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Diseases of the respiratory system (except for pneumoconiosis & similar) - 2,965 entries found

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CIS 02-816 Morinaga K., Kishimoto T., Sakatani M., Akira M., Yokoyama K., Sera Y.
Asbestos-related lung cancer and mesothelioma in Japan
In Japan, crocidolite used to be used for asbestos cement pipes, and amosite was used for building boards; both types were used in spraying applications. The use of these two types of asbestos was discontinued in Japan in the late 1970s. A strong increase in asbestos imports was observed between 1960 (77,000 tons) and 1974 (352,316 tons). This rise in imports correlates well with the recent rapid increase in mortality from malignant pleural mesothelioma. Between 1995 and 1999, the estimated mean annual deaths from pleural mesothelioma was about 500. The annual number of compensated occupational respiratory cancers due to asbestos exposure has also been increasing. Up to the end of March 2000, 162 cases with malignant mesothelioma and 197 cases with lung cancer were compensated. The smoking rate among males in Japan is still over 50%, so lung cancer deaths caused by the interaction between smoking and asbestos exposure are likely to continue.
Industrial Health, Apr. 2001, Vol.39, No.2, p.65-74. Illus. 63 ref.

CIS 02-779 Nicholson W.J.
The carcinogenicity of chrysotile asbestos - A review
The world production of asbestos has been declining dramatically in recent years, particularly in Europe and the United States. However, increases have occurred in Asian nations and chrysotile is the dominant fibre used. Important uses are in cement products, wallboards, friction products and textiles. In a review of studies in the United States and Great Britain, chrysotile has been shown to increase the risk of lung cancer and to cause mesothelioma in exposed workers.
Industrial Health, Apr. 2001, Vol.39, No.2, p.57-64. Illus. 28 ref.

CIS 02-657 Meijer E., Grobbee D.E., Heederik D.J.J.
Health surveillance for occupational chronic obstructive pulmonary disease
Screening for lung disease in all workers with a low prevalence of chronic obstructive pulmonary disease (COPD) would lead to unacceptable costs. Surveillance of high-risk groups may be a useful alternative. Data from 314 workers exposed to dust were used to develop a prediction model. Data from a study comprising 96 rubber workers were used to validate the model's performance. COPD was defined as a ratio of forced expiratory volume in 1 second to forced vital capacity outside the 5th percentile. Shortness of breath, wheeze, heavy smoking, and work-related lower respiratory symptoms were identified as independent determinants of having COPD. Workers with COPD can be distinguished from those without COPD on the basis of a medical and work-related questionnaire, providing occupational physicians with a low-cost strategy for detecting workers at risk for COPD.
Journal of Occupational and Environmental Medicine, May 2001, Vol.43, No.5, p.444-450. Illus. 17 ref.

CIS 02-678 Park R.M.
Medical insurance claims and surveillance for occupational disease: Analysis of respiratory, cardiac, and cancer outcomes in auto industry tool grinding operations
To evaluate medical insurance claims for chronic disease investigation, claims from eight automotive machining plants (1984 to 1993) were linked with work histories (1967 to 1993), and associations with respiratory, cardiac, and cancer conditions were investigated in a case-control study. The primary focus was tool grinding, but metalworking, welding, forging, heat treating, engine testing, and diverse-skilled trades work were also investigated. Asthma incidence increased in tool grinding (at mean cumulative duration: odds ratio (OR), 3.0), as did non-ischaemic heart disease (OR 3.1). These trends appeared in models with deficits (OR <1.0) for those ever exposed to tool grinding because of exposure-response miss-specification, demographic confounding, or removal of high-risk workers from the exposed group. The apparent cancer rates identified from claims greatly exceeded the expected rates from a cancer registry, suggesting that diagnostic, "rule-out," and surveillance functions were contributing.
Journal of Occupational and Environmental Medicine, Apr. 2001, Vol.43, No.4, p.335-346. 41 ref.

CIS 02-708 Mustajbegovic J., Zuskin E., Schachter E.N., Kern J., Vrcic-Keglevic M., Vitale K., Ebling Z.
Respiratory findings in livestock farmworkers
The prevalence of acute and chronic respiratory symptoms and lung function were investigated in 236 (169 male and 67 female) livestock farm workers. The prevalence of acute and chronic respiratory symptoms was recorded by means of a questionnaire. Lung function was measured by recording the maximum expiratory flow-volume curves. There was a high prevalence of almost all chronic respiratory symptoms in farmers: highest among men for chronic cough (27.2%) and highest among women for dyspnoea (28.3%). Occupational asthma was diagnosed in 3.6% of the men and 1.5% of the women. A large number of workers of both sexes complained of acute work-related symptoms, highest for dry cough (52.2%) and shortness of breath (44.9%). Lung function data among these workers demonstrated a trend toward lower lung function in general. Analysis reveals significant effects of length of employment and smoking in male and length of employment in female livestock farm workers.
Journal of Occupational and Environmental Medicine, June 2001, Vol.43, No.6, p.576-584. 51 ref.

CIS 02-732 Chen Y.H., Wu T.N., Liou S.H.
Obstructive pulmonary function defects among Taiwanese firebrick workers in a 2-year follow-up study
In a two-year follow-up study, the pulmonary function of 291 firebrick workers was compared with that of 72 controls. Pulmonary function parameters tested included forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and forced expiratory flow after 50% or 75% of vital capacity has been expelled (FEF50%, FEF75%). Most baseline functions were significantly lower for firebrick workers than in controls. The two-year decreases in FEV1/FVC and FEF50% in the firebrick workers was significantly greater than in controls. FEV1, FEF50%, and FEF75%, also showed a dose-response relationship with job titles. The two-year deterioration in pulmonary functions was the worst in burning work, followed by crushing and moulding. Workers in firebrick manufacturing factories with exposure to silica-containing dusts may develop obstructive pulmonary function defects.
Journal of Occupational and Environmental Medicine, Nov. 2001, Vol.43, No.11, p.969-975. 20 ref.

CIS 02-803 Rice F.L., Park R., Stayner L., Smith R., Gilbert S., Checkoway H.
Crystalline silica exposure and lung cancer mortality in diatomaceous earth industry workers: A quantitative risk assessment
Data from a cohort mortality study of 2342 white male California diatomaceous earth mining and processing workers exposed to crystalline silica dust (mainly cristobalite) were analyzed using different exposure-response models. Exposure to respirable crystalline silica dust was a significant predictor in nearly all of the models evaluated and the linear relative rate model with a 10-year exposure lag seemed to give the best fit in the Poisson regression analysis. For those who died of lung cancer, the linear relative rate model predicted rate ratios for mortality from lung cancer of about 1.6 for the mean cumulative exposure to respirable silica compared with no exposure. Results show that a male worker exposed to 0.05mg/m3 of respirable silica dust containing cristobalite over a 45 year working lifetime has an increase in lifetime risk of lung cancer of about 2%. The predicted number of deaths from lung cancer suggests that current occupational health standards may not be adequately protecting workers from the risk of lung cancer.
Occupational and Environmental Medicine, Jan. 2001, Vol.58, No.1, p.38-45. Illus. 43 ref.

CIS 02-234 Oliver L.C., Miracle-McMahill H., Littman A.B., Oakes J.M., Gaita R.R.
Respiratory symptoms and lung function in workers in heavy and highway construction: A cross-sectional study
Respiratory symptoms and lung function were examined in labourers, tunnel workers (TWs) and operating engineers (OEs) in highway and tunnel construction. Data were obtained on 389 unionized workers: 186 labourers, 45 TWs, and 158 OEs. Prevalence of asthma was 13 and 11.4% for labourers and operating engineers, respectively, and of symptomatic chronic bronchitis, 6.5 and 1.9%, respectively. Odds ratios (OR) for undiagnosed asthma were significantly elevated in TWs compared to OEs, and marginally elevated for chronic bronchitis. Inverse relationships were observed between duration of membership of the union, and risk for asthma and chronic bronchitis. Asthma predicted lower FEV1. TWs, labourers, and OEs in highway construction are at increased risk for asthma. TWs also appear to be at increased risk for chronic bronchitis. The data suggest that symptomatic workers are self-selecting out of their trade. Asthma was associated with lower lung function in those affected.
American Journal of Industrial Medicine, July 2001, Vol.40, No.1, p.73-86. Illus. 36 ref.

CIS 02-459 Caretti D.M., Scott W.H., Johnson A.T., Coyne K.M., Koh F.
Work performance when breathing through different respirator exhalation resistances
An evaluation of the performance in workers, exercising at a fixed workload and wearing full-face piece respirators, and modified to provide different expiratory resistances. Fifteen volunteers exercised on a treadmill at fixed speeds and grades. Performance time decreased linearly with increased resistances. Average oxygen consumption rates and minute ventilation also decreased, indicating that increases in expiratory resistance result in hypoventilation. This study suggests that the only practical expiratory resistance level limitation is the reduction in performance that will be acceptable to the workers.
AIHA Journal, July-Aug. 2001, Vol.62, No.4, p.411-415. Illus. 15 ref.

CIS 02-264 Booth D.W., Guffey S.E.
An evaluation of industrial ventilation branch screening methods for obstructions in working exhaust systems
Methods in identifying obstructed branches in industrial ventilation systems are divided into two categories: pressure comparisons and pressure ratio comparisons. The first compares measured static pressures with the corresponding design static pressures or previously measured pressures. The second compares the ratios of two measured pressures. Data were collected from 6 industrial ventilation systems. Each one was tested for naturally occurring or deliberately inserted obstructions. The pressure ratio method was substantially superior for the detection of obstructions.
AIHA Journal, July-Aug. 2001, Vol.62, No.4, p.401-410. Illus. 23 ref.

CIS 02-209 Leino T.
Epidemiology of skin and respiratory diseases among hairdressers
Results of five epidemiologic studies of skin and respiratory disorders among hairdressers are presented. The studies focused on the working conditions in salons, the perceived health of the hairdressers, the prevalence, incidence and risk of skin and respiratory symptoms and diseases among hairdressers, and the risk and causes of leaving the profession. Physical conditions and chemicals in the ambient air were measured in 20 hairdressing salons. Health data were obtained by questionnaire, phone interviews and medical examinations. It was found that hairdressing salons meet Finnish indoor air criteria. High peak concentrations of certain chemicals during hair treatments cause discomfort and ill health to hairdressers and should be controlled, for example with local exhaust ventilation. Hairdressers have an increased risk of developing asthma and chronic bronchitis. Ammonium persulfate caused most of the occupational skin and respiratory diseases.
Finnish Institute of Occupational Health, Publication Office, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland, 2001. 124p. Illus. 287 ref.

CIS 02-188 Hodgson M.J., Bracker A., Yang C., Storey E., Jarvis B.J., Milton D., Lummus Z., Bernstein D., Cole S.
Hypersensitivity pneumonitis in a metal-working environment
Following an outbreak of lung disease among workers in a metal-working plant, a study was conducted involving the clinical examination of patients, a cross-sectional questionnaire survey of the outbreak plant and two control plant areas (with and without metal-working fluids (MWF) exposures), an industrial hygiene survey with laboratory characterization of microbial flora, and immunological investigations. 39 (79.6%) patients described symptoms consistent with work-related lung disease, and 8 received other diagnoses. Sixteen had hypersensitivity pneumonitis confirmed on biopsy. Mean decrements in lung forced expiratory volume in 1s and forced vital capacity from before to after work were similar in the 16 biopsy-confirmed cases of hypersensitivity pneumonitis and the 19 symptomatic patients without biopsies. Three sources of water-based aerosols were identified that grew similar microbial flora, but antibody testing did not identify a specific single organism. Endotoxin levels were similar in the outbreak and the MWF control plant.
American Journal of Industrial Medicine, June 2001, Vol.39, No.6, p.616-628. 53 ref.

CIS 02-229 Douwes J., McLean D., Slater T., Pearce N.
Asthma and other respiratory symptoms in New Zealand pine processing sawmill workers
To study respiratory symptoms in pine sawmill workers, a respiratory health questionnaire was administered to 772 subjects and the association between symptoms and job-title-based exposure was studied. Asthma in exposed workers (18%) was more common than in the general population (12.1%, adjusted OR=1.6). Asthma was also more common in the low exposure group (15.6%) and high exposure groups (high exposure to "green dust", 20.4%, and high exposure to "dry dust", 18.8%), than in the non-exposed workers (9.2%). Adjusted odds ratios were 1.9, 2.7 and 2.1, respectively. Adjusted odds ratios for symptoms of cough were 2.7 for the low, 5.2 for the high "green dust" and 3.3 for the high "dry dust" exposure groups. Moreover, eye and nose irritations were significantly more prevalent in the exposure groups.
American Journal of Industrial Medicine, June 2001, Vol.39, No.6, p.608-615. 30 ref.

CIS 02-238 Ortega H.G., Daroowalla F., Petsonk E.L., Lewis D., Berardinelli S., Jones W., Kreiss K., Wiessman D.N.
Respiratory symptoms among crab processing workers in Alaska: Epidemiological and environmental assessment
To study possible respiratory symptoms and specific IgE responses among crab processing workers, 107 workers at a crab processing facility completed a survey both at the beginning and end of the processing season. The surveys included standardized symptom questionnaires, spirometry, and serological testing, as well as measurement of workplace airborne crab allergens and microscopic analysis of aerosolized materials. Over the crab processing season, asthma-like symptoms developed in 26% of study participants and bronchitic symptoms in 19%. Only 9% of those with new asthma-like symptoms were IgE-sensitized to crab at the end of the season. Among the crab processing jobs, butchering and degilling workers had the highest incidence of respiratory symptoms. Both personal and process-related factors appear to affect the development of respiratory symptoms in crab processing workers.
American Journal of Industrial Medicine, June 2001, Vol.39, No.6, p.598-607. 20 ref.

CIS 02-313 Redlich C.A., Stowe M.H., Wisnewski A.V., Eisen E.A., Karol M.H., Lemus R., Holm C.T., Chung J.S., Sparer J., Liu Y., Woskie S.R., Appiah-Pippim J., Gore R., Cullen M.R.
Subclinical immunologic and physiologic responses in hexamethylene diisocyanate-exposed auto body shop workers
Diisocyanates are potent sensitizing agents and a frequently identified cause of occupational asthma. A cross-sectional field epidemiologic study was conducted to characterize the effects of hexamethylene diisocyanate (HDI) exposures on auto body shop workers. Data on the 75 subjects enrolled in the study were collected by questionnaire and physiological testing. No overt cases of clinically apparent diisocyanate asthma were identified based on spirometry, methacholine challenge, peak flows, and symptoms. HDI-specific lymphocyte proliferation was present in 30% of HDI-exposed workers and HDI-specific IgG in 34% of HDI-exposed workers, but they were not associated. HDI-specific IgE was detected in two workers. HDI-specific lymphocyte proliferation, increased methacholine responsiveness, and symptoms of chest tightness and shortness of breath were more common in the most heavily HDI-exposed workers, the painters. These findings demonstrate the presence of HDI-specific immune responses in a large proportion of healthy HDI-exposed workers.
American Journal of Industrial Medicine, June 2001, Vol.39, No.6, p.587-597. Illus. 31 ref.

CIS 02-214 Thaon I., Guillemin M., Gonzalez M., Cantineau A.
Toxic hazards and occupational diseases related to the soldering of metals
Risques toxiques et pathologies professionnelles liés au soudage métallique [in French]
Many workers are involved in soldering activities, either full-time or occasionally. Soldering methods vary considerably, whether they are automated or manual. The composition of the soldering fumes varies as a function of the method used, the metals to be soldered and their possible coatings. Among the diseases observed, respiratory diseases (asthma, Brooks' syndrome, chronic obstructive bronchitis, siderosis) represent an important part. The role of soldering fumes in the occurrence of broncho-pulmonary cancers is the object of discussion concerning the possible confounding factors of smoking and exposure to asbestos. As a consequence, preventive measures involve using the least hazardous soldering method, collecting the smoke and avoiding work in confined spaces.
Encyclopédie médico-chirurgicale, Toxicologie-Pathologie professionnelle, 3rd Quarter 2001, No.132, 9p. Illus. 59 ref.

CIS 02-371 De Vuyst P., Dumortier P., Thimpont J., Gevenois P.A.
Respiratory diseases due to asbestos
Pathologies respiratoires de l'amiante [in French]
Diseases caused by asbestos concern not only occupational physicians, but also general practitioners and lung specialists. Indeed, risks are no longer confined to manufacturing sites but extend to thousands of individuals having worked with asbestos (often without being aware of the fact) or having lived in buildings insulated with this material. Improvements in working conditions have lead to a reduced incidence of severe lung fibrosis in favour of less-invalidating pleural lesions associated with lower cumulative, but more frequent exposures. Persons suffering from asbestos-related diseases rarely die from respiratory insufficiency, but from delayed neoplasic complications such as mesothelioma or bronchial cancer, occurring mostly after cessation of occupational activity. Progress in tomodensitometric imaging and in exposure assessment through the mineralogical analysis of lung tissue have resulted in improved approaches in the diagnosis of diseases linked to these fibres.
Encyclopédie médico-chirurgicale, Toxicologie-Pathologie professionnelle, 1st Quarter 2001, No.130, 11p. Illus. 148 ref.

CIS 02-216 Malo J.L., Gautrin D., Lemière C., Cartier A.
Occupational asthma with and without latency
Asthme professionnel avec et sans période de latence [in French]
There are two types of occupational asthma (OA): OA with latency necessary for sensitization, the most commonly encountered form, and OA without latency, also called the bronchial irritation syndrome (BIS), which occurs following single or multiple inhalation accidents where the worker develops asthmatic symptoms with persistent bronchial hyperactivity. Clinical investigation of OA with latency follows a series of tests based on decision charts. Among the various predisposition factors, atopy alone favours the emergence of OA to high molecular-weight substances (proteins), even after an end to the exposure, particularly if the exposure occurred over long periods and workers were not removed soon enough from the source of exposure upon the appearance of symptoms. The use of anti-inflammatory agents improves the outcome. BIS is caused by inhalation of irritant substances at high levels of concentration. This type of exposure gives rise to asthmatic symptoms and persistent bronchial hyperactivity.
Encyclopédie médico-chirurgicale, Toxicologie-Pathologie professionnelle, 1st Quarter 2001, No.130, 7p. Illus. 78 ref.

CIS 02-206 ENT cancers (nose, facial sinus, larynx) - Detection, reporting, compensation
Cancers ORL (nez et sinus de la face, larynx) - Comment les repérer, les déclarer, les faire reconnaître, les faire indemniser [in French]
Contents of this booklet describing the compensation system for occupational ENT (nasal, facial sinus and laryngeal) cancers in France: introduction and general considerations on occupational cancers; reporting procedures; occupational activities having possibly given rise to exposures to agents known to cause ENT cancers (wood dust, vapour or smoke of certain nickel compounds, asbestos dust, sulfuric acid fog or smoke) as well as the corresponding compensation systems. It duplicates the section of the general booklet on the compensation of occupational cancers in France (see CIS 02-201) applicable specifically to ENT cancer.
Ligue nationale contre le cancer, 14 rue Corvisart, 75013 Paris, France, 2001. 13p.

CIS 02-205 Lung cancer - Pleural cancer (mesothelioma) - Detection, reporting and compensation
Cancers du poumon - Cancers de la plèvre (mésothéliomes) - Comment les repérer, les déclarer, les faire reconnaître, les faire indemniser [in French]
Contents of this booklet describing the compensation system for occupational lung cancer and pleural mesothelioma in France: introduction and general considerations on occupational cancers; reporting procedures; occupational activities having possibly given rise to exposures to agents known to cause lung cancer (asbestos, arsenic, bis-chloromethyl ether, sulfuric acid fog and smoke, chromium compounds, tars, soot, nickel compounds, iron oxide, radioactive dust or smoke, silica, cobalt dust in association with tungsten carbide) as well as the corresponding compensation systems. It duplicates the section of the general booklet on the compensation of occupational cancers in France (see CIS 02-201) applicable specifically to lung cancer.
Ligue nationale contre le cancer, 14 rue Corvisart, 75013 Paris, France, 2001. 21p.

CIS 01-837 Sunderman F.W.
Nasal toxicity, carcinogenicity, and olfactory uptake of metals
This review article discusses the impact of occupational exposures to metal dusts or aerosols, which can cause loss of olfactory acuity, atrophy of the nasal mucosa, mucosal ulcers, perforated nasal septum and sinonasal cancer. Anosmia and hyposmia have been observed in workers exposed to nickel- or cadmium-containing dusts in alkaline battery factories, nickel refineries, and cadmium industries. Ulcers of the nasal mucosa and perforated nasal septum have been reported in workers exposed to Cr(VI) in chromate production and chrome plating, or to As(III) in arsenic smelters. Cancers of the nose and nasal sinuses have been reported in workers exposed to Ni compounds in nickel refining, cutlery factories, and alkaline battery manufacture, or to Cr(VI) in chromate production and chrome plating. Possible molecular mechanisms responsible for olfactory loss are proposed, based on the findings of several animal experiments.
Annals of Clinical and Laboratory Science, 2001, Vol.31, No.1, p.3-24. 169 ref.

CIS 01-832 Lee P.N.
Relation between exposure to asbestos and smoking jointly and the risk of lung cancer
To review evidence of the relationship between the combined effect of exposure to asbestos and smoking on the risk of lung cancer, 23 studies epidemiological studies were analysed, comparing the risk of lung cancer in subjects unexposed to asbestos or smoking, exposed to asbestos only, to smoking only, or to both. Eight studies provided insufficient data. Asbestos exposure was associated with a significantly increased risk in non-smokers in six of the remaining studies and with a moderate increase in a further six. In two of the three studies that found no increase, asbestos exposure was insufficient to increase risks in smokers. In 30 of 31 data sets analysed, risk in the combined exposure group was greater than predicted by the additive model. Asbestos exposure multiplies risk of lung cancer by a similar factor in non-smokers and smokers.
Occupational and Environmental Medicine, Mar. 2001, Vol.58, No.3, p.145-153. 37 ref.

CIS 01-881 Melbostad E., Eduard W.
Organic dust-related respiratory and eye irritation in Norwegian farmers
To study the relationship between exposure to organic dust and work-related symptoms, 8,482 farmers and spouses were surveyed. Task-related respiratory and eye symptoms were recorded by questionnaire. Personal exposure to total dust, fungal spores, bacteria, endotoxins and ammonia during 12 different tasks was measured in a random sample of 127 farms. The prevalence of work-related symptoms occurring "often" was 31% and "seldom" 35%. Task mean exposures ranged from 0.04 to 2mg dust/m3, 0.02 x 106 to 2 x 106 fungal spores/m3, 0.2 x 106 to 48 x 106 bacteria/m3, 0.5 x 103 to 28 x 103 endotoxin units/m3, and 0 to 8 ppm ammonia. Task mean exposure levels were positively correlated with task-specific symptom prevalences for total dust, fungal spores and endotoxins, but not for bacteria and ammonia.
American Journal of Industrial Medicine, Feb. 2001, Vol.39, No.2, p.209-217. Illus. 24 ref.

CIS 01-830 Sanderson W.T., Ward E.M., Steenland K., Petersen M.R.
Lung cancer case-control study of beryllium workers
This article describes a case-control study of lung cancer among workers of a beryllium processing plant in Reading, PA, USA. Cases were identified by mortality follow-up through 1992 of a cohort of male workers. Each of 142 cases was age-race-matched to five controls. The potential confounding effects of smoking were also evaluated. Lung cancer cases had shorter tenures and lower cumulative beryllium exposures than controls, but higher average and maximum exposures. However, after applying a 10- and 20-year lag, exposure metrics were higher for cases. Odds ratios in analyses that lagged 20 years were significantly elevated for those with higher exposure compared to the lowest exposure category. Significant positive trends were seen with the log of the exposure metrics. Increased lung cancer among workers with higher lagged beryllium exposures and lack of evidence for confounding by cigarette smoking, provide further evidence that beryllium is a human lung carcinogen.
American Journal of Industrial Medicine, Feb. 2001, Vol.39, No.2, p.133-144. 37 ref.

CIS 01-777 Reinisch F., Harrison R.J., Cussler S., Athanasoulis M., Balmes J., Blanc P., Cone J.
Physician reports of work-related asthma in California, 1993-1996
Work-related asthma was studied in California over a 36-month period. Cases were identified from Doctor's First Reports (DFRs), a mandated physician reporting system. Structured follow-up telephone interviews of DFR asthma cases were conducted to collect work history, exposure, and medical information. Statewide employment data was used to calculate disease rates among industry groups. Based on 945 cases of work-related asthma, the average annual reporting rate for work-related asthma in California was 25/million workers. It is believed that the real rate is considerably higher after adjustment for underreporting. Janitors and cleaners (625/million) and firefighters (300/million) had the highest reporting rates of work-related asthma. Half of all work-related asthma cases were associated with agents not known to be allergens. A greater proportion of work-related asthma associated with irritant exposures was identified than has previously been reported.
American Journal of Industrial Medicine, Jan. 2001, Vol.39, No.1, p.72-83. Illus. 28 ref.


CIS 04-73 Lee H.S.
Your job and asthma
A significant proportion of adult asthma may be caused or aggravated by occupational factors. Asthma is the most common occupational respiratory disease in Singapore. The definition of occupational asthma, common causative agents and the diagnosis and management of a patient with occupational asthma are discussed. It is important in the total management of asthmatic patients that causal or aggravating factors be identified and advice be given to avoid exposure to such factors. Cases of suspected occupational asthma should be investigated to confirm the diagnosis and removed from further exposure to the causal or aggravating factors, where feasible. Early diagnosis and removal from further exposure could result in a better prognosis for the patient.
Singapore Family Physician, Jan.-Mar. 2000, Vol.26, No.1, p.24-28. Illus. 9 ref.

CIS 03-1195 Ferreras de la Fuente A., Antolín García M.T., García Arroyo M.I.
Guide to evaluating work incapacity as a consequence of lung disease
Guía para la determinación de la incapacidad laboral en las enfermedades pulmonares [in Spanish]
This guide to the evaluation of the degree of work incapacity as a consequence of the most common chronic lung diseases is aimed at occupational physicians. Contents: definitions of incapacity; anatomy and physiology of the respiratory system; diagnosis techniques; obstructive ventilatory impairment; interstitial lung diseases; obstructive sleep apnoea syndrome; respiratory diseases due to ventilation alterations (hypoventilation); bronchopulmonary tumours; occupational respiratory diseases (asthma, hypersensitivity pneumonia, pneumoconiosis, silicosis, coal miners' pneumoconiosis, asbestosis, talcosis, siderosis, berylliosis); pulmonary hypertension, international disease classification codes (ICD-9-CM). Appendices include: tables summarizing the incapacity criteria for the most common lung diseases and the criteria for determining the degree of incapacity.
Instituto Nacional de Medicina y Seguridad del Trabajo, Madrid, Spain, 2000. viii, 247p. Illus. Bibl.ref. Index.

CIS 03-300 Browne K., Gee B.L.
Asbestos exposure and laryngeal cancer
Studies of workers exposed to asbestos that included data on laryngeal disease are reviewed, together with studies of laryngeal cancers with epidemiological or experimental evidence of associated exposures. Confounding factors of smoking and alcohol intake create major difficulties for the identification of any asbestos or other occupational effects. Smoking and alcohol are independently and synergistically associated with large increases in the relative risk of laryngeal cancer. However, few studies provide details of either habit. Among 24 prospective studies for which a standardized mortality ratio was available, there was a clear excess risk only in one case. In 17 retrospective studies, only two showed a significantly increased risk. Evidence from animal experiments, studies of associations with pleural plaques, and autopsy findings also appear negative or inconclusive. The evidence does not indicate that asbestos exposure increases the risk of laryngeal cancer.
Annals of Occupational Hygiene, June 2000, Vol.44, No.4, p.239-250. 101 ref.

CIS 03-296 Cocco P., Rice C.H., Chen J.Q., McCawley M., McLaughlin J.K., Dosemeci M.
Non-malignant respiratory diseases and lung cancer among Chinese workers exposed to silica
To explore whether a medical history for non-malignant respiratory disease contributes to an increased lung cancer risk among workers exposed to silica, data from a nested case-control study involving 29 dusty workplaces in China were analysed. The study population consisted of 316 lung cancer cases and 1356 controls matched by facility type and decade of birth. Smoking was the main risk factor for both lung cancer and chronic bronchitis. Lung cancer risk showed a modest association with silicosis and with cumulative silica exposure, which did not vary by history of previous pulmonary tuberculosis. Among subjects without a medical history for chronic bronchitis or asthma, lung cancer risk was associated with silicosis (odds ratio (OR) 1.6). Among subjects with a medical history for chronic bronchitis or asthma, lung cancer risk was associated with neither silicosis (subjects with chronic bronchitis: OR 0.6; subjects with asthma: OR 0.4) nor with silica exposure.
Journal of Occupational and Environmental Medicine, June 2000, Vol.42, No.6, p.639-644. 19 ref.

CIS 03-183 Caccappolo E., Kipen H., Kelly-McNeil K., Knasko S., Hamer R.M., Natelson B., Fiedler N.
Odor perception: Multiple chemical sensitivities, chronic fatigue and asthma
Patients with multiple chemical sensitivities (MCS) often report heightened sensitivity to odours. Odour detection thresholds to phenyl ethyl alcohol (PEA) and pyridine (PYR) were evaluated for 33 MCS subjects, 13 chronic fatigue syndrome subjects, 16 asthmatic subjects and 27 healthy controls. Odour identification ability (based on University of Pennsylvania Smell Identification test results) and ratings in response to four supra-threshold concentrations of PEA and PYR were also assessed. Odour detection thresholds for PTA and PYR and odour identification ability were equivalent for all groups; however, when exposed to supra-threshold concentrations of PEA, MCS subjects reported significantly more trigeminal symptoms and lower aesthetic ratings for the substance. No group differences were found in response to supra-threshold concentrations of PYR.
Journal of Occupational and Environmental Medicine, June 2000, Vol.42, No.6, p.629-638. Illus. 28 ref.

CIS 03-310 Wang X.R., Christiani D.C.
Respiratory symptoms and functional status in workers exposed to silica, asbestos and coal mine dusts
Respiratory symptoms and lung function were studied in 220 silica, 227 asbestos and 551 coal mining workers. Data included responses to questionnaires, results of pulmonary function tests and chest radiographs. Significantly poorer pulmonary function and a higher prevalence of dyspnoea and chronic cough were observed in workers with pneumoconiosis, irrespective of dust type. Workers with stages II and III silicosis had worse pulmonary function and more symptoms than workers with equivalent coal workers' pneumoconiosis or asbestosis. Reductions in single-breath diffusing capacity for carbon monoxide (DLCO) and the occurrence of respiratory symptoms were associated with increasing stages of silicosis, asbestosis and coal workers' pneumoconiosis. Despite the difference in degree and pattern of exposure to different fibrogenic dusts, respiratory impairments of all of the workers were associated with the presence and progression of parenchymal fibrosis and smoking.
Journal of Occupational and Environmental Medicine, Nov. 2000, Vol.42, No.11, p.1076-1084. Illus. 34 ref.

CIS 03-312 Sobaszek A., Boulenguez C., Frimat P., Robin H., Haguenoer J.M., Edme J.L.
Acute respiratory effects of exposure to stainless steel and mild steel welding fumes
This study examined the acute respiratory effects of welding fumes by measuring the across-shift changes in a population of 144 stainless steel (SS) and mild steel (MS) welders and 223 controls. Pulmonary function tests were performed at the start and at the end of the work shift. Higher decreases in forced vital capacity (FVC) and in one-second forced expiratory volume (FEV1) were found among SS workers compared to MS welding. Moreover, the across-shift decreases in FEV1 and FVC, were more apparent for the manual metal arc welding process compared to inert gas techniques. It was also found that the years of SS welding exposure had an effect on lung function variations during the work shift. SS welders with 20 years of activity had more significant across-shift decreases than MS welders with a similar length of exposure.
Journal of Occupational and Environmental Medicine, Sep. 2000, Vol.42, No.9, p.923-931. 36 ref.

CIS 02-1772
Gruppo di lavoro per la sorveglianza del mesotelioma in Romagna
Analysis of occupational exposure to asbestos in cases of mesothelioma registered in Romagna (1986-1998)
Analisi dell'esposizione professionale ad asbesto dei casi di mesotelioma registrati in Romagna - 1986-1998 [in Italian]
Among 125 cases of mesothelioma of the pleura, peritoneum and pericardium registered in the Romagna region (Italy) between 1986 and 1998, adequate information was obtained for 122 subjects with past occupational exposure to asbestos. The male/female ratio was 81/41. The median age was 68 years and pleural location accounted for 96 cases. Time period, residence, kind of diagnosis, information about family relations and smoking habits exerted no independent effect. Occupational exposure occurred in a total of 22 different kind of workplaces.
Medicina del lavoro, Nov.-Dec. 2000, Vol.91, No.6, p.575-586. 44 ref.

CIS 02-1648 Ascoli V., Fantini F., Carnovale-Scalzo C., Blasetti F., Bruno C., Di Domenicantonio R., Lo Presti E., Pasetto R., Nardi F., Comba P.
Malignant mesothelioma in the industrial area of Colleferro
Mesotelioma maligno nel comprensorio industriale di Colleferro [in Italian]
The occurrence of pleural and peritoneal malignant mesothelioma among workers in a large chemical plant near Rome in Italy is analysed. The plant produces organic chemicals, acid mixtures, insecticides and explosives. It is also involved in the manufacturing of rail rolling stock. Asbestos was extensively used in the past. Hospital records reveal 18 cases of malignant mesothelioma (pleural/peritoneal ratio of 2.75:1) among workers and/or residents. In the area surrounding the same chemical plant the incidence of confirmed mesothelioma per 100,000 is 10.1 among men and 4.1 among women, which are the highest rates reported so far in Italy. Besides confirming the risk of mesothelioma in railroad rolling stock manufacturing and asbestos-insulated pipe maintenance workers, a cluster of malignant mesothelioma is also identified in explosives production workers.
Medicina del lavoro, Nov.-Dec. 2000, Vol.91, No.6, p.547-564. 32 ref.

CIS 02-1813 Demers P.A., Teschke K., Davies H.W., Kennedy S.M., Leung V.
Exposure to dust, resin acids, and monoterpenes in softwood lumber mills
The objective of this study was to assess exposure to potential respiratory hazards in a large lumber mill processing spruce, pine and fir. Personal samples of inhalable particulate were collected to measure exposure to dust and resin acids (abietic acid and pimaric acid). Passive dosimeters were used to measure exposure to α-pinene, β-pinene, Δ3-carene and other unidentified wood volatiles believed to be monoterpenes. The mean concentration of inhalable particulates was 1.0mg/m3 whereas the mean abietic acid, pimaric acid and estimated wood dust levels were 7.2µg/m3, 0.6µg/m3 and 0.5mg/m3, respectively. The mean values of the monoterpene samples were 0.1mg/m3 for α-pinene, 0.3mg/m3 for β-pinene, 0.1mg/m3 for Δ3-carene and 0.5mg/m3 for the unidentified wood volatiles. Monoterpene exposures were much lower than those observed in other studies conducted in Sweden and Finland. The results highlight the importance of considering the content of airborne particulates in lumber mills as well as potential exposure to wood chemicals.
AIHA Journal, July-Aug. 2000, Vol.61, No.4, p.521-528. Illus. 40 ref.

CIS 02-1247 Moulin J.J., Clavel T., Roy D., Dananché B., Marquis N., Févotte J., Fontana J.M.
Risk of bronchopulmonary cancer in a stainless and alloyed steels plant
Risques de cancers bronchopulmonaires dans une usine sidérurgique produisant des aciers inoxydables et des aciers alliés [in French]
The mortality of workers involved in the production of stainless and alloyed steel in France from 1968 to 1992 was studied. The study design was a historical cohort mortality study and a nested case-control study concerning lung cancer. Relative risk was expressed in the form of standardized mortality ratios (SMRs). Conditional logistic regression was used to estimate odds ratios (ORs). The cohort comprised 4,288 male and 609 female workers. The observed overall mortality was significantly lower than expected (649 deaths; SMR = 0.91). No significant SMR was observed for mortality from bronchopulmonary cancer (54 deaths; SMR = 1.19). The case-control study was based on 54 cases and 162 individually matched controls. No bronchopulmonary cancer excess was observed for exposure to iron (OR = 0.94), chromium and/or nickel (OR = 1.18), cobalt (OR = 0.64), acid mists (OR = 0.43) and asbestos (OR = 1.00). However, high and statistically significant bronchopulmonary cancer excesses were observed for exposure to polycyclic aromatic hydrocarbons (PAHs) and silica which are often found together in workplaces, the ORs being 1.95 and 2.47 respectively.
Cahiers de notes documentaires - Hygiène et sécurité du travail, 3rd Quarter 2000, No.180, p.49-59. 49 ref.

CIS 02-1238 Alkhuja S., Miller A., Mastellone A.J., Markowitz S.
Malignant pleural mesothelioma presenting as spontaneous pneumothorax: A case series and review
Malignant pleural mesothelioma (MPM) is thought to arise from the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath, and it rarely presents as spontaneous pneumothorax. Case reports of four patients who presented in this manner are included. Three of the patients were exposed to asbestos directly or indirectly at shipyards during World War II; the fourth was exposed as an insulator's wife. Two of our cases were not recognized to have MPM on histological examination at first thoracotomy and remained asymptomatic for 12 and 22 months, respectively. In none of the patients was spontaneous pneumothorax the cause of death. Since many people were exposed to asbestos during and after World War II, spontaneous pneumothorax in a patient with the possibility of such exposure should raise the suspicion of malignant pleural mesothelioma.
American Journal of Industrial Medicine, Aug. 2000, Vol.38, No.2, p.219-223. Illus. 29 ref.

CIS 02-1343 van Kampen V., Merget R., Baur X.
Occupational airway sensitizers: A review on the respective literature
This article consists of a literature review on the topic of allergic occupational asthma. Papers were selected according to criteria of study design and diagnostic test methods. Approximately 300 publications were reviewed including both epidemiological studies and individual case reports. Technical directives on hazardous substances are enforced in several countries and are being continuously updated; in particular, the European Union has established a code for several occupational substances, now labelled R 42 ("may cause sensitization by inhalation"). The most common sensitizing substances causing occupational asthma were dust of cereal flours, enzymes, natural rubber latex, laboratory animals as well as low molecular substances such as isocyanates and acid anhydrides. A table which lists threshold limit values (TLV), R 42 labelling requirements and a summary of clinical data for 250 airway-sensitizing substances is included.
American Journal of Industrial Medicine, Aug. 2000, Vol.38, No.2, p.164-218. 292 ref.

CIS 02-1237 Henneberger P.K., Metayer C., Layne L.A., Althouse R.
Nonfatal work-related inhalations: Surveillance data from hospital emergency departments, 1995-1996
National Electronic Injury Surveillance System (NEISS) data from hospital emergency rooms in the USA were used to estimate the number of nonfatal work-related inhalation injuries and illnesses from July 1995 to July 1996. There were an estimated 44,423 occupational inhalation cases nationwide, with an annual rate of 3.6 cases/104 workers/year The rate for men (4.4 cases/104) was greater than that observed for women (2.6 cases/104), and the rates tended to decline with increasing age. An estimated 4.6% of the cases were hospitalized for further treatment. The highest rate by industry was 16.4 cases/104 for public administration (which included fire and police departments). Among non firefighters, there were an estimated 6,470 cases nationwide in which respiratory symptoms or conditions were noted, which yielded an annual rate of 0.5 cases/104. Chlorine compounds were a common agent for the cases with adverse respiratory outcomes. It is concluded that the NEISS data provides an efficient method for assessing the national frequency of work-related inhalation injuries and illnesses.
American Journal of Industrial Medicine, Aug. 2000, Vol.38, No.2, p.140-148. 36 ref.

CIS 02-1236 Gibb H.J., Lees P.S.J., Pinsky P.F., Rooney B.C.
Lung cancer among workers in chromium chemical production
To assess the risk of lung cancer among chromate production workers, a cohort of 2,357 workers first employed between 1950 and 1974 at a chromate production plant was identified. Work histories of cohort members were compiled from the beginning of employment through 1985, the year the plant closed. Vital status of the workers was followed until 1992. Annual average exposure estimates, based on historical exposure measurements, were made for each job title in the plant for the years 1950-1985. These exposure estimates were used to calculate the cumulative hexavalent chromium exposure of each subject of the study population. Following closure of the plant, settled dust samples were collected, analysed, and used to estimate cumulative chromium exposure for each individual in the study cohort. It was found that cumulative hexavalent chromium exposure was associated with an increased lung cancer risk, while cumulative trivalent chromium exposure was not. The excess risk of lung cancer associated with cumulative hexavalent chromium exposure was not confounded by smoking status.
American Journal of Industrial Medicine, Aug. 2000, Vol.38, No.2, p.115-126. Illus. 24 ref.

CIS 02-1157 Occupational lung diseases
Contents of this information leaflet on occupational lung diseases: occupational asthma; asbestos-related lung diseases (asbestosis, lung cancer; malignant mesothelioma); silicosis; chemical pneumonitis; hard metal lung disease; byssinosis; preventive measures (substitution of asbestos, engineering controls, personal protection); applicable legislation in Singapore.
Ministry of Manpower, Occupational Health Department, 18 Havelock Road #05-01, Singapore 059764, Republic of Singapore, [c2000]. 8p. Illus.

CIS 02-1450 Hole A.M., Draper A., Jolliffe G., Cullinan P., Jones M., Taylor A.J.N.
Occupational asthma caused by bacillary amylase used in the detergent industry
Four cases are reported of occupational asthma due to an enzyme (amylase), used in detergent washing powders. All four employees (men) were from the same factory and developed symptoms that improved during periods away from work. All undertook serial allergy tests and specific bronchial provocation testing. These patients developed occupational asthma despite working only with encapsulated enzymes in the detergent washing powders.
Occupational and Environmental Medicine, Dec. 2000, Vol.57, No.12, p.840-842. Illus. 7 ref.

CIS 02-1327 De Zotti R., Muran A., Zambon F.
Two cases of paraoccupational asthma due to toluene diisocyanate (TDI)
A report of two cases of paraoccupational asthma caused by tolylene diisocyanate (TDI). The first patient was a metal worker with previous occasional work in an adjacent polyurethane factory. A specific inhalation (SIC) test, performed with TDI, confirmed the diagnosis of TDI asthma. The second case was a woman working part time in the offices of a factory for varnishing wooden chairs. TDI was present in the products used. The inhalation test confirmed the diagnosis of TDI asthma, despite the fact that the patient's current job did not present risk of exposure to the substance. These two cases suggest the need for more studies evaluating the health risk for the general population living near polyurethane factories or other firms that use TDI.
Occupational and Environmental Medicine, Dec. 2000, Vol.57, No.12, p.837-839. Illus. 9 ref.

CIS 02-1326 Meredith S.K., Bugler J., Clark R.L.
Isocyanate exposure and occupational asthma: A case-referent study
Case study of 34 workers from two British manufacturing companies. In one plant occupational asthma was mainly attributed to tolylene diisocyanate exposure, while in the other one to 4,4'-diphenylmethane diisocyanate. No difference in peak exposures between cases and referents was found in either plant. However, time weighted average (TWA) exposures at the time of onset of asthma were higher for cases. The findings were that asthma can occur at low concentrations of isocyanates, but even then the higher the exposure, the greater the risk. Smoking and atopy seemed to increase the odds of this occupational asthma due to isocyanates.
Occupational and Environmental Medicine, Dec. 2000, Vol.57, No.12, p.830-836. 25 ref.

CIS 02-1233 McDonald J.C., Keynes H.L., Meredith S.K.
Reported incidence of occupational asthma in the United Kingdom, 1989-97
A report of the 9 years of the Surveillance of Work Related and Occupational Respiratory Disease data. This scheme was based on reports of chest and occupational physicians during the 9 years 1989-97. An estimated 25,674 new cases of occupational respiratory disease, including 7,387 of occupational asthma, were reported. A third of the suspected causes of asthma were organic, a third chemical, 6% metallic and the rest miscellaneous, or unknown. Incidences were higher in men than women. The lowest risk group was that of professional, clerical, and service workers, the highest risk group was that of coach and other spray painters. The conclusion is that there is certainly more occupational asthma in the population than that which reaches specialists; therefore the incidence rates presented here are to be considered as underestimates.
Occupational and Environmental Medicine, Dec. 2000, Vol.57, No.12, p.823-829. Illus. 24 ref.

CIS 02-719 Wild P., Perdrix A., Romazini S., Moulin J.J., Pellet F.
Lung cancer mortality in a site producing hard metals
The mortality from lung cancer from exposures to hard metal dust was examined in a historical cohort of all subjects who had worked for at least 3 months on an industrial site producing hard metals and followed up from January 1968 to December 1992. Mortality from lung cancer was significantly increased among men and was higher than expected in hard metal production before sintering, whereas after sintering it was lower. The excess mortality from lung cancer occurred in subjects exposed to unsintered hard metal dust and could not be attributed to smoking.
Occupational and Environmental Medicine, Aug. 2000, Vol.57, No.8, p.568-573. 15 ref.

CIS 02-374 Rosenberg N.
Occupational asthma from disinfectants used in hospitals
Asthme professionnel dû aux désinfectants employés en milieu hospitalier [in French]
Contents of this data sheet on occupational allergies and chest diseases caused by disinfectants used in hospitals: physiopathology; prevalence; diagnosis at the place of work; confirmation of diagnosis in a specialised medical institution; evolution; prevention; compensation of occupational diseases.
Documents pour le médecin du travail, 4rth Quarter 2000, No.84, p.435-443. 50 ref.

CIS 02-180 Benhamou S., Demenais F., Dupret J.M., Haguenoer J.M., Leszkowicz A., Stucker I.
Genetic susceptibility and occupational exposure
Susceptibilités génétiques et expositions professionnelles [in French]
This literature survey of the importance of genetic factors in the individual susceptibility to diseases caused by exposure at the workplace, in particular asthma and cancer, is based on scientific data available during the first half of the year 2000. Approximately 300 articles were reviewed. Contents include: enzymes of the metabolism of chemical carcinogenic chemicals, and their genetic polymorphisms; metabolism of the most common carcinogenic chemicals; polymorphisms of xenobiotic enzymes and tobacco-related cancers; gene-environment interactions in cancers caused by occupational factors; susceptibility factors for asthma.
Documents pour le médecin du travail, 3rd Quarter 2000, No.83, p.249-258. Illus.

CIS 02-179 Bohadana A.B., Massin N., Wild P., Toamain J.P., Engel S., Goutet P.
Respiratory symptoms, bronchial reactivity and occupational exposure to oak and beech dust
Symptômes respiratoires, réactivité bronchique et exposition professionnelle aux poussières de chêne et de hêtre [in French]
The objective of the study was to investigate the relationship between levels of cumulative exposure to wood dust on one hand, and respiratory symptoms and onset of bronchial hyperreactivity (BHR) among oak and beech wood workers on the other. 114 men working in furniture manufacture exposed to wood dust were selected to participate in the study, together with 14 non-exposed controls and 200 "historical" controls, for whom data from earlier studies were available. Dust concentrations were measured in working air by personal sampling. Lung functions and bronchial hyperreactivity were tested, and medical history data were collected by means of a questionnaire. Results show what exposure levels are generally high, largely exceeding the average exposure limits of 1mg/m3 applied in France and proposed by the ACGIH. Among subjects exposed to oak and beech dust, the prevalence of laryngeal irritation and metacholine BHR increase rapidly with cumulative exposure.
Documents pour le médecin du travail, 3rd Quarter 2000, No.83, p.241-248. 33 ref.

CIS 02-403 Wiethege T., Wesch H., Müller K.M.
Radon - An irradiating subject: Data and facts by the pathologist
Radon - ein strahlendes Thema: Daten und Fakten des Pathologen [in German]
The aim of this study was assess the risk for the development of tumors induced by natural radiation sources such as radon. The preliminary results from a total of 17,466 autopsies performed on uranium miners of the former German Democratic Republic reveal that lung cancer mortality was significantly higher than in the normal population. Among miners who died between 1957 and 1965, a high rate of deaths due to small-cell carcinoma was observed. This rate dropped steadily between 1965 and 1990. Determinations of uranium, silica and arsenic in pulmonary tissue yielded high concentrations in some cases. The final results, including the assessment of the relationship between radon exposure and lung cancer mortality, are not yet available and will be published later.
Atemwegs- und Lungenkrankheiten, Dec. 2000, Vol.26, No.12, p.617-624. Illus. 20 ref.

CIS 02-296 Laforest L., Luce D., Goldberg P., Bégin D., Guérin M., Demers P.A., Brugère J., Leclerc A.
Laryngeal and hypopharyngeal cancers and occupational exposure to formaldehyde and various dusts: A case-control study in France
To assess possible associations between occupational exposures and squamous cell carcinomas of the larynx and hypopharynx, a case-control study was carried out on 201 cases with hypopharyngeal cancers, 296 cases with laryngeal cancers and 296 controls (patients with other tumour sites). Detailed information on smoking, alcohol consumption, and lifetime occupational history was collected. Occupational exposure to formaldehyde, leather dust, wood dust, flour dust, coal dust, silica dust and textile dust was assessed with a job exposure matrix. Hypopharyngeal cancer was found to be associated with exposure to coal dust (odds ratio (OR) 2.31), with a significant rise in risk with probability and level of exposure. Exposure to coal dust was also associated with an increased risk of laryngeal cancer (OR 1.67). A significant relation, limited to hypopharyngeal cancer, was found with the probability of exposure to formaldehyde, with a fourfold risk for the highest category (OR 3.78).
Occupational and Environmental Medicine, Nov. 2000, Vol.57, No.11, p.767-773. 51 ref.

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