Cross-shift and longitudinal changes in FEV1 among wood dust exposed workers.

OBJECTIVES: Acute lung function (LF) changes might predict an accelerated decline in LF. In this study, we investigated the association between cross-shift and longitudinal changes in forced expiratory volume in 1 s (FEV(1)) among woodworkers in a 6-year follow-up study. METHODS: 817 woodworkers and 136 controls participated with cross-shift changes of FEV(1) at baseline and FEV(1) and forced vital capacity at follow-up. Height and weight were measured and questionnaire information on respiratory symptoms, employment and smoking habits was collected. Wood dust exposure was assessed from 3572 personal dust measurements at baseline and follow-up. Cumulative wood dust exposure was assessed by a study-specific job exposure matrix and exposure time. RESULTS: The median (range) of inhalable dust at baseline and cumulative wood dust exposure was 1.0 (0.2-9.8) mg/m(3) and 3.8 (0-7.1) mg year/m(3), respectively. Mean (SD) for %ΔFEV(1)/workday and ΔFEV(1)/year was 0.2 (6.0)%, and -29.1 (41.8) ml. Linear regression models adjusting for smoking, age, height and weight change showed no association between cross-shift and annual change in FEV(1) among woodworkers or controls. Including different exposure estimates, atopy or cross-shift change dichotomised or as quartiles did not change the results. CONCLUSIONS: This study among workers exposed to low levels of wood dust does not support an association between acute LF changes and accelerated LF decline.

Predictors of monoterpene exposure in the Danish furniture industry.

OBJECTIVES: Individuals who work with pine in the furniture industry may be exposed to monoterpenes, the most abundant of which are α-pinene, ß-pinene, and Δ(3)-carene. Monoterpenes are suspected to cause dermatitis and to harm the respiratory system. An understanding of the predictors of monoterpene exposure is therefore important in preventing these adverse effects. These predictors may include general characteristics of the work environment and specific work operations. We sought to assess the extent to which workers are exposed to monoterpenes and to identify possible predictors of monoterpene exposure in the pine furniture industry in Denmark. METHODS: Passive measurements of the levels of selected monoterpenes (α-pinene, ß-pinene, and Δ(3)-carene) were performed on 161 subjects from 17 pine furniture factories in Viborg County, Denmark; one sample was acquired from each worker. Additionally, wood dust samples were collected from 145 workers. Data on potential predictors of exposure were acquired over the course of the day on which the exposure measurements were recorded and could be assigned to one of four hierarchic ordered levels: worker, machine, department, and factory. In addition to univariate analyses, a mixed model was used to account for imbalances within the data and random variation with each of the hierarchically ordered levels. RESULTS: The geometric mean (GM) monoterpene content observed over the 161 measurements was 7.8 mg m(-3) [geometric standard deviation (GSD): 2.4]; the GM wood dust level over 145 measurements was 0.58 mg m(-3) (GSD: 1.49). None of the measured samples exceeded the occupational exposure limit for terpenes in Denmark (25 ppm, 150 mg m(-3)). In the univariate analyses, half of the predictors tested were found to be significant; the multivariate model indicated that only three of the potential predictors were significant. These were the recirculation of air in rooms used for the processing of wood (a factory level predictor), the presence of a supplementary cold air intake (departmental level), and the operation of a glue press (machine level). However, only one factory of the 17 examined used a supplementary cold air intake, and while very high monoterpene levels were observed there, this may be due to factors other than the supplementary intake. In contrast to the situation with wood dust, we found that the bulk of the variation in the data (65%) was attributable to variability on the factory level, with comparatively little being due to the departmental (16%) and machine (0.5%) levels. The fixed terms in the model accounted for 31.8% of the total variance. CONCLUSIONS: The predictors of monoterpenes are not the same as those for wood dust exposure; this has implications for the implementation of preventative measures in factories. In order to decrease monoterpene exposure, efforts should be focused on minimizing the recirculation of air in rooms used for woodworking and on increasing awareness of the importance of effective ventilation and enclosure when operating a glue press.

Wood Dust Exposure Levels and Respiratory Symptoms 6 Years Apart: An Observational Intervention Study Within the Danish Furniture Industry.

OBJECTIVES: Occupational exposure to wood dust can cause respiratory diseases, but few studies have evaluated the impact of declining exposure on health outcome. This study aimed to investigate whether a decline in wood dust exposure between two cross sectional studies performed in 1997-1998 and 2003-2004 was related to the prevalences of respiratory symptoms among woodworkers in a well-defined geographical area. METHODS: Two thousand and thirty-two woodworkers from 54 plants in study 1 and 1889 woodworkers from 52 plants in study 2 returned a questionnaire on respiratory diseases and symptoms, employment and smoking habits. Current individual wood dust exposure level was assessed from 2 study specific job exposure matrix's based on task, factory size and personal passive dust measurements (2217 in study 1 and 1355 in study 2). RESULTS: The median (range) of inhalable dust was 1.0 mg/m3 (0.2-9.8), 0.6 mg/m3 (0.1-4.6) in study 1 and study 2, respectively. In study 2, the prevalence's of self-reported asthma was higher and the prevalence's of respiratory symptoms were lower compared to study 1. In adjusted logistic regression analyses using GEE methodology to account for clustering, dust exposure level could explain the differences in prevalence of coughing, chronic bronchitis and nasal symptoms between study 1 and study 2, while no effect was found for asthma. CONCLUSIONS: A 40% decline in wood dust exposure in a 6 year period may serve as an explanation for the decline in most respiratory symptoms, but do not seems to impact the prevalence of self-reported asthma.

Prenatal Exposure to Nitrate from Drinking Water and Markers of Fetal Growth Restriction: A Population-Based Study of Nearly One Million Danish-Born Children.

BACKGROUND: High levels of nitrate (NO3-) in drinking water cause methemoglobinemia in infants; however, few studies have examined the potential effects of low-level exposure on fetal growth, and the results have been inconsistent. OBJECTIVES: We sought to assess the association between maternal exposure to nitrate in drinking water during pregnancy and offspring size at birth in a nationwide study of full-term (≥37 wk gestation) live-born singletons. METHODS: We estimated maternal nitrate exposure for 898,206 births in Denmark during 1991-2011 by linkage of individual home address(es) with nitrate data from the national monitoring database. Maternal address during pregnancy, infant size at birth [i.e., birth weight, low birth weight (LBW), body length, and birth head circumference] and covariates were compiled from the Danish Civil Registration System, the Danish Medical Birth Register, and The Integrated Database for Longitudinal Labor Market Research. Linear and logistic models with generalized estimating equations were used to account for multiple births to an individual. Nitrate exposure was modeled using five categories and as a log-transformed continuous variable. RESULTS: There was evidence of a decreasing trend in models for term birth weight using categorical or continuous measures of exposure. Modeling exposure continuously, a difference of -9.71 g (95% confidence interval: -14.60, -4.81) was predicted at 25 mg/L (half the value of the European Union drinking water standard) compared with 0 mg/L NO3-. Body length also decreased as nitrate concentrations increased in categorical and continuous models. There was little evidence of an association between NO3- and head circumference or LBW. DISCUSSION: Although the estimated effects were small, our findings for live singleton births to Danish-born parents suggest that maternal intake of nitrate from drinking water may reduce term birth weight and length, which are markers of intrauterine growth. However, there was little evidence for an association between nitrate and head circumference or LBW. Future studies in other populations and with data on dietary sources of nitrate are encouraged to confirm or refute these findings. https://doi.org/10.1289/EHP7331.

Dust exposure and the impact on hospital readmission of farming and wood industry workers for asthma and chronic obstructive pulmonary disease (COPD).

Objectives It is still not well established how occupational air pollutants affect the prognosis of asthma or chronic obstructive pulmonary disease (COPD). This study uses nationwide Danish registers and quantitative dust industry exposure matrices (IEM) for the farming and wood industries to estimate whether previous year dust exposure level impacts hospital readmissions for workers diagnosed with asthma or COPD. Methods We identified all individuals with a first diagnosis of either asthma (769 individuals) or COPD (342 individuals) between 1997 and 2007 and followed them until the next hospital admission for asthma or COPD, emigration, death or 31 December 2007. We included only individuals who worked in either the wood or farming industries at least one year during follow-up. We used logistic regression analysis to investigate associations between dust exposure level in the previous year and hospital readmission, adjusting for sex, age, time since first diagnosis, socioeconomic status, and labor force participation. Results Asthma readmissions for individuals with low and high dust exposure were increased [adjusted rate ratio (RR adj) 2.52, 95% confidence interval (CI) 1.45-4.40] and RR adj2.64 (95% CI 1.52-4.60), respectively. For COPD readmission, the risk estimates were RR adj1.36 (95% CI 0.57-3.23) for low and RR adj1.20 (95% CI 0.49-2.95) for high exposure level in the previous year. For asthma readmission, stratified analyses by type of dust exposure during follow-up showed increased risks for both wood dust [RR adj2.67 (95% CI 1.35-5.26) high exposure level] and farming dust [RR adj3.59 (95% CI 1.11-11.59) high exposure level]. No clear associations were seen for COPD readmissions. Conclusions This study indicates that exposure to wood or farm dust in the previous year increases the risk of hospital readmission for individuals with asthma but not for those with COPD.

Determinants of wood dust exposure in the Danish furniture industry--results from two cross-sectional studies 6 years apart.

OBJECTIVES: This paper investigates determinants of wood dust exposure and trends in dust level in the furniture industry of Viborg County, Denmark, using data from two cross-sectional studies 6 years apart. METHODS: During the winter 1997/1998, 54 factories were visited (hereafter study 1). In the winter 2003/2004, 27 factories were revisited, and personal dust measurements were repeated. In addition, 14 new factories were included (hereafter study 2). A total of 2303 woodworkers participated in study 1, and 2358 measurements from 1702 workers were available. From study 2, 1581 woodworkers participated and 1355 measurements from 1044 workers were available. Information on occupational variables describing potential determinants of exposures like work task, exhaust ventilation, enclosure and cleaning procedures were collected. A total of 2627 measurements and 1907 persons were included in the final mixed model in order to explore determinants of exposure and trends in dust level. RESULTS: The overall inhalable wood dust concentration (geometric means (geometric standard deviation)) has decreased from 0.95 mg/m(3) (2.05) in study 1 to 0.60 mg/m(3) (1.63) in study 2, representing a 7% annual decrease in dust concentration, which was confirmed in the mixed model. From study 1 to study 2 there has been a change towards less manual work and more efficient cleaning methods, but on the contrary also more inadequate exhaust ventilation systems. The following determinants were found to 'increase' dust concentration: sanding; use of compressed air; use of full-automatic machines; manual work; cleaning of work pieces with compressed air; kitchen producing factories and small factories (<20 employees). The following determinants of exposure were found to 'decrease' dust concentration: manual assembling/packing; sanding with adequate exhaust ventilation; adequate exhaust ventilation; vacuum cleaning of machines and special cleaning staff. CONCLUSIONS: Despite a substantial drop in the dust concentration during the last 6 years in the furniture industry in Viborg County, further improvements are possible. There should be more focus on improved exhaust ventilation, professional cleaning methods and avoiding use of compressed air.

Respiratory symptoms and lung function among Danish woodworkers.

A cross-sectional study including 54 furniture factories and three control factories was conducted to survey lung function and prevalence of respiratory symptoms among woodworkers. Spirometry was performed on 2423 persons. Questionnaires regarding respiratory symptoms and wood dust exposure were completed by 2033 woodworkers and 474 controls. Personal passive dust measurements were performed on 1579 persons. The arithmetic mean +/- SD for equivalent inhalable dust was relatively low (1.19 +/- 0.86 mg/m3). Woodworkers had increased frequency of coughing with negative interaction between dust exposure and smoking. A dose-response relationship was seen between dust exposure and asthma symptoms, and a positive interaction for asthma was seen between female gender and dust exposure. Increased frequency of wheezing and a cross-shift decrease in forced expiratory volume in 1 second among workers using pinewood was seen. In conclusion, wood dust exposure might cause respiratory symptoms, despite a relatively low exposure level.

[An outbreak of allergic contact dermatitis caused by 2-hydroxypropyl methacrylate in an anaerobic sealant]. / Allergisk kontakteksem udløst af arbejde med methakrylatbaseret, anaerob metallim.

We report an outbreak of occupational contact dermatitis from an anaerobic sealant. This diagnosis was given to 12 out of 48 exposed workers at two Danish refrigerator factories. Six workers showed a positive patch test reaction to 2-hydroxypropyl methacrylate, a constituent of the sealant. Main causes were insufficient information from the producer and poor work place hygiene.

Immunoglobulin E-mediated sensitization to pine and beech dust in relation to wood dust exposure levels and respiratory symptoms in the furniture industry.

OBJECTIVES: Wood dust exposure may cause Immunoglobulin E (IgE)-mediated allergic diseases. Our objectives were to estimate pine and beech dust sensitization rates among woodworkers and a reference group, explore the association between exposure and sensitization and between sensitization and respiratory symptoms, and finally investigate the impact of proteinogenic specific IgE (sIgE) epitopes on respiratory symptoms. METHODS: In a Danish study among 52 furniture factories and 2 reference factories, we evaluated the workers' asthma and rhinitis status using questionnaires and blood samples collected from 1506 woodworkers and 195 references. Workers with asthma symptoms (N=298), a random study sample (N=399) and a random rhinitis sample (N=100) were evaluated for IgE-mediated sensitization to pine and beech dust. RESULTS: The prevalence of pine and beech sensitization among current woodworkers was 1.7 and 3.1%, respectively. No differences in sensitization rates were found between woodworkers and references, but the prevalence of wood dust sensitization was dose-dependently associated with the current level of wood dust exposure. No relation was observed between wood dust sensitization per se and respiratory symptoms. Only symptomatic subjects had proteinogenic IgE epitopes to pine. Increased odds ratios for sIgE based on proteinogenic epitopes to beech and respiratory symptoms were found, although they were not statistically significant. CONCLUSIONS: Sensitization rates to pine and beech were the same for woodworkers and references but dependent on the current wood dust exposure level. The importance of beech and pine wood sensitization is limited, but may be of clinical significance for a few workers if the IgE epitopes are proteinogenic.

Non-malignant respiratory diseases and occupational exposure to wood dust. Part I. Fresh wood and mixed wood industry.

This paper reviews associations in literature between exposure to wood dust from fresh wood and non-malignant respiratory diseases. Criteria for inclusion are epidemiological studies in English language journals with an internal or external control group describing relationships between wood dust exposure and respiratory diseases or symptoms. The papers took into account smoking, and when dealing with lung function took age into consideration. A total of 25 papers concerning exposure to fresh wood and mixed wood formed the basis of this review. The results support an association between fresh wood dust exposure and asthma, asthma symptoms, coughing, bronchitis, and acute and chronic impairment of lung function. In addition, an association between fresh wood dust exposure and rhino-conjunctivitis was seen across studies. Apart from plicatic acid in western red cedar wood, no causal agent was consistently disclosed. Type 1 allergy is not suspected of being a major cause of wood dust induced asthma. Concurrent exposure to microorganisms and terpenes probably add to the inherent risk of wood dust exposure in the fresh wood industry.

Non-malignant respiratory diseases and occupational exposure to wood dust. Part II. Dry wood industry.

This paper reviews the literature on associations between dry wood dust exposure and non-malignant respiratory diseases. Criteria for inclusion are epidemiological studies in English language journals with an internal or external control group describing relationships between dry wood dust exposure and respiratory diseases or symptoms. Papers took into consideration smoking and when dealing with lung function age. A total of 37 papers forms the basis of this review. The results support an association between dry wood dust exposure and asthma, asthma symptoms, coughing, bronchitis, and acute and chronic impairment of lung function. In addition, an association between wood dust exposure and rhino-conjunctivitis is seen across the studies. Apart from plicatic acid in western red cedar wood, no causal agent has consistently been disclosed. Type 1 allergy is not suspected to be a major cause of wood dust induced asthma.

Determinants of wood dust exposure in the Danish furniture industry.

This paper investigates the relation between wood dust exposure in the furniture industry and occupational hygiene variables. During the winter 1997-98 54 factories were visited and 2362 personal, passive inhalable dust samples were obtained; the geometric mean was 0.95 mg/m(3) and the geometric standard deviation was 2.08. In a first measuring round 1685 dust concentrations were obtained. For some of the workers repeated measurements were carried out 1 (351) and 2 weeks (326) after the first measurement. Hygiene variables like job, exhaust ventilation, cleaning procedures, etc., were documented. A multivariate analysis based on mixed effects models was used with hygiene variables being fixed effects and worker, machine, department and factory being random effects. A modified stepwise strategy of model making was adopted taking into account the hierarchically structured variables and making possible the exclusion of non-influential random as well as fixed effects. For woodworking, the following determinants of exposure increase the dust concentration: manual and automatic sanding and use of compressed air with fully automatic and semi-automatic machines and for cleaning of work pieces. Decreased dust exposure resulted from the use of compressed air with manual machines, working at fully automatic or semi-automatic machines, functioning exhaust ventilation, work on the night shift, daily cleaning of rooms, cleaning of work pieces with a brush, vacuum cleaning of machines, supplementary fresh air intake and safety representative elected within the last 2 yr. For handling and assembling, increased exposure results from work at automatic machines and presence of wood dust on the workpieces. Work on the evening shift, supplementary fresh air intake, work in a chair factory and special cleaning staff produced decreased exposure to wood dust. The implications of the results for the prevention of wood dust exposure are discussed.