Carbon disulphide. III. Risk factors for coronary heart diseases in workers in the viscose industry

Occupational risk factors for hypertension

The identification and characterization of the modifiable risk factors of hypertension is of great value for public health and clinical medicine to achieve primary prevention. A large amount of literature on the effects of occupational factors on blood pressure and hypertension has been published. In this review, I summarize current evidence regarding the role of occupational factors in hypertension. The results of this review suggest that there is sufficient evidence to support the association between increased risk of hypertension and job stress, shift work, occupational lead exposure, and noise exposure. The association of hypertension with physical inactivity, sedentary behavior, and occupational exposure to mercury, arsenic, cadmium, or carbon disulfide remains inconclusive, although several studies have reported this finding. This review will serve as a step toward future research and provide baseline information for developing strategic interventions to prevent hypertension in the working population.

Occupational chemical exposure and diabetes mellitus risk

Diabetes mellitus (DM) is a group of metabolic diseases that may originate from an interaction between genetic and lifestyle risk factors. However, the possible role of occupational chemical exposures in the disease development and progression remains unclear. Therefore, this review aimed to provide a comprehensive evaluation of the relationship between occupational exposure to specific chemical substances or industrial activities and DM morbidity and mortality outcomes. Although some positive findings may support the diabetogenic role of certain pesticides and dioxins in different workplaces, the variable conditions of exposure, the lack of quantitative environmental or biological monitoring data and the different outcomes evaluated do not allow defining a specific exposure-disease causality. Therefore, further epidemiological studies will be necessary to adequately assess modes of action for different substances, dose–response relationships as well as individual susceptibility factors potentially affecting the exposure-disease continuum. Overall, this appears important to adequately assess, communicate and manage risks in occupational chemical exposure settings with the aim to protect workers and build healthier job conditions for diabetic employees.

The emerging role of outdoor and indoor air pollution in cardiovascular disease

Outdoor and indoor air pollution poses a significant cardiovascular risk, and has been associated with atherosclerosis, the main underlying pathology in many cardiovascular diseases. Although, it is well known that exposure to air pollution causes pulmonary disease, recent studies have shown that cardiovascular health consequences of air pollution generally equal or exceed those due to pulmonary diseases. The objective of this article is to evaluate the current evidence on the emerging role of environmental air pollutions in cardiovascular disease, with specific focus on the types of air pollutants and mechanisms of air pollution-induced cardiotoxicity. Published literature on pollution was systematically reviewed and cited in this article. It is hoped that this review will provide a better understanding of the harmful cardiovascular effects induced by air pollution exposure. This will help to bring a better understanding on the possible preventive health measures and will also serve regulatory agencies and researchers. In addition, elucidating the biological mechanisms underlying the link between air pollution and cardiovascular disease is an essential target in developing novel pharmacological strategies aimed at decreasing adverse effects of air pollution on cardiovascular system.

Percutaneous absorption in diseased skin: an overview

The stratum corneum's (SC) functions include protection from external hazardous environments, prevention of water loss and regulation of body temperature. While intact skin absorption studies are abundant, studies on compromised skin permeability are less common, although products are often used to treat affected skin. We reviewed literature on percutaneous absorption through abnormal skin models. Tape stripping is used to disrupt water barrier function. Studies demonstrated that physicochemical properties influence the stripping effect: water-soluble drugs are more affected. Abrasion did not affect absorption as much. Freezing is commonly used to preserve skin. It does not seem to modify water absorption, but still increases the penetration of compounds. Comparatively, heating the skin consistently increased percutaneous absorption. Removing SC lipids may increase percutaneous absorption of drugs. Many organic solvents are employed to delipidize. Delipidization with chloroform-methanol increased hydrophilic compound permeability, but not lipophilic. Acetone pre-treatment enhanced hydrophilic compound penetration. More data is needed to determine influence on highly lipophilic compound penetration. Sodium lauryl sulfate (SLS) induces irritant dermatitis and is frequently used as a model. Studies revealed that SLS increases hydrophilic compound absorption, but not lipophilic. However, skin irritation with other chemicals increases lipophilic penetration as much as hydrophilic. Animal studies show that UV exposure increases percutaneous absorption whereas human studies do not. Human studies show increased penetration in psoriatic and atopic dermatitis skin. The data summarized here begin to characterize flux alteration associated with damaged skin. Understanding the degree of alteration requires interpretation of involved conditions and the enlarging of our database to a more complete physicochemical spectrum.

Risk for hypertension in workers exposed to carbon disulfide in the viscose rayon industry

BACKGROUND

Chronic exposure to carbon disulfide (CS(2)) has been associated with hypertension, elevated cholesterol, arteriosclerosis, ischemic heart disease and related mortality, adverse nervous and reproductive health effects, and hearing impairment. This study assessed the hypertension risk for male rayon workers exposed to CS(2).

METHODS

A total of 251 rayon workers and 226 administrative clerks at two plants in Taiwan received health examination and interviews, and were compared for hypertension risk. On-site CS(2) levels were measured.

RESULTS

The hypertension was more prevalent in the exposure group (43.4%) than in controls (7.1%) with greater impact on systolic blood pressure than diastolic. Multivariate logistic regression analysis showed a significant dose-response relationship between hypertensive risk and cumulative exposure index (CEI) with an odds ratio of 15.1 for workers exposed to 343-468 year-ppm of CS(2). The overall risk was elevated to 7.6 times higher for rayon workers. The risk increased significantly after more than 10 years of employment.

CONCLUSIONS

This study suggests that it takes a long exposure period to develop hypertension for rayon workers with CS(2) exposure.

Electrocardiographic Abnormality for Workers Exposed to Carbon Disulfide at a Viscose Rayon Plant

OBJECTIVE

This study investigated electrocardiography (ECG) manifestations for male workers with carbon disulfide exposure at rayon manufacturing plants.

METHODS

A total of 251 men in the exposure group and 226 administrative clerks in the reference group received physical examinations and completed questionnaires.

RESULTS

The prevalence of ECG abnormalities was much higher in the carbon disulfide exposure group (25.9%, n = 65) than in the reference group (2.7%, n = 6), with an odds ratio (OR) of 12.8 (95% confidence interval [CI] = 5.4-30.2). The foremen were at the highest risk of abnormal ECG (OR = 20.6, 95% CI = 6.5-65.2), followed by filament-spinning workers (OR = 14.2, 95% CI = 5.7-35.3), viscose-manufacturing workers (OR = 11.3, 95% CI = 4.3-30.1), and carbon disulfide-manufacturing workers (OR = 8.1, 95% CI = 2.7-25.6). The multivariate logistic regression analysis based on cumulative exposure index also showed a dose-response relationship with the exposure, and the risk of ECG abnormality could be initiated at the exposure history of 31 to 57 year-ppm with an OR of 7.2 (95% CI = 1.5-36.7).

CONCLUSIONS

In general, the ECG abnormalities observed in workers at the permissible exposure level of carbon disulfide implicate the importance of environmental control of the chemical and of workers' education in exposure prevention at work.

A six year follow up study of the subclinical effects of carbon disulphide exposure on the cardiovascular system

AIMS

A six year prospective cohort study was conducted to clarify whether the current carbon disulphide (CS2) exposure level is low enough to prevent subclinical health impairment and/or to ameliorate health effects due to previous high exposure. This paper describes the effects on the cardiovascular systems.

METHODS

The study subjects were 432 male workers exposed to CS2 and 402 non-exposed workers in Japan, all of whom were examined in 1992-93. A total of 251 CS2 exposed, 140 formerly exposed, and 359 non-exposed workers participated in the follow up survey (follow up rate 89.9%) in 1998-99. Mean duration of exposure was 19.3 years at the end the study. Mean CS2 and 2-thiothiazolidine-4-carboxylic acid (TTCA) concentrations were 5.0 ppm and 1.6 mg/g creatinine. Health items examined were serum biochemical indices including lipids and coagulation-fibrinolysis factors, blood pressure, aortic stiffness, ophthalmography, and electrocardiography at rest and after Master's double 2 step test. Potential confounding factors were adjusted for.

RESULTS

Incidence of ischaemic findings, defined as Minnesota codes I, IV(1-3), V(1-3) (at rest and after the load), or receiving treatment for ischaemia, was significantly higher in the exposed workers, especially for the spinning/refining workers (adjusted OR 2.1; 95% CI 1.1 to 4.0) or the highest quartile of six year mean TTCA (adjusted OR 3.9; 95% CI 1.8 to 8.7), although the observed increase in risk was diminished when rigorous ECG criteria were applied. Incidence of retinal microaneurysm was increased with marginal significance. Among cardiovascular risk factors we examined, only blood pressure values were significantly increased in the exposed workers.

CONCLUSIONS

Increased risk of ischaemic electrocardiogram findings among Japanese viscose rayon workers was observed. Although its clinical significance is to be discussed, the current Japanese occupational exposure limit for CS2, 10 ppm, would be high to prevent subclinical cardiovascular effects in this study population.

Cross-sectional study of cardiovascular effects of carbon disulfide among Chinese workers of a viscose factory

OBJECTIVE

This cross-sectional study investigates the cardiovascular effects among Chinese workers who were occupationally exposed to carbon disulfide (CS2), and evaluates the protective value of the current Chinese Maximum Allowable Concentration (MAC) of CS2 against cardiovascular effects.

METHODS

The measurements of exposure were performed by personal sampling and gas chromatography. The biological monitoring was performed by HPLC. Three hundred and sixty-seven exposed workers and 125 reference workers (never exposed to CS2,) were included in this study. The exposed workers were divided into 2 sub-groups according to their cumulative exposure indices, the cut-off point being at 100 which means 10 years exposure to the Chinese Maximum Allowable Concentration in the workplace (10 mg/m3). All subjects were examined using a self-administered questionnaire including medical and job history, clinical complaints in the previous three months, and underwent a clinical check-up and a 12 lead electrocardiography (ECG) at rest, coded according to the Minnesota code. Blood pressure (BP) was recorded and blood samples were collected for lipid measurements.

RESULTS

The personal monitoring showed that the exposures levels (15.47 +/- 2.34 mg/m3) were below the Threshold Limit Value (TLV, 31 mg/m3), and most of the samples analyzed still showed higher values than the Chinese MAC (10 mg/m3). Clinical complaints and abnormal electrocardiograms were not significantly increased in exposed workers. No significant effect of CS2 on blood pressure, cholesterol, HDL and LDL cholesterol or triglycerides was found. Further studies are recommended to elucidate the mechanism of cardiac intoxication after CS2 exposure.

CONCLUSION

This study showed that Chinese workers exposed to CS2 did not have more clinical complaints, nor more ECG abnormalities than controls and no adverse effects were found in their lipids at an exposure level below the current TLV. The present results indicate that differences of health effects reported worldwide are possibly due to different exposure levels. They also indicate that the current Chinese MAC (10 mg/m3) sufficiently protects workers against negative cardiovascular effects.

Lack of Relationship between Occupational Exposure to Carbon Disulfide and Endocrine Dysfunction: A Six‐year Cohort Study of the Japanese Rayon Workers

OBJECTIVES

A six-year prospective cohort study was conducted to clarify whether the current carbon disulfide (CS2) exposure level is low enough to prevent subclinical health impairment and/or to ameliorate health effects due to previous high exposure. This paper describes the follow-up results, exposure assessment, and effects on the endocrine system.

METHODS

The study subjects were 432 male workers exposed to CS2 at one of the 11 rayon factories in Japan and 402 referent workers from the same factories, all of whom were examined in 1992-93. 251 CS2-exposed, 140 former-exposed and 359 referent workers participated in the follow-up survey (follow-up rate 89.9%) in 1998-99. Urinary 2-thiothiazolidine-4-carboxylic acid (TTCA) at the end of a shift as internal exposure index and the time-weighted average CS2 concentration as external exposure index were measured twice a year from 1992-1993. By using various blood indices, we evaluated effects on thyroid, hypophysis, and gonad function, as well as effects on glucose metabolism. Information on potential confounding factors, such as age, smoking and alcohol drinking, were collected and adjusted for.

RESULTS

When the individual exposure level was represented by arithmetic mean for TTCA and CS2 concentration, geometric means (SD) of CS2 workers were 1.61 (1.91) mg/g.crea and 5.02 (1.84) ppm, respectively. There were no exposure-related differences in glucose metabolism or any of the endocrinological indices.

CONCLUSIONS

No biologically significant effects of CS2 were found on endocrine function in Japanese rayon manufacturing workers when the average internal and external exposure levels were maintained below the current occupational exposure limit.

Cross sectional observation of the effects of carbon disulphide on the nervous system, endocrine system, and subjective symptoms in rayon manufacturing workers

OBJECTIVES

A prospective cohort study was initiated to clarify whether the current level of exposure to carbon disulphide (CS2) is low enough to prevent occurrence of subclinical health impairments or to ameliorate health effects due to past high exposure. This paper describes the effects of exposure to CS2 on the nervous and endocrine systems, and the subjective symptoms in a baseline observation.

METHODS

The effects were evaluated of CS2 on the median nerve conduction velocity, neurobehavioural and psychological tests, and subjective symptoms related to solvents in 432 male workers exposed to CS2 and 402 reference workers from 11 rayon factories in Japan. Adjustment was made for potential confounding factors such as age or alcohol drinking. Exposure to CS2 was either dichotomised or categorised into three groups by job type.

RESULTS

Reductions were observed in motor (-1.9 m/s) and sensory (-0.91 m/s for orthodromic and -1.1 m/s for antidromic) nerve conduction velocities in the workers exposed to CS2 at the spinning and refining processes. Small but significant increases were found in self rated depression scale score and decrease in digit span (backward) in the workers exposed to CS2. Of 54 subjective symptoms many were increased--namely, heavy feeling in the head, light headedness, fainting after suddenly standing up, tremor, dullness, and increased sensitivity of skin in the extremities, reduced grasping power, reduced sexual desire, and increased rough skin. The endocrinological indicator--the concentration of glycosylated haemoglobin--was also increased in the workers exposed to CS2.

CONCLUSIONS

Subclinical effects on the nervous system and on glucose metabolism were found in the workers exposed to CS2. One interpretation is that relatively higher exposure to CS2 in the past may induce these, but the effects are still not entirely ameliorated under the current exposure to CS2. Another possibility is that the current exposure to CS2 may cause these positive findings. A follow up observation is necessary to clarify these questions.