Occupational and Environmental Medicine

IntroductionOccupations vary with respect to workplace factors that influence exposure to COVID-19, such as ventilation, social contacts and protective equipment. Variations between women and men may arise because they have different occupational roles or behavioural responses. We estimate occupational differences in COVID-19 hospital admission and mortality risks by sex. MethodsWe combined individual-level data from 2011 Census with (i) health records and (ii) household-level information from residential identifiers. We used data for a cohort of 1.7 million Scottish adults aged 40-64 years between 1 March 2020 and 31 January 2021. We estimated age-standardised COVID-19 hospital admission and mortality rates, stratified by sex and occupation. Using Cox proportional hazards models, we estimated COVID-19 hospital admission and death risks, adjusting for relevant factors. ResultsGenerally, women had lower age-standardised COVID-19 hospital admission and mortality rates compared to men. Among women, adjusted death risks were lower for health professionals, and those in associate professional and technical occupations (paramedics and medical technicians). Among men, elevated adjusted admission and death risks were observed for large vehicle and taxi drivers. Additionally, admission risks remained high among men working in caring personal services, including home and care workers, while elevated risks were observed among women working in customer service occupations (call centre operators) and as process, plant and machine operatives (assemblers/sorters). ConclusionOccupational differences in COVID-19 hospital admission and mortality risks between women and men highlight the need to account for sex differences when developing interventions to reduce infections among vulnerable occupational groups.

ObjectivesMost earlier studies on occupational risk of Covid-19 covering the entire workforce are based on relatively rare outcomes such as hospital admission and mortality. This study examines the incidence of SARS-CoV-2 infection by occupational group based upon real-time polymerase chain reaction tests (RT-PCR). MethodsThe cohort includes 2.4 million Danish employees, 20-69 years of age. All data were retrieved from public registries. The sex-specific incidence rate ratios (IRR) of first-occurring positive RT-PCR test from week 8 of 2020 through week 50 of 2021 were computed by Poisson regression for each 4-digit DISCO-08 job code with more than 100 employees (337 in men; 297 in women). Occupational groups with low risk of workplace infection according to a job exposure matrix constituted the reference group. Risk estimates were adjusted by demographic, social and health characteristics including household size, completed Covid-19 vaccination, pandemic wave and occupation-specific frequency of testing. ResultsIRRs of SARS-CoV-2 infection were elevated in 34 occupations comprising 12 % of male employees and 45 occupations comprising 41 % of female employees. All IRR estimates were below 2.0. Decreased IRRs were observed in 85 occupations in men but none in women. DiscussionWe observed a modestly increased risk of SARS-CoV-2 infection among employees in numerous occupations indicating a large potential for preventive actions, especially in the female workforce. Cautious interpretation of observed risk in specific occupations is needed because of methodological issues inherent in analyses of RT-PCR-test results and because of multiple statistical tests. WHAT IS ALREADY KNOW ABOUT THIS TOPIC?O_LIEpidemiological studies suggest that the workplace contribute to the Covid-19 pandemic C_LIO_LIResults are mostly based upon studies of less frequent outcomes as Covid-19 morbidity or mortality which limits inference about risk in specific occupations C_LI WHAT THIS STUDY ADDSO_LIThe risk of Covid-19 infection was increased in 34 of 337 occupations in men and in 45 of 297 occupations in women C_LIO_LISome 12% of the Danish male workforce and 41% of the female workforce are at increased risk of Covid-19 infection C_LI HOW THIS RESEARCH MIGHT AFFECT RESEARCH, PRACTICE OR POLICY?O_LIPreventive actions targeting the workplace may contribute substantially to alleviate disease occurrence in the ongoing Covid-19 and similar future pandemics. C_LI

IntroductionThe PROTECT National Core Study was funded by the UK Health and Safety Executive (HSE) to investigate routes of transmission for SARS-CoV-2 and variation between settings. MethodsA workshop was organised in Oct 2022.We brought together evidence from five published epidemiological studies that compared risks of SARS-CoV-2 infection or COVID-19 mortality by occupation or sector funded by PROTECT relating to three non-overlapping data sets, plus additional unpublished analyses relating to the Omicron period. We extracted descriptive study level data and model results. We investigated risk across four pandemic waves using forest plots for key occupational groups by time-period. ResultsResults were largely consistent across different studies with different expected biases. Healthcare and social care sectors saw elevated risks of SARS-CoV-2 infection and COVID-19 mortality early in the pandemic, but thereafter this declined and varied by specific occupational subgroup. The education sector saw sustained elevated risks of infection after the initial lockdown period with little evidence of elevated mortality. ConclusionsIncreased in risk of infection and mortality were consistently observed for occupations in high risk sectors particularly during the early stage of the pandemic. The education sector showed a different pattern compared to the other high risk sectors, as relative risk of infections remained high in the later phased of the pandemic, although no increased in COVID-19 mortality (compared to low-risk occupations) was observed in this sector in any point during the pandemic.

BackgroundOccupational short-latency respiratory disease (SLRD; predominantly asthma, rhinitis, hypersensitivity pneumonitis, and occupational infections) prevalence is difficult to determine but certain occupations may be associated with increased susceptibility. AimsThis study aimed to examine which occupations and industries are currently at high risk for SLRD and determine their respective suspected causal agents based on cases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) scheme in the UK. MethodsSLRD cases reported to the SWORD scheme between 1999 and 2019 were analysed to determine directly standardised rate ratios (SRR) by occupation against the average rate for all other occupations combined. ResultsBakers and flour confectioners showed significantly raised SRR for occupational rhinitis (234.4 [95% CI, 200.5 - 274.0]) and asthma (59.9 [95% CI, 51.6 - 69.5]). Chemical and related process operatives also presented raised SRR values for these two conditions, with SRR of 29.5 [95% CI, 24.3 - 35.7] and 21.0 [95% CI, 16.9 - 26.1] for rhinitis and asthma, respectively. SRR were also significantly raised for vehicle spray painters when considering occupational asthma (63.5 [95% CI, 51.5 - 78.3]) alone, and laboratory technicians were also amongst the top three increased SRR for rhinitis (18.7 [95% CI, 15.1 - 23.1]). The suspected agents most frequently associated with these occupations and conditions were flour, isocyanates, and laboratory animals and insects. Metal machining setters and setter-operators showed increased SRR for occupational hypersensitivity pneumonitis (42.0 [95% CI, 29.3 - 60.3]), largely due to cutting/soluble oils. The occupation mostly affected by infectious disease was welding trades (12.9 [95% CI, 5.7 - 29.3]) and the suspected causal agent predominantly reported for this condition was pathogens and microorganisms, with a predominance of Mycobacterium tuberculosis. ConclusionsThis study identified the occupational groups at increased risk of developing a SLRD based on data recorded over a recent two-decade period in the UK. Asthma and rhinitis were identified as the prevailing conditions and hypersensitivity pneumonitis as a potentially rising respiratory problem in the metalworking industry.

ObjectivesIdentify workplace risk factors for SARS-Cov-2 infection, using data collected by a United Kingdom electricity-generating company. MethodsUsing a test-negative design case-control study we estimated the odds ratios (OR) of infection by job category, site, test reason, sex, vaccination status, vulnerability, site outage, and site COVID-19 weekly risk rating, adjusting for age, test date and test type. ResultsFrom an original 80,077 COVID-19 tests, there were 70,646 included in the final analysis. Most exclusions were due to being visitor tests (5,030) or tests after an individual first tested positive (2,968). Women were less likely to test positive than men (OR=0.71; 95% confidence interval=0.58-0.86). Test reason was strongly associated with positivity and although not a cause of infection itself, due to differing test regimes by area it was a strong confounder for other variables. Compared to routine tests, tests due to symptoms were highest risk (94.99; 78.29-115.24), followed by close contact (16.73; 13.80-20.29) and broader-defined work contact 2.66 (1.99-3.56). After adjustment, we found little difference in risk by job category, but some differences by site with three sites showing substantially lower risks, and one site showing higher risks in the final model. ConclusionsIn general, infection risk was not associated with job category. Vulnerable individuals were at slightly lower risk, tests during outages were higher risk, vaccination showed no evidence of an effect on testing positive, and site COVID-19 risk rating did not show an ordered trend in positivity rates. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIIn the United Kingdom, there is now a considerable body of evidence showing occupational differences in Covid-19 infection and severity, but with understandable focus on high-risk industries like healthcare. C_LIO_LILess is known about differences in risk of COVID-19 infection in other industries that do not involve directly working with the general public, in particular, there is relatively little evidence on the risks of transmission in the electricity-generating industry. C_LI What this study addsO_LIAt this company, infection risk was not associated with job category after adjusting for test reason; however women were less likely to test positive than men and the risk was higher when there was a power outage, requiring more staff to visit the site in person. C_LI How this study might affect research, practice or policyO_LIThe site risk rating showed a consistent (but modest) dose-response with infection risk, indicating that such risk rating may be useful for identifying "high risk" sites. C_LIO_LIThis analysis demonstrates the importance of adjusting for both date of and reason for test, when prevalence and testing protocols differ over time. C_LI

BackgroundWork-related stress (WRS) accounts for 52% of self-reported work-related ill-health. In 2004, the Health and Safety Executive (HSE) developed the Management Standards (MS), aimed at helping organisations reduce WRS. This work investigates WRS post implementation, with reference to six MS risk factor domains: control, support, relationships, demand, change, and role. MethodCases of WRS were extracted from The Health and Occupation Research (THOR) database and mapped to the six domains. Trends in WRS incidence rates attributed to each of the domains were split at 2004 and compared with the overall WRS trend using mixed generalised regression models. ResultsBefore 2004, annual incidence in WRS increased by 1.4%(-0.5%,3.1%), whereas after 2004, there was a decrease of -0.9%(-1.5%,-0.2%), based on 10,815 WRS cases reported between 1996 and 2019. Three of the six MS domains (demands, relationships, and change) were reported in [~]82% of cases. Pre-2004, four of the six domains were observed to be increasing per year. Post 2004, cases increasingly contained multiple precipitating events e.g. demands + another (+2.6% per year) and relationships + another (6.1%). Reports of the two most common domains decreased post 2004 (demands -0.46%, relationships -0.55% per year), whereas incidence in less common domains increased (change 1.1%, support 2.4%, control 4.8%, role 4.7%). ConclusionTrends in WRS, and their common risk factors appear to be decreasing gradually, since introduction of MS in 2004. However, less common risk factors are becoming more prominent, contributing to reporting of WRS with multiple risk factors.

ObjectivesThe United States Environmental Protection Agency has determined that formaldehyde presents an "unreasonable risk of injury to human health." Occupational inhalation exposure is associated with short- and long-term damage to the respiratory, female reproductive, and nervous systems, and is also carcinogenic. The European Union (EU) has recently introduced formaldehyde workplace exposure limits (WELs) that are lower (long-term: 0.3ppm; short-term: 0.6ppm) than those currently applied in the United Kingdom (UK) (long-term: 2ppm; short-term: 2ppm). UK regulation additionally requires exposure to carcinogens to be reduced to as low as is reasonably practicable. We evaluated formaldehyde airborne concentrations in National Health Service (NHS) cell pathology departments to assess the adequacy of exposure controls. MethodsUsing the Freedom of Information Act (2000), we requested 12 months (2024-2025) of formaldehyde airborne monitoring data collected by cell pathology departments across n=122 NHS Trusts in England (n=102), Scotland (n=10), Wales (n=6), and Northern Ireland (n=4). Results were evaluated empirically and using EN 689:2018 statistical methods to assess exposure variability, estimate upper-bound concentrations, and determine the likelihood of adequate exposure control when benchmarked against EU WELs. ResultsA total of 1,715,516 formaldehyde airborne monitoring results were disclosed by n=117 cell pathology departments. Monitoring was infrequent, with 73% of sites measuring formaldehyde airborne concentrations once weekly or less. EU long-term WELs were exceeded regularly at 70% of sites (95th percentile >0.3 ppm), and EU short-term WELs were exceeded regularly at 43% of sites (95th percentile >0.6 ppm). The 95th percentile upper tolerance limit (UTL95,70) exceeded the EU short-term WEL at 68% of sites. Only 11% and 17% of departments demonstrated frequent (once daily or more) formaldehyde airborne monitoring with 95th percentiles below the EU long- and short-term WELs, respectively. ConclusionsFormaldehyde exposure is infrequently monitored and inadequately controlled in NHS cell pathology departments. What is already knownA substantial body of occupational exposure data shows that formaldehyde inhalation is associated with myriad short- and long-term deleterious health effects on the respiratory, female reproductive, and nervous systems. It is also a human carcinogen. Pathology departments are amongst the riskiest occupational environments for formaldehyde inhalation exposure and therefore require a high standard of governance and infrastructure to adequately protect staff. What this study addsWe show that formaldehyde airborne concentrations in most NHS cell pathology departments are monitored infrequently and regularly exceed EU WELs. Our data raises concern for the health of thousands of NHS employees working in these environments. How this study might affect research, practice, or policyUrgent national regulatory intervention is now warranted to improve the occupational hygiene of NHS cell pathology departments. This will require a combination of upgraded infrastructure, more regular personal exposure monitoring, better employee education on basic lab practice and occupational health risks, improved access to appropriate personal protective equipment, management accountability for occupational health, and external oversight by the Health and Safety Executive.

BackgroundAccidental blood exposures (AEB) are a major occupational hazard for healthcare workers (HCWs), with risk of bloodborne pathogen transmission. While organisational factors are known to influence safety, the specific causal pathways linking management quality to AEB risk remain poorly characterised. ObjectivesTo investigate the causal pathways linking organisational factors, particularly supervisor support, to AEB risk among HCWs through stress and fatigue mediators using Directed Acyclic Graph (DAG) analysis. MethodsSecondary analysis of the STRIPPS cohort study including 32 wards across four Paris university hospitals (n=730 HCWs). A DAG was constructed based on a literature review and previously published multivariate analyses to model causal relationships between organisational factors, psychological mediators, and AEB outcomes. ResultsAEB incidence was 4.1 per 100 visits overall, highest in intensive care units (7.1/100). DAG analysis showed that low supervisor support increased AEB risk through both direct and indirect pathways. Literature evidence indicated a protective effect of supervisor support on both stress and fatigue, while these psychological factors are strongly associated with increased AEB risk. Additional organisational factors including irregular work schedules, rotating shifts, and use of external personnel contributed to elevated AEB risk. Individual factors such as work overcommitment and presenteeism further amplified stress and fatigue pathways. The analysis explored multiple converging pathways from organisational and individual factors through psychological mediators to AEB risk. ConclusionsLow supervisor support drives AEB risk through multiple interconnected pathways affecting stress and fatigue. Interventions targeting organisational support and psychological wellbeing could substantially reduce occupational injury risk among HCWs. HighlightsO_LIWhat is already known about this subject? O_LIAccidental blood exposures (AEB) are a major occupational hazard for healthcare workers (HCWs), with significant risks of bloodborne pathogen transmission and psychological distress. C_LIO_LIOrganisational factors, including leadership and safety culture, are known to influence workplace safety, but their specific causal pathways to AEB remain poorly understood. C_LIO_LIStress and fatigue are recognised as mediators between work conditions and safety outcomes, but their roles in AEB have not been systematically modelled using causal methods. C_LI C_LIO_LIWhat are the new findings? O_LIUsing a Directed Acyclic Graph (DAG) approach, we identified that low supervisor support increases AEB risk through both direct and indirect pathways mediated by stress and fatigue. C_LIO_LIFatigue showed a stronger association with AEB (OR 2.94-4.25) than stress (OR 1.12-1.53), highlighting its critical role in occupational safety. C_LIO_LISickness presenteeism and work overcommitment were identified as key individual-level amplifiers of stress and fatigue, further increasing AEB risk. C_LIO_LIIrregular work schedules and use of interim staff were organisational factors with substantial effects on AEB risk (RR > 3.0). C_LI C_LIO_LIHow might this impact on policy or clinical practice in the foreseeable future? O_LIHealthcare organisations should prioritise supervisor training to improve supportiveness, which could reduce both psychological strain and AEB incidents. C_LIO_LIFatigue risk management systems and scheduling optimisations should be implemented to mitigate the strong effects of irregular shifts and long hours. C_LIO_LIPolicies discouraging presenteeism and promoting mental health support could break the cycle of fatigue and injury among HCWs. C_LI C_LI

BackgroundThe COVID-19 pandemic has disproportionately affected workers in certain industries and occupations, and the workplace can be a high risk setting for SARS-CoV-2 transmission. In this study, we measured SARS-CoV-2 antibody prevalence and identified work-related risk factors in a population primarily working at industrial livestock operations. MethodsWe used a multiplex salivary SARS-CoV-2 IgG antibody assay to determine infection-induced antibody prevalence among 236 adult ([≥]18 years) North Carolina residents between February 2021 and August 2022. We used the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System (NIOCCS) to classify employed participants industry and compared infection-induced IgG prevalence by participant industry and with the North Carolina general population. We also combined antibody results with reported SARS-CoV-2 molecular test positivity and vaccination history to identify evidence of prior infection. We used logistic regression to estimate odds ratios of prior infection by potential work-related risk factors, adjusting for industry and date. ResultsMost participants (55%) were infection-induced IgG positive, including 71% of animal slaughtering and processing industry workers, which is 1.5 to 4.3 times higher compared to the North Carolina general population, as well as higher than molecularly-confirmed cases and the only other serology study we identified of animal slaughtering and processing workers. Considering questionnaire results in addition to antibodies, the proportion of participants with evidence of prior infection increased slightly, to 61%, including 75% of animal slaughtering and processing workers. Participants with more than 1000 compared to 10 or fewer coworkers at their jobsite had higher odds of prior infection (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] 1.0 to 21.0). ConclusionsThis study contributes evidence of the severe and disproportionate impacts of COVID-19 on animal processing and essential workers and workers in large congregate settings. We also demonstrate the utility of combining non-invasive biomarker and questionnaire data for the study of workplace exposures. Conflict of InterestThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Whats important about this paperHigh numbers of COVID-19 outbreaks, cases, and deaths have been reported among livestock industry workers, including Black and Hispanic workers, in the United States. Little is known about SARS-CoV-2 infection as measured by antibody prevalence in this setting. Antibody-based estimates of SARS-CoV-2 infection can capture cases missed by SARS-CoV-2 molecular testing, which is important given limitations in worker access to molecular diagnostic testing. We observed high SARS-CoV-2 infection-induced IgG prevalence in animal slaughtering and processing industry workers (71%) between February 2021 and August 2022, which is 1.5 to 4.3 times higher compared to the North Carolina general population, as well as higher than molecularly-confirmed cases and the only serology study we identified of animal slaughtering and processing workers. We also found higher odds of SARS-CoV-2 infection among participants at worksites with larger compared to smaller numbers of employees.

BackgroundIncreasing demands of COVID-19 on the healthcare system necessitated redeployment of HCWs outside their routine specialties. Previous studies, highlighting ethnic and occupational inequalities in redeployment, are limited by small cohorts with limited ethnic diversity. AimsTo assess how ethnicity, migration status, and occupation are associated with HCWs redeployment experiences during COVID-19 in a nationwide ethnically diverse sample. MethodsWe conducted a cross-sectional analysis using data from the nationwide United Kingdom Research Study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) cohort study. We used logistic regression to examine associations of ethnicity, migration status, and occupation with redeployment experiences of HCWs, including provision of training and supervision, patient contact during redeployment and interaction with COVID-19 patients. ResultsOf the 10,889 HCWs included, 20.4% reported being redeployed during the first UK national lockdown in March 2020. Those in nursing roles (Odds Ratio (OR) 1.22, 95% Confidence Interval (CI) 1.04 - 1.42, p=0.009) (compared to medical roles) had higher likelihood of being redeployed as did migrants compared to those born in the UK (OR 1.26, 95% CI 1.06 - 1.49, p=0.01) (in a subcohort of HCWs on the agenda for change (AfC) pay scales). Asian HCWs were less likely to report receiving training (OR 0.66, 95% CI 0.50 - 0.88, p=0.005) and Black HCWs (OR 2.02, 95% CI 1.14 - 3.57, p=0.02) were more likely to report receiving supervision, compared to White colleagues. Finally, redeployed Black (OR 1.33, 95% CI 1.07 - 1.66, p=0.009) and Asian HCWs (OR 1.30, 95% CI 1.14 - 1.48, p<0.001) were more likely to report face-to-face interaction with COVID-19 patients than White HCWs. ConclusionsOur findings highlight disparities in HCWs redeployment experiences by ethnicity, migration, and job role which are potentially related to structural inequities in healthcare. For future emergencies, redeployment should be contingent upon risk assessments, accompanied by training and supervision tailored to individual HCWs experience and skillset. O_TEXTBOXWhat is already known on this topic: Ethnic minority healthcare workers (HCWs) were at an elevated risk of infection during COVID-19 due to occupational and socio-demographic factors. The strain on healthcare systems during the pandemic resulted in acute staffing shortages, prompting redeployment of HCWs to areas outside their professional training. However, recent research suggests inconsistent implementation of redeployment across ethnic groups, revealing structural disparities within the healthcare system. What this study adds: Our study, the largest of its kind, found no ethnic differences in the process of redeployment itself, but disparities emerged in the experiences of redeployment. Asian HCWs reported less likelihood of receiving training, while Black HCWs reported more likelihood of receiving supervision compared to their White counterparts. Ethnic minority HCWs were also more likely to report interaction with COVID-19 patients than their White colleagues. While there were no ethnic differences in the process of redeployment, occupational and migration differences reveal that those in nursing and midwifery roles (in comparison to medical roles), as well as migrant HCWs on the AfC payscale (in comparison to those born in the UK), were more likely to report being redeployed. How this study might affect research, practice or policy: This UK-wide study highlights inconsistencies in the redeployment process, training, supervision, and patient interactions based on occupation, ethnicity and migration status. Further investigation, incorporating qualitative and human resources data, is crucial to understand the complexities and address potential structural discrimination within the NHS. For future practice, redeployment should align with risk assessments and include training and supervision tailored to HCWs experience and skillset. C_TEXTBOX Teaser textThis study explores how ethnicity, migration status, and occupation were associated with healthcare workers (HCWs) redeployment experiences during COVID-19. After adjustment of covariates, we found that nursing roles and migration to the UK increase redeployment likelihood. Asian HCWs reported lesser training and Black HCWs reported more supervision, compared to White colleagues. Redeployed Black and Asian HCWs were more likely to report interaction with COVID-19 patients. Findings highlight disparities in HCWs redeployment experiences in an ethnically diverse sample.

ObjectivesTo assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection. DesignWe analysed data from the UK Office of National Statistics COVID-19 Infection Survey linked to vaccination data from the National Immunisation Management System in England from December 1st 2020 to 11th May 2022. We analysed vaccination uptake and SARS-CoV-2 infection risk by occupational group and assessed whether adjustment for vaccination reduced the variation in risk between occupational groups. Setting ResultsEstimated rates of triple-vaccination were high across all occupational groups (80% or above), but were lowest for food processing (80%), personal care (82%), hospitality (83%), manual occupations (84%), and retail (85%). High rates were observed for individuals working in health (95% for office-based, 92% for those in patient-facing roles) and education (91%) and office-based workers not included in other categories (90%). The impact of adjusting for vaccination when estimating relative risks of infection was generally modest (ratio of hazard ratios reduced from 1.38 to 1.32), but was consistent with the hypothesis that low vaccination rates contribute to elevated risk in some groups. Conversely, estimated relative risk for some occupational groups, such as people working in education, remained high despite high vaccine coverage. ConclusionsVariation in vaccination coverage might account for a modest proportion of occupational differences in infection risk. Vaccination rates were uniformly very high in this cohort, which may suggest that the participants are not representative of the general population. Accordingly, these results should be considered tentative pending the accumulation of additional evidence.

ImportanceNurses work-related stress and sickness absence are high. The consequences of sickness absence are severe for health systems efficiency and productivity. ObjectiveTo measure the association between nurse staffing configurations and sickness absence in hospital ward nursing teams. DesignRetrospective case-control study using hospital routinely collected data SettingFour general acute care hospitals in England Participants3,583,586 shifts worked or missed due to sickness absence by 18,674 registered nurses (RN) and nursing assistant (NA) staff working in 116 hospital units. ExposureNursing team skill-mix; temporary staffing hours; understaffing; proportion of long shifts (12+ hours) worked; full-time/part-time work status in the previous 7 days. Main outcomeEpisodes of sickness absence, defined as a sequence of sickness days with no intervening days of work. ResultsThere were 43,097 sickness episodes. In our reduced parsimonious model, being exposed to a skill mix that was richer in RNs was associated with lower RN sickness absence (OR= 0.98; 95% CI = 0.96-0.99). For each 10% increase in proportion of hours worked as long shifts worked in the previous 7 days odds of sickness were increased by 2% (OR = 1.02; 95% CI = 1.02- 1.03) for RNs. Part-time work for RNs was associated with higher sickness absence (OR = 1.09; 95% CI = 1.04 - 1. 15). When RN staffing over the previous week was below average, the odds of sickness absence for NAs increased by 2% for every 10% increase in understaffing across the period (OR = 1.02; 95% CI = 1.01 - 1.03). For RNs there was a significant interaction between part-time work and RN understaffing, whereby short staffing in the previous week increased sickness absence for full time staff but not among those working part time. NA understaffing was not associated with sickness absence for any staffing group. Conclusions and RelevanceWorking long shifts and working on understaffed wards increases the risk of sickness absence in nursing teams. Adverse working conditions for nurses, already known to pose a risk to patient safety, may also create risks for nurses and the possibility of further exacerbating staff shortages. Key pointsO_ST_ABSQuestionC_ST_ABSWhat is the association between variation in nurse staffing configurations and nurses sickness absence? FindingsRegistered Nurse (RN) understaffing in the preceding 7 days was associated with sickness absence for Nursing Support (NS) staff, but for RNs the association was only seen when working full time. Exposure to shifts with a skill-mix richer in RNs, to higher bank hours and working lower proportions of 12+ h shifts in the preceding 7 days was a protective factor of RN sickness absence. MeaningTo support nurses health and health systems productivity and efficiency, investing in avoiding RN understaffing may be warranted.

BackgroundWorkers differ in their risk of SARS-CoV-2 infection according to their occupation, but the direct contribution of occupation to this relationship is unclear. This study aimed to investigate how infection risk differed across occupational groups in England and Wales up to April 2022, after adjustment for potential confounding and stratification by pandemic phase. MethodsData from 15,190 employed/self-employed participants in the Virus Watch prospective cohort study were used to generate risk ratios for virologically- or serologically-confirmed SARS-CoV-2 infection using robust Poisson regression, adjusting for socio-demographic and health-related factors and non-work public activities. We calculated attributable fractions (AF) amongst the exposed for belonging to each occupational group based on adjusted risk ratios (aRR). FindingsIncreased risk was seen in nurses (aRR=1.44, 1.25-1.65; AF=30%, 20-39%), doctors (aRR=1.33, 1.08-1.65; AF=25%, 7-39%), carers (1.45, 1.19-1.76; AF=31%, 16-43%), primary school teachers (aRR=1.67, 1.42-1.96; AF=40%, 30-49%), secondary school teachers (aRR=1.48, 1.26-1.72; AF=32%, 21-42%), and teaching support occupations (aRR=1.42, 1.23-1.64; AF=29%, 18-39%) compared to office-based professional occupations. Differential risk was apparent in the earlier phases (Feb 2020 - May 2021) and attenuated later (June - October 2021) for most groups, although teachers and teaching support workers demonstrated persistently elevated risk across waves. InterpretationOccupational differentials in SARS-CoV-2 infection risk vary over time and are robust to adjustment for socio-demographic, health-related, and non-workplace activity-related potential confounders. Direct investigation into workplace factors underlying elevated risk and how these change over time is needed to inform occupational health interventions.

ObjectiveTo use a model of occupational stress to quantify and explain the impact of working in critical care during the Covid-19 pandemic on critical care nurses and organisational outcomes. ParticipantsCritical care nurses (CCNs) who worked in the UK NHS between January to November 2021 (n=461). MethodsA self-reported survey measured the components of the Job-Demand Reward model of occupational stress. Job-demands, job-resources, health impairment (mental health (GHQ-12), burnout (MBI), PTSD symptoms (PCL-5)), work engagement and six organisational outcomes (commitment, job satisfaction, changing jobs, certainty about the future, quality of care, patient safety) were measured. Data were compared to baseline data (n=557) collected between April to October 2018. Regression analyses identified predictors of health impairment, work engagement and organisational outcomes. FindingsCompared to 2018, CCNs were at elevated risk of probable psychological distress (GHQ-12, OR 6.03 [95% C.I. 4.75 to 7.95]; burnout emotional exhaustion, OR 4.02 [3.07 to 5.26]; burnout depersonalisation, OR 3.18 [1.99 to 5.07]; burnout accomplishment, OR 1.53 [1.18 to 1.97]). A third of CCNs reported probable PTSD. Job demands predicted psychological distress and job demands increased during the pandemic. Resources reduced the negative impact of job demands on psychological distress, but this moderating effect of resources was not observed at higher levels of demand. CCNs were less engaged in their work. Job and personal resources predicted work engagement and were reduced during the pandemic. All six organisational outcomes were impaired. Lack of resources, especially reduced learning opportunities, lack of focus on staff wellbeing, and reduced focus on quality predicted worse organisational outcomes. ConclusionsThe NHS needs to prioritise the welfare of CCNs, implement workplace change/planning, and support them to recover from the pandemic. The NHS is struggling to retain CCNs and, unless staff welfare is improved, quality of care and patient safety will likely decline.

ObjectivesAgricultural injuries are known to be under-reported in existing surveillance systems. OIICS codes are a standardized classification system developed by the Bureau of Labor Statistics (BLS) which ensure consistency in reporting and analysis of workplace incidents over time across industry sectors. Our study examines OIICS coded injuries obtained via mining emergency response (Pre-Hospital Care Report) records (PCRs) to improve tracking, documentation, and understanding of agricultural injury trends. MethodsWe analyzed frequencies of OIICS subcodes for Primary Injury Source, Event/Exposure, Nature of Injury, and Body Part classifications for 1,583 injuries among agricultural workers in Maine, spanning January 2008 to December 2022. To streamline the dataset and subsequent analysis, subcodes within each category were thematically grouped. We summarized and visualized grouped code frequencies by subject sex, age category, season of injury, and study subperiod. Chi-square tests were used to assess differences in injury patterns by sex and age group. ResultsReported injuries increased over time from 420 in 2008-2011 to 631 in 2019-2022. The most frequently reported classifications were: Tractors/PTOs (Injury Source), Fall (Event), Multiple parts (Body Part), and Pain (Nature of Injury). A marked increase in Nonclassifiable Source subcodes and Fall Event subcodes was observed in 2019-2022 relative to earlier periods. Significant differences by sex were found for injury Event subcodes: The most frequent source of injuries for females were animals, versus objects and equipment being the most frequent source for males. Nature of Injury also varied significantly by sex. All four OIICS categories (Source, Event, Nature, Body Part) showed significant variation by age group. Older subjects reported more injuries due to falls and overexertion, while younger were more frequently subject to exposure, intentional self-injury, injury in fires, and injuries involving farm vehicles and equipment. ConclusionInjury counts rose across each successive study period. All injury subcodes differed significantly by age category, while injury Event and Body Part codes also varied significantly by sex. This suggests that injury risks are not uniform across demographics, and tailored safety interventions by sex and age group may be more effective in reducing agricultural injuries.

BackgroundSince the emergence of SARS-CoV-2, health care workers (HCWs) have been on the front line in caring for COVID-19 patients. Better knowledge of risk factors for SARS-CoV-2 infection is crucial for the prevention of disease among this population. MethodsWe conducted a seroprevalence survey among HCWs in a French university hospital after the first wave (May-June 2020), based on a validated lateral flow immuno-assay test (LFIAT) for SARS-CoV-2. Demographic characteristics as well as data on the working characteristics of COVID-19 and non-COVID-19 wards and 23 care activities were systematically recorded. The effectiveness of protective equipment was also estimated, based on self-declaration of mask use. SARS-CoV-2 IgG status was modelled by multiple imputations approach, accounting for the performance of the test and data on serum validation ELISA immunoassay. FindingsAmong the 3,234 enrolled HCWs, the prevalence of SARS-CoV-2 IgG was 3.8%. Contact with relatives or HCWs who developed COVID-19 were risk factors for SARS-CoV-2 infection, but not contact with COVID-19 patients. In multivariate analyses, suboptimal use of protective equipment during naso-pharyngeal sampling, patient mobilisation, clinical and eye examination was associated with SARS-CoV-2 infection. In addition, patients washing and dressing and aerosol-generating procedures were risk factors for SARS-CoV-2 infection with or without self-declared appropriate use of protective equipment. InterpretationMain routes of transmission of SARS-CoV-2 IgG among HCWs were i) contact with relatives or HCWs with COVID-19, ii) close or prolonged contact with patients, iii) aerosol-generating procedures.

IntroductionA recent meta-analysis confirmed that Chest Xray (CXR) has low sensitivity for the diagnosis of silicosis however the impact of this is unclear. We therefore re- estimated a previously published dose-response relationship between cumulative respirable crystalline silica (RCS) exposure and silicosis risk, under the assumptions that sensitivity was either fixed or relative to the population proportion of severe silicosis. MethodsWe combined unpublished logistic regression models from Scottish coal miners with meta-analysis results to model how CXR sensitivity changed according to cumulative RCS exposure. Among mining cohorts, we calculated the difference in the cumulative risk of silicosis between the unadjusted, and fixed and relative scenarios. Finally, we re-estimated the dose-response meta-analysis and related absolute risk reductions (ARR). ResultsIn all mining cohorts the cumulative risk of silicosis was substantially higher in both the fixed and relative sensitivity scenarios compared to the unadjusted estimate. This was most pronounced in the relative scenario and when cumulative RCS exposures were below approximately 6 mg/m3-years. A reduction from 4 to 2 mg/m3-years in cumulative RCS exposure corresponded to larger ARRs in the fixed and relative scenario than the unadjusted scenario; 409 (374, 434) and 557 (451, 620) cases per 1000 miners compared to 323 (298, 344) cases per 1000 miners, respectively. DiscussionWe were reliant on a single estimate of the proportion of severe disease to link sensitivity and cumulative RCS exposure. Nevertheless, adjusting for the low sensitivity of CXR for silicosis results in meaningful increased risks of silicosis in previously published mining cohorts.

ObjectiveTo determine key workforce variables (demographic, health and occupational) that predicted NHS staffs 1) absence due to illness (both COVID-19 and non-COVID-19 related) and 2) expressed intention to leave their current profession. MethodsStaff from 18 NHS Trusts were surveyed between April 2020 and January 2021, and again approximately 12months later. Logistic and linear regression were used to explore relationships between baseline exposures and 12-month outcomes. ResultsWe included 10,831 participants for analysis. At 12-months, 20% stated they agreed or strongly agreed they were actively seeking employment outside their current profession; 24% said they thought about leaving their profession at least several times per week. Twenty-percent of participants took 5+ days of work absence due to non-COVID-19 sickness in the 12-months between baseline and 12-month questionnaire; 14% took 5+ days of COVID-19 related sickness absence. Sickness absence (COVID-19 and non-COVID-19 related) and intention to leave the profession (actively seeking another role and thinking about leaving) were all more common among NHS staff who were younger, in a COVID-19 risk group, had a probable mental health disorder, and who did not feel supported by colleagues and managers. ConclusionsThere were several factors which affect both workforce retention and sickness absence. Of particular interest because they are modifiable, are the impact of colleague and manager support. The NHS workforce is likely to benefit from training managers to speak with and support staff, especially those experiencing mental health difficulties. Further, staff should be given sufficient opportunities to form and foster social connections. What is already known on this topicO_LIThe ability of the NHS to provide a good service in a timely manner is under more pressure and strain than ever before, and therefore the retention and health of current staff is incredibly important. C_LI What this study addsO_LIWe included survey data collected on 10,831 NHS staff across 18 Trusts in England between April 2020 and February 2022. C_LIO_LISickness absence and intention to leave the profession were more common among NHS staff who were younger, in a COVID-19 risk group, had a probable mental health disorder, and who did not feel supported by colleagues and managers. C_LI How this study might affect research, practice or policyO_LIThis study suggests that in order to improve staff retention and reduce staff sickness, the NHS workforce is likely to benefit from training managers to speak with and support staff, especially those experiencing mental health difficulties. C_LIO_LIFurther, staff should be given sufficient opportunities to form and foster social connections and reflect on the challenges of the work they do together. C_LI

ObjectivesTo establish whether prevalence and severity of long-COVID symptoms vary by industry and occupation. MethodsWe utilised ONS Coronavirus Infection Survey (CIS) data (February 2021-April 2022) of working-age participants (16-65 years). Exposures were industrial sector, occupation and major Standard Occupational Classification (SOC) group. Outcomes were self-reported: (1) long-COVID symptoms; and (2) reduced function due to long-COVID. Binary (outcome 1) and ordered (outcome 2) logistic regression were used to estimate odds ratios (OR) and prevalence (marginal means) for all exposures. ResultsPublic facing industries, including teaching and education, social care, healthcare, civil service, retail and transport industries and occupations had highest odds ratios for long-COVID. By major SOC group, those in caring, leisure and other services (OR 1.44, CIs: 1.38-1.52) had substantially elevated odds than average. For almost all exposures, the pattern of odds ratios for long-COVID symptoms followed that for SARS-CoV-2 infections, except for professional occupations (OR<1 for infection; OR>1 for long-COVID). The probability of reporting long-COVID for industry ranged from 7.7% (financial services) to 11.6% (teaching and education); whereas the prevalence of reduced function by a lot ranged from 17.1% (arts, entertainment and recreation) to 22-23% (teaching and education and armed forces) and to 27% (those not working). ConclusionsThe risk and prevalence of long-COVID differs across industries and occupations. Generally, it appears that likelihood of developing long-COVID symptoms follows likelihood of SARS-CoV-2 infection, except for professional occupations. These findings highlight sectors and occupations where further research is needed to understand the occupational factors resulting in long-COVID. Key messages What is already known on this topicO_LISARS-CoV-2 infection and COVID-19 mortality in the UK varied by occupational group; yet it is not known if any occupational groups are more susceptible to long-COVID than others. C_LI What this study addsO_LIThis is the first study to examine how prevalence of long-COVID and its impacts on functional capacity differ by industrial sector and occupational groups. C_LIO_LIPrevalence of self-reported long-COVID increased with time across all exposure groups and mostly followed SARS-CoV-2 infection trends; with the exception of Professional occupations that demonstrated notable differences in the direction of odds of long-covid when compared to odds of SARS-CoV-2 infection. C_LIO_LIThose working in Teaching and education, and social care industries showed the highest likelihood of having long-COVID symptoms. The exact same pattern was observed when analysis was performed using occupational groups. When we used SOC groups the likelihood was higher in Caring, leisure and other services. C_LI How this study might affect research, practice or policyO_LIThe findings contribute to the evidence base that long-COVID differences occur across industries and occupations, provides insights for employees, employers, occupational and healthcare for the industries and occupations that may need additional support for return- to-work policies and highlights sectors and occupations where further research is needed to understand the mechanisms resulting in long-COVID and how occupational factors influence the risk of developing long-COVID or interact with long-COVID to increase the impact on activities. C_LI

ObjectivesAlthough wood dust remains a leading cause of occupational asthma (OA) in Great Britain, there have been no recent studies in British woodworkers. This cross-sectional study examined asthma risk factors in woodworkers across exposure groups. MethodsParticipants answered a respiratory questionnaire and underwent fractional exhaled nitric oxide (FENO), spirometry, and specific immunoglobulin E measurements. Wood dust exposure was assigned through a specific job-exposure matrix. Multiple regression evaluated asthma risk factors identified a priori including wood dust exposure, atopy, and current asthma symptoms. ResultsA total of 269 woodworkers participated. Median wood dust exposure was 2.00mg/m3 (IQR 1.14 mg/m3). Current asthma symptoms (CAS), work-related respiratory symptoms (WRRS) and eosinophilic airway inflammation (FENO >40ppb) were common, present in 46%, 11% and 19% of the cohort, respectively. Atopic woodworkers were at increased risk of WRRS (OR 2.78, 95% CI 1.11 - 6.92, p<0.05), asthma (OR 3.40, 1.49 - 7.81, p<0.01), and FENO >40ppb (unadjusted OR 2.00, 1.03 - 3.88, p<0.05). No effect was seen for airflow obstruction. Workers with CAS were at increased risk of WRRS and ever asthma (4.29, 2.12 - 8.69, p<0.001) but not FENO >40ppb or airflow obstruction. Increasing exposure did not significantly increase risk of asthma symptoms, asthma, airflow obstruction and inflammation. ConclusionsAsthma symptoms were prevalent among British woodworkers, even at low exposure levels. Atopy significantly increased asthma risk, particularly among symptomatic woodworkers. Further studies to phenotype and endotype populations of workers at risk of, and suffering from, wood dust OA will inform future approaches to screening and diagnosis in these populations. What is already known on this topicWood dust is a leading cause of occupational asthma (OA) in Great Britain. No recent studies have described risk factors for OA in British woodworkers. Evidence identifies atopy, asthma symptoms, and wood species as risk factors for OA, but not consistently so. What this study addsThis cross-sectional study used a detailed job-exposure matrix, questionnaire and clinical data to understand risk factors for asthma in British woodworkers. We found upper airway, asthma symptoms (CAS), work-related symptoms and eosinophilic airway inflammation to be common among British woodworkers, but specific sensitisation to wood dust was low. Among workers with asthma symptoms atopy significantly increased the risk of CAS, asthma, and airway inflammation in woodworkers. Increasing wood dust exposure was not associated with an increased risk of asthma symptoms or asthma. How this study might affect research, practice or policyThis research provides the first epidemiological study on asthma in British woodworkers for decades and highlights specific risk factors for asthma in this group. This data is useful to inform health surveillance programmes and may help inform any future review of exposure limits. This research also helps to understand the phenotype of asthma caused by wood dust which is an area requiring further exploration.