Lung and bladder cancer in a Norwegian municipality with iron and steel producing industry: population based case-control studies

Internal and External Factors Related to Burnout among Iron and Steel Workers: A Cross-Sectional Study in Anshan, China

Background

Burnout is a syndrome of emotional exhaustion, cynicism and reduced professional efficacy, which can result from long-term work stress. Although the burnout level is high among iron and steel workers, little is known concerning burnout among iron and steel worker. This study aimed to evaluate the burnout and to explore its associated internal and external factors in iron and steel workers.

Methods

A cross-sectional survey was conducted in iron and steel workers at the Anshan iron-steel complex in Anshan, northeast China. Self-administered questionnaires were distributed to 1,600 workers, and finally 1,300 questionnaires were returned. Burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS). Effort-reward imbalance (ERI), perceived organizational support (POS), and psychological capital (PsyCap) were measured anonymously. A hierarchical regression model was applied to explore the internal and external factors associated with burnout.

Results

Mean MBI-GS scores were 13.11±8.06 for emotional exhaustion, 6.64±6.44 for cynicism, and 28.96±10.39 for professional efficacy. Hierarchical linear regression analysis showed that ERI and POS were the most powerful predictors for emotional exhaustion and cynicism, and PsyCap was the most robust predictor for high professional efficacy.

Conclusions

Chinese iron and steel workers have a high level of burnout. Burnout might be associated with internal and external factors, including ERI, POS, and PsyCap. Further studies are recommended to develop an integrated model including both internal and external factors, to reduce the level of ERI, and improve POS and workers’ PsyCap, thereby alleviating the level of burnout among iron and steel workers.

Lung cancer – changes in incidence by gender, age and county of residence 1984-2013

BACKGROUND

The Cancer Registry of Norway has reported a decline in age-standardised lung cancer rates for men and an unconfirmed levelling-off in the rate for women. This study describes the development in trends according to gender and age, nationwide as well as by county.

MATERIAL AND METHOD

Data on lung cancer from the Cancer Registry of Norway and the NORDCAN website are presented as age-specific and age-standardised rates by gender and place of residence, with a main emphasis on the period 1984-2013.

RESULTS

Out of 62,937 Norwegian lung cancer patients (1984-2013), altogether 63% were men. Nationally there was a decline in the rate for middle-aged men (50-69 years), but only a levelling-off in the oldest age group (≥ 70 years). For women, the rates increased in both age groups, most markedly in the oldest one. The rates for older men in the Agder, Vestfold and Finnmark counties have remained above the national average for a prolonged period, and there are only modest signs of a decline among the middle-aged. Oslo is a clear exception, with a clear and sustained decline among men in both age groups. Vest-Agder county had the highest rate for women during the last five-year period, while the rates in Oslo are now at the national average. The national rates for middle-aged women and middle-aged men are converging, intersecting each other in Akershus county.

INTERPRETATION

The large differences between genders, age groups, counties and nations in terms of trends in lung cancer indicate that through preventive efforts, we might have achieved much more in a shorter time.

The association of smoking with vaginal flora, urinary tract infection, pelvic floor prolapse, and post-void residual volumes

OBJECTIVE

This study examined the association of smoking with changes in vaginal flora, the prevalence of urinary tract infection, genital prolapse, and incomplete bladder emptying.

METHODS

The authors conducted a retrospective review of charts for 305 women. In addition to smoking habits, data on age, parity, degree of genital prolapse, vaginal flora, urinary residual, urinary tract infection, and hormone replacement therapy were collected and analyzed.

RESULTS

Smoking did not correlate with urinary tract infection, the amount of post-void urine residual volumes, or pessary use. Smoking was significantly associated with the presence of a severe degree of genital prolapse. Smoking independently affected vaginal flora, increasing the odds of developing bacterial vaginosis.

CONCLUSION

Smoking was associated with an increased risk of developing bacterial vaginosis and having severe genital prolapse. Smoking was not associated with urinary tract infection or the amount of post-void residual urine.

Antaxia-telangiectasia mutated gene polymorphisms and susceptibility to chromosomal damage among polycyclic aromatic hydrocarbons exposed workers

The aim was to explore the relationship between the ataxia-telangiectasia mutated (ATM) gene polymorphisms and susceptibility to cytokinesis-block micronucleus among workers exposed to polycyclic aromatic hydrocarbons (PAH). Blood and urine samples of 140 PAH-exposed workers and 66 non-PAH-exposed workers were collected. Seven tagging single nucleotide polymorphisms in ATM gene were selected by pariwise r(2) method and minor allele frequency cutoff of 0.05 from Chinese genotype data in HapMap project. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to analyze the polymorphisms of ATM rs600931, rs652311, rs227060, rs227292, rs624366, rs189037 and rs228589. The results showed that ATM rs600931 AG and AG+AA genotypes exhibited significantly higher cytokinesis-block micronucleus (CBMN) frequency (11.14+/-6.91 per thousand and 10.57+/-6.82 per thousand) than did the GG genotype (7.66+/-5.69 per thousand, P=0.015 and 0.038, respectively). The subjects with rs189037 GA and GA+AA genotypes exhibited significantly higher CBMN frequency (10.99+/-6.90 per thousand and 10.51+/-6.76 per thousand) than that of the GG genotype (7.72+/-5.82 per thousand, P=0.018 and 0.035, respectively). The PAH-exposed workers with rs624366 GC and GC+CC genotypes exhibited significantly higher CBMN frequency (11.34+/-6.74 per thousand and 10.73+/-6.62 per thousand) than did the GG genotype (7.61+/-6.07 per thousand, P=0.001 and 0.003, respectively). rs227092 GT genotype exhibited significantly higher CBMN frequency (10.78+/-6.60 per thousand) than did the GG genotype (7.91+/-6.30 per thousand, P=0.025) among the PAH-exposed workers. The haplotype pairs GGGGTGC/AAACATT exhibited significantly higher CBMN frequency (12.05+/-7.40 per thousand) than did the GGGGTGC/GGGGTGC (7.51+/-6.19 per thousand, P=0.007) among the PAH-exposed group. In conclusion, it is suggested that the polymorphisms of ATM were associated with the CBMN frequencies among PAH-exposed workers.

Bladder cancer incidence and exposure to polycyclic aromatic hydrocarbons among asphalt pavers

OBJECTIVES

To investigate the association between exposures to polycyclic aromatic hydrocarbons (PAH) that arises during asphalt paving, and risk of bladder cancer.

METHODS

7298 men included in the historical cohort were first employed between 1913 and 1999 in companies applying asphalt in Denmark, Norway, Finland and Israel. The minimal duration of employment for inclusion in the cohort was two seasons of work. Occupational histories were extracted from personnel files. A follow-up for cancer incidence was conducted through national cancer registries. The authors estimated exposures to benzo(a)pyrene as a marker for 4-6 ring PAH. Exposures were reconstructed by using information about changes in asphalt paving technology in each company over time, the modelled relation between production characteristics and exposure levels, and job histories. Relative risks and associated 95% confidence intervals were estimated using Poisson regression.

RESULTS

48 bladder cancers among asphalt paving workers were detected; of these, 39 cases were exposed at least 15 years before the diagnosis. Cumulative exposure to PAH was not associated with the incidence of bladder cancer. The association with average exposure became stronger when 15-year lag was considered, revealing a twofold increase in relative bladder cancer risk in the two higher exposure categories. There was an indication of exposure-response association with lagged averaged exposure. Risk estimates were adjusted for age, country, duration of employment and calendar period, did not show heterogeneity among countries and did not materially change when re-estimated after excluding non-primary cancers from follow-up. Previously conducted sensitivity analysis indicates that confounding by cigarette smoking is an unlikely explanation for the observed exposure-response trends.

CONCLUSIONS

The authors were unable to control for all possible sources of confounding and bias. The results do not allow conclusion on the presence or absence of a causal link between exposures to PAH and risk of bladder cancer among asphalt workers.

Cancer morbidity in iron and steel workers in Korea

BACKGROUND

In the iron and steel industry, workers are potentially exposed to a number of carcinogens and are involved in a number of processes of a hazardous nature. The cancer morbidity of iron and steel workers from modern plants in a developing country is described.

METHODS

Cancer morbidity at two Korean iron and steel complexes was analyzed using Poisson regression methods. Work histories were merged with the national cancer registry for 44,974 workers who were followed from 1988-2001.

RESULTS

Four hundred sixty-four cancers, in 1% of the population, were diagnosed over 14 years. Based on national cancer rates, the cohort exhibited a healthy worker effect for all cancer (SIR = 0.87, 95% CI = 0.79-0.95) reflecting relative good health, particularly for lung cancer (SIR = 0.58, 95% CI = 0. 04-0.82), stomach cancer (SIR = 0.78, 95% CI = 0.64-0.93), and liver cancer (SIR = 0.83, 95% CI = 0.68-1.01). Lung cancer morbidity was significantly elevated at the affiliated plants versus the parent plants (SRR = 2.35, 95% CI = 1.07-4.92), and all-cancer morbidity was significantly elevated for maintenance workers compared to office and production workers (SRR = 1.27, 95% CI = 1.00-1.60). Lymphohematopoietic cancer incidence was higher in the coke plants (SRR = 3.46, 95% CI = 1.02-8.91) and stomach cancer incidence was higher in the maintenance departments (SRR = 1.66, 95% CI = 1.05-2.56).

CONCLUSIONS

This recent steelworker cohort exhibits possible excess cancer morbidity in some processing areas. Further follow-up of this cohort and alternate study designs such as case-control study will be needed to elucidate the relationship of exposure and health risks of iron and steel workers.

Occupation and smoking as risk factors for lung cancer: a population-based case-control study

BACKGROUND

Lung cancer is associated with occupation, but not much is known about the influence exerted on risk by length of exposure and the joint effect of occupational exposure and tobacco on risk of lung cancer.

METHODS

Through a population-based case-control study, we defined risk professions as those that have been associated previously with higher risk of lung cancer.

RESULTS

The relative risk seems to increase linearly and significantly with the number of years spent in risk occupations, rising significantly by 28% for every 10 years in a risk profession. Should such occupations be combined with exposure to a smoking habit, then in the case of heavy smokers, a working career spanning 20 years or more in risk occupations would mean tripling the possibility of developing lung cancer from occupation.

CONCLUSIONS

The high risks observed indicate a public health problem and indicate that joint exposure to risk professions and tobacco ought to be avoided. We must stress from these results the need for effective education for all workers.

Risk of bladder cancer in foundry workers: a meta-analysis

To clarify the inconsistent reports of bladder cancer risk in foundry workers, a meta-analytic review of epidemiological studies was undertaken. Summary risk estimates (SRE) were calculated from 40 systematically extracted results. Weakly increased risks were observed overall, with an SRE of 1.11. Twenty three selected study results with better exposure information yielded an SRE of 1.16. This weak increase in risk is consistent with estimates obtained from dose-response trends of PAH exposures in aluminium smelter workers. Summary estimates did not vary substantially with exposure quality, study design, control for smoking, or when limiting the meta-analysis to large study results. Exposure-response findings showed significantly increased risks of about 1.6 to 1.7 after 20 or more years of employment, but this was based on few studies. Occupation specific SREs showed a 40-50% increased risk among moulders, casters, and unskilled foundry labourers. There was limited evidence that bladder cancer risk correlated with lung cancer risk, which is a more established risk among foundry workers. The small increased risk observed is prone to bias and confounding. Further studies of dose-response trends would greatly aid in determining whether this observed association is causal.

Potency of various polycyclic aromatic hydrocarbons as inducers of CYP1A1 in rat hepatocyte cultures

A number of highly toxic environmental pollutants including certain polychlorinated dibenzo-p-dioxins (PCDD), polychlorinated dibenzofurans (PCDF), and 'dioxin-like' polychlorinated biphenyls (PCB) are among the most potent agonists of the aryl hydrocarbon receptor (AHR). Induction of cytochrome P4501A1 (CYP1A1) in mammalian cell culture is widely used as a functional parameter for AHR activation providing an estimate for 'dioxin-like' inducing equivalents in extracts from environmental samples. Since a number of polycyclic aromatic hydrocarbons (PAHs) also act as AHR-agonists, the CYP1A1-inducing potencies, measured as induction of 7-ethoxyresorufin O-deethylase (EROD) activity in rat hepatocyte cultures were analyzed for 16 PAHs frequently present in environmental samples. Among these, seven PAHs including benzo[a]pyrene were relatively potent inducers allowing the determination of Induction Equivalency Factors (IEF). For three PAHs including benzo[k]fluoranthene which acted as weak inducers, IEFs were estimated, while six PAHs including acenaphthylene were classified as inactive. Based on different efficacies the concentration-response characteristics of CYP1A1 induction were analyzed in more detail for benzo[a]pyrene, benzo[k]fluoranthene, and acenaphthylene. Benzo[k]fluoranthene was markedly less effective than benzo[a]pyrene as inducer of EROD activity but even more effective than benzo[a]pyrene as inducer of CYP1A1 protein and mRNA. Acenaphthylene was highly more effective on the level of mRNA than on the levels of protein or EROD activity. Further analysis revealed that the low efficacy of acenaphthylene as inducer of CYP1A1 protein and EROD activity is due to its marked cytotoxicity while no clear-cut explanation was found for the differences in efficacy between benzo[k]fluoranthene and benzo[a]pyrene. The EROD-inducing potency of a mixture of 16 PAH was about 2-fold higher than that calculated on the basis of IEFs of the individual constituents of the mixture.