During the EPICOH conference in Wellington, New Zealand, we organized a Modernet session in collaboration with SCOM on the second day of the Congress. The session was very well attended. After a short introduction on Modernet, our activities and how to become member, we started the meeting with a presentation by Prof Gérard Lasfargues (ANSES) on the data on acknowledgment and costs of work-related mental diseases in France.
Work-related mental diseases in France
Data from NHIF indicate that the number of requests for acknowledgment of WRMD has increased significantly from 2012 to 2017 (200 to 1500). About 50% are recognized and compensated as occupational diseases. Interestingly, mental disorders related to psychosocial risk factors may also be compensated as work injuries in France. In 2016, NHIF compensated over 10,000 mental disorders as work injuries, mostly caused by external events or inadequate working conditions.
Rnv3p data are globally consistent with NHIF concerning compensated occupational mental diseases, highlighting the increase of WRMD in some sectors such as public administration, health and social action, retail business and education. Over 18,000 WRMD (33% men, 67% women; mean age = 46.0 ± 8.9) were recorded in the database between 2010 and 2016, and 1833 cases of burnout situations currently not acknowledged as occupational diseases by the NHIF. Rnv3p data also illustrate the importance of under-reporting of WRMD as occupational diseases.
Occupational diseases and socioeconomic position
After Gerard, Henk van der Molen presented his work on Occupational diseases among workers in different socioeconomic positions (SEP). Occupational diseases occur at a 2.7 higher incidence rate for workers in lower SEP compared with higher SEP. Incapacity for work due to work-related musculoskeletal disorders is higher for workers in lower SEP compared with higher SEP, suggesting fewer opportunities to modify work tasks and working circumstances for lower SEP. Psychosocial risk factors constitute the greatest problem for workers in higher SEP, resulting in distress/burnout, accompanied by temporary incapacity for work.
Hospital Occupational Diseases Units
A Hospital Occupational Diseases Unit (ODU): an experience to increase the recognition of occupational disease was presented by Mercè Soler. Hospital physicians referred possible cases of work-related disease to the ODU, where in-depth medical evaluations were then performed, and a detailed report addressing causation was generated. Between 2010 and 2017, 149 cases were referred to the ODU for evaluation. Of these, 80 (53.7%) were confirmed to have an occupational disease, 54 (67.5%) patients pursued official recognition, and to date 26 (48.1%) were accepted by the Social Security System. The predictive positive value varied by diagnosis group (p=0.003), and was highest for skin diseases (71.4%) and cancer (66.7%), and lowest for hearing loss (29.4%) and musculoskeletal disorders (16.7%). A hospital ODU seem to improve reporting and official recognition of occupational diseases, that otherwise might not have been recognized.
Bridge the gap between clinical cases and epidemiological evidence
Finally, I had the honor to close the session explaining to the present epidemiologist and physicians the importance and how to bridge the gap between clinical cases and epidemiological evidence. Hence, one of the main current gaps in the prevention of work-related diseases (WRDs) is the inefficient link between the assessment of chemical hazards introduced at the workplace, clinical alert, epidemiological studies and policy actions. Alert systems aim to bridge this gap, by collecting information on diseases and exposures in order to raise alert to different stakeholders and trigger timely prevention.
In a recent project supported by EU-OSHA, we have performed a review of the international alert systems, with the aim of identifying good practices and learning more about prerequisites, drivers, and obstacles to implement such approaches. This knowledge has been applied into the Belgian context, where alert systems on three levels have been implemented.
1) Exposure assessment of hazardous chemicals has been introduced through the PROBE system, in which 47 occupational physicians participated. During the periodic health examinations of workers, the physicians filled in a web survey regarding occupational exposure of a random sample of workers to 22 selected hazardous chemicals during the last working week. Results of the first study showed that 47% of workers were exposed to at least one chemical product from the list, with diesel exhaust being the most frequently reported substance (n=91; 14% of workers).
2) A clinical alert system has been established through an online platform called SIGNAAL, where physicians can report suspected cases of new WRDs (new exposure-disease combinations). Each reported case is followed by an investigation of exposure and work-relatedness performed by experts. So far, 22 cases have been reported to the platform.
3) Alert to public health authorities is mainly established through collaboration with the Federal Agency for Occupational Risks (FEDRIS). FEDRIS provides support in the maintenance of these systems and in turn, data derived from the systems is used as an input for FEDRIS regarding the potential preventive strategies.
After this the session was closed, and a lot of talks followed after on Modernet and the next meeting in Berlin. It was great to meet Modernet friends and also a big number of investigators and clinicians during the conference and session.
Lode Godderis, May 2 2019
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