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1.  Occupational disease in the rubber industry. 
We have studied mortality patterns in a large cohort of rubber workers. We have examined workers exposed to curing fumes, processing dusts, and industrial talc and have begun to evaluate exposures of these workers in detail. Gastrointestinal (especially stomach) cancer appears in excess in processing workers. Lung cancer is excessive in curing workers. Leukemia is increased generally. All three groups studied for respiratory disease have an increase in disease prevalence which is related to intensity and duration of exposure. Since both an increase in stomach cancer and respiratory disease is seen in processing workers, exposures in this area must be controlled. Since both lung cancer and chronic respiratory disease is excessive in curing rooms, this exposure must be controlled. The leukemia risk is probably related to solvents. Whether this is all explainable by past benzene exposure is unknown. Further studies are planned to refine our knowledge concerning these risks so that occupational disease in the rubber industry can be prevented.
PMCID: PMC1475254  PMID: 1026415
3.  Concentrations and size distributions of airborne influenza A viruses measured indoors at a health centre, a day-care centre and on aeroplanes 
The relative importance of the aerosol transmission route for influenza remains contentious. To determine the potential for influenza to spread via the aerosol route, we measured the size distribution of airborne influenza A viruses. We collected size-segregated aerosol samples during the 2009–2010 flu season in a health centre, a day-care facility and onboard aeroplanes. Filter extracts were analysed using quantitative reverse transcriptase polymerase chain reaction. Half of the 16 samples were positive, and their total virus concentrations ranged from 5800 to 37 000 genome copies m−3. On average, 64 per cent of the viral genome copies were associated with fine particles smaller than 2.5 µm, which can remain suspended for hours. Modelling of virus concentrations indoors suggested a source strength of 1.6 ± 1.2 × 105 genome copies m−3 air h−1 and a deposition flux onto surfaces of 13 ± 7 genome copies m−2 h−1 by Brownian motion. Over 1 hour, the inhalation dose was estimated to be 30 ± 18 median tissue culture infectious dose (TCID50), adequate to induce infection. These results provide quantitative support for the idea that the aerosol route could be an important mode of influenza transmission.
PMCID: PMC3119883  PMID: 21300628
influenza; bioaerosol; size distribution; aerosol transmission; emissions; deposition
5.  Transient ischaemic colitis following an aeroplane flight 
Gut  2003;52(7):1072-1073.
PMCID: PMC1773721  PMID: 12801974
antiphospholipid antibodies; factor V Leiden; ischaemic colitis; thrombosis
7.  Smoke hoods in aeroplanes. 
BMJ : British Medical Journal  1992;305(6847):256-257.
PMCID: PMC1882659  PMID: 1489429
8.  Smoke hoods in aeroplanes. 
BMJ : British Medical Journal  1992;304(6838):1326.
PMCID: PMC1882060  PMID: 1611326
9.  Skin Hazards in Aeroplane Manufacture 
British Medical Journal  1942;1(4231):188-189.
PMCID: PMC2159929  PMID: 20784090
British Medical Journal  1923;2(3281):927.
PMCID: PMC2317709  PMID: 20771357
British Medical Journal  1918;1(2977):73-76.
PMCID: PMC2339894  PMID: 20768899
British Medical Journal  1919;2(3076):785-786.
PMCID: PMC2344043  PMID: 20769737
British Medical Journal  1916;2(2903):252-254.
PMCID: PMC2354483  PMID: 20768253
15.  Smoking in aeroplanes 
BMJ : British Medical Journal  1994;309(6947):131.
PMCID: PMC2540560
16.  Mortality among benzene-exposed workers in China. 
Environmental Health Perspectives  1996;104(Suppl 6):1349-1352.
A large cohort of 74,828 benzene-exposed and 35,805 nonexposed workers employed between 1972 and 1987 in 12 cities in China was followed to determine mortality from all causes. Benzene-exposed study subjects were employed in a variety of occupations including coating applications, and rubber, chemical, and shoe production. Mortality was slightly increased among workers with greater cumulative exposure to benzene (ptrend < 0.05), but this excess was largely due to cancer deaths (ptrend < 0.01). Deaths due to lymphatic and hematopoietic malignancies (ptrend = 0.01) and lung cancer (ptrend = 0.01) increased with increasing cumulative exposure to benzene. Investigations continue to relate benzene exposure to specific lymphatic and hematopoietic malignancies and other causes of death.
PMCID: PMC1469764  PMID: 9118919
17.  Predictors of malaria-association with rubber plantations in Thailand 
BMC Public Health  2012;12:1115.
The national Global Fund-supported malaria (GFM) program in Thailand, which focuses on the household-level implementation of vector control via insecticide-treated nets (ITNs)/long-lasting insecticidal nets (LLINs) combined with indoor residual spraying (IRS), has been combating malaria risk situations in different provinces with complex epidemiological settings. By using the perception of malaria villagers (MVs), defined as villagers who recognized malaria burden and had local understanding of mosquitoes, malaria, and ITNs/LLINs and practiced preventive measures, this study investigated the predictors for malaria that are associated with rubber plantations in an area of high household-level implementation coverage of IRS (2007–2010) and ITNs/LLINs (2008–2010) in Prachuap Khiri Khan Province.
A structured questionnaire addressing socio-demographics, household characteristics and health behavioral factors (knowledge, perceptions and practices) regarding the performed interventions was administered to the 313 households (70 malaria-affected and 243 malaria-unaffected) that had respondents aged ≥18 years of both genders. In the univariate and multivariate analyses, only 246 (78.6%) MV respondents (62 malaria-affected and 184 malaria-unaffected) were analyzed to determine the predictors for risk (morbidity).
The majority (70%) of households were covered by IRS. For a combination of ITNs/LLINs, there were 74% of malaria-affected households covered and 46% of malaria-unaffected households. In a logistic regression analysis using odds ratios (aORs) adjusted on the variables and a 95% confidence interval (CI), malaria affecting MVs was associated with daily worker (i.e., earning daily income by normally practicing laborious activities mostly in agriculture such as rubber tapping and rubber sheet processing at the smallholdings of rubber plantations) (aOR = 2.9, 95% CI: 1.1-7.4), low-moderate level of malaria knowledge (aOR = 2.4, 95% CI: 1.1-5.0) and sleeping under mosquito-nets (nets/ITNs/LLINs intermittently and ITNs/LLINs only) (aOR = 2.0, 95% CI: 1.0-3.7).
The MV predictors for malaria-association with rubber plantations included occupation (daily worker), misconceptions about malaria (mosquito and prevention) and the use of mosquito-nets. Human practices such as revisiting rubber plantations while exposed to multiple bites at multiple locations are more likely to apply to daily workers than to rubber farmers/tappers and others. The promotion and use of ITNs/LLINs depends substantially on cultural factors and defensive behaviors relevant to their occupational risk despite the perceived threats of malaria and the perceived benefits of ITNs/LLINs. This information supports the conclusion that GFM program implementation in Thailand or elsewhere for malaria-associated with rubber plantations would benefit from the potential use of ITNs/LLINs and changes in personal protection behaviors.
PMCID: PMC3672016  PMID: 23270377
Health behavioral factors; Insecticide-treated nets; Long-lasting insecticidal nets; Malaria-associated rubber plantations; Occupational risk; Personal protection behaviors; Sleeping under mosquito-nets
18.  Mortality in the British rubber industry 1946-85. 
The mortality experienced by a cohort of 36,691 rubber workers during 1946-85 has been investigated. These workers were all male operatives first employed in any one of the 13 participating factories in 1946-60; all had worked continuously in the industry for a minimum period of one year. Compared with the general population, statistically significant excesses relating to cancer mortality were found for cancer of the pharynx (E = 20.2, O = 30, SMR = 149), oesophagus (E = 87.6, O = 107, SMR = 122), stomach (E = 316.5, O = 359, SMR = 113), lung (E = 1219.2, O = 1592, SMR = 131), and all neoplasms (E = 2965.6, O = 3344, SMR = 113). Statistically significant deficits were found for cancer of the prostate. (E = 128.2, O = 91, SMR = 71), testis (E = 11.0, O = 4, SMR = 36), and Hodgkin's disease (E = 26.9, O = 16, SMR = 59). Involvement of occupational exposures was assessed by the method of regression models and life tables (RMLT). This method was used to compare the duration of employment in the industry, the duration in "dust exposed" jobs, and the duration in "fume and/or solvent exposed" jobs of those dying from causes of interest with those of all matching survivors. Positive associations (approaching formal levels of statistical significance) were found only for cancers of the stomach and the lung. The results of the RMLT analysis are independent of those from the SMR analysis, and the study continues to provide limited evidence of a causal association between the risks of stomach cancer and dust exposures, and the risks of lung cancer and fume or solvent exposures in the rubber industry during the period under study.
PMCID: PMC1009715  PMID: 2920137
19.  Impact of Organic Solvents and Environmental Pollutants on the Physiological Function in Petrol Filling Workers 
Long term exposure to solvents and air pollutants can lead to deleterious effects on respiratory, haematological and thyroid functioning. The aim of this study was to investigate whether chronic exposure to solvents like benzene and pollutants like carbon monoxide in petrol filling workers had adverse effect on blood parameters, thyroid and respiratory functions. The study group consisted of 42 healthy, non-smoker petrol filling workers, aged 20–50 years with work (exposure) duration from 2–15 years while 36 healthy subjects of the same age group served as controls. Physical examination and measurement of pulmonary functions by portable electronic spirometer were performed. Complete blood pictures (CBP) were determined by normal haematology lab procedure and hormones by Chemiluminescence immunoassay (CLIA) light absorption techniques. There was a significant decrease in the lung volumes and capacities; the restrictive pattern was more prevalent in the workers when compared with the control groups. But in the workers exposed for long period (more than 10 years) the restrictive pattern was changed to mixed pattern. A significant increase in haemoglobin (Hb) (>16 mg %) and red blood cells (RBC) (5.4 million cells/mm3) were observed in workers with longer period of exposure when compared with the control subjects (14.483 mg% and 4.83 million cells/mm3 for Hb and RBC respectively). White blood cell count except eosinophils and platelets were significantly lower in workers compared to controls. Marked increase in the tetra iodothyroinine (T4), free thyroxine (T4F) level and significant decrease in thyroid stimulating hormones (TSH), and tri-iodothyronine (T3) were observed between long term exposed and non – exposed groups. Till now researchers focused only on the effect of solvents in workers professionally exposed to solvents without considering the effect of concomittant air pollution. The result obtained from present study indicates that there is a significant toxic effect of solvents and air pollutants on workers exposed for longer duration. Improved detection and prevention technologies are needed to answer environmentally related health questions for petrol filling workers.
PMCID: PMC3699983  PMID: 19139531
benzene; carbon monoxide; pulmonary function; thyroid hormones; complete blood picture
20.  Critical assessment of epidemiologic studies on the human carcinogenicity of 1,3-butadiene. 
1,3-Butadiene, a major ingredient of synthetic rubber, has been shown to be carcinogenic in two animal species. To assess the possible human carcinogenicity of 1,3-butadiene, a critical review was undertaken of the epidemiologic literature. An early retrospective study of 8017 males employed in tire manufacturing found excess mortality for lymphatic and hematopoietic neoplasms in production workers (standardized mortality ratio, SMR = 560); these workers were exposed to 1,3-butadiene as well as to styrene and possibly to benzene. A recently updated epidemiologic study of 2568 workers at a butadiene manufacturing plant in Texas reported low mortality overall (SMR = 84) but found excess deaths for lymphosarcoma and reticulum cell sarcoma (SMR = 229). A retrospective study of workers employed at two synthetic rubber plants in Texas found excess mortality for lymphatic and hematopoietic malignancies in the older of these facilities; the excesses for lymphosarcoma (SMR = 224) and leukemia (SMR = 278) were most significant in wartime workers. A large, recently updated retrospective study of 12,113 workers employed in eight synthetic rubber manufacturing plants in the United States and Canada found excess mortality for lymphatic and hematopoietic cancer in production workers; the SMR for other lymphatic cancers in white production workers was 230, and the SMR for all lymphatic malignancies in black production workers was 507. These updated epidemiologic results strongly suggest an etiologic association between occupational exposure to 1,3-butadiene and human cancer. It is reasonable, therefore, to conclude that there now exists at least limited evidence for the human carcinogenicity of 1,3-butadiene.
PMCID: PMC1567758  PMID: 2205484
21.  Indirect validation of benzene exposure assessment by association with benzene poisoning. 
Environmental Health Perspectives  1996;104(Suppl 6):1343-1347.
We present a validation study of a quantitative retrospective exposure assessment method used in a follow-up study of workers exposed to benzene. Assessment of exposure to benzene was carried out in 672 factories in 12 cities in China. Historical exposure data were collected for 3179 unique job titles. The basic unit for exposure assessment was a factory/work unit/job title combination over seven periods between 1949 and 1987. A total of 18,435 exposure estimates was developed, using all available historical information, including 8477 monitoring data. Overall, 38% of the estimates were based on benzene monitoring data. The highest time-weighted average exposures were observed for the rubber industry (30.7 ppm) and for rubber glue applicators (52.6 ppm). Because of its recognized link with benzene exposure, the association between a clinical diagnosis of benzene poisoning and benzene exposure was evaluated to validate the assessment method that we used in the cohort study. Our confidence in the assessment method is supported by the observation of a strong positive trend between benzene poisoning and various measures, especially recent intensity of exposure to benzene.
PMCID: PMC1469750  PMID: 9118918
22.  Cancer mortality in the British rubber industry: 1946-80. 
The mortality experienced by a cohort of 36445 rubber workers during 1946-80 has been investigated. These workers were all male operatives first employed in any one of the 13 participating factories in 1946-60; all had worked continuously in the industry for a minimum period of one year. Compared with the general population, statistically significant excesses relating to cancer mortality were found for cancer of the stomach (E = 245.9, O = 282, SMR = 115), primary cancer of the liver (E = 12.8, O = 22, SMR = 172), cancer of the lung (E = 892.7, O = 1191, SMR = 133), and all neoplasms (E = 2165.2, O = 2487, SMR = 115). Statistically significant deficits were found for cancer of the prostate (E = 79.7, O = 59, SMR = 74) and cancer of the testis (E = 10.3, O = 4, SMR = 39). The method of regression models in life tables (RMLT) was used to compare the duration of employment in the industry, the duration in "dust exposed" jobs, and the duration in "fume and/or solvent exposed" jobs of those dying from causes of interest with those of all matching survivors. Significant positive associations were found only for cancer of the stomach and cancer of the lung. The results of the RMLT analysis are independent of those from the SMR analysis, and the study has provided further evidence of a causal association between the risks of lung and stomach cancer and certain occupational exposures in the rubber industry.
PMCID: PMC1007665  PMID: 3718880
23.  Assessment  of  Genotoxicity  Among  Rubber  Industry Workers  Occupationally  Exposed  to  Toxic  Agents  Using Micronucleus  Assay 
Occupational and environmental exposures mostly represent complexmixture of genotoxic agents, however there is a wide variation in the specificity of biomarkers. Exploration of correlations among biomarkers contributes to the further progress of molecular cancer epidemiology and to the selection of the optimal biomarkers for the investigation of human exposure to carcinogens. The aim of this study was to assess the potential cytogenetic damage associated with occupational exposure to toxic agents among rubber industry workers by using Micronucleus (MN) assay.
In the present study 35 occupationally exposed rubber industry workers and 30 controls were investigated for genetic damage. Both the exposed and control individuals were selected from rural areas of South India. Exfoliated Buccal cells were collected from the study population and examined for the presence of MN.
Rubber industry workers showed a significant increase in micronucleated cells when compared to controls with respect to their smoking and drinking habits (P< 0.05). The present study suggested that occupational exposure to toxic chemicals in rubber industry can cause genetic damage.
MN formation reflects genetic changes and/or events associated with carcinogenesis. Therefore the results of this study indicate that rubber industry workers may be at the risk of cancer. Therefore, it is important to take appropriate measures to protect the workers from occupational hazards.
PMCID: PMC4142917  PMID: 25250114
DNA damage; Micronucleus test; Occupational exposure
24.  Temporal Variation in the Association between Benzene and Leukemia Mortality 
Environmental Health Perspectives  2008;116(3):370-374.
Benzene is a human carcinogen. Exposure to benzene occurs in occupational and environmental settings.
I evaluated variation in benzene-related leukemia with age at exposure and time since exposure.
I evaluated data from a cohort of 1,845 rubber hydrochloride workers. Benzene exposure–leukemia mortality trends were estimated by applying proportional hazards regression methods. Temporal variation in the impact of benzene on leukemia rates was assessed via exposure time windows and fitting of a multistage cancer model.
The association between leukemia mortality and benzene exposures was of greatest magnitude in the 10 years immediately after exposure [relative rate (RR) at 10 ppm-years = 1.19; 95% confidence interval (CI), 1.10–1.29]; the association was of smaller magnitude in the period 10 to < 20 years after exposure (RR at 10 ppm-years = 1.05; 95% CI, 0.97–1.13); and there was no evidence of association ≥ 20 years after exposure. Leukemia was more strongly associated with benzene exposures accrued at ≥ 45 years of age (RR at 10 ppm-years = 1.11; 95% CI, 1.04–1.17) than with exposures accrued at younger ages (RR at 10 ppm-years = 1.01; 95% CI, 0.92–1.09). Jointly, these temporal effects can be efficiently modeled as a multistage process in which benzene exposure affects the penultimate stage in disease induction.
Further attention should be given to evaluating the susceptibility of older workers to benzene-induced leukemia.
PMCID: PMC2265049  PMID: 18335105
benzene; cohort study; leukemia; mortality; Ohio
25.  Leukaemia in benzene workers: a retrospective cohort study. 
A retrospective cohort study was conducted in 233 benzene factories and 83 control factories in 12 cities in China. The benzene cohort and the control cohort consisted of 28,460 benzene exposed workers (178,556 person-years in 1972-81) and 28,257 control workers (199,201 person-years). Thirty cases of leukaemia (25 dead and 5 alive) were detected in the former and four cases (all dead) in the latter. The leukaemia mortality rate was 14/100,000 person-years in the benzene cohort and 2/100,000 person-years in the control cohort; the standardized mortality ratio was 5.74 (p less than 0.01 by U test). The average latency of benzene leukaemia was 11.4 years. Most (76.6%) cases of benzene leukaemia were of the acute type. The mortality due to benzene leukaemia was high in organic synthesis plants followed by painting and rubber synthesis industries. The concentration of benzene to which patients with a leukaemia were exposed ranged from 10 to 1000 mg/m3 (mostly from 50 to 500 mg/m3). Of the 25 cases of leukaemia, seven had a history of chronic benzene poisoning before the leukaemia developed.
PMCID: PMC1007793  PMID: 3814544

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