Estimation of long term exposure to mixed solvents from questionnaire data: a tool for epidemiological investigations.

Quantifying the exposure of construction painters to mixed organic solvents is difficult in the face of a lack of industrial hygiene data, the heterogeneity of the solvents used, and the variability in work practices which influences the amount of solvents to which a worker is actually exposed. This report describes an attempt to derive an estimate of airborne solvent exposure using questionnaire responses in a population of construction and maintenance painters. This exposure index (EI) is a weighted average of the total number of gallons used a year minus the fraction which would be absorbed by a respirator, where the weights are based on the method of application (spraying, rolling, brushing) and the presence of ventilation (per cent time inside v outside). An analysis performed to determine the sensitivity of the EI to variations in the values chosen for several parameters showed that the index is relatively insensitive to the underlying assumptions that we have used. One component of the EI (self report of hours worked) correlated well with union payroll records. The EI appears to provide a useful relative (not absolute) estimate of airborne exposure to organic solvent mixtures which may be used as a dose surrogate in epidemiological investigations.     

Development of solvent exposure index for construction painters

This article describes methodological approaches for reconstructing long-term occupational exposure to organic solvents among construction painters. A detailed exposure questionnaire was administered to 125 painters to develop a job exposure matrix (JEM). The questionnaire inquired about painting activities with solvent-based paints and use of protection equipment for the previous 25 years in 5-year intervals. Current and historical distributions of solvent air concentrations were assessed for the same time period based on the following information: industrial hygiene measurements, paint composition changes, and VOC emission rate changes from architectural and industrial maintenance coatings. Changes in protection factors of respirators were also assessed. A cumulative solvent exposure index was calculated for each painter through Monte Carlo simulations by combining appropriate input distributions of solvent air concentrations and protection factors of respirators with JEM. Sensitivity simulations revealed that the historical variations in solvent air concentrations had a higher impact on the cumulative solvent exposure index than changes in protection factors for respirators. Fifty-eight percent of painters were classified with a different exposure quartile when the solvent exposure index was used vs. an exposure based only on years using solvent-based paints, suggesting the need for more detailed exposure analysis than just years working when conducting epidemiologic studies for this worker population.     

Pilot study on prevalence of color vision dysfunction in long-term solvent-exposed painters

Main purpose of our study was to examine whether painters with long-term exposure to mixtures of organic solvents show slight dysfunctions in color vision ability. The study population consisted of 140 men with chronic exposure to organic solvents from paint and thinners (mean duration of exposure: 26 years). We used the Lanthony Desaturated Panel-D-15 (LDP-D15) to test color vision and calculated the color confusion index (CCI). The results were compared with reference values taken from the literature. Additionally the questionnaire Q18 for solvent related neurotoxic symptoms was applied and its results compared with the CCI. Painters between 25 to 55 years old had higher median CCI values than the respective age group of the references. No statistical significant association between CCI and the actual or chronic solvent exposure was found. The results of the Q18 did also not correlate significantly with the exposure indices. We recommend further studies to explore if the color confusion index is an appropriate indicator of early neurotoxic effects in painters.     

Neurobehavioral changes of shipyard painters exposed to mixed organic solvents

This study was conducted to evaluate neurobehavioral changes arising from occupational exposure to organic solvents among shipyard painters and to establish whether a dose-effect relation existed where there was any observed impairment of neurobehavioral performance by running the test of Simple Reaction Time (SRT), Symbol Digit Substitution (SD), and Finger Tapping Speed (FT) with a computer-assisted neurobehavioral test battery. The study group consisted of 180 shipyard painters and 60 reference workers. The workers answered a self-administered questionnaire on occupational, medical history, and demographic characteristics including age, work duration, education level, and quantity and frequency of alcohol and smoking, and performed three psychometric tests on the Korean Computerized Neurobehavioral tests. To estimate cumulative exposure level, samples of ambient air on 61 painters were analyzed using a gas chromatograph. Shipyard painters and the reference group showed significant differences in the results of test of SD, FT of dominant hand, and FT of non-dominant hand. The test results of SD of shipyard painters also showed significant difference by duration of work. This suggests that occupational exposure of organic solvent could induce neurobehavioral changes in the shipyard painters. Therefore an objective neurobehavioral tests recommended on evaluating neurobehavioral performance of long-term solvent-exposed shipyard workers.     

Adverse reproductive outcomes among male painters with occupational exposure to organic solvents

Objectives

To assess the risks of reproductive disorders and birth defects in offspring of male painters with exposure to organic solvents, and to determine the shape of the dose‐response relationship.

Methods

Random samples of painters and carpenters were drawn from workers affiliated with the Dutch Trade Union for Construction Workers, the Netherlands, 2001. Information on reproductive outcomes, occupational exposures, and lifestyle habits was retrospectively obtained through self‐administered questionnaires filled in by 398 painters exposed to organic solvents in paints, thinners, and cleansers in the period of three months before the last pregnancy, and 302 carpenters with little or no exposure to solvents. A statistical model was used to estimate quantitative exposure measures.

Results

Workers employed as painters at three months before pregnancy had an increased risk (odds ratio 6.2, 95% CI 1.4 to 27.9) of congenital malformations in offspring compared to carpenters. There was a positive exposure‐response trend with increasing exposure to organic solvents based on quantitative model predicted exposure estimates using toluene as a marker. There was some indication of an increased risk of functional developmental disorders in offspring among painters with intermediate and high model predicted exposure. The risk of low birth weight children seemed to be slightly increased among painters as well. Results for other reproductive outcomes (time to pregnancy, spontaneous abortion, and preterm birth) did not show increased risks.

Conclusion

This study showed a positive association between paternal occupational exposure to organic solvents and congenital malformations in offspring. However, the small numbers of cases, especially when examining different exposure levels, as well as the self‐reported nature of exposure and outcome variables, may hamper interpretation of the results.     

Reduced exposure to organic solvents by use of water-based paint systems in car repair shops

Objective The objective of this study was to determine to what extent the substitution of solvent-based paint by water-based paint has reduced potential exposure to organic solvents for spray painters in car repair shops.Methods Full-shift personal air sampling (n=79) was carried out over 3 consecutive days in eight car repair shops. Blood samples on the Monday morning (n=26) and at the end of the shift on the Wednesday (n=26), were analysed for organic solvents by headspace techniques.Results Toluene was the organic solvent detected at the highest geometric mean concentration in air samples when solvent-based paint systems were used (0.8 ppm), whereas xylene was found at the highest level when water-based systems were used (0.25 ppm). Toluene, isopropanol, acetone and butyl acetate were detected at higher concentrations when solvent-based paint was used than when water-based paint was employed. The additive factor, based on Norwegian limit values, was three-times higher for the painters using solvent-based paint (0.15) than for those using water-based paint (0.05). On Wednesday after shift the geometric mean of toluene in blood was significantly higher for the painters using solvent-based paint (0.044 g/ml) than for the painters using water-based paint (0.007 g/ml). There was a significant correlation between toluene in personal air samples and toluene in blood samples taken at the end of the shift on the same day.Conclusions When solvent-based paint systems were used the additive factor for organic solvent exposure was three-times higher than when water-based systems were employed. The exposure levels of the organic solvents were well below the Norwegian limit values. The significant correlation between the toluene concentration in air and blood samples indicated that the uptake of organic solvents was correspondingly reduced. At the levels of organic solvents presently described the risk of acute and chronic health effects caused by organic solvents is low.     

Neurotoxicity of solvent mixtures in spray painters

A multidisciplinary cross-sectional study was carried out in 105 spray painters with long-term solvent exposure (10-44 years) and in 58 control subjects not exposed to solvents. By means of air monitoring the solvent concentrations in the ambient air during spray painting were determined using charcoal and silicagel tubes with pumps and passive samplers. In general, the air concentrations of the individual compounds did not exceed the current limit values (MAK values). Aromatic hydrocarbons like toluene, xylene, ethylbenzene, trimethylbenzene, aliphatic hydrocarbons (e.g., heptane) and acetates (ethylacetate, butylacetate) were determined to be important components of paint solvents. However, in unfavorable work conditions the "exposure index" could exceed the permissible limits two or three times. To assess the body solvent load at the time of examination, biological monitoring (BM) was performed. The main finding was that there was no evidence of neurotoxicologically relevant solvent exposure. Only in the case of methyl hippuric acid in urine spot samples did the spray painters show a higher mean value (80 mg/l) than control subjects (below 20 mg/l), indicating recent xylene exposure. Elevated urinary chromium concentrations (maximum value 29 micrograms/l) were found in 28 spray painters as a result of using zinc chromate-containing wash primers without taking protective measures. To assess the degree of past solvent exposure a special questionnaire was used. This included variables like duration and amount of solvent exposure, the presence of a technical ventilation system, health complaints during painting, etc. Additionally, three "solvent exposure indices' (SEI) were calculated and used for evaluation of "dose-effect relationships.'(ABSTRACT TRUNCATED AT 250 WORDS)     

Prenarcotic and neuraesthenic symptoms among Dutch workers exposed to organic solvents

A population of 379 Dutch workers exposed to organic solvents was compared with a non-exposed population of 443 workers with regard to the prevalence of prenarcotic and neuraesthenic symptoms. Participants completed a questionnaire to collect information about their occupational history, exposure to organic solvents, and the occurrence of symptoms. The results of the study indicated that workers exposed to solvents have a higher reporting rate of prenarcotic symptoms than workers not exposed to solvents. The prevalence of chronic neurotoxic effects, however, in the form of neuraesthenic symptoms was only weakly associated with reported exposure to organic solvents. The influence of work stress in the development of these symptoms is perhaps more important than the role of exposure to organic solvents. It is concluded that the organic solvent syndrome type I, as defined by an international workshop, is not an important health hazard among Dutch painters.     

Exposure-outcome relationships between organic solvent exposure and neuropsychiatric disorders: results from a Dutch case-control study

In this article the material collected for a case-control study is analyzed in order to evaluate the existence of relationships between organic solvent exposure and the entitlement to disability benefits due to neuropsychiatric disorders. Questionnaires were used to collect information on 252 cases receiving compensation due to neuropsychiatric disorders and 822 controls about their occupational history and work practices related to organic solvent exposure. In order to estimate the exposure to organic solvents, three exposure indices were used: duration of exposure, painters' index, and general exposure index. Analysis showed some tendencies indicating positive exposure-outcome relationships. Furthermore, some work activities and working conditions associated with high exposure to organic solvents (e.g., poor ventilation, using paint removers) resulted in a marked increase of the likelihood for receiving disability benefits due to neuropsychiatric disorders.     

Airway symptoms among house painters in relation to exposure to volatile organic compounds (VOCS)—a longitudinal study

The increased use of water-based paint (WBP) for indoor application during the last decade has drastically changed the exposure conditions for Swedish house painters. WBP has a lower emission of volatile organic compounds (VOCs) than solvent-based paint (SBP), but contains more reactive compounds, such as biocides, glycol ethers, and other high molecular solvents. The aim of this study was to compare the incidence of airway symptoms and self-reported asthma in house painters with a different degree of use of WBP and SBP. The incidence of seven general airway symptoms, and three work-related symptoms, was analysed by means of a self-administered questionnaire, in a cohort of 207 house painters followed from 1989 to 1992. Different airway symptoms were compared with clinical information obtained by a methacholine challenge test and dynamic spirometry in a selected subgroup of 44 painters. Information on the degree of use of SBP and WBP was used to estimate the total exposure to volatile organic compounds (TVOC) for each individual. In total, 175 men in the cohort worked as painters during the study period. No increase of asthma or respiratory symptoms was observed among those 50 painters with a pure exposure to WBP (estimated TVOC 1–3mgm⁻³). Most painters (N = 125) had a mixed exposure to SBP and WBP, the main source of the TVOC being the limited use of SBP. WBP was perceived as less irritative than SBP, but complaints on airway irritation from WBP increased during the study period. The most pronounced increase of airway irritation in relation to both SBP and WBP, was observed among those 35 painters with the highest solvent exposure (estimated TVOC 100–380 mgm⁻³). An increase of respiratory symptom index and shortness of breath, in relation to estimated TVOC exposure was also observed. Selection effects were detected. Painters leaving their job during the study period had more non-specific hyper-reactivity symptoms, and more airway irritation from WBP-as compared to painters remaining at their occupation. Our study indicates that VOC emissions from SBPs may contribute to the development of respiratory symptoms and airway irritation. We found no increase of respiratory symptoms among painters exposed only to WBPs. There were, however, indications that VOC exposure from WBPs may cause airway irritation in some subjects. Because of selection effects, cross-sectional studies on respiratory symptoms in relation to occupational exposure to paint emissions may be inconclusive.     

Prenarcotic and neuraesthenic symptoms among Dutch workers exposed to organic solvents.

A population of 379 Dutch workers exposed to organic solvents was compared with a non-exposed population of 443 workers with regard to the prevalence of prenarcotic and neuraesthenic symptoms. Participants completed a questionnaire to collect information about their occupational history, exposure to organic solvents, and the occurrence of symptoms. The results of the study indicated that workers exposed to solvents have a higher reporting rate of prenarcotic symptoms than workers not exposed to solvents. The prevalence of chronic neurotoxic effects, however, in the form of neuraesthenic symptoms was only weakly associated with reported exposure to organic solvents. The influence of work stress in the development of these symptoms is perhaps more important than the role of exposure to organic solvents. It is concluded that the organic solvent syndrome type I, as defined by an international workshop, is not an important health hazard among Dutch painters.     

Occupational exposure to organic solvents as a cause of sleep apnoea.

A high prevalence of sleep apnoea was found in a group of men occupationally exposed to organic solvents. Workers with long term exposure to organic solvents often report symptoms such as fatigue, forgetfulness, and concentration difficulties. These symptoms are strikingly similar to those reported by patients with obstructive sleep apnoea syndrome (OSAS). This is a frequently diagnosed disorder characterised by disturbed sleep causing psychic or somatic complications and daytime sleepiness. A study was undertaken to evaluate whether people with long term occupational exposure to organic solvents have a higher prevalence of sleep apnoea than the general population. Patients exposed to solvents (66 men) were invited to participate in a screening for sleep apnoea. A static charge sensitive bed was used for the monitoring of respiration movements and pulse oximetry during one night. A classical sleep apnoea was diagnosed if periodic respiration movement exceeded 45% of estimated sleep time and the oxygen desaturation index exceeded 6. The prevalence of sleep apnoea among the men exposed to solvents was compared with the prevalence in the general population (1.4%). The prevalence among the participating exposed men was 19.7% which gave a conservative relative risk estimate of 14.1 (95% confidence interval (95% CI) 7.5-24.2). The results indicate that exposure to organic solvents causes sleep apnoea. An alternative possibility is that people with sleep apnoea are misdiagnosed as cases of solvent induced toxic encephalopathy. The interpretation has importance for the caring of the patient.     

Neurotoxicity of solvent mixtures in spray painters

A multidisciplinary cross-sectional study was performed to examine the chronic neurotoxicity of organic solvents. Participating in the study were 105 persons employed as spray painters and having long-term solvent exposure (10-44 years) and a control group consisting of 58 construction workers, electricians, and plumbers without occupational contact to solvents. Samples were matched for age, preexposure intelligence level, occupation, and socioeconomic status. After controlling for potentially non occupational confounding factors (neuropsychiatric diseases, metabolic disorders, high blood pressure, alcohol intake) 83 spray painters and 42 controls were entered finally into the study. The evaluation included work history, self-rating questionnaire, neurologic investigation, psychiatric analysis using the Present State Examination (PSE), psychological testing, and computerized axial tomography (CAT) of the brain. Physical and neurologic examinations demonstrated no case of overt disorders of the central or peripheral nervous system. An important result of the psychiatric analysis was that the syndromes "special features of depression" and "loss of interest and concentration" occurred significantly more frequently among spray painters than among controls. Further analyses demonstrated an association with chronic exposure over 30 years and repeated acute neurotoxic effects during solvent exposures. Neither psychological nor performance tests demonstrated any statistically significant differences in the performance sets after adjustment according to premorbid intelligence level; this finding supports the presumption of only a low grade of mental dysfunction. Correlation analyses indicated a relationship between subjective health complaints and long-term solvent exposure; however, the effect of age cannot be completely ruled out.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of occupational solvent exposure on reproductive hormone concentrations and fecundability in men

BACKGROUND: Little is known about the effects of organic solvents on male reproductive health. To assess fertility and reproductive endocrine function in solvent-exposed men, we investigated time-to-pregnancy using a retrospective cohort design and cross-sectionally measured reproductive hormone concentrations in painters and millwrights compared to a reference group of carpenters. METHODS: Detailed occupational, exposure, medical, and time-to-pregnancy histories were obtained by telephone interview. Plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone concentrations were determined by immunoassay. Exposure indices, which summarized working life exposure to total solvents, chlorinated solvents, aromatic solvents, and thinners, degreasers, varnishes, and adhesives as a category were calculated from exposure histories. RESULTS: FSH concentrations increased significantly with increasing exposure indices for all solvents and for chlorinated solvents. There were no significant associations of solvent exposure indices with LH or testosterone levels. LH, FSH, and testosterone concentrations also did not differ by job title. Using Cox regression, time-to-pregnancy was non-significantly longer in the painters and millwrights than the carpenters. There was no significant association between time-to-pregnancy and any of the solvent exposure indices; however, it should be noted that some of the pregnancies occurred more than 20 years previously, potentially reducing the reliability of the retrospectively collected pregnancy and exposure data. CONCLUSIONS: The significant associations between FSH levels and solvent exposure indices suggest the potential for adverse effects of solvent exposures on reproductive function in men.     

Trends in inhalation exposure to hydrocarbons among commercial painters in The Netherlands

OBJECTIVES: An attempt was made to develop a database for measurements of exposure to solvents that could be used as a tool in the historical exposure assessment of commercial painters participating in a health surveillance program. METHODS: The measurement data on personal exposure from six studies still available for Dutch commercial painters were collected into a database. The database was analyzed to identify time trends for the inhalation exposure levels of hydrocarbons and the production conditions that influence exposure levels among commercial painters in The Netherlands. RESULTS: Altogether 304 measurements of solvent exposure were collected between 1980 and 1999, providing data for 137 workers. Toluene was selected as a marker for solvent exposure, since hydrocarbon exposures appeared to be strongly correlated. Exposure to toluene measured during the application of solvent-based paints has declined by 12% per year. The use of solvent-based paints, painting in small rooms, house (versus shipyard) painting, and spray-painting were associated with increased exposures. Water-based paint was also associated with increased exposure to toluene, relative to tasks in which no paint was used. The exposure model for toluene explained 86% of the between-worker variance. In a subset of the data, we observed that a single cell model did not adequately describe total solvent exposure among painters, because of the stronger-than-expected positive effect of source strength and the lack of the protective effect of general ventilation. CONCLUSIONS: An exposure model was developed that can be used to predict the intensity of inhalation exposure to aromatic solvents among commercial painters in The Netherlands.     

Neurobehavioural effects of occupational exposure to organic solvents among construction painters

A cross sectional study of 101 construction painters was performed to investigate the relation between exposure to mixed organic solvents and changes in central nervous system function. Solvent exposure was estimated using questionnaire data to derive an exposure index (a measure of intensity of exposure) and to estimate the duration and frequency of exposure. Adverse effects on the central nervous system were assessed by self reported questionnaires and eight tests of a computer administered neurobehavioural evaluation system. Factor analysis of both measures of effect yielded factors both biologically plausible and in agreement with other empirical evidence. A consistent positive association was observed between most measures of exposure and the occurrence of neurotoxic symptoms, notably dizziness, nausea, fatigue, problems with arm strength, and feelings of getting "high" from chemicals at work. Associations with exposure were found with the neurobehavioural evaluation system tests of symbol digit substitution and digit span; however, no consistent pattern of effect on neurobehavioural function was observed. This pattern of the occurrence of neurotoxic symptoms without clear evidence of function deficit is consistent with the type 1 toxic central nervous system disorder as classified by the World Health Organisation.     

Neurobehavioural effects of occupational exposure to organic solvents among construction painters.

A cross sectional study of 101 construction painters was performed to investigate the relation between exposure to mixed organic solvents and changes in central nervous system function. Solvent exposure was estimated using questionnaire data to derive an exposure index (a measure of intensity of exposure) and to estimate the duration and frequency of exposure. Adverse effects on the central nervous system were assessed by self reported questionnaires and eight tests of a computer administered neurobehavioural evaluation system. Factor analysis of both measures of effect yielded factors both biologically plausible and in agreement with other empirical evidence. A consistent positive association was observed between most measures of exposure and the occurrence of neurotoxic symptoms, notably dizziness, nausea, fatigue, problems with arm strength, and feelings of getting "high" from chemicals at work. Associations with exposure were found with the neurobehavioural evaluation system tests of symbol digit substitution and digit span; however, no consistent pattern of effect on neurobehavioural function was observed. This pattern of the occurrence of neurotoxic symptoms without clear evidence of function deficit is consistent with the type 1 toxic central nervous system disorder as classified by the World Health Organisation.     

Olfactory function in painters exposed to organic solvents

The olfactory receptor cells are in direct contact with the exterior environment, and some chemical agents can impair olfactory function. The olfactory function of 54 painters exposed to organic solvents was compared with that of 42 unexposed referents. A new clinical test validated for the sense of smell was used, the University of Pennsylvania Smell Identification Test. Age, smoking habits, exposure to organic solvents, and medical disorders of importance for the sense of smell were recorded. The painters had a somewhat lower test score than the referents. However, the influence of the exposure variable was not statistically significant in a multiple regression analysis including age and smoking habits. The exposure to organic solvents was low, and therefore an effect of high exposure on olfactory function cannot be ruled out. Since some of the painters had earlier been highly exposed, the effects of high exposure are likely to be reversible.     

Organic solvents and the risk of multiple sclerosis

BACKGROUND: Epidemiologic studies suggest that environmental factors may be part of the yet unknown causation of multiple sclerosis (MS). Several case-control studies have shown a history of elevated exposure to organic solvents among cases. METHODS: Three cohorts of 11,542 painters, 36,899 construction workers and 9,314 food-processing workers were identified by the 1970 census in Norway. The cohorts were followed until the end of 1986 for registration of disability pensions. RESULTS: A total of nine painters, 12 construction workers and six food workers had received a disability pension because of MS. The relative risk for painters compared with workers not exposed to organic solvents was 2.0 (95% confidence inter-val = 0.9-4.5) for MS. CONCLUSIONS: These results are compatible with the hypothesis of organic solvents being a possible risk factor for MS.     

Toxicokinetics of toluene in occupationally exposed volunteers

The influence on the kinetics of toluene from long-term occupational exposure, cigarette smoking, and ethanol consumption was studied in 26 male spray painters. A group of spray painters with reported subjective symptoms such as concentration deficits, fatigue, and dizziness due to the solvent exposure did not differ in the uptake and disposition of toluene from a group of spray painters with no symptoms. In occupationally exposed workers, a tendency for an enhanced clearance of toluene from the blood was observed in relation to personal habits such as smoking and/or moderate chronic ethanol intake. Long-term occupational exposure to a mixture of organic solvents does not exert any effect on the metabolic rate of toluene as compared with that of an unexposed group.