Peak flow as a measure of airway dysfunction in swine confinement operators

To evaluate the usefulness of a portable peak flow meter in predicting airway dysfunction in symptomatic swine confinement workers, we conducted a study using an established cohort of swine workers in Iowa. Participants were randomly selected from a group of 207 swine confinement workers and a group of nonconfinement farmers who had been followed longitudinally. Swine confinement workers with work-related symptoms were identified, and two control groups (swine confinement workers and nonconfinement workers) without work-related symptoms were frequency matched by age, sex, and smoking status to the symptomatic swine confinement workers. Peak flow measures were obtained for 7 days using a mini-Wright peak flow meter and comparisons were made between the symptomatic swine confinement farmers (n = 24) and both groups of asymptomatic workers: swine confinement workers (n = 21) and neighborhood farmer controls (n = 25). Peak flow readings were recorded by subjects five times per day for 7 days, initially on awakening, then after chores, before lunch, before dinner, and before bedtime. The actual hour of day for each measurement of peak flow was similar between the three groups. Percent changes from initial AM peak flow did not significantly differ between subject groups. However, symptomatic swine confinement workers consistently exhibited significantly lower initial and subsequent mean peak flow values compared with asymptomatic swine confinement workers and neighborhood control farmers, controlling for age, height, gender, and smoking status. These differences occurred on most of the measures of peak flow throughout the work day. The persistence of these lower values throughout the work day is remarkably consistent during the study period and is suggestive of airway disease in the symptomatic swine confinement workers. Our findings suggest that peak flow meters are a useful indicator of potential airway injury and offer an additional portable, diagnostic tool in the assessment of symptomatic workers.

Respiratory dysfunction in swine production facility workers: dose-response relationships of environmental exposures and pulmonary function

Human respiratory health hazards for people working in livestock confinement buildings have been recognized since 1974. However, before comprehensive control programs can be implemented, more knowledge is needed of specific hazardous substances present in the air of these buildings, and at what concentrations they are harmful. Therefore, a medical epidemiological and exposure-response study was conducted on 207 swine producers using intensive housing systems (108 farms). Dose-response relationships between pulmonary function and exposures are reported here. Positive correlations were seen between change in pulmonary function over a work period and exposure to total dust, respirable dust, ammonia, respirable endotoxin, and the interactions of age-of-producer and dust exposure and years-of-working-in-the-facility and dust exposure. Relationships between baseline pulmonary function and exposures were not strong and therefore, not pursued in this study. The correlations between exposure and response were stronger after 6 years of exposure. Multiple regression models were used to identify total dust and ammonia as the two primary environmental predictors of pulmonary function decrements over a work period. The regression models were then used to determine exposure concentrations related to pulmonary function decrements suggestive of a health hazard. Total dust concentrations > or = 2.8 mg/m3 were predictive of a work period decrement of > or = 10% in FEV1. Ammonia concentrations of > or = 7.5 ppm were predictive of a > or = 3% work period decrement in FEV1. These predictive concentrations were similar to a previous dose-response study, which suggested 2.5 mg/m3 of total dust and 7 ppm of NH3 were associated with significant work period decrements. Therefore, dust > or = 2.8 mg/m3 and ammonia > or = 7.5 ppm should be considered reasonable evidence for guidelines regarding hazardous exposure concentrations in this work environment.

Determinants of longitudinal changes in spirometric function among swine confinement operators and farmers

To assess whether working in a swine confinement facility causes an excess or accelerated decline in lung function, we conducted a population-based study to evaluate the determinants of longitudinal changes in airflow in a population of swine confinement operators. Spirometric measures of lung function were compared between swine confinement operators (N = 168) and neighborhood farmer control subjects (N = 127). Study subjects were randomly selected from a cohort of swine confinement operators in eastern Iowa. The control farming population was matched by geographic location, age, and sex to the swine confinement operators. On average, the follow-up time was approximately 2 yr, with a range of follow-up between 56 and 1,900 d. Although swine confinement operators and neighborhood farmers had similar demographic characteristics (age, gender, racial background, smoking history, and atopy status), swine confinement operators tended to have less farming experience and were more extensively followed (more measures of lung function and longer periods of observation) than the neighborhood farmer control group. Swine confinement operators were also exposed to higher environmental dust concentrations and other irritants than the farmer control subjects. Interestingly, the cross-sectional data indicated that swine confinement operators tended to have slightly lower measures of airflow and greater workshift declines in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and mid-expiratory flow (FEF25-75) than the neighborhood farmer control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Agents in organic dust: criteria for a causal relationship

Identification of agents of disease causation in organic dust is complicated by the fact that multiple agents may be involved, and these agents may act in a synergistic or additive fashion and cause a number of conditions resulting from chronic toxic or inflammatory effects. A new systematic approach to evaluating available data for evidence of disease-causing agents in organic dust is proposed. It combines, in a matrix fashion, principles of Koch's postulates, River's postulates, principles of epidemiologic determinants, and weight of evidence theory. By applying these principles in a systematic fashion, the strength of the scientific evidence for a specific agent can objectively be evaluated.

Comparison of bioaerosol sampling methods in barns housing swine

The air in livestock buildings contains bioaerosol levels that are sufficiently high to cause adverse health effects in animals and workers. These bioaerosols are complex mixtures of live and dead microorganisms and their products as well as other aeroallergens. The effectiveness of sampling methods used for quantifying the very high concentrations of microorganisms in these environments has not been well studied. To facilitate an accurate assessment of respiratory hazards from viable organisms in agricultural environments, three bioaerosol sampling methods were investigated: the Andersen microbial sampler method (AMS), the all-glass impinger method (AGI), and the Nuclepore filtration-elution method (NFE). These methods were studied in a parallel fashion in 24 swine confinement buildings. Measurements were taken in two seasons with three types of culture media in duplicate to assess total bacteria, gram-negative enteric bacteria, and total fungi. Methods were analyzed for the proportion of samples yielding data within the limits of detection, intraclass reliability, and correlation between methods. For sampling viable bacteria, the AMS had a poor data yield because of overloading and demonstrated weak correlation with the AGI. Conversely, the AGI and NFE gave sufficient numbers of valid data points (90%), yielded high intraclass reliabilities (alpha greater than or equal to 0.92), and were highly correlated with each other (r = 0.86). The AGI and the NFE were suitable methods for assessing bacteria in this environment, but the AMS was not. The AMS was the only method that consistently recovered enteric bacteria (73% data yield). For sampling fungi, the AGI and AMS both yielded sufficient data and all three methods demonstrated high intraclass reliability.(ABSTRACT TRUNCATED AT 250 WORDS)

Lung dysfunction in animal confinement workers--chairman's report to the Scientific Committee of the Third International Symposium: issues in health, safety and agriculture, held in Saskatoon, Saskatchewan, Canada, May 10-15, 1992

The session traced the course of health hazards in livestock confinement from anticipation of an emerging health hazard in 1974 to its full recognition as a significant health hazard in 1992. The session documented the major health hazards including hydrogen sulfide toxicity, bronchitis, non-allergic asthma, organic dust toxic syndrome, and mucus membrane irritation. In regard to exposures, bioaerosols seem to be the most significant hazard, with endotoxin evident as at least one of the major specific atiologic agents. Other agents were suspected, as newly recognized agents, specifically 1,3 beta-glucan. Previous epidemiological studies have revealed mild decrements in pulmonary function, however symptoms have always been excessively prevalent relative to controls. Recent results of a longitudinal observation showed a 12% drop out of workers with profound decrement in pulmonary function. In summary, the health hazard of livestock confinement workers is now well substantiated in North America and Europe and further work regarding prevention is highly indicated.

Association of environmental air contaminants with disease and productivity in swine

A cross-sectional epidemiologic study associating air quality with swine health was conducted on 28 swine farms in southern Sweden. Correlation of housing air environment to swine diseases and productivity (data collected over the preceding 12 months) were investigated. The most prevalent swine health problems detected at slaughter were pneumonia and pleuritis. In farrowing and nursery operations, the most prevalent problem was neonatal pig mortality. Several air contaminants (dust, ammonia carbon dioxide, and microbes) were found to be correlated with these swine health problems. Maximal safe concentrations of air contaminants were estimated on the basis of dose-response correlation to swine health or human health problems. Recommended maximal concentrations of contaminant were: dust, 2.4 mg/m3; ammonia, 7 ppm; endotoxin, 0.08 mg/m3; total microbes, 10(5) colony-forming units/m3; and carbon dioxide, 1,540 ppm. The overall quality of the ventilation system was correlated with lower concentration of ammonia, carbon dioxide, microorganisms, and endotoxin, but not with dust concentrations. High animal density was related to high ammonia and air microbe concentrations. Animal density measured as kilograms of swine per cubic meter (compared with kilograms of pig weight or swine per square meter) had the highest correlation to animal health and air contaminants.

The farm family perception of occupational health: a multistate survey of knowledge, attitudes, behaviors, and ideas

It is vitally important to integrate the views and concerns of the farm family into the process of policy development. If the input is not there, policy planners could implement programs that are philosophically separated from the farm families' concerns and attitudes. This would destroy credibility and future farmer support of any new program development. From May of 1988 to April of 1989, a phone and mail survey of approximately 1,500 farmers and spouses was conducted to assess knowledge, attitudes, and behaviors regarding agricultural safety and health. The survey was conducted in Iowa, New York, South Carolina, and Washington state. Preliminary results from Iowa and New York indicated that: 1) farmers value highly, and are concerned with, occupational health and safety issues; 2) farmers report that their major concerns include stress, trauma and respiratory problems; 3) farmers would like access to an occupational health and safety service; and 4) any new farm health and safety programs must include farmer input to ensure practicality, applicability, and acceptance.

Prologue: agricultural occupational and environmental health: policy strategies for the future

The conference "Agricultural Occupational and Environmental Health: Policy Strategies for the Future" documented for the public record the epidemic of occupational and environmental deaths, diseases, and injuries experienced by America's farm families and agricultural workers. The conference also gave life to a process aimed at reducing those hazards. The outcome of long-range objectives of lowering death, injury, and disease rates in our agricultural population will not be known for several years. However, there was unanimous consensus that the major short-range objectives were achieved. Extensive regional and national media coverage helped meet the goal of facilitating public awareness of the issues. In addition, a prioritized policy agenda, soundly based on recent scientific information, was produced. This agenda was the product of collaboration between the scientific community, farm constituency groups, farm equipment and chemical manufacturers, and representatives from state and federal governments. Primary changes resulting from the conference include an increase in general awareness and a sense of urgency that agricultural health problems must be addressed. In addition, the conference spawned a new organization called the National Coalition for Agricultural Safety and Health (N-CASH) to help assure a vibrant continuation of conference issues. This coalition will live on to help disseminate the spirit, information, and specific policy recommendations of the conference to the public sector and private institutions. Two years of planning and work by 18 individuals occurred even before the start of the conference. During the conference, 176 individuals put in an equivalent of three and a half person years of work. However, the work is just beginning. This effort is justified if it results in one less death or serious injury in a farm family.

Preventing respiratory disease in swine confinement workers: intervention through applied epidemiology, education, and consultation

A combined epidemiological and intervention study was conducted on 207 swine confinement farmers with matched comparison subjects. The objectives of the study were to define, in detail, the nature and disease determinants in this exposed group and to explore methods of disease prevention. This 5 year prospective study included three annual medical assessments of workers and complementary work environment assessments. Between the first and second assessment periods, an in-depth educational intervention was conducted. An industrial hygiene consultation intervention was conducted between the second and third measurement periods. Outcome measurements included changes in knowledge, attitudes, and behavior following educational intervention. Additionally, the outcomes measured included changes in medical and environmental assessment over the 3 year assessment periods. Results of the baseline respiratory symptoms assessment are reported here. Nearly 20% of swine confinement workers reported chronic cough, and 25% reported phlegm (American Thoracic Society questionnaire). Both symptoms were significantly more prevalent in the confinement workers compared to a blue collar comparison group, but only phlegm production was more prevalent compared to nonconfinement farmers. Work-related symptoms were reported much more frequently than chronic symptoms (e.g., 87% of confinement workers reported work-related cough). Bronchitis as well as airways reactivity were all significantly more prevalent in confinement workers compared to nonconfinement workers. Smoking seemed to have an additive effect with confinement exposure. Bronchitis and chest tightness symptoms were reported to be more severe upon return to work after an absence of 7 days or more. Finally, 34% of workers reported episodes of organic dust toxic syndrome.

Health effects from work in swine confinement buildings

A total of 14 epidemiologic studies from four countries, involving 2,786 workers is reviewed for respiratory symptoms, pulmonary function, antibodies to swine house allergens, and exposure-response variables. Cough and phlegm were the most common symptoms (ranging from 12 to 55%). Tightness of chest and wheezing were frequently reported (12 to 33%) as well as episodes of organic dust toxic syndrome. Acute symptoms, directly associated with work, were from 1.5 to 2 times more prevalent than chronic symptoms. Baseline pulmonary function generally revealed decrements in flow rates, but not volumes; over-shift changes showed small decrements in both flows and volumes. IgG antibodies to swine house antigens were common; no relation to symptoms could be found. Exposure response studies were limited, but relationships were seen between endotoxin and pulmonary function decrements, or respiratory symptoms.

Iowa Agricultural Health and Safety Service Project

A model community-based comprehensive agricultural occupational health and safety service program has been implemented in Iowa. The functional center of coordination is based in the College of Medicine at the University of Iowa. The community-based hub of the service is the community hospital, where the majority of the direct client services originate. The University provides training of hospital staff, programming, direction, consultation, and referral. The services offered include primary care, health surveillance, industrial hygiene and safety, and education. Through a detailed evaluation of the project's objectives we will be able to evaluate, modify, and disseminate a model agricultural health and safety services delivery program. This model should be effective in changing the farming population's health and safety attitudes and behaviors through a community-based program.

Bronchial hyperreactivity among pig and dairy farmers

The presence of work-related symptoms, pulmonary functions, and bronchial reactivity were studied in farmers working with dairy animals or pigs. An increased incidence of the organic dust toxic syndrome, cough, and throat irritation was found. Pulmonary function baseline values were close to normal, and no significant decreases occurred over the work period. Bronchial reactivity was increased.

Effects of exposure to dust in swine confinement buildings--a working group report

Pulmonary and other symptoms among workers in swine confinement buildings were evaluated by an international working group. In several studies in five different countries a total of about 2000 workers has been studied in clinical and epidemiologic investigations. Symptoms indicative of acute and chronic airway inflammation were widespread, as were systemic reactions of organic dust toxic syndrome. The base-line, and across workshift, pulmonary function changes were moderate. There was no evidence that antigen-antibody reactions are important in the pathogenesis. Longitudinal studies are recommended to establish the relationship between acute and chronic symptoms and end stage disease.

Relationships of bovine leukemia virus prevalence in dairy herds and density of dairy cattle to human lymphocytic leukemia

A case-control study was conducted to examine possible relationships between human acute lymphoid leukemia and exposure to dairy cattle and drinking of raw milk. Two hundred twenty-three persons with acute lymphoid leukemia, diagnosed during the years 1969 to 1971 and 1973 to 1980 from the 87 most rural Iowa counties, were accessed from case records at the Iowa State Health Registry for participation in the present study. Each person and 2 matched controls were interviewed for history of residence, exposure to dairy cattle, and consumption of nonpasteurized dairy products. Two types of comparisons between affected persons and controls were done: the prevalence of bovine leukemia virus infection (as measured by serologic study) in dairy herds with which the affected persons and controls had either occupational contact or from which they had consumed raw milk and the density of dairy cattle in the townships where affected persons and controls lived. The bovine leukemia virus infection prevalence in dairy herds with which affected persons had contact was 20%, whereas the infection prevalence in the herds with which the controls had contact was 38%. The density of dairy cows in townships where affected persons resided was generally less than that in townships where controls resided. However, there was one exception; the density of dairy cows at 20 years before diagnosis was higher (589) in townships where affected adult female persons resided, compared with that in townships where controls resided (567).

Characterization of dusts collected from swine confinement buildings

As part of a project to evaluate health hazards for workers in swine confinement buildings, the air in 21 different buildings was sampled with 37 mm cassette filters with and without cyclone preselectors and with cascade impactors. Filter results yielded a mean total aerosol of 6.3 mg/m3, a mean respirable aerosol of 0.5 mg/m3; the geometric mean diameter was 2.9 microns. Cascade impactor measurements revealed a mean total aerosol of 7.6 mg/m3, a respirable aerosol of 2.5 mg/m3 and a mass median diameter of 9.6 microns. The two major constituents in these aerosols were grain particles and dried fecal matter. The grain particles were larger than fecal particles and proportionately more abundant in finishing buildings where 50 kg X 100 kg animals are housed. Therefore the respirable fraction was less in finishing buildings than in farrowing and nursery buildings. Culturing of settled dusts yielded six different mold species, with the highest counts for Verticillium sp. (5 X 10(2) cfu/mg dry dust) grown at 37 degrees C. Thermophilic Actinomycetes and both gram negative and gram positive bacteria were isolated. Azocasein proteinase activity was found in most dust samples analyzed. This dust had a protein content of about 23% and a mean adsorbed ammonia content of 0.4%.