Paper Mill Workers Research Articles

Occupational Dust Exposure as a Risk Factor for Developing Lung Function Impairment.

Dust exposure is high in several industries. We investigated associations of exposure in paper mills, wood pellet plants, and iron foundries with lung function impairment. Respirable silica, inhalable paper dust, or inhalable wood dust were collected as personal samples and spirometry was performed. Multiple linear regression analyzed associations with FEV 1 %pred and FVC%pred. Wood pellet workers with high exposure to inhalable dust had lower FEV 1 %pred (95% CI) (-9.4 [-16 to -2.6]) and FVC%pred (-9.8 [-15 to -4.0]) compared with lowest exposure level. Workers at paper mills and foundries had no dose-dependent association but lower FEV 1 %pred and FVC%pred than in workers at wood pellets plants. Increased exposure to inhalable wood dust is associated with decreased lung function. Foundry and paper mill workers have generally lower lung function than wood pellet workers. Spirometry should be considered in workers in industries with airborne particulate matter pollution.

The Billirud Mill Blastomycosis Outbreak: Comparison to Historical Controls.

A large outbreak of blastomycosis among paper mill workers in Escanaba, Michigan began with the first cases reported on February 28, 2023 and expanded to 120 cases. Analysis of baseline regional data and the data collected during this unprecedented outbreak provide insight on the outbreak's unique characteristics. The Michigan Disease Surveillance System provided descriptive and outcome data on blastomycosis cases in the Upper Peninsula from 2007 through 2022 and the 2023 outbreak. Baseline incidence for the region was estimated and outbreak cases were compared to historic controls using quantitative methods such as t-tests, chi-square, and Poisson and logistic regression. The Billirud blastomycosis outbreak has resulted in 28 confirmed and 92 probable cases. Blastomycosis incidence for the Upper Peninsula was 2.13 (95%CI: 1.75, 2.59) per 100,000 person-years with counties bordering Wisconsin having a higher incidence more than other counties (4.56, 95%CI: 3.48, 5.97; RR=3.46, 95%CI: 2.35, 5.11). Outbreak cases were significantly younger, more likely to be male, reported more respiratory symptoms, and had a shorter time from onset of illness to diagnosis. The Billirud paper mill blastomycosis outbreak is the largest reported to date, the first in an industrial facility, and the first to specifically involve Blastomyces gilchristii. Blastomyces species are endemic in regional forests, so other facilities handling forestry products may be at risk.

Cost and statistical efficiency of posture assessment by inclinometry and observation, exemplified by paper mill work.

Postures at work are paramount in ergonomics. They can be determined using observation and inclinometry in a variety of measurement scenarios that may differ both in costs associated with collecting and processing data, and in efficiency, i.e. the precision of the eventual outcome. The trade-off between cost and efficiency has rarely been addressed in research despite the obvious interest of obtaining precise data at low costs. Median trunk and upper arm inclination were determined for full shifts in 28 paper mill workers using both observation and inclinometry. Costs were estimated using comprehensive cost equations; and efficiency, i.e. the inverted standard deviation of the group mean, was assessed on basis of exposure variance components. Cost and efficiency were estimated in simulations of six sampling scenarios: two for inclinometry (sampling from one or three shifts) and four for observation (one or three observers rating one or three shifts). Each of the six scenarios was evaluated for 1 through 50 workers. Cost-efficiency relationships between the scenarios were intricate. As an example, inclinometry was always more cost-efficient than observation for trunk inclination, except for observation strategies involving only few workers; while for arm inclination, observation by three observers of one shift per worker outperformed inclinometry on three shifts up to a budget of €20000, after which inclinometry prevailed. At a budget of €10000, the best sampling scenario for arm inclination was 2.5 times more efficient than the worst. Arm inclination could be determined with better cost-efficiency than trunk inclination. Our study illustrates that the cost-efficiency of different posture measurement strategies can be assessed and compared using easily accessible diagrams. While the numeric examples in our study are specific to the investigated occupation, exposure variables, and sampling logistics, we believe that inclinometry will, in general, outperform observation. In any specific case, we recommend a thorough analysis, using the comparison procedure proposed in the present study, of feasible strategies for obtaining data, in order to arrive at an informed decision support.

Cardiovascular mortality in a Swedish cohort of female industrial workers exposed to noise and shift work

PurposeThe aim was to study mortality due to cardiovascular disease as well as total mortality, among female industrial workers, and the association to occupational noise and shift work.MethodsWomen from cohorts of soft tissue paper mills (N = 3013) and pulp and paper mills (N = 1483) were merged into one cohort. Job exposure matrices were developed and used for classification of shift work and noise exposure. Every year was classified as shift work excluding nights or shift work including nights. Noise was classified into seven 5 dB(A) bins from < 75 to ≥ 100 dB(A). Mortality from cardiovascular diseases and total mortality during 1956–2013 was calculated as a standardized mortality ratio (SMR) with 95% confidence interval (CI) using the female general population as a reference.ResultsFatal myocardial infarctions (N = 144) were increased in the total cohort, SMR 1.20 (95% CI 1.01–1.41) but not total mortality. The SMR for myocardial infarction for women exposed to noise ≥ 90 dB(A) for > 10 years was 1.41 (95% CI 1.02–1.89) and for those exposed to night shifts > 10 years, 1.33 (95% CI 0.91–1.89). Shift workers without nights ≤ 65 years, with noise exposure ≥ 90 dB(A), had SMR 2.41 (95% CI 1.20–4.31) from myocardial infarction. There was no increased mortality from cerebrovascular disease.ConclusionsFemale paper mill workers had an increased mortality from acute myocardial infarction, especially before retirement age, when exposed to noise ≥ 90 dB(A) and with long-time employment. Exposure to shift work and noise usually occurred concurrently.

Lung function and paper dust exposure among workers in a soft tissue paper mill

PurposeTo study respiratory effects of exposure to soft paper dust exposure, a relationship that is rarely studied.MethodsSoft tissue paper mill workers at a Swedish paper mill were investigated using a questionnaire and lung function and atopy screening. Spirometry without bronchodilation was performed with a dry wedge spirometer, and forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were obtained and expressed as percent predicted. Exposure to soft paper dust was assessed from historical stationary and personal measurements of total dust, in addition to historical information about the work, department, and production. The impact of high exposure to soft paper dust (> 5 mg/m3) vs. lower exposure ≤ 5 mg/m3, as well as cumulative exposure, was analyzed using multiple linear regression models. Multivariate models were adjusted for smoking, atopy, gender, and body mass index.ResultsOne hundred ninety-eight current workers (124 male and 74 female) were included. There were significant associations between both cumulative exposure and years of high exposure to soft paper dust and impaired lung function. Each year of high exposure to soft paper dust was associated with a 0.87% decrease in FEV1 [95% confidence interval (CI) − 1.39 to − 0.35] and decreased FVC (− 0.54%, 95% CI − 1.00 to − 0.08) compared to the lower exposed workers.ConclusionsThe present study shows that occupational exposure to soft paper dust (years exceeding 5 mg/m3 total dust) is associated with lung function impairment and increased prevalence of obstructive lung function impairment.

Trunk and upper arm postures in paper mill work

The aim of this study was to assess postures and movements of the trunk and upper arm during paper mill work, and to determine the extent to which they differ depending on method of assessment. For each of 28 paper mill workers, postures and movements were assessed during three full shifts using inclinometer registration and observation from video. Summary metrics for each shift, e.g., 10th, 50th, and 90th posture percentile, were averaged across shifts and across workers. In addition, the standard deviation between workers, and the standard deviation between shifts within worker were computed. The results showed that trunk and arm postures during paper mill work were similar to other occupations involving manual materials handling, but the velocities of arm movements were lower. While postures determined by inclinometry and observation were similar on a group level, substantial differences were found between results obtained by the two methods for individual workers, particularly for extreme postures. Thus, measurements by either method on individuals or small groups should be interpreted with caution.

Соотношение половых гормонов у мужчин – сотрудников целлюлозно-бумажного производства в г. Архангельске в зависимости от возраста и стажа работы

Соотношение половых гормонов у мужчин – сотрудников целлюлозно-бумажного производства в г. Архангельске в зависимости от возраста и стажа работы

Development of a Job Exposure Matrix for Noise in the Swedish Soft Tissue Paper Industry.

Noise exposure is a common occupational hazard, but has not been sufficiently characterized in paper mills. We developed a job-exposure matrix (JEM) for noise exposure for use in estimating exposures among Swedish soft tissue paper mill workers. We used a combination of area and personal dosimetry noise exposure measurements made at four soft tissue paper mills by industry and research staff between 1977 and 2013 to estimate noise exposures by department, location, and job title. We then utilized these estimates, in conjunction with information on process and facility changes and use of hearing protection collected via focus groups, to create a seven-category, semi-quantitative JEM for all departments, locations, and job titles spanning the years 1940-2010. The results of the 1157 area and personal dosimetry noise measurements indicated that noise levels have generally declined in Swedish paper mills over time, though these changes have been neither uniform nor monotonic within or across the four mills. Focus group results indicated that use of hearing protection has generally increased over time. The noise JEM totals 1917 cells, with each cell representing a unique combination of operation, job title, and single year. We estimated that ~50% of workers at the four mills assessed were exposed at or above the Swedish 8-h average noise exposure limit of an 85 dBA at the conclusion of the study period in 2010. Our results highlight the continuing need for hearing loss prevention and noise control efforts at these and similar mills, and the completed JEM now represents a tool for use in epidemiological studies of noise-related health outcomes.

Predicting Directly Measured Trunk and Upper Arm Postures in Paper Mill Work From Administrative Data, Workers' Ratings and Posture Observations.

A cost-efficient approach for assessing working postures could be to build statistical models for predicting results of direct measurements from cheaper data, and apply these models to samples in which only the latter data are available. The present study aimed to build and assess the performance of statistical models predicting inclinometer-assessed trunk and arm posture among paper mill workers. Separate models were built using administrative data, workers' ratings of their exposure, and observations of the work from video recordings as predictors. Trunk and upper arm postures were measured using inclinometry on 28 paper mill workers during three work shifts each. Simultaneously, the workers were video filmed, and their postures were assessed by observation of the videos afterwards. Workers' ratings of exposure, and administrative data on staff and production during the shifts were also collected. Linear mixed models were fitted for predicting inclinometer-assessed exposure variables (median trunk and upper arm angle, proportion of time with neutral trunk and upper arm posture, and frequency of periods in neutral trunk and upper arm inclination) from administrative data, workers' ratings, and observations, respectively. Performance was evaluated in terms of Akaike information criterion, proportion of variance explained (R2), and standard error (SE) of the model estimate. For models performing well, validity was assessed by bootstrap resampling. Models based on administrative data performed poorly (R2 ≤ 15%) and would not be useful for assessing posture in this population. Models using workers' ratings of exposure performed slightly better (8% ≤ R2 ≤ 27% for trunk posture; 14% ≤ R2 ≤ 36% for arm posture). The best model was obtained when using observational data for predicting frequency of periods with neutral arm inclination. It explained 56% of the variance in the postural exposure, and its SE was 5.6. Bootstrap validation of this model showed similar expected performance in other samples (5th-95th percentile: R2 = 45-63%; SE = 5.1-6.2). Observational data had a better ability to predict inclinometer-assessed upper arm exposures than workers' ratings or administrative data. However, observational measurements are typically more expensive to obtain. The results encourage analyses of the cost-efficiency of modeling based on administrative data, workers' ratings, and observation, compared to the performance and cost of measuring exposure directly.

Cancer incidence among Swedish pulp and paper mill workers: a cohort study of sulphate and sulphite mills

Associations between various malignancies and work in the pulp and paper industry have been reported but mostly in analyses of mortality rather than incidence. We aimed to study cancer incidence by main mill pulping process, department and gender in a Swedish cohort of pulp and paper mill workers. The cohort (18,113 males and 2,292 females, enrolled from 1939 to 1999 with >1year of employment) was followed up for cancer incidence from 1958 to 2001. Information on the workers' department and employment was obtained from the mills' personnel files, and standardized incidence ratios (SIRs) were calculated using the Swedish population as reference. Overall cancer incidence, in total 2,488 cases, was not increased by work in any department. However, risks of pleural mesothelioma were increased among males employed in sulphate pulping (SIR, 8.38; 95% CI, 3.37-17) and maintenance (SIR, 6.35; 95% CI, 3.47-11), with no corresponding increase of lung cancer. Testicular cancer risks were increased among males employed in sulphate pulping (SIR, 4.14; 95% CI, 1.99-7.61) and sulphite pulping (SIR, 2.59; 95% CI, 0.95-5.64). Female paper production workers showed increased risk of skin tumours other than malignant melanoma (SIR, 2.92; 95% CI, 1.18-6.02). Incidence of pleural mesothelioma was increased in the cohort, showing that asbestos exposure still has severe health consequences, and highlighting the exigency of strict asbestos regulations and elimination. Testicular cancer was increased among pulping department workers. Shift work and endocrine disruptors could be of interest in this context.

Acting age in the context of health: Middle-aged working-class men talking about bodies and aging

This article focuses on the intersections of age, gender and class in interpretations of the aging and situational identity work of middle-aged working-class men. Empirically the article is based on interview data (4 focus groups and 9 personal interviews with 40+ men) in which Finnish paper-mill workers are interviewed about health. Based on the theoretical implications of intersectionality, the article provides an empirical analysis of how age-based cultural hierarchies and distinctions are used flexibly in the process of self-identification and how categorizations of age and conceptualizations of aging are tightly interwoven with gender and class. The analyses show that the middle-aged interviewees base their interpretations of the aging self on negotiating their position between the age categories of the ‘young’ and ‘old’. Both these groups are labeled with rather negative characteristics regarding the irresponsibility for health among the young and impaired functional ability of the old, which conflicts with the working-class expectations regarding masculine identity. The findings suggest that studying how people ‘do age’ requires consideration of the respects in which aging is an age-specific and gendered process shaped by class-based values, ideals and practices.

Through the Mill: Personal Recollections by Veteran Men and Women Penicuik Paper Mill Workers. Edited by Ian MacDougall. Pp. 669. ISBN: 9780955998102. Falkirk: Scottish Working People's History Trust, 2009. £11.99.

"Through the Mill: Personal Recollections by Veteran Men and Women Penicuik Paper Mill Workers. Edited by Ian MacDougall. Pp. 669. ISBN: 9780955998102. Falkirk: Scottish Working People's History Trust, 2009. £11.99.." , 89(2), pp. 279–280

Cancer mortality in a Swedish cohort of pulp and paper mill workers

To study cancer mortality among Swedish pulp and paper mill workers by main mill pulping process and department, and to present the Swedish part of an international exposure measurements database. A cohort of 18,163 male and 2,290 female workers at four sulfate and four sulfite mills, enrolled from 1939 to 1999, was followed up for mortality during 1952-2001. Standardized mortality ratios (SMRs) relative to the general Swedish population were calculated. There were 1,340 malignant cases out of 5,898 deaths. Total cancer mortality was not increased in either sulfate or sulfite mill workers, or by gender. Lung cancer mortality was increased among female workers (SMR 1.70, 95% CI 1.04-2.63), especially in paper production, but not among male workers (SMR 0.91, 95% CI 0.79-1.04). Exposure to wood dust and sulfur dioxide frequently exceeded occupational exposure limits. Female paper production workers had an increased mortality from lung cancer.

Genetic Factors Are Associated With Modic Changes in Endplates of Lumbar Vertebral Bodies

A cross-sectional genotype-phenotype evaluation. To evaluate the genetic background to Modic changes in an occupational cohort. Modic changes are vertebral endplate changes visible in magnetic resonance imaging. Twin studies suggest that intervertebral disc degeneration may be primarily explained by genetic factors, but no data exist on genetic factors of Modic changes. Thirteen variations in 8 genes (COL9A2, COL9A3, COL11A2, IL1A, IL1B, IL6, MMP3, and VDR) were genotyped in an occupational cohort of 159 male train engineers and 69 male paper mill workers. All the subjects were scanned by magnetic resonance imaging and evaluated for Modic changes. Out of the 228 subjects, 128 (56%) were found to have Modic changes at one or more disc levels, exclusively of type I in 15%, of type II in 32%, and of both type I and type II in 10%. None of the single nucleotide polymorphisms was significantly associated with Modic changes when analyzed independently, but when gene-gene interactions were evaluated, interleukin-1A (IL1A) and matrix metalloproteinase-3 (MMP3) polymorphisms together were associated with type II Modic changes (OR = 3.2, 95% CI = 1.2-8.5; P = 0.038), as was the IL1 gene cluster together with the MMP3 polymorphism (OR = 8.14, 95% CI = 1.72-38.44; P = 0.008). This is the first study evaluating the role of genetic factors in relation to Modic changes. Genetic variations in the IL1 cluster and the MMP3 gene together were found to be significantly associated with type II Modic changes.

Cohort mortality study of Swedish pulp and paper mill workers—nonmalignant diseases

The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems. The cohort of 18 163 men and 2 291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented. There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98-1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90-0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12-1.32) and SMR 1.11 (95% CI 1.02-1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07-1.54), paper production (SMR 1.26, 95% CI 1.06-1.49), and maintenance (SMR 1.16, 95% CI 1.02-1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased. Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).

Airway Inflammation in Paper Mill Workers

Paper mill workers are exposed to culturable microorganisms (MOs). We hypothesized that inflammatory airway response could be detected in sputum of nonsymptomatic workers. From four paper mills, we included 29 healthy nonsmoking men. Workers exposed to high levels of MOs (HMOE, n = 17) were compared with workers exposed to low levels of MO (LMOE, n = 12). A reference group of 22 healthy, nonsmoking, nonexposed (NE) men were also included. We performed differential cell counts of induced sputum, studied gene expressions of isolated sputum macrophages and analyzed inflammatory parameters, including matrix metalloproteinases. Sputum from HMOE workers had a significantly higher percentage of neutrophils than that from LMOE workers (P < 0.05) and NE controls (P < 0.001). There was also an increased gene expression of different pro-inflammatory cytokines, interleukin-6, tumor necrosis factor-alpha, and macrophage inflammatory protein-1beta in isolated airway macrophages and increased levels of total matrix metalloprotease-9 activity in induced sputum from the HMOE group. Our findings indicate that paper industry workers exposed to MOs develop subclinical airway inflammation.

Increased protease activity in sputum from paper mill workers exposed to viable microorganisms.

Increased protease activity in sputum from paper mill workers exposed to viable microorganisms.

Occupational and Genetic Risk Factors Associated With Intervertebral Disc Disease

Cross-sectional epidemiologic study. To evaluate the interaction between known genetic risk factors and whole-body vibration for symptomatic intervertebral disc disease (IDD) in an occupational sample. Risk factors of IDD include, among others, whole-body vibration and heredity. In this study, the importance of a set of known genetic risk factors and whole-body vibration was evaluated in an occupational sample of train engineers and sedentary controls. Eleven variations in 8 genes (COL9A2, COL9A3, COL11A2, IL1A, IL1B, IL6, MMP-3, and VDR) were genotyped in 150 male train engineers with an average of 21-year exposure to whole-body vibration and 61 male paper mill workers with no exposure to vibration. Subjects were classified into IDD-phenotype and asymptomatic groups, based on the latent class analysis. The number of individuals belonging to the IDD-phenotype was significantly higher among train engineers (42% of train engineers vs. 17.5% of sedentary workers; P = 0.005). IL1A -889T allele represented a significant risk factor for the IDD-phenotype both in the single marker allelic association test (P = 0.043) and in the logistic regression analysis (P = 0.01). None of the other allele markers was significantly associated with symptoms when analyzed independently. However, for all the SNP markers considered, whole-body vibration represents a nominally significant risk factor. The results suggest that whole-body vibration is a risk factor for symptomatic IDD. Moreover, whole-body vibration had an additive effect with genetic risk factors increasing the likelihood of belonging to the IDD-phenotype group. Of the independent genetic markers, IL1A -889T allele had strongest association with IDD-phenotype.

Cardiovascular mortality among Swedish pulp and paper mill workers

Malignant diseases but also cardiovascular and respiratory disorders and diabetes mellitus have been associated with work in pulp and paper production. The present cohort focuses on cardiovascular mortality in relation to various exposures in this industry. The cohort, followed-up for mortality, includes 7,107 workers, 6,350 men and 757 women, from three major old mills in the middle of Sweden. Instead of a healthy-worker effect, a slightly increased risk for death in diseases of the circulatory system was found for male workers. Notably, work with sulfate digestion, steam and power generation and maintenance was associated with significantly increased risks. Cerebrovascular diseases showed non-significantly increased risks for maintenance and paper and paperboard production and manufacture. The differences in risk among various parts of the production are striking although it is hard to pinpoint any specific exposures. Dust and small particles along with sulfur compounds might be suspected.

Individual susceptibility to noise-induced hearing loss

The new EU directive (10/2003/EU) sets new limits for allowable noise levels and sets new requirements to accommodate the individual susceptibility factors, but does not define these factors. We aim to evaluate the effects of environmental and biological factors on the damage to hearing by noise. The history of work exposure, use of hearing protective devices (HPD), audiometric data and information on environmental and biological factors were collected from well over 1000 workers. The group consisted of 406 paper mill workers, 400 miners, 250 metal factory workers, 176 shipyard workers and 124 forestry workers. For comparison we evaluated 685 noise-exposed subjects visiting a hearing aid clinic for fitting of a hearing aid. They were exposed in their work to noise levels of 80–115dB(A). The environmental and biological factors encompassed smoking habits, the use of analgesics, serum cholesterol, systolic or diastolic blood pressure as well as noise exposure. There were a number of confounders which were s...