Incidence of asthma in female Swedish hairdressers

OBJECTIVE

To investigate the risk of asthma in hairdressers.

METHODS

The incidence of asthma was retrospectively estimated in a Swedish nationwide study including all female hairdressers certified from vocational schools from 1970 to 1995, and a stratified sample of women from the general population were referents. A postal questionnaire included questions on respiratory tract symptoms, atopy, smoking, working periods as a hairdresser, and number of specific hair treatments performed/week. Reported exposures were validated by occupational hygienists. Rate ratios of incidence (IRRs) of asthma were estimated by Poisson regression, adjusted for calendar year of observation, hay fever, smoking, and region of domicile.

RESULTS

The crude incidences of asthma/1000 person-years were: 3.9 during active years as a hairdresser, 2.8 among the hairdressers when not working in the profession, and 3.1 among the referents. The corresponding IRR for being an active hairdresser compared with the referents was 1.3 (95% confidence interval (95% CI) 1.0 to 1.6). Moderate effects on risk of asthma were found both from hairdressing work (IRR=1.6 (1.1 to 2.2) among never-smokers) and from smoking (IRR=1.6 (1.2 to 2.2) among referents). However, the combined effect from hairdressing work and smoking (IRR=1.5 (1.0 to 2.1)) was less than expected (p=0.02). No effect modification by respiratory atopy was found. The hairdressers most often performing hair bleaching treatments (IRR=1.5 (0.7 to 3.0)) or using hair spray (IRR=1.4 (0.8 to 2.4)) had, compared with the most infrequent users, a slightly, but not significantly higher incidence of asthma. Exposure to persulphates in hair bleach was estimated to be 0.04-0.15 mg/m(3) during mixing of the powder. Reported average number of bleaching treatments agreed well with those performed according to a diary.

CONCLUSIONS

Active hairdressing work was associated with a moderately increased incidence of asthma among lifelong non-smokers. The results are moderately supportive, but not conclusive, of associations between asthma and exposure to hair bleach or hair spray.

Polychlorinated biphenyls in blood plasma among Swedish female fish consumers in relation to time to pregnancy

The purpose of this study was to assess the association between 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) in plasma, a biomarker of exposure to polychlorinated biphenyls (PCB), and time to pregnancy (TTP) in a group of women with a varying dietary exposure to PCB. For 121 Swedish east coast fishermen's wives (median year of birth 1956, range 1945-1968), information on selt-reported TTP for the first planned pregnancy (median 2 mo, range 0-48) and CB-153 concentrations from blood samples drawn in 1995 (median 144 ng/g lipid, range 16-566) were available. Each woman's CB-153 concentration in plasma at the time immediately preceding her pregnancy was estimated, taking into account reduction of body burden of CB-153 due to lactation, the yearly reduction of PCB in Baltic Sea fish, as well as the biological half-life of CB-153. Based on the estimated CB-153 concentrations, subjects were categorized into tertiles as low (37-206 ng/g lipid), medium (207-330 ng/g lipid), and high (331-,1036 ng/g lipid) exposure groups. TTP in the medium- and high-exposure groups were then compared to TTP in the low-exposure group by estimating the corresponding success rate (i.e., the number of pregnancies per person month) ratios (SuRR) using discrete Cox regression, taking into account essential confounders. No obvious association between estimated CB-153 concentration and TTP was observed (medium vs. low: SuRR 0.77 [95% CI 0.47-1.28] and high vs. low: SuRR 0.95 10.74-1.23]). The present data give no support for a negative association between the plasma CB-153 concentrations observed in the present study and TTP. It should, however, be borne in mind that the study group was rather small and mainly included relatively young women, likely to have been only moderately exposed.

Plasma concentrations of persistent organochlorines in relation to thyrotropin and thyroid hormone levels in women

OBJECTIVES

There is a concern that persistent organohalogen toxicants, such as polychlorinated biphenyls (PCBs), might display endocrine-disrupting effects in exposed populations. In this study the correlations between PCBs and thyrotropin (TSH) and thyroid hormone concentrations in plasma were assessed in adult women.

METHODS

The study group consisted of 182 fishermen's wives from the Swedish east coast, with a median age of 42 years (range 23-62) and a median current consumption of contaminated fatty fish from the Baltic Sea of two meals per month (range 0-12). TSH, free (FT3) and total (TT3) triiodothyronine and free (FT4) and total (TT4) thyroxin in plasma were analyzed by immunofluorometric assays, and 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) in plasma was analyzed by gas chromatography with electron capture detection. Twenty other PCB and two hydroxy-PCB congeners were analyzed in subgroups of the women. Plasma lipid analyses were performed with enzymatic techniques.

RESULTS

The CB-153 concentration in plasma (range 16-776 ng/g lipid) was negatively correlated with the TT3 concentrations (range 1.0-3.0 nmol/l, rs = -0.29, P < 0.001). This association remained after age adjustment.

CONCLUSIONS

The present study gives some support for the notion that dietary exposure to persistent organochlorine compounds (POCs) might weakly affect peripheral thyroid hormone concentrations in adult women.

Exposure to hexahydrophthalic and methylhexahydrophthalic anhydrides--dose-response for sensitization and airway effects

OBJECTIVES

This study clarified the exposure-response relationships for the organic acid anhydrides (OAA) hexahydrophthalic (HHPA) and methylhexahydrophthalic (MHHPA) anhydrides and the development of specific immunoglobulin (IG) E and G antibodies and work-related symptoms.

METHODS

In an epoxy resin-using factory, air levels of OAA were determined by gas chromatography-mass spectrometry. Occupational, smoking, and medical histories (questionnaire) were obtained for 154 exposed workers and 57 referents. Work-related symptoms of the eyes and airways were recorded, and OAA metabolites were analyzed in urine. A skin-prick test with common allergens and conjugates of OAA were performed. Specific IgE (radioallergosorbent test) and IgG (enzyme-linked immumosorbent assay) antibodies were determined in serum, and spirometry was performed.

RESULTS

Air levels of the OAA were low (HHPA < 1 to 94, MHHPA < 3 to 77 microg/m3) and associated with the concentrations of the OAA metabolites in urine. Furthermore, for the exposed workers, there were high prevalences of sensitization (IgE 22%, IgG 21%), which correlated with the exposure. Neither atopy nor smoking increased this risk significantly. Furthermore, work-related symptoms were more prevalent among the exposed workers than among the referents (eyes 23% versus 14%, nose 28% versus 16%, nose bleeding 8% versus 0%, lower airways 10% versus 4%), and they were related to the exposure (adjusted prevalence odds ratios (POR) in the highest group 7.7, 3.6 and 17, respectively) and the IgE levels (POR 4.9, 3.1 and 5.6, respectively).

CONCLUSIONS

In spite of the very low OAA levels in the air and metabolites in the urine, there were high and exposure-related risks of specific IgE and IgG sensitization and of work-related symptoms for the eyes, nose (especially bleeding), and lower airways.

Effects of lead on the endocrine system in lead smelter workers

In this study of the effects of lead on the endocrine system, 77 secondary lead-smelter workers (i.e., 62 active and 15 retired) were compared with 26 referents. Lead concentrations were determined in plasma with inductively coupled plasma mass spectrometry (i.e., index of recent exposure), in blood with atomic absorption spectrophotometry, and in fingerbone with K x-ray fluorescence technique (i.e., index of long-term exposure). In addition, pituitary hormones were determined in serum by fluoroimmunoassay, and thyroid hormones and testosterone in serum were determined with radioimmunoassay. Nine lead workers and 11 referents were challenged with gonadotrophin-releasing hormone and thyrotrophin-releasing hormone, followed by measurements of stimulated pituitary hormone levels in serum. Median levels of lead in plasma were 0.14 microg/dl (range = 0.04-3.7 microg/dl) in active lead workers, 0.08 microg/dl (range = 0.05-0.4 microg/dl) in retired lead workers, and 0.03 microg/dl (range = 0.02-0.04 microg/dl) in referents (1 microg/dl = 48.3 nmol/l). Corresponding blood lead concentrations were 33.2 microg/dl (range = 8.3-93.2 microg/dl), 18.6 microg/dl (range = 10.4-49.7 microg/dl), and 4.1 microg/dl (range 0.8-6.2 microg/dl), respectively. Respective bone lead levels were 21 microg/gm (range = -13 to 99 microg/gm), 55 microg/gm (range = 3-88 microg/gm), and 2 microg/gm (range = -21 to 14 microg/gm). Concentrations of basal serum hormone (i.e., free thyroid hormones, thyrotrophin, sex hormone binding globulin, and testosterone) were similar in the 3 groups. There were no significant associations between the hormones mentioned herein and blood plasma, blood lead, and bone lead levels. In the challenge test, stimulated follicle-stimulating hormone levels were significantly lower in lead workers (p = .014) than in referents, indicating an effect of lead at the pituitary level. Also, there was a tendency toward lower basal stimulated follicle-stimulating hormone concentrations in lead workers (p = .08). This effect, however, was not associated with blood plasma level, blood lead level, or bone lead level. In conclusion, a moderate exposure to lead was associated with only minor changes in the male endocrine function, particularly affecting the hypothalamic-pituitary axis. Given that sperm parameters were not studied, the authors could not draw conclusions about fertility consequences.

Lung cancer risks among lead smelter workers also exposed to arsenic

Recent publications indicate an increased incidence of lung cancer in non-ferrous smelter workers exposed to lead. The present study provides further data on selected subgroups in one such cohort. The cohort was based on 3979 smelter workers employed for at least 1 year between 1928 and 1979, and also exposed to lead and included in the Blood Lead Register that was started at the smelter in 1950. Two subcohorts were formed from the original cohort. One consists of 710 workers employed at the lead departments (Lead subcohort 1), and the other of 383 workers employed at the lead departments (Lead subcohort 2), but never at other works where an excess lung cancer risk was previously identified. Standardized Cancer Incidence Rates (SIR) 1958-1987 were calculated relative to county rates. In the subcohorts, arsenic exposure in lung cancer cases was assessed in detail based on occupational hygiene information from the company. Lung cancer incidence was raised in both subcohorts (Lead subcohort 1: SIR 2.4; 95% CI 1.2-4.5; Lead subcohort 2: SIR 3.6; 95% CI 1.2-8.3). Total cancer incidence in the cohorts was not increased. A detailed study of arsenic exposure in the 10 lung cancer cases in these two subcohorts revealed that all but one of these cases had a significant exposure also to arsenic. An elevated incidence of lung cancer was observed in smelter workers exposed to lead. However, considerable arsenic exposure also occurred in a majority of the lung cancer cases in the investigated subcohorts. In this multifactorial exposure situation it has not been possible to separate the carcinogenic effects of lead and arsenic, but a possible interaction between these metals may be involved in explaining the carcinogenic risks.

A prospective study of the relationship between exposure and specific antibodies in workers exposed to organic acid anhydrides

BACKGROUND

The exposure-response relationships for the induction of specific IgE and IgG were evaluated in a prospective study of workers exposed to organic acid anhydrides (OAAs). Special attention was paid to the modifying effects of atopy and smoking.

METHODS

The subjects were 163 previously unexposed persons exposed to epoxy resins with hexahydro-, methylhexahydro-, and methyltetrahydrophthalic anhydride as curing agents. The levels of OAAs in air and of specific IgE and IgG in serum were recurrently monitored. The mean observation time was 32 (1-105) months.

RESULTS

The mean combined OAA exposure of the subjects was 15.4 (< 1-189) microg/m3. Positive specific IgE was demonstrated by 21 (13%) subjects with a mean induction time of 8.8 (1-35) months. The incidence of sensitization was 4.1 cases/1000 months at risk. The relative risk (OR) for atopics was 5.4 (1.9-15.3; 95% CI). An exposure-response relationship was demonstrated by an increasing risk of sensitization with increasing exposure.

CONCLUSION

An association between exposure and atopy, respectively, and the induction of specific antibodies against OAAs were observed. The risk for atopics was comparable with the risk for the subjects in the most exposed group.

The prognostic impact of karyotypic subgroups in myelodysplastic syndromes is strongly modified by sex

The prognostic impact of karyotypic patterns in a consecutive series of 389 adult myelodysplastic syndromes (MDS) was investigated. Time period did not significantly influence the survival times. In the analyses, the MDS cases were subdivided into the cytogenetic subgroups used in the International Prognostic Scoring System, i.e. favourable [-Y, del(5q) or del(20q) as single aberrations or normal karyotype, n = 241], poor [-7, del(7q), der(1;7) or complex karyotypes, i.e. > or = three abnormalities, n = 89] and intermediate (other aberrations, n = 59). The survival times correlated well with the prognostic subgroups, confirming that the cytogenetic classification was valid. Expressed as hazard ratios (HRs), with the favourable subgroup as the reference, the intermediate and poor subgroup HRs increased to 1.5 (95% confidence interval, 1.1-2.1) and 3.2 (2.4-4.1) respectively. Sex, age, morphological subtype and smoking habits significantly modified this prognostic impact. Shorter survival was detected for men in the favourable and the intermediate subgroups, but not in the poor prognosis subgroup. Using women in the favourable subgroup as the reference and adjusting for age, the HR for men was 1.6 (1.2-2.1) in the favourable subgroup. Adjusting for smoking habits as well decreased the HR to 1.4 (1.1-2.0) and, when also excluding cases with del(5q) as the sole anomaly, no significant difference could be discerned [HR 1.2 (0.9-1.6], suggesting that the better outcome for women in the favourable subgroup was mainly as a result of the '5q-syndrome' and to smoking habits. In the intermediate subgroup, the corresponding HRs were 3.0 (1.5-6.0) when adjusted for age and 2.7 (1.3-5.5) when also adjusted for smoking habits. Different survival times between men and women have never previously been reported for this MDS group. Although it remains to be elucidated whether environmental and/or constitutional factors cause the observed sex-related difference, these observations have obvious clinical ramifications, not least in designing and evaluating therapy protocols.

Questionnaire versus direct technical measurements in assessing postures and movements of the head, upper back, arms and hands

OBJECTIVES

This study compares questionnaire-assessed exposure data on work postures and movements with direct technical measurements.

METHODS

Inclinometers and goniometers were used to make full workday measurements of 41 office workers and 41 cleaners, stratified for such factors as musculoskeletal complaints. The subjects answered a questionnaire on work postures of the head, back, and upper arms and repeated movements of the arms and hands (3-point scales). The questionnaire had been developed on the basis of a previously validated one. For assessing worktasks and their durations, the subjects kept a 2-week worktask diary. Job exposure was individually calculated by time-weighting the task exposure measurements according to the diary.

RESULTS

The agreement between the self-assessed and measured postures and movements was low (kappa = 0.06 for the mean within the occupational groups and kappa = 0.27 for the whole group). Cleaners had a higher measured workload than office workers giving the same questionnaire response. Moreover, the subjects with neck-shoulder complaints rated their exposure to movements as higher than those without complaints but with the same measured mechanical exposure. In addition, these subjects also showed a general tendency to rate their postural exposure as higher. The women rated their exposure higher than the men did.

CONCLUSIONS

The questionnaire-assessed exposure data had low validity. For the various response categories the measured exposure depended on occupation. Furthermore, there was a differential misclassification due to musculoskeletal complaints and gender. Thus it seems difficult to construct valid questionnaires on mechanical exposure for establishing generic exposure-response relations in epidemiologic studies, especially cross-sectional ones. Direct technical measurements may be preferable.

Muscular rest and gap frequency as EMG measures of physical exposure: the impact of work tasks and individual related factors

Owing to an orderly recruitment of motor units, low threshold type I fibres are presumed to be vulnerable in contractions of long duration. To study load on these fibres muscular rest was registered as the time fraction of electromyographic (EMG) activity below a threshold. Moreover, the frequency of periods with muscular rest, EMG gaps, was derived, since a low gap frequency has been shown to be a risk factor for musculoskeletal disorders. Trapezius EMG was registered in 24 female hospital cleaners, 21 female office workers and 13 male office workers during one working day. Cleaners have a high risk of neck/shoulder pain and had much less muscular rest than office workers measured as a percentage of total registered time (median value = 1.5%, range = 0.2-13% vs. median value = 12%, range = 0.0-32%, respectively). Gap frequency showed no difference between the two occupational groups. Both measures displayed a wide inter-individual variation. For the cleaners, some of the variance was explained by body mass index (BMI) and age, with lower values of muscular rest for older subjects with a high BMI. Among the office workers, low values of muscular rest and a high gap frequency were registered in subjects with a low subjective muscular tension tendency. Gender, strength, smoking, job strain, employment time and musculoskeletal symptoms had no impact on either EMG measure.

Exposure biomarkers and risk from gluing and heating of polyurethane: a cross sectional study of respiratory symptoms

OBJECTIVES

To define the relation between exposure to polyurethane (PUR) glue, biomarkers of exposure and effect, and work related symptoms that occur at least once a week.

METHODS

In a cross sectional study, 152 workers and 14 clerks in a factory with exposure to sprayed and heated PUR glue containing 4, 4'-diphenylmethane (MDI) or 1,6-hexamethylene (HDI) di-isocyanate were examined with gas chromatography-mass spectrometry (GC-MS) for metabolites of MDI in plasma (P-MDX) and urine (U-MDX), 2,4- and 2, 6-toluene di-isocyanate (TDI; P-TDX, U-TDX) and HDI in plasma and urine, specific serum IgG (S-IgG-MDI, S-IgG-HDI, and S-IgG-TDI, respectively) and IgE (S-IgE-MDI). Work related symptoms of the eyes and airways (nose or lower airways, or both), and lung function were also evaluated.

RESULTS

P-MDX was detected in 65% of the workers, U-TDX in 47%, HDX in none. Three per cent were positive for S-IgE-MDI, 33% for S-IgG-MDI, 32% for S-IgG-TDI, and 12% for S-IgG-HDI. A few clerks had metabolites, and some had antibodies. Most metabolites and immunoglobulins were slightly correlated-for example, P-MDX v S-IgG-MDI: r(s)=0.21. Workers who heated glue had increased P-MDX (odds ratio (OR)=12 for a value above the median) and S-IgG-MDI (OR=3.7), sprayers P-2,4-TDX (OR=6.2) and P-2,6-TDX (OR=16). Twenty six per cent of the workers had work related symptoms of the airways, 21% from the nose, 11% from the lower airways. Spraying of glue increased the risk of work related symptoms and slightly decreased lung function. U-MDX was associated with work related symptoms from the airways (OR=3.7) and P-2,6-TDX with work related symptoms from the lower airways (OR=6.6). S-IgG-MDI was related to work related symptoms from the airways (OR=2.6).

CONCLUSIONS

There were relations between exposures to sprayed and heated PUR glue based on MDI and HDI, concentrations of metabolites of MDI and TDI in plasma and urine, specific IgG serum antibodies against MDI, TDI, and HDI, and work related symptoms.

Time to pregnancy and infertility among women with a high intake of fish contaminated with persistent organochlorine compounds

OBJECTIVES

The purpose of this study was to assess the effect of persistent organochlorine compounds through the dietary intake of fatty fish from the Baltic Sea on human fertility.

METHODS

Information on time to pregnancy, subfertility, and infertility was collected retrospectively by self-administered questionnaires in 2 cohorts of fishermen's wives from the Swedish east (by the Baltic Sea) and west coasts. In addition to cohort affiliation, current fish consumption and growing up in a fishing village were used as proxies for exposure within the eastcoast cohort.

RESULTS

A decreased success (ie, pregnancy) rate and a tendency towards increased subfertility was found for heavy smokers (> or =10 cigarettes/day) in the eastcoast cohort as compared with the westcoast cohort [success rate ratio 0.66, 95% confidence interval (95% CI) 0.49-.89; subfertility odds ratio 1.64, 95% CI 0.91-2.91). However, internal analyses within the eastcoast cohort did not show that growing up in a fishing village or high current fish consumption decreased the success rate. Eastcoast cohort affiliation showed an increased risk for infertility (odds ratio 2.49, 95% CI 1.05-5.92).

CONCLUSIONS

The present data give some support for a negative association between exposure to persistent organochlorine compounds and fertility among heavy smokers. However, when the proxy exposure measures are also considered, the findings are not consistent. Better individual exposure assessments should be used before more firm conclusions are drawn.

Medical and psychometric examinations of conscripts born to mothers with a high intake of fish contaminated with persistent organochlorines

OBJECTIVES

The present study aimed to investigate whether boys who had been pre- and postnatally exposed to persistent organochlorine compounds through the consumption of contaminated fatty fish from the Baltic Sea (on the east coast of Sweden) had medical or psychometric impairments in the compulsory conscript examination at 18 years of age.

METHODS

Boys born in 1973 to 1975 to fishermen's wives and fishermen's sisters from the Swedish east coast were examined at 18 years of age. For relevant comparisons a corresponding group from the Swedish west coast, where the fish are less contaminated, were used. In addition, comparisons were made with expected values based on conscript examination data for the general population in the same geographic areas.

RESULTS

The boys in the 2 cohorts did not, during the conscript testing, significantly differ in the results of the psychometric tests. On the other hand, the boys from the eastcoast cohort were somewhat shorter and had more visual and hearing impairments than the boys from the west coast. However, the eastcoast boys did not differ from the regional reference population with respect to visual and hearing ability.

CONCLUSIONS

Although no individual exposure data were available, the present results do not support any harmful long-term impact of pre- and postnatal exposure to persistent organochlorine compounds from mothers' fish consumption on the psychometric functions of boys in their conscript examinations.

Survival time in a population-based consecutive series of adult acute myeloid leukemia--the prognostic impact of karyotype during the time period 1976-1993

A consecutive population-based series of 372 adult acute myeloid leukemias, successfully cytogenetically investigated at a single center between 1976 and 1993, is reported. All medical records were reviewed in order to ascertain the prognostic impact of karyotype, divided into three groups; favorable (t(8;21), t(15;17), and inv(16) irrespective of karyotypic complexity; n = 40), poor (der(1;7), inv(3), -5, del(5q), -7, t(9;22), and complex karyotypes including whole or partial losses of chromosomes 5 and/or 7; n = 56), and intermediate (other abnormalities or normal karyotype; n = 276). The possible modification by age, gender, time period, morphologic subtype, and bone marrow transplantation (BMT) on this prognostic impact was also determined. The chemotherapy regimens used were heterogeneous over time but principally the same at any given point in time. The majority of the patients were treated with combinations including an anthracycline and cytarabine with curative intent. Gender, morphology, and BMT did not significantly modify the effect of cytogenetic patterns on survival time, whereas age and time period did. The hazard ratios for the subgroups favorable, intermediate, and poor were 1.0, 1.2 and 1.9 at age 20-49; 1.0, 2.5 and 4.5 at age 50-64; 1.0, 4.1 and 11.4 at age 65-74; 1.0, 1.4 and 2.2 for the time period 1976-1987 and 1.0, 2.0 and 6.7 for 1988-1993. The salient feature of the Kaplan-Meier curves was the improved survival during the later time period for patients with favorable and intermediate cytogenetic abnormalities. The present findings thus suggest that it is mainly these patient groups that have benefited from advances in therapy, including supportive care.

Impact of physical exposure on neck and upper limb disorders in female workers

Physical workload [muscular load of the trapezius and infraspinatus muscles using electromyography (EMG), wrist positions and movements by electrogoniometers] and neck and upper limb disorders (from, for example, a physical examination) were studied in women with repetitive industrial work (n = 95) and referents (n = 74). The repetitive work displayed higher ratings for wrist movements, but not for EMG. The prevalences of neck, shoulder and wrist/hand disorders were elevated for women with repetitive work [age-adjusted prevalence odds ratios (PORs) 2.0-7.5]. For the left hand, high frequency of wrist movements (mean power frequency 0.53 Hz) was associated with a high prevalence of disorders (56%), as compared to low (0.28 Hz and 26%; POR 3.5). We found no consistent and significant effect of muscular load, on either neck or shoulder disorders. However, selection and other bias may have diminished our possibility to observe such effects. Psychosocial work environment factors were not confounding the results. Measurements of wrist movements may be used for identification of high-risk work tasks.

Lowered birth weight among infants born to women with a high intake of fish contaminated with persistent organochlorine compounds

In Sweden fatty fish from the Baltic Sea (at the Swedish east coast) constitute the main exposure route for persistent organochlorine compounds (POC). The present study assessed reproductive outcomes among fishermen's sisters from the Swedish east coast, who were shown to had had a relatively high consumption of contaminated fish in early life. For relevant comparison, we used a similar cohort from the Swedish west coast, where the contamination of fish is considerable less. The east coast cohort women had an increased risk of having an infant with low birth weight (LBW; <2500 g) as compared with the west coast cohort women (odds ratio (OR) 1.6. 95% confidence interval 1.1-2.3). The results strengthen the hypothesized association between exposure to POC during childhood and adolescence and an increased risk for LBW.

Miscarriages and stillbirths in women with a high intake of fish contaminated with persistent organochlorine compounds

OBJECTIVES

The purpose of the present study was to assess the effect, on miscarriages and stillbirths, of persistent organochlorine compounds (POC) through dietary intake of fatty fish from the Baltic Sea.

METHODS

Information on miscarriages and stillbirths was collected retrospectively by a self-administered questionnaire in a cohort of fishermen's wives from the Swedish east coast (by the Baltic Sea) and in a referent cohort of west coast fishermen's wives. Current fish consumption was used as a proxy for exposure within the east coast cohort.

RESULTS

No increase in miscarriages or stillbirths was found in the east coast cohort compared with the west coast group, in fact a decrease in early miscarriages was found (OR 0.48 [95% CI 0.26-0.92]). Moreover, no increase in risk was found for current high consumers of fatty fish within the east coast cohort.

CONCLUSIONS

The present data provided no evidence that dietary POC exposure increases miscarriage and stillbirth rates.

Musculoskeletal disorders among female dental personnel--clinical examination and a 5-year follow-up study of symptoms

OBJECTIVES

To explore the natural course of musculoskeletal disorders during a 5-year period among dental personnel, to survey findings and diagnoses according to a standardized protocol, and to compare and evaluate different methods for the detection of musculoskeletal disorders in a population.

METHODS

In a 5-year follow-up study, dental personnel (n = 90) and referents (n = 30) were studied. The Nordic questionnaire (years 0 and 5), the present pain rating according to the Borg category ratio scale, and physical examination (year 5) were used.

RESULTS

In year 0 the prevalence of symptoms in the shoulders, the wrists/hands, and, unexpectedly, the hips was higher in the dental personnel as compared with the referents. Furthermore, those (16%) who had left the dental profession during the observation period showed a higher prevalence of and, often, combined symptoms from several body regions in year 0 than did those who stayed. Dental personnel who remained in the profession tended to have an increased risk of developing more symptoms in the shoulders and the elbows/wrists/hands in year 5 as compared with year 0 and at year 5 were in more pain and had received more diagnoses for the neck/shoulder region relative to the referents. Furthermore, there was a considerable variation in symptoms during the follow-up period. The sensitivity of the pain rating and of the Nordic questionnaire in detecting musculoskeletal disorders was high for the neck and shoulders but was not as high for the elbow, wrists/hands, or hips. The association was better for diagnoses than for findings. The opposite patterns were observed for specificity.

CONCLUSIONS

Dental personnel had an increased risk of developing musculoskeletal disorders as verified by symptoms and diagnoses and more painful or persistent conditions. This led to a selection out of work. The questionnaire and the present pain rating gave a relatively good picture of the prevalence of musculoskeletal disorders arising from the neck, shoulders, and hips and would be useful as screening tools. Their sensitivity in detecting disorders was higher for diagnoses than for findings. However, these methods were not as sensitive for disorders involving the elbows/wrists/hands. Physical examinations gave more detailed information.

Fish processing work: the impact of two sex dependent exposure profiles on musculoskeletal health

OBJECTIVES

To evaluate the impact of work tasks, physical exposure, and psychosocial factors on the risk of musculoskeletal disorders in men and women, in a defined industrial setting.

METHODS

116 male and 206 female fish industry workers were compared with 129 men and 208 women with more varied work. Physical and psychosocial work load as well as musculoskeletal complaints were recorded by a questionnaire. A physical examination was performed and an observation method was used for work evaluation. 196 male and 322 female former fish processing workers received a postal questionnaire.

RESULTS

The women workers in the fish industry had worse working conditions than the men for repetitiveness, constrained neck postures, and psychosocial work environment. They also had higher prevalences of complaints of the neck and shoulder (prevalence odds ratio (POR) 1.9; 95% confidence interval (95% CI) 1.1 to 3.2), neck and shoulder and elbow and hand complaints (POR 2.9; 95% CI 1.8 to 4.7 and POR 2.8; 95% CI 1.6 to 4.7, respectively). The women more often than the men left the industry because of neck and upper limb complaints. Also, women in other work had a higher prevalence of complaints of the neck and shoulder (POR 2.3; 95% CI 1.1 to 5.1) than the men. The men in the fish processing industry had a higher prevalence of complaints of the neck and shoulder than the men in other work (POR 3.6; 95% CI 1.6 to 8.0). This difference was not shown up by the questionnaire.

CONCLUSIONS

Despite superficially similar work, there were clear sex differences in physical exposure and psychosocial work environment. Work in the fish processing industry was associated with a high risk of neck and upper limb disorders in women, which was probably mainly due to their extremely repetitive work tasks; the corresponding men had less repetitive work and less disorders. Also, a healthy worker effect on neck and upper limb disorders was found. The advantage of a physical examination compared with a questionnaire is clearly shown.

No evidence for congenital malformations or prenatal death in infants born to women with a high dietary intake of fish contaminated with persistent organochlorines

OBJECTIVES

The aim of the present study was to assess whether a high dietary intake of fatty fish from the Baltic Sea, contaminated with persistent organochlorine compounds, might increase the risk for congenital malformations and perinatal death.

METHODS

A cohort of fishermen's wives from the Swedish east coast (at the Baltic Sea) were linked to the Swedish Medical Birth Register (MBR), resulting in the identification of 1501 infants born in the period 1973-1991. A further linkage with the Swedish Registry of Congenital Malformations was performed. Similar linkages were made for a comparison group of fishermen's wives from the Swedish west coast, who gave birth to 3553 infants during the study period. The reproductive end points studied included congenital malformations, stillbirths, and early neonatal deaths. The expected numbers of these end points were calculated from the MBR data for the regional populations.

RESULTS

In the east coast cohort, 3.3% of the infants had some malformation diagnosis as compared with 5.0% of the west coast cohort. As compared with the general population, somewhat fewer malformations than expected were diagnosed in the east coast cohort (risk ratio 0.78, 95% CI 0.58-1.04). No specific malformation was overrepresented in the east coast cohort. The risk ratios for stillbirths and early neonatal deaths did not significantly differ from unity in any of the cohorts.

CONCLUSIONS

The present results exclude in an unequivocal way an association between exposure to persistent organochlorines from fatty Baltic Sea fish and an increased risk for all congenital malformations and perinatal death. The limited power of the study design, however, does not allow the exclusion of slight risk excesses for some specific types of malformation.

Polychlorinated biphenyls in blood plasma among Swedish female fish consumers in relation to low birth weight

The authors examined the hypothesized association between the body burden of polychlorinated biphenyls (PCB) in women and the risk of low birth weight for their infants. In Sweden, a main exposure route for PCBs and other persistent organochlorine compounds is through the consumption of fatty fish from the Baltic Sea (on the Swedish east coast). A previous comparison between a cohort of consumers of large quantities of fish from the Swedish east coast and a reference population, together with a following analysis based on questionnaire data from a case-control study within the east coast cohort, supported the hypothesized association. In 1995, blood samples were collected from the wives and ex-wives of fishermen from the Swedish east coast (n = 192) who had given birth during the period 1973-1991. Cases (n = 57), i.e., infants with low birth weight (1,500-2,750 g), were matched with controls (n = 135; birth weight, 3,250-4,500 g) on gender, parity, and calendar year of birth. The concentration of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) in plasma was analyzed; it has been suggested that CB-153 is a relevant biomarker of exposure to PCBs. The concentration of CB-153 in the plasma of mothers during the year of childbirth was "estimated" using some alternative plausible kinetic models. For two alternative estimated exposure datasets, which were focused on separately, an increase in the risk of a low birth weight was observed at a CB-153 concentration of 300 and 400 ng/g lipid weight, respectively (adjusted odds ratios of 2.1 (95% confidence interval (CI) 1.0-4.7) and 2.3 (95% CI 0.9-5.9)). The present results strengthen the findings reported previously for this study population.

Agreement between reported fish consumption obtained by two interviews and its impact on the results in a reproduction study

In an ongoing study of the hypothesised association between consumption of fish contaminated with persistent organochlorine compounds and low birth weight, a relevant measure of exposure is the accumulated fish consumption over long time periods. An issue of concern in this study is the quality of the retrospective exposure assessments. The present investigation was undertaken to determine the agreement between reported fish consumption in two interviews with approximately one year in between. in order to evaluate its impact on the effect estimates. The agreement decreased with increasing retrospective time interval between interview and focused time period of fish consumption. Furthermore, the exposure assessments based on the two interviews led to considerably different effect estimates.

Airway symptoms and lung function in pipelayers exposed to thermal degradation products from MDI-based polyurethane

OBJECTIVES

To study the prevalence of symptoms from the eyes and the upper and lower respiratory tract, lung function, and immunological sensitisation towards isocyanates in pipelayers exposed to thermal degradation products from methylene diphenyl diisocyanate (MDI)-based polyurethane (PUR).

MATERIAL AND METHODS

50 presently active and 113 formerly active pipelayers were examined. Also, 65 unexposed workers were investigated for comparison. The one year prevalence of symptoms and smoking history (questionnaire data), lung function (vital capacity (VC) and forced expiratory volume in one second (FEV1), and atopy (positive skin prick tests towards standard allergens) were assessed among pipelayers and controls. For the pipelayers, the presence of work related symptoms and estimates of isocyanate and welding exposure were obtained from an interview. Skin prick tests towards specific isocyanate antigens and determinations of IgE-MDI and IgG-MDI in serum were also performed.

RESULTS

The prevalence of episodes (more than once a month) of irritative eye symptoms, congestion of the nose, and soreness or dryness in the throat was much higher among the PUR pipelayers than among the controls. Most of the pipelayers with symptoms reported that these had started and occurred in relation to the PUR welding tasks. Presently active pipelayers with recent high PUR exposure showed a significant reduction of FEV1 compared with the controls. The estimated reduction, adjusted for smoking, was -0.3 l (P = 0.04). There was no confounding effect of ordinary welding. None of the pipelayers showed positive skin prick reactions against the specific isocyanate antigens used, or positive IgE-MDI, and only two had increased IgG-MDI.

CONCLUSIONS

The findings indicate that exposure to thermal degradation products from MDI-based polyurethane has adverse effects on the mucous membranes and airways.

The impact of age, lactation and dietary habits on PCB in plasma in Swedish women

The mean concentration of the chlorinated biphenyl 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) in plasma from 192 fishermen's wives from the Swedish east coast was on a fresh weight basis 960 (range 80-4300) pg/g and lipid adjusted 160 (range 20-780) ng/g lipid. The concentration of CB-153 in plasma was significantly influenced by age, total lactation time and place of living during childhood and adolescence (fishing village vs. other place). The residential variable probably reflects early life consumption of fish from the Baltic Sea (at the Swedish east coast) contaminated with persistent organochlorine compounds.

Monitoring of polychlorinated biphenyls in human blood plasma: methodological developments and influence of age, lactation, and fish consumption

Human plasma samples from 50 wives of fishermen have been analyzed with respect to PCBs. The non-ortho-substituted PCB congeners CB-126 and CB-169 were determined by mass spectrometry in negative ion chemical ionization mode, which demonstrated a limit of detection of 30 fg. The recoveries of the internal standards used for determination of ortho-substituted CBs were approximately 95%. Two methods, one gravimetric and the other based on enzymatic determinations of triglycerides, cholesterol and phospholipids, were compared for the determination of total amount of lipids in the plasma samples; the correlation coefficient was 0.82 and the slope 0.98. For practical reasons, enzymatic determinations are recommended for further use. The total, lipid-adjusted concentrations of PCBs in plasma were influenced by age, total lactation time and consumption of fatty fish from the Baltic Sea.