Detection of anti-HCV antibodies and risk factors in a population with access to public healthcare in Mexico.

INTRODUCTION AND AIM: Timely detection and diagnosis of hepatitis C virus (HCV) involves identifying the population that is predisposed to treatment and prevention, thus limiting complications and preventing infection. The aim of this study was to analyze and describe risk factors associated with anti-HCV antibody detection in a population with access to public healthcare that participated in a national screening program. MATERIAL AND METHODS: An analytic cross-sectional study was conducted that utilized data related to rapid tests carried out between September 2021 and October 2022 in 26 of the 32 states of Mexico. Anti-HCV reactive tests were selected, according to age and sex, for analyzing and comparing possible risk factors through descriptive and inferential statistics. The geographic distribution and density of the screening program at the state and municipal levels was analyzed. RESULTS: There were 75,185 anti-HCV antibody detections, 2,052 reactive tests, and mean participant age was 44.3 years (±15.1). Occupation: 32.3% were employees, 19% were housewives, and 18.2% were healthcare workers. Five out of every 10 cases had no indication of risk factors, but there was a 1.4 and 5-times greater likelihood of anti-HCV detection in men with a history of sharps injury or intravenous psychoactive substance use, compared with women. Regarding place of residence, 80% of the reactive tests were concentrated in the State of Mexico, Mexico City, and Guanajuato. CONCLUSIONS: The evidence herein helps determine the population and risk factors that should be focused on in carrying out the HCV microelimination strategy of continuous screening, diagnosis, medical treatment access, and epidemiologic surveillance.

Job function as determinant of clinker exposure at workplaces during cement production.

OBJECTIVES: In the cement production industry, exposure to airborne particulate matter is associated with a decline in lung function and increased airway symptoms. Exposure to clinker-the major constituent of cement and supposedly the cause of the observed adverse health effects-was determined recently in 15 cement production plants located in 8 different countries (Estonia, Greece, Italy, Norway, Sweden, Switzerland, Spain, Turkey). It was shown that the median clinker abundance in the thoracic fraction varied between approximately 20% and 70% for individual plants. The present study complements the previous work by investigating the significance of job function as a determinant of clinker exposure. METHODS: The elemental composition (water and acid-soluble fractions separately) of 1,227 personal thoracic workplace samples was analyzed by positive matrix factorization (PMF) to determine the contribution of different sources to the composition of airborne particulate matter and to quantify the clinker content. RESULTS: Median thoracic mass air concentrations varied for individual job functions between 0.094 and 12 mg/m3 (estimated separately for different plants). The PMF 5-factor solution yielded median relative clinker abundances in the personal thoracic samples between 7.6% and 81% for individual job functions. Thoracic clinker air concentrations are highest for cleaning, production, and maintenance work, and lowest for administration and other work. Foremen and laboratory personnel show intermediate exposure levels. The plant was found to have a much higher contribution to the total variance of the thoracic clinker air concentrations than the job function. Thoracic clinker air concentrations (medians between 0.01 and 5.5 mg/m3) are strongly correlated with the thoracic mass air concentrations and to a lesser extent with the relative clinker abundance in an aerosol sample. CONCLUSIONS: Job function is an important predictor of exposure to clinker in the cement production industry. As clinker is suspected to be the causal agent for the observed adverse health effects among cement production workers, the clinker air concentration may be a better exposure metric than thoracic air mass concentration despite the strong correlation between the two. Reduction strategies should focus on the most exposed job categories cleaning, production, and maintenance work.

Occupational exposure to organotin substances: Development of a liquid chromatographic separation method for 11 organotin compounds in workplace air samples via HPLC-ICP-MS.

Organotin compounds (OTCs) are widely regulated but rank among the most used organometallic compounds in various industrial sectors. They are significantly more toxic than inorganic tin compounds. At workplaces, OTCs can be released as vapors or dust particles and can be absorbed by inhalation or skin contact. Occupational exposure thus represents a great risk for the absorption of OTCs for employees. Methods for OTCs speciation in workplace air monitoring currently do not exist. This study describes the development of a separation method for eleven in Germany regulated OTCs via HPLC-ICP-MS. The method allows a near baseline separation of MMT, MBT, MOT, MPhT, DMT, DBT, DPhT, TMT, TBT, TPhT and TTMT within 22 min on a C18 column and a ternary solvent and flow rate gradient using methanol, acetonitrile, and ultrapure water + 6% (v/v) acetic acid + 0.17% (m/v) α-tropolone. Ten analytes show linearity in the working range of 10 - 100 µg OTCs/L with R² > 0.999. Due to its high volatility the analyte TTMT showed a quadratic relationship between concentration and signal intensity with R² = 0.9998. The determination of the instrumental limits resulted in detection limits between 0.14 and 0.57 µg Sn/L and limits of quantification between 0.49 and 1.97 µg Sn/L. Over the course of this study thermal instability and cross reactivity of OTC in solution became apparent. Formation of two reaction products in mixed OTCs solutions have been observed. These effects will further be examined within development of appropriate sampling and sample preparation for workplace air to provide a suitable method for the determination of OTCs at workplaces according to normative references.

Use of the dustiness index in combination with the handling energy factor for exposure modelling of nanomaterials.

The use of modelling tools in the occupational hygiene community has increased in the last years to comply with the different existing regulations. However, limitations still exist mainly due to the difficulty to obtain certain key parameters such as the emission rate, which in the case of powder handling can be estimated using the dustiness index (DI). The goal of this work is to explore the applicability and usability of the DI for emission source characterization and occupational exposure prediction to particles during nanomaterial powder handling. Modelling of occupational exposure concentrations of 13 case scenarios was performed using a two-box model as well as three nano-specific tools (Stoffenmanager nano, NanoSafer and GUIDEnano). The improvement of modelling performance by using a derived handling energy factor (H) was explored. Results show the usability of the DI for emission source characterization and respirable mass exposure modelling of powder handling scenarios of nanomaterials. A clear improvement in modelling outcome was obtained when using derived quartile-3 H factors with, 1) Pearson correlations of 0.88 vs. 0.52 (not using H), and 2) ratio of modelled/measured concentrations ranging from 0.9 to 10 in 75% cases vs. 16.7% of the cases when not using H. Particle number concentrations were generally underpredicted. Using the most conservative H values, predictions with ratios modelled/measured concentrations of 0.4-3.6 were obtained.

Industrial Hog Operation Workers' Perspectives on Occupational Exposure to Zoonotic Pathogens: A Qualitative Pilot Study in North Carolina, USA.

Industrial hog operation (IHO) workers face a range of occupational hazards, including exposure to zoonotic pathogens such as livestock-associated antimicrobial-resistant Staphylococcus aureus and swine-origin influenza viruses with epidemic or pandemic potential. To better understand this population's occupational exposure to zoonotic pathogens, we conducted a community-driven qualitative research study in eastern North Carolina. We completed in-depth interviews with ten IHO workers and used thematic analysis to identify and analyze patterns of responses. Workers described direct and indirect occupational contact with hogs, with accompanying potential for dermal, ingestion, and inhalation exposures to zoonotic pathogens. Workers also described potential take-home pathways, wherein they could transfer livestock-associated pathogens and other contaminants from IHOs to their families and communities. Findings warrant future research, and suggest that more restrictive policies on antimicrobials, stronger health and safety regulations, and better policies and practices across all IHOs could afford greater protection against worker and take-home zoonotic pathogen exposures.

Working under the 2021 Heat Dome: A Content Analysis of Occupational Impacts Mentioned in the Canadian Media.

Extreme heat events directly impact worker health and cause additional cascading and transitional workplace impacts. However, current investigations on these impacts often rely on specific datasets (e.g., compensation claims, hospitalizations). Thus, to continue to work towards preventing and mitigating the occupational risks posed by extreme heat events, this study aimed to explore the occupational impacts of the 2021 Heat Dome in Canada using a qualitative content analysis method on a news-based dataset. A systematized review of news articles published before, during, and after the 2021 Heat Dome was conducted on academic (n = 8) and news (n = 5) databases, along with targeted grey literature. Two researchers qualitatively coded the articles in NVivo for occupational impacts or references mentioned within the articles. Overall, 52 different occupations were identified as being impacted by the 2021 Heat Dome. Impacts were diverse and ranged from work cancellations or delays to work modifications and reports of heat-related illnesses. The 2021 Heat Dome impacted the health and safety of many occupational groups and provided new insights into the expanding impacts that extreme heat events can have on the Canadian workforce. With climate projections showing a growing trend of more hot days and intense heat waves in Canada, addressing these concerns should be a critical priority.

Chemical Composition of Thoracic Dust at Workplaces During Cement Production.

OBJECTIVES: Cement belongs to the most used building materials. Clinker is the major constituent of cement, and it is believed that the strong increase of pH after hydration of clinker minerals is responsible for the observed decline in lung function of cement production workers. Information on clinker exposure at workplaces in the cement production industry is scarse. The aims of this study are to determine the chemical composition of thoracic dust and to quantify workplace exposure to clinker in cement production. METHODS: The elemental composition of 1250 personal thoracic samples collected at workplaces in 15 plants located in 8 different countries (Estonia, Greece, Italy, Norway, Sweden, Switzerland, Spain, Turkey) was determined by inductively coupled plasma optical emission spectrometry (ICP-OES), separately for water- and acid-soluble fraction. Positive matrix factorization (PMF) was used to determine the contribution of different sources to the dust composition and to quantify the clinker content in 1227 of the thoracic samples. In addition, 107 material samples were analysed to facilitate interpretation of the factors obtained by PMF. RESULTS: The median thoracic mass concentrations varied for individual plants between 0.28 and 3.5 mg/m3. PMF with 8 water-soluble and 10 insoluble (i.e., acid-soluble) element concentrations yielded a five-factor solution: Ca, K, Na sulfates; silicates; insoluble clinker; soluble clinker-rich; and soluble Ca-rich. The clinker content of the samples was calculated as sum of the insoluble clinker and soluble clinker-rich factors. The median clinker fraction of all samples was 45% (range 0-95%), and varied between 20% and 70% for individual plants. DISCUSSION: The 5-factor solution of PMF was selected on the basis of several mathematical parameters recommended in the literature as well as the mineralogical interpretability of the factors. In addition, interpretation of the factors was supported by the measured apparent solubility of Al, K, Si, Fe, and to a lesser extent Ca in material samples. The total clinker content obtained in the present study is considerably lower than estimates based on the Ca concentrations in a sample, and somewhat lower than estimates based on Si concentrations after selective leaching with a methanol/maleic acid mixture. The clinker abundance in workplace dust of one plant investigated in the present contribution was also estimated in a recent study by electron microscopy, and the good agreement between both studies gives confidence in the results of PMF. CONCLUSIONS: The clinker fraction in personal thoracic samples could be quantified from the chemical composition by positive matrix factorization. Our results allow for further epidemiological analyses of health effects in the cement production industry. As these estimates are more accurate for clinker exposure than aerosol mass, stronger associations with respiratory effects are expected if clinker is the main cause of these effects.

Occupational exposure to per- and polyfluoroalkyl substances: a scope review of the literature from 1980-2021.

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) comprise a large group of chemicals that have been integrated into a wide variety of industrial processes and consumer products since the 1950s. Due to their profuse usage and high persistence in human serum, understanding workplace exposures to PFAS is critical. OBJECTIVE: We aimed to characterize the PFAS exposure profiles of relevant occupational populations, elucidate trends in the PFAS exposure characterization process, and identify major research gaps that remain within the occupational PFAS exposure literature. METHODS: A systematic search of four literature databases for peer-reviewed articles published between 1980 and 2021 on PFAS exposure in occupational settings was conducted. RESULTS: Of the 2574 articles identified, 92 met the inclusion criteria. Fluorochemical workers were the target population in most early exposure assessment research; however, studies conducted within the last 10 years have evaluated a wider range of occupational populations and settings. The highest exposures were reported in fluorochemical workers, but, in comparison to reference populations, one or more PFAS were elevated in most workers and in most workplaces that were assessed. PFAS was most frequently assessed in worker serum using a discrete analytical panel of PFAS, with earlier studies restricted to a few long-alkyl chain PFAS while more recent studies have included more expansive panels due to more robust methods. SIGNIFICANCE: Characterization of occupational exposure to PFAS is limited but expanding. Current analytical methods are not robust enough to fully capture the potential range of PFAS present across different workers and workplaces. While exposures to PFAS for certain occupational groups have been studied in detail, exposure information for other occupational groups with high potential for exposure are limited. This review highlights substantial findings and major research gaps within the occupational literature.

Mesothelioma Due to Workplace Exposure: A Comprehensive Bibliometric Analysis of Current Situation and Future Trends.

Background: This article provides an overview of the current status and research progress of mesothelioma. Methods: A total of 2638 documents published from 1 January 2004 to 30 November 2022 were retrieved from the Web of Science Core Collection and analyzed via Microsoft Office Excel 2019, VOSviewer 1.6.18, and Tableau 2022.2. Results: There was an obvious increase in the number of publications regarding mesothelioma in the last 18 years, with the United States dominating the research field with 715 publications and 23,882 citations, while the University of Turin contributed the most (118). Occupational & Environmental Medicine was the most popular journal (80), with Corrado Magnani being the most prolific author (52) and Michele Carbone obtaining the most citations (4472). "Oncology" and "Health Science of Environment & Occupation" were the two main subjects, while the keywords "asbestos", "lung cancer", "gene expression", "apoptosis", "survival", and "cisplatin" were the most popular. Conclusions: The containment of mesothelioma calls for more participation from low- and middle-income countries, and further attention needs to be paid to clinical research.

Accuracy of professional judgments for dermal exposure assessment using deterministic models.

The accuracy of exposure judgments, particularly for scenarios where only qualitative information is available or a systematic approach is not used, has been evaluated and shown to have a relatively low level of accuracy. This is particularly true for dermal exposures, where less information is generally available compared to inhalation exposures. Relatively few quantitative validation efforts have been performed for scenarios where dermal exposures are of interest. In this study, a series of dermal exposure judgments were collected from 90 volunteer U.S. occupational health practitioners in a workshop format to assess the accuracy of their judgments for three specific scenarios. Accuracy was defined as the ability of the participants to identify the correct reference exposure category, as defined by the quantitative exposure banding categories utilized by the American Industrial Hygiene Association (AIHA®). The participants received progressively additional information and training regarding dermal exposure assessments and scenario-specific information during the workshop, and the relative accuracy of their category judgments over time was compared. The results of the study indicated that despite substantial education and training in exposure assessment generally, the practitioners had very little experience in performing dermal exposure assessments and a low level of comfort in performing these assessments. Further, contrary to studies of practitioners performing inhalation exposure assessments demonstrating a trend toward underestimating exposures, participants in this study consistently overestimated the potential for dermal exposure without quantitative data specific to the scenario of interest. Finally, it was found that participants were able to identify the reference or "true" category of dermal exposure acceptability when provided with relevant, scenario-specific dermal and/or surface-loading data for use in the assessment process. These results support the need for additional training and education of practitioners in performing dermal exposure assessments. A closer analysis of default loading values used in dermal exposure assessments to evaluate their accuracy relative to real-world or measured dermal loading values, along with consistent improvements in current dermal models, is also needed.

Urban workers' cardiovascular health due to exposure to traffic-originated PM2.5 and noise pollution in different microenvironments.

The cardiovascular health of the people in urbanised cities is linked to traffic air, and noise pollution. This study investigated the cardiovascular health of people working in two microenvironments such as street (vendors) and workplace (office workers) whose blood pressure (BP) and heart rate (HR) might be affected due to regular exposure to PM2.5 and traffic noise. The PM2.5 and noise levels measurements, face-to-face questionnaire survey and health check-ups were carried out on working days from 10 A.M. to 8 P.M. in Jan-Dec 2019. The data was analysed by various statistical approaches in which the link between the traffic-borne PM2.5 and noise level at 1/3rd octave frequencies has been established with the participants' BP and HR considering the demographic, socio-contextual, habitual and annoyance perception factors. The median measure of PM2.5 and noise levels violated the WHO and NAAQS limits, i.e. 106.67 µg/m3 at street level and 33.33 µg/m3 at office indoor; and 71.35 dB (A) at the street and 65.78 dB (A) at office indoor. The results further showed that the workers working in traffic corridors had abnormally high BP and HR. The systolic BP, diastolic BP and HR values were higher than normal in male workers than female workers. The influence of low noise spectrum (50-630 Hz) was mostly observed. Therefore, the combined effect of PM2.5 > 50 µg/m3 and noise spectrum (63 and 100 Hz) > 30 dB (A) significantly affect office workers' health in traffic corridors. The hearing aids, breathing troubles in the traffic corridor and annoyance perception also influenced the BP and HR of the respondents. The results are indicative and might be helpful in urban environmental planning to improve the well-being of urban traffic corridor users.

Exposure assessment during paint spraying and drying using PTR-ToF-MS.

Spraying is a common way to distribute occupational products, but it puts worker's health at risk by exposing them to potentially harmful particles and gases. The objective of this study is to use time-resolved measurements to gain an understanding of spray applications at the process level and to compare them to predictions of exposure models. We used proton transfer reaction time-of-flight mass spectrometry (PTR-ToF-MS) at 1-s time resolution to monitor the gas phase concentration of the solvents acetone, ethanol, butyl acetate, xylene and 1-methoxy-2-propy acetate during outdoor spraying and indoor drying of metal plate under various conditions of outdoor air supply. We found that during spraying, gas-phase exposure was dominated by the more volatile solvents acetone and ethanol, which exhibited strong concentration variations due to the outdoor winds. During drying, exposure strongly depended on the strength of ventilation. Under conditions with high supply of outdoor air, our measurements show a near-exponential decay of the solvent concentrations during drying. Conversely, under conditions without outdoor air supply, the drying process required hours, during which the less volatile solvents passed through a concentration maximum in the gas phase, so that the exposure during drying exceeded the exposure during spraying. The concentrations measured during spraying were then compared for each of the substances individually with the predictions of the exposure models ECETOC TRA, Stoffenmanager, and ART using TREXMO. For these conditions, ECETOC TRA and Stoffenmanager predicted exposures in the measured concentration range, albeit not conservative for all solvents and each application. In contrast, ART largely overestimated the exposure for the more volatile solvents acetone and ethanol and slightly underestimated exposure to 1M2PA for one spraying. ECETOC TRA and ART do not have options to predict exposure during drying. Stoffenmanager has the option to predict drying together with spraying, but not to predict the drying phase independently. Our study demonstrates the importance of considering both the spray cloud and solvent evaporation during the drying process. To improve workplace safety, there is a critical need for enhanced exposure models and comprehensive datasets for calibration and validation covering a broader range of exposure situations.

Neuropsychological symptoms in workers handling cargo from shipping containers and export logs.

PURPOSE: Acute poisonings of workers handling shipping containers by fumigants and other harmful chemicals off-gassed from cargo have been reported but (sub)-chronic neuropsychological effects have not been well studied. METHODS: This cross-sectional study assessed, using standardised questionnaires, current (past 3-months) neuropsychological symptoms in 274 container handlers, 38 retail workers, 35 fumigators, and 18 log workers, all potentially exposed to fumigants and off-gassed chemicals, and a reference group of 206 construction workers. Prevalence odds ratios (OR), adjusted for age, ethnicity, smoking, alcohol consumption, education, personality traits and BMI, were calculated to assess associations with the total number of symptoms (≥ 3, ≥ 5 or ≥ 10) and specific symptom domains (neurological, psychosomatic, mood, memory/concentration, fatigue, and sleep). RESULTS: Compared to the reference group, exposed workers were more likely to report ≥ 10 symptoms, statistically significant only for retail workers (OR 6.8, 95% CI 1.9-24.3) who also reported more fatigue (OR 10.7, 95% CI 2.7-42.7). Container handlers with the highest exposure-duration were more likely to report ≥ 10 symptoms, both when compared with reference workers (OR 4.0, 95% CI 1.4-11.7) and with container handlers with shorter exposure duration (OR 7.5, 95% CI 1.7-32.8). The duration of container handling was particularly associated with symptoms in the memory/concentration domain, again both when compared to reference workers (OR 8.8, 95% CI 2.5-31.4) and workers with the lowest exposure-duration (OR 6.8, 95% CI 1.5-30.3). CONCLUSION: Container handlers may have an increased risk of neuropsychological symptoms, especially in the memory/concentration domain. Retail workers may also be at risk, but this requires confirmation in a larger study.

Reported exposure trends among healthcare personnel COVID-19 cases, USA, March 2020-March 2021.

BACKGROUND: Health care personnel (HCP) have experienced significant SARS-CoV-2 risk, but exposure settings among HCP COVID-19 cases are poorly characterized. METHODS: We assessed exposure settings among HCP COVID-19 cases in the United States from March 2020 to March 2021 with reported exposures (n = 83,775) using national COVID-19 surveillance data. Exposure setting and reported community incidence temporal trends were described using breakpoint estimation. Among cases identified before initiation of COVID-19 vaccination programs (n = 65,650), we used separate multivariable regression models to estimate adjusted prevalence ratios (aPR) for associations of community incidence with health care and household and/or community exposures. RESULTS: Health care exposures were the most reported (52.0%), followed by household (30.8%) and community exposures (25.6%). Health care exposures and community COVID-19 incidence showed similar temporal trends. In adjusted analyses, HCP cases were more likely to report health care exposures (aPR = 1.31; 95% CI:1.26-1.36) and less likely to report household and/or community exposures (aPR = 0.73; 95% CI:0.70-0.76) under the highest vs lowest community incidence levels. DISCUSSION: These findings highlight HCP exposure setting temporal trends and workplace exposure hazards under high community incidence. Findings also underscore the need for robust collection of work-related data in infectious disease surveillance. CONCLUSIONS: Many reported HCP cases experienced occupational COVID-19 exposures, particularly during periods of higher community COVID-19 incidence.

Occupational Hazards versus Professional Duty in Reviewing Potentially Traumatizing Evidence.

Electronic evidence, including real-time recordings of crimes by police cameras and smart phones, is becoming increasingly relevant to the practice of forensic psychiatry. A developing literature in fields parallel to our own has described vicarious trauma experienced by mental health and legal professionals exposed to traumatic material in the line of duty. The impact of potentially traumatizing media on the forensic psychiatric evaluation and on the individual forensic psychiatrist is unknown. Calling upon the research and practices of adjacent fields, as well as the personal experience of the authors, this article outlines the benefits and hazards of examining graphic media, addresses potential strategies to mitigate its traumatogenic potential (including among trainees), and suggests how future scholarship may improve understanding of these hazards and inform strategies to prevent them.

Possible Effects on Health of Ultrasound Exposure, Risk Factors in the Work Environment and Occupational Safety Review.

Ultrasonic waves are mechanical waves with a frequency greater than 20,000 Hz. Ultrasonic waves are emitted by devices that are used in industry or that have a medical or aesthetic purpose. There is growing interest in the effect of ultrasound absorption on the human body, since people's exposure to these acoustic waves has increased considerably in recent years. There are more and more devices that emit ultrasounds used for different sanitary procedures, aesthetic treatments and industrial processes, creating more possibilities of ultrasound noise, and therefore an increased risk of occupational hazard and occupational danger. Experiments on animals have shown damage to internal organs from receiving different ultrasonic frequencies. The main task of this work was to organize and summarize recent studies on ultrasound to reflect the current state of this technique and establish a systematic basis for future lines of research. This work has allowed us to better understand the unknown field of these high frequencies of sound, and highlights the need to carry out more studies on the ultrasound emissions that can be absorbed by the human body to determine how this energy could affect humans by calculating the maximum dose of exposure and developing manuals for the use of ultrasound-emitting equipment to protect the health of workers and all people. It is necessary to develop regulations by public administrations to improve the protection of workers, health professionals, patients and all people in general for better occupational safety, indoor environmental quality and environmental health.

COVID-19 infection rates early in the pandemic among full time clinicians in a home health care and hospice organization.

BACKGROUND: Patient-facing health care workers (HCW) experience higher rates of COVID-19 infection, particularly at the start of the COVID-19 pandemic. However, rates of COVID-19 among front-line home health and hospice clinicians are relatively unknown. METHODS: Visit data from a home health care and hospice agency in New Jersey early in the pandemic was analyzed to examine COVID-19 infection rates separately for clinicians exposed to COVID-19-contagious patients, and those without exposure to known COVID-19 contagious patients. RESULTS: Between March 5 and May 31, 2020, among home health clinicians providing in-person care, clinicians treating at least one COVID-19 contagious patient had a case rate of 0.8% compared to 15.7% for clinicians with no exposure to known COVID-19 contagious patients. Among hospice clinicians providing in-person care, those who treated at least one COVID-19 contagious patient had a case rate of 6.5%, compared to 12.9% for clinicians with no known exposure to COVID-19 contagious patients. Non-White clinicians had a higher COVID-19 case rate than White clinicians (10.9% vs 6.2%). DISCUSSION: Lower rates of COVID-19 infection among clinicians providing care to COVID-19-contagious patients may result from greater attentiveness to infection control protocols and greater precautions in clinicians' personal lives. Greater exposure to COVID-19-contagious patients prior to patient diagnosis ("unknown exposures") may explain differences in infection rates between home health and hospice clinicians with workplace exposures. CONCLUSION: Clinicians providing in-person care to COVID-19-contagious patients experience lower rates of COVID-19 infection than clinicians providing face-to-face care with no known exposure to COVID-19 contagious patients. Our findings suggest there was a low incidence of potential workplace infections.

Airborne Fumigants and Residual Chemicals in Shipping Containers Arriving in New Zealand.

BACKGROUND: Airborne fumigants and other hazardous chemicals inside unopened shipping containers may pose a risk to workers handling containers. METHODS: Grab air samples from 490 sealed containers arriving in New Zealand were analysed for fumigants and other hazardous chemicals. We also collected grab air samples of 46 containers immediately upon opening and measured the total concentration of volatile organic compounds in real-time during ventilation. Additive Mixture Values (AMV) were calculated using the New Zealand Workplace Exposure standard (WES) and ACGIH Threshold Limit Values (TLV) of the 8-h, time-weighted average (TWA) exposure limit. Regression analyses assessed associations with container characteristics. RESULTS: Fumigants were detectable in 11.4% of sealed containers, with ethylene oxide detected most frequently (4.7%), followed by methyl bromide (3.5%). Other chemicals, mainly formaldehyde, were detected more frequently (84.7%). Fumigants and other chemicals exceeded the WES/TLV in 6.7%/7.8%, and 7.8%/20.0% of all containers, respectively. Correspondingly, they more frequently exceeded '1' for the AMV-TLV compared to the AMV-WES (25.7% versus 7.8%). In samples taken upon opening of doors, fumigants were detected in both fumigated and non-fumigated containers, but detection frequencies and exceedances of the WES, TLV, and AMVs were generally higher in fumigated containers. Detection frequencies for other chemicals were similar in fumigated and non-fumigated containers, and only formaldehyde exceeded both the WES and TLV in both container groups. Volatile compounds in container air reduced rapidly during ventilation. Some cargo types (tyres; personal hygiene, beauty and medical products; stone and ceramics; metal and glass; and pet food) and countries of origin (China) were associated with elevated airborne chemical and fumigant concentrations. CONCLUSION: Airborne chemicals in sealed containers frequently exceed exposure limits, both in fumigated and non-fumigated containers, and may contribute to short-term peak exposures of workers unloading or inspecting containers.

Prediction of Dermal Exposure to Chemical Substances Using a Fluorescence Method within the SysDEA Project.

Dermal exposure is an important exposure route for occupational exposure and risk assessment. A fluorescence method has been developed to quantify occupational dermal exposure based on a visualization technique, using Tinopal SWN as a fluorescent tracer. The method was developed within the framework of a large experimental study, the SysDEA project. In SysDEA, dermal exposure was measured with different methods for 10 simulated exposure situations by sampling powder and liquid formulations containing Tinopal SWN on coveralls and patches and subsequently chemically analysing them. For the fluorescence method, photographs of exposed volunteers who performed the experiments were taken inside a room which consisted of an optimized arrangement of several UV irradiating tube light brackets, reflective and non-reflective backgrounds for maximum light diffusion and a camera. Image processing analysis software processed these photographs to obtain corresponding light intensity in terms of summed pixel values. To be able to estimate the amount of Tinopal SWN, 25% of the measured data from the SysDEA experiments were used to calibrate by correlating the summed pixel values from the photographs to actual measured exposure values using a second order regression model. For spraying both high and low viscosity liquids, showing uniformly distributed exposure patterns, strong Pearson correlation coefficients (R > 0.77) were observed. In contrast, the correlations were either inconsistently poor (R = -0.17 to 0.28 for pouring, rolling high viscosity liquid, manually handling objects immersed in low viscosity liquid and handling objects contaminated with powder), moderate (R = 0.73 for dumping of powder), or strong (R = 0.83 and 0.77 for rolling low viscosity liquid and manually handling objects immersed in high viscosity liquid). A model for spraying was developed and calibrated using 25% of the available experimental data for spraying and validated using the remaining 75%. Under given experimental conditions, the fluorescence method shows promising results and can be used for the quantification of dermal exposure for different body parts (excluding hands) for spraying-like scenarios that have a more uniform exposure pattern, but more research is needed for exposure scenarios with less uniform exposure patterns. For the estimation of exposure levels, the surface loading limit should be lower than 1.5░µg/cm2 (a lower limit could not be quantified based on experiments conducted in this study) on a large surface, like a coverall, which should be ideally perpendicular to the camera.

Occupational Exposure to Diisocyanates in the European Union.

OBJECTIVES: Diisocyanates are a chemical group that are widely used at workplaces in many sectors. They are also potent skin- and respiratory sensitizers. Exposure to diisocyanates is a main cause of occupational asthma in the European Union. To reduce occupational exposure to diisocyanates and consequently the cases of diisocyanate-induced asthma, a restriction on diisocyanates was recently adopted under the REACH Regulation in the European Union. METHODS: A comprehensive evaluation of the data on occupational exposure to the most important diisocyanates at workplaces was made and is reported here. The diisocyanates considered are methylene diphenyl diisocyanate (MDI), toluene diisocyanate (TDI), and hexamethylene diisocyanate (HDI), accounting for more than 95% of the market volume in the EU. The exposure assessment is based on data from Chemical Safety Reports (CSRs) of REACH Registration Dossiers, workplace air monitoring data from Germany, from the UK Health and Safety Executive (HSE), and literature data relevant for the EU, and the USA. RESULTS: Occupational exposure to diisocyanates is particularly relevant in: (i) C.A.S.E. applications (Coatings, Adhesives, Sealants, Elastomers), (ii) production of polyurethanes (PUs) (e.g. slab-stock foam), (iii) handling of partly uncured PU products (e.g. cutting, demoulding, spray application of foam), and (iv) when diisocyanates/PUs are heated (e.g. hot lamination, foundry applications/casting forms). Ranking of the reported data on inhalation to diisocyanate exposure at workplaces (maximum values) leads to following order: (i) HDI and its oligomers in coatings, (ii) MDI in spray foam applications, (iii) TDI in manufacture of foam, (iv) TDI in manufacture of PUs and PU composite materials, (v) TDI in adhesives, (vi) MDI in adhesives, (vii) MDI in manufacture of PUs and PU composite materials, (viii) TDI in coatings, (ix) MDI in manufacture of foam, and (x) HDI in adhesives.