The Working Environment Research Fund allocates funds for reviews of occupational diseases within two themes
Notice October 2009
 
The objective of the Working Environment Research Fund is to strengthen working environment research in Denmark.

The Fund supports working environment research and development aiming at improving the working environment. Read more about The Working Environment Research Fund.
 
The Working Environment Research Fund has prepared a Strategy for Working Environment Research and Development 2009-2010  (in English) with a number of themes to be advertised in the said period.

1. Call for applications
 
The Working Environment Research Fund offers review projects in the form of reference documents on occupational diseases. The reviews are used by the National Board of Industrial Injuries (Arbejdsskadestyrelsen) and the Occupational Diseases Committee in connection with the ongoing negotiations on the inclusion of new diseases in the lists of occupational diseases and, furthermore, for the ongoing adjustment of the practice of the Occupational Diseases Committee regarding recognition of unlisted diseases caused by the particular nature of the work.

In this application round the Working Environment Research Fund may grant support for reviews, in the form of reference documents, within the following themes:

Theme 1: Correlations between exposures at work and deep vein thrombosis (DVT, blood clots in the legs)
 
Against the background of the ongoing discussions of occupational diseases, the National Board of Industrial Injuries and the Occupational Diseases Committee have found that there is a need for a detailed review, in the form of a scientific reference document, of possible causalities between various physical exposures at work and the development of deep vein thrombosis (DVT, blood clots in the legs).
 
Project framework
 
Against the background of a primarily epidemiologically based examination of the most significant Danish and international research results in the field, the scientific reference document will elucidate in detail, summarise and assess knowledge of any causalities between work-related exposures and the development of deep vein thrombosis (DVT, blood clots in the legs). The review will give an account of the correlation between deep vein thrombosis and various exposures in the workplace, such as sitting still during long-term supervision or transport, including long flights.
 
In this context there is a need for a description and an assessment of the evidence of various exposures and the likely causality mechanisms, as well as a detailed estimate of any increased risk in relation to the nature, severity/scope and duration of the exposures.
 
For deep vein thrombosis (DVT, blood clots in the legs) the following information is required –
 
About the disease:
  • Delimitation and specification of the individual disease, including a diagnostic clarification
  • Exact information on how the diagnosis was made
  • An assessment of the validity of the survey results
  • Information on the severity of the disease or the symptoms
About the exposure:
  • The general nature of the exposures (the types of work and general exposure conditions in question)
  • The more concrete nature and severity/scope of the exposures, described in terms of quality and quantity, including sitting still where the work has caused long-term leg immobility
  • The duration of the exposures per day
  • The total duration of the exposures over time
  • The nature, severity/scope and duration of the exposures, compared with an assessment of the size of the risk
  • The nature, severity/scope and duration of the exposures, compared with possible threshold values (lower limit values) for effect
About the causality:
  • A summarising description and assessment of the dose-response and dose-effect correlations
  • Description and assessment of the time of the onset of the disease in relation to the exposure
  • An explicit assessment of the disease prognosis, including the extent to which there is evidence that symptoms and clinical findings persist after exposure cessation, as well as the impact of the exposure on the prognosis
About competitive and pre-existing diseases/conditions:
  • Description of the significance of competitive/pre-existing diseases for the disease development
  • Description of the significance of non-occupational exposures (exposures in leisure time)
  • Description of the significance of other, non-occupational factors (e.g. heredity, gender, age, traumas, systemic diseases, rheumatoid arthritis, etc.)
  • If possible a quantitative assessment of the role played by occupational exposures in the development of the disease in relation to non-occupational diseases/factors, cf. the above   

Summary:

  • Description and assessment of the reliability of the exposure and disease documentation in the individual article
  • A summarised and graduated assessment of the evidence (see also special guidelines for reviews of occupational diseases)
  • Gender data and differences, including an assessment of any independent impact of gender on the development of deep vein thrombosis (DVT, blood clots in the legs)
  • The project report will include a summary directed at lay persons
Various types of work involving immobility of the legs will be included and carry a lot of weight in the project report.
 
The scope of the exposures, including the severity and number of exposures and the total duration per day and over time, should in this context, to the extent possible, be estimated and assessed in detail.
 
If there is insufficient evidence of a correlation between deep vein thrombosis (DVT, blood clots in the legs) and various types of work-related exposures, or if the literature is otherwise inadequate for the elucidation of the required causalities, this should be stated and the specific grounds should be given. 
 
If, in this connection, it is found that additional research should be initiated, it would be desirable for a substantiated and specific statement of the relevant additional-research goals to be included in the overall project conclusion.

Theme 2: Correlations between exposures at work and lunatum malacia (Kienböck’s disease) and other diseases of hand/wrist, including impact on the ulnar nerve and other nerves of the forearm
 
Against the background of the ongoing discussions of occupational diseases, the National Board of Industrial Injuries and the Occupational Diseases Committee have found that there is a great need for a detailed review, in the form of a scientific reference document, of possible causalities between various physical exposures at work and the development of lunatum malacia (Kienböck’s disease) and other diseases of the hand/wrist, including impact on the ulnar nerve and other nerves of the forearm.
 
Project framework
 
Against the background of a primarily epidemiologically based examination of the most significant Danish and international research results in the field, the scientific reference document will elucidate in detail, summarise and assess knowledge of any causalities between the development of lunatum malacia (Kienböck’s disease), which is poor blood supply with secondary bone death (avascular necrosis) of a lunate bone (os lunatum); other diseases of the hand/wrist, including impact on the ulnar nerve and other nerves of the forearm, and various physical exposures in the workplace.
 
In this context there is a great need for a description and an assessment of the evidence of various exposures and the likely causality mechanisms, as well as a detailed estimate of any increased risk in relation to the nature, severity/scope and duration of the exposures.
 
For lunatum malacia (Kienböck’s disease) and other diseases of hand/wrist, including the ulnar nerve and other nerves of the forearm, the following information is required –
 
About the disease:
  • Delimitation and specification of the individual disease, including a diagnostic clarification
  • Exact information on how the diagnosis was made
  • An assessment of the validity of the survey results
  • Information on the severity of the disease or the symptoms
About the exposure:
  • The general nature of the exposures (the types of work and general exposure conditions in question)
  • The more concrete nature and severity/scope of the exposures, described in terms of quality and quantity, including wrist-loading work and exposure to vibrations and non-strenuous, repetitive work
  • The duration of the exposures per day
  • The total duration of the exposures over time
  • The nature, severity/scope and duration of the exposures, compared with an assessment of the size of the risk
  • The nature, severity/scope and duration of the exposures, compared with possible threshold values (lower limit values) for effect
About the causality:
  • A summarising description and assessment of the dose-response and dose-effect correlations
  • Description and assessment of the time of the onset of the disease in relation to the exposure
  • An explicit assessment of the disease prognosis, including the extent to which there is evidence that symptoms and clinical findings persist after exposure cessation, as well as the impact of the exposure on the prognosis
About competitive and pre-existing diseases/conditions:
  • Description of the significance of competitive/pre-existing diseases for the disease development
  • Description of the significance of non-occupational exposures (exposures in leisure time)
  • Description of the significance of other, non-occupational factors (e.g. heredity, gender, age, traumas, systemic diseases, rheumatoid arthritis, etc.)
  • If possible a quantitative assessment of the role played by occupational exposures in the development of the disease in relation to non-occupational diseases/factors, cf. the above   

Summary:

  • Description and assessment of the reliability of the exposure and disease documentation in the individual article
  • A summarised and graduated assessment of the evidence (see also special guidelines for reviews of occupational diseases)
  • Gender data and differences, including an assessment of any independent impact of gender on the development of lunatum malacia
  • The project report will include a summary directed at lay persons
Various types of work involving many daily, severe stresses, such as blows with a hammer, exertion with upward/downward movements of wrists or the use of hand-held tools with severe vibrations, will be included and carry a lot of weight in the project report.
 
The scope of the exposures, including the severity and number of exposures and the total duration per day and over time, should in this context, to the extent possible, be estimated and assessed in detail.
 
If there is insufficient evidence of a correlation between lunatum malacia (Kienböck’s disease) and other diseases of the hand/wrist, including an impact on the ulnar nerve and other nerves of the forearm, and various types of work-related exposures, or if the literature is otherwise inadequate for the elucidation of the required causalities, this should be stated and the specific grounds should be given. 
 
If, in this connection, it is found that additional research should be initiated, it would be desirable for a substantiated and specific statement of the relevant additional-research goals to be included in the overall project conclusion.

2. General requirements to reference documents

The application must follow the guidelines set out in the Guide to application for subsidies from the Working Environment Research Fund and Special guidelines for preparation and quality approval of reviews in the form of reference documents in the field of occupational diseases.

The special guidelines must be integrated in the total project framework, also with regard to time.

It is presumed in connection with the project application that costs for project quality assurance, including costs deriving from the review process, are included in, and clearly appear from the overall financing of the project.

3. Procedure for processing of applications

Applications submitted to the Fund first has to be quality assessed, and the qualified applications are subsequently prioritised.

The procedure is as follows.

Applications for support for reviews must go through a scientific/professional assessment of the quality of the review. The quality will be assessed by the Committee for Development projects and Reviews.

For a description of the Committee’s definitions and guidelines in connection with the assessment of applications, see the Danish Working Environment Authority’s “Guide to application for subsidies from the Working Environment Research Fund”.

If the Committee for Development projects and Reviews finds that the project does not meet the quality criteria, the Danish Working Environment Authority, in their capacity as secretariat, turns down the application.

The Strategic Working Environment Research Committee subsequently assesses all the qualified applications and recommend for approval by the Minister for Employment one application per theme. Before making the recommendation to the Minister for Employment, the Committee hears the National Board of Industrial Injuries.

The Danish Working Environment Authority is secretariat to the Fund and administers the assets. The Danish Working Environment Authority gives the approved applicants the assurance that they will receive the subsidy. The other applications receive a refusal from the Working Environment Authority.

4. General information

The total budget: A total of DKK 1 million (aprox. 135.000 €) is set aside for the five reviews.

Duration: The reviews for all themes must be completed by September 15. 2010.

Reply to application: Applicants may expect a conclusive reply not later than 3 months from expiry of the time limit for application.

Requirements to the applicant: A subsidy may be granted to a broad field of applicants in working environment research and development.

Applicants might for instance be institutions/institutes, undertakings, organisations, consortiums, etc. - It should be noted that approval is not in principle given to individuals, but to institutions, undertakings, etc.

Cross-boundary co-operation: The Fund wishes to promote cross-boundary co-operation in connection with support for research and development activities.

Cross-boundary co-operation is understood as a group of several applicants, for instance institutions, undertakings, organisations etc., participating in the project.

Projects with cross-boundary co-operation will be prioritised if such co-operation is substantiated in relation to the problem concerned.

5. Formal requirements to the application

The applicant must complete the application form of the Working Environment Research Fund  and enclose the appendices stated in the form, including a project description of a maximum of five A4 pages, a time and production plan, a plan for publication and communication, a detailed budget, as well as CV and publication list.

For major applications a project description must be enclosed (max. two A4 pages) per part project.

The applicant may find additional information in the “Guide to application for subsidies from the Working Environment Research Fund” and below in the “Special guidelines for preparation and quality approval of reviews in the form of reference documents in the field of occupational diseases”.

It should be noted that applications which do not meet the formal requirements stated above will be turned down without being processed by the two committees.

6. Submitting applications

The application with original signature and appendices, as well as four copies of the same, must be sent to the Working Environment Research Fund/Arbejdsmiljøforskningsfonden, Arbejdstilsynet, postboks 1228, DK-0900 København C, or delivered by hand to Arbejdsmiljøforskningsfonden, Arbejdstilsynet, Landskronagade 33, København Ø. In addition, the application and appendices should be mailed in Word format to the Working Environment Research Fund, at@at.dk.

7. Time limit for application

Applications must reach the Working Environment Research Fund not later than January 4. 2010 at 12:00.

It should be noted that applications which do not meet the time limit will be turned down without being processed by the Fund. 

8. Additional information

Read application form and guide to application for subsidies from the Working Environment Research Fund as well as special guidelines for preparation and quality approval of reference document in the field of occupational diseases. 
 
Se also the Administrative Order Bekendtgørelse om Arbejdsmiljøforskningsfonden (in Danish) as well as the Fund’s strategy for working environment research and development Strategy for research and development in the working environment 2009-2010. (in English).

Special guidelines for preparation and quality approval of reviews in the form of reference documents in the field of occupational diseases

October 2009

The objective of preparing a reference document in the field of occupational diseases is to provide the best evidence-based answers to questions regarding possible causalities between various types of work-related exposures and the development of various types of diseases/complaints.

Therefore, with a view to ensuring the highest possible targeted quality of the required scientific literature examination, the following special guidelines have been set up for preparation and quality approval of a reference document in the field of occupational diseases.
  1. In connection with carrying out the project, the applicant will point to three or four external experts in the research area in question as relevant and competent reviewers. The Working Environment Research Fund (Arbejdsmiljøforskningsfonden) quality approves all reviewers and finally appoints two of those reviewers for the further process. All costs deriving from the work of the two reviewers will form part of the overall financial budget of the project, cf. the guide to application for subsidies from the Working Environment Research Fund. Budgets must be kept within an overall frame of DKK 50,000 for the reviewers’ work. Once the reviewers have been finally appointed by the Fund, a detailed budget for the project will be determined and approved by the Fund.
  2. The reference document must be prepared according to the requirement specifications of the notice and will also, in addition to the budget, include a detailed plan for time consumption and deadlines for each phase of the project, including for the reviewing phase.
  3. Within one month after receiving the applicant’s first final draft, the two reviewers will prepare and deliver to the applicant their written comments on the document.
  4. The subsidy recipient will write the final conclusion of the manuscript, in accordance with the comments received, and the revised work will be forwarded to the reviewers for any new comments. If needed, there may be one or more rounds of changes and comments in this conclusive part of the process. If it is not possible to reach a final agreement on the evidence basis and conclusions in connection with the conclusive evaluation of the work, such disagreement, and the specific origin of it, will appear explicitly from the final document. Any disagreement will be set out separately in the document.
  5. The final document with incorporated contributions from reviewers will be delivered to the Fund within the agreed time limit for conclusion of the project.
  6. The reference document will be delivered in a Danish, Swedish, Norwegian or English version, including an exhaustive summary. The summary will focus in particular on answering the most substantial, overall questions of the notice, including in particular a summary of conclusions regarding causalities between exposures and disease(s) and the respective evidence levels.
  7. In connection with the assessment of the evidence, the subsidy recipient will apply the recognised evidence model seen below. In the event of the exceptional application of any other evidence model, such a model is required to give a presentation of the evidence which is just as clear and transparent, based on equivalent principles.
  8. The subsidy recipient will be under an obligation to personally present the results of the project, including the main conclusions of the reference document and the work method applied, to the Occupational Diseases Committee. Arrangements will be made with the National Board of Industrial Injuries. The presentation will in principle be made not later than two months after conclusion of the project.
  9. As soon as the National Board of Industrial Injuries and the Occupational Diseases Committee have finalised their negotiations on the review, the National Board of Industrial Injuries, in connection with publishing the results of the negotiations, will also publish the reference document on their website www.ask.dk. This will also appear from any press release.
  10. The subsidy recipient must hold back his/her own publication of the reference document and its results, including part results, until the National Board of Industrial Injuries has reported back to the subsidy recipient that negotiations have been concluded and that the document may be released for own publication. The time of publication/release of the document and its results, including part results, cannot be determined in detail, this depending on the course of the negotiations.
  11. In connection with any own publication of the reference document and its results after release by the National Board of Industrial Injuries, the subsidy recipient must state that the document was written on the initiative of the National Board of Industrial Injuries and the Occupational Diseases Committee and that the reference document can also be found on the website of the National Board of Industrial Injuries www.ask.dk.
  12. In the event of an own publication of the reference document and its results after release by the National Board of Industrial Injuries, the Board will receive a copy of the subsidy recipient’s own published versions of the review and its results.
  13. The subsidy recipient and reviewers must not be members of the Occupational Diseases Committee or employees of wage-earner or employer organisations or the National Board of Industrial Injuries.
Further reference is made to the current standard terms for subsidies from the Working Environment Research Fund. These standard terms also apply to the preparation of reference documents.

Requirements to evidence assessment in connection with reviews of occupational diseases
 
The assessment of the evidence needs to take its starting point in the following evidence scale, which is based on internationally recognised epidemiological principles.

Good evidence: +++
Several prospective studies have found a strong association, which is also biologically plausible.
 
Some evidence: ++
Several cross-section and case-control studies have found a fairly certain association, which is also biologically plausible.
 
Limited evidence: +
Several studies have found a possible association, but this association can be explained by coincidence, bias or confounding.
 
Insufficient evidence: 0
Only few, not prospective studies have found an association. Other studies have found no association.
 
Good evidence of lacking correlation: -
Several prospective studies have found a lack of association and an association is not very biologically plausible.

The evidence scale is based on Bradford Hill’s criteria for causation. The greater the number of criteria met, the greater the likelihood of evidence. There is broad international consensus on the following four criteria in particular, and therefore the evidence assessment needs to give these a lot of weight.
 
1. Strength of association. The stronger the statistical association, the greater the likelihood of causation.
 
2. Consistency of association. The greater the number of good studies finding similar association results, the greater the likelihood of causation.
 
3. Temporality of association. The exposure must precede the effect.
 
4. Biological plausibility of association. It is desirable to be able to give a fairly reasonable, biological explanation to a found association. The better the explanation, the greater the likelihood of causation.