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PubMed2003

Occupational exposure to electromagnetic fields and acute leukaemia: analysis of a case-control study.

AIMS: To investigate whether the risk of acute leukaemia among adults is associated with occupational exposure to electromagnetic fields. METHODS: Probable occupational exposure to electromagnetic fields at higher than typical residential levels was investigated among 764 patients diagnosed with acute leukaemia during 1991-96 and 1510 sex and age matched controls. A job exposure matrix was applied to the self reported employment histories to determine whether or not a subject was exposed to electromagnetic fields. Risks were assessed using conditional logistic regression for a matched analysis. RESULTS: Study subjects considered probably ever exposed to electromagnetic fields at work were not at increased risk of acute leukaemia compared to those considered never exposed. Generally, no associations were observed on stratification by sex, leukaemia subtype, number of years since exposure stopped, or occupation; there was no evidence of a dose-response effect using increasing number of years exposed. However, relative to women considered never exposed, a significant excess of acute lymphoblastic leukaemia was observed among women probably exposed to electromagnetic fields at work that remained increased irrespective of time prior to diagnosis or job ever held. CONCLUSION: This large population based case-control study found little evidence to support an association between occupational exposure to electromagnetic fields and acute leukaemia. While an excess of acute lymphoblastic leukaemia among women was observed, it is unlikely that occupational exposure to electromagnetic fields was responsible, given that increased risks remained during periods when exposure above background levels was improbable.

Adolescent↗

PubMed2002

A job-exposure matrix for potential endocrine-disrupting chemicals developed for a study into the association between maternal occupational exposure and hypospadias.

A study to assess the association between the prevalence of hypospadias and maternal occupational exposure to potential endocrine-disrupting chemicals was carried out using data from the congenital anomaly register of the Office for National Statistics. The occupation of the mother is recorded in this register and to facilitate the assessment of maternal occupational exposure, a specific job-exposure matrix for potential endocrine-disrupting chemicals was developed. Seven categories of contaminants were evaluated (pesticides, polychlorinated organic compounds, phthalates, alkylphenolic compounds, bi-phenolic compounds, heavy metals and other substances). Maternal occupations were all coded using the 1980 version of Categories of Occupations. Three occupational hygienists assessed the likelihood of exposure (unlikely, possible, probable) to these seven substance groups for all 348 possible job titles independently. Almost 30% of the job titles were classified as exposed to at least one substance category (possible or probable), with approximately 16% of the job titles being probably exposed to at least one substance category. Some examples of occupations with probable exposure to potential endocrine-disrupting chemicals include: farm workers, electricians, workers in the plastics industry, painters, printers, hairdressers, dental practitioners, laboratory workers, textile workers and cleaners. It is recognized that there are a lot of limitations to the use of job-exposure matrices in general and with the matrix presented in this paper in particular. However, the matrix forms the basis on which further developments on occupational exposure assessment of potential endocrine-disrupting chemicals could be founded. In addition, the job-exposure matrix has identified areas where more exposure information is required. For example, exposure to potential endocrine-disrupting chemicals can occur in occupations such as hairdressing and workers in beauty salons, where the working population is more likely to be female and for which little data exist on levels of exposure.

Adult↗

PubMed1998

Parental occupational exposures and risk of childhood cancer.

Occupational exposures of parents might be related to cancer in their offspring. Forty-eight published studies on this topic have reported relative risks for over 1000 specific occupation/cancer combinations. Virtually all of the studies employed the case-control design. Occupations and exposures of fathers were investigated much more frequently than those of the mother. Information about parental occupations was derived through interviews or from birth certificates and other administrative records. Specific exposures were typically estimated by industrial hygienists or were self-reported. The studies have several limitations related to the quality of the exposure assessment, small numbers of exposed cases, multiple comparisons, and possible bias toward the reporting of positive results. Despite these limitations, they provide evidence that certain parental exposures may be harmful to children and deserve further study. The strongest evidence is for childhood leukemia and paternal exposure to solvents, paints, and employment in motor vehicle-related occupations; and childhood nervous system cancers and paternal exposure to paints. To more clearly evaluate the importance of these and other exposures in future investigations, we need improvements in four areas: a) more careful attention must be paid to maternal exposures; b) studies should employ more sophisticated exposure assessment techniques; c) careful attention must be paid to the postulated mechanism, timing, and route of exposure; and d) if postnatal exposures are evaluated, studies should provide evidence that the exposure is actually transferred from the workplace to the child's environment.

Brain Neoplasms↗

PubMed2001

[Incidence of occupation-related skin diseases in skin-exposure occupational groups].

BACKGROUND AND OBJECTIVE: Occupational skin diseases (OSD) rank at the top of occupational diseases in Germany. We studied the cases with initial medical report of an OSD reported to our Register of OSD in North Bavaria (BKH-N). PATIENTS/METHODS: From 1990-99 5.285 cases were closed and recorded. Since the number of employees in the different occupations was known, a population-based study was performed to investigate incidences and demographic characteristics in occupations classified into 24 groups. RESULTS: In the occupational groups in 3.097 cases a work-related skin disease was stated. The estimated overall incidence was 6.7 cases per 10,000 workers per year. The highest incidence was in hairdressers (97.4), bakers (33.2), and florists (23.9), while the largest number of cases was in hairdressers (856), health services (481), and metal-surface workers (260). The median age of all cases was 25 years. In 1.611 cases (52%) a delayed-type sensitisation with occupational relevance was perceived. CONCLUSIONS: The descriptive data of the BKH-N highlight occupational groups being at risk for OSD. The results assist in working out prevention measures aiming on lowering the incidence of OSD.

Adult↗

PubMed2005

Primary osteoarthritis of hip, knee, and hand in relation to occupational exposure.

AIM: To identify occupations with excess prevalence of osteoarthritis of the knee, hip, and hand in a nationwide survey and to compare occupations with and without excess prevalence with regard to biomechanical stresses and severity of osteoarthritis. METHODS: Patients presenting with osteoarthritis of the knee, hip, or hand were recruited throughout France by their treating physician who collected information on history, including age at onset, occupation, and occupational stresses to joints. Severity was assessed using joint specific functional status questionnaires: Lequesne for the hip and knee and Dreiser for the hand. The distribution of osteoarthritis patients by occupation was compared with the distribution of occupations in all workers in France to obtain prevalence rate ratios. RESULTS: Occupations with the greatest prevalence rate ratio were female cleaners (6.2; 95% CI 4.6 to 8.0), women in the clothing industry (5.0; 95% CI 3.9 to 6.3), male masons and other construction workers (2.9; 95% CI 2.6 to 3.3), and agriculture male and female workers (2.8; 95% CI 2.5 to 3.2). A twofold greater prevalence rate was observed within certain occupations between self-employed and salaried workers. Early onset of osteoarthritis was seen in the more heavy labour jobs with almost 40% of patients reporting their first symptoms before the age of 50. CONCLUSION: The early onset and severity of osteoarthritis in certain occupations warrants an urgent need for occupation specific studies for the development and evaluation of preventive strategies in this leading cause of disability in Western countries.

Adult↗

PubMed2003

Perceptions that influence occupational exposure reporting.

Statistics on health care workers' occupational exposures to bloodborne pathogens underestimate the true extent of the problem because of a tendency for underreporting. A descriptive correlational design was used to investigate compliance with standard precautions and occupational exposure reporting practices among perioperative nurses in Australia. The study found that although intention to report both percutaneous and mucocutaneous exposures was relatively high, mean compliance rates for actually reporting exposures incurred were considerably lower. The perception of barriers to reporting significantly influenced compliance.

Attitude of Health Personnel↗

PubMed1997

Postexposure chemoprophylaxis for occupational exposure to HIV in the dental office.

Occupational exposure to HIV continues to be a concern for health care workers. Preventing exposure through the use of universal precautions is the primary means of protection. New Public Health Service interagency work group recommendations for postexposure chemoprophylaxis provide information to help manage occupational exposure to HIV.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Approaches and considerations for setting occupational exposure limits for sensory irritants: report of recent symposia.

Over the past 50 years significant strides have been made in reducing occupational exposure to airborne chemicals. To a large extent, the impetus behind the reductions has been the identification of presumably safe levels of exposure, or occupational exposure limits (OELs). Most of the reduction in exposure has been to chemicals such as hepatotoxins, neurotoxins, nephrotoxins, and carcinogens that cause frank toxic effects. Recently, however, a number of industrial hygiene and occupational medicine initiatives have sought to identify acceptable levels of exposure to sensory irritants and reduce exposure to this class of chemicals. This article presents an overview of the field with emphasis on the work presented at two symposia sponsored by the Chemical Manufacturers Association: "How Do We Set an Occupational Exposure Limit (OEL) for Irritation?" (1998) at the American Industrial Hygiene Conference and Exposition and "Respiratory Tract Irritation and Olfaction Conference" (1997). The two symposia reviewed clinical and experimental methods used to assess odor and sensory irritation, to increase understanding of the research needed to establish OELs for sensory irritants, and to discuss how to use this information to identify appropriate values. The symposia illustrated that research in this area is evolving quickly and that there is already sufficient understanding to permit scientists to identify chemicals likely to be sensory irritants. Further, there appears to be an ample number of research methods for identification of airborne concentrations that should protect most workers. This article summarizes some of the key points raised at these symposia and suggests areas deserving of future study.

Air Pollutants, Occupational↗

PubMed1997

The role of psychosocial assessment and support in occupational exposure management.

Hundreds of thousands of occupational exposures to the blood and body fluids of patients occur every year in health care settings. The risk of acquiring HIV infection after exposure to HIV infected blood is 0.452%. Despite this low risk, the impact of each of these exposures is significant to the health care worker who is exposed. This paper focuses on the importance of adapting HIV education and counseling models to occupational settings. It recommends the incorporation of psychosocial assessment, risk reduction education, counseling, and support into existing exposure management programs. Barriers to effective occupational exposure counseling and their possible solutions are examined. Case studies are used to illustrate the complex issues raised during counseling.

AIDS Serodiagnosis↗

PubMed1999

Nested case-control study of esophageal cancer in relation to occupational exposure to silica and other dusts.

BACKGROUND: Standardized proportionate mortality ratio (SPMR) was found to be 2.2 (95% CI = 1.3-3.5) for esophageal cancer (EC) among workers exposed to refractory brick dust in a large iron-steel complex in China. METHODS: A nested case-control design within a cohort of industrial workers. One hundred and twenty-five EC cases and 250 controls were identified from the death registry file. Interviews were conducted of the next of kin for past exposure information on job, domestic, and lifestyle factors. History of occupational exposure to various dusts was reconstructed from personnel files and by interviewing colleagues utilizing a job-exposure matrix. RESULTS: After adjusting for confounders, occupational exposure to silica dust was the most important risk factor among all variables investigated, with a 2.8-fold risk and a clear dose-response by length of exposure. Alcohol drinking (OR = 1.8) and coal cooking (OR = 2.0) were risk factors and high consumption of fruit diet (OR = 0.5) and meat diet (OR = 0.6) were protective factors. CONCLUSIONS: The relationship between occupational exposure to silica dust and the risk of EC found in an earlier SPMR study was confirmed. Ingestion of silica particles after lung clearance may increase the risk of EC among workers exposed to silica.

Aged↗

PubMedDate not supplied

[Occupational exposure to respiratory irritants and chronic obstructive pulmonary disease].

Cigarette smoking and occupational exposure to respiratory irritants are the major riskfactors for chronic obstructive pulmonary disease (COPD), which is characterized by small-airway obstruction and destruction of pulmonary parenchyma: emphysema. We studied two groups of subjects: one exposed and the other one not-exposed to respiratory irritants, to investigate the relationship, if any, between occupational exposure and COPD. Subjects underwent high-resolution computed tomography-density mask of the chest to quantify pulmonary emphysema, pulmonary function tests, sputum induction and analysis for cell counts and measurements of metalloproteinase (MMP)-9 and its tissue inhibitor TIMP-1. Subjects with occupational exposure to respiratory irritants had higher residual volume and functional residual capacity, higher total inflammatory cells and neutrophils in induced sputum. By contrast, sputum levels of MMP-9, TIMP-1 and MMP-91TIMP-1 ratio did not differ between the 2 groups. We conclude that sputum induction and analysis could be a useful and non-invasive tool to study and follow subjects with occupational exposure to respiratory irritants.

Aged↗

PubMed2003

Job titles and work areas as surrogate indicators of occupational exposure.

BACKGROUND: Job titles or work areas are often used as surrogate indicators of exposure in occupational epidemiological studies. In this article, we assess the validity and comparability of commonly used surrogate indicators. METHODS: We analyzed lung cancer mortality among a hypothetical and an actual cohort of rubber workers. Surrogate indicators of exposure were defined according to jobs in which workers were "only," "ever," "longest" or "last" employed, or in which they were employed at the "census" of the study. Occupational risks were estimated using standardized mortality ratios. Validity of surrogate indicators was assessed in the simulated data by comparison between estimated effects and the known underlying associations. Comparisons of surrogate indicators were conducted in both simulated and empirical data. RESULTS: Use of the definition "only" as the surrogate indicator gave valid but imprecise results. For all other definitions, we observed a moderate overestimation of risks in no-risk or low-risk jobs and attenuation of underlying dose-response relationships, without substantial differences among the applied definitions. CONCLUSIONS: Our results demonstrate a limitation of using surrogate indicators of exposure in occupational epidemiological studies. However, they suggest that the inconsistencies of published study findings in the rubber industry are unlikely to be attributable to the use of different surrogate indicators.

Cohort Studies↗

PubMedDate not supplied

Health risks from occupational exposures to mechanical vibration.

Health effects of occupational exposure to hand-transmitted vibration (HTV) and whole-body vibration (WBV) are reviewed. Excessive exposure to HTV from powered processes or tools is associated with an increased occurrence of symptoms and signs of disorders in the vascular, neurological and musculoskeletal systems of the upper limbs. This complex set of disorders is called hand-arm vibration syndrome. Long-term occupational exposure to intense WBV is associated with an increased risk for disorders of the lumbar spine and the connected nervous system. With a lower probability, the neck-shoulder, the gastrointestinal system, the female reproductive organs, the peripheral veins, and the cochleo-vestibular system are also assumed to be affected by WBV. However, there is weak epidemiological support for WBV-induced disorders of organ systems other than the lower back. In addition to the health effects of human vibration, this review provides information on methods for the protection and health surveillance of vibration-exposed workers according to the European Directive 2002/44/EC on mechanical vibration.

Hand-Arm Vibration Syndrome↗

PubMed1998

Assessment of occupational exposures in community-based case-control studies.

Assessing occupational exposures in community-based studies is a challenge for investigators because there are no standardized or validated approaches for collecting information regarding occupational history. The strengths and limitations of the methods available for assessing occupational exposures are reviewed. In community-based case-control studies, the prevalence of most chemical agents is low. The common sources of misclassification in these studies are addressed, as are strategies for dealing with misclassification bias. Methods to assess the presence and magnitude of differential reporting by cases and controls are outlined, together with analytic strategies to improve the classification of occupational exposures.

Bias↗

PubMed1994

Occupational exposures to carcinogens in developing countries.

There have been very few studies of exposure to occupational carcinogens in developing countries, and even fewer studies of the health consequences of such exposures. However, all industrial chemicals, occupations and industrial processes classified by the International Agency for Research on Cancer (IARC) as Group 1 or Group 2A (carcinogenic or possibly carcinogenic to humans) have been described in developing countries, and there is growing concern that the health impact of many chemicals used in the developing world has been underestimated. In all regions a very large workforce is employed in the construction industry, in which substantial exposure to asbestos may occur, and there has been a rapid increase in production in countries such as Brazil and India. There is, for instance, a similar pattern for tyre production with a large increase in production in developing countries in the 1980s. Thus, the number of workers in industries entailing a carcinogenic risk is increasing in developing countries, partly as a result of the transfer of hazardous industry from industrialized countries. There is much that could be achieved in the prevention of occupational cancer in developing countries, and there have been a number of successful initiatives. However, the greatest progress in the prevention of occupational cancer in developing countries is most likely to come from political and economic changes.

Carcinogens↗

PubMedDate not supplied

[Occupational exposure to 50 Hz magnetic fields in workers employed in various jobs].

BACKGROUND: Information on occupational exposure to ELF magnetic fields (MF) in workers is largely insufficient, and is mostly based on results obtained in Scandinavian countries and North America. Accordingly, the collection of further data is needed, especially in workers exposed in other countries, including in Italy. METHODS: One hundred and fifty workers (84 males and 66 females) employed in 28 different jobs in the Emilia-Romagna Region of Italy were examined. Individual exposure was measured using personal monitors worn on the hip in a belted pouch during three whole work-shifts (8 hours each) of a normal working week. A sampling interval of 10 seconds was adopted, resulting in the collection of more than 8600 measurements for each worker. The individual Time-Weighted Average (TWA) occupational exposure of workers was calculated as the arithmetic mean of all measurements during each work-shift. Environmental non-occupational exposure was also measured. RESULTS: The 50 degrees percentile of individual TWA in the whole group was 0.15 microT, and the 5 degrees - 95 degrees percentile was respectively 0.02-1.45 microT. Job-related exposure (expressed as the mean of the TWA measured in all workers engaged in that job) was highest in substation electric power plant workers (1.12 microT) and in sewing machine workers (0.84 microT), but was lower than 0.2 microT in more than the 70% of the examined jobs. Considering the geometric mean of individual TWA are 27 out of 28 the jobs inducing an exposure lower than 0.2 microT. The lowest exposure was observed in infant school teachers. A high variability was observed among different workers engaged in the same occupation, mainly in substation electric power plant workers, machine testers and grinders in the engineering industry and in sewing machine workers and quality control in garment production. A marked variability of the pattern of exposure during the work-shift was also observed The overall environmental (non-occupational) exposure was 0.044 microT, and individual exposure was lower than 0.2 microT in about 97% of the examined subjects. Occupational exposure was usually higher and was not correlated with environmental exposure. CONCLUSIONS: The results show that the occupational component of overall exposure must be considered in studies on the biological effects of ELF-MF in populations. The high variability observed among workers engaged in the same occupation and the variability of the pattern of exposure certainly constitute major problems and could be a cause of the scarce coherence of the results of epidemiological studies on biological effects of ELF-MF to date. An improvement in protocols for the evaluation of exposure in workers, including the use of personal monitoring, is certainly needed.

Electromagnetic Fields↗

PubMed1993

Case-control studies in cancer patients as a surveillance system of occupational exposure in the European Community. European Community Working Party.

STUDY OBJECTIVE: The main aim was to detect known relationships between lung and blood cancers and various occupational exposures (using job titles as proxies) using a case-control design. The suitability of this system for routine surveillance could then be assessed. DESIGN: A case-control study was carried out in 1989. SETTING: Hospitals in eight European Community countries. SUBJECTS: Men aged 25 to 75 years with incident and prevalent cancer of the lung (190 cases), haematopoietic system (210 cases), or gastrointestinal tract (245 controls) were studied. MEASUREMENTS AND MAIN RESULTS: The crude estimate of the overall odds ratio exposure (OR) for relevant occupational exposure of lung cancer relative to gastrointestinal cancer was 1.20 (95% confidence interval (CI) 0.82, 1.77). In a logistic regression analysis adjusting for country, age at diagnosis, smoking, and alcohol consumption, the overall OR was not greatly changed. A significant interaction of occupational exposure and age at diagnosis showed that lung cancer patients diagnosed at a younger age had a higher OR than patients diagnosed at an older age. Thus, the overall, insignificant result may have been due to a low reliability of occupational history in older age or to a selective mechanism related to age. The overall OR for occupational exposure of cancer of the blood relative to gastrointestinal cancer was 0.88 (95% CI 0.60, 1.31). The logistic regression analysis did not alter these results. CONCLUSION: A surveillance based on a case-control design using job titles would not be sensitive enough to detect possible occupational risks.

Adult↗

PubMed2005

A proposed methodology for setting occupational exposure limits for hydrocarbon solvents.

Occupational exposure limit (OEL) development for hydrocarbon solvents is complicated because most of these solvents have complex compositions and only a few representative constituents have been studied in detail. A proposed solution to this problem is to group constituents with similar physical, chemical, and toxicological properties and to assign "guidance values" to each group. A unique OEL can then be calculated for each solvent, using a reciprocal calculation procedure (RCP) based on the liquid composition. This procedure follows the American Conference of Governmental Industrial Hygienists' (ACGIH) generic advice for complex mixtures and is recommended by the U.K. Health and Safety Executive for OEL calculations by hydrocarbon solvent manufacturers. The RCP is justified, as the toxicological properties of the constituents are additive and the differences between the vapor and liquid compositions do not substantially affect the calculated exposure limits. The guidance values are based principally on acute central nervous system depression and eye and respiratory tract irritation, effects that are the most sensitive indicators of hydrocarbon solvent exposure. One benefit of this procedure is that it is a relatively simple but practical procedure that requires limited compositional information. Further, it provides OEL recommendations that are consistent with occupational experience and current regulatory advice. Groupings and guidance values are proposed, and sample calculations are provided.

Eye Diseases↗