Small bakeries--a cross-sectional study of respiratory symptoms, sensitization and dust exposure

Work-related musculoskeletal disorders and related risk factors among bakers: A systematic review

BACKGROUND

Work-related musculoskeletal disorders (WRMSDs) and ergonomic risk factors are very common in bakery workers.

OBJECTIVE

The purpose of this study is to (1) assess the prevalence of musculoskeletal disorders among bakers because they use automated machines or traditional baking, and (2) to determine the strategies to prevent musculoskeletal disorders in bakers.

METHODS

A systematic review of PubMed, Scopus, and Web of Science was conducted from the beginning to February 4, 2022, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Mesh keywords and phrases were used to execute the search strategy. Information on MSDs and ergonomic risk factors in bakery workers was collected. Two reviewers worked independently on study selection, data extraction, and paper quality ranking.

RESULTS

This study identified 14 papers from seven countries. Although the prevalence of MSDs in bakery workers has been studied, only a handful of them have been studied ergonomic risk factors, and the findings have been very limited. The association between different risk factors and MSDs seemed significant compared to many other occupational diseases. The traditional bread-baking system and lack of mechanization may increase the risk of MSDs in bakery workers.

CONCLUSION

WRMSDs for bakery workers have been less studied than other occupational diseases. Our systematic review found several significant relations between the factors influencing the prevalence of MSDs. This study also showed the comparison of traditional and modern cooking systems with diseases of the upper limbs, shoulders, and back pain as possible fields for future research.

Lung Function of Grain Millers Exposed to Grain Dust and Diesel Exhaust in Two Food Markets in Ibadan Metropolis, Nigeria

Background

Despite growing concern over occupational exposure to particulate matter (PM) such as grain dust and diesel exhaust, information about the exposure level and health implications among workers in small-scale milling enterprises in developing countries like Nigeria has not been adequately documented. The purpose of this study was to assess the level of exposure to grain dust and diesel exhaust and effect on lung function among grain millers in food markets in Ibadan metropolis, Nigeria.

Methods

The study adopted descriptive cross-sectional design with a comparative approach. Sixteen grain milling shops each were randomly selected from two major food markets in Ibadan metropolis for indoor PM₁₀ and PM_2.5 monitoring. Seventy-two respondents each were proportionately selected from grain millers and shop owners for forced expiratory volume in one second and peak expiratory flow rate tests.

Results

The PM_2.5 concentrations for both market locations ranged between 1,269.3 and 651.7 μg/m³, while PM₁₀ concentrations were between 1,048.2 and 818.1 μg/m³. The recorded concentrations exceeded the World Health Organization guideline limit of 50 μg/m³ and 25 μg/m³ for PM_2.5 and PM₁₀, respectively. As compared with control group (2.1 L), significantly lower forced expiratory volume in one second value (1.61 L) was observed among the exposed group (p < 0.05). Likewise, significantly lower peak expiratory flow rate value (186.7 L/min) was recorded among the exposed group than the control group (269.51 L/min) (p < 0.05).

Conclusion

Exposure to grain dust and diesel exhaust accentuated respiratory disorders with declines in lung functions amongst grain millers. Improved milling practices and engaging cleaner milling facilities should be adopted to minimize exposure and related hazards.

Exposure to flour dust in the occupational environment

Exposure to flour dust can be found in the food industry and animal feed production. It may result in various adverse health outcomes from conjunctivitis to baker's asthma. In this paper, flour dust exposure in the above-mentioned occupational environments is characterized and its health effects are discussed. A peer-reviewed literature search was carried out and all available published materials were included if they provided information on the above-mentioned elements. The hitherto conducted studies show that different components of flour dust like enzymes, proteins and baker's additives can cause both non-allergic and allergic reactions among exposed workers. Moreover, the problem of exposure to cereal allergens present in flour dust can also be a concern for bakers' family members. Appreciating the importance of all these issues, the exposure assessment methods, hygienic standards and preventive measures are also addressed in this paper.

Evaluation of Dust Exposure among the Workers in Agricultural Industries in North-East India

This study aims to quantify dust exposure among the workers in four different industrial settings: rice mills, flour mills, oil mills, and tea factories and to compare the obtained data with the permissible exposure limit (PEL) of Indian Union Ministry of Labour as well as to compare the dust exposure across activities and seasons. RespiCon(TM) particle sampler was used for collecting dust concentration in the breathing zone of the workers. In total, 149 workers participated in the study and 204 samples were collected. Samples were collected in the vicinity of different processing operations. Samples in the rice mills were collected for two consecutive years in two seasons; however samples from other industries were collected for 1 year. The results indicate that geometric mean (GM) of dust exposure was significantly (P < 0.0001) different among industrial settings. Respirable dust were 8.22, 5.76, 2.98, and 6.34mg m(-3) and total dust exposure were 81.05, 111.02, 56.68, and 39.85mg m(-3) in the rice mills, oil mills, flour mills, and tea factories, respectively. Considerable variations in dust exposure were observed in different activities in the rice and oil mills; however variation was relatively less in the flour mills and tea factories. In the rice mills, dust concentration was higher in winter than those obtained in autumn and it is significantly different (P < 0.05) for inhalable dust and total dust. Positive correlation was obtained in thoracic dust (r (2) = 0.94) and inhalable dust (r (2) = 0.97) with total dust and thoracic dust with inhalable dust (r (2) = 0.89). The results show that majority of the workers are exposed to higher level of respirable dust as compared to the PEL, while total dust exposure to all the workers were higher than the PEL; thus, immediate reduction of dust exposure among the workers is necessary for preventing respiratory system impairment.

Airborne fungal and bacterial components in PM1 dust from biofuel plants

Fungi grown in pure cultures produce DNA- or RNA-containing particles smaller than spore size (<1.5 microm). High exposures to fungi and bacteria are observed at biofuel plants. Airborne cultivable bacteria are often described to be present in clusters or associated with larger particles with an aerodynamic diameter (d(ae)) of 2-8 microm. In this study, we investigate whether airborne fungal components smaller than spore size are present in bioaerosols in working areas at biofuel plants. Furthermore, we measure the exposure to bacteria and fungal components in airborne particulate matter (PM) with a D(50) of 1 microm (called PM(1) dust). PM(1) was sampled using Triplex cyclones at a working area at 14 Danish biofuel plants. Millipore cassettes were used to sample 'total dust'. The PM(1) particles (29 samples) were analysed for content of 11 different components and the total dust was analysed for cultivable fungi, N-acetyl-beta-D-glucosaminidase (NAGase), and (1 --> 3)-beta-D-glucans. In the 29 PM(1) samples, cultivable fungi were found in six samples and with a median concentration below detection level. Using microscopy, fungal spores were identified in 22 samples. The components NAGase and (1 --> 3)-beta-D-glucans, which are mainly associated with fungi, were present in all PM(1) samples. Thermophilic actinomycetes were present in 23 of the 29 PM(1) samples [average = 739 colony-forming units (CFU) m(-3)]. Cultivable and 'total bacteria' were found in average concentrations of, respectively, 249 CFU m(-3) and 1.8 x 10(5) m(-3). DNA- and RNA-containing particles of different lengths were counted by microscopy and revealed a high concentration of particles with a length of 0.5-1.5 microm and only few particles >1.5 microm. The number of cultivable fungi and beta-glucan in the total dust correlated significantly with the number of DNA/RNA-containing particles with lengths of between 1.0 and 1.5 microm, with DNA/RNA-containing particles >1.5 microm, and with other fungal components in PM(1) dust. Airborne beta-glucan and NAGase were found in PM(1) samples where no cultivable fungi were present, and beta-glucan and NAGase were found in higher concentrations per fungal spore in PM(1) dust than in total dust. This indicates that fungal particles smaller than fungal spore size are present in the air at the plants. Furthermore, many bacteria, including actinomycetes, were present in PM(1) dust. Only 0.2% of the bacteria in PM(1) dust were cultivable.

Sensitization to wheat flour and enzymes and associated respiratory symptoms in British bakers

RATIONALE

Current literature suggests that flour exposed workers continue to be at risk of allergic sensitization to flour dust and respiratory ill health.

OBJECTIVES

A cross-sectional study of 225 workers currently potentially exposed to flour dust in British bakeries was performed to identify predictors of sensitization to wheat flour and enzymes.

RESULTS

Work-related nasal irritation was the most commonly reported symptom (28.9%) followed by eye irritation (13.3%) and work-related cough or chest tightness (both 10.2%). Work-related chest tightness was significantly associated (OR 7.9, 1.3-46.0) with co-sensitization to wheat flour and any added enzyme. Working at a bakery with inadequate control measures was not a risk factor for reporting work-related respiratory symptoms (OR 1.3, 0.4-3.7). Fifty-one workers were atopic and 23 (14%) were sensitized to workplace allergens. Atopy was the strongest predictive factor (OR 18.4, 5.3-64.3) determining sensitization. Current versus never smoking (OR 4.7, 1.1-20.8) was a significant risk factor for sensitization to wheat flour or enzymes in atopic workers only, corrected for current level and duration of exposure. This effect was not seen in non-atopic workers (OR 1.9, 0.2-17.9). Evidence of sensitization to less commonly encountered allergens was also seen to Aspergillus niger derived cellulase, hemicellulase and xylanase mix, in addition to glucose oxidase and amyloglucosidase mix.

CONCLUSIONS

The combination of health surveillance and exposure control in this population has been insufficient to prevent clinically significant workplace sensitization. Smoking may pose an additional risk factor for sensitization in atopic workers. Am. J. Ind. Med. 52:133-140, 2009.

Diagnostic model for sensitization in workers exposed to occupational high molecular weight allergens

BACKGROUND

Occupational allergy has great impact on workers exposed to high molecular weight (HMW) allergens. The present study is aimed to develop and validate a generic diagnostic model for sensitization to HMW allergens, defined as positive IgE.

METHODS

The model was developed in pooled data from Dutch laboratory animal (LA) workers and bakers using logistic regression analysis. Validity was assessed internally by bootstrapping procedure, and externally in British LA workers.

RESULTS

The model included working hours/week, work-related symptoms, total IgE, and IgE to common allergen. Significant interactions between the type of work and the predictors resulted in different scores for LA workers and bakers. Internal and external validation showed that the model was satisfactorily calibrated and discriminated between workers at high and low risk of being sensitized.

CONCLUSIONS

It is possible to develop a generic model for sensitization to occupational HMW allergens. However, the weighing of predictors differs across specific work environments.

Supermarket baker's asthma: how accurate is routine health surveillance?

BACKGROUND

Regular health surveillance is commonly recommended for workers exposed to occupational antigens but little is known about how effective it is in identifying cases.

AIMS

To report one large company's surveillance and compare its findings with those of a standard cross-sectional survey in the same workforce.

METHODS

A supermarket company with 324 in-store bakeries producing bread from raw ingredients conducted a three-stage health surveillance programme in around 3000 bakery employees. The first stage involved the administration of a simple respiratory questionnaire. If chest symptoms were present a second questionnaire focusing on their work relationship was administered. If positive a blood sample was requested for the measurement of specific IgE to flour and fungal alpha-amylase. The results were compared to an independent cross-sectional survey of employees in 20 of the company's stores.

RESULTS

Two hundred and ninety nine (92%) of the company's bakeries took part in surveillance. The overall employee response for the first stage was 77%; a quarter of those with respiratory symptoms reported that they were work related. Seventy four (61%) of those with work related chest symptoms had a measurement of specific IgE to either flour or fungal alpha-amylase, of whom 30 (41%) had a positive result. Surveillance estimated that 1% of bakery employees (1% bakers, 2% managers, 0.6% confectioners) had work related symptoms with specific IgE. This compared with 4% (7.5% bakers, 3.3% managers, 0% confectioners) in the cross-sectional survey (n = 166, 93% response).

CONCLUSION

Comparison with a standard cross-sectional survey suggests that routine surveillance can underestimate the workplace burden of disease. The reasons may include technical or resource issues and uncertainties over confidentiality or the perceived consequences of participation. More research needs to be done looking into the design and efficacy of surveillance in occupational asthma.

Occupational Exposure Among Bakery Workers: Impact on the Occurrence of Work-Related Symptoms as Compared With Allergic Characteristics

OBJECTIVE

The aim of the study is to examine the relationship between exposure to occupational allergens, sensitization, and atopy and several outcome variables and the independent associations of these interrelated risk factors to work-related symptoms in particular.

METHODS

Data were collected by questionnaire, skin prick tests, lung function tests, and exposure measurements among 246 workers from 74 bakeries and analyzed using logistic and linear regression analyses.

RESULTS

Exposure levels were associated with respiratory symptoms, sensitization to baker's allergens, and lung function. High exposure and sensitization to common and bakers' allergens were independent risk factors for work-related symptoms. However, allergy determinants performed best in predicting work-related symptoms.

CONCLUSIONS

Current exposure to occupational allergens is a risk factor for work-related symptoms, but sensitization to occupational allergens and atopy are more adequate and easier obtainable predictors of work-related symptoms.

Incidence and host determinants of work-related rhinoconjunctivitis in apprentice pastry-makers

BACKGROUND

The authors recently assessed the incidence and determinants of immunologic sensitization to flour in apprentice pastry-makers. The aim of this work was to determine the incidence of work-related rhinoconjunctivitis (RC) symptoms and their determinants.

METHODS

For this 188/230 entrants (81.7%) were evaluated before starting exposure to flour, and again 10.8 and 16.8 months after. Questionnaires and skin prick testing to common and work-related allergens were administered at each visit. Bronchial responsiveness to methacholine was assessed at baseline in all subjects and in a subgroup at follow-up.

RESULTS

Thirty subjects (16.1%) reported new work-related RC symptoms (13.1 per 100 person-years); in three subjects (1.6%), these were accompanied by incident skin prick test reactivity to flour-derived allergens. Skin prick test reactivity to grass pollens (OR = 3.0, 95% CI, 1.3-6.7) and to pets (OR = 2.5, 95% CI, 1.1-5.9), persistent rhinitis (OR = 3.1, 95% CI, 1.1-8.4), seasonal RC (OR = 2.5, 95% CI, 1.1-5.5), RC on contact with pets (OR = 2.3, 95% CI, 1.03-5.0) and skin prick test reactivity to wheat flour (OR = 10.5, 95% CI, 2.3-46.8), assessed at baseline, were significantly associated with the incidence of work-related RC symptoms. Multivariate logistic regression analysis yielded significant OR of skin prick test reactivity to wheat flour at baseline (OR = 7.1, 95% CI, 1.7-35.1) and persistent rhinitis (OR = 3.9, 95% CI, 1.01-9.6) for the incidence of work-related RC symptoms. Increased bronchial hyperresponsiveness at follow-up was more frequent, although not significantly, in subjects positive to skin prick test to flour on entry and reporting new work-related symptoms (3/5), than in other subjects (4/17).

CONCLUSIONS

The incidence of work-related RC symptoms among apprentice pastry-makers was high (16.1% 30/186), while a minority (3/30) also developed skin prick test reactivity to flour. Skin prick test reactivity to wheat flour and persistent allergic rhinitis on starting exposure to flour are significant determinants for the development of work-related RC symptoms.