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Modernet, a network for development of new techniques for measuring trends in occupational and work-related diseases and tracing new and
emerging risks
COST Action IS1002 ModernetAnnet Lenderink
19 March 2012, ICOH congress 2012
Overview of this presentation
• Introduce myself• Introduce Modernet en COST Action IS1002• OSH vigilance and signal management• Current activities
Annet Lenderink
• Occupational physician 1984-1996
• Freelance journalist/webmaster 1996-2005
• Coordinator Knowledge Dissemination Netherlands Center for Occupational Diseases (NCOD) 2005-2009
• Physician-researcher NCOD since July 2009
• Research projects on occupational diseases
Netherlands
Tulips and wind mills and orange coloured sports
What is Modernet?
• Network of institutes and people dedicated to research in Occupational Diseases
• Started small, but with great ambitions for international collaboration
• Funded by EU for meetings to exchange knowledge and expertise
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Background (1)• High morbidity and mortality by Occupational
Diseases (ODs)• High economic costs• Changing working conditions may cause new ODs
– Nanotechnology– Introduction of new substances– Global economy
• EU Community Strategy on health and safety 2007-2012: Ongoing reduction of occupational diseases is a prime objective
Background (2)
• Present systems for monitoring and recognition of new OH risks are inadequate
• Need for:– reliable and comparable systems for monitoring
ODs – Better methods for identifying and assessing new
risks in a changing work environment– international collaboration (intelligence network)
Modernet goals
• Improvement of quality of data on ODs• New and smarter techniques for early
detection of trends of occupational diseases• Early detection of new OH risks • Rapid exchange of research knowledge with
the use of (new) internet techniques such as social media
• Enhance the opportunities for appropriate preventive action
Modernet, brief history (1)• Mutual meetings between institutes on OD
registries in Manchester and Amsterdam between 2004 and 2006
• Invitational conferences (Amsterdam, 2007 and 2008), mainly on tracing new OH risks with participants from NL, F, UK, I, Fi, Cz
• Meetings of Modernet consortium in Paris (2009) and Milan (2010) , 1 day on methodology, 1 day on new OH risks with participants from same countries
COST Modernet, brief history• Funding granted from EU in summer 2010• Start of COST Action IS1002 Modernet,
November 2010 • More countries participating up till 15 now• International congress “Tracing New
Occupational Diseases” in Amsterdam, April 2011
• Meetings In Amsterdam and Manchester in 2011• Next COST Action meeting in Leuven, Belgium,
June 2012
Participants of Modernet
UK
Netherlands
France
Italy
Ireland
Finland
Germany
Czech Republic
Croatia
Albania
Norway
Iceland
Belgium
Spain
Portugal**
FYROM
Australia
Working groups
• WG1 Quality of data: improvement of quality of data collection in occupational diseases (WG-leader: Prof. Stefano Mattioli)
• WG2 Trends Analysis: New techniques for analysis of trends in occupational diseases (WG-leaders: Dr. Roseanne McNamee and Prof. Raymond Agius)
• WG3 Tracing new risks: New techniques for tracing newly occurring occupational diseases (WG-leader: Dr. Vincent Bonneterre)
• WG4 Dissemination: dissemination and implementation of new knowledge on occupational diseases (WG-leaders: Dr. Claudio Colosio)
• Tracing new occupational diseases• Work groups on new and emerging respiratory, skin,
musculoskeletal, psychosocial, neurological and reproductive problems
• Key note speakers on methodology and policy• Participation through either oral presentation or poster• Also half term meeting ICOH SCOM• 100+ participants
Diagnosis of ODs
Occupational Disease (OD)The 5-step roadmap
1. Diagnose the disease or disorder2. Is there evidence for a relation between
disease and the occupation, work situation or work exposure?
3. Determine/measure the exposure to risk/work factors
4. Determine/measure the exposure to other factors
5. Weigh the information, decide and report to the patient/worker, the employer and to the registry of NCvB (Netherlands Center for Occupational Diseases)
Louis Pasteur:“Chance favours
only the prepared mind…”
But what about new occupational diseases?
New risks or diseases• From symptoms and signs no
disease can be diagnosed• No certainty on possible causal
factors• Hardly any research reported• No plausible biological model to
explain the relation between exposure and disease
Emerging OSH risks “New”• Previously unknown and caused by new
processes, new technologies, new types of workplace, or social or organizational change;
• Long-standing issue, newly considered as a risk due to a change in social or public perceptions (e.g. stress, bullying);
• New scientific knowledge allows a long-standing issue to be identified as a risk
Johan Cruijff:"You will only see
it, if you understand it"
20
Anticipation on new OH risks (1)Europe / worldwide: main focus is on
risk assessment, by means of– Risk analyses– Follow-up of risk groups– REACH initiative: Registration, Evaluation,
Authorization and Restriction of Chemical substances
– Expert Forecasts of Risk Observatory Bilbao
21
Anticipation on new OH risks (2)• Complementary to risk assessment is the
“Disease first” approach• Use of disease as a starting point for analysis• Disease tracking by for example by
– Trend analyses (useful with high prevalence, low occupational Attributive Risk)
– Spontaneous reporting (useful with low prevalence, high occupational Attributive Risk)
Detect new health risks in work
• Learn from the detection of adverse drug reactions
• Pharmacovigilance OHS vigilance
OSH vigilance goals:• Aims to detect, assess and prevent adverse effects of
work or any other possible work-related problems• Detect unexpected, unknown adverse effects of work• Detect increases in frequency of adverse work effects• Detect risk factors (i.e. risk groups, co-morbidity) and
mechanisms • Quantitative evaluation of adverse work effects• Interpretation of data and disseminating knowledge
It’s all about signal management• Signal generation and detection• Signal strengthening• Signal validation• From signal to action
A signal is……a hypothesis about a possible relation between exposure and a health problem, supported by data and arguments, that needs to be tested
Signal generation and detection• Spontaneous reports of disease-exposure links
by OPs, GPs or medical specialists• Spontaneous reports by workers• Periodic literature screening• Data mining in databases• Linking databases• Active detection of effects on health• Secondary analysis of patient data in other
databases
‘Your case might be the first one!’
Bottum line: an urgent need for vigilant physicians
Signal strengthening (1)
Preliminary evaluation of the relevance of the signal:
• Early warning• Social perspective• Interesting signal from a scientific or
educational perspective
Signal strengthening (2)Using 5-step roadmap1. Determine the health damage 2. Determine the relationship with work3. Determine the exposure4. Are other explanations possible? 5. Finally, a conclusion must be reached
and an associated report issued
Signal validation (1)
through (epidemiological) research:• The strength of the signal: for instance
doubling of the risk of developing disease when exposed to the risk (RR>2)
• Consistency of the data: different studies point in the same direction
• Specificity: the specific risk concerned is associated with a clearly defined disease
• Sequence: first exposure, then disease development
Signal validation (2)• Biologic gradient, or dose-effect relation:
higher exposure leads to greater risk of disease
• Biologic plausibility: does the clinical picture match up with what is known about how the disease develops?
• Analogy: evidence of corresponding experiences with related material
• Nature and quality of the data: objective observations, precise documentation
From signal to action
• Communication with parties directly involved
• Communication with external parties • Initiation of further research • When and where necessary: amending
guidelines, protocols, legislation and regulations
Research by COST Modernet participants (1)
Improvement of data on occupational diseases, examples – By use of more sources (triangulation):
• GP surveillance (Hussey et al, 2008)• Specialist physicians surveillance (McNamee et al, 2008; Pal et
al, 2009)– Improvement of physician participation (Spreeuwers et al, 2008,
Lenderink et al, 2009) – Review on the validity of self-report to assess work-related diseases
(Lenderink et al, 2011)– Audit tool for the quality of registries of occupational diseases
(Spreeuwers et al, 2009)– Joined proposal for Cochrane review on how to reduce
underreporting of occupational diseases
Research by COST Modernet participants (2)
Analysis of trends, examples of techniques:•MLM (Multi Level Model) - THOR, McNamee et al.•ZINB (zero inflation negative binomial model) - RNV3P, Paris et Ngatchou•ACMMT (Adjusted Count Models for Measuring Trends - RNV3P•ILRMMT (Internal logistic regression for measuring trends - RNV3P, Paris et al.; Bensefa et al.
Analysis of trends, examples of research into impact of prevention•Directives etc. regarding Chromium VI (Stocks et al -UK)•Reduction of exposure to latex allergen in gloves (Turner et al -UK)•Use of glutaraldehyde (In preparation: Stocks et al –UK)•CTE- Chronic toxic encephalopathy in the Netherlands (van der Laan)
Research by COST Modernet participants (3)
New methods to trace newly occurring occupational diseases•Preparation for clinical watch system (sentinel approach)•Discussion on examples of new associations of exposure and disease discussed within the network (congress “Tracing new Occupational diseases” book of abstracts on www.costmodernet.org)•Concerning Data Mining Methods
– The UK group has been working on QSARS and asthma– Comparison of pharmacovigilance methods : article to be
published in SH@W in early 2012– French and UK groups start working on the use of GIS
(Geographical Information Systems): mobility project (IEF) and a PhD thesis 2012-2015 (Grenoble / Paris, France).
Current activities within COST Modernet
• Dissemination:
• Website
• Facebook• LinkedIn
