Identification of early-stage silicosis through health screening of stone benchtop industry workers in Victoria, Australia.

OBJECTIVES: The popularity of high silica content artificial stone has been associated with emergence of severe, progressive silicosis as a major health issue affecting workers in the stone benchtop industry. This population-based health assessment programme has been implemented with the aim of identifcation of silica-associated disease at a preclinical stage. METHODS: All current and former workers from the stone benchtop industry in the State of Victoria are offered free health assessments. Primary evaluations include a standardised questionnaire, physical examination, spirometry and gas transfer assessment and International Labour Organisation-categorised chest X-ray. Secondary evaluations include high-resolution CT chest, blood tests and a respiratory physician evaluation. RESULTS: At the end of the first 12 months, 86/239 (36%) workers who had completed secondary evaluation were diagnosed with silicosis (65 simple silicosis and 21 complicated silicosis). 22 had worked in the industry for less than 10 years at the time of diagnosis. Of those with simple silicosis, 80% of workers reported breathlessness only with strenuous exercise (modified Medical Research Council score of 0), and lung function was well preserved (prebronchodilator forced vital capacity mean 99.8% predicted (SD 13.6), diffusion capacity of the lung for carbon monoxide mean 96.2% predicted (SD 18.0)). Antinuclear antibodies were detected in 37% with silicosis and 24% without silicosis. CONCLUSION: Early results from this comprehensive health assessment programme have indicated a high proportion of referred artificial stone benchtop workers have silicosis, including many with early-stage disease. The common finding of antinuclear antibodies suggest significant potential for autoimmune disease in this occupational group.

Patch test results in patients with suspected contact allergy to shoes: Retrospective IVDK data analysis 2009-2018.

BACKGROUND: Allergic contact dermatitis caused by shoes is common and new relevant allergens have been identified. OBJECTIVES: To investigate the pattern of type IV sensitization in patients with suspected allergic contact dermatitis of the feet related to shoes as a presumed culprit trigger. METHODS: Retrospective analysis of data of the Information Network of Departments of Dermatology (IVDK), 2009-2018. RESULTS: Six hundred twenty-five patients with presumed shoe dermatitis were identified in a cohort of 119 417 patients. Compared to patients with suspected contact sensitization from other allergen sources (n = 118 792), study group patients were more frequently sensitized to potassium dichromate (10.8% vs 3.5%), colophony (7.2% vs 3.7%), mercaptobenzothiazole (MBT; 4.0% vs 0.6%), mercapto mix (4.6% vs 0.6%), and p-tert-butylphenol formaldehyde resin (1.6% vs 0.5%). Sensitizations to urea formaldehyde resin, melamine formaldehyde resin, glutaraldehyde, tricresyl phosphate, and phenyl glycidylether were rare. Moreover, reactions to compounds in the leather or textile dyes test series were scarce. CONCLUSION: A distinct sensitization pattern was observed in patients with suspected allergy to shoe materials. Although substances with low sensitization rates should be removed from the leather and shoe patch test series, novel potential allergens should be added.

Artificial stone-associated silicosis in China: A prospective comparison with natural stone-associated silicosis.

BACKGROUND AND OBJECTIVE: We recently noted a dramatic increase in the number of patients with accelerated silicosis associated with exposure to artificial stone dust. Therefore, the natural history of artificial stone-associated silicosis was compared with that of natural stone-associated silicosis. METHODS: A total of 18 patients with artificial stone-associated silicosis and 63 with natural stone-associated silicosis were diagnosed sequentially in 2018 and followed up for a period of 6-12 months. Data were collected from clinical charts. RESULTS: The median duration of exposure prior to onset of symptoms of silicosis was shorter for patients who had been exposed to artificial stone dust (6.4 vs 29.3 years, P < 0.01). Four of the 18 patients experienced rapid deterioration in lung function over the follow-up period, with declines in pre-bronchodilator FVC of 587 (210-960) mL/year and FEV1 of 625 (360-860) mL/year. GGO, PMF, emphysema and pulmonary artery widening were more frequently observed on computed tomography scans of patients with artificial stone-associated silicosis than of those with natural stone-associated silicosis. Approximately 38.9% of the patients with artificial stone-associated silicosis were lung transplant candidates and 27.8% died, both rates being significantly higher than in patients with natural stone-associated silicosis (3.2% and 0%, both P < 0.01). CONCLUSION: Compared to natural stone-associated silicosis, artificial stone-associated silicosis was characterized by short latency, rapid radiological progression, accelerated decline in lung function and high mortality.

Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand.

Coal mine lung dust disease (CMDLD) and artificial stone (AS) silicosis are preventable diseases which have occurred in serious outbreaks in Australia recently. This has prompted a TSANZ review of Australia's approach to respiratory periodic health surveillance. While regulating respirable dust exposure remains the foundation of primary and secondary prevention, identification of workers with early disease assists with control of further exposure, and with the aims of preserving lung function and decreasing respiratory morbidity in those affected. Prompt detection of an abnormality also allows for ongoing respiratory specialist clinical management. This review outlines a medical framework for improvements in respiratory surveillance to detect CMDLD and AS silicosis in Australia. This includes appropriate referral, improved data collection and interpretation, enhanced surveillance, the establishment of a nationwide Occupational Lung Disease Registry and an independent advisory group. These measures are designed to improve health outcomes for workers in the coal mining, AS and other dust-exposed and mining industries.

Severe Silicosis in Engineered Stone Fabrication Workers - California, Colorado, Texas, and Washington, 2017-2019.

Silicosis is an incurable occupational lung disease caused by inhaling particles of respirable crystalline silica. These particles trigger inflammation and fibrosis in the lungs, leading to progressive, irreversible, and potentially disabling disease. Silica exposure is also associated with increased risk for lung infection (notably, tuberculosis), lung cancer, emphysema, autoimmune diseases, and kidney disease (1). Because quartz, a type of crystalline silica, is commonly found in stone, workers who cut, polish, or grind stone materials can be exposed to silica dust. Recently, silicosis outbreaks have been reported in several countries among workers who cut and finish stone slabs for countertops, a process known as stone fabrication (2-5). Most worked with engineered stone, a manufactured, quartz-based composite material that can contain >90% crystalline silica (6). This report describes 18 cases of silicosis, including the first two fatalities reported in the United States, among workers in the stone fabrication industry in California, Colorado, Texas, and Washington. Several patients had severe progressive disease, and some had associated autoimmune diseases and latent tuberculosis infection. Cases were identified through independent investigations in each state and confirmed based on computed tomography (CT) scan of the chest or lung biopsy findings. Silica dust exposure reduction and effective regulatory enforcement, along with enhanced workplace medical and public health surveillance, are urgently needed to address the emerging public health threat of silicosis in the stone fabrication industry.

An assessment of formaldehyde emissions from laminate flooring manufactured in China.

Formaldehyde emissions from two laminate flooring products, labeled as California Air Resources Board (CARB) compliant, were evaluated. Passive 24-hr samples (n = 79) and real-time measurements were collected following installation and removal of the products in two rooms of similar size. Mean formaldehyde concentrations following installation were 0.038 and 0.022 ppm for Products 1 and 2 respectively, and 7 days after flooring removal the concentrations returned to background pre-installation levels. Both products were also evaluated in a small chamber (ASTM D6007) using Deconstructive (de-laminated product) and Non-Deconstructive (intact product) methods. Deconstructive testing showed that Product 1 exceeded the applicable CARB emission standard by 4-fold, while Product 2 was equivalent to the standard. Non-Deconstructive measurements were far below the Deconstructive results and were used to predict 24-hr steady-state room air concentrations. Based on the products that we tested (one of which was found to not be compliant with the CARB standard), the airborne formaldehyde concentrations measured following installation in a real-world setting would not be expected to elicit adverse acute health effects.

[Malignant mesotheliomas with unknown exposure to asbestos: a re-examination]. / Mesoteliomi maligni con esposizione ad amianto ignota: un riesame a distanza.

INTRODUCTION: Malignant Mesothelioma (MM) is a rare neoplasm associated with asbestos exposure. In 24,5% of MM cases reported to the Lombardy Mesothelioma Registry (LMR), asbestos exposure has been defined as "unknown". OBJECTIVE: To evaluate the cases with "unknown exposure to asbestos" diagnosed in 2000-2004 in agreement with new knowledge about source of asbestos exposure. METHODS: Information regarding exposure has been reviewed in order to select the cases susceptible of further investigations, including: interview of relatives and/or colleagues; further evaluations by local PSAL (Prevention and Security in workplace) services; contact of industrial hygienists; analysis of production processes. The same procedure has been followed for extra-occupational exposure. These cases have been subjected to the LMR evaluation group. RESULTS: Fourthy four out of 364 (12,1%) MM have been reclassified. In 47,7% of the cases, a "possible occupational exposure" has been recognized, 15,9% have been attributed a "certain occupational exposure", while 36,4% an extra-occupational (domestic, environmental and leisure-time) exposure. No significant differences between age, sex, cancer site, diagnostic certainty, residence, year of diagnosis, interviewed subjects were detected. The occupational sector with the highest amount of reclassifications was the clothing production. CONCLUSIONS: The detailed reconstruction of clinical and occupational history and of lifestyle habits of patients affected by MM, close cooperation with Local Services of Occupational Medicine and literature review make it possible for previously overlooked asbestos exposure to be acknowledged.

Comparative assessment of nanomaterial definitions and safety evaluation considerations.

Nanomaterials continue to bring promising advances to science and technology. In concert have come calls for increased regulatory oversight to ensure their appropriate identification and evaluation, which has led to extensive discussions about nanomaterial definitions. Numerous nanomaterial definitions have been proposed by government, industry, and standards organizations. We conducted a comprehensive comparative assessment of existing nanomaterial definitions put forward by governments to highlight their similarities and differences. We found that the size limits used in different definitions were inconsistent, as were considerations of other elements, including agglomerates and aggregates, distributional thresholds, novel properties, and solubility. Other important differences included consideration of number size distributions versus weight distributions and natural versus intentionally-manufactured materials. Overall, the definitions we compared were not in alignment, which may lead to inconsistent identification and evaluation of nanomaterials and could have adverse impacts on commerce and public perceptions of nanotechnology. We recommend a set of considerations that future discussions of nanomaterial definitions should consider for describing materials and assessing their potential for health and environmental impacts using risk-based approaches within existing assessment frameworks. Our intent is to initiate a dialogue aimed at achieving greater clarity in identifying those nanomaterials that may require additional evaluation, not to propose a formal definition.

Liver damage in automotive and industrial workers of the glass.

OBJECTIVE: High doses of organic solvents can cause hepatic disease. We investigated whether exposure to low doses of solvents in automotive and industrial workers may lead to changes in liver tests. METHODS: We studied the liver parameters (glutamic oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), gamma-glutamyl-traspeptidasi (γ-GT), alkaline phosphatase (PHA), total (TB) and direct bilirubin (DB) of 24 workers exposed to organic solvents and of 30 unexposed controls. RESULTS: A significant increase of GOT, GPT and γ-GT was found in exposed workers compared to unexposed controls workers. The ratio GPT/GOT was significantly higher among the exposed compared to controls. CONCLUSIONS: The results confirmed the hypothesis that exposure to low doses of solvents may determine a liver damage.

[Trend of the asbestos related diseases mortality in workers of a company in the province Cremona which manufactured asbestos products]. / Andamento delle patologie e della mortalità asbesto correlate in lavoratori di un'azienda della provincia di Cremona che produceva manufatti in amianto.

The study analyzes the trend of asbestos-related diseases and mortality in workers of a company in the province of Cremona which manufactured asbestos products. It is confirmed that the exposure to a high concentration of asbestos fibers (estimated to more than 20 fibers/cc) strictly correlates with the onset of pathologies from asbestos. In the studied population were found 19 cases of neoplastic diseases (12 mesotheliomas and 7 bronchopulmonary carcinomas). This figure, compared to the company working population, which over the years has been an average of 80 units, while not enabling to calculate an incidence rate due to the lack of reliable data on population, is indicative of a very significant cause-effect relationship since these are neoplastic diseases that can still arise. So it is necessary to continue the health monitoring of formerly exposed workers and appropriate to try to extend it to all workers of the asbestos compartment.

"Car seat dermatitis": a newly described form of contact dermatitis.

Over the last several years, our clinic has documented an increasing trend of contact dermatitis presenting in areas that are in direct contact with certain types of car seats composed of a shiny, nylon-like material. Our practice has encountered these cases in both atopic and nonatopic infants, with a seasonal predilection for the warmer months. This brief report highlights some of the key features of this condition and alerts the clinician to this newly described form of contact dermatitis.

Physicochemical properties and cytotoxicities of Sr-containing biphasic calcium phosphate bone scaffolds.

This study demonstrates a new biomaterial system composed of Sr-containing hydroxyapatite (Sr-HA) and Sr-containing tricalcium phosphate (Sr-TCP), termed herein Sr-containing biphasic calcium phosphate (Sr-BCP). Furthermore, a series of new Sr-BCP porous scaffolds with tunable structure and properties has also been developed. These Sr-BCP scaffolds were obtained by in situ sintering of a series of composites formed by casting various Sr-containing calcium phosphate cement (Sr-CPC) into different rapid prototyping (RP) porous phenol formaldehyde resins, which acted as the negative moulds for controlling pore structures of the final scaffolds. Results show that the porous Sr-BCP scaffolds are composed of Sr-HA and Sr-TCP. The phase composition and the macro-structure of the Sr-BCP scaffold could be adjusted by controlling the processing parameters of the Sr-CPC pastes and the structure parameters of the RP negative mould, respectively. It is also found that both the compressive strength (CS) and the dissolving rate of the Sr-BCP scaffold significantly vary with their phase composition and macropore percentage. In particular, the compressive strength achieves a maximum CS level of 9.20 +/- 1.30 MPa for the Sr-BCP scaffold with a Sr-HA/Sr-TCP weight ratio of 78:22, a macropore percentage of 30% (400-550 microm in size) and a total-porosity of 63.70%, significantly higher than that of the Sr-free BCP scaffold with similar porosity. All the extracts of the Sr-BCP scaffold exhibit no cytotoxicity. The current study shows that the incorporation of Sr plays an important role in positively improving the physicochemical properties of the BCP scaffold without introducing obvious cytotoxicity. It also reveals a potential clinical application for this material system as bone tissue engineering (BTE) scaffold.

Increased risk of lung cancer mortality among residents near an asbestos product manufacturing plant.

We investigated whether individuals exposed to asbestos by living near an asbestos-manufacturing facility experienced increased lung cancer mortality. We studied a neighborhood around such a plant in the central Japanese city of Hashima. From 1943 to 1991 this plant produced insulation and packing material using amosite- and chrysotile-type asbestos fibers. The study group was comprised of 577 households. We obtained demographic information by a questionnaire and determined the underlying cause of death for deceased household members from death certificates. Using hourly meteorological data from local observatories, we estimated relative asbestos concentrations in the plant's vicinity, determined the quartile boundaries, and designated each study subject's quartile of ambient exposure. Finally, we calculated standardized mortality ratios to evaluate the association of residential asbestos with lung cancer risk. Our findings strongly suggest that neighborhood asbestos exposure can increase the risk of lung cancer mortality in men and probably in women.

Asbestos-related diseases in entertainment workers.

OBJECTIVES: To investigate asbestos exposure in 4 patients (3 cases of malignant mesothelioma and 1 case ofpleural plagues) previously employed in the entertainment business. METHODS: The patients were seen at the Occupational Health Unit of the "Clinica del Lavoro Luigi Devoto" in Milan (Italy). Information regarding exposure to asbestos (occupational, environmental, and familial) was collected through a standardized questionnaire administered to the patients by an occupational physician. RESULTS AND CONCLUSION: The presence of asbestos in the building structures and its use were described by all patients. The presence of asbestos in public buildings used for entertainment such as cinemas and theatres was in fact confirmed by the Occupational Health Services of the Local Heath Unit. An occupational aetiology was recognised in all the cases mentioned above, thus leading to the identification of an atypical occupational sector at risk in the past for asbestos exposure,

Are environmental regulations keeping up with innovation? A case study of the nanotechnology industry.

Manufactured nanomaterials entered the marketplace of consumer goods in the mid-1990s. With the exception of pending reporting requirements in Canada, no new regulatory requirements have been imposed on the manufacture or use of nanomaterials or their commercial products, although in the past three years governments, industry, and nongovernmental organizations have questioned the need for new regulatory approaches. The debate hinges on whether current scientific information is sufficient for making risk-based decisions, if nanomaterial effects differ from macroscale products, and how much knowledge about potential risk governments should require before products are brought to market. The debate over when and how to regulate manufactured nanomaterials opens the door for a renewed discussion on regulatory environmental policy and suggests that the public may be demanding increased precaution and assurances from government. How government, in concert with industry and the open market, responds will set the bar for future regulations of emerging technologies.

Serum PCB levels and congener profiles among US construction workers.

BACKGROUND: The presence of PCB in caulking (sealant) material found in masonry buildings has been well-documented in several countries. A recent investigation of 24 buildings in the greater Boston area found that 8 buildings had high PCB levels in caulking materials used around window frames and in joints between masonry blocks. Workers removing caulking material have been shown to have elevated serum PCB levels. METHODS: This project compared serum PCB levels among male workers who installed and/or removed PCB-containing caulking material from buildings in the greater Boston area with reference serum PCB levels from 358 men from the same area. Serum PCB levels were measured in the same laboratory by liquid-liquid extraction, column chromatography clean-up and dual capillary column GC/microECD analysis. RESULTS: When the congener profiles were compared between the reference population and the construction workers, the serum levels of the more volatile, lighter PCBs (di-, tri-and tetrachloro, sum of IUPAC# 6-74) were substantially higher among the construction workers. One of the youngest workers had the lowest total serum PCB levels (sum of 57 congeners) of all 6 workers, but the contribution of more volatile (less chlorinated) PCB congeners (#16, 26,28,33,74,66, and 60) was markedly higher than in other 5 workers and reference men. Only this worker was working on a job that involved removing PCB caulking at the time of the blood sampling. CONCLUSION: While the results of this pilot study are based upon small numbers (6 construction workers who handled PCB caulking), the serum PCB levels among the construction workers exceed the referents. Comparison of the congener profiles suggests that there are substantial differences between the construction workers and the general population samples. These differences, and the similarities of profiles among the construction workers strongly suggest that occupational contact with caulking material can be a major source of PCB exposure for construction workers.

Asbestos products, hazards, and regulation.

Asbestos is present in the United States in a multitude of products used in past decades, and in some products that continue to be imported and domestically produced. We have limited information on the hazards posed by some of these individual products and no information at all on most of them. Legal discovery of corporate documents has shed some light on the use of asbestos in some products and exposures from asbestos in others, sometimes adding considerably to what was in the published literature. But liability concerns have motivated corporate efforts to curtail governmental public health guidance on long-recognized hazards to workers. Liability considerations have also evidently led, in the case of asbestos brake linings, to the support of publication in the scientific literature of review articles denying in the 21st century what had been widely accepted and established in health policy in the 20th century. This report is an effort to illustrate the suppression and emergence of scientific knowledge in a climate of regulation and liability. Examples discussed are vinyl-asbestos flooring, feminine hygiene products, automotive friction materials, and asbestos contamination of other minerals such as talc and vermiculite. Global efforts to deal with the hazards of continuing marketing of asbestos products are also discussed.