Occupational and Environmental Medicine

Hillerdal, G

doi: 10.1136/oem.56.8.505pmid: 10492646

OBJECTIVES: To estimate the importance of low dose exposure to asbestos on the risk of mesothelioma. METHODS: A review of the literature. RESULTS AND CONCLUSIONS: There is no evidence of a threshold level below which there is no risk of mesothelioma. Low level exposure more often than not contains peak concentrations which can be very high for short periods. There might exist a background level of mesothelioma occurring in the absence of exposure ot asbestos, but there is no proof of this and this "natural level" is probably much lower than the 1-2/million/year which has been often cited.

Raza, S N; Fletcher, A M; Pickering, C A; Niven, R M; Faragher, E B

doi: 10.1136/oem.56.8.514pmid: 10492647

OBJECTIVES: To investigate a large population of cotton textile weavers for reported respiratory symptoms relative to occupational factors, smoking, and exposure to dust. Cotton processing is known to produce a respiratory disease known as byssinosis particularly in the early processes of cotton spinning. Relatively little is known about the respiratory health of the cotton weavers who produce cloth from spun cotton. By the time cotton is woven many of the original contaminants have been removed. METHODS: 1295 operatives from a target population of 1428 were given an interviewer led respiratory questionnaire. The presence of upper and lower respiratory tract symptoms were sought and the work relatedness of these symptoms determined by a stem questionnaire design. Also occupational and demographic details were obtained and spirometry and personal dust sampling performed. RESULTS: Byssinosis was present in only four people (0.3%). Chronic bronchitis had a moderate overall prevalence of about 6% and was related predominantly to smoking. There were several other work related respiratory symptoms (persistent cough 3.9%, chronic production of phlegm 3.6%, chest tightness 4.8%, wheezing 5.4%, and breathlessness 2.3%). All of these were predicted predominantly by smoking (either past or present), with no consistent independent effect of exposure to dust. Work related eye and nasal symptoms were more common (10.4% and 16.9% respectively). CONCLUSION: Byssinosis is a rare respiratory symptom in cotton weaving. Other work related respiratory symptoms were reported but their presence was predominantly related to smoking with no consistent effects of exposure to dust.

Raza, S N; Fletcher, A M; Pickering, C A; Niven, R M; Faragher, E

doi: 10.1136/oem.56.8.520pmid: 10492648

BACKGROUND: To report findings on ventilatory function and estimations of concentrations of personal breathing zone dust in Lancashire textile weavers. Weaving room dust is considered to be less harmful than that encountered in the cardroom or spinning room and weavers are generally thought to have less respiratory disability than carders or spinners. However, this occupational group has not been extensively studied. METHODS: Each person was given a respiratory symptom questionnaire (modified Medical Research Council, UK, questionnaire on respiratory diseases). Ventilatory function tests, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were performed on each person. A representative sample of workers from each occupational group underwent dust sampling in their personal breathing zone. Dust concentrations and ventilatory tests were analysed statistically with the Student's t test, Pearson's correlation coefficient, and forward step regression for relations with symptoms and environmental factors. Significance was p > or = 0.05. RESULTS: The FEV1 and FVC were reduced in workers with respiratory symptoms (non-specific chest tightness, shortness of breath, persistent cough, and wheezing) as well as in preparation room workers, current and former smokers, Asians, those working with predominantly cotton fibre (> 50% cotton) and starch size. Mean total dust concentration (pd1) in the personal breathing zone was 1.98 mg/m3. The corresponding value for total dust with large fibres lifted off the filter paper (pd2) was 1.55 mg/m3. There was a strong correlation (r = 0.94, p < 0.0001) between pd1 and pd2. Non-specific chest tightness was predicted by low dust concentrations and persistent cough by high dust concentrations. On regression analysis, impairment of ventilatory function (FEV1, FVC) was predicted by smoking, male sex, age, not working in the weaving shed, not being white, and personal dust concentrations. CONCLUSIONS: The FEV1 and FVC were impaired in smokers and those exposed to high dust concentrations in the personal breathing zone. Symptoms were inconsistently related to dust concentrations in the personal breathing zone.

Rudell, B; Blomberg, A; Helleday, R; Ledin, M C; Lundbäck, B; Stjernberg, N; Hörstedt, P; Sandström, T

doi: 10.1136/oem.56.8.527pmid: 10492649

OBJECTIVES: Air pollution particulates have been identified as having adverse effects on respiratory health. The present study was undertaken to further clarify the effects of diesel exhaust on bronchoalveolar cells and soluble components in normal healthy subjects. The study was also designed to evaluate whether a ceramic particle trap at the end of the tail pipe, from an idling engine, would reduce indices of airway inflammation. METHODS: The study comprised three exposures in all 10 healthy never smoking subjects; air, diluted diesel exhaust, and diluted diesel exhaust filtered with a ceramic particle trap. The exposures were given for 1 hour in randomised order about 3 weeks apart. The diesel exhaust exposure apperatus has previously been carefully developed and evaluated. Bronchoalveolar lavage was performed 24 hours after exposures and the lavage fluids from the bronchial and bronchoalveolar region were analysed for cells and soluble components. RESULTS: The particle trap reduced the mean steady state number of particles by 50%, but the concentrations of the other measured compounds were almost unchanged. It was found that diesel exhaust caused an increase in neutrophils in airway lavage, together with an adverse influence on the phagocytosis by alveolar macrophages in vitro. Furthermore, the diesel exhaust was found to be able to induce a migration of alveolar macrophages into the airspaces, together with reduction in CD3+CD25+ cells. (CD = cluster of differentiation) The use of the specific ceramic particle trap at the end of the tail pipe was not sufficient to completely abolish these effects when interacting with the exhaust from an idling vehicle. CONCLUSIONS: The current study showed that exposure to diesel exhaust may induce neutrophil and alveolar macrophage recruitment into the airways and suppress alveolar macrophage function. The particle trap did not cause significant reduction of effects induced by diesel exhaust compared with unfiltered diesel exhaust. Further studies are warranted to evaluate more efficient treatment devices to reduce adverse reactions to diesel exhaust in the airways.

Adir, Y; Merdler, A; Ben Haim, S; Front, A; Harduf, R; Bitterman, H

doi: 10.1136/oem.56.8.535pmid: 10492650

OBJECTIVE: To assess the effects of exposure to low concentrations of carbon monoxide (CO), as commonly measured in atmospheric urban air pollution and certain occupational environments, on exercise performance and myocardial perfusion in young healthy men, and the possible need for tighter restrictions on ambient concentrations of CO. METHODS: 15 young, healthy non-smoking men, 18-35 years old, were exposed blindly and randomly to air or to a mixture of CO and air, followed by an exercise treadmill test with thallium heart scintigraphy. Blood was drawn for determination of carboxyhaemoglobin before and at the end of the exposure, and for lactic and pyruvic acid at the beginning and the end of the exercise test. The main outcome measures include the duration of the exercise test, the maximal effort expressed in metabolic equivalent units (METs), the mean plasma lactic to pyruvic acid ratio at the end of the ergometry, ECG changes in the exercise test, and perfusion deficits in thallium heart scintigraphy. RESULTS: At the end of exposure to CO, the mean (SD) blood carboxyhaemoglobin concentration rose from 0.59% (0.08%) to 5.12% (0.65%) (p < 0.0001). At the end of the exercise period, the mean (SD) plasma lactate/pyruvate ratio, which reflects the level of anaerobic metabolism (69.9 (5.9) after air and 75.9 (7.0) after CO), was not significantly different between the two experimental groups. Exercise induced electrocardiographic changes were noted in only one subject after exposure to CO. No arrhythmias were detected in any of the subjects. Significant differences were found in the mean duration of the exercise test (p = 0.0012) and the METs (p = 0.0001). The mean adjusted difference of exercise duration between exposure to air and CO was 1.52 minutes 95% confidence interval (95% CI) 0.73 to 2.32 minutes. The mean adjusted difference of METs between exposure to air and CO was 2.04 95% CI 1.33 to 2.76. The models for duration of exercise and METs showed no significant sequence and period effects. Thallium myocardial perfusion imaging disclosed normal perfusion in all regions of the heart, with no significant differences in perfusion between the two exercise tests (after air or CO). CONCLUSION: Acute exposure to a low concentration of CO which produces blood carboxyhaemoglobin concentrations of 4%-6% significantly decreases exercise performance in young healthy men. No ischaemic electrocardiographic changes or disturbances in myocardial perfusion were found by graded exercise with thallium scintigraphy. Our findings suggest that pollution of atmospheric air by CO at concentrations which are commonly found in urban and industrial environments may exert an adverse effect on skeletal muscles, manifesting as decreased exercise performance.

Bobak, M; Leon, D A

doi: 10.1136/oem.56.8.539pmid: 10492651

OBJECTIVES: Outdoor air pollution has consistently been shown to predict mortality. The finding that this association is stronger in infants than in children or adults raises the question whether air pollution could also be related to pregnancy outcomes--such as birthweight and stillbirth. The association between outdoor air pollution and stillbirths and low birthweight in the Czech Republic, where air pollution was high, was examined. METHODS: An ecological study was conducted, with routinely collected data on stillbirths and low birthweight (< 2500 g), air pollution (total suspended particulates, sulphur dioxide (SO2), and nitrogen oxides (NOx)), and socioeconomic factors (mean income, car ownership, divorce rate, etc). The analyses were restricted to 45 districts on which data on air pollution were available for the period 1986-8. The effects of exposure variables on frequency of pregnancy outcomes were estimated by logistic regression with district-years as the units of analysis. RESULTS: Stillbirth rate (4.2/1000 births in monitored districts) was not significantly associated with any indicator of air pollution, and was weakly related to mean income and proportion of births outside marriage. Crude prevalence of low birthweight (prevalence 5.5%) showed highly significant associations with several socioeconomic factors; after controlling for these, odds ratios (ORs)/50 micrograms/m3 increase in pollutant were: 1.04 (95% confidence interval (95% CI) 0.96 to 1.12) for total suspended particles, 1.10 (1.02 to 1.17) for SO2, and 1.07 (0.98 to 1.16) for NOx. When all pollutants were included in one model, SO2 remained related to low birthweight (OR 1.10 (1.01 to 1.20), p = 0.033). CONCLUSION: These results are consistent with a recent study in China where birthweight was also associated with total suspended particles and SO2 but ecological studies must be interpreted cautiously. Residual confounding by socioeconomic factors cannot be ruled out. The association between air pollution and birthweight requires further investigation.

Trenga, C A; Koenig, J Q; Williams, P V

doi: 10.1136/oem.56.8.544pmid: 10492652

OBJECTIVES: To screen adult subjects with asthma for sensitivity to inhaled sulphur dioxide (SO2) and identify subject characteristics associated with that sensitivity. Medication use, symptoms, and plasma antioxidant nutrients between SO2 responders and non-responders were compared. METHODS: Adult subjects (ages 18-39 years) with asthma were exposed to 0.5 ppm SO2 for 10 minutes during moderate exercise. Pulmonary function tests and symptom ratings were assessed before and after exposure (n = 47). A subject was classified as sensitive to SO2 if forced expiratory volume in 1 second (FEV1) showed a drop > or = 8% over baseline. Blood samples were obtained from subjects (n = 38) before the SO2 challenge; plasma ascorbate, alpha-tocopherol, retinol, carotenoids, and lipids were measured. RESULTS: Of the 47 subjects screened, 53% had a drop in FEV1 > or = 8% (ranging from -8% to -44%). Among those 25 subjects, the mean drop in FEV1 was -17.2%. Baseline pulmonary function indices (FEV1% of predicted and FEV1/FVC% (forced vital capacity)) did not predict sensitivity to SO2. Although use of medication was inversely related to changes in pulmonary function after SO2 (p < 0.05), both SO2 responders and non-responders were represented in each medication category. Total symptom scores after exposure were significantly correlated with changes in FEV1 (p < 0.05), FVC (p < 0.05), and peak expiratory flow (PEF) (p < 0.01) but not forced expiratory flow between 25% and 75% vital capacity (FEF25-75). Plasma beta-carotene concentrations were inversely associated with PEF values and ascorbate concentrations were inversely associated with FEV1 and FEV1/FVC (p = 0.05 in all cases). High density lipoprotein concentrations were positively correlated with FEV1% of predicted (p < 0.05) and inversely correlated with change in FEF25-75 (p < 0.05) after SO2. CONCLUSION: These results show that the response to SO2 among adults with mild to moderate asthma is very diverse. Severity of asthma defined by medication category was not a predictor of sensitivity to SO2. Lung function values were associated with beta-carotene and ascorbate concentrations in plasma; however, plasma antioxidant nutrient concentrations were not associated with sensitivity to inhaled SO2.

Amre, D K; Infante-Rivard, C; Dufresne, A; Durgawale, P M; Ernst, P

doi: 10.1136/oem.56.8.548pmid: 10492653

OBJECTIVES: To investigate the risk of lung cancer among sugar cane farmers and sugar mill workers. METHODS: A case-control study was conducted based in six hospitals in the predominantly sugar cane farming districts of the province of Maharashtra in India. Newly diagnosed, histologically confirmed cases were identified from these hospitals between May 1996 and April 1998. Other cancers were chosen as controls and matched to cases by age, sex, district of residence, and timing of diagnosis. RESULTS: Adjusting for confounders, an increased risk of lung cancer was found for workers ever employed on a sugar cane farm (odds ratio (OR) 1.92, 95% confidence interval (95% CI) 1.08 to 3.40). Increased risks were found for work involving preparation of the farm (OR 1.81, 95% CI 0.99 to 3.27) and burning of the farm after harvesting (OR 1.82, 95% CI 0.99 to 3.34). Non-significant increases in risks were found for harvesting the crop (OR 1.41, 95% CI 0.70 to 2.90) and processing the cane in the mills (OR 1.70, 95% CI 0.20 to 12.60). CONCLUSIONS: Exposure to fibres of biogenic amorphous silica (BAS) formed from silica absorbed from the soil and deposited in the leaves of the sugar cane crop or crystalline silica formed as a result of conversion of BAS to cristobalite at high temperatures may account for the increased risks of lung cancer among sugar cane farmers.

Mason, H J; Williams, N; Armitage, S; Morgan, M; Green, S; Perrin, B; Morgan, W D

doi: 10.1136/oem.56.8.553pmid: 10492654

OBJECTIVES: To study longitudinal biological monitoring data on urinary and blood cadmium collected in a small cohort of nine workers who had been brazing for several years with solders containing cadmium. METHODS: Cadmium was measured by neutron activation analysis in livers and kidneys, and estimates of renal function were carried out in 1983 and 1995. During the intervening period exposure to cadmium was dramatically reduced by local exhaust ventilation control and substitution of the solder containing cadmium. RESULTS: From urinary protein measurements there was evidence within the group of increasing renal tubular damage over the 12 year period, even though exposure to cadmium was dramatically reduced over this period and almost eliminated by 1995. There was no evidence from serum creatinine of decreasing glomerular filtration rate, and the renal tubular handling of calcium, phosphate, or urate had not worsened significantly. Blood and urinary cadmium concentrations reduced significantly over the 12 year period but were still substantial in 1995. Blood cadmium concentrations tended to reflect cadmium body burden in 1995 when exposure had been low for several years, and decreased most significantly during 1983-90. By contrast urinary cadmium concentrations only decreased significantly from about 1990 onwards. Urinary cadmium was not significantly correlated with liver or kidney cadmium concentration in either 1983 or 1995. This may be due to the level of tubular dysfunction in the cohort. Calculated cumulative excretion of cadmium over the 12 year period was substantially greater than the loss of cadmium measured in livers and kidneys and the derived loss in body burden. Reasons for this are discussed. It is possible that in cohorts, where renal damage is apparent, urinary concentrations reflect a substantial component of current exposure rather than stored body losses. CONCLUSIONS: The data reinforce the concept that blood cadmium concentrations may not always reflect recent exposure, but may reflect body burden derived from historical exposure depending on the degree of current exposure; and that the decline in urinary and blood cadmium measurements after removal from, or reduction in, exposure will be slow and depend on the historical body burden.

Rapiti, E; Sperati, A; Miceli, M; Forastiere, F; Di Lallo, D; Cavariani, F; Goldsmith, D F; Perucci, C A

doi: 10.1136/oem.56.8.559pmid: 10492655

OBJECTIVES: To evaluate whether ceramic workers exposed to silica experience an excess of end stage renal disease. METHODS: On the basis of a health surveillance programme, a cohort of 2980 male ceramic workers has been enrolled during the period 1974-91 in Civitacastellana, Lazio, Italy. For each worker, employment history, smoking data, and x ray film readings were available. The vital status was ascertained for all cohort members. All 2820 people still alive and resident in the Lazio region as in June 1994 were searched for a match in the regional end stage renal diseases registry, which records (since June, 1994) all patients undergoing dialysis treatment in public and private facilities of the region. Expected numbers of prevalent cases from the cohort were computed by applying the rate of patients on dialysis treatment by the age distribution of the cohort. RESULTS: A total of six cases was detected when 1.87 were expected (observed/expected (O/E) = 3.21; 95% confidence interval (95% CI) 1.17 to 6.98). The excess risk was present among non-smokers (O = 2; O/E = 4.34) and smokers (O = 4; O/E = 2.83), as well as among workers without silicosis (O = 4; O/E = 2.78) and workers with silicosis (O = 2; O/E = 4.54). The risk was higher among subjects with < 20 years since first employment (O = 4; O/E = 4.65) than among those employed > 20 years. CONCLUSION: These results provide further evidence that exposure to silica dust among ceramic workers is associated with nephrotoxic effects.