Trawler fuel exhaust and respiratory impairments: a cross-sectional pilot study among Indian fishermen working in informal sectors

Background:

An estimated half a billion people are engaged in fishing related occupations in India. Exposure to adulterated fuel exhaust is common among deep-sea fishermen, yet little is known about the potential impacts on the exposure to health.

Objective:

The aim of this study was to investigate whether fuel emission exposure was associated with increased respiratory impairments among fishermen who were occupationally exposed to fuel exhaust compared to fisherman occupationally unexposed to fuel exhaust.

Methods:

This cross-sectional study compared the prevalence of respiratory symptoms and lung function variables between 152 marine-water and 107 fresh water fishermen considering the use of fuel-driven trawlers. Data were obtained from questionnaires and computerized spirometer.

Results:

Fishermen exposed to trawler fuel exhaust reported more than double the number of respiratory symptoms compared to the unexposed fisherman (86.2 vs. 40.2%). They also had a significantly higher chance experiencing chronic cough (adjusted OR = 3.51, 95% confidence interval (CI) = 2.09–6.35), chronic phlegm (8.61, 4.76–15.97), and wheezing (4.29, 2.55–7.61) symptoms. Finally, there was a significant reduction of the ratio of mid portion of forced expiratory flow rate and forced vital capacity (FEF_25–75/FVC) in the exposed fishermen compared to the unexposed (0.84 vs. 0.73 second⁻¹, P = 0.015).

Conclusion:

Fuel exhaust may negatively impact on the respiratory health of Indian fishermen. More attention and surveillance of occupational health for fishermen in India is needed.     

Childhood illness in households using biomass fuels in India: secondary data analysis of nationally representative national family health surveys

Abstract

Background: Half of the world’s population uses solid fuels for energy and cooking, resulting in 1·5 million deaths annually, approximately one-third of which occur in India. Most deaths are linked to childhood pneumonia or acute lower respiratory tract infection (ALRI), conditions that are difficult to diagnose. The overall effect of biomass combustion on childhood illness is unclear.

Objectives: To evaluate whether type of household fuel is associated with symptoms of ALRI (cough and difficulty breathing), diarrhea or fever in children aged 0–36 months.

Methods: We analyzed nationally representative samples of households with children aged 0–36 months from three national family health surveys conducted between 1992 and 2006 in India. Households were categorized as using low (liquid petroleum gas/electricity), medium (coal/kerosene) or high polluting fuel (predominantly wood/agricultural waste). Odds ratios adjusted for confounders for exposure to high and medium polluting fuel were compared with low polluting fuel (LPF).

Results: Use of high polluting fuel (HPF) in India changed minimally (82 to 78 %), although LPF use increased from 8% to 18%. HPF was consistently associated with ALRI [adjusted odds ratio (95% confidence interval) 1·48 (1·08–2·03) in 1992–3; 1·54 (1·33–1·77) in 1998–9; and 1·53 (1·21–1·93) in 2005–6). Fever was associated with HPF in the first two surveys but not in the third survey. Diarrhea was not consistently associated with HPF.

Conclusions: There is an urgent need to increase the use of LPF or equivalent clean household fuel to reduce the burden of childhood illness associated with IAP in India.     

Health Effects of Occupational Exposures to Vehicle Emissions in Shanghai

Abstract

The authors investigated the health effects of occupational exposures to vehicle emissions in 745 bus drivers, conductors, and taxi drivers, compared with 532 unexposed controis, in Shanghai. Logistic regression and general linear models were used to examine the relationship between exposure and respiratory illness. Results showed that the prevalences of some respiratory symptoms and chronic respiratory diseases were significantly higher (p < 0.05) in the exposed group than in. the controls. The adjusted odds ratios for throat pain, phlegm, chronic rhinitis, and chronic pharyngitis were 1.95 (95% CI 1.55–2.46), 3.90 (95% CI 2.61–5.81), 1.96 (95% CI 1.11–3.46), and 4;19 (95% CI 2.49–7.06), respectively. Also, there were exposure time-response relationships for the prevalences of phlegm and chronic respiratory disease. Pulmonary function and blood lead levels were not significantly correlated with exposure status. The results suggest that occupational exposure to vehicle emissions may induce detectable adverse health effects.     

The association of biomass fuel combustion on pulmonary function tests in the adult population of Mid-Anatolia

Summary Objectives:To assess the association of biomass as domestic energy source on respiratory function in rural areas of Mid-Anatolia in Turkey where biomass use is frequent.Methods:In a cross-sectional study, pulmonary functions measurements of 112 cow-dung users and 153 modern energy source users, all non-smokers, were assessed and compared. Several sociodemographic factors were assessed by questionnaire, and ventilatory function measurements included forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC ratio and the flow between the first 25 and 75 of forced expiratory flow (FEF_25–75), and were compared, deploying univariate and multivariate methods, between the two groups.Results:The individuals in the biomass exposed and unexposed group were similar regarding demographic characteristics: 67.0% were female (exposed) vs 60.1% (unexposed) with an age range of 17 to 64 (exposed) and 18 to 70 years (unexposed), and with 36% of biomass users having had pulmonary tract infections (20% in non-users). For all pulmonary function test parameters FEV₁, FVC, FEV₁/FVC, and FEF_25–75 a highly significant (p<0.0001) reduction was observed in biomass users. A 12.4% (95% confidence interval: 7.0% to 17.7%) reduction in forced vital capacity was observed in multivariate linear regression.Conclusions:It is well known that biomass combustion is a relevant public health problem. The substantial differences in pulmonary functions associated with biomass use as an energy source observed in this cross-sectional study in non-smokers support that also in rural Turkey measures may be in need to reduce this public health problem.     

Respiratory symptoms and pulmonary function in flour processing workers in the baking industry

Respiratory symptoms and ventilatory capacity were studied in 63 flour processing male bakery workers in Umtata, Transkei, Southern Africa. The controls were from a bottling plant in the same city. Both groups were black Africans from the Xhosa-speaking population. The studied population was nonsmoking and no significant difference was noted in age, race, sex, or height between the groups. The exposed workers had significantly lower forced expiratory indices than the control group. Mean percent predicted values of forced expiratory volume in one second (FEV₁), forced expiratory ratio (FEV₁/FVC x 100), forced mid-expiratory flow between 25% and 75% of FVC (FMF), forced expiratory flow between the first 200 ml and 1.200 ml of FVC (FEF 200-1,200), and peak expiratory flow rate (PEF) were, respectively, 11.2%, 20.0%, 31.0%, 27.4%, and 36.1% lower in the exposed group compared with the controls. The prevalence of forced expiratory ratio less than 70% in the exposed group was 37% while in the controls it was 8%. The prevalence of PEF rate less than 5 l/s in the exposed group was 32% while in the controls it was 11%. The exposed workers reported a significantly higher prevalence of respiratory symptoms compared to the controls. The prevalence of nasal symptoms, phlegm, and cough in the exposed workers was 53.9%, 30.1%, and 25.4%, respectively. The present study demonstrated that exposure to flour dust in flour processing workers in the baking industry is associated with significantly lower pulmonary functions and a higher prevalence of respiratory symptoms, and that these workers show signs of airway obstruction, compared to workers not exposed to flour. Flour processing workers have a significant occupationally related respiratory impairment.     

The Adverse Health Effects of Oil Spills: A Review of the Literature and a Framework for Medically Evaluating Exposed Individuals

Abstract

In April 2010, an explosion on an oil rig in the Gulf of Mexico killed 11 workers, injured 17 workers, and spilled an estimated 185 million gallons of crude oil into the Gulf. Adverse effects on the health of cleanup workers, fishermen, and others as well as on the ecosystem are being studied. This paper reviews published studies of the adverse health effects due to previous oil spills. Acute effects have included: respiratory, eye, and skin symptoms; headache; nausea; dizziness; and tiredness or fatigue. Chronic effects have included: psychological disorders, respiratory disorders, genotoxic effects, and endocrine abnormalities. We also present a systematic approach to evaluating individuals exposed to oil spills.     

Respiratory health effects from occupational exposure to wood dust in sawmills

Spirometric lung functions were recorded for 109 workers (mean age 26.4 +/- 8.2 yr) occupationally exposed (mean exposure 8.9 +/- 7.7 yr) to soft wood dust in local sawmills along with 88 unexposed controls (mean age 28.7 +/- 9.9 yr) belonging to the same socioeconomic status to assess the prevalence of respiratory impairment in the exposed population. The results of the study showed a significantly higher prevalence of overall respiratory impairment in the exposed group even after standardizing for smoking habits (p less than 0.001). The adjusted rate for respiratory impairment in the exposed group was 29.4% as compared to 2.2% observed in the unexposed controls. The pattern of respiratory abnormality observed in the sawmill workers was predominantly the restrictive type (28.4%), indicating lower levels of forced vital capacity (FVC) in the exposed group; while in the control group, there were none with lung restriction The prevalence of airflow limitation, however, was similar in the exposed workers (1.8%) and controls (2.2%), thereby, indicating that bronchial obstruction was independent of wood dust exposure. It is concluded that the dust exposure in sawmills is associated mainly with restrictive type of pulmonary impairment in the exposed workers.     

Occupational exposure to aerosolized brevetoxins during Florida red tide events: effects on a healthy worker population

Karenia brevis (formerly Gymnodinium breve) is a marine dinoflagellate responsible for red tides that form in the Gulf of Mexico. K. brevis produces brevetoxins, the potent toxins that cause neurotoxic shellfish poisoning. There is also limited information describing human health effects from environmental exposures to brevetoxins. Our objective was to examine the impact of inhaling aerosolized brevetoxins during red tide events on self-reported symptoms and pulmonary function. We recruited a group of 28 healthy lifeguards who are occupationally exposed to red tide toxins during their daily work-related activities. They performed spirometry tests and reported symptoms before and after their 8-hr shifts during a time when there was no red tide (unexposed period) and again when there was a red tide (exposed period). We also examined how mild exercise affected the reported symptoms and spirometry tests during unexposed and exposed periods with a subgroup of the same lifeguards. Environmental sampling (K. brevis cell concentrations in seawater and brevetoxin concentrations in seawater and air) was used to confirm unexposed/exposed status. Compared with unexposed periods, the group of lifeguards reported more upper respiratory symptoms during the exposed periods. We did not observe any impact of exposure to aerosolized brevetoxins, with or without mild exercise, on pulmonary function.     

Respiratory symptoms and lung function in bauxite miners

Objectives: To determine whether cumulative bauxite exposure is associated with respiratory symptoms or changes in lung function in a group of bauxite miners. Methods: Current employees at three bauxite mines in Australia were invited to participate in a survey comprising: questionnaire on demographic details, respiratory symptoms, and work history; skin prick tests for four common aeroallergens; and spirometry. A task exposure matrix was constructed for bauxite exposure in all tasks in all jobs based on monitoring data. Data were examined for associations between cumulative bauxite exposure, and respiratory symptoms and lung function, by regression analyses. Results: The participation rate was 86%. Self-reported work-related respiratory symptoms were reported by relatively few subjects (1.5%–11.8%). After adjustment for age and smoking no significant differences in the prevalence of respiratory symptoms were identified between subjects, in the quartiles of cumulative bauxite exposure distribution. The forced expiratory volume in 1 s (FEV₁) of the exposed group was found to be significantly lower than that for the unexposed group. After adjustment for age, height, and smoking there were no statistically significant differences between quartiles in FEV₁, forced vital capacity (FVC) and FEV₁/FVC ratio. Conclusions: These data provide little evidence of a serious adverse effect on respiratory health associated with exposure to bauxite in an open-cut bauxite mine in present day conditions. Received: 14 August 2000 / Accepted: 12 April 2001     

Volcanic ash and respiratory symptoms in children on the island of Montserrat,British West Indies

Background: In July 1995 the volcano on the West Indian island of Montserrat erupted after being inactive for several hundred years. Since then, clouds of ash have been released intermittently from the volcano. Some of this ash is <10 µm in diameter and therefore respirable. Concerns were raised that the particles might cause respiratory problems.

Aims: To evaluate whether ashfalls had any effect on the respiratory health of children in Montserrat.

Methods: A survey of asthma diagnoses, respiratory symptoms, exercise induced bronchoconstriction (EIB), and current and previous exposure to volcanic ash was carried out in schools in Montserrat during February 1998.

Results: Questionnaire information was available for nearly 80% of the 443 children on the school rolls. The prevalence of wheeze symptoms in the previous 12 months was 18% in children aged 12 years and under and 16% in children aged 13 years and over. In children aged 12 and under, the prevalence of wheeze was greater in those who had ever been heavily or moderately exposed to volcanic ash compared with the group who had only ever been exposed to low levels (wheeze in last 12 months: odds ratio (OR) 4.30; wheeze ever: OR 3.45). The prevalence of EIB in 8–12 year olds was about four times higher in those who were currently heavily exposed to volcanic ash (OR 3.85) compared to those currently exposed to low levels.

Conclusions: Volcanic ash emissions adversely affected the respiratory health of Montserrat children. The findings emphasise the need to limit exposures of children to volcanic ash and ensure the appropriate management of respiratory symptoms.

     

The effects of ambient temperature variation on respiratory hospitalizations in summer,New York State

Abstract

Objective: A time-series study was used to assess the effect of temperature variation during summer on respiratory disease in New York State.

Methods: Daily respiratory admissions were linked with various meteorological indicators including daily and weekly temperature variation from June–August, 1991–2004. Two-stage Bayesian hierarchical models were used to first compute percent excess risks at the region level while controlling for air pollutants and time-varying variables using Poisson generalized additive models, and then to pool statewide estimates together after controlling for regional confounders.

Results: This study found that the daily temperature range between maximum and minimum temperature was associated with a 0·27–0·38% increased risk of admission. Minimum temperature (TMIN) above the previous 6-day average was associated with a 0·93% higher risk of respiratory morbidity. Multiday temperature ranges within 5 and 7 days were associated with 0·49 and 0·73% increases in admissions, respectively.

Conclusions: We concluded that daily and multiday temperature variation may increase respiratory hospitalizations with a larger risk associated with TMIN.     

Respiratory function in shoe manufacturing workers

A study of respiratory findings was performed on 376 female workers employed in a shoe manufacturing plant. The mean age of the workers was 32 years and the mean duration of their employment was 12 years. These workers were predominantly nonsmokers. Acute and chronic respiratory symptoms were recorded for each worker, and lung function was measured before and after the work shift. Maximum expiratory flow-volume (MEFV) curves were performed on which forced vital capacity (FVC), 1-second forced expiratory volume (FEV₁), and flow rates at 50% and the last 25% (FEF₅₀, FEF₂₅) were measured. Significantly higher prevalences of all chronic respiratory symptoms were recorded in exposed compared to control workers; in particular, chest tightness (exposed: 44.7%; control: 0%), dyspnea (exposed: 42.6%; control: 2.0%), and rhinitis (exposed: 46.3%; control: 2.4%) were far more prevalent in workers than in controls. Among the shoe workers, there was also a high prevalence of acute symptoms that developed during the work shift, being most pronounced for nose and throat irritation (61.4%). The prevalence of acute and chronic respiratory symptoms increased with duration of employment. Statistically significant across-shift reductions were recorded for all ventilatory capacity tests for the group as a whole. In comparison to predicted, the measured ventilatory capacity parameters were significantly lower for all workers (p < 0.01). Lung function abnormalities increased with duration of employment. Environmental measurements demonstrated that benzene, fur, and synthetic fibers were found at higher than allowable maximal concentrations (Croatian standards). The data suggest that work in the shoe manufacturing industry may be responsible for the development of acute and chronic respiratory impairment. Am. J. Ind. Med. 31:50–55 © 1997 Wiley-Liss, Inc.     

Effects of cooking fuel smoke on respiratory symptoms and lung function in semi-rural women in Cameroon

Background:

Indoor air pollution is a major health problem in the developing world. In sub-Saharan Africa more than 90% of people rely on biomass to meet their domestic energy demands. Pollution from biomass fuel ranks 10th among preventable risk factors contributing to the global burden of diseases.

Objectives:

The present study aimed to determine the prevalence of respiratory symptoms and the factors associated with reduced lung function in a population of women exposed to cooking fuel smoke.

Methods:

A cross-sectional study was conducted in a semi-rural area in Cameroon. We compared forced respiratory volume between women using wood (n = 145) and women using alternative sources of energy (n = 155) for cooking.

Results:

Chronic bronchitis was found in 7·6% of the wood smoke group and 0·6% in the alternative fuels group. We observed two cases of airflow obstruction in the wood smoke group. Factors associated with lung function impairment were chronic bronchitis, use of wood as cooking fuel, age, and height.

Conclusion:

Respiratory symptoms and reduced lung function are more pronounced among women using wood as cooking fuel. Improved stoves technology should be developed to reduce the effects of wood smoke on respiratory health.     

What are the health costs of uranium mining? A case study of miners in Grants,New Mexico

Abstract

Background:

Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny.

Objectives:

This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico.

Methods:

Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs.

Results:

Total health costs ranged from $2·2 million to $7·7 million per excess death. This amounts to between $22·4 million and $165·8 million in annual health costs over the 1955–1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185·4 miners per 100?000, with a range of 1419·8–2974·3 per 100?000.

Conclusions:

Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions.     

Dust exposure and impairment of lung function at a small iron foundry in a rapidly developing country

OBJECTIVES—A cross sectional prospective study was carried out among iron foundry workers (exposed) and soft drink bottling and supply company workers (unexposed) to assess their occupational exposure to ambient respiratory dust in their work environment and its effect on their lung function profile.
PARTICIPANTS—Lung function was measured in 81 exposed and 113 unexposed workers. Personal respirable dust concentrations were measured for all the exposed and the unexposed workers. Information on respiratory signs and symptoms was also collected from the participants.
RESULTS—Among the exposed workers, midexpiratory flow (FEF_25-75), forced expiratory volume in 1 second (FEV₁), peak expiratory flow (PEF), FEV₁/FVC, and FEV₁/VC ratios were significantly lower whereas the vital capacity (VC) and forced vital capacity (FVC) were non-significantly higher. Job at the iron foundry was a significant predictor of lung function. Exposure to high concentration of respirable dust at the iron foundry was also a significant predictor. Workers working in high exposure areas (general works, furnace, continuous casting areas, and fabrication workshop) had lower lung function values than workers in medium and low exposure areas. Smoking did not enhance the effects of exposure to dust on lung function.
CONCLUSIONS—Exposure to respirable dust was higher among the iron foundry workers; and among these, general, furnace, rolling mill, and fabrication workers had higher exposures to dust than did workers in continuous casting, the mechanical workshop, and the bottling plant. Job type and exposure to dust were significant predictors of lung function. Implementation of industrial hygiene and proper and efficient use of personal protection equipment while at work could help to protect the respiratory health of industrial workers.


Keywords: lung function; dust exposure; foundry; smoking; personal protection     

Pulmonary function and respiratory symptoms in a population of airport workers

OBJECTIVES: To assess the prevalence of respiratory symptoms and to measure spirometry in a sample of employees of Birmingham International Airport, United Kingdom, to examine whether occupational exposure to aircraft fuel or jet stream exhaust might be associated with respiratory symptoms or abnormalities of lung function. METHODS: Cross sectional survey by questionnaire and on site measurement of lung function, skin prick tests, and exhaled carbon monoxide concentrations. Occupational exposure was assigned by job title, between group comparison were made by logistic regression analysis. RESULTS: 222/680 full time employees were studied (mean age 38.6 y, 63% male, 28% current smokers, 6% self reported asthma, 19% self reported hay fever). Upper and lower respiratory tract symptoms were common and 51% had one or more positive skin tests. There were no significant differences in lung function tests between exposure groups. Between group comparisons of respiratory symptoms were restricted to male members of the medium and high exposure groups. The adjusted odds ratio (OR) for cough with phlegm and runny nose were found to be significantly associated with high exposure (OR 3.5, 95% confidence interval (95% CI) 1.23 to 9.74 and 2.9, 1.32 to 6.40 respectively) when the measured confounding effects of age and smoking, and in the case of runny nose, self reported hay fever had been taken into account. There was no obvious association between high exposure and the presence of shortness of breath or wheeze, or for the symptoms of watering eyes or stuffy nose. CONCLUSIONS: These findings support an association in male airport workers, between high occupational exposures to aviation fuel or jet stream exhaust and excess upper and lower respiratory tract symptoms, in keeping with a respiratory irritant. It is more likely that these effects reflect exposure to exhaust rather than fuel, although the effects of an unmeasured agent cannot be discounted.

 

     

China and the US: asbestos in common

Abstract

Background: Gender inequalities in the exposure to work-related psychosocial hazards are well established. However, little is known about how welfare state regimes influence these inequalities.

Objectives: To examine the relationship between welfare state regimes and gender inequalities in the exposure to work-related psychosocial hazards in Europe, considering occupational social class.

Methods: We used a sample of 27,?465 workers from 28 European countries. Dependent variables were high strain, iso-strain, and effort-reward imbalance, and the independent was gender. We calculated the prevalence and prevalence ratio separately for each welfare state regime and occupational social class, using multivariate logistic regression models.

Results: More female than male managers/professionals were exposed to: high strain, iso-strain, and effort–reward imbalance in Scandinavian [adjusted prevalence ratio (aPR)?=?2·26; 95% confidence interval (95% CI): 1·87–2·75; 2·12: 1·72–2·61; 1·41: 1·15–1·74; respectively] and Continental regimes (1·43: 1·23–1·54; 1·51: 1·23–1·84; 1·40: 1·17–1·67); and to high strain and iso-strain in Anglo-Saxon (1·92: 1·40–2·63; 1·85: 1·30–2·64; respectively), Southern (1·43: 1·14–1·79; 1·60: 1·18–2·18), and Eastern regimes (1·56: 1·35–1·81; 1·53: 1·28–1·83).

Conclusion: Gender inequalities in the exposure to work-related psychosocial hazards were not lower in those welfare state regimes with higher levels of universal social protection policies.     

Relative chronic effects of different occupational dusts on respiratory indices and health of workers in three Ethiopian factories

The respiratory effects of dusts in different sections of yarn, cement, and cigarette factories were studied in 211 nonsmoking male and female workers aged 21–57 years. The controls used were 211 healthy nonsmoking and nonexposed male and female subjects aged 20–57 years from the general population. Forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV₁), FEV₁/FVC ratio, forced expiratory flow (FEF_{200–1,200 ml}), forced mid-expiratory flow (FMF_25–75%) and peak expiratory flow rate (PEFR) were recorded in all subjects with and without respiratory symptoms. Taking exposures to all dusts of different concentrations together, it was found that the frequency of respiratory illness was greater among exposed workers (40.5% in males, 36% in females) than it was among controls (21.6% in males,18% in females). In exposed subjects, the symptom prevalence was only 4.5% higher in males than in females.The mean lung function indices, including FEV₁, FEV_1%, FEF_{200–1,200 ml}, FMF_25–75%, and PEFR, in subjects exposed to all dusts in general decreased markedly, with dust concentration being more important than duration of exposure, and FMF being affected slightly more consistently. About 38.4% of the dust-exposed subjects developed corresponding respiratory illnesses including chronic cough (24.7%), chronic bronchitis (21.8%) and bronchial asthma (24.2%). The respective control values were 9.0%, 9.5%, and 8.5%. Exposure to different occupational dusts resulted in the development of respiratory illness with different rates of prevalence. The effects of exposure to cotton and cement dusts on respiratory health of exposed subjects were relatively more significant (p < 0.001) than that of exposure to tobacco dust (p < 0.05). Am. J. Ind. Med. 34:373–380, 1998. © 1998 Wiley-Liss, Inc.     

Alveolar macrophages as biomarkers of pulmonary irritation in kitchen workers

OBJECTIVES: Alveolar macrophages (AM) are used as a biomarker of pulmonary irritation due to occupational exposure in the AM test. The aim of this study was to investigate whether there is a co-variation between the number of AM and exposure to cooking fumes. MATERIALS AND METHODS: The study group consisted of 62 volunteers. People who worked in a kitchen preparing hot meals were considered as occupationally exposed (35 persons). The exposed group was further divided into highly and slightly exposed persons according to the levels of fat aerosols and aldehydes in the working atmosphere. People who were not preparing hot meals were considered as unexposed (27 persons). The number of AM was counted in smears prepared from expectorate samples from each participant. Samples were taken on three different days. RESULTS: Highly occupationally exposed persons had a higher number of AM in their samples than both slightly occupationally exposed persons and unexposed persons. Highly exposed smokers had a statistically significantly higher number of AM compared with both slightly and unexposed smokers (P < or = 0.05). CONCLUSION: The results suggest an increase in the number of AM due to exposure to cooking fumes and a synergistic effect between occupational exposure and smoking.     

Hypersensitivity pneumonitis with Mycobacterium avium complex among spa workers

Abstract

Background: The New Mexico Department of Health (NMDOH) investigated the cause of two cases of hypersensitivity pneumonitis (HP) in spa maintenance workers with laboratory confirmed Mycobacterium avium complex (MAC). The investigation occurred in tandem with worker protection and swimming pool regulatory investigations by the New Mexico Environment Department at the spa where the workers were employed.

Objectives: The investigation was conducted in order to identify unreported cases, exposure source(s), and to prevent further worker exposure.

Methods: NMDOH surveyed 57 spa employees about symptoms and exposures, categorized jobs according to self-reported exposure to water, and computed odds ratios for symptom reporting by exposure category. Environmental isolates from spa water and filter swabs were cultured and compared to patient isolates by the Environmental and Applied Microbiology Team, Centers for Disease Control and Prevention (CDC).

Results: Workers with the highest exposure reported more HP-like symptoms (OR?=?9·6), as did intermediate exposure workers (OR?=?6·5), compared to workers with no aerosolized water exposure. Two of 13 environmental isolates were closely related to one of the patient isolates.

Conclusions: Workers were likely exposed during spray cleaning of cartridge filters in a poorly ventilated work space. Recommendations include inhibiting organism growth in spa systems, assuring the use of respiratory protection, and adequately ventilating work spaces where filters and equipment are cleaned.