[Show abstract][Hide abstract] ABSTRACT: Occupational and environmental exposures remain important modifiable risk factors of public health. Existing cohort studies are often limited by the level of detail of data collected on these factors and health. It is also often assumed that the more healthy group is over-represented in cohort studies, which is of concern for their external validity. In this cohort profile, we describe how we set up the population-based Occupational and Environmental Health Cohort Study (AMIGO) to longitudinally study occupational and environmental determinants of diseases and well-being from a multidisciplinary and life course point of view. Reviewed by the Medical Ethics Research Committee of the University Medical Center Utrecht (protocol 10-268/C). All cohort members participate voluntarily and gave informed consent prior to their inclusion.
14 829 adult cohort members (16% of those invited) consented and filled in the online baseline questionnaire. Determinants include chemical, biological, physical (eg, electromagnetic fields), and psychosocial factors. Priority health outcomes include cancer, neurological, cardiovascular and respiratory diseases and non-specific symptoms. Owing to the recruitment strategy via general practitioners of an established network, we also collect longitudinal data registered in their electronic medical records including symptoms, diagnosis and treatments. Besides the advantage of health outcomes that cannot be easily captured longitudinally by other means, this created a unique opportunity to assess health-related participation bias by comparing general practitioner-registered prevalence rates in the cohort and its source population.
We found no indications of such a systematic bias. The major assets of the AMIGO approach are its detailed occupational and environmental determinants in combination with the longitudinal health data registered in general practice besides linkage to cancer and mortality registries and self-reported health.
We are now in the phase of prospective follow-up, with the aim of continuing this for as long as possible (20+ years), pending future funding. Findings will be disseminated through scientific conferences and peer-reviewed journals, and through newsletters and the project website to participants, stakeholders and the wider public.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BMJ Open 11/2014; 4(11):e005858. · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Movement in the magnetic fields around MRI systems showed acute negative effects on concentration, memory, visuo-spatial orientation and postural body sway. A crucial role of the vestibular system has been hypothesised. We aimed to gain more insight whether subjects with a relatively (un)sensitive vestibular system performed differently on cognitive tasks when (moving) in a the static magnetic field of an MRI scanner.
Occupational and Environmental Medicine 06/2014; 71 Suppl 1:A16. · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the association between occupational exposure to extremely low frequency magnetic fields (ELF-MF) or electric shocks and brain cancer, haemopoietic and lymphatic malignancies, and breast cancer incidence in the Nordic Occupational Cancer cohort.
Occupational and environmental medicine. 06/2014; 71 Suppl 1:A50.
[Show abstract][Hide abstract] ABSTRACT: Evidence for the carcinogenicity of shift work in humans is limited because of significant heterogeneity of the results, thus more in-depth research in needed. The Nightingale Study is a nationwide prospective cohort study on occupational exposures and risks of chronic diseases among female nurses and focuses on the potential association between shift work and risk of breast cancer. The study design, methods, and baseline characteristics of the cohort are described.
The source population for the cohort comprised 18 to 65 year old women who were registered as having completed training to be a nurse in the nationwide register for healthcare professionals in the Netherlands. Eligible women were invited to complete a web-based questionnaire including full job history, a detailed section on all domains of shift work (shift system, cumulative exposure, and shift intensity) and potential confounding factors, and an informed consent form for linkage with national (disease) registries. Women were also asked to donate toenail clippings as a source of DNA for genetic analyses. Between October 6, 2011 and February 1, 2012, 31% of the 192,931 women who were invited to participate completed the questionnaire, yielding a sample size of 59,947 cohort members. The mean age of the participants was 46.9 year (standard deviation 11.0 years). Toenail clippings were provided by 23,439 participants (39%).
Results from the Nightingale Study will contribute to the scientific evidence of potential shift work-related health risks among nurses and will help develop preventive measures and policy aimed at reducing these risks.
BMC Cancer 01/2014; 14(1):47. · 3.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the association between exposure to occupational extremely low-frequency magnetic fields (ELF-MF) and the risk of a priori selected cancer outcomes within the prospective Netherlands Cohort Study.
120,852 men and women aged 55-69 years at time of enrollment in 1986 were followed up (17.3 years) for incident lung, breast and brain cancer, and hemato-lymphoproliferative malignancies. Information on occupational history and potential confounders such as sex, age, smoking, alcohol use, and attained educational level were collected at baseline through a self-administered questionnaire. Occupational ELF-MF exposure was assigned with a job-exposure matrix. Using a case-cohort approach, associations with cancer incidence were analyzed with Cox regression stratified by sex, using three exposure metrics: (1) ever had a job with low or high exposure to ELF-MF versus background, (2) duration of exposure, and (3) cumulative exposure.
None of the exposure metrics showed an effect on incidence for lung, breast, and brain cancer, nor any of the assessed subtypes in men and women. Of the hemato-lymphoproliferative malignancies in men, ever high exposed to ELF-MF showed a significant association with acute myeloid leukemia (AML) [hazard ratio (HR) 2.15; 95 % confidence interval (CI) 1.06-4.35] and follicular lymphoma (FL) (HR 2.78; 95 % CI 1.00-5.77). Cumulative exposure to ELF-MF showed a significant, positive association with FL but not AML among men.
In this large prospective cohort study, we found some indications of an increased risk of AML and FL among men with occupational ELF-MF exposure. These findings warrant further investigation.
Cancer Causes and Control 11/2013; · 3.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: At present, the relationship between chronic exposure to static magnetic fields (SMF) and health effects is unclear. We developed a task-based deterministic model for estimating historical electromagnetic field exposure from the static B-field (B0) of magnetic resonance imaging (MRI) systems, for a cohort of employees working at an MRI systems development and production facility. Technical maps describing the spatial distribution of fringe fields of B0 surrounding different types of MRI systems of various core strengths were exploited to derive estimates of static B0 exposure as a function of distance from the bore of the MRI system. Detailed information on tasks performed per exposed job and other model determinants were acquired through face-to-face interviews and used to derive base estimates of most recent exposure (2009) for each job title. The model was partially validated with actual exposure measurements. The exposure estimates from the deterministic model were used to construct a job-exposure matrix that will enable estimation of cumulative exposures for each cohort member. The generic approach described for estimating chronic MRI-related SMF exposure makes it universally applicable in other studies investigating health effects of MRI-related SMF exposure.
Annals of Occupational Hygiene 09/2013; · 2.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aims to characterise and quantify the population that is occupationally exposed to electromagnetic fields (EMF) from magnetic resonance imaging (MRI) devices and to identify factors that determine the probability and type of exposure.
A questionnaire survey was used to collect information about scanners, procedures, historical developments and employees working with or near MRI scanners in clinical and research MRI departments in the Netherlands.
Data were obtained from 145 MRI departments. A rapid increase in the use of MRI and field strength of the scanners was observed and quantified. The strongest magnets were employed by academic hospitals and research departments. Approximately 7000 individuals were reported to be working inside an MRI scanner room and were thus considered to have high probability of occupational exposure to static magnetic fields (SMF). Fifty-four per cent was exposed to SMF at least one day per month. The largest occupationally exposed group were radiographers (n∼1700). Nine per cent of the 7000 involved workers were regularly present inside a scanner room during image acquisition, when exposure to additional types of EMF is considered a possibility. This practice was most prevalent among workers involved in scanning animals.
The data illustrate recent trends and historical developments in magnetic resonance imaging and provide an extensive characterisation of the occupationally exposed population. A considerable number of workers are potentially exposed to MRI-related EMF. Type and frequency of potential exposure depend on the job performed, as well as the type of workplace.
European journal of radiology 08/2013; · 2.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: Although a study among utility workers found an increased risk for acute myocardial infarction and arrhythmia-related deaths associated with occupational extremely low-frequency magnetic fields (ELF-MF) exposure, later studies largely failed to replicate these findings. This study investigated the association between occupational ELF-MF exposure and cardiovascular disease (CVD) mortality within a community-based prospective cohort study. METHODS: The Netherlands Cohort Study is a prospective cohort study among 120 852 men and women aged 55-69 years at baseline. Participants were followed-up for CVD mortality over a period of 10 years, resulting in 8200 CVD deaths. Information on occupational history and potential confounders, such as educational level, smoking and alcohol use were collected at baseline through a self-administered questionnaire. Occupational ELF-MF exposure was assigned using a job-exposure matrix. Associations with CVD mortality were analysed using Cox regression. RESULTS: Ever low or high exposure to ELF-MF showed no association with total CVD mortality (HR of 1.02, 95% CI 0.99 to 1.06), nor with any cause-specific subtypes of CVD mortality. Other ELF-MF exposure metrics showed no increased risks either. CONCLUSIONS: In this study, we found no indication of an association between occupational ELF-MF exposure and risk of CVD mortality.
Occupational and environmental medicine 01/2013; · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study characterises neurocognitive domains that are affected by movement-induced time-varying magnetic fields (TVMF) within a static magnetic stray field (SMF) of a 7 Tesla (T) MRI scanner.
Using a double-blind randomised crossover design, 31 healthy volunteers were tested in a sham (0 T), low (0.5 T) and high (1.0 T) SMF exposure condition. Standardised head movements were made before every neurocognitive task to induce TVMF.
Of the six tested neurocognitive domains, we demonstrated that attention and concentration were negatively affected when exposed to TVMF within an SMF (varying from 5.0% to 21.1% per Tesla exposure, p<0.05), particular in situations were high working memory performance was required. In addition, visuospatial orientation was affected after exposure (46.7% per Tesla exposure, p=0.05).
Neurocognitive functioning is modulated when exposed to movement-induced TVMF within an SMF of a 7 T MRI scanner. Domains that were affected include attention/concentration and visuospatial orientation. Further studies are needed to better understand the mechanisms and possible practical safety and health implications of these acute neurocognitive effects.
Occupational and environmental medicine 08/2012; 69(10):759-66. · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:In epidemiological studies, occupational exposure estimates are often assigned through linkage of job histories to job-exposure matrices (JEMs). However, available JEMs may have a coding system incompatible with the coding system used to code the job histories, necessitating a translation of the originally assigned job codes. Since manual recoding is usually not feasible in large studies, this is often done by use of automated crosswalks translating job codes from one system to another. We set out to investigate whether automatically translating job codes led to different exposure estimates compared with those resulting from manual recoding using the original job descriptions. METHODS: One hundred job histories were randomly drawn from the Netherlands Cohort Study on diet and cancer (NLCS), using a sampling strategy designed to oversample potentially exposed jobs. This resulted in 220 job codes that were automatically translated from the original Dutch coding system to the International Standard Classification of Occupations (ISCO)-68 and ISCO-88 as well as manually recoded from the job descriptions in the original questionnaire by two coders. Exposure to several agents (i.e. chromium, asbestos, silica, pesticides, aromatic solvents, and extremely low-frequency magnetic fields) was assigned by JEMs based on job codes resulting from automatic and manual recodings. RESULTS: The agreement between occupational exposure estimates based on the crosswalk versus those based on manual recoding reached a Cohen's Kappa (κ) of 0.66 or higher and were similar to the agreements between the two coders. CONCLUSIONS: Results of this study indicate that using automated crosswalks to recode job codes from one occupational classification system to another results only in a limited loss in agreement in assigned occupational exposure estimates compared with direct manual recoding. Therefore, in this case, crosswalks provide an efficient alternative to the costly and time-consuming direct manual recoding from job history descriptions from questionnaires.
Annals of Occupational Hygiene 07/2012; · 2.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is continuing public and scientific interest in the possibility that exposure to radiofrequency (RF) electromagnetic fields (EMF) from mobile telephones or other wireless devices and applications might increase the risk of certain cancers or other diseases. The interest is amplified by the rapid world-wide penetration of such technologies. The evidence from epidemiological studies published to date have not been consistent and, in particular, further studies are required to identify whether longer term (well beyond 10 years) RF exposure might pose some health risk.
The "Cosmos" study described here is a large prospective cohort study of mobile telephone users (ongoing recruitment of 250,000 men and women aged 18+ years in five European countries - Denmark, Finland, Sweden, The Netherlands, UK) who will be followed up for 25+ years. Information on mobile telephone use is collected prospectively through questionnaires and objective traffic data from network operators. Associations with disease risks will be studied by linking cohort members to existing disease registries, while changes in symptoms such as headache and sleep quality and of general well-being are assessed by baseline and follow-up questionnaires.
A prospective cohort study conducted with appropriate diligence and a sufficient sample size, overcomes many of the shortcomings of previous studies. Its major advantages are exposure assessment prior to the diagnosis of disease, the prospective collection of objective exposure information, long-term follow-up of multiple health outcomes, and the flexibility to investigate future changes in technologies or new research questions.
[Show abstract][Hide abstract] ABSTRACT: Electronic anamnesis is to transform ordinary paper trails to digitally formatted health records, which include the patient's general information, health status, and follow-ups on chronic diseases. Its main purpose is to let the records could be stored ...
Journal of Medical Systems 01/2011; 36(3):1779-80. · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Given the inconsistent associations of cortisol with posttraumatic stress disorder (PTSD), analysis of basal functioning of the hypothalamic-pituitary-adrenal (HPA) axis in subjects frequently exposed to trauma and critical incidents with a range of PTSD symptomatology, may be valuable. In an epidemiological sample of 1880 police officers and firefighters, associations of salivary cortisol with PTSD, negative life events (NLE) and exposure to a major air disaster more than 8 years earlier, was explored. Probable PTSD was unrelated to cortisol level while past (>8 years earlier) and more recently experienced NLE were associated with lower cortisol levels even after adjustment for confounders. Disaster exposure interacted significantly with PTSD symptoms on cortisol level. In the disaster-exposed subgroup, PTSD symptomclusters of intrusion and hyperarousal (in particular sleep disturbances), were associated with lower and higher cortisol levels, respectively. A final model using backward elimination strategy, retained time of saliva sampling, smoking, gender, and NLE>8 years earlier in the total sample, and additionally symptomclusters of intrusion and hyperarousal in the disaster-exposed subgroup. The final model explained 10% of the variance in cortisol. The findings are discussed in relation to literature on posttraumatic stress and basal functioning of the HPA-axis.
[Show abstract][Hide abstract] ABSTRACT: Environmental health impact assessments often have to deal with substantial uncertainties. Typically, the knowledge-base is limited with incomplete, or inconsistent evidence and missing or ambiguous data. Consulting experts can help to identify and address uncertainties.
Formal expert elicitation is a structured approach to systematically consult experts on uncertain issues. It is most often used to quantify ranges for poorly known parameters, but may also be useful to further develop qualitative issues such as definitions, assumptions or conceptual (causal) models. A thorough preparation and systematic design and execution of an expert elicitation process may increase the validity of its outcomes and transparency and trustworthiness of its conclusions. Various expert elicitation protocols and methods exist. However, these are often not universally applicable, and need customization to suite the needs of a specific study. In this paper, we set out to develop a widely applicable method for the use of expert elicitation in environmental health impact assessment.
We present a practical yet flexible seven step procedure towards organising expert elicitation in the context of environmental health impact assessment, based on existing protocols. We describe how customization for specific applications is always necessary. In particular, three issues affect the choice of methods for a particular application: the types of uncertainties considered, the intended use of the elicited information, and the available resources. We outline how these three considerations guide choices regarding the design and execution of expert elicitation. We present signposts to sources where the issues are discussed in more depth to give the newcomer the insights needed to make the protocol work. The seven step procedure is illustrated using examples from earlier published elicitations in the field of environmental health research.
We conclude that, despite some known criticism on its validity, formal expert elicitation can support environmental health research in various ways. Its main purpose is to provide a temporary summary of the limited available knowledge, which can serve as a provisional basis for policy until further research has been carried out.
Environmental Health 01/2010; 9:19. · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Toxicological studies have provided evidence of the toxicity of ultrafine particles (UFP), but epidemiological evidence for health effects of ultrafines is limited. No quantitative summary currently exists of concentration-response functions for ultrafine particles that can be used in health impact assessment. The goal was to specify concentration-response functions for ultrafine particles in urban air including their uncertainty through an expert panel elicitation. Eleven European experts from the disciplines of epidemiology, toxicology, and clinical medicine selected using a systematic peer-nomination procedure participated. Using individual ratings supplemented with group discussion, probability distributions of effect estimates were obtained for all-cause mortality and cardiovascular and respiratory hospital admissions. Experts judged the small database of epidemiological studies supplemented with experimental studies sufficient to quantify effects of UFP on all-cause mortality and to a lesser extent hospital admissions. Substantial differences in the estimated UFP health effect and its uncertainty were found between experts. The lack of studies on long-term exposure to UFP was rated as the most important source of uncertainty. Effects on hospital admissions were considered more uncertain. This expert elicitation provides the first quantitative evaluation of estimates of concentration response functions between urban air ultrafine particles and all-cause mortality and hospital admissions.
Environmental Science and Technology 12/2009; 44(1):476-82. · 5.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and objective: It has become commonplace to analyze separately atopic and non-atopic asthma in studies on genetic, environmental, and immunological characteristics of asthma. Atopic asthma is in most studies defined simply based on presence of both asthma and positive skin prick test or specific IgE antibodies. We here illustrate the problems introduced by using atopic and non-atopic asthma as endpoint in analyses exploring characteristics associated with asthma/atopy.
[Show abstract][Hide abstract] ABSTRACT: Exposure to fine ambient particulate matter (PM) has consistently been associated with increased morbidity and mortality. The relationship between exposure to ultrafine particles (UFP) and health effects is less firmly established. If UFP cause health effects independently from coarser fractions, this could affect health impact assessment of air pollution, which would possibly lead to alternative policy options to be considered to reduce the disease burden of PM. Therefore, we organized an expert elicitation workshop to assess the evidence for a causal relationship between exposure to UFP and health endpoints.
An expert elicitation on the health effects of ambient ultrafine particle exposure was carried out, focusing on: 1) the likelihood of causal relationships with key health endpoints, and 2) the likelihood of potential causal pathways for cardiac events. Based on a systematic peer-nomination procedure, fourteen European experts (epidemiologists, toxicologists and clinicians) were selected, of whom twelve attended. They were provided with a briefing book containing key literature. After a group discussion, individual expert judgments in the form of ratings of the likelihood of causal relationships and pathways were obtained using a confidence scheme adapted from the one used by the Intergovernmental Panel on Climate Change.
The likelihood of an independent causal relationship between increased short-term UFP exposure and increased all-cause mortality, hospital admissions for cardiovascular and respiratory diseases, aggravation of asthma symptoms and lung function decrements was rated medium to high by most experts. The likelihood for long-term UFP exposure to be causally related to all cause mortality, cardiovascular and respiratory morbidity and lung cancer was rated slightly lower, mostly medium. The experts rated the likelihood of each of the six identified possible causal pathways separately. Out of these six, the highest likelihood was rated for the pathway involving respiratory inflammation and subsequent thrombotic effects.
The overall medium to high likelihood rating of causality of health effects of UFP exposure and the high likelihood rating of at least one of the proposed causal mechanisms explaining associations between UFP and cardiac events, stresses the importance of considering UFP in future health impact assessments of (transport-related) air pollution, and the need for further research on UFP exposure and health effects.
Particle and Fibre Toxicology 08/2009; 6:19. · 6.99 Impact Factor