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Presenting author profile

Dr. Vidhya Venugopal, a Professor of Occupational and Environmental Health at SRIHER, is a renowned occupational hygienist and climate change scientist. With a Ph.D. from NEERI and international training, she leads research on heat stress, workload, and renal health. She has completed eight large-scale heat stress studies, guided multiple Ph.D. scholars, and collaborated globally. A British Chevening Scholar, she serves on key climate-health committees and directs the NIHR Centre’s HEAT-PROJECT in India.

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Vidhya Venugopal (1); Rekha Shanmugam (1); PK Latha (1); KG Gayathri (1); D Nikitha (1)

1. Sri Ramachandra Institute of Higher Education and Research, Chennai, India

Background

Climate change increases occupational heat risks for women in outdoor informal employment, where heat exposure, productivity losses that require longer work hours, and gendered social duties create poorly understood vulnerabilities. This study examined how occupational heat stress and the need for extended work hours to maintain productivity affect women's health and social well-being in hot working environments.

Methods/Approach

We conducted a cross-sectional study with ~1,500 women in high-temperature occupations (construction, agriculture, salt production, brick manufacturing, stone quarrying) across Tamil Nadu, India (2017-2021). Environmental heat stress was measured using Wet Bulb Globe Temperature (WBGT), physiological strain through core body temperature (CBT) and urine specific gravity (USG), and elicited occupational/social impacts via a questionnaire. Analysis included descriptive statistics, odds ratios, and multivariable logistic regression.

Results

The study population had a mean age of 40.9 ± 11.5 years. Heat exposure exceeded ACGIH TLVs in 41% of participants, with 89% reporting heat-related symptoms. Among workers with extended shifts and inadequate rest, 60% exhibited dehydration (USG > 1.020). Multivariable analysis showed 2.1-fold higher odds of hazardous heat exposure (95% CI: 1.6–2.8; p<0.001), and 3.7-fold greater likelihood of heat strain symptoms (95% CI: 2.4–5.5; p<0.001). Women with combined heat stress and extended work schedules had a 1.7-fold increased risk of adverse social outcomes (95% CI: 1.2–2.3; p<0.05). 50% reported psychological distress from compromised caregiving, including guilt and frustration, leading to deteriorated family relationships and social isolation that intensified during peak heat seasons.

Conclusions

Occupational heat stress intersects with gendered social responsibilities, showing dose-response relationships among heat exposure, extended hours, and health-social outcomes that extend beyond individual health to household and community well-being. Findings support the urgent need for climate-sensitive policies and intersectional worker protection addressing physiological and social climate vulnerabilities.

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Yonah Amster (1)

1. University of Haifa School of Public Health, Haifa, Israel

Background

While the concept of environmental justice has significantly reshaped how environmental health disparities are understood and addressed, a parallel framework has not yet been fully articulated in the field of occupational health. This gap leaves many structural and social inequities in the workplace unaddressed, particularly those affecting low-wage workers, marginalized communities, migrant laborers, and workers in the informal economy. The emerging concept of occupational justice offers a powerful lens for examining how systemic barriers restrict certain groups from fair, healthy, and dignified work.

Methods/Approach

This presentation explores how the principles of occupational justice—originally developed in occupational therapy—can be adapted to the field of occupational health. These principles include the right to meaningful, safe work, equitable access to protections, and agency in shaping one’s work environment. We will discuss a framework that integrates social determinants of work, power dynamics in labor structures, and the role of policy in perpetuating or alleviating disparities. Real-world examples from essential, precarious, and marginalized labor sectors will illustrate how occupational injustice manifests and how current occupational health paradigms fall short in addressing it.

Results

Adopting an occupational justice approach compels a shift from individual-level risk mitigation to systemic advocacy and reform in occupational health. It highlights the need for intersectional data collection, community-engaged research, and regulatory accountability that prioritizes worker voices and lived experiences.

Conclusions

Actions include developing participatory research partnerships with underrepresented worker communities, advocating for inclusive policy reforms, and embedding occupational justice principles into occupational health education, standards, and practice. Public health professionals should integrate this emerging framework in their research and advocacy, as essential to achieving health equity in the workplace.

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Michael D. Weiden (1,2); David G. Goldfarb (2,5,6); Marie-Hélène Walraedt (3); Xander Bertels (3,4); Guy G. Brusselle (4,7); Hillel W. Cohen (6); David J. Prezant (2,5,6), Lies Lahousse (3,4)

1. New York University School of Medicine, New York, New York, USA
2. Fire Dept of New York City, Brooklyn, New York, USA
3. Ghent University, Ghent, Belgium
4. Erasmus Medical Center, Rotterdam, the Netherlands
5. Montefiore Medical Center, Bronx, New York, USA
6. Albert Einstein College of Medicine, Bronx, New York, USA
7. Ghent University Hospital, Ghent, Belgium

Background

Decline in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) are associated with mortality. Moreover, visit-to-visit FEV1-variation is associated with mortality in World Trade Center (WTC) exposed Fire Department of the City of New York (FDNY) rescue/recovery workers and in cystic fibrosis patients, supporting our hypothesis that FEV1 variability is a pathophysiologic relevant mortality risk factor and not just measurement error. Our aim was to investigate whether FEV1- or FVC-visit-to-visit-variability are mortality risk factors in occupational and a community-based cohort.

Methods/Approach

The WTC FDNY cohort was 39.0+/-7.7 years old (mean +/- SD) at first forced expiratory volume at 1-second (FEV1) measurement, with 4.5% mortality (454/10,106) from 2001 to 2023. Each doubling of FEV1-visit-to-visit-variability increased mortality hazard 26% (HR=1.26, 95%CI=1.13-1.41). Each doubling of forced vital capacity (FVC)-visit-to-visit-variability increased mortality hazard 35% (HR=1.34, 95%CI=1.22 to 1.51) The Rotterdam replication cohort was 67.5 +/- 5 years old, with 21.7% mortality (171/788) from enrollment 2009-2014 to study end-date (2022). Each doubling of FEV1-visit-to-visit-variability increased mortality hazard 17% (HR=1.17, 95%CI=1.14 to 1.20).

Results

Increasing pulmonary function-visit-to-visit-variability are mortality risk factors in both a young occupational cohort with low mortality (WTC FDNY) and an older general population-based cohort with higher mortality (Rotterdam). The observed associations may be useful for developing risk stratification models that include measures of longitudinal lung function-variability, along with absolute values for FEV1 or FVC.

Conclusions

Lung function visit-to-visit-variation is a relevant mortality risk factor in an occupational cohort (WTC FDNY) and a community-based cohort (Rotterdam). Future intervention studies could use lung function visit-to-visit-variation as a pre-specified outcome to predict mortality

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Davide Bergonzini (1); Alberto Modenese (1)

1. University of Modena and Reggio Emilia, Modena, Italy

Background

Solar ultraviolet radiation (UVR) is a well-established risk factor for skin cancer. However, the
specific relationship between occupational UVR exposure and different melanoma subtypes
remains controversial. Malignant melanoma has historically not been consistently recognized as an
occupational disease in outdoor workers, despite accumulating evidence linking it to chronic sun
exposure. This study aims to evaluate the association between occupational solar UVR exposure
and the development of cutaneous melanoma, with a particular focus on subtypes related to
cumulative sun damage (CSD), in patients attending the Dermatology Clinic of Modena University
Hospital.

Methods/Approach

We will conduct a case-control study involving approximately 300 participants (120 melanoma
cases and 180 controls with other skin lesions), matched by age and sex. All participants will
complete a standardized, interviewer-administered questionnaire covering sociodemographic
characteristics, non-occupational melanoma risk factors, and detailed occupational histories.
Outdoor workers will receive additional evaluation regarding UVR exposure intensity and
photoprotection practices. Clinical data—including dermoscopic, reflectance confocal microscopy,
and histopathologic subtype information—will be collected. Occupational UVR exposure will be
assessed using a Job Exposure Matrix (JEM) based on ISCO-88 codes and data from the EPHOR
project. Multivariate statistical models will be used to estimate the association between UVR
exposure and melanoma risk.

Results

This study aims to support the validation of the Italian workers’ compensation authority, i.e. INAIL,
criteria for occupational melanoma, particularly for CSD-associated subtypes such as lentigo
maligna melanoma.

Conclusions

Findings are expected to inform targeted prevention strategies, enhance occupational disease
reporting accuracy in Italy, and contribute to global efforts to quantify the burden of work-related
skin cancers and promote occupational health policy updates.

Presenting author profile

Kurt Straif is a Research Professor at Boston College and Research Associate at ISGlobal, where he focuses his work on research and policy on topics including global cancer prevention and climate change and health.

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Kurt Straif (1,2)

1. Boston College, Boston, Massachusetts, USA
2. ISGlobal, Barcelona, Spain

Background

The international health community advocates for bringing health to the COP climate negotiations, with the strategic perspective that anticipated health benefits may support more ambitious climate negotiations. While climate change and occupational health has so far not played a significant role, the topic may provide unique opportunities.

Methods/Approach

This presentation reports and updates on international negotiations including at UNFCCC COP29 and SB negotiations, related IPCC activities and WHO, with a focus on progress, hurdles and opportunities. After the first ever official Health Day at COP28 in Dubai in December 2023, last year’s World Health Assembly (WHA) endorsed a resolution on Climate Change and Health: While COP29 in Baku, in late 2024, did not make significant progress on bringing health to the COP negotiation table, there are expectations that COP30 in Belem, in November 2025, may mark the next milestone on the nexus on climate change and health at official COP negotiations. Discussions and preparatory negotiations at the annual mid-year Subsidiary Body (SB62) meetings in Bonn, Germany will provide important directions. At WHO, after difficult discussions, the WHA78 in May finally endorsed the Global Programme of Action, supporting the continued and broadened focus of WHO on topics at the intersection of climate change and health.

Results

Additional and ongoing opportunities for engagement include the preparation of the IPCC 7th Assessment Report (specifically the inclusion of health topics), and the support of countries in developing the next round of Nationally Determined Contributions (NDC 3.0), and the development of a consensus on health indicators to be adopted by the COP.

Conclusions

The presentation aims to update all Fellows on progress and hurdles regarding international negotiations on climate change and health and stimulate discussion and sustained action by the Collegium.

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Rebecca Gasparini (1); Sara Scilli (1); Alberto Modenese (1)

1. University of Modena and Reggio Emilia, Modena, Italy

Background

Occupational contact dermatitis (OCD) is a common occupational health condition with substantial socioeconomic impact. However, underreporting - driven by the perceived low severity of symptoms, limited awareness of work-related causes, and mistrust in reporting systems - hinders effective surveillance and intervention. This study aims to quantify the extent of OCD underreporting in Italy by comparing the national workers’ compensation authority, i.e. INAIL (National Institute for Insurance against Accidents at Work), data with the expected incidence rates.

Methods/Approach

Claims for dermatitis and eczema (ICD-10 codes L20-L30) filed between 2019 and 2023 were extracted from the INAIL database. Expected incidence in selected sectors, identified by ISCO-08 codes, was estimated using data from the EPIDERM study (McDonald et al., 2006) and, when available, more recent cohort studies. While INAIL reported an average of 199.4 OCD cases/year, EPIDERM estimates range from 1,396 to 14,621 cases/year, based on reports from dermatologists and occupational physicians, respectively. Adjusting for cohort-based incidence rates - 410 cases per 100,000 healthcare workers in Italy, and 214 per 100,000 construction workers in the Netherlands - yields an estimated 24,556 expected cases annually. This suggests that only 0.8% to 14.3% of OCDs are currently being reported. High-risk sectors such as hairdressing may account for additional underreported cases with up to 150 cases annually in Italy for this category alone.

Results

To mitigate underreporting, targeted strategies are required. These include increasing awareness among both workers and employers, improving workers’ health surveillance with dermatological screening programs in high-risk sectors and simplifying INAIL reporting procedures.

Conclusions

To reduce OCD burden and enhance occupational health outcomes, future actions should include the development of longitudinal cohort studies, educational campaigns, training on the proper use of personal protective equipment, and the creation of multidisciplinary task forces involving dermatologists, occupational physicians, and workplace safety experts.

Presenting author profile

Dr. Ching-Chun Lin is an assistant professor of the Institute of Environmental Health Sciences at National Taiwan University College of Public Health where she has worked with residents in several areas to better understand and then remediate environmental hazards.

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Ching-Chun Lin (1); Chi-Jen Chen (1); Pau-Chung Chen (1,2)

1. National Taiwan University College of Public Health, Taipei, Taiwan
2. National Institute of Environmental Health Sciences, Miaoli, Taiwan

Background

Given growing concerns about climate-related health impacts, this study assessed the relationship between ambient temperature fluctuations and perinatal mortality in Taiwan.

Methods/Approach

A time-stratified case-crossover design was employed using data from the National Health Insurance Research Database (NHIRD) and the national birth and death registration databases covering the period from 2004 to 2014. A total of 25,067 perinatal deaths were identified, comprising 22,998 stillbirths and 2,069 early neonatal deaths. Associations between ambient temperature and perinatal mortality were assessed using distributed lag nonlinear models (DLNM) within conditional logistic regression, as well as generalized estimating equations (GEE) with a Poisson link function. Exposure to extreme ambient temperatures during the 1–6 days preceding delivery was associated with an increased risk of perinatal mortality, including stillbirths and early neonatal deaths. Elevated risks were consistently observed at high temperatures (>28–30°C), particularly for daily maximum temperature. U-shaped exposure–response relationships were evident across all temperature parameters. Early neonatal deaths exhibited the greatest sensitivity to both cold and heat exposures, while stillbirths and overall perinatal deaths were more strongly associated with heat.

Results

Both heat and cold exposures shortly before delivery may elevate the risk of perinatal mortality, with high temperatures posing a particularly consistent threat. As climate change intensifies the frequency and severity of temperature extremes, these findings highlight the need for targeted public health interventions to protect pregnant individuals and newborns.

Conclusions

Strategies such as heat alerts, environmental modifications, and enhanced thermal regulation in maternal care settings are essential to reduce temperature-related perinatal risks.

Presenting author profile

Oladele Ogunseitan holds the title of distinguished professor in the Department of Population Health & Disease Prevention, and the Department of Environmental & Occupational Health at the University of California, Irvine. He co-directs the World Institute for Sustainable Development of Materials (WISDOM). His research identifies opportunities for adopting less-toxic materials in consumer products, and for managing hazardous wastes through a circular economy approach. He co-chairs the green chemistry advisory board for Apple, Inc.

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Candace Tsai (1); Shane Que Hee (1); Yifang Zhu (1); Tian Xia (1); Danny Kim (2); Airek Mathews (3); Oladele Ogunseitan (4)

1. University of California, Los Angeles, California, USA
2. California State University, Fullerton, California, USA
3. Compton College, Compton, California, USA
4. University of California, Irvine, California, USA

Background

The persistent demand for technically innovative and functionally versatile electronic products drives the use of nanomaterials and toxic metals and compounds in manufacturing and the accumulation of hazardous waste. Consequently, there is a need to characterize emerging environmental exposures and work practices to reduce pollution and prevent diseases. Since 2021, the Southern California Superfund Training Program, funded by the US National Institute of Environmental Health Sciences, has implemented academic curricula, research experiences, and continuing education courses in industrial hygiene and environmental health sciences for postgraduate students and industrial hygienists in the Southern California region.

Methods/Approach

We developed an immersion summer program to engage trainees through six areas of study: (1) fundamental knowledge of nanotechnology and nanomaterials (NMs), (2) occupational and environmental exposure and health effect of NMs including toxicological responses in humans, in animals and in vitro bioassays in response to exposures, managements of exposures, and regulatory enforcement, (3) best practices for preventing hazardous exposures, and managing occupational exposures including nanotechnology-enabled products in electronics, quantum dots, and graphene, (4) environmental impacts of e-waste and NM-containing waste, (5) industrial hygiene policies including universal precautions and health risk guidelines, and (6) augmented reality technology to provide unique learning experiences.

Results

Through integration of innovative pedagogical activities and research projects, trainees gain an understanding of theoretical frameworks underpinning the attribution of materials used in manufacturing to the research outcomes on burden of diseases, occupational and environmental policy development, and solutions including green chemistry and materials life cycle analysis.

Conclusions

A consortium of investigators, industry partners, and policy agencies convened to develop a proposal for Southern California Superfund Research Center for E-Waste (SoCal-SRCE) focusing on translational research on priority and emerging toxicants with results leading to healthier communities in remediated environments; and training of the next generation of professionals to ensure sustainable implementation of SoCal-SRCE’s vision.

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Elida Mataj (1); Eugena Tomini (1); Gjergji Koja (2); Ivana Sulaj (1); Samira Mataj (3)

1. Institute of Public Health, Tiranë, Albania
2. University of Elbasan Aleksander Xhuvani, Elbasan, Albania
3. Polyclinic No.7, Tiranë, Albania

Background

The air quality crisis in cities is largely due to vehicle emissions. Transportation systems are growing everywhere and improvements in technology are insufficient to counteract the growth. The air quality crisis in cities is often attributed to a large extent (40-80%) to vehicle emissions. Exposure to these pollutants, especially in urban environments, is linked to respiratory problems, cardiovascular problems. The aim of this study was to assess lead and CO₂ emissions and the impact on the development of health problems

Methods/Approach

The study is an ecological study based on the Driving force-Pressure-State-Exposure-Effect-Action (DSPEEA) framework recommended by WHO. The basic unit of the study was the population and not the individual. The study included 24 districts of Albania. The information collected was based on data from the source of air pollution (vehicles and the fuels used by them). Data were also used to assess morbidity and mortality from respiratory and cardiovascular diseases at the country level.

Results

The coefficient of average consumption of leaded gasoline per car per capita was positive and significant p<0.001, indicating that the increase in leaded gasoline consumption is associated with an increase in Pb concentration in μg/m³/year/volume of air in the 4 years studied. The positive and statistically significant coefficient of diesel consumption (B = 40.183, p = 0.005) indicates that an increase in annual diesel consumption is associated with a corresponding increase in CO₂ emissions per capita. Infant mortality from respiratory problems during the period varied from 0 - 6.45/1000 live births. Prevalence of respiratory and cardiovascular diseases increased during 2021-2024. Respiratory and cardiovascular mortality rates for all age groups showed an increasing trend.

Conclusions

At the conclusion of this study, based on the results obtained, essential gaps in data and methods were identified that limit the ability to draw valid correlations between exposure and health impact.

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Johanna Elbel (1)

1. Sciences Po University School of Public Affairs, Paris, France

Background

Ghana’s informal e-waste sector sits at the intersection of global waste
and recycling value chains and is central to circular economy narratives. The sector
faces severe environmental and health risks, and policy approaches to
regulate these risks differ. This study investigates decision-making
processes in Ghana’s e-waste sector, focusing specifically on the
power dynamics that shape policy and its effects on workers’ health.

Methods/Approach

The case study showcases the potential for the sustainable
transformation of the Ghanaian e-waste sector within a multi-stakeholder landscape. These stakeholders are setting up a novel approach to the organization of the
e-waste sector and its environmental hazards, which is based on
incentive-based mechanisms. In addition, e-waste workers, are
returning to the scrapyard Agbogbloshie in 2025 after its destruction in
2021, highlighting resistance to coercive, top-down approaches.
Differentiating policy strategies can be identified. The success of policy
depends on the recognition of informal e-waste workers, which
influences environmental policy compliance and health outcomes.

Results

Informal e-waste workers’ health can be positively impacted by a
strengthened multi-stakeholder e-waste management system that
addresses workers’ needs. By strengthening workers’ associations and
increasing the willingness of workers to join these, the participation and
reach of collectors can be ensured. To organize the system in Ghana
sustainably, donor dependency must be decreased, potentially by
expanding national recycling capacities. General awareness of e-waste
as a problem, along with its environmental and health effects, must be
improved.

Conclusions

Future research on the willingness of workers to shift to the organized
sector and on the willingness of the public to participate in collection
systems is recommended. Further, a comparison of private versus
public initiatives and their different potential to impact occupational
and environmental health should be explored to develop best-practice
examples.

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Dagllas Alushi (1); Enrico Barbolini (1); Alberto Modenese (1); Roberto Lucchini (1,2); Maurilio Missere (3)

1. University of Modena and Reggio Emilia, Modena, Italy
2. Florida International University, Miami, Florida, USA
3. Giardini Margherita Clinic, Bologna, Italy

Background

The automotive industry is experiencing a major transformation toward electric mobility, introducing novel occupational risks alongside traditional hazards. Innovations involve the adoption of cutting-edge materials and technologies—such as lithium-ion batteries, high-voltage systems, and advanced mechatronic components—that expose workers to unfamiliar dangers.
This study provides an overview of emerging occupational risk factors related to electric vehicle (EV) production, with a particular focus on chemical, ergonomic, and electromagnetic hazards. It is based on a comprehensive literature review combined with interviews with health and safety professionals, field data consultations and observations at production facilities of a leading automotive company in northern Italy currently undergoing transition to electric mobility.

Methods/Approach

The findings highlight four main categories of emerging risks:
1. Electrical and fire/explosion hazards associated with components operating at voltages exceeding 400 V, necessitating updated safety protocols and specialized infrastructure (e.g., ventilated battery shelters).
2. Exposure to electromagnetic fields (EMF), which is especially concerning for workers with active implantable medical devices and requires targeted preventive measures.
3. Chemical exposures to lithium, cobalt, nickel, manganese, and solvents during battery production, underscoring the need for enhanced monitoring and protective strategies.
4. Ergonomic strain from handling heavy and bulky components (e.g., battery packs), calling for detailed biomechanical risk assessments and customized interventions.

Results

The study underscores the urgent need to revise occupational health surveillance protocols to reflect these evolving risks and implement focused preventive actions. Occupational physicians play a pivotal role in supporting companies through this technological transition by detecting early warning signs and updating health and safety practices accordingly.

Conclusions

This work contributes to a deeper understanding of the impact of industrial innovation on worker health and highlights the critical importance of adaptive preventive measures in rapidly evolving production environments.

Presenting author profile

Davide Degli Esposti is a molecular biologist, research scientist in molecular ecotoxicology and toxicology with main research interest on the reprotoxicity of pesticides and phenotypic plasticity to environmental exposures.

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Davide Degli Esposti (1)

1. Centre de Lyon-Grenoble Auvergne-Rhône-Alpes, Villeurbanne Cedex, France

Background

Endocrine disrupting chemicals (EDCs) are an important part of the anthropogenic chemical pollution that affects the entire ecosystem, hindering human and ecosystem health. A substance is identified as an EDC if: i) it interferes with hormone function (endocrine activity); ii) it produces adverse effects in an intact organism or its descendants or future generations; iii) there is a plausible biological link between the endocrine activity and the harmful effect. This framework underscores the need for integrating multiple lines of evidence—in silico, in vitro, and in vivo—to support the identification of EDCs.

Methods/Approach

This presentation offers a comparative overview of endocrine systems and toxicological tools used to assess endocrine disruption in selected vertebrate (fish, mammals) and invertebrate (crustaceans) models. Through case studies, I will highlight both progress and existing research gaps that must be addressed to improve our ability to identify and predict chemical-induced chronic effects on the endocrine system.

Results

Understanding endocrine disruption through a One Health framework calls for a unifying approach that balances the health of humans, animals, and ecosystems. In order to achieve this goal, it is necessary overcoming methodological and conceptual challenges to develop a protective, cross-species framework for managing chemical hazards.

Conclusions

In order to promote understanding of and prevent the causes of endocrine disruptors in a One Health framework, deeper collaboration is needed among researchers in mechanistic (eco)toxicology, long-term and multigenerational bioassays, ecological and epidemiological studies and risk assessors.

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Warren Casey (1)

1. National Institute of Environmental Health Sciences, Durham, North Carolina, USA

Background

The field of toxicology is rapidly evolving, with growing emphasis on New Approach Methodologies (NAMs) that aim to improve human relevance, reduce reliance on animal testing, and enhance the efficiency of safety evaluations. Understanding the historical development of NAMs—including early validation efforts, regulatory considerations, and conceptual shifts—provides critical context for their current and future application

Methods/Approach

Over the past several decades, the field of toxicology has undergone a profound transformation, driven by the need for more human-relevant, efficient, and ethical testing strategies. This presentation provides a historical perspective on the development of New Approach Methodologies (NAMs), tracing key milestones from early conceptual debates around validation to the growing shift away from animal replacement as the central goal, toward the broader imperative of modeling human biology. The evolution from mimicking traditional apical endpoints to adopting mechanistic and pathway-based approaches is highlighted, along with the increasing role of chemoinformatics and integrative data platforms that support predictive and transparent risk assessments. Together, these developments illustrate how regulatory science, policy changes, and scientific innovation have converged to reshape the future of toxicology.

Results

A historical perspective clarifies how key decisions and evolving scientific priorities have shaped the current landscape of NAMs. By examining the transition from animal replacement to human-centric, mechanism-based approaches, stakeholders can better appreciate the rationale for adopting NAMs in both regulatory and research contexts. Integrative platforms and chemoinformatics tools are now enabling more predictive and transparent assessments, supporting broader acceptance and implementation.

Conclusions

Future efforts should focus on harmonizing validation frameworks, expanding access to curated, interoperable data platforms, and fostering collaborations that support the integration of NAMs into decision-making. Continued education and stakeholder engagement will be essential for accelerating progress and ensuring scientifically robust, policy-relevant applications of NAMs.

Presenting author profile

Dr. Luoping Zhang is a Professor Emerita in toxicology and has worked for 30-plus years at the School of Public Health at Berkeley. Her research focuses on understanding molecular mechanisms of bone marrow toxicity and carcinogenesis caused by many toxic chemicals detected in the environment and workplaces. She was elected a fellow of the Collegium Ramazzini in 2019 and awarded a Fulbright Scholar visiting appointment at University of Udine, Italy in 2022.

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Iemaan Rana (1); Gabrielle Rigutto (1); Azhagiya Singam Ettayapuram Ramaprasad (1); Cliona McHale (1); Alan Hubbard (1); Martyn Smith (1); Luoping Zhang (1)

1. University of California, Berkeley, CA, USA

Background

The key characteristics (KCs) of carcinogens reflect properties commonly exhibited by human carcinogens, including chemical, physical and biological hazards. This novel approach has been recently adapted to evaluate mechanistic evidence by IARC and other agencies.

Methods/Approach

To identify, organize, and assess these mechanistic studies, however, can be challenging and time-consuming as they are voluminous and involved in a wide variety of model systems and assay procedures.

Results

This presentation will introduce a newly developed framework aiming to systematically identify relevant studies, uniformly organize and integrate the data, and quantitatively analyze large volumes of data efficiently. In addition, a comprehensive KC-based assay database, an online system mapping all KC-related endpoints, will be presented and discussed.

Conclusions

The quantitative KC approach should be tested with more toxic chemicals by others, and the KC-based assay database could be applied by more users for all ten KCs in the near future.

Presenting author profile

Dr. Carlos Santos-Burgoa is a Mexican physician and epidemiologist, former Dean at INSP, and architect of COFEPRIS. He has held senior roles at PAHO/WHO, led research identifying 1,3-butadiene as a carcinogen, and advanced lead exposure regulations. Now a Professor at George Washington University, he leads major public health initiatives and studies, including Hurricane Maria Mortality in Puerto Rico. He is a Fellow of the National Academy of Medicine, the Rockefeller Foundation, and the Collegium Ramazzini.

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Carlos Santos-Burgoa (1,2)

1. The George Washington University School of Public Health, Washington DC, USA
2. Colaborativo Mundo Quimico, Mexico City, Mexico

Background

Lead, the oldest known toxin, entered widespread use in Mexico following the Spanish conquest. Its dangers were recognized in Europe by the 18th century, leading to restrictions; such measures were not mirrored in the Americas. This presentation addresses recent efforts to secure resources for lead-related work amid limited public budget, the normalization of lead exposure, and the complex web of interests—including significant conflicts of interest involving global NGOs—shaping the issue. The aim is to provide insights applicable to similar situations elsewhere.

Methods/Approach

We present the unique sources and patterns of lead exposure in Mexico, the country’s regulatory landscape, and progress in measuring childhood lead intoxication. The 2018 National Health Survey, 17.5% of Mexican children under five had B-Pb levels above 5 mcg/dl—an unchanged figure. An Immediate Action Program, approved in 2019, was hampered by the COVID-19 pandemic, the collapse of the public healthcare system, chronic underfunding, and shifting political priorities. Although some progress was made, the program lacked financial support, social foundation, and declining political interest, with deregulation removing key interventions. Additional challenges stem from research and intervention supported by lead industry-funded NGOs, creating conflicts of interest that complicate efforts to lower blood lead levels guidelines.

Results

A trend of reduced financial support for environmental and occupational health research is emerging globally. While private funding may offer an alternative, it introduces risks of policy interference, such as adjusting exposure limits to favor commercial interests or shielding production chains from regulation. This dynamic affects many in the Collegium and demands attention.

Conclusions

To address these challenges, there is a need for institutional frameworks that expand resources for lead intervention and research, tailored to local realities and safeguarded against the capture of regulatory and health protection processes by private or political interests. An outline for such an architecture will be presented.

Presenting author profile

Bruce Lanphear, MD, MPH, a preventive medicine physician and professor at Simon Fraser University in Vancouver, British Columbia, has investigated the toxicity of lead and other toxic chemicals on human health for the past 30 years. Bruce led studies used by federal agencies to set standards for lead in air, water and house dust, and his studies were the impetus for federal agencies to conclude that no amount of lead is safe for children.

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Bruce P. Lanphear (1)

1. Simon Fraser University, Vancouver, British Columbia, Canada

Background

Lead is a potent toxic metal with no known safe level of exposure. Despite major declines in industrial use, lead remains a widespread environmental hazard. This presentation examines the health effects of low-level lead exposure across the life course and highlights striking global disparities in disease burden.

Methods/Approach

Even very low levels of lead are linked to serious health effects, including preterm birth, IQ deficits, and increased risk for attention-deficit/hyperactivity disorder (ADHD). In adults, chronic lead exposure contributes to kidney disease and significantly increases the risk of coronary heart disease. Recent global estimates suggest that lead exposure accounts for more than 5.5 million deaths annually—primarily from cardiovascular causes—and disproportionately affects industrializing countries. Blood lead levels that are common in many nations remain strongly predictive of cognitive and cardiovascular outcomes, reinforcing lead’s lifelong impact on health and development.

Results

These findings challenge long-standing assumptions about “tolerable” lead exposure and underscore the urgent need for updated regulatory standards. Public health protections should reflect cumulative and population-level risks. The burden of lead-attributable disease from under-regulated industries is not only preventable—it represents a clear failure of environmental justice and global governance.

Conclusions

We call for coordinated international efforts to eliminate remaining sources of lead, with priority given to high-exposure communities in industrializing countries. Surveillance of environmental lead hazards must be expanded, especially in high-risk populations. Policy action should include stricter standards for lead in air, water, food, and consumer products, and sustained investments to eliminate lead hazards. Treating lead as a global environmental health emergency is essential to preventing chronic disease and reducing health inequities worldwide.

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Marina Steiner (1,2); Casey Bartrem (2); Petr Sharov (3); Aidar Kapassov (4); Gregory Moller (1)

1. University of Idaho, Moscow, Idaho, USA
2. TerraGraphics International Foundation, Moscow, Idaho, USA
3. Environmental Health Pollution Management Institute, Tbilisi, Georgia
4. Human Health Institute, Astana, Kazakhstan

Background

Shymkent, Kazakhstan is home to approximately 1.1 million people and the largest former lead and zinc smelter of the Soviet Union. Built in the 1930s, this refining and smelting center produced about 70% of all lead in the Soviet Union. During its more than 80 years of operation, the smelter released enormous amounts of lead-containing dust, which contaminated vast areas of the city, including residential properties. A 2011 study found that 95% of the children tested in the city had blood lead levels (BLLs) above 10 µg/dl, the average BLL was 20 µg/dl, and the highest measured child BLL was over 100 µg/dl.

Methods/Approach

In collaboration with the Environmental Health Pollution Management Institute (EHPMI) and Human Health Institute (HHI), TerraGraphics International Foundation is supporting ongoing efforts to assess heavy metal contamination in Shymkent. Handheld x-ray fluorescence (XRF) analyzers were used to quickly and reliably screen media for heavy metals. Throughout May and June 2025, additional XRF screening throughout the industrial zone will expand understanding of the extent and depth of heavy metal contamination in public spaces. Detailed site assessments of residences, including home vegetable gardens, coupled with testing of consumer products such as toys, paint, and dishes will help identify key areas for intervention and remediation in the home. Engaging residents in the screening process increases understanding of heavy metal exposures. In partnership with local government, researchers, and community members, site-specific remedial and health intervention strategies will be proposed to reduce heavy metal burdens on the most vulnerable communities.

Results

Results from the 2025 field work and analysis will be presented, along with multi-media human health risk assessment and proposed health intervention strategies.

Conclusions

This approach may be applied to similar smelter zones and other industrial communities across the world that are affected by decades of heavy metal contamination.

Presenting author profile

Stephan Bose-O´Reilly, is a professor for Environmental and Public Health at the Institute and Clinic for Occupational, Social, and Environmental Medicine, University Hospital, LMU Munich. He is a pediatrician whose main interest is to prevent children from disease by helping to reduce their exposure to toxic substances, such as lead and mercury. His special interests are introducing micro-sampling methods, transferring knowledge and capacities, and training of scientists and experts to improve children’s environmental health.

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Stephan Bose-O'Reilly (1)

1. Ludwig-Maximilians University (LMU), Munich, Germany

Background

Decades of mining and smelting activities in Kabwe have resulted in chronic environmental lead pollution. Lead is a potent neurotoxin, particularly harmful to children due to their developmental vulnerability and exposure behaviors. Despite the cessation of mining, contaminated soils and airborne dust continue to pose serious health risks.

Methods/Approach

Environmental and biological samples were collected from four townships near Kabwe's former smelting site. Blood lead concentrations were compared to WHO guideline values. Tree ring isotopic analysis identified historic contamination pathways. A cross-sectional study of 10,718 children (0–15 years) assessed BLLs, hemoglobin (Hb) levels, and growth indicators (height and weight).

Results

Median BLL was 22.4 μg/dL—over four times the WHO threshold. Over 95% of children had elevated BLLs; 1,500 exceeding 45 μg/dL, requiring chelation therapy. Anemia affected 23% of children, with a 50% increased likelihood of very high BLLs in anemic individuals. Stunted children were much more likely to have BLLs above 45 μg/dL. Exposure levels were highest in areas closest to the "Black Mountain" tailings and followed spatial patterns influenced by wind and distance.

Conclusions

Children in Kabwe remain severely exposed to toxic lead due to long-term environmental contamination. Elevated BLLs are strongly associated with anemia and stunting, especially in younger children. Immediate medical and environmental interventions are urgently needed. The situation exemplifies a pressing failure of environmental justice and public health responsibility.

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Jessica Harrison Fullerton (1); Hirushan Thayalan (1); Ben Savonen (1)

1. Global Development Incubator (GDI) Americas, Washington DC, USA

Background

Researchers, implementers, and funders engaged in addressing childhood lead poisoning in LMICs have largely reached a consensus that used lead-acid battery (ULAB) recycling is meaningfully contributing to lead poisoning and is a priority pathway to eliminate global lead poisoning, despite significant tractability challenges. Although there are a number of disparate research and mitigation efforts, the complexity of the challenge has inhibited funders, implementers and policy-makers from fully prioritizing the elimination of unsafe ULAB recycling. GDI is working to change that.

Methods/Approach

GDI leverages a multi-phase incubation model to identify a hypothesized solution to a root problem; validate the solution with partners, stakeholders, and funders; pilot interventions and build operational infrastructure; and launch independent initiatives that are strategically and operationally set up to achieve transformative impact.

This presentation will explain how GDI works with social impact leaders - oftentimes academics and researchers - to implement its incubation model and translate research into scalable evidence-based solutions. To illustrate our incubation approach, we will explain how GDI is working with a founding team of researchers to incubate an organization that seeks to catalyze government action and market condition shifts through foundational research, pilot implementation, and stakeholder coordination.

Results

A GDI-incubated organization will aim to address knowledge gaps and catalyze new collective mitigation efforts by i) launching and coordinating cross-cutting research, ii) designing and directly implementing pilot interventions to test ‘what works’ to eliminate unsafe ULAB recycling, and iii) sharing our lessons and collaborating with a network of stakeholders to scale successful pilots. Our goal is to generate evidence, share knowledge, and accelerate collective action from governments, industry-players, funders and NGOs to eliminate unsafe ULAB recycling.

Conclusions

GDI is in the early stages of the incubation process and will continue to refine the proposed organization’s strategy.

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Debraj Mukhopadhyay (1); Pierluigi Cocco (2); Roberto Cusano (3); Alice Spanu (4); Roberto Cherchi (5); Sara De Matteis (6)

1. University of Cagliari, Sardinia, Italy
2. University of Manchester, Manchester, United Kingdom
3. CRS4 (Center for Advanced Studies, Research, and Development), Cagliari, Italy.
4. Asbestos Related Respiratory Diseases in Industrial Areas (ARRDIA) Project, Cagliari, Italy
5. “G. Brotzu” Hospital, Cagliari, Italy
6. University of Turin, Turin, Italy

Background

The microRNA (miRNA) profile in the exhaled breath condensate (EBC) might serve as an early biomarker of asbestos-related disease.
The Asbestos-Related Respiratory Diseases in Industrial Areas (A.R.R.D.I.A.) follow-up study aims to detect the miRNA expression in the plasma and exhaled breath condensate (EBC) of 450 subjects, including workers with past exposure to asbestos, cases of asbestos-related lung cancer, pleural mesothelioma, and interstitial lung disease, and 200 healthy volunteers from the general population of the study area.

Methods/Approach

We used a Next Generation Sequency platform (HiSeq3000™, Illumina, San Diego, CA, USA), to investigate the miRNA expression in the plasma and the EBC. We then compared the EBC microRNA profile in 28 subjects, including 9 healthy, unexposed subjects, nine past-exposed free from asbestos-related disease, and 10 with interstitial lung disease (ILD), and explored the correlation between the EBC miRNA count and the cumulative asbestos exposure estimated retrospectively.

MicroRNAs are much less represented in the EBC compared to plasma. However, we observed a correspondence between the EBC and the plasma miRNA profile. There was no difference in the miRNA profile between the unexposed subjects and those with asbestos-related ILD. We detected an inverse correlation between specific EBC miRNA count and the estimated cumulative exposure to asbestos in subjects free from asbestos-related ILD.

Results

MicroRNA expression in the EBC might reflect in a smaller scale what observed in the plasma, with a higher organ-specificity. It might discriminate subjects with past exposure to asbestos from healthy, unexposed subjects. Their value in predicting asbestos-related disease was suggested following positive results in lung cancer and mesothelioma patients, However, we did not observe a differential miRNA profile in asbestos-related ILD patients.

Conclusions

The ARRDIA study is currently in progress. The analysis of the final dataset will have enough statistical power to confirm or discard these preliminary results.

Presenting author profile

Dr. Baur is retired chair of the Department of Occupational Medicine, University of Hamburg, Germany, and current president of the charity European Society for Environmental and Occupational Medicine.

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Xaver Baur (1); Johannes Ludwig (2); Arthur L. Frank (3)

1. European Society for Environmental and Occupational Medicine, Berlin, Germany
2. Hamburg University of Applied Sciences, Hamburg, Germany
3. Drexel University School of Public Health, Philadelphia, Pennsylvania, USA

Background

Millions of previously asbestos-exposed workers developed asbestos-related diseases (ARD) especially asbestosis, lung cancer and mesothelioma. This is due to mainly inadequate preventive measures and far too late asbestos bans in many parts of the world. We describe the related troublesome approach to prevention in Germany since 1973.

Methods/Approach

This is a project of the charity European Society for Environmental and Occupational Medicine (EOM) of a review of German historic documents and evaluation of the archive of the German anti-asbestos crusader Hans-Joachim Woitowitz, a longtime Collegium Ramazzini fellow.
In view of the increasing ARD morbidity and mortality figures over time the TLV of asbestos fibres was reduced step-by-step which was associated with significant sociopolitical controversies and opposition by industry and its associates. Finally, in 1993 an asbestos ban was initiated. Professor Woitowitz was the main initiator and driver of these most beneficial measures and of amendments for compensation of ARD.
Mesotheliomas of both pleura and peritoneum were caused by amphiboles as well as by chrysotile. In the former East Germany, DDR, the latter was mostly asbestos imported from Russia and a small amount from Canada; dozens of mesotheliomas were seen following such use.

Results

Our data demonstrate that amphiboles as well as chrysotile cause all mentioned ARD. History shows that powerful opposition by vested interests and their influences on sociopolitical boards and in the scientific literature led to a significant delay of urgently needed preventive measures resulting in a steady increase of ARD till 2019, of which only a small proportion ever received compensation. It was not until 2021, i.e. nearly 30 years after the asbestos ban, that related figures show a slight decline in Germany.

Conclusions

We will finalize and publish this review of initiatives of heavily opposed beneficial asbestos-related preventive measures and compensation issues in Germany.

Presenting author profile

Dr. Pelclova is a full professor at the Toxicological Information Centre of the Department of Occupational Medicine, Charles University and General University Hospital, focusing on occupational toxicology.

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Daniela Pelclova (1,2)

1. Charles University, Prague, Czech Republic
2. General University Hospital in Prague, Czech Republic

Background

Consistent prevention and expansion of the List of Occupational Diseases has contributed to the decrease in occupational diseases. However, unexpected exposures still occur..

Methods/Approach

The statistical data on occupational diseases in the Czech Republic (population of 10 million) were obtained from the National Registry of Occupational Diseases at State Institute of Public Health in Prague. The number gradually decline from a peak of 4,658 cases in 1962, to 1,112 - 1,370 cases in 2015-2019. The majority occurred in men (57%). In 2021-2024, due to the COVID-19 pandemic, the numbers increased to 5,290 and 7,001 cases.with 85 % of the cases in the economic sector “Health and Social Care.” 83% of patients were females.There is a several months delay before the acknowledgement can be completed, as both the clinical picture and the exposure has to be documented in every patient.

After exclusion of COVID-19 cases from the total of 5,290 diseases, the number of occupational disease cases in 2024 was 683. Eight were caused by exposure to chemicals and 368 by physical agents. Ninety-four were respiratory disorders, 69 skin diseases, 143 non-COVID infectious diseases and one dyspnonia.

On February 28, 2025, the Czech Republic experienced the world's largest benzene accident in central Moravia, when a freight train derailed due to high speed (95 km/h instead of permitted 40 km/h).About 350 tons of benzene was emitted and 15 rail cars exploded and caught fire. The firefighters had to work in special chemical-resistant suits during several shifts and undergo repeated decontamination.No one suffered serious injuries or acute poisoning, although late consequences cannot be completely ruled out.

Results

The number of occupational diseases in the Czech Republic is rapidly declining. Nevertheless, the consequences of unexpected accidents cannot be excluded.

Conclusions

It is necessary to follow-up with the exposed firefighters.

Presenting author profile

Roberto Lucchini is a Professor of Occupational and Environmental Health specializing in metal neurotoxicity. He has led cohort studies on workers, children, and Parkinsonian patients, examining neurodevelopmental and neurodegenerative effects of metal exposure. His research has defined dose-response relationships and documented the long-term neurological impact of 9/11 exposures in first responders. His work has supported risk assessment and the development of protective standards for manganese, lead, and mercury.

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Roberto G Lucchini (1,2)

1. Florida International University, Miami, Florida, USA
2. University of Modena and Reggio Emilia, Modena, Italy

Background

Although working life occupies a substantial portion of the human lifespan—including critical and vulnerable stages such as pregnancy. Occupational exposures remain significantly underrepresented in exposome research. These exposures are typically more intense and frequent than general environmental exposures and are closely linked to lifestyle, behavior, and socioeconomic status. A comprehensive integration of the occupational exposome into the broader environmental framework is essential to improve the accuracy and precision of exposome characterization, thereby enhancing disease prevention strategies.

Methods/Approach

Current exposomic studies reveal a notable gap in data collection on occupational history and related health risks within human cohorts. This deficiency may stem from challenges in accessing workplace-related data, often due to employer liability concerns and limited representation of workers in health and safety matters. Nonetheless, emerging multi-omics research underscores the relevance of occupational exposures—particularly regarding their impact on the nervous system—in the pathogenesis of various diseases.

Results

As exposome science advances, there is growing consensus on its potential to deepen our understanding of disease etiology and support more effective personalized prevention and intervention strategies. To achieve this, occupational exposures must no longer be overlooked. Innovative approaches—such as wearable technologies, digital symptom tracking, individual-level biomonitoring, and the integration of publicly available data on occupation, census, and risk factors—offer promising avenues for more robust assessment. This will lead to a more complete characterization of the exposome and its implications for both physical and mental health.

Conclusions

Continued dialogue within the scientific community should prioritize occupational health perspectives, promoting novel tools and strategies to capture the dynamic interactions between work, human health, well-being, and disease. A renewed focus on occupational factors will be essential in fully realizing the potential of exposomic science.

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Elia Lettucci (1); Matteo Montanari (1); Tommaso Filippini (1); Marco Vinceti (1)

1. University of Modena and Reggio Emilia, Modena, Italy

Background

Asbestos is classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC) and is known to cause mesothelioma and several other cancers. While occupational exposure is well regulated, domestic exposure through aging asbestos-cement water pipes remains under-investigated. Many Italian water networks still rely on pipes installed between the 1940s and 1970s. Pipe deterioration can release fibers into drinking water, and daily activities like showering may aerosolize these fibers, increasing inhalation risk.

Methods/Approach

This ecological observational study will assess whether higher percentages of asbestos-cement pipes in municipal water systems are associated with increased cancer incidence and mortality in Emilia-Romagna (specifically Modena, Reggio Emilia, and Bologna provinces). Pipe data from 2014 and cancer data from 1998 onwards will be analyzed. The study will control for population size, potential occupational exposure, and other environmental factors. Geospatial mapping will be used to identify possible clusters.

Results

Data collection is ongoing. The study aims to clarify whether domestic exposure to asbestos via drinking water and indoor air contributes to higher rates of asbestos-related cancers, such as mesothelioma and gastrointestinal malignancies.

Conclusions

The results are expected to provide evidence for updating national water safety standards and guiding local public health policies. Addressing overlooked exposure routes is crucial to better protect communities from asbestos-related diseases.

Presenting author profile

Dr. Steven Markowitz is Professor and Director of the Barry Commoner Center for Health and the Environment at the City University of New York. He has directed an occupational medicine screening program that has screened more than 35,000 U.S. nuclear weapons workers over the past 25 years.

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Steven Markowitz (1); Albert Miller (1)

1. City University of New York, New York, USA

Background

Occupational exposures contribute to 10% to 15% lung cancers. The advent of annual low dose chest CT scans during the past 2 decades offers an unprecedented opportunity to intervene in this lethal occupational disease. Unfortunately, few current programs target workers with a prior exposure to asbestos, silica, diesel exhaust, and other lung carcinogens. Moreover, in the general population, lung cancer screening uptake (<20%) and adherence (50-55%) have been disappointingly slow and sub-optimal.

Methods/Approach

We enrolled and offered annual low dose chest CT scans to 1,498 former nuclear weapons workers from 2014 to 2017; they were over age 50, smoked > 20 pack-years, and had at least 2 years of work in high risk jobs at the Department of Energy. We achieved 89% mean annual screening adherence over an 8 year period. In a larger screened cohort (~5,300) over the same period, we detected 104 lung cancers during the 10 year period, or ~10 cancers per year. 69% of lung cancers were detected at an early stage (1 or 2). Nearly one-half of the lung cancers were detected on or after the 4th annual scan. 75% of these later detected lung cancers were early stage.

Results

Blue collar workers at risk of lung cancer are highly interested in lung cancer screening if a suitable program of education, recruitment, follow-up, and annual communications is implemented. Emphasizing the occupational origin of lung cancer risk may help overcome the ambivalence that many smokes have about lung cancer screening. However, few countries address occupational lung cancer risk with lung cancer screening eligibility guidelines or implementation programs.

Conclusions

Occupational health personnel have an essential role in integrating occupational risk in lung cancer screening being undertaken in health care systems. They are also key to creating screening programs that target workers at high risk of lung cancer.

Presenting author profile

Dr Ringen retired in 2025 as Principal Investigator of the Building Trades National Medical Screening Program and Senior Science Advisor of the Center for Construction Research and Training (CPWR). He has spent his career focused on occupational high-risk management and construction and nuclear safety and health.

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Knut Ringen (1); John Dement (2); Marianne Cloeren (3); Sammy Almashat (3); William Grier (3); Trish Quinn (1)

1. CPWR – The Center for Construction Research and Training, Silver Spring, Maryland, USA
2. Duke University Medical Center, Durham, North Carolina, USA
3. University of Maryland School of Medicine, Baltimore, Maryland, USA

Background

The Building Trades National Medical Screening Program (BTMed) is a medical screening program for workers with a significant increase in mortality risk. Started in 1997, it has so far enrolled 30,000 participants. This study investigates its impact on mortality reduction.

Methods/Approach

BTMed uses a two-step screening process. Step one is an occupational history interview to establish exposure risks. Step two is an occupational medicine exam that includes a medical history, a physical examination, spirometry, audiometry, blood tests, urine tests (as needed), screening for colorectal cancer, and chest radiograph. Participants are eligible for a re-screening exam every 3 years. A subset of participants are also enrolled in lung cancer screening using low dose CT. We compared mortality for a subset of 3,500 participants who only completed the occupational history interview to 23,500 participants who completed both the occupational history interview and subsequent exams and 2,100 who also participated in lung cancer screening. We used Cox proportional hazard and Poisson regression models to estimate hazard ratios and risk ratios while controlling for potential confounders.

Results

Exam participants experienced a reduction in mortality risk of 28% for all causes combined; 27% for all respiratory diseases combined; 37% for chronic obstructive pulmonary disease; 31% for cardiovascular diseases combined; 32% for all cancers combined; 36% for lung cancer; and 53% for colorectal cancer. The more exams they undertook the greater the mortality risk reduction (25%, 29% and 43% for one, two and three exams respectively), demonstrating a clear “dose response.” BTMed has so far prevented 3,000 premature deaths among our participants and added 42,500 years of life, an average of 1.8 years per participant, at a cost of USD $2,883 per year of life saved.

Conclusions

Workers' compensation systems should include such secondary prevention for workers identified to be at high risk of occupational diseases.

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Matteo Silvestri (1); Loretta Casolari (2); Ylenia Curzi (1); Alberto Modenese (1); Roberto Lucchini (1,2,3); Francesca Nepoti (1); Barbara Pistoresi (1); Erica Poma (1); Andrea Ziglio (2)

1. University of Modena and Reggio Emilia, Modena, Italy
2. University Hospital of Modena, Modena, Italy
3. Florida International University, Miami, Florida, USA

Background

Workplace violence (WPV) in emergency care settings is an escalating phenomenon with severe repercussions for both individuals and healthcare systems (1). Emergency professionals often endure unpredictable and emotionally intense environments, compounded by organizational constraints and limited resources. These stressors significantly impact mental well-being, job satisfaction, and workforce retention, demanding immediate and structured preventive strategies.

Methods/Approach

This study investigates the relationship between workplace violence concerns (WVC) and a range of individual and organizational determinants. A mixed-methods approach was applied to capture both quantitative trends and qualitative insights. A structured questionnaire was administered to 192 healthcare professionals across two emergency departments of the University Hospital of Modena, achieving a 68% response rate. Ordinary Least Squares (OLS) regression was used to assess how gender, interpersonal skills, role seniority, job autonomy, workload intensity, and environmental factors influenced WVC and job-related outcomes. Additionally, 11 semi-structured interviews with department managers enriched the analysis by offering managerial perspectives on preventive and organizational practices.

Results

Findings indicate that perceived exposure to WPV is multifactorial and shaped by a combination of personal vulnerabilities and institutional dynamics. Actionable interventions should prioritize staff rotation, architectural redesign of high-risk zones, and continuous professional development focusing on de-escalation, assertive communication, and emotional regulation. These measures can mitigate perceived risk and enhance resilience and engagement.

Conclusions

To ensure sustainable impact, institutional leadership must foster a culture of safety through policy innovation, interdepartmental collaboration, and systematic evaluation. Future research could explore longitudinal outcomes and the scalability of integrated violence prevention frameworks across diverse clinical settings

1. Liu J, et al. Occup Environ Med 2019;76:927–937. doi:10.1136/oemed-2019-105849

Presenting author profile

Dr. McDiarmid is Professor of Medicine and Director of the University of Maryland, School of Medicine’s Division of Occupational and Environmental Medicine. She has authored numerous journal articles on occupational and environmental medicine topics related to heavy metal exposures, healthcare workers, medical surveillance, reproductive hazards and occupational cancers. She is a Co-Director of the University of Maryland WHO Collaborating Center for Occupational Health.

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Melissa A. McDiarmid (1); Joanna Gaitens (1)

1. University of Maryland School of Medicine, Baltimore, Maryland, USA

Background

Hepatitis B infection is a significant global health threat contributing to health worker (HW) harm, threatening already precarious health systems. Although the prevalence of hepatitis B in the general Gambian population is high (~10%), vaccination of HWs for hepatitis B has not been a standard practice, due, in part, to a history of infant vaccination programs that began in the late 1980s. However, concerns about incomplete vaccine coverage, lack of records and possible waning vaccine immunity drove a pilot assessment of serology testing for high risk for blood and body fluid exposed HWs at the main teaching hospital in Banjul.

Methods/Approach

Serology testing was performed using rapid response, point-of-care tests to determine the HW hepatitis B surface antigen and antibody status. 70 HWs from laboratory services, labor and delivery, surgery and the dialysis unit participated in this pilot study.

Results

Testing revealed 3 participants of 70 (4.3%) tested positive for hepatitis B antigen, thus were already infected with the virus. 42 of the 70 (60%) had no protective hepatitis B antibody present and were vaccinated. These results indicated the need for systematic serology testing and vaccination, where needed, for the entire Gambian health workforce.

Conclusions

Planning for a national Scale-Up of serology testing and vaccination is presently underway. This presentation will discuss detailed results of the pilot study and planned operations and protocols trialed in the pilot, which will be used for the Scale-Up campaign. Implementation of serology testing and vaccine policies can help ensure that HWs are not lost to a vaccine-preventable disease. These efforts bolster preparedness and result in more resilient and secure health systems.

Presenting author profile

Alberto Modenese, MD, PhD, works as Professor of Occupational Medicine at the University of Modena and Reggio Emilia. His research focuses on health risks of occupational radiation exposure and has published >150 contributions in the OSH area (https://orcid.org/0000-0002-0850-5615). Professor Modenese serves as external Technical Advisor at the WHO Radiation and Health Unit. He is also the Chair of the ICOH Scientific Committee "Radiation and Work" and is an ICNIRP Commissioner.

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Alberto Modenese (1); Roberto Lucchini (1, 2); Fabrizionamaria Gobba (1)

1. University of Modena and Reggio Emilia, Modena, Italy
2. Florida International University, Miami, Florida, USA

Background

Outdoor workers (OW) are increasingly exposed to hazardous environmental conditions due to climate change. Prolonged exposure to solar ultraviolet radiation (UVR) significantly raises the risk of skin and eye diseases, while rising temperatures contribute to heat-related illnesses and fatalities. Additionally, extreme weather events—such as wildfires, storms, and floods—represent a growing threat to occupational safety.

Methods/Approach

These risks not only result in acute injuries but also in chronic health outcomes. Long-term heat exposure is associated with cardiovascular and kidney diseases, while psychological disorders such as post-traumatic stress may affect survivors and rescuers of extreme events. Among chronic occupational diseases, cumulative UVR exposure is a major contributor, linked to conditions including ocular melanoma, cataracts, pterygium, and various skin cancers. Notably, non-melanoma skin cancers (NMSCs)—especially squamous and basal cell carcinomas—are, with actinik keratosis and photoaging, the most common occupational diseases linked to UVR. According to WHO and ILO estimates, 1.6 billion workers are exposed globally, with nearly 19,000 annual deaths and over 500,000 DALYs lost due to NMSCs.

Results

Climate change is redefining OSH challenges. Comprehensive, evidence-based strategies are essential to protect outdoor workers and ensure safe working environments under evolving environmental conditions.

Conclusions

Given that OW constitute nearly half of the global workforce, urgent actions are needed. Key priorities include enhancing research on chronic heat and trauma-related conditions, improving disease burden estimates, strengthening disease reporting systems, and promoting inclusive preventive measures that cover OW in informal economies. Emergency preparedness should also be reinforced to address the increasing frequency and severity of climate-related events.

Presenting author profile

Mitchel A. Rosen, PhD, is Director of the Center for Public Health Workforce Development and Associate Professor at the Rutgers School of Public Health. Dr. Rosen has developed a program with an international reputation for outstanding education and training in the areas of occupational and public health practice. Since 1988, he has managed the training of over 750,000 workers in occupational safety and health, environmental health, and public health education.

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Mitchel A. Rosen (1)

1. Rutgers University School of Public Health, New Brunswick, New Jersey, USA

Background

The New York and New Jersey Education and Research Center (ERC) provides a range of graduate and continuing education for occupational safety and health professionals. Providing interdisciplinary and experiential education to safety professionals, industrial hygienists, ergonomists, occupational medicine physicians and nurses, and other health and safety trainees, helps prepare them for the collaboration required to solve the complex occupational health and safety problems they will face in their careers.

Methods/Approach

It is important that trainees experience the conditions that workers face in their workplace. This presentation will focus on the key aspects of developing an interdisciplinary and experiential learning approach to occupational safety and health. The Industrial Site Visits course (a 3-credit graduate course) and historical perspectives on occupational safety and health tour (a 5-day bus tour) provides a review of major industrial processes and health hazards associated with each site. Each course allows our students to identify exposure mechanisms to occupational safety and health hazards in industrial facilities and to develop a basic risk assessment plan for the characterization, management, and remediation of health and safety hazards.

Results

The Industrial Site Visits course has been provided for over 25 years. Student feedback has been overwhelmingly positive to the experiences in the class. The ERC has conducted fifteen tours and participants consistently rate the tour as providing a high amount of OSH knowledge, and that the goal of providing interdisciplinary education was achieved.

Conclusions

Interdisciplinary and experiential training is critical for OSH students to bridge the OSH fields to better understand how occupational and environmental exposures have occurred, in order to prevent future exposures so that workplace conditions and health can be improved.

Presenting author profile

Dr. López-Carrillo is emeritus professor and former director of research and development at the National Institute of Public Health in Mexico. She trained as an epidemiologist at Yale University. She is considered a pioneer and promoter of the teaching and practice of environmental epidemiology in her country. Her research has significantly contributed to understanding the relationship between exposure to chemical pollutants, diet, and various health outcomes including breast cancer, gastric cancer, and child neurodevelopment.

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Lizbeth López Carrillo (1); Angel Merida-Ortega (1); Rodrigo Ugalde-Resano (1)

(1) Mexico National Institute of Public Health, Cuernavaca, Mexico

Background

Breast cancer has been considered a non-preventable disease at the primary health care level, as its risk is related to a woman's "non-modifiable" reproductive characteristics (age at menarche, menopause, parity, etc.), that increase the periods of exposure to endogenous estrogens. However, we have discovered that many chemical compounds in the environment are endocrine disruptors that account for a large proportion of cases and constitute "the environmental origin of breast cancer."

Methods/Approach

Through several population-based studies, we have identified that arsenic, bisphenol, some phthalates, metals, and pesticides, found in water, food, and personal care products, are risk factors for breast cancer. We have also documented that the consumption of various foods can mitigate the damage caused by some of these compounds.

Results

Primary prevention strategies need to be designed at the population level, providing information about environmental risk factors for breast cancer. We have created a program titled "More Awareness, Less Cancer," currently available in Spanish on social media. It contains summarized information based on scientific evidence, in clear and simple language, suitable for making daily lifestyle decisions to prevent breast cancer. It describes the contaminant, evidence of its association with breast cancer, and recommendations for avoiding exposure.

Conclusions

Health education must be accompanied by regulation of these products, which has significant gaps and is nonexistent in most countries. This is a field of action for the coming years.

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C. Vyvyan Howard (1); Gesa Staats (2)

1. Centre for Molecular Biosciences, Ulster University, Coleraine, UK
2. QuanToxPath Ltd, Coleraine, UK

Background

Prior to 2017 there were some 60 cross-sectional ecological studies, mainly in China, most of which showed population IQ loss associated with higher fluoride intake. Since then a number of well-designed US funded studies have confirmed previous findings. This paper examines possible pathological mechanisms which could explain this phenomenon.

Methods/Approach

Systematic review of the scientific literature for experimental animal research and human health studies, concentrating on possible toxico-pathological mechanisms.

Results

The timing of a toxic insult is critical, as organs pass through ‘windows of vulnerability’. There are ~10^15 connections in the brain but only ~20,000 genes. Therefore, the connectivity of the brain is not arrived at in a deterministic manner. There is a large ‘probabilistic’ element during ‘selective stabilization’ which is achieved through a balance between proliferation and apoptosis. Following an overproduction of neuroblasts, a thinning process occurs resulting in a stable network. Anything effecting cell proliferation or apoptosis will lead to a suboptimal outcome. Fluoride disrupts apoptosis.
There is remarkable consistency in the measured loss of population IQ caused by apoptosis disruptors which suggests a common mechanism. It usually lies between 4 and 6 IQ points. This has been observed with fetal exposure via maternal exposure to: opioid drugs, lead, radiation, fluoride, all of which are apoptosis disruptors.
Profound maternal hypothyroidism has been observed, in the rat, not to affect the total number of neuroblasts in the developing brain. However, it does severely affect neuroblast differentiation. Fluoride is known to interfere with thyroid gland function and even minor perturbations in thyroid hormone levels can affect IQ negatively. This mechanism would act at a later stage in development than would apoptosis disruption.

Conclusions

Literature supporting these putative mechanisms will be presented. The possibility of a common mechanism for sub-optimal brain development suggests a need for more research and for regulation of apoptosis disrupting chemicals.

Presenting author profile

Dr. Grandjean is a professor of environmental medicine at the National Institute of Public Health and a research professor at University of Rhode Island.

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Philippe Grandjean (1,2)

1. National Institute of Public Health, Copenhagen, Denmark
2. University of Rhode Island, Kingston, Rhode Island, USA

Background

Fluoride occurs in high concentrations in certain minerals, such as cryolite (Na3AlF6). A major occurrence of cryolite ore was discovered in southern Greenland about 1850, and it was soon put into use. Apart from some export to Pennsalt in the USA, most of the ore was transported to Copenhagen, Denmark, and purified for use, e.g., in making opal glass and enamel, later on as a catalyst in the greatly expanding aluminum production. Initial concern focused on impurities of quartz that might cause silicosis. In the 1930s, chest X-rays showed serious osteosclerosis, i.e., skeletal fluorosis, in the cryolite workers. Kaj Roholm wrote this doctoral thesis on “Fluorine intoxication”, published in 1937 (with 893 references). The workers also showed nervous system symptoms.

Methods/Approach

Copenhagen cryolite workers were tracked from 1924 and onwards, with substantial excess mortality, mainly from violent causes and cancer. These results were communicated in the 1980s.

Results

Particularly noteworthy was the strong link to cancer of the bladder. These reports have been mainly cited in occupational health studies from the aluminum industry. When IARC evaluated fluoride in 1982, focus was on drinking water and dental preparations only, while occupational exposures were ignored. A preliminary assessment of fluoride toxicity was published by WHO/IPCS in 1984, despite disagreements in the expert committee, thus requiring a renewed review.

Conclusions

In the meantime, of course, fluoride had shown beneficial effects in preventing caries in children. Overall, historical accounts of fluoride toxicity and potential carcinogenicity were disregarded due to the promotion of fluoride in dentistry.

Presenting author profile

Dr. Bucher is a retired Senior Scientist and former Scientific Director of the Division of the National Toxicology Program (NTP) and Associate Director of the NTP at the National Institute of Environmental Health Sciences, US National Institutes of Health.

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Kyla Taylor (1); Andrew Rooney (1); John Bucher (1)

1. National Institute of Environmental Health Sciences, Durham, North Carolina, USA

Background

Background:
Along with skeletal and dental fluorosis, emerging evidence suggested that exposure to fluoride from multiple sources during early life may affect neurodevelopment. We evaluated the relevant literature.

Methods/Approach

Methods/Approach
Following the OHAT approach for systematic reviews, we searched English and Chinese language databases for experimental animal, mechanistic, and human health studies. Selected literature was systematically evaluated for quality (risk of bias), data were extracted, summarized, and confidence in an association determined. A separate meta-analysis was performed on studies of fluoride exposures and children’s IQ.

Results

Results
Although the experimental animal, mechanistic and adult human epidemiology studies provided little insight into whether fluoride could affect human neurodevelopment, a large epidemiological evidence base supported adverse neurodevelopmental effects in children. The majority of these studies examined children’s IQ, with few publications on other endpoints that were too heterogeneous in exposure and outcome measures to provide more than low confidence for potential neurological effects. In contrast, the body of research on children’s IQ was large and consistent, providing moderate confidence of an inverse association between fluoride exposure and children’s IQ. A subsequent meta-analysis of 74 cross-sectional and prospective cohort studies conducted across multiple countries found statistically significant inverse linear associations between fluoride exposure and children’s IQ, that remained significant in the subset of higher-quality studies with estimated fluoride exposures restricted to < 1.5 mg/L when measured in drinking water or urine. There were insufficient data available to evaluate effects from exposure to only artificially fluoridated drinking water at 0.7 mg/L.

Conclusions

Conclusions and Next Steps
The qualitative assessment of the literature establishing “moderate confidence” was supported by the quantitative meta-analysis. None of the children’s IQ studies were performed in the United States, and confidence in the associations at lower fluoride levels could be increased by additional prospective cohort studies.

Presenting author profile

Bruce Lanphear, MD, MPH, a professor and public health physician at Simon Fraser University in Vancouver, British Columbia, has studied the toxicity of lead, fluoride, pesticides, and other chemicals on human health for 30 years. Bruce led studies used by federal agencies to set standards for lead in air, water and house dust, and his studies were the impetus for the conclusion that no amount of lead is safe.

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Presenter - Policy Discussion

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Bruce P. Lanphear (1)

1. Simon Fraser University, Vancouver, British Columbia, Canada

Background

For decades, public health authorities in some countries have championed community water fluoridation as a key tool for preventing tooth decay. But emerging science suggests it’s time to re-evaluate this mid-20th-century policy.

Methods/Approach

Water fluoridation was originally based on studies showing that 1 part per million (ppm) of fluoride reduced cavities with minimal dental fluorosis. Yet early warnings—by H. Trendley Dean and others—urged caution, given fluoride’s known toxicity. Despite this, fluoridation spread rapidly in the 1950s, aligned with the era’s faith in "better living through chemistry" and technocratic solutions. Now, new research is challenging long-held assumptions. Recent studies—using the same rigorous designs once applied to lead—link fluoride exposure in pregnancy with reduced IQ in children. Prospective cohort studies report as much as 3 to 5-point IQ loss for every 1 ppm increase in fluoride exposure. A meta-analysis from the National Toxicology Program confirmed these findings across multiple countries and populations. A recent US federal court ruling declared that fluoridation at current levels poses an “unreasonable risk” to children’s brain development.

Results

The implications are troubling. Fluoride’s benefits in reducing caries are now thought to come mainly from topical contact—not ingestion. Meanwhile, studies since 1975 show only marginal or statistically insignificant reductions in tooth decay from fluoridated water. Vulnerable populations, including formula-fed infants and low-income families, may bear the brunt of harm. Moreover, new evidence shows how the sugar industry promoted fluoridation. Despite mounting evidence, regulatory standards remain unchanged, and fluoridation continues largely unchallenged.

Conclusions

It’s time for public health agencies to reconsider fluoridation. We need policies grounded in current science, not outdated assumptions. Alternatives like fluoride toothpaste are widely available, effective, and voluntary. A national re-evaluation of fluoridation is overdue—especially to protect pregnant women and young children from unnecessary, involuntary exposure to a neurotoxicant.

Presenting author profile

Dr. Krishna Nirmalya Sen is the Head of Environment, Health and Safety Department of Minerals & Metals IC of Larsen & Toubro Limited. He also volunteers as the Chair of OHS Expert Committee of Indian Chamber of Commerce and President of ASSP India Chapter. He is a Fellow of Collegium Ramazzini and Institution of Engineers India. He also serves as Honorary Professor at Sri Sri University in Odisha, India.

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Krishna Nirmalya Sen (1); Gollapalli Muralidhar (1)

1. Larsen & Toubro Limited, Kolkata, India

Background

The iron & steel industry is a major contributor to India's rapid economic and industrial growth. Domestic steel demand is expected to grow by 9-10%. To meet emerging needs, organizations in the steel sector are driving new expansion as well as upgrades of existing units for operational efficiency and infusion of the latest technologies.

Upgradation of existing steel plants involve huge dismantling and repair of major facilities like blast furnace. In addition to inherent high risks of construction activities, such brown field expansion exposes workers to several broad range of occupational health and safety hazards, resulting from multitude of factors as well as harsh work environment, presence of multiple agencies, and tight deadlines etc.

Methods/Approach

Method/Approach:
In this study, efforts were made to highlight high potential OSH hazards under various categories; structured safety frameworks were adopted to mitigate OSH risks and to ensure wellbeing of the employees at the workplace. These mitigation measures include, but are not limited to, qualitative risk assessment of activities involving multiple disciplines, detailed job planning and work procedures and risk control measures aligned with hierarchy of controls.

Results

Results:
Detailed risk assessments revealed potential hazards and risks such as thermal hazards, exposure to harmful dusts and fumes, confined spaces, and mechanical and structural stability. Through a proactive and systematized approach these risks are addressed in a systematic manner to achieve tangible reduction in safety incidents.

Conclusions

Highly complex, time-bound dismantling, repair and reconstruction of a blast furnace presents heightened OHS challenges requiring proactive approach. To mitigate these OSH risks, it is essential to adopt a multi-pronged strategy towards OSH management system that includes detailed job-specific risk assessments, strict adherence to safe procedures, engagement of competent workmen, adequate employee training and continuous environmental monitoring. Adoption of technological solutions can further provide opportunities to improve OSH performance.

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Mitia Stiscia (1); Sara Colazzo (1); Alberto Modenese (1); Roberto Lucchini (1,2); Davide Marotta (3)

1. University of Modena and Reggio Emilia, Modena, Italy
2. Florida International University, Miami, Florida, USA
3. International Space Station National Laboratory, Exploration Park, Florida, USA

Background

Aircrew members are exposed to ionizing radiation (IR) at flight altitudes between 8 and 15 km, where the effective dose can exceed 1 mSv/year depending on altitude, latitude, and flight duration. In this range, validated computational models are used to assess exposure risks. Above 15 km individual dosimeters are required. At altitudes >100 km astronauts experience significantly higher IR exposure, mainly from high-LET cosmic radiation.
This study aims to review scientific literature on occupational IR exposure data among flight personnel, including astronauts, through a PubMed/MedLine search (2010–present) with specific keywords. Additionally, grey literature was examined from sources such as the IAEA, ICAO, ENAC, ICRP, UNSCEAR and NASA.

Methods/Approach

According to UNSCEAR data, aircrew members receive an average annual effective dose (ED) of 2–3 mSv (UNSCEAR, 2008). European data from the ALARA Network report lower values between 1.2 and 2.5 mSv/year, with a maximum of 7 mSv/year observed on a German airline (Andresz, 2015). The EURATOM Directive 2013/59, aligned with ICRP guidelines, sets the ED limit at 20 mSv/year, meaning aircrew exposures range from 1/16 to 1/8 of the legal threshold. Astronaut exposure usually requires special authorization as exposure is much higher: NASA estimates a cumulative ED of 465 mSv for a hypothetical astronaut mission to the ISS and lunar surface, within the maximum career dose limit of 600 mSv established by international space agencies (OCHMO, 2023).

Results

Given the ongoing advancements in space exploration and the expected rise in the number of individuals exposed in the years ahead, and considering the significant ionizing radiation exposures astronauts face, it's necessary to focus more on prevention for these particular workers too.

Conclusions

For future human deep space exploration, using current technologies, cumulative radiation doses significantly above current limits could be expected. This would require a thorough review of radiological protection strategies and human spaceflight authorization protocols.

Presenting author profile

Dr Adetoun Mustapha is a leading Environmental Epidemiologist in Africa, an adjunct Professor at Lead City University, Ibadan, Nigeria and adjunct Researcher at the Nigerian Institute of Medical Research, Lagos, Nigeria. She has about 30 years of work experience spanning academia, industry and research. She is renowned for her pioneering research on the health effects of air pollution in Nigeria, including one of the first studies linking traffic air pollution to respiratory illness in schoolchildren.

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Adetoun Mustapha (1); Adesola Zaidat Musa (1); Abdul-Ganiyu Usman (2); Prince Ikonwa (1); Babatunde Salako (3); Deo Okure (2); Engineer Bainomugisha (2); Eric Coker (4)

1. Nigerian Institute of Medical Research, Lagos, Nigeria
2. Makerere University, Kampala, Uganda
3. University of Ibadan, Ibadan, Nigeria
4. British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada

Background

Air pollution is a growing public health concern in Sub-Saharan Africa, yet many mega-cities in the region lack robust air quality monitoring systems. Lagos, Nigeria, one of Africa's most populous cities, faces significant challenges in understanding and mitigating the population health impacts of air pollution due to limited air monitoring infrastructure. This study addresses this gap by deploying four low-cost sensors manufactured by AirQo, an African-based organization, to measure fine particulate matter (PM2.5) across Lagos between July 2023 and December 2024.

Methods/Approach

Strategically deployed to capture variations in population socioeconomic status and emission sources, including traffic-related air pollution (TRAP), the sensors provided critical insights into spatial and temporal air quality patterns. The 24-hour overall median PM2.5 concentration was 20.6 µg/m3 (IQR=16.3, 29.8), indicating poor air quality throughout the city. Results revealed significant variability in PM2.5 concentrations across the city, with levels lowest in the more affluent community of Eti Osa Island. Notably, dramatic seasonal fluctuations were observed. PM2.5 levels were significantly elevated in December (mean=43.1 µg/m3), January (mean=62.1 µg/m3), and February (mean= 68.3 µg/m3) at all study sites.

Results

Despite these insights, challenges emerged during deployment, including optimizing sensor placement to accurately capture ground-level TRAP and navigating the region's absence of regulatory air quality standards. Collaborative efforts with local stakeholders were essential for sensor placement and data collection.

This study underscores the critical role of low-cost sensor networks in addressing air quality monitoring gaps in Sub-Saharan Africa. The dramatic elevations in PM2.5 levels from December to February highlight the unique challenges of air pollution research in SSA, where distinct PM2.5 sources and meteorological conditions shape seasonal variations. These findings also contrast sharply with patterns observed in higher-income countries.

Conclusions

This study's marked spatial and temporal variability underscores the need for tailored, context-specific approaches to air pollution monitoring and exposure assessment in SSA.

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Presenter - Policy Discussion

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Alessandra D'Alterio (1); Fabriziomaria Gobba (1); Alberto Modenese (1); Annalisa Bargellini (1); Federico Ricci (1,2)

1. University of Modena and Reggio Emilia, Modena, Italy
2. AiNTS - Italian Non-Technical Skill Association, Modena, Italy

Background

In 2024, over 500,000 occupational accidents were reported in Italy, including 1,077 fatalities (INAIL,2024). These figures underscore the urgent need for both companies and the general public—particularly young people—to recognize the importance of prevention and to develop a deeper awareness of workplace safety.
Theater, already recognized as an effective training tool for risk prevention (Ricci,2022; McCallum et al.,2022), offers a unique means to engage audiences emotionally and intellectually, encouraging reflection on occupational health and safety issues in contemporary society.

Methods/Approach

The play “Nessun Dubbio” (NB: original Italian title, the translation is “No Doubt”), supported by the University of Modena & Reggio Emilia, dramatizes a fatal workplace accident. Using an interactive "murder mystery dinner" format, twelve characters explore the causes of the incident. While human error initially seems to be the culprit, a more nuanced investigation raises deeper questions: Could this tragedy have been avoided? Were adequate safety measures in place?
The audience, positioned as a metaphorical thirteenth participant, observes the characters’ evolving perspectives, prompting critical reflection and challenging initial assumptions.

Results

Between May 2022 and September 2024, Nessun Dubbio was performed 15 times—four of which were sponsored by Unimore—reaching approximately 200 citizens and 1,000 high school students in Modena and Mantua.
Impact assessments, conducted through surveys, revealed a significant improvement in hazard perception, safety knowledge, and awareness. Participants also demonstrated a stronger understanding of the importance of collective empowerment. Notably, the initiative led to measurable progress in three key areas: increased risk awareness, a stronger safety culture within organizations, and more positive attitudes toward safe workplace behaviors.

Conclusions

These findings suggest that theatre is a powerful tool for public engagement. By involving audiences directly and appealing to both rational thought and emotional resonance, it fosters meaningful awareness and dialogue around workplace safety and prevention.

Presenting author profile

Dr. Stephan Böse-O´Reilly is a Professor for Environmental and Public Health at the LMU University Hospital, Institute and Clinic for Occupational, Social and Environmental Medicine, Munich, Germany. He is a pediatrician, and his main interest is to prevent children from disease by helping to reduce their exposure to toxic substances, such as lead and mercury.

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Stephan Bose-O’Reilly (1); Morando Soffritti (2,3); Dennis Nowak (1); Daniele Mandrioli (3); Stefan Rakete (1); Melissa McDiarmid (4)

1. Ludwig-Maximilians University (LMU), Munich, Germany
2. European Foundation Ruberti-Schileo, Treviso, Italy
3. Ramazzini Institute, Bologna, Italy
4. University of Maryland School of Medicine, Baltimore, Maryland, USA

Background

Toxic metals such as lead, mercury, and arsenic remain critical global health threats, with mounting evidence that even low-level exposure contributes significantly to cancer, cognitive impairments, and cardiovascular diseases.

Methods/Approach

The Symposium Toxic Metals held in July 2025 in Munich convened around 150 experts across disciplines to establish a comprehensive road map for reducing human exposure, particularly in low- and middle-income countries (LMICs). The symposium featured sessions on environmental and human biomonitoring, risk assessment, and mitigation strategies. Key discussions emphasized the need for systematic monitoring of toxic metal exposure, especially in communities affected by industrial emissions, artisanal mining, and the extraction of transition minerals essential for renewable energy technologies. Participants highlighted the environmental trade-offs of decarbonization, warning that mining for critical materials such as lithium, cobalt, and rare earth elements may increase exposure risks if not properly managed. Technological advances, including microsampling and high-resolution analytical methods, were presented as promising tools for improving biomonitoring accuracy and accessibility, especially in resource-constrained settings. Several case studies underscored the importance of integrating biomonitoring data into health surveillance systems to assess exposure trends and vulnerable populations.

Results

A central outcome was intensive discussion, a dialogue among scientists, policymakers, and civil society actors. The symposium identified several priority actions:
- harmonization of international exposure limits,
- development of public health messaging tailored to local contexts,
- strengthening regulatory frameworks for industrial emissions,
- securing funding for long-term monitoring and remediation.

Conclusions

The symposium concluded with a call to action for a coordinated global strategy. This includes expanding interdisciplinary research, supporting community-driven exposure reduction programs, and ensuring that the green energy transition does not come at the cost of public health. The road map developed during the meeting serves as both a scientific consensus and a policy blueprint aimed at reducing the health burden from toxic metals over the coming decade.

Presenting author profile

Dr. Carlos Santos-Burgoa is a Mexican physician and epidemiologist, former Dean at INSP, and architect of COFEPRIS. He has held senior roles at PAHO/WHO, led research identifying 1,3-butadiene as a carcinogen, and advanced exposure regulations. Now a Professor at GWU, he leads major public health initiatives and studies, including Hurricane Maria Mortality in Puerto Rico. He is a Fellow of the National Academy of Medicine, the Rockefeller Foundation, and the Collegium Ramazzini.

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Carlos Santos-Burgoa (1,3); Raul Mercer (2); Maria Jose Talayero-Schettino (1,3); Rebecca C. Robbins (1); the GWU based “Unlocking Team” (1); Leonora Rojas-Bracho (3)

1. The George Washington University School of Public Health, Washington DC, USA
2. Facultad Latinoamericana de Ciencias Sociales, Buenos Aires, Argentina
3. Colaborativo Mundo Quimico, Mexico City, Mexico

Background

Weak public health authority has resulted in insufficient action on chemical safety, chronic diseases, and environmental risks, particularly in LMICs. Poor knowledge translation, lack of transparency, and limited institutional capacity obstruct effective risk governance and contribute to preventable mortality and health inequities.

Methods/Approach

We conducted a comparative study of 13 regulatory case studies across 5 countries in America and Europe, representing various levels of development. Focus areas included chemicals, occupational safety, food, agriculture, medical products, and breast milk substitutes, at national and subnational levels.
Our methodology combined situational analyses, surveys, site visits, participant observation during compliance activities, interviews and agency leaders and staff, and expert presentation. Critical instance case analysis was used to identify distinctive institutional features, supplemented by document review and cross-case comparison.
We assessed governance, institutional capacity, performance evaluation, and organizational development using 5 domains and 17 variables. We also developed provisional indicators for personnel and budget coverage.
Key findings include persistent institutional weaknesses in LMICs, most notably, the inability to conduct risk assessments. Regulatory capture, minimal engagement with academia or civil society, and a lack of ex-post evaluation were widespread. Chemical and workers’ health were the least prioritized, despite their role as structural determinants of inequity. While staff demonstrated strong professional commitment, most institutions and their personnel lacked awareness of the public health implications of their work, which was often framed narrowly through legalistic and procedural lenses.

Results

Chronic underfunding, low staffing, weak social foundations, and absent public health orientation explain the marginalization of these institutions. Our findings highlight the need for systemic reform.

Conclusions

We will describe efforts to develop a scholarly line of work aimed at restoring the public health mission of these organizations and building a collaborative network to rethink regulatory methods and organizational development with a focus on public health.

Presenting author profile

Jennifer Sass is a senior scientist with the Natural Resources Defense Council (NRDC). She has a master’s degree and a Ph.D. in anatomy and cell biology from the University of Saskatchewan Canada and a postdoctoral certificate from the University of Maryland USA. She is a Professorial Lecturer at George Washington University Milken School of Public Health, Washington DC, USA.

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Jennifer Sass (1,2)

1. Natural Resources Defense Council, Washington DC, USA
2. George Washington University, Washington DC, USA

Background

Neonicotinoid Pesticides are the most widely used class of insecticides in the world. Their largest use by volume is as a coating on crop seeds, which is largely untracked and unregulated.

Methods/Approach

Pesticide registrant-sponsored rodent developmental neurotoxicity studies (DNTs) fail to identify a true ‘no effect’ level in juvenile rodents for most of the neonics (Sass et al 2024). For all of the neonics, the studies show adverse effects in the developing brain in offspring in the high-dose groups. Effects include structural alterations in brain tissue and some functional deficits such as altered auditory startle reflexes.

However, both the US and European Union are advancing the replacement of rodent bioassay toxicology with ‘new approach methodologies” (NAMs), in vitro cell-based assays paired with in silico computational models. In this work the neonic pesticides are being explored as case studies for the application of NAMs for regulatory decision-making (see acetamiprid, OECD 2022 and imidacloprid OECD 2022). The Organisation for Economic Co-operation and Development (OECD) recently reviewed the Developmental Neurotoxicity (DNT) in vitro battery of tests, warning that, “Several gaps in coverage of neurodevelopment processes and cell types … may result in lower sensitivity and specificity.” (OECD, 2023).

Results

The “Collaboration to Harmonise the Assessment of Next Generation Evidence” (CHANGE) is a global collection of 50-75 scientists and policy experts, largely from academia, industry, and government (Mathisen et al 2025, Diemar et al 2025). It is a 3-year project funded by the European Food Safety Authority (EFSA). The goal is to shape the effective use of NAMs in regulation. Several Collegium Fellows are engaged, including myself.

Conclusions

Regulatory solutions to reduce harmful neonic use are happening at the local and state level. For example, landmark legislation in New York passed that will eliminate up to 90 percent of the neonics entering the state’s environment annually.

Presenting author profile

Prof. Filippini is Associate Professor in Public Health at the Department of Biomedical, Metabolic and Neural Sciences at University of Modena and Reggio Emilia where he works in the study of health effects of environmental and dietary risk factors, specifically regarding risk of chronic diseases as neurodegenerative diseases and cancer.

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Tommaso Filippini (1,2); Camilla Soncini (1); Annalisa Chiari (3); Niccolò Martini (1); Sofia Costanzini (1); Francesca Despini (1); Andrea Cherubini (4); Manuela Tondelli (1,3); Giovanna Zamboni (1,3); Giuseppe Maffeis (4); Sergio Teggi (1); Marco Vinceti (1,5)

1. University of Modena and Reggio Emilia, Modena, Italy
2. University of California School of Public Health, Berkeley, CA, USA
3. University Hospital of Modena, Modena, Italy
4. TerrAria, Milan, Italy
5. Boston University School of Public Health, Boston, Massachusetts, USA

Background

Dementia is a group of disorders characterized by the development of multiple cognitive deficits. When the condition affects individuals aged <65 years, it is referred to as early-onset dementia (EOD). This study aims at investigating the role of environmental factors, namely air pollution from motorized traffic, availability of green spaces (the so-called “greenness”) and artificial light at night (ALAN) as possible risk factors for EOD.

Methods/Approach

We recruited 327 EOD cases and 1949 sex and age-matched population controls from Modena, Northern Italy. We georeferenced each subject’s address of residence and estimated exposure data to traffic-related benzne, the normalized difference vegetation index (NDVI), and ALAN using Visible Infrared Imaging Radiometer Suite satellite data. We assessed EOD risk using conditional logistic regression model and computing odds ratio (OR) and 95% confidence interval, mutually adjusting for environmental factors.
We found increased EOD risk for subjects exposed to high levels of benzene. As regard NDVI, we noted a non-linear relation with higher EOD risk in the middle category of exposure, and lower risk at low and high NDVI values. ALAN showed lower EOD risk with increasing exposure. Stratified analyses by sex showed higher risk for males than females due to benzene exposure, while NDVI showed almost linear decrease in risk in females. ALAN did not demonstrate sex-differences.

Results

Overall, our findings suggest that environmental factors may modify EOD risk, with also non-linear relations and sex-specific differences. The use of co-exposure scenario allowed to assess the effect modification of environmental factors, with possible implementation of mitigation strategies, especially lowering traffic-related air pollution and increasing green spaces availability.

Conclusions

This research indicates the need for public policy intervention aimed at further lowering exposure levels to air pollution, in line with the new 2025 EU regulation, and promoting of urban plans against land consuming in favour of green areas.

Presenting author profile

Dr. von Braun is Professor/Dean emerita at the University of Idaho. Her specialty as an environmental engineer is in health risk assessment. She is co-founder of TIFO, an NGO that collaborates with communities, governments and universities to develop and implement interventions that improve environmental health. Many TIFO projects have been in mining communities around the world in cooperation with Doctors without Borders.

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Margrit von Braun (1,2); Ian von Lindern (2); Casey Bartrem (2); Faith Quigley (1)

1. University of Idaho, Moscow, Idaho, USA
2. TerraGraphics International Foundation (TIFO) NGO, Moscow, Idaho, USA

Background

Climate and geopolitical factors are fueling an unprecedented demand for precious, green, and strategic metals. In the US, state and federal agencies face pressure to relax health protections. Arguments for facilitating mine permits include climate change, energy independence, remediation of legacy sites, and socio-economic benefits. Reinterpretation of regulations is increasing allowable carcinogenic emissions and avoiding well-established cancer protections.

Methods/Approach

The proposed Stibnite mine in Idaho, US has drawn national attention for minerals critical to national defense and climate-friendly energy technologies. The mine has been described by the Trump administration as the second most important mine in the US because of the antimony it will produce. Investors are more attracted by the gold reserves. Health and environment professionals are concerned about the arsenic that would be released and the state’s willingness to relax cancer protections.

Results

The Stibnite project proposes to emit arsenic into air at rates that would expose children to a lifetime of cancer risk in just 16 years. Idaho changed long-standing public health projections by using “dose averaging” to justify emitting arsenic at rates resulting in 100-fold increases in allowable pediatric cancer risk. The reinterpretation of standards – without public input – benefits one mine now but may set precedence over future industries in Idaho and across the nation.

Conclusions

The Consortium for Children’s Health (including Collegium members) has called for revamping laws to provide protections for 350,000 manufactured synthetic chemicals, mostly produced in the last 100 years with minimal knowledge about their toxicity (1/8/2025, N Engl J Med). In the US, laws are being revamped to rescind protections for “old chemicals” with known toxicity – metals like arsenic and lead – while scientific research is being suppressed. The Collegium could consider a statement on the alarming risks to children’s health from both new and old chemical industries and mining.

Presenting author profile

Davide Degli Esposti is a molecular biologist, research scientist in molecular ecotoxicology and toxicology with main research interest on the reprotoxicity of pesticides and phenotypic plasticity to environmental exposures.

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Davide Degli Esposti (1)

1. Centre de Lyon-Grenoble Auvergne-Rhône-Alpes, Villeurbanne Cedex, France

Background

More than 300 thousand chemicals are currently registered for commercial use in the world. This complexity overwhelms our societies’ ability to evaluate chemical contaminants. The concept of One Health was proposed to describe a holistic, transdisciplinary approach aiming to improve conditions for people, animals, and the environment as a global and highly interconnected ecosystem. However, the One Health approach has to overcome many challenges to provide a protective framework for managing chemical hazards toward the great diversity of life forms. In this context, animal-based bioassays, that have been pivotal in predicting chemical-induced chronic diseases, will likely not be able to cover the increased number of chemical hazards for humans and other species.
New conceptual frameworks, such as the Adverse Outcome Pathways (AOPs) or the key characteristics, have been developed to improve the use of mechanistic information derived from molecular, cellular and computational biology approaches to predict chemical risks for the health of humans and other species.

Methods/Approach

Chair and Presenter: Davide Degli Esposti
Co-chairs and discussants: John Bucher; Jia Chen
Presenters: Warren Casey (NIEHS) and Luoping Zhang (Collegium)

Results

This panel will highlight how NAMs can be applied to better investigate and anticipate toxicological effects across species. This exchange aims to foster critical reflection on how mechanistic methods can support and strengthen risk assessment of chemical, physical, and biological hazards within a One Health framework/knowledge. We will discuss conceptual and technological advances in the development of NAMs to investigate toxicological mechanisms and chemical-induced toxicity.

Conclusions

This panel will offer the opportunity to foster interdisciplinary cooperation between environmental and health scientists inside and outside the Collegium on a topic of current and future importance in chemical risk assessment. Follow-up activities may include the formation of working groups, collaborative research initiatives, or contributions to international guidance on the application of mechanistic data in hazard and risk assessment.

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Presenter - Policy Discussion

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Leslie London (1); Andrea Rother (1)

1. University of Cape Town School of Public Health, Cape Town, South Africa

Background

South Africa continues to import highly hazardous pesticides (HHPs) banned in Europe. Despite a 2010 policy to phase out HHPs, the Department of Agriculture has delayed taking firm policy action. As a result, HHPs are easily available and poorly controlled. Because of failing municipal waste services, residents of poor communities access HHPs sold on the black market in the informal sector to control infestations of rats.

Methods/Approach

In October 2024, 6 Soweto children tragically died from pesticide ingestion, likely in an accident following its use in bait to poison rats. Faced with intense media attention, industry immediately tried to deflect any responsibility by blaming Aldicarb, a carbamate banned in 2016, as the culprit. When it was confirmed that the pesticide responsible was Terbufos, a WHO Class Ia organophosphate legally registered in South Africa, industry changed its narrative to argue this was Terbufos coming illegally from Zimbabwe. However, investigation by a Ministerial Advisory Committee (MAC) confirmed that at least 375 deaths had occurred from Terbufos in 2023 and 2024, of which 35% were children, and that HHPs could not be managed safely through restrictions. The South African Cabinet adopted the MAC recommendation to ban Terbufos against the wishes of the Minister of Agriculture who wanted to delay any ban until 2035 and only if an alternative was found.

Results

South Africa’s system of pesticide governance, like many LMICs, is captured by industry. However, evidence-based research presented at the highest levels, particularly highlighting our particular obligation to protect children, can persuade policy makers to put people before profit.

Conclusions

Civil society in South Africa will continue to press for the banning of the other 194 HHPs registered for use in South Africa, but banned in the European Union, many for health and environmental reasons. Scientific support to civil society is needed to strengthen environmental justice.