Cotton Dust Exposure and Respiratory Disorders among Textile Workers at a Textile Company in the Southern Part of Benin

Pulmonary function assessment among conventional and organic cotton farmers exposed to pesticides in the Central-West region of Burkina Faso

BACKGROUND

Respiratory diseases have been associated with the exposure of populations to some environmental pollutants such as pesticides. To assess effects of pesticides on farmers' respiratory health, this study aimed to evaluate the pulmonary function of cotton farmers exposed to synthetic and natural pesticides in the Central-West region of Burkina Faso.

METHODS

A cross-sectional study was conducted from June to July 2022 among 281 conventional and 189 organic cotton farmers. After collecting information on pesticide use conditions, pulmonary function tests (PFTs) were performed on each farmer according to the American Thoracic Society/European Respiratory Society guidelines, in order to assess chronic respiratory effects among cotton producers. Binary logistic regression was used to assess factors associated with the occurrence of ventilatory changes.

RESULTS

Both conventional and organic cotton farmers reported similar chronic respiratory symptoms in different proportions. The main reported were rhinitis (54.45% conventional vs. 34.92% organic), chest pains (41.28% conventional vs. 23.81% organic), cough (33.45% conventional, 24.34% organic), breathlessness (31.67% conventional, 4.23% organic) (p<0.05). 16.18% and 27.50% of conventional male and female cotton farmers, respectively, had a restrictive defect. Among organic cotton farmers, 15.85% and 18.69%, respectively, of males and females had a restrictive defect. Furthermore, a significant increase in the predicted average percentage of FEV1/FVC ratio was observed among organic cotton farmers after salbutamol's use (p = 0.039). The type of cultivated cotton was not associated with ventilatory changes neither in the univariate analysis, nor in the multivariate analysis. Other factors such as farmers' age, BMI and insecticides use frequency per year were also important. Farmers who used insecticides more than 6 times per season had an increased risk of developing an obstructive defect (OR = 1.603; 95%CI: 0.484-5.309) compared to those who used them 6 times or less.

CONCLUSION

Chronic respiratory signs and ventilatory impairments were found among conventional and, to our knowledge, for the first time among organic cotton producers. However, these health effects were more prevalent among conventional cotton farmers than organic ones.

Respiratory Diseases Associated With Organic Dust Exposure

Organic dusts are complex bioaerosol mixtures comprised of dust and par ticulate matter of organic origin. These include components from bacteria, fungi, pollen, and viruses to fragments of animals and plants commonplace to several environmental/occupational settings encompassing agriculture/farming, grain processing, waste/recycling, textile, cotton, woodworking, bird breeding, and more. Organic dust exposures are linked to development of chronic bronchitis, chronic obstructive pulmonary disease, asthma, asthma-like syndrome, byssinosis, hypersensitivity pneumonitis, and idiopathic pulmonary fibrosis. Risk factors of disease development include cumulative dust exposure, smoking, atopy, timing/duration, and nutritional factors. The immunopathogenesis predominantly involves Toll-like receptor signaling cascade, T-helper 1/T-helper 17 lymphocyte responses, neutrophil influx, and potentiation of manifestations associated with allergy. The true prevalence of airway disease directly attributed to organic dust, especially in a workplace setting, remains challenging. Diagnostic confirmation can be difficult and complicated by hesitancy from workers to seek medical care, driven by fears of potential labor-related consequence. Clinical respiratory and systemic presentations coupled with allergy testing, lung function patterns of obstructive versus restrictive disease, and radiological characteristics are typically utilized to delineate these various organic dust-associated respiratory diseases. Prevention, risk reduction, and management primarily focus on reducing exposure to the offending dust, managing symptoms, and preventing disease progression.

Respiratory symptoms and pulmonary function impairment among textile industry workers in Alexandria, Egypt

Occupational exposure to cotton dust is still an important cause of respiratory problems in textile workers particularly in less developed countries like Egypt. Evaluate respiratory symptoms and diseases, and pulmonary function pattern among Egyptian textile workers. Cross sectional comparative study was conducted from December 2019 to September 2020 in a textile factory in Egypt; 364 male workers (184 cotton dust exposed workers, and 180 unexposed workers) were included. Participants were subjected to an interviewing questionnaire, British Medical Research Council questionnaire, anthropometric measurements, pulmonary function tests, and byssinosis grading format. Descriptive and analytic statistics were conducted. Chronic cough, phlegm production, and shortness of breath grade I, II and III were more reported in cotton dust exposed workers than unexposed workers (P#x003C;0.01, P#x003C;0.01, and P=0.02, respectively). Prevalence of chronic bronchitis was significantly higher among cotton dust exposed workers (12%) than unexposed workers (3.9%) (P#x003C;0.01). The mean percent predicted values of lung function indices reflecting large-1irway function (VC, FVC, FEV1, FEV1%, PEFR, and FEF75) were significantly lower in cotton dust exposed workers (P#x003C;0.01). Prevalence of byssinosis was 22.8%. Workers with byssinosis had significantly higher prevalence of respiratory symptoms, chronic bronchitis, cross-shift reduction in PEFR and significant decrease in mean percent predicted values of FVC, FEV1, PEFR, FEF75, and FEF50 than workers without byssinosis. This study revealed a substantial association between cotton dust exposure at work and respiratory symptoms and morbidity. Regular measurement of cross shift change in PEFR is recommended among exposed workers for early diagnosis of byssinosis.

Behavior of Users Personal Protective Equipment based on Health Belief Model and Social Capital

Background: Developing a health belief model using social capital in social groups that have the same social characteristics has never been done. Methods: This study was conducted on employees of the weaving division in one of the largest textile industries in Indonesia located in Sukoharjo Regency, Central Java, Indonesia. In this case, 178 respondents were selected randomly to be assessed for the health belief model through the construct of perception: vulnerability, severity, benefit, threat, self-efficacy, barriers to readiness for action, and social capital through the construction of social networks, norms, trust, and reciprocity. In order to get a suitable model, the data were analyzed using path analysis with the assistance of Stata 13. Results: The results of the development of the health belief model using social capital for behavioral changes in weaving employees obtained the following results. First, the health belief model consists of the constructs of perception of vulnerability, perception of severity, perception of benefits, and perception of barriers that indirectly affect the perception of threats to behavioral changes using personal protective equipment. (b= -1.07; 95% CI = -1.88 to -0.26; p=0.010). Second, social capital has a direct effect on behavioral changes in the use of personal protective equipment. (b= 0.85; 95% CI = 0.18 to 1.53; p=0.013). Furthermore, cues to action has a direct effect on behavioral changes in the use of personal protective equipment (b= 1.35; 95% CI = 0.49 to 2.21; p=0.02). Conclusion: Behavioral changes to use personal protective equipment for weaving employees who are exposed to high intensity noise are directly affected by cues to action and social capital. In addition, it is also indirectly affected by the variable of Health Belief Model.

Contemporary Prevalence of Byssinosis in Low- and Middle-Income Countries: A Systematic Review

We aimed to identify the contemporary prevalence of byssinosis through a systematic review. We used Medline, Web of Science, Embase, and Global Health databases to identify studies published in any language between 2000 and 2019, reporting primary data on byssinosis among adults. We used the Joanna Briggs Institute checklist to estimate the risk of bias in studies and undertook a qualitative, narrative data analysis. The review considered the prevalence of byssinosis, chest tightness, and airflow obstruction in textile workers in low- and middle-income countries (LMICs). We found 26 relevant studies that included 6930 workers across 12 countries. Most of the studies (n = 19) were from Asia, and 7 from African countries. Twenty-five studies were cross-sectional surveys while 1 was a cohort study. The prevalence of byssinosis was reported by 18 studies, and ranged from 8% to 38%, without any clear associations, at the group level, between the prevalence of byssinosis and durations of workers’ exposures. Prevalence of chest tightness ranged between 4% and 58% and that of airflow obstruction between 10% and 30%. We found a strong correlation ( r = 0.72) between prevalence of byssinosis and cotton dust levels. Our findings indicate that byssinosis remains a significant, contemporary problem in some parts of the textile sector in LMICs.

Impact of using different predictive equations on the prevalence of chronic byssinosis in textile workers in Pakistan

Objective

byssinosis remains a significant problem among textile workers in low- and middle-income countries. Here we share our experience of using different prediction equations for assessing ‘chronic’ byssinosis according to the standard WHO classification using measurements of FEV₁.

Methods

we enrolled 1910 workers in a randomized controlled trial of an intervention to improve the health of textile workers in Pakistan. We included in analyses the 1724 (90%) men who performed pre-bronchodilator spirometry tests of acceptable quality. We compared four different equations for deriving lung function percentage predicted values among those with symptoms-based byssinosis: the third US National Health and Nutrition Examination Survey (NHANES-III, with “N. Indian and Pakistani” conversion factor); the Global Lung Function Initiative (GLI, “other or mixed ethnicities”); a recent equation derived from survey of a western Indian population; and one based on an older and smaller survey of Karachi residents.

Results

58 men (3.4%) had symptoms-based byssinosis according to WHO criteria. Of these, the proportions with a reduced FEV₁ (< 80% predicted) identified using NHANES, GLI, Indian and Pakistani reference equations were 40%, 41%, 14% and 12%, respectively. Much of this variation was eliminated when we substituted FEV1/FVC ratio (<LLN) as a measure of airway obstruction.

Conclusion

accurate measures of occupational disease frequency and distribution require approaches that are both standardised and meaningful. We should reconsider the WHO definition of ‘chronic’ byssinosis based on changes in FEV₁, and instead use the FEV₁/FVC.

Pulmonary function, respiratory symptoms and associated factors among cotton-ginning workers at Gondar city, Northwest Ethiopia: a comparative cross-sectional study

BACKGROUND

Cotton dust is one of the risk factors for occupational respiratory diseases, a condition characterized by reduced pulmonary function and overwhelming respiratory symptoms. Therefore, this study aimed to determine pulmonary function parameters, respiratory symptoms, and associated factors among cotton-ginning workers at Gondar city, northwest Ethiopia.

METHODS

A comparative cross-sectional study was conducted on 166 (83 cotton-ginning workers and 83 healthy controls) individuals. Simple random sampling and convenience sampling techniques were used to recruit cotton-ginning workers and controls, respectively. Pulmonary function parameters were measured using Spirometer. Data on respiratory symptoms were collected using the Modified American Thoracic Society questionnaire. We used Chi-square (χ2) and independent "t" test to compare the outcome variables between the two groups. Binary logistic regression was used to identify the associated factors of respiratory symptoms among cotton-ginning workers. The strength of association was determined using an adjusted odds ratio (AOR) with its 95% confidence interval (CI) and statistical significance was decided at P<0.05.

RESULTS

Cotton-ginning workers had reduced FVC, FVC%, FEV1, FEV1/FVC%, PEFR and FEF25-75%) as compared with controls. The prevalence of overall respiratory symptom was 68.6% (95% CI: 57.8, 77.8) among cotton-ginning workers and 19.2% (95% CI: 12, 29.3) among controls. Females (AOR=5.9, 95% CI: 1.19, 29.9), those with primary and secondary education (AOR=7.9, 95% CI: 1.2, 52), working at ginning department (AOR=9.4, 95% CI 1.6, 53) and pressing department (AOR=8.0, 95% CI: 1.3, 48) and not using personal protective equipment (PPE) (AOR=9.1, 95% CI: 1.8, 45.1) had an increased odds of having respiratory symptoms.

CONCLUSION

Reduced pulmonary function parameters and a higher prevalence of respiratory symptoms were observed among cotton-ginning workers than controls. This suggests the need to tailor workplace safety measures to prevent occupational respiratory diseases.

The Cotton Dust-Related Allergic Asthma: Prevalence and Associated Factors among Textile Workers in Nam Dinh Province, Vietnam

Objective: To determine the prevalence of cotton dust-related allergic asthma and associated factors among textile workers in Nam Dinh province, Vietnam. Methods: A cross-sectional study was performed with 1082 workers in two textile garment companies using the asthma diagnostic criteria of the GINA (Global Initiative for Asthma) 2016 guidelines. Results: Among study participants, 11.9% had suspected asthma symptoms, 7.4% were diagnosed with asthma, and 4.3% (3.6% in men and 4.5% in women) were diagnosed with cotton dust-related allergic asthma. Overweight, seniority more than 10 years, history of asthma, allergic rhinitis, family history of allergy, and exposure to cotton dust from more than one hour per day in the working environment were found to be important predictors of cotton dust-related allergic asthma among textile workers. Conclusions: Textile workers in two companies in Nam Dinh, Vietnam had a high prevalence of dust-related allergic asthma compared to estimates from the general population. There is a need to design appropriate measures of prevention, screening, and care for dust-related asthma in the textile industry. Further evaluation with better exposure assessment is necessary.

Assessment of respiratory dust exposure and lung functions among workers in textile mill (Thamine), Myanmar: a cross-sectional study

BACKGROUND

Airborne dusts are being potentially harmful for workers in occupational environment. Exposure to respirable dust is the most important concern in textile workers for the widespread of occupational lung diseases, especially more serious in developing countries. The aim of the study was to assess the respirable dust exposure and associated factors of lung functions among textile workers.

METHODS

A cross-sectional study was carried out at a textile mill (Thamine), Yangon Region, from April to December, 2018 and a total of 207 textile workers were randomly selected by using a multistage sampling procedure. Data were collected by using a structured questionnaire for respiratory symptoms, an air sampling pump for assessment of respirable dust exposure, and a spirometer for testing the lung functions. Logistic regression analysis was performed to assess the associated factors of lung functions. Odds ratios with a 95% confidence interval were computed for strength of associations at the significance level of α ≤ 0.05.

RESULTS

The mean (± standard deviation, SD) respirable dust exposure was 3.3 mg/m³ (± 0.69) and the prevalence of increased respirable dust exposure (> 3 mg/m³) was 50.7%. The level of respirable dust exposure was highest in the textile workers involving at twisting department. The means (± SD) spirometry values were FVC 82.8% (± 17.8), FEV₁ 83.6% (± 18.5), and FEV₁/FVC 0.9 (± 0.1). Overall magnitude of reduced lung functions was 40.1%, and the prevalence of reduced FVC, FEV_1, and FEV₁/FVC were 36.7, 34.3 and 3.9% respectively. The current working at twisting department, > 5 years of service duration, respiratory symptoms and increased respirable dust exposure were associated with reduction in FVC and FEV₁.

CONCLUSIONS

The current working department, service duration, respiratory symptoms and exposure to respirable dust were predictors of lung functions in textile workers. An adequate ventilation, good work practices, hygienic workplace, safety and health training regarding potential health effects, and periodically assessment of lung functions are the critical elements for control of respirable dust exposure and reduction of occupational lung diseases.

Respiratory symptoms and their association with exposure to respiratory dust among indigo-dyed cotton workers

Indigo-dyed cotton weavers are exposed to various dust particles that may contain chemical contaminants from indigo fermentation process and can be related to respiratory symptoms. This cross-sectional study thus investigates the prevalence of respiratory symptoms and their association with respiratory dust (RD) exposure among workers in northeastern Thailand. It recruited 146 indigo-dyed cotton weavers. The prevalence of respiratory symptoms was collected by a self-report questionnaire included cough, phlegm, chest tightness, wheezing, and dyspnea. The average RD was 47.9 ± 28.3 μg/m³. Logistic regression models revealed a strong association between RD exposure and respiratory symptoms after adjustment. An exposure to RD ≥50 µg/m³ was associated with 5.05-, 3.58-, 2.88-, and 3.30-fold increased odds ratio of cough, phlegm, chest tightness, and dyspnea, respectively. The study results reveal that RD exposure may contribute to respiratory symptoms among indigo-dyed cotton weavers.

Health disorders and safety measures among workers in Tanta Flax and Oil Company, Egypt

Flax industry has an adverse effect on health status of exposed workers especially in developing countries with lack of appropriate safety measures to identify the health hazards, health disorders among workers in flax and oil company, and to assess the applied safety measures in the factory. A cross sectional study was conducted in Tanta Flax and Oil Company in Egypt. The company includes eight factories which are divided into four departments according to the manufacturing end products. The study was conducted from August 2018 to December 2019 on 353 workers out of 400 workers. An interview questionnaire and clinical medical examination were done to assess the health status of exposed workers. Check list from occupational safety and health administration (OSHA) standards was filled by researcher to check safety measures in work place environment. Respiratory manifestations were detected in 65% of the examined workers in flax manufacturing departments while allergic manifestations were more obvious in formaldehyde factory department. Approximately one quarter of workers complained that personal protective equipment's are not available. Regarding the mask for dust, nearly half (44.5%) of the workers rarely used them, and only 7.1% always use them. Byssinosis was obvious among workers in flax manufacturing and particle board manufacturing department with statistically significant differences between the four departments, in which 36.9% and 24.1% of workers in these two departments suffered from chest tightness, respectively. The safety measures were inadequate in flax manufacturing departments and to somewhat sufficient in formaldehyde factory department. Most of exposed workers had inadequate health status due to lack of standard safety measures. Therefore, periodic medical examination should be done regularly with investigation of pulmonary functions of exposed workers with application of high level of safety measure standards in the work place environment.

Environmental Health Research in Africa: Important Progress and Promising Opportunities

The World Health Organization in 2016 estimated that over 20% of the global disease burden and deaths were attributed to modifiable environmental factors. However, data clearly characterizing the impact of environmental exposures and health endpoints in African populations is limited. To describe recent progress and identify important research gaps, we reviewed literature on environmental health research in African populations over the last decade, as well as research incorporating both genomic and environmental factors. We queried PubMed for peer-reviewed research articles, reviews, or books examining environmental exposures and health outcomes in human populations in Africa. Searches utilized medical subheading (MeSH) terms for environmental exposure categories listed in the March 2018 US National Report on Human Exposure to Environmental Chemicals, which includes chemicals with worldwide distributions. Our search strategy retrieved 540 relevant publications, with studies evaluating health impacts of ambient air pollution (n=105), indoor air pollution (n = 166), heavy metals (n = 130), pesticides (n = 95), dietary mold (n = 61), indoor mold (n = 9), per- and polyfluoroalkyl substances (PFASs, n = 0), electronic waste (n = 9), environmental phenols (n = 4), flame retardants (n = 8), and phthalates (n = 3), where publications could belong to more than one exposure category. Only 23 publications characterized both environmental and genomic risk factors. Cardiovascular and respiratory health endpoints impacted by air pollution were comparable to observations in other countries. Air pollution exposures unique to Africa and some other resource limited settings were dust and specific occupational exposures. Literature describing harmful health effects of metals, pesticides, and dietary mold represented a context unique to Africa. Studies of exposures to phthalates, PFASs, phenols, and flame retardants were very limited. These results underscore the need for further focus on current and emerging environmental and chemical health risks as well as better integration of genomic and environmental factors in African research studies. Environmental exposures with distinct routes of exposure, unique co-exposures and co-morbidities, combined with the extensive genomic diversity in Africa may lead to the identification of novel mechanisms underlying complex disease and promising potential for translation to global public health.

Fractional exhaled nitric oxide and respiratory complaints in Hajj pilgrims wearing a cotton towel or plain cotton ihram

Objective

Hajj is an important component of Islam. This study aimed to determine the effect of wearing a cotton towel or plain cotton ihram on the onset of respiratory symptoms and fractional exhaled nitric oxide (FeNO) levels in Hajj pilgrims.

Methods

One hundred male nonsmoking subjects (age: 20–60 years) without a previous clinical history of respiratory illnesses were included. Fifty subjects were dressed in a cotton towel ihram and 50 wore a plain cotton ihram (control group). Respiratory symptoms and FeNO levels were recorded on the day before leaving for Hajj, when ihrams were removed, and when the pilgrims had returned home.

Results

Pilgrims who wore cotton towel ihrams showed significantly higher rates of respiratory symptoms, including being generally ill, coughing, a sore throat, and a runny nose, than those who wore plain ihrams. FeNO levels also tended to be higher in pilgrims who wore a cotton towel ihram compared with those with a plain cotton ihram during and after Hajj.

Conclusions

Hajj pilgrims who wear cotton towel ihrams may have a risk of respiratory symptoms, including a cough, sore throat, and runny nose. Therefore, a plain cotton ihram is advisable while performing Hajj to minimize respiratory illness.

Association of air pollutants, airborne occupational exposures, and chronic rhinosinusitis disease severity

BACKGROUND

Previous work has shown that chronic rhinosinusitis (CRS) severity may be associated with particulate matter 2.5 (PM_2.5 ) and black carbon (BC) in CRS patients without nasal polyps (CRSsNP). Data regarding occupational exposures, however, are lacking. We assessed the impact of PM_2.5 , BC, as well as occupational airborne exposure on CRS disease severity.

METHODS

Patients with CRS with nasal polyps (CRSwNP), CRSsNP, and aspirin-exacerbated respiratory disease (AERD) were identified from an institutionwide database. Spatial modeling from 37 pollutant monitoring sites in Allegheny County was used to estimate exposures. Patient occupations using the 2010 Standard Occupation Classification (SOC10) and airborne occupation exposures to vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) or diesel fumes were recorded. Disease severity was measured by modified Lund-Mackay score (LMS), systemic corticosteroid therapy, and incidence of functional endoscopic sinus surgery (FESS).

RESULTS

Two hundred thirty-four patients were included (CRSwNP, n = 113; CRSsNP, n = 96; AERD, n = 25). The prevalence of AERD among those with CRSwNP was 18%. Patients exposed to VGDFFiM or diesel fumes required higher steroid doses vs nonexposed patients (p = 0.015 and p = 0.03, respectively); patients with VGDFFiM levels >5% were more likely to undergo FESS vs nonexposed patients (p = 0.0378). There was no difference in PM_2.5 and BC with regard to disease severity and FESS between CRSwNP, CRSsNP, and AERD patients. Steroid use was significantly higher in CRSwNP and AERD vs CRSsNP (p = 0.001). LMS was significantly higher in AERD as compared with CRSwNP and CRSsNP (p = 0.001).

CONCLUSION

Occupational airborne exposure to VGDFFiM correlated with increased prevalence of FESS and need for corticosteroids in CRS patients. There was no difference in PM_2.5 and BC levels and disease severity outcome measures between CRS subtypes in this subset.

Association Between Organic Dust Exposure and Adult-Asthma: A Systematic Review and Meta-Analysis of Case-Control Studies

Background

Exposure to organic dust has been widely investigated as a potential risk factor for asthma with different results. To clarify a potential relationship, we performed the present meta-analysis to integrate the results of studies examining the association of organic dust exposure with asthma.

Methods

A comprehensive literature search in the electronic databases including EMBASE, PubMed and Cochrane Library databases (up to August 2018) was conducted. The adjusted odds ratios (ORs) with corresponding 95% confidence interval (CI) for organic dust exposure and asthma were retrieved and pooled to generate summary effect estimates in Revman 5.2.

Results

Database searches retrieved 1,016 records. A total of 17 studies containing 3,619 cases and 6,585 controls were finally included in our meta-analysis. The summary estimates suggested that organic dust exposure was positively associated with asthma (OR, 1.48; 95% CI, 1.26–1.75; P < 0.00001), whether among population-based case-control studies (OR, 1.24; 95% CI, 1.13–1.35; P < 0.00001) or hospital-based case-control studies (OR, 2.79; 95% CI, 1.27–6.12; P = 0.01). Subgroup analysis showed that paper/wood (OR, 1.62; 95% CI, 1.38–1.90; P < 0.00001), flour/grain (OR, 1.48; 95% CI, 1.11–1.97; P = 0.008), and textile dust (OR, 1.50; 95% CI, 1.08–2.09; P = 0.02) exposure were significantly associated with asthma.

Conclusions

Based on the studies evaluated, our meta-analysis results prompt that organic dust exposure is a risk factor inducing asthma, although precise analysis focus on specific organic dust materials is still warranted.

Job titles classified into socioeconomic and occupational groups identify subjects with increased risk for respiratory symptoms independent of occupational exposure to vapour, gas, dust, or fumes

Objectives: To evaluate the ability of three different job title classification systems to identify subjects at risk for respiratory symptoms and asthma by also taking the effect of exposure to vapours, gas, dust, and fumes (VGDF) into account. Background: Respiratory symptoms and asthma may be caused by occupational factors. There are different ways to classify occupational exposure. In this study, self-reported occupational exposure to vapours, gas, dust and fumes was used as well as job titles classifed into occupational and socioeconomic Groups according to three different systems. Design: This was a large population-based study of adults aged 30-69 years in Northern Sweden (n = 9,992, 50% women). Information on job titles, VGDF-exposure, smoking habits, asthma and respiratory symptoms was collected by a postal survey. Job titles were used for classification into socioeconomic and occupational groups based on three classification systems; Socioeconomic classification (SEI), the Nordic Occupations Classification 1983 (NYK), and the Swedish Standard Classification of Occupations 2012 (SSYK). Associations were analysed by multivariable logistic regression. Results: Occupational exposure to VGDF was a risk factor for all respiratory symptoms and asthma (odds ratios (ORs) 1.3-2.4). Productive cough was associated with the socioeconomic groups of manual workers (ORs 1.5-2.1) and non-manual employees (ORs 1.6-1.9). These groups include occupations such as construction and transportation workers, service workers, nurses, teachers and administration clerks which by the SSYK classification were associated with productive cough (ORs 2.4-3.7). Recurrent wheeze was significantly associated with the SEI group manual workers (ORs 1.5-1.7). After adjustment for also VGDF, productive cough remained significantly associated with the SEI groups manual workers in service and non-manual employees, and the SSYK-occupational groups administration, service, and elementary occupations. Conclusions: In this cross-sectional study, two of the three different classification systems, SSYK and SEI gave similar results and identified groups with increased risk for respiratory symptoms while NYK did not give conclusive results. Furthermore, several associations were independent of exposure to VGDF indicating that also other job-related factors than VGDF are of importance.

Occupational Safety and Related Impacts on Health and the Environment

The inter-relationship between safety, health and the ‘environment’ is a complex and at times a relatively neglected topic. In this issue, ‘safety’ is often viewed by contributors as ‘health and safety’ and includes occupationally-related ill health as well as injury or harm to employees and the wider public. ‘Environment’ is also interpreted in the widest sense covering both physical and work environments with upstream work hazards presenting risks to downstream communities. The focus is very much on exploring and where possible addressing the challenges, some old and some facing workers in a range of public and private settings and also at times their nearby communities. The 19 papers in the issue cover public and private sectors, global and very local populations, macro-theoretical perspectives, large epidemiological and some single factory or hospital site small case studies. A number of the papers are just beginning to explore and draw out for the first time the risks from hazards in their part of the world. The methodologies adopted also range from lab-based studies through ergonomic assessments and interventions to therapeutic approaches.