Upper airway inflammation and respiratory symptoms in domestic waste collectors

Respiratory health of municipal solid waste workers

BACKGROUND

There is an increasing evidence that the incidence of work-related pulmonary problems is greater in waste collectors than in the general workforce.

AIMS

To evaluate the respiratory health of municipal solid waste workers (MSWWs).

METHODS

One hundred and eighty-four municipal employees of Keratsini (104 MSWWs and 80 controls) participated in a cross-sectional study. All participants were asked to fill in a slightly modified version of the Medical Research Council questionnaire. Lung function was evaluated by spirometry.

RESULTS

Spirometry revealed reduced mean forced vital capacity (FVC) and forced expiratory volume in 1 s (as a percentage of predicted values) in MSWWs compared with controls. After adjustment for smoking status, only the decline in FVC was statistically significant (P < 0.05). Prevalence of all respiratory symptoms was higher in MSWWs than in controls. After adjustment for confounding factors, the difference reached statistical significance (P < 0.05) for morning cough, cough on exertion and sore throat.

CONCLUSIONS

The results of this cross-sectional study indicate a higher prevalence of respiratory symptoms and a greater decrease in lung function in MSWWs. A number of limitations such as the relatively small size of population and the 'healthy worker' effect should be taken into account.

beta-(1,3)-Glucan exposure assessment by passive airborne dust sampling and new sensitive immunoassays

Associations between house dust-associated beta-(1,3)-glucan exposure and airway inflammatory reactions have been reported, while such exposures in early childhood have been suggested to protect against asthma and wheezing. Most epidemiological studies have used reservoir dust samples and an inhibition enzyme immunoassay (EIA) for beta-(1,3)-glucan exposure assessment. The objective of this study was to develop inexpensive but highly sensitive enzyme immunoassays to measure airborne beta-(1,3)-glucans in low-exposure environments, like homes. Specificities of available anti-beta-(1,3)-glucan antibodies were defined by direct and inhibition experiments. Three suitable antibody combinations were selected for sandwich EIAs. beta-(1,3)-Glucans in passive airborne dust collected with an electrostatic dust fall collector (EDC) and floor dust from seven homes were measured with the three EIAs. Floor dust samples were additionally analyzed in the inhibition EIA. The sandwich EIAs were sensitive enough for airborne glucan measurement and showed different specificities for commercial glucans, while the beta-(1,3)-glucan levels in house dust samples correlated strongly. The feasibility of measuring glucans in airborne dust with the recently introduced EDC method was further investigated by selecting the most suitable of the three EIAs to measure and compare beta-(1,3)-glucan levels in the EDC and in floor and actively collected airborne dust samples of the previously performed EDC validation study. The EDC beta-(1,3)-glucan levels correlated moderately with beta-(1,3)-glucans in actively collected airborne dust and floor dust samples, while the glucan levels in the airborne dust and floor dust samples did not correlate. The combination of the newly developed beta-(1,3)-glucan sandwich EIA with EDC sampling now allows assessment in large-scale population studies of exposure to airborne beta-(1,3)-glucans in homes or other low-exposure environments.

The influence of sampling duration on recovery of culturable fungi using the Andersen N6 and RCS bioaerosol samplers

The influence of sampling duration on recovery of culturable fungi was compared using the Andersen N6 and the Reuter Centrifugal Sampler (RCS). Samplers were operated side-by-side, collecting 15 samples each of incrementally increasing duration (1-15 min). From 270 samples collected, 26 fungal genera were recovered. Species of Alternaria, Aspergillus, Cladosporium, Epicoccum, Penicillium and Ulocladium were most frequent. Data adjusted to CFU/m3 were fitted to a Poisson regression model with a logarithmic link function and evaluated for the impact of sampling time on qualitative and quantitative recovery of fungi, both as individual taxa and in aggregate according to xerotolerance. Significant differences between the two samplers were observed for xerotolerant and normotolerant moulds, as well as Aspergillus spp. and Cladosporium spp. With the exception of Cladosporium spp., overall recoveries were higher with the RCS. When the Andersen N6 was used, the recovered levels of Cladosporium spp. and unidentified yeasts were reduced significantly at sampling times over 6 min. Similarly, when the RCS was used, recovery of Aspergillus spp., Penicillium spp., Ulocladium spp., unidentified yeasts, and low water activity fungi declined significantly at sampling times over 6 min.

PRACTICAL IMPLICATIONS

Currently, the industry-wide trend for viable air sampling in indoor environmental investigations is to use sampling times between 2 and 4 min in duration. Our results support the routine use of a 6-min sampling time where low spore loads are expected, resulting in improved limits of detection.

Ambient air monitoring of Beijing MSW logistics facilities in 2006

In China, "green" integrated waste management methods are being implemented in response to environmental concerns. We measured the air quality at several municipal solid waste (MSW) sites to provide information for the incorporation of logistics facilities within the current integrated waste management system. We monitored ambient air quality at eight MSW collecting stations, five transfer stations, one composting plant, and five disposal sites in Beijing during April 2006. Composite air samples were collected and analyzed for levels of odor, ammonia (NH3), hydrogen sulfide (H2S), total suspended particles (TSPs), carbon monoxide (CO), sulfur dioxide (SO2), and nitrogen dioxide (NO2). The results of our atmospheric monitoring demonstrated that although CO and SO2 were within acceptable emission levels according to ambient standards, levels of H2S, TSP, and NO2 in the ambient air at most MSW logistics facilities far exceeded ambient limits established for China. The primary pollutants in the ambient air at Beijing MSW logistics facilities were H2S, TSPs, NO2, and odor. To improve current environmental conditions at MSW logistics facilities, the Chinese government encourages the separation of biogenic waste from MSW at the source.

Acute effect of glucan-spiked office dust on nasal and pulmonary inflammation in guinea pigs

The acute effects of pure inhaled glucan on respiratory inflammation remain inconclusive and not sufficiently examined with regards to the simultaneous interaction of glucan, endotoxin (lipopolysaccharide, LPS), and house dust in airway inflammation. This study aims at determining effects of simultaneous exposure to office dust and glucan on nasal and pulmonary inflammation. This is relevant for humans with occupational exposure in waste handling and farming and buildings with mold problems. Office dust collected from Danish offices was spiked with 1% (1-3)-beta-glucan (curdlan). Guinea pig nasal cavity volume was measured by acoustic rhinometry (AR) and animals were exposed by inhalation for 4 h to curdlan-spiked dust, unspiked dust, purified air (negative controls), or LPS (positive controls). After exposure (+5 h) or the following day (+18 h), measurements were repeated by AR and followed by bronchoalveolar lavage (BAL). Total and differential cell counts, interleukin (IL)-8 in BAL fluid, and change in nasal volume were compared between groups. A 5-10% increase in nasal volume was seen for all groups including clean air except for a significant 5% decrease for spiked-dust inhalation (+18 h). No marked differences were observed in BAL cells or IL-8 except in LPS-exposed controls. The delayed decrease of nasal cavity volume after exposure to glucan spiked dust suggests a slow effect on the upper airways for curdlan and office dust together, though no pulmonary response or direct signs of inflammation were observed. Glucan-spiked office dust exposures produced a delayed nasal subacute congestion in guinea pigs compared to office dust alone, but extrapolated to nasal congestion in humans, paralleling the nasal congestion seen in human volunteers exposed to the same dust, this may not have clinical importance.

Analysis of portable impactor performance for enumeration of viable bioaerosols

Portable impactors are increasingly being used to estimate concentration of bioaerosols in residential and occupational environments; however, little data are available about their performance. This study investigated the overall performances of the SMA MicroPortable, BioCulture, Microflow, Microbiological Air Sampler (MAS-100), Millipore Air Tester, SAS Super 180, and RCS High Flow portable microbial samplers when collecting bacteria and fungi both indoors and outdoors. The performance of these samplers was compared with that of the BioStage impactor. The Button Aerosol Sampler equipped with gelatin filter was also included in the study. Results showed that the sampling environment can have a statistically significant effect on sampler performance, most likely due to the differences in airborne microorganism composition and/or their size distribution. Data analysis using analysis of variance showed that the relative performance of all samplers (except the RCS High Flow and MAS-100) was statistically different (lower) compared with the BioStage. The MAS-100 also had statistically higher performance compared with other portable samplers except the RCS High Flow. The Millipore Air Tester and the SMA had the lowest performances. The relative performance of the impactors was described using a multiple linear regression model (R(2) = 0.83); the effects of the samplers' cutoff sizes and jet-to-plate distances as predictor variables were statistically significant. The data presented in this study will help field professionals in selecting bioaerosol samplers. The developed empirical formula describing the overall performance of bioaerosol impactors can assist in sampler design.

House dust (1-3)-beta-D-glucan and wheezing in infants

BACKGROUND

(1-3)-Beta-D-glucan is a fungal cell wall component, suspected to cause respiratory symptoms in adults. However, very little is known on the possible health effects of (1-3)-beta-D-glucan during infancy. We examined the association between (1-3)-beta-D-glucan exposure and the prevalence of allergen sensitization and wheezing during the first year of life in a birth cohort of 574 infants born to atopic parents. Endotoxin exposure was included as a possible confounder.

METHODS

(1-3)-Beta-D-glucan and endotoxin exposures were measured in settled dust collected from infants' primary activity rooms. The primary outcomes at approximately age one included parental reports of recurrent wheezing and allergen sensitization evaluated by skin prick testing to a panel of 15 aeroallergens as well as milk and egg white.

RESULTS

Exposure to high (1-3)-beta-D-glucan concentration (within fourth quartile) was associated with reduced likelihood of both recurrent wheezing [adjusted OR (aOR) = 0.39, 95% CI = 0.16-0.93] and recurrent wheezing combined with allergen sensitization (aOR = 0.13, 95% CI = 0.03-0.61). Similar trends were found between (1-3)-beta-D-glucan concentrations and allergen sensitization (aOR = 0.57, 95% CI = 0.30-1.10). In contrast, recurrent wheezing with or without allergen sensitization was positively associated with low (1-3)-beta-D-glucan exposure within the first quartile (aOR = 3.04, 95% CI = 1.25-7.38; aOR = 4.89, 95% CI = 1.02-23.57). There were no significant associations between endotoxin exposure and the studied health outcomes.

CONCLUSIONS

This is the first study to report that indoor exposure to high levels of (1-3)-beta-D-glucan (concentration >60 microg/g) is associated with decreased risk for recurrent wheezing among infants born to atopic parents. This effect was more pronounced in the subgroup of allergen-sensitized infants.

Change in airway responsiveness over a workweek in organic waste loaders

OBJECTIVE

Organic waste workers are exposed to high endotoxin levels that may result in respiratory health effects. This study describes changes in lung function and methacholine airway responsiveness over a workweek in household organic waste loaders.

METHODS

Assessment of lung function and methacholine airway responsiveness before and after a workweek in six organic waste loaders with and ten loaders without regular respiratory symptoms. Methacholine responsiveness was expressed as dose-response slope, i.e. % fall in FEV(1) per mg methacholine compared to either the post-saline value (DRS(sal)), or the highest FEV(1) (DRS(max)).

RESULTS

Monday morning, FEV(1) was similar in cases and controls. Over the workweek, FEV(1) and MMEF decreased slightly in both cases and controls (P > 0.10). In contrast, DRS increased in cases and decreased in control subjects (P < 0.10). The difference in % change of DRS was statistically significant after adjustment for smoking and age.

CONCLUSION

Our results suggest exaggeration of pre-existent airway inflammation during the workweek in organic waste loaders with regular respiratory symptoms. This needs confirmation in larger studies.

Use of portable microbial samplers for estimating inhalation exposure to viable biological agents

Portable microbial samplers are being increasingly used to determine the presence of microbial agents in the air; however, their performance characteristics when sampling airborne biological agents are largely unknown. In addition, it is unknown whether these samplers could be used to assess microbial inhalation exposure according to the particle sampling conventions. This research analyzed collection efficiencies of MAS-100, Microflow, SMA MicroPortable, Millipore Air Tester, SAS Super 180, BioCulture, and RCS High Flow portable microbial samplers when sampling six bacterial and fungal species ranging from 0.61 to 3.14 microm in aerodynamic diameter. The efficiencies with which airborne microorganisms were deposited on samplers' collection medium were compared to the particle inhalation and lung deposition convention curves. When sampling fungi, RCS High Flow and SAS Super 180 deposited 80%-90% of airborne spores on agar - highest among investigated samplers. Other samplers showed collection efficiencies of 10%-60%. When collecting bacteria, RCS High Flow and MAS-100 collected 20%-30%, whereas other samplers collected less than 10% of these bioparticles. Comparison of samplers' collection efficiencies with particle inhalation convention curves showed that RCS High Flow and SAS Super 180 could be used to assess inhalation exposure to particles larger than 2.5 microm, such as fungal spores. Performance of RCS High Flow sampler was also reflective of the particle lung deposition pattern when sampling both bacteria and fungi. MAS-100 and SAS Super 180 matched the total deposition curve fairly well when collecting bacterial and fungi species, respectively. For other tested samplers, we observed substantial discrepancies between their performances and particle deposition efficiencies in the lung. The results show that feasibility of applying portable microbial samplers for exposure assessment depends on a particular sampler model and microbial species.

Exposure to aerosolized bacteria and fungi among collectors of commercial, mixed residential, recyclable and compostable waste

Biological hazards associated with the collection of solid and compostable waste have not been well characterized in North America. This is an issue because workers who handle such materials may be exposed to bioaerosols (airborne bacteria and fungi) and dusts resulting in infections or allergic diseases. We conducted a personal sampling campaign for culturable bacteria and fungi in the breathing zones of waste collectors in a variety of typical work settings (scenarios) in the province of Quebec, Canada. Total culturable bacterial and fungal counts were analyzed and compared to ambient environmental levels (background) to determine the degree of incremental exposure among workers. In several scenarios, worker exposure counts were significantly (p < or = 0.05) higher than ambient levels measured upwind, with the highest personal exposures to bacteria observed for urban compostable waste collectors (median = 50,300 Colony Forming Units/m(3) of air (CFU/m(3))). On the other hand, fungal counts collected on an every-other-week cycle were highest among a group of rural compostable waste collectors (median = 101,700 CFU/m(3)). Similar exposures to culturable bacteria and fungi have been reported in European workers who showed such adverse health effects as nausea, diarrhea, upper respiratory tract irritation, and allergy. Therefore, it may be necessary to modify certain work practices in order to minimize exposure. Recommendations include automation of waste and compost collection, use of personal protective equipment including goggles, gloves, and disposable masks, and meticulous personal hygiene.

Endotoxin and occupational airway disease

PURPOSE OF REVIEW

This review provides an update on the role of bacterial endotoxin in occupational airway disease, a problem of importance from diagnostic and preventive points of view.

RECENT FINDINGS

Data from human inhalation studies have increased our understanding of the cell mechanisms underlying diseases related to endotoxin exposure. In addition, knowledge from molecular genetics may help us to identify individuals at risk. Several investigations have demonstrated that, apart from endotoxin, other microbial cell wall agents are also related to the risk for symptoms of occupational lung diseases, with pathogenic mechanisms different to those caused by endotoxin. Diagnostic methods have progressed from traditional lung function measurements to sampling of indicators of inflammation in the blood, nasal lavage and induced sputum. Investigations of a longitudinal design have provided important findings on the relationship between acute and chronic effects as well as exposures of risk and risk factors among individuals.

SUMMARY

Endotoxin, as well as other agents derived from microbes, are important causative agents for occupational respiratory and other diseases, and exposure may occur in a large variety of occupational environments. Recent data from longitudinal studies provide important information on diagnostic and preventive measures.

The assessment of airborne bacterial contamination in three composting plants revealed site-related biological hazard and seasonal variations

AIMS

The purpose of this study was to evaluate the degree of bacterial contamination generated by three Italian composting plants (1, 2 and 3) in two different seasons and to assess the health risk for the employees.

METHODS AND RESULTS

Aerosols samples were collected with an agar impact sampler. Several plant sites and external upwind and downwind controls were examined. Total colony-forming counts of mesophilic and thermophilic bacteria, actinomycetes and streptomycetes, Gram-negatives, coliforms and sulfite-reducers were determined. Selective media were used in order to isolate pathogenic bacteria. The levels of total mesophilic and thermophilic micro-organisms ranged between 33 and >40,000 CFU m(-3) in plant 1, 39 and 18,700 CFU m(-3) in plant 2 and 261 and 6278 CFU m(-3) in plant 3. Strains of Escherichia coli, Staphylococcus aureus and Clostridium perfringens were also found.

CONCLUSIONS

The plants monitored in this study have proved to be sources of aerosolized bacteria. The activities involving mechanical movement of the composting mass and the indoor activities were of greatest potential risk. In all the studied plants, a statistically significant dependence was found between the bacterial contamination and the season for some or almost all the analysed parameters, but a clear seasonal trend could not be observed.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides broad evidence of bacterial aerosol dispersion and site-related biological hazards that may be useful to the regional government to implement regulations on worker safety in composting plants.

(1-->3)-Beta-D-glucans and respiratory health: a review of the scientific evidence

(1-->3)-Beta-D-glucan are non-allergenic structural cell wall components of most fungi that have been suggested to play a causal role in the development of respiratory symptoms associated with indoor fungal exposure. This review describes the currently available epidemiological literature on health effects of (1-->3)-beta-D-glucan, focusing on atopy, airway inflammation and symptoms, asthma, and lung function. In addition to population studies, studies in human volunteers experimentally exposed to (1-->3)-beta-D-glucan are described as well as relevant animal studies. Furthermore, the review discusses exposure assessment methods, the potential for exposure control and it concludes with identifying research needs. The observational and experimental studies reviewed suggested some association between (1-->3)-beta-D-glucan exposure, airway inflammation and symptoms, however, results were mixed and specific symptoms and potential underlying inflammatory mechanisms associated with exposure could not be identified. Large observational studies using well validated exposure assessment methods are needed to further our knowledge regarding the potential health effects of indoor (1-->3)-beta-D-glucan exposure.

PRACTICAL IMPLICATIONS

The currently available epidemiological data do not permit conclusions to be drawn regarding the presence (or absence) of an association between environmental (1-->3)-beta-D-glucan exposure and specific adverse health effects, nor is it clear from the currently available evidence which specific immunological mechanisms underlie the presumed health effects. More and larger observational studies are needed to asses whether (1-->3)-beta-D-glucan exposure plays a significant role in respiratory morbidity. In addition, existing methods to assess environmental (1-->3)-beta-D-glucan exposure require validation and further development before they can be used routinely in large scale epidemiological studies.

Endotoxin exposure and atopic sensitization in adult pig farmers

BACKGROUND

Recent studies have reported a low prevalence of atopic sensitization and respiratory allergy in children growing up on farms.

OBJECTIVES

We sought to evaluate the dose-response relationship between endotoxin and atopic sensitization in adult farmers and to assess the effect on respiratory health outcomes.

METHODS

Data on endotoxin exposure and serum IgE levels were available for 162 pig farmers from a cross-sectional case-control study, with case selection on the basis of respiratory symptoms. Exposure to endotoxin was modeled in detail, and respiratory health effects were assessed during a medical examination. Exploratory analysis was done by using nonparametric modeling and was followed by classical parametric regression.

RESULTS

IgE to one or more common allergens was detected in sera from 28 (17%) farmers. The average (geometric mean) total serum IgE levels was 37 IU/mL (geometric SD, 4 IU/mL). A strong inverse relationship was found between endotoxin and sensitization to common allergens for exposures of 75 ng/m 3 or less, with an odds ratio of 0.03 (95% CI, 0.0-0.34) for a 2-fold increase in endotoxin. For endotoxin exposure of greater than 75 ng/m 3 , the association was weak (odds ratio, 1.2 [95% CI, 0.38-3.6]). No association was found between endotoxin exposure and total serum IgE levels. Endotoxin was associated with increased airway hyperresponsiveness to histamine and lower lung function in sensitized farmers, without evidence of a nonlinear relationship.

CONCLUSIONS

The prevalence of atopic sensitization in adult pig farmers is low. Endotoxin or related exposures might protect from sensitization, even in an adult working population exposed to high levels of endotoxin, but is a risk factor for increased airway hyperresponsiveness and low lung function.

Preventive measures to reduce bioaerosol exposure during refuse collection: results of field studies in the real-life situation

The aim of the present research project was to investigate and evaluate technical and organisational measures targeted at bioaerosol reduction during the refuse collection and to determine the exposure of refuse collectors to dust, fungi and endotoxins in an on-the-job situation with different vehicle technologies and states of hygiene. The following technical factors were found to influence the bioaerosol concentration at the refuse collector's workplace: compaction method, lifting device control, rave rail height, hopper depth, design of intake area and dust interception. For instance, notably higher total fungal counts were recorded with rotating drum compaction than with packer plate compaction. A hinged lid closure at the lifting device in conjunction with a suction unit induced a positive effect. In addition, the automatic lifting system had a positive influence on rear-end loaders, as did loading operation control from the closed driver's cab on side loaders. Regular internal and external high-pressure cleaning of the lifting device at intervals of not more than 14 days is recommended as a basic rule for vehicle hygiene.

Working Group report 1: tools for the diagnosis of organic dusts-induced disease

This paper describes the outcomes of the discussion of Working Group 1. The tasks of the workgroup were to: i) review current methods for the clinical diagnosis of organic dust induced disease, and ii) suggest how further research in this field should proceed. The working group proceeded on the paradigm that for diagnosis specific and precise tests are needed, where outcomes can be related to the risk for disease. The different methods available for the investigation of individuals and groups exposed to organic dusts are summed and graded according to scientific or diagnostic values. Many of the tools should be used in experimental research only, but can be used diagnostically for evaluation during follow up of patients when treated or removed from exposure. These techniques may also be employed for investigations of outbreaks, however, only after comparison with a proper control group. Future research should focus on associations between markers of inflammation and symptoms or clinical outcomes and dose-response relationships both for short-term and long-term health effects.

Upper airway inflammation in waste handlers exposed to bioaerosols

AIMS

To examine work associated upper airway inflammation in 31 waste handlers, and to correlate these findings with personally monitored exposure to different bioaerosol components.

METHODS

Cell differentials, interleukin 8 (IL-8), myeloperoxidase (MPO), and eosinophilic cationic protein (ECP) were examined in NAL (nasal lavage), and swelling of the nasal mucosa was determined by acoustic rhinometry before work start on Monday and the following Thursday. Bioaerosol exposure was determined by personal full shift exposure measurements on Monday, Tuesday, and Wednesday and analysed for total bacteria, fungal spores, endotoxin, and beta(1-->3)-glucans.

RESULTS

The increased percentage of neutrophils from Monday (28%) to Thursday (46%) correlated with increases in ECP (r(S) = 0.71, p < 0.001) and MPO (r(S) = 0.38, p < 0.05), and showed a close to significant correlation with nasal swelling (r(S) = -0.55, p = 0.07). The Thursday levels of neutrophils, MPO, and IL-8 were associated with the exposure to fungal spores (range 0-2.0 x 10(6)/m(3)) and endotoxin (range 4-183 EU/m(3)) measured the day before, and the median exposure to beta(1-->3)-glucans (range 3-217 ng/m(3)), respectively (r(S) = 0.47-0.54, p < 0.01). Swelling of the nasal mucosa was associated with the fungal spore and beta(1-->3)-glucan exposure (r(S) = 0.58-0.59, p < 0.05).

CONCLUSION

These results are based on a relatively small population, and conclusions must be drawn with care. The results suggested that a moderate exposure to fungal spores, endotoxins, and beta(1-->3)-glucans during waste handling induced upper airway inflammation dominated by neutrophil infiltration and swelling of the nasal mucosa.

Estudo epidemiologico dos coletores de lixo seletivo

O artigo aborda epidemiologicamente o perfil dos coletores de lixo seletivo e descreve as lesões musculares e acidentes de trabalho mais freqüentes. Este estudo transversal foi desenvolvido com duas empresas (denominadas como empresa A e empresa B), em Porto Alegre, selecionando-se 50 funcionários aleatoriamente (presentes e aptos nos dias das entrevistas para a pesquisa) e aos quais foi aplicado um questionário. A Média de idade da amostra foi de 34 e 22 anos para a empresa A e B, respectivamente. Cerca de 66% dos funcionários da empresa B trabalham a menos de 5 anos na companhia, ao passo que 95% dos funcionários da empresa A trabalham há mais de 5 anos. O índice de lesões entre as duas empresas é alta 90% e 46,6% para empresas A e B, respectivamente. Lesões são mais comuns nos membros inferiores, seguidas pelas lesões dos membros superiores e da coluna. Ambas as empresas apresentavam deficiência do uso de equipamentos de proteção, sendo estes praticamente ignorados pelos funcionários, embora de uso obrigatório. As avaliações médicas são realizadas esporadicamente, sem acompanhamento regular. Ambas as empresas apresentam altos índices de leões em geral, sendo as lesões de membros inferiores mais comuns. Também são altos os índices de cortes e outros pequenos ferimentos, provavelmente pelo não uso de equipamentos de proteção obrigatórios.