&MS and occupational health service activities have gradually been adopted and implemented by many hospital. In fact, Occupational Safety, Health and Environment Act B.E. 2554(A.D.2011) has been integrated to 2P Safety Goals Guide. 1,007 out of 1,471 (68.5%) voluntary hospitals in Thailand participated (2018-2024) and the number of incident reports increased suggesting a building reporting culture; the most reported incidents are effects of unsafe physical structures. Health workers revealed the lower incidents of airborne and droplet exposure from between 2022 to 2024. These finding showed the evidence of increasing awareness of occupational health and safety management for health workers in Thailand.

Conclusions

In Thailand, all hospitals are required to achieve the hospital accreditation (HA) and are required to reaccredit every three years. The 2P Safety Goals implementation are enforced and followed up through the process of reaccreditation.

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Mazin B. Qumsiyeh (1)
1. Bethlehem University, Bethlehem, Palestine.

Background

Many conflicts in Western Asia over the past 75 years left devastation and refugees and the last war on the Gaza Strip is a good example. Our interests as environmentalists are the effects of conflict (including active conflict, pre-conflict activities, and post conflict impact). In this work, I review impacts on the Palestinian environment of activities since 1948 (establishment of the state of Israel) with special attention paid to the Gaza Strip: pre-conflict (such as training sites, military bases, military installation), during conflicts (use of different munitions, pollution, altering habitats), and post-conflicts (unexploded munitions, ground-water pollution, devastated landscape). The data show significant environmental damage that operates short-term and long-term. In addition to the ongoing genocide, there is an ongoing ecocide. While more studies are needed and encouraged, the data does suggest that environmental and human health impacts need to be highlighted in public discourse and remedial actions must be taken in protracted situations such as the colonization of Palestine.

Methods/Approach

Description of conflict on environmental damage and its implication to sustainability is given.

Results

Data shows way forward to sustain human and natural communities.

Conclusions

Formation of networks of concerned people globally is needed to bring peace and environmental justice.

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Alejandra Battocletti (1); Monica Mendez (1); Amalia Laborde (1); Alba Negrín (1)
1. University of The Republic, Montevideo, Uruguay.

Background

Internationally collaborative scientific events may be essential activities in order to put occupational and environmental threats on the public health agenda.

Methods/Approach

The International Scientific Conference, "Environmental Health in Political Agenda" was held in Uruguay 12 years ago and was supported by the Collegium Ramazzini. It was a milestone for developing new programs, creating the environmental pediatric units, and generating interest in environmental research.

Results

Nowadays, a collaborative effort initiative from the pediatric and obstetric sector is developing a 1,000 mother-child pair cohort to investigate their exposure to environmental toxicants, particularly endocrine disruptors including pesticides, household products and plastics.

Conclusions

This project aims to become a good platform for mutual interaction and collaboration between the Collegium Ramazzini and Uruguayan researchers to increase scientific knowledge in environmental and occupational health. Additionally, it will communicate this knowledge to decision-makers and to the global public to protect the most vulnerable populations from the increasing threats from toxic chemicals.

Presenting author profile

Dr. Comba worked at the Italian National Institute of Health between 1980-2019 where he was the Head of the Environmental Epidemiology Unit at the Department of Environment and Health from 1992 until his retirement. His research includes epidemiological studies on exposure to asbestos and toxic wastes. He designed and implemented SENTIERI, an Italian epidemiological survey in National Priority Contaminated Sites. In this frame he developed international cooperation with Latin American countries.

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Pietro Comba (1), Daniela Marsili (1), Corrado Magnani (2)
1. National Health Institute, Rome, Italy.
2. University of Eastern Piedmont, Novara, Italy.

Background

The initial attempts to set up a framework for collaboration between Italy and Latin America in the field of environmental and occupational health concerned asbestos. Italy had been a major producer and user of this substance; estimates of its health impact on workers, family members and residents living in the neighborhood of major asbestos industrial sites were already available before the asbestos ban in 1992. The Italian National Institute of Health (Istituto Superiore di Sanità, ISS) together with the Italian Ministry of Health and the 20 Regional Governments, agreed to implement initiatives for the prevention of asbestos-related diseases, recognizing occupational and environmental asbestos exposures among the priorities of environmental health literacy. International cooperation played a role in these undertakings also sharing technical documents on asbestos risks and impacts through EU projects.

Methods/Approach

International cooperation with Colombia, with Prof. Juan Pablo Ramos Bonilla and his coworkers of Universidad de Los Andes (Uniandes), started with the participation to the Latin-American Chapter during the International Society for Environmental Epidemiology (ISEE) conference on 2011. The organization of the Symposium on preventing asbestos-related diseases in Latin America during the ISEE conference on 2015 (Brazil) strengthened the cooperation.

ISS-Uniandes collaboration was consolidated by implementing the Sibaté Project. Cooperation was later extended with visits of Colombian researchers to Casale Monferrato, University of Eastern Piedmont and University of Torino.

Results

Some key elements that played a major role in the success of the Sibaté project were:
1) several Memorandum of Understanding between ISS and Uniandes;
2) promotion of a twinning of the communities of Sibaté and Casale Monferrato;
3) adoption in Sibaté of the Casale Monferrato approach to environmental cleanup and waste management; and
4) mutual contribution to define priorities for environmental remediation.

Conclusions

Further discussions on how to improve these collaborative efforts within the Collegium, using the presented successful approach as example.

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(1); Abu Hasan Samad
1. Academy of Occupational and Environmental Medicine Malaysia, Kuala Lumpur, Malaysia

Background

There is need for ASEAN countries to keep workplaces healthy, safe and protect workers. This requires proper management of occupational safety and health (OSH) risks by controlling the hazards and preventing work-related injury and illnesses. One effective approach is an effective regulatory framework relevant to the changes and the need of workplaces, which translates into better OSH and overall performances of the organizations and the country.

Methods/Approach

The OSH regulatory framework in Malaysia started with piecemeal legislation and regulations. The Factories and Machinery Act (FMA 1967) applicable to a few industrial sectors and prescriptive approach required significant effort to implement. The Occupational Safety and Health Act (OSHA 1994) with its self-regulatory approach and wider coverage complements FMA 1967. New regulations on workplace safety, hazardous chemicals and competent person introduced and amendments made to address specific issues on noise and hazardous chemicals. However, there were “overlaps” for a few regulations under the two Acts which caused difficulties in the implementation. This led to the introduction of OSH (Amendment) Act (OSHA 2022); FMA 1967 repealed, a few specific regulations introduced, and amendments made to a few others.

Results

ASEAN countries like Malaysia need an effective OSH regulatory framework. The authority needs to periodically review the existing regulations and develop the new ones as the country progresses. Coming up with pertinent and effective regulations, however, takes time and effort, with many challenges and pushbacks by the employers. OSHA 2022 is expected to improve compliance resulting in improved notification and lowered workplace incident of injuries, poisoning and diseases. Certain economic sectors, however, may need assistance in achieving this.

Conclusions

Stakeholders’ engagement is a norm before any amendment, or new regulation is introduced. OSH practitioners, workers, and employers can collectively contribute.. ASEAN countries can learn from each other and the sharing of experience facilitates effective implementation.

Presenting author profile

Oladele (Dele) Ogunseitan holds the title of Distinguished Professor at the University of California, Irvine, where he led the establishment of the Program in Public Health, and served as founding chair of the Department of Population Health and Disease Prevention. He is also appointed to the Department of Environmental and Occupational Health, and Co-Directs the World Institute for Sustainable Development of Materials (WISDOM).

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Oladele A. Ogunseitan (1)
1. University of California, Irvine, Irvine, CA USA

Background

Around midnight on 7 November 2023, one of two blimp hangars located on a former military facility in Tustin, California caught on fire. The facility was established in 1942 by the United States Navy to support lighter-than-air craft. At 323m long, 91m wide, and 54m tall, the hangar was among the world's largest wood constructions. The hangar was constructed to be fire-proof with asbestos components. Since its construction and military decommissioning, a vibrant neighborhood emerged in the immediate vicinity. The hangar fire led to emissions of toxic pollutants including asbestos-laden debris, lead (Pb), and volatile organic substances. Panic ensued in the neighborhoods, and several community-engagement events were held to evaluate the risks of exposure and potential disease outcomes.

Methods/Approach

Qualitative appraisal of community perspectives of risks of toxic exposures were conducted through town hall meetings and compared with quantitative assessment of concentrations of toxic emissions conducted by the U.S. Environmental Protection Agency and data interpretations provided by the California Department of Toxic Substances Control, the City of Tustin, the School District, and the County Health Care Agency.

Results

Despite assurances by the government agencies responsible for emergency response, remediation, and communication, and by an expert panel about the toxic aftermath of the hangar fire, the level of public anxiety remained high, particularly regarding exposure to asbestos fibers. There was notable discrepancy between the data collected by private testing agencies commissioned to sample within domiciles and the ambient measurements provided by the laboratories commissioned by government agencies, which fueled uncertainty and public distrust.

Conclusions

Climate change is fueling wildfires in many parts of California. So is the development of neighborhoods around old buildings that were constructed with toxic materials, including asbestos, and leaded compounds. It is necessary in this and similar cases to develop comprehensive response procedures for exposure prevention and community engagement.

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Poma Erica (1), Bandiera Geminiano (2), Boni William (2), Curzi Ylenia (1), Mastroberardino Michele (2), Pezzuto Giuseppe (2), Pisani Oriana (2), Pistoresi Barbara (1), Silvestri Matteo (1), Casolari Loretta (2)

(1) University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy
(2) University Hospital of Modena, Modena, Italy

Background

Recruitment and retention strategies for healthcare personnel represent a priority for European political agendas, which are examining how to counteract the high turnover rate in healthcare facilities, particularly among emergency professionals. To combat the increase in resignations among healthcare professionals, empirical evidence shows that the level of work capacity and well-being are significant determinants of absenteeism, the intention to leave one's job, or early retirement, and thus factors that can promote the extension of productive working life. Alongside work ability, studies on hospital turnover recognize the central role of organizational conditions, work environment (physical and social environment, structural characteristics), job satisfaction, and emotional exhaustion in influencing turnover and the intention to leave one's job. The family and territorial system that supports a better work-life balance is also particularly crucial, as it is an important determinant of the well-being of workers.

Methods/Approach

This study, through the administration of a questionnaire in two different waves (August-September 2022; May-June 2024), will focus on the well-being, work ability, and working conditions of professionals in the Emergency Departments of the Azienda Ospedaliero-Universitaria di Modena.

Results

Medical, psychological and organizational expertise will be integrated in an interdisciplinary framework to develop a theoretical model, supported by empirical evidence, that can help design multilevel interventions to promote organizational well-being in these areas, which are characterized by significant levels of psychosocial risk (work-related stress, aggression and violence against workers, etc.).

Conclusions

Future steps in this research include further administration of a questionnaire in the emergency departments of the Azienda Ospedaliero-Universitaria di Modena, indicatively in May-June 2025, which will allow us to assess the effects of the variables and policies under consideration over a medium-term time frame.

Presenting author profile

Dr. Mustapha is a leader in environmental epidemiology in Africa and researcher in air pollution, social determinants of health. plastic pollution and climate change.

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Adetoun Mustapha (1); Margaret Spring (2); Christos Symeonides (3); Hervé Raps (4); Sarah Dunlop (5); Philip Landrigan (6)
1. Nigerian Institute of Medical Research, Lagos, Nigeria
2. Monterey Bay Aquarium, Monterey, USA
3. Minderoo Foundation, Perth, Australia
4. Centre Scientifique de Monaco, Monaco, France
5. Minderoo Foundation, Perth, Australia
6. Boston College, Chestnut Hill, USA

Background

Plastic use occurs in every aspect of modern life and results in widespread human exposure to the chemicals contained in plastics. To manufacture plastics, thousands of chemicals are incorporated into carbon-based polymers to convey specific properties. The chemicals include carcinogens, neurotoxicants and endocrine disruptors such as phthalates, bisphenols, poly-fluoroalkyl substances, brominated and organophosphate flame retardants. The Minderoo-Monaco Commission on Plastics and Human Health has produced an extensive review of the plastics impacts on human health and well-being; the global environment, especially the ocean; the economy; and vulnerable populations.

Methods/Approach

This talk is based on Section 6 of the report, which examines the intersection between plastic, social inequity, and environmental injustice. Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally. Vast quantities of plastic waste are exported from high-income to low-income countries, where it accumulates in landfills, pollutes air and water, degrades vital ecosystems, befouls beaches and estuaries, and harms human health—environmental injustice on a global scale. The adverse effects of plastics and plastic pollution on human health, the economy and the environment are not evenly distributed. They disproportionately affect poor, disempowered, and marginalized populations such as workers, racial and ethnic minorities, “fence-line” communities, Indigenous groups, women, and children, all of whom had little to do with creating the current plastics crisis and lack the political influence or the resources to address it. Plastics’ harmful impacts across its life cycle are most keenly felt in the Global South, in small island states, and in disenfranchised areas in the Global North.

Results

Social and environmental justice principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics’ negative impacts and that those who benefit economically from plastic bear their fair share of its currently externalized costs.

Conclusions

Continued discussion of recommendations.

Presenting author profile

Dr Tibaldi is the Head of the Pathology Unit at the Cesare Maltoni Cancer Research Center, Ramazzini Institute. Her work is focused on conducting histopathological evaluation and peer review for all in vivo studies.

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Eva Tibaldi (1)
(1) Ramazzini Institute, Bologna, Italy.

Background

An increased incidence of pleural mesotheliomas in Biancavilla, Italy, was attributed to the environmental exposure to fluoro-edenite (FE). Results from the Ramazzini Institute (RI) in vivo long-term study confirmed the evidence that exposure to FE fibres is correlated with an increase of malignant pleural mesotheliomas in Sprague-Dawley rats. Recently asbestosis-like features were substantiated in tissue of Biancavilla residents without known occupational exposures. The aim of this work was to establish whether FE-induce lung fibrosis with a pathogenetic mechanism like other asbestiform fibres.

Methods/Approach

Original slides from the RI study were systematically re-examined to characterize the FE-induced lesions. Quantitative analysis of lung fibrosis was assessed following the Ashcroft method on sections stained with Masson's Trichrome Goldner kit. The mean scores obtained from Ashcroft analysis were statistically analyzed using Mann-Whitney test. An immunohistochemistry panel was used for the evaluation of lung fibrosis: alpha-smooth muscle actin, collagen type I, vimentin. The presence of iron deposits in lungs was evidenced using the Perls’ staining and ferritin antibody expression.

Results

Like asbestos, FE-caused fibrotic lesions, pleural plaques or nodules and mesotheliomas. From the quantitative analysis carried out with the Ashcroft method, a significant increase of lung fibrosis (p<0.001) was observed in the FE-treated groups compared to untreated controls. Following immuno-histochemical analysis it was observed that, in the fibrotic responses to FE, vimentin was the most expressed protein, followed by collagen-I and alpha-SMA. Finally, ferruginous bodies, characterized by iron deposits and ferritin expression, were observed in FE-induced lesions.

Conclusions

This study confirmed that FE exposure promotes the onset of fibrotic lesions at pleural level, as fibrous plaques or nodules and fibrosis, through a mechanism like other form of asbestos. These results combined with epidemiological study reported in Biancavilla residents, corroborate the need to promote health and epidemiological surveillance plans of respiratory diseases in population living in FE-contaminated sites.

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Daria Sgargi (1)
(1) Ramazzini Institute, Bologna, Italy.

Background

The SPRINT project, financed by the European Union’s Horizon 2020 Program , is being carried out by a consortium of 28 partners with interdisciplinary experience. The project aims at developing and testing an Integrated Global Health Approach to assess the risk associated with Plant Protection Products (PPPs) on ecosystems, plants, animals and human health, and at identifying transition paths towards a use of these substances that is sustainable in an economic, social and environmental way.

Methods/Approach

The Project adopts a comprehensive approach based on 4 actions:
• Case studies to assess the actual exposure scenario to PPPs and the main components of mixtures
• Laboratory tests to assess the effects of these exposure
• Development of a Global Health Risk Assessment Toolbox for the investigation of health effects and impacts
• Development of transition paths towards more sustainable farming.

Results

Several peer-reviewed articles are being published, both on methods and on the results of the sampling campaign. Our research has found that pesticides are recurrent across the case study sites, in all farming systems, although organic samples were less contaminated than those from conventionally farmed fields. Of the 625 environmental samples, 86% contained at least 1 pesticide residue above its detection limit. Indoor dust was the type of sample which contained the highest number of pesticide residues and concentrations. Most residues detected in soil, water, crops, and air are hazardous to non-target organisms, including humans.

Conclusions

The health impacts of pesticide mixtures are not well understood, remarking the relevance of this study. Baseline data on pesticides and their mixtures distribution and hazards should guide decision-making and risk reduction strategies. A monitoring hazard-based prioritization tool could improve decisions on pesticides approval in the EU and support the EU in meeting its targets, while also helping develop tailored transition plans and protecting humans and the environment.

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Margherita Schiavi(1,2); Stefania Costi(1,2); Irene Barbieri (2); Luca Ghirotto (2); Stefania Fugazzaro (23); Barbara Bressi (2), Sara Paltrinieri (2,3); Stefano Luminari (1,2); Angela Contri (1)
1. University of Modena and Reggio, Modena, Italy
2. Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
3. University of Milan, Milan, Italy

Background

Advances in cancer detection and treatment have extended cancer survivor (CSs) life expectancy, but their evolving health needs remain unmet. This study analyzes 14 patient-reported outcome measures (PROMs) for CSs with non-cutaneous cancers, using the International Classification of Functioning, Disability and Health (ICF) framework.

Methods/Approach

Each PROM was examined for correspondence to ICF health and functioning dimensions. Two independent reviewers extracted meaningful concepts from each PROM item, linking them to ICF categories. Discrepancies were resolved through discussion with a third expert reviewer.

Results

PROMs varied in ICF component correspondence, with "Activities and Participation" and "Environmental Factors" most frequently represented, highlighting their significance. "Body Structures" received minimal attention, suggesting its limited relevance to CSs' needs.

Conclusions

This evaluation of PROMs enhances understanding and addresses the diverse needs of CSs, crucial for improving their quality of life. The study underscores the importance of addressing "Activities and Participation" and "Environmental Factors" in PROMs for CSs. These insights support developing comprehensive PROMs and help healthcare providers prioritize critical areas of survivorship care, ultimately enhancing CSs' well-being.

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Elia Lettucci (1); Matteo Montanari (1); Tommaso Filippini (1); Marco Vinceti (1)
1. University of Modena and Reggio Emilia, Modena, Italy

Background

Asbestos and related diseases are a major public health concern. Historically used for construction, asbestos is classified as a Group 1 carcinogen by the IARC. Asbestos-cement (AC) pipes remain widely used for tap-water distribution. In the Emilia-Romagna region, Northern Italy, it is estimated that 5,120,750 meters of AC pipes still in use, accounting on average for 26.84% of the total, with some municipalities having up to 48.45% of their pipes made of AC. In particular, measurements conducted in the city of Carpi in 2015 revealed concentrations exceeding 20,000 fibers per liter (f/L), with a maximum of 105,780 f/L. Some studies have suggested a link between asbestos ingestion and cancer, including airborne asbestiform fibers when contaminated water is used in humidifiers and showers. This study aims to explore the association between asbestos levels in tap-water and asbestos-related diseases in Emilia-Romagna region.

Methods/Approach

We will integrate the map of AC pipes in Emilia-Romagna with the analysis of fiber types and concentrations, and of water properties, including hardness, pH, and seasonal temperature variations. We will integrate data from the regional mesothelioma and cancer registry to assess risk of cancer using a dose-response approach to assess the safe level of asbestos fibers in potable water, considering the reference standards of US-EPA (7 million fibers per liter, MF/L) and WHO (0.1 MF/L).

Results

We will evaluate any potential link between increasing asbestos concentrations in contaminated water over time and gastrointestinal, urothelial, renal and mesothelioma cancers. We also plan to pool our results with those from similar international studies that showed weak but positive associations.

Conclusions

From a public health perspective, the identification of any association between asbestos levels in tap water and cancer will urge the enforcing of mitigating interventions, including replacement of AC pipes and implementation of water treatments to prevent further deterioration of the pipes.

Presenting author profile

Dr. Bucher received a PhD in Pharmacology and is currently a Retired Senior
Scientist, National Toxicology Program and National Institute of Environmental
Health Sciences, US National Institutes of Health.
Daniele Mandrioli, MD, PhD is the Director of the Cesare Maltoni Cancer Research
Center of the Ramazzini Institute, Bologna, Italy. He conducts research on environmental
toxicants and carcinogens and evidence-based methods in toxicology and epidemiology.

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John Bucher (1), Daniele Mandrioli (2)
1. National Institute of Environmental Health Sciences, Research Triangle Park, NC USA
2. Ramazzini Institute, Bologna, Italy.

Background

In 2021 the Ramazzini Institute celebrated 50 years of activities of the Cesare Maltoni Cancer Research Center (CMCRC) located in the Castle of Bentivoglio. The CMCRC is the largest and longest-existing programs of experimental carcinogenesis bioassays in Europe. In 50 years, long-term carcinogenicity studies on more than 200 agents present in the occupational and general environment have been conducted at the CMCRC. In light of the increasing understanding of the role of chemical
exposures in different non-communicable diseases, the CMCRC bioassays designs recently evolved in order to include a number of outcomes other than cancer, such as reproductive/developmental toxicity or neurotoxicity. Furthermore, the CMCRC activities expanded over the years and now include epidemiological studies, mechanistic studies and systematic reviews.

Methods/Approach

The session is co-chaired by Dr. John Bucher from the National Institute of Environmental Health Sciences. and Dr. Daniele Mandrioli from the Cesare Maltoni Cancer Research Center, Ramazzini Institute.
The session will include a number of presentations on studies performed by the CMCRC in collaboration with other national and international partners, including the US National Institute of Environmental
Health Sciences and the Italian National Institute of Health. The presenters of the session will be:
Daniele Mandrioli, Simona Panzacchi and Eva Tibaldi from the from the Cesare Maltoni Cancer Research Center, Ramazzini Institute and Georgia Roberts from the National Institute of Environmental Health Sciences.

Results

The collaborative studies of the CMCRC and its partners consistently provided independent and solid evidence over the years to regulators, decision makers, public health authorities and consumers.

Conclusions

The CMCRC scientific activities evolved and expanded over the last 50 years, but the values are still the ones of its founder Prof. Cesare Maltoni: independence, scientific rigor and focus on exposures of public health concern. These values intertwine the past, the present and the future of the CMCRC with the Collegium Ramazzini.

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Camilla Soncini (1); Tommaso Filippini (1,2); Marco Vinceti (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

Dementia is defined as a group of disorders characterized by the development of multiple cognitive deficits. When the condition affects individuals under the age of 65, it is referred to as early-onset dementia. The average incidence of the condition between the ages of 30 and 64 is about 120/100,000, with an incidence that increases with age. The etiological causes of the condition are varied and while the study of risk factors for late-onset dementia has yielded important results, there are still many gaps regarding early-onset dementia.

Methods/Approach

The aim of this study is to investigate environmental pollutants, such as benzene and PM10 (Particulate Matter with diameter <10 µm), as possible risk factors for early-onset dementia. We conducted a case-control study in a population from the province of Modena consisting of 335 cases matched by sex and age to 5-6 controls each. Each subject was geolocated, and exposure data to PM10 and benzene were collected for their coordinates using the California Line Source Dispersion Model version 4, a mathematical model used to estimate the dispersion of atmospheric pollutants emitted by linear sources. The information was then integrated using a Geographic Information System that allows for the analysis and visualization of spatial and geographic data.

Results

We analyzed the data using multivariate conditional and unconditional logistic regression, adjusting for confounding factors (sex and age), and proceeding with nonlinear analyses based on restricted cubic splines. Overall, the results show that exposure to high levels of benzene and PM10 is correlated with an increased risk of early-onset dementia and exposure to extremely low levels seems to be correlated with a slight increase in disease risk.

Conclusions

We conclude that it is essential to further research the effects of atmospheric pollutants on cognitive health, particularly in young adults.

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KL. Cleven (1); R. Zeig-Owens (1); AK. Mueller (1); B. Vaeth (1); CB. Hall (3); J. Choi (1); DG. Goldfarb (1); DE. Schecter (1); MD. Weiden (2,3); A Nolan (2,3); S Salzman (2); N Jaber (2); HW. Cohen (1); DJ. Prezant (1,2)
1 Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA.
2 Fire Department of the City of New York, Brooklyn, NY, USA.
3 New York University Grossman School of Medicine, New York, NY, USA

Background

World Trade Center (WTC) exposure is associated with obstructive airway diseases and sarcoidosis. There is limited research regarding the incidence and progression of non-sarcoidosis interstitial lung diseases (ILD) after WTC-exposure. ILD encompasses parenchymal diseases which may lead to progressive pulmonary fibrosis (PPF). We used the Fire Department of the City of New York’s (FDNY’s) WTC Health Program cohort to estimate ILD incidence and progression.

Methods/Approach

This longitudinal study included 14,525 responders without ILD prior to 9/11/2001. ILD incidence and prevalence were estimated and standardized to the US 2014 population. Poisson regression modeling of risk factors associated with ILD included WTC-exposure and forced vital capacity (FVC). Follow-up time ended at the earliest of end of study period, transplant, or death.

Results

Non-sarcoid ILD developed in 80/14,525 FDNY WTC responders. Age, smoking, and gastroesophageal reflux disease (GERD) prior to diagnosis were associated with incident ILD, though FVC was not. PPF developed in 40/80 ILD cases. Including sarcoidosis cases increased ILD cases by 5 and PPF cases by 3 persons. Among the 80 cases, the average follow-up time after ILD diagnosis was 8.5 years, with the majority of deaths occurring among those with PPF (PPF: N=13; ILD without PPF: N=6).

Conclusions

The prevalence of post-9/11 ILD was more than two-fold greater than in the general population, despite excluding sarcoid-related ILD from our primary analyses. An exposure-response gradient could not be demonstrated. Half the ILD cases developed PPF, higher than previously reported. Age, smoking, and GERD were risk factors for ILD and PPF, while lung function was not. This may indicate that lung function measured after respirable exposures would not identify those at risk for ILD or PPF.

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Tushar K Joshi (1)
1. Occupational & Environmental Health Consultant and Advisor, New Delhi, India

Background

Household air pollution (HAP) caused by solid fuels (such as wood, animal dung, crop residues, charcoal and coal) for cooking and heating is a significant cause of respiratory morbidity and mortality, especially in women.

Methods/Approach

Interventions and Initiatives
Ever since the magnitude of the problem was realized, attempts has focused on primary prevention by substituting the biomass fuel with cleaner fuels and introducing improved cooking stoves. The Government of India promoted liquefied petroleum gas (LPG) use since 2015 with a positive effect on women’s welfare due to: (a) reduced fuel collection/preparation time, (b) reduced cooking time and (c) convenient cooking arrangement. These benefits of LPG adoption have received little attention in the literature.

The Ministry of Petroleum and Natural Gas (MOPNG) launched the 'Pradhan Mantri Ujjwala Yojana' (PMUY) as a flagship scheme on 1st May 2016. The objective was to make clean cooking fuel such as LPG available to the rural and deprived households, in order to move them away from traditional cooking fuels such as firewood, coal, cow dung, etc. The target under the scheme was to provide 80 million LPG connections to the deprived households by March 2020. The scheme was extended further and by 1st March 2024 there were 102.7 million PMUY beneficiaries.

Results

The Government of India is addressing the public health concerns of women's and children's health by providing clean cooking fuel, i.e., LPG to poor and rural households. This initiative has saved 7.2 million tons of fuel wood with decreased pressure on forests and a small gain for climate change. There have been many benefits to women for switching to using LPG such as women’s time-saving for fuel collection/preparation and cooking and a convenient cooking experience.

Conclusions

A robust outcome assessment, along with barriers and challenges would help improve such schemes elsewhere.

Presenting author profile

Dr. Rima R. Habib is a professor of environmental and occupational health at the Faculty of Health Science at the American University of Beirut.

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Rima R. Habib (1); Iman Nuwayhid (1); Lina Fakih (1); Fida Awada (1); Lea Saad (1)
(1) American University of Beirut, Beirut, Lebanon

Background

Syrian agricultural workers, displaced to Lebanon following the Syrian conflict in 2011, live under precarious conditions in informal settlements, face hazardous exposures in agricultural work, and suffer from legal and social discrimination. The GEOHealth-MENA research project, funded by NIH, aims to link pesticide exposure, heat stress, and social stressors with wellbeing, mental health, and neurobehavioral performance among 300 Syrian refugee workers (150 agricultural and 150 non-agricultural for comparison). The challenges faced in recruiting workers into the pilot study undertaken in summer 2023 are discussed.

Methods/Approach

Forty-one Syrian refugee workers [21 agricultural; and 20 non-agricultural] were recruited. A stakeholder’s coalition was formed to secure the approval of employers and recruit consented workers. Following IRB approval, recruitment in the pilot study took several months.
We faced multiple challenges in recruiting Syrian refugee workers. Employers in non-agricultural workplaces questioned the research relevance and the focus on Syrian workers, while excluding national workers. Employers in agricultural workplaces, where almost all workers are Syrian, were concerned about documenting exposures, which may encourage workers to demand improvements of working conditions. Female workers were reluctant to participate without the permission of their male next of kin (husband/father/brother). They were accompanied by a male figure during data collection. As agricultural work in greenhouses is gendered, with almost only males applying pesticides and only females harvesting crops early or late during the day, recruitment of male and female workers required multiple visits to greenhouses at odd times, as early as 5:00AM or late at 6:00PM.

Results

Occupational health research of agricultural workers in humanitarian settings is complex and has to account for multiple work- and non-work-related hazards and stressors.

Conclusions

The pilot study provided valuable tips. Support from a wider circle of stakeholders and a well-planned study protocol were adopted to ensure high response rates in the larger study in summer 2024.

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.

Format

Research Data Abstract Form

All authors and affiliations

Iman Nuwayhid (1); Rima R. Habib (1); Lina Fakih (1); Lea Saad (1); Fida Awada (1)
(1) American University of Beirut, Beirut, Lebanon

Background

Syrian refugee agricultural workers are the labor backbone of agriculture in Lebanon. They are exposed to multiple work hazards in settings where occupational health and safety measures and pesticide control regulations are almost non-existent. This project aims to assess the exposure of this vulnerable population to pesticides in greenhouses in the Beqaa region of Lebanon.

Methods/Approach

A pilot study, conducted in summer 2023, recruited 21 Syrian agricultural workers (11 males/10 females) from greenhouse farms where tomatoes and cucumbers are planted. Following IRB clearance, consent was secured from each participant. One or two pesticide mixers/sprayers were recruited at the time of pesticide spraying. Within 12-48 hours, two workers harvesting the crops from the same greenhouses were recruited. The names and active ingredients of the applied pesticides were listed. Multiple methods were adopted to measure the workers’ pesticide exposure during the 1–3-hour work shift: 1) field observation to document work practices; 2) wearing a FreshAir wristband to collect ambient air exposures; 3) collecting pre- and post-shift urine samples to measure pesticide urinary metabolites. An end-of-shift questionnaire was also introduced.

Results

Observations showed that mixing several types of pesticide is a common practice: using a ‘cocktail’ of pesticides for preventive purposes every 10-14 days. The frequency of spraying with targeted curative pesticides is increased when harmful insects are spotted. Personal protective equipment are hardly used. Agricultural work is gendered with men mixing/spraying pesticides and women harvesting the crops. Laboratory results for FreshAir wristbands and urinary metabolites to assess pesticide types and concentrations are underway.

Conclusions

Exposure of workers to pesticides in low-resourced settings is influenced by irregular and dynamic practices that are often economically driven. Field observations revealed high exposure to pesticides among workers Next step is to correlate field observations with measured environmental exposures (air, urine).