Background and aims: Health risk assessment is an essential tool in protecting public health and ... more Background and aims: Health risk assessment is an essential tool in protecting public health and a key aspect of EU policy and legislation. There is a lack of coordinated training opportunities for...
BackgroundOccupational lead exposure can lead to serious health effects that range from general s... more BackgroundOccupational lead exposure can lead to serious health effects that range from general symptoms (depression, generalised ache, and digestive signs, such as loss of appetite, stomach ache, nausea, diarrhoea, and constipation) to chronic conditions (cerebrovascular and cardiovascular diseases, cognitive impairment, kidney disease, cancers, and infertility). Educational interventions may contribute to the prevention of lead uptake in workers exposed to lead, and it is important to assess their effectiveness.ObjectivesTo assess the effect of educational interventions for preventing lead uptake in workers exposed to lead.Search methodsWe searched CENTRAL, MEDLINE, Embase, CINAHL, and OSH UPDATE to 5 June 2020, with no language restrictions.Selection criteriaWe sought randomised controlled trials (RCT), cluster‐RCTs (cRCT), interrupted time series (ITS), controlled before‐after studies (CBA) and uncontrolled before‐after studies that examined the effects of an educational intervention aimed at preventing lead exposure and poisoning in workers who worked with lead, for which effectiveness was measured by lead levels in blood and urine, blood zinc protoporphyrin levels and urine aminolevulinic acid levels.Data collection and analysisTwo review authors independently screened the search results, assessed studies for eligibility, and extracted data using standard Cochrane methods. We used the ROBINS‐I tool to assess the risk of bias, and GRADE methodology to assess the certainty of the evidence.Main resultsWe did not find any RCT, cRCT, ITS or CBA studies that met our criteria. We included four uncontrolled before‐after studies studies, conducted between 1982 and 2004. Blood lead levelsEducational interventions may reduce blood lead levels, but the evidence is very uncertain. In the short‐term after the educational intervention, blood lead levels may decrease (mean difference (MD) 9.17 µg/dL, 95% confidence interval (CI) 4.14 to 14.20; one study with high baseline blood lead level, 18 participants; very low‐certainty evidence).In the medium‐term, blood lead levels may decrease (MD 3.80 µg/dL, 95% CI 1.48 to 6.12; one study with high baseline blood lead level, 34 participants; very low‐certainty evidence).In the long‐term, blood lead levels may decrease when the baseline blood lead levels are high (MD 8.08 µg/dL; 95% CI 3.67 to 12.49; two studies, 69 participants; very low‐certainty evidence), but not when the baseline blood lead levels are low (MD 1.10 µg/dL, 95% CI ‐0.11 to 2.31; one study, 52 participants, very low‐certainty evidence).Urine lead levelsIn the long‐term, urinary lead levels may decrease after the educational intervention, but the evidence is very uncertain (MD 42.43 µg/L, 95% CI 29.73 to 55.13; one study, 35 participants; very low‐certainty evidence).Behaviour changeThe evidence is very uncertain about the effect of educational intervention on behaviour change. At medium‐term follow‐up after the educational intervention, very low‐certainty evidence from one study (89 participants) found inconclusive results for washing before eating (risk ratio (RR) 1.71, 95% CI 0.42 to 6.91), washing before drinking (RR 1.37, 95% CI 0.61 to 3.06), and not smoking in the work area (RR 1.04, 95% CI 0.74 to 1.46). Very low‐certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.87, 95% CI 1.16 to 3.01), and prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 4.25, 95% CI 1.72 to 10.51), however, the results were inconclusive for the adequate provision of protective clothing (RR 1.40, 95% CI 0.82 to 2.40).At long‐term follow‐up, very low‐certainty evidence from one study (89 participants) suggested that workers may improve washing before drinking (RR 3.24, 95% CI 1.09 to 9.61), but results were inconclusive for washing before eating (RR 11.71, 95% CI 0.66 to 208.33), and for not smoking in the work area (RR 1.56, 95% CI 0.98 to 2.50). Very low‐certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.70, 95% CI 1.09 to 2.63), may provide adequate protective clothing (RR 2.80, 95% CI 1.23 to 6.37), and may prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 2.13, 95% CI 1.19 to 3.81).Improved knowledge or awareness of the adverse health effects of leadThe evidence is very uncertain about the effect of educational intervention on workers' knowledge. At medium‐term follow‐up, questionnaires found that workers' knowledge may improve (MD 5.20, 95% CI 3.29 to 7.11; one study, 34 participants; very low‐certainty evidence).At long‐term follow‐up, there may be an improvement in workers' knowledge (MD 5.80, 95% CI 3.89 to 7.71; one study, 34 participants; very low‐certainty evidence), but results were inconclusive for employers' knowledge (RR 1.67, 95% CI 0.74 to 3.75; one study, 21 participants; very low‐certainty evidence).None of the studies measured the other outcomes of interest: blood zinc protoporphyrin levels, urine aminolevulinic acid levels, air lead levels, and harms. One study provided the costs of each component of the intervention.Authors' conclusionsEducational interventions may prevent lead poisoning in workers with high baseline blood lead levels and urine lead levels but this is uncertain. Educational interventions may not prevent lead poisoning in workers with low baseline blood lead levels but this is uncertain.
This thesis focuses on two aspects which are of major importance in the broad field of control me... more This thesis focuses on two aspects which are of major importance in the broad field of control measures in occupational hygiene: the selection of control measures in a structured way and the impact of factors modifying the effectiveness of these control measures.The main objectives of the thesis are to determine the feasibility of a model approach in the selection of control measures and to assess the impact of work practices on the exposure to and uptake of chemical agents.Two models, i.e. the "dynamic model of exposure, susceptibility and effect" and the "multiple source model" describe the impact of control measures on workers' exposure. The feasibility of these models and the impact of the factors modifying the effectiveness of control measures was studied in the occupational hygiene practice by performing field studies at different types of workplaces: chromium plateries, lead smelter, battery factory and at construction sites.In the lead and chromium industries environmental and biological monitoring was carried out together with observations and questionnaires to assess hygienic behaviour. In the construction industry quartz exposure was characterized by personal air sampling and workplace observations.From the results of these studies it can be concluded that the application of the two models proved to be an important aid in the determination of sources of exposure. Consequently the selection of control measures in different branches of industry was facilitated.The differences in individual hygienic behaviour and working methods proved to be an important modifier of the relation between external and internal exposure. These results indicate that work practices need to be considered in the implementation of control measures.
In January 1987, an air pollution episode occurred in central and western Europe. Levels of SO2, ... more In January 1987, an air pollution episode occurred in central and western Europe. Levels of SO2, NO2, black smoke, sulphates and other components were elevated, with 24 hour average concentrations of SO2 reaching a maximum of close to 300 micrograms/m3 in an area in the southeast of the Netherlands. Pulmonary function was measured in a group of children of 6-12 years old at the end of the episode, and also two and three and a half weeks after the episode. A baseline lung function value was obtained about three months before the episode. Pulmonary function growth between baseline and retest dates was estimated from a simple growth model which was validated using measured pulmonary function growth data from a longitudinal study. A decline of pulmonary function (FVC, FEV1 and PEF) from predicted baseline levels was observed, starting on the last day of the episode. Two weeks after the episode, FVC, FEV1, PEF and MMEF were all decreased, and three and a half weeks after the episode, the...
In January 1985, a decline of primary school children's pulmonary function was observed durin... more In January 1985, a decline of primary school children's pulmonary function was observed during an air pollution episode. Ambient 24 hour average levels of SO2, TSP and RSP were in the range of 200-250 micrograms/m3. The response persisted for at least two weeks. In January 1987, again a decline of school children's pulmonary function was observed associated with an air pollution episode. Levels of TSP were about as elevated as in the 1985 episode. Two weeks after the episode, lung function levels were even lower than during the episode. In June 1987 a long term study was started to investigate potential effects of winter and summer air pollution episodes on pulmonary function and occurrence of acute respiratory symptoms of primary school children. An important issue for this study is the characterization of short term variation of lung function in absence of air pollution. Exposure is characterized by ambient levels of several gases (SO2, NO2, O3, HNO3), PM10, TSP and compon...
In the demand-control model (see T. Theorell & R. A. Karasek, 1996), it is hypothesized t... more In the demand-control model (see T. Theorell & R. A. Karasek, 1996), it is hypothesized that workers in active jobs (high demands-high decision latitude) can exert effective coping strategies when confronted with environmental stessors. Thus, when exposed to similar levels of a chemical agent, lower concentrations of this agent in blood could be expected in these workers in comparison with workers in passive jobs. This theory was tested in 2 studies of lead-exposed workers: 18 male Caucasian workers from an electric accumulatory factory and 18 male Caucasian workers from a lead smelting factory. The results did not follow the hypothesized outcomes. In the work environment of the workers in active jobs, lower concentrations of lead in air were measured, but higher levels of lead in blood were observed in these workers. The opposite was true of workers in passive jobs. Differences in hygienic behavior at work may explain these unexpected results.
Applied Occupational and Environmental Hygiene, 1994
Page 1. The Impact of Hygienic Behavior and Working Methods on the Uptake of Lead and Chromium Mi... more Page 1. The Impact of Hygienic Behavior and Working Methods on the Uptake of Lead and Chromium Mieke EGL Lumens,- Paul UlenbelfC Robert FM Herber,B and The0 F. MeymanA AResearch Institute on Work and Health ...
Background and aims: Health risk assessment is an essential tool in protecting public health and ... more Background and aims: Health risk assessment is an essential tool in protecting public health and a key aspect of EU policy and legislation. There is a lack of coordinated training opportunities for...
BackgroundOccupational lead exposure can lead to serious health effects that range from general s... more BackgroundOccupational lead exposure can lead to serious health effects that range from general symptoms (depression, generalised ache, and digestive signs, such as loss of appetite, stomach ache, nausea, diarrhoea, and constipation) to chronic conditions (cerebrovascular and cardiovascular diseases, cognitive impairment, kidney disease, cancers, and infertility). Educational interventions may contribute to the prevention of lead uptake in workers exposed to lead, and it is important to assess their effectiveness.ObjectivesTo assess the effect of educational interventions for preventing lead uptake in workers exposed to lead.Search methodsWe searched CENTRAL, MEDLINE, Embase, CINAHL, and OSH UPDATE to 5 June 2020, with no language restrictions.Selection criteriaWe sought randomised controlled trials (RCT), cluster‐RCTs (cRCT), interrupted time series (ITS), controlled before‐after studies (CBA) and uncontrolled before‐after studies that examined the effects of an educational intervention aimed at preventing lead exposure and poisoning in workers who worked with lead, for which effectiveness was measured by lead levels in blood and urine, blood zinc protoporphyrin levels and urine aminolevulinic acid levels.Data collection and analysisTwo review authors independently screened the search results, assessed studies for eligibility, and extracted data using standard Cochrane methods. We used the ROBINS‐I tool to assess the risk of bias, and GRADE methodology to assess the certainty of the evidence.Main resultsWe did not find any RCT, cRCT, ITS or CBA studies that met our criteria. We included four uncontrolled before‐after studies studies, conducted between 1982 and 2004. Blood lead levelsEducational interventions may reduce blood lead levels, but the evidence is very uncertain. In the short‐term after the educational intervention, blood lead levels may decrease (mean difference (MD) 9.17 µg/dL, 95% confidence interval (CI) 4.14 to 14.20; one study with high baseline blood lead level, 18 participants; very low‐certainty evidence).In the medium‐term, blood lead levels may decrease (MD 3.80 µg/dL, 95% CI 1.48 to 6.12; one study with high baseline blood lead level, 34 participants; very low‐certainty evidence).In the long‐term, blood lead levels may decrease when the baseline blood lead levels are high (MD 8.08 µg/dL; 95% CI 3.67 to 12.49; two studies, 69 participants; very low‐certainty evidence), but not when the baseline blood lead levels are low (MD 1.10 µg/dL, 95% CI ‐0.11 to 2.31; one study, 52 participants, very low‐certainty evidence).Urine lead levelsIn the long‐term, urinary lead levels may decrease after the educational intervention, but the evidence is very uncertain (MD 42.43 µg/L, 95% CI 29.73 to 55.13; one study, 35 participants; very low‐certainty evidence).Behaviour changeThe evidence is very uncertain about the effect of educational intervention on behaviour change. At medium‐term follow‐up after the educational intervention, very low‐certainty evidence from one study (89 participants) found inconclusive results for washing before eating (risk ratio (RR) 1.71, 95% CI 0.42 to 6.91), washing before drinking (RR 1.37, 95% CI 0.61 to 3.06), and not smoking in the work area (RR 1.04, 95% CI 0.74 to 1.46). Very low‐certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.87, 95% CI 1.16 to 3.01), and prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 4.25, 95% CI 1.72 to 10.51), however, the results were inconclusive for the adequate provision of protective clothing (RR 1.40, 95% CI 0.82 to 2.40).At long‐term follow‐up, very low‐certainty evidence from one study (89 participants) suggested that workers may improve washing before drinking (RR 3.24, 95% CI 1.09 to 9.61), but results were inconclusive for washing before eating (RR 11.71, 95% CI 0.66 to 208.33), and for not smoking in the work area (RR 1.56, 95% CI 0.98 to 2.50). Very low‐certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.70, 95% CI 1.09 to 2.63), may provide adequate protective clothing (RR 2.80, 95% CI 1.23 to 6.37), and may prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 2.13, 95% CI 1.19 to 3.81).Improved knowledge or awareness of the adverse health effects of leadThe evidence is very uncertain about the effect of educational intervention on workers' knowledge. At medium‐term follow‐up, questionnaires found that workers' knowledge may improve (MD 5.20, 95% CI 3.29 to 7.11; one study, 34 participants; very low‐certainty evidence).At long‐term follow‐up, there may be an improvement in workers' knowledge (MD 5.80, 95% CI 3.89 to 7.71; one study, 34 participants; very low‐certainty evidence), but results were inconclusive for employers' knowledge (RR 1.67, 95% CI 0.74 to 3.75; one study, 21 participants; very low‐certainty evidence).None of the studies measured the other outcomes of interest: blood zinc protoporphyrin levels, urine aminolevulinic acid levels, air lead levels, and harms. One study provided the costs of each component of the intervention.Authors' conclusionsEducational interventions may prevent lead poisoning in workers with high baseline blood lead levels and urine lead levels but this is uncertain. Educational interventions may not prevent lead poisoning in workers with low baseline blood lead levels but this is uncertain.
This thesis focuses on two aspects which are of major importance in the broad field of control me... more This thesis focuses on two aspects which are of major importance in the broad field of control measures in occupational hygiene: the selection of control measures in a structured way and the impact of factors modifying the effectiveness of these control measures.The main objectives of the thesis are to determine the feasibility of a model approach in the selection of control measures and to assess the impact of work practices on the exposure to and uptake of chemical agents.Two models, i.e. the "dynamic model of exposure, susceptibility and effect" and the "multiple source model" describe the impact of control measures on workers' exposure. The feasibility of these models and the impact of the factors modifying the effectiveness of control measures was studied in the occupational hygiene practice by performing field studies at different types of workplaces: chromium plateries, lead smelter, battery factory and at construction sites.In the lead and chromium industries environmental and biological monitoring was carried out together with observations and questionnaires to assess hygienic behaviour. In the construction industry quartz exposure was characterized by personal air sampling and workplace observations.From the results of these studies it can be concluded that the application of the two models proved to be an important aid in the determination of sources of exposure. Consequently the selection of control measures in different branches of industry was facilitated.The differences in individual hygienic behaviour and working methods proved to be an important modifier of the relation between external and internal exposure. These results indicate that work practices need to be considered in the implementation of control measures.
In January 1987, an air pollution episode occurred in central and western Europe. Levels of SO2, ... more In January 1987, an air pollution episode occurred in central and western Europe. Levels of SO2, NO2, black smoke, sulphates and other components were elevated, with 24 hour average concentrations of SO2 reaching a maximum of close to 300 micrograms/m3 in an area in the southeast of the Netherlands. Pulmonary function was measured in a group of children of 6-12 years old at the end of the episode, and also two and three and a half weeks after the episode. A baseline lung function value was obtained about three months before the episode. Pulmonary function growth between baseline and retest dates was estimated from a simple growth model which was validated using measured pulmonary function growth data from a longitudinal study. A decline of pulmonary function (FVC, FEV1 and PEF) from predicted baseline levels was observed, starting on the last day of the episode. Two weeks after the episode, FVC, FEV1, PEF and MMEF were all decreased, and three and a half weeks after the episode, the...
In January 1985, a decline of primary school children's pulmonary function was observed durin... more In January 1985, a decline of primary school children's pulmonary function was observed during an air pollution episode. Ambient 24 hour average levels of SO2, TSP and RSP were in the range of 200-250 micrograms/m3. The response persisted for at least two weeks. In January 1987, again a decline of school children's pulmonary function was observed associated with an air pollution episode. Levels of TSP were about as elevated as in the 1985 episode. Two weeks after the episode, lung function levels were even lower than during the episode. In June 1987 a long term study was started to investigate potential effects of winter and summer air pollution episodes on pulmonary function and occurrence of acute respiratory symptoms of primary school children. An important issue for this study is the characterization of short term variation of lung function in absence of air pollution. Exposure is characterized by ambient levels of several gases (SO2, NO2, O3, HNO3), PM10, TSP and compon...
In the demand-control model (see T. Theorell & R. A. Karasek, 1996), it is hypothesized t... more In the demand-control model (see T. Theorell & R. A. Karasek, 1996), it is hypothesized that workers in active jobs (high demands-high decision latitude) can exert effective coping strategies when confronted with environmental stessors. Thus, when exposed to similar levels of a chemical agent, lower concentrations of this agent in blood could be expected in these workers in comparison with workers in passive jobs. This theory was tested in 2 studies of lead-exposed workers: 18 male Caucasian workers from an electric accumulatory factory and 18 male Caucasian workers from a lead smelting factory. The results did not follow the hypothesized outcomes. In the work environment of the workers in active jobs, lower concentrations of lead in air were measured, but higher levels of lead in blood were observed in these workers. The opposite was true of workers in passive jobs. Differences in hygienic behavior at work may explain these unexpected results.
Applied Occupational and Environmental Hygiene, 1994
Page 1. The Impact of Hygienic Behavior and Working Methods on the Uptake of Lead and Chromium Mi... more Page 1. The Impact of Hygienic Behavior and Working Methods on the Uptake of Lead and Chromium Mieke EGL Lumens,- Paul UlenbelfC Robert FM Herber,B and The0 F. MeymanA AResearch Institute on Work and Health ...
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