"New Zealand has been one of the world's heaviest users of pesticides, including some contaminated with dioxin, a notorious toxic chemical. In this BWB Text a leading epidemiologist uses the example of dioxin to illustrate how badly New Zealand handles problems of environmental pollutants, and why we can do better. Concern with public health has been recast by the Covid-19 pandemic. Neil Pearce's eye-opening account of our country's ongoing failures in environmental protection shows there is much more work to be done"--Back cover
Diabetes is a major problem worldwide. Among Pacific people, prevention and control of diabetes lies in counteracting rapid changes in lifestyle and must take account of political and economic factors and social structure.
Diabetes is a major problem worldwide. Among Pacific people, prevention and control of diabetes lies in counteracting rapid changes in lifestyle and must take account of political and economic factors and social structure
There has perhaps been no issue as contentious in Covid-19 as face masks. The most contentious scientific debate has been between those who argue that "there is no scientific evidence", by which they mean that there are no randomized controlled trials (RCTs), versus those who argue that when the evidence is considered together, "the science supports that face coverings save lives". It used to be a 'given' that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence. This approach is being increasingly challenged, both scientifically and politically. The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard, with priority being given, either to evidence from RCTs or to observational studies which closely mimic RCTs. The political challenge has come from various interests calling for the exclusion of epidemiological evidence from consideration by regulatory and advisory committees.
There has perhaps been no issue as contentious in Covid-19 as face masks. The most contentious scientific debate has been between those who argue that "there is no scientific evidence", by which they mean that there are no randomized controlled trials (RCTs), versus those who argue that when the evidence is considered together, "the science supports that face coverings save lives". It used to be a 'given' that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence. This approach is being increasingly challenged, both scientifically and politically. The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard, with priority being given, either to evidence from RCTs or to observational studies which closely mimic RCTs. The political challenge has come from various interests calling for the exclusion of epidemiological evidence from consideration by regulatory and advisory committees.
In: Pearce , N & Vandenbroucke , J P 2021 , ' Arguments about face masks and Covid-19 reflect broader methodologic debates within medical science ' , European Journal of Epidemiology , vol. 36 , no. 2 , pp. 143-147 . https://doi.org/10.1007/s10654-021-00735-7
There has perhaps been no issue as contentious in Covid-19 as face masks. The most contentious scientific debate has been between those who argue that "there is no scientific evidence", by which they mean that there are no randomized controlled trials (RCTs), versus those who argue that when the evidence is considered together, "the science supports that face coverings save lives". It used to be a 'given' that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence. This approach is being increasingly challenged, both scientifically and politically. The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard, with priority being given, either to evidence from RCTs or to observational studies which closely mimic RCTs. The political challenge has come from various interests calling for the exclusion of epidemiological evidence from consideration by regulatory and advisory committees.
The health status of indigenous peoples worldwide varies according to their unique historical, political, and social circumstances. Disparities in health between Maoris and non-Maoris have been evident for all of the colonial history of New Zealand. Explanations for these differences involve a complex mix of components associated with socioeconomic and lifestyle factors, availability of health care, and discrimination. Improving access to care is critical to addressing health disparities, and increasing evidence suggests that Maoris and non-Maoris differ in terms of access to primary and secondary health care services. We use 2 approaches to health service development to demonstrate how Maori-led initiatives are seeking to improve access to and quality of health care for Maoris.
The health status of indigenous peoples worldwide varies according to their unique historical, political, and social circumstances. Disparities in health between Maoris and non-Maoris have been evident for all of the colonial history of New Zealand. Explanations for these differences involve a complex mix of components associated with socioeconomic and lifestyle factors, availability of health care, and discrimination.
Objectives Previous studies have reported high concentrations of airborne fumigants and other chemicals inside unopened shipping containers, but it is unclear whether this is reflective of worker exposures.
Methods We collected personal 8-h air samples using a whole-air sampling method. Samples were analysed for 1,2-dibromoethane, chloropicrin, ethylene oxide, hydrogen cyanide, hydrogen phosphide, methyl bromide, 1,2-dichloroethane, C2-alkylbenzenes, acetaldehyde, ammonia, benzene, formaldehyde, methanol, styrene, and toluene. Additive Mixture Values (AMVs) were calculated using the New Zealand Workplace Exposure standard (WES) and American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Values (TLVs) of the 8-h, time-weighted average exposure limit. Linear regression was conducted to assess associations with work characteristics.
Results We included 133 workers handling shipping containers, 15 retail workers unpacking container goods, 40 workers loading fumigated and non-fumigated export logs, and 5 fumigators. A total of 193 personal 8-h air measurements were collected. Exposures were generally low, with >50% below the limit of detection for most chemicals, and none exceeding the NZ WES, although formaldehyde exceeded the TLV in 26.2% of all measurements. The AMV-TLV threshold of 1 was exceeded in 29.0% of the measurements. Levels and detection frequencies of most chemicals varied little between occupational groups, although exposure to methyl bromide was highest in the fumigators (median 43 ppb) without exceeding the TLV of 1000 ppb. Duration spent inside the container was associated with significantly higher levels of ethylene oxide, C2-alkylbenzenes, and acetaldehyde, but levels were well below the TLV/WES. Exposure levels did not differ between workers handling fumigated and non-fumigated containers.
Conclusions Personal exposures of workers handling container cargo in New Zealand were mainly below current exposure standards, with formaldehyde the main contributor to overall exposure. However, as it is not clear whether working conditions of participants included in this study were representative of this industry as a whole, and not all relevant exposures were measured, we cannot exclude the possibility that high exposures may occur in some workers.
OBJECTIVES: Previous studies have reported high concentrations of airborne fumigants and other chemicals inside unopened shipping containers, but it is unclear whether this is reflective of worker exposures. METHODS: We collected personal 8-h air samples using a whole-air sampling method. Samples were analysed for 1,2-dibromoethane, chloropicrin, ethylene oxide, hydrogen cyanide, hydrogen phosphide, methyl bromide, 1,2-dichloroethane, C2-alkylbenzenes, acetaldehyde, ammonia, benzene, formaldehyde, methanol, styrene, and toluene. Additive Mixture Values (AMVs) were calculated using the New Zealand Workplace Exposure standard (WES) and American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Values (TLVs) of the 8-h, time-weighted average exposure limit. Linear regression was conducted to assess associations with work characteristics. RESULTS: We included 133 workers handling shipping containers, 15 retail workers unpacking container goods, 40 workers loading fumigated and non-fumigated export logs, and 5 fumigators. A total of 193 personal 8-h air measurements were collected. Exposures were generally low, with >50% below the limit of detection for most chemicals, and none exceeding the NZ WES, although formaldehyde exceeded the TLV in 26.2% of all measurements. The AMV-TLV threshold of 1 was exceeded in 29.0% of the measurements. Levels and detection frequencies of most chemicals varied little between occupational groups, although exposure to methyl bromide was highest in the fumigators (median 43 ppb) without exceeding the TLV of 1000 ppb. Duration spent inside the container was associated with significantly higher levels of ethylene oxide, C2-alkylbenzenes, and acetaldehyde, but levels were well below the TLV/WES. Exposure levels did not differ between workers handling fumigated and non-fumigated containers. CONCLUSIONS: Personal exposures of workers handling container cargo in New Zealand were mainly below current exposure standards, with formaldehyde the main contributor to overall exposure. However, as it is not clear whether working conditions of participants included in this study were representative of this industry as a whole, and not all relevant exposures were measured, we cannot exclude the possibility that high exposures may occur in some workers.
Objectives Food processing facilities represent critical infrastructure that have stayed open during much of the COVID-19 pandemic. Understanding the burden of COVID-19 in this sector is thus important to help reduce the potential for workplace infection in future outbreaks.
Methods We undertook a workplace survey in the UK food and drink processing sector and collected information on workplace size, characteristics (e.g. temperature, ventilation), and experience with COVID-19 (e.g. numbers of positive cases). For each site, we calculated COVID-19 case rates per month per 1000 workers. We performed an ecological analysis using negative binomial regression to assess the association between COVID-19 rates and workplace and local risk factors.
Results Respondents from 33 companies including 66 individual sites completed the survey. COVID-19 cases were reported from the start of the pandemic up to June 2021. Respondents represented a range of industry subgroups, including grain milling/storage (n = 16), manufacture of malt (n = 14), manufacture of prepared meals (n = 12), manufacture of beverages (n = 8), distilling (n = 5), manufacture of baked goods (n = 5), and other (n = 6), with a total of 15 563 workers across all sites. Average monthly case rates per 1000 workers ranged from 0.9 in distilling to 6.1 in grain milling/storage. Incidence rate ratios were partially attenuated after adjusting for several local and workplace factors, though risks for one subgroup (grain milling/storage) remained elevated. Certain local and workplace characteristics were related to higher infection rates, such as higher deprivation (5 km only), a lower proportion of remote workers, lower proportion of workers in close proximity, and higher numbers of workers overall.
Conclusions Our analysis suggests some heterogeneity in the rates of COVID-19 across sectors of the UK food and drink processing industry. Infection rates were associated with deprivation, the proportions of remote workers and workers in close proximity, and the number of workers.
The Team Sports Risk Exposure Framework (TS-REF) was developed in July 2020 by experts in sports medicine, virology, sports science and public health to facilitate the safe return of sport during the COVID-19 pandemic. The TS-REF was developed at the time when the outdoor transmission risk of SARS-CoV-2 during sport was unknown. The TS-REF has been adopted by Public Health England and the UK Government (Department for Digital, Culture, Media and Sport), for use within both elite and community sports, to both determine the risk of SARS-CoV-2 transmission during specific sporting activities (eg, rugby tackle), and to identify and isolate increased risk contacts during sport. The TS-REF classified increased risk contacts as player-to-player interactions 'within 1 m, directly face to face, for 3 or more seconds'.
Background The public order and safety (POS) sector remains susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks, as workplace attendance is typically compulsory and close physical contact is often needed. Here, we report on a SARS-CoV-2 outbreak with an attack rate of 39% (9/23), which occurred between 19 and 29 June 2021 among a cohort of new POS recruits participating in a mandatory 18-week training programme in England.
Methods The COVID-OUT (COVID-19 Outbreak investigation to Understand Transmission) study team undertook a multidisciplinary outbreak investigation, including viral surface sampling, workplace environmental assessment, participant viral and antibody testing, and questionnaires, at the two associated training facilities between 5 July and 24 August 2021.
Results Environmental factors, such as ventilation, were deemed inadequate in some areas of the workplace, with carbon dioxide (CO2) levels exceeding 1,500 ppm on multiple occasions within naturally ventilated classrooms. Activities during safety training required close contact, with some necessitating physical contact, physical exertion, and shouting. Furthermore, most participants reported having physical contact with colleagues (67%) and more than one close work contact daily (97%).
Conclusions Our investigation suggests that site- and activity-specific factors likely contributed to the transmission risks within the POS trainee cohort. Potential interventions for mitigating SARS-CoV-2 transmission in this POS training context could include implementing regular rapid lateral flow testing, optimizing natural ventilation, using portable air cleaning devices in classrooms, and expanding use of well-fitted FFP2/FFP3 respirators during activities where prolonged close physical contact is required.
Background: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. Objective: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. Methods: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure–response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. Results: We obtained 2005–2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11.7μg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0–23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. Discussion: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures. https://doi.org/10.1289/EHP4495
