Non-Hodgkin lymphoma and occupational exposures: multiple exposures not = multiple papers.
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Electromagnetic Fields↗
Biomedical subjects
H Kromhout
Publications and source records attributed to H Kromhout.
Exposure to antineoplastic drugs outside the hospital environment.
OBJECTIVES: The objectives were (i) to identify occupational populations outside hospitals working with antineoplastic drugs, (ii) to determine the size of the populations 'at risk', (iii) to identify major determinants and routes of exposure outside hospitals and (iv) to estimate exposure levels and frequencies relative to levels found in hospitals. METHODS: The survey consisted of two phases; (i) identification of activities with potential exposure to antineoplastic drugs by literature review, interviews, questionnaires and workplace visits, (ii) exploratory measurements of exposure and surface contamination in selected sectors. RESULTS: Eight sectors were identified with potential exposure to antineoplastic drugs: pharmaceutical industry, pharmacies, universities, veterinary medicine, nursing homes, home care, laundry facilities, and waste treatment. Four sectors were of primary concern: veterinary medicine, home care, nursing homes and industrial laundries. The populations potentially exposed in these sectors vary considerably (from several tens to thousands of workers), as do their levels of exposure. Exposure measurements collected in the veterinary medicine sector showed that workers are indeed exposed to antineoplastic drugs and, in some cases (on gloves after administration), levels were 15 times higher than levels measured during administration in hospitals. Workers sorting contaminated hospital laundry in industrial laundry facilities were exposed to antineoplastic drugs through inhalation. For the home care and nursing homes sectors the highest exposure levels were found when cleaning toilets and washing treated patients. These two sectors are expected to have the largest exposed population (5,000-10,000 individuals). CONCLUSIONS: This study has resulted in a comprehensive overview of populations with potential exposure to antineoplastic drugs. Exposure levels can potentially be high compared with the hospital environment, because exposure routes are complex and awareness of the hazard (and therefore use of protective measures) is low. The number of individuals outside hospitals in The Netherlands exposed to antineoplastic drugs is estimated to be between 5,000 and 15,000.
Antineoplastic Agents↗
A probabilistic assessment of the impact of interventions on oncology nurses' exposure to antineoplastic agents.
OBJECTIVE: The main goal was to investigate the potential of a probabilistic approach for exposure assessment and use this information to evaluate the impact of a complex of policy actions/interventions on dermal exposure to antineoplastic agents among oncology nurses. The central theme of this study was to make optimal use of existing data, supplemented only with limited additional information from a questionnaire survey. METHODS: A task based exposure model was used to estimate dermal exposure of the hands among oncology nurses in non-academic hospitals in the Netherlands. Monte Carlo simulation was used to integrate information from available (exposure) studies and generate exposure distributions for the total population of oncology nurses in both pre- and post-intervention situation. Graphs and descriptive statistics of the simulated exposure distributions were used to evaluate trends in population exposure. RESULTS: The inventory showed that important intervention occurred in the preparation and administering of antineoplastic agents and in the handling of urine. Hardly any changes were identified in de nursing tasks. The use of gloves seemed to have decreased for a number of tasks. The results of the analysis show that the interventions did not affect the median exposure. However frequencies of occurrence of individuals with very high and very low total dermal exposures decreased substantially in the post-intervention situation. Analysis of the effect of pregnancy showed that pregnancy is very unlikely to influence exposure or any of the key input variables. CONCLUSIONS: The present study shows that the probabilistic approach adds valuable information to deterministic exposure assessment, especially when extrapolating data on a subpopulation to populations of individuals at large. The results show that the identified changes in the past decade in Dutch non-academic hospitals resulted in changes in the exposure distribution of antineoplastic agents among oncology nurses.
Antineoplastic Agents↗
Suicide and exposure to organophosphate insecticides: cause or effect?
BACKGROUND: Suicide using pesticides as agent is recognized as a major cause of pesticide poisoning. METHODS: A literature review of mortality and morbidity studies related to suicide among pesticide-exposed populations, and of human and animal studies of central nervous system toxicity related to organophosphate (OP) pesticides was performed. RESULTS: Suicide rates are high in farming populations. Animal studies link OP exposure to serotonin disturbances in the central nervous system, which are implicated in depression and suicide in humans. Epidemiological studies conclude that acute and chronic OP exposure is associated with affective disorders. Case series and ecological studies also support a causal association between OP use and suicide. CONCLUSIONS: OPs are not only agents for suicide. They may be part of the causal pathway. Emphasizing OPs solely as agents for suicide shifts responsibility for prevention to the individual, reducing corporate responsibility and limiting policy options available for control.
Agricultural Workers' Diseases↗
An assessment of dermal exposure to semi-synthetic metal working fluids by different methods to group workers for an epidemiological study on dermatitis.
BACKGROUND: Assessment of exposure assessment to metal working fluids (MWF) has almost exclusively focused on inhalation exposure. AIMS: To assess levels of, and factors affecting, dermal and inhalation exposure to semi-synthetic MWF, and to identify suitable dermal exposure grouping schemes among metal workers for an epidemiological survey on dermatitis of hands, forearms, and head. METHODS: A cross-sectional survey was conducted in four metal working machining departments of a truck manufacturing plant, estimating dermal and inhalation exposure levels to semi-synthetic metal working fluids (SMWF) in machine operators. Dermal exposure levels to SMWF were estimated by three different methods for dermal exposure assessment (VITAE, surrogate skin pad method, and a semi-quantitative dermal exposure assessment method (DREAM)). RESULTS: The identified factors affecting dermal exposure were similar for the three methods, although differences were found for estimated variability in dermal exposure levels between groups, within groups (among workers), and from day to day. With the VITAE method differences in exposure levels were detected between workers that were not detected with the surrogate skin pad method, and only partly with the DREAM method. CONCLUSIONS: Considering the additional effort and costs that use of the VITAE method entailed, the observational semi-quantitative DREAM method appeared to be more efficient for grouping of dermal exposure levels for the epidemiological study on dermatitis.
Cross-Sectional Studies↗
Historical limitations of determinant based exposure groupings in the rubber manufacturing industry.
AIMS: To study the validity of using a cross-sectional industry-wide exposure survey to develop exposure groupings for epidemiological purposes that extend beyond the time period in which the exposure data were collected. METHODS: Exposure determinants were used to group workers into high, medium, and low exposure groups. The contrast of this grouping and other commonly used grouping schemes based on plant and department within this exposure survey and a previously conducted survey within the same industry (and factories) were estimated and compared. RESULTS: Grouping of inhalable and dermal exposure based on exposure determinants resulted in the highest, but still modest, contrast (epsilon approximately 0.3). Classifying subjects based on a combination of plant and department resulted in a slightly lower contrast (epsilon approximately 0.2). If the determinant based grouping derived from the 1997 exposure survey was used to classify workers in the 1988 survey the average contrast decreased significantly for both exposures (epsilon approximately 0.1). On the contrary, the exposure classification based on plant and department increased in contrast (from epsilon approximately 0.2 to epsilon approximately 0.3) and retained its relative ranking overtime. CONCLUSIONS: Although determinant based groupings seem to result in more efficient groupings within a cross-sectional survey, they have to be used with caution as they might result in significant less contrast beyond the studied population or time period. It is concluded that a classification based on plant and department might be more desirable for retrospective studies in the rubber manufacturing industry, as they seem to have more historical relevance and are most likely more accurately recorded historically than information on exposure determinants in a particular industry.
Air Pollutants, Occupational↗
Accuracy of a semiquantitative method for Dermal Exposure Assessment (DREAM).
BACKGROUND: The authors recently developed a Dermal Exposure Assessment Method (DREAM), an observational semiquantitative method to assess dermal exposures by systematically evaluating exposure determinants using pre-assigned default values. AIM: To explore the accuracy of the DREAM method by comparing its estimates with quantitative dermal exposure measurements in several occupational settings. METHODS: Occupational hygienists observed workers performing a certain task, whose exposure to chemical agents on skin or clothing was measured quantitatively simultaneously, and filled in the DREAM questionnaire. DREAM estimates were compared with measurement data by estimating Spearman correlation coefficients for each task and for individual observations. In addition, mixed linear regression models were used to study the effect of DREAM estimates on the variability in measured exposures between tasks, between workers, and from day to day. RESULTS: For skin exposures, spearman correlation coefficients for individual observations ranged from 0.19 to 0.82. DREAM estimates for exposure levels on hands and forearms showed a fixed effect between and within surveys, explaining mainly between-task variance. In general, exposure levels on clothing layer were only predicted in a meaningful way by detailed DREAM estimates, which comprised detailed information on the concentration of the agent in the formulation to which exposure occurred. CONCLUSIONS: The authors expect that the DREAM method can be successfully applied for semiquantitative dermal exposure assessment in epidemiological and occupational hygiene surveys of groups of workers with considerable contrast in dermal exposure levels (variability between groups >1.0). For surveys with less contrasting exposure levels, quantitative dermal exposure measurements are preferable.
Clothing↗
Assessing historical exposure is like solving a mystery.
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Air Pollutants, Occupational↗
Biological dust exposure in the workplace is a risk factor for chronic obstructive pulmonary disease.
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Although the main risk factor is smoking, 15-19% of COPD even in smokers has been attributed to occupational exposures. The aim of this study was to investigate the association between occupational exposure and risk of COPD. METHODS: Participants were part of a cross sectional study of risk factors for COPD. A total of 1232 completed a detailed respiratory questionnaire, spirometric testing and measurement of gas transfer. Job histories were coded according to the International Standard Classification of Occupations. These codes were then used to establish occupational exposures using the ALOHA job exposure matrix. RESULTS: The prevalence of emphysema was 2.4%, chronic obstructive bronchitis 1.8%, and COPD 3.4%. Subjects ever exposed to biological dusts had an increased risk of chronic obstructive bronchitis (OR 3.19; 95% CI 1.27 to 7.97), emphysema (OR 3.18; 95% CI 1.41 to 7.13), and COPD (OR 2.70, 95% CI 1.39 to 5.23). These risks were higher in women than in men. For biological dust, the risk of emphysema and COPD was also significantly increased in both the duration of exposure categories, again in women but not in men. No significant increased risks for COPD were found for mineral dust (OR 1.13; 95% CI 0.57 to 2.27) or gases/fumes (OR 1.63; 95% CI 0.83 to 3.22). CONCLUSION: In this general population sample of adults, occupational exposures to biological dusts were associated with an increased risk of COPD which was higher in women. Preventive strategies should be aimed at reducing exposure to these agents in the workplace.
Aged↗
Cross-shift changes in FEV1 in relation to wood dust exposure: the implications of different exposure assessment methods.
BACKGROUND: Exposure-response analyses in occupational studies rely on the ability to distinguish workers with regard to exposures of interest. AIMS: To evaluate different estimates of current average exposure in an exposure-response analysis on dust exposure and cross-shift decline in FEV1 among woodworkers. METHODS: Personal dust samples (n = 2181) as well as data on lung function parameters were available for 1560 woodworkers from 54 furniture industries. The exposure to wood dust for each worker was calculated in eight different ways using individual measurements, group based exposure estimates, a weighted estimate of individual and group based exposure estimates, and predicted values from mixed models. Exposure-response relations on cross-shift changes in FEV1 and exposure estimates were explored. RESULTS: A positive exposure-response relation between average dust exposure and cross-shift FEV1 was shown for non-smokers only and appeared to be most pronounced among pine workers. In general, the highest slope and standard error (SE) was revealed for grouping by a combination of task and factory size, the lowest slope and SE was revealed for estimates based on individual measurements, with the weighted estimate and the predicted values in between. Grouping by quintiles of average exposure for task and factory combinations revealed low slopes and high SE, despite a high contrast. CONCLUSION: For non-smokers, average dust exposure and cross-shift FEV1 were associated in an exposure dependent manner, especially among pine workers. This study confirms the consequences of using different exposure assessment strategies studying exposure-response relations. It is possible to optimise exposure assessment combining information from individual and group based exposure estimates, for instance by applying predicted values from mixed effects models.
Cross-Sectional Studies↗
Risk of fatal industrial accidents and death from other external causes among asphalt workers.
The hypothesis that asphalt workers are at increased risk of mortality from industrial accidents and other external causes was tested. Mortality rates for external and violent causes of death in a cohort of asphalt industry employees from seven European countries and Israel were compared to that of the general population. There was no evidence that mortality from external causes was increased among long term employees in asphalt application and mixing. There was an increased risk for mortality due to external causes among short term workers. However, none of the fatal accidents among short term workers appear to have occurred during employment in the studied asphalt companies. Overall, no evidence was found supporting the hypothesis that asphalt workers are at increased risk of fatal industrial or road accidents. Mortality from other external causes did not increase in this population as a whole, but increased risks among short term workers deserve further attention.
Accidents, Occupational↗
The use of occupation and industry classifications in general population studies.
Occupation and industry classifications are used in epidemiological studies to classify study subjects according to their job and subsequently to study risk by job, to infer social class indicators, or to infer exposure to specific agents through job-exposure matrices. However, documentation on methodological aspects concerning the use of occupation and industry classifications is sparse within epidemiology. This paper reviews the diverse applications of occupation and industry classifications in population-based epidemiological studies. The different classifications in use are discussed, and criteria are given for choosing a classification in an epidemiological study. Finally, the reliability of coding for occupation and industry is reviewed. A further standardization of the use of occupation and industry classifications in epidemiology is recommended, in order to facilitate future comparisons between studies and fully exploit their possibilities, especially when occupational exposures are to be inferred.
Databases, Factual↗
How important is personal exposure assessment in the epidemiology of air pollutants?
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Air Pollutants↗
Exposure related mutagens in urine of rubber workers associated with inhalable particulate and dermal exposure.
AIMS: To determine the relation of the inhalation and dermal exposure routes and mutagenic activity in the urine of rubber workers (n = 105). METHODS: Mutagenic activity of ambient total suspended particulate matter (TSPM), surface contamination wipes, and Sunday and weekday urine samples was assessed with S typhimurium YG1041 in the presence of a metabolic activation system. Each subject was grouped into one of two exposure categories for dermal exposure (high (>/=25 revertants/cm(2)), low (<25 revertants/cm(2))) based on the mutagenic activity detected on likely skin contact surfaces and into two airborne mutagenic exposure categories (high (>/=210 revertants/m(3)), low (<210 revertants/m(3))). The potential influence of skin aberrations and acetylation status (NAT2) on urinary mutagenicity levels was also evaluated. RESULTS: A non-significant increase of +1605 revertants/g creatinine in urinary mutagenicity during the workweek relative to levels observed on Sunday was observed for the total population. Subsequent multivariate regression analyses, with the subjects' weekday urinary mutagenicity levels as the dependent variable, revealed associations with environmental and mainstream tobacco smoke exposure, with the level of mutagenic contamination on surfaces with which the subjects had likely contact, with the subjects' inhalable particulate exposure level, with observed mild skin aberrations, and when the subjects had a slow acetylation phenotype. Similar associations, although weaker were observed with Sunday urinary mutagenicity levels as well, except for the association with slow acetylation phenotype. Based on measured exposure levels it could be estimated that a high potential for exposure to surface contamination with mutagenic activity increased weekday urinary mutagenicity by about 62% when compared to low exposed workers, while high inhalable particulate exposure levels increased weekday urinary mutagenicity levels by about 21%. Subjects with mild skin aberrations had an additional, non-significant, increase in weekday urinary mutagenic activity compared to subjects without any skin aberrations. DISCUSSION: Results suggest that the dermal exposure route may contribute more to the level of genotoxic compounds in urine of rubber workers than the inhalation route. Although the study was limited in size, the results warrant further investigation in the importance of and ways to effectively control the dermal exposure route in the rubber industry.
Acetylation↗
Application of mixed-effects models for exposure assessment.
The benefits of using linear mixed-effects models for occupational exposure assessment were studied by re-analysing three data sets from two published surveys with repeated exposure measurements. The relative contributions of particular characteristics affecting exposure levels were assessed as in a multiple regression model, while controlling for the correlation between repeated measurements. While one-way ANOVA allows one only to estimate unconditioned variance components, a mixed model enables estimation of between- and within-worker variance components of exposure levels while accounting for the fixed effects of work characteristics. Consequently, we can identify the work characteristics affecting each variance component. Mixed models were applied to the data sets with repeated measurements and auxil iary information on work characteristics. The between-worker variance components were reduced by 35, 66 and 80%, respectively, in the three data sets when work characteristics were taken into account. The within-worker (day-to-day) variability was reduced only in the pig farmer data set, by 25%, when accounting for work activities. In addition, coefficients of work characteristics from the mixed model were compared with coefficients resulting from originally published multiple linear regression models. In the rubber manufacturing data, the coefficients of the mixed model showed similar relative importance, but were generally smaller than the coefficients from regression models. However, in the pig farm data, only the coefficients of work activities were somewhat reduced. The mixed model is a helpful tool for estimating factors affecting exposure and suitable variance components. Identifying the factors in the working environment that affect the between-worker variability facilitates a posteriori grouping of workers into more uniformly exposed groups. Identifying the factors that affect the within-worker variance is helpful for hazard control and in designing efficient sampling schemes with reference to time schedule.
Analysis of Variance↗
Validity of empirical models of exposure in asphalt paving.
AIMS: To investigate the validity of empirical models of exposure to bitumen fume and benzo(a)pyrene, developed for a historical cohort study of asphalt paving in Western Europe. METHODS: Validity was evaluated using data from the USA, Italy, and Germany not used to develop the original models. Correlation between observed and predicted exposures was examined. Bias and precision were estimated. RESULTS: Models were imprecise. Furthermore, predicted bitumen fume exposures tended to be lower (-70%) than concentrations found during paving in the USA. This apparent bias might be attributed to differences between Western European and USA paving practices. Evaluation of the validity of the benzo(a)pyrene exposure model revealed a similar to expected effect of re-paving and a larger than expected effect of tar use. Overall, benzo(a)pyrene models underestimated exposures by 51%. CONCLUSIONS: Possible bias as a result of underestimation of the impact of coal tar on benzo(a)pyrene exposure levels must be explored in sensitivity analysis of the exposure-response relation. Validation of the models, albeit limited, increased our confidence in their applicability to exposure assessment in the historical cohort study of cancer risk among asphalt workers.
Air Pollutants, Occupational↗
Chronic nervous-system effects of long-term occupational exposure to DDT.
Dichlorodiphenyltrichloroethane (DDT) is a compound with moderate toxicity that is judged to be safe for occupational use, although little is known about its long-term effects on the human nervous system. We investigated chronic nervous-system effects of long-term occupational exposure to DDT by comparing the neurobehavioural performance of retired malaria-control workers with a reference group of retired guards and drivers. DDT-exposed workers did worse on tests assessing various neurobehavioural functions than controls; performance significantly deteriorated with increasing years of DDT application. Our results could not be explained by exposure to cholinesterase-inhibiting pesticides or other potential confounding factors.
Aged↗
Mutagenic exposure in the rubber manufacturing industry: an industry wide survey.
Mutagenic exposure conditions in several rubber manufacturing companies (n=9) in The Netherlands were studied. Mutagenicity of total suspended particulate matter in air (TSPM) and of wipe samples from possible contact surfaces were measured in the Ames mutagenicity assay with Salmonella typhimurium YG1041 in the presence of a metabolic activation system. Large differences in median mutagenicity of TSPM samples were observed between companies (range 49-1056rev/m(3)) and to a lesser extent between production functions (range 129-402rev/m(3)). The production function curing revealed overall the highest TSPM mutagenicity levels. Forty-one percent of the surface wipe samples revealed mutagenic activity ranging from 26 to 665rev/cm(2). Mixing had the largest proportion of positive samples resulting in a median surface mutagenic contamination of 39rev/cm(2). Surface mutagenic contamination, averaged per department/company combination, showed only a weak correlation with TSPM mutagenicity (r=0.28, P=0.05). Company, production function and total soluble matter (e.g. mass collected upon extraction with organic solvents with different polarity) explained 79 and 81% of the variability in mutagenicity of TSPM and surface contamination levels, respectively. "Company" was identified as the most important exposure determinant for mutagenic activity in TSPM and surface wipe samples. This indicates the importance of company specific determinants like production volume and rubber chemicals used for the encountered mutagenic exposure conditions. Detection of substantial mutagenic activity on possible contact surfaces supports furthermore the potential importance of the dermal route in the uptake of genotoxic compounds of workers in the rubber manufacturing industry.
Air Pollutants, Occupational↗