Wetenschappelijke publicaties

Identifying occupationally exposed populations for lung cancer screening: it is about time

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25

Lung cancer is responsible for nearly one in five of all cancer deaths in the world and is the leading occupationally related cancer type.1 Tobacco smoke exposure contributes the most significant risk although in developed countries, occupational exposures are estimated to contribute to 10%–30% of all lung cancers.1 The International Agency for Research on Cancer recognises at least 13 occupational exposures that are associated with a raised risk of lung cancer and at least 6 of these (asbestos, arsenic, radon, polyaromatic hydrocarbons, silica and nickel) may have a more than additive (ie, synergistic) risk when combined with tobacco smoke exposure.1

The National Lung Screen Trial (NLST) demonstrated a 20.0% mortality reduction for lung cancer deaths with three screening rounds using low-dose CT (LDCT) of the chest.2 However, LDCT screening for lung cancer is only effective when a high-risk population is screened. The...

Early detection of lung cancer in a population at high risk due to occupation and smoking

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Objective

The US National Comprehensive Cancer Network (NCCN) recommends two pathways for eligibility for Early Lung Cancer Detection (ELCD) programmes. Option 2 includes individuals with occupational exposures to lung carcinogens, in combination with a lesser requirement on smoking. Our objective was to determine if this algorithm resulted in a similar prevalence of lung cancer as has been found using smoking risk alone, and if so to present an approach for lung cancer screening in high-risk worker populations.

Methods

We enrolled 1260 former workers meeting NCCN criteria, with modifications to account for occupational exposures in an ELCD programme.

Results

At baseline, 1.6% had a lung cancer diagnosed, a rate similar to the National Lung Cancer Screening Trial (NLST). Among NLST participants, 59% were current smokers at the time of baseline scan or had quit smoking fewer than 15 years prior to baseline; all had a minimum of 30 pack-years of smoking. Among our population, only 24.5% were current smokers and 40.1% of our participants had smoked fewer than 30 pack-years; only 43.5% would meet entry criteria for the NLST. The most likely explanation for the high prevalence of screen-detected lung cancers in the face of a reduced risk from smoking is the addition of occupational risk factors for lung cancer.

Conclusion

Occupational exposures to lung carcinogens should be incorporated into criteria used for ELCD programmes, using the algorithm developed by NCCN or with an individualised risk assessment; current risk assessment tools can be modified to incorporate occupational risk.

Work-unit organisational changes and subsequent prescriptions for psychotropic medication: a longitudinal study among public healthcare employees

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Objectives

We examined exposure to different types of organisational changes at work as risk factors for subsequent prescription for psychotropic medication among employees.

Methods

The study population included 15 038 public healthcare employees nested within 1284 work units in the Capital Region of Denmark. Multilevel mixed-effects parametric survival models were developed to examine time to prescription for psychotropic medications (anxiolytics/hypnotics/sedatives/antidepressants) during the 12-month interval following exposure to organisational changes relative to no change from January to December 2013. Data on work-unit level organisational changes (including mergers, split-ups, relocation, change in management, employee lay-offs and budget cuts) were collected from work-unit managers (59% response).

Results

Any organisational change versus no change was associated with a higher risk of psychotropic prescription (HR: 1.14, 95% CI: 1.02 to 1.26), especially change in management (HR: 1.23, 95% CI: 1.07 to 1.41). Splitting the 12-month follow-up period into two halves yielded particularly high rates of psychotropic prescription in the latter half of the follow-up, for example, any change (HR: 1.25, 95% CI: 1.11 to 1.41), change in management (HR: 1.42, 95% CI: 1.22 to 1.65), mergers (HR: 1.26, 95% CI: 1.06 to 1.50), employee lay-off (HR: 1.23, 95% CI: 1.03 to 1.46) and budget cuts (HR: 1.13, 95% CI: 1.00 to 1.41). The associations did not vary by sex.

Conclusions

Organisational changes in the workplace, especially change in management, may be associated with increased risk of psychotropic prescription among employees regardless of sex.

ECG conduction disturbances and ryanodine receptor expression levels in occupational lead exposure workers

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Objectives

A significant number of researches have evidenced that occupational lead (Pb) exposure increased risks of cardiovascular disease. However, evidences about the potential effects of Pb on the cardiac conduction system are sparse and inconclusive. Besides, ryanodine receptors (RyRs) induced dysfunction of cardiac excitation contraction coupling which is considered to be one of the mechanisms in cardiovascular diseases. Therefore, we examined the association between occupational Pb exposure and ECG conduction abnormalities, as well as RyRs in Pb-induced ECG abnormalities.

Methods

We investigated 529 Pb smelter workers, and measured blood lead (BPb), zinc protoporphyrin (ZPP), ECG outcomes and RyR expression levels. Based on BPb levels, the workers were divided into three groups: the BPb not elevated group, the BPb elevated group and the Pb poisoning group. Descriptive and multivariable analyses were performed.

Results

Compared with the BPb not elevated group, the Pb poisoning group had a higher incidence of high QRS voltage, and a lower level of RyR1 gene expression (p<0.05). Further unconditional multivariable logistic regression analyses showed that high QRS voltage was positively related to BPb (OR=1.045, 95% CI 1.014 to 1.078) and inversely associated with RyR1 expression (OR=0.042, 95% CI 0.002 to 0.980) after adjusting for potential confounders. In addition, multiple linear regression analyses showed that the QTc interval was positively associated with ZPP (β=0.299, 95% CI 0.130 to 0.468) after adjusting for potential confounders.

Conclusions

Our study provided evidences that occupational exposure to Pb may be associated with worse ECG outcomes (high QRS voltage), which might be related to decreased levels of RyR1.

Cancer mortality in an international cohort of reinforced plastics workers exposed to styrene: a reanalysis

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Objective

To investigate the carcinogenicity of styrene by reanalysing data from a previous international cohort study of workers in the reinforced plastics industry.

Methods

Mortality from cancers of prior interest was analysed with more detailed consideration of exposure–response relations and an updated classification of leukaemias and lymphomas in data from a previous international cohort study of 37 021 reinforced plastics workers exposed to airborne styrene.

Results

Increased mortality from non-Hodgkin’s lymphoma (NHL) was associated with the mean level of exposure to styrene in air (relative risk (RR) 2.31, 95% CI 1.29 to 4.12 per 100 ppm), but not with cumulative styrene exposure. Similar associations with mean exposure were observed for the oesophagus (RR 2.44, 95% CI 1.11 to 5.36 per 100 ppm) and pancreas (RR 1.89, 95% CI 1.17 to 3.09). Oesophageal cancer mortality was also associated with cumulative styrene exposure lagged 20 years (RR 1.16, 95% CI 1.03 to 1.31). No other cancer, including lung cancer, was associated with any indicator of styrene exposure.

Conclusion

This reanalysis does not substantially change the conclusions of the original study with respect to NHL or lung cancer but new evidence concerning cancers of the oesophagus and pancreas merits further investigation.

Night work and sick leave during pregnancy: a national register-based within-worker cohort study

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Objective

The aim of our study was to investigate the acute effect of night work during pregnancy on the risk of calling in sick the following day using register-based information and the workers as their own controls.

Methods

Using the payroll-based national Danish Working Hour Database, including all public hospital employees in Denmark, we identified 9799 pregnant women with ≥1 day shift and ≥1 night shift and ≥1 day of sick leave during the first 32 pregnancy weeks from January 2007 to December 2013. We performed fixed effects logistic regression, that is, within-worker comparisons, of the risk of sick leave of any duration starting within 24 hours after night shifts of different length versus day shifts.

Results

Most of the participants were nurses (64%) or physicians (16%). We found an increased relative risk of sick leave following night shifts compared with day shifts during all pregnancy trimesters. The risk was highest for night shifts lasting >12 hours (OR 1.37, 95% CI 1.15 to 1.63 for nurses; OR 1.87, 95% CI 1.69 to 2.08 for physicians) and among women aged >35 years (OR 1.42, 95% CI 1.24 to 1.63).

Conclusion

Among Danish public hospital employees night shifts during pregnancy, especially shifts longer than 12 hours, increased the risk of calling in sick the following day independent of personal factors and time-invariant confounders in all pregnancy trimesters.

Functional variant of the carboxypeptidase M (CPM) gene may affect silica-related pneumoconiosis susceptibility by its expression: a multistage case-control study

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Objectives

In a genome-wide association study, we discovered chromosome 12q15 (defined as rs73329476) as a silica-related pneumoconiosis susceptibility region. However, the causal variants in this region have not yet been reported.

Methods

We systematically screened eight potentially functional single-neucleotide polymorphism (SNPs) in the genes near rs73329476 (carboxypeptidase M (CPM) and cleavage and polyadenylation specific factor 6 (CPSF6)) in a case–control study including 177 cases with silicosis and 204 healthy controls, matched to cases with years of silica dust exposure. We evaluated the associations between these eight SNPs and the development of silicosis. Luciferase reporter gene assays were performed to test the effects of selected SNP on the activity of CPM in the promoter. In addition, a two-stage case–control study was performed to investigate the expression differences of the two genes in peripheral blood leucocytes from a total of 64 cases with silicosis and 64 healthy controls with similar years of silica dust exposure as the cases.

Results

We found a strong association between the mutant rs12812500 G allele and the susceptibility of silicosis (OR=1.45, 95% CI 1.03 to 2.04, p=0.034), while luciferase reporter gene assays indicated that the mutant G allele of rs12812500 is strongly associated with increased luciferase levels compared with the wild-type C allele (p<0.01). Moreover, the mRNA (peripheral blood leucocytes) expression of the CPM gene was significantly higher in subjects with silicosis compared with healthy controls.

Conclusions

The rs12812500 variant of the CPM gene may increase silicosis susceptibility by affecting the expression of CPM, which may contribute to silicosis susceptibility with biological plausibility.

Pyromellitic dianhydride (PMDA) may cause occupational asthma

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Introduction

Anhydrides are widely used as cross-linking agents in epoxy resins and alkyd production, for example, as coatings and adhesives in plastic products. Sensitisation to several anhydrides is known to cause occupational asthma. There are indications that the lesser known pyromellitic dianhydride (PMDA) can cause irritative respiratory symptoms and possibly asthma. We report three cases of workers from a plastic foil manufacturing plant, who developed asthma when exposed to PMDA during specific inhalation challenge (SIC).

Methods

SIC was performed over 2 days according to recommendations of European Respiratory Society. Lactose powder was used in control challenges and a mixture of 10% PMDA and 90% lactose powder in active challenges.

Results

All cases experienced a delayed decrease in forced expiratory flow in 1 s (FEV1) 4–12 hours after active challenge. FEV1 decreased by 19%, 15% and 16%, respectively. After 21 hours, FEV1 decreased by 24% in one worker.

Discussion

Respiratory symptoms after working hours may represent delayed work-related asthma. During SIC, the three patients developed lower respiratory symptoms and a delayed decrease in FEV1 which suggest sensitisation. The mechanism of anhydride-related asthma is not well understood. Anhydrides are known irritants and hence an irritative response cannot be excluded. The company improved ventilation and enforced the use of respiratory protection equipment, and finally phased out PMDA. Occupational workplace risk identification may help to identify exposures. SIC can contribute to improving working conditions, by identifying and confirming asthmogens in the environment.

Multiorgan accelerated silicosis misdiagnosed as sarcoidosis in two workers exposed to quartz conglomerate dust

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Introduction

Clusters of silicosis cases have been reported in the fabrication of quartz conglomerate, a new high-silica-content artificial stone for kitchen and bathroom benchtops (countertops).

Aim

We describe two cases of accelerated-type silicosis with hepatic granulomas arising in workers exposed to artificial quartz conglomerates.

Methods

A confident diagnosis of multiorgan silicosis was based on high level of respirable silica in the workplace, typical radiological alterations in chest high-resolution CT, histological findings in the lung and liver, and detection of silica crystals in both tissues by phase-contrast polarising light microscopy and scanning electron microscopy and energy dispersive spectroscopy.

Results

The development of the disease <10 years after the first exposure is consistent with an accelerated-type of silicosis. Compared with other studies related to quartz conglomerate exposure, we determined that the levels of airborne crystalline silica during activity in the finishing area were between 0.260 and 0.744 mg/m3, that is, much higher than the threshold limit value according to American Conference of Governmental Industrial Hygienists (0.025 mg/m3). Moreover, liver granulomas were associated with accumulation of crystalline silica particles in the hepatic tissue.

Conclusions

Quartz conglomerate fabrication is a potentially dangerous occupation. General practitioners and physicians should have awareness of this newly described occupational hazard. Accurate occupational history is critical in avoiding misdiagnosis, as silicosis caused by inhalation of dust from artificial quartz conglomerates may exhibit atypical presentation. These features seem to be related to the extremely high level of silica exposure and, possibly, to an increased toxicity of the dust generated in this process.

Urinary 2,5-dicholorophenol and 2,4-dichlorophenol concentrations and prevalent disease among adults in the National Health and Nutrition Examination Survey (NHANES)

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Objective

To test cross-sectional associations between urinary concentrations of 2,5-dichlorophenol (2,5-DCP) and 2,4-dichlorophenol (2,4-DCP) with the prevalence of cardiovascular disease (CVD), cancer, lung disease, thyroid problems and liver conditions.

Methods

Logistic regression was used to evaluate associations of urinary concentrations of 2,5-DCP and 2,4-DCP with prevalence of various medical conditions among 3617 National Health and Nutrition Examination Survey participants from 2007–2008 and 2009–2010. ORs and 95% CIs for each disease were estimated. All regression models were adjusted for urinary creatinine.

Results

We observed a monotonically increasing association between quartiles of 2,5-DCP and prevalence of CVD. After adjustment for sociodemographic and lifestyle characteristics, participants with the highest versus lowest quartile of urinary 2,5-DCP had an OR=1.84 (95% CI 1.26 to 2.70) (p linear trend=0.006). The association was similar with further adjustment for established clinical CVD risk factors. Higher 2,5-DCP was also associated with prevalence of all cancers combined (ORQ4 vs Q1=1.50 (95% CI 1.00 to 2.26); p trend=0.05) and, in exploratory analyses, with gynaecological cancers (ORQ4 vs Q1=4.15 (95% CI 1.51 to 11.40; p trend=0.01)). No associations were detected between 2,5-DCP and lung diseases, thyroid problems or liver conditions, nor between 2,4-DCP and prevalent disease.

Conclusion

In this nationally representative study, higher urinary 2,5-DCP concentrations were associated with greater prevalence of CVD and all cancers combined. Further examination may be warranted to assess whether chronic exposure to 2,5-DCP is associated with incidence of adverse health outcomes.

Work-focused interventions that promote the labour market transition of young adults with chronic disabling health conditions: a systematic review

http://oem.bmj.com/rss/current.xml - vr, 02/15/2019 - 07:25
Objective

Young adulthood is an important transitional life phase where careers are established. Young adults with chronic disabling health conditions are underrepresented in the labour market. Our study aims to examine the effectiveness of work-focused interventions that support the labour market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ across work transition phase (eg, preparation, entry and sustaining work, employment advancement) and disability type.

Methods

A systematic review of articles published between January 1990 and July 2018 was conducted. Medline, EMBASE and PsycInfo were searched, and titles/abstracts and full texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis was applied to medium-quality/high-quality studies to develop recommendations.

Results

5816 articles were identified; 10 articles were relevant and of moderate–high methodological quality. Six intervention categories were identified which focused on young adults with mental health or intellectual/learning disabilities (n=3) and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. Strong evidence existed for tailored supported employment (SE) interventions having a positive impact on preparation and entry into competitive employment. Also, moderate evidence existed for the positive impact of SE on preparation and entry into competitive employment for young adults with mental health conditions.

Conclusions

Tailored SE is recommended to foster preparation and entry into the labour market. Evidence-based interventions are needed to facilitate sustained work and career advancement of young adults living with different disabling health conditions.

Understanding skin absorption of common aldehyde vapours from exposure during hazardous material incidents

Understanding skin absorption of common aldehyde vapours from exposure during hazardous material incidents

Understanding skin absorption of common aldehyde vapours from exposure during hazardous material incidents, Published online: 15 February 2019; doi:10.1038/s41370-019-0127-4

Understanding skin absorption of common aldehyde vapours from exposure during hazardous material incidents

Predictors of residential mobility and its impact on air pollution exposure among children diagnosed with early childhood leukemia

Predictors of residential mobility and its impact on air pollution exposure among children diagnosed with early childhood leukemia

Predictors of residential mobility and its impact on air pollution exposure among children diagnosed with early childhood leukemia, Published online: 15 February 2019; doi:10.1038/s41370-019-0126-5

Predictors of residential mobility and its impact on air pollution exposure among children diagnosed with early childhood leukemia

Towards Evidence-Informed Occupational Exposure Limits for Enzymes

Enzymes are proteins that catalyze chemical reactions. Humans made use of the specific catalytic properties of enzymes, present in microorganisms, since prehistoric times when producing for instance wines, cheese, bread, and beer. Enzymes were discovered in the 19th century and proteolytic enzymes were first introduced, in isolated form, in the washing powder industry in the 1960s. Soon after this introduction in industrial processes, enzyme use was associated with the respiratory allergy outbreaks among workers in the detergent industry. Clinical evaluations showed that workers who were exposed to enzymatic preparations of Bacillus subtilus, containing proteolytic enzymes and alive bacterial spores, expressed breathlessness at work and had positive skin prick tests against enzymes and bacterial extracts (Flindt, 1969).

Nicotine levels in silicone wristband samplers worn by children exposed to secondhand smoke and electronic cigarette vapor are highly correlated with child’s urinary cotinine

Nicotine levels in silicone wristband samplers worn by children exposed to secondhand smoke and electronic cigarette vapor are highly correlated with child’s urinary cotinine

Nicotine levels in silicone wristband samplers worn by children exposed to secondhand smoke and electronic cigarette vapor are highly correlated with child’s urinary cotinine, Published online: 06 February 2019; doi:10.1038/s41370-019-0116-7

Nicotine levels in silicone wristband samplers worn by children exposed to secondhand smoke and electronic cigarette vapor are highly correlated with child’s urinary cotinine

Permethrin exposure from wearing fabric-treated military uniforms in high heat conditions under varying wear-time scenarios

Permethrin exposure from wearing fabric-treated military uniforms in high heat conditions under varying wear-time scenarios

Permethrin exposure from wearing fabric-treated military uniforms in high heat conditions under varying wear-time scenarios, Published online: 06 February 2019; doi:10.1038/s41370-019-0120-y

Permethrin exposure from wearing fabric-treated military uniforms in high heat conditions under varying wear-time scenarios

Within-individual and interlaboratory variability analyses of urinary metabolites measurements of organophosphorus insecticides

Within-individual and interlaboratory variability analyses of urinary metabolites measurements of organophosphorus insecticides

Within-individual and interlaboratory variability analyses of urinary metabolites measurements of organophosphorus insecticides, Published online: 06 February 2019; doi:10.1038/s41370-019-0124-7

Within-individual and interlaboratory variability analyses of urinary metabolites measurements of organophosphorus insecticides

Age-related changes to environmental exposure: variation in the frequency that young children place hands and objects in their mouths

Age-related changes to environmental exposure: variation in the frequency that young children place hands and objects in their mouths

Age-related changes to environmental exposure: variation in the frequency that young children place hands and objects in their mouths, Published online: 06 February 2019; doi:10.1038/s41370-019-0115-8

Age-related changes to environmental exposure: variation in the frequency that young children place hands and objects in their mouths

The association of urinary phosphorous-containing flame retardant metabolites and self-reported personal care and household product use among couples seeking fertility treatment

The association of urinary phosphorous-containing flame retardant metabolites and self-reported personal care and household product use among couples seeking fertility treatment

The association of urinary phosphorous-containing flame retardant metabolites and self-reported personal care and household product use among couples seeking fertility treatment, Published online: 06 February 2019; doi:10.1038/s41370-019-0122-9

The association of urinary phosphorous-containing flame retardant metabolites and self-reported personal care and household product use among couples seeking fertility treatment