Modeling emissions from CAFO poultry farms in Poland and evaluating potential risk to surrounding populations.

The world-wide use of concentrated animal feeding operations (CAFOs) for livestock production demands the need to evaluate the potential impact to public health. We estimated the exposure of various airborne pollutants for populations residing in close proximity to 10 poultry CAFOs located in Central Poland. Ammonia (NH3), carbon dioxide (CO2), carbon monoxide (CO), hydrogen sulfide (H2S), methane (CH4), nitrogen dioxide (NO2), nitrous oxide (N2O), sulfur dioxide (SO2), and organic dust were the pollutants of interest for this study. Because no monitoring data were available, we used the steady-state Gaussian dispersion model AERMOD to estimate pollutant concentrations for the exposed population in order to calculate the hazard index (HI) for a combined mixture of chemicals. Our results indicate that while the levels of certain pollutants are expected to exceed background levels commonly found in the environment they did not result in calculated hazard indexes which exceeded unity suggesting low potential for adverse health effects for the surrounding community for the mixture of chemicals. The study was conducted through a cooperation between the Agency for Toxic Substances and Disease Registry (ATSDR) in the USA and the Nofer Institute of Occupational Medicine (NIOM) in Poland.

Occupational exposure to chemical agents in the paper industry.

As part of an International Agency for Research on Cancer (IARC) international epidemiological study of workers in the pulp and paper industry, previously unpublished exposure measurements were assembled in a database. This article summarizes the results of 3,873 measurements carried out in the production departments of paper and paperboard mills and recycling plants in 12 countries. In the paper and paperboard mills, most of the agents were measured in the pulping and refining departments and in on-machine coating and winding of paper/paperboard. Exposures to asbestos, carbon monoxide, formaldehyde, fungal spores, bacteria, nitrogen dioxide, minerals dusts, paper dust, sulphuric acid and different solvents sometimes exceeded exposure limit values. In the re-pulping and de-inking departments of recycling plants high exposures to formaldehyde, fungal spores, bacteria and paper dust were observed. High exposures to asbestos, bioaerosols, carbon monoxide and paper dust were found in many departments; ammonia, formaldehyde, mineral and paper dust and solvents were found in coating machines; and diphenyl and polychlorobiphenyls (PCBs) were found in some special circumstances. Measurements in the newsprint and uncoated paper machine departments revealed only a few elevated exposures. In nearly all departments, measurements of epichlorohydrin, PCBs, sulphur dioxide, hydrogen sulphide and mercaptans tended to be low, often even below their detection limits. In spite of some uncertainties in the measurement data, the study provides new insights into the level and variation of occupational exposures of production workers in the paper and paperboard industry.

Cancer mortality in rubber tire workers in Poland.

The study aimed at assessing cancer risk in a cohort of workers employed in the rubber tire production. The cohort consisted of 17,747 workers (11,660 men and 6087 women) employed in a rubber tire plant for at least three months during the years 1950-1995. The cohort follow-up was completed on December 31, 1995. Deaths by causes were analyzed using standardized mortality ratio (SMR) calculated by the person-years method. The mortality pattern of the general population of Poland was used as the reference. The study indicated significantly lower total mortality in the cohort (men: SMR = 72; women: SMR = 62) as compared to the general population, which is an example of a well known "healthy worker effect". The number of deaths from malignant neoplasms was also lower than expected (men: SMR = 67; women: SMR = 64). Only in a very small sub-cohort of men involved in dosing and mixing of raw material for the production of rubber, an excess of total mortality (SMR = 104) and from all cancers (SMR = 115) was found. Mortality from all neoplasms was enhanced (SMR = 108) in the sub-cohort of women employed in the technical service work area. When analyzing individual cancer sites in men of the whole cohort or sub-cohorts, the observed number of deaths from cancers of the lip, tongue, pharynx, stomach, gallbladder, pancreas, peritoneum, articular cartilage, connective tissue, skin, testis, prostate, bladder, kidney, brain, as well as from Hodgkin's disease, multiple myeloma and leukemia was larger than the expected number. Among women the excess mortality was due to cancers of the large myeloma and leukemia. The SMR calculated for these sites were statistically insignificant. The cohort under study was "young" and thus relatively small numbers of deaths were recorded. The excess mortality, based quite frequently on single cases of selected cancer sites, cannot be regarded as a basis for final conclusions. Nevertheless, the fact that these observations are in agreement with the findings of other authors who carried out studies in the rubber industry of other countries justifies the need to follow-up this cohort in the future.

[Occupational monitoring of lung cancer in epidemiologic studies]. / Zawodowe uwarunkowania raka pluca w badaniach epidemiologicznych.

This paper addresses the problem of diagnosing occupational lung cancer faced in different countries. The risks of lung cancer attributed to occupational exposure in selected epidemiological studies are presented. Evidenced and probable lung carcinogens, as well as occupations and industries responsible for the increased risk for the incidence of this pathology are discussed in the light of epidemiological studies.

Nested case-control study of lung cancer among pulp and paper workers in relation to exposure to dusts.

BACKGROUND: Numerous studies have indicated an increased risk of lung cancer in pulp and paper industry workers. In a 1990 survey, standardized mortality ratio (SMR) was found to be 122 (95% CI:96-153) for lung cancer in Polish male workers in the pulp and paper industry, and 166 (95% CI:95-270) among workers engaged in paper production. METHODS: A nested case-control design within a cohort of pulp and paper workers was applied. Seventy-nine lung cancer cases and 237 "healthy" controls were selected from the cohort of 10,460 workers employed during the years 1968-1990, and observed until the end of 1995. Based on personnel files, occupational exposure was reconstructed by experts. Using a questionnaire, data on smoking habits were collected. ORs unadjusted and adjusted for smoking were calculated applying the model of conditional logistic regression. RESULTS: Occupational exposure to inorganic dusts (kaolin, lime, cement, brick, grindstone) adjusted for smoking was a significant lung cancer risk factor, with a 4.0-fold risk (95% CI:1.3-12.6), and a dose-response by cumulative dose index. Among organic dusts only wood dust increased albeit insignificantly the risk for those exposed (adjusted for smoking OR = 2.1, 95% CI:0.9-4.9), but without dose-response relationship. CONCLUSIONS: Exposure to occupational dust with relatively low content of silica, but at high concentrations may be considered as a factor increasing lung cancer risk. However, the observation made in this study should be viewed with caution as it was based on a small number of cases, and further evidence is needed to confirm or refute the authors' hypothesis.

[Occupational exposure to chemicals in the manufacture of rubber tires]. / Ekspozycja na czynniki chemiczne pracowników zakladu produkcji opon gumowych.

The work environment of the rubber industry company, producing various types of tires, was assessed and the workers of the plant were included in a cohort study of mortality. Concentrations of twenty chemical substances at 137 workposts were measured by employees of the plant laboratory and the sanitary and epidemiological station in 1981-1996. The mean values and concentration ranges were determined by departments and workposts. The excess of threshold limit values was analyzed. The workposts with exposure to agents possibly carcinogenic to humans were identified. The analysis performed will render it possible to calculate doses of cumulative exposure to given compounds among workers covered by the epidemiological study.

[Carcinogenic effects of diesel emission: an epidemiological review]. / Epidemiologiczne dowody kancerogennego dzialania spalin emitowanych przez silniki Diesla.

The results of recent epidemiological studies and meta-analysis relating to carcinogenic effects of diesel emissions in exposed populations were reviewed. Statistical, but still not causal association between risk of lung cancer and occupational exposure to diesel emissions was found in a great number of studies under review. Long-term exposure to diesel exhausts (> 20 years) increases by 30-40% lung cancer risk in workers of the transport industry: truck drivers, diesel engine mechanics, locomotive engineers and brakesmen. The results are inconsistent among heavy equipment operators, bus drivers and miners. Relative risk of lung cancer among workers occupationally exposed to diesel emission may be comparable with that of environmental tobacco smoke. Further research is also needed in the area of carcinogenic mechanisms, and biomarkers of exposure should be developed and validated before reliable quantitative estimates of risk of harmful effects to the human health in occupational setting are made.

[Mortality in the tire plant workers]. / Umieralnosc pracowników zakladu oponiarskiego.

This paper describes a cohort study of the mortality among workers employed in one of Polish tyre plants. The scope of the study was limited to the analysis of mortality from main disease categories. Mortality from particular cancer sites will be discussed in a separate publication. The cohort comprised 17,747 workers (11,660 men and 6,087 women) employed during the years 1950-95 for at least three months in the tyre plant. As of 31 December 1995, the follow-up of the cohort was completed. A detailed analysis of mortality by causes was carried out using standardised mortality ratio (SMR) calculated by the person-years method. The general population of Poland was used as the reference. The results indicated general mortality significantly lower in the cohort (men: SMR = 72; women: SMR = 62), than in the reference population. The number of observed deaths from main disease categories was also lower than those expected. The analysis by specific causes revealed significant excess of deaths, due to hypertensive disease among men (36 deaths, SMR = 142; 95% CI: 99-197). SMRs were also calculated in sub-cohorts identified by activities performed (preparatory works: production of tyres and inner tubes; maintenance; storage; others). General mortality in sub-cohorts was similar to that in the total cohort. After analysis by causes of death, some non-significant excess mortality could be observed. It was very small or it applied only to single cases of death. Excess mortality from hypertensive disease in male maintenance workers (21 deaths, SMR = 262; 95% CI: 162-400) was the only exception. The absence of adverse health effects pronounced by significant excess mortality should be attributed to a relatively short period of exposure among the majority of the followed-up workers (over 58% of workers in the cohort employed in the plant for a period shorter than five years) and to their young age. Almost 56% of workers in the cohort were born in the 1950s or later which means that at the end of the follow-up they were not older than 45 years. In order to complete the final mortality assessment the follow-up should continue.

[Occupational exposure to electromagnetic fields and its health effects in electric energy workers]. / Ekspozycja zawodowa na pola elektromagnetyczne i jej skutki zdrowotne u pracowników elektroenergetyki.

Power frequency (50 to 60 Hz) electromagnetic fields (EMF) are briefly characterised, EMF sources occurring in the electromagnetic industry are discussed, and methods for and problems involved in the evaluation of individual occupational EMF exposure are also presented. The results of certain cohort industrial and case-referent studies indicate slightly enhanced risk of brain cancer and leukaemia in the group under study. The meta-analysis of the results obtained from numerous studies, published recently, showed a relative risk (RR) of 1.1-1.3 for leukaemia, and of 1.1-1.2 for brain cancer. Only a few studies demonstrate a dose-effect relationship for malignant neoplasms which decreases the power of the hypothesis on the cause-effect relationship. Among health effects of EMF exposure in electric utility workers, other than malignant neoplasms, an increased risk of certain diseases of the circulatory and neurological systems has been reported. The difficulty in the assessment of individual exposure is the main problem in evaluating the relationship between EMF exposure and adverse health effects in electric utility workers. We hope to investigate this further.

[The causes of increased risk for lung cancer in the pulp and paper industry workers. The effect of smoking and exposure to chemicals]. / Przyczyny podwyzszonego ryzyka raka pluca wsród pracowników przemyslu celulozowo-papierniczego. Rola palenia tytoniu oraz ekspozycji na czynniki chemiczne.

An analysis of mortality in a cohort of workers employed in the pulp and paper industry, carried out by the authors of this presentation several years ago, indicated an increase of 22% in the risk of mortality from lung cancer. This risk decreased by only 4% after taking account of smoking. The results obtained then were considered as sufficient to undertake further studies aimed at identifying specific occupational factors responsible for an increased risk for mortality from lung cancer in the population under study. The nested case-control study, in which cases (of lung cancer) and controls were selected from the same cohort observed earlier, was approved as the most suitable method for achieving the aforesaid aim. The study covered 79 cases of deaths from lung cancer confirmed by histological and cytological or radiological examinations, and 237 'healthy' controls matched in the ratio of one to three, taking into account gender, date of birth and date of employment. A group of experts carried out in-depth analysis of exposure to harmful factors in each case of death and in each control. Using a questionnaire, specially developed for this purpose, detailed data on smoking habits among persons under study were collected. Odds ratio was used as a measure of a relative risk for death from lung cancer. A crude relative risk and risk adjusted by eliminating the effect of smoking, applying the model of conditional logistic regression, were calculated for individual exposure factors. Smoking proved to be a significant causal factor responsible for the development of lung cancer in the cohort studied. That was evidenced by relative risk accounting for 12.9 for smokers in relation to non-smokers and an enhanced risk with the increasing number of cigarettes smoked daily, the number of smoking years and an accumulated dose. The study does not confirm a hypothesis that chemical factors specific of the pulp and paper industry exert a significant effect on the risk of death from lung cancer. Odds ratios, crude and adjusted for smoking, were lower than one in all distinguished categories of exposure.

Occupational exposure to chemical and biological agents in the nonproduction departments of pulp, paper, and paper product mills: an international study.

As part of an international epidemiological study of workers in the pulp and paper industry, previously unpublished exposure measurements were assembled in a database. This article describes 7293 measurements in nonproduction departments from 147 mills in 11 countries. The greatest variety of agents was measured in the maintenance, construction, and cleaning department, where high exposures to asbestos, chromium [VI] compounds, copper, mercury in urine, nitrogen dioxide, ozone, styrene, sulfur dioxide, trichloroethylene, and welding fumes were observed. Measurements in the storage, yard, loading, and shipping department indicated high exposures to asbestos, carbon monoxide, fungal spores, nitrogen oxides, sulfur dioxide, and total dust. The steam and power generation department had high exposures to methyl mercaptan, silica, and total dust. Measurements in process and effluent water treatment, laboratory and research, engineering, and office, administration, and cafeteria areas had few elevated exposures. Throughout the nonproduction departments, measurements of pulp-production chemicals such as chlorine and sulfur compounds tended to be low, with many below detection limits. There were some problems with the available data; in particular, detection limits were often not specified, and the data tended to be clustered in such a way that sources of exposure variability could not be distinguished. Despite these problems, the data provide new insight into the exposures of nonproduction pulp and paper industry personnel.

Cancer risk in workers of the pulp and paper industry in Poland. A continued follow-up.

A mortality cohort study was undertaken among Polish pulp and paper workers. This paper concentrates on neoplasms mortality among men and women employed continuously for at least one year in the factory producing sulphate pulp, paper board and paper products. A retrospective observation carried out till 31 December 1995 covered 10,460 workers employed during the years 1968-1990. The cohort accessibility was 99%. Cancer risk was evaluated on the basis of standardized mortality ratio (SMR) calculated according to the person-years method. The general population of Poland was the reference population. The results of a 23-year cohort observation, published earlier, showed a lowered overall mortality from all causes and from all malignant neoplasms, and a significant excess of death from peritoneum and prostate cancer among pulp mill male subcohort. The conclusion was drawn that a 'young' cohort and relatively short follow-up period might have affected the results. The results presented in this paper, obtained after further five years of observation showed in the male cohort an excess of deaths from cancer of respiratory tract and peritoneum (lung SMR = 122, nasal cavities SMR = 587, peritoneum SMR = 562). An approximate correction for smoking habits resulted in only 4 decreased risk estimates for lung cancer, indicating a small positive confounding effect of smoking in this material. In female cohort an excess of brain cancer was found (SMR = 355). Only the excess mortality from cancers of nose, lung and peritoneum was coherent with the exposure to higher concentrations of wood dust, pulp, paper and board dust. It may support a hypothesis that these factors as well as dust pollutants, not yet identified in this study, may be considered as one of the risk factors contributing to the incidence of neoplasms of these sites.

[Mortality among workers in the pulp-paper industry. A successive follow up of the cohort]. / Umieralnosc wsród pracowników przemyslu celulozowo-papierniczego. Dalsza obserwacja kohorty.

After five successive years of observation the authors present a verified evaluation of the delayed health effects in the pulp and paper industry workers (with particular regard to mortality from malignant neoplasms). The cohort studied consisted of 10,460 workers employed for at least 12 months between 1967 and 1990 in the plants manufacturing sulfate pulp, paper, board and paper products. Subjects were assigned to three subcohorts according to the work areas: 1. pulp mill workers; 2. paper mill workers (paper and board as well as their products); 3. other workers. The workers were enrolled in the subcohort if they were employed for at least one year in one of these departments. One subject could be included in more than one subcohort. The vital status of the cohort was determined through a variety of sources over an observation period of 28 yrs (1967-95). Mortality data were analysed in terms of cause-specific standardized mortality ratios (SMRs) with expected deaths count based on the national mortality rates in Poland. The results of a twenty three-year cohort observation, published earlier, showed the lowered overall mortality (explained by a "healthy worker effect") and the excess of deaths from malignant neoplasms for some sites (peritoneum, prostate, brain). Due to a small number of deaths recorded, kind of exposure and its duration, were left out of the analysis. The results presented in this paper, obtained after five successive years of the male cohort observation, showed an excess of deaths from cancers of the respiratory tract and peritoneum. In the female cohort an excess of brain cancers was found. Only an excessive mortality from malignant neoplasms of the respiratory system was coherent with the exposure to higher concentrations of wood, paper and board dust. An excess mortality from diseases of the circulatory system was found in both males and females employed in paper production.

Cancer mortality among pulp and paper workers in Poland. A cohort study.

Mortality among workers in the Polish pulp and paper industry was evaluated in a cohort study of 10,460 workers who had been employed continuously for at least one year, between 1968 and 1990 in the factory producing sulphate pulp, paper, board and paper products. Three subcohorts were formed according to the work areas. A standardized mortality ratio (SMR) analysis was used to compare death rates for each group exposed with Polish national rates. Mortality from all causes and from all malignant neoplasms, both in the female and in male cohorts was lower than that observed in the general population. In the pulp male subcohort a significantly elevated risk of death from peritoneum cancer (2 obs, SMR = 2,530) and prostate cancer (4 obs, SMR = 854) was recorded, although overall mortality from all causes and from all malignant neoplasms was lower than expected. The excess of deaths from neoplasms in other sites was statistically nonsignificant in all subcohorts. This study did not confirm the excess mortality from lung, stomach and lymphatic cancers found by other authors. The "young" cohort and a relatively short follow-up period (23 years) might have affected the results.

[Risk of death from malignant neoplasms among paper mill workers]. / Ryzyko zgonu z powodu nowotworów zlosliwych wsród pracowników papierni.

A cohort study was designed to evaluate the risk of death from malignant neoplasms among pulp and paper workers. This paper presents the evaluation of death risk among workers engaged only in the production of paper, paperboard and paper products. The cohort study covered 1,322 males and 1,914 females employed for, at least, one year in a big pulp and paper mill during the period 1968-90. The study of exposure to harmful factors revealed that concentrations of paper and paperboard dusts in this mill exceeded hygienic standards. The analysis of death risk by causes and gender of those under study was based on standardized mortality rate (SMR) calculated using the method of person-year observation. The general population of Poland was used as reference. The results do not confirm excess mortality from lung, stomach and hematopoietic cancers in paper mill workers reported by other authors. However, an elevated risk of bladder cancer in males (SMR = 491, two deaths) and brain cancer in females (SMR = 353, two deaths) was observed. Both SMR values were not statistically significant. Because of small number of deaths, risk according to exposure and latency was not evaluated.

[Selected diseases of the spine and spinal cord as a cause of work disability]. / Wybrane choroby kregoslupa i rdzenia kregowego jako przyczyna czasowej niezdolnosci do pracy.

Diseases of the musculo-skeletal and peripheral nervous systems has become one of the most serious health problems of the working population in Poland. They also make one third of the total sickness absenteeism. The analysis of the magnitude of temporary work disability due to diseases of the spine and spinal cord as well as changes observed over five recent years are presented. The reference material is derived from the national database on sickness absenteeism, covering a 17% random sample of punched cards of certified work disability. The sickness absenteeism is expressed by the number of work disability days per 100 persons employed in a given year. In 1955 the rheumatoid spine diseases proved to be the cause of 194 days of work disability per 100 employed and made 9% of the total sickness absenteeism. In the last five years sickness absenteeism due to these diseases have doubled. In rheumatoid pathologies of the spine, 50% of absenteeism was caused by discopathy. Among diseases of the peripheral nervous system, 78% of absenteeism was caused by diseases of nerve roots and plexus. During the period under discussion a 126% increase in absenteeism caused by these pathologies was noted and it applied mostly to males. In 1995 rheumatoid diseases of the spine as well as diseases of nerve roots and mostly plexus were the cause of 375 days of work disability per 100 employed what made 18% of the total sickness absenteeism. Sickness absenteeism due to these disease has increased by 134% over the last five years. The highest level and dynamics are observed among coal miners.

[Mortality in a cohort of workers working with pulp and paper]. / Umieralnosc w kohorcie pracowników przemyslu celulozowo-papierniczego.

Mortality among workers in the Polish pulp and paper industry was evaluated in retrospective cohort study of 10460 workers who had been employed continuously for at least one year between 1968 and 1990 in the factory producing sulphate pulp, paper, board and paper products. A standardized mortality ratio (SMR) analysis was used to compare death rates for the exposure group with Polish national rates. For all the subjects death due to all causes and all malignant neoplasms were lower than the number expected. The only significantly increased risks were those of malignant neoplasm of brain among women (4 cases, SMR = 318) and of retroperitoneum and peritoneum among men (2 cases, SMR = 659), exposed to high level of wood dust and irritant sulphur compounds. The authors could not find any etiological explanation of the excessive mortality from brain and peritoneum cancers.

[Risk of death from malignant neoplasms among cellulose industry workers]. / Ryzyko zgonu z powodu nowotworów zlosliwych wsród pracowników celulozowni.

The pulp mill workers are exposed to substances suspected of carcinogenic effect during production and bleaching of chemical paper-pulp. In order to assess the risk of death from malignant neoplasm, a cohort study covering 1,432 males and 546 females, employed in the sulfate pulp mills of a big cellulose and paper plant, was carried out. Those persons had worked in pulp mills during the years 1967-1990 for, at least, one year. The analysis of risk by causes and gender of those under study was based on standard mortality rate (SMR) calculated using the method of person-year observation. The general population of Poland was used as reference. Significant excess mortality from malignant neoplasm of peritoneum (SMR = 2530) and prostate (SMR = 854) was observed among males, however, the number of observed deaths in these groups was small. Excess female mortality was insignificant. It is rather doubtful whether an increased risk of death from some neoplasms, observed in this group (in this phase of exposure identification) could be linked with occupational exposure.

[Evaluation of exposure to toxic factors occurring in the cellulose and paper industry]. / Ocena narazenia na czynniki toksyczne wystepujace w przemysle celulozowo-papierniczym.

The study covered the work environment of a big plant producing sulfate cellulose, paper and paperboard. Measurements of chemical substance concentrations, performed by a local plant laboratory during the years 1976-1991, were analysed with reference to production departments and particular workplaces. Out of 37 substances under study, 16 were found in the air of workplaces. Their concentrations exceeded periodically hygienic standards. The most frequent excess of TLV applied to such compounds as wood dust (including hard beechwood), non-organic dusts containing 2-50% of crystalline silica and below 2% of silica, welding fumes, furfuryl aldehyde, sulfur dioxide, phenol and hydrogen sulfide. A computer-aided registrer of hygienic data facilitated the follow-up of dynamics of exposure to toxic compounds of workers employed at given workplaces.

Epidemiological evaluation of death risk from cardiovascular diseases among Polish population of working age.

"The aim of the study was an evaluation of death risk among men and women of working age exposed to cardiovascular risk factors. The survey covered random samples of the population living in the regions of Wroclaw and Ciechanow, [Poland,] including families of all who died from cardiovascular diseases in 1988.... The results of demographic analyses [indicate] that social factors exerting a negative effect on health behaviours are responsible for high mortality in males. Moreover, difficulties of Polish life place additional stress on male population.... For each from among 18 analysed factors the risk of death from cardiovascular diseases was several times higher in exposed males than in females."