A multidisciplinary cross-sectional study on solvent-related health effects in painters compared with construction workers

Objectives: The main aim of the study was to examine possible solvent-associated effects on the nervous system in currently employed painters. Special attention was paid to evaluate subtle health effects. Materials and methods: A total of 401 painters and 209 construction workers without solvent exposure with at least 10 years of professional experience were subjected to a clinical, neurological, psychiatric, neuropsychological and neurophysiological examination. For personal medical and occupational history, standardized questionnaires were used. A quantitative rating of exposure was obtained by expert rating of the respective occupational history without knowledge of the individual test results. Results: There was no excess of somatic disorders or solvent-associated adverse effects on the nervous system. No distinct effects of solvent exposure on nerve conduction velocities (NCV) or cognition were found. Discrete NCV deficits in painters were not considered a sign of subclinical polyneuropathy. Painters, however, reported an excess of specific symptoms that could be assigned to “mood and behaviour”. The differences between specific and non-specific questionnaire outcomes on the one hand and the positive correlation between chronic exposure index and symptom scores on the other hand support the hypothesis of solvent-induced effects. Because data is lacking on past solvent exposure, it is not possible to relate these effects to current exposure limits. Conclusions: Currently employed painters differ from controls not exposed to solvents with respect to the frequency of certain symptoms in mood and behaviour. These symptoms are related to life-long solvent exposure rather than to current exposure. At present, the issue of time course and reversibility or irreversibility of these symptoms cannot be answered. The predictive value for subsequent neuropsychiatric morbidity remains to be elucidated in follow-up studies. Received: 5 August 1998 / Accepted: 7 February 1999     

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.     

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.     

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.     

Neuropsychological symptoms in Chinese male and female painters: an epidemiological study in dockyard workers

OBJECTIVES: To study the prevalences of neuropsychological symptoms in male and female dockyard painters in China and to compare them with those in British dockyard painters. METHODS: All 116 painters were identified, active and retired, who had been employed in two Chinese dockyards for at least 1 year together with a matched random sample of 263 dockyard non-painters. Neuropsychological and personality questionnaires that we had used previously in a study of United Kingdom dockyard painters were used, translated into Chinese. Neuropsychological symptoms in painters and controls were compared, adjusting for age, educational level, smoking, alcohol intake, and personality. RESULTS: The response rate was 94% for painters and 97% for controls. Highly significant excesses of symptoms were found in painters, suggestive of neuropsychological dysfunction. Both male and female painters showed higher relative risks than were found in similar tradespeople in the United Kingdom. The relative risk increased with increasing score of both neurological and psychological symptoms. Relative risk of having a high symptom score, compared with controls and adjusted for confounders, was 6.61 (95% confidence interval (95% CI) 2.36 to 18.50) for 2-15 years exposure, 14.88 (5.74 to 38.56) for 16-22 years and 9.42 (3.97 to 22.36) for > or = 22 years. CONCLUSION: These results indicate that neuropsychological symptoms are associated with heavy exposure to painting work in China, and that the phenomenon is likely to be found worldwide wherever there is such exposure to solvent based paints. The high response rate in this study answers a possible criticism of the earlier United Kingdom study.

 

     

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.     

Neurobehavioral changes among shipyard painters exposed to solvents

Painters in three shipyards, exposed to a wide variety of solvents, were examined. A short battery of performance tests, a detailed occupational history, and a special questionnaire to assess acute (prenarcotic, transitory) and chronic (persistent) neurologic symptoms was administered. The results of the neurobehavioral performance tests demonstrated decrements in central nervous system function in painters when compared with a control group matched for age, sex, race, and education. The prevalence of reported acute neurological symptoms among painters was increased significantly compared to other occupational groups in the same yards; for chronic, persistent symptoms the difference was not statistically significant. Performance test scores were significantly, negatively correlated with chronic symptoms but not with acute symptoms. No significant correlations between performance test scores and duration of solvent exposure or between symptoms and duration of solvent exposure were observed. The reversibility of such symptoms and of decrements in central nervous system function after cessation of exposure is still uncertain.     

The organic solvent syndrome

Summary A study was conducted to investigate the existence of a specific neurotoxic effect due to long-term exposure to organic solvents. A comparison was made regarding diagnoses, symptoms and other relevant medical data between persons receiving a disability pension on the basis of a neuropsychiatric disorder selected from an exposed (painters) and non-exposed (construction workers) trade organization. Information was collected from their medical files at the occupational health department. Concerning diagnoses and symptoms, no significant differences were found between exposed and non-exposed patients. No indications were found for the existence of a typical complex of symptoms associated with exposure to organic solvents among painters in The Netherlands. The number of reported symptoms was not related to the duration of exposure, thus lending no support for a dose-effect relationship. If a neurotoxic effect does exist among Dutch painters, it is of a non-specific type and not clearly distinguishable from other mental disorders.     

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)     

Respiratory symptoms and diseases among construction painters

Objective: To study the self-reported prevalence of respiratory symptoms and diseases among construction painters and estimate the potential risk for this group compared with a representative group of carpenters sharing the construction work environment but without significant exposure to paint. Methods: A questionnaire study was conducted on 1,000 male Finnish construction painters and 1,000 carpenters (mean response rate 60.5%). Symptoms and diseases of the respiratory tract were studied, by logistic regression modelling, in relation to occupation and duration of painting experience. Age, atopy and smoking habits were taken into account. Results: The painters reported more asthma-like, rhinitis, laryngeal and eye symptoms than the carpenters [odds ratio (OR) 1.4–1.8]. The difference in the prevalence of asthma between the occupations was not statistically significant, but the painters with 1–10 years of painting experience had a threefold risk of asthma compared with the carpenters. Chronic bronchitis was linked to painting occupation [OR 1.9, 95% confidence interval (CI) 1.2–3.0] and to the duration of exposure; OR (CI) for over 30 years of painting was 2.2 (1.2–4.0). Occupation was not associated with allergic rhinitis or conjunctivitis. Conclusions: The results indicate a higher risk for respiratory symptoms and chronic bronchitis among construction painters than among carpenters.     

Individual serum bile acids in apprentice spray painters in association with solvent exposure

The effects of exposure to solvents on serum bile acids were investigated by comparing a group of apprentice vehicle spray painters (exposed group) with one of apprentice electricians. Apprentice spray painters from the study were subdivided into high-and low-solvent-exposure groups. Concentrations of individual serum bile acids (SBA) were measured and compared with conventional liver function tests (LFTs). Total, free, glycine-and taurine-conjugated SBA were consistently found to be present at higher levels in the spray painters than in the electricians, even at the beginning of the apprenticeship. Total SBA tended to increase in spray painters with increasing years of exposure during the apprenticeship, but this was significant at only one time point. No rises were observed over the sampling period in electricians. The mean values of individual and total SBA concentrations were all found to be higher in the high-exposure group than in the low-exposure group, with some differences reaching statistical significane. None of the routine liver biochemistry parameters was different between spray painters and electricians. γ-Glutamyl transferase (GGT) was the only enzyme found to be significantly different between the high-and low-exposure groups, but all values were within the normal range. This study suggests that occupational exposure even to low levels of solvent mixtures results in increases in SBA. The increased SBA may be indicative of a subclinical liver dysfunction. Alternatively, they may reflect solvent exposure only, with the raised levels having no pathologic implication or consequence. The views expressed in this article are those of the authors and do not necessarily reflect those of the National Occupational Health and Safety Commission     

Occupational exposure to water based paint and symptoms from the skin and eyes.

Water based paints contain organic solvents and many additives, such as biocides, surfactants, pigments, binders, amines, and monomers. The chemical complexity may introduce new potential health hazards to house painters, in particular irritative and allergic disorders. This study was performed to compare how house painters experience work with water based paints or solvent based paints, and to evaluate whether exposure to water based paints increases mucous membrane and dermal symptoms among house painters. 255 male house painters aged 20 to 65 were invited to participate in the study. Controls were two industrial populations, in total 302 men, without exposure to water based paints. Self administered questionnaires were used to assess the painter's experiences of working with different types of paints and the occurrence of symptoms in the exposed and unexposed groups. Hygiene measurements were performed during normal working days when only water based paints and no solvent based paints were used. The painters were exposed to low concentrations of dust, metals, ammonia, formaldehyde, and volatile organic compounds. The work environment was considered better when working with water based paints than with solvent based paints. There were more complaints of frequent urination when working with water based paint. Taste or olfactory disturbances were less common. General as well as work related eye and skin irritation was more common among the exposed workers. For other symptoms no significant differences were found. The study indicates that the introduction of water based paints has improved the work environment for house painters. Water based paints cause less discomfort and airway irritation than the earlier solvent based paints. Adverse general health effects seem low. Some of the painters may have dermal symptoms caused by the components in water based paints.     

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.     

Subjective and objective signs of organic solvent toxicity among occupationally exposed workers. An experimental evaluation

A questionnaire consisting of 55 items concerning acute and long-term symptoms associated with exposure to organic solvents, as well as questions about type and duration of exposure, was distributed to 225 male spray painters in the Stockholm region. From the 152 respondents, two extreme groups were selected on the basis of frequency of solvent-related symptoms. Subjects for the experimental study (N = 26) were chosen from these groups and matched with respect to age and number of years employed as a painter. The subjects were experimentally exposed for 4 h to 3.2 mmol/m3 (300 mg/m3) of toluene and a control condition in an exposure chamber. Effects on performance were assessed with a computerized battery of four tests. Ratings of acute symptoms were also studied, and toluene exposure was found to affect them. However, there were no indications of toluene effects on performance, nor was there any correlation between symptom frequencies and performance levels. The only difference found between the two groups was a higher frequency of symptoms of local irritation in the group which had reported high symptom frequencies on the questionnaire.     

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.     

Longitudinal study to explore chronic neuropsychologic effects on solvent exposed workers

AIM: The aim of the study was to examine possible neurotoxic effects on the central nervous system (CNS) in relation to a chronic solvent exposure at the workplace. METHOD: The collective included 127 workers exposed to solvent mixtures, such as spray painters and printers. They were examined twice by means of a physical examination, neuropsychological testbattery, biological and air monitoring. RESULTS: Major component of the solvents were white spirits in concentrations up to 127 ppm in air and 2,666 microg/l in blood. Single substances were mainly toluene and xylenes in concentrations below current threshold values at the workplace. During the 2 yr interval, the concentrations of solvents decreased, and no significant associations between the neuropsychological tests and the solvent exposure were found. Regarding the whole working history of each participant, we found a significant reduction on information processing velocity and performance in the trailmaking test, as well as more complaints of workers with higher solvent exposure in the past. CONCLUSIONS: A slight increase of subjective complaints and a deteriorated power of concentration seems to be associated with chronic solvent exposure.     

Occupational exposure to water-based paints and self-reported asthma,lower airway symptoms,bronchial hyperresponsiveness,and lung function

The associations between occupational exposure to water-based paints and the prevalence of self-reported asthma, other lower airway symptoms, bronchial hyperresponsiveness (BHR), and lung function were studied in house painters. Symptom prevalences were obtained from a self-administered questionnaire sent to 415 male painters during 1989–1992. Clinical investigations were carried out in three selected groups: 23 painters with asthmatic symptoms, nine painters with other lower airway symptoms, and 12 painters without airway symptoms. The clinical studies included lung function test, methacholine provocation test, and occurrence of atopy, confirmed by skin prick test to common allergens. In addition, a group of 18 young male painters with no occupational exposure to solvent-based paints were followed with dynamic spirometry before and after a workshift, when only water-based paints were used. The prevalence of self-reported asthma (7%) was somewhat, but not statistically, increased compared to an industrial population without exposure to water-based paints or other airway irritants. A decrease in FEV₁ and FVC during the workday was observed in the young painters. In the clinical studies the painters exhibited increased BHR compared to the referents and a decreased FEV₁. The number of years working as a painter was related to a decrease in FEV₁, which was most pronounced in subjects with atopy who also reported lower airway symptoms in relation to the degree of work with water-based paints, but not to the degree of use of solvent-based paints. Our results indicate that house painters have an increased risk of airway problems. A contributory cause could be exposure to volatile organic compounds or other volatile compounds emitted from water-based paints. It is also concluded that painters with atopy should be informed about the increased risk of airway illness. This would be an important task for occupational health services in their aim of preventing the adverse effects of occupational exposures.     

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)     

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.