End stage renal disease among ceramic workers exposed to silica

OBJECTIVES

To evaluate whether ceramic workers exposed to silica experience an excess of end stage renal disease.

METHODS

On the basis of a health surveillance programme, a cohort of 2980 male ceramic workers has been enrolled during the period 1974-91 in Civitacastellana, Lazio, Italy. For each worker, employment history, smoking data, and x ray film readings were available. The vital status was ascertained for all cohort members. All 2820 people still alive and resident in the Lazio region as in June 1994 were searched for a match in the regional end stage renal diseases registry, which records (since June, 1994) all patients undergoing dialysis treatment in public and private facilities of the region. Expected numbers of prevalent cases from the cohort were computed by applying the rate of patients on dialysis treatment by the age distribution of the cohort.

RESULTS

A total of six cases was detected when 1.87 were expected (observed/expected (O/E) = 3.21; 95% confidence interval (95% CI) 1.17 to 6.98). The excess risk was present among non-smokers (O = 2; O/E = 4.34) and smokers (O = 4; O/E = 2.83), as well as among workers without silicosis (O = 4; O/E = 2.78) and workers with silicosis (O = 2; O/E = 4.54). The risk was higher among subjects with < 20 years since first employment (O = 4; O/E = 4.65) than among those employed > 20 years.

CONCLUSION

These results provide further evidence that exposure to silica dust among ceramic workers is associated with nephrotoxic effects.

Case-control study of lung cancer among sugar cane farmers in India

OBJECTIVES

To investigate the risk of lung cancer among sugar cane farmers and sugar mill workers.

METHODS

A case-control study was conducted based in six hospitals in the predominantly sugar cane farming districts of the province of Maharashtra in India. Newly diagnosed, histologically confirmed cases were identified from these hospitals between May 1996 and April 1998. Other cancers were chosen as controls and matched to cases by age, sex, district of residence, and timing of diagnosis.

RESULTS

Adjusting for confounders, an increased risk of lung cancer was found for workers ever employed on a sugar cane farm (odds ratio (OR) 1.92, 95% confidence interval (95% CI) 1.08 to 3.40). Increased risks were found for work involving preparation of the farm (OR 1.81, 95% CI 0.99 to 3.27) and burning of the farm after harvesting (OR 1.82, 95% CI 0.99 to 3.34). Non-significant increases in risks were found for harvesting the crop (OR 1.41, 95% CI 0.70 to 2.90) and processing the cane in the mills (OR 1.70, 95% CI 0.20 to 12.60).

CONCLUSIONS

Exposure to fibres of biogenic amorphous silica (BAS) formed from silica absorbed from the soil and deposited in the leaves of the sugar cane crop or crystalline silica formed as a result of conversion of BAS to cristobalite at high temperatures may account for the increased risks of lung cancer among sugar cane farmers.

A study of forced vital capacity and its predictors among the sand stone quarry workers

The study assesses the relationship of selected demographic, anthropometric, radiological, work-history and smoking-history related variables with Forced Vital Capacity (FVC) in a sample of 168 sand stone quarry workers in a desert environment. Except the variables related to smoking behaviour, all are found significantly associated with FVC. The predictors of FVC screened through the multiple regression analysis were age, weight, height, profusion of opacities in chest X-ray and duration of work. Mean FVC was found significantly lower as compared to the healthy adult population. On an average FVC% was 90% of predicted (Percentage deviation of 10%). A clear increasing trend in FVC% along age/duration of work was observed among the young workers, which may be due to building of muscles in this job. Percentage deviation of 20% or more in FVC was significantly associated with presence of radiological opacities suggestive of silicosis (odds Ratio = 3.3). The diagnostic utility of the same is also assessed.

Cancer mortality in women with probable exposure to silica: a death certificate study in 24 states of the U.S

BACKGROUND

Silica exposure is known to cause an increased risk of pneumoconiosis and some types of cancers. Exposure to silica is becoming an increasingly common occupational hazard for women. Studies contradict each other on whether or not women suffer more occupational pneumoconiosis than men, but no studies have evaluated cancer risks among women exposed to silica.

METHODS

Death certificate data on occupation and industry from 24 states in the U.S. between 1984 and 1993 were used to calculate proportional mortality ratios (PMRs) for workers exposed to silica.

RESULTS

Over 20,000 deaths (4% of all deaths in persons with possible work-related silica-exposure) occurred among women. The PMR for pneumoconiosis among women working in occupations or industries with possible silica exposure was 13.6 (95% CI: 7.2-23.2), for men 3.8 (CI: 3.7-4.0). Both men and women had higher than expected PMRs for respiratory diseases, lung and esophageal cancers, and external causes of death. In the group with probable silica exposure (both occupation and industry associated with silica), women had elevated PMRs for thyroid cancer (PMR = 5.5), multiple myeloma (PMR = 1.3), digestive organ cancers (PMR = 1.2), whereas men had no increased PMRs for these cancers. Both genders had significantly decreased PMRs for breast cancer, cerebrovascular diseases, nervous system diseases, and brain and other central nervous system cancers.

CONCLUSIONS

An in depth look at the types of silica exposures (specific work duties) and adjustment for confounders is warranted to determine the importance of these gender-specific excess mortalities associated with possible silica exposure.

Accelerated silicosis with mixed-dust pneumoconiosis in a hard-metal grinder

We describe a fatal case of accelerated silicosis with a component of mixed-dust pneumoconiosis in a young hard-metal grinder that we believe is the first case of its kind in Israel and one of the rare cases reported worldwide. The patient's diagnosis was based on typical features: restrictive lung function, abnormal chest roentgenogram suggesting lung fibrosis, a history of exposure to silica and hard metals, bronchoalveolar lavage (BAL) fluid findings, and mineralogical studies. BAL cells showed an abundance of giant multinucleated macrophages. The CD4/CD8 ratio of T lymphocytes was 1.1, with a high percentage of CD8 and CD8/38 positive cells (37% suppressor/cytotoxic and 12% cytotoxic T lymphocytes, respectively). mRNA transcripts isolated from BAL cells were positive for interleukin-1 (IL-1) and transforming growth factor (TGF) Il-5, IL-2, and IL-10 but not for IL-6, IL-4, and interferon. Polarizing light microscopic studies of BAL and induced sputum cells showed polarizing particles, which are typical for silica. Mineralogical studies of electron microscopy performed on BAL fluid and on dust collected at the patient's workstation revealed silica particles as well as aluminum-titanium and other particles. The latter might have contributed to the patient's lung disease.

Mineralogy of lung tissue in dental laboratory technicians' pneumoconiosis

This article reports on a case of pneumoconiosis in a dental laboratory technician with a history of respiratory exposure to dental materials. Special attention is paid to the mineralogical analysis of the lung biopsy. The abundance of chromium, cobalt, and silica particles suggests that the dental technician's pneumoconiosis is the result of the combined effects of hard metal dusts and silica particles generated during finishing dental frameworks. Adequate technical protection such as a local ventilation system should be considered in dental laboratories to prevent respiratory exposure of dental technicians to airborne contaminants.

Systemic sclerosis (scleroderma) in two iron ore mines

Six males with systemic sclerosis were observed in the work forces of two iron ore mines. The usual spectrum of clinical features encountered in systemic sclerosis patients were present. Histologic examination of pulmonary tissue was performed on three of the cases and showed features of both silicosis and scleroderma but to different degrees and stages of development. Exposure to high levels of silica-containing dusts had occurred in all six cases.

Silica dust and lung cancer in the German stone, quarrying, and ceramics industries: results of a case-control study

BACKGROUND

A work force based case-control study of lung cancer was performed in non-silicotic subjects exposed to crystalline silica to investigate the association between silica dust and lung cancer excluding the influence of silicosis.

METHODS

Two hundred and forty seven patients with lung cancer and 795 control subjects were enrolled, all of whom had been employed in the German stone, quarrying, or ceramics industries. Smoking was used as a matching criterion. Exposure to silica was quantified by measurements, if available, or otherwise by industrial hygienists. Several indices (peak, average and cumulative exposure) were used to analyse the relationship between the level of exposure and risk of lung cancer as odds ratios (OR).

RESULTS

The risk of lung cancer is associated with the year of and age at first exposure to silica, duration of exposure, and latency. All odds ratios were adjusted for these factors. Considering the peak exposure, the OR for workers exposed to high levels (>/=0.15 mg/m3 respirable silica dust which is the current occupational threshold value for Germany) compared with those exposed to low levels (<0.15 mg/m3) was 0.85 (95% CI 0.58 to 1. 25). For the time weighted average exposure the OR was 0.91 (95% CI 0.57 to 1.46). The OR for the cumulative exposure was 1.02 (95% CI 0. 67 to 1.55). No increase in risk was evident with increasing exposure.

CONCLUSIONS

This study shows no association between exposure to crystalline silica and lung cancer. The exclusion of subjects with silicosis may have led to dilution with respect to the level of exposure and therefore reduced the power to detect a small risk. Alternatively, the risk of getting lung cancer may be restricted to subjects with silicosis and is not directly linked to silica dust.

Cerebral astrocyte response to micromachined silicon implants

The treatment of neurologic disorders and the restoration of lost function due to trauma by neuroprosthetic devices has been pursued for over 20 years. The methodology for fabricating miniature devices with sophisticated electronic functions to interface with nervous system tissue is available, having been well established by the integrated circuit industry. Unfortunately, the effectiveness of these devices is severely limited by the tissue reaction to the insertion and continuous presence of the implant, a foreign object. This study was designed to document the response of reactive astrocytes in the hope that this information will be useful in specifying new fabrication technologies and devices capable of prolonged functioning in the brain. Model probes fabricated from single crystal silicon wafers were implanted into the cerebral cortices of rats. The probes had a 1 x 1-mm tab, for handling, and a 2-mm-long shaft with a trapezoidal cross-section (200-microm base, 60microm width at the top, and 130 microm height). The tissue response was studied by light and scanning electron microscopy at postinsertion times ranging from 2 to 12 weeks. A continuous sheath of cells was found to surround the insertion site in all tissue studied and was well developed but loosely organized at 2 weeks. By 6 and 12 weeks, the sheath was highly compacted and continuous, isolating the probe from the brain. At 2 and 4 weeks, the sheath was disrupted when the probe was removed from the fixed tissue, indicating that cells attached more strongly to the surface of the probe than to the nearby tissue. The later times showed much less disruption. Scanning electron microscopy of the probes showed adherent cells or cell fragments at all time points. Thus, as the sheath became compact, the cells on the probe and the cells in the sheath had decreased adhesion to each other. Immunocytochemistry demonstrated that the sheath was labeled with antibodies to glial fibrillary acidic protein (GFAP), an indicator for reactive gliosis. The tissue surrounding the insertion site showed an increased number of GFAP-positive cells which tended to return to control levels as a function of time after probe insertion. It was concluded that reactive gliosis is an important part of the process forming the cellular sheath. Further, the continuous presence of the probe appears to result in a sustained response that produces and maintains a compact sheath, at least partially composed of reactive glia, which isolates the probe from the brain.

Mortality from nephritis and nephrosis in the fibreglass manufacturing industry

OBJECTIVES

To investigate the question of whether there is an association between exposure to silica or respirable glass fibre and mortality from nephritis or nephrosis among workers in fibrous glass wool manufacturing facilities.

METHODS

A case-control study with cases and controls derived from the Owens Corning mortality surveillance system. Two case-control analyses were carried out, one where the cases are defined with nephritis or nephrosis as the underlying cause of death and one where cases are defined as those where nephritis or nephrosis is either the underlying or a contributing cause of death.

RESULTS

There is no consistent relation between respirable fibres or respirable silica and nephritis or nephrosis when the analysis is based either on underlying cause only or on underlying plus contributing cause of death. None of the sociodemographic variables considered suggests an increased risk when considering both underlying and contributing cause of death.

CONCLUSIONS

These data would seem to support the contention that the most accurate picture of renal disease will be gained from the use of all information on the death certificate and not only the underlying cause. For these data, all odds ratios (ORs) for respirable fibres and silica based on both underlying and contributing cause of death are < 1 with the exception of the highest exposure to silica which is slightly > 1 (OR = 1.04). Although these results do not prove that there is no association between nephritis and nephrosis and exposure to fibreglass or silica in the fibreglass manufacturing environment, they do not support the assertion that such an association exists.

Nested case-control study of esophageal cancer in relation to occupational exposure to silica and other dusts

BACKGROUND

Standardized proportionate mortality ratio (SPMR) was found to be 2.2 (95% CI = 1.3-3.5) for esophageal cancer (EC) among workers exposed to refractory brick dust in a large iron-steel complex in China.

METHODS

A nested case-control design within a cohort of industrial workers. One hundred and twenty-five EC cases and 250 controls were identified from the death registry file. Interviews were conducted of the next of kin for past exposure information on job, domestic, and lifestyle factors. History of occupational exposure to various dusts was reconstructed from personnel files and by interviewing colleagues utilizing a job-exposure matrix.

RESULTS

After adjusting for confounders, occupational exposure to silica dust was the most important risk factor among all variables investigated, with a 2.8-fold risk and a clear dose-response by length of exposure. Alcohol drinking (OR = 1.8) and coal cooking (OR = 2.0) were risk factors and high consumption of fruit diet (OR = 0.5) and meat diet (OR = 0.6) were protective factors.

CONCLUSIONS

The relationship between occupational exposure to silica dust and the risk of EC found in an earlier SPMR study was confirmed. Ingestion of silica particles after lung clearance may increase the risk of EC among workers exposed to silica.

Sol-gel-processed sintered silica xerogel as a carrier in controlled drug delivery

Sol-gel-processed sintered silica xerogel was studied as a controllable, dissolvable, implantable material. The erosion of the matrix and the release of the preadsorbed drug toremifene citrate was investigated both in vitro and in vivo using mice. In an in vitro dissolution study, 50 to 60% of the drug was released after 24 h, according to the square root of time kinetics, and the weight loss of the silica was 24 wt %. Silica xerogel with tritium-labeled toremifene was implanted subcutaneously in mice for 56 days. To determine the amount of tritiated drug remaining in the silica disks at the implantation site, the disks were excised periodically and the radioactivity measured. About 40% of the radioactivity was released during the first 4 days and all of it within 28 days. Radioactivity also was measured in the liver, lungs, kidneys, uterus, and blood. The radioactivity reached a maximum level after 4 days in the liver, kidneys, and lungs and slowly decreased until all of the drug had been released from the matrix after 28 days. After release of the drug (28 days) the amount of remaining silica xerogel implant was 45 wt %, and at the end of the study (56 days) it was 24 wt %. In the histopathological study, sintered silica xerogel did not show any tissue toxicity at the site of the implantation, in the liver, or in the kidneys. It was concluded that sintered silica xerogel is a biocompatible and controllably resorbable material and therefore is a promising matrix for use in the sustained delivery of drugs.

Exposures of geotechnical laboratory workers to respirable crystalline silica

Geotechnical laboratory testing involves the determination of the physical properties of soil, rock, and other building materials for engineering purposes. Individuals working in these laboratories are exposed to airborne soil, rock, and other dusts during the preparation and testing of these materials. Crystalline silica as quartz is a common constituent of these materials and represents a potential hazard to geotechnical laboratory workers when airborne as a respirable dust. The authors conducted an examination of the potential for geotechnical laboratory workers to be exposed to respirable dust and respirable quartz during the performance of three routine laboratory tasks. A task-based exposure assessment strategy was used. Although respirable dust was generated during the performance of each of these tasks, its impact on exposures was generally overridden by the presence of respirable quartz in the dust. Quartz content in the respirable dust ranged from below the detection limit to greater than 50 percent. Mean exposure to respirable quartz, based on the duration of the task and assuming no other exposures for the rest of the 8-hour day, exceeded the National Institute for Occupational Safety and Health (NIOSH) "action level" (the exposure level at which certain actions must be taken) of 0.025 mg/m3. If exposure was assumed to continue for the rest of the 8-hour day at the measured concentration, mean exposure to respirable quartz exceeded the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) time-weighted average (TWA), the Occupational Safety and Health Administration (OSHA) PEL, and the NIOSH REL. Seven percent of 57 individual task exposure measurements exceeded the TLV-TWA and the PEL, 18 percent exceeded the REL, and another 12 percent exceeded excursion limits as defined by ACGIH. The results of this study support the conclusion that geotechnical laboratory workers are potentially exposed to respirable crystalline silica as quartz at levels that may be harmful. Because the quartz content of the materials being tested in these laboratories is highly variable and is almost never determined prior to testing, all materials being tested in the geotechnical laboratory should be assumed to contain quartz. Appropriate controls should be used to protect workers from inhaling dusts generated from these materials.

[The dynamics of exposure to silicotic dusts and silicosis in a foundry]

This work presents the concentrations dynamics of dust in a cast iron foundry, in parallel with the frequency and gravity dynamics of the getting sick of silicosis. The knowing of the real risk of exposure to silicotic dust was possible through the data processing concerning the dusting degree (the average of working place), the content of silicon free-crystalline dioxide (SiO2 l.c.) for the calculation of the maximum admitted concentration (C.M.A.) and the dispersion degree of dust in a cast iron and steel foundry for the studied period (1982-1996). New cases of silicosis appeared in this period were studied and they were colligated with the age at declaration, the average length of service and the profession. The values of the dusting degree outrun the C.M.A. up to 168 times, especially at the preparation of mixture and grinding with a prevalence of particles under 3 micron (40-70%) and the Si02 l.c. content varies between 35.2% and 64.5%. From those 98 new cases of silicosis appeared in 15 years, 82.65% were traced out in the incipient phases of the disease. The average age in service and the average age increase (43.1 respective 19.8 years). The coefficients of correlation and regress (+0.286 respective +0.383) show a good correlation between the silicosis number and the age in service. The advanced stages of silicosis and age in service under 10 years were found at the foundry-workers and formators, occupations which imply a high silicotic risk. The foretelling calculations for the next 20 years show an increase of the silicosis incidence for foundry-workers.

Immunocytochemical characterization of lung macrophage surface phenotypes and expression of cytokines in acute experimental silicosis in mice

The expression of the surface phenotypical profile and the cytokines TNF-alpha and IL-1beta from murine lung macrophages was studied in parenchymal lung tissue and bronchoalveolar fluid of mice, over a 2-week period, following a single intratracheal instillation of silica. The acute inflammatory reaction, confirmed by a significant augmentation of four times the control values of the number of macrophages recovered by lavage from experimental animals, was followed by organized granulomas in the interstitium. The immunohistochemical analysis of lung tissue sections after silica instillation demonstrated the increased alveolar and interstitial tissue expression of all surface antigens and cytokines studied, mainly Mac-1, F4/80 antigens, TNF-alpha and IL-1beta, which were occasionally observed in normal uninjected and saline-treated mice. These findings show that, after silica instillation, the expression of surface phenotypical markers of lung macrophages increased, and this change was concomitantly associated with an increased expression of the cytokines TNF-alpha and IL-1beta. These changes support the conclusion that an influx of the newly recruited and activated macrophage population, with a different phenotype, is induced by treatment during inflammation. The populational changes involve difference in functional activity and enhance TNF-alpha and IL-1beta expression. These cytokines, produced in the silicosis-induced inflammatory process, are associated with the development of fibrosis and may contribute to disease severity.

Failure of psyllium mucilloid to hasten evaluation of sand from the equine large intestine

OBJECTIVE

To examine the efficacy of psyllium mucilloid in evacuating sand from the equine large intestine.

ANIMALS

12 clinically healthy pony geldings.

PROCEDURE

Twelve ponies were assigned to 2 groups of six each. One group was treated with psyllium and the second was a control group. All ponies had an exploratory celiotomy and 10 g/kg body weight of sand was placed into the cecum. Ponies were fed a grain mixture alone at 1 g/kg (controls), a grain mixture plus psyllium pellets, each at 1 g/kg body weight (3 ponies), or fed a grain mixture and given psyllium powder by nasogastric tube at 1 g/kg body weight divided into two daily doses in 3 L of water (3 ponies). Radiographs were taken on days 1 (3 per group), 5 (all ponies), and 11 (3 per group) to monitor sand transit through the large intestine. Ponies were euthanatized 11 days after surgery. Sand was collected from the contents of the cecum, ventral colon, dorsal colon, and small colon. Dry weight of the recovered sand was compared between the two treatment groups as a percentage of the dry weight of sand placed in the cecum.

RESULTS

No significant differences were detected in the mean percentage of sand recovered between the two treatment groups (P < .05), with 39.2% recovered in ponies treated with psyllium and 27.4% recovered in control ponies.

CLINICAL RELEVANCE

Psyllium mucilloid had no apparent effect on sand evacuation from the equine large intestine. When intake of sand is prevented, the equine large intestine can reduce and possibly eliminate its sand burden.

Silica urolithiasis without magnesium trisilicate intake

Two cases of silica stones, without previous oral intake of magnesium trisilicate, are reported. A 64-year-old Japanese woman had bilateral renal stones. Infrared spectrophotoscopy revealed that one of the fragments consisted of silicate and the others consisted of calcium oxalate. A 75-year-old woman had right renal stones. The composition of 1 stone was a mixture of silicate and unspecified matrices. Silicate urolithiasis may not necessarily be related to oral intake of silicate-containing antacids.

Silica induced scleroderma--clinical and experimental aspects

Clinical and experimental data concerning silica induced systemic sclerosis (SSc) are discussed in comparison to current knowledge of the pathophysiology of idiopathic SSc. About 280 patients with SSc after longterm silica dust exposure, some with associated silicosis, have been reported; 111 of them were analyzed as the largest cohort in our department. Based on clinical and laboratory data, silica induced and idiopathic SSc show similar pathophysiology and similar markers of the disease including vascular involvement, immunological abnormalities, and dysregulation of extracellular matrix metabolism. Experimental studies show that silica dust is able to activate microvascular endothelial cells, mononuclear cells from peripheral blood, and dermal fibroblasts in vitro in a fashion in common with pathophysiological events known from idiopathic SSc.

[The mortality due to pulmonary silicosis in the Tuscany region in the last decade demonstrates that the health effects of work exposure to silica are still marked]

An analysis of death certificates from 1987 to 1996 among residents of the Tuscany Region identified 1518 deaths from pneumoconiosis, the large majority from silicosis, a disease explained by occupational exposure to silica dust. A dozen of deaths are from asbestosis, occurred at younger ages and are concentrated in a restricted area where a cement-asbestos factory was active. Deaths from pneumoconiosis occurred mainly among males, and the rates of the disease are decreasing only in the latest years. About 10% of deaths from silicosis are among subjects dying before 65 years of age. Mortality rates are very high in several areas of the Region, approximating those from lung cancer and ischaemic heart disease. For the above reasons the disease is still of concern from the point of view of public health and actions are suggested to obtain a description of prevalence and incidence of the disease.

Postoperative dental bleaching: effect of microleakage on Class V tooth colored restorative materials

The effect of 3 percent, 11 percent, and 16 percent carbamide peroxide bleaching solutions and 35 percent hydrogen peroxide bleaching gel on microleakage of Class V composite resins, resin modified glass ionomer cements, and compomer restorative materials together with corresponding (if indicated) fourth/fifth generation bonding agents was evaluated using previously extracted human teeth. Five groups of Class V cavity preparations were placed in enamel of the facial surfaces of 200 teeth. Groups A through D included 40 restorations each (4 different restorative materials and their accompanying bonding agent multiplied by 10 teeth) treated with 3 percent, 11 percent, and 16 percent carbamide peroxide bleach and 35 percent hydrogen peroxide bleach. Group E included 40 restorations without treatment of bleach and stood as the control. The restorative materials included were: Fuji II LC resin modified glass ionomer cement, Helioprogress composite resin/-Heliobond adhesive system, Aelitefil composite resin/Allbond 2 adhesive and Dyract compomer material/Prime & Bond adhesive system. Bleaching agents included were Rembrandt 3 percent peroxide gel, Perfecta 16 percent carbamide peroxide gel, White & Brite 11 percent carbamide peroxide solution and Superoxyl 35 percent hydrogen peroxide gel. All teeth were thermally stressed for 100 cycles and microleakage were assessed by dye penetration. The results were tabulated using Analysis of Variance (ANOVA) testing procedures. The Aelitefil composite resin material behaved the least favorably (relative to microleakage) compared to the other materials when exposed to various concentrations of dental bleaching agents.

Association between exposure to crystalline silica and risk of sarcoidosis

OBJECTIVES

The possibility of an association between exposure to silica and autoimmune diseases has recently come under discussion. In the following case-referent study, a cohort exposed to diatomaceous earth and cristobalite provided an opportunity to evaluate such an exposure with reference to sarcoidosis.

METHODS

The inhabitants of a district served by a single healthcare centre and a hospital formed the study base. A diatomaceous earth plant is located in this community and the medical institutions are responsible for primary and secondary health care of the population. Cases of sarcoidosis were identified from the hospital records according to certain clinical, radiological, and histological criteria. Referents were selected randomly from the population of the district. Information on exposure to crystalline silica, cristobalite, was obtained by record linkage of the cases and referents with a file which included all present and past workers at the diatomaceous earth plant and those who had worked at loading vessels with the product from the plant.

RESULTS

Eight cases of sarcoidosis were found, six of which were in the exposed group. Of the 70 referents, 13 were exposed. The odds ratio (95% confidence interval) was 13.2 (2.0 to 140.9).

CONCLUSION

The odds ratios were high and there were some indications of a dose-response relation which will hopefully encourage further studies. To our knowledge this is the first study to indicate a relation between sarcoidosis and exposure to the crystalline silica, cristobalite.

Impact of exposure to insulation wool on lung function and cough in Swedish construction workers

OBJECTIVES

To investigate whether application of insulation wool adversely affects lung volumes and increases the occurrence of symptoms of airway irritation.

METHODS

Data from nationwide health check ups in 1981-93 of male construction workers born in 1955 or later were used to investigate cross sectional (n = 96,004) and longitudinal (n = 26,298) associations between lung volumes, vital capacity (VC), and forced expiratory volume in one second (FEV1) and exposure to insulation wool by combining a job exposure matrix (JEM) and self reported exposure. Data on 12 month prevalence of persistent cough not associated with the common cold was available for the period 1989-92. Potential confounding from smoking, exposure to asbestos, silica, and isocyanates, was considered in the analyses.

RESULTS

For those in the highest exposure category (self reported duration of exposure of > or = 11 years, and high exposure according to the JEM) VC was on average 2.5 cl lower (95% CI -6.5 to 1.5) than in those with no exposure. The corresponding figures for FEV1 was -2.4 cl (95% CI -6.1 to 1.3). In the longitudinal analyses, the yearly change in VC between the first and last spirometry for those in the highest exposure category was 0.50 cl (95% CI -0.97 to 1.98) less than in the unexposed category. The corresponding figure for FEV1 was 0.89 cl (95% CI - 0.70 to 2.06). High exposure to insulation wool, asbestos, or silica, during the 12 months preceding the check up was associated with increased odds ratios (ORs) for persistent cough of the same magnitude as current smoking.

CONCLUSIONS

The results indicate no effects on VC or FEV1 from exposure to insulation wool. Recent exposure to insulation wool, asbestos, and silica was associated with an increased prevalence of persistent cough.

Radiographic evidence of silicosis risk in the diatomaceous earth industry

There is limited and conflicting evidence regarding the exposure-response relationship between exposure to crystalline silica and silicosis; the level of risk to current workers remains uncertain. We conducted an epidemiologic investigation of 1,809 workers in the diatomaceous earth industry, where exposures to crystalline silica are primarily to the cristobalite form. On the basis of the median of three independent readings, 81 (4.5%) workers were judged to have opacities on chest radiographs (small opacities, profusion >= 1/0, and/or large opacities). Age-adjusted relative risk of opacities increased significantly with cumulative exposure to crystalline silica. The concentration of respirable crystalline silica to which workers were exposed (highly correlated with period of hire) was an important determinant of risk after accounting for cumulative exposure. For workers with an average exposure to crystalline silica of <= 0.50 mg/m3 (or hired >= 1950), the cumulative risk of opacities for a cumulative exposure to crystalline silica of 2.0 mg/m3-yr was approximately 1.1%; for an average exposure > 0.50 mg/m3 (or hired < 1950), the corresponding cumulative risk was 3.7%. These findings indicate an exposure-response relationship between cumulative exposure to crystalline silica and radiographic opacities; moreover, the relationship was substantially steeper among workers exposed at the highest average concentrations of crystalline silica.