Postural stability assessment in sewer workers

Exposure to volatile hydrocarbons and neurologic function among oil spill workers up to 6 years after the Deepwater Horizon disaster

BACKGROUND

During the 2010 Deepwater Horizon (DWH) disaster, oil spill response and cleanup (OSRC) workers were exposed to toxic volatile components of crude oil. Few studies have examined exposure to individual volatile hydrocarbon chemicals below occupational exposure limits in relation to neurologic function among OSRC workers.

OBJECTIVES

To investigate the association of several spill-related chemicals (benzene, toluene, ethylbenzene, xylene, n-hexane, i.e., BTEX-H) and total petroleum hydrocarbons (THC) with neurologic function among DWH spill workers enrolled in the Gulf Long-term Follow-up Study.

METHODS

Cumulative exposure to THC and BTEX-H across the oil spill cleanup period were estimated using a job-exposure matrix that linked air measurement data to detailed self-reported DWH OSRC work histories. We ascertained quantitative neurologic function data via a comprehensive test battery at a clinical examination that occurred 4-6 years after the DWH disaster. We used multivariable linear regression and modified Poisson regression to evaluate relationships of exposures (quartiles (Q)) with 4 neurologic function measures. We examined modification of the associations by age at enrollment (<50 vs. ≥50 years).

RESULTS

We did not find evidence of adverse neurologic effects from crude oil exposures among the overall study population. However, among workers ≥50 years of age, several individual chemical exposures were associated with poorer vibrotactile acuity of the great toe, with statistically significant effects observed in Q3 or Q4 of exposures (range of log mean difference in Q4 across exposures: 0.13-0.26 μm). We also observed suggestive adverse associations among those ≥ age 50 years for tests of postural stability and single-leg stance, although most effect estimates did not reach thresholds of statistical significance (p < 0.05).

CONCLUSIONS

Higher exposures to volatile components of crude oil were associated with modest deficits in neurologic function among OSRC workers who were age 50 years or older at study enrollment.

Noise and neurotoxic chemical exposure relationship to workplace traumatic injuries: A review

INTRODUCTION

More than 5,000 fatalities and eight million injuries occurred in the workplace in 2007 at a cost of $6 billion and $186 billion, respectively. Neurotoxic chemicals are known to affect central nervous system functions among workers, which include balance and hearing disorders. However, it is not known if there is an association between exposure to noise and solvents and acute injuries.

METHOD

A thorough review was conducted of the literature on the relationship between noise or solvent exposures and hearing loss with various health outcomes.

RESULTS

The search resulted in 41 studies. Health outcomes included: hearing loss, workplace injuries, absence from work due to sickness, fatalities, hospital admissions due to workplace accidents, traffic accidents, hypertension, balance, slip, trips, or falls, cognitive measures, or disability retirement. Important covariates in these studies were age of employee, type of industry or occupation, or length of employment.

DISCUSSION

Most authors that evaluated noise exposure concluded that higher exposure to noise resulted in more of the chosen health effect but the relationship is not well understood. Studies that evaluated hearing loss found that hearing loss was related to occupational injury, disability retirement, or traffic accidents. Studies that assessed both noise exposure and hearing loss as risk factors for occupational injuries reported that hearing loss was related to occupational injuries as much or more than noise exposure. Evidence suggests that solvent exposure is likely to be related to accidents or other health consequences such balance disorders.

CONCLUSIONS

Many authors reported that noise exposures and hearing loss, respectively, are likely to be related to occupational accidents. Practical applications: The potential significance of the study is that findings could be used by managers to reduce injuries and the costs associated with those injures.

Ergonomics and Beyond: Understanding How Chemical and Heat Exposures and Physical Exertions at Work Affect Functional Ability, Injury, and Long-Term Health

OBJECTIVE

To honor Tom Waters's work on emerging occupational health issues, we review the literature on physical along with chemical exposures and their impact on functional outcomes.

BACKGROUND

Many occupations present the opportunity for exposure to multiple hazardous exposures, including both physical and chemical factors. However, little is known about how these different factors affect functional ability and injury. The goal of this review is to examine the relationships between these exposures, impairment of the neuromuscular and musculoskeletal systems, functional outcomes, and health problems with a focus on acute injury.

METHOD

Literature was identified using online databases, including PubMed, Ovid Medline, and Google Scholar. References from included articles were searched for additional relevant articles.

RESULTS

This review documented the limited existing literature that discussed cognitive impairment and functional disorders via neurotoxicity for physical exposures (heat and repetitive loading) and chemical exposures (pesticides, volatile organic compounds [VOCs], and heavy metals).

CONCLUSION

This review supports that workers are exposed to physical and chemical exposures that are associated with negative health effects, including functional impairment and injury. Innovation in exposure assessment with respect to quantifying the joint exposure to these different exposures is especially needed for developing risk assessment models and, ultimately, preventive measures.

APPLICATION

Along with physical exposures, chemical exposures need to be considered, alone and in combination, in assessing functional ability and occupationally related injuries.

Postural sway and exposure to jet propulsion fuel 8 among US Air Force personnel

OBJECTIVE

To determine whether short-term jet propulsion fuel 8 (JP-8) exposure is associated with balance measurements in JP-8-exposed air force personnel.

METHODS

As part of a larger neuroepidemiology study, balance tasks were completed by JP-8-exposed individuals (n = 37). Short-term JP-8 exposure was measured using personal breathing zone levels and urinary biomarkers. Multivariate linear regression analyses were conducted to examine the relationship between workday JP-8 exposure and postural sway.

RESULTS

Balance control decreased as the task became more challenging. Workday exposure to JP-8, measured by either personal air or urinary metabolite levels, was not significantly related to postural sway. Increases in workday postural sway were associated with demographic variables, including younger age, being a current smoker, and higher body mass index.

CONCLUSION

Results suggest that short-term workday JP-8 exposure does not significantly contribute to diminished balance control.

Motor function in adults of an Ohio community with environmental manganese exposure

OBJECTIVES

The objective of the present study was to evaluate motor function in order to assess the effects of long-term, low-level environmental manganese (Mn) exposure in residents of an Ohio community where a large ferro- and silico-Mn smelter has been active for more than 50 years.

METHODS

One hundred residents from the Mn-exposed Ohio community were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), a postural sway test, and a comprehensive questionnaire exploring demographics and general health. The results were compared to those of 90 residents from a demographically similar comparison town in Ohio. Mn exposure was assessed using modeled airborne Mn and blood Mn (Mn-B). The UPDRS was employed to evaluate parkinsonian motor features. Postural sway was measured using a CATSYS 2000 (Danish Product Development).

RESULTS

No significant difference between the exposed and comparison groups was evident as to Mn-B, demographics or major health outcomes. The risk of abnormal UPDRS performance using "Motor and Bradykinesia" criteria was increased in the Mn-exposed group after adjustment for potential confounders such as the presence of other neurotoxic metals, factors affecting susceptibility to Mn, potential factors influencing motor performance, and other possible demographic confounders. No participant was diagnosed with clinical manganism by neurological examination. After adjustment for various potential confounders, the Mn-exposed group showed significantly higher postural sway scores under eyes-open conditions than the comparison group.

CONCLUSIONS

Subclinical findings on the UPDRS and postural sway in the Mn-exposed group may possibly reflect early subtle effects of chronic low-level Mn exposure. However, the cross-sectional study design, the small to medium effect sizes, and the little biological plausibility are limiting the possibility of a causal relationship between the environmental Mn-air exposure and the early subclinical neurotoxic effects observed.

Neuromotor effects of short-term and long-term exposures to trichloroethylene in workers

BACKGROUND

Health effects of long-term exposure to organic solvents at low levels are a major concern in industrialized countries. To assess the neuromotor impact of trichloroethylene objectively, static postural sway and hand tremor parameters, along with urinary trichloroethanol (TCOH) and trichloroacetic acid (TCAA) levels, were investigated in 57 workers without obvious neurological disorders and 60 control subjects.

METHODS

The workers had been occupationally exposed to trichloroethylene for 0.1-37 years. The cumulative exposure index (CEI) was calculated from their occupational history and total trichloro-compounds (TCOH + TCAA).

RESULTS

Median levels in the workers were 1.7 mg/L for TCOH and 2.5 mg/L for TCAA, and the maximum ambient trichloroethylene concentration was estimated to be <22 ppm from the previously reported equation using TCOH + TCAA. Sway parameters with eyes open and tremor intensity in dominant hand were significantly larger in the exposed workers than in the control subjects when adjusting for possible confounders. A significant dose-effect association was seen between two sway parameters and urinary TCOH level in the workers. Tremor intensities in non-dominant hand differed significantly among three groups of the workers divided according to the CEI.

CONCLUSIONS

These findings suggest that trichloroethylene exposure, even at low levels of less than the short-term exposure limit by the ACGIH, can affect the neuromotor function of workers. The postural instability appears to result from recent exposure, and the increased tremor may occur due to short-term and long-term exposures. Hereafter, such objective measures, along with subjective symptoms, should be carefully used for the occupational exposure limit setting.

Neurotoxic effect of occupational exposure to mixed organic solvents in Korea: Posturographic study

BACKGROUND

This study used static posturography to investigate the neurotoxic effects on workers exposed to mixed organic solvents at low concentrations under the levels of the threshold limit values (TLV).

METHODS

Forty-one workers from four plants exposed to mixed solvents and 90 non-exposed referents were examined. The lifetime cumulative biological exposure (CE) was estimated according to subject's occupational history and biological monitoring results. Static posturography and questionnaire were the basis of data collection.

RESULTS

The mean exposure index of mixed organic solvents of four plants was 0.47 (SD: 0.33, range: 0.08-1.39). The exposed group showed a larger sway area and length under the eye open condition than did the non-exposed group. In a multiple linear regression, a significant positive association was demonstrated between postural sway area and CE.

CONCLUSIONS

This study results suggest that the exposure to organic solvents under TLV levels may cause disturbance in postural stability.

Effect of chronic low level manganese exposure on postural balance: a pilot study of residents in southern Ohio

OBJECTIVE

The objective of this study was to determine the effect of non-occupational exposure to manganese (Mn) on postural balance.

METHODS

Residents living near a ferromanganese refinery provided hair and blood samples after postural balance testing. The relationship between hair Mn and postural balance was analyzed with logistic regression. Following covariate adjustment, postural balance was compared with control data by analysis of covariance.

RESULTS

Mean hair Mn was 4.4 microg/g. A significantly positive association was found between hair Mn and sway area (eyes open on the platform, P = 0.05; eyes closed on the platform, P = 0.04) and sway length (eyes open on the platform, P = 0.05; eyes closed on the platform, P = 0.04). Postural balance of residents was significantly larger than controls in 5 out of 8 postural balance outcomes.

CONCLUSION

Preliminary findings suggest subclinical impairment in postural balance among residents chronically exposed to ambient Mn. A prospective study with a larger sample size is warranted.

Impaired neuromotor functions in hospital laboratory workers exposed to low levels of organic solvents

Solvents are ubiquitous in industrial societies in a wide range of processes, and long-term exposure to these organic compounds may impair neuromotor functions such as equilibrium function. However, there is limited knowledge of effects on posture and gaze control after organic solvent exposures below workplace threshold limit values. The aim of this study was to evaluate the consequences of low-level co-exposure to organic solvents on balance and gaze control in hospital laboratory workers. Twelve hospital laboratory female subjects mainly exposed to toluene and ethanol, with median exposure duration of 24 years, and 12 non-exposed female controls were submitted to posturography and oculomotricity testings including sensory organization and motor control tests and saccade and smooth pursuit tests. Although current measured exposure values to toluene and ethanol were much below workplace threshold limit values (current median exposure levels of 32.5 mg/cubic meter and 39.9 mg/cubic meter, respectively), exposed workers displayed a weaker balance and a less precise gaze control. They presented, on the one hand, a reduced ability to resolve sensorial conflict situations compared to controls, particularly when situations were managed by the vestibular information, and, on the other hand, longer saccadic reaction time. Organic solvents might have an impact on vestibular pathways involved in postural control and exert a depressant central pathway effect implicated in the management of oculomotor response. Evaluating balance control in sensory conflicting situations and saccadic reaction time is proposed as a way to reveal subclinical neurotoxicological effects due to low-level exposure to organic solvents.

Postural balance changes in on-duty firefighters: effect of gear and long work shifts

OBJECTIVE

The objective of this study was to investigate the impact of long work shifts and turnout gear, including the self-contained breathing apparatus (SCBA) on firefighters' postural stability.

METHODS

Sixteen firefighters were assessed using a portable forceplate system at the fire station. Postural sway parameters were recorded at the beginning of the work shift and repeated until the work shift ended.

RESULTS

Task had the greatest impact on postural stability for all sway parameters. Turnout gear, with and without SCBA, improved postural stability. Postural stability decreased as firefighters spent more time on duty.

CONCLUSIONS

Prolonged work shifts may be an important contributor to the high prevalence of slips and falls among firefighters. In all, the results indicate that many aspects of the firefighters' job may adversely impact their postural stability and potentially increase the risk of falling.

Effect of Styrene on Postural Stability Among Reinforced Plastic Boat Plant Workers in Finland

OBJECTIVE

Many drugs are vestibulotoxic and may impair balance. Styrene is both ototoxic and neurotoxic, but its effect on balance has been little studied. We evaluate the effect of low concentrations of styrene on balance among Finnish fiberglass-reinforced plastic boat manufacturers.

METHODS

From 252 male employees, we measured postural stability and urine mandelic and phenylglycolic acid concentrations. Individual exposure to styrene in breathing zone was measured for 148 workers. For analysis, 88 matched pairs were selected.

RESULTS

The postural stability of laminators was aggravated compared with nonlaminators. This impairment was observed in young workers, and it worsened with age.

CONCLUSIONS

This study documents styrene as an additional risk factor in impaired postural stability, with the negative effects of the styrene exposure starting already in younger workers.

Long-term exposure to solvents impairs vigilance and postural control in serigraphy workers

OBJECTIVES

To investigate the effects of solvent exposure (mainly aromatic hydrocarbons) on central regulation of vigilance and postural control, particularly in occasional difficult situations that provide sensorial conflicts.

METHODS

Twenty-two workers occupationally exposed to solvents for an average of approximately 6 years and 21 controls were compared by the use of a questionnaire on their state of vigilance and quality of sleep and on performance measurements of postural control under six different sensorimotor conditions. Their current median exposure levels to aromatic hydrocarbons was 80.1 mg/m(3).

RESULTS

Exposed workers reported reduced alertness but not disturbance of sleep quality compared with controls. Moreover, they had the worst postural performance in all sensory conditions and demonstrated a reduced ability to resolve sensory conflict situations. The precision of stance was clearly affected by solvent exposure in contrast with energy consumption required to regulate proper balance control.

CONCLUSIONS

The depressive effect of aromatic hydrocarbon exposure on cortical and subcortical structures controlling vigilance and postural stability could lead to increased risk of occupational accident, especially due to falls. The detection of central neurotoxic effects by posturographic and vigilance tests could be useful in preventive strategies.

Work-related symptoms and inflammation among sewage plant operatives

Sewage operatives at five sewage treatment plants (n = 59) and controls not exposed to sewage (n = 55) were examined to determine work-related symptoms and inflammatory responses. Symptoms were elicited using a questionnaire, and spirometry was performed. Inflammatory markers were determined in blood and nasal lavage. Workplace endotoxin and hydrogen sulfide were measured and adeno- and enterovirus antibodies were evaluated in blood. Gastrointestinal and airway symptoms, joint pains, unusual tiredness, and toxic pneumonitis were more common among operatives, and the proportion of blood neutrophils was higher among operatives as compared with controls. A relationship was found between several reported symptoms and the inflammatory markers. Hydrogen sulfide levels were very low. Endotoxin levels were generally low, but high at some work sites.

Health effects among employees in sewage treatment plants: A literature survey

BACKGROUND

Over the years, there have been regular reports in the media of work-related symptoms among employees at sewage treatment plants. Concern has spread among employees over the lack of knowledge of risk agents' symptoms, and diseases in that environment. This paper reviews the investigations of health risks in employees working in the sewage treatment plants.

METHODS

A literature search was performed with the search terms; sewage, waste water, health effects, infection, and health hazards. Articles on health effects in relation to sewage were selected.

RESULTS

Work in sewage water plants can involve exposure to different types of microorganisms and chemicals. The bacterial exposure is dominated by bacteria that naturally occur in nature. However, different bacteria and viruses that give rise to infections can be present in this environment and thus there exists a risk of infection, especially of hepatitis A. Investigations suggest that gastrointestinal tract symptoms are more common among employees at sewage treatment plants than among controls. Respiratory symptoms, fatigue, and headache have also been reported in several investigations. The cause of the symptoms is unknown, although certain data suggest that they are caused by inflammation. The results suggest that endotoxin in Gram-negative bacteria may be one of the causative agents. As regards cancer, some studies report an increased risk of stomach cancer and a few studies report an increased risk of cancer in the larynx, liver or, prostate or of leukemia. The spread of the cancers over a multitude of organs does not support a hypothesis of causality with agents commonly found in sewage treatment plants.

CONCLUSIONS

Further investigations are needed to determine the work-related effects and ascertain the causal agents.

An experimental controlled study on postural sway and therapeutic exercise in subjects with low back pain

OBJECTIVES

To describe postural sway and its associations to background factors, low back pain and functional capacity. To evaluate the changes in postural sway after three months of therapeutic exercise in the gym or at home.

DESIGN

A one-year randomized experimental trial evaluated postural sway in three study groups: intensive training, home exercise and control group.

SETTING

Subjects were recruited from seven local occupational health care centres in Central Finland and were examined at Central Finland Hospital by medical doctors. Measurements and therapeutic exercise programmes were carried out in the Research Laboratory of Sport and Health Sciences at Jyväskylä University.

SUBJECTS

Initially, 49 male and 41 female subjects (aged 20-55 years) with nonspecific and subacute low back pain were examined.

MAIN OUTCOME MEASURES

Postural sway using a force platform, the Oswestry Index, as well as a measure of low back pain intensity were measured at the initial stage of the study, directly after interventions, as well as at three and nine months after the interventions.

RESULTS

The background variables were not strongly correlated with postural sway. No changes occurred in the amplitude of sway during the study, but the sway velocity of the home exercise group increased.

CONCLUSIONS

Postural sway measurements with a force platform may be suitable for detecting impairments of balance performance among subjects with pronounced functional or activity limitations and severe low back pain problems. In order to enhance balance performance, specific and customized exercise programmes are required.

Quantitative posturagraphy as an alternative noninvasive tool for alcohol/drug/chemical testing--preliminary thoughts

This article provides preliminary ideas regarding how the quantitative posturagraphy technique can be used as an alternative noninvasive tool to currently available blood/urine test for alcohol/drug/chemical exposure. It is argued that the urine or blood level of any chemical is highly dependent on the individual's metabolism without providing any insight into individual's task performance abilities under exposure to neurotoxic chemicals. On the other hand, the quantitative posturagraphy if carried out as proposed in this article will provide quantitative data regarding individual's ability to maintain "safe" upright balance while carrying out certain tasks. The proposed evaluation method is simple, portable, quick, and noninvasive and has been found to be sensitive to detecting low level solvent induced modifications in postural stability.