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WORLD HOSPITAL DIRECTORY
Occupational Medicine Medical Annals of Occupational Hygiene - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Occupational exposure to respirable crystalline silica (RCS) is a known cause of respiratory diseases, such as silicosis and lung cancer. Binder jetting additive manufacturing (AM) uses silica sand coated with sulphonic acid as feedstock material and operators are potentially exposed to RCS during various activities associated with AM. This includes the cleaning of the AM machine and associated equipment. This study aimed to investigate particulate exposures associated with additive manufacturing of sand moulds and its preceding silica sand coating process.<div class="boxTitle">Methods</div>The particle size distribution (PSD) and particle shape analysis of different forms of silica sand (virgin, coated, and used) was determined using a Malvern Morphologi G3 automated microscope and the structural characteristics was measured using X-ray diffraction (XRD). Personal exposure and area monitoring for airborne respirable dust and RCS were performed using MDHS 14/4 and NIOSH 7602, while real-time particle number concentrations of 0.3 to 10 µm sized particles was measured using the TSI Aerosol Particle Counter (APC). Monitoring was performed for 2 operators over 8 d and included 3 d of coating, one day of cleaning the AM machine, and 4 d of printing during which 3 identical parts were manufactured.<div class="boxTitle">Results</div>According to the PSD analysis, virgin and used silica sand particles were mostly in the respirable size range (d(0.9) = 3.98 ± 0.72 µm; and d(0.9) = 6.51 ± 2.71 µm, respectively), while coated sand was mostly in the inhalable size fraction d(0.5) = 29.76 ± 42.91 µm). The wt% results of the XRD analysis for the bulk virgin, coated and used silica sand were 97.3%, 92.6%, and 96.8% quartz, respectively. Personal exposure to RCS exceeded the exposure limit of 0.1 mg/m<sup>3</sup> when the operator used compressed air to clean the coating machine’s filter (0.112 mg/m<sup>3</sup>) and exceeded the action level on the day the AM machine was cleaned (0.70 mg/m<sup>3</sup>). The results for real-time particle number concentrations of 0.3 to 10 µm sized particles showed peaks while the cleaning activities such as dry sweeping were performed.<div class="boxTitle">Conclusion</div>The personal exposure to RCS was the highest on days when cleaning activities that used compressed air and dry sweeping took place. The high quartz content of the silica sand feedstock material and the respirable size of the virgin and used silica sand particles means that cleaning activities pose an RCS exposure risk to AM operators. Nine recommendations are made to reduce exposure to RCS during cleaning activities.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>In response to limitations in foundational anthropometric research efforts as well as the increasingly diversifying workforce, researchers have attempted to define the presence or absence of differences in respirator-related facial measurements between different demographic groups. The purpose of the present study was to assess the presence of differences in facial measurements from 3D scans related to respirator fit, based on demographic factors of gender, race/ethnicity, and age in a sample of 2,022 3D scans.<div class="boxTitle">Methods</div>Three-dimensional (3D) body scanning technology was used to gather facial measurement data. Principal components analysis (PCA) and multivariate analysis of variance (MANOVA) were employed to determine the presence or absence of differences in measurements from 3D scans between the demographic groups.<div class="boxTitle">Results</div>Results indicated that measurements from 3D scans related to respirator fit were significantly different for all groups within each demographic category (gender, race/ethnicity, and age).<div class="boxTitle">Conclusion</div>The findings suggest that demographic factors such as gender, race/ethnicity, and age have a significant impact on facial measurements from 3D scans, which has implications for respirator fit and design considerations.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>There is an international epidemic of chronic kidney disease of unknown cause (CKDu) in agricultural working populations. Particulate air pollution is a likely contributing factor in populations at risk for CKDu, but there is little personal breathing zone data for these workers.<div class="boxTitle">Methods</div>We collected 1 to 3 personal breathing zone particulate matter <5 microns (PM<sub>5</sub>) gravimetric measurements in 143 male sugarcane harvesters over 2 seasons and concurrent ambient samples using personal sampling pumps and cyclone inlets as a sampling train. Due to very high concentrations observed during a pilot of these methods, personal breathing zone sampling duration was set to 4 h, beginning either at the start of a work shift (AM) or delayed for 4 h (PM). To obtain full-shift exposure concentrations we calculated 8-h time-weighted average (TWA, in µg/m<sup>3</sup>) estimates of each worker’s full-shift personal breathing zone PM<sub>5</sub> exposure concentration by averaging their individual monitored concentration with the median concentration of the unmonitored AM or PM segment from all workers that day to obtain an 8-h TWA.<div class="boxTitle">Results</div>Median full-shift personal TWA PM<sub>5</sub> concentrations were 449 μg/m<sup>3</sup> (range 20.5 to 1,930 μg/m<sup>3</sup>), which were much higher than ambient concentrations in these fields (median 136, range 22.5 to 2,360 μg/m<sup>3</sup>). These findings document very high personal breathing zone PM<sub>5</sub> exposure in workers at risk for CKDu: median concentrations for all workers were 3.5 (range <1 to 33.6) times as high as concurrent ambient concentrations.<div class="boxTitle">Significance</div>These findings suggest that ambient measurements of particulate matter are insufficient to estimate personal exposure in this population and that personal breathing zone monitoring should be used to fully explore air pollution as a risk factor for CKDu. Given that particulate matter from this source likely has multiple hazardous constituents, future research should focus on characterizing all constituents and explore associations with biomarkers of kidney injury.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>Outdoor workers are exposed to high levels of solar ultraviolet radiation (UVR). UVR causes skin cancer and is a risk factor for cataract and other short- and long-term health effects, but there are significant knowledge gaps regarding the exposure-response relations based on quantitative measures of UVR exposure. We developed a quantitative UVR job-exposure matrix (JEM) for the general working population of Europe.<div class="boxTitle">Methods</div>Three experts from each of Northern, Central, and Southern Europe rated duration of outdoor work for all 372 occupations defined by the International Standard Classification of Occupations from 1988 (ISCO-88(COM)). A systematic literature search identified 12 studies providing 223 sets of summary workday UVR exposure for 49 ISCO-88(COM) occupations based on 75,711 personal workday measurements obtained from 2,645 participants and reported as arithmetic mean standard erythemal dose (SED). We combined the expert ratings with the measured occupational UVR exposure data and estimated harmonized workday UVR exposures for all 372 occupations in a linear mixed effects model.<div class="boxTitle">Results</div>Monotonically increasing workday UVR exposure of 0.68, 1.57, 1.80, and 2.49 SED were seen by increasing expert ratings of 0, 1 to 2, 3 to 4, and ≥5 h of daily outdoor work. The UVR exposure showed a 6-fold increase from lowest to highest exposed occupation. Farm hands, roofers, concrete placers, and other occupations within craft and related trades were among the highest exposed, while bartenders, wood-processing-plant operators, and several white-collar occupations who typically work indoor were among the lowest exposed.<div class="boxTitle">Conclusion</div>This quantitative JEM for solar UVR exposure proves able to provide substantial discrimination between occupations, shows good agreement with expert assessments, and may facilitate epidemiological studies characterizing the exposure-response relation between occupational solar UVR exposure and different health effects.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>This study examines occupational exposure to perchloroethylene among dry cleaning workers in Bogotá, Colombia, where its use remains prevalent despite global trends toward alternatives. A cross-sectional analysis was conducted with 9 workers to measure perchloroethylene exposure levels and blood concentrations. Additionally, a case–control study assessed gamma glutamyl transferase (GGT) and alanine aminotransferase (ALT) as biomarkers for hepatocellular damage. Workers were classified into 3 job categories: dry cleaning operators, ironers, and cold washing operators. Results indicated that dry cleaning operators experienced significantly higher exposure levels (0.72 to 7.22 ppm) compared to ironers and cold washers (0.001 to 3.39 ppm). All exposure levels were below the adjusted threshold limit of 19.58 ppm, and blood perchloroethylene concentrations were below detection limits. No significant differences in GGT and ALT levels were observed between exposed workers and the control group. Given the small sample size, further research is warranted to better understand exposure risks in this sector. Emphasizing a culture of prevention is crucial due to the carcinogenic potential of perchloroethylene, even at low environmental exposure levels.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><span style="font-style:italic;">Decent work</span>, a United Nations Sustainable Development Goal, is built on the ethical treatment of workers and ensures respect of their security, freedom, equity, and dignity. In the future, a wide range of technological forces may pose significant impediments to the availability and quality of decent work. This paper applies a prescriptive taxonomy to categorize evidence of the psychosocial impacts technology may bring to the future of work and elucidate the associated ethical concerns. Ethical objectives in support of a future defined by decent work are also offered. Central to this technoethical discourse are the principles of nonmaleficence, beneficence, autonomy, justice, and respect for persons. Expanded technoethical education, ethical technology assessments, ethical foresight analysis, and revised ethical standards are important ways to address technology-related ethical challenges on a larger scale. The findings in this paper may serve as a foundation for the systemic prevention and control of adverse effects and ethical concerns from the use of technology in the workplace of the future.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives</div>The generic term man-made vitreous fibres (MMVFs) also known as man-made mineral fibres (MMMFs) denotes non-crystalline, fibrous inorganic material manufactured primarily from glass, rock, minerals, slag, glass, and processed inorganic oxides. The International Agency for Research on Cancer has classified rock (stone) wool, glass wool, and continuous glass filament as Group 3 (not classifiable for carcinogenicity). This study contains an updated systematic review and meta-analysis of respiratory health outcomes and MMMFs.<div class="boxTitle">Methods</div>Cinahl, EMBASE, Medline, Web of Science, and OpenGrey were searched for epidemiological studies of occupational MMMF exposure and malignant and non-malignant respiratory diseases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted for reporting. Meta-analyses were carried out separately for cohort and case–control studies.<div class="boxTitle">Results</div>A total of 25 studies were identified for inclusion in the systematic review, with 19 of these (9 cohort; 10 case–control) providing risk estimates for the meta-analyses. Of the cohort studies, 3 were carried out in Sweden, 2 each in Canada and the United States, one in France, and one several European countries. The start of follow-up ranged from 1933 to 1975. The meta-RR for lung cancer from cohort studies (incidence or mortality) was 1.15 (95% CI: 1.01 to 1.32), for laryngeal cancer was 1.03 (95% CI: 0.78 to 1.37), and for non-malignant respiratory diseases (NMRD) mortality was 0.89 (95% CI: 0.66 to 1.22). Of the case-control studies, 9 examined lung cancer and one laryngeal cancer. Three of the lung cancer studies were carried out in France and one each in Germany, Russia, Canada, and China, with one in several European countries and one was a nested case–control study of several case cohorts from across the globe. The meta-OR for lung cancer from the case–control studies was 1.28 (95% CI: 1.10 to 1.50).<div class="boxTitle">Conclusions</div>Our findings broadly agree with a previously published meta-analysis of respiratory system cancers, in that they were similar in terms of magnitude of relative risk. However, overall, our results suggest that exposure to MMMFs is associated with a small, but statistically significantly elevated risk for lung cancer, but not for laryngeal cancer or NMRDs. Given the heterogeneity between studies, and the possibility of residual confounding, further work is required to determine if this association is causal.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The construction industry is well-documented as having numerous sources of hazardous noise on the job. Framers who cut and install steel studs on commercial construction sites use a variety of power tools throughout the course of their normal workday and have the potential to be exposed to levels of noise that can lead to occupational noise-induced hearing loss. This study assessed the noise dose of commercial steel stud framers and characterized the noise of common power tools that contribute to their daily noise dose. Occupational exposure limits exist in both required and recommended forms to protect workers; however, large differences in the level of worker protection are apparent between the mandated Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) and the voluntary National Institute for Occupational Safety and Health (NIOSH) recommended exposure limit (REL) for noise exposure. Steel stud framers in this study had a mean OSHA PEL dose of 27.6% and a mean NIOSH REL dose of 340.7% for the same workers. As a comparison, ambient equivalent noise doses at the construction site were 1.4% for PEL criteria and 12.4% for REL criteria. Of task assignments during the workday, workers who were assigned primarily as saw operators had statistically significant higher noise exposures than workers who were assigned as stud installers (<span style="font-style:italic;">P</span> = 0.037). Octave band analysis was conducted for full-day exposures and indicated an upward trend of higher noise exposures at higher frequencies. Overall, among all steel stud framers involved in this study, all workers had noise doses below the OSHA PEL (range 5.8% to 61.4%), and all but 2 workers (<span style="font-style:italic;">n</span> = 35) had noise doses above the NIOSH REL (range 63.9% to 823.2%), indicating exposure to hazardous levels of noise based on more protective RELs.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives</div>With continued global warming, the effects of elevated temperatures on the health of agricultural workers are a particular concern. This study characterized the levels of heat stress in Thai sugarcane workers and investigated whether season and harvesting method were associated with it.<div class="boxTitle">Methods</div>Three hundred sugarcane workers in Nakhon Sawan Province, Thailand, were recruited, and information on demographics, working conditions, and clothing characteristics was collected from participants during the cooler months (<span style="font-style:italic;">n</span> = 152 participants, mid-January to mid-February) and hotter month (<span style="font-style:italic;">n</span> = 148, March). Heat stress was measured using the Wet Bulb Globe Temperature (WBGT) index, and the WBGT instruments were operated for a full work shift in the sugarcane fields where the participants worked. One-hour time weighted average (TWA) effective WBGT (WBGT<sub>eff</sub>-1hrTWA) estimates were determined for different times of the day based on the measured WBGT and clothing adjustment factor.<div class="boxTitle">Results</div>The average WBGT<sub>eff</sub>-1hrTWA in the cooler months ranged from 22.5 °C during the early morning to 31.3 °C during the hottest time of the day, and for the hotter month, it ranged from 25.4 °C to 33.9 °C, respectively. The measured WBGT, natural wet-bulb temperature (Tnwb), dry-bulb temperature (Tdb), globe temperature (Tg), air velocity (Av), and absolute water vapor pressure (e<sub>a</sub>) were all statistically significantly higher in the hotter month than in the cooler months. Harvesting during the hotter month and harvesting burnt sugarcane were significantly associated with increased effective WBGT. The harvesters’ heat stress in both seasons exceeded the American Conference of Governmental Industrial Hygienists - Threshold limit value for 72.7% of the working time in the cooler months and 90.9% in the hotter month.<div class="boxTitle">Conclusions</div>The heat stress in Thai sugarcane workers was high in both seasons, particularly in the hotter month and when harvesting burnt sugarcane. This results in a very high risk of developing heat-related health effects, and measures are needed to reduce heat stress. Heat stress in agricultural and other outdoor work in tropical climates is an immediate and growing problem.</span>
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