2015-05-01 12:00 - Messages

Risks to Health Care Workers from Nano-Enabled Medical Products

Nanotechnology is rapidly expanding into the health care industry. However, occupational safety and health risks of nano-enabled medical products have not been thoroughly assessed. This manuscript highlights occupational risk mitigation practices for nano-enabled medical products throughout their life cycle for all major workplace settings including (1) medical research laboratories, (2) pharmaceutical manufacturing facilities, (3) clinical dispensing pharmacies, (4) health care delivery facilities, (5) home health care, (6) health care support, and (7) medical waste management. It further identifies critical research needs for ensuring worker protection in the health care industry.

Source: Murashov V., Howard J. J Occup Environ Hyg. 2015 Jun; 12 (6): p. D75-85.
http://dx.doi.org/10.1080/15459624.2015.1006641

Aerosol Transmission of Infectious Disease

Objective: The concept of aerosol transmission is developed to resolve limitations in conventional definitions of airborne and droplet transmission.
Methods: The method was literature review.
Results: An infectious aerosol is a collection of pathogen-laden particles in air. Aerosol particles may deposit onto or be inhaled by a susceptible person. Aerosol transmission is biologically plausible when infectious aerosols are generated by or from an infectious person, the pathogen remains viable in the environment for some period of time, and the target tissues in which the pathogen initiates infection are accessible to the aerosol. Biological plausibility of aerosol transmission is evaluated for Severe Acute Respiratory Syndrome coronavirus and norovirus and discussed for Mycobacterium tuberculosis, influenza, and Ebola virus.
Conclusions: Aerosol transmission reflects a modern understanding of aerosol science and allows physically appropriate explanation and intervention selection for infectious diseases.

Source: Jones, Rachael M.; Brosseau, Lisa M. Journal of Occupational & Environmental Medicine: May 2015, Volume 57, Issue 5, p. 501–508.
http://dx.doi.org/10.1097/JOM.0000000000000448

Mesothelioma in Australia

Incidence (1982 to 2013) and Mortality (1997 to 2012)
Mesothelioma is a fatal cancer that typically occurs 20 to 40 years after exposure to asbestos, although exposure does not always result in the disease. Mesothelioma of the pleura (a cancer affecting the protective lining of the lungs and chest cavity) is the most common form of mesothelioma in Australia and has accounted for approximately 93% of cases since 1982. Mesothelioma of the peritoneum (a cancer affecting the abdominal lining) is less common and has accounted for approximately 6% of cases since 1982. The figures in this report include all forms of mesothelioma.

Source: http://www.safeworkaustralia.gov.au/sites/swa/about/publications/pages/mesothelioma-in-australia-2015

Thresholds in chemical respiratory sensitisation

There is a continuing interest in determining whether it is possible to identify thresholds for chemical allergy. Here allergic sensitisation of the respiratory tract by chemicals is considered in this context. This is an important occupational health problem, being associated with rhinitis and asthma, and in addition provides toxicologists and risk assessors with a number of challenges.
In common with all forms of allergic disease chemical respiratory allergy develops in two phases. In the first (induction) phase exposure to a chemical allergen (by an appropriate route of exposure) causes immunological priming and sensitisation of the respiratory tract. The second (elicitation) phase is triggered if a sensitised subject is exposed subsequently to the same chemical allergen via inhalation. A secondary immune response will be provoked in the respiratory tract resulting in inflammation and the signs and symptoms of a respiratory hypersensitivity reaction. In this article attention has focused on the identification of threshold values during the acquisition of sensitisation.
Current mechanistic understanding of allergy is such that it can be assumed that the development of sensitisation (and also the elicitation of an allergic reaction) is a threshold phenomenon; there will be levels of exposure below which sensitisation will not be acquired. That is, all immune responses, including allergic sensitisation, have threshold requirement for the availability of antigen/allergen, below which a response will fail to develop. The issue addressed here is whether there are methods available or clinical/epidemiological data that permit the identification of such thresholds. This document reviews briefly relevant human studies of occupational asthma, and experimental models that have been developed (or are being developed) for the identification and characterisation of chemical respiratory allergens.
The main conclusion drawn is that although there is evidence that the acquisition of sensitisation to chemical respiratory allergens is a dose-related phenomenon, and that thresholds exist, it is frequently difficult to define accurate numerical values for threshold exposure levels. Nevertheless, based on occupational exposure data it may sometimes be possible to derive levels of exposure in the workplace, which are safe.
An additional observation is the lack currently of suitable experimental methods for both routine hazard characterisation and the measurement of thresholds, and that such methods are still some way off. Given the current trajectory of toxicology, and the move towards the use of non-animal in vitro and/or in silico) methods, there is a need to consider the development of alternative approaches for the identification and characterisation of respiratory sensitisation hazards, and for risk assessment.

Source: Cochrane SA, Arts JHE, Ehnes C, Hindle S, Hollnagel HM, Poole A, Suto H, Kimber I. 2015. Toxicology, 333 : 179-194.
http://dx.doi.org/10.1016/j.tox.2015.04.010

La qualité de l'air intérieur

Si elle ne représente pas un risque majeur, l'importance qu'elle commence à prendre mérite amplement que l'on s'attarde sur son cas : la pollution de l'air intérieur. D'autant que c'est une très grande partie des salariés de tous secteurs qui est potentiellement concernée et que ses effets, même modérés, peuvent être particulièrement gênants. Les origines de cette pollution sont très diverses, mais des solutions efficaces existent.

Source: Dossier spécial, Travail & Sécurité, n° 761, mai 2015. 
http://www.travail-et-securite.fr/ts/dossier.html

Risk of cancer among firefighters in California, 1988–2007

Background: Most studies of firefighter cancer risks were conducted prior to 1990 and do not reflect risk from advances in building materials.
Methods: A case–control study using California Cancer Registry data (1988–2007) was conducted to evaluate the risk of cancer among firefighters, stratified by race.
Results: This study identified 3,996 male firefighters with cancer. Firefighters were found to have a significantly elevated risk for melanoma (odds ratio [OR] = 1.8; 95% confidence interval [CI] 1.4–2.1), multiple myeloma (OR 1.4; 95%CI 1.0–1.8), acute myeloid leukemia (OR 1.4; 95%CI 1.0–2.0), and cancers of the esophagus (OR 1.6; 95%CI 1.2–2.1), prostate (OR 1.5; 95%CI 1.3–1.7), brain (OR 1.5; 95%CI 1.2–2.0), and kidney (OR 1.3; 95%CI 1.0–1.6).
Conclusions: In addition to observing cancer findings consistent with previous research, this study generated novel findings for firefighters with race/ethnicity other than white. It provides additional evidence to support the association between firefighting and several specific cancers. © 2015 This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Source: Rebecca J. Tsai, Sara E. Luckhaupt, Pam Schumacher, Rosemary D. Cress, Dennis M. Deapen, Geoffrey M. Calvert. American Journal of Industrial Médicine, 2015.
http://dx.doi.org/10.1002/ajim.22466

Carbon Nanotube and Nanofiber Exposure Assessments

An Analysis of 14 Site Visits
Recent evidence has suggested the potential for wide-ranging health effects that could result from exposure to carbon nanotubes (CNT) and carbon nanofibers (CNF). In response, the National Institute for Occupational Safety and Health (NIOSH) set a recommended exposure limit (REL) for CNT and CNF: 1 µg m-3 as an 8-h time weighted average (TWA) of elemental carbon (EC) for the respirable size fraction. The purpose of this study was to conduct an industrywide exposure assessment among US CNT and CNF manufacturers and users. Fourteen total sites were visited to assess exposures to CNT (13 sites) and CNF (1 site). Personal breathing zone (PBZ) and area samples were collected for both the inhalable and respirable mass concentration of EC, using NIOSH Method 5040. Inhalable PBZ samples were collected at nine sites while at the remaining five sites both respirable and inhalable PBZ samples were collected side-by-side. Transmission electron microscopy (TEM) PBZ and area samples were also collected at the inhalable size fraction and analyzed to quantify and size CNT and CNF agglomerate and fibrous exposures. Respirable EC PBZ concentrations ranged from 0.02 to 2.94 µg m-3 with a geometric mean (GM) of 0.34 µg m-3 and an 8-h TWA of 0.16 µg m-3. PBZ samples at the inhalable size fraction for EC ranged from 0.01 to 79.57 µg m-3 with a GM of 1.21 µg m-3. PBZ samples analyzed by TEM showed concentrations ranging from 0.0001 to 1.613 CNT or CNF-structures per cm3 with a GM of 0.008 and an 8-h TWA concentration of 0.003. The most common CNT structure sizes were found to be larger agglomerates in the 2-5 µm range as well as agglomerates >5 µm. A statistically significant correlation was observed between the inhalable samples for the mass of EC and structure counts by TEM (Spearman ρ = 0.39, P < 0.0001). Overall, EC PBZ and area TWA samples were below the NIOSH REL (96% were <1 μg m-3 at the respirable size fraction), while 30% of the inhalable PBZ EC samples were found to be >1 μg m-3. Until more information is known about health effects associated with larger agglomerates, it seems prudent to assess worker exposure to airborne CNT and CNF materials by monitoring EC at both the respirable and inhalable size fractions. Concurrent TEM samples should be collected to confirm the presence of CNT and CNF.

Source: Dahm MM, Schubauer-Berigan MK, Evans DE, Birch ME, Fernback JE, Deddens JA. Ann Occup Hyg, 2015 Apr 7.
http://dx.doi.org/10.1093/annhyg/mev020

Biomarkers for Lung Epithelium Injury in Occupational Hexavalent Chromium-Exposed Workers

Objective: To evaluate whether Club (Clara) cell protein (CC16) and surfactant-associated protein D (SP-D) can be used as biomarkers for lung injury caused by chromium exposure.
Methods: The concentrations of chromium in the air (CrA), chromium in the blood (CrB), lung function, CC16, SP-D, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were detected in 91 chromium-exposed workers and 38 controls.
Results: In chromium-exposed group, the levels of CrA, CrB, SP-D, TNF-α, and IL-6 were significantly higher, whereas forced expiratory volume in one second (FEV1), FEV1/FVC, maximal expiratory flow (MEF), maximum ventilation volume (MVV), CC16, and CC16/SP-D were lower. Negative correlations were shown between CC16, SP-D or CC16/SP-D, and CrB or inflammatory cytokines (TNF-α and IL-6). Positive relationships were shown between CC16 or CC16/SP-D with indicators of lung function. Tobacco smoking and chromium exposure had synergic effects on lung injury.
Conclusions: CC16, as an immunosuppressive protein, and CC16/SP-D can be used as sensitive and noninvasive biomarkers for lung injury. Smoking should be banned in chromium workplaces.

Source: Li, Ping; Li, Yang; Zhang, Ji; Yu, Shan Fa; Tong, Wei; Hu, Xiao; Jia, Guang. Journal of Occupational & Environmental Medicine: April 2015, Volume 57, Issue 4, p. e45-e50.
http://dx.doi.org/10.1097/JOM.0000000000000436

IARC evaluation of five organophosphate pesticides

A Working Group of 17 experts from 11 countries met at the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization on 3-10 March 2015 to review the available published scientific evidence and evaluate the carcinogenicity of five organophosphate insecticides and herbicides: diazinon, glyphosate, malathion, parathion, and tetrachlorvinphos.  A summary of the final evaluations together with a short rationale have now been published online in The Lancet Oncology, and the detailed assessments will be published as Volume 112 of the IARC Monographs.

Source: https://osha.europa.eu/en/oshnews/int-iarc-evaluation-of-five-organophosphate-pesticides

Is There an Association of Circulatory Hospitalizations Independent of Mining Employment in Coal-Mining and Non–Coal-Mining Counties in West Virginia?

Objective: Exposures associated with coal mining activities, including diesel fuel exhaust, products used in coal processing, and heavy metals and other forms of particulate matter, may impact the health of nearby residents. We investigated the relationships between county-level circulatory hospitalization rates (CHRs) in coal and non–coal-mining communities of West Virginia, coal production, coal employment, and sociodemographic factors.
Methods: Direct age-adjusted CHRs were calculated using West Virginia hospitalizations from 2005 to 2009. Spatial regressions were conducted to explore associations between CHR and total, underground, and surface coal production.
Results: After adjustment, neither total, nor surface, nor underground coal production was significantly related to rate of hospitalization for circulatory disease.
Conclusions: Our findings underscore the significant role sociodemographic and behavioral factors play in the health and well-being of coal mining communities.

Source: Talbott, Evelyn O.; Sharma, Ravi K.; Buchanich, Jeanine; Stacy, Shaina L. Journal of Occupational & Environmental Medicine: April 2015, Volume 57, Issue 4, p. e30-e36.
http://dx.doi.org/10.1097/JOM.0000000000000425

Bladder Cancer Screening in Aluminum Smelter Workers

Objective: To present results of a bladder cancer screening program conducted in 18 aluminum smelters in the United States from January 2000 to December 2010.
Methods: Data were collected on a cohort of workers with a history of working in coal tar pitch volatile exposed areas including urine analysis for conventional cytology and ImmunoCyt/uCyt+ assay.
Results: ImmunoCyt/uCyt+ and cytology in combination showed a sensitivity of 62.30%, a specificity of 92.60%, a negative predictive value of 99.90%, and a positive predictive value of 2.96%. Fourteen cases of bladder cancer were detected, and the standardized incidence ratio of bladder cancer was 1.18 (95% confidence interval, 0.65 to 1.99). Individuals who tested positive on either test who were later determined to be cancer free had undergone expensive and invasive tests.
Conclusions: Evidence to support continued surveillance of this cohort has not been demonstrated.

Source: Taiwo, Oyebode A.; Slade, Martin D.; Cantley, Linda F.; Tessier-Sherman, Baylah; Galusha, Deron; Kirsche, Sharon R.; Donoghue, A. Michael; Cullen, Mark R. Journal of Occupational & Environmental Medicine: April 2015, Volume 57, Issue 4, p. 421-427.
http://dx.doi.org/10.1097/JOM.0000000000000377

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