End-stage renal disease and metalworking fluid exposure.

OBJECTIVE: Despite increasing prevalence of end-stage renal disease (ESRD), little attention has been directed to how occupational exposures may contribute to risk. Our objective was to investigate the relationship between metalworking fluids (MWF) and ESRD in a cohort of 36 703 male autoworkers. METHODS: We accounted for competing risk of death, using the subdistribution hazard approach to estimate subhazard ratios (sHRs) and 95% CIs in models with cubic splines for cumulative exposure to MWF (straight, soluble or synthetic). RESULTS: Based on 501 ESRD cases and 13 434 deaths, we did not observe an association between MWF and ESRD overall. We observed modest associations between MWF and ESRD classification of glomerulonephritis and diabetic nephropathy. For glomerulonephritis, the 60th percentile of straight MWF was associated with an 18% increased subhazard (sHR=1.18, 95% CI: 0.99 to 1.41). For diabetic nephropathy, the subhazard increased 28% at the 60th percentile of soluble MWF (sHR=1.28, 95% CI: 1.00 to 1.64). Differences by race suggest that black males may have higher disease rates following MWF exposure. CONCLUSIONS: Exposure to straight and soluble MWF may be related to ESRD classification, though this relationship should be further examined.

The Influence of UV Varnishes on the Content of Cysteine and Methionine in Women Nail Plates-Chromatographic Studies.

The main purpose of this work was to determine if the use of hybrid nail polishes causes changes in concentration of the most important sulfur amino acids that build nail plate structures, cysteine and methionine. We found that the average contents of cysteine and methionine in studied samples before the use of hybrid manicure were 1275.3 ± 145.9 nmol mg-1 and 111.7 ± 23.8 nmol mg-1, respectively. After six months of hybrid manicure use, the average amount of these sulfur amino acids in studied samples were 22.1% and 36.5% lower in the case of cysteine and methionine, respectively. The average amounts of cysteine and methionine in nail plate samples after the use of hybrid manicures were 992.4 ± 96.2 nmol mg-1 and 70.9 ± 14.8 nmol mg-1, respectively. We also confirmed that in studied women the application of UV light varnishes reduced the thickness of the nail plate, from 0.50 ± 0.12 mm before to 0.46 ± 0.12 mm after the use of the hybrid manicure.

Contact sensitization in metalworkers: Data from the information network of departments of dermatology (IVDK), 2010-2018.

BACKGROUND: Metalworkers are exposed to a variety of contact allergens by handling tools, metals, metalworking fluids (MWFs), oils and greases, rubber materials, and so on. Most large-scale reports on contact allergy due to MWFs are more than 10-years-old, and there are only few studies on contact allergy in mechanics and other metal workers not exposed to MWFs. OBJECTIVES: To describe a current spectrum of contact sensitization in metalworkers with occupational dermatitis (OD). PATIENTS AND METHODS: Retrospective analysis of patch test data collected by the Information Network of Departments of Dermatology (IVDK; 2010-2018), stratifying for 804 cutting metalworkers, 2197 mechanics, and 355 other metalworkers. RESULTS: Cutting metalworkers were most frequently sensitized to monoethanolamine (12.6%), colophonium/abietic acid (11.4%) and formaldehyde releasers (up to 8.5%) from the MWF series, and formaldehyde (4.6%) and iodopropynyl butylcarbamate (4.6%) from the baseline series. Sensitization among mechanics and other metalworkers indicates possible occupational exposure to MWFs, glues, and resins, although this may not be expected from their job titles. CONCLUSIONS: The spectrum of MWF contact allergens remained largely unchanged during the last years. Taking a comprehensive occupational history is indispensable in order to not miss relevant allergen exposures.

Investigating the risk of breast cancer among women exposed to chemicals: a nested case-control study using improved exposure estimates.

PURPOSE: The aim of this study was to examine if exposures to chemicals at the workplace were associated with an increased risk of postmenopausal breast cancer, using improved exposure estimates. METHODS: The design is a case-control study, nested within a cohort of women from the Malmö Diet and Cancer Study. The study comprised 2400 women, 731 cases and 1669 matched controls, born 1923-1950 and living in Malmö, Sweden between 1991 and 1996. An occupational hygienist reclassified the probability for exposure given by a job-exposure matrix, using individual data on work tasks. First-time diagnoses of invasive breast cancer were identified through the Swedish Cancer Registry. RESULTS: Women exposed to chemicals in their occupational environment had a statistically significantly increased risk (OR 1.59, 95% CI 1.11-2.29) of breast cancer, and the risk correlated positively with duration of exposure but not with exposure intensity. Women exposed to chlorinated hydrocarbon solvents for more than 10 years had a significant higher risk of breast cancer (OR 3.06, 95% CI 1.18-7.96) as well as women exposed to oil mist for more than 10 years (OR 3.08, 95% CI 1.12-8.49). CONCLUSIONS: This study gives some support to the hypothesis that exposure to organic solvents as well as oil mist is associated with increased risk of breast cancer.

Maternal Occupational Oil Mist Exposure and Birth Defects, National Birth Defects Prevention Study, 1997⁻2011.

Workers in various industries can be exposed to oil mists when oil-based fluids are aerosolized during work processes. Oil mists can be inhaled or deposited on the skin. Little research exists on the reproductive effects of oil mist exposure in pregnant workers. We aimed to investigate associations between occupational oil mist exposure in early pregnancy and a spectrum of birth defects using data from 22,011 case mothers and 8140 control mothers in the National Birth Defects Prevention Study. In total, 150 mothers were rated as exposed. Manufacturing jobs, particularly apparel manufacturing, comprised the largest groups of exposed mothers. Mothers of infants with septal heart defects (odds ratio (OR): 1.8, 95% confidence interval (CI): 1.0-3.3), and especially perimembranous ventricular septal defects (OR: 2.5, CI: 1.2-5.2), were more likely to be occupationally exposed to oil mists in early pregnancy than control mothers; and their rater-estimated cumulative exposure was more likely to be higher. This was the first U.S. study evaluating associations between oil mist exposure and a broad spectrum of birth defects. Our results are consistent with previous European studies, supporting a potential association between oil-based exposures and congenital heart defects. Further research is needed to evaluate the reproductive effects of occupational oil mist exposure.

Laboratory Estimation of Occupational Exposures to Volatile Organic Compounds During Nail Polish Application.

In the United States, there are more than 120,000 nail salons in which workers could be potentially exposed to a number of volatile organic compounds (VOCs) used in various procedures. Measuring workers exposure in the field is time-consuming and could be very expensive. The purpose of this study was to estimate the VOC levels in the proximity of workers in nail salons through simulating the application process of some popular nail polishes in a laboratory chamber. The worst-case scenario was defined as a worker's exposure during nail polish application to one set of fingernails every 15 minutes for an 8-hour shift (total nail sets = 32). Nail polish was applied on paper plates in a flow-controlled test chamber. Air was sampled during the application of five different nail polishes for 8 hours using passive air samplers and the experiment was triplicated. Passive samplers were used for VOCs and formaldehyde. In this worst-case scenario setting, a total of 17 VOCs were detected, with eight that were found in all the samples. The mean concentration of butyl acetate (161-330 ppm, parts per million) and ethyl acetate (440 ppm) exceeded the threshold limit value (TLV) of 150 ppm and 400 ppm, respectively. Formaldehyde was analyzed separately and the mean concentrations exceeded the TLV of 0.10 ppm in all types of nail polish, ranging from 0.12 ppm to 0.22 ppm. Occupational safety and health professionals could use these data to increase awareness of workers' potential exposure to high levels of VOCs in nail salons and recommend practical measures to reduce potential exposures.

A rare case of orbital granulomatous inflammation from explosive hydraulic oil masquerading as orbital cellulitis.

The differential diagnosis for acute orbital inflammation is broad. We report a case of granulomatous orbital inflammation due to high-pressure oil injury to the orbit presenting as an atypical orbital cellulitis. Here we review the presentation and treatment of orbital inflammation from oil.

Quenching tank: Accidental drowning in hot quenching oil.

We describe an unusual case of drowning in fluid other than water in an industrial setting. A 26-year-old man was working in an industry which performs surface treatment of mechanical steel parts with quenching oil. He fell into the quenching oil (which was hot due to immersion of red hot metal parts), and as he was working alone in the particular section, there was a fatal outcome. A medico-legal autopsy was performed. The causes of death were found to be multiple, with the association of drowning, extensive superficial burns and asphyxia due to laryngeal oedema. To our knowledge, it is the first report of drowning in hot quenching oil, and only nine previous observations of drowning in industrial environments have been reported in the international literature. Even though rare, these kinds of accidental deaths can be prevented in dangerous industries with proper precautions and strict adherence to standard operating procedures.

Estimation of the probability of exposure to machining fluids in a population-based case-control study.

We describe an approach for estimating the probability that study subjects were exposed to metalworking fluids (MWFs) in a population-based case-control study of bladder cancer. Study subject reports on the frequency of machining and use of specific MWFs (straight, soluble, and synthetic/semi-synthetic) were used to estimate exposure probability when available. Those reports also were used to develop estimates for job groups, which were then applied to jobs without MWF reports. Estimates using both cases and controls and controls only were developed. The prevalence of machining varied substantially across job groups (0.1->0.9%), with the greatest percentage of jobs that machined being reported by machinists and tool and die workers. Reports of straight and soluble MWF use were fairly consistent across job groups (generally 50-70%). Synthetic MWF use was lower (13-45%). There was little difference in reports by cases and controls vs. controls only. Approximately, 1% of the entire study population was assessed as definitely exposed to straight or soluble fluids in contrast to 0.2% definitely exposed to synthetic/semi-synthetics. A comparison between the reported use of the MWFs and U.S. production levels found high correlations (r generally >0.7). Overall, the method described here is likely to have provided a systematic and reliable ranking that better reflects the variability of exposure to three types of MWFs than approaches applied in the past. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a list of keywords in the occupational histories that were used to link study subjects to the metalworking fluids (MWFs) modules; recommendations from the literature on selection of MWFs based on type of machining operation, the metal being machined and decade; popular additives to MWFs; the number and proportion of controls who reported various MWF responses by job group; the number and proportion of controls assigned to the MWF types by job group and exposure category; and the distribution of cases and controls assigned various levels of probability by MWF type.].

Hypothetical interventions to limit metalworking fluid exposures and their effects on COPD mortality: G-estimation within a public health framework.

BACKGROUND: Current recommendations for limits on metalworking fluids may provide insufficient protection from workplace-related illness. Chronic obstructive pulmonary disease (COPD) is a challenging outcome in occupational cohorts because its long period of worsening pulmonary function allows sicker workers to reduce exposure, causing a healthy worker survivor bias. G-estimation is a statistical method that reduces this bias. We introduce a public health approach using g-estimation to compare a series of potential exposure-reducing interventions. METHODS: Autoworkers at three General Motors plants in Michigan were followed for COPD mortality from 1 January 1941 to 31 December 1994. For each of the three fluid types (straight, soluble, synthetic), a series of binary variables indicated whether exposure exceeded a series of potential limits. Separate g-estimation analyses for each limit yielded results expressed as the total number of years of life that could have been saved among those who died from COPD had that exposure limit been enforced. RESULTS: Lower limits would have had greater effect than higher limits. A ban on soluble fluids (the most common type) would have had the greatest effect, saving an estimated 1550 years of life. Corresponding estimates were 737 and 260 years for straight and synthetic fluids, respectively. Few workers were exposed to synthetic fluids, limiting analytic power. CONCLUSIONS: This application of g-estimation suggests that limiting exposure to metalworking fluids could have saved many years of life lost to COPD in this cohort. The approach permits comparison of different interventions. Separate limits should be considered for different types of fluids.

Occupational respiratory and skin diseases among Finnish machinists: findings of a large clinical study.

PURPOSE: Machinists are exposed to many sensitizing and irritant substances, but no previous study has assessed the occurrence of clinically verified occupational diseases in an unselected large workforce of machinists. Our aim was to study the occurrence of clinically verified occupational respiratory and skin diseases cross-sectionally in a large sample of machinists in southern Finland. METHODS: A computer-assisted telephone interview on occupational exposures and health was carried out in a sample of 961 machining workers from 64 metalworking companies. Of these, 757 (79%) answered the interview. A total of 245 subjects reported work-related respiratory or skin symptoms and were invited to clinical examinations; 138 of these underwent a clinical interview and examination by an occupational health physician. On the basis of this examination, 32 subjects were further examined at the Finnish Institute of Occupational Health (FIOH) for occupational skin or respiratory diseases. RESULTS: One case of occupational asthma (OA) and seven cases of occupational dermatoses (OD) were diagnosed, giving a prevalence of 0.13% (95% CI 0-0.39) for OA, and 0.92% (95% CI 0.24-1.16) for OD. The OA was induced by the patient's own MWF. Additional five cases of newly diagnosed non-occupational asthma (0.79%, 95% CI = 0.16-1.42) were detected. No cases of occupational rhinitis or COPD were diagnosed. The dermatoses diagnoses consisted of four cases of allergic contact dermatitis and three cases of irritant contact dermatitis. The most common causes of the ODs were MWFs. CONCLUSION: This large clinical study of machinists representing metalworking in South Finland showed a prevalence of 0.13% of OA and 0.92% of OD. This relatively low occurrence of occupational diseases may reflect the strict Finnish criteria for the diagnosis of these occupational diseases and the relatively good level of occupational hygiene in machining workshops in Finland. Reported respiratory and skin symptoms were common, and these milder conditions may be linked to irritant rather than sensitizing exposures.

A comparison of standard methods with g-estimation of accelerated failure-time models to address the healthy-worker survivor effect: application in a cohort of autoworkers exposed to metalworking fluids.

BACKGROUND: Studies of autoworkers exposed to straight metalworking fluids report excess risks of several cancers. These studies, however, have not addressed the healthy-worker survivor effect. Most methods proposed to address this bias do not consider that it may be caused by time-varying confounders affected by prior exposure. G-estimation of accelerated failure-time models was developed to handle this issue but has never been applied to account for the healthy-worker survivor effect. METHODS: We compare results from Cox models and g-estimation in 38,747 autoworkers exposed to straight metalworking fluids. Exposure was defined based on job records and air samples. We examine relationships between duration of exposure and mortality from all causes, cancers, ischemic heart disease, and chronic obstructive pulmonary disease (COPD). RESULTS: In standard models, hazard ratios were elevated for cancers of the larynx, prostate, and rectum, but below or approximately equal to 1.0 for all other outcomes considered. Adjustment for the healthy-worker survivor effect using time off work, employment status, time since hire, and restriction to inactive workers after 15 years of follow-up did not substantially change the hazard ratios. However, g-estimation yielded higher hazard ratios than standard Cox models for most outcomes. Exposure was related to increased risks of mortality from all causes combined, heart disease, COPD, and all cancers, as well as lung and prostate cancers. CONCLUSIONS: G-estimation may provide a better control for the healthy-worker survivor effect than standard methods.