Understanding the pathogenesis of engineered stone-associated silicosis: The effect of particle chemistry on the lung cell response.

BACKGROUND AND OBJECTIVE: The resurgence of severe and progressive silicosis among engineered stone benchtop industry workers is a global health crisis. We investigated the link between the physico-chemical characteristics of engineered stone dust and lung cell responses to understand components that pose the greatest risk. METHODS: Respirable dust from 50 resin-based engineered stones, 3 natural stones and 2 non-resin-based materials was generated and analysed for mineralogy, morphology, metals, resin, particle size and charge. Human alveolar epithelial cells and macrophages were exposed in vitro to dust and assessed for cytotoxicity and inflammation. Principal component analysis and stepwise linear regression were used to explore the relationship between engineered stone components and the cellular response. RESULTS: Cutting engineered stone generated fine particles of <600 nm. Crystalline silica was the main component with metal elements such as Ti, Cu, Co and Fe also present. There was some evidence to suggest differences in cytotoxicity (p = 0.061) and IL-6 (p = 0.084) between dust samples. However, IL-8 (CXCL8) and TNF-α levels in macrophages were clearly variable (p < 0.05). Quartz explained 11% of the variance (p = 0.019) in macrophage inflammation while Co and Al accounted for 32% of the variance (p < 0.001) in macrophage toxicity, suggesting that crystalline silica only partly explains the cell response. Two of the reduced-silica, non-engineered stone products induced considerable inflammation in macrophages. CONCLUSION: These data suggest that silica is not the only component of concern in these products, highlighting the caution required as alternative materials are produced in an effort to reduce disease risk.

Current and projected heatwave-attributable occupational injuries, illnesses, and associated economic burden in Australia.

INTRODUCTION: The costs of global warming are substantial. These include expenses from occupational illnesses and injuries (OIIs), which have been associated with increases during heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs and their costs in Australia. MATERIALS AND METHODS: Climate and workers' compensation claims data were extracted from seven Australian capital cities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat Factor. OIIs and associated costs were estimated separately per city and pooled to derive national estimates. Results were projected to 2030 (2016-2045) and 2050 (2036-2065). RESULTS: The risk of OIIs and associated costs increased during heatwaves, with the risk increasing during severe and particularly extreme heatwaves. Of all OIIs, 0.13% (95% empirical confidence interval [eCI]: 0.11-0.16%) were heatwave-attributable, equivalent to 120 (95%eCI:70-181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18-0.34%), equal to $AU4.3 (95%eCI: 1.4-7.4) million annually. Estimates of heatwave-attributable OIIs by 2050, under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.10-0.27%) and 0.23% (95%eCI: 0.13-0.37%), respectively. National costs estimates for 2030 under RCP4.5 and RCP8.5 were 0.13% (95%eCI: 0.27-0.46%) and 0.04% (95%eCI: 0.66-0.60), respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02-0.06%) and 0.04% (95%eCI: 0.01-0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: 0.27-0.46) for all heatwaves and 0.04% (95%eCI: 0.01-0.09%) for extreme heatwaves. Attributable fractions were approximately similar to baseline when assuming theoretical climate adaptation. DISCUSSION: Heatwaves represent notable and preventable portions of preventable OIIs and economic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in 2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributable morbidity and costs.

Engineered Stone Fabrication Work Releases Volatile Organic Compounds Classified as Lung Irritants.

Engineered stones are often characterized for their crystalline silica content. Their organic composition, particularly that of the emissions generated during fabrication work using hand-held power tools, is relatively unexplored. We forensically screened the emissions from dry-cutting 12 engineered stone products in a test chamber for their organic composition by pyrolysis-gas chromatography-mass spectrometry (GC-MS) plus selected traditional capture and analysis techniques. Phthalic anhydride, which has a Respiratory Sensitization (RSEN) Notation by the American Conference of Governmental Industrial Hygienists (ACGIH), was the most common and abundant compound, at 26-85% of the total organic composition of engineered stone emissions. Benzaldehyde and styrene were also present in all twelve samples. During active cutting, the predominant volatile organic compound (VOC) emitted was styrene, with phthalic anhydride, benzene, ethylbenzene, and toluene also detected. These results have important health implications as styrene and phthalic anhydride are irritants to the respiratory tract. This study suggests a risk of concurrent exposure to high levels of respirable crystalline silica and organic lung irritants during engineered stone fabrication work.

Are music students at 'high-risk' of experiencing musculoskeletal symptom outcomes compared with other students?

Musicians have been described as a 'high-risk' group for experiencing musculoskeletal symptoms (MSSs), yet few studies have tested this assumption. We aimed to determine whether the prevalence and profile of MSS outcomes differed between university music students and a reference group (science students). A survey was conducted of university music and science students. Reported MSS outcomes among the two groups were compared using regression analyses. The majority of participants in both groups reported experiencing MSSs in the last 12 months and 7 days. Music students reported a higher prevalence of wrist/hand MSSs compared with science students. Compared with symptomatic science students, music students reported a higher emotional impact of MSSs. We recommend prioritizing research into interventions for music students that address MSSs in the wrist/hand region, and the emotional impact of MSSs. Addressing these MSS outcomes could reduce the MSS burden for musicians during and beyond their studies.

Prevention of the Occupational Silicosis Epidemic in Australia: What Do Those Who Assess Workplace Health Risk Think Should Be Done Now?

An Australian National Dust Disease Taskforce was established to address the re-emergence of occupational lung disease, in particular silicosis. Exposure to respirable crystalline silica (RCS) occurs in various industries in Australia. We asked occupational hygienists about their practical experiences and perspectives on RCS exposure and regulatory action. A total of 105 members of the Australian Institute of Occupational Hygienists completed an anonymous questionnaire, which addressed individual characteristics, experience, perceived level of employer awareness, effectiveness of current regulation, and recommendations for improvement, across three main industrial sectors. Based on professional experience, 71% were concerned about the potential for RCS over-exposure. Barriers to adequate exposure control included lack of management commitment and financial resources. The employment of specialist occupational hygiene inspectors was considered to be the most effective regulatory strategy. Given the large number of exposed workers in the construction industry, with only a moderate awareness, there is the potential for significant cost shifting of the burden of occupational lung disease from employers on to individuals and the public health system. A nationally consistent approach to RCS exposure control across all industrial sectors is now recommended, with an increased focus on measuring and controlling exposure.

Hospitalization Costs of Respiratory Diseases Attributable to Temperature in Australia and Projections for Future Costs in the 2030s and 2050s under Climate Change.

This study aimed to estimate respiratory disease hospitalization costs attributable to ambient temperatures and to estimate the future hospitalization costs in Australia. The associations between daily hospitalization costs for respiratory diseases and temperatures in Sydney and Perth over the study period of 2010-2016 were analyzed using distributed non-linear lag models. Future hospitalization costs were estimated based on three predicted climate change scenarios-RCP2.6, RCP4.5 and RCP8.5. The estimated respiratory disease hospitalization costs attributable to ambient temperatures increased from 493.2 million Australian dollars (AUD) in the 2010s to more than AUD 700 million in 2050s in Sydney and from AUD 98.0 million to about AUD 150 million in Perth. The current cold attributable fraction in Sydney (23.7%) and Perth (11.2%) is estimated to decline by the middle of this century to (18.1-20.1%) and (5.1-6.6%), respectively, while the heat-attributable fraction for respiratory disease is expected to gradually increase from 2.6% up to 5.5% in Perth. Limitations of this study should be noted, such as lacking information on individual-level exposures, local air pollution levels, and other behavioral risks, which is common in such ecological studies. Nonetheless, this study found both cold and hot temperatures increased the overall hospitalization costs for respiratory diseases, although the attributable fractions varied. The largest contributor was cold temperatures. While respiratory disease hospitalization costs will increase in the future, climate change may result in a decrease in the cold attributable fraction and an increase in the heat attributable fraction, depending on the location.

Food grown on fire stations as a potential pathway for firefighters' exposure to per- and poly-fluoroalkyl substances (PFAS).

Human exposure to per- and polyfluoroalkyl substances also known as PFAS is an ongoing occupational and environmental health problem. This study seeks to characterise multiple pathways for firefighters' exposure to PFAS. PFAS were analysed in 688 environmental samples such as eggs, fruits, vegetables, dust, soil, surface swabs, appliance washes and water obtained from fire stations. Relevant exposure pathways were identified and daily intake levels were estimated using PFAS concentrations and exposure factors relevant to firefighters. Five PFAS including perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), 6:2 fluorotelomer sulfonate (6:2 FTS), and 8:2 fluorotelomer sulfonic acid (8:2 FTS) were frequently detected in the samples. Based on the median concentrations in each sample type, PFOS was the most abundant contaminant in eggs (80%), fruits (52%), dust (81%), surface swab (66%), soil (83%) and appliance wash (31%) samples. On the other hand, PFHxS was most abundant in vegetables (77%) and 8:2 FTS in water (58%). The intake estimation results show that dietary exposure from ingestion of foods produced on fire stations was the predominant exposure pathway, representing 82% and 62% of firefighters' total PFAS intake under typical and worst-case exposure scenarios, respectively. Incidental ingestion and dermal absorption of PFAS in dust contributed 15% for typical and 34% for worst-case exposure scenarios. The relative contributions from incidental ingestion and dermal absorption of PFAS in soil and appliance washes were insignificant. Overall, the study identifies multiple exposure pathways relevant to career firefighters including consumption of food grown on fire stations, which has not previously been recognised within the occupational exposure context. The results suggest exposure control strategies that target foods produced on fire stations could substantially reduce firefighters' exposure to PFAS.

Musculoskeletal Symptoms in Professional Musicians: Do Self-employed and Employer-employed Musicians Differ?

Concerns have been raised for the health and wellbeing of self-employed workers. Musicians are the 'original' gig workers, and musicians have a high prevalence of musculoskeletal symptoms (MSSs). Studies of musicians' MSSs have typically focused on classical, employer-employed musicians; leaving self-employed musicians under-investigated. We investigated the prevalence of MSS outcomes in all types of professional musicians, and compared the MSS outcomes between self-employed and employer-employed musicians. We conducted a cross-sectional study of professional musicians. Given the large proportion of musicians who were both self-employed and employer-employed, three groups were compared: self-employed only (self-employed group), employer-employed only (employer-employed group), and both self-employed and employer-employed (both group) musicians. Multivariable regression analyses were conducted. A total of 225 professional musicians were included in the study, 87.9% of whom reported MSSs in the last 12 months. For MSSs that impaired musical activity, the 12-month prevalence was 43.2%. Musicians in the self-employed group reported a significantly higher 7-day prevalence of MSSs compared with those in the employer-employed group. Compared with musicians in the employer-employed group, musicians in the both group reported a higher 12-month prevalence of MSSs that impaired musical activity. A higher proportion of symptomatic musicians in the both group reported seeing a health professional for their MSSs, compared with the employer-employed group. Similarly, symptomatic musicians in the both group reported higher ratings of emotional impact from MSSs, compared with symptomatic musicians in the employer-employed group. The majority of musicians have experienced MSSs. Several significant differences were reported between the three groups of musicians, with musicians in the both group generally reporting poorer MSS outcomes, compared with musicians in the employer-employed group. There are several potential reasons for why musicians who are both self-employed and employer-employed appear to have poorer MSS outcomes, including the stress of balancing multiple demands. Further research is required into the risk factors for MSS outcomes in self-employed musicians, including those who are both self-employed and employer-employed, and interventions should be directed towards self-employed musicians to minimise the MSS burden.

Understanding current and projected emergency department presentations and associated healthcare costs in a changing thermal climate in Adelaide, South Australia.

BACKGROUND: Exposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures. METHODS: A time series analysis using a distributed lag nonlinear model was used to explore the exposure-response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014-2017) and future periods (2034-2037 and 2054-2057) under three climate representative concentration pathways (RCPs). RESULTS: The baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s. CONCLUSIONS: Projected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.

What Do Safety Data Sheets for Artificial Stone Products Tell Us About Composition? A Comparative Analysis with Physicochemical Data.

Artificial stone (AS) is a composite material that has seen widespread use in construction, particularly for kitchen benchtops. However, fabrication processes with AS have been associated with serious lung disease. Safety data sheets (SDSs) aim to provide important information pertaining to composition and health risks. In the case of a complex mixture, SDSs may be problematic in terms of specific information on overall health risks. To assess this issue, we compared empirically determined mineral, metallic, and organic resin content of 25 individual AS products across six suppliers, with the corresponding SDS information. X-ray diffraction was used to quantitate the mineralogical components of AS samples, and X-ray fluorescence was used to estimate the metallic components. Organic material (resin content) was estimated using weight loss during calcination. Although the resin content for all AS samples was within the SDS-reported ranges, there was considerable variability in the crystalline silica content when comparing with supplier's SDS. Potentially toxicologically relevant metallic and mineral constituents were not reported. Some supplier SDSs were found to provide more information than others. Only one of the six suppliers provided crystalline mineral content other than silica, and only two suppliers provided any information about metals. There remains a limited understanding of lung pathogenesis from AS, and this study highlights the need for more comprehensive and standardized SDS information for risk assessment and management.

The role of formulation co-ingredients in skin and glove barrier protection against organophosphate insecticides.

BACKGROUND: Commercially formulated pesticide products are complex mixtures of one or more active ingredients and several co-ingredients. However, the modifying effect of co-ingredients on skin uptake and glove barrier protection has been poorly studied. The aim of this study was to understand the role of formulation co-ingredients in skin and glove barrier protection performance against organophosphate insecticides. RESULTS: We adapted standard in vitro diffusion cell methods to test permeation kinetics of two commonly used organophosphate insecticides: dimethoate and omethoate. For spray dilutions, dimethoate and omethoate did not reach breakthrough glove permeation rate (1 µg·cm-2 ·min-1 ) and no or little skin permeation was observed for up to 8 h, regardless of formulation. For exposure conditions involving highly concentrated products, significant differences in glove permeation were observed between different formulations of dimethoate (about 1.5-fold, P < 0.05) and of omethoate (184-fold, P < 0.001). In contrast, no difference (P > 0.05) was observed between formulations in terms of skin permeation. CONCLUSION: These results suggest that co-ingredients play a critical role in glove barrier protection against undiluted organophosphate insecticides, whereas their influence on skin uptake was insignificant within the exposure time tested. This implies that dermal exposure risk may vary between handling different formulated products of the same active ingredient hence recommending a common glove material for different formulations of the same chemical without careful consideration of co-ingredients and their permeation properties may not necessarily be appropriate. © 2021 Society of Chemical Industry.

Blue light exposure in the workplace: a case study of nail salons.

Fluorescent or LED nail lamps are used in manicure and pedicure salons to cure nail coatings. These are UV sources, but with significant blue light emissions. Most of the literature emphasizes skin damage and cancer risk from UV exposure rather than blue light-induced damage to visual photoreceptors. Nail technicians using the lamps routinely may have potentially greater exposure than customers. However, there are no data on blue light radiance levels combined with time activity patterns for exposure assessment. This research aimed to determine exposures through simulation experiments, informed by observational studies in seven nail salons. Typical and worst-case time activity patterns were established, and spectral radiance doses determined in the occupational visual field for two LED nail curing lamps. The results showed the effective spectral radiance dose were below the current guideline promulgated by the International Commission on Non-Ionising Radiation Protection. Interestingly, radiances at the corners of one LED nail curing lamp was higher than at the center, which shows the amount of exposure can differ depending on the viewing angle. This research is the first to determine spectral radiance doses. A covered design is highly recommended for blocking the emission of blue light from a nail lamp.

What do musicians think caused their musculoskeletal symptoms?

Objectives. The purpose of this study was to determine the factors that university music students and professional musicians believe caused their musculoskeletal symptoms (MSSs). Methods. Data were collected using a questionnaire distributed to university music students and professional musicians. Using a musician-driven data collection approach, musicians with MSSs were asked to nominate their top three perceived causes of their symptoms. Responses were categorized, and percentages reported for the main categories. Results. Of the 213 musicians, 37.6% reported biological factors, 21.1% reported external, physical factors, 93.9% reported behavioural factors, 18.8% reported psychosocial factors and 9.9% reported 'other' factors (e.g., accidents) as the perceived causes of their MSSs. Conclusion. This study is the first to investigate perceived causes of musicians' MSSs across a diverse range of musicians, using musician-driven methods. By using open response data collection strategies, a comprehensive, unbiased list of perceived causes of MSSs was compiled. Perceived causes not identified in previous research included manual handling, physical activity and sleep problems. Future research should consider the association between perceived causes and MSSs, and barriers and enablers of behaviour changes that may prevent MSSs. This research may guide the development of new strategies to reduce the burden of MSSs in musicians.

Musculoskeletal symptoms in university music students: does major matter?

We aimed to evaluate and compare the prevalence and profile of musculoskeletal symptom (MSS) outcomes across cohorts of university music students with different 'majors': (i) performance and nonperformance students, and (ii) classical and non-classical performance students. Data were collected using a cross-sectional questionnaire survey, and regression analyses were used to compare the groups. Of the 166 participating students, 92.5% reported experiencing MSSs in the last 12 months, and 72.6% in the last 7 days. Few significant differences were identified between groups. Musculoskeletal symptoms are a problem for all types of university music students, and all should have access to support to prevent and manage their MSSs, regardless of their majors.

The effect of strategies to prevent and manage musicians' musculoskeletal symptoms: A systematic review.

The objective of this systematic review was to determine the safety and effectiveness of any public health intervention designed to prevent and/or manage musculoskeletal symptoms (MSSs) in any type of musician. A total of 14 studies were included. Studies investigated exercise and/or education programs, and changes to equipment, with a range of musicians. There was some evidence to suggest that smaller piano keyboards, and exercise programs may be effective. Studies suggesting a benefit of exercise programs typically had lower level designs and higher risk of methodological bias, compared with those that reported no benefit. Future research should use more robust methods to reduce bias and come to definitive conclusions regarding the safety and effectiveness of interventions prior to implementation, to reduce the burden of MSSs for musicians.

Metal Ion Release from Engineered Stone Dust in Artificial Lysosomal Fluid-Variation with Time and Stone Type.

Inhalational exposure to dust from engineered stone (ES), also known as artificial or composite stone, is associated with a specific disease profile, namely accelerated silicosis, and scleroderma. The pathogenic mechanisms are poorly understood, particularly the role of resin and metal ions. Metal ions are present in pigments and constituent minerals and may be considered potential contributors to toxicity. The aim of this preliminary study was to understand the solubility of ES-containing metals in artificial lysosomal fluid (ALF) simulating the acidic intracellular environment of the lung macrophage lysosome. Differences with respect to ES types and temporal release were explored. Ten ES products of variable colour and company origin were comminuted and assessed for four different metals, solubilized into ALF solutions at 1,2,4 and 8 weeks at 37 °C. There was significant variability in metal release, particularly with regard to iron and manganese, which could be correlated with the reflected brightness of the stone. A majority of the available Mn, Fe, Al and Ti was solubilized. Time trends for metal release varied with ES type but also with metal ion. The data suggest a high metal ion bioavailability once engulfed by lung macrophages. There is a need to investigate a wider range of ES dust and relate metal content to markers of ES toxicity.

Increasing impacts of temperature on hospital admissions, length of stay, and related healthcare costs in the context of climate change in Adelaide, South Australia.

BACKGROUND: A growing number of studies have investigated the effect of increasing temperatures on morbidity and health service use. However, there is a lack of studies investigating the temperature-attributable cost burden. OBJECTIVES: This study examines the relationship of daily mean temperature with hospital admissions, length of hospital stay (LoS), and costs; and estimates the baseline temperature-attributable hospital admissions, and costs and in relation to warmer climate scenarios in Adelaide, South Australia. METHOD: A daily time series analysis using distributed lag non-linear models (DLNM) was used to explore exposure-response relationships and to estimate the aggregated burden of hospital admissions for conditions associated with temperatures (i.e. renal diseases, mental health, diabetes, ischaemic heart diseases and heat-related illnesses) as well as the associated LoS and costs, for the baseline period (2010-2015) and different future climate scenarios in Adelaide, South Australia. RESULTS: During the six-year baseline period, the overall temperature-attributable hospital admissions, LoS, and associated costs were estimated to be 3915 cases (95% empirical confidence interval (eCI): 235, 7295), 99,766 days (95% eCI: 14,484, 168,457), and AU$159 million (95% eCI: 18.8, 269.0), respectively. A climate scenario consistent with RCP8.5 emissions, and including projected demographic change, is estimated to lead to increases in heat-attributable hospital admissions, LoS, and costs of 2.2% (95% eCI: 0.5, 3.9), 8.4% (95% eCI: 1.1, 14.3), and 7.7% (95% eCI: 0.3, 13.3), respectively by mid-century. CONCLUSIONS: There is already a substantial temperature-attributable impact on hospital admissions, LoS, and costs which are estimated to increase due to climate change and an increasing aged population. Unless effective climate and public health interventions are put into action, the costs of treating temperature-related admissions will be high.

Occupational heat stress and economic burden: A review of global evidence.

BACKGROUND: The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change. METHODS: Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English. RESULTS: Twenty studies met criteria for inclusion. Eighteen studies estimated costs secondary to heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.4-2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, medium-sized businesses, amongst males, and workers aged 25-44 years. CONCLUSIONS: The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages. The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies.