Response Letter to Koivisto et al. 'Evaluating the Theoretical Background of STOFFENMANAGER® and the Advanced REACH Tool'.

In this article, we have responded to the key statements in the article by Koivisto et al. (2022) that were incorrect and considered to be a biased critique on a subset of the exposure models used in Europe (i.e. ART and Stoffenmanager®) used for regulatory exposure assessment. We welcome scientific discussions on exposure modelling (as was done during the ISES Europe workshop) and criticism based on scientific evidence to contribute to the advancement of occupational exposure estimation tools. The tiered approach to risk assessment allows various exposure assessment models from screening tools (control/hazard banding) through to higher-tiered approaches. There is a place for every type of model, but we do need to recognize the cost and data requirements of highly bespoke assessments. That is why model developers have taken pragmatic approaches to develop tools for exposure assessments based on imperfect data. We encourage Koivisto et al. to focus on further scientifically robust work to develop mass-balance models and by independent external validations studies, compare these models with alternative model tools such as ART and Stoffenmanager®.

Occupation, occupational exposures and mammographic density in Spanish women.

INTRODUCTION: Mammographic density (MD), the proportion of radiologically dense breast tissue, is a strong risk factor for breast cancer. Our objective is to investigate the influence of occupations and occupational exposure to physical, chemical, and microbiological agents on MD in Spanish premenopausal women. METHODS: This is a cross-sectional study based on 1362 premenopausal workers, aged 39-50, who attended a gynecological screening in a breast radiodiagnosis unit of Madrid City Council. The work history was compiled through a personal interview. Exposure to occupational agents was evaluated using the Spanish job-exposure matrix MatEmESp. MD percentage was assessed using the validated semi-automated computer tool DM-Scan. The association between occupation, occupational exposures, and MD was quantified using multiple linear regression models, adjusted for age, educational level, body mass index, parity, previous breast biopsies, family history of breast cancer, energy intake, use of oral contraceptives, smoking, and alcohol consumption. RESULTS: Although no occupation was statistically significantly associated with MD, a borderline significant inverse association was mainly observed in orchard, greenhouse, nursery, and garden workers (ß = -6.60; 95% confidence interval (95%CI) = -14.27; 1.07) and information and communication technology technicians (ß = -7.27; 95%CI = -15.37; 0.84). On the contrary, a positive association was found among technicians in art galleries, museums, and libraries (ß = 8.47; 95%CI = -0.65; 17.60). Women occupationally exposed to fungicides, herbicides, and insecticides tended to have lower MD. The percentage of density decreased by almost 2% for every 5 years spent in occupations exposed to the mentioned agents. CONCLUSIONS: Although our findings point to a lack of association with the occupations and exposures analyzed, this study supports a deeper exploration of the role of certain occupational agents in MD, such as pesticides.

Occupational exposures and mammographic density in Spanish women.

OBJECTIVES: The association between occupational exposures and mammographic density (MD), a marker of breast cancer risk, has not been previously explored. Our objective was to investigate the influence of occupational exposure to chemical, physical and microbiological agents on MD in adult women. METHODS: This is a population-based cross-sectional study based on 1476 female workers aged 45-65 years from seven Spanish breast cancer screening programmes. Occupational history was surveyed by trained staff. Exposure to occupational agents was assessed using the Spanish job-exposure matrix MatEmESp. Percentage of MD was measured by two radiologists using a semiautomatic computer tool. The association was estimated using mixed log-linear regression models adjusting for age, education, body mass index, menopausal status, parity, smoking, alcohol intake, type of mammography, family history of breast cancer and hormonal therapy use, and including screening centre and professional reader as random effects terms. RESULTS: Although no association was found with most of the agents, women occupationally exposed to perchloroethylene (eß=1.51; 95% CI 1.04 to 2.19), ionising radiation (eß=1.23; 95% CI 0.99 to 1.52) and mould spores (eß=1.44; 95% CI 1.01 to 2.04) tended to have higher MD. The percentage of density increased 12% for every 5 years exposure to perchloroethylene or mould spores, 11% for every 5 years exposure to aliphatic/alicyclic hydrocarbon solvents and 3% for each 5 years exposure to ionising radiation. CONCLUSIONS: Exposure to perchloroethylene, ionising radiation, mould spores or aliphatic/alicyclic hydrocarbon solvents in occupational settings could be associated with higher MD. Further studies are needed to clarify the accuracy and the reasons for these findings.

Occupation and mammographic density: A population-based study (DDM-Occup).

INTRODUCTION: High mammographic density is one of the main risk factors for breast cancer. Although several occupations have been associated with breast cancer, there are no previous occupational studies exploring the association with mammographic density. Our objective was to identify occupations associated with high mammographic density in Spanish female workers. METHODS: We conducted a population-based cross-sectional study of occupational determinants of high mammographic density in Spain, based on 1476 women, aged 45-68 years, recruited from seven screening centers within the Spanish Breast Cancer Screening Program network. Reproductive, family, personal, and occupational history data were collected. The latest occupation of each woman was collected and coded according to the 1994 National Classification of Occupations. Mammographic density was assessed from the cranio-caudal mammogram of the left breast using a semi-automated computer-assisted tool. Association between mammographic density and occupation was evaluated by using mixed linear regression models, using log-transformed percentage of mammographic density as dependent variable. Models were adjusted for age, body mass index, menopausal status, parity, smoking, alcohol intake, educational level, type of mammography, first-degree relative with breast cancer, and hormonal replacement therapy use. Screening center and professional reader were included as random effects terms. RESULTS: Mammographic density was higher, although non-statistically significant, among secondary school teachers (eß = 1.41; 95%CI = 0.98-2.03) and nurses (eß = 1.23; 95%CI = 0.96-1.59), whereas workers engaged in the care of people (eß = 0.81; 95%CI = 0.66-1.00) and housewives (eß = 0.87; 95%CI = 0.79-0.95) showed an inverse association with mammographic density. A positive trend for every 5 years working as secondary school teachers was also detected (p-value = 0.035). CONCLUSIONS: Nurses and secondary school teachers were the occupations with the highest mammographic density in our study, showing the latter a positive trend with duration of employment. Future studies are necessary to confirm if these results are due to chance or are the result of a true association whose causal hypothesis is, for the moment, unknown.

[Update the wood dust exposure values included in the job-exposure matrix MatEmESp by making use of the WOODEX database]. / Actualización de los valores de exposición a polvo de madera incluidos en la matriz empleo-exposición MatEmESp a partir de datos procedentes de la base de datos WOODEX.

OBJECTIVE: To revise and complete information on prevalence and intensity of wood dust exposure among Spanish workers in the MatEmESp job-exposure matrix, based on data from the WOODEX database. METHODS: Exposure groups by economic activity in WOODEX were linked to the occupations in MatEmESp. The WOODEX data were then used to calculate new values of exposure prevalence and intensity for the occupations included in MatEmESp. RESULTS: A total of 18 occupations in MatEmESp were linked to exposure groups in the WOODEX database. This allowed estimation of new exposure intensity values for these 18 occupations and calculation of new exposure prevalence values for 16 of them. In addition, a new at-risk occupation, previously not in MatEmESp, was identified. The occupations with the highest prevalence values are sawmill operators (CNO-94 code 8141) and operators of machinery for making wood products (CNO-94 code 8340). The new calculations indicate that 10.5% of at-risk workers in MatEmESp are exposed to concentrations above 5 mg/m3. CONCLUSIONS: The WOODEX data provided more detailed information about exposure profiles to wood dust and are mainly based on Spanish data. In contrast, 95% of the data on wood dust exposure inMatEmESp is based on extrapolations from other countries or on expert considerations.

OBJETIVO: Revisar y completar la información de la matriz de empleo-exposición MatEmESp sobre la prevalencia e intensidad de exposición a polvo de madera en trabajadores españoles con datos de la base de datosWOODEX. MÉTODOS: Se relacionaron los diferentes grupos de exposición incluidos en cada actividad económica expuesta segúnWOODEX con las ocupaciones de la matriz MatEmESp. Se utilizaron los datos de WOODEX para calcular nuevos valores de intensidad y prevalencia de exposición para las ocupaciones incluidas en MatEmESp. RESULTADOS: Se han podido relacionar 18 ocupaciones procedentes deMatEmESp con grupos de exposición descritos por WOODEX. Ello permitió obtener nuevos datos de intensidad para estas 18 ocupaciones y de prevalencia para 16 de ellas. También se ha identificado una nueva ocupación expuesta que MatEmESp no contemplaba. Las ocupaciones con valores de prevalencia de exposición más altos son los operadores de serrerías, código CNO-94, 8141 y los operadores de máquinas para fabricar productos de madera, código CNO-94, 8340. Los nuevos datos calculados muestran que el 10,5% del total de trabajadores expuestos en MatEmESp lo están a cantidades superiores a 5 mg/m3. CONCLUSIONES: Los datos aportados porWOODEX ofrecen un mayor detalle en perfiles de exposición a polvo de madera y, están basados, en gran medida, en datos españoles. En cambio, el 95% de los datos de la MatEmESp para polvo de madera, se basan en extrapolaciones de otras matrices de otros países o de consideraciones del evaluador.

Actualización de los valores de exposición a polvo de madera incluidos en la matriz empleo-exposición MatEmESp a partir de datos procedentes de la base de datos WOODEX / Update the wood dust exposure values included in the job-exposure matrix matemesp by making use of the woodex database

Objetivo. Revisar y completar la información de la matriz de empleo-exposición MatEmESp sobre la prevalencia e intensidad de exposición a polvo de madera en trabajadores españoles con datos de la base de datos WOODEX. Métodos. Se relacionaron los diferentes grupos de exposición incluidos en cada actividad económica expuesta según WOODEX con las ocupaciones de la matriz MatEmESp. Se utilizaron los datos de WOODEX para calcular nuevos valores de intensidad y prevalencia de exposición para las ocupaciones incluidas en MatEmESp. Resultados. Se han podido relacionar 18 ocupaciones procedentes de MatEmESp con grupos de exposición descritos por WOODEX. Ello permitió obtener nuevos datos de intensidad para estas 18 ocupaciones y de prevalencia para 16 de ellas. También se ha identificado una nueva ocupación expuesta que MatEmESp no contemplaba. Las ocupaciones con valores de prevalencia de exposición más altos son los operadores de serrerías, código CNO-94, 8141 y los operadores de máquinas para fabricar productos de madera, código CNO-94, 8340. Los nuevos datos calculados muestran que el 10,5% del total de trabajadores expuestos en MatEmESp lo están a cantidades superiores a 5 mg/m3 . Conclusiones. Los datos aportados por WOODEX ofrecen un mayor detalle en perfiles de exposición a polvo de madera y, están basados, en gran medida, en datos españoles. En cambio, el 95% de los datos de la MatEmESp para polvo de madera, se basan en extrapolaciones de otras matrices de otros países o de consideraciones del evaluador

Objective. To revise and complete information on prevalence and intensity of wood dust exposure among Spanish workers in the MatEmESp job-exposure matrix, based on data from the WOODEX database. Methods. Exposure groups by economic activity in WOODEX were linked to the occupations in MatEmESp. The WOODEX data were then used to calculate new values of exposure prevalence and intensity for the occupations included in MatEmESp Results. A total of 18 occupations in MatEmESp were linked to exposure groups in the WOODEX database. This allowed estimation of new exposure intensity values for these 18 occupations and calculation of new exposure prevalence values for 16 of them. In addition, a new at-risk occupation, previously not in MatEmESp, was identified. The occupations with the highest prevalence values are sawmill operators (CNO-94 code 8141) and operators of machinery for making wood products (CNO-94 code 8340). The new calculations indicate that 10.5% of at-risk workers in MatEmESp are exposed to concentrations above 5 mg/m3. Conclusions. The WOODEX data provided more detailed information about exposure profiles to wood dust and are mainly based on Spanish data. In contrast, 95% of the data on wood dust exposure in MatEmESp is based on extrapolations from other countries or on expert considerations

[Comprehension of hazard pictograms of chemical products among cleaning workers]. / La comprensión de los pictogramas de peligro de productos químicos entre trabajadores del sector de limpieza.

OBJECTIVE: To assess the comprehension among cleaning workers of the hazard pictograms as defined by the Globally Harmonized System (GHS) of the United Nations, concerning the classification, labeling and packaging of substances and mixtures. METHODS: A sample of 118 workers was surveyed on their perception of the GHS hazard pictograms. Comprehensibility was measured by the percentage of correct answers and the degree to which they reflected International Organization for Standardization and American National Standards Institute standards for minimum level of comprehension. The influence of different variables to predict comprehension capacity was assessed using a logistic regression model. RESULTS: Three groups of pictograms could be distinguished which were statistically differentiated by their comprehensibility. Pictograms reflecting "acute toxicity" and "flammable", were described correctly by 94% and 95% of the surveyed population, respectively. For pictograms reflecting "systemic toxicity", "corrosive", "warning", "environment" and "explosive" the frequency of correct answers ranged from 48% to 64%, whereas those for pictograms "oxidizing" and "compressed gas" were interpreted correctly by only 7% of respondents. Prognostic factors for poor comprehension included: not being familiar with the pictograms, not having received training on safe use of chemical products, being an immigrant and being 54 years of age or older. CONCLUSIONS: Only two pictograms exceeded minimum standards for comprehension. Training, a tool proven to be effective to improve the correct interpretation of danger symbols, should be encouraged, especially in those groups with greater comprehension difficulties.

OBJETIVO: Valorar la comprensión de los pictogramas de peligro del Sistema Globalmente Armonizado (SGA) de las Naciones Unidas referente a la clasificación, envasado y etiquetado de sustancias y mezclas químicas en trabajadores del sector de la limpieza. MÉTODOS: Se encuestó a una muestra de 118 trabajadores sobre su percepción de los pictogramas de riesgo químico del SGA. Se valoró la comprensibilidad de los pictogramas mediante el porcentaje de aciertos y su adecuación a los estándares de comprensión mínima de la Organización International de Normalización y del Instituto Nacional Estadounidense de Estándares. Se valoró la influencia de distintas variables en la capacidad de comprensión mediante un modelo de regresión logística. RESULTADOS: Se observaron tres grupos de pictogramas estadísticamente diferenciados según su comprensibilidad: los pictogramas "toxicidad aguda" y "inflamable" fueron descritos correctamente por 94 y 95% de los trabajadores encuestados respectivamente, los pictogramas "toxicidad sistémica", "corrosivo", "atención", "medio ambiente" y "explosivo", presentaron frecuencias de acierto del 48 al 64%, mientras que los pictogramas "comburente" y "gases a presión" fueron correctamente interpretados por un 7% de los encuestados. Los factores pronósticos para una peor comprensión fueron no estar familiarizado con los pictogramas, no haber recibido formación en prevención sobre el uso de productos químicos, ser inmigrante y tener más de 54 años de edad. CONCLUSIONES: Solo dos pictogramas superaron los estándares mínimos de comprensión en la muestra estudiada. La formación, un instrumento que ha probado su eficacia para mejorar la interpretación correcta de los símbolos de peligro, debería fomentarse, especialmente en aquellos colectivos con mayor dificultad de comprensión.

Occupational exposure assessment of highway toll station workers to vehicle engine exhaust.

Toll station workers are occupationally exposed to vehicle engine exhaust, a complex mixture of different chemical substances, including carcinogenic compounds. Therefore, a study was carried out on attendants of two highway toll stations to describe their occupational exposure to vehicle engine exhaust, based on a worst-case scenario approach. Personal sampling was conducted during the day shift for all attendants, testing for three groups of chemical substances: polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs) and aldehydes (formaldehyde and acrolein). Concentrations of total PAH, BTEX (benzene, toluene, ethylbenzene, and xylenes) and formaldehyde content varied between 97.60-336.08 ng/m3, 5.01-40.52 µg/m3, and 0.06-19.13 µg/m3, respectively. No clear relationships could be established between exposure levels and the number of vehicles. Furthermore, no differences were found between truck versus car lanes, or inside versus outside the tollbooth. Not all the detected VOCs were related to vehicle exhaust; some were consistent with the use of cleaning products. The measured concentrations were far below the established occupational exposure limits, but tended to be higher than values reported for outdoor urban environments. There are very few international studies assessing occupational exposures among toll station workers, and this is the first such study to be conducted in Spain. The results suggest that further, more detailed studies are necessary to characterize exposure properly, and ones which include other airborne pollutants, such as ultrafine particles. The comparison of the results to other similar studies was difficult, since no data related to some important exposure determinants have been provided. Therefore, it is recommended that these determinants be considered in future studies.

[Occupational exposure to carcinogens: analysis of the application of the CAREX information system to Catalonia]. / Exposición laboral a cancerígenos: análisis del sistema de información CAREX para su uso en Cataluña.

OBJECTIVE: The objective of this study is to estimate occupational exposures to human carcinogens in Catalonia in 2009, taking as a reference the CAREX ESP 2007 information system, and to evaluate the suitability of extrapolating these data to Catalonia. METHODS: The reference population is the number of people registered with the Social Security system in Catalonia in 2009. Carcinogens considered are those which the International Agency for Research on Cancer (IARC) classified into groups 1 and 2A and are related to occupational exposures. The exposure prevalences from the CAREX ESP 2007, adapted to the Catalonian Industrial Classification (CCAE 09), were used. Technical survey reports from the Occupational Safety and Health Centers of the Catalonian local government, and related databases were consulted. RESULTS: The most frequent occupational exposures to human carcinogens were solar radiation, crystalline silica, diesel exhaust, radon and wood dust, although based mainly on data not considered adequate for extrapolation to Catalonia. Around 217 exposure situations for 25 carcinogens, not previously considered in CAREX ESP 2007, were identified. CONCLUSIONS: The estimated number of workers exposed to human carcinogens in Catalonia in 2009 based on the CAREX ESP 2007 system could differ from the real situation. Development of a CAREX CAT system that incorporates exposure data from Catalonia is recommended.

OBJETIVO: El objetivo de este estudio es estimar la exposición laboral a cancerígenos en Cataluña para el año 2009 utilizando el sistema de información CAREX ESP 2007 como referencia, y valorar la adecuación o no de extrapolar estos datos a Cataluña. MÉTODOS: La población de referencia es aquella afiliada a cualquier régimen de la Seguridad Social de Cataluña en 2009. Se han considerado agentes cancerígenos los clasificados por la IARC (International Agency for Research on Cancer) en los grupos 1 y 2A relacionados con exposiciones laborales. Se ha utilizado la prevalencia de exposición de CAREX ESP 2007 adaptada a la clasificación económica Clasificación Catalana de Actividades Económicas (CCAE 09). Además, se han consultado actuaciones de técnicos de los Centres de Seguretat i Salut Laboral de la Generalitat de Catalunya, y bases de datos relacionadas con este tema. RESULTADOS: Las exposiciones laborales estimadas más comunes a agentes cancerígenos han sido para radiación solar, sílice cristalina, humos diesel, radón y polvo de madera, aunque con datos considerados en buena medida no extrapolables a Cataluña. Además, se han detectado 217 situaciones de exposición para 25 agentes cancerígenos que no se habían considerado en el sistema CAREX ESP 2007. CONCLUSIONES: Las estimaciones de trabajadores expuestos en Cataluña a agentes cancerígenos en 2009 en base al sistema CAREX ESP 2007 podrían diferir de la realidad. Se considera necesario desarrollar un sistema CAREX CAT con incorporación de datos de exposición propios de Cataluña.

La higiene ocupacional en América Latina: una guía para su desarrollo

Presenta información acerca del desarrollo histórico, el alcance, funciones y perfil del higienista, areas de conocimiento, formación, certificación y acreditación, y conclusiones y recomendaciones. Documento en formato pdf; requiere Acrobat Reader.

Formación de recursos humanos en el área de salud ocupacional en América Latina: informe preliminar / Preliminary report on the training of human resources in the ocupational health area in Latin America

Este documento presenta los resultados de una encuesta en América Latina sobre los centros existentes encargados de formar recursos humanos en el campo de la salud ocupacional con especial énfasis en higiene ocupacional. El documento incluye, además, algunas conclusiones relacionadas con la formación de recursos humanos, productos de una reunión consultiva sobre el desarrollo de la Salud Ocupacional en América Latina que se llevó a cabo en diciembre de 1998 en Sao Paulo, Brasil. En el apartado 2, se presenta la metodología usada para la realización de la encuesta, en el apartado 3 los resultados y en el apartado 4 la discusión sobre el tema