Occupational health and safety, metal exposures and multi-exposures health risk in Canadian electronic waste recycling facilities.

Electronic waste recycling (e-recycling) involves manual operations that expose workers to toxic metals. We aim to describe occupational health and safety practices and workers' exposures to metals in the Canadian formal e-recycling industry, and to estimate the health risk associated with multiple exposures. This cross-sectional study documented practices through observations and questionnaires, and assessed metal exposures using personal air samples and biomarkers. Health risks were estimated relative to recognised occupational exposure guidelines, and using an additive approach for consideration of multiple exposures. Six e-recycling and one commercial recycling facilities were investigated, and the metal exposures of 99 workers (23 women) were measured. In most facilities, dust control was inadequate and personal protective equipment was improperly worn. In e-recycling, lead was detected in all air samples and in most blood samples, up to 48 µg/m3 and 136 µg/l, respectively. Other quantified metals included beryllium, mercury, arsenic, barium, cadmium, chrome, cobalt, copper, indium, manganese, nickel and yttrium. When handling cathode ray tube screens, workers were 4.9 times and 8.5 times more likely to be exposed to lead and yttrium, respectively, than workers who were not assigned to a specific type of electronics. Overall, exposures were largely associated with facility size and airborne dust concentration. The additive hazard indices for airborne exposures raised concerns for kidney disorders, for peripheral and central nervous systems, and for the male reproductive system. Minimizing airborne dust through collective control methods and adequately using personal protection should reduce metal exposures and associated health risks in this growing industry.

Can Silicone Passive Samplers be Used for Measuring Exposure of e-Waste Workers to Flame Retardants?

Silicone passive samplers were assessed for measuring personal exposure to 37 flame retardants at three Québec e-waste recycling facilities. Silicone brooches (n = 45), wristbands (n = 28), and armbands (n = 9) worn during a ∼8 h work shift accumulated detectable amounts of 95-100% of the target compounds. Brooch concentrations were significantly correlated with those from active air samplers from which we conclude that the brooches could be used to approximate inhalation exposure and other exposures related to air concentrations such as dermal exposure. The generic sampling rate of the brooch (19 ± 11 m3 day-1 dm-2) was 13 and 22 times greater than estimated for home and office environments, respectively, likely because of the dusty work environment and greater movement of e-waste workers. BDE-209 concentrations in brooches and wristbands were moderately and significantly (p < 0.05) correlated with levels in blood plasma; organophosphorus esters in brooches and wristbands were weakly and insignificantly correlated with their metabolite biomarkers in post-shift spot urine samples. Silicone brooches and wristbands deployed over a single shift in a dusty occupational setting can be useful for indicating the internal exposure to compounds with relatively long biological half-lives, but their use for compounds with relatively short half-lives is not clear and may require either a longer deployment time or an integrated biomarker measure.

Overlapping vulnerabilities in workers of the electronics recycling industry formal sector: A commentary.

Vulnerabilities in workers performing electronics recycling (e-recycling) in the informal sector worldwide have been well documented. However, the growing e-recycling industry in the formal sector still brings many challenges to protect the health of workers and their environment. This commentary aims to draw attention to the overlooked vulnerabilities faced by the workers of the e-recycling industry formal sector in high-income countries and discuss the potential impact on health inequalities experienced by these workers. Expanding the definition of vulnerability, not limited to the biological susceptibility to chemical and physical exposures, the demographic characteristics of workers in the e-recycling formal sector often reveal social groups known to be disadvantaged regarding occupational exposures and health effects, including young workers, immigrant or ethnic minorities, and workers with mental or physical health issues or disabilities. Overlapping structural vulnerabilities of the e-recycling industry stem from its newness, its working conditions, its conditions of employment, and the sociodemographic characteristics of its workforce. This phenomenon in high-income countries is not restricted to the e-recycling industry alone. It is rather a symptom of more generalized macro socioeconomical phenomena. The present challenges are in line with the new gig and green economies and changes in the global market, and their consequences on the solid waste sector. Continued efforts to strengthen the inclusion of social aspects of health into the complex interaction of the structural vulnerabilities met by e-recycling workers will be essential to anticipate and prevent health issues in this essential but still emerging workforce.

Multi-exposures to suspected endocrine disruptors in electronic waste recycling workers: Associations with thyroid and reproductive hormones.

Electronic waste recycling (e-recycling) exposes workers to substances such as flame retardants and metals. Some of them are known or suspected endocrine disruptors that could affect hormonal homeostasis and eventually result in adverse health outcomes. Our aim was to measure biological concentrations of organophosphate ester (OPE) metabolites, polybrominated diphenyl ethers (PBDEs), mercury, lead and cadmium in e-recycling workers, and to explore associations with thyroid and sexual hormones. In a cross-sectional study, end-of-shift blood and urine spot samples were collected from 23 women and 77 men in six e-recycling facilities and one commercial recycling facility. Urinary concentrations of 15 OPE metabolites and mercury, and blood concentrations of 12 PBDE congeners, lead, cadmium, and thyroid (thyroxine [T4], triiodothyronine [T3], thyroid stimulating hormone [TSH]) and sexual (testosterone [T], estradiol, Follicle Stimulating Hormone [FSH], Luteinizing hormone [LH]) hormones were measured. E-recycling workers had higher concentrations of BDE209, all OPE metabolites, and lead than commercial recycling workers. In e-recycling workers, plasma geometric mean concentration of BDE209 was 18 ng/g lipids (geometric standard deviation [GSD]: 2.8) vs.1.7 ng/g lipids (GSD: 2.8) in commercial recycling, and urinary geometric mean concentration of diphenyl phosphate (DPhP), a major metabolite of triphenyl phosphate, was 1.7 ng/ml (GSD: 2.5), vs. 0.95 ng/ml (GSD: 2.0). In men, a two-fold increase in BDE209 was associated with 3.1% (95% Confidence interval: 0.07, 6.1) higher levels of total T4, and a two-fold increase in tert-butyl diphenyl phosphate (tb-DPhP) was associated with 18% (-29, -4.7) lower total T, 18% (-27, -6.9) lower free T and 13% (-25, 0.70) lower free T/estradiol ratio. In women, a two-fold increase in BDE153 was associated with 10% (-17, -3.2) lower free T3. To our knowledge, this is the first study to show associations between OPE metabolites and sex hormones in adults. Although some of our results are not conclusive and need replication, they suggest that prudent avoidance should be applied in risk management of flame retardants.

Halogenated flame retardants and organophosphate esters in the air of electronic waste recycling facilities: Evidence of high concentrations and multiple exposures.

BACKGROUND: In response to a worldwide increase in production of electronic waste, the e-recycling industry is rapidly rowing. E-recycling workers are exposed to many potentially toxic contaminants, among which flame retardants (FRs), mainly suspected of being endocrine disruptors, are thought to be the most prevalent. OBJECTIVE: To conduct an exposure assessment of four chemical groups of FRs in Canadian e-recycling facilities, and to identify the main cofactors of exposure. METHODS: Personal air samples were collected over a workday for 85 workers in six e-recycling facilities, grouped into three facility sizes, and for 15 workers in control commercial waste facilities. Total particulate matter was measured by gravimetry with stationary air samples. FRs were collected on OSHA versatile samplers, which allow particulate and vapor phases collection. Fifteen polybrominated diphenyl ether congeners (PBDEs), nine novel brominated (NBFRs), two chlorinated (ClFRs), and fourteen organophosphate ester (OPEs) flame retardants were analysed by gas chromatography-mass spectrometry. Sociodemographic data, tasks performed and materials processed by participating workers were recorded. Tobit regressions were used to identify cofactors of exposure, and their conclusions were corroborated using semi-parametric reverse Cox regressions. RESULTS: Thirty-nine of the 40 FRs analysed were detected in at least one air sample in e-recycling, and workers in this industry were exposed on average to 26 (range 12 to 39) different substances. The most detected chemical group of FRs in e-recycling was PBDEs with geometric mean sums of all congeners ranging from 120 to 5100 ng/m3, followed by OPEs with 740 to 1000 ng/m3, NBFRs with 7.6 to 100 ng/m3, and finally ClFRs with 3.9 to 32 mg/m3. The most important cofactor of exposure was the size of the e-recycling facility, with the largest one presenting on average 12 times the concentrations found in the control facility. Among tasks as potential cofactors of exposure, manual dismantling and baler operation exposed workers to some of the highest concentrations of PBDEs and ClFRs. There was a reduction of up to 27% in exposure to FRs associated with a 3-year increase in seniority. Finally, particulate matter concentrations in e-recycling facilities were highly correlated with all chemical classes except OPEs, and were higher in the large facility. CONCLUSIONS: Among the FRs analysed, PBDE exposure was particularly high in e-recycling. Dust and particulate matter reduction strategies in these workplaces, together with training on proper working practices would certainly be important first steps to lower occupational exposures and prevent potential health effects.

Assessment of Occupational Exposure to Organic Flame Retardants: A Systematic Review.

BACKGROUND: Flame retardants (FRs) are widespread in common goods, and workers in some industries can be exposed to high concentrations. Numerous studies describe occupational exposure to FRs, but the diversity of methods and of reported results renders their interpretation difficult for researchers, occupational hygienists, and decision makers. OBJECTIVES: The objectives of this paper are to compile and summarize the scientific knowledge on occupational exposure to FRs as well as to identify research gaps and to formulate recommendations. METHODS: Five databases were consulted for this systematic literature review (Embase, Medline [Pubmed], Global health, Web of Science, and Google Scholar), with terms related to occupational exposure and to FRs. Selected studies report quantitative measurements of exposure to organic FRs in a workplace, either in air, dust, or in workers' biological fluids. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines were followed. RESULTS: The search yielded 1540 published articles, of which 58 were retained. The most frequently sampled FRs were polybrominated diphenyl ethers and novel brominated FRs. Offices and electronic waste recycling facilities were the most studied occupational settings, and the highest reported exposures were found in the latter, as well as in manufacturing of printed circuit boards, in aircrafts, and in firefighters. There were recurrent methodological issues, such as unstandardized and ill-described air and dust sampling, as well as deficient statistical analyses. CONCLUSIONS: This review offers several recommendations. Workplaces such as electronic waste recycling or manufacturing of electronics as well as firefighters and aircraft personnel should be granted more attention from researchers and industrial hygienists. Methodical and standardized occupational exposure assessment approaches should be employed, and data analysis and reporting should be more systematic. Finally, more research is needed on newer chemical classes of FRs, on occupational exposure pathways, and on airborne FR particle distribution.

Exposure to polybrominated diphenyl ethers (PBDEs) in American and Canadian workers: Biomonitoring data from two national surveys.

Polybrominated diphenyl ethers (PBDEs) are flame retardants commonly found in many household and industrial products. They can be detected in the serum of the general population, and in even higher concentrations in workers of certain industries, due to an additional occupational exposure. The purpose of this analysis is to determine background exposure levels of PBDEs in the general working population, using national surveys where working status was self-reported. Participants aged 20-65 were selected from the 2003-2004 U.S. National Health and Nutrition Examination Survey (n=1141) and the 2007-2009 Canadian Health Measures Survey (n=1337). Only four congeners were detected in at least 25% of samples for both surveys: BDE47, 99, 100 and 153. NHANES workers had a geometric mean (GM [95% C.I.]) BDE47 concentration of 20.9ng/g lipids [19.3, 22.7], and CHMS workers, 11.4ng/g lipids [10.8, 12.1]. PBDE levels were not statistically significantly different between workers and non-workers, except for BDE153 in CHMS. Among workers, women had a significantly lower concentration of BDE153 than men in both surveys (% change [95% C.I.] with 1ng/g lipid increase: -33.4% [-49.0, -12.9] in NHANES, -18.8% [-27.5, - 8.9] in CHMS), in regressions adjusted for age, body mass index, smoking status, ethnicity and education. CHMS workers in the Information, finance, real-estate, and education industry group had significantly higher BDE47 concentrations than non-workers. These results indicate a high exposure to PBDEs in two North American countries, compared to data from other national surveys. The heterogeneity of the data did not permit a clear-cut distinction between workers and non-workers. Sex differences noted with BDE153 are consistent with those reported in other human exposure assessments and animal studies. Overall, industry-specific concentrations showed no particular pattern across both surveys. Despite some limitations, these data provide a useful estimate of the background exposure to PBDEs in American and Canadian workers.

Has the question of e-waste opened a Pandora's box? An overview of unpredictable issues and challenges.

Despite regulatory efforts and position papers, electrical and electronic waste (e-waste) remains ill-managed as evidenced by the extremely low rates of proper e-waste recycling (e-recycling) worldwide, ongoing illegal shipments to developing countries and constantly reported human health issues and environmental pollution. The objectives of this review are, first, to expose the complexity of e-waste problems, and then to suggest possible upstream and downstream solutions. Exploring e-waste issues is akin to opening a Pandora's box. Thus, a review of prevailing e-waste management practices reveals complex and often intertwined gaps, issues and challenges. These include the absence of any consistent definition of e-waste to date, a prevalent toxic potential still involving already banned or restricted hazardous components such as heavy metals and persistent and bioaccumulative organic compounds, a relentless growth in e-waste volume fueled by planned obsolescence and unsustainable consumption, problematic e-recycling processes, a fragile formal e-recycling sector, sustained and more harmful informal e-recycling practices, and more convoluted and unpredictable patterns of illegal e-waste trade. A close examination of the e-waste legacy contamination reveals critical human health concerns, including significant occupational exposure during both formal and informal e-recycling, and persistent environmental contamination, particularly in some developing countries. However, newly detected e-waste contaminants as well as unexpected sources and environmental fates of contaminants are among the emerging issues that raise concerns. Moreover, scientific knowledge gaps remain regarding the complexity and magnitude of the e-waste legacy contamination, specifically, a comprehensive characterization of e-waste contaminants, information on the scale of legacy contamination in developing countries and on the potential environmental damage in developed countries, and a stronger body of evidence of adverse health effects specifically ascribed to e-waste contaminants. However, the knowledge accumulated to date is sufficient to raise awareness and concern among all stakeholders. Potential solutions to curb e-waste issues should be addressed comprehensively, by focusing on two fronts: upstream and downstream. Potential upstream solutions should focus on more rational and eco-oriented consumer habits in order to decrease e-waste quantities while fostering ethical and sustained commitments from manufacturers, which include a limited usage of hazardous compounds and an optimal increase in e-waste recyclability. At the downstream level, solutions should include suitable and pragmatic actions to progressively reduce the illegal e-waste trade particularly through international cooperation and coordination, better enforcement of domestic laws, and monitoring in both exporting and receiving countries, along with the supervised integration of the informal sector into the recycling system of developing countries and global expansion of formal e-waste collection and recycling activities. Downstream solutions should also introduce stronger reverse logistics, together with upgraded, more affordable, and eco-friendly and worker-friendly e-recycling technologies to ensure that benefits are derived fully and safely from the great economic potential of e-waste.

The Canadian Systemic Sclerosis Oral Health Study IV: oral radiographic manifestations in systemic sclerosis compared with the general population.

OBJECTIVE: The aim of this study was to compare oral radiologic abnormalities associated with systemic sclerosis (SSc) against abnormalities in the general population. STUDY DESIGN: Patients with SSc and healthy controls were enrolled in a multi-site cross-sectional study. Included in the radiology examination were a panoramic radiograph, four bitewings, and an anterior mandibular periapical radiograph. Radiographs were evaluated by two oral and maxillofacial radiologists tested for interobserver and intraobserver reliability. Chi-squared tests, Fisher exact tests, and Mann Whitney U tests were used to summarize the radiologic manifestations of patients and controls. RESULTS: We assessed 163 SSc patients and 231 controls. Widening of the periodontal ligament space (PLS) (P < .001), with higher percentage of teeth with PLS widening (P < .001), was significantly more frequent in patients with SSc than in controls. The most significant differences between the two groups were found in the molars and premolars (P < .001). Moreover, 26% of the patients with SSc had a periapical PLS greater than 0.19 mm compared with 13% of the controls (P = .003). Patients with SSc had significantly more erosions compared with controls (14.5% vs. 3.6%; P < .001), mostly in the condyles (P = .022), coronoid processes (P = .005) and other locations (P = .012). CONCLUSION: Patients with SSc had more teeth with PLS widening and erosions of the mandible compared with controls.

The Canadian systemic sclerosis oral health study II: the relationship between oral and global health-related quality of life in systemic sclerosis.

OBJECTIVE: Both oral and global health-related quality of life (HRQoL) are markedly impaired in SSc. In this study we aimed to determine the degree of association between oral HRQoL and global HRQoL in SSc. METHODS: Subjects were recruited from the Canadian Scleroderma Research Group registry. Global HRQoL was measured using the Medical Outcomes Trust 36-item Short Form Health Survey (SF-36) and oral HRQoL with the Oral Health Impact Profile (OHIP). The Medsger Disease Severity Score was used to determine organ involvement. Multivariate regression models determined the independent association of the OHIP with the SF-36 after adjusting for confounders. RESULTS: This study included 156 SSc subjects. The majority (90%) were women, with a mean age of 56 years, mean disease duration 13.8 years (s.d. 8.5) and 29% of the subjects had dcSSc. Mean total OHIP score was 40.8 (s.d. 32.4). Mean SF-36 mental component summary (MCS) score was 49.7 (s.d. 11.1) and physical component summary (PCS) score was 37.0 (s.d. 10.7). In adjusted analyses, the total OHIP score was significantly associated with the SF-36 MCS and PCS, accounting for 9.7% and 5.6% of their respective variances. Measures of disease severity were not related to OHIP score. CONCLUSION: Oral HRQoL in SSc is independently associated with global HRQoL. Oral HRQoL, however, is not related to physician-assessed disease severity. This suggests that physicians may be disregarding issues related to oral health. HRQoL is an additional dimension of HRQoL not captured by generic instruments such as the SF-36.

Relationship between disease characteristics and orofacial manifestations in systemic sclerosis: Canadian Systemic Sclerosis Oral Health Study III.

OBJECTIVE: Systemic sclerosis (SSc; scleroderma) is associated with decreased saliva production and interincisal distance, more missing teeth, and periodontal disease. We undertook this study to determine the clinical correlates of SSc with these oral abnormalities. METHODS: Subjects were recruited from the Canadian Scleroderma Research Group cohort. Detailed dental and clinical examinations were performed according to standardized protocols. Associations between dental abnormalities and selected clinical and serologic manifestations of SSc were examined. RESULTS: One hundred sixty-three SSc subjects were included: 90% women, mean ± SD age 56 ± 11 years, mean ± SD disease duration 14 ± 8 years, 72% with limited cutaneous disease, and 28% with diffuse cutaneous disease. Decreased saliva production was associated with Sjögren's syndrome-related autoantibodies (ß = -43.32; 95% confidence interval [95% CI] -80.89, -5.75), but not with disease severity (ß = -2.51; 95% CI -8.75, 3.73). Decreased interincisal distance was related to disease severity (ß = -1.02; 95% CI -1.63, -0.42) and the modified Rodnan skin thickness score (ß = -0.38; 95% CI -0.53, -0.23). The number of missing teeth was associated with decreased saliva production (relative risk [RR] 0.97; 95% CI 0.94, 0.99), worse hand function (RR 1.52; 95% CI 1.13, 2.02), and the presence of gastroesophageal reflux disease (GERD; RR 1.68 [95% CI 1.14, 2.46]). No clinical or serologic variables were correlated with periodontal disease. CONCLUSION: In SSc, diminished interincisal distance is related to overall disease severity. Decreased saliva production is related to concomitant Sjögren's syndrome antibodies. Tooth loss is associated with poor upper extremity function, GERD, and decreased saliva. The etiology of excess periodontal disease is likely multifactorial and remains unclear.

The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population.

OBJECTIVE: The aim of this study was to compare oral abnormalities and oral health-related quality of life (HRQoL) of patients with SSc with the general population. METHODS: SSc patients and healthy controls were enrolled in a multisite cross-sectional study. A standardized oral examination was performed. Oral HRQoL was measured with the Oral Health Impact Profile (OHIP). Multivariate regression analyses were performed to identify associations between SSc, oral abnormalities and oral HRQoL. RESULTS: We assessed 163 SSc patients and 231 controls. SSc patients had more decayed teeth (SSc 0.88, controls 0.59, P = 0.0465) and periodontal disease [number of teeth with pocket depth (PD) >3 mm or clinical attachment level (CAL) ≥5.5 mm; SSc 5.23, controls 2.94, P < 0.0001]. SSc patients produced less saliva (SSc 147.52 mg/min, controls 163.19 mg/min, P = 0.0259) and their interincisal distance was smaller (SSc 37.68 mm, controls 44.30 mm, P < 0.0001). SSc patients had significantly reduced oral HRQoL compared with controls (mean OHIP score: SSc 41.58, controls 26.67, P < 0.0001). Multivariate regression analyses confirmed that SSc was a significant independent predictor of missing teeth, periodontal disease, interincisal distance, saliva production and OHIP scores. CONCLUSION: Subjects with SSc have impaired oral health and oral HRQoL compared with the general population. These data can be used to develop targeted interventions to improve oral health and HRQoL in SSc.

Polymerase chain reaction detection of potentially pathogenic free-living amoebae in dental units.

Several genera of amoebae can be found in water from dental units and on the inner surface of waterlines. The presence of bacterial biofilms on these surfaces is thought to favor the proliferation of amoebae. Potentially pathogenic Acanthamoeba and Naegleria spp. may be an infection risk for patients through contact with open surgical sites or aerosolization. A polymerase chain reaction of DNA extracted from pelleted samples showed that Acanthamoeba spp. and Naegleria spp. were present in water from dental units, suction lines, and suction filters at the dental clinic of the Université de Montréal. Acanthamoeba spp. were detected in 24.2% of 66 samples and Naegleria spp. in 3.0%. We discuss the infection risk associated with these results.

Altered salivary redox homeostasis in patients with systemic sclerosis.

OBJECTIVE: Oxidative stress has been implicated in the pathogenesis of systemic sclerosis (SSc). Our objective was to determine whether SSc is associated with altered redox homeostasis in human saliva. METHODS: Study participants were 70 women with SSc and 120 female controls. 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-epi-prostaglandin F 2alpha (8-epi-PGF2alpha), and total protein carbonyls were assayed by ELISA to quantify oxidative damage to nucleic acids, lipids, and proteins, respectively, in whole nonstimulated saliva. RESULTS: We observed a significantly positive association between salivary log protein carbonyls and SSc in a crude statistic (OR 9.06, p < 0.0001), and multivariable model adjusted for log 8-OHdG, log 8-epi-PGF2alpha, and antioxidant exposure (OR 9.26, p < 0.0001). No significant association was noted between SSc and salivary log 8-epi-PGF2alpha or log 8-OHdG. CONCLUSION: Salivary redox homeostasis is perturbed in patients with SSc and may inform on the pathophysiology and presence of the disease (biomarkers) and efficacy of therapeutic interventions.