Effects of Interventions to Prevent Work-Related Asthma, Allergy, and Other Hypersensitivity Reactions in Norwegian Salmon Industry Workers (SHInE): Protocol for a Pragmatic Allocated Intervention Trial and Related Substudies.

BACKGROUND: Workers in the salmon processing industry have an increased risk of developing respiratory diseases and other hypersensitivity responses due to occupational exposure to bioaerosols containing fish proteins and microorganisms, and related allergens. Little is known about effective measures to reduce bioaerosol exposure and about the extent of skin complaints among workers. In addition, while identification of risk factors is a core activity in disease prevention strategies, there is increasing interest in health-promoting factors, which is an understudied area in the salmon processing industry. OBJECTIVE: The overall aim of this ongoing study is to generate knowledge that can be used in tailored prevention of development or chronification of respiratory diseases, skin reactions, protein contact dermatitis, and allergy among salmon processing workers. The main objective is to identify effective methods to reduce bioaerosol exposure. Further objectives are to identify and characterize clinically relevant exposure agents, identify determinants of exposure, measure prevalence of work-related symptoms and disease, and identify health-promoting factors of the psychosocial work environment. METHODS: Data are collected during field studies in 9 salmon processing plants along the Norwegian coastline. Data collection comprises exposure measurements, health examinations, and questionnaires. A wide range of laboratory analyses will be used for further analysis and characterization of exposure agents. Suitable statistical analysis will be applied to the various outcomes of this comprehensive study. RESULTS: Data collection started in September 2021 and was anticipated to be completed by March 2023, but was delayed due to the COVID-19 pandemic. Baseline data from all 9 plants included 673 participants for the health examinations and a total of 869 personal exposure measurements. A total of 740 workers answered the study's main questionnaire on demographics, job characteristics, lifestyle, health, and health-promoting factors. Follow-up data collection is not completed yet. CONCLUSIONS: This study will contribute to filling knowledge gaps concerning salmon workers' work environment. This includes effective workplace measures for bioaerosol exposure reduction, increased knowledge on hypersensitivity, allergy, respiratory and dermal health, as well as health-promoting workplace factors. Together this will give a basis for improving the work environment, preventing occupational health-related diseases, and developing occupational exposure limits, which in turn will benefit employees, employers, occupational health services, researchers, clinicians, decision makers, and other stakeholders. TRIAL REGISTRATION: ClinicalTrials.gov NCT05039229; https://www.clinicaltrials.gov/study/NCT05039229. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48790.

Work environment factors and respiratory complaints in Norwegian cooks.

PURPOSE: Norwegian cooks exhibit relatively high mortality, particularly from respiratory diseases. Both occupational hazards and lifestyle factors have been suggested as possible explanations. Negative health effects from exposure to cooking fumes are well documented in non-Western populations, and it has been claimed that cooking fumes in Western style cooking might be substantially different. We hypothesise that exposure to cooking fumes contributes to respiratory diseases also in professional cooks in Western countries. The aim of this study was to elucidate if specific work environment factors related to cooking fume exposure are determinants for respiratory morbidity in Norwegian cooks. METHODS: We surveyed specific work environment factors and respiratory complaints in 553 subjects that were currently working as skilled cooks. Inclusion was based on the register of people that had graduated as skilled cooks in central Norway between 1988 and 2008. Determinants for the occurrence of respiratory complaints were explored by logistic regression. RESULTS: Overall, 17.2% of subjects reported respiratory complaints at work, while 8.1% had chronic bronchitis. Those who performed frying for over half of their workday exhibited an increased odds ratio for having chronic bronchitis of 2.5 (95% CI 1.2-5.3). Using gas for frying and using a fryer in the kitchen were also related to the occurrence of respiratory complaints. CONCLUSIONS: This study in Norwegian cooks demonstrates a relationship between the extent of frying and the occurrence of work-related respiratory complaints. Therefore, reducing exposure to cooking fumes could reduce respiratory complaints in cooks, and potentially help alleviate excess morbidity and mortality in this occupation.

Work environment factors and work sustainability in Norwegian cooks.

OBJECTIVES: Cooks have increased morbidity and mortality. A high turnover has also been reported. We aimed to elucidate work environment and work sustainability in Norwegian cooks. MATERIAL AND METHODS: A questionnaire inquiring about working conditions and work participation was sent to 2082 cooks who had qualified from 1988 onwards. Of these, 894 responded. Time at work was analyzed with Kaplan-Meier plots and possible determinants for quitting work as a cook was analyzed with Cox regression. RESULTS: The median time at work was 16.6 years. There were differences in sustainability between types of kitchens for both sexes (p = 0.00). The median time in the profession was 9.2 years for the cooks in restaurants, while the cooks in institutions and canteens showed a substantially higher sustainability with 75.4% still at work after 10 years, and 57% still at work after 20 years in the profession. Of those still at work as a cook, 91.4% reported a good or very good contentment, and the 67.4% who expected to stay in the profession the next 5 years frequently answered that excitement of cooking, the social working environment, and the creative features of cooking were reasons to continue. Musculoskeletal complaints were the most common health-related reason for leaving work as a cook, while working hours was the most common non-health-related reason. CONCLUSIONS: There are significant differences in work sustainability between the cooks in the different types of kitchens. The identified determinants for length of time in the occupation can be used for preventive purposes.

Inflammatory markers in blood and exhaled air after short-term exposure to cooking fumes.

OBJECTIVES: Cooking fumes contain aldehydes, alkanoic acids, polycyclic aromatic hydrocarbons, and heterocyclic compounds. The inhalation of cooking fumes entails a risk of deleterious health effects. The aim of this study was to see if the inhalation of cooking fumes alters the expression of inflammatory reactions in the bronchial mucosa and its subsequent systemic inflammatory response in blood biomarkers. METHODS: Twenty-four healthy volunteers stayed in a model kitchen on two different occasions for 2 or 4 h. On the first occasion, there was only exposure to normal air, and on the second, there was exposure to controlled levels of cooking fumes. On each occasion, samples of blood, exhaled air, and exhaled breath condensate (EBC) were taken three times in 24 h and inflammatory markers were measured from all samples. RESULTS: There was an increase in the concentration of the d-dimer in blood from 0.27 to 0.28 mg ml(-1) on the morning after exposure to cooking fumes compared with the levels the morning before (P-value = 0.004). There was also a trend of an increase in interleukin (IL)-6 in blood, ethane in exhaled air, and IL-1ß in EBC after exposure to cooking fumes. In a sub-analysis of 12 subjects, there was also an increase in the levels of ethane--from 2.83 parts per billion (ppb) on the morning before exposure to cooking fumes to 3.53 ppb on the morning after exposure (P = 0.013)--and IL-1ß--from 1.04 on the morning before exposure to cooking fumes to 1.39 pg ml(-1) immediately after (P = 0.024). CONCLUSION: In our experimental setting, we were able to unveil only small changes in the levels of inflammatory markers in exhaled air and in blood after short-term exposure to moderate concentrations of cooking fumes.