Ramazzini

Nano-scale deserves special attention

Annet Lenderink — Sat, 20 Jan 2018 10:48:56 +0000

Over the last years there has been a big load of research into the health and safety implications of man-made nano-materials. The term nanomaterials refers to materials that have at least one dimension (height, width or length) that is smaller than 100 nanometres (10−7 metre), which is about the size of a virus particle. This particular size dimension represents a major characteristic of manufactured nanomaterials (MNMs). The unique properties of MNMs may result in highly desirable behaviour leading to such
varying applications as better paints, better drugs and faster electronics. However, for the same reason, MNMs may also present health hazards that differ from those of the substance in bulk form, and may require different test methods for hazard, exposure and risk assessment.

The toxicity of MNMs may largely depend on numerous physicochemical properties, including size, shape (i.e. size in a particular dimension), composition, surface characteristics, charge and rate of dissolution. There is currently a paucity of precise information about human exposure pathways for MNMs, their fate in the human body and their ability to induce unwanted biological effects such as generation of oxidative stress. Data from in vitro, animal and human MNM inhalation studies are available for only a few MNMs. So far, no long-term adverse health effects in humans have been observed. This could be due to the recent introduction of MNMs, the precautionary approach to avoid exposure and ethical concerns about conducting studies
on humans.

The increased production of MNMs and their use in consumer and industrial products means that workers in all countries will be at the front line of exposure to these materials, placing them at increased risk for potential adverse health effects. Currently an extensive WHO-report was published in which this literature was taken into account to develop guidelines with recommendations on how best to protect workers from the potential risks of MNMs.

The report: “WHO guidelines on protecting workers from potential risks of manufactured nanomaterials.” is online available and is very informative on the state of the art information available

Preferred citation of source : WHO guidelines on protecting workers from potential risks of manufactured nanomaterials. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO

How valid is workers’ self-reported work-related illness?

Annet Lenderink — Sat, 11 Feb 2012 15:15:47 +0000

Finally published as HSE report our review on workers’ self-report

RR903 – Review on the validity and reliability of self-reported work-related illness

Self-report is an efficient and accepted means of assessing population characteristics, risk factors, and diseases and is frequently used in occupational health studies. Little is known on the validity of self-reports used to measure work-related illness. This study reviews the evidence on the reliability and validity of workers’ self-reported work-related ill health.

Legislation helps prevention

Annet Lenderink — Thu, 09 Feb 2012 09:28:29 +0000

One of the most difficult things in Occupational Health is show that preventive measures really have impact on the incidence of work-related disease. In an interesting study by Jill Stocks et al. data of the registries for occupational diseases in the UK are used to study the influence of European legislation on reducing chromate exposure in cement. They found a steeper decline in allergic contact dermatitis attributed to chromate than for other types of allergic contact dermatitis after introduction of the legislation.

S J Stocks, R McNamee, S Turner, M Carder, R M Agius Has European Union legislation to reduce exposure to chromate in cement been effective in reducing the incidence of allergic contact dermatitis attributed to chromate in the UK? Occup Environ Med2012;69:150-152

Abstract

Objective

Hexavalent chromate (chromate) in cement is a well-recognised cause of allergic contact dermatitis (ACD). Consequently in January 2005, following European Union legislation (EU Directive 2003/53/EC), the use or supply of cement containing >2 ppm of chromate was prohibited in the UK (COSHH 2004). This analysis of work-related ill-health surveillance aims to evaluate the effectiveness of this legislation.

Method

Changes in the incidence of work-related ACD cases returned to The Health and Occupation Reporting network by dermatologists were analysed taking in to account attribution to chromate and occupation.

Results

There was a significant decline in the incidence of both ACD attributed to chromate (incidence rate ratio 0.48, 95% CI 0.36 to 0.64) and ACD not-attributed chromate (0.76, 95% CI 0.69 to 0.85) between the time period preceding the EU legislation (2002–2004) and the postlegislation period (2005–2009). However, the decline in ACD attributed to chromate was significantly greater (p=0.006). This decline was further increased in workers potentially exposed to cement (incidence rate ratio 0.37, p=0.001). The majority of the decline in incidence occurred during 2005.

Conclusion

The timing of this significant decline in the UK incidence of chromate attributed ACD, and the greater decline in workers potentially exposed to cement strongly suggests that the EU Directive2003/53/EC was successful in reducing exposure to chromate in cement in the UK

Suggestive relation between multiple myeloma and chlorinated solvent exposure

Annet Lenderink — Wed, 18 May 2011 10:42:51 +0000

The relationship between multiple myeloma and occupational exposure to six chlorinated solvents
Laura S Gold et al. 2011

Evidence from a relatively large case-control study (181 cases (71% response) vs. 481 controls (52% response)) suggests that exposures to certain chlorinated solvents may be associated with increased incidence of multiple myeloma; however, the study is limited by relatively low participation (52%) among controls

What this paper adds:

The aetiology of multiple myeloma is poorly understood.
The purpose of this research was to examine relationships between occupational exposures to chlorinated solvents and multiple myeloma.
This research provides evidence that certain chlorinated solvents, most notably trichloroethylene, are associated with increased incidence of multiple myeloma.
While results were less clear, exposure to 1,1,1-trichloroethane, methylene chloride, perchloroethylene, carbon tetrachloride and chloroform also conferred increased risk of multiple myeloma in our population.

Abstract

Objectives Few studies have examined whether exposure to chlorinated solvents is associated with multiple myeloma. We evaluated associations between multiple myeloma and occupational exposure to six chlorinated solvents: 1,1,1-trichloroethane, trichloroethylene (TCE), methylene chloride (DCM), perchloroethylene, carbon tetrachloride and chloroform.

Methods In-person interviews obtained occupational histories and information on jobs with likely solvent exposure. We assigned exposure metrics of probability, frequency, intensity and confidence using job-exposure matrices modified by job-specific questionnaire information. We used logistic regression to estimate ORs and 95% CIs for associations between multiple myeloma and ever exposure to each, and any, chlorinated solvent and analysed whether associations varied by duration and cumulative exposure. We also considered all occupations that were given the lowest confidence scores as unexposed and repeated all analyses.

Results Risk of multiple myeloma was elevated for subjects ever exposed to 1,1,1-trichloroethane (OR (95% CI): 1.8 (1.1 to 2.9)). Ever exposure to TCE or DCM also entailed elevated, but not statistically significant, risks of multiple myeloma; these became statistically significant when occupations with low confidence scores were considered unexposed (TCE: 1.7 (1.0 to 2.7); DCM: 2.0 (1.2 to 3.2)). Increasing cumulative exposure to perchloroethylene was also associated with increasing multiple myeloma risk. We observed non-significantly increased multiple myeloma risks with exposure to chloroform; however, few subjects were exposed.

Conclusions Evidence from this relatively large case-control study suggests that exposures to certain chlorinated solvents may be associated with increased incidence of multiple myeloma; however, the study is limited by relatively low participation (52%) among controls.

Daily exposure measures prevent further hearing loss

Annet Lenderink — Wed, 18 May 2011 09:02:20 +0000

Interesting study on a preventive intervention for occupational noise-induced hearing loss (NIHL). Workers who could daily monitor their noise exposure “at-ear” experienced no further worsening of high frequency hearing 4 years after the intervention. This might be a promising approach to enhance the situation of this frequent occupational disease.

Effect of daily noise exposure monitoring on annual rates of hearing loss in industrial workers
Peter M Rabinowitz, Deron Galusha, Sharon R Kirsche, Mark R Cullen, Martin D Slade, Christine Dixon-Ernst
Occup Environ Med 2011;68:414-418
Abstract

Objectives Occupational noise-induced hearing loss (NIHL) is prevalent, yet evidence on the effectiveness of preventive interventions is lacking. The effectiveness of a new technology allowing workers to monitor daily at-ear noise exposure was analysed.

Methods Workers in the hearing conservation program of an aluminium smelter were recruited because of accelerated rates of hearing loss. The intervention consisted of daily monitoring of at-ear noise exposure and regular feedback on exposures from supervisors. The annual rate of change in high frequency hearing average at 2, 3 and 4 KHz before intervention (2000–2004) and 4 years after intervention (2006–2009) was determined. Annual rates of loss were compared between 78 intervention subjects and 234 controls in other company smelters matched for age, gender and high frequency hearing threshold level in 2005.

Results Individuals monitoring daily noise exposure experienced on average no further worsening of high frequency hearing (average rate of hearing change at 2, 3 and 4 KHz=–0.5 dB/year). Matched controls also showed decelerating hearing loss, the difference in rates between the two groups being significant (p<0.0001). Analysis of a subset of intervention subjects matched to controls for initial rate of hearing loss showed a similar trend but the difference was not statistically significant (p=0.06).

Conclusion Monitoring daily occupational noise exposure inside hearing protection with ongoing administrative feedback apparently reduces the risk of occupational NIHL in industrial workers. Longer follow-up of these workers will help determine the significance of the intervention effect. Intervention studies for the prevention of NIHL need to include appropriate control groups.

More respiratory symptoms in municipal solid waste workers in Greece

Annet Lenderink — Sun, 02 Jan 2011 10:30:29 +0000

To evaluate the respiratory health of municipal solid waste workers (MSWWs), Greek researchers studied 184 municipal employees of Keratsini (104 MSWWs and 80 controls) with questionnaire and spirometry. Spirometry revealed a reduced mean forced vital capacity (FVC) and forced expiratory volume in 1 s (as a percentage of predicted values) in MSWWs compared with controls. After adjustment for smoking status, only the decline in FVC was statistically significant (P < 0.05).
Prevalence of all respiratory symptoms was higher in MSWWs than in controls. After adjustment for confounding factors, the difference reached statistical significance (P < 0.05) for morning cough, cough on exertion and sore throat. Although this study had some limitations like small sample size, the results indicate a higher prevalence of respiratory symptoms and a greater decrease in lung function in MSWWs.

M. Athanasiou, G. Makrynos and G. Dounias, Respiratory health of municipal solid waste workers,
Occup Med (Lond) (2010) 60 (8): 618-623

Abstract

Background: There is an increasing evidence that the incidence of work-related pulmonary problems is greater in waste collectors than in the general workforce.

Aims: To evaluate the respiratory health of municipal solid waste workers (MSWWs).

Methods: One hundred and eighty-four municipal employees of Keratsini (104 MSWWs and 80 controls) participated in a cross-sectional study. All participants were asked to fill in a slightly modified version of the Medical Research Council questionnaire. Lung function was evaluated by spirometry.

Results: Spirometry revealed reduced mean forced vital capacity (FVC) and forced expiratory volume in 1 s (as a percentage of predicted values) in MSWWs compared with controls. After adjustment for smoking status, only the decline in FVC was statistically significant (P < 0.05). Prevalence of all respiratory symptoms was higher in MSWWs than in controls. After adjustment for confounding factors, the difference reached statistical significance (P < 0.05) for morning cough, cough on exertion and sore throat.

Conclusions: The results of this cross-sectional study indicate a higher prevalence of respiratory symptoms and a greater decrease in lung function in MSWWs. A number of limitations such as the relatively small size of population and the ‘healthy worker’ effect should be taken into account.

Exposure to neurotoxic solvents may influence blue-yellow color vision in aircraft maintenance workers

Annet Lenderink — Sun, 02 Jan 2011 10:13:40 +0000

Australian researchers studied the possible persisting effects to color vision of exposure to formulations containing neurotoxins during F-111 fuel tank maintenance. They studied 3 groups: 512 exposed personnel, 458 technical-trade comparisons, and 330 non-technical comparisons. Forty five percent of all participants had blue-yellow color deficient vision (CDV) in at least one eye. Deficiencies of this nature are caused by environmental exposures. There were statistically significant differences in CCI a blue-yellow confusion in the exposed group versus technical group (odds ratio 1.4: 95% CI 1.1–1.7). No differences were observed between the exposed group and the non-technical group. The researchers concluded that the results indicate reduced color discrimination among the exposed subjects compared to one of two control groups. The findings may be due to previous exposure to solvents among the air force personnel

Maya Guest et al. 2010, Impairment of color vision in aircraft maintenance workers
International Archives of Occupational and Environmental Health (13 November 2010), pp. 1-11

Abstract

Purpose: The purpose of the study was to examine possible persisting effects to color vision in a group from the Royal Australian Air Force who had exposure to formulations containing neurotoxins during F-111 fuel tank maintenance, relative to two contemporaneous comparison groups.

Methods: Color vision was tested in 512 exposed personnel, 458 technical-trade comparisons, and 330 non-technical comparisons using the Ishihara test plates and the Lanthony D-15 Desaturated Color disk arrangement test. Participants were excluded if they failed the Ishihara test as this indicates congenital color blindness. From the Lanthony results, the type of color deficient vision (CDV) was diagnosed, and additionally, the Bowman’s color confusion index (CCI) was calculated. Regression models were used to examine whether there was an association between color vision deficiencies and F-111 fuel tank maintenance, adjusting for possible confounders.

Results The CCI ranged from 1 to 2.8 (median 1.2, quartiles 1.1, 1.4) in the 2,600 eyes tested. Forty five percent of all participants had blue-yellow CDV in at least one eye. Deficiencies of this nature are caused by environmental exposures. Logistic regression demonstrated statistically significant differences in CCI category in the exposed group versus technical group (odds ratio 1.7: 95% CI 1.3–2.0) and a blue-yellow confusion in the exposed group versus technical group (odds ratio 1.4: 95% CI 1.1–1.7). No differences were observed between the exposed group and the non-technical group.

Conclusion The results indicate reduced color discrimination among the exposed subjects compared to one of two control groups. The findings may be due to previous exposure to solvents among the air force personnel.

HAVS at your feet? Vibration-white foot

Annet Lenderink — Thu, 07 Oct 2010 17:27:30 +0000

At the Netherlands Center of Occupational Diseases earlier this year a question was asked about complaints of back and legs in a construction worker exposed to vibration through his feet. At that time no relevant literature was found in an initial search, now there is this interesting case-report of a 54-year-old miner presented with a chief complaint of blanching and pain in his toes. He had a history of foot-transmitted vibration exposure over 18 years. The complaints at his feet were analogous to complaints of hand arm vibration syndrome (HAVS) occurring at the hands of workers handling vibrating tools.

Vibration-white foot: a case report
A. M. S. Thompson, R. House, K. Krajnak and T. Eger
Occupational Medicine Volume 60, Issue 7 Pp. 572-574

Background
Hand–arm vibration syndrome (HAVS) refers to the neurological, vascular and musculoskeletal problems that may arise due to exposure to segmental vibration to the hands. An analogous syndrome may occur in the lower extremities of workers exposed to foot-transmitted vibration.

Aims: This report describes the case of a worker with a history of foot-transmitted vibration exposure presenting with cold intolerance in the feet and blanching in the toes.

Case report:
A 54-year-old miner presented with a chief complaint of blanching and pain in his toes. The worker had a history of foot-transmitted vibration exposure over his 18 year career as a miner, primarily from the operation of vehicle-mounted bolting machines. Cold provocation digital plethysmography showed cold-induced vasospastic disease in the feet, but not in the hands.

Conclusions This case illustrates a condition descriptively termed ‘vibration-white foot’: a disease analogous to HAVS arising after segmental vibration exposure to the feet. Further research is required to increase awareness of, and direct preventive efforts for, this potentially debilitating condition.

Mold and damp work spaces may cause new-onset adult asthma

Annet Lenderink — Thu, 11 Mar 2010 18:23:31 +0000

Damp and moldy indoor environments aggravate pre-existing asthma, but may also induce new-onset asthma. Finnish researchers assessed the probability of molds being the cause of asthma in a series of 694 patients examined because of respiratory symptoms in relation to workplace dampness and molds between 1995 and 2004. They had all been exposed to molds at work and had suffered from work-related lower respiratory symptoms.

Using internationally recommended diagnostic criteria for occupational asthma (OA), they categorized the patients into three groups: probable, possible, and unlikely OA (156, 45, and 475 patients, respectively). In the group of probable OA, mold sensitization was found in 20%. The level of exposure and sensitization to molds was associated with probable OA. Exposure to damp and moldy workplaces can induce new-onset adult asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown.

New-onset adult asthma in relation to damp and moldy workplaces
Kirsi Karvala1 et al. International Archives of Occupational and Environmental Health 0340-0131 (Print) 1432-1246 (Online) February 02, 2010

Abstract

Objective: Damp and moldy indoor environments aggravate pre-existing asthma. Recent meta-analyses suggest that exposure to such environments may also induce new-onset asthma. We assessed the probability of molds being the cause of asthma in a patient series examined because of respiratory symptoms in relation to workplace dampness and molds.

Methods: Altogether 694 such patients had been clinically assessed between 1995 and 2004. According to their histories, they had all been exposed to molds at work and had suffered from work-related lower respiratory symptoms. The investigations had included specific inhalation challenge (SIC) tests with mold extracts and serial peak expiratory flow (PEF) recordings. Using internationally recommended diagnostic criteria for occupational asthma (OA), we categorized the patients into three groups: probable, possible, and unlikely OA (156, 45, and 475 patients, respectively). The clinical details of 258 patients were analyzed, and their levels of microbial exposure were evaluated.

Results: The agreement between the serial PEF recordings and SIC tests (both being either positive or negative) was 56%. In the group of probable OA, mold sensitization was found in 20%. The level of exposure and sensitization to molds was associated with probable OA. At 6 months, the follow-up examinations of 136 patients with probable OA showed that the symptoms were persistent, and no improvement in spirometry was noted despite adequate treatment. Only 58% of the patients had returned to work.

Conclusions: Exposure to damp and moldy workplaces can induce new-onset adult asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown.

Occupational diseases surveillance in France

Annet Lenderink — Thu, 11 Mar 2010 18:03:44 +0000

The French national occupational disease surveillance and prevention network (RNV3P) includes the 30 occupational disease consultation centres in university hospitals to which patients are referred for potentially work-related diseases, and an occupational health service.

Analysis of data from 2001 to 2007 (58 777 occupational health reports) showed that referrals increased significantly for asbestos-related diseases, mood disorders and adjustment disorders related to psychological and organisational demands, and for elbow and shoulder disorders related to manual handling.

Referrals significantly decreased for asthma and for rhinitis related to exposure to organic dusts (vegetable or animal) or chemicals, except for cosmetics and cleaning products.

Programmed health surveillance and detection of emerging diseases in occupational health: contribution of the French national occupational disease surveillance and prevention network (RNV3P)
Vincent Bonneterre et al. Occup Environ Med 2010;67:178-186

Abstract

Objective: The French national occupational disease surveillance and prevention network (RNV3P) includes the 30 occupational disease consultation centres in university hospitals to which patients are referred for potentially work-related diseases, and an occupational health service. The aim of this work is to demonstrate the contribution of RNV3P to national health surveillance.

Methods: Data from consultations are recorded in standardised occupational health reports and coded using international or national classifications. Programmed health surveillance is carried out through annual follow-up of annual referrals to experts for pre-selected disease–exposure associations, as well as incidence estimations for the well characterised working population followed by the occupational health service. Hypotheses on new emerging diseases are generated using statistical methods employed in pharmacosurveillance and by modelling as an exposome to analyse multiple exposures.

Results: 58 777 occupational health reports were collected and analysed from 2001 to 2007. Referrals to the 30 university hospital centres increased significantly for asbestos-related diseases, mood disorders and adjustment disorders related to psychological and organisational demands, and for elbow and shoulder disorders related to manual handling. Referrals significantly decreased for asthma and for rhinitis related to exposure to organic dusts (vegetable or animal) or chemicals, except for cosmetics and cleaning products. Estimation of incidences by the occupational health services showed different patterns in different sectors of activity. The methods for detecting emerging diseases are presented and illustrated using the example of systemic sclerosis, identifying new exposures and new sectors of activity to be investigated.

Conclusion The RNV3P collects data from two complementary samples: 30 university hospital centres (workers or former workers) and an occupational health service (current workers). This dual approach is useful for surveillance and for hypothesis generation on new emerging disease–exposure associations.