L. G B Lillienberg

The cancer morbidity pattern among 788 men with at least five years' exposure to oil mist was investigated. Based on measurements, interviews of workers and a survey of changes over the years, the average exposure level was estimated to have been 5 mg/m3 or more prior to 1965. Exclusive of cancer of the scrotum, there were 39 observed cases of cancer compared to 52.9 expected. There were four cases of cancer of the scrotum among the turners but none among the grinders. Three cases of lung cancer were found, compared to 5.4 expected. Among the grinders there was a doubled, but not statistically significant, increase in cancer of the stomach. The mortality from all causes showed a so-called "healthy worker effect," that is, 126 deaths compared to 154.3 expected.

Cerebrospinal fluid (CSF) was obtained from 17 men occupationally exposed to organic solvents and diagnosed as having a psycho-organic syndrome. Healthy volunteers and patients without neurological disorders were used as controls. The albumin ratio was increased in three heavily exposed men, indicating an increased passage of albumin over the blood-brain barrier. A slight monocytoid reaction was present in three of the subjects in the exposed group. Myelin basic protein and enolase activity were within normal limits. Isoelectric focusing of CSF-enriched proteins obtained by absorption chromatography showed alterations in nine out of 17 exposed individuals: The most prominent change was a relative increase of the protein band with Ip 4.7.

The method is demonstrated in connection with a study of lung cancer among metal-workers exposed to oil mist. As exposure to oil mist is uncommon and lung cancer is common, the cohort study is the method of choice. Estimation of exposure, problems of selection, calculation of person-years etc is discussed. There was no increased morbidity from lung cancer.

To study the importance of sensitisation to occupational allergens for the occurrence of asthma and rhinitis in bakers. This is a nested clinical case-referent study of bakers based on a cohort of Swedish former bakery students. Cases were asthmatic ( n=25) or rhinitic bakers ( n=20). Randomly selected bakers ( n=44) were referents. All subjects underwent skin prick tests (SPTs) with common allergens, flours, fungal alpha-amylase and the storage mite L. destructor. Indices of airway inflammation were assessed in serum and the nose. Seven of the asthmatics and eight of the rhinitics reported onset of disease during bakery work. Flour SPTs were positive in 43% of the asthmatics or rhinitics vs 16% of referents. The corresponding figures for alpha-amylase were 29%, 25%, and 7%. The odds ratio, adjusted for atopy, for an SPT positive to flour or alpha-amylase for asthmatics with onset during bakery work was 5.8 (95% confidence interval 1.1-32), and 2.6 (0.4-16) for the corresponding rhi...

The exacerbation of asthma by workplace conditions is common, but little is known about which agents pose a risk. We used data from an existing survey of adults with asthma to identify occupational exposures associated with severe exacerbation of asthma. Questionnaires were completed by 557 working adults with asthma. Severe exacerbation of asthma in the past 12 months was defined as asthma-related hospitalization, or reports of both unplanned asthma care and treatment with a short course of oral corticosteroids. Occupational exposures for the same time period were assessed using an asthma-specific job exposure matrix. We modeled severe exacerbation to yield prevalence ratios (PRs) for exposures while controlling for potential confounders. A total of 164 participants (29%) were positive for severe exacerbation, and 227 (40.8%) were assessed as being exposed to asthma agents at work. Elevated PRs were observed for several specific agents, notably the irritant subcategories of environ...

This study describes a new technique for measuring skin exposure to cutting fluids and evaluates the variability of skin exposure among machine operators performing cyclic (repetitive) work. The technique is based on video recording and subsequent analysis of the video tape by means of computer-synchronized video equipment. The time intervals at which the machine operator's hand was exposed to fluid were registered, and the total wet time of the skin was calculated by assuming different evaporation times for the fluid. The exposure of 12 operators with different work methods was analyzed in 6 different workshops, which included a range of machine types, from highly automated metal cutting machines (ie, actual cutting and chip removal machines) requiring operator supervision to conventional metal cutting machines, where the operator was required to maneuver the machine and manually exchange products. The relative wet time varied between 0% and 100%. A significant association betw...

To explore relations between two estimates of exposure to inhalable flour dust, and the incidence rates (IRs) of asthma and rhinitis in bakers. This was a retrospective cohort study among 2923 bakers. A posted questionnaire registered the disease and work history. For every year, each baker was assigned an estimate of the exposure concentration to inhalable flour dust derived from reported job-tasks and dust measurements. Exposure at onset of disease was expressed as current dust exposure concentration, and as cumulative dose of exposure to dust. A multiple Poisson regression analysis assessed the impacts of the exposure estimates on the IRs of asthma and rhinitis. IRs of asthma and rhinitis increased by dust concentration at onset of disease. The IR of asthma for the bakers with highest exposure (dough makers) was 7. 3/1000 person-years in men and 6.5 in women and for rhinitis 43.4 and 38.5, respectively. There was a significant association between the dust concentration at onset o...

This study examined certain occupational exposures and the risk for adult-onset asthma. A nested case-referent study of adult-onset asthma was performed on a random population sample (N=15813), aged 21 to 51 years. Cases for the study included 2 groups: subjects reporting "physician-diagnosed" asthma (N=251) and a broader "asthma" group (N=362). The "asthma" group consisted of subjects with "physician-diagnosed" asthma (N=251) and subjects reporting asthma-like symptoms without having "physician-diagnosed" asthma (N=111). The referents (N=2044) were randomly selected from the whole population sample. The case-referent sample was investigated with a comprehensive questionnaire about occupational exposures, asthma, respiratory symptoms, smoking, and atopy. Odds ratios were calculated with stratification for gender, year of diagnosis, and birth year. The highest odds ratio for "physician-diagnosed" asthma was associated with exposure to flour dust [odds ratio (OR) 2.8, 95% confidence interval (95% CI) 1.5-5.2] and the occupational handling of resin-based paints (isocyanates) (OR 3.0, 95% CI 1.6-5.9). Exposure to welding fumes, textile dust, and work with glues containing acrylates was also associated with an increased odds ratio for "physician-diagnosed" asthma. Including persons with asthma-like symptoms (ie, the asthma group) showed similar results. This population-based case-referent study from Sweden indicates that occupational exposure to acrylate-based compounds and welding fumes is associated with increased risk for adult-onset asthma.

OBJECTIVE: To investigate the prevalence and incidence rate of chronic bronchitis (CB) in relation to smoking habits and exposure to welding fumes in a general population sample.METHODS: Subjects from Northern Europe born between 1945 and 1971 who participated in Stage 1 (1989-1994) of the European Community Respiratory Health Survey were mailed a respiratory questionnaire in 1999-2001 (the RHINE study); 15 909 answered the questionnaire and gave complete data on smoking. CB was defined as chronic productive cough of at least 3 months a year for 2 consecutive years. The questionnaire comprised an item about age when CB started and items about exposure to welding fumes. The incidence of CB was retrospectively assessed for the observation period 1980-2001.RESULTS: CB had a prevalence of 5.4%, and was associated with current smoking and welding exposure. The incidence rate of CB was 1.9 per 1000 person-years, and was increased in relation to welding exposure (low exposure HR 1.4, 95%CI 1.1-1.8; high exposure HR 2.0, 95%CI 1.6-2.7) and in relation to smoking (HR 2.1, 95%CI 1.8-2.5).CONCLUSION: Smoking and occupational exposure to welding fumes are both associated with an increased risk of CB.

To analyze whether indices of nasal airway inflammation in bakers were related to nasal symptoms and exposure to airborne flour dust. A cross-sectional study was performed in 12 currently flour-exposed bakers. They were examined by nasal lavage (NAL), visual inspection, a test of mucociliary clearance, and nasal peak expiratory flow (nasal PEF). NAL fluid was analyzed according to the inflammatory markers eosinophil cationic protein (ECP), indicating eosinophilic activity; myeloperoxidase (MPO), indicating active neutrophils; hyaluronic acid (HA) from active fibroblasts; tryptase, indicating activation of mast cells; and albumin, indicating plasma exudation. The bakers were also questioned about respiratory symptoms and working history. Their current and cumulative exposure to inhalable flour dust was estimated after exposure measurements and information about earlier work tasks. Office workers (n=16) without occupational exposure to dust or any other known nasal irritant or sensitizer served as controls. Personal inhalable dust measurements among the bakers working as dough makers or bread formers ranged from 1.0 to 3.8 mg/m3. Of the 12 bakers, 10 reported at least 1 nasal symptom (crusts, blockage, or a runny nose), a proportion significantly greater than that of the controls (P=0.009). Bakers with nasal symptoms had higher concentrations of markers of inflammation in their NALs as compared with nonsymptomatic bakers. The difference was significant for MPO (P=0.02) and HA (P=0.04) in relation to a runny nose. Tryptase was detected in only one NAL of the bakers. There was a positive correlation between the cumulative dose of inhalable flour dust and concentrations of MPO and HA in NAL. Two bakers were sensitized to wheat; they had the highest NAL concentrations of inflammatory markers. Our results indicate that flour dust exposure in bakers at levels below the current occupational exposure limit causes nasal mucosal inflammation, which, in turn, is related to nasal symptoms. We propose that the inflammation may be nonallergic, characterized by activation of neutrophils and fibroblasts.

Bakery workers are at risk of developing respiratory symptoms, such as asthma and rhinitis. Exposure to inhalable flour dust in 12 Swedish bakeries was therefore determined: concentrations of airborne inhalable flour dust were measured with the IOM personal inspirable dust sampler and the particle size distribution assessed using the IOM personal inspirable aerosol spectrometer, and the fractions of alpha-amylase, water-soluble protein and total protein in flour dust were determined. A total of 129 measurements were performed of which 77 were repeated measurements. There was a clear hierarchy in geometric mean exposure among bakery workers, with in descending order doughmakers (5.46 mg m-3), bread-formers (2.69 mg m-3), oven workers (1.17 mg m-3), and packers and confectionery workers (0.53 mg m-3). The repeated measurements revealed that within each task group there were considerable differences in mean exposure among the workers: this was demonstrated by geometric standard deviations of between-worker variance of 1.63-1.77. Partitioning of the total variability of inhalable flour dust exposure showed that the task group was the principal source of variance, accounting for 61-69% of the total variability. The optimum grouping strategy was independent of whether the oven workers and the packers were assigned to the same or to different task groups. The doughmakers and the bread-formers are two clearly distinguishable exposure groups with largely overlapping exposure distributions. On average, the flour dust contained 9% total protein, 2.3% water-soluble protein and 0.03% alpha-amylase. The inhalable flour dust was characterized by a substantial proportion of particles with a d(ac) above 10 microns. It was estimated that the thoracic subfraction contributed 39% to the total mass of inhalable dust, and the respirable subfraction 19%.