Exposure to Particles and Nitrogen Dioxide Among Workers in the Stockholm Underground Train System.

OBJECTIVES: Exposure to fine particles in urban air has been associated with a number of negative health effects. High levels of fine particles have been detected at underground stations in big cities. We investigated the exposure conditions in four occupational groups in the Stockholm underground train system to identify high-exposed groups and study variations in exposure. METHODS: PM1 and PM2.5 were measured during three full work shifts on 44 underground workers. Fluctuations in exposure were monitored by a real-time particle monitoring instrument, pDR, DataRAM. Qualitative analysis of particle content was performed using inductively coupled plasma mass spectrometry. Nitrogen dioxide was measured using passive monitors. RESULTS: For all underground workers, the geometric mean (GM) of PM1 was 18 µg/m3 and of PM2.5 was 37 µg/m3. The particle exposure was highest for cleaners/platform workers, and the GM of PM1 was 31.6 µg/m3 [geometric standard deviation (GSD), 1.6] and of PM2.5 was 76.5 µg/m3 (GSD, 1.3); the particle exposure was lowest for ticket sellers, and the GM of PM1  was 4.9 µg/m3 (GSD, 2.1) and of PM2.5 was 9.3 µg/m3 (GSD, 1.5). The PM1 and PM2.5 levels were five times higher in the underground system than at the street level, and the particles in the underground had high iron content. The train driver's nitrogen dioxide exposure level was 64.1 µg/m3 (GSD, 1.5). CONCLUSIONS: Cleaners and other platform workers were statistically significantly more exposed to particles than train drivers or ticket sellers. Particle concentrations (PM2.5) in the Stockholm underground system were within the same range as in the New York underground system but were much lower than in several older underground systems around the world.

Blood markers of inflammation and coagulation and exposure to airborne particles in employees in the Stockholm underground.

OBJECTIVES: Although associations have been found between levels of ambient airborne particles and cardiovascular disease (CVD) in the general population, little is known about possible cardiovascular effects from high exposure to particles in underground railway systems. This study investigates risk markers for CVD in employees exposed to particles in the Stockholm underground system. METHODS: 79 workers (54 men and 25 women) in the Stockholm underground were investigated between November 2004 and March 2005. All were non-smokers aged 25-50 years. Three exposure groups were delineated: 29 platform workers with high exposure to particles, 29 train drivers with medium exposure and 21 ticket sellers with low exposure (control group). A baseline blood sample was taken after 2 non-working days, and a second sample after 2 working days, for analysis of levels of plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), interleukin-6, fibrinogen, von Willebrand factor and factor VII. The study investigated changes in plasma concentrations between sample 1 and sample 2, and differences in average concentrations between the groups. RESULTS: No changes between sample 1 and 2 were found that could be attributed to particle exposure. However, the highly exposed platform workers were found to have higher plasma concentrations of PAI-1 and hs-CRP than the ticket sellers and train drivers. This suggests that particle exposure could have a long-term inflammatory effect. These differences remained for PAI-1 in the comparison between platform workers and ticket sellers after adjusting for body mass index. CONCLUSIONS: Employees who were highly exposed to airborne particles in the Stockholm underground tended to have elevated levels of risk markers for CVD relative to employees with low exposure. However, the differences observed cannot definitely be linked to particle exposure as such.

Airborne occupational exposures and risk of oesophageal and cardia adenocarcinoma.

BACKGROUND: The reasons for the increasing incidence of and strong male predominance in patients with oesophageal and cardia adenocarcinoma remain unclear. The authors hypothesised that airborne occupational exposures in male dominated industries might contribute. METHODS: In a nationwide Swedish population based case control study, 189 and 262 cases of oesophageal and cardia adenocarcinoma respectively, 167 cases of oesophageal squamous cell carcinoma, and 820 frequency matched controls underwent personal interviews. Based on each study participant's lifetime occupational history the authors assessed cumulative airborne occupational exposure for 10 agents, analysed individually and combined, by a deterministic additive model including probability, frequency, and intensity. Furthermore, occupations and industries of longest duration were analysed. Relative risks were estimated by odds ratios (OR), with 95% confidence intervals (CI), using conditional logistic regression, adjusted for potential confounders. RESULTS: Tendencies of positive associations were found between high exposure to pesticides and risk of oesophageal (OR 2.3 (95% CI 0.9 to 5.7)) and cardia adenocarcinoma (OR 2.1 (95% CI 1.0 to 4.6)). Among workers highly exposed to particular agents, a tendency of an increased risk of oesophageal squamous cell carcinoma was found. There was a twofold increased risk of oesophageal squamous cell carcinoma among concrete and construction workers (OR 2.2 (95% CI 1.1 to 4.2)) and a nearly fourfold increased risk of cardia adenocarcinoma among workers within the motor vehicle industry (OR 3.9 (95% CI 1.5 to 10.4)). An increased risk of oesophageal squamous cell carcinoma (OR 3.9 (95% CI 1.2 to 12.5)), and a tendency of an increased risk of cardia adenocarcinoma (OR 2.8 (95% CI 0.9 to 8.5)), were identified among hotel and restaurant workers. CONCLUSIONS: Specific airborne occupational exposures do not seem to be of major importance in the aetiology of oesophageal or cardia adenocarcinoma and are unlikely to contribute to the increasing incidence or the male predominance.

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.

Pulmonary reactions caused by welding-induced decomposed trichloroethylene.

This is the report of a welder who performed argon-shielded electric arc welding in an atmosphere containing trichloroethylene. He developed immediate respiratory symptoms, pulmonary edema 12 hours after exposure, and recurring dyspnea ten days after exposure. These pulmonary reactions might be explained by inhalation of decomposition products of trichloroethylene such as dichloroacetyl chloride and phosgene.

Comparison of information on occupation and lifestyle habits obtained from European man-made vitreous fibre production workers and their relatives.

BACKGROUND: Studies of the aetiology of fatal diseases often rely on data obtained from relatives, which can cause loss of precision and introduce bias. We assessed the quality of such information on demographics, occupation, smoking and alcohol habits. METHODS: We compared contemporary interviews, based on a structured questionnaire, with male workers from the man-made vitreous fibre production industry in four European countries and their relatives. The participation rate was 63% (74 pairs of workers and relatives). RESULTS: Only minor differences in the ability to answer the questions appeared among workers and relatives, except for specific occupational questions. There was moderate to excellent agreement for demographics, residential and work history (kappa or intraclass correlation range: 0.44-0.98). For smoking habits, beer and wine consumption the agreement was good to excellent (range: 0.59-0.99). In particular, number of different residential areas, jobs, industries, and duration of wine drinking were significantly underreported by the relatives. No general determinant for reduced agreement appeared. CONCLUSIONS: In general, the quality of information obtained from relatives appeared good. However, information on specific occupational exposures may be improved by supplementing the information from relatives with details obtained from colleagues, occupational hygiene experts or occupation-exposure matrices.

Cutaneous melanoma: hints from occupational risks by anatomic site in Swedish men.

AIMS: To improve knowledge of the epidemiology of melanoma by comparing occupational risks of cutaneous melanoma (CM) by anatomic site in Swedish workers. METHODS: Male workers employed in 1970 and living in the country in 1960 were followed up from 1971 to 1989 using the Swedish Registers of Death and Cancer. A more specifically exposed subcohort included men reporting the same occupation in 1960 and 1970. For each location, occupational risk ratios (RRs) were extracted from Poisson regression models adjusted by age, period, town size, and geographical area. To diminish the influence of socioeconomic factors, intrasector analyses, comparing only jobs belonging to the same occupational sector, were performed. Risk patterns for different locations were compared. RESULTS: High RRs for different sites were found among workers exposed to UV sources (dentists, physiotherapists, and lithographers), and sun exposed workers (harbour masters, and lighthouse/related work). Risk excesses were seen in fur tailors, tanners/fur dressers, patternmakers/cutters, electrical fitters/wiremen, telephone/telegraph installers/repairmen, and some glass/pottery/tile workers. Results for lower and upper limbs were significantly correlated but somewhat independent of those found in thorax, the most frequent location. Correlation between head/neck and thorax was moderate. Specific risk excesses were found for rolling mill workers in head/neck, for chimney sweeps in upper limbs, and for aircraft pilots/navigators/flight engineers in lower limbs. CONCLUSIONS: High RRs in the trunk among occupations with UV exposure from artificial sources suggest an effect not restricted to exposed sites. An unusual distribution of cases and RRs in chimney sweeps, rolling-mill, or glass/pottery/tile workers suggests local effects of exposures. The not previously reported risk excess in this job and in fur related processes, and the RR in electrical fitters and telephone/telegraph installers deserve further investigation. Disparities between locations, as RRs in thorax and limbs, may reflect differences in aetiological mechanisms.

Lung cancer and exposure to diesel exhaust among bus garage workers.

Mortality and cancer incidence was investigated among the 695 bus garage workers employed as mechanics, servicemen, or hostlers for at least six months in five bus garages in Stockholm between 1945 and 1970. The exposure to diesel exhaust and asbestos was estimated by industrial hygienists. A small excess of lung cancer mortality was found in the cohort when occupationally active men in Stockholm were used as the reference group. A case-referent study was performed within the cohort, six referents being selected for each of the 20 lung cancer cases. The lung cancer risk increased with increasing cumulative exposure to diesel exhaust, but not with cumulative asbestos exposure. The relative risk for lung cancer among the highly exposed men was 2.4 (95% CI 1.3-4.5) as compared with those with low exposure. The study indicates that exposure to diesel exhaust increases the risk for lung cancer.

Fiber exposure assessment in the Swedish rock wool and slag wool production industry in 1938-1990.

OBJECTIVE: A multiplicative model was developed to assess past exposure to respirable fibers among rock wool and slag wool production workers in Sweden in 1938-1990. METHODS: Information on the job titles, work tasks and employment times of 1487 workers exposed to man-made vitreous fibers was obtained from company records and interviews with older employees. A mathematical model developed earlier for assessing historical fiber exposure, based on factory averages, was further developed. Matrices of multipliers for each plant that were specific for job title were modified to assess fiber exposure with respect to job title and calendar period. The model was based on measurements made in 1977. Two methods of exposure assessment were compared, cumulative exposure based on factory average (model I) and cumulative exposure based on job title (model II). RESULTS: The exposure changed considerably in the two factories during the period 1938-1990, and it varied also between job titles. The estimated average fiber (f) exposure level at the two plants in the middle of the 1940s was 1.32 and 0.78 f.ml-1. These values are 26 and 16 times higher, respectively, than the exposure in 1980. Process changes, as well as the addition of binders and oil, reduced the exposure drastically around 1950. The mean cumulative respirable fiber exposure for the 1487 subjects was 1.44 (range 0.05-18.40) f.ml-1.year. The cleaners had 14 times higher annual fiber exposure than the preproduction workers. CONCLUSIONS: Model II was judged to be more valid than model I in assessing exposure to man-made vitreous fibers.

Fever and respiratory symptoms after welding on painted steel.

Electric-arc welding generates particles and gases that can induce chronic bronchitis and airway obstruction. In this case report two welders are described who had fever, spirometric deterioration, and bronchial hyperreactivity after welding steel painted with chloro-containing polymer lacquer. Pyrolysis of this paint releases many different compounds, for example, hydrogen chloride and complex chlorinated compounds.

Cancer incidence, mortality and exposure-response among Swedish man-made vitreous fiber production workers.

OBJECTIVE: The objective of this study was to provide an extended follow-up of workers in three Swedish plants producing man-made vitreous fibers (MMVF). METHOD: Mortality and cancer incidence was investigated among 3539 male and female workers, employed for at least one year before 1978. Mortality was followed from 1952 to 1990 and cancer incidence from 1958 to 1989. National and regional mortality and cancer incidence rates were used to calculate the expected numbers. RESULTS: Twenty-seven lung cancer deaths were observed compared with 23 expected (standardized mortality ratio 117, 95% confidence interval 81-176), based on regional mortality. With a latency time of 30 years, the lung cancer risk was significantly elevated, but not trend was found for the standardized mortality ratio with increasing duration of exposure to MMVF. The lung cancer and stomach cancer mortality was higher in the rock wool industry than in the fiber glass industry. Fiber exposure from 1938 to 1990 was estimated in the two rock wool plants by applying a model for historical fiber exposure estimation, specific for different job titles in the rock wool production industry. No relationship was found between individually cumulated rock wool fiber exposure and lung cancer or stomach cancer risk. CONCLUSIONS: The numbers of lung cancers and stomach cancer cases were low and did not therefore allow more general conclusions regarding the cancer hazard for exposed workers. A large European study in progress will probably allow more precise conclusions.

Cancer incidence among European man-made vitreous fiber production workers.

OBJECTIVES: This study analyzed cancer incidence among man-made vitreous fiber workers. METHODS: A cancer incidence follow-up was conducted among 3685 rock-slag wool (RSW) and 2611 glass wool (GW) production workers employed for > or =1 year in Denmark, Finland, Norway, or Sweden, and the standardized incidence ratios (SIR) were calculated on the basis of national incidence rates. RESULTS: Overall cancer incidence was close to expectation. Lung cancer incidence was increased among the RSW [SIR 1.08, 95% confidence interval (95% CI) 0.85-1.36] and GW (SIR 1.28, 95% CI 0.91-1.74) workers. For both subcohorts, a trend was suggested for time since first employment (P-value for linear trend 0.1 and 0.2, respectively). Neither subcohort showed an association with employment during the early technological phase, when fiber exposure was high. The incidence of oral, pharyngeal, and laryngeal cancer was increased among the RSW (SIR 1.46, 95% CI 0.99-2.07) and the GW (SIR 1.41, 95% CI 0.80-2.28) subcohorts. Despite a trend in risk for these neoplasms among the GW workers with time since first employment, the lack of a positive relation with other indirect indicators of fiber exposure points against a causal interpretation. No association between RSW or GW exposure and the risk of other neoplasms was suggested. CONCLUSIONS: These lung cancer results are similar to those of a mortality study that included a larger number of factories. For other cancers there was no suggestion of an association with RSW or GW exposure.

Exposure, lung function, and symptoms in car painters exposed to hexamethylendiisocyanate and biuret modified hexamethylendiisocyanate.

Individuals who paint cars often complain to doctors about respiratory problems. Car painters are exposed to isocyanates, especially hexamethylendiisocyanate (HDI), and biuret modified HDI (HDI-BT). The mean exposure to HDI-BT was 115 micrograms/m3 in the air (range 10-385 micrograms/m3), which exceeds the time-weighted Swedish threshold level of 90 micrograms/m3. Exposure to HDI was about 1.0 microgram/m3 with brief peaks. This study investigated the effect of HDI and HDI-BT on lung function and included two control groups: (1) car platers, exposed to the same solvents and grinding dust as car painters, but not to isocyanates, and (2) car mechanics (controls), not exposed to the mentioned agents. Car painters and car platers were compared to car mechanics on Monday before work. Acute effects of car painting were tested by comparing the lung function values on Monday morning with those on Friday afternoon. Pulmonary function was evaluated by means of spirometry and a single breath nitrogen washout. Spirometry in painters and platers did not differ from that in controls, i.e., car mechanics. Closing volume in relation to vital capacity (CV%) was increased in car painters, suggestive of a "small airways disease" on Monday before work and tended to increase during a work week. Car platers did not differ from controls.

Methodology and utility of a job-exposure matrix.

We have previously reported a study in which a job-exposure matrix was applied to census data, identifying, e.g., polychlorinated biphenyls (PCBs) and creosote as increasing the risk of urothelial cancer. In this article, we expand on some theoretical issues, and present detailed accounts of constructed linkages for PCBs, creosote, and phenols. For agents of interest, one should emphasize the positive predictive value rather than the sensitivity in the construction of the matrix. The reverse is true for confounding factors; to avoid residual confounding after restriction to subjects unexposed for the confounding factors, one should emphasize sensitivity, possibly compromising the positive predictive value. This discrepancy between agents of interest and confounding factors may limit the application of a general matrix for studying several different diseases. The construction of the matrix is much harder, if sensitivity rather than positive predictive value is emphasized for an agent. Confounding from industry-related agents arises due to a true mixed exposure in certain work tasks, but also due to a gross classification of occupations in the census. One should not confuse different levels of the positive predictive value with exposure dose. A "dose-response" with different levels of positive predictive value reflects an accuracy of the matrix, not a biological phenomenon. Studies with exposure information from a job-exposure matrix applied to registers with scant information on occupation and industry may be warranted for exposures and diseases for which previous studies with a detailed documentation of exposure have low precision.

Assessment of past exposure to man-made vitreous fibers in the Swedish prefabricated house industry.

Large quantities of man-made vitreous fibers (MMVF) are handled in the Swedish prefabricated wooden house industry. The present study is part of a program to investigate mortality, cancer incidence, and current as well as previous exposure to MMVF among workers in the Swedish prefabricated wooden house industry. Since measurements of historical fiber exposure levels are lacking, these were calculated by the application of a matrix of multipliers to recently measured MMVF levels. The multipliers represented changes over time in production rate, technical properties of the fibers, manual handling vs. automation, and ventilation control. The multipliers were based on a similar matrix, developed for the MMVF-manufacturing industry, which was modified to reflect the conditions in the wooden house industry. The model was developed for the highest-exposed job title in the study, insulators. One hundred and twenty samples of airborne fiber were taken in 11 plants to reflect current exposure levels. The highest mean fiber exposure level for insulators was assessed as 0.18 f/ml (geometric mean), which occurred during the mid-1970s, compared to 0.10 f/ml at the end of the 1980s and the early 1960s. Changes in production rate, improved ventilation control, and the surface area of the total amount of MMVF sheets handled per insulator were the most important variables of the model. No increased risk of lung cancer was found in the present industry.

Decreased lung function and exposure to diisocyanates (HDI and HDI-BT) in car repair painters: observations on re-examination 6 years after initial study.

Thirty-six car painters and 115 control persons participated in a follow-up investigation 6 years after the initial study, including measurement of lung function (dynamic spirometry and nitrogen washout test) and estimation of exposure to diisocyanates based on individual working routines, use of respiratory protection equipment, and measurements. The mean exposure for the car painters was 0.0015 mg/m3 hexamethylenediisocyanate (HDI) and 0.09 mg/m3 hexamethylenediisocyanate-biurettrimer (HDI-BT), but frequently there were peak exposures exceeding 2.0 mg/m3 HDI-BT for at least 30 sec. Compared with smoking controls, the smoking car painters had greater yearly reduction in FVC (95 versus 38 ml), FEV1 (61 versus 28 ml), and VC (77 versus 30 ml). The nonsmoking car painters showed no differences in lung volumes compared with their nonsmoking controls. The impairment correlated well with the frequency of high peak exposures to HDI-BT, but not with the mean exposure to diisocyanates.

Urothelial cancer and some industry-related chemicals: an evaluation of the epidemiologic literature.

In a previous cohort study by our group, certain industry-related chemicals were judged as warranting further attention as possible urothelial carcinogens. In this paper, the epidemiologic literature of cancer of the lower urinary tract is evaluated for these substances. We would like to add combustion gases/soot from coal to the substances considered as increasing the risk of urothelial cancer. It is, however, uncertain whether this risk is due to contaminants of aromatic amines in tar volatiles or whether it depends on other agents, such as nitroarenes or polycyclic aromatic hydrocarbons. Furthermore, we find some support for the hypothesis that exposure to chlorinated aliphatic hydrocarbons increases the risk of urothelial cancer. For creosote, cutting fluids and cutting oils, hair dyes, and polychlorinated biphenyls, data are scarce. Available data do not support the hypothesis that asbestos is associated with urothelial cancer. "Publication bias," such that only limited information was available, was judged to be a potential problem in the review for many, but not all, of the substances investigated.