Analysis of factors affecting nonalcoholic fatty liver disease in Chinese steel workers and risk assessment studies.

BACKGROUND: The global incidence of nonalcoholic fatty liver disease (NAFLD) is rapidly escalating, positioning it as a principal public health challenge with significant implications for population well-being. Given its status as a cornerstone of China's economic structure, the steel industry employs a substantial workforce, consequently bringing associated health issues under increasing scrutiny. Establishing a risk assessment model for NAFLD within steelworkers aids in disease risk stratification among this demographic, thereby facilitating early intervention measures to protect the health of this significant populace. METHODS: Use of cross-sectional studies. A total of 3328 steelworkers who underwent occupational health evaluations between January and September 2017 were included in this study. Hepatic steatosis was uniformly diagnosed via abdominal ultrasound. Influential factors were pinpointed using chi-square (χ2) tests and unconditional logistic regression analysis, with model inclusion variables identified by pertinent literature. Assessment models encompassing logistic regression, random forest, and XGBoost were constructed, and their effectiveness was juxtaposed in terms of accuracy, area under the curve (AUC), and F1 score. Subsequently, a scoring system for NAFLD risk was established, premised on the optimal model. RESULTS: The findings indicated that sex, overweight, obesity, hyperuricemia, dyslipidemia, occupational dust exposure, and ALT serve as risk factors for NAFLD in steelworkers, with corresponding odds ratios (OR, 95% confidence interval (CI)) of 0.672 (0.487-0.928), 4.971 (3.981-6.207), 16.887 (12.99-21.953), 2.124 (1.77-2.548), 2.315 (1.63-3.288), 1.254 (1.014-1.551), and 3.629 (2.705-4.869), respectively. The sensitivity of the three models was reported as 0.607, 0.680 and 0.564, respectively, while the precision was 0.708, 0.643, and 0.701, respectively. The AUC measurements were 0.839, 0.839, and 0.832, and the Brier scores were 0.150, 0.153, and 0.155, respectively. The F1 score results were 0.654, 0.661, and 0.625, with log loss measures at 0.460, 0.661, and 0.564, respectively. R2 values were reported as 0.789, 0.771, and 0.778, respectively. Performance was comparable across all three models, with no significant differences observed. The NAFLD risk score system exhibited exceptional risk detection capabilities with an established cutoff value of 86. CONCLUSIONS: The study identified sex, BMI, dyslipidemia, hyperuricemia, occupational dust exposure, and ALT as significant risk factors for NAFLD among steelworkers. The traditional logistic regression model proved equally effective as the random forest and XGBoost models in assessing NAFLD risk. The optimal cutoff value for risk assessment was determined to be 86. This study provides clinicians with a visually accessible risk stratification approach to gauge the propensity for NAFLD in steelworkers, thereby aiding early identification and intervention among those at risk.

Sensitive methods for assessment of lung health in welders and controls.

BACKGROUND: Welders are exposed to gas and particle emissions that can cause severe lung disease, such as chronic obstructive pulmonary disease (COPD), a leading cause of mortality and morbidity worldwide. It is difficult to detect COPD early and therefore mitigating measures may be delayed. The aim of this study was to investigate lung health in welders and evaluate new sensitive methods with potential to assess early onset pulmonary changes in occupational settings. METHODS: This study assessed the lung health and symptoms in active welders (n = 28) and controls (n = 17). Lung measurements were performed with standard spirometry and new methods: airspace dimension assessment (AiDA), oscillometry, blood serum biomarkers (club cell secretory protein 16, surfactant protein D, matrix metalloproteinases, fibroblast, hepatocyte growth factor, interleukins), and one urine biomarker (desmosine). RESULTS: According to spirometry measurements, all participants had normal lung function. However, prevalence of cough was significantly higher among welders compared with controls and lung changes were found in welders with the novel methods. Welders had significantly higher respiratory system resistance assessed with oscillometry, serum levels of metalloproteinases 9 and hepatocyte growth factor, compared with controls. Airspace dimensions were on average higher among welders compared with controls, but the difference was not significant. The number of welding years correlated with decreased respiratory system reactance and increased serum levels of matrix metalloproteinases 9, interleukin 6, and hepatocyte growth factor. Airspace dimension assessment indices were correlated with increasing levels of inflammatory markers and matrix metalloproteinases. CONCLUSIONS: This study indicated the potential to use new and more sensitive methods for identification of changes in lungs when standard spirometry failed to do so.

Occupational Exposure to Metal Fumes Among Iranian Welders: Systematic Review and Simulation-Based Health Risk Assessment.

There have been numerous reports of welder's worker exposure to metal fumes. Carcinogenic and non-carcinogenic (neurological, dermal, and etc.) effects are the adverse outcomes of exposure to welding fumes. In this review study, data were collected from previous studies conducted in Iran from 1900 to 2020. The risk of carcinogenicity and non-carcinogenicity due to exposure to welding metal fumes was assessed using the United States Environmental Protection Agency (USEPA) method based on the Monte Carlo simulation (MCS). Results showed mean of metal fume concentration in gas welding was in the range of 1.8248 to 1060.6 (µg/m3) and in arc welding was 54.935 to 4882.72 (µg/m3). The mean concentration of fumes in gas welding is below the recommended American Conference of Governmental Industrial Hygienists (ACGIH) standard exposure limit except for manganese, and in the arc welding, all metal fume concentrations are below the standard exposure limit except for manganese and aluminum. The results showed that the risk of carcinogenicity due to exposure to nickel, manganese in both gas and arc welding, and cadmium in gas welding was higher than standard level (hazard quotient (HQ) more than 1). Cancer risk due to exposure to nickel in both gas and arc welding was probable (1 × 10-6 < cancer risk (CR) < 1 × 10-4). Health risk assessment showed that welders are exposed to health risks. Preventive measures should be applied in welding workplaces to reduce the concentrations of metal fumes.

Exploring a new method for the assessment of metal exposure by analysis of exhaled breath of welders.

PURPOSE: Air monitoring has been the accepted exposure assessment of toxic metals from, e.g., welding, but a method characterizing the actual dose delivered to the lungs would be preferable. Sampling of particles in exhaled breath can be used for the biomonitoring of both endogenous biomarkers and markers of exposure. We have explored a new method for the sampling of metals in exhaled breath from the small airways in a study on welders. METHODS: Our method for particle sampling, Particles in Exhaled Air (PExA®), is based on particle counting and inertial impaction. We applied it on 19 stainless steel welders before and after a workday. In parallel, air monitoring of chromium, manganese and nickel was performed as well as blood sampling after work. RESULTS: Despite substantial exposure to welding fumes, we were unable to show any significant change in the metal content of exhaled particles after, compared with before, exposure. However, the significance might be obscured by a substantial analytical background noise, due to metal background in the sampling media and possible contamination during sampling, as an increase in the median metal contents were indicated. CONCLUSIONS: If efforts to reduce background and contamination are successful, the PExA® method could be an important tool in the investigations of metals in exhaled breath, as the method collects particles from the small airways in contrast to other methods. In this paper, we discuss the discrepancy between our findings and results from studies, using the exhaled breath condensate (EBC) methodology.

Associations between welding fume exposure and blood hemostatic parameters among workers exposed to welding fumes in confined space in Chonburi, Thailand.

BACKGROUND: Occupational welding fumes contain varieties of toxic metal particles and may affect cardiovascular system like the Particulate Matters (PM). Few studies have focused on the effects of toxic metals on the hemodynamic balance; however, the reporting results were not consistent. This study aimed to investigate the association between toxic metals exposure (Chromium (Cr), Manganese (Mn) and Lead (Pb)) and blood hemostatic parameters status after a 3-week exposure cessation among workers exposed to welding fumes. METHODOLOGY: Structured interviews and biological samplings were conducted for 86 male workers without a history of Anemia and Cardiovascular diseases (CVDs) and working in a confined space to construct crude oil tanks. Metal levels of Cr, Mn and Pb in urine were measured during the working days using Inductively Coupled Plasma Mass Spectrometer (ICP-MS) method. The concentrations of hemostatic proteins in blood (White blood cell counts (WBC), Lymphocytes, Monocyte, Eosinophil, Neutrophil, Hematocrit (Hct) were assessed after a 3 weeks exposure cessation. Workers were divided into groups based on occupation type (welder group and non-welder group), and based on metal levels (high and low exposure groups) for comparison. Linear regression models were used to explore the association between metal exposure and multiple blood hemostatic parameters adjusted for age, Body Mass Index (BMI), and smoking status. RESULTS: Urine Mn and Cr level of the welder group was significantly higher than the non-welder group (Mn: 0.96 VS 0.22 ug/g creatinine, p < 0.001; Cr: 0.63 VS 0.22 ug/g creatinine, p < 0.01). The mean value of Hct in the welder group was 44.58 ± 2.84 vol%, significantly higher than the non-welder group (43.07 ± 3.31 vol%, p = 0.026). The median value of WBC in the high Mn-exposed group (6.93 ± 1.59 X 106 Cell/ml) was significantly lower than the low Mn-exposed group (7.90 ± 2.13 X 106 Cell/ml, p = 0.018). The linear regression analyses showed that there was a significantly negative association between log transformed WBC value and the Mn exposure groups (high and low) after adjusting for age, BMI, and smoking status (ß = - 0.049, p = 0.045), but no significant result was found between WBC and occupation types (welder and non-welder) (p > 0.05). Multiple linear regression analysis also showed positive association between Hct and occupational types (welder and non-welders) (ß = 0.014, p = 0.055). The other hemostatic parameters were not different from controls when divided by occupation type or metal level groups. CONCLUSIONS: Our results showed that welders were exposed to about 3 to 4 times higher Mn and Cr concentrations than non-welders. Moreover, one third of the non-welders were exposed to high-exposure groups of Mn and Cr metals. Regression models revealed a significant association of the WBC counts with the Mn exposure group. Therefore, we infer that Mn exposure may play a significant role on the blood hemostatic parameters of workers in the confined space. Hazard identification for non-welders should also be conducted in the confined space.

Exposure characterization and risk assessment of ultrafine particles from the blast furnace process in a steelmaking plant.

OBJECTIVES: This study aimed to clarify the exposure characteristics and risks of ultrafine particles from the blast furnace process and to provide a reasonable control strategy for protecting the health of workers. METHODS: The blast furnace location of a steelmaking plant was selected as a typical investigation site. A membrane-based sampling system was used to collect ultrafine particles to analyze their morphology and elemental compositions. A real-time system was used to monitor the total number concentration (NC), total respirable mass concentration (MC), surface area concentration (SAC), and size distribution by number. The risk level of ultrafine particles was analyzed using the Stoffenmanager-Nano model. RESULTS: The total NC, total MC, and SAC increased significantly relative to background concentrations after slag releasing started and decreased gradually after the activity stopped. The three highest total concentrations during slag releasing were 3-10 times higher than those of the background or non-activity period. The ultrafine particles were mainly gathered at 10.4 or 40 nm, and presented as lump-like agglomerates. The metal elements (Al and Pt) in the ultrafine particles originated from slag and iron ore. The risk level of the ultrafine particles was high, indicating the existing control measures were insufficient. CONCLUSIONS: The blast furnace workers are at high risk due to exposure to high levels of ultrafine particles associated with working activity and with a bimodal size distribution. The existing control strategies, including engineering control, management control, and personal protection equipment need to be improved.

Welding Fume Exposure and Health Risk Assessment in a Cohort of Apprentice Welders.

Welding fumes vary in composition depending on the materials and processes used, and while health outcomes in full-time welders have been widely studied, limited research on apprentices exists. Besides, few data are available for metals such as vanadium and antimony. This study aimed to look at individual metals present in welding fumes in the learning environment of apprentice welders. Forty-three welders and 41 controls were chosen from trade programmes at the Northern Alberta Institute of Technology. Ambient and personal air samples were collected at days 0, 1, 7, and 50 of their training and analysed for mass and metal concentrations using Inductively Coupled Plasma Mass Spectrometry. Results showed increases in particle and metal concentrations as apprentices progressed throughout their education and that concentrations at day 50 were similar to levels found in the literature for professional welders. Variable concentrations indicate that some individuals may not properly use the local exhaust ventilation system. Other possible explanation for variations are the position of the sampler on the shoulder, the time spent welding and in each welding position, and the skills of the welders. Strong relationships were observed between particle and metal concentrations, suggesting that these relationships could be used to estimate metal exposure in welders from particle exposure. Welding processes were the most important determinant of exposure in apprentice welders, with Metal Core Arc Welding producing the largest particle concentrations followed by oxyacetylene cutting, and Gas Metal Arc Welding. Health risk assessment showed that welder apprentices are at risk for overexposure to manganese, which suggests that professional welders should be monitored for manganese as they are exposed more than apprentices. Training in proper positioning of local exhaust ventilation system and proper use of respirators are recommended in training facilities.

Metal additive manufacturing and possible clinical markers for the monitoring of exposure-related health effects.

Additive manufacturing (AM) includes a series of techniques used to create products, in several different materials, such as metal, polymer or ceramics, with digital models. The main advantage of AM is that it allows the creation of complex structures, but AM promises several additional advantages including the possibility to manufacture on demand or replacing smaller worn parts by directly building on an existing piece. Therefore, the interest for and establishment of AM is rapidly expanding, which is positive, however it is important to be aware that new techniques may also result in new challenges regarding health and safety issues. Metals in blood and possible clinical effects due to metal exposure were investigated in AM operators at one of the first serial producing AM facilities in the world during two consecutive years with implementation of preventive measures in-between. As comparison, welders and office workers as control group were investigated. Health investigations comprised of surveys, lung function tests, antioxidant activity and vascular inflammation as well as renal- and hepatic function analysis. AM operators had significantly reduced nickel levels in blood (10.8 vs 6.2 nmol/L) as well as improved lung function (80 vs 92% of predicted) from year 1 to year 2. This is in line with previously published results displaying reduced exposure. Blood cobalt and nickel levels correlated with previously reported urinary levels, while blood chromium did not. Multivariate modelling showed that blood cobalt, antioxidant/inflammatory marker serum amyloid A1/serum paraoxonase/arylesterase 1 activity and the hepatic markers aspartate transaminase, alanine transaminase, and alkaline phosphatase were higher in AM operators compared to controls. The study show that the selected clinical analyses could function as a complement to metal analyses in biological fluids when investigating exposure-related health effects in AM operators. However, validation in larger cohorts is necessary before more definite conclusions could be drawn.