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1.  Mortality and incidence of cancer in a cohort of Swedish chimney sweeps: an extended follow up study. 
Despite 200 years of efforts to regulate safety in this occupation, chimney sweeps have increased mortality from cancer, ischaemic heart disease, and respiratory disease. Mortality and incidence of cancer were examined in a cohort of 5542 Swedish chimney sweeps employed through their national trade union at any time between 1918 and 1980. Previous studies of this cohort found increased risks of ischaemic heart disease, respiratory disease, accidental deaths, and various neoplasms. By increasing follow up, we sought to increase the power of the study and examine disease time trends. Mortality analysis was extended 7.5 years to cover the period 1951-90; cancer incidence analysis was extended six years to cover the period 1958-87. New findings include increased incidence and mortality of prostate cancer (SMR 169, 95% CI 106-256, 22 observed) and increased incidence of total haematolymphatic cancers (SIR 151, 95% CI 106-209, 36 observed). When only the most recent follow up period was analysed, previously observed risks persisted for total lung cancer (SIR 178, 95% CI 99-293), oat cell lung cancer (SIR 240, 95% CI 103-472), bladder cancer (SIR 247, 95% CI 131-422), and oesophageal cancer (Obs/Exp = 2/1.1). Mortality from ischaemic heart disease (SMR 98, 95% CI 76-123) and respiratory disease (SMR 111, 95% CI 56-199) declined during recent follow up, although significant excess mortality remained during analysis of the entire study period (ischaemic heart disease SMR 128, 95% CI 112-145; respiratory disease SMR 159, 95% CI 115-213). In analyses of the entire study period, risks of ischaemic heart disease and lung, bladder, and oesophageal cancer were adjusted for smoking; oesophageal cancer was also adjusted for use of alcohol. All risks remained significantly raised. Exposure-response analyses showed significant positive associations between duration of employment and risks for mortality from lung, oesophageal, and total cancer. Chimney sweeps remain at increased risk for cancers of the lung, oesophagus, and bladder. Our study supports a casual role for exposure to chimney soot, which contains carcinogens including polycyclic aromatic hydrocarbons. Extended follow up of this cohort now shows increased risks of prostate and haematolymphatic cancers.
PMCID: PMC1012164  PMID: 8507598
2.  Radiographic osteoarthrosis in the acromioclavicular joint resulting from manual work or exposure to vibration. 
The hypothesis that manual work and exposure to vibration are antecedents to the development of osteoarthrosis was assessed employing a cross sectional study design. The frequency of osteoarthrosis in the acromioclavicular joint was studied in three groups of workers in the construction industry. Two groups were manual workers (54 bricklayers and 55 rock blasters); the third group consisted of 98 foremen. The radiographic appearance of the right and left acromioclavicular joints was classified into one of five grades of osteoarthrosis. A protocol was developed to assess exposure on the basis of job title, years of manual work, total weight lifted during working life, and total hours of exposure to vibrating tools. Odds ratios for job titles (manual worker v foreman) and for years of manual work as indicators of exposure were of similar magnitude of around 2.5. Construction workers who had lifted more than 709 tonnes had an increased risk of developing severe osteoarthrosis of the right acromioclavicular joint, odds ratio: 2.62 (95% confidence interval (95% CI), 1.13-6.06). The odds ratio for the left side was 7.67 (95% CI, 2.76-21.34). In the analysis of vibration exposure, workers who had been highly exposed to vibration had an odds ratio of 1.99 (95% CI, 1.00-3.92) on the right side and 2.20 (95% CI, 1.07-4.56) on the left. This effect almost disappeared after simultaneous adjustment for manual work. Occupational and ergonomic factors, such as the sum of lifted tonnes during working life, job title, and the sum of years of manual work seem to be risk factors for osteoarthrosis of the acromioclavicular joint, whereas vibration alone was a weaker risk factor.
PMCID: PMC1039293  PMID: 1515351
3.  Neuropsychiatric symptoms among welders exposed to neurotoxic metals. 
Neuropsychiatric symptoms in 65 welders exposed to aluminium and 217 railroad track welders were studied with the aid of a previously validated questionnaire. Semiquantitative data on exposure to the metals aluminium, chromium, lead, manganese, and nickel were also recorded by questionnaire. Logistic regression was employed to study the relation between exposure and the prevalence of symptoms. Welders exposed to aluminium, lead, or manganese for a long period had significantly more neuropsychiatric symptoms than welders not exposed to these metals. The results indicate that detailed psychometric studies should be performed on welders exposed long term to specific metals as such exposures might affect their nervous system.
PMCID: PMC1012030  PMID: 2223663
4.  Excess of cancer in Swedish chimney sweeps. 
The incidence of cancer was investigated among 5266 Swedish chimney sweeps employed for any period between 1918 and 1980. An analysis of the mortality has been reported earlier and showed an increased number of deaths from coronary heart disease, respiratory diseases, and lung, oesophageal, and liver cancer. Excess risks for cancer of the lung and oesophagus were confirmed in this analysis. Among the lung cancers, both squamous cell carcinoma and oatcell/undifferentiated carcinoma were in excess. In addition, a more than doubled risk for bladder cancer (23 observed v 9.8 expected cases) and an increase of malignancies of the haematopoietic system was found. There were, however, no cases of scrotal cancer, the classic occupational hazard among chimney sweeps. Chimney sweeps are exposed to polycyclic aromatic hydrocarbons generated by the combustion of organic material (coal, wood, coke, and oil). They are also exposed to cancerogenic metals (arsenic, nickel, and chromium). These results support the need for improved working conditions.
PMCID: PMC1009696  PMID: 2849478
5.  Excess mortality among Swedish chimney sweeps. 
In a cohort study of 5464 union organised Swedish chimney sweeps employed at any time between 1918 and 1980 mortality was studied from 1951 to 1982 with national statistics used as a reference. Follow up was possible for 98.6% of the individuals: 717 deaths were observed against 540 expected. There was an increased mortality from coronary heart disease, respiratory diseases, and several types of malignant tumours. Lung cancer mortality was significantly increased and positively correlated to the number of years employed. A fivefold risk increase for oesophageal cancer and liver cancer was found. The increased mortality could be attributed to exposure to combustion products in the work environment but not to smoking habits.
PMCID: PMC1007911  PMID: 3689705
6.  Urinary screening for potentially genotoxic exposures in a chemical industry. 
Mutagenic activity, measured by the bacterial fluctuation assay and thioether concentration in urine from workers at a chemical plant producing pharmaceuticals and explosives, was determined before and after exposure. Of 12 groups only those exposed to trinitrotoluene (n = 14) showed a significant increase in mutagenic activity using Salmonella typhimurium TA 98 without any exogenous metabolic system. The same strain responded only weakly when the S-9 mix was used; with Escherichia coli WP2 uvrA no effect of exposure was observed. Urinary thioether concentration was higher among smokers than among non-smokers, but occupational exposure had no effect. Urinary mutagenicity testing may be a useful tool for screening potentially genotoxic exposures in complex chemical environments.
PMCID: PMC1007560  PMID: 3899158
7.  Cancer mortality of cadmium workers. 
Several epidemiological studies of workers exposed to cadmium indicate an increased risk of lung and prostatic cancer. The increase is statistically significant in some of the studies but the SMR is greater than 100 in almost all. A cohort study of the mortality among 522 Swedish workers exposed to cadmium for at least one year in a nickel-cadmium battery plant support the earlier findings. The SMR for lung and prostatic cancer increased with increasing dose and latency but did not obtain statistical significance. A combination of all the available data from the most recent follow up of causes of death among cadmium workers in six different cohorts shows 28 cases of prostatic cancer (SMR = 162) and 195 cases of lung cancer (SMR = 121). This new analysis suggests that long term, high level exposure to cadmium is associated with an increased risk of cancer. The role of concomitant exposure to nickel needs further study.
PMCID: PMC1007553  PMID: 4041382
8.  Ventilatory decrements in former asbestos cement workers: a four year follow up. 
A four year follow up of the ventilatory function in former asbestos cement workers has been performed to determine whether any further decrease occurred after cessation of exposure. Seventy five of 125 subjects were eligible for re-examination and were compared with local referents. None showed signs of asbestosis but 32% had pleural plaques at the renewed examination. Cumulative asbestos exposure calculated as fibre x years had been estimated individually in the original examination. After adjustment for age, height, tracheal area, and smoking category the FVC and FEV1 for all exposed subjects were on average 7% v 6% less than predicted from the referents and twice as much for the subjects with the highest exposure. The four year declines in FVC and FEV1 were larger than in the referents, significantly so for FEV1. There were no significant correlations between pleural plaque and ventilatory function after adjustment for exposure. Thus the age adjusted reduction in ventilatory function had progressed during the follow up period despite the cessation of exposure and the lack of radiological signs of asbestosis.
PMCID: PMC1007543  PMID: 3849974
9.  Lung cancer among asbestos cement workers. A Swedish cohort study and a review. 
A cohort study of 1176 Swedish asbestos cement workers did not indicate any asbestos related excess mortality. Possible explanations of the negative outcome are relatively low exposure levels and the predominant use of chrysotile in production. Such a tentative conclusion is supported by a review of five mortality studies of workers exposed to asbestos cement that report considerable differences in relative risks for lung cancer. These differences could be explained by various degrees of cumulative exposure, the amount of amphiboles in the production, and methodological shortcomings. A median exposure of 10-20 fibre-years does not seem to cause an increased risk of lung cancer, particularly when only chrysotile is used.
PMCID: PMC1007497  PMID: 4005192
10.  Neuropsychological test results and symptoms among workers with well-defined long-term exposure to lead. 
Lead intoxication is a classical environmental hazard that can cause encephalopathy. During recent years several studies have suggested poor performances in psychological tests and increased numbers of subjective symptoms among workers with comparatively low blood lead concentrations. Forty-nine long-term lead-exposed male workers with time-weighted average blood lead concentrations between 1.3 and 3.3 mumol/l calculated from at least seven years' results have been compared with a referent group of 27 male industrial workers with normal blood lead concentrations and comparable intellectual backgrounds. Several indices of exposure were used. Both groups were examined with neuropsychological tests and a questionnaire covering neuropsychiatric symptoms. The exposed group performed less well in 11 of 14 non-verbal tests, and there were significant differences in tests of memory and reaction time. A non-linear dose-effect trend was indicated. The results are in accordance with those found in similar studies, and it is concluded that the blood lead concentration should be below 2.5 mumol/l to avoid the effects shown in this study.
PMCID: PMC1009126  PMID: 6824607
11.  48-hour ambulatory electrocardiography in dynamite workers and controls 
ABSTRACT Sudden deaths and chronic cardiovascular diseases have been reported in excess frequency from the explosives industry. Forty-two active dynamite workers and 43 healthy, unexposed workers have been studied by ambulatory electrocardiographic monitoring during two 24-hour periods covering an exposed shift and the “abstinence phase,” 40-64 hours after the last exposure to dynamite. To achieve comparability the non-exposed individuals were screened for risk factors of heart disease in the same way as those employed in exposed work. No statistically significant differences were found between the groups concerning the mean individual number of ventricular or supraventicular ectopic beats per hour or per 10 000 heart beats during the whole recorded time. Among those who showed only ectopic beats in one of the two periods dynamite workers tended to have more ectopic beats in the second period. “Complicated” ventricular ectopic beats (multifocal, bigemeny, or coupled) were seen in six dynamite workers and four controls. The only observed period of ventricular tachycardia was seen in a dynamite worker on Monday morning. The mean individual corrected QT-time was similar between the two groups, and there was no tendency towards longer QT-times among the dynamite workers during the abstinence period. Continuous monitoring detected several cases with pronounced ventricular arrhythmias despite normal short-time ECG and may be used to investigate the heart rhythm in active workers.
PMCID: PMC1008711  PMID: 6775683
12.  A cohort study of mortality and cancer incidence in ethylene oxide production workers. 
Ethylene oxide, important as an intermediate product in the chemical industry and for sterilising hospital equipment, is mutagenic in several organisms; carcinogenicity has been suspected although this had not been supported by clinical data. Ethylene oxide has been produced by a Swedish company since the beginning of the 1940s. This paper describes a cohort study of the mortality and the cancer incidence among full-time exposed workers in ethylene oxide production, a group of maintenance workers with intermittent exposure and a group of unexposed controls. Investigation of the production processes in the building at different times has shown that workers were exposed to ethylene dichloride, ethylene chlorohydrin, ethylene, and small amounts of bis-(2-chloroethyl) ether as well as to ethylene oxide and traces of other chemicals. The full-time exposed cohort shows a considerable excess mortality deriving mainly from increased mortality from tumours and also from diseases of the circulatory system. The cancer incidence study, including living persons with malignancies, showed a significant excess in the full-time cohort. Of the 16 patients with tumours in the two more exposed cohorts there were three cases of leukaemia, six of tumours in the alimentary tract and four of urogenital malignancy. The excess mortality and cancer incidence cannot be attributed to any particular chemical in the production process, but ethylene oxide and ethylene dichloride are the prime suspects.
PMCID: PMC1008604  PMID: 508639

Results 1-12 (12)