MultiTex RCT - a multifaceted intervention package for protection against cotton dust exposure among textile workers - a cluster randomized controlled trial in Pakistan: study protocol.

BACKGROUND: In the Pakistani textile industry the prevalence of workplace respiratory illnesses, including byssinosis, is high. The MultiTex RCT study aims to determine the effectiveness of a multifaceted intervention package in reducing dust levels in cotton mills, decreasing the frequency of respiratory symptoms among cotton textile workers, and improving their lung function. METHODS/DESIGN: We will conduct a cluster-randomized controlled trial at 28 textile mills in Karachi. The intervention will comprise: training in occupational health for all workers and managers reinforced by regular refresher sessions; the formation of workplace committees to draw up, agree and promote a health and safety plan that includes wet mopping, safe disposal of cotton dust, and the use of simple face-masks, as well as further publicity about the risks from cotton dust; and provision of adequate supplies of face-masks to support the health and safety plan. Participating mills will be randomized to intervention and control arms following a baseline survey. The impact of the intervention will be determined through follow-up surveys conducted at 3, 12 and 18 months. Data collection in the surveys will include spirometry, questionnaire-based interviews and cotton-dust measurements. DISCUSSION: If successful, the study may pave the way for simple, low-cost interventions that can help reduce cotton-dust levels in textile mills, and improve the respiratory health of textile workers in developing countries such as Pakistan. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03738202. Registered on 12 November 2018.

Byssinosis and tuberculosis amongst "home-based" powerloom workers in Madhya Pradesh State, India.

BACKGROUND: Byssinosis is an occupational lung disease observed among workers exposed to cotton, flax, and hemp dust. The severity and extent of Byssinosis are well recognised in the high-income countries and control measures have been implemented to prevent the disease. In India, there are conflicting evidence on burden estimation of the disease, followed by inadequate prevention and control of Byssinosis. DESIGN/METHODS: We did a cross-sectional study to assess the prevalence of Byssinosis in "home-based" power-loom workers in Mominpura, an administrative ward of Burhanpur Municipality with 2800 population in the state of Madhya Pradesh, India. 290 adults working from "home-based" power loom units were randomly selected, profiled and screened for Byssinosis like symptoms with the help of a semi-structured questionnaire and simple hand-held peak expiratory flow monitor. For epidemiological purposes the symptoms were classified based on Schilling's classification. Chest x-rays were done for selected subjects. Sputum smear microscopy for detecting TB was done for those who had Byssinosis like symptoms. RESULTS: Prevalence of Byssinosis among "home based" powerloom workers was found to be 98% [n = 283, 95 CI (95.65-98.96)]. Peak expiratory flow rate (PEFR) was reduced in 44% (n = 124), of which 81 (29%) had more than 50% PEFR reduction, and of these, 69 (29%) were in early stage of Byssinosis (Grade 0.5). 11% of study participants who had Byssinosis like symptoms, also had TB. CONCLUSIONS: Byssinosis is highly prevalent in "home-based" power loom units in Madhya Pradesh. Adequate advocacy on awareness and prevention; prompt diagnosis and linkages to treatment services in "home-based" power loom units are urgently required to address Byssinosis at an early disease stage.

The bacterial profile of cotton lint from worldwide origins, and links with occupational lung disease.

BACKGROUND: Byssinosis, the cotton worker's lung disease persists today in many countries. Several agents have been investigated with respect to causality; among these are Gram-negative bacteria. These organisms are a source of lipopolysaccharide toxins, which are potentially hazardous to the respiratory tract. Despite byssinosis being most prevalent in countries where adequate preventive procedures are lacking, the majority of past studies have been conducted on cotton from the United States. METHODS: The current investigation, involved the identification of Gram-negative bacteria from cotton lint samples originating in 12 world regions. RESULTS: The current investigation, involved the identification of Gram-negative bacteria from cotton lint samples originating in 12 world regions. CONCLUSIONS: Building a bacterial profile of cotton samples with worldwide origins will be useful in isolating sources of these organisms, assessing the risk posed to industry, workers and ultimately assisting the prevention of byssinosis and related conditions.

Otras enfermedades obstructivas: bisinosis, bronquitis crónica y EPOC de origen laboral y bronquitis eosinofílica / Other obstructive diseases: byssinosis, chronic bronchitis and occupational COPD and eosinophilic bronchitis

Además del asma ocupacional y las enfermedadesderivadas de la inhalación aguda, otras enfermedadesobstructivas también reconocen un origen laboral.Aunque en la actualidad la bisinosis es una enfermedadrara en España, describimos las características de lamisma por su interés histórico dentro de las enfermedadesrespiratorias de origen laboral y porque todavíasigue vigente en los países en vías de desarrollo. Labronquitis crónica también puede estar relacionadacon la exposición laboral a polvos y humos, con frecuenciadenominada “bronquitis industrial”. La relaciónocupacional de la EPOC ha sido más controvertidaa lo largo de la historia, pero en la actualidad estarelación está aceptada; describimos la evidencia actualque sustenta esta relación. En último lugar, describimosla bronquitis eosinofílica sin asma, entidad descritapor primera vez en 1989 y que en ocasiones tambiénpuede tener un origen laboral, compartiendo agentesetiológicos con el asma ocupacional

Besides occupational asthma and diseases derivedfrom acute inhalation, other obstructive diseases alsohave an occupational origin. Although at presentbyssinosis is a rare disease in Spain, we describe itscharacteristics because of its historical interestamongst occupational respiratory diseases andbecause it is still relevant in developing countries.Chronic bronchitis can also be related to exposure atwork to dust and smoke, and is often referred to as“industrial bronchitis”. Historically, the relation ofCPOD to occupation has been subject to controversy,but nowadays this relationship is accepted; wedescribe the present evidence supporting thisrelationship. Finally, we describe eosinophilicbronchitis without asthma, an entity that wasdescribed for the first time in 1989 and that cansometimes have an occupational origin, sharingaetiological agents with occupational asthma

Bactericidal treatment of raw cotton as the method of byssinosis prevention.

In early studies, research to control byssinosis focused on methods to reduce the trash in the textile mill environment. Dust control has been effective in reducing the prevalence of byssinosis, but simple reduction in dust levels does not always assure its prevention. Also, bacteria and fungi present in cotton do not in themselves cause byssinosis, but the endotoxins-heat-stable lipopolysaccharide-protein complexes contained in the cell wall of Gram-negative bacteria-are responsible for the development of this respiratory disease of workers on cotton, flax, and some other fibers. Experimental work was carried out in cotton fields in different cotton growing countries. Opened cotton capsules were treated by spraying them with bactericidal water solutions of benzododecinium bromide to avoid the growth of bacteria by bacteriostatic effect during transportation and storage and thus to prevent the formation of endotoxins. To simulate transport conditions, treated and nontreated cotton samples were incubated under high air humidity. The endotoxin contents were determined by Limulus amebocyte lysate assay depending on the duration of incubation. In nontreated samples the endotoxin content grew to over 5,000 ng/mg. In comparison, in treated samples the endotoxin content grew extremely slowly. Thus, the bactericidal treating of raw cotton showed high efficiency as a potential method of byssinosis prevention. The irradiation by gamma-rays is also efficient, but it is not realistic in cotton growing areas of developing countries at the present time.

[Byssinosis--an occupational disease of textile workers]. / Bisinoza--professionalna bolest tekstilnih radnika.

Byssinosis as a nonspecific chronic respiratory disease in textile workers exposed to cotton, hemp and flax is described. Pathogenesis and ethiologic factors responsible for bissynosis are listed. Clinical symptoms of byssinosis and differential diagnosis with occupational asthma are presented. Characteristic functional changes of ventilatory capacity in textile workers are described. Clinical and functional criteria for diagnosis of byssinosis are presented. Particular emphasis is given to preventive medical and technical measures in order to prevent the development of respiratory diseases in textile workers.

Diseases associated with exposure to plant dusts: focus on cotton dust.

Research during recent years has made clear that pulmonary disease and certain general symptoms caused by organic dusts are far more common than previously suspected. To the traditional environments of cotton dust and moldy hay has been added a series of environments, such as swine confinement buildings, sewage treatment stations and industrial fermentation plants. It has been suggested that, rather than linking clinical disease with a specific environment (farmer's lung, byssinosis, etc), symptoms should be related to the relevant pulmonary cellular reactions, particularly inflammation. In so doing, a more homogenous picture of the various clinical entities has emerged. It is now understood that symptoms once considered to be unique to one particular environment, such as chest tightness in cotton mills, are also present in other organic dust environments. New models for organic dust-induced disease have been established using the criteria developed for disease among workers in cotton mills and swine confinements buildings. This has led to uniform methods for diagnosis, description of symptomatology and understanding of pathogenesis. Employing this experience on an international basis, provides an important background for dealing with new problems in this important area of occupational health and is a prerequisite for the establishment of treatment and prevention programs.

[Occupational lung diseases in modern manufacturing and the ways to prevent them]. / Professional'nye zabolevaniia legkikh v usloviiakh sovremennogo proizvodstva i puti ikh profilaktiki.

In up-to-date industrial conditions the new clinical forms of occupational pulmonary diseases occur more and more frequently in addition to the most prevalent dust pathology of the lungs. They occur in workers exposed to industrial aerosols of complex composition, including toxic substances and allergens along with fibrogenic dust. Exogenous allergic alveolitis, metalloconioses and occupational bronchitis should be distinguished among the diseases in consideration. The prophylaxis is to include measures aimed at the improvement of the working conditions, performance of preliminary and periodic medical examinations, early specialized employment and clinical examination of the patients.

Methods to assess airborne concentrations of cotton dust.

Assessment of concentrations of airborne cotton dust in the factory is necessary to determine adherence to applicable Permissible Exposure Limits (PELs) on a day-to-day basis, as well as for investigatory studies of an epidemiological nature. The latter are required on an ongoing basis to determine the adequacy of PELs to prevent disease in the exposed population. A strategy of sampling includes considerations of the numbers of samples to be obtained for statistical validity and the locations of samples. Current practice is to obtain more "personal samples" of exposure wherever possible, but with regard to cotton dust, instrumentation is not available for such sampling. In the U.S., the vertical elutriator is the instrument of choice for determining the concentrations of cotton dust in air. Results are expressed as milligrams of airborne particulate (cotton dust) per cubic meter.

Strategies for prevention of byssinosis.

Cotton dust is a heterogeneous mixture of plant parts and contaminants from the soil, weeds, and microorganisms. Research to control byssinosis has focused on methods to reduce the trash associated with harvested fiber and control the dust in the textile mill environment. Dust control has been effective in reducing the prevalence of byssinosis, but because cotton dust is a heterogeneous mixture of components, simple reduction in dust levels does not always assure the prevention of byssinosis. Research to identify the agents that cause byssinosis and development of methods to eliminate those agents from cotton is needed to prevent new cases of byssinosis.

Ventilatory impairment from pre-harvest retted flax.

A new method of retting flax recently developed to suit the United Kingdom climate has allowed the reintroduction of flax growing to this country. The weed killer glyphosate is sprayed on the crop which then rets before harvesting six weeks later. The acute bronchoconstrictor responses of 11 normal subjects to dust from dew retted and from pre-harvest retted flaxes were compared in a double blind crossover fashion. There were no significant differences in the dust levels nor in the size of the dust particles in the experimental dust room. The decreases in pulmonary function after six hours of dust inhalation were significantly larger after pre-harvest retted flax dust than after dew retted flax dust (delta FEV1, -0.21 and -0.40 1; delta MEF50, -0.72 and -1.211/s; delta sGaw (specific airway conductance), -0.17 and -0.65 kPa/s for dew retted and pre-harvest retted respectively). The subjects also reported more symptoms after inhaling pre-harvest retted flax dust. It is concluded that the acute bronchoconstrictor response to flax dust is increased by pre-harvest retting, suggesting an increased risk of byssinosis.

Evaluation of mechanical prototype machines for continuous separation of respirable cotton dust fractions.

The original cotton particulates analyzer used stationary screens to separate aerodynamically the coarse and fine dust fractions from small samples of cotton. By replacing stationary with rotary screens that were continuously cleaned, larger supplies of respirable dust were obtained without interruption. A ginned and a waste cotton were used to test two methods of separation: a rotating 38-micron screen and a tandem rotating 710- or 38- micron screen and cyclone. The fine dust fractions from both systems were captured on filters and examined gravimetrically, by Coulter counter, and scanning electron microscope. The dust passing 38 micron stationary or rotary screens contained particles of 15 micron maximum diameter whereas dust from the 710-gmm rotary screen and tandem cyclone exhibited particles of 10 micron maximum diameter and lint fragments. Dust fractions with particles less than 10 micron diameter and free of lint were obtained with a 38-micron rotary screen and tandem cyclone.