The cost of hypertension-related ill-health attributable to environmental noise.

Hypertension (HT) is associated with environmental noise exposure and is a risk factor for a range of health outcomes. The study aims were to identify key HT related health outcomes and to quantify and monetize the impact on health outcomes attributable to environmental noise-related HT. A reiterative literature review identified key HT related health outcomes and their quantitative links with HT. The health impact of increases in environmental noise above recommended daytime noise levels (55 dB[A]) were quantified in terms of quality adjusted life years and then monetized. A case study evaluated the cost of environmental noise, using published data on health risks and the number of people exposed to various bands of environmental noise levels in the United Kingdom (UK). Three health outcomes were selected based on the strength of evidence linking them with HT and their current impact on society: Acute myocardial infarction (AMI), stroke and dementia. In the UK population, an additional 542 cases of HT-related AMI, 788 cases of stroke and 1169 cases of dementia were expected per year due to daytime noise levels ≥55 dB(A). The cost of these additional cases was valued at around £1.09 billion, with dementia accounting for 44%. The methodology is dependent on the availability and quality of published data and the resulting valuations reflect these limitations. The estimated intangible cost provides an insight into the scale of the health impacts and conversely the benefits that the implementation of policies to manage environmental noise may confer.

Occupational Asthma and Its Causation in the UK Seafood Processing Industry.

OBJECTIVES: The processing of seafood (fish and shellfish) for human consumption can lead to health consequences, including occupational asthma (OA). Several non-UK studies have reported both respiratory outcomes and airborne levels of major allergens in seafood processing. However, there is a paucity of such evidence in the UK land-based seafood processing sector, which employs some 20 000 workers. METHODS: University of Manchester's Surveillance of Work-related and Occupational Respiratory Disease (SWORD) reporting system has been interrogated over the period 1992-2017 to define the incidence rate of OA cases that can be ascribed to the UK land-based processing sector, and the seafood species implicated. Airborne allergen monitoring data undertaken at Health and Safety Executive's laboratory from 2003 to 2019 have also been collated. RESULTS: The estimated annual OA incidence rate in seafood processors was 70 [95% confidence intervals (CIs) 48.9, 91.1] per 100 000 workers compared with 2.9 (95% CIs 2.8, 3.1) in 'all other industries'. The annual calculated percentage trend in OA (1992-2017) was -8.1% (95% CIs -15.9, 0.4) in seafood processing showing a similar trend to 'all other industries' (mean -7.0%; 95% CIs -7.8, -6.1). Prawns and salmon/trout were notably implicated by SWORD as causative species related to OA. There is a general paucity of available UK airborne allergen monitoring data, particularly concerning processing salmon or trout. Available airborne monitoring for salmon parvalbumin in seven processors ranged between the limit of detection and 816 ng m-3 (n = 64). Available air monitoring levels of the major shellfish allergen (tropomyosin) during processing of crabs and prawns ranged between 1 and 101 600 ng m-3 (n = 280), highlighting that high levels of exposure can occur. CONCLUSIONS: These data show an excess incidence of OA in the UK seafood processing industry during 1992-2017, with limited airborne monitoring data for the processing of prawn, crab, and salmon suggesting that significant exposure to major seafood allergens can occur in this industry. Further investigation of current levels of respiratory ill-health and the sources of allergen exposure are warranted.

The development of methods to measure exposure to a major rabbit allergen (Ory c 1).

Rabbits are used as laboratory animal models and are also popular domestic pets. Allergic responses to rabbit allergens have been documented in both settings, and several rabbit allergens identified. We have purified an 18 kD protein extracted from rabbit fur that was shown by N-terminal sequencing and mass spectrometry (MS) to be a lipocalin, identical to that identified as an odorant binding protein and an allergen with the formal nomenclature of Ory c 1. De novo sequencing of the MS peptide fragments gave additional primary sequence data of this protein. Polyclonal antisera were raised against the purified protein and used to develop two types of immunoassay. Ory c 1 content was measured in used rabbit bedding and household dust samples from homes keeping rabbits as pets. Atmospheric sampling was also undertaken in an animal facility undertaking rabbit experimental work. Ory c 1 levels in house dust where rabbits were kept as pets were between undetectable-41,290 ng·g-1, and in used bedding between 370-26,740 ng·g-1. Significantly higher house dust levels were found where rabbits spent large amounts, or all of, their time indoors. Personal air sampler levels within the animal facility were between 65-216 ng·m-3. Low levels (0.8-2 ng·m-3) were found in the facility's changing rooms, but undetected in the entrance lobby, office and laundry. We believe that these immunochemical assays may be used to identify activities in the occupational and domestic setting which produce higher levels of exposure to rabbit allergens, and where measures to control exposure may be warranted to reduce potential risk of allergic outcomes.

Relationship between self-reported upper limb disability and quantitative tests in hand-arm vibration syndrome.

PURPOSE: To establish the relationship between quantitative tests of hand function and upper limb disability, as measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, in hand-arm vibration syndrome (HAVS). METHOD: A total of 228 individuals with HAVS were included in this study. Each had undergone a full HAVS assessment by an experienced physician, including quantitative tests of vibrotactile and thermal perception thresholds, maximal hand-grip strength (HG) and the Purdue pegboard (PP) test. Individuals were also asked to complete a DASH questionnaire. RESULTS: PP and HG of the quantitative tests gave the best and statistically significant individual correlations with the DASH disability score (r2 = 0.168 and 0.096). Stepwise linear regression analysis revealed that only PP and HG measurements were statistically significant predictors of upper limb disability (r2 = 0.178). Overall a combination of the PP and HG measurements, rather than each alone, gave slightly better discrimination, although not statistically significant, between normal and abnormal DASH scores with a sensitivity of 73.1% and specificity of 64.3%. CONCLUSIONS: Measurements of manual dexterity and hand-grip strength using PP and HG may be useful in helping to confirm lack of upper limb function and 'perceived' disability in HAVS.

Speciation of arsenic compounds in urine from occupationally unexposed and exposed persons in the U.K. using a routine LC-ICP-MS method.

This paper describes a routine, robust, and reproducible liquid chromatography-inductively coupled plasma-mass spectrometry (LC-ICP-MS) speciation method for five arsenic compounds [arsenobetaine (AB), arsenite, arsenate, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA)] in urine. Concentrations of these arsenic species in urine samples are reported in two sets of non-occupationally exposed controls with one set having consumed fish within 24 h (n = 31) and the other not having consumed fish for 48 h (n = 34). Arsenic species in urine samples from workers in both the timber treatment industry (n = 49) and semiconductor industry (n = 46) are also reported. The arsenic content in all of the samples was also determined using hydride-generation coupled with ICP-MS. The results show that urine samples from people not occupationally exposed to arsenic contain low levels of DMA, MMA, and AB and that only urine from smokers contained any inorganic arsenic. Consumption of seafood was seen to significantly increase the levels of AB and DMA in the unexposed persons. Urine samples from the semiconductor workers exhibited significantly higher levels of arsenite, arsenate, and DMA than the unexposed samples. The urine samples from timber treatment workers exhibited significantly higher levels of four arsenic species (not AB) than those observed in both the control groups and the semi-conductor workers.

Cold-provocation testing for the vascular component of hand-arm vibration syndrome in health surveillance.

The aim was to investigate whether the use of infra-red thermography (I-R) and measurement of temperature gradients along the finger could improve the diagnostic accuracy of cold-provocation testing (15 degrees C for 5 min) in vascular hand-arm vibration syndrome (HAVS). Twenty-one controls and 33 individuals with stages 2/3V HAVS were studied. The standard measurement of time to rewarm by 4 degrees C (T4 degrees C) and temperature gradients between the finger tip, base and middle (measured using I-R) were calculated. Receiver Operating Characteristics (ROC) analysis to distinguish between the two groups revealed that for T4 degrees C the area under the ROC curve was not statistically significantly different from 0.5 (0.64 95% confidence interval 0.49-0.76). The difference between the tip and middle portion of the finger during the sixth minute of recovery was the most promising gradient with an area of 0.76 (95% confidence interval 0.62-0.87), and sensitivity and specificity of 57.6% and 85.7% respectively. However, this was not significantly different from that for the time to rewarm by 4 degrees C. In conclusion, the cold-provocation test used in this study does not appear to discriminate between individuals with stage 2/3V HAVS and controls and this is not improved by the measurement of temperature gradients along the fingers using I-R.

Urinary corticosterone measures: effects of strain and social rank in BKW and CD-1 mice.

We used urinary assays as a non-invasive method to examine corticosterone levels in two outbred strains of male laboratory mice (BKW and CD-1). Measures were taken before and after 2 weeks of pair housing, to examine the effects of social stress. We found that CD-1 mice had significantly higher corticosterone levels compared to BKW mice both before and after pairing. Behavioural measures provided evidence that, when paired, both strains of mice polarised into dominants and subordinates, with a higher overall incidence of aggressive acts in the BKW mice. Some pairings had to be separated to prevent injuries so the pairing procedure introduced a selection for non-aggressive socially tolerant mice. Social status was nevertheless found to be associated with pre-existing differences in urinary corticosterone in the CD-1 strain: mice that later became dominant had overall lower levels of urinary corticosterone compared to subordinates. In conclusion, urinary corticosterone levels indicated clear differences in physiology, likely to be related to the adrenal stress response, dependent on both strain and social status. Thus, this non-invasive measure could help to predict the welfare outcomes of social housing and how these may depend on dominance status, rather than overall levels of aggression, in different strains of mice.

Disability in the upper extremity and quality of life in hand-arm vibration syndrome.

PURPOSE: To investigate whether hand-arm vibration syndrome (HAVS) leads to disability in the upper extremity or deficit in quality of life (QoL) using validated questionnaire tools, and to establish whether these effects are related to the Stockholm Workshop Staging (SWS). METHOD: This was a postal cross-sectional questionnaire study with a 50% response rate. Four hundred and forty-four males, who had been diagnosed and staged according to the SWS were sent the Disability in the Arm, Shoulder and Hand (DASH) and the SF-36v2 QoL questionnaires. RESULTS: HAVS cases had significantly greater DASH disability scores and reduced QoL physical and mental component scores compared to published normal values. Those HAVS cases with a presumptive diagnosis of Carpal Tunnel Syndrome(CTS) had even higher disability scores. There was a clear, linear relationship between both the DASH disability score and the physical component of the QoL and sensorineural SWS, but not with the vascular SWS. CONCLUSIONS: HAVS has a significant effect on an individual's perceived ability to perform everyday tasks involving the upper extremity, and their quality of life. Physical capability may be further compromised in those individuals who have a presumptive diagnosis of CTS. These findings may have important implications regarding management of the affected worker.

Levels of house dust mite allergen in cars.

This small study investigated house dust mite (HDM) allergen levels in cars and their owners' homes in north-east Scotland. Dust samples from twelve households and cars were collected in a standardised manner. The dust samples were extracted and measured for the Dermatophagoides group 2 allergens (Der p 2 and Der f 2) and total soluble protein. Allergen levels at homes tended to be higher than in the cars, but not significantly. However, they significantly correlated with paired car dust samples expressed either per unit weight of dust or soluble protein (rho=0.657; p=0.02 and 0.769; p=0.003, respectively). This points to house-to-car allergen transfer, with the car allergen levels largely reflecting levels in the owner's home. Car HDM allergen levels were lower than those reported in Brazil and the USA. Twenty-five percent of the houses and none of the cars had allergen levels in dust greater than 2000 ng g(-1). This value is often quoted as a threshold for the risk of sensitisation, although a number of studies report increased risk of sensitisation at lower levels. This small study does not allow for characterisation of the distribution of HDM allergen in vehicles in this geographic area, or of the likely levels in other warmer and more humid areas of the UK. Cars and other vehicles are an under-investigated micro-environment for exposure to allergenic material.

Levels of soya aeroallergens during dockside unloading as measured by personal and static sampling.

Soya is an important worldwide agricultural product widely shipped and imported in bulk. It contains a number of recognised allergens and the use of soya products and its dockside unloading have been associated with occupational asthma and community episodes of asthma. Two recognised inhalation soya allergens, soya trypsin inhibitor (STI) and hydrophobic soya protein (HSP), were measured in personal and static air samples collected at a United Kingdom (UK) dock during 3 days of unloading three bulks of processed soya beans and soya pelletised husk. Static samples included task-related and those taken at the workplace perimeter and neighbouring sites. Soluble total protein (STP) and gravimetric dust analyses were also undertaken. While gravimetric dust results in personal air samples were below half of the current UK exposure limit of 10 mg m(-3) for grain dust, and generally less than 0.5 mg m(-3) for the static samples, airborne concentrations for STI and HSP ranged between 0-3,071 and 11-12,629 ng m(-3), respectively, while the correlation between the two specific allergen measurements was generally good (Rank Spearman coefficient 0.74). The data from this investigation suggest that HSP is a more sensitive indicator of soya exposure than STI, but only for soya husk, while STI may be equipotent in detecting exposure to both hull and bean derived soya products. Both assays appear sensitive techniques for investigating the control of exposure to allergenic soy material. The endotoxin level in the husk bulk was 15-60-fold that found in the two chipped bean bulks.

Relative Performance of Frequency Weighting W(h) and Candidates for Alternative Frequency Weightings for Predicting the Occurrence of Hand-transmitted Vibration-induced Injuries.

Exposure to hand-transmitted vibration is usually assessed according to International Standard ISO 5349-1:2001 using the frequency weighting W(h). This paper compares eight frequency weightings that might be used to supplement or replace W(h). The comparison is based on a data from two databases, one containing over 7200 measured hand-arm vibration (HAV) spectra from a wide range of industrial machines the other recording exposure history and injury for workers referred to the Health and Safety Laboratory. Acceleration spectra from the machinery database are analysed to give weighted values for the alternative frequency weightings. These weighted values are compared and then used to estimate a set of alternative lifetime vibration dose values for subjects in the referral database. Statistical comparison of these lifetime dose values against assessments of hand-arm vibration syndrome (HAVS) and sensorineural HAVS prevalence suggests that values based the two weightings W(h) and W(h50lp) (the W(h) weighing low-pass filtered at 50 Hz) provide the strongest indicators for developing these injuries. For vascular HAVS there was no clear evidence to advocate any individual frequency weighting. For all injury categories the strongest relationships were for the first power of acceleration magnitude.

Modification of the Stockholm Vascular Scale.

BACKGROUND: Staging hand-arm vibration syndrome (HAVS) depends upon accurate reporting of the extent and frequency of blanching attacks. Reporting may not be repeatable and not all individuals classifiable using the Stockholm Workshop Scale (SWS). For Department of Trade and Industry (Dti) coal miners' assessments, the SWS was modified to include a blanching score. Further modifications, which involve splitting Stage 2V into 'early' and 'late' have been proposed but the impact of this on classification has not been investigated. AIM: To investigate the impact of modifications in the SWS on HAVS classification. METHODS: Staging of individuals with HAVS according to the SWS using two modified scales. Two different cut-offs for defining 'frequent' blanching attacks (>or=3 or >or=7 attacks/week, respectively) were used. RESULTS: One hundred and sixty-five individuals were staged. Using the SWS, 58 and 31% of the population were unclassifiable using the two cut-offs, respectively. The modification splitting Stage 2V reduced the proportions that were unclassifiable to 2 and 9%, respectively, and increased those classified as Stage 2V. The cut-off for frequent attacks used (3 or 7) affected the proportion of individuals falling into the subdivisions of Stage 2 with 17 and 42% being classified as 2Vearly and 45 and 20% as 2Vlate, respectively. CONCLUSIONS: Subdividing Stage 2V enables more individuals to be classified, but the proportion falling into each category is susceptible to the cut-off used for defining frequent attacks. Caution may need to be applied if this categorization is used to make decisions regarding fitness to work.

A screening questionnaire for HAVS?

AIM: To define the diagnostic power of simple questions most applicable for a hand-arm vibration syndrome (HAVS) assessment screening questionnaire. METHOD: Using a binary logistic regression we analysed 365 physician led HAVS health surveillance assessments to identify which questions could form the basis of a screening questionnaire. RESULTS: Four sensorineural related questions regarding tingling and numbness in response to the cold and after using vibrating tools, and two vascular-related questions focusing on the patient's fingers going white on exposure to cold and numbness during an attack of whiteness were identified. CONCLUSIONS: Questions of high sensitivity for screening subjects for the vascular and neurosensory components of HAVS were identified, which can be used to identify those requiring further clinical investigation and functional testing.

Window renovation and exposure to lead--an observational study.

BACKGROUND: Renovation of windows in old houses has recently established itself as an industry. A recognizable occupational lead exposure exists, which has not been studied previously. AIM: To compare lead exposure amongst window renovators with other groups of lead-exposed workers. METHODS: Using blood lead results measured at the Health and Safety Laboratory (HSL), Sheffield, comparisons were made between three cohorts: window renovation workers, all male workers monitored by HSL during the period 1999-2001 and 63 male subjects involved in chemical paint-stripping of wood. RESULTS: Both the window renovation and the wood-stripping cohorts show significantly higher blood lead distributions than the 'all workers' cohort (P < 0.001). A similar pattern was also found for comparison of the prevalence of subjects above the UK suspension level of 60 microg/dl (2.89 microM) (window renovation, P < 0.001; wood-stripping, P < 0.0001). Blood lead results at or above the suspension level in wood-strippers were significantly higher compared to window renovators (P = 0.034). CONCLUSION: Window renovation is shown to present a potential for significant lead exposure, and suspension from work under The Control of Lead at Work Regulations 2002. Two groups of risk factors predominate: the well-documented potential for release of lead from old paint, and the peripatetic nature of the work.

Occupational exposure to cytotoxic drugs in two UK oncology wards.

AIMS: To investigate the potential exposure to cytotoxic drugs of staff on two oncology wards in a large district, UK hospital under normal working conditions. METHODS: Cytotoxic drug exposure was monitored in urine samples, surface wipes, and on disposable gloves by using a number of commonly used marker drugs, namely cyclophosphamide, ifosfamide, methotrexate, and the platino coordinated drugs. Questionnaire data on their work practices, potential exposure, use of protective personal equipment, and relevant training were collected from nursing, domestic, and clerical staff on two oncology wards. RESULTS: The majority of staff were female with a mean age of 31 years. Roughly half of the staff studied were specifically trained nurses with an average of 3.5 years experience of administering cytotoxic drugs. No cytotoxic drug preparation or reconstitution was carried out on the wards. Disposable gloves, plastic armlets and aprons, but not eye protection, were invariably worn where there was potential exposure to cytotoxics. No cytotoxic drug was detected in any of the staff's urine samples. Isolated disposable latex gloves from nurses administering drugs showed some contamination, as did some surfaces within the wards' sluice rooms, but not in the ward areas where the drugs were stored and checked prior to administration. CONCLUSIONS: The risk management strategies in place, including use of personal protective equipment, staff training, and other organisational measures, have ensured that internal exposure is lower than the detection limits for the current biological monitoring methods. Levels of contamination appear significantly lower than earlier, non-UK published studies where different risk management strategies were in place and, in particular, ward staff may have been involved in some degree of cytotoxic drug reconstitution.