Impact of worker education on respiratory symptoms and sensitization in bakeries

Laboratory study of the effectiveness of substituting traditional wheat flour with low dust flour and use of different sieve designs as controls to reduce exposure to inhalable flour dust in commercial bakeries

Exposure to flour dust remains one of the leading causes of occupational asthma in Great Britain (GB). The average annual incidence rate per 100,000 bakers and flour confectioners in GB was 47.8 for the 3 yr period 2017 to 2019 compared with 0.53 for all occupations. There are many processes in commercial bakeries that can cause exposure to flour dust. Exposures are typically controlled by using local exhaust ventilation or respiratory protective equipment. The aim of this study was to evaluate the potential to reduce exposure to inhalable flour dust in commercial bakeries by modification of the process by use of a conical sieve in place of a round sieve; and substitution of traditional wheat flour (TWF) with 'low dust' flours LD1 and LD2 for dusting surfaces. Two simulated commercial bakery tasks were performed in a laboratory whilst dust exposures were measured in the breathing zone of the operator using an Institute of Occupational Medicine (IOM) sampler, button sampler and a real-time direct reading monitor. Analysis of variance tests were used to assess whether differences in mean exposures were statistically significant with the different control approaches. A qualitative visual exposure assessment was also undertaken using Tyndall illumination. Substituting TWF with LD1 and LD2 reduced exposure to inhalable flour dust by 86% and 53% respectively when sieving and by 78% and 67% respectively when filling a hopper. There was no statistically significant difference between dust emissions for all 3 flours when using the conical sieve instead of the round sieve for flour dusting tasks. This laboratory study has shown that substituting TWF with low-dust flour may reduce inhalable dust exposures when dusting surfaces in bakeries.

Workers' Occupational Dust Exposure and Pulmonary Function Assessment: Cross-Sectional Study in China

OBJECTIVE

This study aims to determine the occupational health status of workers exposed to dust and the risk factors of lung function decline, to provide a basis for formulating corresponding occupational disease-prevention strategies.

METHODS

Data on 2045 workers exposed to dust, including their age, gender, exposure time, chest X-ray test results, and pulmonary function test results, were obtained from a key occupational disease monitoring project in Chongqing, China, in 2021. Chi-square tests and multifactorial logistic regression, and other methods, were used for statistical analysis.

RESULTS

The prevalence of pneumoconiosis-like changes was 0.83% (17/2045), and the prevalence of abnormal forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC was 4.25% (87/2045), 12.81% (262/2045), and 1.47% (30/2045), respectively. With increasing worker's age, the prevalence of abnormal pneumoconiosis-like changes (p = 0.0065), FEV₁ (p = 0.0002), FVC (p < 0.0001), and FEV₁/FVC (p = 0.0055) all increased. Factors such as age, exposure duration, enterprise size, and dust exposure concentration were associated with abnormal lung function.

CONCLUSIONS

Workers exposed to occupational dust have a high rate of abnormal lung function. The government, enterprises, and individuals should pay attention to occupational dust exposure, and various effective measures should be actively taken to protect the life and health of workers.

Case Report: Occupational Dust Exposure Among Bakery Workers in Perth, Western Australia

Occupational dust exposure can occur in various settings, including bakeries. A case study was conducted in an industrial bakery in Perth, Western Australia, to assess exposure to particulate dust concentration. The factory was separated into three production zones and an office area which represented as a control zone. Results indicated that bakery workers in the production zones were exposed to higher ambient dust particle concentrations compared to those from the office environment. Coarse particles (>10 μm in aerodynamic diameter) were the predominant particle size fraction measured in all studied areas with the highest median exposure level recorded in the dough room (0.181 mg/m3, interquartile range 0.283). High personal concentration of respirable particles was also measured in the dough room (median 2.26 mg/m3) which exceeded the recommended limit of 1.5 mg/m3 and was more than 50 times higher than the concentration recorded in the office (0.04 mg/m3). The variation in dust concentrations between production zones underlines the need of more knowledge about how aerosol fractions are distributed across the production process. The findings also suggest that bakery workers are exposed to high dust levels that may increase their risk of developing respiratory diseases and the decrease of present exposure levels is imperative.

Mental and self-rated health of bakery workers in Lebanon: A national study

Objectives:

The relationship between poverty and health has been well addressed in public health research. The health effects of social and economic inequalities on working groups have also drawn the attention of occupational health scholars. Research addressing workers in low-paying jobs showed increased risks for poor health. This research examined the psychosocial factors associated with poor mental health and self-rated health among low-income bakery workers performing demanding tasks.

Methods:

Face-to-face interviews in 504 randomly selected bakeries in Lebanon provided data on socio-demographics, perception of the workplace environment, job security, job satisfaction, general health, and mental health.

Results:

In total, 16.5% of bakery workers reported poor self-rated health, and 45% reported poor mental health. Workers with a chronic illness were almost three times more likely to report poor self-rated health (OR = 2.86; 95% CI = 1.44–5.67), and those with musculoskeletal pain reported poor self-rated health five times as often (OR = 5.34; 95% CI = 2.9–9.80). Those with a chronic illness and musculoskeletal pain were twice as likely to report poor mental health (OR = 1.94; 95% CI = 1.07–3.50 and OR = 2.07; 95% CI = 1.32–3.23, respectively); and those dissatisfied with their job reported poorer self-rated health (OR = 2.18; 95% CI = 1.12–4.23) and mental health (OR = 2.57; 95% CI = 1.54–4.26). In addition, workers reporting job insecurity had poor mental health twice as often (OR = 1.93; 95% CI = 1.24–2.99). Low socioeconomic indicators showed a gradient association with both poor self-rated health and mental health.

Conclusion:

Reporting job dissatisfaction and insecurity, musculoskeletal pain, and chronic illness were associated with poor mental and self-rated health among bakery workers. Interventions to improve the working conditions of bakery workers are timely and essential. This research provided evidence for policy to guide occupational health practice and safeguard the health of bakery workers.

Occupational Exposure to Flour Dust. Exposure Assessment and Effectiveness of Control Measures

The adverse effects associated with exposure to flour dust have been known since the 1700s. The aim of the study was to assess the occupational exposure to flour dust in Italian facilities, identify the activities characterized by the highest exposure, and provide information to reduce workers’ exposure. The study was performed in different facilities such as flourmills (n = 2), confectioneries (n = 2), bakeries (n = 24), and pizzerias (n = 2). Inhalable flour dust was assessed by personal and area samplings (n = 250) using IOM (Institute of Occupational Medicine) samplers. The results showed personal occupational exposure to flour dust over the American Conference of Governmental Industrial Hygiene (ACGIH) and the Scientific Committee on Occupational Exposure Limit (SCOEL) occupational limits (mean 1.987 mg/m³; range 0.093–14.055 mg/m³). The levels were significantly higher for dough makers in comparison to the dough formers and packaging area subjects. In four bakeries the industrial hygiene surveys were re-performed after some control measures, such as installation of a sleeve to the end of pipeline, a lid on the mixer tub or local exhaust ventilation system, were installed. The exposure levels were significantly lower than those measured before the introduction of control measures. The exposure level reduction was observed not only in the dough making area but also in all bakeries locals.

Eliminating Take-Home Exposures: Recognizing the Role of Occupational Health and Safety in Broader Community Health

Toxic contaminants inadvertently brought from the workplace to the home, known as take-home or paraoccupational exposures, have often been framed as a problem that arises due to unsanitary worker behavior. This review article conceptualizes take-home exposures as a public health hazard by (i) investigating the history of take-home contaminants and how they have been studied, (ii) arguing that an ecosocial view of the problem is essential for effective prevention, (iii) summarizing key structural vulnerabilities that lead populations to be at risk, and (iv) discussing future research and prevention effort needs. This article reframes take-home exposures as one of many chronic pathways that contributes to persistent health disparities among workers, their families, and communities. Including the role of work in community health will increase the comprehensiveness of prevention efforts for contaminants such as lead and pesticides that contribute to environmental disparities.

Workplace interventions for treatment of occupational asthma

BACKGROUND

The impact of workplace interventions on the outcome of occupational asthma is not well understood.

OBJECTIVES

To evaluate the effectiveness of workplace interventions on occupational asthma.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); EMBASE(Ovid); NIOSHTIC-2; and CISILO (CCOHS) up to July 31, 2019.

SELECTION CRITERIA

We included all eligible randomized controlled trials, controlled before and after studies and interrupted time-series of workplace interventions for occupational asthma.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study eligibility and risk of bias, and extracted data.

MAIN RESULTS

We included 26 non-randomized controlled before and after studies with 1,695 participants that reported on three comparisons: complete removal from exposure and reduced exposure compared to continued exposure, and complete removal from exposure compared to reduced exposure. Reduction of exposure was achieved by limiting use of the agent, improving ventilation, or using protective equipment in the same job; by changing to another job with intermittent exposure; or by implementing education programs. For continued exposure, 56 per 1000 workers reported absence of symptoms at follow-up, the decrease in forced expiratory volume in one second as a percentage of a reference value (FEV1 %) was 5.4% during follow-up, and the standardized change in non-specific bronchial hyperreactivity (NSBH) was -0.18.In 18 studies, authors compared removal from exposure to continued exposure. Removal may increase the likelihood of reporting absence of asthma symptoms, with risk ratio (RR) 4.80 (95% confidence interval (CI) 1.67 to 13.86), and it may improve asthma symptoms, with RR 2.47 (95% CI 1.26 to 4.84), compared to continued exposure. Change in FEV1 % may be better with removal from exposure, with a mean difference (MD) of 4.23 % (95% CI 1.14 to 7.31) compared to continued exposure. NSBH may improve with removal from exposure, with standardized mean difference (SMD) 0.43 (95% CI 0.03 to 0.82).In seven studies, authors compared reduction of exposure to continued exposure. Reduction of exposure may increase the likelihood of reporting absence of symptoms, with RR 2.65 (95% CI 1.24 to 5.68). There may be no considerable difference in FEV1 % between reduction and continued exposure, with MD 2.76 % (95% CI -1.53 to 7.04) . No studies reported or enabled calculation of change in NSBH.In ten studies, authors compared removal from exposure to reduction of exposure. Following removal from exposure there may be no increase in the likelihood of reporting absence of symptoms, with RR 6.05 (95% CI 0.86 to 42.34), and improvement in symptoms, with RR 1.11 (95% CI 0.84 to 1.47), as well as no considerable change in FEV1 %, with MD 2.58 % (95% CI -3.02 to 8.17). However, with all three outcomes, there may be improved results for removal from exposure in the subset of patients exposed to low molecular weight agents. No studies reported or enabled calculation of change in NSBH.In two studies, authors reported that the risk of unemployment after removal from exposure may increase compared with reduction of exposure, with RR 14.28 (95% CI 2.06 to 99.16). Four studies reported a decrease in income of 20% to 50% after removal from exposure.The quality of the evidence is very low for all outcomes.

AUTHORS' CONCLUSIONS

Both removal from exposure and reduction of exposure may improve asthma symptoms compared with continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function compared to continued exposure. When we compared removal from exposure directly to reduction of exposure, the former may improve symptoms and lung function more among patients exposed to low molecular weight agents. Removal from exposure may also increase the risk of unemployment. Care providers should balance the potential clinical benefits of removal from exposure or reduction of exposure with potential detrimental effects of unemployment. Additional high-quality studies are needed to evaluate the effectiveness of workplace interventions for occupational asthma.

Career Advice for Young Allergy Patients

BACKGROUND

One-third of all young persons entering the work force have a history of atopic disease. Occupationally induced allergy and asthma generally arise in the first few months on the job, while pre-existing symptoms tend to worsen. Young persons with a history of an atopic disease should receive evidence-based advice before choosing a career.

METHODS

We systematically searched PubMed for cohort studies investigating the new onset of asthma, rhinitis, or hand eczema among job trainees from before the start of training and onward into the first few years on the job. The search revealed 514 articles; we read their abstracts and selected 85 full-text articles for further analysis. 24 of these met the inclusion criteria.

RESULTS

According to present evidence, atopy and a history of allergic disease (allergic rhinitis, atopic dermatitis) are the main risk factors for occupationally induced disease. The predictive value of a personal history of allergic diseases for the later development of an occupationally induced disease varies from 9% to 64% in the studies we analyzed. It follows that only young people with severe asthma or severe atopic eczema should be advised against choosing a job that is associated with a high risk of allergy, e.g., hairdressing or working with laboratory animals. Young people with a history of other atopic diseases should be counseled about their individual risk profile.

CONCLUSION

In view of the relatively poor predictive value of pre-existing atopic disease, secondary prevention is particularly important. This includes frequent medical follow-up of the course of symptoms over the first few years on the job. If sensitization or allergic symptoms arise, it should be carefully considered whether exposure reduction will enable the apprentice to stay on the job.

Exposure to crystalline silica at Alberta work sites: review of controls

From 2009 to 2013, Alberta Jobs, Skills, Training, and Labour (JSTL) conducted a project to evaluate exposure to crystalline silica and assess controls to protect workers. Information on exposure results has been previously reported; this article discusses the data collected on workplace controls. Information on work site controls was collected during exposure assessments consisting of qualitative information on controls in place and used by workers at the time of the assessments. Where there was sufficient data, the information was further analyzed to evaluate the impact of a particular control. While many types of controls were observed, they were not always effective or in use. The control available most often was respiratory protective equipment (RPE). Generally, when respirators were used, they were correctly selected for the level of measured exposure. However, not all workers who were potentially overexposed wore respirators at the time of the assessments. When the use of respirators was taken into account, about one-third of workers were still potentially exposed over the Alberta occupational exposure limit. The industries with the highest levels of exposure tended to be those with the most unprotected workers. Issues were identified with the use of improper work practices such as dry cleaning methods, lack of documented work procedures, poor housekeeping, and lack of training which may have contributed to worker exposure levels. There is a wide range in the efficacy of controls, particularly engineering controls. Most of the literature focuses on engineering controls; however administrative controls also play a role in reducing worker exposure. Data collected in this work indicated that simple changes to work procedures and behavior (such as improved housekeeping) may be effective, low-cost ways to reduce workplace exposure. More study is required to evaluate the impact and efficacy of administrative controls such as housekeeping and training. Employers must select and evaluate controls in the context of overall workplace health and safety programs and ensure that they are supported by supervision, good work practices. and training.

Prevalence and risk factors for allergic rhinitis in bakers in Douala, Cameroon

OBJECTIVE

To determine the prevalence and risk factors of allergic rhinitis among bakers in Douala.

DESIGN

A cross-sectional study; the logistic regression model was use to find the risk factors of allergic rhinitis.

SETTING

The study was conducted in 42 bakeries randomly selected among a total of 151 bakeries in the city of Douala.

PARTICIPANTS

All bakers who consented to participate in the study between 1 May and 31 July 2013.

OUTCOME MEASURES

Allergic rhinitis was the outcome of interest. It was defined as the presence of the following symptoms: itchy nose, rhinorrhea, nasal obstruction and sneezing.

RESULTS

During the study period, a total of 273 bakers were invited and 229 finally agreed to participate in this study. Males were the most represented gender with 222 (96.9%) participants. The mean age of the participants was 36.29±8.9 years. Smoking was found in 55 participants (24.5%). The symptoms of allergic rhinitis were observed in 24.5% of participants. Work related nasal symptoms were present in 15% of participants. Sensitisation to wheat flour and α-amylase was found in 16.6% and 8.3% of participants, respectively. The Prick test was positive for mites in 12.2% of participants. After multivariate analysis, sensitisation to flour (OR 3.95, 95% CI 1.85 to 8.47) and storage mites (OR 3.44, 95% CI 1.45 to 8.18) were the factors independently associated with symptoms of allergic rhinitis.

CONCLUSIONS

Allergic rhinitis is frequent among bakers in Cameroon. Implementation of preventive measures against inhalation of airborne allergens in bakeries and clinical monitoring of bakers sensitised to wheat flour and mites could help to reduce the prevalence of allergic rhinitis among bakers.

EAACI Position Paper on assessment of cough in the workplace

Cough is a nonspecific and relatively common symptom that can present difficulties in diagnosis and management, particularly when it is reported to be associated with the workplace. The present consensus document, prepared by a taskforce of the Interest Group on Occupational Allergy of the European Academy of Allergy and Clinical Immunology by means of a nonsystematic review of the current literature, is intended to provide a definition and classification of work-related chronic cough (WRCC) to assist the daily practice of physicians facing with this symptom. The review demonstrates that several upper and lower airway work-related diseases may present with chronic cough; hence, the possible link with the workplace should always be considered. Due to the broad spectrum of underlying diseases, a multidisciplinary approach is necessary to achieve a definite diagnosis. Nevertheless, more epidemiological studies are necessary to estimate the real prevalence and risk factors for WRCC, the role of exposure to environmental and occupational sensitizers and irritants in its pathogenesis and the interaction with both upper and lower airways. Finally, the best management option should be evaluated in order to achieve the best outcome without adverse social and financial consequences for the worker.

Occupational asthma

Occupational asthma has been defined as asthma due to conditions attributable to work exposures, not to causes outside the workplace. This review focuses on current data on pathogenesis, evaluation, and management.

The 'take home' burden of workplace sensitizers: flour contamination in bakers' families

BACKGROUND

Exposure to flour/flour constituents is a leading cause of occupational asthma. Paternal occupational exposure to flour has been associated with increased likelihood of childhood asthma, raising the possibility of para-occupational exposure whereby family members are exposed to sensitizers 'taken home' on contaminated skin/clothing.

OBJECTIVE

To establish whether workplace contamination of skin/clothing with wheat flour allergen (WFA) and fungal α-amylase (FAA) is associated with increased levels of these allergens in bakers' homes.

METHODS

Bakeries in north-east Scotland were invited to participate. Control subjects were recruited from University of Aberdeen staff and students. Exposure assessment was carried out in bakeries, bakers' cars and the homes of bakers and controls using surface wipe and vacuum sampling; samples were analyzed for total protein, FAA and WFA.

RESULTS

164 wipe samples and 49 vacuum samples were collected from 38 bakers (from 5 bakeries) and 10 controls. Compared to non-bakers, bakers had higher median levels of WFA and FAA in house vacuum samples; the difference was statistically significant for WFA/total protein (515.8×10(-6) vs. 163.7×10(-6), p=0.031), FAA/total protein ratios (1.45×10(-6) vs. 0.04×10(-6), p<0.001) and FAA loading (median 1.2 pg/cm(2) vs. 0.1 pg/cm(2), p<0.001) with workplace exposure-home contamination relationships between bakers with higher and lower workplace contamination. We found positive correlations between WFA contamination of the bakers' foreheads and cars (r(s)0.57, p=0.028), foreheads and houses (r(s)0.46, p=0.025), shoes and houses (r(s)0.45, p=0.029); and between FAA contamination of shoes and houses (r(s)0.46, p=0.023), and cars and houses (r(s)0.70, p=0.008). There was no evidence of bakers using work-sourced flour for domestic baking.

CONCLUSIONS

This work demonstrates pathways for 'take home' exposure of occupationally sourced flour. Taken with our previous work, showing that bakers' children are more likely to have asthma, this supports the need for further investigation to establish whether 'take home' of occupationally sourced flour is widespread with health consequences.