Cancer incidence in a cohort of Swedish merchant seafarers between 1985 and 2011.

PURPOSE: Lung cancer, mesothelioma and several lifestyle-associated cancer forms have been reported more common in merchant seafarers. However, few studies reflect recent occupational settings and women seafarers are usually too scarce for meaningful analyses. We conducted a study on cancer incidence between 1985 and 2011 in a Swedish cohort consisting of male and female seafarers. METHODS: All seafarers in the Swedish Seafarers' Register with at least one sea service between 1985 and 2011 and a cumulated sea service time of ≥ 30 days (N = 75,745; 64% men, 36% women; 1,245,691 person-years) were linked to the Swedish Cancer Register and followed-up until 31 December 2011. Standardized incidence ratios (SIR) were calculated with the general population as reference. RESULTS: There were 4159 cancer cases in total, with 3221 among men and 938 among women. Male seafarers had an increased risk of total cancer (SIR 1.05; 95% CI 1.01-1.09), lung cancer (SIR 1.51; 95% CI 1.35-1.67) and urinary bladder cancer (SIR 1.17; 95% CI 1.02-1.33). Several lifestyle-associated cancer forms were more common in men. Previous work on tankers was associated with leukaemia (SIR 1.41; 95% CI 1.00-1.86). The risk of cancer decreased with a start as a male seafarer after 1985, with a significant trend for total cancer (P < 0.001), lung cancer (P = 0.001) and, for tanker seafarers, leukaemia (P = 0.045). Women seafarers had an increased risk of lung cancer (SIR 1.54; 95% CI 1.23-1.87) but the risk of total cancer was not increased (SIR 0.83; 95% CI 0.78-0.89). CONCLUSIONS: In this cohort of merchant Swedish seafarers 1985-2011, the risk of total cancer was increased in men but not in women compared to the general population. Lung cancer was increased in both genders. The risk of cancer seems to decrease over the last decades, but better exposure assessments to occupational carcinogens and longer observation times are needed.

Metabolomic Profile in HFpEF vs HFrEF Patients.

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) are associated with metabolic derangements, which may have different pathophysiological implications. METHODS AND RESULTS: In new-onset HFpEF (EF of ≥50%, n = 46) and HFrEF (EF of <40%, n = 75) patients, 109 endogenous plasma metabolites including amino acids, phospholipids and acylcarnitines were assessed using targeted metabolomics. Differentially altered metabolites and associations with clinical characteristics were explored. Patients with HFpEF were older, more often female with hypertension, atrial fibrillation, and diabetes compared with patients with HFrEF. Patients with HFpEF displayed higher levels of hydroxyproline and symmetric dimethyl arginine, alanine, cystine, and kynurenine reflecting fibrosis, inflammation and oxidative stress. Serine, cGMP, cAMP, l-carnitine, lysophophatidylcholine (18:2), lactate, and arginine were lower compared with patients with HFrEF. In patients with HFpEF with diabetes, kynurenine was higher (P = .014) and arginine lower (P = .014) vs patients with no diabetes, but did not differ with diabetes status in HFrEF. Decreasing kynurenine was associated with higher eGFR only in HFpEF (Pinteraction = .020). CONCLUSIONS: Patients with new-onset HFpEF compared with patients with new-onset HFrEF display a different metabolic profile associated with comorbidities, such as diabetes and kidney dysfunction. HFpEF is associated with indices of increased inflammation and oxidative stress, impaired lipid metabolism, increased collagen synthesis, and downregulated nitric oxide signaling. Together, these findings suggest a more predominant systemic microvascular endothelial dysfunction and inflammation linked to increased fibrosis in HFpEF compared with HFrEF. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03671122 https://clinicaltrials.gov.

Hematologic malignancy in tanker crewmembers: A case-referent study among male Swedish seafarers.

BACKGROUND: Work on Swedish petroleum tankers before the late 1980s has been associated with an increased risk of hematologic malignancy (HM). Since then, ship modernizations have decreased occupational exposure to gases, including the carcinogen benzene. We explored the risk of HMs in Swedish seafarers who had worked on newer types of tankers. METHODS: A case-referent study in male seafarers from a cohort of all Swedish seafarers was set up by record linkage with the Swedish Cancer Registry using the subjects' personal identification number. For each case (N = 315), five referents were randomly chosen from within the cohort, matched by birth year and three different periods of first sea service (<1985, 1985-1991, and ≥1992). Information on the type of ship and dates of service was retrieved from the Swedish Seafarers' Registry. Odds ratios (OR) were calculated by conditional logistic regression together with 95% confidence intervals (CI). RESULTS: The OR of HM was 1.07 (95% CI, 0.80-1.42) for work on tankers. In seafarers that had started to work on tankers ≥1985, the OR was 0.85 (95% CI, 0.50-1.43). For those who started to work on tankers before 1985, the OR was 1.17 (95% CI, 0.84-1.21) and 1.32 (95% CI, 0.86-2.03) if the cumulative time on tankers exceeded 5 years of service. In this last group, the OR of multiple myeloma was 5.39 (95% CI, 1.11-26.1). CONCLUSION: Although limited by crude exposure contrast and a short follow-up, work on tankers after 1985 was not associated with an increased risk of HM among Swedish seafarers.

Work environment and safety climate in the Swedish merchant fleet.

PURPOSE: To get knowledge of the work environment for seafarers sailing under the Swedish flag, in terms of safety climate, ergonomical, chemical and psychosocial exposures, and the seafarers self-rated health and work ability. METHODS: A Web-based questionnaire was sent to all seafarers with a personal e-mail address in the Swedish Maritime Registry (N = 5608). Comparisons were made mainly within the study population, using Student's t test, prevalence odds ratios and logistic regressions with 95% confidence intervals. RESULTS: The response rate was 35% (N = 1972; 10% women, 90% men), with 61% of the respondents working on deck, 31% in the engine room and 7% in the catering/service department (1% not classifiable). Strain on neck, arm or back and heavy lifting were associated with female gender (p = 0.0001) and younger age (below or above 30 years of age, p < 0.0001). Exposures to exhausts, oils and dust were commonly reported. Major work problems were noise, risk of an accident and vibrations from the hull of the ship. The safety climate was high in comparison with that in land-based occupations. One-fourth had experienced personal harassment or bullying during last year of service. CONCLUSIONS: Noise, risk of accidents, hand/arm and whole-body vibrations and psychosocial factors such as harassment were commonly reported work environment problems among seafarers within the Swedish merchant fleet.

Benzene Exposure and Biomarkers in Alveolar Air and Urine Among Deck Crews on Tankers Transporting Gasoline.

INTRODUCTION: Increased rates of leukaemia have been found among tanker crews. Occupational exposures to the leukomogen benzene during loading, unloading, and tank cleaning are possible causes. Studies on older types of tankers carrying gasoline with most handling being done manually have revealed important exposures to benzene. Our study explores benzene exposures on tankers with both automatic and manual systems. Correlations between benzene exposure and benzene in alveolar air (AlvBe), benzene in urine (UBe), and trans,trans-muconic acid (ttMA) in urine were investigated. METHODS: Forty-three male seafarers (22 deck crewmembers and 21 not on deck) on five Swedish different product and chemical tankers transporting 95- or 98-octane gasoline were investigated between 1995 and 1998. The tankers used closed systems for the loading and unloading of gasoline but stripping and tank cleaning were done manually. Benzene in respiratory air was measured using personal passive dosimeters during a 4-h work shift. Samples for biomarker analyses were collected pre- and post-shift. Smoking did occur and crewmembers did not use any respiratory protection during work. RESULTS: The average 4-h benzene exposure level for exposed was 0.45 mg m-3 and for non-exposed 0.02 mg m-3. Benzene exposure varied with type of work (range 0.02-143 mg m-3). AlvBe, UBe, and ttMA were significantly higher in post-shift samples among exposed and correlated with exposure level (r = 0.89, 0.74, and 0.57, respectively). Smoking did not change the level of significance among exposed. DISCUSSION: Benzene in alveolar air, unmetabolized benzene, and ttMA in urine are potential biomarkers for occupational benzene exposure. Biomarkers were detectable in non-exposed, suggesting benzene exposure even for other work categories on board tankers. Work on tankers carrying gasoline with more or less closed handling of the cargo may still lead to significant benzene exposure for deck crewmembers, and even exceed the Swedish Occupational Exposure Limit (OEL; 8-h time-weighted average [TWA]) of 1.5 mg m-3.

Lung cancer and mesothelioma among engine room crew--case reports with risk assessment of previous and ongoing exposure to carcinogens.

OBJECTIVE: The aim of this article is to illustrate, by means of case reports on occupational exposure in four men with cancer, the hazards of previous and ongoing carcinogenic exposures in ships' engine rooms. Several cases of cancer occurred within a few years among the engine room crew of a passenger ferry. An investigation was undertaken to establish the number of cases, the types of cancers involved, and their possible relation to work. SUBJECTS AND METHODS: Nine cases of cancer among crew members of the ferry were reported between 2001 and 2006, six of which occurred in crew working in the engine room. During the investigated time period, 65 men had been employed in the engine room (mean age 40, range 16-65, years). Four cases were referred to our department. Medical history, personal risk factors and specific diagnoses were collected by medical examinations and from the medical files. An experienced occupational hygienist evaluated work-related exposure to carcinogens. RESULTS: Two engine room ratings contracted lung cancer at the age of 54 and 61, respectively. Both men had been smokers for many years (33 and 45 years, respectively). One engine room rating and one electrical engineer were diagnosed with mesothelioma at the age of 61 and 63, respectively. All four had started to work in engine rooms between 1959 and 1967. Carcinogenic exposure included asbestos, with an estimated cumulative exposure of 2-5 fibreyears/mL, as well as polycyclic aromatic hydrocarbons (PAHs) and nitroarenes from oils, soot and engine exhaust. CONCLUSIONS: For the lung cancer cases, smoking and asbestos exposure were considered clear risk factors, and PAHs and nitroarenes possible risk factors. For the mesothelioma cases, former asbestos exposure was considered a causal factor. Asbestos can still be present on ships. Steps should be taken to reduce the exposure to asbestos, PAHs and nitroarenes, and smoking.

Telemedical Maritime Assistance Service (TMAS) to Swedish merchant and passengers ships 1997-2012.

BACKGROUND: Telemedical Maritime Assistance Service (TMAS) for seafarers and traveling passengers is important and can be crucial for the optimal medical treatment on board ships. The aim of this study was to analyse and to compare the data from consultations and evacuations from merchant ships and passenger ferries for possible improvements. MATERIALS AND METHODS: Data for seafarers from 1997, 2002 and 2007 and for passengers on Swedish ferries for the years 2007, 2009, 2011 and 2012 from the Swedish Radio Medical were studied. Symptoms and diseases were classified according to the International Classification for Primary Care (ICPC-2). The distribution of symptoms, accidents and diseases, treatments/actions taken, evacuations and the communication forms were analysed. RESULTS: One thousand ninety-five contacts for seafarers from merchant ships and 651 passenger patients from Swedish ferries were analysed. While the evacuations for the seafarers gradually decreased over the years from 18% in 1997 to 14% in 2007, still 39.5% of the passenger patient contacts were evacuated mainly by helicopters and 70 patients were picked up by an ambulance on the quay. Accidents were 20% for seafarers and 25% for passengers of the contacts. Evacuations for passengers were mainly in the diagnostic groups: unspecific (A), digestive (D), cardiology (K), musculoskeletal (L) and neurology (N). The use of VHF, radio communications and fax machines have been greatly reduced while the use of e-mail and satellite phone increased. CONCLUSIONS: No significant differences in reasons for contact or actions over the years have been identified. The evacuations of seafarers decreased over the years but was stable among the passenger patients (39%). The circumstances and reasons behind the evacuations should be analysed for prevention. Standard forms and digital images for documentation can facilitate knowledge exchange and further studies.

Gliomas among men employed in the Swedish pulp and paper industry.

OBJECTIVES: This study investigated whether previous findings of an increased risk of gliomas among workers in some pulp and paper mills could be confirmed for all Swedish pulp and paper mill workers and whether the increase could be attributed to certain occupational groups. METHODS: The study was based on the Swedish Cancer Environment Register, which links the incidence of cancer from 1971 to 1990 and the 1960 and 1970 census data on codes of occupation and industry for the whole population. Standardized incidence ratios (SIR) were used to estimate the risks for men in different occupations in pulp (N = 28,142) and paper (N = 39,169) mills in 1960, 1970 or both years as compared with those of all gainfully employed men in Sweden. RESULTS: Maintenance workers employed in pulp or paper mills in 1960, 1970 or both years, as well aspulp workers, showed an increased incidence of gliomas in 1971-1990 [SIR 1.5, 95% confidence interval (95% CI) 1.1-2.1 and SIR 1.5,95% CI 1.0-2.2, respectively], whereas the incidence among process workers in paper mills was lower than expected (SIR 0.6, 95% CI 0.3-0.9). Taken together, all employed men in the pulp mill industry had an increased incidence of gliomas (SIR 1.3, 95% CI 1.0-1.7). CONCLUSIONS: Pulp mill workers, but not paper mill workers, were found to have more gliomas in 1971-1990 than expected. There was an increased risk of gliomas among maintenance workers in both pulp and paper mills. Few risk factors for brain tumors are recognized, and the causes of the increase are not obvious.

Testicular cancer among Swedish pulp and paper workers.

BACKGROUND: The incidence of testicular cancer has increased in recent decades. The aims of the present study were to elucidate whether Swedish paper and pulp mill workers had an increased incidence of testicular cancer, and to investigate whether certain occupational groups within the pulp and paper mill workforce were at increased risk. METHODS: The study was based on the Swedish Cancer Environment Register, which links the incidence of cancer for the period 1971-1990 with 1960 and 1970 National Census data on specific industries and occupations for all employed subjects in Sweden. RESULTS: Among maintenance workers employed both in 1960 and in 1970 in paper mills there was an increased risk for testicular cancer (standardized incidence ratio (SIR) 7.4, 95% confidence intervals (CI) 1.5-22), especially for seminomas (SIR 10.1, 95% CI 2.1-29). Maintenance workers were also at increased risk when analyzing workers employed in 1960, 1970, or both years. CONCLUSIONS: This study indicates an increased risk for testicular cancer, especially seminomas, among maintenance workers, but not among process workers, in Swedish paper mills.

Adult-onset asthma and wheeze among irritant-exposed bleachery workers.

BACKGROUND: Whether new-onset asthma is associated with irritant exposure is unclear. The aim was to investigate if occupational exposure to irritant gases, especially repeated peak exposure (gassings), increased the risk of obstructive airways disease. METHODS: Data on airway symptoms and exposure among bleachery (n = 101) and paper department workers (n = 314) were collected by a questionnaire. Incidence rates and hazard ratios (HR) (Cox regression) were calculated. Non-responders were interviewed by telephone. RESULTS: The incidence rate for adult-onset physician-diagnosed asthma among bleachery workers reporting gassings giving rise to respiratory symptoms was 7.6/10(3) person-years and for those without gassings 2.2/10(3) person-years, compared to 1.0/10(3) person-years for paper workers. In a Cox regression model for asthma (n = 12), stratified for sex, HR for gassings were 5.6 (95% confidence intervals (CI) 1.6-20), for hay fever 3.0 (95% CI 0.8-11), and for ever smoking 0.7 (95% CI 0.2-2.4). The same model for adult-onset wheeze gave HR of 5.2 (95% CI 2.2-12), 1.7 (95% CI 0.6-5.4), and 1.1 (95% CI 0.5-2.7), respectively. CONCLUSIONS: Repeated peak exposure to irritant gases, here studied as gassings in the pulp industry, increased the risk for both adult-onset asthma and wheeze.