[Dust Exposure and Respiratory Health Effects Among Stones Crushers in Haut-Katanga Province, D.R. Congo]. / Exposition aux Poussières et Santé Respiratoire des Broyeurs de Pierres dans la Province du Haut-Katanga en R. D. Congo.

The aim of this study was to determine the prevalence of symptoms and respiratory diseases and to assess respiratory function in stones crushers stones in the province of Haut Katanga, Democratic Republic of Congo (DRC). This cross-sectional analytical study included 293 stones crushers and 295 office workers from public administrative services. A standardized respiratory health questionnaire was used, and lung function test performed with the use of peak flow-meters. PM 2.5 and volatile organic compounds (VOC) in different places of work have also been measured. The prevalence of respiratory symptoms was markedly higher in dust-exposed cement carriers than in controls. Air dust measurements showed higher mean PM 2.5 [197.5 µg/m3(range: 185-210 µg/m3) vs 33.5 µg/m3(range: 22-45 µg/m3)] and VOC [1.95 mg/m3(1.5-2.4 mg/m3) vs 0.75 mg/m3(0.6-0.9 mg/m3)] levels at stones crushers' worksites as compared with the control sites. On the other hand, peak flow rate (PEFR) was significantly lower in the exposed group as compared with the control group (421.84± 88.18 l/mn vs 450.37 ± 70.90 l/mn; p< 0.05). It is necessary to improve the environment and occupational conditions of stones crushers.

Protocol for evaluating a workplace intervention within the framework of consultations for suffering at work in French-speaking Switzerland.

INTRODUCTION: Psychosocial suffering involves diverse human, social and economic costs. Some 34.4% of workers in Switzerland report chronic stress related to their jobs. Medical consultations for suffering at work aim to maintain-or renew-patients' abilities to make decisions and act following a diagnosis of psychological suffering related to their work; they also aim to help workers return to their workstations or remain there. Workplace interventions by consulting occupational physicians can go beyond the subjective issues: they can be offered to employees, in anticipation of a return to work when this appears feasible from the outset. OBJECTIVE: To qualitatively evaluate perceptions of workplace interventions and identify their effects by collecting the verbatim statements of employees and their employers. MATERIALS AND METHODS: Qualitative single-centre study of workplace interventions conducted by the Consultation Service for Suffering at Work's occupational physicians for patients seen between January 2015 to December 2017. Nineteen workplace interventions took place, out of 184 different consultations. The verbatim statements of employees and their employers will be collected over a variable timeframe, using semi-structured face-to-face interviews. These will then be recorded, transcribed and analysed. Fourteen patients refused the workplace intervention. Their professional path will be collected for comparison and exploratory purposes. CONCLUSION: This exploratory research project will provide a better understanding of the issues surrounding work-related psychological suffering and of which strategies support patients most effectively.

Silicosis in underground miners in Lubumbashi, Democratic Republic of the Congo: 27 cases.

Silicosis is one of the most prevalent occupational lung diseases and a public health problem throughout the world. Underground miners of copper and cobalt are exposed to the dust of these minerals and thus to the risk of developing silicosis. The objective of this report was to describe a series of silicosis cases in miners exposed to mineral dusts at a mining company operating since the colonial era in Lubumbashi, Katanga province, in the Democratic Republic of the Congo (DRC). This descriptive retrospective study reviewed records at the occupational safety and health department of the mining company mentioned above and included 2500 underground miners who worked there between 1970 and 1995; it collected and analyzed their medical records. Chest radiographs of silicosis patients were classified according to the ILO International Classification of Radiographs of Pneumoconiosis. All miners were males (mean age: 48.5 ±12.5), had low literacy levels, and used no protective device (i.e., mask) against dust. Their mean number of working years in the underground mines was 25.07±7.39 years. Of the 2500 miners, 1.08 % (27/2,500) had developed silicosis. The most common clinical manifestations were dyspnea and cough, and the most prevalent radiologic features large opacities (92.59 %), small opacities (96.27 %), and pleural thickening (25.92 %). The fatality rate was 100 %. This study revealed the absence of safety measures among Congolese underground miners from Lubumbashi, which might have contributed to the development of silicosis in some of them. It is thus necessary to implement occupational safety measures to reduce their risk of silicosis.

Respiratory health of women selling cassava, corn and soybean flour in Lumbumbashi, Democratic Republic of the Congo.

The aim of this study was to determine the prevalence of respiratory complaints in Congolese women selling grain flours in Lubumbashi. The study enrolled 370 women, including 183 cassava, corn and soybean flour selling women (exposed group) and 187 tax collectors in municipal markets (control group) in Lubumbashi, DRC. A standardized respiratory health questionnaire was used, and a lung function test performed with the use of peak flow-meters. The prevalence of respiratory complaints was markedly higher in dust-exposed women than controls. In addition, peak expiratory flow rate (PEFR) was significantly lower in the exposed group than in controls (342.46 ± 65.62 vs. 410.89 ± 70.91, respectively ; P<0.05). After adjustment for age and education level, women involved in cassava, corn and soybean flour selling business were more likely to develop respiratory complaints ad disorders as compared to controls.

[Factors influencing the return to work after transplantation in 61 renal or liver recipient]. / Facteurs influençant le retour au travail après transplantation chez 61 patients rénaux ou hépatiques.

The rate of return to work after transplantation is generally low, however this improves the quality of life of recipients. The aim of our study was to investigate the low rate after transplantation in 61 renal or liver patients followed at the Transplant Center (CTO) of the CHUV in Lausanne, and to analyse the occupational, individual and medical factors which may influence it. 39% of recipients returned to work after transplantation. The factors and

Estimating the contribution of occupational solar ultraviolet exposure to skin cancer.

BACKGROUND: Exposure to solar ultraviolet (UV) radiation is the main causative factor for skin cancer. Outdoor workers are at particular risk because they spend long working hours outside, may have little shade available and are bound to take their lunch at their workplace. Despite epidemiological evidence of a doubling in risk of squamous cell carcinoma (SCC) in outdoor workers, the recognition of skin cancer as an occupational disease remains scarce. OBJECTIVES: To assess occupational solar UV doses and their contribution to skin cancer risk. METHODS: A numerical model (SimUVEx) was used to assess occupational and lunch break UV exposure, and to characterize exposure patterns and anatomical distribution. Risk of SCC was estimated from an existing epidemiological model. RESULTS: Horizontal body locations received 2.0-2.5 times more UV than vertical locations. The dose associated with having lunch outdoors every day was similar to that from doing outdoor work 1 day per week, but only half that of a seasonal worker. Outdoor work is associated with an increased risk of SCC and also with frequent acute episodes. CONCLUSIONS: Occupational solar exposure contributes greatly to overall lifetime UV dose, resulting in an excess risk of SCC. The magnitude of the estimated excess in risk supports the recognition of SCC as an occupational disease.

Acute life-threatening extrinsic allergic alveolitis in a paint controller.

BACKGROUND: Occupational diisocyanate-induced extrinsic allergic alveolitis (EAA) is a rare and probably underestimated diagnosis. Two acute occupational EAA cases have been described in this context, but neither of them concerned hexamethylene diisocyanate (HDI) exposure. AIMS: To investigate the cause of a life-threatening EAA arising at work in a healthy 30-year-old female paint quality controller. METHODS: Occupational medical assessment, workplace evaluation, airborne and biological monitoring and immunodermatological tests. RESULTS: Diagnosis of EAA relied on congruent clinical and radiological information, confirmed occupational HDI exposure and positive IgG antibodies and patch tests. The patient worked in a small laboratory for 7 years, only occasionally using HDI-containing hardeners. While working with HDI for 6 h, she developed breathlessness, rapidly progressing to severe respiratory failure. Workplace HDI airborne exposure values ranged from undetectable levels to 4.25 p.p.b. Biological monitoring of urinary hexamethylene diamine in co-workers ranged from <1.0 to 15.4 µg/g creatinine. Patch tests 8 months later showed delayed skin reaction to HDI at 48 h. Subsequent skin biopsy showed spongiotic dermatitis with infiltration of CD4(+) and CD8(+) T cells. CONCLUSIONS: We believe this is the first reported case of acute life-threatening EAA following exposure to HDI. Low concentrations of airborne HDI and relatively high urinary hexamethylene diamine suggest significant skin absorption of HDI could have significantly contributed to the development of this acute occupational EAA.

[Protection of working pregnant women and the fetus: what medical doctors have to know]. / Protection des travailleuses enceintes et des enfants à naître: ce que doit savoir le médecin.

45% of workers in Switzerland are women who will sooner or later have to accomodate work and pregnancy. Pregnancy is not a disease but some occupational activities become more difficult and may cause health problems for the pregnant woman or the child to be born. Employers and medical doctors have to assure to the working pregnant women a pregnancy without work risks. Consequently they have to know the legal recommandations for the pregnancy protection which are noticed in the Swiss law. This article summarizes this topic in giving to medical doctors the necessary informations and advices, and explains the role of the occupational physician.

Occupational risk assessment of aspergillosis after renal transplantation.

Returning to work after transplantation is a much-discussed topic today, especially as a measure to avoid permanent work disability. Many transplant patients regain their ability to work 2-6 months after transplantation. However, returning to work should not endanger their health. This means that occupational risks such as occupational exposure to Aspergillus spores must be evaluated. We evaluated the community-acquired aspergillosis risk and in particularly the occupational aspergillosis risk, using the example of a 39-year-old construction worker immunosuppressed after renal transplantation. On one hand the risk is linked to the exposure to microorganisms that the individual is likely to be subjected to, and on the other hand to the factors that modify his state of susceptibility or resistance to these infectious agents. The necessity of immunosuppressive therapy after transplantation elevates the aspergillosis risk, especially 1-6 months after transplantation. There are many professions in which exposure to Aspergillus spores can occur. The risk of acquiring aspergillosis at work exists, but is not quantifiable today. Nevertheless, the risk should be minimized during the period of vulnerability by preventive measures such as restriction of certain activities, changing work methods and reorganizing the work day to adapt to the risk, and wearing personal protective equipment, as well as attention to information about aspergillosis risk and about the likelihood of exposure in the patient's professional and leisure activities.

[Respiratory diseases in European farmers-II. Part of the European farmers' project]. / Atemwegs- und Lungenerkrankungen in der Europäischen Landwirtschaft - Teil 2: Ergebnisse der europäischen Landwirtschaftsstudie -

BACKGROUND: The aim of the European Farmers' Project was to estimate the prevalence of respiratory diseases in farmers across Europe. Furthermore, risk factors for respiratory symptoms in different parts of agricultural production should be assessed. METHODS: In the first part of the study, 7496 farmers from four European countries answered a written questionaire. Of these, 229 were visited at their farms in the second part of the survey. On site, spirometry, allergy tests, as well exposure measurements were performed. RESULTS: Farmers with animal production had a significantly lower prevalence of allergic diseases than the general population. In contrast, the prevalence of chronic phlegm was higher in animal farmers. Organic dust toxic syndrome (ODTS) was a major predictor of chronic bronchitis. It was indicated that allergens found in the working environment could be transfered to the living environment of the farmer. Poor ventilation as well as high temperatures inside the animal buildings were shown to have a negative impact on respiratory symptoms and lung function parameters. CONCLUSION: Animal farmers are at high risk of chronic bronchitis. Intervention studies on the efficacy of different types of ventilation are now warranted. Furthermore, prospective studies on the associaton between ODTS and COPD should be done.

Region-related risk factors for respiratory symptoms in European and Californian farmers.

The aim of this study was to determine the prevalences and regional risk factors for respiratory symptoms in European and Californian farmers. Farmers participating in the 1993-1997 surveys performed in Europe (n = 7,188) and California (n = 1,839) were included in this cross-sectional study. Respiratory symptoms and farming characteristics were assessed by questionnaire and risk factors associated with symptoms using logistic regression. The prevalences of rhinitis and asthma were lower in European (12.7% and 2.8%) than in Californian farmers (23.9% and 4.7%), but chronic bronchitis and toxic pneumonitis were more prevalent in Europe (10.7% and 12.2%) than in California (4.41% and 2.7%). Respiratory symptoms were associated with poultry and rabbit farming, flower growing and the cultivation of grain and oil plants. Working in Europe was a statistically significant risk factor for chronic bronchitis and toxic pneumonitis. Chronic bronchitis was related to toxic pneumonitis, work inside confinement buildings and greenhouses. Chronic bronchitis and toxic pneumonitis are highly prevalent among European farmers and are mainly attributable to indoor work.

Acute sensory responses of nonsmokers at very low environmental tobacco smoke concentrations in controlled laboratory settings.

The objective of this study was to provide a basis for effectively protecting nonsmokers from acute sensory impacts and for preventing deterioration of indoor air quality caused by environmental tobacco smoke (ETS) emissions. With an olfactory experiment we determined odor detection thresholds (OT) of sidestream ETS (sETS), and with a full-body exposure experiment we investigated sensory symptoms at very low sETS exposure concentrations. OT concentrations for sETS are three and more orders of magnitude lower than ETS concentrations measured in field settings and correspond to a fresh air dilution volume of > 19,000 m(3) per cigarette, over 100 times more than had previously been suggested for acceptable indoor air conditions. Eye and nasal irritations were observed at one order of magnitude lower sETS concentrations than previously reported, corresponding to a fresh air dilution volume of > 3,000 m(3) per cigarette. These findings have great practical implications for defining indoor air quality standards in indoor compartments where ETS emissions occur. Our study strongly supports the implementation and control of smoking policies such as segregating smoking areas from areas where smoking is not permitted or instituting smoking bans in public buildings.

Respiratory symptoms in European animal farmers.

Farmers are known to be at high risk for the development of occupational airway disease. The aim of this European study was to determine which airway symptoms predominate in different types of animal farmers (cattle, pigs, poultry, sheep) and to compare the prevalence of symptoms to the general population. A total of 6,156 randomly selected animal farmers in Denmark, Germany (Schleswig-Holstein, Niedersachsen), Switzerland, and Spain completed a questionnaire on respiratory symptoms and farming characteristics in 1995-1997. The prevalence of general respiratory symptoms was compared to the results of the European Community Respiratory Health Survey (ECRHS) obtained in the same regions. Pig farmers were at highest risk for the development of work-related symptoms. A significant dose-response relationship between daily hours worked inside animal houses and symptoms was established for pig and poultry farmers. Additionally, self-reported nasal allergies (odds ratio (95% confidence interval): 3.92 (3.26-4.71)) and nasal irritation during work (3.98 (3.35-4.73)) were shown to be associated with the development of chronic phlegm. The prevalence of wheezing, shortness of breath, asthma and nasal allergies was signficantly lower among all farmers in the age group 20-44 yrs than among the general population. However, the prevalence of usually bringing up phlegm in winter among farmers was significantly higher than in the general population (9.4 (8.3-10.5%) versus 7.5 (6.5-8.5%)). Individual factors have been shown to be related to the prevalence of chronic phlegm among farmers. Additionally, this study could support the hypothesis that farming could be negatively related to allergic diseases.

Exposure assessment and lung function in pig and poultry farmers.

OBJECTIVES: To describe the relation between spirometric findings and farming characteristics and variables of exposure to organic dust measured during work in animal buildings. Farmers have traditionally been described as having one of the most dangerous occupations, so a large scale study on European farmers was carried out. This is the report of the second part of that study. METHODS: 40 pig farmers in Denmark and 36 poultry farmers in Switzerland were chosen randomly and were assessed over 1 working day. RESULTS: Mean (SD) baseline spirometric results in pig farmers were higher than in poultry farmers (forced expiratory volume in 1 second (FEV(1)) (% of reference value) 108.3 (16.7) v 100.2 (14.2); p=0.04). Baseline lung function results were significantly associated with ventilation of the animal houses. Furthermore, temperature was related to spirometric findings in pig farmers. CONCLUSIONS: Ventilation of the animal house and temperature might influence respiratory morbidity in farmers.

Candidate physiological measures of annoyance from airborne chemicals.

Annoyance due to short-term exposure to airborne chemicals is a key factor in modern environmental research. Unpleasant odors or those that are believed harmful can annoy us. Since annoyance is modulated by the psychological and physiological states of the exposed persons, it is essential that we understand how these factors interact with environmental stimuli to yield a given level of this response. A potentially fruitful approach in this effort may be to treat annoyance as an emotion induced by the odor, and possibly irritation, resulting from chemical exposures. In this way, methods applied to assess induced emotions will likely be of value in elucidating annoyance. A rationale is presented for use of the startle reflex to elucidate the motor component of annoyance, which is manifest as a redirecting of attention towards the annoying odor (or irritant). Although evidence supporting the use of breathing changes to assess the vegetative component of annoyance is somewhat more scattered and indirect, this approach seems likely to be the most fruitful for future research. Experiments to enhance our understanding of annoyance using these two non-verbal end-points are outlined.

Respiratory symptoms in Swiss farmers: an epidemiological study of risk factors.

BACKGROUND: The study was undertaken to assess the prevalence and risk factors of self-reported asthma, symptoms of chronic bronchitis, hay fever, and work-related respiratory symptoms in Swiss farmers as well as to compare the prevalence rates of respiratory symptoms with the Swiss population (SAPALDIA-Study). METHODS: An epidemiological study was performed with a representative sample of 1,542 Swiss farmers using a self-administered questionnaire. To investigate the effect of the type of farming on reported symptoms, the farmers were subdivided into seven groups according to the time farmers spent in different animal confinement buildings. A multivariate analysis was performed by the methods of binary and multivariate logistic regression adjusted for age and smoking habits. RESULTS: In farmers the prevalence rate was 16.0% for chronic bronchitis, 15.4% for asthma symptoms, and 42.0% for reporting at least one work-related symptom. Using logistic regression analysis, it was established that poultry farming and pig/cattle farming was a risk factor for reporting nasal irritation at work [OR 5.33, (1.57-18.0), OR 3.37 (1.04-10.87)]. Poultry farmers experienced the highest symptom rates. In crop farmers, the prevalence for chronic bronchitis was increased [OR 2.32 (1.03-5.23)]. Over 4 hr spent per day in animal confinement buildings more than doubled the risk for reporting chronic bronchitis [OR 2.61 (1.01-6.76)] and phlegm [OR 2.3 (0.99-5.4)] independent of the type of farming. The comparison of Swiss farmers with the Swiss population showed a twofold elevated risk of reporting chronic bronchitis [OR 1.89 (1.32-2.95)] and a 4.5-fold elevated risk for bringing up phlegm regularly [OR 4.5 (3.25-6.69)] in farmers. In contrast, the risk of farmers to report nasal allergies was less than half as high [OR 0.40 (0.29-0.56)] as that of the general population. CONCLUSIONS: This study shows that agricultural work in Switzerland is associated with an elevated risk for reporting symptoms of chronic bronchitis and chronic phlegm compared with the general Swiss population. These main results most likely indicate occupational disorders as the exposure-response relationship (hours spent in animal confinements) was particularly obvious for these symptoms.

Respiratory symptoms of obstructive lung disease in European crop farmers.

Crop farming as a risk factor for respiratory symptoms of obstructive lung disease was assessed. Random samples of crop farmers from four European countries were studied following a cross-sectional design. A questionnaire on respiratory symptoms and occupation was administered to determine prevalences, and the roles of the various crops as risk factors for respiratory symptoms were assessed through logistic regression modeling. The 4,793 crop farmers included in the study (response rate: 85.3%) reported the following respiratory symptoms: wheezing (14.9%), asthma (3.3%), nasal allergy (14.4%), chronic phlegm (12.4%), organic dust toxic syndrome (ODTS) (15.2%), and symptoms at work (22.0%). In the multivariate analysis, adjusting for age, sex, smoking, country, and exposure to other plants or livestock, flower growing was a risk factor for asthma (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1-3.9) and cultivating oil plants was associated with ODTS (OR 1.5, 95% CI 1.3-1.9), symptoms at work (OR 1.4, 95% CI 1.2- 1.7), and chronic phlegm (OR 1.3, 95% CI 1.1-1.6). Working inside greenhouses was a marginal risk factor for asthma (OR 2.1, 95% CI 0.9-4.5). We conclude that flower and oil plant production is associated with increased risk of respiratory symptoms in European crop farmers.

Lipopolysaccharide-induced nasal cytokine response: a dose-response evaluation.

Information on the dose-response relationship is a prerequisite to defining the non-response threshold of exposure. We investigated whether nasal lipopolysaccharide (LPS) challenges induce an inflammatory response in a dose-dependent way. In three settings nasal lavage was performed before, and 20 min, 1, 6, 23, and 29 h after instillation of 0 microg, 10 microg, and 40 microg LPS for 10 s, in seven healthy subjects. Lavage fluids were analysed for concentrations of interleukin-6 (IL-6), IL-8, tumour necrosis factor-alpha (TNF-alpha), histamine, and albumin. Symptoms were recorded by questionnaire and spirometric lung function was assessed after each lavage. The instillation of 40 microg LPS caused a small increase in nasal symptoms. TNF-alpha was below the detection limit (0.5 pg/ml) in most subjects and, like IL-8 and albumin, showed no relation to the LPS challenge. IL-6 increased over twofold with 10 microg LPS and over 13-fold with 40 microg LPS, with a peak at 6 h after LPS provocation, and the repeated design ANOVA was significant for dose and for time. Six hours after the 40 microg LPS challenge the histamine level significantly increased compared to the saline treatment. We conclude that short-lasting instillation of LPS causes a dose-dependent IL-6 release in the upper airways and minor nasal symptoms.