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
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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?
Like us on Facebook!
• 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
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 20072012: 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
Iceland
Ireland
Norway
Finland
Germany
UK
Belgium
Netherlands
Spain
France
Czech Republic
Portugal**
Italy
FYROM
Croatia
Australia
Albania
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)
But what about new occupational diseases?
Louis Pasteur:
“Chance favours
only the prepared
mind…”
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"
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
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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)
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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
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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
Bottum line:
an urgent need for vigilant physicians
‘Your case
might be
the first
one!’
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:
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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
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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
Thank you
Gracias
Time for
questions
a.f.lenderink@amc.nl