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1.  Health impacts of exposure to second hand smoke (SHS) amongst a highly exposed workforce: survey of London casino workers 
BMC Public Health  2007;7:257.
Casino workers are exposed to high levels of secondhand smoke (SHS) at work, yet remain at risk of being excluded from smoke-free legislation around the world. If the prime motivation for smoke-free legislation is the protection of workers, then a workforce experiencing ill-health associated with SHS exposure should not be excluded from legislation. This study aimed to determine the prevalence of respiratory and sensory irritation symptoms among a sample of casino workers, to identify any association between the reporting of symptoms and exposure to SHS at work, and to compare the prevalence of symptoms with that in other workers exposed to SHS.
A postal questionnaire survey of 1568 casino workers in London. Using multivariate analysis we identified predictors of respiratory and sensory irritation symptoms.
559 workers responded to the questionnaire (response of 36%). 91% of casino workers reported the presence of one or more sensory irritation symptoms in the previous four weeks, while the figure was 84% for respiratory symptoms. The presence of one or more sensory irritation symptoms was most strongly associated with reporting the highest exposure to SHS at work (OR 3.26; 1.72, 6.16). This was also true for reporting the presence of one or more respiratory irritation symptoms (OR 2.24; 1.34, 3.74). Prevalence of irritation symptoms in the casino workers was in general appreciably higher than that reported in studies of bar workers.
Our research supports the need for comprehensive smoke-free legislation around the world, covering all indoor workplaces including casinos.
PMCID: PMC2040157  PMID: 17888155
2.  Health complaints and immunological markers of exposure to bioaerosols among biowaste collectors and compost workers 
OBJECTIVES—In a cross sectional study, work related health complaints and diseases of 58 compost workers and 53 biowaste collectors were investigated and compared with 40 control subjects. Levels of specific IgG antibodies to moulds and bacteria were measured as immunological markers of exposure to bioaerosols.
METHODS—With a standardised protocol, the participants of the study were interviewed for work related symptoms, conditions of exposure to bioaerosols at their workplaces, exposure to bioaerosols from other sources, atopic diseases, and smoking habits. They were clinically examined by physicians specialised in occupational medicine. Also, concentrations of specific IgG antibodies against antigens of moulds and actinomycetes occurring regularly at these workplaces were measured and compared with the health complaints of the workers.
RESULTS—Compost workers had significantly more symptoms and diseases of the airways (p=0.003) and the skin (p=0.02) than the control subjects. Health complaints of biowaste collectors did not differ significantly from those of the control group. Subjects with atopic diseases were underrepresented in the compost workers (p=0.003). Significantly increased antibody concentrations against fungi and actinomycetes were measured in workers at composting plants. The concentrations in biowaste collectors did not differ significantly from those in the control subjects. A significant association between the diseases and increased antibody concentrations were found in the compost workers.
CONCLUSION—The high exposure to bioaerosols of compost workers is significantly associated with a higher frequency of health complaints and diseases as well as higher concentrations of specific antibodies against moulds and actinomycetes. A healthy worker effect is indicated by the underrepresentation of atopic diseases among the compost workers compared with biowaste collectors and the control group.

Keywords: exposure to bioaerosols; organic dust; IgG antibodies; moulds; actinomycetes
PMCID: PMC1739988  PMID: 10854498
3.  A comparative study of respiratory function in female non-smoking cotton and jute workers 
Valić, F., and Žuškin, E. (1971).Brit. J. industr. Med.,28, 364-368. A comparative study of respiratory function in female non-smoking cotton and jute workers. To compare the effect of cotton and jute dust, respiratory symptoms were studied and respiratory function measured in 60 cotton and 91 jute non-smoking female workers of similar age distribution, similar length of exposure to dust, and exposed to similar respirable airborne dust concentrations. Cotton workers had a significantly higher prevalence of byssinosis, of persistent cough, and of dyspnoea (P < 0·01) than jute workers. Among cotton workers 28·3% were found to have characteristic symptoms of byssinosis, whereas none was found among jute workers.
Exposure to cotton but also to jute dust caused significant reductions of FEV1·0, FVC, and PEF (P < 0·01) over the first working shift in the week. Functional grading of jute and cotton dust effects has shown that about 30% of cotton workers had functional grades F1 and F2, while only 13% of jute workers were found in the same grades (F1). It is concluded that cotton dust may be considered more active than jute though the latter cannot be considered inactive.
PMCID: PMC1009330  PMID: 5124836
4.  Respiratory symptoms and ventilatory function in confectionery workers. 
Respiratory symptoms and ventilatory capacity were studied in a group of 288 workers (259 women and 29 men) employed in a confectionery plant. A group of workers (96 women and 31 men) not exposed to confectionery manufacture were also studied as controls. The prevalence of chronic respiratory symptoms was higher in exposed than in control workers, being greatest for confectionery workers exposed to the dust of flour, talc, and starch and the vapours of alcohol. Chronic bronchitis was reported by 7% of the women and 21% of the men, and chest tightness was reported by 27% of women and 66% of men. There was a high prevalence of acute irritative symptoms during the workshift in all groups of confectionery workers, especially for cough, dyspnoea, burning and dryness of the throat, and eye irritation. For all groups of confectionery workers there were statistically significant across shift reductions in ventilatory capacity, being most pronounced for maximum flow rate at 50% of the control vital capacity (FEF50; range 4.6-13.0%) and at 25% of the control vital capacity (FEF25; range 4.7-22.3%). Preshift values of FEF50 and FEF25 were significantly lower than predicted values. The data suggest that some workers employed in confectionery plants may develop acute and chronic respiratory symptoms associated with changes in lung function.
PMCID: PMC1128010  PMID: 8044240
5.  Respiratory effects of borax dust. 
The relation of respiratory symptoms, pulmonary function, and abnormalities of chest radiographs to estimated exposures of borax dust has been investigated in a cross sectional study of 629 actively employed borax workers. Ninety three per cent of the eligible workers participated in the study and exposures ranged from 1.1 mg/m3 to 14.6 mg/m3. Symptoms of acute respiratory irritation such as dryness of the mouth, nose, or throat, dry cough, nose bleeds, sore throat, productive cough, shortness of breath, and chest tightness were related to exposures of 4.0 mg/m3 or more, and were infrequent at exposures of 1.1 mg/m3. Symptoms of persistent respiratory irritation meeting the definition of chronic simple bronchitis were related to exposure among non-smokers. Decrements in the FEV1 as a percentage of predicted were seen among smokers who had heavy cumulative borax exposures (greater than or equal to 80 mg/m3 years) but were not seen among less exposed smokers or among non-smokers. Radiographic abnormalities were uncommon and were not related to dust exposure. Borax dust appears to act as a simple respiratory irritant and perhaps causes small changes in the FEV1 among smokers who are heavily exposed.
PMCID: PMC1007587  PMID: 3878156
6.  Airway Symptoms and Biological Markers in Nasal Lavage Fluid in Subjects Exposed to Metalworking Fluids 
PLoS ONE  2013;8(12):e83089.
Occurrence of airway irritation among industrial metal workers was investigated. The aims were to study the association between exposures from water-based metal working fluids (MWF) and the health outcome among the personnel, to assess potential effects on the proteome in nasal mucous membranes, and evaluate preventive actions.
The prevalence of airway symptoms related to work were examined among 271 metalworkers exposed to MWF and 24 metal workers not exposed to MWF at the same factory. At the same time, air levels of potentially harmful substances (oil mist, morpholine, monoethanolamine, formaldehyde) generated from MWF was measured. Nasal lavage fluid was collected from 13 workers and 15 controls and protein profiles were determined by a proteomic approach.
Airway symptoms were reported in 39% of the workers exposed to MWF although the measured levels of MWF substances in the work place air were low. Highest prevalence was found among workers handling the MWF machines but also those working in the same hall were affected. Improvement of the ventilation to reduce MWF exposure lowered the prevalence of airway problems. Protein profiling showed significantly higher levels of S100-A9 and lower levels of SPLUNC1, cystatin SN, Ig J and β2-microglobulin among workers with airway symptoms.
This study confirms that upper airway symptoms among metal workers are a common problem and despite low levels of MWF-generated substances, effects on airway immune proteins are found. Further studies to clarify the role of specific MWF components in connection to airway inflammation and the identified biological markers are warranted.
PMCID: PMC3877012  PMID: 24391738
7.  Prenarcotic and neuraesthenic symptoms among Dutch workers exposed to organic solvents. 
A population of 379 Dutch workers exposed to organic solvents was compared with a non-exposed population of 443 workers with regard to the prevalence of prenarcotic and neuraesthenic symptoms. Participants completed a questionnaire to collect information about their occupational history, exposure to organic solvents, and the occurrence of symptoms. The results of the study indicated that workers exposed to solvents have a higher reporting rate of prenarcotic symptoms than workers not exposed to solvents. The prevalence of chronic neurotoxic effects, however, in the form of neuraesthenic symptoms was only weakly associated with reported exposure to organic solvents. The influence of work stress in the development of these symptoms is perhaps more important than the role of exposure to organic solvents. It is concluded that the organic solvent syndrome type I, as defined by an international workshop, is not an important health hazard among Dutch painters.
PMCID: PMC1009831  PMID: 2775680
8.  Dust exposure and impairment of lung function at a small iron foundry in a rapidly developing country 
OBJECTIVES—A cross sectional prospective study was carried out among iron foundry workers (exposed) and soft drink bottling and supply company workers (unexposed) to assess their occupational exposure to ambient respiratory dust in their work environment and its effect on their lung function profile.
PARTICIPANTS—Lung function was measured in 81 exposed and 113 unexposed workers. Personal respirable dust concentrations were measured for all the exposed and the unexposed workers. Information on respiratory signs and symptoms was also collected from the participants.
RESULTS—Among the exposed workers, midexpiratory flow (FEF25-75), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), FEV1/FVC, and FEV1/VC ratios were significantly lower whereas the vital capacity (VC) and forced vital capacity (FVC) were non-significantly higher. Job at the iron foundry was a significant predictor of lung function. Exposure to high concentration of respirable dust at the iron foundry was also a significant predictor. Workers working in high exposure areas (general works, furnace, continuous casting areas, and fabrication workshop) had lower lung function values than workers in medium and low exposure areas. Smoking did not enhance the effects of exposure to dust on lung function.
CONCLUSIONS—Exposure to respirable dust was higher among the iron foundry workers; and among these, general, furnace, rolling mill, and fabrication workers had higher exposures to dust than did workers in continuous casting, the mechanical workshop, and the bottling plant. Job type and exposure to dust were significant predictors of lung function. Implementation of industrial hygiene and proper and efficient use of personal protection equipment while at work could help to protect the respiratory health of industrial workers.

Keywords: lung function; dust exposure; foundry; smoking; personal protection
PMCID: PMC1740042  PMID: 11555687
9.  Respiratory abnormalities among workers in an iron and steel foundry. 
A study of the health of 78 workers in an iron and steel foundry in Vancouver, British Columbia, was carried out and the results compared with those found in 372 railway repair yard workers who were not significantly exposed to air contaminants at work. The foundry workers were exposed to PepSet, which consists of diphenyl methane diisocyanate (MDI) and phenol formaldehyde and their decomposition products as well as to silica containing particulates. A questionnaire was administered by trained interviewers, and chest radiography, allergy skin tests, pulmonary function tests, and methacholine inhalation tests were carried out as well as measurement levels of dust and MDI. Compared with the controls, the foundry workers had more respiratory symptoms and a significantly lower mean FEV1 and FEF25-75% after adjustments had been made for differences in age, height, and smoking habit. Three workers (4.8%) had radiographic evidence of pneumoconiosis and 12 (18.2%) had asthma defined as presence of bronchial hyperreactivity, cough, and additional respiratory symptoms such as wheeze, chest tightness, or breathlessness. Sensitisation to MDI is probably the cause of asthma in these workers.
PMCID: PMC1007429  PMID: 2982392
10.  Prevalence of byssinosis in Swedish cotton mills. 
The prevalence of byssinosis and of chronic bronchitis was studied in a questionnaire investigation among workers in bale opening areas, carding rooms, and spinning rooms in five Swedish cotton mills. Airborne dust and Gram-negative bacteria was measured. Nineteen per cent of the interviewed workers reported symptoms of light byssinosis (grade 1/2). The prevalence of symptoms was not related to the duration of employment, and cases of byssinosis were found among people who had worked in cotton mills for only a few years. A significantly higher proportion of male than female workers reported symptoms. No difference in the extent of byssinosis was found between smokers and non-smokers, but the prevalence was significantly higher among those workers who had ceased smoking. The prevalence of byssinosis was related to the number of airborne viable Gram-negative bacteria as well as to the dust level in the different mills.
PMCID: PMC1008836  PMID: 7236538
11.  Grain dust and respiratory health in South African milling workers. 
Respiratory health was investigated in 224 grain milling workers. The likelihood of respiratory symptoms and chronic airflow limitation was raised for workers exposed to dust independent of the effects of smoking. Smokers were more likely than non-smokers to respond to a bronchodilator at the end of the working week. Dust was more strongly associated with most abnormal outcomes than was smoking. Subjective categories of exposure to dust were more strongly associated with most abnormal outcomes than were objective categories. The prevalence of all symptoms at the time of a survey conducted at the mill six years before was higher in workers who subsequently left the mill than in those who remained employed although the differences were not significant.
PMCID: PMC1012056  PMID: 1931723
12.  An epidemiological study of the respiratory health of workers in the European refractory ceramic fibre industry 
OBJECTIVES—To investigate possible relations between respiratory health and past airborne exposure to refractory ceramic fibres (RCFs) and respirable dust in workers at six European factories, studied previously in 1987.
METHODS—The target population comprised all current workers associated with RCF production, plus others who had participated in 1987 "leavers". Information was collected on personal characteristics, chest radiographs, lung function, respiratory symptoms, smoking, and full occupational history. Regression analysis was used to study relations between indices of health of individual workers and of cumulative exposure to airborne dust and fibres, and likely past exposure to asbestos. 
RESULTS AND DISCUSSION—774 workers participated (90% of current workers, 37% of leavers). Profusion of small opacities in exposed workers (51% 0/1+; 8% 1/0+) was similar to that among an unexposed control group but higher than in new readings of the 1987 study films (11% 0/1+, 2% 1/0+). The large difference between 1987 and recent films may be, at least in part, a reading artefact associated with film appearance. Small opacities of International Labour Organisation (ILO) category 1/0+ were not associated with exposure. An association of borderline significance overall between 0/1+ opacities and exposure to respirable fibres was found for some exposure periods only, the time related pattern being biologically implausible. Pleural changes were related to age and exposure to asbestos, and findings were consistent with an effect of time since first exposure to RCFs. Among men, forced expired volume in 1 second (FEV1) and forced vital capacity (FVC) were inversely related to exposure to fibres, in current smokers only. FEV1/ FVC ratio and transfer factor (TLCO) were not related to exposures. The estimated restrictive effect was on average mild. Prevalence of respiratory symptoms was low. Chronic bronchitis and its associated symptoms (cough, phlegm) showed some association with recent exposure to respirable fibres. This could be due to an irritant effect of RCFs.

Keywords: respiratory health; ceramic fibres
PMCID: PMC1740079  PMID: 11706147
13.  Respiratory symptoms and airflow limitation in asphalt workers 
Aims: To assess the occurrence of respiratory symptoms and signs of airflow limitations in a group of asphalt workers.
Methods: All 64 asphalt workers and a reference group of 195 outdoor construction workers from the same company participated in a cross-sectional study. Spirometric tests and a questionnaire on respiratory symptoms and smoking habits were administered. Respiratory symptoms and lung function were adjusted for age and smoking.
Results: The FEV1/FVC% ratio was significantly lower in the asphalt workers than in the referents. Symptoms of eye irritation, chest tightness, shortness of breath on exertion, chest wheezing, physician diagnosed asthma, and chronic obstructive pulmonary disease (COPD) were all significantly more prevalent among the asphalt workers.
Conclusion: In asphalt workers there is an increased risk of respiratory symptoms, lung function decline, and COPD compared to other construction workers.
PMCID: PMC1740758  PMID: 15031397
14.  China clay workers in the south west of England: analysis of chest radiograph readings, ventilatory capacity, and respiratory symptoms in relation to type and duration of occupation. 
In 1985, employees in the china clay industry were offered chest x ray examinations and 4478 (52.6% of the total workforce) accepted. Of these, 4167 workers and pensioners of the largest single employer also completed occupational histories, respiratory symptom questionnaires, and underwent ventilatory capacity tests. The x ray readings (read to the 1980 ILO classification) of the 4167 workers and pensioners were analysed to seek relations between the indices of pulmonary health and occupational exposure. The information available, particularly on occupational history, was more detailed than in previous studies of 1961, 1977, and 1981. Analyses show that in the improved operating conditions of recent years the average worker exposed to dust only after 1971 would not expect to develop category 1 pneumoconiosis through a full working life in any of the industry's occupations. For those with exposure before 1971 the category reached will depend on the amount of early exposure, but the rate of development of pneumoconiosis since 1971 is about half that before 1971. The milling of china stone, a practice that ceased over 15 years ago in the china clay industry, had by far the largest effect on x ray category, whereas of the current occupations, employment in china clay attritor mills has the greatest effect. Ventilatory capacity is related to x ray category as well as age, and results for loss of ventilatory capacity in relation to age, x ray category, and smoking habits were similar to the results in previous studies. Respiratory symptoms are associated with smoking class and a loss in ventilatory capacity (FVC or FEV1), FEV1 being the most dominant. Allowing for this, there was no further effect for years of exposure, x ray category, or age.
PMCID: PMC1009765  PMID: 2713282
15.  Anosmia in Alkaline Battery Workers 
The sense of smell of 106 alkaline battery workmen exposed at their work to cadmium and nickel dust has been compared with a control group of 84 men matched for age. The battery workers reported significantly more anosmia than the controls (15% to zero) and did less well in the phenol smelling test (27·3% to 4·8%). Cadmium proteinuria was found in 17 of the battery workers, 11 of whom showed virtual anosmia. Figures of recent concentrations of cadmium and nickel in the atmosphere are given. The noses of 85 battery workers and 75 controls were examined. Signs of non-specific chronic irritation were more frequent in the battery workers but no significant relationship was established between this appearance and the presence of anosmia. It is concluded that the anosmia is due to exposure to cadmium or nickel dust or a mixture of the two.
PMCID: PMC1038151  PMID: 13681418
16.  Work related symptoms among sewage workers: a nationwide survey in Sweden 
Aims: To assess the risk for work related symptoms among sewage workers in Sweden using a postal questionnaire.
Methods: All municipalities in Sweden were contacted and asked to provide addresses of sewage workers and controls. Controls were recruited among other municipal workers not exposed to sewage, such as workers in drinking water plants and gardeners. A questionnaire was sent to the subjects and after two reminders, the response rate was 74% among sewage workers and 59% among controls.
Results: Significantly increased risks for airway symptoms, chronic bronchitis, and toxic pneumonitis, as well as central nervous system symptoms such as headache, unusual tiredness, and concentration difficulties were found among the sewage workers compared with controls. Furthermore, an increased risk for non-specific work related gastrointestinal symptoms was found among the sewage workers; an increased risk for joint pains, related to pains in more than four joints but not with loading, was also found.
Conclusions: The results of this questionnaire survey show an increased risk for airway, gastrointestinal, and general symptoms such as joint pains and central nervous system symptoms among sewage workers. Clinical investigations are needed to determine the cause of the reported symptoms among sewage workers, and further field studies are required to assess the causal agents.
PMCID: PMC1740343  PMID: 12151615
17.  Respiratory symptoms and cotton dust exposure; results of a 15 year follow up observation 
Aims: To determine chronic effects of long term exposure to cotton dust and endotoxin on incidence of respiratory symptoms and the effect of cessation of exposure.
Methods: Respiratory health in 429 Chinese cotton textile workers (study group) and 449 silk textile workers (control group) was followed prospectively from 1981 to 1996. Byssinosis, chest tightness, and non-specific respiratory symptoms were assessed by means of identical standardised questionnaires at four time points. Exposures to cotton dust and endotoxin were estimated using area samples collected at each survey. Incidence and persistence of symptoms were examined in relation to cumulative exposure and exposure cessation using generalised estimating equations (GEE).
Results: Among cotton workers, the cumulative incidence of byssinosis and chest tightness was 24% and 23%, respectively, and was significantly more common in smokers than in non-smokers. A high proportion of symptoms was found to be intermittent, rather than persistent. Among silk workers, no typical byssinosis was identified; the incidence of chest tightness was 10%. Chronic bronchitis, cough, and dyspnoea were more common and persistent in the cotton group than in the silk group. Significantly lower odds ratios for symptoms were observed in cotton workers who left the cotton mills; risk was also related to years since last worked. Multivariate analysis indicated a trend for higher cumulative exposure to endotoxin in relation to a higher risk for byssinosis.
Conclusion: Chronic exposure to cotton dust is related to both work specific and non-specific respiratory symptoms. Byssinosis is more strongly associated with exposure to endotoxin than to dust. Cessation of exposure may improve the respiratory health of cotton textile workers; the improvement appears to increase with time since last exposure.
PMCID: PMC1740446  PMID: 14634185
18.  Respiratory symptoms and ventilatory capacity in swine confinement workers. 
A group of 59 workers (41 men and 18 women) employed in swine confinement areas was studied to assess the presence of acute and chronic respiratory symptoms and the prevalence of abnormalities in ventilatory function. A control group of 46 (31 men and 15 women) unexposed workers was studied for the prevalence of chronic respiratory symptoms. For both male and female swine confinement workers complaints of chronic cough, dyspnoea, and chest tightness were significantly more frequent than among control workers. Male workers also complained more of chronic phlegm. Male swine confinement workers who were smokers had significantly higher prevalences of chronic cough, chronic phlegm, and chronic bronchitis than male non-smoking swine confinement workers. The frequency of acute symptoms associated with the workshift was high among the swine confinement workers with more than half of the workers complaining of cough and dyspnoea associated with work. Significant acute across shift reductions in lung function occurred in swine confinement workers, being largest for FEF25. All Monday preshift ventilatory capacity measurements in male confinement workers were significantly lower than predicted values; FVC and FEV1 were found to be lower than predicted values for women. The data indicate that exposure in swine confinement buildings is associated with the development of acute and chronic respiratory symptoms and impairment of lung function. Smoking appears to aggravate these changes.
PMCID: PMC1012126  PMID: 1606030
19.  Health effects among refrigeration repair workers exposed to fluorocarbons. 
Refrigeration repair workers may be intermittently exposed to fluorocarbons and their thermal decomposition products. A case of peripheral neuropathy (distal axonopathy) in a commercial refrigeration repairman prompted an epidemiological investigation of the health of refrigeration repair workers. No additional cases of peripheral neuropathy were identified among the 27 refrigeration repair workers studied. A reference group of 14 non-refrigeration repair workers was also studied. No differences were noted between groups for the ulnar (motor and sensory), median (motor and sensory), peroneal, sural, or tibial nerve conduction velocities. Refrigeration repair workers reported palpitations and lightheadedness significantly more often than workers in the reference group. No clinical neurological or electroneurophysiological abnormalities were detected in eight refrigeration repair workers followed up for three years during continuous employment.
PMCID: PMC1007616  PMID: 3004555
20.  The World Trade Center Disaster and the Health of Workers: Five-Year Assessment of a Unique Medical Screening Program 
Environmental Health Perspectives  2006;114(12):1853-1858.
Approximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the 11 September 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders, such as firefighters and police, and a diverse population of construction, utility, and public sector workers.
To characterize WTC-related health effects, the WTC Worker and Volunteer Medical Screening Program was established. This multicenter clinical program provides free standardized examinations to responders. Examinations include medical, mental health, and exposure assessment questionnaires; physical examinations; spirometry; and chest X rays.
Of 9,442 responders examined between July 2002 and April 2004, 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. Among those who had been asymptomatic before September 11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry; forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 27% had abnormal spirometry compared with 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site.
WTC responders had exposure-related increases in respiratory symptoms and pulmonary function test abnormalities that persisted up to 2.5 years after the attacks. Long-term medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters.
PMCID: PMC1764159  PMID: 17185275
air pollution; disaster response; occupational lung disease; pulmonary function; September 11; spirometry; World Trade Center
21.  Environmental and health studies of farm workers in Swedish swine confinement buildings. 
The relation between the health of workers and the environment in swine confinement buildings was investigated in a study of 57 workers on 30 swine farms in southern Sweden and 55 matched controls. Swine workers reported significantly higher frequencies of respiratory symptoms, more frequent colds and absence due to chest illness, and a history of pneumonia. The increased frequency of symptoms of respiratory disease was related to the number of years and percent of the day spent working with swine. Symptoms were also associated with respirable dust, total dust, endotoxin in total dust, and number of microbes in the air of the work environment. In a multiple regression analysis of the relation between 16 different environmental parameters to work period shifts of five pulmonary function parameters, endotoxin was found to be significantly related to the FEV1 in a dose dependent way.
PMCID: PMC1009719  PMID: 2920141
22.  Sensitisation to enzymes in the animal feed industry 
OBJECTIVES—To assess the prevalence of enzyme sensitisation in the animal feed industry.
METHODS—A cross sectional study was conducted in four animal feed factories, where several enzymes had been used in powder form for 7-9 years. Before this study, enzymes in liquid form had started to be used. Sensitisation to enzymes was examined by skin prick and radioallergosorbent (RAST) tests. Altogether 218 workers were tested; 140 people in various tasks in manufacturing, where exposure to various organic dusts and to enzymes was possible, and 78 non-exposed office workers. The workers were interviewed for work related respiratory and skin symptoms. Total dust concentrations were measured by a gravimetric method. The concentrations of protease and α-amylase were measured with catalytic methods and that of xylanase with an immunological method.
RESULTS—Ten workers (7%) were sensitised to enzymes in the exposed group of 140, whereas none were sensitised in the non-exposed group. Six of the sensitised people had respiratory symptoms at work: two of them especially in connection with exposure to enzymes. Enzyme concentrations in the air varied greatly: xylanase from less than 0.8 ng/m3 up to 16 ng/m3, α-amylase from less than 20 ng/m3 up to 200 ng/m3, and protease from less than 0.4 ng/m3up to 2900 ng/m3. On average, highest xylanase and α-amylase concentrations were found in the various manufacturing sites, whereas the highest protease concentrations were found in areas of high total dust.
CONCLUSIONS—Industrial enzymes may cause allergies in the animal feed industry. There is a need to assess exposure to enzymes at various phases of production, and to minimise exposures.

Keywords: animal feed; enzyme allergy; occupational exposure
PMCID: PMC1740093  PMID: 11160990
23.  Prevalence of airway symptoms among hairdressers in Bergen, Norway 
OBJECTIVE—To assess respiratory symptoms among hairdressers in Norway.
METHODS—The study was based on a questionnaire sent to 100 hairdressers (91% responding) and 95 office workers (84% responding). The questionnaire sought information about allergy, respiratory symptoms in the past year, and symptoms after exposures to different types of pollutants, working conditions, and smoking habits. A population based control group was established because the hairdressers and office workers differed in age and smoking habits.
RESULTS—The prevalence of respiratory symptoms in the past year did not differ significantly between hairdressers and office workers after adjusting for age, atopy, and smoking. The hairdressers over 40 years of age reported significantly more symptoms—such as wheezing and breathlessness—in the past year than the office workers of the same age. Compared with the population based control group, both hairdressers younger than 30 and those over 40 reported more symptoms—such as breathlessness in the past year. The oldest hairdressers reported such symptoms as wheezing and breathlessness more often than did the younger hairdressers. These differences in breathlessness were significant after adjusting for smoking and wheezing. The same trend was not found among the office workers. The hairdressers reported significantly more wheezing, breathlessness, runny eyes, and blocked or runny nose from exposure to hair dyes, permanent oils, bleaching powder, and other chemicals used in a hairdressing salon, compared with the office workers. Prevalence of symptoms during exposure to other types of generel pollutants was similar in the two groups.
CONCLUSIONS—Hairdressers are exposed to low levels of various irritating chemicals every day. The prevalences of acute symptoms related to the exposure of hairdressers to hairdressing chemicals are very high. Hairdressers, especially the oldest hairdressers, have more asthma-like symptoms than the control groups.

Keywords: hairdresser; allergy; asthma
PMCID: PMC1740085  PMID: 11706144
24.  Risk of enzyme allergy in the detergent industry 
OBJECTIVES—To assess the prevalence of enzyme sensitisation in the detergent industry.
METHODS—A cross sectional study was conducted in a detergent factory. Sensitisation to enzymes was examined by skin prick and radioallergosorbent (RAST) tests. 76 Workers were tested; 40 in manufacturing, packing, and maintenance, and 36 non-exposed people in management and sales departments. The workers were interviewed for work related respiratory and skin symptoms. Total dust concentrations were measured by a gravimetric method, and the concentration of protease in air by a catalytic method.
RESULTS—Nine workers (22%) were sensitised to enzymes in the exposed group of 40, whereas none were sensitised in the non-exposed group. All the sensitised people had symptoms at work; all had rhinitis and one had asthma.
 Protease concentrations were generally <20 ng/m3, but occasional peak values up to 80 ng/m3 were detected in the packing and maintenance tasks, and high values of >1 µg/m3 in the mixing area.
CONCLUSION—Despite the use of encapsulated enzyme preparations, high enzyme concentrations in workplace air are possible, resulting in a higher risk of sensitisation than expected.

Keywords: detergent enzymes; occupational exposure; allergy
PMCID: PMC1739908  PMID: 10711280
25.  Byssinosis, respiratory symptoms and spirometric lung function tests in Tanzanian sisal workers 
ABSTRACT Byssinosis and other respiratory symptoms and acute and chronic changes in FVC and FEV1·0 were investigated in 77 workers in sisal spinning and 83 workers in sisal brushing departments in six Tanzanian sisal factories. Although the prevalence of byssinosis in spinning departments was found to be low (5·2%), it was very high in brushing departments (48·2%). Workers in brushing were exposed to sisal dust for a significantly longer period (11·77 ± 7·3 years) compared to workers exposed to sisal in spinning (2·85 ± 2·56 years). Although the number of smokers in brushing (42%) was similar to that in spinning (37%), smokers were more prone to byssinosis than were non- or ex-smokers after standardisation for duration of exposure. We were unable to measure dust levels in this study, but dust levels in spinning and brushing are cited from previous studies. These confirm our impression that the dust level in spinning is higher than that in an average cotton carding department and far higher in brushing than in spinning. Acute falls in FVC and FEV1·0 were found during the work shift. The extent of the fall in FEV1·0 correlated well with the severity of byssinosis; 75% of the workers with grade II byssinosis and 33% of those with grade ½ + I were found to have acute falls in FEV1·0 greater than 0·2 litres. However some workers, 10% in spinning and 33% in brushing, who denied symptoms of byssinosis, were also found to have acute falls in FEV1·0. Some workers had slight or severe chronic ventilatory impairment from dust (FEV1·0 less than 80%, or less than 60% of the respective predicted values), and these workers were mostly from the brushing department. The prevalence of chronic cough and chronic bronchitis was found to be negligible in workers in the spinning and in the brushing departments: 9·6% had a chronic cough and 12% had chronic bronchitis. It is concluded that a high prevalence of byssinosis associated with chronic and acute changes in FVC and FEV1·0 occurs in the brushing departments of sisal factories, and that this is related to lengthy exposure, high dust level and smoking.
PMCID: PMC1008365  PMID: 656336

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