Epidemiological occupational health studies in the carbon black and amorphous silica industries, two classic examples of nanomaterials, were carried out in the late 1980s/mid 1990s. These days, some initial studies started to address the health of workers exposed to novel types of manufactured nanomaterials. These studies face three main challenges: exposure assessment, identification of suitable effect markers and size of populations. The relatively small current workforces in individual countries will probably necessitate the pooling of cohorts internationally. However, at the moment, the necessary conditions for such a pooling are not in place: namely agreements on design, exposure and effect characterisation are not in place. To bridge this gap and to provide a coherent approach in view of future epidemiological research, we recently proposed a roadmap  to reach global consensus on need a well defined, globally harmonised framework for the careful choice of materials, exposure characterisation, identification of study populations, definition of health endpoints, evaluation of appropriateness of study designs, data collection and analysis, and interpretation of the results. The proposed strategy should ensure that the costs of action are not disproportionate to the potential benefits, and importantly, that the approach is pragmatic and practical. Moreover, we should aim to go beyond the collection of health complaints, illness statistics or even counts of deaths: the manifestation of such clear endpoints would indicate a failure of preventive measures. Instead, we should agree on a minimum set of biomarkers and metrics of early effects for acute and chronic diseases while evaluating how concepts of systems biology, gene activation and epigenetics can inform such studies on outcomes and related biomarkers of potential interest.
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