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Astani S, Lorestani B, Cheraghi M, Kiani Sadr M. Assessing the health risks of chemicals in a company supplying chemicals to drilling rigs in Southern Iran using COSHH, SHEM-SAM, and SQRA methods. Front Public Health 2024; 12:1395695. [PMID: 39391152 PMCID: PMC11464427 DOI: 10.3389/fpubh.2024.1395695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/20/2024] [Indexed: 10/12/2024] Open
Abstract
Chemical industries are among the process industries and cause many risks. The present research aimed to analyze the health risks of a chemical warehouse of drilling rigs chemical Supply Company based on COSHH (Control of Substances Hazardous to Health), CHEM-SAM (Chemical Risk Management Self-Assessment Model), and SQRA (Subjective Quantified Risk Assessment) methods in 2021. The information was collected based on document review, MSDS of chemicals, processes, employees, and chemical exposure. Flammability, toxicity, allergy-causing, corrosivity, reactivity, LD50, and permissible thresholds of chemicals were also collected. The present research results showed that out of 59 main chemicals in the operational processes of the chemical warehouse of drilling rigs, 14 chemicals are flammable, 22 cause allergy responses, and three can cause death if inhaled. According to the results of the CHEM-SAM method, the employees and people outside the organization are at medium and low chemical risk based on the current management of the chemical warehouse, respectively. The results of the COSHH health assessment showed that chemicals had low, medium, high, and very high risk in 31, 13, 12, and 3 cases, respectively. The high-risk cases consisted of Ammonium Nitrate، Caustic Soda, and Poly.Aluminum.Chloride. Health risk assessment was also performed using the SQRA method, and results showed that chemicals have a very low, low, medium, high, and very high risk in 27, 12, 8, 9, and 3 cases, respectively. The results showed that the adverse health effects of chemical exposure in the drilling industry are alarming. Employees of different sectors of oil and gas industries are exposed to chemicals.
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Zhang M, Ichihara G, Zhou Z, Lou J, Wang D. Editorial: Qualitative and quantitative risk assessment of hazardous substances in the workplace. Front Public Health 2023; 11:1207487. [PMID: 37325321 PMCID: PMC10264768 DOI: 10.3389/fpubh.2023.1207487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Meibian Zhang
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gaku Ichihara
- Department of Occupational and Environmental Health, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Noda, Japan
| | - Zhijun Zhou
- School of Public Health, Fudan University, Shanghai, China
| | - Jianlin Lou
- School of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Huang Y, Miao F, Dai Y, Chang C, Zhang X, Dai H. Qualitative and quantitative evaluation of a standardized training model for improving patients' ability to use inhalers. Front Public Health 2023; 11:1065311. [PMID: 37139393 PMCID: PMC10149962 DOI: 10.3389/fpubh.2023.1065311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Training contributes to the effectiveness of aerosol inhalation therapy. However, qualitative and quantitative evaluation of effective training methods is rarely reported. This study aimed to evaluate the effectiveness of a standardized training model by pharmacists based on verbal instruction and physical demonstration in improving patients' ability to use inhalers using qualitative and quantitative methods. Risk or protective factors affecting correct inhaler use were also explored. Methods 431 Outpatients with asthma or COPD were recruited and randomly divided into a standardized training group (n = 280) and a usual training group (control group, n = 151). A framework of qualitative (e.g., multi-criteria analysis) and quantitative comparisons [percentage of correct use (CU%), percentage of complete error (CE%), and percentage of partial error (PE%)] was established to evaluate the two training models. In addition, the changes of key factors (age, education level, adherence, device type, etc.) influencing patients' ability to use inhalers of two models were observed. Results The multi-criteria analysis showed that the standardized training model had comprehensive advantages in qualitative indicators. The average correct use percentage (CU%) of the standardized training group was significantly higher than that of the usual training group (77.6% vs. 35.5%). A stratified analysis further demonstrated that the ORs (95%CI) in the usual training group of age and educational level was 2.263 (1.165-4.398) and 0.556 (0.379-0.815), while in the standardized training group, age and educational level were not the key factors influencing the ability to use inhaler devices (P > 0.05). Logistic regression analysis demonstrated that standardized training was a protective factor for inhalation ability. Conclusion These findings indicate that the framework of qualitative and quantitative comparisons could be used to evaluate training models, and the standardized training model by pharmacists can significantly improve patients' ability to use inhalers correctly and address the influence of older age and lower education because of its methodological advantages. Further studies with more extended follow-up are needed to validate the role of the standardized training model by pharmacists in the correct use of inhalers. Clinical trial registration chictr.org.cn, ChiCTR2100043592 (23-02-2021).
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Affiliation(s)
- Yuwen Huang
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Fangzhou Miao
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunjian Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cuie Chang
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyu Zhang
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Huang Q, Su S, Zhang X, Li X, Zhu J, Wang T, Wen C. Occupational health risk assessment of workplace solvents and noise in the electronics industry using three comprehensive risk assessment models. Front Public Health 2023; 11:1063488. [PMID: 37006568 PMCID: PMC10065190 DOI: 10.3389/fpubh.2023.1063488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundOccupational hazards such as solvents and noise in the electronics industry are serious. Although various occupational health risk assessment models have been applied in the electronics industry, they have only been used to assess the risks of individual job positions. Few existing studies have focused on the total risk level of critical risk factors in enterprises.MethodsTen electronics enterprises were selected for this study. Information, air samples and physical factor measurements were collected from the selected enterprises through on-site investigation, and then the data were collated and samples were tested according to the requirements of Chinese standards. The Occupational Health Risk Classification and Assessment Model (referred to as the Classification Model), the Occupational Health Risk Grading and Assessment Model (referred to as the Grading Model), and the Occupational Disease Hazard Evaluation Model were used to assess the risks of the enterprises. The correlations and differences between the three models were analyzed, and the results of the models were validated by the average risk level of all of the hazard factors.ResultsHazards with concentrations exceeding the Chinese occupational exposure limits (OELs) were methylene chloride, 1,2-dichloroethane, and noise. The exposure time of workers ranged from 1 to 11 h per day and the frequency of exposure ranged from 5 to 6 times per week. The risk ratios (RRs) of the Classification Model, the Grading Model and the Occupational Disease Hazard Evaluation Model were 0.70 ± 0.10, 0.34 ± 0.13, and 0.65 ± 0.21, respectively. The RRs for the three risk assessment models were statistically different (P < 0.001), and there were no correlations between them (P > 0.05). The average risk level of all of the hazard factors was 0.38 ± 0.18, which did not differ from the RRs of the Grading Model (P > 0.05).ConclusionsThe hazards of organic solvents and noise in the electronics industry are not negligible. The Grading Model offers a good reflection of the actual risk level of the electronics industry and has strong practicability.
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Affiliation(s)
- Qifan Huang
- Institute of Occupational Health Assessment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shibiao Su
- Institute of Occupational Health Assessment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, China
- *Correspondence: Shibiao Su
| | - Xiaoshun Zhang
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiang Li
- Institute of Occupational Health Assessment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, China
| | - Jiawei Zhu
- Institute of Occupational Health Assessment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, China
| | - Tianjian Wang
- Institute of Occupational Health Assessment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, China
| | - Cuiju Wen
- Department of Management of Research and Education, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, China
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Su S, Liang Z, Zhang S, Xu H, Chen J, Zhao Z, Zhang M, Wang T. Application of multiple occupational health risk assessment models in occupation health risk prediction of trichloroethylene in the electroplating and electronics industries. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:70-76. [PMID: 34983310 DOI: 10.1080/10803548.2021.2022956] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objectives. This study assessed the occupational health risks of work group exposure to trichloroethylene (TCE) in the electroplating and electronics industries in China. Methods. The UK Control of Substances Hazardous to Health (COSHH) Essential, the US Environmental Protection Agency (EPA) and the Singapore and the Chinese semiquantitative risk assessment models were used to assess the risks of TCE. Twenty degreasing groups and 14 cleaning groups were recruited in the companies selected. Results. The concentrations of TCE in 66.7% of the cleaning groups and 35.0% of the degreasing groups exceeded the permissible concentration time-weighted average (PC-TWA) in China, and the concentrations of TCE in 100.0% of the cleaning groups and 70.0% of the degreasing groups exceeded the permissible concentration short-term exposure limit (PC-STEL) in China. Over 60.0% of the work groups were evaluated at high risk and over half of the work groups were evaluated at high cancer risk by the risk assessment models. Conclusion. Most work groups exposed to TCE in the electroplating and electronics industries in China are at high risk. The cleaning groups may have a higher risk for TCE exposure. The Chinese exposure index method and the synthesis index method are more practical than the other methods.
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Affiliation(s)
- Shibiao Su
- Institute of Occupational Health Assessment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangdong Provincial Key Laboratory of Occupational Disease Prevention and Treatment, China
| | - Zhiming Liang
- Occupational Health Department, Foshan Shunde District Center for Disease Control and Prevention, China
| | - Sheng Zhang
- Occupational Health Department, Songgang Institute for Disease Prevention and Healthcare of Baoan District, China
| | - Haijuan Xu
- Institute of Occupational Health Assessment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangdong Provincial Key Laboratory of Occupational Disease Prevention and Treatment, China
| | - Jinru Chen
- Occupational Health Department, Songgang Institute for Disease Prevention and Healthcare of Baoan District, China
| | - Zhuandi Zhao
- Occupational Health Department, Songgang Institute for Disease Prevention and Healthcare of Baoan District, China
| | - Meibian Zhang
- Institution for Occupational Health and Radiation Protection, Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Tianjian Wang
- Institute of Occupational Health Assessment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangdong Provincial Key Laboratory of Occupational Disease Prevention and Treatment, China
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Duan D, Leng P, Li X, Mao G, Wang A, Zhang D. Characteristics and occupational risk assessment of occupational silica-dust and noise exposure in ferrous metal foundries in Ningbo, China. Front Public Health 2023; 11:1049111. [PMID: 36844828 PMCID: PMC9947523 DOI: 10.3389/fpubh.2023.1049111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction To investigate the major existing occupational hazards and to assess the occupational health risks for ferrous metal foundries (FMFs) in Ningbo, China. Methods Unified questionnaires were formulated to investigate the information on the basic situations, occupational hazards, and occupational health management for 193 FMFs in Ningbo. Furthermore, we used the semi-quantitative risk assessment model, which was developed by the International Council on Mining and Metals (ICMM), to assess occupational health risks for 59 of 193 the FMFs. Results The casting process of FMFs in Ningbo was mainly divided into sand casting and investment casting, and silica-dust and noise were the major occupational hazards in both sand casting and investment casting foundries. Silica-dust mainly occurred in industries with such work as sand handling, modeling, falling sand, and sand cleaning, with the median of the permissible concentration-time weighted average (PC-TWA) was 0.80, 1.15, 3.52, 0.83 mg/m3, respectively. The noise mainly existed in industries with such work as sand handling, core making, falling sand, sand cleaning, cutting and grinding, and smelting with median of PC-TWA was 81.72 dB(A), 82.93 dB(A), 90.75 dB(A), 80.18 dB(A), 90.05 dB(A), 82.70 dB(A), respectively. In addition, the results of the ICMM assessment model indicated that 100 and 98.7% of the jobs exposed to silica-dust and noise in 59 FMFs have an "intolerable risk" level of risks of causing pneumoconiosis and noise deaf, respectively. Discussion The hazard risk of silica-dust and noise is serious for FMFs in Ningbo. It is necessary to supervise enterprises to improve operating environmental conditions, accelerate the reduction of silica-dust and noise exposure risks, and promote the healthy and sustainable development of the foundry industry.
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Affiliation(s)
| | | | | | | | - Aihong Wang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Dandan Zhang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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Askari A, Poursadeqiyan M, Sahl Abadi AS, Mahdinasab L, Farhadi AR. Semi-quantitative risk assessment for workers exposed to occupational harmful agents in an oilfield in Iran. Work 2023; 76:147-157. [PMID: 36872822 DOI: 10.3233/wor-220077] [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] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Workers are exposed to occupational health hazards from physical, chemical, biological, ergonomic, and psychological agents. Assessing occupational health risks is vital for executing control measures to protect employees' health against harmful occupational agents. OBJECTIVE The present study aimed to identify, evaluate, and prioritize occupational health risks to assist senior management in determining where to allocate the budget to carry out the required corrective actions in the oilfields project. METHODS This descriptive-analytical cross-sectional study was performed in 2021 among Iran's Sarvak Azar oil field job groups. The occupational health risk was assessed using the Harmful Agents Risk Priority Index (HARPI) as a semi-quantitative method. Then, to simplify decision-making and budget allocation, we reported HARPI final score in the Pareto principle format. RESULTS The results show that in this oil field, controlling exposure to adverse lighting, improving the thermal conditions and ergonomics, and preventing noise exposure has the highest priority, with scores of 6342, 5269, 5629, and 5050, respectively. Production, HSE, laboratory, and commissioning need the most health care measures with scores of 8683, 5815, 5394, and 4060, respectively. CONCLUSION HARPI could be used to prioritize occupational health hazards, and this method can simplify managers' decisions to allocate resources to implement control measures.
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Affiliation(s)
- Ali Askari
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Health, Safety, and Environment, OICO Occupational Health Division, Azar Oilfield, Ilam, Iran
| | - Mohsen Poursadeqiyan
- Department of Occupational Health Engineering, School of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Salehi Sahl Abadi
- Workplace Health Promotion Research Center, Department of Occupational Health and Safety at Work, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Laila Mahdinasab
- Department of Work and Knowledge, Work and Education School, Mehran Education Office, Ilam, Iran
| | - Ali Reza Farhadi
- Department of Medical Education, Kermanshah University of Medical Sciences. Kermanshah, Iran
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Shi B, Su S, Wen C, Wang T, Xu H, Liu M. The prediction of occupational health risks of benzene in the printing industry through multiple occupational health risk assessment models. Front Public Health 2022; 10:1038608. [PMID: 36589933 PMCID: PMC9797023 DOI: 10.3389/fpubh.2022.1038608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background Benzene poisoning is a common occupational poisoning event in the printing industries. Up to now there is still a lack of research data on risk assessment of benzene operations in enclosed workshops. It is crucial to assess the risk level of these positions and put forward effective measures and suggestions. Methods The information of selected companies and air samples were collected through on-site investigation, data collation and sample testing were carried out according to the requirements of Chinese standards. The Control of Substances Hazardous to Health (COSHH) Essential, the EPA non-carcinogenic risk assessment model, the Singapore exposure index method and the Chinese semi-quantitative risk assessment models were used to assess the risks of benzene. Results The exposed groups all worked more than 8 h per day, and the cleaning, pasting, and packaging groups used general ventilation rather than local ventilation. 28.6% of the printing group and 16.7% of the pasting group had benzene concentrations that exceeded the permissible concentration-time weighted average (PC-TWA) in China. Over 60.0% of the work groups were evaluated at high risk and over 20% of the work groups were evaluated at high cancer risk by the risk assessment models. Conclusion The Chinese exposure index method and the synthesis index method may have a stronger practicability. The printing and pasting groups may have a higher risk for benzene exposure. It is necessary to increase protective measures and strengthen occupational hygiene management to reduce risks.
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Zhu J, Su S, Wen C, Wang T, Xu H, Liu M. Application of multiple occupational health risk assessment models in the prediction of occupational health risks of n-Hexane in the air-conditioned closed workshop. Front Public Health 2022; 10:1017718. [PMID: 36568752 PMCID: PMC9784923 DOI: 10.3389/fpubh.2022.1017718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background n-Hexane (NH) poisoning is a common occupational poisoning in the hardware and electronics industries. However, there is few research data on risk assessment of positions using NH in enclosed workshops. It is very important to assess the risk level of these positions and put forward effective measures and suggestions. Methods The information of selected companies and air samples were collected through on-site investigation, and data collation and sample testing were carried out according to the requirements of Chinese standards. The Control of Substances Hazardous to Health (COSHH) Essential, the EPA non-carcinogenic risk assessment model, the Singapore exposure index method and the Chinese semi-quantitative risk assessment models were used to assess the risks of NH. Results The working hours of the exposure groups, printing groups and packing groups all exceeded 9 h per day, less than 30% of each similar exposure groups (SEG) was equipped with the local exhaust ventilation, and 11.1% of the cleaning group and 8.3% of the printing group had NH concentrations in the air that exceeded the Chinese occupational exposure limit (OEL). In the EPA non-carcinogenic risk assessment model, each SEG was evaluated at high risk. In the Chinese semi-quantitative risk assessment models, all of the work groups of exposure groups, 91.7% of the work groups of printing groups, 77.8% of the work groups of printing groups, and 57.1% of the work groups of printing groups were evaluated at unacceptable risk. More than 40.0% of the work groups of printing groups and cleaning groups and over 20.0% of the work groups of exposure groups and packing groups were evaluated at high risk in the Chinese semi-quantitative risk assessment models. Conclusions The Chinese exposure index method and the synthesis index method may have a stronger practicability. Some work groups that use NH in air-conditioned enclosed workshops in China, especially the cleaning groups, are still in a high-risk state. It is necessary to increase protective measures and strengthen occupational hygiene management to reduce risks.
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Dong Y, Wang X, Hu W, Bian H, Wang X, Kang N, Han F, Zhang S, Ye M. Improvements in protective measures in factories with acetylene hydrochlorination and ethylene oxychlorination techniques declined risk assessment levels and affected liver health status. Front Public Health 2022; 10:1053300. [PMID: 36483242 PMCID: PMC9723347 DOI: 10.3389/fpubh.2022.1053300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
Acetylene hydrochlorination and ethylene oxychlorination are the two most common methods of producing vinyl chloride monomer (VCM), which has been linked to liver impairment, hepatocellular carcinoma (HCC), and angiosarcoma of the liver (ASL) in occupational settings. However, whether and how these impairments could be effectively improved from workplace root causes has yet to be discovered. This study aimed to evaluate whether improvements in protective measures in groups Y (408 subjects) and Z (349 subjects) could have an influential impact on the alleviation of liver impairment by comparing risk assessment levels under several semi-quantitative models and results from liver ultrasound detection and liver function tests before and after the improvement. Importantly, significant differences in constituent ratio involved in parameters among age, length of employment, weekly exposure time, smoking status, alcohol consumption, and sleeping quality were found between Y and Z before improvement took place in 2020 (P < 0.05 or P < 0.001), and population distribution by gender between Y and Z was in a large homogeneity with differences in age and length of employment. CSTE involves ore breaking, acetylene generation, steam stripping, outward processing, and welding maintenance, was disqualified in 2020 compared to OEL, and was said to have declined to meet OEL requirements by 2021. Further, a negative correction of fresh air requirement and ventilation air changing rate with ambient concentration toward hazards in Y was stronger in 2021 than in 2020. Significant differences in risk levels in Y between 2020 and 2021 were found as ore breaking, acetylene generation, steam stripping, outward processing, VCM polymerization, welding, and repairing, decreasing to relatively lower risk levels in 2021 from the original ones in 2020 only under the semi-quantitative comprehensive index model. Abnormal rates toward other hepatic symptoms decreased in the majority of positions after the improvement, as referred to by alterations such as ALT, AST, and GGT. Overall, the effect of improvements on protective measures effectively reduced positions' risk assessment levels through ventilation enhancement and airtight strengthening, which further affected abnormal rates toward other hepatic symptoms, and alterations such as ALT, AST, and GGT were much more significant in Y than effect in Z.
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Affiliation(s)
- Yiwen Dong
- Department of Occupational Epidemiology and Risk Assessment, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xingang Wang
- Department of Occupational Health and Radiological Health, Tianjin Binhai New Area Center for Disease Control and Prevention, Tianjin, China
| | - Weijiang Hu
- Department of Occupational Epidemiology and Risk Assessment, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongying Bian
- Department of Occupational Epidemiology and Risk Assessment, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xin Wang
- Department of Occupational Epidemiology and Risk Assessment, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ning Kang
- Department of Occupational Epidemiology and Risk Assessment, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feng Han
- Department of Occupational Epidemiology and Risk Assessment, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Siyu Zhang
- Department of Occupational Epidemiology and Risk Assessment, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Meng Ye
- Department of Occupational Epidemiology and Risk Assessment, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China,*Correspondence: Meng Ye
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Zhou L, Xue P, Zhang Y, Wei F, Zhou J, Wang S, Hu Y, Lou X, Zou H. Occupational health risk assessment methods in China: A scoping review. Front Public Health 2022; 10:1035996. [PMID: 36466494 PMCID: PMC9714297 DOI: 10.3389/fpubh.2022.1035996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Over the decades, many assessment methods have been developed around the world and used for occupational health risk assessment (OHRA). This scoping review integrated the literature on methodological studies of OHRA in China and aimed to identifies the research hot-spots and methodological research perspectives on OHRA in China. Methods A scoping review of literature was undertaken to explore the research progress on OHRA methods in China. Focusing on OHRA methods, the authors systematically searched Chinese and English databases and relevant guideline websites from the date of establishment to June 30, 2022. Databases included Web of Science, PubMed, Scopus, the China National Knowledge Internet, WanFang Database. Some other websites were also searched to obtain gray literature. The extracted information included the author, year, region of first author, the target industry, risk assessment model, study type, the main results and conclusions. Results Finally, 145 of 9,081 studies were included in this review. There were 108 applied studies, 30 comparative studies and 7 optimization studies on OHRA in China. The OHRA methods studied included: (1) qualitative methods such as Romanian model, Australian model, International Council on Mining and Metals model, and Control of Substances Hazardous to Health Essentials; (2) quantitative methods such as the U. S. Environmental Protection Agency inhalation risk assessment model, Physiologically Based Pharmacokinetic, and Monte Carlo simulation; (3) semi-quantitative methods such as Singapore model, Fuzzy mathematical risk assessment model, Likelihood Exposure Consequence method and Occupational Hazard Risk Index assessment method; (4) comprehensive method (Chinese OHRA standard GBZ/T 298-2017). Each of the OHRA methods had its own strengths and limitations. In order to improve the applicability of OHRA methods, some of them have been optimized by researchers. Conclusions There is a wide range of OHRA methods studied in China, including applied, comparative, and optimization studies. Their applicability needs to be further tested through further application in different industries. Furthermore, quantitative comparative studies, optimization studies, and modeling studies are also needed.
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Affiliation(s)
- Lifang Zhou
- Institute of Occupational Health and Radiation Protection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Panqi Xue
- Institute of Occupational Health and Radiation Protection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yixin Zhang
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Fang Wei
- Institute of Occupational Health and Radiation Protection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jiena Zhou
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Shasha Wang
- Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Yong Hu
- Institute of Occupational Health and Radiation Protection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoming Lou
- Institute of Occupational Health and Radiation Protection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,Xiaoming Lou
| | - Hua Zou
- Institute of Occupational Health and Radiation Protection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,*Correspondence: Hua Zou
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Xu Q, Zhang M, Xu L, Yuan W, Ren H, Wang P, Shao X, Zhou Z, Zou H, Cao Y. Evaluation of strategies for the occupational health risk assessment of chemical toxicants in the workplace based on a quantitative analysis model. Front Public Health 2022; 10:1035065. [PMID: 36466512 PMCID: PMC9709462 DOI: 10.3389/fpubh.2022.1035065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives The commonly used methods for the occupational health risk assessment (OHRA) of chemical toxicants cannot fully meet the needs of practical work. This study evaluated OHRA strategies for chemical toxicants in the workplace by establishing a quantitative analysis model. Methods Five typical industries in China that implement OHRA using the six common models (the Environmental Protection Agency, Australian, Romanian, Singaporean, International Council on Mining and Metals, and the Control of Substances Hazardous to Health models) were selected as the research objects. We established a quantitative analysis model to compare the six models and applied it to compare the results obtained using each model and preliminarily analyze the advantages, limitations, and application scope of each method. Results The risk ratio (RR) values of the six methods decreased in the following order: RREPA > RRCOSHH > RRICMM > RRAustralia > RRSingaporean > RRRomanian (P < 0.05). Among the six models, the Singaporean model had the strongest RR correlation with the other models (P < 0.01). The sequence of RRs obtained from the Singaporean, ICMM, Australian, and Romanian models in the five industries was consistent with the sequence of the three inherent risk levels in those industries. Only the Romanian model could distinguish between the RRs of all five industries. The EPA and Singaporean models could effectively distinguish the differences in inherent risk for four hazard factors (manganese and inorganic compounds, benzene, xylene, and ethyl acetate), with the assessment accuracy being relatively higher for the EPA model. Conclusions Among the six models, the EPA model had the relatively highest accuracy in assessing chemical toxicants, followed by the Singaporean model. The EPA and Romanian models were strongest in differentiating the differences in toxicity risk. More studies on OHRA methodology are needed.
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Affiliation(s)
- Qiuliang Xu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Meibian Zhang
- Chinese Center for Disease Control and Prevention, National Institute of Occupational Health and Poison Control, Beijing, China
| | - Lingtong Xu
- Zhejiang Tianlan Environmental Protection Engineering Co., Ltd., Hangzhou, China
| | - Weiming Yuan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Hong Ren
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Peng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xincun Shao
- Zhejiang Jidi Testing Technology Co., Ltd., Taizhou, China
| | - Zhen Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,Zhen Zhou,
| | - Hua Zou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,Hua Zou,
| | - Yiyao Cao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,*Correspondence: Yiyao Cao,
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Hao P, Ren D, Yang L, Liu Z, Du H. Occupational Exposures and Health Risks of Benzene, Toluene, and Xylenes (BTX) in Automobile Repair Industry in Beijing City, China. Asia Pac J Public Health 2022; 34:778-785. [PMID: 36205352 DOI: 10.1177/10105395221131121] [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: 12/15/2022]
Abstract
This study aimed to evaluate the occupational health risks of benzene, toluene, and xylenes (BTX) exposure in the automobile repair industry in Beijing city in China. The concentrations of BTX were monitored at 140 operating positions of 51 randomly selected automobile repair enterprises in 2018. Samples analysis showed that all monitoring concentrations were not higher than the occupational exposure limits. The long-term exposure concentration ranges of benzene, toluene, and xylenes were 0.1 to 0.3, 0.1 to 49.7, and 0.2 to 49.5 mg/m3, respectively. The short-term exposure concentration ranges of benzene, toluene, and xylenes were 0.1 to 0.3, 0.1 to 98.7, and 0.2 to 100.0 mg/m3, respectively. But assessment results revealed unneglectable occupational health risks, especially the combined health risks of BTX exposure. Thereafter, effective control and improvement measures were put forward, including strengthening the management of the production, sale, and use of vehicle paints and coatings; improving ventilation; and implementing hierarchical management measures for occupational health risks.
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Affiliation(s)
- Pengpeng Hao
- School of Management and Engineering, Capital University of Economics and Business, Beijing, China
| | - Dongmei Ren
- School of Management and Engineering, Capital University of Economics and Business, Beijing, China
| | - Ling Yang
- School of Management and Engineering, Capital University of Economics and Business, Beijing, China
| | - Zhimin Liu
- School of Management and Engineering, Capital University of Economics and Business, Beijing, China
| | - Huifang Du
- Occupational Hazard Research Institute, China Academy of Safety Science and Technology, Beijing, China
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14
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Ruan XY, Tan SW, Zhu L, Shi YP, Yu JM, Zhang MB, Wang TS, Fu H. A multiple and comprehensive approach to assess health risk in amalgam-exposed Chinese workers. Front Public Health 2022; 10:999095. [PMID: 36203661 PMCID: PMC9530277 DOI: 10.3389/fpubh.2022.999095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/01/2022] [Indexed: 01/26/2023] Open
Abstract
Fluorescent lamp manufacturing workers have been extensively exposed to mercury (Hg). Our aim was to assess their health risks using several approved occupational health risk assessment methods, and to find out which method was more suitable for identification of occupational health risks. Work locations, and air and urine samples were collected from 530 exposed workers in Zhejiang, China. Based on the calculated exposure doses, health risks and risk ratios (RRs) as health risk indices, were evaluated using: Environmental Protection Agency (EPA), Australian, Romanian, Singaporean, International Council on Mining and Metals (ICMM), and Control of Substances Hazardous to Health (COSHH) methods. Among the workers, 86.0% had higher Hg levels than the Chinese occupational exposure limits of 0.02 mg/m3, and 16.7% urine samples were higher than the biological exposure limits of 35.0 μg/g·creatinine. Among workers at the injection, etc. locations, their average RRs, evaluated by the EPA, COSHH and Singaporean methods were 0.97, 0.76, and 0.60, respectively, and were significantly higher than the ICMM (0.39), Australian (0.30) and Romanian (0.29) methods. The RRs from the Singaporean method showed significant correlations with the urinary Hg levels (P < 0.01). In conclusion, the Singaporean method was more appropriate than the others for health risk evaluation because the excessive risks were significantly associated with urinary Hg levels among the workers.
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Affiliation(s)
- Xiao-ying Ruan
- Department of Occupational Health, Hangzhou Hospital for Prevention and Treatment of Occupational Disease, Hangzhou, China
| | - Si-wei Tan
- Department of Occupational Health, Hangzhou Hospital for Prevention and Treatment of Occupational Disease, Hangzhou, China
| | - Lin Zhu
- Department of Occupational Health, Hangzhou Hospital for Prevention and Treatment of Occupational Disease, Hangzhou, China
| | - Yan-peng Shi
- Department of Occupational Health, Hangzhou Hospital for Prevention and Treatment of Occupational Disease, Hangzhou, China
| | - Jia-mian Yu
- Department of Occupational Health, Hangzhou Hospital for Prevention and Treatment of Occupational Disease, Hangzhou, China
| | - Mei-bian Zhang
- Department of Occupational Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tong-shuai Wang
- Shanghai Key Laboratory of Maternal Fetal Medicine, Clinical and Translational Research Center of Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Tong-shuai Wang
| | - Hong Fu
- Department of Occupational Health, Hangzhou Hospital for Prevention and Treatment of Occupational Disease, Hangzhou, China,Hong Fu
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15
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Chalak MH, Bahramiazar G, Rasaee J, Fahimi R, Anbardan AN, Jafari H, Nasab FR. Occupational health risk assessment at healthcare institutions: Developing a semi-quantitative risk method. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 32:265-278. [PMID: 33646181 DOI: 10.3233/jrs-200048] [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: 11/15/2022]
Abstract
BACKGROUND Environmental hazards in healthcare institutions affect the quality of patient care as well as personnel and patient safety. OBJECTIVE The aim of this study was to develop and apply a semi-quantitative risk assessment method to calculate occupational health risk levels with regard to the sensitivities of healthcare institutions. METHODS The present research was conducted in three phases. In phases 1 and 2, the model was developed using a review of different risk assessment methods, extracting expert opinions (N = 10) through semi-structured interviews, and using the fuzzy analytical hierarchy process (FAHP). In phase 3, in order to validate the proposed method, one of the five public hospitals was randomly selected and a case study comprising 6 sections was performed. RESULTS A total of 43 health risks were identified and evaluated using the present method, 41.86% of which were at very high levels, 16.27% at high levels, 30.23% at substantial ones, 9.3% at medium and 2.32% at low levels. The highest health risks were found in paraclinical and operating room wards. CONCLUSION To overcome the shortcomings of the proposed health risk assessment methods, a semi-quantitative method was used in the present study to more accurately calculate the risk levels in the healthcare institutions and also calculate the risk level of each hospital unit. The proposed semi-quantitative method can be used as a tool for assessing occupational health risks as a key element of risk management. In addition, by focusing on an appropriate framework for occupational health risk assessment, specialists in the organization will be able to take significant and effective steps to implement an efficient risk management system.
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Affiliation(s)
- Mohammad Hossein Chalak
- Student Research Committee, Faculty of Public Health Branch, Iran University of Medical Sciences, Tehran, Iran.,Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Javad Rasaee
- Department of Health, Safety and Environment Engineering, School of Health, Islamic Azad University, Najafabad Branch, Isfahan, Iran
| | - Reza Fahimi
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Asghar Noran Anbardan
- Department of Health and Safety, School of Health, University of Applied Science, Ebnesina Hospital, Tehran, Iran
| | - Hossein Jafari
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fatemeh Ramroudi Nasab
- Department of Occupational Health Engineering, School of Health, Zahedan University of Medical Sciences, Zahedan, Iran
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Korchevskiy A. Using benchmark dose modeling for the quantitative risk assessment: Carbon nanotubes, asbestos, glyphosate. J Appl Toxicol 2020; 41:148-160. [PMID: 33040390 DOI: 10.1002/jat.4063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 11/12/2022]
Abstract
Benchmark dose method is one of the most famous quantitative approaches available for toxicological risks prediction. However, it is not fully clear how occupational health professionals can use it for specific workplace scenarios requiring carcinogen risk assessment. The paper explores the hypothesis that benchmark dose method allows to effectively approximate dose-response data on carcinogenic response, providing reasonable estimations of risks in the situations when a choice between more complex models is not warranted for practical purposes. Three case studies were analyzed for the agents with different levels of scientific confidence in human carcinogenicity: carbon nanotubes, amosite asbestos, and glyphosate. For each agent, a critical study was determined, and a dose-response slope factor was quantified, based on the weighted average lower bound benchmark dose. The linear slope factors of 0.111 lifetime excess cases of lung carcinoma per mg/m3 of MWCNT-7 (in rats exposure equivalent), 0.009 cases of mesothelioma per f/cc-years of cumulative exposure to amosite asbestos, and 0.000094 cases of malignant lymphoma per mg/kg/day of glyphosate (in mice equivalent) were determined. The correlations between the proposed linear predictive models and observed data points were R = 0.96 (R2 = 0.92) for carbon nanotubes, R = 0.97 (R2 = 0.95) for amosite asbestos, and R = 0.89 (R2 = 0.79) for glyphosate. In all three cases, the linear extrapolation yielded comparable level of risk estimations with the "best fit" nonlinear model; for nanoparticles and amosite asbestos, linear estimations were more conservative. By performing a simulation study, it was demonstrated that a weighted average benchmark dose expressed the highest correlation with multistage and quantal-linear models.
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17
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Xu Q, Yu F, Li F, Zhou H, Zheng K, Zhang M. Quantitative differences between common occupational health risk assessment models. J Occup Health 2020; 62:e12164. [PMID: 32949432 PMCID: PMC7507535 DOI: 10.1002/1348-9585.12164] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Methodological studies on occupational health risk assessment (OHRA) models are rarely reported. This study aimed to explore the quantitative differences between common OHRA models. Methods The risk ratios (RRs) in five typical industries (leather, wooden furniture manufacturing, printing and dyeing, printing, and garment manufacturing) were investigated using six OHRA models, namely the models from the US Environmental Protection Agency (EPA), Singapore, the Control of Substances Hazardous to Health (COSHH), Australia, Romania, and International Council on Mining and Metals (ICMM). The consistency, correlation, and reliability were evaluated for quantitative differences between the models. Results The order of the RRs obtained from the EPA, Singaporean, and COSHH models in the five industries was consistent with the order of the inherent risk levels in those industries. The EPA and Singaporean models could effectively distinguish the inherent risk levels of risk factors like xylene and ethyl acetate. The order of RR between the six models was: RR EPA > RR COSHH > RR Singaporean > RR Australian > RR Romanian and RR ICMM (P < .05). The EPA model had the weakest correlations with other models. The Singaporean model had positive correlations in RRs with the other models (P<0.01). Conclusions The EPA and Singaporean models exhibited good reliability since they could distinguish the inherent risk of the industry or risk factor and tended to get higher risk levels. The EPA model was independent and the Singaporean model had a good correlation with other models. More studies on OHRA methodology are needed.
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Affiliation(s)
- Qiuliang Xu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Fang Yu
- Zhejiang Zheng'an Testing Technology co. LTD, Wenzhou, Zhejiang, China
| | - Fei Li
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Hua Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Kang Zheng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Meibian Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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18
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Gao X, Zou H, Zhou Z, Yuan W, Quan C, Zhang M, Tang S. Qualitative and quantitative differences between common control banding tools for nanomaterials in workplaces. RSC Adv 2019; 9:34512-34528. [PMID: 35529962 PMCID: PMC9073898 DOI: 10.1039/c9ra06823f] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/14/2019] [Indexed: 11/23/2022] Open
Abstract
A number of control banding (CB) tools have been developed specifically for managing the risk of exposure to engineered nanomaterials. However, data on the methodological differences between common CB tools for nanomaterials in workplaces are rare. A comparative study with different CB tools, such as Nanosafer, Stoffenmanager-Nano, Nanotool, Precautionary Matrix, ECguidance, IVAM Guidance, ISO, and ANSES, was performed to investigate their qualitative and quantitative differences in real exposure scenarios. These tools were developed for different purposes, with different application domains, methodological principles, and criteria. Multi-criteria analysis showed that there was a diverse distribution of these eight CB tools across different evaluation indicators. The total evaluation scores for Nanotool, Stoffenmanager-Nano, and Nanosafer were higher than the other tools. Quantitative comparisons demonstrated that ANSES, ECguidance, and IVAM Guidance tools were better in terms of information availability. Nanotool, Stoffenmanager-Nano, and ECguidance were better in terms of the sensitivity of outputs to changes in exposure parameters. The Nanotool, ANSES, and ECguidance tools were better in terms of accuracy of hazard outcomes evaluated with toxicological data. The Stoffenmanager-Nano, Nanotool, and Nanosafer tools' exposure scores for seven scenarios had a good correlation with measurement data. The Nanotool and Stoffenmanager-Nano tools had much higher comprehensive advantages based on quantitative and qualitative assessment. More comparative studies evaluating different tools are required, using more types of nanomaterials in real exposure scenarios. A number of control banding (CB) tools have been developed specifically for managing the risk of exposure to engineered nanomaterials.![]()
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Affiliation(s)
- Xiangjing Gao
- Zhejiang Provincial Center for Disease Control and Prevention
- Hangzhou 310051
- China
| | - Hua Zou
- Zhejiang Provincial Center for Disease Control and Prevention
- Hangzhou 310051
- China
| | - Zanrong Zhou
- Zhejiang Provincial Center for Disease Control and Prevention
- Hangzhou 310051
- China
| | - Weiming Yuan
- Zhejiang Provincial Center for Disease Control and Prevention
- Hangzhou 310051
- China
| | - Changjian Quan
- Zhejiang Provincial Center for Disease Control and Prevention
- Hangzhou 310051
- China
| | - Meibian Zhang
- Zhejiang Provincial Center for Disease Control and Prevention
- Hangzhou 310051
- China
| | - Shichuan Tang
- Beijing Municipal Institute of Labour Protection
- Beijing 100054
- China
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