Occupational exposure to UV light and mortality from multiple sclerosis.

BACKGROUND: The etiology of multiple sclerosis (MS) is largely unknown; low exposure to ultraviolet (UV) light has been a suggested risk factor. The aim of this study was to investigate whether occupational exposure to UV light reduces the risk of death from MS. METHODS: The cohort was based on all individuals in the Swedish census in 1980. All MS-related deaths were identified in the national registry of causes of death. A job-exposure matrix was developed to classify the occupational exposure to UV light. RESULTS: MS was recorded as a cause of the death for 839 individuals. The risk of MS-related death decreased with increasing occupational exposure to UV light. The relative risk adjusted for age, sex, and socioeconomic status was 0.48 (95% CI 0.28-0.80) in the high-exposure group and 0.88 (95% CI 0.73-1.06) in the intermediate-exposure group. CONCLUSIONS: Occupational exposure to UV light was associated with a reduced risk of MS. Our findings are corroborated by previous observations that UV light has a preventive role in the development of MS, although the possibility of reversed causality cannot be completely ruled out.

Mortality, morbidity and occupational exposure to airway-irritating agents among men with a respiratory diagnosis in adolescence.

OBJECTIVES: To examine the influence of an airway diagnosis in adolescence on future health and occupation in Swedish men. METHODS: Data were collected from the linkage of four Swedish national registers: the Military Service Conscription Register, the Population and Housing Censuses, the Inpatient Care Register and the National Cause of Death Register. A job-exposure matrix for airway-irritating substances was developed for application on the conscription cohort. The cohort included 49 321 Swedish men born 1949-51. Three groups-(1) healthy, (2) asthmatics (mild and severe asthma) and (3) subjects with allergic rhinitis without concurrent asthma-were identified at conscription and analysed for mortality, in-patient care and strategies for choice of occupation with emphasis on airway-irritating job exposure. Analyses were adjusted for smoking and childhood socioeconomic position. RESULTS: The prevalence of total asthma was 1.8%, severe asthma 0.45% and allergic rhinitis 2.7%. Mortality for all causes was significantly higher in total asthma, hazard ratio (HR) 1.49 (95% CI 1.00 to 2.23), and lower in allergic rhinitis, HR 0.52 (95% CI 0.30 to 0.91). Asthma was a risk factor for inpatient care while allergic rhinitis was associated with less in-patient care (odds ratio (OR) for total asthma 1.16 (95% CI 1.00 to 1.34), severe asthma 1.38 (95% CI 1.04 to 1.85), allergic rhinitis 0.92 (95% CI 0.82 to 1.03)). Those with asthma tended to avoid jobs with a high probability for airway-irritating exposure (OR 0.88, 95% CI 0.71 to 1.09), but not to the same extent as subjects with allergic rhinitis (OR 0.58, 95% CI 0.47 to 0.70) (ORs from 1990). CONCLUSION: Subjects with asthma did not change their exposure situation to the same extent as subjects with allergic rhinitis. Further, asthmatics had an increased risk for morbidity and mortality compared to healthy subjects and subjects with allergic rhinitis.

Parkinson's disease and other basal ganglia or movement disorders in a large nationwide cohort of Swedish welders.

INTRODUCTION: Although it has been hypothesised that metal welding and flame cutting are associated with an increased risk for Parkinson's disease due to manganese released in the welding fume, few rigorous cohort studies have evaluated this risk. METHODS: The authors examined the relation between employment as a welder and all basal ganglia and movement disorders (ICD-10, G20-26) in Sweden using nationwide and population based registers. All men recorded as welders or flame cutters (n = 49,488) in the 1960 or 1970 Swedish National Census were identified and their rates of specific basal ganglia and movement disorders between 1964 and 2003 were compared with those in an age and geographical area matched general population comparison cohort of gainfully employed men (n = 489,572). RESULTS: The overall rate for basal ganglia and movement disorders combined was similar for the welders and flame cutters compared with the general population (adjusted rate ratio (aRR) = 0.91 (95% CI 0.81 to 1.01). Similarly, the rate ratio for PD was 0.89 (95% CI 0.79 to 0.99). Adjusted rate ratios for other individual basal ganglia and movement disorders were also not significantly increased or decreased. Further analyses of Parkinson's disease by attained age, time period of follow up, geographical area of residency, and educational level revealed no significant differences between the welders and the general population. Rates for Parkinson's disease among welders in shipyards, where exposures to welding fumes are higher, were also similar to the general population (aRR = 0.95; 95% CI 0.70 to 1.28). CONCLUSION: This nationwide record linkage study offers no support for a relation between welding and Parkinson's disease or any other specific basal ganglia and movement disorders.

Occupational magnetic field exposure among women in Stockholm County, Sweden.

BACKGROUND: Most epidemiological studies on adverse health effects among women in relation to occupational magnetic field exposure have been based on information about men's exposure. AIMS: To create a job-exposure matrix for occupational exposure to extremely low frequency magnetic fields among women. METHODS AND RESULTS: Measurements were performed using personal magnetic field meters (Emdex Lite) carried by the subjects for 24 hours on a normal workday. Subjects were volunteer women working in the occupations identified as common among women in Stockholm County based on the 1980 census. A total of 471 measurements were made in 49 different occupations, with a minimum of 5 and a maximum of 24 measurements in each occupation. The included occupations cover about 85% of the female population gainfully employed in 1980. Parameters representing average and peak magnetic field exposures, temporal change in the exposure, and proportion of time spent above certain exposure levels were calculated both for the workday and for the total 24 hour period grouped by occupational titles. The occupations with higher than average exposure were cashiers, working proprietors in retail trade, air stewardesses, dental nurses, cooks, post-office clerks and kitchen maids. CONCLUSIONS: This new job-exposure matrix substantially increases the knowledge about magnetic field exposure among women and can be used for exposure assessment in future studies.

Paternal occupational exposures and childhood cancer.

The objective of the study described here was to test the hypothesis that paternal occupational exposure near conception increases the risk of cancer in the offspring. We conducted a cohort study based on a population of 235,635 children born shortly after two different censuses in Sweden. The children were followed from birth to 14 years, and cases of cancer were identified in the Swedish Cancer Registry. Occupational hygienists assessed the probability of exposure to different agents in each combination of the father's industry and occupation as reported in the censuses. We also analyzed individual job titles. We compared the cancer incidence among children of exposed fathers to that among children of unexposed fathers using Cox proportional hazards modeling. The main findings were an increased risk of nervous system tumors related to paternal occupational exposure to pesticides [relative risk (RR) = 2.36; 95% confidence interval (CI), 1.27-4.39] and work as a painter (RR = 3.65; 95% CI, 1.71-7.80), and an increased risk of leukemia related to wood work by fathers (RR = 2.18; 95% CI, 1.26-3.78). We found no associations between childhood leukemia and paternal exposure to pesticides or paint. Our results support previous findings of an increased risk of childhood brain tumors and leukemia associated with certain paternal occupational exposures. Some findings in previous studies were not confirmed in this study.

Cancer incidence and work place exposure among Swedish biomedical research personnel.

OBJECTIVE: This cohort study aimed to elucidate cancer occurrence in relation to occupational exposure to specific chemical, biological and physical agents among biomedical research laboratory personnel in Sweden. METHODS: Standardized incidence ratios (SIRs) for the period 1970-1994 were calculated for specific exposures in the laboratory group (n = 3,277) and for personnel working in non-laboratory departments (n = 2,011), as an internal reference group. Expected numbers were based on national cancer rates. RESULTS: The total number of cancer cases was lower than expected in both laboratory and non-laboratory personnel. Elevated SIRs were noted for malignant melanoma among female laboratory employees for whom use was reported of solvents (SIR 2.73; CI 1.10-5.63) and of selected carcinogenic (International Agency for Research on Cancer (IARC) group 2B) agents (SIR 3.15; CI 1.16-6.85). A light increase of the risk estimate for breast cancer was also observed. CONCLUSIONS: In general, there were few cases of cancer in this comparatively young cohort, but the findings give some indication of increased risks for malignant melanoma in female laboratory personnel after exposure to organic solvents or substances classified by IARC as being possibly carcinogenic.

Evaluation of the Q16 questionnaire on neurotoxic symptoms and a review of its use.

OBJECTIVES: The questionnaire 16 (Q16) is commonly used to study prevalences of neurotoxic symptoms among workers exposed to organic solvents. It has also been recommended that exposed workers reporting more than six symptoms should be referred for further examination of possible chronic toxic encephalopathy. It would be useful to know whether symptoms reported in the questionnaire also reflect impairment of similar functions measured with objective or semiobjective methods in a formerly highly exposed group. METHODS: 135 painters and 71 carpenters answered the Q16, were interviewed about symptoms compatible with an organic brain damage, and took a battery of psychometric tests. A subsample of 52 painters and 45 carpenters were interviewed for psychiatric diagnosis according to Diagnostic and Statistical Manual for Mental Disorders, 3rd version (DSM III) and their vibration thresholds in hands and feet were measured. The entire group was followed up in the register of diagnoses at early retirement 1971-93. The lifetime exposure to organic solvents was assessed. Current exposure to organic solvents was found to be low or none. RESULTS: The prevalence of people with more than six symptoms in the Q16 rose with increasing cumulative exposure to solvents. The sensitivity of the questionnaire (more than six symptoms) to detect people who were assessed to exhibit symptoms compatible with an organic brain damage was only 38%. One of seven people who had retired early with a diagnosis compatible with a chronic toxic encephalopathy, and two of five people with a psychiatric diagnosis compatible with this condition, had more than six symptoms in the Q16. The agreement between Q16 replies and psychometric test results, as well as other examinations, was low. CONCLUSIONS: The notable exposure-response relation indicates that the questionnaire is useful for comparison of groups with different exposures to organic solvents. There was low agreement between the number of symptoms on the questionnaire and the assessment of symptoms compatible with organic brain damage, as well as psychiatric, or early retirement diagnoses compatible with chronic toxic encephalopathy. The questionnaire does not seem useful for screening of patients with chronic toxic encephalopathy in groups without ongoing exposure to organic solvents.

Glioma and occupational exposure in Sweden, a case-control study.

OBJECTIVES: The aim of the study was to analyse whether any job titles, industrial codes, and certain occupational exposures were associated with an increased risk of glioma. METHODS: A population based case-control study of incident primary brain tumours in adults was carried out in Uppsala, Sweden in the period 1987-90. The study included 192 cases of glioma and 192 matched controls. It also included cases with other tumours of the central nervous system with matched controls. Information from all 343 controls was used in this study. Information was collected by means of a questionnaire that was sent to all subjects. An occupational hygienist reviewed the questionnaires for self reported exposures to substances and assessed whether these reported exposures were plausible or not in the corresponding occupation. RESULTS: The kappa coefficient for those classified by the two methods ranged between 0.46 and 0.88, and they were almost the same for cases and controls. For men exposed to solvents a relative risk (RR) of 2.6 (95% CI 1.3 to 5.2) was found. For men exposed to pesticides the RR was 1.8 (95% CI 0.6 to 5.1), and for plastic materials the RR was 3.6 (95% CI 1.0 to 12.4). For men employed in forestry and logging the RR was 2.2 (95% CI 0.9 to 5.3) and in basic metal industries 2.0 (95% CI 1.0 to 4.0). CONCLUSION: An increased risk of glioma was associated with use of solvents, pesticides, and plastic materials but this should be interpreted with some caution.

Neuropsychiatric function of housepainters with previous long-term heavy exposure to organic solvents.

Neuropsychiatric effects were examined among 206 men, of whom 135 had been house painters and 71 had been house carpenters, affiliated with their respective trade unions for at least 10 years before 1970. Their lifetime organic solvent exposure was evaluated through the aid of an interview. Relevant potential confounding factors were accounted for in the statistical analysis. Neuropsychiatric symptoms compatible with chronic toxic encephalopathy were more common among the painters than among the carpenters, and these symptoms became increasingly prevalent with increasing cumulative solvent exposure. On only one of 12 psychometric tests, block design, did the painters perform worse than the carpenters, and in this test the painters' performance deteriorated with increasing cumulative exposure. For the majority of the psychometric tests, and for the coordination tests, there were no differences between the painters and carpenters, but the painters with "low" exposure tended to show better, and "heavily" exposed painters worse, results than the carpenters. The 52 painters with the heaviest cumulative exposures and 45 carpenters were examined for psychiatric diagnosis according to DSM-III, with electroencephalography and auditory evoked potential, P-300. Three painters and two carpenters had diagnoses compatible with an organic mental disorder. There were no overall differences between the painters and carpenters, either for the visually examined electroencephalograms or the P-300 latencies. The excess of neuropsychiatric symptoms among the painters was probably causally linked to solvent exposure. However, these symptoms seemed only rarely, if ever, serious enough to entail a psychiatric diagnosis. Concerning other outcomes, the investigation may not lead to a determination of whether the exposure-response relationship among the painters, with no difference between the entire group of painters and carpenters, is caused by solvent exposure or by selection factors within the group of painters.

Liver function tests and urinary albumin in house painters with previous heavy exposure to organic solvents.

The serum activities or concentrations of aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), alkaline phosphatase (ALP), albumin, gamma-glutamyl transpeptidase (GGT), bilirubin (BIL), cholic acid (CHOL), chenodeoxycholic acid (CHENO), and transferrin with isoelectric point 5.7, and the urinary excretion of albumin were determined among male current or former house painters (n = 135) and house carpenters (n = 71) who had worked in their trades for at least 10 years before 1970. Workers who showed a value above the 90th percentile among the carpenters in at least one of the tests ASAT, ALAT, GGT, BIL, CHOL, or CHENO were regarded as showing "possible signs of liver dysfunction". Each participant's lifetime solvent exposure was evaluated by interview. The painters were divided into categories with low, intermediate, and heavy cumulative exposure during life (LTSE) or during the most exposed year (MEYSE). All participants stated none or slight recent exposure. The prevalence of possible signs of liver dysfunction increased with solvent exposure category according to LTSE as well as MEYSE with a numerically higher risk estimate in the heavy exposure category for MEYSE than for LTSE. ALP activity increased with exposure category according to both exposure estimates. This increase seemed to be due to an interaction between exposure to solvents and current or previous long term intake of medicines potentially toxic to the liver. None of these results was affected by whether or not the subjects had been exposed to solvents during the year before the investigation. The exposure to solvents was not significantly related to any other outcome variable. It is concluded that long term heavy exposure to solvents may elicit changes in conventional liver function tests indicative of a mild chronic effect on the liver. The findings also suggest that heavy solvent exposure during short time periods is a more likely cause of the findings than lifetime cumulative solvent exposure and that an interaction between solvent exposure and medicines potentially harmful to the liver may be important in the causation of the effects.

Neuroendocrine effects in printing workers exposed to toluene.

The effect of exposure to toluene on plasma concentrations of testosterone, prolactin, luteinising (LH) and follicle stimulating (FSH) hormones was investigated in 47 rotogravure printers (time weighted average air toluene below 80 ppm; blood toluene concentration post-shift 0.19-7.99 mumol/l) and compared with a reference group. Increasing exposure concentrations of toluene (concentrations less than 5 to greater than 45 ppm) were significantly associated with decreasing plasma concentrations of LH (tau = -0.21, p = 0.003) and testosterone (tau = -0.25, p = 0.02). No correlation was found between cumulative exposure (ppm x years) and plasma hormone concentrations. The associations with exposure were present even when nine printers with heavy alcohol consumption were excluded. The study indicates an effect of low toluene exposure on the hypothalamus-pituitary axis, with a secondary decrease in testosterone secretion.

Diagnoses of alcohol abuse and other neuropsychiatric disorders among house painters compared with house carpenters.

The incidence of alcoholism and the incidence of other neuropsychiatric diagnoses were compared between the 767 house painters and the 1212 house carpenters, born in 1925 or later, who were members of the Stockholm branches of their respective trade unions in 1965 and who had been members for at least 10 years before 1970. Four different outcome registers were used: (1) the alcohol crime register, which contained all persons who had broken any law regulating the handling and consumption of alcohol (follow up period 1972-6). (2) The register of diagnoses at early retirement (follow up period 1971-84). (3) The register of diagnoses at discharge from inpatient psychiatric care (follow up period 1968-83). (4) The register of causes of death (follow up period 1965-86). Exposures to solvents and consumption of alcohol were evaluated by interviews with samples of the cohorts. A high average cumulative exposure to solvents was found among the painters. The mean consumption of alcohol was similar in the two cohorts. The incidence of diagnoses of neuropsychiatric disorders was higher in painters than in carpenters in all registers. Alcoholism was the most common neuropsychiatric disorder diagnosed and showed the highest relative risk. The excess of alcoholism among the painters was, however, due singularly to painters who had several registrations in the alcohol crime register or diagnoses of alcoholism in multiple registers. Thus the study implies that excessive alcohol consumption or severe damage due to alcohol, or both, but not less severe problems, were more common in painters than in carpenters. This suggests an interaction between exposure to solvents and intake of alcohol causing an increase in diagnosis of alcoholism among painters.

Hormone status in occupational toluene exposure.

Twenty toluene-exposed rotogravure printers, without signs of solvent-induced toxic encephalopathy, had lower median plasma levels of follicle stimulating hormone (FSH) (3.2 vs. 4.9 IU/L; p = .02) and luteinizing hormone (LH) (6.4 vs. 7.2 IU/L; p = .05) and also lower serum levels of free testosterone (7.8 vs. 86.8 pmol/L; p = .05), respectively, than 44 unexposed referents. The individual time-weighted toluene levels in air were 36 (median; range 8-111) ppm. The printers' median toluene levels in blood were 1.7 (1.0-6.6) mumol/l, and in subcutaneous adipose tissue 5.7 (2.5-21) mg/kg fat. There was a negative association between blood toluene and plasma levels of prolactin. In eight printers, the levels of FSH and LH increased during a 4 week vacation, while the levels of thyroid stimulating hormone, free triiodothyronine, and free thyroxine decreased during the same period. The results indicate a slight, reversible effect of toluene on the cortical level or on the hypothalamic-pituitary axis at exposures well below the permissible levels, possibly mediated through an effect on catecholamine neurotransmission.

Urinary excretion of o-cresol and hippuric acid after toluene exposure in rotogravure printing.

In 62 male rotogravure printers, the time-weighted average (TWA) toluene exposure during one workweek ranged from 8 to 496 mg/m3 (median 96). Post-shift urinary excretion of hippuric acid showed a poor correlation with the air toluene concentration. Level of o-cresol excretion ranged from 0.08 to 2.37 mmol/mol creatinine and was associated with the exposure (rS = 0.57, P less than 0.0001), although the variation was considerable. However, this metabolite was significantly influenced by smoking habits, both in the workers (0.34 vs 0.10 mmol/mol creatinine after adjustment to zero exposure for the smokers and non-smokers, respectively; P = 0.03) and in 21 unexposed controls (0.18 vs 0.06 mmol/mol creatinine; P = 0.002). The excretion of these metabolites was followed during vacation, when the workers were unexposed. The shared one-compartment half-time was 44 h (+/- SE 30, 82). After 2-4 weeks of vacation, the concentration of o-cresol was significantly higher for the smokers than the non-smokers (0.14 vs 0.06 mmol/mol creatinine; P = 0.02). No smoking-associated difference was found for the urinary hippuric acid concentration. However, there was an association between alcohol consumption and hippuric acid excretion (P = 0.03); no such difference was shown for o-cresol. These results demonstrate that hippuric acid excretion is unsuitable for biological monitoring of toluene exposure when the exposure level is below 200 mg/m3. Also, in spite of the favourable excretion kinetics, the impact of smoking and the large interindividual variation warrant the same conclusion for o-cresol as a means of monitoring low level exposure in an individual worker.

Cytogenetic effects in rotogravure printers exposed to toluene (and benzene).

Comparing 21 rotogravure printers exposed to toluene (medians: time-weighted air level 150 mg/m3, blood toluene 1.6 mumole/l) and 21 unexposed controls (median blood toluene less than or equal to 0.01 mumole/l) there was a significant increase in the frequency of micronuclei (MN) in pokeweed mitogen (PWM)-stimulated peripheral blood lymphocytes in the printers, as compared to the controls (2.8% vs. 1.5%; p = 0.03; all p adjusted for age and smoking). The frequency of small MN (size ratio MN/main nucleus less than or equal to 0.03) in PWM-stimulated lymphocytes was associated with the exposure (1% vs. 0.3%; p = 0.05). Furthermore, among the exposed subjects there was an association between blood toluene and small MN (0.17% per mumole/l; p = 0.0005). Small MN in phytohemagglutinin (PHA) cultures displayed no association with any exposure parameter. However, in the printers, an estimated cumulative exposure index was weakly correlated with the frequency of total MN in PHA-stimulated cells (0.00003% per mg/m3 x year; p = 0.07). Among the printers, chromosomal breaks in PHA-stimulated cells were associated with the duration of earlier benzene exposure (0.03% per year; p = 0.01). The results of this study strongly indicate that toluene causes a clastogenic effect on the B-cells even at low exposure levels. Further, earlier benzene exposure seems to have caused chromosomal breaks in T-cells.

Deaths and tumours among rotogravure printers exposed to toluene.

A cohort of 1020 rotogravure printers exposed to toluene and employed for a minimum period of three months in eight plants during 1925-85 was studied. Air levels of toluene were available since 1943 in one plant and since 1969 in most. Based on these measurements and on present concentrations of toluene in blood and subcutaneous fat, the yearly average air levels in each plant were estimated. They reached a maximum of about 450 ppm in the 1940s and 1950s but were only about 30 ppm by the mid-1980s. Exposure to benzene had occurred up to the beginning of the 1960s. Compared with regional rates, total mortality did not increase during the observation period 1952-86 (129 observed deaths v 125 expected; SMR = 1.03). There was no increase in mortality from non-malignant diseases of the lungs, nervous system, or gastrointestinal and urinary tracts. There was no overall excess of tumours 1958-85 (68 v 54, SMR = 1.26; 95% confidence interval, CI = 0.95-1.7). Among the specific cancers, only those of the respiratory tract were significantly increased (16 v 9; SMR = 1.76, CI = 1.03-2.9). Statistical significance was not attained, however, when only subjects with an exposure period of at least five years and a latency period of at least 10 years were considered. Further, there were no dose response relations with cumulated toluene dose (ppm years). There were no significant increases of tumours at other sites, including leukaemias/lymphomas/myelomas.

Elimination of toluene from venous blood and adipose tissue after occupational exposure.

In a group of 37 rotogravure printers a close correlation (rs = 0.78) was found between the time weighted toluene exposure during a five day working week (range 8-416 mg/m3, median 75) and the concentration of toluene in subcutaneous adipose tissue (range 1.1-20.7 mg/kg, median 3.8). After exposure ceased, the elimination of toluene was followed up in 11 subjects. The toluene concentration in venous blood decreased non-linearly and the elimination curves contained at least three exponential components. The first two had median estimated half times of nine minutes and two hours respectively. The third component, with a median half time of 90 hours, reflected the decline in adipose tissue, which had a median half time of 79 hours (range 44-178). The study showed protracted endogenous toluene exposure from adipose tissue depots long after the end of exogenous exposure. The observations also suggest that the blood toluene concentrations on Monday mornings might be used as an index of the exposure in the previous week.

Neurasthenic complaints and psychometric function of toluene-exposed rotogravure printers.

In 1985, 30 rotogravure printers exposed to toluene for 4-43 years (median 29) were examined by means of interviews and psychometric testing. They were 33-61 years of age (mean 50). Comparisons were made with a reference group of 72 men aged 27-69 (mean 47). The referents had never been exposed to solvents and were all in good health. The printers were employed by two Swedish companies. The mean exposure levels were 43 and 157 mg/m3 of toluene, respectively, at the two printing shops. Before 1980 the exposure levels had exceeded 300 mg/m3. On Monday mornings, before psychometric testing at the department of occupational medicine, toluene was measured in venous blood samples from most of the exposed subjects. A high proportion of the printers reported fatigue (60%), recent short-term memory problems (60%), concentration difficulties (40%), mood lability (27%), and other neurasthenic symptoms. In the psychometric tests their performance was poorer than the reference group's in most of the tests applied. Even performance on the synonyms test, usually considered resistant to mild brain affliction, was worse in the group of printers. Adjusting for this difference in the group comparisons reduced the group differences substantially. Alcohol consumption above 200 g/week was found to reduce the subjects' psychometric function more than toluene exposure. The printers' sum of neurasthenic complaints correlated negatively with their score in several tests. Exposure variables showed only weak associations with test results. Blood toluene levels were positively correlated with scores in spatial tests. The direction of the correlations suggests that the influence of acute pharmacologic effects is undetectable on Monday mornings before work. In conclusion, we found that exposure to toluene at levels below 157 mg/m3 following long-term exposure did induce neurasthenic problems and might reduce psychometric test performance.