1
|
Huo C, Jiao X, Wang Y, Jiang Q, Ning F, Wang J, Jia Q, Zhu Z, Tian L. Silica aggravates pulmonary fibrosis through disrupting lung microbiota and amino acid metabolites. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 945:174028. [PMID: 38889818 DOI: 10.1016/j.scitotenv.2024.174028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
Silicosis, recognized as a severe global public health issue, is an irreversible pulmonary fibrosis caused by the long-term inhalation of silica particles. Given the intricate pathogenesis of silicosis, there is no effective intervention measure, which poses a severe threat to public health. Our previous study reported that dysbiosis of lung microbiota is associated with the development of pulmonary fibrosis, potentially involving the lipopolysaccharides/toll-like receptor 4 pathway. Similarly, the process of pulmonary fibrosis is accompanied by alterations in metabolic pathways. This study employed a combined approach of 16S rDNA sequencing and metabolomic analysis to investigate further the role of lung microbiota in silicosis delving deeper into the potential pathogenesis of silicosis. Silica exposure can lead to dysbiosis of the lung microbiota and the occurrence of pulmonary fibrosis, which was alleviated by a combination antibiotic intervention. Additionally, significant metabolic disturbances were found in silicosis, involving 85 differential metabolites among the three groups, which are mainly focused on amino acid metabolic pathways. The changed lung metabolites showed a substantial correlation with lung microbiota. The relative abundance of Pseudomonas negatively correlated with L-Aspartic acid, L-Glutamic acid, and L-Threonine levels. These results indicate that dysbiosis in pulmonary microbiota exacerbates silica-induced fibrosis through impacts on amino acid metabolism, providing new insights into the potential mechanisms and interventions of silicosis.
Collapse
Affiliation(s)
- Chuanyi Huo
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Xukun Jiao
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Yan Wang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Qiyue Jiang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Fuao Ning
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Jiaxin Wang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Qiyue Jia
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China.
| | - Zhonghui Zhu
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China.
| | - Lin Tian
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China.
| |
Collapse
|
2
|
Kromhout H, van Tongeren M, Cherrie JW. Should engineered stone products be banned? Occup Environ Med 2024; 81:329-330. [PMID: 39107095 DOI: 10.1136/oemed-2024-109708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024]
Affiliation(s)
- Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - John W Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University, Edinburgh, UK
| |
Collapse
|
3
|
Ma R, Huang X, Sun D, Wang J, Xue C, Ye Q. Tetrandrine Alleviates Silica-induced Pulmonary Fibrosis Through PI3K/AKT Pathway: Network Pharmacology Investigation and Experimental Validation. Inflammation 2024; 47:1109-1126. [PMID: 38265677 DOI: 10.1007/s10753-023-01964-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
Tetrandrine (TET) is a bisbenzylisoquinoline alkaloid derived from Stephania tetrandra S. Moor, known for its potential use in attenuating the progression of silicosis. However, the precise effects and underlying mechanisms of TET remain controversial. In this study, we aimed to elucidate the pharmacological mechanism of TET using a network pharmacology approach, while also evaluating its effect on silica-induced lung fibrosis in mice and TGF-β1-stimulated pulmonary fibroblasts in vitro. We employed network pharmacology to unravel the biological mechanisms through which TET may exert its therapeutic effects on pulmonary fibrosis and silicosis. In a silica-induced mouse model of lung fibrosis, TET was administered orally either during the early or late stage of fibrotic progression. Additionally, we examined the effects of TET on fibroblasts stimulated by TGF-β1 in vitro. Through the analysis, we identified a total of 101 targets of TET, 7,851 genes associated with pulmonary fibrosis, and 80 overlapping genes. These genes were primarily associated with key pathways such as epidermal growth factor receptor tyrosine kinase inhibitor resistance, the vascular endothelial growth factor signaling pathway, and the phosphatidylinositol 3 kinase (PI3K)-protein kinase B (PKB or AKT) signaling pathway. Furthermore, molecular docking analysis revealed the binding of TET to AKT1, the catalytic subunit of phosphatidylinositol-3 kinase, and KDR. In vivo experiments demonstrated that TET significantly alleviated silica-induced pulmonary fibrosis and reduced the expression of fibrotic markers. Moreover, TET exhibited inhibitory effects on the migration, proliferation, and differentiation of TGF-β1-induced lung fibroblasts in vitro. Notably, TET mitigated silica-induced pulmonary fibrosis by suppressing the PI3K/AKT pathway. In conclusion, our findings suggest that TET possesses the ability to suppress silica-induced pulmonary fibrosis by targeting the PI3K/AKT signaling pathway. These results provide valuable insights into the therapeutic potential of TET in the treatment of pulmonary fibrosis and silicosis.
Collapse
Affiliation(s)
- Ruimin Ma
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China
- Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoxi Huang
- Medical Research Center, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Di Sun
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China
| | - Jingwei Wang
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China
| | - Changjiang Xue
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China
| | - Qiao Ye
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chao-Yang District, Beijing, China.
| |
Collapse
|
4
|
Yatera K, Nishida C. Contemporary Concise Review 2023: Environmental and occupational lung diseases. Respirology 2024; 29:574-587. [PMID: 38826078 DOI: 10.1111/resp.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
Air pollutants have various effects on human health in environmental and occupational settings. Air pollutants can be a risk factor for incidence, exacerbation/aggravation and death due to various lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis or pneumonia (HP), pulmonary fibrosis such as pneumoconiosis and malignant respiratory diseases such as lung cancer and malignant pleural mesothelioma. Environmental and occupational respiratory diseases are crucial clinical and social issues worldwide, although the burden of respiratory disease due to environmental and occupational causes varies depending on country/region, demographic variables, geographical location, industrial structure and socioeconomic situation. The correct recognition of environmental and occupational lung diseases and taking appropriate measures are essential to their effective prevention.
Collapse
Affiliation(s)
- Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Chinatsu Nishida
- Department of Environmental Health Engineering, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| |
Collapse
|
5
|
Cool CD, Murray J, Vorajee NI, Rose CS, Zell-Baran LM, Sanyal S, Franko AD, Almberg KS, Iwaniuk C, Go LHT, Green FHY, Cohen RA. Pathologic Findings in Severe Coal Workers' Pneumoconiosis in Contemporary US Coal Miners. Arch Pathol Lab Med 2024; 148:805-817. [PMID: 37852172 DOI: 10.5858/arpa.2022-0491-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT.— The pathology of coal workers' pneumoconiosis (CWP) and its most severe form-progressive massive fibrosis (PMF)-in US coal miners has changed in recent years. Severe disease is occurring in younger miners and has been linked to an increase in silica dust exposure. OBJECTIVE.— To update the description of the pathologic features of CWP in contemporary miners compared to historical miners. DESIGN.— This study is a retrospective expert classification of lung tissue from 85 historical and contemporary coal miners with PMF. Significant pathologic features were scored by using a standardized instrument with consensus achieved for major findings, including newly defined categories of PMF as coal-type, mixed-type, and silica-type. RESULTS.— Pathologic features associated with silica dust exposure, including silica-type PMF, mineral dust alveolar proteinosis (MDAP), and immature (early stage) silicotic nodules, were increased in contemporary miners. Detailed descriptions of the pathology of contemporary CWP with illustrative figures are provided. CONCLUSIONS.— Silica-related pathologies are more common in contemporary miners. Severe forms of CWP can be detected by subtyping PMF lesions (if present) or by identification of mature and immature silicotic nodules, coal mine dust-related alveolar proteinosis, and severe inflammation in coal miners' lungs. Silica-type PMF cases showed significantly higher levels of MDAP than either mixed- or coal-type PMF (P < .001). High profusion of birefringent silica/silicate particles was observed more frequently in cases with immature (early stage) silicotic nodules (P = .04). Severe inflammation was also significantly increased in contemporary miners (P = .03). Our findings underscore the urgent need to revise current exposure limits and monitoring of respirable crystalline silica in US coal mines.
Collapse
Affiliation(s)
- Carlyne D Cool
- From the Department of Pathology, University of Colorado School of Medicine, Aurora (Cool)
- the Department of Pathology, National Jewish Health, Denver, Colorado (Cool)
| | - Jill Murray
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa (Murray)
| | - Naseema I Vorajee
- Histopathology, Lancet Laboratories, Johannesburg, South Africa (Vorajee)
| | - Cecile S Rose
- the Department of Environmental and Occupational Health Sciences, National Jewish Health and University of Colorado, Denver (Rose, Zell-Baran)
| | - Lauren M Zell-Baran
- the Department of Environmental and Occupational Health Sciences, National Jewish Health and University of Colorado, Denver (Rose, Zell-Baran)
| | - Soma Sanyal
- the Department of Pathology, Upstate Medical University, State University of New York, Syracuse (Sanyal)
| | - Angela D Franko
- the Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada (Franko, Green)
| | - Kirsten S Almberg
- the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago (Almberg, Iwaniuk, Go, Cohen)
| | - Cayla Iwaniuk
- the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago (Almberg, Iwaniuk, Go, Cohen)
| | - Leonard H T Go
- the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago (Almberg, Iwaniuk, Go, Cohen)
| | - Francis H Y Green
- the Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada (Franko, Green)
| | - Robert A Cohen
- the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago (Almberg, Iwaniuk, Go, Cohen)
| |
Collapse
|
6
|
Martínez-González D, Carballo-Menéndez M, Guzmán-Taveras R, Quero-Martínez A, Fernández-Tena A. Evaluating silicosis risk: Assessing dust constitution and influence of water as a primary prevention measure in cutting and polishing of silica agglomerates, granite and marble. ENVIRONMENTAL RESEARCH 2024; 251:118773. [PMID: 38522742 DOI: 10.1016/j.envres.2024.118773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
An increasing number of silicosis cases have been reported related to the use of silica agglomerates. Many studies agree on the severity of this disease, which often presents with severe clinical forms in young workers and after a short latency period. Are there differences in the composition of dust generated by cutting and polishing with silica agglomerates versus granite and marble? Does the use of water injection reduce the risk associated with the use of these materials? We carried out a comparative observational-analytical study, measuring the concentration of dust generated during different machining operations on three different materials: granite, marble, and silica agglomerates. The effect of water injection on dust generation was evaluated. Personal sampling pumps were used, connected to a cyclone with polyvinyl chloride filters. The flow rate of the pumps was adjusted using a piston flowmeter. Measurements with a cascade impactor were made to assess the size distribution of respirable crystalline silica particles within the respirable fraction. In addition, environmental measurements with a spectrometer were made. 10 tests were carried out on granite and silica agglomerates for each procedure. In the case of marble, with very low silica content, only 2 tests of each type were carried out. Duration of each measurement was between 6 and 25 min. Cleaning times were set for each of the operations. The amount of dust collected in the respirable fraction was 70.85, 32.50 and 35.78 mg/m3 for dry cutting; 6.50, 3.75 and 3.95 mg/m3 for wet cutting; and 21.35, 13.68 and 17.50 mg/m3 for dry polishing, for granite, marble, and silica agglomerates respectively. Dry procedures in marble, silica agglomerates and granite showed higher dust concentration of particles smaller than 0.5 μm. Silica agglomerates showed higher concentrations of respirable crystalline silica particles than granite and marble, mainly with dry procedures. The greater production of small particles in dry and wet procedures with silica agglomerates shows that water injection is an insufficient preventive measure.
Collapse
Affiliation(s)
- Daniel Martínez-González
- Instituto Nacional de Silicosis and GRUBIPU-ISPA and Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja, Spain.
| | | | | | | | - Ana Fernández-Tena
- Instituto Nacional de Silicosis, GRUBIPU-ISPA and Facultad de Enfermería, Universidad de Oviedo, Spain.
| |
Collapse
|
7
|
Hsu SC, Chen YJ, Fan HY, Wang CW, Lee HJ, Tsao YC. Successful lung transplantation for artificial stone-associated accelerated silicosis: a case report. INDUSTRIAL HEALTH 2024; 62:209-214. [PMID: 37866925 PMCID: PMC11170085 DOI: 10.2486/indhealth.2023-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
This report focuses on the occupational health risks associated with the use of artificial stones containing high levels of crystalline silica in the production of kitchen countertops. It presents the case of a 43-yr-old man who developed severe silicosis due to his occupation involving cutting and polishing quartz stone raw materials. A retrospective analysis of the patient's medical records and occupational history was conducted. The diagnosis of severe silicosis, moderate restrictive lung disease, and bilateral pneumothorax was based on clinical manifestations, pulmonary function test, radiological findings, and histological reports. The patient underwent lung transplantation, and his pulmonary function improved post-surgery. The study highlights the significant health risks associated with procedures involving artificial stones and emphasizes the importance of awareness and protective measures for employees and workers. Clinicians should be cautious when diagnosing respiratory symptoms in patients with a history of occupational exposure to artificial stones containing high levels of crystalline silica.
Collapse
Affiliation(s)
- Shou-Chien Hsu
- Department of Occupational Medicine, Linkou Chang Gung Memorial Hospital, Taiwan
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taiwan
| | - Yun-Ju Chen
- Department of Occupational Medicine, Linkou Chang Gung Memorial Hospital, Taiwan
| | - Hao-Yi Fan
- Department of Occupational Medicine, Linkou Chang Gung Memorial Hospital, Taiwan
- College of Medicine, Chang Gung University, Taiwan
| | - Chih-Wei Wang
- College of Medicine, Chang Gung University, Taiwan
- Department of Anatomic Pathology, Linkou Chang Gung Memorial Hospital, Taiwan
| | - Han-Jui Lee
- Department of Radiology, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taiwan
| | - Yu-Chung Tsao
- Department of Occupational Medicine, Linkou Chang Gung Memorial Hospital, Taiwan
- College of Medicine, Chang Gung University, Taiwan
- Master of Science Degree Program in Innovation for Smart Medicine, Chang Gung University, Taiwan
| |
Collapse
|
8
|
Ramkissoon C, Gaskin S, Song Y, Pisaniello D, Zosky GR. From Engineered Stone Slab to Silicosis: A Synthesis of Exposure Science and Medical Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:683. [PMID: 38928930 PMCID: PMC11203299 DOI: 10.3390/ijerph21060683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Engineered stone (ES) is a popular building product, due to its architectural versatility and generally lower cost. However, the fabrication of organic resin-based ES kitchen benchtops from slabs has been associated with alarming rates of silicosis among workers. In 2024, fifteen years after the first reported ES-related cases in the world, Australia became the first country to ban the use and importation of ES. A range of interacting factors are relevant for ES-associated silicosis, including ES material composition, characteristics of dust exposure and lung cell-particle response. In turn, these are influenced by consumer demand, work practices, particle size and chemistry, dust control measures, industry regulation and worker-related characteristics. This literature review provides an evidence synthesis using a narrative approach, with the themes of product, exposure and host. Exposure pathways and pathogenesis are explored. Apart from crystalline silica content, consideration is given to non-siliceous ES components such as resins and metals that may modify chemical interactions and disease risk. Preventive effort can be aligned with each theme and associated evidence.
Collapse
Affiliation(s)
- Chandnee Ramkissoon
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5064, Australia; (S.G.); (D.P.)
| | - Sharyn Gaskin
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5064, Australia; (S.G.); (D.P.)
| | - Yong Song
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (Y.S.); (G.R.Z.)
| | - Dino Pisaniello
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5064, Australia; (S.G.); (D.P.)
| | - Graeme R. Zosky
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (Y.S.); (G.R.Z.)
| |
Collapse
|
9
|
Huang X, Liang R, Liu Y, Yu L, Yang M, Shang B, Zhang H, Ma J, Chen W, Wang D. Incidence, mortality, and disability-adjusted life years due to silicosis worldwide, 1990-2019: evidence from the global burden of disease study 2019. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:36910-36924. [PMID: 38758446 DOI: 10.1007/s11356-024-33701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
Silicosis is an occupational lung disease because of exposure to silica dust in the workplace. Evidence on the spatiotemporal change of silicosis burden worldwide remains limited. This study utilized data extracted from the Global Burden of Disease Study 2019 to examine the numbers and age-standardized rates of incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) caused by silicosis between 1990 and 2019. Average annual percentage changes (AAPCs) were calculated to evaluate the temporal trends of age-standardized indicators by sex, region, and socio-demographic index (SDI) since 1990. Results indicated an increase in new silicosis cases globally, rising by 64.61% from 84,426 in 1990 to 138,971 in 2019, with a sustained high number of DALYs attributed to this disease. Although the global age-standardized rates of incidence, mortality, and DALYs of silicosis have decreased since 1990, the number of new cases has increased in 168 countries and territories, and the ASIR of silicosis has also risen in 118 countries and territories, primarily in developing countries. Since 1990, the burden of silicosis among the elderly has significantly increased. Countries with higher SDI experienced a more rapid decline in the silicosis burden. Silicosis remains a public health problem that requires significant attention. Programs for prevention and elimination of this public health issue need to be established in more countries and territories. Protecting young workers from silica dust exposure is crucial to prevent the onset of silicosis in their later years and to reduce the disease burden among older workers.
Collapse
Affiliation(s)
- Xuezan Huang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ruyi Liang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yang Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Linling Yu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Meng Yang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Bingxin Shang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Haozhe Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jixuan Ma
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
10
|
Barnes H, Hoy RF. Changing trends in mesothelioma: Important lessons for an occupational disease registry. Respirology 2024; 29:269-270. [PMID: 38404135 DOI: 10.1111/resp.14692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
See related article
Collapse
Affiliation(s)
- Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ryan F Hoy
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Vasse GF, Melgert BN. Microplastic and plastic pollution: impact on respiratory disease and health. Eur Respir Rev 2024; 33:230226. [PMID: 39009408 PMCID: PMC11262622 DOI: 10.1183/16000617.0226-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/28/2024] [Indexed: 07/17/2024] Open
Abstract
Throughout their lifecycle, from production to use and upon disposal, plastics release chemicals and particles known as micro- and nanoplastics (MNPs) that can accumulate in the environment. MNPs have been detected in different locations of the human body, including in our lungs. This is likely a consequence of MNP exposure through the air we breathe. Yet, we still lack a comprehensive understanding of the impact that MNP exposure may have on respiratory disease and health. In this review, we have collated the current body of evidence on the implications of MNP inhalation on human lung health from in vitro, in vivo and occupational exposure studies. We focused on interactions between MNP pollution and different specific lung-resident cells and respiratory diseases. We conclude that it is evident that MNPs possess the capacity to affect lung tissue in disease and health. Yet, it remains unclear to which extent this occurs upon exposure to ambient levels of MNPs, emphasising the need for a more comprehensive evaluation of environmental MNP exposure levels in everyday life.
Collapse
Affiliation(s)
- Gwenda F Vasse
- Groningen Research Institute for Pharmacy, Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbro N Melgert
- Groningen Research Institute for Pharmacy, Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
12
|
Hore-Lacy F, Gwini S, Glass DC, Dimitriadis C, Jimenez-Martin J, Hoy RF, Sim MR, Walker-Bone K, Fisher J. Psychometric properties of the Perceived Stress Scale (PSS-10) in silica-exposed workers from diverse cultural and linguistic backgrounds. BMC Psychiatry 2024; 24:181. [PMID: 38439053 PMCID: PMC10913222 DOI: 10.1186/s12888-024-05613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The Perceived Stress Scale (PSS-10) has been used in a range of occupational cohorts, but only recently in stone benchtop workers undergoing screening for silicosis. The aim of this study was to compare psychometric properties of the PSS-10 in stone benchtop workers amongst those born overseas or who used an interpreter. METHODS Stone benchtop workers in Melbourne, Australia completed the PSS-10 as part of their occupational screening for silicosis. Internal consistency was assessed with Cronbach's α for the total score and the positive and negative subscales. Validity was assessed using confirmatory factor analysis (CFA). Analysis was performed for the total group and for subgroups according to sex, interpreter use, overseas-born, and language spoken at home. RESULTS The results of 682 workers with complete PSS-10 scores were included in analysis. Most participants were male (93%), with mean age 36.9 years (SD 11.4), with just over half (51.6%) born in Australia, 10.1% using an interpreter, and 17.5% using a language other than English at home. Cronbach's α for the overall group (α = 0.878) suggested good internal consistency. DISCUSSION CFA analysis for validity testing suggested PSS-10 performance was good for both sexes, moderate for country of birth and language spoken at home categories, but poorer for those who used an interpreter. Whilst professional interpreters provide a range of benefits in the clinical setting, the use of translated and validated instruments are important, particularly in cohorts with large numbers of migrant workers. CONCLUSION This study describes the psychometric properties of the PSS-10 in a population of stone benchtop workers, with good internal consistency, and mixed performance from validity testing across various subgroups.
Collapse
Affiliation(s)
- Fiona Hore-Lacy
- Monash University, Melbourne, Australia.
- Alfred Health, Melbourne, Australia.
| | | | | | | | | | - Ryan F Hoy
- Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | | | | | | |
Collapse
|
13
|
Chen CH, Tsai PJ, Chang WW, Chen CY, Chen CY, Yates D, Guo YL. Dose-response relationship between lung function and chest imaging response to silica exposures in artificial stone manufacturing workers. Environ Health 2024; 23:25. [PMID: 38429786 PMCID: PMC10908069 DOI: 10.1186/s12940-024-01067-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Occupational exposure to artificial stone, a popular material used for countertops, can cause accelerated silicosis, but the precise relationship between silica dose and disease development is unclear. OBJECTIVES This study evaluated the impact of silica exposure on lung function and chest imaging in artificial stone manufacturing workers. METHODS Questionnaire and spirometry assessments were administered to workers in two plants. A high-exposure subset underwent further evaluation, including chest CT and DLco. Weighting factors, assigned as proxies for silica exposure, were based on work tasks. Individual cumulative exposures were estimated using area concentration measurements and time spent in specific areas. Exposure-response associations were analyzed using linear and logistic regression models. RESULTS Among 65 participants, the mean cumulative silica exposure was 3.61 mg/m3-year (range 0.0001 to 44.4). Each 1 mg/m3-year increase was associated with a 0.46% reduction in FVC, a 0.45% reduction in FEV1, and increased lung function abnormality risk (aOR = 1.27, 95% CI = 1.03-1.56). Weighting factors correlated with cumulative exposures (Spearman correlation = 0.59, p < 0.0001), and weighted tenure was associated with lung function abnormalities (aOR = 1.04, 95% CI = 1.01-1.09). Of 37 high-exposure workers, 19 underwent chest CT, with 12 (63%) showing abnormal opacities. Combining respiratory symptoms, lung function, and chest X-ray achieved 91.7% sensitivity and 75% specificity for predicting chest CT abnormalities. CONCLUSION Lung function and chest CT abnormalities occur commonly in artificial stone workers. For high-exposure individuals, abnormalities on health screening could prompt further chest CT examination to facilitate early silicosis detection.
Collapse
Affiliation(s)
- Chi-Hsien Chen
- Department of Environmental and Occupational Medicine, College of Medicine and NTU Hospital, National Taiwan University (NTU), No. 7, Zhongshan S. Rd., Zhongzheng Dist, Taipei City, Taiwan
| | - Perng-Jy Tsai
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd., North District, Tainan, 70403, Taiwan
| | - Wen-Wen Chang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd., North District, Tainan, 70403, Taiwan
| | - Cheng-Yao Chen
- Division of Occupational Hazards Assessment, Institute of Labor, Occupational Safety and Health, Ministry of Labor, No. 99, Ln. 407, Hengke Rd., Xizhi Dist, New Taipei City, 221004, Taiwan
| | - Chih-Yong Chen
- Division of Occupational Hazards Assessment, Institute of Labor, Occupational Safety and Health, Ministry of Labor, No. 99, Ln. 407, Hengke Rd., Xizhi Dist, New Taipei City, 221004, Taiwan
| | - Deborah Yates
- Respiratory Medicine, St Vincent's Public Hospital, Sydney, Australia
- St Vincent's Hospital Clinical School, Sydney, Australia
| | - Yue Leon Guo
- Department of Environmental and Occupational Medicine, College of Medicine and NTU Hospital, National Taiwan University (NTU), No. 7, Zhongshan S. Rd., Zhongzheng Dist, Taipei City, Taiwan.
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei City, Taiwan.
- National Institute of Environmental Health Sciences, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Township, Miaoli County, Taiwan.
- Department of Environmental and Occupational Medicine, College of Medicine and National Taiwan University Hospital, National Taiwan University, Rm 339, 17 Syujhou Road, Taipei, 100, Taiwan.
| |
Collapse
|
14
|
Weller M, Clemence D, Lau A, Rawlings M, Robertson A, Sankaran B. An assessment of worker exposure to respirable dust and crystalline silica in workshops fabricating engineered stone. Ann Work Expo Health 2024; 68:170-179. [PMID: 38096573 DOI: 10.1093/annweh/wxad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/29/2023] [Indexed: 02/21/2024] Open
Abstract
There is a significant silicosis risk for workers fabricating engineered stone (ES) products containing crystalline silica. The aims of this study by SafeWork NSW were to: (i) assess current worker exposure to respirable dust (RD) and respirable crystalline silica (RCS) following a 5-y awareness and compliance program of inspections in ES workshops and (ii) to identify improvements in work practices from the available evidence base to further reduce exposures. One hundred and twenty-three personal full shift samples taken on as many workers and 34 static samples across 27 workshops fabricating ES were included in the final assessment. The exposure assessment was conducted using Casella Higgins-Dewell cyclones (Casella TSI) placed in the breathing zone of workers attached to SKC Air Check XR 5000 or SKC Chek TOUCH sampling pumps. Sample filters were sent to an ISO (2017) 17025:2017 accredited laboratory for gravimetric analysis for RD and X-Ray Diffraction (XRD) analysis to determine the amount of deposited RCS i.e. alpha-quartz and cristobalite. All workshops used wet methods of fabrication. The geometric mean (GM) of the pooled result for respirable dust (RD) was 0.09 mg/m3 TWA-8 h and 0.034 mg/m3 TWA-8 h for RCS. The highest exposed workers with a GM RCS of 0.062 mg/m3 TWA-8 h were those using pneumatic hand tools for cutting or grinding combined with polishing tasks. Workers operating semiautomated routers and edge polishers had the lowest GM RCS exposures of 0.022 mg/m3 TWA-8 h and 0.018 mg/m3 TWA-8 h respectively. Although ES workers remain exposed to RCS above the workplace exposure limit (WEL) of 0.05 mg/m 3 TWA-8 h, these results point to a very substantial reduction in exposures compared to poorly controlled dry methods of fabrication. Therefore, the wearing of respiratory protection by workers remains necessary until further control measures are more widely adopted across the entire industry e.g. reduction in the crystalline silica content of ES.
Collapse
Affiliation(s)
- Michael Weller
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Dennis Clemence
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Abe Lau
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Mark Rawlings
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Amy Robertson
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Bhoopathy Sankaran
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| |
Collapse
|
15
|
Jiao B, Zhang Q, Jin C, Yu H, Wu Q. IRF4 Participates in Pulmonary Fibrosis Induced by Silica Particles through Regulating Macrophage Polarization and Fibroblast Activation. Inflammation 2024; 47:45-59. [PMID: 37938462 DOI: 10.1007/s10753-023-01890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/16/2023] [Accepted: 08/15/2023] [Indexed: 11/09/2023]
Abstract
Long-term exposure to silica dust can cause silicosis, which is characterized by chronic progressive inflammatory injury, fibroblast activation, and the deposition of extracellular matrix. IRF4 is involved in immune response. However, the potential regulation of IRF4 in silicosis and pulmonary fibrosis remains largely unexplored. In this study, RNA-seq analysis identified the upregulated expression of IRF4 in fibrotic lung tissues of mice exposed to silica particles. And we verified the increased expression of IRF4 in SiO2-treated macrophages and TGF-β1-treated fibroblasts. We further found that the down-regulation of IRF4 impeded the macrophage polarization and the release of pro-fibrotic factors. Moreover, the down-regulation of IRF4 alleviated the migration, invasion, and the expression of fibrotic molecules in fibroblasts. Using ChIP-qPCR assay, we confirmed that IRF4 regulated the transcriptional activity of the IL-17A promoter, thus stimulated fibroblast activation, migration and invasion. In vivo experiment, the AAV-siIRF4 was designed to interfere with the expression of IRF4 in lung tissues of mice exposed to silica particles. Whole blood, bronchoalveolar lavage fluid and lung tissues were obtained from mice at 7, 14, 28 and 56 days after silica exposure. The results showed that the leukocyte content and inflammatory factors reached a peak at day 14 and remained peak for a long time after IRF4 knockdown. Furthermore, the fibrotic responses of mouse lung tissues were alleviated after IRF4 knockdown. Our study explored the important roles of IRF4 in inflammatory and fibrotic responses, which provided a new target for the treatment of silicosis and pulmonary fibrosis.
Collapse
Affiliation(s)
- Biyang Jiao
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China
| | - Qianyi Zhang
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China
| | - Chunmeng Jin
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China
| | - Hongmin Yu
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China
| | - Qiuyun Wu
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China.
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, 221004, China.
| |
Collapse
|
16
|
Jiang F, Jiang Q, Hou L, Zhao J, Zhu Z, Jia Q, Xue W, Wang H, Wang Y, Tian L. Inhibition of macrophage pyroptosis ameliorates silica-induced pulmonary fibrosis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 268:115693. [PMID: 37976936 DOI: 10.1016/j.ecoenv.2023.115693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023]
Abstract
Macrophage pyroptosis has recently been involved in some inflammatory and fibrosis diseases, however, the role of macrophage pyroptosis in silica-induced pulmonary fibrosis has not been fully elucidated. In this study, we explored the role of macrophage pyroptosis in silicosis in vivo and in vitro. A mouse model of silicosis was established and mice were sacrificed at 7, 14, and 28 days after exposure of silica. The results revealed that the expression of GSDMD and other pyroptosis-related indicators was up-regulated obviously at 14 days after silica exposure, indicating that silica induced pyroptosis in vivo. In vitro, human monocytic leukemia cells (THP-1) and human lung fibroblasts (MRC-5) were used to detect the relationship between macrophage pyroptosis and lung fibroblasts. It showed that silica increased the levels of GSDMD and other pyroptosis-related indicators remarkably in macrophages and the supernatant of macrophage stimulated by silica could promote the upregulation of fibrosis markers in fibroblasts. However, GSDMD knockdown suppressed silica-induced macrophage pyroptosis and alleviated the upregulation of fibrosis markers in fibroblasts, suggesting the important role of macrophage pyroptosis in the activation of myofibroblasts during the progression of silicosis. Taken together, it showed that silica could induce macrophage pyroptosis and inhibiting macrophage pyroptosis could be a feasible clinical strategy to alleviate silicosis.
Collapse
Affiliation(s)
- Fuyang Jiang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Qiyue Jiang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Lin Hou
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Jing Zhao
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Zhonghui Zhu
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Qiyue Jia
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Wenming Xue
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Hongwei Wang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Yan Wang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China.
| | - Lin Tian
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China.
| |
Collapse
|
17
|
Spagnolo P, Ryerson CJ, Guler S, Feary J, Churg A, Fontenot AP, Piciucchi S, Udwadia Z, Corte TJ, Wuyts WA, Johannson KA, Cottin V. Occupational interstitial lung diseases. J Intern Med 2023; 294:798-815. [PMID: 37535448 DOI: 10.1111/joim.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Millions of workers are exposed to substances known to cause occupational interstitial lung diseases (ILDs), particularly in developing countries. However, the burden of the disease is likely to be underestimated due to under-recognition, under-reporting or both. The diagnosis of occupational ILD requires a high level of suspicion and a thorough occupational history, as occupational and non-occupational ILDs may be clinically, functionally and radiologically indistinguishable, leading to delayed diagnosis and inappropriate management. A potential occupational aetiology should always be considered in the differential diagnosis of ILD, as removal from the workplace exposure, with or without treatment, is a key therapeutic intervention and may lead to significant improvement. In this article, we provide an overview of the 'traditional' inorganic dust-related ILDs but also address idiopathic pulmonary fibrosis and the immunologically mediated chronic beryllium disease, sarcoidosis and hypersensitivity pneumonitis, with emphasis on the importance of surveillance and prevention for reducing the burden of these conditions. To this end, health-care professionals should be specifically trained about the importance of occupational exposures as a potential cause of ILD.
Collapse
Affiliation(s)
- Paolo Spagnolo
- Respiratory, Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Christopher J Ryerson
- Department of Medicine, St. Paul's Hospital, University of British Columbia and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Sabina Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna Feary
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Churg
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew P Fontenot
- Department of Medicine, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado, USA
| | - Sara Piciucchi
- Department of Radiology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Zarir Udwadia
- Hinduja Hospital and Research Center, Breach Candy Hospital, Mumbai, Maharashtra, India
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, University of Leuven, Leuven, Belgium
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Coordinating Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, UMR754, IVPC, Lyon, France
| |
Collapse
|
18
|
Ding M, Zhang C, Wang W, Wang P, Pei Y, Wang N, Huang S, Hao C, Yao W. Silica-exposed macrophages-secreted exosomal miR125a-5p induces Th1/Th2 and Treg/Th17 cell imbalance and promotes fibroblast transdifferentiation. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 267:115647. [PMID: 37918332 DOI: 10.1016/j.ecoenv.2023.115647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
Until now, the specific pathogenesis of silicosis is not clear. Exosomal miRNAs, as a newly discovered intercellular communication medium, play an important role in many diseases. Our previous research found that serum exosomal miR125a-5p was increased in silicosis patients by miRNAs high-throughput sequencing. TRAF6, is a target gene of miR125a-5p, which is involved in T-cell differentiation. Furthermore, results from animal study indicate that knockdown of miR-125a-5p can regulate T lymphocyte subsets and significantly reduce pulmonary fibrosis by targeting TRAF6. However, the level of serum exosomal miR125a-5p in silicosis patients has not been reported, the role of macrophages-secreted exosomal miR-125a-5p in regulating T cell differentiation to promote fibroblast transdifferentiation (FMT) remains unknown. In this study, the levels of serum exosomal miR125a-5p and serum TGF-β1, IL-17A, IL-4 cytokines in silicosis patients were elevated, with the progression of silicosis, the level of serum exosomal miR125a-5p and serum IL-4 were increased; thus, the serum level of IFN-γ was negatively correlated with the progression of silicosis. In vitro, the levels of miR125a-5p in macrophages, exosomes, and T cells stimulated by silica were significantly increased. When the mimic was transfected into T cells, which directly suppressed TRAF6 and caused the imbalance of T cells differentiation, induced FMT. To sum up, these results indicate that exosomal miR-125a-5p may by targeting TRAF6 of T cells, induces the activation and apoptosis of T cells and the remodeling of Th1/Th2 and Th17/Tregs distribution, ultimately promotes FMT. Suggesting that exosomal miR-125a-5p may be a potential therapeutic target for silicosis.
Collapse
Affiliation(s)
- Mingcui Ding
- Department of Nosocomial Infection Control, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, Henan, China
| | - Chengpeng Zhang
- Department of Occupational Health and Occupational Disease, School of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Wei Wang
- Department of Occupational Health and Occupational Disease, School of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Pengpeng Wang
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yangqing Pei
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Na Wang
- Department of Occupational Health and Occupational Disease, School of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Shan Huang
- Henan Institute of Food and Salt Industry Inspection Technology, Zhengzhou 450001, Henan, China
| | - Changfu Hao
- Department of child and Adolecence health, School of public health, Zhengzhou University, Zhengzhou 450001, Henan, China.
| | - Wu Yao
- Department of Occupational Health and Occupational Disease, School of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China.
| |
Collapse
|
19
|
RenChen X, Wang W, Lu Y. Emerging trends in silicosis research: a scientometric review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:113280-113296. [PMID: 37864705 DOI: 10.1007/s11356-023-30418-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/08/2023] [Indexed: 10/23/2023]
Abstract
Silicosis is a global disease whose prevention efforts cannot be ignored today. Although numerous silicosis-related data have been published recently, emphasizing the characteristics and nature of silicosis, a summary of the developmental laws of research is lacking, especially in the visual analysis of the literature. We aim to address this issue through a scientometric review. The Web of Science Core Collection and the All Databases were searched with "silicosis" as the topic, excluding unrelated publications, and obtained data from 9802 and 1613 publications, respectively. The data was then analyzed using the Web of Science's online scientometric analysis function and CiteSpace's visual analysis functionality, including publication volume analysis, co-occurrence analysis, co-citation analysis, cluster analysis, and explosive detection. The results identify the "respiratory system" as the most influential area over a century. Furthermore, the publication's number was correlated with the gross domestic product. We ranked countries and institutions based on the frequency of publications and discovered that Europe, the USA, and China are the leading regions for silicosis research, with the USA and Europe having a stronger influence. Many reports related to artificial stone and denim jean production have been studied through citation analysis, indicating new epidemic trends in silicosis. Besides, silicosis-related diseases and the pathogenesis of silicosis were the research hotspots of silicosis through co-occurrence keyword analysis and outbreak detection. Furthermore, related diseases include coal workers' pneumoconiosis and tuberculosis, while the mechanism of silicosis includes studies on inflammation and fibrosis, oxidative stress, alveolar macrophages, apoptosis, and pathways.
Collapse
Affiliation(s)
- Xiaotian RenChen
- School of Medicine, Department of Medical Frontier Experimental Center, Anhui University of Science and Technology, Anhui, China
| | - Wenyang Wang
- Center for Clinical Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian, 271000, Shandong, China.
| | - Yuting Lu
- School of Medicine, Department of Medical Frontier Experimental Center, Anhui University of Science and Technology, Anhui, China
| |
Collapse
|
20
|
Gandhi SA, Heinzerling A, Flattery J, Fazio JC, Alam A, Cummings KJ, Harrison RJ. Active Surveillance of Engineered Stone Workers Facilitates Early Identification of Silicosis: A Discussion of Surveillance of Occupational Lung Diseases. New Solut 2023; 33:119-129. [PMID: 37649363 PMCID: PMC11268947 DOI: 10.1177/10482911231189503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Silicosis in workers exposed to respirable crystalline silica while fabricating engineered stone products is an emerging respiratory health issue. We describe silicosis in engineered stone workers in California and examine clinical features by the source of identification. Cases were identified passively using hospital-based patient discharge data or actively through outreach and medical testing following enforcement investigation. Outcomes were examined based on the source of case identification. We identified 18 cases diagnosed between 2006 and 2020. Cases identified passively compared to other identification methods were associated with lower percent predicted forced vital capacity (FVC) (P ≤ .01), forced expiratory volume in 1 s (FEV1) (P ≤ .01), and diffusing capacity of the lungs for carbon monoxide (DLCO) (P < .01) at the time of diagnosis and were more likely to be identified following death or lung transplant (P = .01). Our experience demonstrates delays in diagnosis and case identification when relying on passive surveillance methods. Enhanced public health surveillance systems can improve the early detection of occupational lung disease and inform future prevention policies.
Collapse
Affiliation(s)
- Sheiphali A. Gandhi
- Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amy Heinzerling
- California Department of Public Health, Occupational Health Branch, Richmond, CA, USA
| | - Jennifer Flattery
- California Department of Public Health, Occupational Health Branch, Richmond, CA, USA
| | - Jane C. Fazio
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Asim Alam
- California Pacific Medical Center, Division of Pulmonary and Critical Care Medicine, San Francisco, CA, USA
| | - Kristin J. Cummings
- California Department of Public Health, Occupational Health Branch, Richmond, CA, USA
| | - Robert J. Harrison
- California Department of Public Health, Occupational Health Branch, Richmond, CA, USA
| |
Collapse
|
21
|
Howlett P, Mousa H, Said B, Mbuya A, Kon OM, Mpagama S, Feary J. Silicosis, tuberculosis and silica exposure among artisanal and small-scale miners: A systematic review and modelling paper. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002085. [PMID: 37733799 PMCID: PMC10513209 DOI: 10.1371/journal.pgph.0002085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
An estimated 44 million artisanal and small-scale miners (ASM), largely based in developing economies, face significant occupational risks for respiratory diseases which have not been reviewed. We therefore aimed to review studies that describe silicosis and tuberculosis prevalence and respirable crystalline silica (RCS) exposures among ASM and use background evidence to better understand the relationship between exposures and disease outcomes. We searched PubMed, Web of Science, Scopus and Embase for studies published before the 24th March 2023. Our primary outcome of interest was silicosis or tuberculosis among ASM. Secondary outcomes included measurements of respirable dust or silica, spirometry and prevalence of respiratory symptoms. A systematic review and narrative synthesis was performed and risk of bias assessed using the Joanna Briggs Prevalence Critical Appraisal Tool. Logistic and Poisson regression models with predefined parameters were used to estimate silicosis prevalence and tuberculosis incidence at different distributions of cumulative silica exposure. We identified 18 eligible studies that included 29,562 miners from 13 distinct populations in 10 countries. Silicosis prevalence ranged from 11 to 37%, despite four of five studies reporting an average median duration of mining of <6 years. Tuberculosis prevalence was high; microbiologically confirmed disease ranged from 1.8 to 6.1% and clinical disease 3.0 to 17%. Average RCS intensity was very high (range 0.19-89.5 mg/m3) and respiratory symptoms were common. Our modelling demonstrated decreases in cumulative RCS are associated with reductions in silicosis and tuberculosis, with greater reductions at higher mean exposures. Despite potential selection and measurement bias, prevalence of silicosis and tuberculosis were high in the studies identified in this review. Our modelling demonstrated the greatest respiratory health benefits of reducing RCS are in those with highest exposures. ASM face a high occupational respiratory disease burden which can be reduced by low-cost and effective reductions in RCS.
Collapse
Affiliation(s)
- Patrick Howlett
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Hader Mousa
- Centre for Occupational and Environmental Health, Kigali, Rwanda
| | - Bibie Said
- Kibong’oto Infectious Disease Hospital, Kilimanjaro, Tanzania
| | - Alexander Mbuya
- Kibong’oto Infectious Disease Hospital, Kilimanjaro, Tanzania
| | - Onn Min Kon
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Stellah Mpagama
- Kibong’oto Infectious Disease Hospital, Kilimanjaro, Tanzania
| | - Johanna Feary
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
22
|
Fazio JC, Gandhi SA, Flattery J, Heinzerling A, Kamangar N, Afif N, Cummings KJ, Harrison RJ. Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California. JAMA Intern Med 2023; 183:991-998. [PMID: 37486642 PMCID: PMC10366949 DOI: 10.1001/jamainternmed.2023.3295] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/27/2023] [Indexed: 07/25/2023]
Abstract
Importance Silicosis associated with inhalation of respirable crystalline silica among engineered stone countertop fabrication workers is an emerging health concern. Objective To describe clinical, socioeconomic, and occupational characteristics of patients diagnosed with silicosis associated with engineered stone in California. Design, Setting, and Participants This case series included reported cases of silicosis associated with fabrication of engineered stone countertops, as identified by statewide surveillance by the California Department of Public Health (2019-2022). Data analysis was performed from October 2022 to March 2023. Exposures Patient interviews and medical record abstractions were used to assess occupational exposure to respirable crystalline silica, including duration of work tenure and preventive measures undertaken. Main Outcomes and Measures Demographics, clinical characteristics, health care utilization, and clinical outcomes were obtained, including vital status, hypoxia, and lung transplant. Results This case series identified 52 male patients meeting inclusion criteria; median (IQR) age was 45 (40-49) years, and 51 were Latino immigrants. Ten (19%) were uninsured, and 20 (39%) had restricted-scope Medi-Cal; 25 (48%) presented initially to an emergency department. A delay in diagnosis occurred in 30 (58%) patients, most commonly due to alternative initial diagnoses of bacterial pneumonia (9 [30%]) or tuberculosis (8 [27%]). At diagnosis, 20 (38%) patients had advanced disease (progressive massive fibrosis) with severely or very severely reduced forced expiratory volume in 1 second in 8 (18%) and 5 (11%), respectively. Of the cases, 10 (19%) were fatal; median (IQR) age at death was 46 (38-51) years, and 6 patients (12%) were alive with chronic resting hypoxia. Eleven were referred for lung transplant: 3 underwent transplant with 1 fatality; 7 were declined transplant, with 6 fatalities; and 1 died prior to listing. Median (IQR) work tenure was 15 (10-20) years; 23 (45%) reported use of water suppression for dust mitigation, and 25 (48%) continued to fabricate stone after being diagnosed with silicosis. Conclusions and Relevance In this case series performed in California, silicosis associated with occupational exposure to dust from engineered stone primarily occurred among young Latino immigrant men. Many patients presented with severe disease, and some cases were fatal.
Collapse
Affiliation(s)
- Jane C. Fazio
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Occupational Health Branch, California Department of Public Health, Richmond
- Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Sheiphali A. Gandhi
- Occupational Health Branch, California Department of Public Health, Richmond
- Division of Occupational, Environmental, and Climate Medicine, University of California, San Francisco
| | - Jennifer Flattery
- Occupational Health Branch, California Department of Public Health, Richmond
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, Richmond
| | - Nader Kamangar
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Nawal Afif
- Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Kristin J. Cummings
- Occupational Health Branch, California Department of Public Health, Richmond
| | - Robert J. Harrison
- Occupational Health Branch, California Department of Public Health, Richmond
| |
Collapse
|
23
|
Qin S, Tan P, Xie J, Zhou Y, Zhao J. A systematic review of the research progress of traditional Chinese medicine against pulmonary fibrosis: from a pharmacological perspective. Chin Med 2023; 18:96. [PMID: 37537605 PMCID: PMC10398979 DOI: 10.1186/s13020-023-00797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023] Open
Abstract
Pulmonary fibrosis is a chronic progressive interstitial lung disease caused by a variety of etiologies. The disease can eventually lead to irreversible damage to the lung tissue structure, severely affecting respiratory function and posing a serious threat to human health. Currently, glucocorticoids and immunosuppressants are the main drugs used in the clinical treatment of pulmonary fibrosis, but their efficacy is limited and they can cause serious adverse effects. Traditional Chinese medicines have important research value and potential for clinical application in anti-pulmonary fibrosis. In recent years, more and more scientific researches have been conducted on the use of traditional Chinese medicine to improve or reduce pulmonary fibrosis, and some important breakthroughs have been made. This review paper systematically summarized the research progress of pharmacological mechanism of traditional Chinese medicines and their active compounds in improving or reducing pulmonary fibrosis. We conducted a systematic search in several main scientific databases, including PubMed, Web of Science, and Google Scholar, using keywords such as idiopathic pulmonary fibrosis, pulmonary fibrosis, interstitial pneumonia, natural products, herbal medicine, and therapeutic methods. Ultimately, 252 articles were included and systematically evaluated in this analysis. The anti-fibrotic mechanisms of these traditional Chinese medicine studies can be roughly categorized into 5 main aspects, including inhibition of epithelial-mesenchymal transition, anti-inflammatory and antioxidant effects, improvement of extracellular matrix deposition, mediation of apoptosis and autophagy, and inhibition of endoplasmic reticulum stress. The purpose of this article is to provide pharmaceutical researchers with information on the progress of scientific research on improving or reducing Pulmonary fibrosis with traditional Chinese medicine, and to provide reference for further pharmacological research.
Collapse
Affiliation(s)
- Shanbo Qin
- Key Laboratory of Biological Evaluation of TCM Quality of State Administration of Traditional Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, 610041, China
| | - Peng Tan
- Key Laboratory of Biological Evaluation of TCM Quality of State Administration of Traditional Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, 610041, China.
| | - Junjie Xie
- Key Laboratory of Biological Evaluation of TCM Quality of State Administration of Traditional Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, 610041, China
| | - Yongfeng Zhou
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Junning Zhao
- Key Laboratory of Biological Evaluation of TCM Quality of State Administration of Traditional Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, 610041, China.
| |
Collapse
|
24
|
Hoy RF, Dimitriadis C, Abramson M, Glass DC, Gwini S, Hore-Lacy F, Jimenez-Martin J, Walker-Bone K, Sim MR. Prevalence and risk factors for silicosis among a large cohort of stone benchtop industry workers. Occup Environ Med 2023; 80:439-446. [PMID: 37328266 PMCID: PMC10423513 DOI: 10.1136/oemed-2023-108892] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES High silica content artificial stone has been found to be associated with silicosis among stone benchtop industry (SBI) workers. The objectives of this study were to determine the prevalence of and risk factors for silicosis among a large cohort of screened SBI workers, and determine the reliability of respiratory function testing (RFT) and chest x-ray (CXR) as screening tests in this industry. METHODS Subjects were recruited from a health screening programme available to all SBI workers in Victoria, Australia. Workers undertook primary screening, including an International Labour Office (ILO) classified CXR, and subject to prespecified criteria, also underwent secondary screening including high-resolution CT (HRCT) chest and respiratory physician assessment. RESULTS Among 544 SBI workers screened, 95% worked with artificial stone and 86.2% were exposed to dry processing of stone. Seventy-six per cent (414) required secondary screening, among whom 117 (28.2%) were diagnosed with silicosis (median age at diagnosis 42.1 years (IQR 34.8-49.7)), and all were male. In secondary screening, silicosis was associated with longer SBI career duration (12 vs 8 years), older age, lower body mass index and smoking. In those with silicosis, forced vital capacity was below the lower limit of normal in only 14% and diffusion capacity for carbon monoxide in 13%. Thirty-six (39.6%) of those with simple silicosis on chest HRCT had an ILO category 0 CXR. CONCLUSION Screening this large cohort of SBI workers identified exposure to dry processing of stone was common and the prevalence of silicosis was high. Compared with HRCT chest, CXR and RFTs had limited value in screening this high-risk population.
Collapse
Affiliation(s)
- Ryan F Hoy
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Christina Dimitriadis
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Abramson
- School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Deborah C Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - StellaMay Gwini
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona Hore-Lacy
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Javier Jimenez-Martin
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
25
|
Zhang Y, Rajaram N, Lau A, Mehta K, Holness DL, Tarlo SM, Arrandale VH. Silicosis, asbestosis, and pulmonary fibrosis in Ontario, Canada from 1996 to 2019. Am J Ind Med 2023; 66:670-678. [PMID: 37302125 DOI: 10.1002/ajim.23504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/31/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Silicosis is a fibrotic lung disease caused by exposure to respirable crystalline silica. Historically, silicosis was common among miners and other professions in the 20th century, and in recent decades has re-emerged in coal mining and appeared in new workplaces, including the manufacture of distressed jeans and artificial stone countertops. METHODS Physician billing data for the province of Ontario between 1992 and 2019 were analyzed across six time-periods (1993-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015, and 2016-2019). The case definition was two or more billing records within 24 months with a silicosis diagnosis code (ICD-9 502, ICD-10 J62). Cases from 1993 to 1995 were excluded as prevalent cases. Crude incidence rates per 100,000 persons were calculated by time-period, age, sex, and region. Analyses were repeated in parallel for pulmonary fibrosis (PF) (ICD-9 515, ICD-10 J84) and asbestosis (ICD-9 501; ICD-10 J61). RESULTS From 1996 to 2019, 444 cases of silicosis, 2719 cases of asbestosis and 59,228 cases of PF were identified. Silicosis rates decreased from 0.42 cases per 100,000 in 1996-2000 to 0.06 per 100,000 people in 2016-2019. A similar trend was observed for asbestosis (1.66 to 0.51 per 100,000 persons) but the incidence rate of PF increased from 11.6 to 33.9 per 100,000 persons. Incidence rates for all outcomes were higher among men and older adults. CONCLUSIONS A decreasing incidence of silicosis was observed in this analysis. However, the incidence of PF increased, consistent with findings from other jurisdictions. While cases of silicosis have been recorded among artificial stone workers in Ontario these cases do not seem to have impacted the population rates thus far. Ongoing, periodic surveillance of occupational diseases is helpful for tracking population-level trends over time.
Collapse
Affiliation(s)
- Yizhi Zhang
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Nikhil Rajaram
- Department of Medicine, Division of Occupational Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Ministry of Labour, Immigration, Training and Skills Development, Ontario, Canada
| | - Ambrose Lau
- Department of Medicine, Toronto Western Hospital, Ontario, Canada
- Department of Medicine, Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Kruti Mehta
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Medicine, Division of Occupational Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto-St Michaels, Ontario, Canada
- Center for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
| | - Susan M Tarlo
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Medicine, Toronto Western Hospital, Ontario, Canada
- Department of Medicine, Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Ontario, Canada
- Center for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
| | - Victoria H Arrandale
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Yi X, He Y, Zhang Y, Luo Q, Deng C, Tang G, Zhang J, Zhou X, Luo H. Current status, trends, and predictions in the burden of silicosis in 204 countries and territories from 1990 to 2019. Front Public Health 2023; 11:1216924. [PMID: 37521973 PMCID: PMC10372342 DOI: 10.3389/fpubh.2023.1216924] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Background Silicosis, a severe lung disease caused by inhaling silica dust, predominantly affects workers in industries such as mining and construction, leading to a significant global public health challenge. The purpose of this study is to analyze the current disease burden of silicosis and to predict the development trend of silicosis in the future the world by extracting data from the GBD database. Methods We extracted and analyzed silicosis prevalence, incidence, mortality, and disability-adjusted life years (DALYs) data from the Global Burden of Disease 2019 program for 204 countries and territories from 1990 to 2019. The association between the Sociodemographic Index (SDI) and the burden of age-standardized rates (ASRs) of DALYs has been examined at the regional level. Jointpoint regression analysis has been also performed to evaluate global burden trends of silicosis from 1990 to 2019. Furthermore, Nordpred age-period-cohort analysis has also been projected to predict future the burden of silicosis from 2019 to 2044. Results In 2019, global ASRs for silicosis prevalence, incidence, mortality, and DALYs were 5.383, 1.650, 0.161, and 7.872%, respectively which are lower than that in 1990. The populations of 45-59 age group were more susceptible to silicosis, while those aged 80 or above suffered from higher mortality and DALY risks. In 2019, the most impacted nations by the burden of silicosis included China, the Democratic People's Republic of Korea, and Chile. From 1990 to 2019, most regions observed a declining burden of silicosis. An "M" shaped association between SDI and ASRs of DALYs for silicosis was observed from 1990 to 2019. The age-period-cohort analysis forecasted a decreasing trend of the burden of silicosis from 2019 to 2044. Conclusion Despite the overall decline in the global silicosis burden from 1990 to 2019, some regions witnessed a notable burden of this disease, emphasizing the importance of targeted interventions. Our results may provide a reference for the subsequent development of appropriate management strategies.
Collapse
Affiliation(s)
- Xinglin Yi
- Department of Respiratory Medicine, Southwest Hospital of Third Military Medical University, Chongqing, China
| | - Yi He
- Department of Cardiovascular Medicine Department, Southwest Hospital of Third Military Medical University, Chongqing, China
| | - Yu Zhang
- Department of Cardiovascular Medicine Department, Southwest Hospital of Third Military Medical University, Chongqing, China
| | - Qiuyue Luo
- Department of Cardiovascular Medicine Department, Southwest Hospital of Third Military Medical University, Chongqing, China
| | - Caixia Deng
- Department of Respiratory Medicine, Southwest Hospital of Third Military Medical University, Chongqing, China
| | - Guihua Tang
- Department of Respiratory Medicine, Southwest Hospital of Third Military Medical University, Chongqing, China
| | - Jiongye Zhang
- Department of Respiratory Medicine, Southwest Hospital of Third Military Medical University, Chongqing, China
| | - Xiangdong Zhou
- Department of Respiratory Medicine, Southwest Hospital of Third Military Medical University, Chongqing, China
| | - Hu Luo
- Department of Respiratory Medicine, Southwest Hospital of Third Military Medical University, Chongqing, China
| |
Collapse
|
27
|
Feary J, Lindstrom I, Huntley CC, Suojalehto H, de la Hoz RE. Occupational lung disease: when should I think of it and why is it important? Breathe (Sheff) 2023; 19:230002. [PMID: 37377854 PMCID: PMC10292794 DOI: 10.1183/20734735.0002-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/05/2023] [Indexed: 06/29/2023] Open
Abstract
Exposure to toxic inhalants in the workplace has the potential to cause (in susceptible individuals) almost any major type of lung disease, such as asthma, COPD and interstitial lung diseases. Patients with occupational lung disease will often present to or will be managed by respiratory specialists without training in occupational respiratory medicine, and patients (or their clinicians) may not identify a link between their disease and their current or a past job. Without an awareness of the range of different occupational lung diseases that exist, their similarity to their non-occupational counterparts, and without directed questioning, these conditions may go unidentified. Patients with occupational lung diseases are often in lower paid work and are disproportionally affected by health inequality. Both clinical and socioeconomic outcomes generally improve if cases are identified early. This allows appropriate advice to be given about the risks of ongoing exposure, clinical management, occupational mobility and, in some cases, eligibility for legal compensation. As respiratory professionals, it is important that these cases are not missed, and if needed, are discussed with a physician with specialised expertise. Here we describe some of the most common occupational lung diseases and outline the diagnostic and treatment approach.
Collapse
Affiliation(s)
- Johanna Feary
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Irmeli Lindstrom
- Finnish Institute of Occupational Health, Occupational Health Department, Helsinki, Finland
| | - Christopher C. Huntley
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Hille Suojalehto
- Finnish Institute of Occupational Health, Occupational Health Department, Helsinki, Finland
| | - Rafael E. de la Hoz
- Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
28
|
Xu W, Ma R, Wang J, Sun D, Yu S, Ye Q. Pneumoconiosis combined with connective tissue disease in China: a cross-sectional study. BMJ Open 2023; 13:e068628. [PMID: 37012009 PMCID: PMC10083820 DOI: 10.1136/bmjopen-2022-068628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE To describe the prevalence, clinical features and potential risk factors of pneumoconiosis in combination with connective tissue disease (CTD) or positive autoantibodies. DESIGN Cross-sectional study. SETTING A retrospective study of adults recruited in China between December 2016 and November 2021. PARTICIPANTS A total of 931 patients with pneumoconiosis at Beijing Chao-Yang Hospital were enrolled in this study; of these, 580 patients were included in the final analysis. MAIN OUTCOME MEASURES Pneumoconiosis combined with CTD or positive autoantibodies was a major adverse outcome. RESULTS In total, 13.8% (80/580) of the patients had combined pneumoconiosis with CTD, among whom the prevalence of CTD was 18.3% (46/251) in asbestosis and 11.4% (34/298) in silicosis/coal mine workers' pneumoconiosis. In comparison to the general Chinese adult population, the relative risk of various CTD in pneumoconiosis, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, primary Sjögren's syndrome, idiopathic inflammatory myopathy and antineutrophil cytoplasmic antibodies-associated vasculitis, were 11.85, 12.12, 127.40, 4.23, 9.94 and 644.66, respectively. Multivariate analysis revealed that female sex (OR 2.55, 95% CI 1.56 to 4.17) and a later stage of pneumoconiosis (OR 2.04, 95% CI 1.24 to 3.34) were the independent risk factors for CTD in patients with pneumoconiosis (all p<0.050). CONCLUSION CTD is highly prevalent in patients with pneumoconiosis, especially in patients of asbestosis, and silicosis/coal mine workers' pneumoconiosis. Female sex and later stages of pneumoconiosis are associated with an increased risk of combined with CTD.
Collapse
Affiliation(s)
- Wenjing Xu
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Ruimin Ma
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingwei Wang
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Di Sun
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shiwen Yu
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiao Ye
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
29
|
Anlimah F, Gopaldasani V, MacPhail C, Davies B. A systematic review of the effectiveness of dust control measures adopted to reduce workplace exposure. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:54407-54428. [PMID: 36964805 PMCID: PMC10121514 DOI: 10.1007/s11356-023-26321-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
The recent increase in silicosis cases in several countries casts doubt on dust control practices and their effectiveness in preventing respirable crystalline silica (RCS) exposure. Apart from silicosis, RCS may lead to other illnesses, health-related quality of life losses for workers and their families, and economic losses for companies. Thus, this systematic literature review examined the effectiveness of interventions employed to prevent exposure to RCS and increase the use of dust control measures. The review used keywords related to dust control interventions to search seven databases. Search results were screened and extracted for synthesis. The narrative synthesis showed the extent of research investment in China. In several designs and combinations, the interventions utilized water, surfactant, foam, and air currents to reduce dust exposure. These interventions offer varying degrees of dust control effectiveness against RCS and respirable dust. Although evidence indicates that interventions significantly decrease dust concentration levels, the control measures in place may not effectively prevent workplace overexposure to RCS. The review found that education and training interventions are employed to improve dust controls and respiratory protective equipment (RPE) use. Also, marketing strategies promote the use of RPE. These interventions can increase the frequency of use of RPE and the adoption of best practice dust control measures. Interventions increase knowledge, awareness, and attitudes about RPE usage and generate positive perceptions while reducing misconceptions. However, the benefits obtained from an intervention may diminish after its implementation, indicating that the interventions may not continually motivate workers to adopt control measures or use RPE.
Collapse
Affiliation(s)
- Frederick Anlimah
- Faculty of the Arts, Social Sciences and Humanities, School of Health and Society, Centre for Occupational Public and Environmental Research in Safety and Health (COPERSH), University of Wollongong, Building 29, Wollongong, NSW 2522 Australia
| | - Vinod Gopaldasani
- Faculty of the Arts, Social Sciences and Humanities, School of Health and Society, Centre for Occupational Public and Environmental Research in Safety and Health (COPERSH), University of Wollongong, Building 29, Room 124, Wollongong, NSW 2522 Australia
| | - Catherine MacPhail
- Faculty of the Arts, Social Sciences and Humanities, School of Health and Society, University of Wollongong, Building 29, Room 242, Wollongong, NSW 2522 Australia
| | - Brian Davies
- Faculty of the Arts, Social Sciences and Humanities, School of Health and Society, Centre for Occupational Public and Environmental Research in Safety and Health (COPERSH), University of Wollongong, Building 29, Room 116, Wollongong, NSW 2522 Australia
| |
Collapse
|
30
|
Afif N, Fazio J, Gandhi S, Kamangar N, Monteiro AC. A 35-Year-Old Man with Chronic Cough and Worsening Dyspnea. NEJM EVIDENCE 2023; 2:EVIDmr2200338. [PMID: 38320024 DOI: 10.1056/evidmr2200338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
A 35-Year-Old Man with Chronic Cough and DyspneaA 35-year-old man presented for evaluation of chronic cough and worsening dyspnea. How do you approach the evaluation, and what is the diagnosis?
Collapse
Affiliation(s)
- Nawal Afif
- from the University of California, Los Angeles Pulmonary and Critical Care Fellowship Program, Olive View-University of California, Los Angeles Internal Medicine Residency Program, and University of California, San Francisco Occupational and Environmental Medicine Residency Program
| | - Jane Fazio
- from the University of California, Los Angeles Pulmonary and Critical Care Fellowship Program, Olive View-University of California, Los Angeles Internal Medicine Residency Program, and University of California, San Francisco Occupational and Environmental Medicine Residency Program
| | - Sheiphali Gandhi
- from the University of California, Los Angeles Pulmonary and Critical Care Fellowship Program, Olive View-University of California, Los Angeles Internal Medicine Residency Program, and University of California, San Francisco Occupational and Environmental Medicine Residency Program
| | - Nader Kamangar
- from the University of California, Los Angeles Pulmonary and Critical Care Fellowship Program, Olive View-University of California, Los Angeles Internal Medicine Residency Program, and University of California, San Francisco Occupational and Environmental Medicine Residency Program
| | - Ana Costa Monteiro
- from the University of California, Los Angeles Pulmonary and Critical Care Fellowship Program, Olive View-University of California, Los Angeles Internal Medicine Residency Program, and University of California, San Francisco Occupational and Environmental Medicine Residency Program
| |
Collapse
|
31
|
León-Jiménez A. New Etiological Agents of Silicosis. Arch Bronconeumol 2023:S0300-2896(23)00099-6. [PMID: 36967343 DOI: 10.1016/j.arbres.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
|
32
|
Silica-associated lung disease in developing countries. Curr Opin Pulm Med 2023; 29:65-75. [PMID: 36695765 DOI: 10.1097/mcp.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW There is a considerable burden of silica-associated lung diseases in the developing world. This review summarizes the epidemiology of these diseases, especially silicosis and silico-tuberculosis, mitigative efforts and treatment, especially in the context of developing countries. RECENT FINDINGS In 2017, the highest incidence of silicosis was in China, India and Brazil among the developing countries. The prevalence of silicosis amongst exposed workers may vary from 4 to 55%; there is a risk of underestimation because of the 'healthy worker effect'. The permissible exposure limit for respirable silica adopted by governments in developing countries remains higher than the proposed 0.025 mg/m3. Silica exposure in informal or unorganized industries is challenging, as it falls outside statutory controls. Recent efforts on regulation and compensation by various governments in developing countries are encouraging but need proper implementation on the ground. Biomarkers such as club cell protein 16 and imaging methods such as computed tomography may offer earlier and easier detection of silicosis. Advanced silicosis remains incurable; novel treatments such as antifibrotics agents may be potentially effective. SUMMARY Silica-associated lung diseases are prevalent in developing countries. Efforts directed at preventing or minimizing exposure to respirable crystalline silica are required for mitigation.
Collapse
|
33
|
Thompson D, Qi C. Characterization of the Emissions and Crystalline Silica Content of Airborne Dust Generated from Grinding Natural and Engineered Stones. Ann Work Expo Health 2023; 67:266-280. [PMID: 36219621 PMCID: PMC9928769 DOI: 10.1093/annweh/wxac070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/31/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022] Open
Abstract
In this study, we systematically characterized the airborne dust generated from grinding engineered and natural stone products using a laboratory testing system designed and operated to collect representative respirable dust samples. Four stone samples tested included two engineered stones consisting of crystalline silica in a polyester resin matrix (formulations differed with Stones A having up to 90wt% crystalline silica and Stone B up to 50wt% crystalline silica), an engineered stone consisting of recycled glass in a cement matrix (Stone C), and a granite. Aerosol samples were collected by respirable dust samplers, total dust samplers, and a Micro-Orifice Uniform Deposit Impactor. Aerosol samples were analyzed by gravimetric analysis and x-ray diffraction to determine dust generation rates, crystalline silica generation rates, and crystalline silica content. Additionally, bulk dust settled on the floor of the testing system was analyzed for crystalline silica content. Real-time particle size distributions were measured using an Aerodynamic Particle Sizer. All stone types generated similar trimodal lognormal number-weighted particle size distributions during grinding with the most prominent mode at an aerodynamic diameter of about 2.0-2.3 μm, suggesting dust formation from grinding different stones is similar. Bulk dust from Stone C contained no crystalline silica. Bulk dust from Stone A, Stone B, and granite contained 60, 23, and 30wt% crystalline silica, respectively. In Stones A and B, the cristobalite form of crystalline silica was more plentiful than the quartz form. Only the quartz form was detected in granite. The bulk dust, respirable dust, and total dust for each stone had comparable amounts of crystalline silica, suggesting that crystalline silica content in the bulk dust could be representative of that in respirable dust generated during grinding. Granite generated more dust per unit volume of material removed than the engineered stones, which all had similar normalized dust generation rates. Stone A had the highest normalized generation rates of crystalline silica, followed by granite, Stone B, and Stone C (no crystalline silica), which likely leads to the same trend of respirable crystalline silica (RCS) exposure when working with these different stones. Manufacturing and adoption of engineered stone products with formulations such as Stone B or Stone C could potentially lower or eliminate RCS exposure risks. Combining all the effects of dust generation rate, size-dependent silica content, and respirable fraction, the highest normalized generation rate of RCS consistently occurs at 3.2-5.6 µm for all the stones containing crystalline silica. Therefore, removing particles in this size range near the generation sources should be prioritized when developing engineering control measures.
Collapse
Affiliation(s)
- Drew Thompson
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH 45226, USA
| | - Chaolong Qi
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH 45226, USA
| |
Collapse
|
34
|
Wu WH, Feng YH, Min CY, Zhou SW, Chen ZD, Huang LM, Yang WL, Yang GH, Li J, Shi J, Quan H, Mao L. Clinical efficacy of tetrandrine in artificial stone-associated silicosis: A retrospective cohort study. Front Med (Lausanne) 2023; 10:1107967. [PMID: 36873890 PMCID: PMC9981789 DOI: 10.3389/fmed.2023.1107967] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
Background Outbreaks of silicosis have occurred among workers in the artificial stone (AS) industry, and there is currently no effective antifibrosis treatment for silicosis. Design A retrospective cohort study. Methods We retrospectively analyzed the clinical data of 89 artificial stone-associated silicosis patients treated in Shanghai Pulmonary Hospital (China). Patients who agreed to be administered tetrandrine entered the observation group and those who disagreed entered the control group. Changes in chest HRCT, pulmonary function, and clinical symptoms of patients in two groups were compared pre- and post-treatment. Results After treatment for 3-12 months, 56.5%-65.4% of patients in the observation group showed improvements in HRCT imaging, while there was no improvement in the control group (p < 0.05). Disease progression occurred in 0%-17.4% of patients in the observation group after 3-12 months of treatment compared with 44.4%-92.0% of patients in the control group (p < 0.05). After 3 months of treatment, the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and diffusing capacity of the lung for carbon monoxide (DLco) in the observation group increased by 136.7 ± 189.2 mL (p < 0.05), 124.2 ± 169.9 mL (p < 0.05), and 1.4 ± 2.3 mL/min/mmHg (p > 0.05), respectively, while those in the control group decreased (145.8 ± 356.5; 107.5 ± 272.1; 1.9 ± 3.8). After 6 months of treatment, FVC, FEV1, and DLco in the observation group increased by 207.8 ± 372.2 mL (p > 0.05), 107.8 ± 295.2 mL (p > 0.05) and 0.7 ± 6.0 mL/min/mmHg (p > 0.05), respectively, while those of the control group decreased (383.3 ± 536.7; 215.6 ± 228.9; 1.4 ± 1.7). The incidences of clinical symptoms such as cough, expectoration, dyspnea, chest tightness, and chest pain in the observation group were decreased-after treatment (all p < 0.05), while the incidences of these symptoms increased in the control group, although the change was not statistically significant (all p > 0.05). Conclusion Tetrandrine can control and delay the progression of AS-associated silicosis fibrosis, with improved chest HRCT imaging and pulmonary function.
Collapse
Affiliation(s)
- Wen-Hong Wu
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.,School of Public Heath, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Yong-Hong Feng
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Chun-Yan Min
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.,The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Shao-Wei Zhou
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Zi-Dan Chen
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Li-Min Huang
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Wen-Lan Yang
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Guang-Hong Yang
- School of Public Heath, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Jun Li
- School of Public Heath, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Jin Shi
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Hua Quan
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.,Department of Health, Qingyang District Center for Disease Control and Prevention, Chengdu, China
| | - Ling Mao
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| |
Collapse
|
35
|
Weissman DN. Progressive massive fibrosis: An overview of the recent literature. Pharmacol Ther 2022; 240:108232. [PMID: 35732247 PMCID: PMC10053429 DOI: 10.1016/j.pharmthera.2022.108232] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022]
Abstract
This review provides an overview of literature addressing progressive massive fibrosis (PMF) from September 2009 to the present. Advances are described in understanding its pathophysiology, epidemiology of the occurrence of PMF and related conditions, the impact of PMF on pulmonary function, advances in imaging of PMF, and factors affecting progression of pneumoconiosis in dust-exposed workers to PMF. Basic advances in understanding the etiology of PMF are impeded by the lack of a well-accepted animal model for human PMF. Recent studies evaluating lung tissue samples and epidemiologic investigations support an important role for the silica component of coal mine dust in causing coal workers' pneumoconiosis and PMF in contemporary coal miners in the United States and for silica in causing silicosis and PMF in artificial stone workers throughout the world. Development of PMF is associated with substantial decline in pulmonary function relative to no disease or small opacity pneumoconiosis. In recent reports, computed tomography has had greater sensitivity for detecting PMF than chest x-ray. Magnetic resonance imaging shows promise in differentiating between PMF and lung cancer. Although PMF develops in dust-exposed workers without previously identified small opacity pneumoconiosis, the presence of small opacity pneumoconiosis increases the risk for progression to PMF, as does heavier dust exposure. Recent literature does not document any effective new treatments for PMF and new therapies to prevent and treat PMF are an important need.
Collapse
Affiliation(s)
- David N Weissman
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States of America.
| |
Collapse
|
36
|
Qi C, Thompson D, Feng HA. Caution on Using Tetrahydrofuran for Processing Crystalline Silica Samples From Engineered Stone for XRD Analysis. Ann Work Expo Health 2022; 66:1210-1214. [PMID: 36066421 PMCID: PMC9669205 DOI: 10.1093/annweh/wxac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/07/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022] Open
Abstract
We conducted laboratory experiments to investigate a suspected effect of tetrahydrofuran (THF) on quantifying crystalline silica in samples collected from working with engineered stone when THF is used to process samples prior to the X-ray diffraction (XRD) analysis. Two groups of samples from grinding either engineered stone or granite were simultaneously taken from a laboratory testing system, with one group of samples using THF for processing and another group using muffle furnace for ashing. For each stone type, we also tested four levels of respirable dust loading on the samples by varying the grinding time from 1 to 8 min. Statistical analysis of the experimental results on crystalline silica contents of the two groups of samples showed that the difference between the two methods was not significant (P ≥ 0.05) for the granite at all four levels of respirable dust loading and for the engineered stone at the two levels of respirable dust loading greater than 0.5 mg. However, the crystalline silica content from using THF processing was significantly lower (P = 0.001) than that from using muffle furnace ashing for engineered stone when the respirable dust loading levels were less than 0.5 mg. For the engineered stone dust samples with grinding times of 1 and 2 min, the average respirable dust loading was about 0.19 and 0.34 mg, respectively; while the crystalline silica content from using THF processing was 30.9 and 21.5% lower than that from using muffle furnace ashing, respectively. Since most full-shift samples from field assessments in this industry are expected to have respirable dust loading less than 0.5 mg, muffle furnace or radio frequency plasma ashing should be specified as the preferred sample processing method instead of the THF processing method for quantification of crystalline silica when engineered stone is expected to present to avoid artificially reduced silica content values, which are likely caused by the reactions between THF and the resins in engineered stone.
Collapse
Affiliation(s)
- Chaolong Qi
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, 1090 Tusculum Ave, MS: R5, Cincinnati, OH, 45226, USA
| | - Drew Thompson
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, 1090 Tusculum Ave, MS: R5, Cincinnati, OH, 45226, USA
| | - H. Amy Feng
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, 1090 Tusculum Ave, MS: R5, Cincinnati, OH, 45226, USA
| |
Collapse
|
37
|
César Santos de Castro1,2,3 M, Santos Ferreira Nani2 A, Cezar Rodrigues Salum1 K, de Mendonça Rolando1 J, Fernandes Barbosa dos Santos1 J, Albuquerque de Castro4 H, Canto Ribeiro4 P, Costa3 W, Brasileiro de Mello1,5 C, Barzotto Kohlrausch5 F. Genetic polymorphisms and their effects on the severity of silicosis in workers exposed to silica in Brazil. J Bras Pneumol 2022; 48:e20220167. [DOI: 10.36416/1806-3756/e20220167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Silicosis is a pneumoconiosis characterized by fibrosis of the lung parenchyma caused by inhalation of silica particles. Genetic factors might play a role in the severity silicosis. We sought to evaluate the influence of polymorphisms in the ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1, and TNF genes on the severity of silicosis. Methods: Nine polymorphisms were genotyped by PCR in a sample of 143 patients with silicosis in the state of Rio de Janeiro, Brazil. Results: Fifty-seven patients (40%) were classified as having simple silicosis and 86 (60%) were classified as having complicated silicosis. The TT genotype of rs1800469 in the TGFB1 gene showed a protective effect for complicated silicosis (OR = 0.35; 95% CI, 0.14-0.92; p = 0.028) when compared with the other two genotypes (CC+CT). The polymorphic T allele of rs763110 in the FASLG gene (OR = 0.56; 95% CI, 0.31-0.99; p = 0.047), as well as a dominant model for the T allele (TT+CT: OR = 0.37; 95% CI, 0.15-0.96; p = 0.037), also showed a protective effect. When patients with simple silicosis despite having been exposed to silica for a longer time (> 44,229 hours) were compared with patients with complicated silicosis despite having been exposed to silica for a shorter time, the T allele of rs763110 in the FASLG gene (OR = 0.20; 95% CI, 0.08-0.48; p < 0.0001), as well as dominant and recessive models (OR = 0.06; 95% CI, 0.00-0.49; p = 0.01 and OR = 0.22; 95% CI, 0.06-0.77; p = 0.014, respectively), showed a protective effect against the severity of silicosis. Conclusions: It appears that rs1800469 polymorphisms in the TGFB1 gene and rs763110 polymorphisms in the FASLG gene are involved in the severity of silicosis. Given the lack of studies relating genetic polymorphisms to the severity of silicosis, these results should be replicated in other populations.
Collapse
Affiliation(s)
- Marcos César Santos de Castro1,2,3
- 1. Programa de Pós-Graduação em Ciências e Biotecnologia, Universidade Federal Fluminense, Niterói (RJ) Brasil. 2. Departamento de Medicina Clínica, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói (RJ) Brasil. 3. Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Angela Santos Ferreira Nani2
- 2. Departamento de Medicina Clínica, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Kaio Cezar Rodrigues Salum1
- 1. Programa de Pós-Graduação em Ciências e Biotecnologia, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | | | | | | | | | - Walter Costa3
- 3. Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Cícero Brasileiro de Mello1,5
- 1. Programa de Pós-Graduação em Ciências e Biotecnologia, Universidade Federal Fluminense, Niterói (RJ) Brasil. 5. Departamento de Biologia Geral, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | | |
Collapse
|
38
|
Manglani R, Akbar S, Beasley M, Epelbaum O. A 44-year-old stone worker with progressive dyspnea: lessons from a new twist on an old foe. Monaldi Arch Chest Dis 2022; 93. [PMID: 36111414 DOI: 10.4081/monaldi.2022.2345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Silicosis is typically an indolent lung disease caused by long-standing occupational exposure to respirable crystalline silica, classically in professions such as sandblasting and mining. An increasingly popular industry that has earned particular interest because of its association with silicosis is customization and installation of artificial stone countertops for domestic applications. In addition to causing a spike in cases of chronic and accelerated silicosis, both quite familiar to respiratory clinicians, outbreaks of artificial stone silicosis have brought to the fore a historically rare entity known as acute silicosis, or silicoproteinosis, a more rapid presentation of the disease. Failure to suspect this uncommon condition can lead to diagnostic confusion and therefore ineffective treatment as was true initially of the patient we describe herein. The case description is followed by a clinical, radiological, and pathological overview of acute artificial stone silicosis (or silicoproteinosis), which is an emerging pneumoconiosis with sparse coverage in the literature to date. This case also adds to the few existing reports on the use of therapeutic whole lung lavage for silicoproteinosis.
Collapse
|
39
|
Noi DDT, Davies B, Gopaldasani V. End-of-Shift Monitoring of Respirable Crystalline Silica: A Critical Review of Measurement Techniques and Factors Influencing Accurate Measurements. Crit Rev Anal Chem 2022:1-10. [PMID: 36063400 DOI: 10.1080/10408347.2022.2117979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This article presents the findings of a systematic literature review focusing on the impact of interferences in host materials on Respirable Crystalline Silica (RCS) measurement, and the development of a validated method of calibration for RCS instrumentation for in-field use. The impact of interferences in host materials on RCS measurement has been shown to be critical information required for in-field use of portable RCS devices. Portable RCS instruments such as FTIR and XRD have been established to have good sensitivity for measurement but relatively low specificity due to interference in host materials. It has been shown that correction factors are needed to be applied to account for known interferences, especially when calibrating portable RCS instrumentation in-field. The potential to obtain reliable and repeatable results from RCS analysis instrumentation has also been demonstrated. There was significant evidence that interference materials could be present in host materials, and they influence RCS measurement. There is the potential and possibility of using portable RCS instrument for in-field measurement however the challenge is the calibration of such instrumentation in the field to account for changing host materials and thus potential interferences.
Collapse
Affiliation(s)
- David Dennis Tettey Noi
- School of Health and Society, Faculty of Arts, Social Sciences and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Centre for Occupational Public Environmental Research in Safety and Health (COPERSH), Wollongong, New South Wales, Australia
| | - Brian Davies
- School of Health and Society, Faculty of Arts, Social Sciences and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Centre for Occupational Public Environmental Research in Safety and Health (COPERSH), Wollongong, New South Wales, Australia
| | - Vinod Gopaldasani
- School of Health and Society, Faculty of Arts, Social Sciences and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Centre for Occupational Public Environmental Research in Safety and Health (COPERSH), Wollongong, New South Wales, Australia
| |
Collapse
|
40
|
Surasi K, Ballen B, Weinberg JL, Materna BL, Harrison R, Cummings KJ, Heinzerling A. Elevated exposures to respirable crystalline silica among engineered stone fabrication workers in California, January 2019-February 2020. Am J Ind Med 2022; 65:701-707. [PMID: 35899403 DOI: 10.1002/ajim.23416] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Workers fabricating engineered stone face high risk for exposure to respirable crystalline silica (RCS) and subsequent development of silicosis. In response, the California Division of Occupational Safety and Health (Cal/OSHA) performed targeted enforcement inspections at engineered stone fabrication worksites. We investigated RCS exposures and employer adherence to Cal/OSHA's RCS and respiratory protection standards from these inspections to assess ongoing risk to stone fabrication workers. METHODS We extracted employee personal air sampling results from Cal/OSHA inspection files and calculated RCS exposures. Standards require that employers continue monitoring employee RCS exposures and perform medical surveillance when exposures are at or above the action level (AL; 25 μg/m3 ); exposures above the permissible exposure limit (PEL; 50 μg/m3 ) are prohibited. We obtained RCS and respiratory protection standard violation citations from a federal database. RESULTS We analyzed RCS exposures for 152 employees at 47 workplaces. Thirty-eight (25%) employees had exposures above the PEL (median = 89.7 μg/m3 ; range = 50.7-670.7 μg/m3 ); 17 (11%) had exposures between the AL and PEL. Twenty-four (51%) workplaces had ≥1 exposure above the PEL; 7 (15%) had ≥1 exposure between the AL and PEL. Thirty-four (72%) workplaces were cited for ≥1 RCS standard violation. Twenty-seven (57%) workplaces were cited for ≥1 respiratory protection standard violation. CONCLUSIONS Our investigation demonstrates widespread RCS overexposure among workers and numerous employer Cal/OSHA standard violation citations. More enforcement and educational efforts could improve employer compliance with Cal/OSHA standards and inform employers and employees of the risks for RCS exposure and strategies for reducing exposure.
Collapse
Affiliation(s)
- Krishna Surasi
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, USA
| | - Brittany Ballen
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Justine L Weinberg
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- Public Health Institute, Richmond, Richmond, USA
| | - Barbara L Materna
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| | - Robert Harrison
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| |
Collapse
|
41
|
Akgün M, Ozmen I, Ozari Yildirim E, Tuzun B, Nur Toreyin Z, Kayinova A, Arbak P, Akkurt I. Pitfalls of using the ILO classification for silicosis compensation claims. Occup Med (Lond) 2022; 72:372-377. [PMID: 35304606 DOI: 10.1093/occmed/kqac010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The International Labour Organization (ILO) Classification of Radiographs of Pneumoconioses is used as the primary tool to determine compensation for pneumoconiosis in Turkey. AIMS We aimed to evaluate how the ILO classification applied, but obtaining chest radiographs in the workplace for screening until the completion of compensation claim files by the referral centres, based on the ILO reading. METHODS The study included 320 digital chest radiographs previously taken for screening from eight different ceramic factories and having finalised claim files by referral centres. We used an expert reference panel consisting of five ILO readers to re-evaluate all the radiographs independently using ILO standard films and reached a conclusion based on the agreement among at least three readers. The evaluation primarily included technical quality and silicosis diagnosis with an ILO 1/0 or above small profusion. The results were compared with previous findings. RESULTS Sixty-three (20%) chest radiographs were unacceptable for classification purposes according to the ILO technical quality grades. Among the remaining 257 chest radiographs, we diagnosed 103 with silicosis (40%), while the referral centres diagnosed 182 (71%). A discrepancy was found between our results and previous evaluations. We diagnosed silicosis in 50% and 17% of the previous silicosis and normal evaluations, respectively. CONCLUSIONS Our findings suggest that the use of the ILO classification for compensation claims may be problematic due to the way of its implementation in Turkey in addition to its subjectivity.
Collapse
Affiliation(s)
- Metin Akgün
- Department of Pulmonary Diseases, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Ipek Ozmen
- Health Science University, Süreyyapasa Chest Diseases, and Chest Surgery Education and Research Hospital, Istanbul, Turkey
| | - Elif Ozari Yildirim
- Health Science University, Süreyyapasa Chest Diseases, and Chest Surgery Education and Research Hospital, Istanbul, Turkey
| | - Bahar Tuzun
- Occupational Disease Hospital, Chest Diseases Clinic, Istanbul, Turkey
| | - Zehra Nur Toreyin
- Department of Public Health, Ege University, School of Medicine, Division of Occupational Health and Occupational Diseases, Izmir, Turkey
| | - Atinc Kayinova
- ODAS Mining Company, Occupational Safety and Health Unit, Istanbul, Turkey
| | - Peri Arbak
- Department of Pulmonary Diseases, Düzce University, School of Medicine, Düzce, Turkey
| | - Ibrahim Akkurt
- Retired Pulmonary Physician and Occupational Diseases Specialist, Ankara, Turkey
| |
Collapse
|
42
|
Mandler WK, Qi C, Qian Y. Hazardous dusts from the fabrication of countertop: a review. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2022; 78:118-126. [PMID: 35912480 PMCID: PMC9909587 DOI: 10.1080/19338244.2022.2105287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Artificial countertop materials, including solid surface composites (SSC) and engineered stone (ES) may pose significant pulmonary health risks for workers who manipulate them. These materials have rapidly become popular in the multibillion-dollar countertop industry, rivaling that of natural materials such as granite and marble due to their variety of desirable esthetic qualities and reduced costs. Both SSC and ES consist of a mineral substrate bound together in a polymer matrix. For SSC the mineral is about 70% aluminum trihydrate (ATH) while ES contains up to 95% crystalline silica by weight. Both materials emit airborne dusts when being manipulated with power tools during the fabrication process. Several deaths and dozens of cases of silicosis have been identified worldwide in workers who fabricate ES, while a single case of fatal pulmonary fibrosis has been associated with SCC dust exposure. This review examines the current state of knowledge for both SSC and ES regarding the composition, particle emission characteristics, workplace exposure data, particle constituent toxicity, and possible methods for reducing worker exposure.
Collapse
Affiliation(s)
- W. Kyle Mandler
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Chaolong Qi
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Yong Qian
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| |
Collapse
|
43
|
Hoy RF, Sim MR. Correspondence on 'Demographic, exposure and clinical characteristics in a multinational registry of engineered stone workers with silicosis' by Hua et al. Occup Environ Med 2022; 79:oemed-2022-108496. [PMID: 35738889 DOI: 10.1136/oemed-2022-108496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Ryan F Hoy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
44
|
Li J, Yin P, Wang H, Wang L, You J, Liu J, Liu Y, Wang W, Zhang X, Niu P, Zhou M. The burden of pneumoconiosis in China: an analysis from the Global Burden of Disease Study 2019. BMC Public Health 2022; 22:1114. [PMID: 35659279 PMCID: PMC9166455 DOI: 10.1186/s12889-022-13541-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pneumoconiosis refers to a class of serious diseases threatening the health of workers exposed to coal or silicosis dust. However, the burden of pneumoconiosis is unavailable in China.
Methods
Incident cases, deaths, and disability-adjusted life years (DALYs) from pneumoconiosis and its subtypes in China were estimated from the Global Burden of Disease Study 2019 using a Bayesian meta-regression method. The trend of the burden from pneumoconiosis was analyzed using percentage change and annualized rate of change (ARC) during the period 1990–2019. The relationship between subnational socio-demographic index (SDI) and the ARC of age-standardised death rate was measured using Spearman’s Rank-Order Correlation.
Results
In 2019, there were 136.8 (95% uncertainty interval [UI] 113.7–162.5) thousand new cases, 10.2 (8.1–13.6) thousand deaths, and 608.7 (473.6–779.4) thousand DALYs from pneumoconiosis in China. Of the global burdens from pneumoconiosis, more than 60% were in China. Both the total number of new cases and DALYs from pneumoconiosis was keeping increasing from 1990 to 2019. In contrast, the age-standardised incidence, death, and DALY rates from pneumoconiosis and its subtypes, except for the age-standardised incidence rate of silicosis, and age-standardised death rate of asbestosis, experienced a significant decline during the same period. The subnational age-standardised death rates were higher in western China than in eastern China. Meanwhile, the subnational ARC of age-standardised death rates due to pneumoconiosis and its subtypes were significantly negatively correlated with SDI in 2019.
Conclusion
China suffers the largest health loss from pneumoconiosis in the world. Reducing the burden of pneumoconiosis is still an urgent task in China.
Collapse
|
45
|
Liu TC, Tang HH, Lei SY, Peng YI. Asian dust storms result in a higher risk of the silicosis hospital admissions. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2022; 20:305-314. [PMID: 35669799 PMCID: PMC9163224 DOI: 10.1007/s40201-021-00777-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/25/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE Previous studies found that silicosis was majorly associated with occupation-related risks. However, little evidence was available to clarify the relation between Asian dust storm (ADS) and silicosis hospital admissions. This present paper aims to investigate the association between ADS events and hospital admissions for silicosis. METHODS We applied a Poisson time-series regression on the 2000-2012 National Health Insurance Research Database in Taiwan, linking air quality data and ambient temperature data to estimate the impact of ADS on silicosis hospital admissions in the age-specific groups. RESULTS A total of 2154 hospital admissions were recorded for silicosis in Taiwan, for a daily average number of 0.45. The number rises from 0.43 on a day without ADS to 0.70 on the outbreak day and continues increasing to 0.83 one day after outbreak. Among patients under 45, the effect of ADS appears on the event day as well as several post-event days (lag2-6) at the significant level of p < 0.1. There is also a significant lag effect on post-event day 2 (p < 0.05) for those aged above 74. CONCLUSION Asian dust storms do result in a rise of silicosis hospital admissions, particularly for those above 74, those under 45, and for females.
Collapse
Affiliation(s)
- Tsai-Ching Liu
- Department of Public Finance, National Taipei University, 151, University Rd., San Shia, New Taipei City, Taiwan 237
| | - Hui-Hsuan Tang
- Department of Economics, National Taipei University, 151, University Rd., San Shia, New Taipei City, Taiwan 237
| | - Shu-Yi Lei
- Department of Statistics, National Taipei University, 151, University Rd., San Shia, New Taipei City, Taiwan 237
| | - Yu-I Peng
- Department of Public Finance, National Taipei University, 151, University Rd., San Shia, New Taipei City, Taiwan 237
| |
Collapse
|
46
|
Thredgold L, Ramkissoon C, Kumarasamy C, Gun R, Rowett S, Gaskin S. Rapid Assessment of Oxidative Damage Potential: A Comparative Study of Engineered Stone Dusts Using a Deoxyguanosine Assay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106221. [PMID: 35627757 PMCID: PMC9140999 DOI: 10.3390/ijerph19106221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022]
Abstract
The popularity of engineered stone (ES) has been associated with a global increase in occupational lung disease in workers exposed to respirable dust during the fabrication of benchtops and other ES products. In this study, the reactivity and subsequent oxidative reduction potential of freshly generated ES dusts were evaluated by (i) comparing different engineered and natural stones, (ii) comparing settled and respirable stone dust fractions and (iii) assessing the effect of ageing on the reactivity of freshly generated stone dust. An established cell-free deoxyguanosine hydroxylation assay was used to assess the potential for oxidative DNA damage. ES dust exhibited a higher relative reactivity than two of the three natural stones tested. Respirable dust fractions were found to be significantly more reactive than their corresponding settled fraction (ANOVA, p < 0.05) across all stone types and samples. However, settled dust still displayed high relative reactivity. The lower reactivity of the settled dust was not due to decay in reactivity of the respirable dust when it settled but rather a result of the admixture of larger nonrespirable particles. No significant change in respirable dust reactivity was observed for three ES samples over a 21-day time period, whereas a significant decrease in reactivity was observed in the natural stone studied. This study has practical implications for dust control and housekeeping in industry, risk assessment and hazard management.
Collapse
Affiliation(s)
- Leigh Thredgold
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
| | - Chandnee Ramkissoon
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
| | - Chellan Kumarasamy
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
| | - Richard Gun
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
| | - Shelley Rowett
- SafeWork SA, Government of South Australia, Adelaide, SA 5035, Australia;
| | - Sharyn Gaskin
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
- Correspondence:
| |
Collapse
|
47
|
Hua JT, Zell-Baran L, Go LHT, Kramer MR, Van Bree JB, Chambers D, Deller D, Newbigin K, Matula M, Fireman E, Dahbash M, Martinez-Gonzalez C, León-Jimenez A, Sack C, Ferrer J, Villar A, Almberg KS, Cohen RA, Rose CS. Demographic, exposure and clinical characteristics in a multinational registry of engineered stone workers with silicosis. Occup Environ Med 2022; 79:oemed-2021-108190. [PMID: 35504722 PMCID: PMC9453561 DOI: 10.1136/oemed-2021-108190] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/18/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate differences in workplace exposure, demographic and clinical findings in engineered stone (ES) workers from a multinational consortium using the Engineered Stone Silicosis Investigators (ESSI) Global Silicosis Registry. METHODS With ethics board approval in Israel, Spain, Australia and the USA, ES workers ages 18+ with a physician diagnosis of work-related silicosis were enrolled. Demographic, occupational, radiologic, pulmonary function and silica-related comorbidity data were compared cross-sectionally among countries using analysis of variance, Fisher's exact tests and logistic regression. RESULTS Among 169 ES workers with silicosis, most were men, with mean age 51.7 (±11.4) years. Mean work tenure in stone fabrication or masonry was 19.9 (±9.8) years. Different methods of case ascertainment explained some inter-country differences, for example, workers in Queensland, Australia with a state-based surveillance program were likely to be identified earlier and with shorter work tenure. Overall, 32.5% of workers had progressive massive fibrosis, the most severe form of dust-related pneumoconiosis, of whom 18.5% reported ≤10 years of work tenure. Lung function impairment including restriction, reduced diffusion capacity and hypoxaemia was common, as was autoimmunity. CONCLUSIONS Findings from a multinational registry represent a unique effort to compare demographic, exposure and clinical information from ES workers with silicosis, and suggest a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases. This younger worker population is at high risk for disease progression, multiple comorbidities and severe disability. The ESSI registry provides an ongoing framework for investigating epidemiological trends and developing prospective studies for prevention and treatment of these workers.
Collapse
Affiliation(s)
- Jeremy Tang Hua
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lauren Zell-Baran
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Leonard H T Go
- School of Public Health, University of Illinois, Chicago, Illinois, USA
| | | | | | - Daniel Chambers
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David Deller
- Gold Coast Respiratory and Sleep Clinic, Pindara Private Hospital, Gold Coast, Queensland, Australia
| | - Katrina Newbigin
- Department of Radiology, Wesley Hospital, Brisbane, Queensland, Australia
| | - Michael Matula
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Elizabeth Fireman
- Occupational Environmental Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mor Dahbash
- Occupational Environmental Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Antonio León-Jimenez
- Pulmonology, Allergy and Thoracic Surgery Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Coralynn Sack
- Departments of Medicine & Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Jaume Ferrer
- Pulmonology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ana Villar
- Respiratory Medicine Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Kirsten S Almberg
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois, Chicago, Illinois, USA
| | - Robert A Cohen
- Environmental and Occupational Health Sciences, University of Illinois, Chicago, Illinois, USA
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
48
|
Bollenbecker S, Czaya B, Gutiérrez OM, Krick S. Lung-kidney interactions and their role in chronic kidney disease-associated pulmonary diseases. Am J Physiol Lung Cell Mol Physiol 2022; 322:L625-L640. [PMID: 35272496 DOI: 10.1152/ajplung.00152.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Chronic illnesses rarely present in a vacuum, devoid of other complications, and chronic kidney disease is hardly an exception. Comorbidities associated with chronic kidney disease lead to faster disease progression, expedited dialysis dependency, and a higher mortality rate. Although chronic kidney disease is most commonly accompanied by cardiovascular diseases and diabetes, there is clear cross talk between the lungs and kidneys pH balance, phosphate metabolism, and immune system regulation. Our present understanding of the exact underlying mechanisms that contribute to chronic kidney disease-related pulmonary disease is poor. This review summarizes the current research on kidney-pulmonary interorgan cross talk in the context of chronic kidney disease, highlighting various acute and chronic pulmonary diseases that lead to further complications in patient care. Treatment options for patients presenting with chronic kidney disease and lung disease are explored by assessing activated molecular pathways and the body's compensatory response mechanisms following homeostatic imbalance. Understanding the link between the lungs and kidneys will potentially improve health outcomes for patients and guide healthcare professionals to better understand how and when to treat each of the pulmonary comorbidities that can present with chronic kidney disease.
Collapse
Affiliation(s)
- Seth Bollenbecker
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian Czaya
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Stefanie Krick
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
49
|
Hoy RF, Brims FJ. The National Occupational Respiratory Disease Registry (NORDR): it is time to learn from failure. Med J Aust 2022; 216:328-330. [PMID: 35325499 PMCID: PMC9314969 DOI: 10.5694/mja2.51465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Ryan F Hoy
- Monash University, Melbourne, VIC.,Alfred Health, Melbourne, VIC
| | - Fraser J Brims
- Sir Charles Gairdner Hospital, Perth, WA.,Curtin University, Perth, WA
| |
Collapse
|
50
|
Hore-Lacy F, Hansen J, Dimitriadis C, Hoy R, Fisher J, Glass D, Sim MR. Predictors of psychological stress in silica-exposed workers in the artificial stone benchtop industry. Respirology 2022; 27:455-461. [PMID: 35421270 PMCID: PMC9322397 DOI: 10.1111/resp.14257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/30/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022]
Abstract
Background and objective Artificial stone benchtops are a popular kitchen product, but dust from their preparation and installation contains respirable crystalline silica, which causes silicosis. Silicosis is a preventable, permanent lung disease. The aim of this study was to assess mental health in workers from the artificial stone benchtop industry at risk of silicosis. Methods Workers from the artificial stone benchtop industry undergoing assessment for silica‐associated disease were included. Information on demographics; occupational, medical and smoking history; modified Medical Research Council dyspnoea scale; Perceived Stress Scale (PSS‐10) questionnaire; spirometry; and chest x‐ray was collected. Univariate and multivariate regression analyses were conducted. Results Of the 547 participants, the majority were men, aged under 45 years, in the industry for less than 10 years. With each increase of dyspnoea score, PSS‐10 scores increased. Higher PSS‐10 scores were also observed in those no longer in the industry, with a history of anxiety or depression, attending assessment early in the programme and a medium exposure duration. Participants who used an interpreter reported lower stress. No difference was observed across job title, age, sex, smoking, spirometry or chest x‐ray categories after multivariate analysis. Conclusion This study identified workers with dyspnoea as likely to report higher stress. Other factors, such as leaving the industry, early attendance and a history of anxiety or depression, are also helpful in identifying workers at risk of poorer mental health outcomes. This study describes psychological stress scores in silica‐exposed workers from the artificial stone benchtop industry and identifies predictors of elevated stress. See relatedEditorial
Collapse
Affiliation(s)
- Fiona Hore-Lacy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Jessy Hansen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christina Dimitriadis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ryan Hoy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Deborah Glass
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|