Longitudinal decline in pulmonary diffusing capacity among nitrate fertilizer workers.

BACKGROUND: This study is part of a 3-year follow-up of lung function among nitrate fertilizer production workers. AIMS: To study the possible adverse effects of occupational exposure to aerosols and gases on pulmonary diffusing capacity. METHODS: A longitudinal study of a cohort of fertilizer workers who performed single-breath carbon monoxide diffusing capacity (DLco) tests and spirometry in 2007 and 2010. The workers completed a questionnaire on respiratory symptoms and smoking habits. Exposure to mineral dust, acid aerosols and inorganic gases was measured. The overall median inhalable and thoracic aerosol mass concentrations were 1.1mg/m(3) (min-max: <0.93-45) and 0.21mg/m(3) (min-max: <0.085-11), respectively. RESULTS: There were 308 participants in 2007 with 168 returning subjects in 2010. Overall, we found a statistically significant decline in the DLco of 0.068 mmol/min/kPa/year, adjusted for gender, age, height, weight, smoking status and doctor-diagnosed asthma during the 3-year follow-up (P < 0.01). The change in DLco did not vary significantly between the various job groups. Subjects with respiratory symptoms did not show a larger decline in DLco than those without symptoms. CONCLUSIONS: This study indicates a larger than expected decline in the DLco of fertilizer workers during a 3-year follow-up. However, the decline was not related to specific exposures at work, or to possible covariates of exposure.

Exposure to thoracic dust, airway symptoms and lung function in cement production workers.

Cement dust exposure has previously been associated with airway symptoms and ventilatory impairment. The aim of the present study was to examine lung function and airway symptoms among employees in different jobs and at different levels of exposure to thoracic dust in the cement production industry. At the start of a 4-yr prospective cohort study in 2007, exposure to cement dust, symptoms and lung function were recorded cross-sectionally in 4,265 employees in 24 European cement plants. Bronchial exposure was assessed by 2,670 full-shift dust samples with cyclones collecting the thoracic aerosol fraction. A job exposure matrix was constructed by grouping dust concentrations according to job type and plant. Elevated odds ratios for symptoms and airflow limitation (range 1.2-2.6 in the highest quartile), but not for chronic bronchitis, were found in the higher quartiles of exposure compared with the lowest quartile. Forced expiratory volume in 1 s (FEV(1)) showed an exposure-response relationship with a 270-mL deficit of FEV(1) (95% CI 190-300 mL) in the highest compared with the lowest exposure level. The results support the hypothesis that exposure to dust in cement production may lead to respiratory symptoms and airway obstruction.

Lung function and respiratory symptoms in male Palestinian farmers.

In a cross-sectional study of 250 farmers aged 22 to 77 years, of whom 36.4% are smokers, the authors aimed at describing lung function and respiratory symptoms and to estimate associations with exposures to pesticides and dust. Lung function was measured using a spirometer. Respiratory symptoms and exposure levels were self-reported based on a modified standardized questionnaire. Mean forced vital capacity (FVC) was 4.20 L (SD = 0.93 L), 95.51% of predicted as compared to European standards. Mean forced expiratory volume in one second (FEV(1)) was 3.28 L (SD = 0.80 L), 91.05% of predicted. The authors found high symptom prevalences: 14.0% for chronic cough; 26.4% for wheeze; and 55.2% for breathlessness. There was no clear association between exposure to pesticides or dust and lung function or between such exposures and respiratory symptoms. However, a significant association was found between smoking and respiratory symptoms such as chronic cough, cough with phlegm, and wheezes. The lack of farm exposure associations could be due to improvement in farmers' awareness to pesticides hazards as well as regulations of pesticide import, or because of inherent problems with the experimental design. Farmers who kept animals and poultry seem to have less respiratory symptoms and better lung function.

Circulating lipopolysaccharides in the blood from "bioprotein" production workers.

BACKGROUND: Workers producing bacterial single-cell protein (BSCP), "bioprotein," are exposed to organic dust containing high levels of endoxins (lipopolysaccharides, LPS). Workers in this industry have complained of episodes of fever, fatigue, chest tightness, skin dryness and rubor. The aim of the present study was to quantify LPS and inflammatory mediators in plasma among the workers and non-exposed control subjects. METHODS: We included eight non-smoking production workers, aged 32-51 (median 38), and eight non-smoking, non-exposed controls, aged 30-51 (median 39). Airborne and plasma endotoxin concentrations were measured, as well as plasma hsCRP and different cytokines, chemokines and metalloproteinases. RESULTS: The workers who did not use personal respiratory protection were exposed to varying airborne levels of endotoxin, 430 (75-15 000) EU/m3 (median, range). The level of plasma LPS was significantly elevated (p = 0.01) among the workers compared to the non-exposed controls. The workers also had elevated levels of MCP-1 (p = 0.02), MIP-1alpha (p = 0.05) and MMP-3 (p = 0.04). IL-6 and hsCRP were also elevated among the exposed group, but not significantly (p = 0.10 and p = 0.07, respectively). CONCLUSIONS: In this study, we detected LPS in plasma of individuals exposed to high levels of LPS at their workplace. This finding is supported by elevated levels of several inflammatory cytokines among the workers, significantly exceeding that of the non-exposed control group. To the best of our knowledge, this is the first time that plasma LPS, together with increased inflammatory markers in plasma, has been detected in an occupational setting.

Cross shift changes in lung function among bar and restaurant workers before and after implementation of a smoking ban.

OBJECTIVE: To study possible cross shift effects of environmental tobacco smoke (ETS) on pulmonary function among bar and restaurant employees before and after the implementation of a smoking ban in Norway. METHODS: The study included 93 subjects employed in 13 different establishments in Oslo. They were examined at the beginning and end of a workshift both while ETS exposure was present and when smoking was banned. The mean exposure level of nicotine and total dust before the ban was 28 microg/m3 (range 3-65) and 275 microg/m3 (range 81-506), respectively. Following the smoking ban, the mean level of nicotine and total dust was 0.6 mug/m3 and 77 microg/m3, respectively. Assessment of lung function included dynamic lung volumes and flows. RESULTS: The cross shift reduction in forced vital capacity (FVC) among 69 subjects participating in both examinations changed from 81 ml (SD 136) during exposure to ETS to 52 ml (SD 156) (p = 0.24) following the smoking ban. The reduction in forced expired volume in one second (FEV1) during a workshift, was borderline significantly reduced when comparing the situation before and after the intervention, by 89 ml (SD = 132) compared to 46 ml (SD = 152) (p = 0.09), respectively. The reduction in forced mid-expiratory flow rate (FEF25-75%) changed significantly from 199 ml/s (SD = 372) to 64 ml/s (SD = 307) (p = 0.01). Among 26 non-smokers and 11 asthmatics, the reduction in FEV1 and FEF25-75% was significantly larger during ETS exposure compared to after the smoking ban. There was an association between the dust concentration and decrease in FEF25-75% before the ban among non-smokers (p = 0.048). CONCLUSIONS: This first study of cross shift changes before and after the implementation of a smoking ban in restaurants and bars shows a larger cross shift decrease in lung function before compared with after the implementation of the ban.

Short term changes in lung function, leukocytosis in blood, and lachrymal fluid among bacterial single cell protein workers after an episode with high exposure to endotoxins.

AIMS: To study possible effects of endotoxin exposure among bacterial single cell protein workers on pulmonary function, blood parameters, and lachrymal fluid before and after a work shift. METHODS: The study included 23 men and five women who were examined at the start and at the end of a work shift. Most workers performed a task with unusually high exposure levels. Twelve of the workers were re-examined the day after. The workers were divided into three exposure groups: production workers with the highest assumed exposure levels (n = 18), engineers (n = 5), and clerks (n = 2). The median endotoxin level during a work shift was 34000 EU/m3 in the high exposure group (range 3300-89000 EU/m3 ), 11000 EU/m3 (range 350-27000 EU/m3) among the engineers, and 180 EU/m3 (range 60-300 EU/m3) for the clerks. The workers answered a questionnaire about work related symptoms. Assessment of lung function included dynamic lung volumes and flows. The blood analysis included cell count of leukocytes and mediators of inflammation, fibrinogen, interleukin-6 (IL-6), D-dimer, and C-reactive protein (CRP). Cells in lachrymal fluid were counted with a microscope. RESULTS: The forced vital capacity (FVC) changed significantly (p<0.05) from 5.34 l (SD 0.9) to 5.25 l (SD 0.9) and forced expired volume in one second (FEV1) from 4.15 l (SD 0.7) to 4.07 l (SD 0.7) during the work shift. The leukocytes increased significantly (p<0.05) from 6.9 10(9)/l (SD 1.2) to 7.7 10(9)/l (SD 1.5) and IL-6 from 1.5 ng/l (SD 0.6) to 3.31 ng/l (SD 2.7). Except for fibrinogen, which had a borderline increase and PEF that decreased, the parameters were normalised the day after. Four of the workers had an increase of neutrofile granulocytes in the lachrymal fluid during the shift. There was a significant association between the endotoxin concentration and decrease of FEV1 despite the use of powered respirators. CONCLUSIONS: During a work shift with unusual high levels of endotoxins at a plant manufacturing bacterial single cell protein the results show that FVC and FEV1 were reduced. Mediators of inflammation increased along with leucocytosis in blood and lachrymal fluid among the workers.

Pulmonary and auditory function among experienced construction divers: a cross-sectional study.

We studied pulmonary and auditory function in a cross-sectional study of 26 experienced construction divers compared with 26 workshop workers matched for age, height, and smoking habits. The divers used air as breathing gas and performed open-sea bounce dives to a maximum of 50 m in sea water. The mean number of dives over a mean diving period of 20 yr (SD = 11) was 4746 (SD = 4743) (Range: 450-17000). Assessment of lung function included dynamic lung volume and flow and diffusion capacity (transfer factor) for carbon monoxide (TlCO). The auditory examination was performed measuring air conduction thresholds in a cabin. The results show a significantly higher mean forced vital capacity (FVC) of 6.01 L (SD = 0.88) in the divers compared with 5.67 L (SD = 0.84) (p = 0.045) in the controls, and an alveolar volume (VA) of 7.74 L (SD = 0.99) in the divers compared with 7.35 L (SD = 0.74) (p = 0.035) in the controls. There was a nonsignificant reduction in forced mid-expiratory flow rate (FEF25-75%) and a significant reduction in forced expiratory flow rate at 50% of FVC (FEF50%) among the divers of 4.69 L (SD = 1.41) compared with 5.76 L (SD = 2.03) among the controls of (p = 0.03). There were no differences in FEV1 and TlCO between the two groups. The divers showed reduced auditory function in their left ear compared with their right ear in the 3 kHz (p = 0.006) and 8 kHz (p = 0.022) area. No statistical difference was found in hearing thresholds of the divers compared with those of the controls. Our results indicate that exposure to diving may be associated with changes in pulmonary function and that the left ear may be more vulnerable than the right ear to hearing impairment in construction divers.

Divers' pulmonary function after open-sea bounce dives to 10 and 50 meters.

We have studied pulmonary function before and 2 h after open sea dives to 10 and 50 m and 24 h after the dive to 10 m. Nine trainee divers participated in the dive to 10 m and 17 in the dive to 50 m. Mean time in water was 53 (32-62) min for the 10-m dive and 38 (26-76) min for the 50-m dive. Assessment of lung function included dynamic lung volumes and flows and transfer factor for carbon monoxide (TlCO). There were significant reductions (P < 0.05) in forced vital capacity of 5.8% (SD = 3.9) and 1.8% (SD = 2.8), in forced expired volume in 1 s of 6.6% (SD = 3.5) and 2.7% (SD = 2.4), in forced mid-expiratory flow rate of 10.3% (SD = 7.8) and 5.2% (SD = 6.5), and in TlCO of 11.3% (SD = 7.9) and 12.8% (SD = 5.9) 2 h after the 10- and 50-m dive, respectively. Our results indicate that factors related to submersion and increased breathing resistance contribute to changes in pulmonary function in the first hours after open-sea bounce dives.

[Maintenance treatment with methadone--an alternative]. / Vedlikeholdsbehandling med metadon--et alternativ.

Two case studies are used to demonstrate the possibility of rehabilitating heroin addicts by means of maintenance treatment with methadone. The subjects had been addicted to heroin for more than 20 years, and had gone through several drug-free programmes of treatment. The subjects were studied using a series of neuropsychological tests. These showed normal neuropsychological status, and the necessary cognitive conditions for attending work and driving a car. Important factors in a successful maintenance treatment are: thorough psychological diagnosis before the treatment is started, close follow-up and frequent urine tests.