2016-06-01 12:00 - Messages

Professional Cleaning Activities and Lung Cancer Risk Among Women

Results From the ICARE Study
Objectives: Lung cancer risk associated with occupational cleaning activities has been investigated in the population-based case–control study ICARE.
Methods: Occupational history was collected by standardized interviews. Jobs were first defined according to the International Standard Classification of Occupations (ISCO) codes and then categorized according to activity sectors. Adjusted odds ratios (ORs) were estimated by unconditional logistic regression, separately for women (619 cases and 760 controls) and men (2265 and 2780).
Results: Thirty percent of women and 2.3% of men controls ever held a cleaner or care job. Women who worked as housemaids longer than 7 years showed an OR of 1.76 [95% confidence interval (95% CI) 1.09 to 2.87] with respect to controls. Women employed in domestic service sector for a long time had an OR of 2.06 (95% CI 1.15 to 3.66).
Conclusion: We confirmed and redefined the association of lung cancer with occupational cleaning, which concerns a considerable proportion of women workers.

Source: Atramont, A., Guida, F., Mattei, F., Matrat, M., Cenée, S., Sanchez, M., ... & Luce, D. (2016). Journal of Occupational and Environmental Medicine, 58(6), 610-616.

Bronchoalveolar Lavage Fluid microRNA-146a: A Biomarker of Disease Severity and Pulmonary Function in Patients With Silicosis

Objective: To examine the impact of microRNA-146a (miR-146a) on pulmonary function and disease severity in silicosis patients.
Methods: Twenty-nine silicosis patients and six observation subjects were recruited. MiR-146a expression level was detected by qRT-PCR, and pulmonary function was assessed with a spirometer.
Results: MiR-146a expression level was higher in silicosis patients than in observation subjects, and the probability of suffering from silicosis increased with increasing miR-146a level. MiR-146a was associated with the severity of silicosis. As the miR-146a increased, the probability of suffering from silicosis increased for stage I patients, and for stage II & III patients, the probability first increased and then decreased. MiR-146a was also associated with decreased pulmonary function measures, pulmonary function impairment, and restrictive ventilator dysfunction.
Conclusions: miR-146a was significantly associated with the disease severity and pulmonary function of silicosis.

Source: Zhang, Yang; Zhou, Dingzi; Wang, Faxuan; Ren, Xiaohui; Gao, Xiaosi; Zhang, Qin; Lan, Yajia. Journal of Occupational & Environmental Medicine: May 2016, Volume 58, Issue 5, p. e177-e182.

Occupational dermal exposure to nanoparticles and nano-enabled products

Part 2, exploration of exposure processes and methods of assessment
In the first of a series of two papers (Larese Filon et al., 2016), we focused our attention on identifying conditions or situations, i.e. a combination of nanoparticle physico-chemical properties, skin barrier integrity, and occupations with high prevalence of skin disease, which deserve further investigation. This second paper focuses on the broad question of dermal exposure assessment to nanoparticles and attempts to give an overview of the mechanisms of occupational dermal exposure to nanoparticles and nano-enabled products and explores feasibility and adequacy of various methods of quantifying dermal exposure to NOAA. We provide here a conceptual framework for screening, prioritization, and assessment of dermal exposure to NOAA in occupational settings, and integrate it into a proposed framework for risk assessment.

Source: Derk H. Brouwer, Suzanne Spaan, Martin Roff, Anne Sleeuwenhoek, Ilse Tuinman, Henk Goede, Birgit van Duuren-Stuurman, Francesca Larese Filon, Dhimiter Bello, John W. Cherrie. International Journal of Hygiene and Environmental Health, 2016.

Occupational dermal exposure to nanoparticles and nano-enabled products

Part I - Factors affecting skin absorption
The paper reviews and critically assesses the evidence on the relevance of various skin uptake pathways for engineered nanoparticles, nano-objects, their agglomerates and aggregates (NOAA). It focuses especially in occupational settings, in the context of nanotoxicology, risk assessment, occupational medicine, medical/epidemiological surveillance efforts, and the development of relevant exposure assessment strategies.
Skin uptake of nanoparticles is presented in the context of local and systemic health effects, especially contact dermatitis, skin barrier integrity, physico-chemical properties of NOAA, and predisposing risk factors, such as stratum corneum disruption due to occupational co-exposure to chemicals, and the presence of occupational skin diseases. Attention should be given to: (1) Metal NOAA, since the potential release of ions may induce local skin effects (e.g. irritation and contact dermatitis) and absorption of toxic or sensitizing metals; (2) NOAA with metal catalytic residue, since potential release of ions may also induce local skin effects and absorption of toxic metals; (3) rigid NOAA smaller than 45 nm that can penetrate and permeate the skin; (4) non rigid or flexible NOAA, where due to their flexibility liposomes and micelles can penetrate and permeate the intact skin; (5) impaired skin condition of exposed workers.
Furthermore, we outline possible situations where health surveillance could be appropriate where there is NOAA occupational skin exposures, e.g. when working with nanoparticles made of sensitizer metals, NOAA containing sensitizer impurities, and/or in occupations with a high prevalence of disrupted skin barrier integrity. The paper furthermore recommends a stepwise approach to evaluate risk related to NOAA to be applied in occupational exposure and risk assessment, and discusses implications related to health surveillance, labelling, and risk communication.

Source: Francesca Larese Filon, Dhimiter Bello, John W. Cherrie, Anne Sleeuwenhoek, Suzanne Spaan, Derk H. Brouwere. International Journal of Hygiene and Environmental Health, 2016.

Des effets sanitaires à long terme liés aux conditions de travail dans les égouts

L'Anses publie une expertise sur les expositions et les risques sanitaires spécifiques auxquels sont soumis les égoutiers. Sur la base d'une analyse approfondie de la littérature scientifique mettant en évidence des expositions à de multiples agents chimiques et biologiques, dont des composés cancérogènes, mutagènes et reprotoxiques présents dans les eaux usées brutes et dans l'atmosphère des égouts, l'Anses conclut à l'existence d'effets sanitaires à long terme liés aux conditions de travail dans les égouts.

Source: https://www.anses.fr/fr/content/des-effets-sanitaires-%C3%A0-long-terme-li%C3%A9s-aux-conditions-de-travail-dans-les-%C3%A9gouts

Feedback on Measured Dust Concentrations Reduces Exposure Levels Among Farmers

Background: The high burden of exposure to organic dust among livestock farmers warrants the establishment of effective preventive and exposure control strategies for these workers. The number of intervention studies exploring the effectiveness of exposure reduction strategies through the use of objective measurements has been limited.
Objective: To examine whether dust exposure can be reduced by providing feedback to the farmers concerning measurements of the exposure to dust in their farm.
Methods: The personal dust levels of farmers in 54 pig and 26 dairy cattle farms were evaluated in two measurement series performed approximately 6 months apart. Detailed information on work tasks and farm characteristics during the measurements were registered. Participating farms were randomized a priori to a control (n = 40) and an intervention group (n = 40). Shortly after the first visit, owners of intervention farms only received a letter with information on the measured dust concentrations in the farm together with some general advises on exposure reduction strategies (e.g. use of respirators during certain tasks). Relationships between measured dust concentrations and intervention status were quantified by means of linear mixed effect analysis with farm and worker id as random effects. Season, type of farming, and work tasks were treated as fixed effects. Changes in exposure over time were explored primarily at a farm level in models combined, as well as separate for pig and cattle farmers.
Results: After adjustment for fixed effects, an overall reduction of 23% in personal dust exposures was estimated as a result of the intervention (P = 0.02). Exposure reductions attributable to the intervention were similar across pig and cattle farmers, but statistically significant only for pig farmers. Intervention effects among pig farmers did not depend on the individuals' information status; but among cattle farmers a significant 48% reduction in exposure was found only among individuals that reported to have been informed. No systematic differences in changes over time considering the use of respiratory protection between the intervention and control groups were observed.
Conclusion: The results of the present study suggest reductions between 20 and 30% in personal exposure to inhalable dust to be feasible through simple information provided to the farm owners regarding actual levels of exposure together with instructions on basic measures of prevention. The exact reasons for these effects are unclear, but likely they involve changes in behavior and working practices among intervention farmers.

Source: Basinas I, Sigsgaard T, Bonlokke JH, et al. Annals of Occupational Hygiene, 2016.

Perturbateurs endocriniens

Le colloque INRS/AISS 2016 « Perturbateurs endocriniens et agents sensibilisants : quels risques au travail ? quelle prévention ? » s'est tenu début juin à Paris. Les perturbateurs endocriniens, qui ont la capacité d'interférer avec le système hormonal, sont susceptibles de provoquer des effets nocifs tant chez les individus exposés que sur leur descendance. Ils constituent à la fois un sujet de santé publique et une problématique de santé au travail. En milieu professionnel, les salariés peuvent être exposés à divers perturbateurs endocriniens dans des secteurs d'activité variés. La démarche recommandée pour la prévention des risques liés à ces substances chimiques est similaire à celle qui doit être mise en oeuvre vis-à-vis des produits chimiques CMR (cancérogènes, mutagènes, reprotoxiques).

Source: http://kiosque.inrs.fr/alyas/view/news/lettre/105/html#suite

Prévention des expositions liées aux émissions des moteurs thermiques

Les moteurs thermiques sont largement utilisés sur les véhicules routiers ou non routiers ainsi que pour des applications fixes (compresseurs, groupes électrogènes). Les émissions de ces moteurs peuvent entraîner des effets néfastes sur la santé du fait des nombreuses substances dangereuses qu'elles contiennent. Les expositions professionnelles à ces émissions sont fréquentes et peuvent atteindre des niveaux bien supérieurs aux expositions environnementales de la population générale car les moteurs thermiques sont généralement utilisés à proximité directe des salariés ou à l'intérieur des locaux de travail.
Cet aide-mémoire technique fait le point sur les caractéristiques des gaz d'échappement, sur leurs effets sur la santé, sur la réglementation des émissions des moteurs thermiques, et sur les moyens de prévention qui peuvent être mis en oeuvre en milieu professionnel (réduction à la source, ventilation mécanique). Les préconisations décrites dans la suite de ce document portent surtout sur équipements généralement utilisés sur un lieu de travail : engins mobiles non routiers (chariots automoteurs, engins de chantier, groupes électrogènes...), véhicules utilitaires. La réglementation et les recommandations relatives aux travaux souterrains sont également rappelées.

Source: http://www.inrs.fr/media.html?refINRS=ED%206246

Occupational Exposure to Bioaerosols in Norwegian Crab Processing Plants

Introduction: Aerosolization of components when processing king crab (Paralithodes camtschaticus) and edible crab (Cancer pagurus) may cause occupational health problems when inhaled by workers.
Methods: A cross-sectional study was carried out in three king crab plants and one edible crab plant. Personal exposure measurements were performed throughout work shifts. Air was collected for measurement of tropomyosin, total protein, endotoxin, trypsin, and N-acetyl-β-d-glucosaminidase (NAGase). T-tests and ANOVAs were used to compare the levels of exposure in the different plants and areas in the plants.
Results: Total protein and tropomyosin levels were highest in the edible crab plant, endotoxin levels were highest in king crab plants. King crab exposure levels were highest during raw processing. Tropomyosin levels were highest during raw king crab processing with geometric mean (GM) 9.6 versus 2.5ng m−3 during cooked processing. Conversely, edible crab tropomyosin levels were highest during cooked processing with GM 45.4 versus 8.7ng m−3 during raw processing. Endotoxin levels were higher in king crab plants than in the edible crab plant with GM = 6285.5 endotoxin units (EU) m−3 versus 72 EU m−3. In the edible crab plant, NAGase levels were highest during raw processing with GM = 853 pmol4-methylumbelliferone (MU) m−3 versus 422 pmol4-MU m−3 during cooked processing. Trypsin activity was found in both king crab and edible crab plants and levels were higher in raw than cooked processing. Differences in exposure levels between plants and worker groups (raw and cooked processing) were identified.
Conclusions: Norwegian crab processing workers are exposed to airborne proteins, tropomyosin, endotoxins, trypsin, and NAGase in their breathing zone. Levels vary between worker groups and factories.

Source: Thomassen MR, Kamath SD, Lopata AL, et al. Annals of Occupational Hygiene, 2016.

Captage des poussières de silice sur les chantiers de rabotage routier aux États-Unis

En France, pour diminuer l'exposition à la silice lors des travaux de recyclage routier, il est conseillé d'équiper les raboteuses d'un dispositif de captage des poussières. Aux États-Unis, des mesures ont été réalisées en atelier et sur le terrain sur le sujet depuis 2003 et ont fait l'objet d'une publication (NIOSH 2015-105)2. Une efficacité de captage des poussières supérieure à 90 % est préconisée. Un protocole de vérification de cette efficacité a été publié (annexe B, NIOSH 2015-105) et serait applicable en l'état au contexte français.

Source: http://www.inrs.fr/media.html?refINRS=NT%2032

Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires’ Disease

North America, 2000-2014
Background: The number of reported cases of Legionnaires' disease, a severe pneumonia caused by the bacterium Legionella, is increasing in the United States. During 2000–2014, the rate of reported legionellosis cases increased from 0.42 to 1.62 per 100,000 persons; 4% of reported cases were outbreak-associated. Legionella is transmitted through aerosolization of contaminated water. A new industry standard for prevention of Legionella growth and transmission in water systems in buildings was published in 2015. CDC investigated outbreaks of Legionnaires' disease to identify gaps in building water system maintenance and guide prevention efforts.

Source: http://www.cdc.gov/mmwr/volumes/65/wr/mm6522e1.htm?s_cid=mm6522e1_x

Programme de prévention - Expositions au sang chez les travailleurs de la santé

Ce guide, révisé en 2016, présente l'ensemble des composantes à mettre en place pour un programme complet de prévention des expositions au sang chez les travailleurs de la santé. Il aide à cibler les priorités d'action et il offre de nombreux outils pour agir en prévention.

Source: http://www.asstsas.qc.ca/publication/programme-de-prevention-expositions-au-sang-chez-les-travailleurs-de-la-sante-gp68

The risk of cataract in relation to metal arc welding

Objectives: There are indications that solar ultraviolet radiation (UVR) increases the risk of cataract, but there is only circumstantial evidence that metal welding, an important occupational source of UVR exposure, is a risk factor. The objective of this study is to unravel if metal welding increases the risk of cataract.
Method: We compared the risk of being diagnosed with cataract from 1987–2012 in a historic cohort of 4288 male metal arc welders against a reference group comprised of Danish skilled and unskilled male workers with similar age distribution. For the welders' cohort, information on welding was collected from questionnaires and, for both cohorts, information about cataract diagnosis and operation was gathered from Danish national registers. Using Cox regression analysis, the hazard ratio (HR) for cataract diagnosis and/or operation was calculated in the follow-up period adjusted for baseline data regarding age, diabetes, and social group.
Results: There were 266 welders and 29 007 referents with a diagnosis and/or operation for cataract. The unadjusted HR for cataract comparing ever-welders with referents was 1.07 [95% confidence interval (95% CI) 0.95–1.21] and the adjusted HR was 1.08 (95% CI 0.95–1.22). Age and diabetes were as expected strong risk factors.
Conclusion: We found no increased risk of developing cataract among Danish metal welders who worked with arc welding from 1950–1985. This may be attributed to the effectiveness of personal safety equipment.

Source: Slagor RM, La Cour M, Bonde JP. Scand J Work Environ Health, 2016. 

Occupational health risks associated with the use of germicides in health care

Environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Clostridium difficile, norovirus, and multidrug-resistant gram-negative bacilli. For this reason, routine disinfection of environmental surfaces in patient rooms is recommended. In addition, decontamination of shared medical devices between use by different patients is also recommended. Environmental surfaces and noncritical shared medical devices are decontaminated by low-level disinfectants, most commonly phenolics, quaternary ammonium compounds, improved hydrogen peroxides, and hypochlorites. Concern has been raised that the use of germicides by health care personnel may increase the risk of these persons for developing respiratory illnesses (principally asthma) and contact dermatitis. Our data demonstrate that dermatitis and respiratory symptoms (eg, asthma) as a result of chemical exposures, including low-level disinfectants, are exceedingly rare. Unprotected exposures to high-level disinfectants may cause dermatitis and respiratory symptoms. Engineering controls (eg, closed containers, adequate ventilation) and the use of personal protective equipment (eg, gloves) should be used to minimize exposure to high-level disinfectants. The scientific evidence does not support that the use of low-level disinfectants by health care personnel is an important risk for the development of asthma or contact dermatitis.

Source: Weber, David J., Consoli, Stephanie A., & Rutala, William A. (2016). AJIC : American Journal of Infection Control, 44 (5), suppl., p. e85-e89.

Workplace air quality: International consensus standards

Standardization is essential to fostering the use of harmonized methods for exposure assessment in occupational hygiene nationally and internationally. A standardized method for sampling and analysis provides data of known quality and reliability through the assurance of acceptable accuracy or uncertainty, which can then be compared to results collected at other times or in other places. Consensus standards can be used by regulatory agencies or advisory bodies to determine compliance with occupational exposure limit values. In addition, harmonized methods can be employed to generate high-quality databases of exposure results that can be used for other purposes such as epidemiological studies.

Source : Lee, Eun Gyung, Ashley, Kevin, Breuer, Dietmar, Brisson, Michael J., Harper, Martin, & Thom, Christian. (2016). Journal of Occupational and Environmental Hygiene, 13 (7), D111-D117.

Inflammatory Markers and Genetic Polymorphisms in Workers Exposed to Flour Dust

Objective: The aim of this study is to evaluate inflammatory markers and pro-inflammatory CD14 and Toll-like Receptor 4 (TLR4) polymorphisms in workers exposed to flour dust.
Methods: Polymorphisms in TLR4 and CD14 were identified in our study population of 167 workers that included 63 healthy subjects (HS), 45 atopic subjects (A), and 59 subjects diagnosed clinically with occupational asthma/rhinitis (OAR). Endpoint measures in this study included fractional exhaled nitric oxide and serum concentrations of interleukin IL-6, IL-8, and tumor necrosis factor-alpha (TNF-α).
Results: We identified a polymorphism in CD14 (rs2569190) that may be differentially expressed (P?=?0.06). IL-6 concentrations in the serum were significantly higher in the A and OAR groups (P?<?0.01) than in subjects in the HS group, while IL-8 concentrations were significantly elevated only in the OAR group (P?<?0.01). Interestingly, TNF-α concentrations in the OAR group were significantly reduced when compared with subjects in the HS group (P?<?0.01).
Conclusion: Cytokines are likely a defensive response in atopic and healthy workers. A protective genotype is hypothesized for occupational asthma.

Source: Marraccini, Paolo; Cantone, Laura; Barretta, Francesco; Marsili, Chiara; Leghissa, Paolo; Santini, Marisa; Elli, Francesca; Bertazzi, Pier A.; Previdi, Mario. Journal of Occupational & Environmental Medicine: May 2016, Volume 58, Issue 5, p. e166-e170.

Cross-Sectional Study on Nonmalignant Respiratory Morbidity due to Exposure to Synthetic Amorphous Silica

Objectives: The aim of this study was to assess the health impact of chronic exposure to synthetic amorphous silica (SAS) on nonmalignant respiratory morbidity.
Methods: We used multiple linear and logistic regression models and Monte Carlo multimodel analyses of two exposure scenarios to evaluate the effect of cumulative exposure to inhalable SAS dust on symptoms, spirometry, and chest films in 462 male workers from five German SAS-producing plants.
Results: Exposure to SAS was associated with a reduction in forced vital capacity (FVC) in one of the two exposure scenarios but had no effect on forced expiratory volume in 1?second (FEV1) or FEV1/FVC in either exposure scenario. Monte Carlo analysis indicated a decline in FVC of -11?mL per 10?mg/m3-years exposure (-6 to -0.4). Chest films showed no evidence of pneumoconiosis.
Conclusion: This study provides limited evidence of minor dose-related effects of chronic exposure to SAS on lung function.

Source: Taeger, Dirk; McCunney, Robert; Bailer, Ursula; Barthel, Kai; Küpper, Ulrich; Brüning, Thomas; Morfeld, Peter; Merget, Rolf. Journal of Occupational & Environmental Medicine: April 2016, Volume 58, Issue 4, p. 376-384.

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