Self-reported symptoms and their effects on cognitive functioning in workers with past exposure to solvent-based glues: an 18-year follow-up.

OBJECTIVES: To examine to what extent exposure to organic solvents during the working life affects general well-being in the long term, and to explore the relationship between self-reported symptoms and cognitive functioning in previously solvent-exposed floor layers. METHODS: The study included 41 solvent-exposed floor layers and 40 unexposed referents participating in a longitudinal follow-up study 18 years after the baseline assessment. Symptom prevalence and level of spare time activities were studied using the same methods as in the initial study. These include a general health examination, the Q16 symptom questionnaire, and a questionnaire for spare time activities. Relationships between symptoms and cognitive functioning were analysed based on recently published data on cognitive functioning of the participants at follow-up. RESULTS: At follow-up neuropsychiatric symptoms such as need to check things, depressive mood, and abnormal fatigue, were more prevalent among floor layers, particularly the most exposed individuals, than among referents. In addition, the most highly exposed floor layers reported more concentration difficulties and irritability. Fatigue and depressive mood increased over the follow-up time in the most exposed floor layers but not in the referents. Memory difficulties, although more frequent among floor layers than among referents, had decreased in floor layers while increased in referents. Floor layers also reported some negative effects on intimate relations and activity level. Neuropsychiatric symptoms were related to poorer performance chiefly in memory tasks and tests of complex attention and perceptual speed, more seldom in visuospatial tasks. CONCLUSIONS: Findings of exposure-related, long-lasting, partly deteriorating neuropsychiatric complaints indicate that general well-being later in life has been affected in floor layers with past heavy solvent exposure. We also found frequent associations between symptom prevalence and the cognitive functioning. Together with previous findings of dose-related cognitive decrements, the present results strengthen the evidence that long-term heavy occupational solvent exposure may negatively interact with the normal ageing process.

Incidence of asthma among workers exposed to sulphur dioxide and other irritant gases.

The aim of the present study was to investigate whether repeated peak exposure (gassings) to sulphur dioxide (SO2) and other irritant gases increases the risk of new-onset asthma. A questionnaire was sent to 4,112 sulphite workers, of whom 1,919 completed the questionnaire and 396 completed the short-form questionnaire, which was sent out as a last reminder. A sample of 130 nonrespondents completed a telephone interview using the short-form questionnaire. The incidence of adult-onset, physician-diagnosed asthma during employment duration was analysed in relation to exposure to SO2 and gassings giving rise to respiratory symptoms. Incidence rates, as well as incidence rate ratios with 95% confidence interval (CI), were calculated. Further Cox regression models were used allowing assessment of hazard ratios (HR) stratified for sex and adjusted for atopy, smoking habits and age. The incidence rate for asthma among sulphite mill workers reporting gassings of SO2 was 6.2 out of 1,000 person-yrs, compared with 1.9 out of 1,000 person-yrs among subjects unexposed to SO2 and any gassings (HR (95% CI) 4.0 (2.1-7.7)). Among males reporting gassings to SO2, the HR (95% CI) for asthma was 5.8 (2.6-13) compared with unexposed males. In conclusion, repeated peak exposure to sulphur dioxide increased the incidence of asthma during work in sulphite pulp mills, which supports the hypothesis of irritant-induced asthma.

Prevalence of asthma and exhaled nitric oxide are increased in bleachery workers exposed to ozone.

The aims of the present study were to determine whether exposure to high peaks of ozone resulted in an increased prevalence of asthma or respiratory symptoms among bleachery workers and whether nitric oxide (NO) was elevated in the exhaled air of these workers. Bleachery workers (n=228) from three Swedish pulp mills who had been exposed to ozone, together with 63 unexposed control subjects, were investigated by means of spirometry, Phadiatop, exhaled and nasal NO and answers to a questionnaire concerning respiratory symptoms and exposure. Exposure to an ozone peak that gave rise to respiratory symptoms was defined as a "gassing". Bleachery workers reporting four or more gassings involving ozone had an increased prevalence of adult-onset asthma, wheeze, and current asthma symptoms. They also had a higher median concentration of exhaled NO in comparison with those who reported no such gassings (19.2 versus 15.7 parts per billion). No such associations were found in respect of nasal NO. The results from this study show that bleachery workers who have been repeatedly exposed to ozone gassings have an increased prevalence of adult-onset asthma. The results also indicate exhaled nitric oxide may be a marker of airway inflammation in bleachery workers who have been exposed to high peaks of ozone.

Influence of solvent exposure and aging on cognitive functioning: an 18 year follow up of formerly exposed floor layers and their controls.

OBJECTIVES: To extend our knowledge of how exposure to neurotoxic substances during working life affects cognitive functioning in the long term. Does long term occupational exposure to organic solvents lead to aggravated cognitive impairment later in life? METHODS: A follow up was conducted of floor layers exposed to solvents and their unexposed referents (carpenters) 18 years after the baseline assessment. The pattern of cognitive changes in the two groups was compared, with the same 10 neuropsychological tests from the test battery for investigating functional disorders (TUFF) that were used at baseline. The study included 41 floor layers and 40 carpenters. A medical examination focused on health at the present and during the past 18 years. An extensive exposure assessment made in the initial study included questionnaires, interviews, and measurements. Additional exposure during the follow up period was minor, as explored in interviews at follow up. RESULTS: The entire group of floor layers did not deteriorate significantly more over time than did the carpenters. However, among the oldest subjects (>60 years), only floor layers showed decline in visual memory. Moreover, the most highly exposed floor layers deteriorated significantly more than their referents in visual memory and perceptual speed, and they tended to display larger decrements in motor speed. Significant dose effect relations were found; higher cumulative exposure was associated with decrements in visual episodic memory, perceptual speed and attention, and visuospatial skill. CONCLUSIONS: The hypothesis that floor layers would deteriorate more in cognitive performance than their unexposed referents over a period of 18 years was partly supported by the results of this study. The results are consistent with the view that the negative effects of exposure to solvents may interact with the normal aging process, primarily at heavy exposure.

Nasal symptoms among workers exposed to soft paper dust.

OBJECTIVES: To clarify whether occupational exposure to paper-dust is associated with an increased risk of non-infectious rhinitis. METHODS: Thirty-seven workers exposed to paper-dust in a soft-paper mill were compared with 36 unexposed controls. The study was performed under normal working conditions during the non-pollen season. Medical and occupational history was taken down in a comprehensive questionnaire and nasal symptoms were scored on a visual analogue scale (VAS). Pulmonary and nasal function was assessed by spirometry, acoustic rhinometry and peak nasal inspiratory flow. Nasal lavage was analysed for interleukin-8 (IL-8) and nasal transit time was monitored with the saccharine test. Concentrations of inhalable dust for each exposed subject during the day of the clinical study were measured with personal sampling devices. RESULTS: There was an increased prevalence of nasal blockage and crust formation among the exposed workers. However, there was no difference with regard to acoustic rhinometry, nasal transit time or nasal peak inspiratory flow. In the whole population, IL-8 in nasal lavage was higher among men than among women, 193 ng/l vs 132 ng/l, P = 0.006. There was also a positive trend (P = 0.01) with increasing nasal IL-8 going from non-smokers (122 ng/l), ex-smokers (126 ng/l) to current smokers (235 ng/l). CONCLUSIONS: We have found that occupational exposure to paper-dust is associated with symptoms of nasal blockage and nasal crusting. We find no objective signs of nasal inflammation, even among the subgroup with the highest current exposure.

A case-referent study of cancer mortality among sulfate mill workers in Sweden.

OBJECTIVES: To investigate whether workers in Swedish sulfate mills have an increased risk of death from certain malignancies that have previously been linked to the pulping process. METHODS: Subjects of the study (n=2480) were men aged 40-75 at death during 1960-89 in the parishes surrounding four sulfate mills. Exposure assessment was based on information from the personnel files in the mills- 35% of the subjects were recognised there, and work categories were created. RESULTS: Among all sulfate mill workers, the odds ratio (OR) (90% confidence interval (90% CI)) for death from lung cancer was 1.6 (1.1 to 2.3), pleural mesotheliomas 9.5 (1.9 to 48), brain tumours 2.6 (1.2 to 5.3), and liver or biliary tract cancer 2.3 (1.0 to 5.2). There was an increased mortality from leukaemia among workers in the soda recovery plant (5.9 (2.6 to 13)) and bleaching plant and digester house (2.8 (1.0 to 7.5)). CONCLUSIONS: Sulfate mill workers were at increased risk of dying from lung cancer and pleural mesotheliomas, probably due to exposure to asbestos. Increased risks of brain tumours and cancers of the liver or biliary tract were also found but the aetiology is not obvious.

Adult-onset asthma and occupational exposures.

OBJECTIVES: This study examined certain occupational exposures and the risk for adult-onset asthma. METHODS: A nested case-referent study of adult-onset asthma was performed on a random population sample (N=15813), aged 21 to 51 years. Cases for the study included 2 groups: subjects reporting "physician-diagnosed" asthma (N=251) and a broader "asthma" group (N=362). The "asthma" group consisted of subjects with "physician-diagnosed" asthma (N=251) and subjects reporting asthma-like symptoms without having "physician-diagnosed" asthma (N=111). The referents (N=2044) were randomly selected from the whole population sample. The case-referent sample was investigated with a comprehensive questionnaire about occupational exposures, asthma, respiratory symptoms, smoking, and atopy. Odds ratios were calculated with stratification for gender, year of diagnosis, and birth year. RESULTS: The highest odds ratio for "physician-diagnosed" asthma was associated with exposure to flour dust [odds ratio (OR) 2.8, 95% confidence interval (95% CI) 1.5-5.2] and the occupational handling of resin-based paints (isocyanates) (OR 3.0, 95% CI 1.6-5.9). Exposure to welding fumes, textile dust, and work with glues containing acrylates was also associated with an increased odds ratio for "physician-diagnosed" asthma. Including persons with asthma-like symptoms (ie, the asthma group) showed similar results. CONCLUSION: This population-based case-referent study from Sweden indicates that occupational exposure to acrylate-based compounds and welding fumes is associated with increased risk for adult-onset asthma.

Exhaled nitric oxide among pulpmill workers reporting gassing incidents involving ozone and chlorine dioxide.

The aim of the study was to investigate whether measurement of nitric oxide in exhaled air could be used for assessing the effects of irritants on the respiratory system, in this case recurrent ozone gassing in an occupational setting. The study population comprised bleachery workers (n=56) from a Swedish pulpmill carrying out ozone-based pulp bleaching since 1992 and controls (n=39). Both groups were investigated by measuring NO in exhaled air, methacholine challenge test and answers to a questionnaire concerning history of respiratory symptoms and accidental exposure to ozone peaks. There was no significant difference in NO output between exposed subjects and controls (median 67.2 versus 55.0 nL x min(-1), p=0.64). However, among bleachery workers reporting ozone gassings, the median NO output was 90.0 nL x min(-1) compared to 58.8 nL x min(-1) among those not reporting such incidents (p=0.019). There was no relation between exhaled NO and the prevalence of respiratory symptoms or bronchial hyperresponsiveness. In a multiple regression model, only reported ozone gassings were associated (p=0.016) with NO output. The results indicate an association between previous response to ozone gassing and nitric oxide output. The increased nitric oxide output among the bleachery workers reporting peak ozone exposure may indicate that chronic airway inflammation is present. Further studies are needed to evaluate the extent to which nitric oxide can be used for biological monitoring of respiratory health effects, and to relate it to other markers of airway inflammation.

Substance abuse treatment cost offsets vary with gender, age, and abstinence likelihood.

The cost-offset effect has been promoted as a way for substance abuse treatment to pay for itself by generating reductions in health care utilization in other areas. Clients (n = 5,434) that were abstinent for 24 months following substance abuse treatment had lower posttreatment utilization than clients that had relapsed. An examination of cost offsets revealed a complex interplay between gender, age, and type of utilization (medical versus psychiatric). Cost offsets were especially pronounced for women over 40 years old.

Improved nasal clearance among pulp-mill workers after the reduction of lime dust.

OBJECTIVES: The purpose of this study was to investigate nasal symptoms and function among workers exposed to lime dust and to determine if a reconstruction of the workplace improved the worker's nasal health. METHODS: In 1992, pulp-mill workers (N = 15) exposed to lime dust and an equal number of matched unexposed referents were examined by questionnaires, nasal peak expiratory flow, the saccharin test, nasal lavage, and a clinical examination of the upper airways. The study was repeated one year later, after the pulp mill had been rebuilt. Dust levels were measured on both occasions with stationary and personal samplings. RESULTS: In 1992 the total dust level was 1.2 mg.m-3. The saccharin test showed a significantly increased nasal transit time for the exposed workers in comparison with that of the unexposed referents (difference 3.5 min, 95% confidence interval 0.1-6.9 min). One year later the dust levels had decreased to 0.1 mg. m-3, and the difference in nasal transit time had decreased (difference- 0.8 min, 95% confidence interval -4.8-3.3 min). CONCLUSIONS: Workers exposed to lime dust have an impaired mucociliary function. This impairment is probably due to the alkalinity of the lime. When dust levels are reduced, mucociliary function improves; therefore renovating a workplace to reduce dust levels has a positive effect.

Health effects of working in pulp and paper mills: exposure, obstructive airways diseases, hypersensitivity reactions, and cardiovascular diseases.

Workers in the pulp and paper industry are exposed to different substances, such as hydrogen sulfide and other reduced sulfur compounds, chlorine, chlorine dioxide, sulfur dioxide, terpenes, and paper dust. The exposure level depends on the process, i.e., sulfite, sulfate, groundwood, bleachery, or paper production. Hitherto, exposures have been poorly described and more studies are certainly needed. Workers with repeated exposure peaks to chlorine, e.g., bleachery workers, seem to have an impaired lung function and an increased prevalence of respiratory symptoms. Exposure to high levels of paper dust, (> 5 mg/m3) causes impaired lung function. Therefore, exposure to respiratory irritants is an important, and probably overlooked, occupational risk among certain groups of pulp and paper workers. Some studies indicate that sulfate workers with high exposure to reduced sulfur compounds have an increased mortality due to ischemic heart disease. However, before any definite conclusions can be drawn, the impact of important confounders, such as shift-work and smoking habits have to be further evaluated.

Quantitative importance of asbestos as a cause of lung cancer in a Swedish industrial city: a case-referent study.

We wanted to assess the quantitative importance of asbestos as a cause of lung cancer. In a case-referent study, the exposure to asbestos, tobacco smoke and some other occupational exposures were compared between 147 cases of lung cancer (100 men, 47 women), 111 hospital referents, and 109 population referents, all below the age of 75 yrs and living in an industrial city. The attributable risk of lung cancer due to asbestos exposure was 16% in men (95% confidence interval 1-31%). No woman had occupational exposure to asbestos. We conclude that in the mid 1980's tobacco smoking was the major attributable risk, being 95% for men and 78% for women, but that in men asbestos was an appreciable contributing factor in the general population of a Swedish industrial city.

Evaluation of skin symptoms among workers at a Swedish paper mill.

Process and office workers at a Swedish paper mill (n = 274) and dairy workers (n = 45) were investigated with questionnaires regarding skin symptoms. In the second part of the study, subjects reporting skin symptoms and a random sample of subjects without symptoms were examined and investigated with patch testing. Pruritus and skin irritation probably related to exposure to dust were found. The results do not indicate an increased prevalence of contact allergy. In two cases, positive patch test reactions to paper size (rosin) and a slimicide, mercaptobenzothiazole (MBT), were noted.

Adolescent suicide attempts: outcomes at follow-up.

Adolescents seen in a general hospital emergency department or psychiatrically hospitalized were followed up at one month and three months following a suicide attempt. Findings included substantial drop-out rates for psychotherapy and high rates of repeated suicide attempts by three months. Implications for disposition planning and care of such adolescents are discussed.

Prenatally diagnosed gastroschisis--a preliminary report advocating the use of elective caesarean section.

Seven cases of prenatally diagnosed gastroschisis were evaluated. All infants were delivered by elective Caesarean section and brought to the operating theatre immediately after birth where the abdominal wall defect was closed within one hour post partum. Primary closure was easy and successful in all cases without widening of the defect and with the umbilicus left intact, because of the total lack of oedema and bowel peel. The average duration of postoperative total parenteral nutrition (7 days) and hospital stay (18 days) was significantly shorter in this prenatally diagnosed group compared to traditionally treated cases.

Management of esophageal atresia: review of 16 years' experience.

This report reviews 16 years' experience in the management of patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF), with special emphasis on long-term results and early complications in relation to the magnitude of the gap between the esophageal segments. In 94 infants with no or moderate distance between the esophageal ends (less than 2 cm), an end-to-end anastomosis was performed in 90 cases after closing the TEF. In 51 of the 90 patients, no complications were seen (57%), whereas in the remaining 39, postoperative complications were noted with anastomotic leakage (24 patients, 26%), anastomotic stricture (16 patients, 18%) and gastroesophageal reflux (5 patients, 5%). Sixteen patients (9 with and 7 without TEF) had a "long gap" between the esophageal segments (greater than 2 cm). Thirteen (9 with and 4 without TEF) of these 16 patients were subjected to an end-to-end anastomosis, 11 primarily and two secondarily after 3 and 12 weeks, respectively. All 13 patients with an end-to-end anastomosis had anastomotic leakage (100%)--nine had stricture (75%) and 5 had gastroesophageal reflux (50%). The remaining three patients in this long-gap group were subjected to colon transposition, two primarily and one secondarily. The total mortality rate decreased from 19/57 patients (33%) from 1969 to 1977, to 5/53 (9%) from 1978 to 1984. The main cause of death in both periods was associated anomalies (18% and 7%, respectively), whereas deaths related to the EA malformation as such had almost disappeared during the latter period (15% and 2%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Early complications and long-term results of colorectal resection ad modum Rehbein for Hirschsprung's disease.

Ten years experience with Rehbein's procedure in the surgical treatment of Hirschsprung's disease (23 patients) is reported. Eleven patients were operated with a covering colostomy. Clinically overt anastomotic dehiscence was seen in 6/23 patients, being more common in the patients without a colostomy (5/12). Five of the patients with anastomotic dehiscence recovered completely after surgical intervention (4) or conservative treatment (1), whereas one patient ended up with incontinence. One patient died in enterocolitis apparently without relation to the surgical treatment. Early postoperative constipation and soiling were common, whereas at late follow-up constipation was reported only in one patient. At late follow up barium enemas showed a normal colorectal calibre in most patients. Anorectal manometry (n = 8) showed absence of normal rectoanal inhibition and rectal volumes slightly larger than among controls.

Asbestos pleural effusion: a clinical entity.

In a case-control study asbestos exposure in 64 consecutive men with idiopathic pleural effusion and 129 randomly sampled age matched male controls was compared. Furthermore, seven women and 64 men with idiopathic pleural effusion were studied, including a three year re-examination, in an attempt to identify characteristics that might distinguish asbestos exposed from non-exposed patients. Asbestos exposure was significantly (p less than 0.01) more frequent in men with idiopathic effusions than in controls. The idiopathic effusions seen in asbestos exposed patients were compatible with the diagnosis "asbestos pleural effusion." Two features were characteristic of patients with asbestos pleural effusion: a chest radiograph at the initial examination showing converging pleural linear structures or rounded atelectasis or a history of recurrent pleural effusion, or both.