To explore the natural course of musculoskeletal disorders during a 5-year period among dental personnel, to survey findings and diagnoses according to a standardized protocol, and to compare and evaluate different methods for the detection of musculoskeletal disorders in a population.
In a 5-year follow-up study, dental personnel (n = 90) and referents (n = 30) were studied. The Nordic questionnaire (years 0 and 5), the present pain rating according to the Borg category ratio scale, and physical examination (year 5) were used.
In year 0 the prevalence of symptoms in the shoulders, the wrists/hands, and, unexpectedly, the hips was higher in the dental personnel as compared with the referents. Furthermore, those (16%) who had left the dental profession during the observation period showed a higher prevalence of and, often, combined symptoms from several body regions in year 0 than did those who stayed. Dental personnel who remained in the profession tended to have an increased risk of developing more symptoms in the shoulders and the elbows/wrists/hands in year 5 as compared with year 0 and at year 5 were in more pain and had received more diagnoses for the neck/shoulder region relative to the referents. Furthermore, there was a considerable variation in symptoms during the follow-up period. The sensitivity of the pain rating and of the Nordic questionnaire in detecting musculoskeletal disorders was high for the neck and shoulders but was not as high for the elbow, wrists/hands, or hips. The association was better for diagnoses than for findings. The opposite patterns were observed for specificity.
Dental personnel had an increased risk of developing musculoskeletal disorders as verified by symptoms and diagnoses and more painful or persistent conditions. This led to a selection out of work. The questionnaire and the present pain rating gave a relatively good picture of the prevalence of musculoskeletal disorders arising from the neck, shoulders, and hips and would be useful as screening tools. Their sensitivity in detecting disorders was higher for diagnoses than for findings. However, these methods were not as sensitive for disorders involving the elbows/wrists/hands. Physical examinations gave more detailed information.
In order to investigate possible effects of exposure to pesticides, mainly fungicides and insecticides, we studied a cohort of 2370 subjects, who, during the period 1965-1982, had been members of a horticulturists' trade association (market gardeners and orchardists). Compared to a regional reference population, total mortality (542 deaths; standardized mortality morbidity ratio, SMR = 0.8; 95% confidence limits, CLs = 0.7, 0.9) and mortality due to malignant tumours (133 deaths, SMR = 0.9; CLs = 0.7, 1.0), and cardiovascular and respiratory deaths were somewhat decreased. Suggestive excesses in mortality were seen for mental disorders and tumours of the stomach, skin and nervous system. The tumours of the nervous system were in particular excess in the young and middle-aged horticulturists (below age 60; six cases, SMR = 2.9; CLs = 1.1, 6.2). During the period 1965-1986, the total tumour morbidity was slightly decreased (255 cases; SMR = 0.9; CLs = 0.8, 1.0), as were gastrointestinal and respiratory tract tumours. The incidence of melanomas was increased (15 cases, SMR = 2.1; CLs = 1.2, 3.5), and tumours of the female genital organs, myelomas, and brain tumours (12 cases, SMR = 1.5; CLs = 0.8, 2.7) were slightly numerically elevated. Brain tumours in the young and middle-aged horticulturists (11 cases, SMR = 3.2; CLs = 1.6, 5.7), including meningiomas (four observed, SMR = 6.8; CLs = 1.9, 17.4), were increased, especially in the period 1975-1979. The mortality and tumour morbidity patterns in gardeners and orchardists, analysed separately, were similar to the patterns in all the horticulturists.(ABSTRACT TRUNCATED AT 250 WORDS)
It has not previously been clear whether cytogenetic biomarkers in healthy subjects will predict cancer. Earlier analyses of a Nordic and an Italian cohort indicated predictivity for chromosomal aberrations (CAS) but not for sister chromatid exchanges (SCES). A pooled analysis of the updated cohorts, forming a joint study base of 5271 subjects, will now be performed, allowing a more solid evaluation. The importance of potential effect modifiers, such as gender, age at testing, and time since testing, will be evaluated using Poisson regression models. Two other potential effect modifiers, occupational exposures and smoking, will be assessed in a case-referent study within the study base.
The cytogenetic endpoints in peripheral blood lymphocytes: chromosomal aberrations (CA), sister chromatid exchange (SCE) and micronuclei (MN) are established biomarkers of exposure for mutagens or carcinogens in the work environment. However, it is not clear whether these biomarkers also may serve as biomarkers for genotoxic effects which will result in an enhanced cancer risk. In order to assess this problem, Nordic and Italian cohorts were established, and preliminary results from these two studies indicated a predictive value of CA frequency for cancer risk, whereas no such associations were observed for SCE or MN. A collaborative study between the Nordic and Italian research groups, will enable a more thorough evaluation of the cancer predictivity of the cytogenetic endpoints. We here report on the establishment of a joint data base comprising 5271 subjects, examined 1965-1988 for at least one cytogenetic biomarker. Totally, 3540 subjects had been examined for CA, 2702 for SCE and 1496 for MN. These cohorts have been followed-up with respect to subsequent cancer mortality or cancer incidence, and the expected values have been calculated from rates derived from the general populations in each country. Stratified cohort analyses will be performed with respect to the levels of the cytogenetic biomarkers. The importance of potential effect modifiers such as gender, age at test, and time since test, will be evaluated using Poisson regression models. The remaining two potential effect modifiers, occupational exposures and smoking, will be assessed in a case-referent study within the study base.
BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs. METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umeå and Malmö in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited. RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one. CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.
Total mercury concentrations (mean +/- standard deviation) in breast milk, blood, and hair samples collected 6 wk after delivery from 30 women who lived in the north of Sweden were 0.6 +/- 0.4 ng/g (3.0 +/- 2.0 nmol/kg), 2.3 +/- 1.0 ng/g (11.5 +/- 5.0 nmol/kg), and 0.28 +/- 0.16 microg/g (1.40 +/- 0.80 micromol/kg), respectively. In milk, an average of 51% of total mercury was in the form of inorganic mercury, whereas in blood an average of only 26% was present in the inorganic form. Total and inorganic mercury levels in blood (r = .55, p = .003; and r = .46, p = .01 6; respectively) and milk (r = .47, p = .01; and r = .45, p = .018; respectively) were correlated with the number of amalgam fillings. The concentrations of total mercury and organic mercury (calculated by subtraction of inorganic mercury from total mercury) in blood (r = .59, p = .0006, and r = .56, p = .001; respectively) and total mercury in hair (r = .52, p = .006) were correlated with the estimated recent exposure to methylmercury via intake of fish. There was no significant between the milk levels of mercury in any chemical form and the estimated methylmercury intake. A significant correlation was found between levels of total mercury in blood and in milk (r = .66, p = .0001), with milk levels being an average of 27% of the blood levels. There was an association between inorganic mercury in blood and milk (r = .96, p
Acid precipitation affects the solubility of several metals in aquatic systems and in soil. Cadmium levels in tap water samples from geological areas having low resistance to acidic pollution were significantly higher than those in samples from a neighbouring reference area where there was a different geological structure. The median cadmium levels and pH values were 0.14 microgram l-1 and 5.6 respectively, for the acidic areas compared with 0.07 microgram l-1 and 6.4 respectively for the reference area. Further, there was a significant inverse relationship between both cadmium and lead contents and the pH values of the samples. The mobility of the metals was thus dependent on the acidity. The blood lead levels in 195 subjects from the acidic areas were lower than those in 91 subjects from the reference area (medians 60 vs. 70 micrograms l-1); no significant differences were found in blood cadmium or blood mercury levels. Subjects in the acidic areas had lower plasma selenium levels than those from the reference area (medians 85 vs. 90 micrograms l-1); the difference was mainly attributed to subjects with private wells. The data may indicate a negative effect of the acidic pollution on selenium intake via water and/or foods. There was also a positive relationship between intake of fish on the one hand and blood mercury and plasma selenium on the other, which is in accordance with the role of fish as a source of these metals.
Samples of vertebral bone were obtained by skeletal biopsy and lead concentrations were determined by atomic absorption spectroscopy. The median level of lead in bone in 27 active lead workers was 29 micrograms/g wet weight (range 2-155), corresponding to 370 micrograms/g calcium (range 30-1,120). In 9 retired workers, the corresponding levels were 19 micrograms/g (5-76) and 250 micrograms/g calcium (60-700); in 14 reference subjects without occupational exposure, 1.3 micrograms/g (1-4) and 13 micrograms/g calcium (8-40). The bone lead content rose with time of exposure. Comparison of levels in vertebra with those in fingerbone, as measured by in vivo x-ray fluorescence in the same subjects, strongly suggested the presence of lead pools with different kinetics. The accumulation pattern, as well as the relation between levels in vertebra and fingerbone, suggests a much shorter half-time of lead in the mainly trabecular vertebral bone as compared to the mainly cortical fingerbone. Further, there was an association between vertebral and blood lead levels in the retired workers, which shows a considerable endogenous lead exposure from the skeletal pool.
OBJECTIVES: The sensitizing properties of organic acid anhydrides (OAA) were evaluated in a rat model. METHODS: The development of specific immunoglobulin (Ig)E and Ig G in serum was investigated after immunization with 14 OAA and 3 OAA conjugates. Brown Norway rats were injected intradermally with 0.1 ml of 0.2 M OAA in liquid paraffin or 1.4 mg of rat serum albumin conjugate in saline. Serum samples were collected after 4 weeks. Antibodies were analyzed with enzyme-linked immunosorbent assay. RESULTS: The serum titers of specific Ig E after immunization with the different free OAA varied from
Higher air lead levels (time-weighted average 660, range 112-2238 micrograms/m3) were measured in firing ranges where powder charges were employed than in ranges where air guns were used (4.6, range 1.8-7.2 micrograms/m3); levels in the latter were in turn higher than those in ranges used for archery (0.11, range 0.10-0.13 micrograms/m3). Twenty-two marksmen who used powder charges had significantly increased blood lead levels during the indoor shooting season (before: median 106, range 32-176 micrograms/l; after: 138; range 69-288 micrograms/l; P = 0.0001), while 21 subjects who mainly used air guns displayed no significant increase (before: median 91, range 47-179 micrograms/l; after: 84; range 20-222 micrograms/l). Thirteen archers had significantly lower levels than the pistol shooters before the season (P = 0.006), and showed a significant decrease during the season (before: median 61, range 27-92 micrograms/l; after: 56; range 31-87 micrograms/l; P = 0.04). At the end of the indoor season, there was a significant association between weekly pistol shooting time and blood lead levels.
Twenty-five moderately exposed lead workers (mean blood-lead level 1.9 mumol/l) had lower plasma levels of follicle stimulating hormone than 25 individually matched controls without occupational lead exposure (blood-lead level 0.2 mumol/l). In addition, the ten most heavily exposed individuals had higher levels of thyroid stimulating hormone, and the 14 workers under the age of 40 had decreased plasma levels of luteinizing hormone and serum levels of cortisol, as compared to the controls. All values were within "normal" reference limits. There was no significant change of the plasma testosterone level. These data indicate a complex effect on the endocrine system by moderate lead exposure, possibly mediated by changes at the hypothalamic-pituitary level. Besides the effect on hormone levels, there was also a decrease in plasma selenium level for the lead exposed workers.
An X-ray fluorescence (XRF) technique using plane polarized X-rays for excitation was used for in vivo measurements of cadmium in the kidney cortex among non-occupationally exposed members of the general population in southern Sweden. The measured concentrations of cadmium in the kidney cortex of smokers (median 28 micrograms/g, n = 10) were significantly higher (P = 0.0036) as compared to those in non-smokers (median 8 micrograms/g, n = 10), and so were the cadmium concentrations in blood and urine. The results show that smoking considerably increases the cadmium concentration in the kidney cortex and that smoking is a major source of cadmium exposure in the general population of Sweden. Except in the presence of very deeply situated kidneys, where the minimum detectable concentration is high, non-invasive in vivo XRF analysis of kidney cadmium should be a useful tool for evaluating the effects of long-term low-level exposure to cadmium and the risk of kidney damage.
Urinary mercury (U-Hg) and plasma mercury (P-Hg) levels were higher in 244 dental personnel than in 81 matched referents (U-Hg: 1.8 and 1.1 mumol/mol creatinine, respectively; p less than .001; P-Hg: 6.7 and 6.2 nmol/l, respectively; p = .03). The amalgam in the mouth influenced mercury levels in whole blood (B-Hg), plasma, and urine. The association was nonlinear: the more amalgam, the larger the relative increase in mercury levels. The number of amalgam surfaces accounted for more of the variance in blood and urine mercury levels than did the number of fillings (e.g., U-Hg: 44% and 36%, respectively). The estimated increases in mercury level with rising amalgam load were 3.0%, 2.0%, and 0.8% per filled surface for U-Hg, P-Hg, and B-Hg, respectively (p less than .0001 in all cases). The impact of occupational exposure on U-Hg in the dental personnel corresponded to approximately 19 amalgam surfaces. Ceramo metallic restorations were associated with higher (31%) U-Hg.
Chromosomal aberrations in lymphocytes from peripheral blood were significantly more frequent in six workers from a plant manufacturing polyester resin boats (average 10.8 per 100 cells) than in six age-and sex-matched referents (5.2 per 100 cells). The contamination of the workroom air with styrene, as measured on three occasions within three years in different areas of the plant, was 50--400 mg/m3.
The geometric mean of the blood lead concentrations in 1,781 samples obtained from children during 1978 to 1988 was 46.9 micrograms/l (0.23 mumol/l) (range: 14-250 micrograms/l [0.07-1.2 mumol/l]). There was a significant (p less than .001) decrease in blood lead concentrations of 7%/y in rural and urban areas. In 134 children who were sampled twice, the decrease over 2-y periods was 14%. The striking decrease in blood lead levels is most likely the result of a reduction of lead additives in motor fuel during this period.
OBJECTIVES: This study compares questionnaire-assessed exposure data on work postures and movements with direct technical measurements. METHODS: Inclinometers and goniometers were used to make full workday measurements of 41 office workers and 41 cleaners, stratified for such factors as musculoskeletal complaints. The subjects answered a questionnaire on work postures of the head, back, and upper arms and repeated movements of the arms and hands (3-point scales). The questionnaire had been developed on the basis of a previously validated one. For assessing worktasks and their durations, the subjects kept a 2-week worktask diary. Job exposure was individually calculated by time-weighting the task exposure measurements according to the diary. RESULTS: The agreement between the self-assessed and measured postures and movements was low (kappa = 0.06 for the mean within the occupational groups and kappa = 0.27 for the whole group). Cleaners had a higher measured workload than office workers giving the same questionnaire response. Moreover, the subjects with neck-shoulder complaints rated their exposure to movements as higher than those without complaints but with the same measured mechanical exposure. In addition, these subjects also showed a general tendency to rate their postural exposure as higher. The women rated their exposure higher than the men did. CONCLUSIONS: The questionnaire-assessed exposure data had low validity. For the various response categories the measured exposure depended on occupation. Furthermore, there was a differential misclassification due to musculoskeletal complaints and gender. Thus it seems difficult to construct valid questionnaires on mechanical exposure for establishing generic exposure-response relations in epidemiologic studies, especially cross-sectional ones. Direct technical measurements may be preferable.
Recent reports on concentrations of lead, cadmium, methylmercury, arsenic and nickel in some biological media in populations in the Baltic region are reviewed. In particular, children in parts of Poland, the Czech Republic, and Germany have uptakes of lead sufficient to cause adverse effects on the central nervous system and kidneys. Cadmium exposure is also high in Poland. Slight cadmium-induced effects on the kidneys have been reported from Germany and Sweden. Methylmercury uptake is dependent upon the intake of fish, in particular from contaminated lakes and rivers in Sweden and Finland, as well as the eastern coast of the Baltic Sea. There are some indications of immunotoxic effects associated with the intake of such fish. However, fish also contain other immunomodulating agents. Exposure to arsenic seems to be low everywhere in the Baltic region. There is high nickel exposure in northern Russia.
Fatty fish species, e.g., salmon and herring, in the Baltic Sea have high levels of polychlorinated biphenyls (PCBs) and 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT), and its main metabolite: 1,1-dichloro-2,2-bis(p-chlorophenyl)-ethylene (p,p'-DDE). We determined levels of 10 different PCB congeners, including non- and mono-ortho-PCBs, as well as DDT and DDE, in human blood plasma from 37 subjects with varying intake of fish (0-1 750 g/wk) from the Baltic Sea. With respect to all of the PCB congeners we investigated, as well as for DDT and DDE, there were statistically significant associations with fish intake. Thus, fish from the Baltic Sea is a major source of exposure to these compounds in Swedes. Polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDF) had been determined earlier in 29 of the subjects. The PCB contribution to "dioxin-like" effects among high consumers of fish (calculated as Nordic TCDD equivalents) was almost 80%, whereas that from PCDD and PCDF was only 20%.