July 2023 additions to NERDB

July 2023 additions to NERDB

NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Airtable.

More information on this database is on the NERDB page

We will publish regular updates on new disease-exposure combinations we added to the database on the website. Currently, we have 384 entries. Ordered by the year in which the abstract is published

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New entries:

Picture by Christoffer Borg Mattisson via Pixabay

Enbom, T., Suominen, K., Laitinen, S. et al. Cryptosporidium parvum: an emerging occupational zoonosis in Finland. Acta Vet Scand 65, 25 (2023). https://doi.org/10.1186/s13028-023-00684-z


Cryptosporidiosis has increased in recent years in Finland. We aimed to identify risk factors for human cryptosporidiosis and to determine the significance of Cryptosporidium parvum as a causative agent. Based on notifications to the Finnish Infectious Disease Register (FIDR), we conducted a case-control study and genotyped Cryptosporidium species from patient samples from July to December 2019. We also retrieved the occupational cryptosporidiosis cases from 2011 to 2019 from the Finnish Register of Occupational Diseases (FROD).


Of 272 patient samples analyzed, 76% were C. parvum and 3% C. hominis. In the multivariable logistic regression analysis of 82 C. parvum cases and 218 controls, cryptosporidiosis was associated with cattle contact (OR 81, 95% confidence interval (CI) 26–251), having a family member with gastroenteritis (OR 34, 95% CI 6.2–186), and spending time at one’s own vacation home (OR 15, 95% CI 4.2–54). Of the cases, 65% had regular cattle contact. The most common gp60 subtypes identified were IIaA15G2R1 and IIaA13G2R1. In FROD, 68 recognized occupational cryptosporidiosis cases were registered in 2011–2019.


C. parvum is the most common Cryptosporidium species found in humans in Finland and poses a moderate to high risk of occupational infection for people working with cattle. The number of occupational notifications of cryptosporidiosis increased between 2011 and 2019. Cryptosporidiosis should be recognized as an important occupational disease among persons working with livestock in Finland, criteria to identify occupational cryptosporidiosis need to be created, and occupational safety in cattle-related work should be improved.

Aiken, P., Rumbach, A., & Madill, C. (2022). Listening to Video Game Voices: A Call for Action for Research into the Vocal Health of Video Game Voice ActorsJournal of Voice.

Video game voice actors (VGVAs) are a professional voice user (PVU) population whose occupation relies on their ability to reliably deliver extremes in vocal performance. In their work VGVAs are required to perform solo for extended durations, producing highly complex character performances that not only include extremes of vocal parameters and qualities but also highly demanding vocal acts (ie, screaming, singing) within those voice archetypes.

Based on the vocal demands of their work and current understanding of occupational voice disorder, it is reasonable to consider that VGVAs may be at increased risk of vocal fatigue, injury, and disorder, as manifestations of occupational disease. This risk is of primary concern to VGVAs who recently organized industrial action to highlight their concerns regarding vocal health within their industry. As a group that is not well represented within voice research, there is little literature currently available to inform clinical support of the population.

Due to the unique nature of VGVA work and the highly specific nature of occupational voice use among PVUs, we cannot necessarily generalize research from other populations to VGVAs. As such, research utilizing frameworks designed to capture the complexity of voice use, demands on the voice, and experiences of its use are required to support the concerns of the population.

This paper introduces VGVAs as an emerging PVU population, describes the concerns of this population within the context of current understandings of vocal fatigue, occupational voice problems and PVU populations, and details the approaches required in the development of research into the population.

Feng, Q., Wei, J., Wang, Y., Wu, J., Kong, H., Guo, S., … & Yang, J. (2023). Focusing on testosterone levels in male: A half-longitudinal study of polycyclic aromatic hydrocarbon exposure and diastolic blood pressure in coke oven workers. Environmental Pollution329, 121614.

Polycyclic aromatic hydrocarbons (PAHs) can interfere with testosterone levels, and low levels of testosterone are associated with increased cardiovascular events. To explore the role of testosterone in PAHs exposure and cardiovascular health, we used data from the 2011–2016 National Health and Nutrition Examination Survey (NHANES) and a longitudinal database of 332 male coke oven workers from China.

The urine PAHs, tobacco metabolites and plasma testosterone levels of coke oven workers were measured. There were inverse associations between serum (plasma) testosterone concentrations and the risk of dysarteriotony and dyslipidemia among the NHANES participants and coke oven workers.

The results of the cross-lagged panel analysis among workers showed that the decrease in testosterone preceded the increase in diastolic blood pressure (DBP), and the absolute value of the path coefficient from baseline testosterone to follow-up DBP (β2 = −8.162, P = 0.077) was significantly larger than the absolute value of the path coefficient from baseline DBP to follow-up testosterone (β1 = −0.001, P = 0.781).

Results from the half-longitudinal mediation analysis showed that baseline hydroxyfluorene predicted significant decreases in plasma testosterone from baseline to follow-up (path a: 0.71, 95% CI: 1.26, −0.16), whereas plasma testosterone at baseline also predicted significant increments in DBP from baseline to follow-up (path b: 9.22, 95% CI: 17.24, −1.19). The indirect effect of PAHs on DBP via plasma testosterone level was marginally significant (test for indirect effects a*b (P = 0.08)).

In conclusion, testosterone level is a longitudinal precursor to increased DBP and plays an essential role in the association between PAHs exposure and damage to the cardiovascular system. Coke oven workers with low plasma testosterone levels are more likely to experience adverse changes in blood pressure and lipid levels after exposure to PAHs.

Iain T Parsons and others, Cardiovascular risk in high-hazard occupations: the role of occupational cardiologyEuropean Journal of Preventive Cardiology, Volume 29, Issue 4, March 2022, Pages 702–713, https://doi.org/10.1093/eurjpc/zwab202

Work is beneficial for health, but many individuals develop cardiovascular disease (CVD) during their working lives. Occupational cardiology is an emerging field that combines traditional cardiology sub-specialisms with prevention and risk management unique to specific employment characteristics and conditions.

In some occupational settings, incapacitation through CVD has the potential to be catastrophic due to the nature of work and/or the working environment. These are often termed ‘hazardous’ or ‘high-hazard’ occupations.

Consequently, many organizations that employ individuals in high-hazard roles undertake pre-employment medicals and periodic medical examinations to screen for CVD. The identification of CVD that exceeds predefined employer (or regulatory body) risk thresholds can result in occupational restriction, or disqualification, which may be temporary or permanent.

This article will review the evidence related to occupational cardiology for several high-hazard occupations related to aviation and space, diving, high altitude, emergency workers, commercial transportation, and the military. The article will focus on environmental risk, screening, surveillance, and risk management for the prevention of events precipitated by CVD.

Occupational cardiology is a challenging field that requires a broad understanding of general cardiology, environmental, and occupational medicine principles. There is a current lack of consensus and contemporary evidence which requires further research.

The provision of evidence-based, but individualized, risk stratification and treatment plans is required from specialists that understand the complex interaction between work and the cardiovascular system. There is a current lack of consensus and contemporary evidence in occupational cardiology and further research is required



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