Occupational and Environmental Medicine

Callas, P W; Pastides, H; Hosmer, D W

doi: 10.1136/oem.51.10.649pmid: 8000487

OBJECTIVES--This survey was conducted to determine the frequency with which different data analysis techniques are being used in occupational cohort studies. Of particular interest was the relative use of external and internal comparison groups, and the choice of multivariable model. METHODS--Occupational cohort studies published in 1990-91 were located with Medline and Index Medicus, and the contents of several relevant journals were systematically reviewed. Each study was categorised by the methods of external or internal comparisons performed. RESULTS--Of 200 occupational cohort studies identified, 104 (52%) conducted only external comparisons, 46 (23%) conducted only internal, and 50 (25%) presented both. Of those that used an external referent population, about two thirds used a national standard. 40 of the studies that performed internal comparisons fitted multivariable models, with use divided about equally between proportional hazards regression, Poisson regression, and logistic regression. DISCUSSION--The finding that logistic regression is used quite commonly, even though it does not directly model time dependent data of the type frequently encountered in occupational cohort studies, was suprising. The reasons why investigators choose from among the available statistical and modelling techniques are likely to include familiarity, ease of use, restrictions in study population characteristics, especially study size, and others. Authors should be encouraged to be more explicit about the statistical methods used in the analysis of occupational cohort studies, as well as whether important assumptions about their data have been evaluated.

Holland, R I; Ellingsen, D G; Olstad, M L; Kjuus, H

doi: 10.1136/oem.51.10.656pmid: 8000488

OBJECTIVES--The dental health of 73 workers previously exposed to mercury vapour at a chloralkali plant was studied and compared with that of 51 non-exposed referents. METHODS--A record of oral, periodontal, gingival and mucosal conditions, including teeth, restorations, prostheses, and oral hygiene, was established during a 30 min examination. The participants' periodontal conditions were assessed according to the community periodontal index of treatment needs (CPITN). The results with the CPITN index were also compared with previously published data for another similar population. RESULTS--There was no significant difference between the exposed workers and the referents with respect to the number of remaining teeth, amount of amalgam restorations, crowns, bridges, or endodontically treated teeth. The oral hygiene among the exposed workers was significantly better than among the referents, but the periodontal health conditions did not significantly differ between the two groups, nor from those of another Norwegian population. DISCUSSION--The present results seem to contradict previous reports claiming tooth loss as a possible result of exposure to mercury vapour.

Ishihara, N; Urushiyama, K

doi: 10.1136/oem.51.10.660pmid: 8000489

Seven Japanese female workers exposed to mercury vapour at a concentration of < 0.02 mg Hg/m3 (8 h/day, 44 h/week) were examined for inorganic (I-Hg) and organic (O-Hg) mercury concentrations in urine, blood, and hair after 0, 4, 8, 17, and 23 months of exposure. Both I-Hg and O-Hg concentrations in urine and hair did not increase significantly even after 23 months of exposure. The concentration of I-Hg and O-Hg in plasma and O-Hg in erythrocytes, however, increased significantly after four months of exposure, and the high concentrations were maintained until the end of the study (23 months of exposure). Absence of a significant increase in the concentration of O-Hg in hair indicates that changes in concentrations of I-Hg and O-Hg in blood could be caused by the occupational exposure to mercury vapour. These results show clearly that mercury concentration in blood indicates the uptake of mercury compared with data from before employment with mercury. Even after 23 months of exposure to mercury vapour, however, urinary mercury concentration was not affected.

Gao, M; Levy, L S; Faux, S P; Aw, T C; Braithwaite, R A; Brown, S S

doi: 10.1136/oem.51.10.663pmid: 8000490

OBJECTIVES--Molecular epidemiological techniques, capable of detecting damage to DNA, were used to see if such damage occurred in the lymphocytes of a group of workers exposed to chromium. The two aims of this pilot study were to see if these new techniques might make useful biological monitoring tools for workers exposed to chromium and also, to help assess whether the current occupational exposure limit for chromium (VI) was sufficiently protective in this specific working situation. METHODS--Volunteer groups of 10 workers exposed to chromium and 10 non-exposed workers provided urine and blood samples towards the end of the working week. Chromium concentrations were measured in whole blood, plasma, lymphocytes, and urine. Lymphocytes were used to examine two forms of DNA damage in the two groups; these were the level of DNA strand breakage and, the production of 8-hydroxydeoxyguanosine. RESULTS--Chromium concentration in whole blood, plasma, and urine of workers exposed to chromium was significantly raised (P < 0.01) compared with non-exposed controls, but in isolated lymphocytes, there was only a modest but significant (P < 0.05) increase in chromium in the group exposed to chromium. There was no difference in the levels of DNA strand breaks or 8-hydroxydeoxyguanosine between the groups. Air monitoring for chromium was not undertaken but current levels for the group exposed to chromium were reported to be around 0.01 mg/m3, which is 20% of the current United Kingdom occupational exposure limit. CONCLUSIONS--We were unable to detect any damage in lymphocytic DNA due to exposure to chromium. This may have been due to the low chromium exposure (< 20% of the United Kingdom occupational exposure limit), the ability of plasma to detoxify chromium (VI) to chromium (III) before it reached the lymphocytes, or perhaps the insensitivity of the molecular techniques used. It is now important to test these and other such techniques on groups exposed to levels closer to the United Kingdom occupational exposure limit.

Schwartz, B S; McGrail, M P; Stewart, W; Pluth, T

doi: 10.1136/oem.51.10.669pmid: 8000491

OBJECTIVES--To describe 6 h urinary lead excretion (6 h PbU) after 1 g intravenous ethylene diamine tetraacetic acid (EDTA) in organolead manufacturing workers with mixed exposure to organic and inorganic lead; to determine the predictors of lead excretion (PbU); and to determine the extent to which internal lead stores and ongoing external exposure govern blood concentrations of lead (PbB). METHODS--A case series of 21 active workers were studied. Personal industrial hygiene data, grouped by 29 exposure zones, in combination with personal interviews about work location and times were used to derive several measures of recent and cumulative exposure to organic and inorganic lead. The average exposure intensities assigned to the 29 zones ranged from 4 to 119 micrograms/m3 (0.02-0.57 mumol/m3 as lead) for organic lead and from 1 to 56 micrograms/m3 (0.004-0.27 mumol/m3) for inorganic lead. RESULTS--After controlling for age, 6 h PbU was significantly and positively correlated with summary measures of PbB--for example, lifetime peak PbB, time weighted PbB--and zinc protoporphyrin concentrations--for example, lifetime peak zinc protoporphyrin, time weighted zinc protoporphyrin--but not with measures of estimated external exposure--for example, duration of exposure and cumulative exposure to inorganic or organic lead. Among workers with higher chelatable lead burdens (6 h PbU > or = 212.4 micrograms (1.03 mumol) divided at the median), there was no apparent relation between recent inorganic lead exposure and PbB at the time of chelation. Among workers with lower chelatable lead burdens (6 h PbU < 212.4 micrograms (1.03 mumol) however, there was a significant relation between exposure and effect between recent exposure to inorganic lead and PbBs. CONCLUSION--These findings are consistent with the concept of physiological dampening. The high chelatable lead burden, a source of internal exposure, dampens the effect of external exposure on PbBs. The data suggest that in organolead workers with high chelatable lead burdens, PbBs may be more influenced by internal lead stores than by variations in airborne exposure to organic and inorganic lead.

Cocco, P L; Carta, P; Belli, S; Picchiri, G F; Flore, M V

doi: 10.1136/oem.51.10.674pmid: 8000492

The mortality of 4740 male workers of two lead and zinc mines was followed up from 1960 to 1988. Exposure to respirable dust was comparable in the two mines, but the median concentration of silica in respirable dust was 10-fold higher in mine B (12.8%) than in mine A (1.2%), but the mean annual exposure to radon daughters in underground workplaces differed in the opposite direction (mine A: 0.13 working levels (WL), mine B: 0.011 WL). Total observed deaths (1205) were similar to expected figures (1156.3) over a total of 119 390.5 person-years at risk. Underground workers of mine B had significant increases in risk of pulmonary tuberculosis (SMR 706, 95% confidence interval (95% CI) 473-1014) and non-malignant respiratory diseases (SMR 518; 95% CI 440-1606), whereas the only significant excess at mine A was for non-malignant respiratory diseases (SMR 246; 95% CI 191-312). Total cancer and lung cancer mortality did not exceed the expectation in the two mines combined. A 15% excess mortality for lung cancer, increased up to an SMR 204 (95% CI 89-470) for subjects employed > or = 26 years, was, however, found among underground workers in mine A who on the average experienced an exposure to radon daughters 10-fold higher than those of mine B. By contrast, despite their higher exposure to silica, mine B underground workers experienced a lower than expected lung cancer mortality. A ninefold increase in risk of peritoneal and retroperitoneal cancer combined was also found among underground workers of mine A (SMR 917; 95% CI 250-2347; based on four deaths). A causal association with workplace exposures is unlikely, however, as the SMR showed an inverse trend by duration of employment. These findings are consistent with low level exposure to radon daughters as a risk factor for lung cancer among metal miners. Exposure to silica at the levels estimated for the mine B underground environment did not increase the risk of lung cancer.

Nordström, K; Norbäck, D; Akselsson, R

doi: 10.1136/oem.51.10.683pmid: 8000493

The sensation of dryness and irritation is essential in the sick building syndrome (SBS), and such symptoms are common in both office and hospital employees. In Scandinavia, the indoor relative humidity in well ventilated buildings is usually in the range 10-35% in winter. The aim of this study was to evaluate the effect of steam air humidification on SBS and perceived air quality during the heating season. The study base consisted of a dynamic population of 104 hospital employees, working in four new and well ventilated geriatric hospital units in southern Sweden. Air humidification raised the relative air humidity to 40-45% in two units during a four months period, whereas the other two units served as controls with relative humidity from 25-35%. Symptoms and perceived indoor air quality were measured before and after the study period by a standardised self administered questionnaire. The technical measurements comprised room temperature, air humidity, static electricity, exhaust air flow, aerosols, microorganisms, and volatile organic compounds in the air. The most pronounced effect of the humidification was a significant decrease of the sensation of air dryness, static electricity, and airway symptoms. After four months of air humidification during the heating season, 24% reported a weekly sensation of dryness in humidified units, compared with 73% in controls. No significant changes in symptoms of SBS or perceived air quality over time were found in the control group. The room temperature in all units was between 21-23 degrees C, and no significant effect of air humidification on the air concentration of aerosols or volatile organic compounds was found. No growth of microorganisms was found in the supply air ducts, and no legionella bacteria were found in the supply water of the humidifier. Air humidification, however, significantly reduced the measured personal exposure to static electricity. It is concluded that air humidification during the heating season in colder climates can decrease symptoms of SBS and perception of dry air.

Guo, Y L; Wang, B J; Lee, J Y; Chou, S Y

doi: 10.1136/oem.51.10.689pmid: 8000494

OBJECTIVES--To determine the prevalence, clinical features, and patterns of hand dermatosis in hairdressers in Tainan, Taiwan, and to examine the associations between patterns of dermatosis and risk factors such as job description, work exposure, and sensitisation to common allergens. METHODS--Interviews, examinations, and patch tests of the hairdressers from nine hairdressing stores randomly selected from Tainan City. Patch test agents included 41 substances with common allergens, shampoo preservatives, hair dyes, permanent waving and bleaching agents. RESULTS--98 hairdressers finished the examination, 83% of them had occupational dermatosis and 32% had scissor induced scars or wounds. Most of the dermatoses belonged to either dry metacarpophalangeal dermatitis or eczema of the fingers. 44% of the hairdressers showed positive skin reaction to one or more patch test agents. The patch test results were different from previous reports in that the most common allergens were nickel, thimerosal, Captan, Kathon CG, and fragrance mix, and that the sensitivity to hair dye and permanent wave ingredients were low. The dry metacarpophalangeal dermatitis was associated with exposure to shampoo, and the eczema of the fingers with skin sensitivity to patch test agents. CONCLUSION--Hairdressers in Tainan City had a high prevalence of dermatoses including traumatic wounds, and allergic and irritant contact dermatitis. The rates of sensitivity to some of the common sensitising agents were different from previous reports.

de Cock, J; Westveer, K; Heederik, D; te Velde, E; van Kooij, R

doi: 10.1136/oem.51.10.693pmid: 8000495

OBJECTIVES--Although pesticides are regularly used in agriculture, relatively little is known about possible adverse health effects, especially reproductive effects, due to occupational exposure. This explorative study investigates the relation between exposure of the fruit grower to pesticides and fecundability (probability of pregnancy) in a population of fruit growers. METHODS--The analysis is based on self reported data and includes 91 pregnancies during 1978-1990 of 43 couples. Cox' proportional hazards model was used to analyse time to pregnancy after correction for gravidity and consultation with a physician for fertility problems. RESULTS AND CONCLUSIONS--Application of pesticides solely by the owner was associated with a long time to pregnancy, resulting in a fecundability ratio of 0.46 (95% confidence interval (95% CI) 0.28-0.77). Similarly a low spraying velocity (< or = 1.5 hectares/h) resulted in a fecundability ratio of 0.47 (95% CI 0.29-0.76) and is associated with the use of older spraying techniques and tractors without a cabin. These factors were assumed to cause high exposure, which was confirmed by exposure measurements in the field. The effect of high exposure was mainly apparent if the couple had intended to become pregnant in the period from March-November (fecundability ratio 0.42, 95% CI 0.20-0.92). This is the period in which pesticides are applied. Out of the spraying season the effect of a high exposure was absent (fecundability ratio 0.82, 95% CI 0.33-2.02). In the high exposure group 28% of the pregnancies had been preceded by consulting a physician because of fertility problems, compared with 8% in the low exposure group. These findings indicate that an adverse effect of exposure to pesticides on fecundability is likely.

Barbosa, A; Bonin, A M

doi: 10.1136/oem.51.10.700pmid: 8000496

Phosphine has been claimed to cause chromosomal damage at exposures close to the current time weighted average exposure standard of 0.3 ppm (0.4 mg/m3). The current study involved 31 phosphine fumigators and 21 controls during the high fumigation season. All were volunteers and were evaluated for genotoxicity variables, including micronuclei in peripheral blood lymphocytes and urine mutagenicity. In parallel, all fumigators and 17 controls were evaluated for full haematology, multiple biochemical analysis, whole blood organochlorines, and whole blood and serum cholinesterase activity. The results for micronuclei showed no significant differences between fumigators and controls, but detected a strong association between age and increased frequency of micronuclei. Measurement of urine mutagenicity did not show any significant difference between fumigators and controls, but did show increased excretion of mutagens in smokers. All haematological and biochemical variables were within normal ranges, except for some non-specific changes in biochemistry. At monitored occupational exposures of < 2.4 ppm/h our results show no association between phosphine exposure and genotoxic or toxicological effects in fumigators.