Occup Environ Health Research Articles

Exposure-response relation for vibration-induced white finger: effect of different methods for predicting prevalence.

A pooled analysis of vibration-induced white finger (VWF) in population groups of workers has been performed using the results of a published meta-analysis as source material (Nilsson T, Wahlström J, Burström L. Hand-arm vibration and the risk of vascular and neurological diseases a systematic review and meta-analysis. PLoS One. 2017:12(7):e0180795. https://doi.org/10.1371/journal.pone.0180795). The methods of data selection follow those described previously by Scholz et al. (in Scholz MF, Brammer AJ, Marburg S. Exposure-response relation for vibration-induced white finger: inferences from a published meta-analysis of population groups. Int Arch Occup Environ Health. 2023a:96(5):757-770. https://doi.org/10.1007/s00420-023-01965-w) to enable comparison with the results of the present work. The analyzed epidemiologic studies contain different prevalences of VWF observed after different durations of employment involving exposure to the vibration of power tools and machines. These prevalences are transformed to 10% prevalence by either linear or polynomial (i.e. "S"-shaped curvilinear) interpolation in order to compare with the exposure-response relation contained in the relevant international standard (ISO 5349-1:2001). An exposure-response relation is constructed using regression analysis for the time (in years) to reach 10% prevalence in a population group, when subjected to a daily vibration exposure calculated according to the procedures specified in the standard, A(8). Good fits to the data are obtained when polynomial and linear prevalence interpolation is used. The 95-percentile confidence intervals (CIs) of the exposure-response relation predicted by polynomial prevalence interpolation lie at somewhat larger lifetime exposures than those obtained by linear prevalence interpolation. Uncertainty in the precision of polynomial prevalence interpolation is mitigated by giving equal weight to linear interpolation when interpreting the results. When the 95-percentile CIs of the exposure-response models obtained by linear and polynomial prevalence interpolation are used to define the most probable exposure-response relation, the resulting common range of values includes the ISO exposure-response relation. It is proposed that an exposure-response relation for the onset of VWF derived from a regression analysis is specified in terms of the lower limit of its CI. Hence, when exposure measures are constructed according to the ISO standard and equal weight is given to the results of the 2 methods for interpolating prevalence described here, the ISO exposure-response relation would be considered to provide a conservative estimate for a 10% prevalence of VWF to develop in a population group, at least for A(8) > 4 m/s2. It thus remains the relation to use for assessing exposure to hand-transmitted vibration in the workplace. Additional research is needed to resolve inconsistencies in the ISO method for calculating daily exposures.

Geographic distribution and environmental triggers of systemic sclerosis cases from 2 large academic tertiary centers in Massachusetts

To the Editor: Systemic sclerosis (SSc) is a chronic autoimmune sclerosing disease with the highest case fatality rate among connective tissue diseases.1Feghali-Bostwick C.A. Varga J. Systemic Sclerosis.in: Bradshaw R.A. Dennis E.A. Handbook of Cell Signaling. 2nd ed. Academic Press, 2010: 2913-2917Crossref Scopus (1) Google Scholar Since the 1980s, the annual incidence rates in North America have increased from 1.7 to 2.7 per 100,000 individuals.2Bergamasco A. Hartmann N. Wallace L. Verpillat P. Epidemiology of systemic sclerosis and systemic sclerosis-associated interstitial lung disease.Clin Epidemiol. 2019; 11: 257-273Crossref PubMed Scopus (66) Google Scholar Although the exact pathogenesis of SSc remains unclear, environmental triggers have been hypothesized to provoke disease development among genetically predisposed hosts.3Barnes J. Mayes M.D. Epidemiology of systemic sclerosis: incidence, prevalence, survival, risk factors, malignancy, and environmental triggers.Curr Opin Rheumatol. 2012; 24: 165-170Crossref PubMed Scopus (212) Google Scholar,4McCormic Z.D. Khuder S.S. Aryal B.K. Ames A.L. Khuder S.A. Occupational silica exposure as a risk factor for scleroderma: a meta-analysis.Int Arch Occup Environ Health. 2010; 83: 763-769Crossref PubMed Scopus (82) Google Scholar The assessment of high-prevalence geographic clusters may be a crucial first step in cause identification. Our objectives were to analyze SSc hotspots in Massachusetts and identify possible environmental triggers. The research patient data registry was utilized to identify 4579 potential SSc cases and zip codes from medical records between 1989 and 2019 of Massachusetts General Hospital and Brigham and Women's Hospital. Cases confirmed by dermatologists or rheumatologists were included (n = 2196). The period prevalence was calculated based on the population per zip code. QGIS3.10, a geospatial program, was used to create and analyze SSc distribution and prevalence maps (Fig 1). These maps were compared to environmental toxins and social justice maps to determine trends in etiologic triggers and demographic clusters. Statistical analysis was performed using 2 sample t tests. Hazardous waste facilities (P = .0039) and oil release or disposal sites (P = .0203) were significantly associated with a higher SSc prevalence (Fig 2). Although the association between chemical release sites and SSc prevalence was not independently significant (P = .3166), a spatial correlation was found to exist. Exposure to all 3 sites together posed a significantly increased SSc risk (P = .0002). Disease hotspots showed greater particulate pollution levels and were in proximity to ash pollution and combustion facilities (Supplemental Fig 1 available via Mendeley at https://data.mendeley.com/datasets/59zfn6fdb2/2). The maps of low-income and minority communities demonstrated a spatial relationship with SSc hotspots, suggesting a possible association between socioeconomic factors and disease (Supplemental Fig 2 available via Mendeley at https://data.mendeley.com/datasets/59zfn6fdb2/2).5Environmental justice populations in Massachusetts | Mass.gov.https://www.mass.gov/info-details/environmental-justice-populations-in-massachusettsDate accessed: January 27, 2021Google Scholar The presence of SSc regional clustering and increased density of industry and waste sites in these areas suggest that environmental pollutants play a critical role in disease development. Additionally, the clustering of SSc hotspots and environmental pollutants around low-income and minority neighborhoods indicates that these residents face a disproportionate burden of toxin exposure and disease. High-SSc prevalence pockets in Central and Western Massachusetts with few or no direct toxin sites may be impacted by their surrounding environmental factors, such as water sources collecting precipitated pollutants from nearby facilities or by cross-state pollution, both waterborne and airborne. Another possible explanation for SSc regional clustering is the social drift hypothesis, suggesting that those with chronic diseases are more likely to reside in low-income areas because of disease burden. The study limitations include potential confounders contributing to disease, such as genetic predispositions, sociodemographic factors, and proximity bias. Finally, our study demonstrated a correlation but could not prove causation, making further study of this important topic crucial. Further investigations, including wider geographies and more diverse patient populations, are warranted. Ultimately, this research may provide a greater understanding of the potential role of environmental toxins in SSc onset. Furthermore, it may be used as an advocate for environmental and health policy reforms to protect communities disproportionately burdened by their exposure to environmental toxins and their adverse health effects. None disclosed.

Physical activity and preterm birth: risk factor or benefit?

Although risk factors and determinants of spontaneous preterm birth have been identified, effective primary and secondary prevention strategies to reduce the global incidence and neonatal consequences of prematurity remain elusive. Physically demanding work (prolonged standing, heavy lifting, physical exertion, occupational fatigue, demanding posture) during pregnancy has been associated with an increased risk of preterm birth (van Beukering MDM, et al. Int Arch Occup Environ Health 2014; 87:809-34). This article is protected by copyright. All rights reserved.

Corporate corruption of science-Another asbestos example.

Kelsh et al. [2007]: Occup Med (Lond) 57:581-589 published a paper reanalyzing one of the few data sources publicly available on mesothelioma amongst brake workers, the Australian Mesothelioma Surveillance Registry (AMSR). This reanalysis was commissioned by lawyers representing the automobile manufacturing companies and did not align with an independent analysis published by Leigh and Driscoll [2003]: Occup Environ Health 9:206-217. We sought to reevaluate the AMSR data ourselves to understand how the company-sponsored research categorized the data. In our re-analysis of the 78 brake-related folios in the AMSR, we determined that 57 were employed brake mechanics, 35 were employed brake mechanics with no other asbestos exposure besides brake work or repair, and 41 of these cases had no other asbestos exposure besides brake work or repair. Our classifications differed significantly from Kelsh et al. We discuss how Kelsh et al. methodically reduced the relevant cases by following overly stringent criteria for inclusion. Am. J. Ind. Med. 60:152-162, 2017. © 2017 Wiley Periodicals, Inc.

Chronic Eosinophilic Pneumonia in a Cardboard Factory Worker With Inadequate Response to Prednisone

SESSION TITLE: Student/Resident Case Report Poster - Occupational and Environmental Lung Diseases SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Occupation related exposures in paper and pulp factory workers have been implicated in chronic bronchitis, asthma, and general symptoms of breathlessness. Symptoms have been attributed to exposure to paper dust as well as non-organic chemicals. We describe a case of chronic eosinophilic pneumonia (CEP) in a patient with prolonged employment at a cardboard factory. CASE PRESENTATION: A 62 year old male with 25 year history of working in a cardboard factory presented with complaints of dyspnea, cough, malaise. He has been symptomatic for 20 years but was diagnosed with asthma and treated with albuterol with poor control and frequent recurrence. Exam revealed bilateral rales. Computer tomography (CT) of the chest showed extensive upper lobe pulmonary interstitial and alveolar lung disease. Bronchoalveolar lavage (BAL) showed intense eosinophilia (99%) and pathology exam of wedge resection of right middle lobe was consistent with CEP with features of organizing pneumonia. Prednisone 40mg daily was started but tapered to 20 mg over 6 months with continued employment. He began requiring oxygen at 3 L/min, received short term disability, and stopped working. 4 months later, a repeat CT showed stable ground glass opacities and increased interstitial markings. Spirometry revealed FEV1 49%, FVC 45%, and DLCO was 29% predicted. BAL demonstrated persistent yet improved eosinophilia (30%). DISCUSSION: Patients with CEP improve quickly with systemic steroids and exposure avoidance. Our patient had poor response to prednisone which could be attributed to his continued work-related exposure. We hypothesize that even after exposure cessation the additional pathology of organizing pneumonia likely contributed to poor steroid responsiveness. CONCLUSIONS: Our aim is to describe a case of refractory chronic eosinophilic pneumonia probably caused by prolonged non-organic chemical and paper dust exposures from working in a cardboard factory. Reference #1: Westberg H, Elihn K, Andersson E, Persson B, Andersson L, Bryngelsson IL, Karlsson C, Sjögren B. Inflammatory markers and exposure to airborne particles among workers in a Swedish pulp and paper mill. Int Arch Occup Environ Health. 2016 Feb 13. Reference #2: Arakawa H, Kurihara Y, Niimi H, Nakajima Y, Johkoh T, Nakamura H. Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients. AJR Am J Roentgenol. 2001 Apr;176(4):1053-8. Reference #3: Murgia N, Torén K, Kim JL, Andersson E. Risk factors for respiratory work disability in a cohort of pulp mill workers exposed to irritant gases. BMC Public Health. 2011 Sep 6;11:689. DISCLOSURE: The following authors have nothing to disclose: Kirill Lipatov, Tasnim Lat, Rachael Pattison, Darwin Ashbaker, Shekhar Ghamande No Product/Research Disclosure Information

RE: Gordon R, Fitzgerald S, and Millette J. Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women. Int J Occup Environ Health. 2014;20(4):318-332.

Dear Editor:Thank you for the opportunity to reply to the letter you received from by Dr. Lee and Mr. Van Orden.1 It is clear that Dr. Lee and Mr. Van Orden have no idea of what constitutes a true ...

Report on the two‐phase public consultation on the draft EFSA scientific opinion on bisphenol A (BPA)

Report on the two‐phase public consultation on the draft EFSA scientific opinion on bisphenol A (BPA)

Spine Surgeon's Kinematics during Discectomy, Part II: Operating Table Height and Visualization Methods, Including Microscope

Introduction Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope. Materials and Methods We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position. Results Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method. When using a microscope, lumbar lordosis, thoracic kyphosis, and cervical lordosis showed no differences according to table heights above the umbilicus. Conclusion This study suggests that the use of a microscope and a table height above the umbilicus are optimal for reducing surgeon musculoskeletal fatigue. Disclosure of Interest J. Y. Park: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) S. U. Kuh: None declared Y. E. Cho: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) References Wunderlich M, Jacob R, Stelzig Y, Rüther T, Leyk D. [Analysis of spinal stress during surgery in otolaryngology]. HNO 2010;58(8):791–798 Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE. Spine surgeon's kinematics during discectomy according to operating table height and the methods to visualize the surgical field. Eur Spine J 2012;21(12):2704–2712 van Det MJ, Meijerink WJ, Hoff C, Totté ER, Pierie JP. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 2009;23(6):1279–1285 Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ. A survey of static and dynamic work postures of operating room staff. Int Arch Occup Environ Health 1992;63(6):423–428 Shirzadi A, Mukherjee D, Drazin DG, et al. Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine 2012;37(24):E1517-E1523 Postacchini F, Postacchini R. Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl (Wien) 2011;108:17–21 Kranenburg G, Gossot. Ergonomic problems encountered during video-assisted thoracic surgery. Minim Invasive Ther Allied Technol 2004;13(3):147–155 Lee G, Lee T, Dexter D, et al. Ergonomic risk associated with assisting in minimally invasive surgery. Surg Endosc 2009;23(1):182–188 Mirbod SM, Yoshida H, Miyamoto K, Miyashita K, Inaba R, Iwata H. Subjective complaints in orthopedists and general surgeons. Int Arch Occup Environ Health 1995;67(3):179–186 Cenic A, Kachur E. Lumbar discectomy: a national survey of neurosurgeons and literature review. Can J Neurol Sci 2009;36(2):196–200 Branson BG, Bray KK, Gadbury-Amyot C, et al. Effect of magnification lenses on student operator posture. J Dent Educ 2004;68(3):384–389 Mamoun JS. A rationale for the use of high-powered magnification or microscopes in general dentistry. Gen Dent 2009;57(1):18-26, quiz 27-28, 95–96 Maggio MP, Villegas H, Blatz MB. The effect of magnification loupes on the performance of preclinical dental students. Quintessence Int 2011;42(1):45–55 Chang BJ. Ergonomic benefits of surgical telescope systems: selection guidelines. J Calif Dent Assoc 2002;30(2):161–169 Berquer R, Smith WD, Davis S. An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg Endosc 2002;16(3):416–421 van Veelen MA, Kazemier G, Koopman J, Goossens RH, Meijer DW. Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech A 2002;12(1):47–52

Longitudinal changes in hearing threshold levels of noise-exposed construction workers

Longitudinal analysis of audiometric data of a large population of noise-exposed workers provides insight into the development of noise-induced hearing loss (NIHL) as a function of noise exposure and age, particularly during the first decade of noise exposure. Data of pure-tone audiometry of 17,930 construction workers who underwent periodic occupational hearing screening at least twice during a 4-year period were available for analysis. These concerned all follow-up measurements of the baseline cohort described by Leensen et al. (Int Arch Occup Environ Health 84:577-590, 2011). Linear mixed models explored the relationship between the annual rate of change in hearing and noise exposure level, exposure duration, and age. Data of 3,111 workers who were tested on three occasions were used to investigate the pattern of hearing loss development. The mean annual deterioration in hearing in this study population was 0.54 dB/yr, and this became larger with increasing noise exposure level and increasing age. Remarkably, during the first decade of noise exposure, an improvement in hearing threshold levels (HTLs) was observed. The change in hearing over three measurements showed a concave development of hearing loss as a function of time, which corresponds to NIHL development. Overall, hearing deteriorated over the measurement period. Because HTLs at follow-up were better than those obtained at baseline, no statement can be made about the NIHL development during the first decade of noise exposure. This improvement in HTLs rather resembles the result of measurement variation in occupational screening audiometry than an actual improvement in hearing ability.

PFCs and Early Menopause: Association Raises Questions about Causality

Polyfluoroalkyl chemicals (PFCs)—chemicals used in the manufacture of stain- and water-repellant products—are suspected endocrine disrupters.1 Animal studies have suggested an association between exposure to two of the most commonly encountered PFCs (perfluorooctanoate, or PFOA, and perfluorooctane sulfonate, or PFOS) and altered hormonal function,1,2 although evidence in humans remains inconsistent. A small number of cross-sectional epidemiological studies have reported an association between PFOA/PFOS exposure and timing of puberty,3 menopause,4 and thyroid function,5 while others have reported no association.6 In this issue of EHP, researchers report an association between PFC concentrations in circulating blood and rate of hysterectomy as well as earlier age at natural menopause.7 The findings, say the researchers, raise the question of whether high PFC exposure may lead to early menopause or, conversely, whether early menopause may lead PFCs to build up in women’s bodies. Either way, the results are of interest because women who reach menopause by their late 40s are at increased risk for various forms of heart disease.8,9,10 “If PFC levels are predictors of earlier menopause,” the investigators write, “exposure may also increase the risk of other serious health outcomes (e.g., cardiovascular disease and stroke).”7 According to the North American Menopause Society, menopause occurs, on average, at age 51 in U.S. women. Women characterized as having early or premature menopause will have had their last menstrual period before age 40.11 In the current study, researchers from the National Institute of Environmental Health Sciences (NIEHS) and the University of North Carolina at Chapel Hill analyzed data for 2,732 women, more than two-thirds of whom were premenopausal. The investigators compared blood concentrations of four PFCs—PFOA, PFOS, perfluorononanoate (PFNA), and perfluorohexane sulfonate (PFHxS)—and, for postmenopausal women, age at natural or surgically induced menopause. The data were collected as part of the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2010. NHANES data are intended to be nationally representative, and past analyses have indicated ubiquitous exposure to PFOS, PFOA, and other PFCs. One 2007 NHANES analysis showed that 98% of adults sampled had measurable levels of at least two PFCs in their blood.12 In the current study, women with the highest blood levels of PFOA, PFNA, and PFHxS were, respectively, 36%, 47%, and 70% more likely to have experienced menopause than women with the lowest concentrations of these compounds. Premenopausal women had the lowest levels of all four PFCs, whereas women who had undergone hysterectomy had the highest levels.7 PFHxS was most strongly associated with rate of hysterectomy. Women with the highest blood levels were 3.5 times more likely to have had a hysterectomy than women with the lowest levels. PFOA, PFNA, and PFOS were also significantly associated with having had a hysterectomy.7 Hysterectomy was associated with the highest blood levels of all four PFCs studied, possibly a result of unusually early menopause— although longitudinal studies are necessary to test that hypothesis. Women in the study reached natural menopause at a median age of 49, while women who had hysterectomies reported their last period at a median age of 38. The cross-sectional nature of the study makes it impossible to distinguish whether higher PFC levels may have led to earlier menopause or vice versa. “PFCs circulate in blood, so menstruating women may lose PFCs through blood loss, which would not be the case for postmenopausal women,” says lead author Kyla Taylor, a health scientist at the NIEHS. Whereas many persistent organic pollutants are stored primarily in fat tissue, PFCs form bonds with blood proteins. That means they tend to accumulate in serum rather than in fat. “While this study suggests the potential for reverse causation in the association between PFCs and earlier menopause, we don’t know what that means or whether it’s the sole explanation [for the association],” says Sarah Knox, an epidemiologist at West Virginia University who studies PFCs but was not involved in this research. Only a longitudinal study can provide the insight to determine causality. “This is an area of concern and an area clearly in need of further research,” Knox says.

Fighting Noise Pollution: A Public Health Strategy

In this issue of EHP, investigators from the University of Michigan at Ann Arbor describe the most serious health effects of noise and propose a blueprint for an effective U.S. public health response.1 The team, led by Richard L. Neitzel, an assistant professor of environmental health sciences, estimated that nearly one-third of Americans are exposed to noise levels deemed injurious to hearing by the U.S. Environmental Protection Agency (EPA)—a 24-hour average noise level exceeding 70 dBA.1 The authors based this figure on 1981 estimates from the EPA.2 But mounting evidence also connects noise exposures with cardiovascular disease, sleep disturbance, stress, general annoyance, impaired learning and concentration, and other health effects. The EPA’s limit for protecting against all health effects of noise is a 24-hour average 55 dBA, weighted with a penalty for nighttime exposures to account for the special impact of disrupted sleep.2 In 1981 the EPA estimated about 3% of the U.S. population could be exposed to noise levels high enough to increase the risk of hypertension.2 A recently implemented labeling requirement in Europe advises consumers about tires’ noise emissions as well as their energy economy and wet braking distance. Noise activates the body’s sympathetic nervous system, raising blood pressure and heart rate.3 Although inhabitants of noisy environments may be able to tune out noise, that habituation does not appear to extend to the cardiovascular system during nighttime exposures.4 Repeated arousals have been reported to prevent blood pressure from dropping during sleep the way it’s supposed to.5 Disrupted sleep is also associated with increased levels of lipids and the stress hormone cortisol, potentially increasing the risk of disorders such as depression6 and atherosclerosis.7 Two 2013 studies involving millions of British residents living airports reported an association between exposure to aircraft noise and increased hospital admissions for cardiovascular diseases.8,9 Annoyance can increase sympathetic tone—that is, put the sympathetic nervous system on high alert—especially in sensitive individuals.10 This increase in sympathetic tone has been postulated as a pathway by which individuals with high occupational noise exposures develop heart disease.”11 The major sources of chronic unwanted noise in the United States include road, rail, and air transportation,12 although adverse health effects are possible with enjoyable sources—loud sporting events, firearms, and music, for example.1 The authors advocate two approaches as the “least costly, most logistically feasible, and most effective” federal-level interventions: direct regulation of noise emissions, and improved public education. Between 1981 and 2000, regulation of aircraft noise under the Noise Control Act of 1972 drastically reduced the number of people exposed to excessive noise from neighboring airports, even though air travel increased sixfold in the same period.13 The EPA retains regulatory authority to reduce noise exposures from other sources, despite the 1981 defunding of its Office of Noise Abatement and Control. But the agency’s funding peaked in 1978, rendering action on noise control unlikely without congressional support, according to Neitzel and colleagues.1 Another strategy, labeling products with their noise emissions, is already mandatory for some products in the European Union, Argentina, Brazil, and China, and has been implemented in the United States for air compressors. The authors point out that labeling is only effective if consumers understand what they are reading; public education is critical. The authors also recommend comprehensive noise mapping at the national level to identify hot spots for further study and remediation. The necessary data could be collected relatively inexpensively through crowdsourcing using people’s cell phones, Neitzel says: “We have a minicomputer in our pockets, every one with a microphone, and existing software platforms can compile noise data.” They also recommend sustainable building design and municipal procurement policies that consider noise levels when purchasing noisy items such as emergency vehicles, construction equipment, and buses. Experts studying community noise highlight the need for controlling noise at the source. Arline Bronzaft, an environmental psychologist and professor emerita of City University of New York, cautions that communities that are quiet today “could be intruded upon in the near future.” It’s therefore important to focus on quieting communities overall, not just separating people from noise today, she says. Others point out the need to consider noise as part of a holistic approach to public health. As one example, Hugh Davies, an associate professor in the School of Population and Public Health at the University of British Columbia, says efforts to mitigate traffic emissions must be achieved in ways that don’t increase noise levels. Distancing houses from vehicles reduces exposures to both noise and vehicular emissions, but reducing air pollution by reducing stop-and-go traffic may actually increase noise, because faster traffic is often noisier. Thus, Davies say, “we are replacing one health hazard with another.”

Staff report on Medtronic's influence on INFUSE clinical studies. United States Senate Finance Committee. Int J Occup Environ Health 2013;19(2):67-76.

Staff report on Medtronic's influence on INFUSE clinical studies. United States Senate Finance Committee. Int J Occup Environ Health 2013;19(2):67-76.

Higher prevalence of breathlessness in elderly exposed to indoor aldehydes and VOCs in a representative sample of French dwellings

The purpose of this study was to explore respiratory health effects of indoor exposures to aldehydes and volatile organic compounds (VOCs) in elderly living in a population-based representative sample of French dwellings and to compare them to the rest of the occupants of the dwellings. Twenty VOCs were objectively measured in 490 main dwellings. The respiratory conditions were assessed through a standardized questionnaire in 1012 inhabitants aged over 15 years, 144 of whom were aged over 65 years. Generalized estimating equations (GEE) were used to model the relationship between respiratory health outcomes and air pollutants concentrations using the median value of the distribution to define elevated exposure. Similar levels of indoor air pollutants were found in elderly and others. However, associations between breathlessness and living in dwellings with elevated concentrations of toluene and o-xylene respectively were statistically significant in elderly but not in the rest of the population (adjusted odds ratios (AOR(95% confidence interval)=3.36(1.13, 9.98) and 2.85(1.06, 7.68) in elderly vs. 0.91(0.59, 1.39) and 0.79( 0.47, 1.34) in the others respectively). A more pronounced effect of n-decane on past year breathlessness was observed in case of poor ventilation in the dwellings. Our results showed a higher risk of breathlessness in elderly exposed to indoor air pollution than in the rest of the exposed population. Further investigations are needed to confirm whether this is related to frailty in elderly.

Can observations of workplace bullying really make you depressed? A response to Emdad et al.

A recent study by Emdad and colleagues published in International Archives of Occupational and Environmental Health concluded that being a bystander to workplace bullying is related to future symptoms of depression. In this response to the authors, we argue, through the use of empirical evidence, that this relationship can be explained by the observers own exposure to bullying. Furthermore, by also investigating the reversed association between the variables, we show that observations of workplace bullying can be influenced by symptoms of psychological distress. A reanalysis of prospective questionnaire survey data with a two-year time lag based on a representative sample of Norwegian employees was used to determine long-term relationships between observed bullying, self-reported exposure to bullying, and psychological distress. Bivariate, baseline observations of others being bullied were significantly associated with subsequent symptoms of psychological distress. Yet, this association disappeared when controlling for the observers own exposure to bullying. Analyzing reversed relationship between the variables, baseline symptoms of distress predicted being a bystander at follow-up. By showing that the relationship between being a bystander to bullying and distress can be fully explained by the observers own exposure to bullying, our results question the conclusion by Emdad et al. (Int Arch Occup Environ Health. doi: 10.1007/s00420-012-0813-1 , 2012) that observed bullying in itself is related to subsequent distress. Together with the finding that psychological distress predicts subsequent observations of bullying, it is concluded that future research on observers should always take the observers' own exposure to bullying, as well as negative perceptions biases, into account.

Roles of pollution in the prevalence and exacerbations of allergic diseases in Asia

The prevalence of asthma and allergic diseases has been found to be increasingly rapidly, especially in developing countries. Environmental factors have been found to be important contributors to the manifestations of allergic diseases. Air pollution has been extensively studied in different regions of the world. The levels of ambient air pollutants in many Asian countries are very high when compared with those in developed Western countries. However, the prevalence of asthma was relatively low across many Asian countries. Many studies have clearly documented that environmental air pollution is an important factor resulting in exacerbations of asthma. In particular, levels of traffic-related pollutants are increasing rapidly across many Asian countries in parallel with the level of urbanization and economic development. The loss of protective factors associated with a rural environment will further contribute to the adverse effect on patients with allergic diseases such as asthma. In this review the roles of air pollution were examined in relation to the inception and exacerbations of allergic diseases in Asia.

Gate Wait for Better Air

Commercial jets may spend as much as 30% of their total flight time taxiing on the tarmac before takeoff.1 In the United States, this “taxi-out time” translates into 6 million metric tons of carbon dioxide, 45,000 metric tons of carbon monoxide, 8,000 metric tons of nitrogen oxides, and 4,000 metric tons of hydrocarbons emitted into the atmosphere yearly.1 Holding planes at the gate for fewer than 5 extra minutes may be a simple way to reduce these emissions, according to a pilot study conducted at Boston Logan International Airport by researchers at the Massachusetts Institute of Technology (MIT).2 The MIT team studied departure data from Logan and developed models to minimize runway congestion by increasing the amount of time planes spent at the gate. Working with the Federal Aviation Administration (FAA) and air traffic controllers, the MIT team ran eight 4-hour tests in August and September 2010 during Logan’s busiest arrival and departure times. The average taxi-out time at Logan is about 20 minutes. Holding 247 flights at the gate for an average of 4.3 extra minutes reduced taxiing time by an average of 20%, and fuel consumption dropped by 16–20 gallons per plane. Takeoff times were not delayed, because once planes pushed back they proceeded quickly to takeoff. About 18 hours of taxi-out time were eliminated over the course of the study, resulting in an overall estimated fuel savings of 3,900–4,900 gallons. This simple strategy offers a potential win–win situation for airports, airlines, and neighboring communities whose air is polluted by airport emissions. Air traffic controllers and aircraft pilots “were very positive and liked the fluid flow of aircraft on the ground instead of long queues,” says study leader Hamsa Balakrishnan. She’s working with the FAA to improve the method and test it at other congested airports. The team is also working on a model to estimate emissions avoided through the reduction in fuel consumption. Hazardous air pollutants measured at or near airports include nitrogen dioxide, polycyclic aromatic hydrocarbons, fine particles, carbonyls, and volatile organic compounds.3,4,5 These pollutants have been generally linked to cancer,6 heart attack,7 and type 1 diabetes.8 In one study, people living within 5 miles of airports were 1.5 times more likely than people living farther away to be admitted to hospitals for a variety of respiratory diseases.9 “It’s important that we minimize emissions,” says Lourdes Maurice, executive director for environment and energy at the FAA. Although it remains to be seen whether reduced taxi-out times at other airports will translate into significant fuel savings and emissions reductions, Maurice says, “The initial benefits look very good and we are continuing efforts with MIT.”

Longitudinal study on potential neurotoxic effects of aluminium: II. Assessment of exposure and neurobehavioral performance of Al welders in the automobile industry over 4 years

This is the second of two parallel longitudinal studies investigating Al exposure and neurobehavioral health of Al welders over 4 years. While the first published study in the trail and truck construction industry examined the neurobehavioral development of Al welders from age 41-45 in the group mean (Kiesswetter et al. in Int Arch Occup Environ Health 81:41-67, 2007), the present study in the automobile industry followed the development from 35 to 39. Although no conspicuous neurobehavioral developments were detected in the first study, which furthermore exhibited the higher exposure, it cannot be excluded that exposure effects appear in earlier life and exposure stages. The longitudinal study is based on a repeated measurement design comprising 4 years with three measurements in 2 years intervals. 92 male Al welders in the automobile industry were compared with 50 non-exposed construction workers of the same industry and of similar age. The repeated measurements included total dust in air, and Al pre- and post-shift plasma and urine samples. Neurobehavioral methods comprised symptoms, verbal intelligence, logic thinking, psychomotor behavior, memory, and attention. The computer aided tests came from the Motor Performance Series and the European Neurobehavioral Evaluation System. The courses of neurobehavioral changes were analyzed with multivariate covariance-analytical methods considering the covariates age, indicators of 'a priori' intelligence differences (education or markers of 'premorbid' intelligence), and alcohol consumption (carbohydrate-deficient transferrin in plasma). Additionally, the interrelationship, reliability and validity of biomonitoring measures were examined. The mean environmental dust load during welding, 0.5-0.8 mg/m(3), and the mean internal load of the welders (pre-shift: 23-43 microg Al/g creatinine in urine; 5-9 microg Al/l plasma) were significantly lower than in the parallel study. Under low exposure, the stability of biomonitoring measures was reduced, but the Al load differed significantly between Al welders and referents. It could not be shown that the development of neurobehavioral performances over the 4-year period differed between both groups. Mainly, markers of premorbid intelligence and age were related to neurobehavioral performance differences but not Al exposure. The biomonitoring and neurobehavioral results are in line with the results of the first published study. The repeated measurement models of both studies showed no adverse neurobehavioral effects of Al welding. A modular lifetime-oriented research concept is outlined aiming at the investigation of sequential periods of exposure life with special focus on the biologically most sensitive phases like first exposure and old age.

Preventive Effects of Taurine and Vitamin C on Renal DNA Damage of Mice Exposed to Arsenic

Arsenic (As), as a pollutant, ubiquitously exists in well water and contaminated soil. There is also exposure to arsenic in some industries, such as non-ferrous smelting, wood preservation, and electronics. The risk of Asinduced human diseases is high in some developing countries such as Bangladesh, India, and China . Epidemiologic investigations and animal experiments have demonstrated that acute and chronic exposure to As can cause injury to the kidney and increase the risk of renal cancer, so the kidney may be a major target of toxicities induced by As. It was reported that As depresses the functions of the antioxidant defense system and led to oxidative damage to cellular macromolecules . The above results show that increase of oxidative stress and subsequent oxidative DNA damage of cells may be involved in the renal disorders induced by As. Taurine, an end product of l-cysteine metabolism, is the most abundant free amino acid in many tissues and protects against the adverse effects of reactive oxygen species (ROS) caused by various toxic substances. Vitamin C (Vit C), as a kind of water-soluble antioxidant, also prevents oxidative damage to many important macromolecules. 8-OHdG is formed from deoxyguanosine (dG) in DNA by hydroxy free radicals. Because of its stability, 8-OHdG is known as one of the most reliable markers of oxidative DNA damage. In the present study, in order to investigate the protective effects of taurine and Vit C against As-induced nephrotoxicity, we examined the expression of 8-OHdG and the histopathological changes in the renal tissues of mice administered As or both As and taurine or Vit C.

Answer to comments by A. Lerchl on “Radiofrequency electromagnetic fields (UMTS, 1,950 MHz) induce genotoxic effects in vitro in human fibroblasts but not in lymphocytes” published by C. Schwarz et al. 2008

Genotoxic effects induced in vitro by the third generation mobile communication standard UMTS have recently been described by Schwarz et al. (Int Arch Occup Environ Health 81:755-767, 2008). These findings which may have considerable significance for environmental health have been commented upon by Lerchl (Int Arch Occup Environ Health in press, 2008) (this issue). These comments which are invalid in part have to be set right. Although some of his minor points are correct the objected inconsistencies are largely based on the author's incomplete and superficial consideration of published data in the field. Moreover, the statistical points being made cannot cast doubts on the validity of the experimental data reported by Schwarz et al. and may not change the principal conclusion of in vitro genotoxic action of UMTS signals.

Comments on “Radiofrequency electromagnetic fields (UMTS, 1,950 MHz) induce genotoxic effects in vitro in human fibroblasts but not in lymphocytes” by Schwarz et al. (Int Arch Occup Environ Health 2008: doi: 10.1007/s00420-008-0305-5)

A recent publication by Schwarz et al. describes the effects of exposure of human fibroblast and lymphocytes to radiofrequency-electromagnetic fields at frequencies used for communication with mobile phones. Even at very low specific absorption rates of 0.05 W/kg, thus well below internationally accepted exposure limits, significant effects were seen in fibroblasts whose DNA molecules were damaged as assessed by their comet tail factor (CTF) in the comet assay. The CTF mean values and the standard deviations of the replicates revealed very low coefficients of variation, ranging from 1.2 to 4.9% (average 2.9%), which are in contrast to much higher variations reported by others. Moreover, inter-individual differences of the CTF values strongly disagree with the previously published data from the same group of researchers. The critical analysis of the data given in the figures and the tables furthermore reveal peculiar miscalculations and statistical oddities which give rise to concern about the origin of the reported data.