Are safety data sheets for cleaning products used in Norway a factor contributing to the risk of workers exposure to chemicals?

Objectives

Cleaning products are considered less hazardous than those used in other sectors. Suppliers and distributors are less conscientious when it comes to informing users on health risks. The aim of the study was to elaborate on the usefulness and clarity of information in the safety data sheets (SDS) for cleaning products, and considering if the use of these SDSs can be seen as a risk factor towards occupational exposure to hazardous chemicals in the sector.

Material and Methods

Safety data sheets were selected based on the risk level of the product assigned in an industrial sector scheme. 320 SDSs for cleaning products were reviewed. Constituent components found in the products over a given threshold were listed and available information thereof used to assess the perceived non-hazard consideration of the chemicals.

Results

The contents of the SDSs was generic and mostly incomplete. Safety measures and health information lacked sufficient specificity despite varying compositions and concentrations of components. There is generally incompatibility between mentioned sections on the suggested non-hazardous nature of the products and health effects. Not all substances used in these products have harmonized classifications, which makes them open to various classification of the products and the suggested safety measures. This results in different companies classifying similar products differently. Risk management measures and suggested personal protective equipment (PPEs) are given haphazardly. Physical properties relevant to risk assessment are not included.

Conclusions

The safety data sheets are ambiguous, and they lack relevant and important information. Inadequate information and risk assessment concerning the products can lead to workers being exposed to hazardous chemicals. Underestimation of the hazard contribution of the components of the products and the insufficient, non-objective mention of appropriate control and protective measures are the major contributing elements. There is a need to test the products in order to establish health effects and product specific safety measures.     

Are current species extrapolation models a good basis for ecological risk assessment?

Extrapolating the effects of toxicants with either the fixed application factor approach or one of the species sensitivity distribution models currently in widespread use presumes that toxicant effects on single, individual-level endpoints (e.g., survival, fecundity, and growth) reflect effects at the population level. Here, we consider if extrapolations derived on the basis of individual-level endpoints might be misleading with regard to risk assessment and, hence, risk management decisions for ecosystems. Both analytically and by simulation, we demonstrate that for populations with multiplication rates close to one, effects of toxicants at the population level likely are less than or equal to effects on individual life-cycle traits, suggesting that risk assessments based on the latter likely are protective of population-level impacts. We used Monte Carlo simulations to explore how both the frequency of different life-cycle types in a community as well as their relative sensitivity to toxicants influence the toxicant sensitivity distribution of the community as a whole. We compared the output of our simulations with predicted no-effect concentrations derived by an application factor approach and a log-normal distribution-based model, using no-observed-effect concentrations for juvenile survival as input variables in both cases. Our analyses suggest that current extrapolation approaches appear to be protective, and may often be very overprotective, but we have identified conditions in which this may not be the case. We recommend that additional consideration be given to the relative frequency of different life-cycle types, to the proportions of sensitive and insensitive taxonomic groups in communities, and to the role of density-dependent influences on population dynamics to ensure that we develop environmental quality criteria that are sufficiently--but not overly--protective.     

Are community health workers cost-effective for childhood vaccination in India?

IntroductionAccredited Social Health Activists (ASHAs) are female community health workers whose primary role is to promote utilization of primary healthcare services and improve sanitation in rural areas and are financially incentivized for services provided. Prior studies evaluating ASHAs have been largely qualitative, and assess their knowledge, skills, and practice. Globally, there have been very few studies that have quantitatively assessed community health workers. We analyzed the cost effectiveness of ASHAs in facilitating measles vaccination among children under 5 years during 2012–2013.MethodsWe utilized Markov modeling simulating a cohort of children in villages with and without ASHAs. We extrapolated the health states to a lifetime of 68 years to estimate the effects of ASHA intervention. Measles vaccination rates were obtained from 2013 District Level Household and Facilities Survey 4. Other parameter estimates were obtained from a review of relevant literature.ResultsASHA intervention was highly cost effective at $162 per DALY averted compared to no ASHA and remained cost effective with the ASHA incentive increased from $2 to $15, across the range of probabilities and cost parameters. Analyses were sensitive to probability of death due to childhood pneumonia, susceptibility to measles after one dose measles vaccine, and probability of pneumonia after measles infection.ConclusionASHAs were cost-effective under a wide range of scenarios even when a single health outcome such as measles vaccination was considered. The Government of India and individual state governments of India should consider increasing the incentives provided to ASHAs.     

Are informal carers and community care workers effective in managing malnutrition in the older adult community? A systematic review of current evidence

Background

Enhancing the effectiveness of the community and aged care workforce to prevent malnutrition and functional decline is important in reducing hospital and aged care facility demand.

Objective

To investigate the impact of nutrition-related interventions delivered to or by informal carers and non-clinical community care workers on malnutrition-related health outcomes of community-dwelling older adults (≥65years).

Methods

Intervention studies were searched for using six electronic databases for English-language publications from January 1980 to 30 May 2012.

Results

Nine studies were eligible for inclusion. The strength and quality of the evidence was moderate (six studies with level II intervention evidence, five with positive quality). Types of interventions used were highly varied. The majority of interventions were delivered to informal carers (6 studies), with three of these studies also involving older adult care recipients. Five interventions were targeted at identifying, preventing and/or treating malnutrition specifically (two positive quality, three neutral quality, n=2368). As a result of these interventions, nutritional status improved or stabilized (two positive quality, two neutral quality, n=2333). No study reported an improvement in functional status but two successfully prevented further decline in their participants (two neutral quality, n=1097).

Conclusion

Interventions targeted at identifying, preventing and/or treating malnutrition were able to improve or prevent decline in nutritional and functional status, without increasing informal carer burden. The findings of this review support the involvement of non-clinical community care workers and informal carers as part of the nutritional care team for community-dwelling older adults.     

Environmental risk assessment of six human pharmaceuticals: are the current environmental risk assessment procedures sufficient for the protection of the aquatic environment?

In this study, exposure and ecotoxicity data of six human pharmaceuticals (carbamazepine, clofibric acid, diclofenac, ofloxacin, propranolol, and sulfamethoxazole) were collected, including our own experimental data and literature data. From this data collection, the two-tiered European draft guideline on the environmental risk assessment of human pharmaceuticals was tested. Measured environmental concentrations in effluents from France and in effluents and surface waters from Germany were compared to the predicted environmental concentrations (PECs) in both countries. In a similar manner, predicted no-effect concentrations (PNECs) derived from acute data and PNECs derived from chronic data were estimated for each pharmaceutical and corresponding PEC/PNEC ratios then were compared in both countries. Globally, results demonstrated that all environmental concentrations (predicted or measured) for each considered pharmaceutical exceeded the 10-ng/L cutoff value, which requires the implementation of the second-tier assessment based on ecotoxicity data. Moreover, the six pharmaceuticals showed a relatively limited acute toxicity, and carbamazepine and propranolol were inaccurately identified as having negligible risks under the current European draft procedure. Such results lead to discussion of the actual procedure on pharmaceuticals, especially on the need of appropriate ecotoxicity tests.     

Characterization of α-cypermethrin exposure in Egyptian agricultural workers

Pyrethroids are neurotoxic insecticides that exert their effects by prolonging the open time of sodium channels, which increases the duration of neuronal excitation. α-cypermethrin (αCM) is derived from the 8-stereoisomers that together make up the pyrethroid cypermethrin, which is one of the most common pyrethroids being used in agriculture throughout the world. The objective of this study was to characterize the occupational exposure to αCM in a cohort of Egyptian agriculture workers (n = 37) before, during and after 6–10 consecutive days of application of αCM to cotton fields. Daily spot urine specimens were collected and analyzed by GC-MS NCI for the αCM metabolites 3-phenoxybenzoic acid (3-PBA) and cis-3-(2′,2′-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (cis-DCCA). Prior to αCM application, median urinary levels of 3-PBA (4.59 nmol/g creatinine) were greater than cis-DCCA (0.33 nmole/g creatinine) demonstrating low background exposures to pyrethroids. During the application period for αCM, median urinary levels of both biomarkers increased (13.44 nmol 3-PBA/g creatinine and 7.76 nmol cis-DCCA/g creatinine) and ranged from 2.3–93.96 nmol 3-PBA/g creatinine and 0.09–90.94 nmol cis-DCCA/g creatinine, demonstrating that workers had a wide range of exposures to αCM. The data also demonstrate that pesticide applicators had greater exposures to αCM than workers who play a supporting role in the seasonal application of pesticides on the cotton crop. Urinary cis-DCCA and 3-PBA concentrations were elevated at 7–11 days after the cessation of αCM application, compared to baseline levels. This study is the first to use these biomarkers to quantify occupational exposures specifically to αCM. This urinary biomarker data will be useful for estimating daily internal dose, comparing exposures across job categories within the Egyptian pesticide application teams, and for modeling human exposures to αCM.     

Are current definitions of sarcopenia applicable for older Chinese adults?

This study aims to explore whether the current definitions of sarcopenia are applicable to the older Chinese population. Participants were 783 Chinese adults recruited from four regions in Mainland China: Jinan, Guangzhou, Xi’an, and Chengdu. Body composition was measured by dual energy x-ray absorptiometry. Handgrip strength, body weight, and height were measured by trained technicians, and demographic data were collected through questionnaires. Relative appendicular skeletal muscle, skeletal muscle index (SMI=100 × skeletal muscle mass/body mass) and residuals methods were applied to identify sarcopenia. Compared with young adults, no significant decrease was found in the relative appendicular skeletal muscle (ASM/height²) in older adults. If the criterion of two standard deviations below the mean value of ASM/height² in young adults is used, none of older adults in this study could be diagnosed with sarcopenia. In addition, compared with the ASM/height² and residuals methods, SMI shows higher discriminating power in the identifying persons with low handgrip strength. The data suggest that ASM/height² method may not be appropriate for diagnosis of sarcopenia in Chinese population. However, whether SMI is a better choice remains inconclusive. Prospective studies are needed to clearly define sarcopenia in Chinese population.     

Are tick medications pesticides? Implications for health and risk perception for workers in the dairy cattle sector

This article seeks to characterize the risks related to the use of pesticides in dairy production, in terms of legislation, health and perception of risk for workers involved in this activity. It is based on methodological articulation that included: a) systematic review of the reference literature on the research topic; b) analysis of related legislation (veterinary products and pesticides); c) risk identification regarding the use of veterinary products formulated using active ingredients listed as pesticides; d) and risk perception analysis of a group of dairy production workers. Results indicate a situation of particular interest to Public Health. Regarding dairy production workers, the invisibility of risks associated with handling pesticides for veterinary use, increases their exposure and is related to several health problems, especially for women. This same invisibility leads to a neglect of the prohibition period between pesticide use and consumption of other products. Part of the problem may be associated with the non-classification of pesticides for veterinary use as 'pesticides' (they are classified as veterinary products), which highlights the importance and the urgency of discussion of the theme.     

Low-level environmental lead exposure and intellectual impairment in children — The current concepts of risk assessment

Lead is an environmental contaminant. The majority of epidemiological research on the health effects of lead has been focused on children, because they are more vulnerable to lead than adults. In children, an elevated blood lead (B-Pb) is associated with reduced Intelligence Quotient (IQ) score. This paper summarizes the current opinions on the assessment of the health risk connected with the children’s environmental exposure to lead. The B-Pb level of concern of 100 μg/l proposed by the US Centers of Disease Control in 1991 was for a long time accepted as the guideline value. In the meantime there has been a significant worldwide decrease of B-Pb levels in children and present geometric mean values in the European countries range from 20 to 30 μg/l. The recent analyses of the association of intelligence test scores and B-Pb levels have revealed that the steepest declines in IQ occur at blood levels < 100 μg/l and that no threshold below which lead does not cause neurodevelopmental toxicity can be defended. European Food Safety Authority (EFSA) concluded in 2010, on the basis of results of Benchmark Dose (BMD) analysis, that an increase in B-Pb of 12 μg/l (BMDL01) could decrease the IQ score by one point. It seems that this value can be used as a “unit risk” to calculate the possible decrease of IQ and, consequently, influence of the low-level exposure to lead (< 100 μg/l) on the health and socioeconomic status of the exposed population.     

How reliable and robust are current biomarkers for copper status?

Cu is an essential nutrient for man, but can be toxic if intakes are too high. In sensitive populations, marginal over- or under-exposure can have detrimental effects. Malnourished children, the elderly, and pregnant or lactating females may be susceptible for Cu deficiency. Cu status and exposure in the population can currently not be easily measured, as neither plasma Cu nor plasma cuproenzymes reflect Cu status precisely. Some blood markers (such as ceruloplasmin) indicate severe Cu depletion, but do not inversely respond to Cu excess, and are not suitable to indicate marginal states. A biomarker of Cu is needed that is sensitive to small changes in Cu status, and that responds to Cu excess as well as deficiency. Such a marker will aid in monitoring Cu status in large populations, and will help to avoid chronic health effects (for example, liver damage in chronic toxicity, osteoporosis, loss of collagen stability, or increased susceptibility to infections in deficiency). The advent of high-throughput technologies has enabled us to screen for potential biomarkers in the whole proteome of a cell, not excluding markers that have no direct link to Cu. Further, this screening allows us to search for a whole group of proteins that, in combination, reflect Cu status. The present review emphasises the need to find sensitive biomarkers for Cu, examines potential markers of Cu status already available, and discusses methods to identify a novel suite of biomarkers.     

Increase in the amount of erythrocyte δ-aminolevulinic acid dehydratase in workers with moderate lead exposure

Summary The amount of ALA-D in human erythrocytes was determined directly by radioimmunoassay or calculated from the restored activity assayed in the presence of zinc and dithiothreitol, and a good correlation was observed between the RIA-based and the restored activity-based amounts.The RIA-based amount of ALA-D in the blood of 10 normal individuals (blood lead levels of 5.6 ± 2.3 g/100 ml: mean ± SD) and 19 lead-exposed workers (blood lead levels of 41.2 ± 10.2 g/100 ml) was 54.1 ± 11.8 g/ml blood and 92.3 ± 20.6 g/ml blood, respectively, indicating an apparent increase of the enzyme amount in lead-exposed workers.A significant increase in the amount of erythrocyte ALA-D calculated from the restored activity in lead-exposed workers was observed even in the low blood lead level of 10–20 g/100 ml, resulting in the range of blood lead level 20–40 g/100 ml. No significant difference was observed in hematocrit and hemoglobin content between lead-exposed and non-exposed groups. These observations suggested that the increase of erythrocyte ALA-D in lead exposure was not due to anemia, which might result in the increase of young erythrocytes in peripheral blood.This increase in the amount of ALA-D in human erythrocytes might be a result of the function to overcome the inhibition of the enzyme in bone marrow cells during lead exposure, and these findings may throw light on the danger to human health of low-level lead toxicity.Abbreviations ALA-D -Aminolevulinic acid dehydratase or 5-Amnoevulinic acid hydro-lyase, EC 4.2.1.24 - ALA -Aminolevulinic acid - Rc Reticulocyte - RIA Radioimmunoassay - DTT Dithiothreitol Supported in parts by Science Research Fund of the Ministry of Education, Science and Culture of Japan and by Research Grant of Fujiwara Foundation of Kyoto University     

Can We protect workers from developing the adverse respiratory effects of isocyanate exposure?

In this review, the authors have attempted to present the difficulty in defining a permissible exposure limit (PEL) to agents that act as sensitizers and may induce asthma-even at exposure levels less than the PEL. One approach to this relatively unaddressed problem may be to define the separate aspects of exposure to the specific sensitizing agent. The first effect is an accelerated rate of decline in lung function in nonsensitized individuals who are exposed to the agent (in this case the model used is isocyanates). The second effect is sensitization. Rules for developing a PEL might take this sensitizing effect into account, and this group of agents with such dual effects may be defined as "sensitizers." Exposure to agents with this designation would require special educational and surveillance initiatives to facilitate early detection. The elimination of sensitization may be a greater challenge. An important form of prevention is medical screening of exposed workers, yet it is unclear which screening approach best identifies workers with early isocyanate asthma.