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 Modernet Annet 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 Freelance journalist/webmaster Coordinator Knowledge Dissemination Netherlands Center for Occupational Diseases (NCOD) 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 Like us on Facebook!

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 : 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 disorder 2.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 Foreca sts 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 roadmap 1. Determine the health damage 2. Determine the relationship with work 3. Determine the exposure 4. 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 Concerning Data Mining Methods – The UK group has been working on QSARS and asthma – Comparison of pharmacovigilance methods : article to be published in in early 2012 – French and UK groups start working on the use of GIS (Geographical Information Systems): mobility project (IEF) and a PhD thesis (Grenoble / Paris, France).

Current activities within COST Modernet Dissemination: Website Facebook LinkedIn

Thank you Gracias Time for questions