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  • 1
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    Occupational exposures and chronic obstructive pulmonary disease (COPD): comparison of a COPD-specific job exposure matrix and expert-evaluated occupational exposures (2017)
    BMJ Publishing Group
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    Publication Date: 2017-03-16
    Description: Objectives To compare the occupational exposure levels assigned by our National Institute for Occupational Safety and Health chronic obstructive pulmonary disease-specific job exposure matrix (NIOSH COPD JEM) and by expert evaluation of detailed occupational information for various jobs held by members of an integrated health plan in the Northwest USA. Methods We analysed data from a prior study examining COPD and occupational exposures. Jobs were assigned exposure levels using 2 methods: (1) the COPD JEM and (2) expert evaluation. Agreement (Cohen's coefficients), sensitivity and specificity were calculated to compare exposure levels assigned by the 2 methods for 8 exposure categories. Results indicated slight to moderate agreement (0.19–0.51) between the 2 methods and was highest for organic dust and overall exposure. Sensitivity of the matrix ranged from 33.9% to 68.5% and was highest for sensitisers, diesel exhaust and overall exposure. Specificity ranged from 74.7% to 97.1% and was highest for fumes, organic dust and mineral dust. Conclusions This COPD JEM was compared with exposures assigned by experts and offers a generalisable approach to assigning occupational exposure.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 2
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    Occupational exposures and the risk of amyotrophic lateral sclerosis (2017)
    BMJ Publishing Group
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    Publication Date: 2017-01-14
    Description: Objectives To examine the associations of specific occupations and occupational exposures with the risk of amyotrophic lateral sclerosis (ALS) in the Swedish population. Methods A nested case–control study was conducted in Sweden. Patients with ALS diagnosed during 1991–2010 (n=5020) were identified from the National Patient Register and 5 controls per case (n=25 100) were randomly selected from the general Swedish population, individually matched to cases by birth year and sex. Occupational history was obtained from the Swedish censuses in 1970, 1980 and 1990. The Nordic Occupational Cancer Study Job Exposure Matrix was used to identify exposures related to individual occupations. Conditional logistic regression was used to estimate ORs and their 95% CIs. Results Higher risk of ALS was associated with precision-tool manufacturing (OR 1.68, 95% CI 1.11 to 2.52) and glass, pottery and tile work (OR 1.76, 95% CI 1.03 to 3.00), whereas lower risk was associated with textile work (OR 0.44, 95% CI 0.21 to 0.91). None of the examined occupational exposures were associated with ALS risk overall. However, among individuals younger than 65 years of age, an association with a higher risk of ALS was found for formaldehyde (OR 1.29, 95% CI 1.00 to 1.65), and an association with a lower risk of ALS was found for methylene chloride (OR 0.49, 95% CI 0.26 to 0.93). Conclusions We identified several occupations and occupational exposures that may be associated with the risk of ALS in Sweden. Occupational history obtained from censuses every 10 years remains a limitation of the study.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 3
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    Is diesel equipment in the workplace safe or not? (2016)
    BMJ Publishing Group
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    Publication Date: 2016-11-17
    Description: Objectives Recently, diesel motor exhaust (DME) has been classified as a known human carcinogen. We used data from epidemiological studies of diesel exposures to perform a quantitative risk assessment to calculate DME exposure levels, expressed as elemental carbon (EC), corresponding to acceptable risk (AR) and maximum tolerable risk (MTR) levels of 4 to 10 –5 and 4 to 10 –3 for the lifetime excess probability of dying from lung cancer. Methods Previously published slope estimates (n=14) of the exposure–response curve (ERC) for EC exposure and lung cancer were used in life-table analyses to calculate EC exposure levels corresponding to the specified AR and MTR levels. Results Considered ERC slope factors ranged from 0.00060 to 0.0012 natural logarithm of the relative rate (InRR) per μg/m 3  years based on different selections of studies and study-specific risk estimates. Exposure limits based on these slope factors were between 0.009–0.017 and 0.85–1.67 μg/m 3 EC for the AR and MTR, respectively. Conclusions Derived exposure limits based on the AR and MTR are around or well below 1 μg/m 3 EC. Such limits are below current occupational exposure levels, and in some instances even below environmental exposure levels. Although uncertainties exist in the exact slope factors, these results indicate that an acceptable excess lung cancer mortality risk can only be achieved at very low DME exposure levels, suggesting that diesel engines using older technologies should be removed from the workplace when possible or emissions strictly controlled.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 4
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    Occupational exposure to crystalline silica and gastric cancer: a systematic review and meta-analysis (2016)
    BMJ Publishing Group
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    Publication Date: 2016-10-15
    Description: Crystalline silica is a widely used industrial material that is readily available worldwide, and is one of the most common types of particulate mineral pollutants. It has been classified as a group 1 human carcinogen of the respiratory system; however, whether it is linked to gastric cancer remains uncertain. We conducted a systemic review and meta-analyses to search for evidence of the relationship between gastric cancer and occupational exposure to crystalline silica. We searched for articles on occupations involving silica exposure and gastric cancer studies up to December 2014. Pooled-risk estimates of the association between occupational crystalline silica exposure and risk of gastric cancer were calculated by a random effects model. Metaregression analyses of industry type and histological confirmation status, study design and industrial subgroup analyses were performed. 29 articles, including 9 case–control and 20 cohort studies, were analysed. The overall summary effects size was 1.25 (95% CI 1.18 to 1.34) for the association of occupational silica exposure with gastric cancer. Both heterogeneity and publication bias were partially attenuated after subgroup analyses. Heterogeneity of studies was attenuated after metaregression by industry. Higher overall effects were observed in the mining and foundry industries. We found a significant relationship between occupational crystalline silica exposure and gastric cancer. Our results were strengthened by various subgroup analyses and, considering the biological plausibility of our premise, further studies are required to better understand this association.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 5
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    Occupational exposure to chemicals drives the increased risk of asthma and rhinitis observed for exposure to vapours, gas, dust and fumes: a cross-sectional population-based study (2016)
    BMJ Publishing Group
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    Publication Date: 2016-09-16
    Description: Objectives Occupational exposure to the composite measure vapours, gases, dusts and fumes (VGDF), contribute to the burden of asthma and rhinitis. The objective was to evaluate occupational exposure to VGDF, which is further divided into the components chemicals, organic and inorganic dust in relation to asthma and rhinitis. Methods Previously examined participants from three population-based cohorts in the Obstructive Lung disease In Northern Sweden (OLIN) studies were re-examined during 2002–2004. In total, 4036 participated in a structured interview and answered a questionnaire on occupational exposures. Results Occupational exposure to VGDF increased the risk of asthma, and concomitant asthma and rhinitis. Exposure to chemicals, but not dust, showed a similar pattern. Exposure to chemicals increased the risks (OR, 95% CI) of rhinitis without asthma (1.29, 1.10 to 1.52), asthma without rhinitis (1.42, 1.15 to 1.77) and concomitant asthma and rhinitis (1.60, 1.31 to 1.96) when adjusted for confounders such as age, smoking habits, body mass index and sex. The association between exposure to chemicals and asthma and rhinitis remained independent of exposure to dust and was also so when excluding exposure to isocyanates and welding fumes. The results were similar for women and men, as well as for never-smokers and participants without a history of allergy. Conclusions In this cross-sectional population-based study, occupational exposure to chemicals contributed substantially to the increased risk of asthma and rhinitis observed for occupational exposure to VGDF.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 6
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    Natural resource-based industries and prostate cancer risk in Northeastern Ontario: a case-control study (2016)
    BMJ Publishing Group
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    Publication Date: 2016-07-16
    Description: Objective Prostate cancer continues to be the most commonly diagnosed cancer in men, and there is limited knowledge on its preventable risk factors. A number of occupational exposures in natural resource-based industries are suspected to be related to prostate cancer risk. This study investigates associations between employment in these industries and prostate cancer. Methods Data were from a population-based, case–control study previously conducted in Northeastern Ontario. Incident cases (N=760) aged 45–85 years and diagnosed with prostate cancer between 1995 and 1998 were identified from the Ontario Cancer Registry. Controls (N=1632) were recruited using telephone listings, and were frequency matched to cases by age. Lifetime occupational history was collected for all participants. Logistic regression was used to estimate ORs and their associated 95% CIs. Results Elevated risks were observed for employment in forestry and logging industries (OR=1.87, 95% CI 1.32 to 2.73) and occupations (OR=1.71, 95% CI 1.24 to 2.35), and these risks increased with duration of employment for ≥10 years. Elevated risks were also found for employment in wood products industries (OR=1.45, 95% CI 1.07 to 1.97), and paper and allied products industries (OR=1.43, 95% CI 1.03 to 2.00), and when duration of employment was ≥10 years. There were also elevated risks in agriculture and mining-related work; however, these findings were not consistent across industry and occupation categories. Conclusions Prostate cancer risk may be associated with work in several natural resource industries, primarily in the forest industries. To further evaluate observed associations, studies should focus on natural resource-based exposures in larger populations with improved exposure assessment.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 7
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    Personal exposure to ultrafine particles from PVC welding and concrete work during tunnel rehabilitation (2016)
    BMJ Publishing Group
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    Publication Date: 2016-06-17
    Description: Objectives To investigate the exposure to number concentration of ultrafine particles and the size distribution in the breathing zone of workers during rehabilitation of a subsea tunnel. Methods Personal exposure was measured using a TSI 3091 Fast Mobility Particle Sizer (FMPS), measuring the number concentration of submicrometre particles (including ultrafine particles) and the particle size distribution in the size range 5.6–560 nm. The measurements were performed in the breathing zone of the operators by the use of a conductive silicone tubing. Working tasks studied were operation of the slipforming machine, operations related to finishing the verge, and welding the PVC membrane. In addition, background levels were measured. Results Arithmetic mean values of ultrafine particles were in the range 6.26 x 10 5 –3.34 x 10 6 . Vertical PVC welding gave the highest exposure. Horizontal welding was the work task with the highest maximum peak exposure, 8.1 x 10 7 particles/cm 3 . Background concentrations of 4.0 x 10 4 –3.1 x 10 5 were found in the tunnel. The mobility diameter at peak particle concentration varied between 10.8 nm during horizontal PVC welding and during breaks and 60.4 nm while finishing the verge. Conclusions PVC welding in a vertical position resulted in very high exposure of the worker to ultrafine particles compared to other types of work tasks. In evaluations of worker exposure to ultrafine particles, it seems important to distinguish between personal samples taken in the breathing zone of the worker and more stationary work area measurements. There is a need for a portable particle-sizing instrument for measurements of ultrafine particles in working environments.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 8
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    Impact of aggregating exposure information from cases and controls when building a population-based job-exposure matrix from past expert evaluations (2016)
    BMJ Publishing Group
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    Publication Date: 2016-06-17
    Description: Objectives To assess whether the inclusion of data from cases would bias a job-exposure matrix (JEM), we evaluated whether exposures were systematically different between cases and controls from a large historical case–control study. Methods Data included 10 381 jobs assessed for occupational exposure to 294 agents within a lung cancer case–control study. For each sex, 1 JEM was developed from case jobs, and 1 from control jobs: with occupation (four-digit occupational codes), time period (1945–1959, 1960–1984, 1985–1995) and agent axes. We estimated concordance in exposure status (defined as probability of exposure threshold ≥5%) and exposure metrics of probability and intensity of exposure, between the 2 JEMs. Results Of all hypothetical occupation-period-agent combinations, most had no or few observations. Among males there were 8136 common cells (24—occupational codes, 3—periods, 226—agents), containing sufficient observations for comparison with 92% concordance in exposure status; discordance was equally likely to be towards cases or controls. Females had 1710 common cells (9—occupational codes, 3—periods, 114—agents) with 93% concordance in exposure status; discordant cells were more likely to reflect greater exposure among cases. Among concordantly exposed cells, probability and intensity of exposures were highly correlated between the case JEM and control JEM (Kendall 〉0.50), and absolute differences were small (median difference in probability 〈1.5%, median ratio in intensity=1.00) for both sexes. Conclusions Agreement between the case JEM and control JEM was high, suggesting that aggregating the case and control information in our study into a single JEM is justifiable given the benefits of increased sample size.
    Keywords: Other exposures
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    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 9
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    Assessment of occupational exposure to pesticides in a pooled analysis of agricultural cohorts within the AGRICOH consortium (2016)
    BMJ Publishing Group
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    Publication Date: 2016-05-18
    Description: Background This paper describes methods developed to assess occupational exposure to pesticide active ingredients and chemical groups, harmonised across cohort studies included in the first AGRICOH pooling project, focused on the risk of lymph-haematological malignancies. Methods Three prospective agricultural cohort studies were included: US Agricultural Health Study (AHS), French Agriculture and Cancer Study (AGRICAN) and Cancer in the Norwegian Agricultural Population (CNAP). Self-reported pesticide use was collected in AHS. Crop-exposure matrices (CEMs) were developed for AGRICAN and CNAP. We explored the potential impact of these differences in exposure assessment by comparing a CEM approach estimating exposure in AHS with self-reported pesticide use. Results In AHS, 99% of participants were considered exposed to pesticides, 68% in AGRICAN and 63% in CNAP. For all cohorts combined (n=316 270), prevalence of exposure ranged from 19% to 59% for 14 chemical groups examined, and from 13% to 46% for 33 active ingredients. Exposures were highly correlated within AGRICAN and CNAP where CEMs were applied; they were less correlated in AHS. Poor agreement was found between self-reported pesticide use and assigned exposure in AHS using a CEM approach resembling the assessment for AGRICAN ( –0.00 to 0.33) and CNAP ( –0.01 to 0.14). Conclusions We developed country-specific CEMs to assign occupational exposure to pesticides in cohorts lacking self-reported data on the use of specific pesticides. The different exposure assessment methods applied may overestimate or underestimate actual exposure prevalence, and additional work is needed to better estimate how far the exposure estimates deviate from reality.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 10
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    Heavy manual work throughout the working lifetime and muscle strength among men at retirement age (2016)
    BMJ Publishing Group
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    Publication Date: 2016-03-17
    Description: Introduction Reductions in heavy manual work as a consequence of mechanisation might adversely impact muscle strength at older ages. We investigated the association between grip strength at retirement age and lifetime occupational exposure to physically demanding activities. Grip strength is an important predictor of long-term health and physical function in older people. Methods Grip strength (maximum of three readings in each hand) was measured in men from the Hertfordshire Cohort Study at a single examination when their mean age was 65.8 (SD 2.9) years. Associations with lifetime occupational exposure (ascertained by questionnaire) to three activities (standing/walking ≥4 h/day; lifting ≥25 kg; and energetic work sufficient to induce sweating) were assessed by multivariable linear regression with adjustment for various potential confounders. Results Complete data were available from 1418 men who had worked for at least 20 years. After adjustment for age, height and weight, those with longer exposures to walking/standing and heavy lifting had lower grip strength, but the relationship disappeared after further adjustment for confounders. Working at physical intensity sufficient to induce sweating was not significantly associated with grip strength. Conclusions We found no evidence that physically demanding occupational activities increase hand grip strength at normal retirement age. Any advantages of regular physical occupational activity may have been obscured by unmeasured socioeconomic confounders.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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