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Reflections on MODERNET- an international network dealing with

occupational diseases.

Work & Health workshop (PHE network)Manchester 10th November 2014

Prof Raymond AgiusCentre for Occupational and Environmental Health

Centre for EpidemiologyInstitute of Population Health

Faculty of Medical and Human SciencesThe University of Manchester

http://www.medicine.manchester.ac.uk/oeh

Structure of presentation

• Background and context

• Work in the UK

• Building up an International Network

• Objectives

• Organisation

• Some scientific highlights

• Growth and outcomes

• Legacy and way ahead ... evolving networks

Scientific context and objectives

Background / Problem statement:•Occupational diseases (ODs) impose a heavy burden on both workers and employers and represent enormous economic costs. •Generally information on incidence of OD is poor and inconsistent between countries.•New OD can remain unrecognised without better methods to find them

Objectives:

• To set up a network to address the above problems and to:

•Develop and share methods to study trends in Occupational Diseases (OD)

•Develop techniques for identifying new OD or novel causes thereof

•Use modern techniques to discuss and disseminate the above information

The Health & Occupation Research Network THOR (UK & ROI)

• Research and surveillance programme - fulfilling a national medical observatory function for occupational disease, work related ill health (& sickness absence since 2005)

• Started in UK with 1st scheme set up in 1989: SWORD (Surveillance of work-related and occupational respiratory disease)

• Republic of Ireland data since 2005,

• Electronic reporting in 2005 (GPs, Irish Republic et al)

• Founding partner of MODERNET (EU) since 2007

• > 1000 doctors participate (2014)

General Practitioner

Clinical Specialist

Occupational Physician

THOR-GPThe Health & Occupation

Reporting network in General Practice

SWORDSurveillance of Work-

related & Occupational Respiratory Disease

OPRAOccupational Physicians

Reporting Activity

EPIDERMOccupational Skin

Surveillance

MOSSMusculoskeletal

Occupational Surveillance Scheme

SOSMISurveillance of

Occupational Stress & Mental Illness

N=384

OPRAConsultant Occupational

Physicians

THOR-GPGeneral Physicians

with DipOccMed training

N=265

Industrial division reported by diagnostic category THOR-GP 2009 to 2011

0 200 400 600 800

(SWI) Self-reports

(THOR-GP) GPs

(OPRA) Occupational Physicians

(THOR) Specialists

Incidence rate per 100,000 persons employed per ann um

RespiratorySkinMusculoskeletalMental ill-health

Incidence rates (per 100,000 persons employed) of work-related mentalill-health, musculoskeletal disorders and skin disease calculated from

self-reports (SWI), GPs (THOR-GP), OPs (OPRA) and clinical specialists(THOR) 2009-2011

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Relative rates by year (2002 estimate = 1), with 95 % comparison intervals, other work stress versus spine/back as reported by

occupational physicians to OPRA in the health and social care sector

Estimated annual change (1996-2010)Other work stress: +9.8% (95% CI: 6.8%, 12.9%)Spine/back: -7.1% (95% CI: -9.8%, -4.3%)

0

0.5

1

1.5

2

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3

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Year

Back pain

Other work stress

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

0

10

20

30

40

50

Other work stress Spine/back

1999 Incidence rate per100,000 employed

The International Network – Title and Timeline to date

• MODERNET: A network for development of new techniques for discovering trends in occupational and work-related diseases, and tracing new and emerging risks

• 2007 – ‘self’ funded start – meetings Amsterdam, Manchester, Milan, Paris etc

• COST.EU funding (European Cooperation in Science and Technology). Action dates: 09/11/2010 - 08/11/2014.

Final report by 08/04/2015

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Research directions:Scientific context and objectives • Collect the best evidence (1st Cochrane Review on the

subject) and use it to drive better data quality

• Innovate in methodology in observational epidemiology –studying trends in OD incidence in several countries and using novel controlled methods and interrupted time series designs to test whether EU directives or other measures reduce risk of OD

• Develop novel tools (Web based and others) to use collective vigilance and data processing methods to identify new OD or new causes of OD

• Tell everyone about this!

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ManagementChair: Raymond Agius (UK)

Vice Chair: Annet Lenderink (NL)

WG1 Leader: Stefano Mattioli (IT)

Improvement of quality of data collection

WG2 Leader: Roseanne McNamee (UK)

Application of new techniques and methods for analysis of trends

WG3 Leader: Vincent Bonneterre (FR)

New techniques for tracing newly occurring occupational diseases

WG4 Leader: Claudio Colosio (IT)

Dissemination

STSM co-ordinator: Lode Godderis (BE)

Scientific highlights of the international MODERNET network

.... Some snippets of examples follow ...

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Belgium FBZ

Czech Registry

Finland Register

France CNAM-TS

France TMS

France PNSM

France ONAP2

France WRD

France RNV3P

Germany DGUV

Ireland DSP

Ireland CSO

Ireland Injuries

Ireland THOR

Italy Malprof

Macedonia Register

Netherlands

Norway Labour Inspectorate

Norway OM clinic register

Spain

UK THOR

UK SWI

UK RIDDOR

UK IIDB

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Significant Highlights in ScienceTrends over time in incidence of selected Occupational Diseases in the EU (2000-2012). Stocks et al (submitted for publication)• 10 countries collaborated in data sharing for 1st time• Contact dermatitis, asthma, NIHL and Carpel tunnel syndrome (used as proof of

principle)

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Significant Highlights in Science..

• Results presented at EU commission’s conference on Occupational Diseases, Brussels Dec. 2013

Significant Highlights in Science..

• Further work in France & UK showing how such data could be used to evaluate the impact of EU interventions (such as the CrVI Directive) to prevent ill-health.

• This is essential to support policy makers and to i nform regulatory needs.

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Significant Highlights in Science ....- Early detection of new work-related diseases / occ upational diseases / ‘emerging risks’

MODERNET developed the OccWatch project (Occupational Diseases Sentinel Clinical Watch System) designed to :

1. CAPTURE case-reports of potentially new work related diseases

2. EXCHANGE AND ANALYSE the relevance of clinical signals3. SUMMARIZE: produce a common expertise4. DISSEMINATE briefing notes to stakeholders

•Web-based tool: https://occwatch.anses.fr/ (limited access)•Presented in EU commission’s conference on Occupational Diseases, Brussels Dec. 2013•Better to capture cases or ‘pick up weak signals’ than similar extant initiatives at national levels (including within MODERNET)•Hence powerful tool to protect society through improved surveillance and preparedness

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Networking

• Research partnerships within the COST Action

• Sharing knowledge and methods between partners

• Fostering of early stage researchers

• Networking with other COST Actions e.g StanDerm

• Further strengthening links with EU Agencies

e.g. DGV, EU-OSHA, …. EuroStat

• Networking with others e.g. Public Health etc

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Results vs. ObjectivesGoals/objectives Progress Value of

networkingComplete survey on extant EU data.Develop evidence based methods for improving data quality.

Survey completed.Cochrane Review completed.Recommendations made.

EU wide survey on extant data. Joint working on review.

Study trends in OD across the EU.Evaluate selected interventions.

Generally consistent EU trends shown. International evaluations showed that EU and other interventions tend to work.

Debate on methods. Consistency in data from several EU countries

Innovate in methods to identify new OD and emerging risks

Launch of “OccWatch” online Wide consensus on methods and acceptability. ‘Power’ to capture cases.

Disseminate in peer-reviewed and other media

Further dissemination in Web & social media. Special issue of “Occupational Medicine” planned

Essential to secure a strong and balanced portfolio to persuade the Editorial Board

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Participating countries

Albania (non-Cost)Australia (non-Cost)BelgiumBosnia & Herzegovina

CroatiaCzech RepublicFinlandFranceGermanyIceland

Ireland ItalyMacedoniaMaltaNetherlandsNorway

Portugal**RomaniaSpainSwitzerlandUnited Kingdom

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Action participants

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Use of COST ‘Instruments’

Activity (No.) Year 1 Year 2 Year 3 Year 4

MC/WG Meetings

2/2 2/3 2/3 2/2

STSMs* 0 3 5 6

Workshops or Conferences

1 2 2 2

Joint Publications**

0 1 9 (~ 12 )

*STSMs = ‘Short term scientific missions’.

There were 14 of these: 5 were from France and 8 were hosted by the UK.

**Estimate of net additional ‘partnership’ output

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Legacy of MODERNET to date

• Extensive Peer reviewed public domain output

• Wider sharing and application of better methods to:

• Achieve quality of data collection

• Trace new Hazards e.g. OccWatch

• Measure trends and evaluate interventions

• Cadre of better trained ‘Early Stage Researchers’

• Research active partnerships – bilateral / informal to multilateral / formal

• Website / forum

• Final Action Publication (being written)

Way ahead

These include:

•Horizon 2020 application submitted

• Widening UK networks ( today’s event refers)

• Other research partnership grant applications

Thank you for listening

Relevant URLs:

http://www.population-health.manchester.ac.uk/epidemiology/COEH/research/thor/

..or the following shorter URL instead:

www.coeh.man.ac.uk/thor

http://www.costmodernet.org/

AcknowledgementsPhysicians reporting to THOR

Members of ModernetUK HSE, & COST.EU for financial support

and especially for this presentation:Dr Melanie Carder, Dr Louise Hussey, Dr Annemarie MoneyDr Jill Stocks