Modernet, a network for development of new techniques for

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 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
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
• Funded by EU for meetings to
exchange knowledge and
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
– 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
• Meetings In Amsterdam and Manchester in 2011
• Next COST Action meeting in Leuven, Belgium,
June 2012
Participants of Modernet
Czech Republic
Working groups
• WG1 Quality of data: improvement of quality of data
collection in occupational diseases (WG-leader: Prof. Stefano
• 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
• WG4 Dissemination: dissemination and implementation of
new knowledge on occupational diseases (WG-leaders: Dr. Claudio
• 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
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
New risks or diseases
• From symptoms and signs no
disease can be diagnosed
• No certainty on possible causal
• 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
– Expert Forecasts of Risk Observatory Bilbao
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
– Spontaneous reporting (useful with low
prevalence, high occupational Attributive
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
• 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
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
Bottum line:
an urgent need for vigilant physicians
‘Your case
might be
the first
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
Signal validation (2)
• Biologic gradient, or dose-effect relation:
higher exposure leads to greater risk of
• 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
• Communication with external parties
• Initiation of further research
• When and where necessary: amending
guidelines, protocols, legislation and
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,
– 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
• Concerning Data Mining Methods
– The UK group has been working on QSARS and asthma
– Comparison of pharmacovigilance methods : article to be
published in [email protected] 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
Time for
[email protected]
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