Physician diagnosed asthma, respiratory symptoms, and associations with workplace tasks among radiographers in Ontario, Canada.

BACKGROUND: Medical radiation technologists (MRTs) or radiographers have potential exposure to chemicals including sensitisers and irritants such as glutaraldehyde, formaldehyde, sulphur dioxide, and acetic acid. AIMS: To determine the prevalence of asthma and work related respiratory symptoms among MRTs compared with physiotherapists, and to identify work related factors in the darkroom environment that are associated with these outcomes. METHODS: As part of a two component study, we undertook a questionnaire mail survey of the members of the professional associations of MRTs and physiotherapists in Ontario, Canada, to ascertain the prevalence of physician diagnosed asthma, and the prevalence in the past 12 months of three or more of the nine respiratory symptoms (previously validated by Venables et al to be sensitive and specific for the presence of self reported asthma). Information on exposure factors during the past 12 months, such as ventilation conditions, processor leaks, cleanup activities, and use of personal protective equipment was also collected. RESULTS: The survey response rate was 63.9% among MRTs and 63.1% among physiotherapists. Most analyses were confined to 1110 MRTs and 1523 physiotherapists who never smoked. The prevalence of new onset asthma (since starting in the profession) was greater among never smoking MRTs than physiotherapists (6.4% v 3.95%), and this differed across gender: it was 30% greater among females but fivefold greater among males. Compared with physiotherapists, the prevalence of reporting three or more respiratory symptoms, two or more work related, and three or more work related respiratory symptoms in the past 12 months was more frequent among MRTs, with odds ratios (ORs) (and 95% confidence intervals) adjusted for age, gender, and childhood asthma, of 1.9 (1.5 to 2.3), 3.7 (2.6 to 5.3), and 3.2 (2.0 to 5.0), respectively. Analyses examining latex glove use indicated that this was not likely to account for these differences. Among MRTs, respiratory symptoms were associated with a number of workplace and exposure factors likely to generate aerosol or chemical exposures such as processors not having local ventilation, adjusted OR 2.0 (1.4 to 3.0); leaking processor in which clean up was delayed, 2.4 (1.6 to 3.5); floor drain clogged, 2.0 (1.2 to 3.2); freeing a film jam, 2.9 (1.8 to 4.8); unblocking a blocked processor drain, 2.4 (1.6 to 3.7); and cleaning up processor chemical spill, 2.8 (1.9 to 4.2). These outcomes were not associated with routine tasks unlikely to generate exposures, such as working outside primary workplace, loading film into processor, routine cleaning of processors, or removing processed film. Males reported that they carried out a number of tasks potentially associated with irritant exposures more frequently than females, consistent with the marked increase in risk for new onset asthma. CONCLUSIONS: These findings suggest an increase of work related asthma and respiratory symptoms shown to denote asthma among MRTs, which is consistent with previous surveys. The mechanism is not known but appears to be linked with workplace factors and may involve a role for irritant exposures.

MCPA permeation through protective gloves.

Permeation of 4-chloro-2-methylphenoxyacetic acid (MCPA) in commercial herbicide formulations through common protective glove types was evaluated to aid in the selection of appropriate skin protection. The ASTM test method F739-91 was used to measure the permeation of two undiluted formulations, one containing a salt, and the other an ester form of MCPA. The four glove types tested were natural rubber, neoprene 73, nitrile 37-145, and Viton-coated chloroprene. Triplicate tests of each combination of formulation and glove material were conducted. Permeation cells with a 0.01 M sodium hydroxide collection medium were used for the experiments. Aliquots of the collection medium were withdrawn at regular intervals and acidified, and quantification of the free acid was achieved using HPLC-UV (230 nm). There was no appreciable permeation of the salt formulation over a 24-hour test period. For the ester formulation, the following mean steady-state permeation rate (microg x cm(-2) min(-1)) and mean lag time (hours), respectively, were measured: Viton (0.06, 17.8), natural rubber (0.08, 15.4), neoprene 73 (0.21, 15.1), and nitrile (0.04, 24.2). Permeation was associated with significant swelling, averaging a nearly 30 percent increase from the pre-immersion thickness. All four glove types provide adequate protection against permeation by the salt formulation and at least eight-hour protection against the ester formulation. Given the greater permeation of the ester formulation, the salt formulation of MCPA herbicide should be used whenever possible.

The development of a new method to estimate total daily dose of pesticides in professional turf applicators following multiple and varied exposures in occupational settings.

The evaluation of absorbed dose of pesticides in humans requires a knowledge of the kinetics and dynamics of the compound. In some circumstances, data that allow for the estimation of dose may be available from human volunteer studies, although often, it will be based on results from animal studies. If human metabolism data are available, estimates of dose may be more accurate, but it should be recognized that pesticide exposure in an occupational setting may differ from that in a controlled laboratory study. In this study, data from previously published studies are used to evaluate the urinary excretion of 2,4-dichlorophenoxyacetic acid (2,4-D), following single dermal applications to human volunteers. These studies are evaluated with the objective of determining the best method of predicting total absorbed dose following multiple and varied exposures in occupational settings. Further, an alternative to laboratory-controlled human volunteer studies is presented. Data from a third previously published biological monitoring study on six professional pesticide applicators over a 2-week period were used to generate estimates of the urinary excretion of the pesticide 2,4-D that would result from a single dose. The method used to estimate the urinary excretion parameters is a variation of an overlay technique used in pharmacology, and may provide information on the kinetics of other pesticides when it is not possible to conduct human studies. The generated estimates of 24-h urinary excretion of 2,4-D over a 6-day period were remarkably similar to those obtained in controlled studies. Finally, a method was developed to use the generated estimates to determine total absorbed dose of pesticides for an independent group of 95 professional pesticide applicators. This method requires information on the amount of pesticide used for 6 days prior to the collection of two, 24-h urine samples.

An evaluation of 24-hour urinary creatinine excretion for use in identification of incomplete urine collections and adjustment of absorbed dose of pesticides.

The accurate quantification of the absorbed dose of pesticides following occupational exposures generally requires complete 24-hour urine collections, often over extended periods of time. Difficulty in obtaining volunteer cooperation may result in incomplete urine collections. Traditionally, 24-hour urinary creatinine has been used to identify incomplete urine samples and has been used to standardize pesticide and other chemical dose estimates. More recently, the use of creatinine to standardize dose estimates has been questioned, as has its utility in the identification of incomplete urine collections. This research evaluates the use of personal observation, statistical methods, and published models to predict creatinine excretion to identify and adjust for incomplete urine collections. Based on the use of published creatinine prediction models, an evaluation of the day-to-day creatinine excretion within subjects, and personal observation, a small number of suspected urine samples were identified. Although it is likely that these samples were incomplete, correction of these urine volumes based on the published models did little to improve pesticide dose prediction. Further, results indicate that subjects who report missed urine samples may be able to estimate the missing volumes with some accuracy. In future pesticide exposure studies, the use of self-reported missed volumes may help to increase the accuracy of dose prediction when there is strong cooperation with collection procedures. A statistical model to predict creatinine excretion in professional turf applicators was developed to provide a preliminary screening for urinary completeness for future studies in which compliance with urinary collection is thought to be insufficient.

Prostate cancer risk. Medical history, sexual, and hormonal factors.

PURPOSE: Various medical conditions, infectious agents, sexual, and hormonal factors have been investigated in relation to prostate cancer risk. Given inconsistent results these factors were examined in this study.METHODS: This population-based case-control study was conducted in northeastern Ontario from 1995 to 1999. Cases (n = 760), aged 45 to 84 at the time of diagnosis, were identified through the Ontario Cancer Registry and diagnosed between January 1995 and December 1998. Controls (n = 1,634) were age-frequency matched and were selected from the northeastern Ontario population using published telephone listings. Mail and telephone questionnaires were used for data collection. Logistic regression was used to investigate risk associated with: 1) particular medical conditions and 2) hormonal and sexual factors. Cases were subdivided into those with symptoms of prostate disease and those with few or no such symptoms.RESULTS: Symptomatic cases who reported a history of venereal disease (age-adjusted odds ratio (OR) = 2.11, 95% confidence interval (CI) 1.18-3.80) and vasectomy (age-adjusted OR = 1.49, 95% CI 1.14-1.95) were at significantly increased risk of prostate cancer. Asymptomatic cases who reported a check-up at least once a year were at increased risk (age-adjusted OR = 1.46, 95% CI 1.08-1.98). Asymptomatic and symptomatic cases who reported a history of prostate cancer in a first degree relative were at increased risk (age-adjusted OR = 2.41, 95% CI 1.64-3.54; age-adjusted OR = 3.18, 95% CI 2.28-4.45, respectively). Symptomatic cases with a history of urinary tract infection were at non-significantly increased risk (age-adjusted OR = 1.31, 95% CI 0.98-1.76). Heart disease, mumps, allergies, and height were generally not associated with prostate cancer.CONCLUSIONS: A history of venereal disease, family history of prostate cancer, and vasectomy were positively associated with prostate cancer. Further investigation of selected medical conditions, sexual, and hormonal factors in prostate cancer development is warranted.

Leukemia in electric utility workers: the evaluation of alternative indices of exposure to 60 Hz electric and magnetic fields.

BACKGROUND: Epidemiological studies have inconsistently demonstrated a positive relationship between magnetic and/or electric fields and leukemia. Although exposure to both 60 Hz electric and magnetic fields can be characterized in many ways, to date, risk assessment has been performed by using only a limited number of exposure indices. METHODS: The associations between adult leukemia and indices of electric and magnetic fields were explored within a nested case-control study of 31,453 Ontario electric utility workers. RESULTS: The percentage of time spent above electric field thresholds of 20 and 39 V/m was predictive of leukemia risk after adjusting for duration of employment and the arithmetic mean exposure to both electric and magnetic fields (P<0.05). Duration of employment was strongly associated with an increased risk of leukemia. Those who had worked for at least 20 years, and were in the highest tertiles of percentage of time spent above 10 and 20 V/m had odds ratios of 10.17 (95% CI = 1.58-65.30) and 8.23 (95% CI = 1. 24-54.43), respectively, when compared to those in the lowest tertile. Nonsignificant elevations in risk were observed between indices of magnetic fields and leukemia. CONCLUSIONS: Our results support the hypothesis that electric fields act as a promoting agent in the etiology of adult leukemia. Exposure assessment based on alternate indices of electric and magnetic fields should be incorporated into future occupational studies of cancer.

The evaluation of exposure of printing trade employees to polycyclic aromatic hydrocarbons.

Epidemiological studies of the lung cancer experience of workers in the printing industry have been inconclusive. Where there have been positive findings, the effect has generally been attributed to polycyclic aromatic hydrocarbon (PAH) exposure, although no exposure measurements were made. This study was undertaken to determine the exposures of printing press operators to PAH and total particulate (TP), and to evaluate the factors contributing to exposure. Personal time-weighted average exposures of press room workers were determined on two consecutive days at nine sites, including two newspaper operations. The average PAH exposure was 16.5 micrograms m-3 (including naphthalene). The average TP exposure was 0.63 mg m-3. Examination of the data revealed that there were significant differences between sites for exposure both to TP and to PAH. Newspaper plants had significantly lower exposures than commercial printing operations. There were no significant differences in exposure between the various job classifications of workers in the press rooms. Factors identified as contributing to exposure to TP were: the effectiveness of the ventilation systems, the method of feeding the press, the type of paper and the print impression area.

Exposure of hospital operating room personnel to potentially harmful environmental agents.

Epidemiologic studies of risk to reproductive health arising from the operating room environment have been inconclusive and lack quantitative exposure information. This study was undertaken to quantify exposure of operating room (OR) personnel to anesthetic agents, x-radiation, methyl methacrylate, and ethylene oxide and to determine how exposure varies with different operating room factors. Exposures of anesthetists and nurses to these agents were determined in selected operating rooms over three consecutive days. Each subject was asked to wear an x-radiation dosimeter for 1 month. Exposure to anesthetic agents was found to be influenced by the age of the OR facility, type of surgical service, number of procedures carried out during the day, type of anesthetic circuitry, and method of anesthesia delivery. Anesthetists were found to have significantly greater exposures than OR nurses. Exposure of OR personnel to ethylene oxide, methyl methacrylate, and x-radiation were well within existing standards. Exposure of anesthetists and nurses to anesthetic agents, at times, was in excess of Ontario exposure guidelines, despite improvements in the control of anesthetic pollution.

Effects of mailing strategies on response rate, response time, and cost in a questionnaire study among nurses.

We conducted a pilot study to determine the most efficient mailing strategy for a postal questionnaire study among nurses in Ontario, Canada. Five mailing strategies involving types of stamps on the return envelopes were considered: no stamp, business-reply stamp, metered stamp, small regular stamp, and large commemorative stamp. We found that paper stamps, especially large commemorative stamps, on return envelopes increased the response rate and reduced the response time, as compared with other mailing strategies. Business-reply stamps had the lowest cost per response received and a low total cost.

Acute and chronic respiratory effects of occupational exposure to ammonia.

In a soda ash plant, 58 workers exposed to mean airborne ammonia levels of 9.2 +/- 1.4 ppm were compared with 31 control workers with a mean exposure of 0.3 +/- 0.1 ppm. There were no differences between the groups in the reporting of respiratory or cutaneous symptoms, sense of smell, baseline lung function, or change in lung function over a work shift at the beginning and end of a workweek. No relationships between level or length of ammonia exposure and lung function results were demonstrated.

Exposure of operating room personnel to anaesthetic agents: an examination of the effectiveness of scavenging systems and the importance of maintenance programs.

Ten Alberta hospitals were monitored to assess the exposure of operating room personnel to nitrous oxide, halothane and enflurane during the average work day. Exposure to these agents in operating rooms without scavenging systems was determined to be well above the recommended guidelines. Contaminants were significantly lower in operating rooms with scavenging systems of either the wall suction type or the air-conditioning exhaust type. In the majority of studies, leakage points of anaesthetic gases were found throughout the anaesthesia systems. Where maintenance programs for the anaesthesia equipment were designed for the detection and elimination of leakage, contaminant levels were significantly lower than in those hospitals where the maintenance programs were concerned solely with proper equipment function as it relates to patient care. A regular, frequent maintenance program for all anaesthesia and scavenging systems designed to identify and correct leakage points is therefore recommended. We consider a nitrous oxide monitor to be the ideal tool for detection of leakage.

An assessment of operating room environment air contamination with nitrous oxide and halothane and some scavenging methods.

This study was designed to assess operating room contamination with nitrous oxide and halothane when nitrous oxide 3 1/min and oxygen 2 1/min containing halothane one per cent were passed into a semiclosed circle absorber system from which the patients' lungs were ventilated with an Ohio ventimeter through a cuffed tracheal tube, with the exhaled gas vented to the floor. The normal room ventilation did not consistently maintain levels below the suggested amounts, which are nitrous oxide 25 ppm and halothane 2 ppm. Careful daily check for and correction of high and low pressure leaks combined with the use of a Foregger scavenging device (7--351--005) and continuous wall vacuum accepting approximately 22 1/min enabled geometric mean values below the suggested levels to be achieved. The Protection Filter Foregger 7--365--001 was only effective in removing halothane and only if the plastic holder provided was radically modified. Attention is drawn to the numerous factors influencing the magnitude of contamination, aspects of controlling it, and the necessity to cope with the problem of dealing with scavenged gases and vapours.