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.

Content of clinker and other materials in personal thoracic aerosol samples from cement plants estimated by scanning electron microscopy and energy-dispersive X-ray microanalysis.

OBJECTIVES: To estimate the composition and exposure to clinker and other specific components in personal thoracic dust samples of cement production workers. METHODS: A procedure for the classification of airborne particles in cement production plants was developed based on classification trees. For this purpose, the chemical compositions of 27,217 particles in 29 material samples (clinker, limestone, gypsum, clay, quartz, bauxite, iron source, coal fly ash, and coal) were determined automatically by scanning electron microscopy (SEM) and energy-dispersive X-ray microanalysis (EDX). The concentrations of the major elements in cement (calcium, aluminium, silicon, iron, and sulphur) were used for the classifications. The split criteria of the classification trees obtained in the material samples were used to classify 44,176 particles in 34 personal thoracic aerosol samples. The contents of clinker and other materials were estimated, and the clinker contents were analysed statistically for differences between job types and job tasks. RESULTS: Between 64% and 88% of the particles from material samples were classified as actual materials. The material types with variable composition (clay, coal fly ash, and coal) were classified with the lowest consistency (64% to 67%), while materials with a more limited compositional variation (clinker, gypsum, and quartz) were classified more consistently (76% to 85%). The arithmetic mean (AM) of the clinker content in personal samples was 62.1%, the median was 55.3%, and 95% confidence interval (CI) was 42.6% to 68.1%. No significant differences were observed between job types. However, the clinker content in samples when workers handled materials with high clinker content was significantly higher than when materials with lower clinker content were handled, 85% versus 65% (P = 0.02). The limestone content was AM 14.8%, median 13.2% (95% CI 5.5 to 20.9), whereas the other materials were present with relative abundances of median ≤ 6.4%. DISCUSSION: Automated particle analysis by SEM-EDX followed by classification tree analysis quantified clinker with fairly high consistency when evaluated together with raw materials that are expected to be airborne in cement production plants. The clinker proportions for job types were similar. Tasks a priori ranked by assumed clinker content were significantly different and according to expectations, which supports the validity of the chosen methodology. CONCLUSIONS: The composition of personal samples of mineral aerosols in the cement production industry could be estimated by automated single particle analysis with SEM-EDX and classification by a classification tree procedure. Clinker was the major component in the thoracic aerosol that cement production workers were exposed to. Differences between job types were relatively small and not significant. The clinker content from tasks was in agreement with assumptions.

Development of a quantitative North and Central European job exposure matrix for wood dust.

Wood dust is an established carcinogen also linked to several non malignant respiratory disorders. A major limitation in research on wood dust and its health effects is the lack of (historical) quantitative estimates of occupational exposure for use in general population-based case-control or cohort studies. The present study aimed to develop a multinational quantitative Job Exposure Matrix (JEM) for wood dust exposure using exposure data from several Northern and Central European countries. For this, an occupational exposure database containing 12653 personal wood dust measurements collected between 1978 and 2007 in Denmark, Finland, France, The Netherlands, Norway, and the United Kingdom (UK) was established. Measurement data were adjusted for differences in inhalable dust sampling efficiency resulting from the use of different dust samplers and analysed using linear mixed effect regression with job codes (ISCO-88) and country treated as random effects. Fixed effects were the year of measurement, the expert assessment of exposure intensity (no, low, and high exposure) for every ISCO-88 job code from an existing wood dust JEM and sampling duration. The results of the models suggest that wood dust exposure has declined annually by approximately 8%. Substantial differences in exposure levels between countries were observed with the highest levels in the United Kingdom and the lowest in Denmark and Norway, albeit with similar job rankings across countries. The jobs with the highest predicted exposure are floor layers and tile setters, wood-products machine operators, and building construction labourers with geometric mean levels for the year 1997 between 1.7 and 1.9 mg/m3. The predicted exposure estimates by the model are compared with the results of wood dust measurement data reported in the literature. The model predicted estimates for full-shift exposures were used to develop a time-dependent quantitative JEM for exposure to wood dust that can be used to estimate exposure for participants of general population studies in Northern European countries on the health effects from occupational exposure to wood dust.

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.

Gender differences in respiratory health outcomes among farming cohorts around the globe: findings from the AGRICOH consortium.

Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents.Methods: Cohorts collected data between 1992 and 2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large-scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD).Results: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than non-allergic asthma.Conclusions: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers.

Characterization and pro-inflammatory potential of indoor mold particles.

A number of epidemiological studies find an association between indoor air dampness and respiratory health effects. This is often suggested to be linked to enhanced mold growth. However, the role of mold is obviously difficult to disentangle from other dampness-related exposure including microbes as well as non-biological particles and chemical pollutants. The association may partly be due to visible mycelial growth and a characteristic musty smell of mold. Thus, the potential role of mold exposure should be further explored by evaluating information from experimental studies elucidating possible mechanistic links. Such studies show that exposure to spores and hyphal fragments may act as allergens and pro-inflammatory mediators and that they may damage airways by the production of toxins, enzymes, and volatile organic compounds. In the present review, we hypothesize that continuous exposure to mold particles may result in chronic low-grade pro-inflammatory responses contributing to respiratory diseases. We summarize some of the main methods for detection and characterization of fungal aerosols and highlight in vitro research elucidating how molds may induce toxicity and pro-inflammatory reactions in human cell models relevant for airway exposure. Data suggest that the fraction of fungal hyphal fragments in indoor air is much higher than that of airborne spores, and the hyphal fragments often have a higher pro-inflammatory potential. Thus, hyphal fragments of prevalent mold species with strong pro-inflammatory potential may be particularly relevant candidates for respiratory diseases associated with damp/mold-contaminated indoor air. Future studies linking of indoor air dampness with health effects should assess the toxicity and pro-inflammatory potential of indoor air particulate matter and combined this information with a better characterization of biological components including hyphal fragments from both pathogenic and non-pathogenic mold species. Such studies may increase our understanding of the potential role of mold exposure.

Exposure Determinants of Wood Dust, Microbial Components, Resin Acids and Terpenes in the Saw- and Planer Mill Industry.

OBJECTIVES: Sawmill workers have an increased risk of adverse respiratory outcomes, but knowledge about exposure-response relationships is incomplete. The objective of this study was to assess exposure determinants of dust, microbial components, resin acids, and terpenes in sawmills processing pine and spruce, to guide the development of department and task-based exposure prediction models. METHODS: 2474 full-shift repeated personal airborne measurements of dust, resin acids, fungal spores and fragments, endotoxins, mono-, and sesquiterpenes were conducted in 10 departments of 11 saw- and planer mills in Norway in 2013-2016. Department and task-based exposure determinants were identified and geometric mean ratios (GMRs) estimated using mixed model regression. The effects of season and wood type were also studied. RESULTS: The exposure ratio of individual components was similar in many of the departments. Nonetheless, the highest microbial and monoterpene exposure (expressed per hour) were estimated in the green part of the sawmills: endotoxins [GMR (95% confidence interval) 1.2 (1.0-1.3)], fungal spores [1.1 (1.0-1.2)], and monoterpenes [1.3 (1.1-1.4)]. The highest resin acid GMR was estimated in the dry part of the sawmills [1.4 (1.2-1.5)]. Season and wood type had a large effect on the estimated exposure. In particular, summer and spruce were strong determinants of increased exposure to endotoxin (GMRs [4.6 (3.5-6.2)] and [2.0 (1.4-3.0)], respectively) and fungal spores (GMRs [2.2 (1.7-2.8)] and [1.5 (1.0-2.1)], respectively). Pine was a strong determinant for increased exposure to both resin acid and monoterpenes. Work as a boilerman was associated with moderate to relatively high exposure to all components [1.0-1.4 (0.8-2.0)], although the estimates were based on 13-15 samples only. Cleaning in the saw, planer, and sorting of dry timber departments was associated with high exposure estimates for several components, whereas work with transportation and stock/finished goods were associated with low exposure estimates for all components. The department-based models explained 21-61% of the total exposure variances, 0-90% of the between worker (BW) variance, and 1-36% of the within worker (WW) variances. The task-based models explained 22-62% of the total variance, 0-91% of the BW variance, and 0-33% of the WW variance. CONCLUSIONS: Exposure determinants in sawmills including department, task, season, and wood type differed for individual components, and explained a relatively large proportion of the total variances. Application of department/task-based exposure prediction models for specific exposures will therefore likely improve the assessment of exposure-response associations.

Fungal aerosol composition in moldy basements.

Experimental aerosolization studies revealed that fungal fragments including small fragments in the submicrometer size are released from fungal cultures and have been suggested to represent an important fraction of overall fungal aerosols in indoor environments. However, their prevalence indoors and outdoors remains poorly characterized. Moldy basements were investigated for airborne fungal particles including spores, submicron fragments, and larger fragments. Particles were collected onto poly-L-lysine-coated polycarbonate filters and qualitatively and quantitatively analyzed using immunogold labeling combined with field emission scanning electron microscopy. We found that the total fungal aerosol levels including spores, submicrometer, and larger fragments in the moldy basements (median: 80 × 103  m-3 ) were not different from that estimated in control basements (63 × 103  m-3 ) and outdoor (90 × 103  m-3 ). However, mixed effect modeling of the fungal aerosol composition revealed that the fraction of fragments increased significantly in moldy basements, versus the spore fraction that increased significantly in outdoor air. These findings provide new insight on the compositional variation of mixed fungal aerosols in indoor as compared to outdoor air. Our results also suggest that further studies, aiming to investigate the role of fungal aerosols in the fungal exposure-disease relationships, should consider the mixed composition of various types of fungal particles.

Predictors for Increased and Reduced Rat and Mouse Allergen Exposure in Laboratory Animal Facilities.

Introduction: Exposure to rat and mouse allergens during work in laboratory animal facilities represents a risk for being sensitized and developing allergic diseases, and it is important to keep the exposure level as low as possible. The objective of this study was to characterize the personal Mus m 1 and Rat n 1 exposure during work in laboratory animal facilities, and to investigate the effect of identified predictors of increased and reduced exposure. Methods: Mus m 1 and Rat n 1 were analysed in whole day or task-based personal air samples by enhanced sensitivity sandwich enzyme-linked immunosorbent assay. Information about cage-and-rack systems, tasks, and other conditions known to influence the allergen exposure was registered. Predictors for allergen exposure were identified by multiple linear regression analyses. Results: The median allergen exposure was 3.0 ng m-3 Mus m 1 and 0.5 ng m-3 Rat n 1, with large task-dependent variations among the samples. The highest exposed job group were animal technicians. Cage emptying and cage washing in the cage washroom represented the highest exposure, whereas animal experiments in the lab/operation room represented the lowest exposure, with laminar airflow bench being an exposure-reducing determinant. Cage changing was the highest exposed task in the animal room, where individually ventilated cages (IVCs) were predictors of reduced exposure for both Mus m 1 and Rat n 1, whereas cage-rack systems with open shelves and sliding doors were predictors of increased Rat n 1 exposure. Cages of IVC type with positive air pressure (IVC+) as well as open shelves and sliding doors were strong predictors of increased exposure during cage emptying and cage washing. Conclusions: Significant different exposure levels depending on type of work and task imply different risks of sensitization and allergy development. The fact that IVC+ cages have opposite impact on Mus m 1 and Rat n 1 exposure during different tasks may have positive clinical implications when taken into account.

Pneumoproteins and markers of inflammation and platelet activation in the blood of grain dust exposed workers.

PURPOSE: To investigate if blood biomarkers could indicate early signs of lung damage or cardiovascular risk due to exposure to grain dust. MATERIALS AND METHODS: Pneumoproteins and markers of inflammation and platelet activation were analysed in blood samples of 102 grain elevator and compound feed mill workers. Differences between exposed (n = 67) and controls (n = 35), and associations with exposure measurements and respiratory health were investigated by multiple linear regression analyses. RESULTS: Concentrations of CC-16 and IL-6 were higher in exposed workers compared with controls (p < 0.001 for both), whereas fibrinogen was lower (p = 0.005). Concentrations of CRP, TNF-α, sCD40L and sP-selectin were similar in both groups. Serum CC-16 was significantly higher in workers with farm childhood, regardless of exposure. The impact of farm childhood on CC-16 interacted with smoking. None of the biomarkers were associated with exposure measurements or any of the tested respiratory health parameters. CONCLUSION: Dust exposure induced inflammatory and anti-inflammatory reactions, but did not induce systemic inflammation and had no effect on platelet activation. No cause-effect relationship could be established in spite of relatively high exposure levels, particularly to endotoxin. Whether increased serum CC-16 is an early sign of lung damage or a reversible defense reaction remains unclear.

Exposure to Wood Dust, Microbial Components, and Terpenes in the Norwegian Sawmill Industry.

Sawmill workers are exposed to wood dust (a well-known carcinogen), microorganisms, endotoxins, resin acids (diterpenes), and vapours containing terpenes, which may cause skin irritation, allergy, and respiratory symptoms including asthma. The health effects of most of these exposures are poorly understood as most studies measure only wood dust. The present study assessed these exposures in the Norwegian sawmill industry, which processes predominantly spruce and pine. Personal exposures of wood dust, resin acids, endotoxin, fungal spores and fragments, mono-, and sesquiterpenes were measured in 10 departments in 11 saw and planer mills. The geometric mean (GM) and geometric standard deviation (GSD) thoracic exposures were: 0.09 mg m-3 dust (GSD 2.6), 3.0 endotoxin units (EU) m-3 (GSD 4.9), 0.4 × 105 fungal spores m-3 (GSD 4.2), 2 × 105 fungal fragments m-3 (GSD 3.2), and 1560 ng m-3 of resin acids (GSD 5.5). The GM (GSD) inhalable exposures were: 0.72 mg m-3 dust (2.6), 17 EU m-3 (4.3), 0.4 × 105 fungal spores m-3 (3.8), and 7508 ng m-3 (4.4) of resin acids. The overall correlation between the thoracic and inhalable exposure was strong for resin acid (rp = 0.84), but moderate for all other components (rp = 0.34-0.64). The GM (GSD) exposure to monoterpenes and sesquiterpenes were 1105 µg m-3 (7.8) and 40 µg m-3 (3.9), respectively. Although mean exposures were relatively low, the variance was large, with exposures regularly exceeding the recommended occupational exposure limits. The exposures to spores and endotoxins were relatively high in the dry timber departments, but exposures to microbial components and mono-and sesquiterpenes were generally highest in areas where green (undried) timber was handled. Dust and resin acid exposure were highest in the dry areas of the sawmills. Low to moderate correlation between components (rp ranging from 0.02 to 0.65) suggests that investigations of exposure-response associations for these components (both individually and combined) are feasible in future epidemiological studies.

Fungal Fragments and Fungal Aerosol Composition in Sawmills.

Assessment of exposure to fungi has commonly been limited to fungal spore measurements that have shown associations between fungi and development or exacerbation of different airway diseases. Because large numbers of submicronic fragments can be aerosolized from fungal cultures under laboratory conditions, it has been suggested that fungal exposure is more complex and higher than that commonly revealed by spore measurements. However, the assessment of fungal fragments in complex environmental matrix remain limited due to methodological challenges. With a recently developed immunolabeling method for field emission scanning electron microscope (FESEM), we could assess the complex composition of fungal aerosols present in personal thoracic samples collected from two Norwegian sawmills. We found that large fungal fragments (length >1 µm) dominated the fungal aerosols indicating that the traditional monitoring approach of spores severely underestimate fungal exposure. The composition of fungal aerosols comprised in average 9% submicronic fragments, 62% large fragments, and 29% spores. The average concentrations of large and submicronic fragments (0.2-1 µm) were 3 × 105 and 0.6 × 105 particles m-3, respectively, and correlated weakly with spores (1.4 × 105 particles m-3). The levels of fragments were 2.6 times higher than the average spore concentration that was close to the proposed hazardous level of 105 spores per m3. The season influenced significantly the fungal aerosol concentrations but not the composition. Furthermore, the ratio of spores in the heterogeneous fungal aerosol composition was significantly higher in saw departments as compared to sorting of green timber departments where the fungal fragments were most prevalent. Being the dominating particles of fungal aerosols in sawmills, fungal fragments should be included in exposure-response studies to elucidate their importance for health impairments. Likewise, the use of fungal aerosol composition in such studies should be considered.

Job Tasks as Determinants of Thoracic Aerosol Exposure in the Cement Production Industry.

Background: The aims of this study were to identify important determinants and investigate the variance components of thoracic aerosol exposure for the workers in the production departments of European cement plants. Methods: Personal thoracic aerosol measurements and questionnaire information (Notø et al., 2015) were the basis for this study. Determinants categorized in three levels were selected to describe the exposure relationships separately for the job types production, cleaning, maintenance, foreman, administration, laboratory, and other jobs by linear mixed models. The influence of plant and job determinants on variance components were explored separately and also combined in full models (plant&job) against models with no determinants (null). The best mixed models (best) describing the exposure for each job type were selected by the lowest Akaike information criterion (AIC; Akaike, 1974) after running all possible combination of the determinants. Results: Tasks that significantly increased the thoracic aerosol exposure above the mean level for production workers were: packing and shipping, raw meal, cement and filter cleaning, and de-clogging of the cyclones. For maintenance workers, time spent with welding and dismantling before repair work increased the exposure while time with electrical maintenance and oiling decreased the exposure. Administration work decreased the exposure among foremen. A subjective tidiness factor scored by the research team explained up to a 3-fold (cleaners) variation in thoracic aerosol levels. Within-worker (WW) variance contained a major part of the total variance (35-58%) for all job types. Job determinants had little influence on the WW variance (0-4% reduction), some influence on the between-plant (BP) variance (from 5% to 39% reduction for production, maintenance, and other jobs respectively but an 79% increase for foremen) and a substantial influence on the between-worker within-plant variance (30-96% for production, foremen, and other workers). Plant determinants had little influence on the WW variance (0-2% reduction), some influence on the between-worker variance (0-1% reduction and 8% increase), and considerable influence on the BP variance (36-58% reduction) compared to the null models. Conclusion: Some job tasks contribute to low levels of thoracic aerosol exposure and others to higher exposure among cement plant workers. Thus, job task may predict exposure in this industry. Dust control measures in the packing and shipping departments and in the areas of raw meal and cement handling could contribute substantially to reduce the exposure levels. Rotation between low and higher exposed tasks may contribute to equalize the exposure levels between high and low exposed workers as a temporary solution before more permanent dust reduction measures is implemented. A tidy plant may reduce the overall exposure for almost all workers no matter of job type.

Bakers' exposure to flour dust.

We aimed to characterize bakers' personal exposure to airborne flour dust with respect to the health-related aerosol fractions inhalable, extrathoracic, and thoracic dust, and to examine possible production-related determinants of dust exposure. Sixty-eight bakers from 7 bakeries in Bergen, Norway (2009-2012) participated in the exposure assessment, comprising full-shift personal samples of inhalable dust (n = 107) and thoracic dust (n = 61). The relation between possible determinants and exposure was estimated using mixed effects models, while associations between the various aerosol fractions across task groups and type of bakeries were described by Pearson's correlation coefficients. Bakers' overall geometric mean personal exposure to inhalable, extrathoracic, and thoracic dust were 2.6 mg/m3 (95% CI: 2.0, 3.2), 2.2 mg/m3 (95% CI: 1.9, 2.7), and 0.33 mg/m3 (95% CI 0.3, 0.4), respectively. A total of 29% of the measurements of inhalable dust were above the Norwegian Occupational Exposure Limit of 3 mg/m3. The exposure variability of inhalable dust could not be explained by any of the examined production-related determinants, while the daily production volume explained 18% of the variance in thoracic dust exposure. Overall, the thoracic dust represented 15% of the inhalable dust, being rather stable across the production-related determinants. The overall correlation between inhalable and thoracic dust was nevertheless moderate (r = 0.52, p < 0.001), with the highest correlation for craft bakers (r = 0.62) and no correlation during dough forming (r = 0.01). Bakers are exposed to flour dust at a level that most likely represents an excess risk of developing chronic diseases of the respiratory system, and a decrease of present exposure level is imperative. Extrathoracic dust-likely the most relevant sub-fraction in respect to flour-induced sensitization and occupational rhinitis-represented the main proportion of the measured inhalable dust. The variation in correlation coefficients between the dust fractions across bakery types and task groups underlines the need of more knowledge about how these aerosol fractions are distributed across the production process and bakery types.

Cross-shift study of exposure-response relationships between bioaerosol exposure and respiratory effects in the Norwegian grain and animal feed production industry.

OBJECTIVE: We have studied cross-shift respiratory responses of several individual bioaerosol components of the dust in the grain and feed industry in Norway. METHODS: Cross-shift changes in lung function and nasal congestion, as well as in respiratory and systemic symptoms of 56 exposed workers and 36 referents, were recorded on the same day as full-shift exposure to the inhalable aerosol fraction was assessed. Exposure-response associations were investigated by regression analysis. RESULTS: The workers were exposed on average to 1.0 mg/m(3) of grain dust, 440 EU/m(3) of endotoxin, 6 µg/m(3) of ß-1,3-glucans, 17×10(4)/m(3) of bacteria and 4×10(4)/m(3) of fungal spores during work. The exposure was associated with higher prevalence of self-reported eye and airway symptoms, which were related to the individual microbial components in a complex manner. Fatigue and nose symptoms were strongest associated with fungal spores, cough with or without phlegm was associated with grain dust and fungal spores equally strong and wheeze/tight chest/dyspnoea was strongest associated with grain dust. Bioaerosol exposure did not lead to cross-shift lung function decline, but several microbial components had influence on nose congestion. CONCLUSIONS: Exposure to fungal spores and dust showed stronger associations with respiratory symptoms and fatigue than endotoxin exposure. The associations with dust suggest that there are other components in dust than the ones studied that induce these effects.

Occupational Exposure to Bioaerosols in Norwegian Crab Processing Plants.

INTRODUCTION: Aerosolization of components when processing king crab (Paralithodes camtschaticus) and edible crab (Cancer pagurus) may cause occupational health problems when inhaled by workers. METHODS: A cross-sectional study was carried out in three king crab plants and one edible crab plant. Personal exposure measurements were performed throughout work shifts. Air was collected for measurement of tropomyosin, total protein, endotoxin, trypsin, and N-acetyl-ß-d-glucosaminidase (NAGase). T-tests and ANOVAs were used to compare the levels of exposure in the different plants and areas in the plants. RESULTS: Total protein and tropomyosin levels were highest in the edible crab plant, endotoxin levels were highest in king crab plants. King crab exposure levels were highest during raw processing. Tropomyosin levels were highest during raw king crab processing with geometric mean (GM) 9.6 versus 2.5ng m(-3) during cooked processing. Conversely, edible crab tropomyosin levels were highest during cooked processing with GM 45.4 versus 8.7ng m(-3) during raw processing. Endotoxin levels were higher in king crab plants than in the edible crab plant with GM = 6285.5 endotoxin units (EU) m(-3) versus 72 EU m(-3). In the edible crab plant, NAGase levels were highest during raw processing with GM = 853 pmol4-methylumbelliferone (MU) m(-3) versus 422 pmol4-MU m(-3) during cooked processing. Trypsin activity was found in both king crab and edible crab plants and levels were higher in raw than cooked processing. Differences in exposure levels between plants and worker groups (raw and cooked processing) were identified. CONCLUSIONS: Norwegian crab processing workers are exposed to airborne proteins, tropomyosin, endotoxins, trypsin, and NAGase in their breathing zone. Levels vary between worker groups and factories.

Thoracic dust exposure is associated with lung function decline in cement production workers.

We hypothesised that exposure to workplace aerosols may lead to lung function impairment among cement production workers.Our study included 4966 workers in 24 cement production plants. Based on 6111 thoracic aerosol samples and information from questionnaires we estimated arithmetic mean exposure levels by plant and job type. Dynamic lung volumes were assessed by repeated spirometry testing during a mean follow-up time of 3.5 years (range 0.7-4.6 years). The outcomes considered were yearly change of dynamic lung volumes divided by the standing height squared or percentage of predicted values. Statistical modelling was performed using mixed model regression. Individual exposure was classified into quintile levels limited at 0.09, 0.89, 1.56, 2.25, 3.36, and 14.6 mg·m(-3), using the lowest quintile as the reference. Employees that worked in administration were included as a second comparison group.Exposure was associated with a reduction in forced expiratory volume in 1 s (FEV1), forced expiratory volume in 6 s and forced vital capacity. For FEV1 % predicted a yearly excess decline of 0.84 percentage points was found in the highest exposure quintile compared with the lowest.Exposure at the higher levels found in this study may lead to a decline in dynamic lung volumes. Exposure reduction is therefore warranted.

Profiling of 3-hydroxy fatty acids as environmental markers of endotoxin using liquid chromatography coupled to tandem mass spectrometry.

3-Hydroxy acids are constituents of the lipid A part of lipopolysaccharides and may potentially be used as chemical markers of endotoxin. While commercial enzymatic assays, such as the widely used Limulus amebocyte lysate (LAL) assay, commonly detect merely the water-soluble fraction of the bioactive endotoxin, the chemical approach aims to estimate the total amount of endotoxin present in a sample. Our objective was to develop a simple method for quantitative profiling of 3-hydroxy fatty acids in occupational and environmental samples based on detection with HPLC-MS/MS. We included eleven 3-hydroxy fatty acids (3-hydroxyoctanoic acid to 3-hydroxyoctadecanoic acid) in the HPLC-MS/MS based method, which involved base hydrolysis of filter samples using 1M sodium hydroxide and removal of the base as well as concentration of the fatty acids using solid-phase extraction on a functionalized polystyrene-divinylbenzene polymer. Recovery trials from spiked glass fiber filters, using threo-9,10-dihydroxyhexadecanoic acid as internal standard, gave an overall recovery of 54-86% for 3-hydroxy fatty acids of medium chain length (3-hydroxynonanoic to 3-hydroxypentadecanoic acid). 3-Hydroxyoctanoic acid and the longer chain fatty acids were more problematic yielding overall spike recoveries of 11-39%. While the 3-hydroxy fatty acid profile of pure lipopolysaccharides was dominated by 3-hydroxydecanoic, 3-hydroxydodecanoic and 3-hydroxytetradecanoic acid the aqueous phase from drilling mud contained in addition relatively high amounts of 3-hydroxyoctanoic and 3-hydroxynonanoic acid. Endotoxin activity as measured by the LAL assay was reasonably correlated (R(2)=0.54) to the sum of 3-hydroxydecanoic acid, 3-hydroxydodecanoic acid and 3-hydroxytetradecanoic acid in these samples.

Relationships between Personal Measurements of 'Total' Dust, Respirable, Thoracic, and Inhalable Aerosol Fractions in the Cement Production Industry.

AIMS: The aims of this study were to examine the relationships and establish conversion factors between 'total' dust, respirable, thoracic, and inhalable aerosol fractions measured by parallel personal sampling on workers from the production departments of cement plants. 'Total' dust in this study refers to aerosol sampled by the closed face 37-mm Millipore filter cassette. METHODS: Side-by-side personal measurements of 'total' dust and respirable, thoracic, and inhalable aerosol fractions were performed on workers in 17 European and Turkish cement plants. Simple linear and mixed model regressions were used to model the associations between the samplers. RESULTS: The total number of personal samples collected on 141 workers was 512. Of these 8.4% were excluded leaving 469 for statistical analysis. The different aerosol fractions contained from 90 to 130 measurements and-side-by side measurements of all four aerosol fractions were collected on 72 workers.The median ratios between observed results of the respirable, 'total' dust, and inhalable fractions relative to the thoracic aerosol fractions were 0.51, 2.4, and 5.9 respectively. The ratios between the samplers were not constant over the measured concentration range and were best described by regression models. Job type, position of samplers on left or right shoulder and plant had no substantial effect on the ratios. CONCLUSIONS: The ratios between aerosol fractions changed with different air concentrations. Conversion models for estimation of the fractions were established. These models explained a high proportion of the variance (74-91%) indicating that they are useful for the estimation of concentrations based on measurements of a different aerosol fraction. The calculated uncertainties at most observed concentrations were below 30% which is acceptable for comparison with limit values (EN 482, 2012). The cement industry will therefore be able to predict the health related aerosol fractions from their former or future measurements of one of the fractions.

Can selection explain the protective effects of farming on asthma?

INTRODUCTION AND OBJECTIVE: Reduced asthma and allergy risks in farmers have been ascribed to microbial exposures. However, selection may also play a role and this was assessed in two Scandinavian farming populations. MATERIALS AND METHODS: Asthma prevalence in 739 Danish farming students was compared to that of 1,105 siblings. 8,482 Norwegian farmers were also compared with 349 early retired farmers. RESULTS: The prevalence of ever-asthma was 5.4% in farming students and 5.2% in siblings (OR 1.1; 95%CI 0.73-1.7). Current asthma in farmers was 3.0% compared to 6.3% in farmers who had retired early (OR 1.8, 95%CI 1.1-2.9). Adjustments for early retirement increased the asthma prevalence by 0.3-0.6%. Farmers who had changed production were more likely to have asthma (OR 9.8, 95% CI 6.0-16). CONCLUSIONS: No healthy worker selection into farming was observed and changes in asthma prevalence due to early retirement were small. Selection effects are therefore unlikely to explain the protective effects of farming on asthma.