Diagnoses of alcohol abuse and other neuropsychiatric disorders among house painters compared with house carpenters.

The incidence of alcoholism and the incidence of other neuropsychiatric diagnoses were compared between the 767 house painters and the 1212 house carpenters, born in 1925 or later, who were members of the Stockholm branches of their respective trade unions in 1965 and who had been members for at least 10 years before 1970. Four different outcome registers were used: (1) the alcohol crime register, which contained all persons who had broken any law regulating the handling and consumption of alcohol (follow up period 1972-6). (2) The register of diagnoses at early retirement (follow up period 1971-84). (3) The register of diagnoses at discharge from inpatient psychiatric care (follow up period 1968-83). (4) The register of causes of death (follow up period 1965-86). Exposures to solvents and consumption of alcohol were evaluated by interviews with samples of the cohorts. A high average cumulative exposure to solvents was found among the painters. The mean consumption of alcohol was similar in the two cohorts. The incidence of diagnoses of neuropsychiatric disorders was higher in painters than in carpenters in all registers. Alcoholism was the most common neuropsychiatric disorder diagnosed and showed the highest relative risk. The excess of alcoholism among the painters was, however, due singularly to painters who had several registrations in the alcohol crime register or diagnoses of alcoholism in multiple registers. Thus the study implies that excessive alcohol consumption or severe damage due to alcohol, or both, but not less severe problems, were more common in painters than in carpenters. This suggests an interaction between exposure to solvents and intake of alcohol causing an increase in diagnosis of alcoholism among painters.     

Disability, mortality, and incidence of cancer among Geneva painters and electricians: a historical prospective study.

The 1916 painters and the 1948 electricians who resided in the Canton of Geneva at the time of the 1970 census were identified and followed up to 1984. During the study period 121 disability pensions were awarded to painters and 59 to electricians. Age standardised incidence of disability per 1000 man-years at risk was higher among painters than among electricians for all neuropsychiatric causes (1.23/1000 and 0.68/1000, respectively) and for all other causes (5.50/1000 and 3.41/1000, respectively). No case of presenile dementia was diagnosed among painters. There was inadequate evidence to indicate that the higher risk of neuropsychiatric disability for painters might have been due to their occupational exposure to organic solvents. A possible toxic effect of these substances on the central nervous system was confounded with alcoholism which was associated with disability from neuropsychiatric disease in 12 of 20 painters and in only one of 10 electricians. Mortality and incidence of cancer were assessed among both cohorts and compared with the expected figures calculated from Geneva rates. Among painters there was a significant increase in overall mortality (O = 254, E = 218.5), in mortality from all cancers (O = 96, E = 75.4), and in incidence from all cancers (O = 159, E = 132.0). For the specific cancer sites, there was a significant excess risk for lung cancer (mortality: O = 40, E = 23.0), which was possibly related to occupational exposure to asbestos and to zinc chromate, although cigarette smoking was not controlled. The significant excesses of biliary tract cancer and of bladder cancer were in accordance with previous observations among painters from other countries. There was also a significant increase in incidence from testicular cancer (O=5, E=1.6), which has not been reported before. For causes of death other than cancer the excesses for alcoholism (O=5, E=0.8). for liver cirrhosis (O=14, E=8.8), for motor vehicle accidents (O=12, E=5.9), and for cerebrovascular disease when allowing for ten years of latency (O=8, E=4.0), were consistent with a probable increased risk of alcohol abuse. Among electricians overall mortality was similar to that expected (O=137, E=139.0). No significant excess risk was found for all cancers or for any specific cancer site. Because of the small number of expected deaths the statistical power was low for the assessment of a possible risk for leukaemia or for brain tumour.     

Disability, mortality, and incidence of cancer among Geneva painters and electricians: a historical prospective study

The 1916 painters and the 1948 electricians who resided in the Canton of Geneva at the time of the 1970 census were identified and followed up to 1984. During the study period 121 disability pensions were awarded to painters and 59 to electricians. Age standardised incidence of disability per 1000 man-years at risk was higher among painters than among electricians for all neuropsychiatric causes (1.23/1000 and 0.68/1000, respectively) and for all other causes (5.50/1000 and 3.41/1000, respectively). No case of presenile dementia was diagnosed among painters. There was inadequate evidence to indicate that the higher risk of neuropsychiatric disability for painters might have been due to their occupational exposure to organic solvents. A possible toxic effect of these substances on the central nervous system was confounded with alcoholism which was associated with disability from neuropsychiatric disease in 12 of 20 painters and in only one of 10 electricians. Mortality and incidence of cancer were assessed among both cohorts and compared with the expected figures calculated from Geneva rates. Among painters there was a significant increase in overall mortality (O = 254, E = 218.5), in mortality from all cancers (O = 96, E = 75.4), and in incidence from all cancers (O = 159, E = 132.0). For the specific cancer sites, there was a significant excess risk for lung cancer (mortality: O = 40, E = 23.0), which was possibly related to occupational exposure to asbestos and to zinc chromate, although cigarette smoking was not controlled. The significant excesses of biliary tract cancer and of bladder cancer were in accordance with previous observations among painters from other countries. There was also a significant increase in incidence from testicular cancer (O=5, E=1.6), which has not been reported before. For causes of death other than cancer the excesses for alcoholism (O=5, E=0.8). for liver cirrhosis (O=14, E=8.8), for motor vehicle accidents (O=12, E=5.9), and for cerebrovascular disease when allowing for ten years of latency (O=8, E=4.0), were consistent with a probable increased risk of alcohol abuse. Among electricians overall mortality was similar to that expected (O=137, E=139.0). No significant excess risk was found for all cancers or for any specific cancer site. Because of the small number of expected deaths the statistical power was low for the assessment of a possible risk for leukaemia or for brain tumour.     

Liver function tests and urinary albumin in house painters with previous heavy exposure to organic solvents.

The serum activities or concentrations of aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), alkaline phosphatase (ALP), albumin, gamma-glutamyl transpeptidase (GGT), bilirubin (BIL), cholic acid (CHOL), chenodeoxycholic acid (CHENO), and transferrin with isoelectric point 5.7, and the urinary excretion of albumin were determined among male current or former house painters (n = 135) and house carpenters (n = 71) who had worked in their trades for at least 10 years before 1970. Workers who showed a value above the 90th percentile among the carpenters in at least one of the tests ASAT, ALAT, GGT, BIL, CHOL, or CHENO were regarded as showing "possible signs of liver dysfunction". Each participant's lifetime solvent exposure was evaluated by interview. The painters were divided into categories with low, intermediate, and heavy cumulative exposure during life (LTSE) or during the most exposed year (MEYSE). All participants stated none or slight recent exposure. The prevalence of possible signs of liver dysfunction increased with solvent exposure category according to LTSE as well as MEYSE with a numerically higher risk estimate in the heavy exposure category for MEYSE than for LTSE. ALP activity increased with exposure category according to both exposure estimates. This increase seemed to be due to an interaction between exposure to solvents and current or previous long term intake of medicines potentially toxic to the liver. None of these results was affected by whether or not the subjects had been exposed to solvents during the year before the investigation. The exposure to solvents was not significantly related to any other outcome variable. It is concluded that long term heavy exposure to solvents may elicit changes in conventional liver function tests indicative of a mild chronic effect on the liver. The findings also suggest that heavy solvent exposure during short time periods is a more likely cause of the findings than lifetime cumulative solvent exposure and that an interaction between solvent exposure and medicines potentially harmful to the liver may be important in the causation of the effects.     

Evaluation of the Q16 questionnaire on neurotoxic symptoms and a review of its use.

OBJECTIVES: The questionnaire 16 (Q16) is commonly used to study prevalences of neurotoxic symptoms among workers exposed to organic solvents. It has also been recommended that exposed workers reporting more than six symptoms should be referred for further examination of possible chronic toxic encephalopathy. It would be useful to know whether symptoms reported in the questionnaire also reflect impairment of similar functions measured with objective or semiobjective methods in a formerly highly exposed group. METHODS: 135 painters and 71 carpenters answered the Q16, were interviewed about symptoms compatible with an organic brain damage, and took a battery of psychometric tests. A subsample of 52 painters and 45 carpenters were interviewed for psychiatric diagnosis according to Diagnostic and Statistical Manual for Mental Disorders, 3rd version (DSM III) and their vibration thresholds in hands and feet were measured. The entire group was followed up in the register of diagnoses at early retirement 1971-93. The lifetime exposure to organic solvents was assessed. Current exposure to organic solvents was found to be low or none. RESULTS: The prevalence of people with more than six symptoms in the Q16 rose with increasing cumulative exposure to solvents. The sensitivity of the questionnaire (more than six symptoms) to detect people who were assessed to exhibit symptoms compatible with an organic brain damage was only 38%. One of seven people who had retired early with a diagnosis compatible with a chronic toxic encephalopathy, and two of five people with a psychiatric diagnosis compatible with this condition, had more than six symptoms in the Q16. The agreement between Q16 replies and psychometric test results, as well as other examinations, was low. CONCLUSIONS: The notable exposure-response relation indicates that the questionnaire is useful for comparison of groups with different exposures to organic solvents. There was low agreement between the number of symptoms on the questionnaire and the assessment of symptoms compatible with organic brain damage, as well as psychiatric, or early retirement diagnoses compatible with chronic toxic encephalopathy. The questionnaire does not seem useful for screening of patients with chronic toxic encephalopathy in groups without ongoing exposure to organic solvents.     

Neuropsychological function in retired workers with previous long-term occupational exposure to solvents

OBJECTIVES: It is plausible that neurodegenerative processes of aging might have a contributing role in the development of chronic effects of exposure to organic solvents. This study evaluated the risk for neuropsychological deficits among retired workers, relative to their histories of exposure to occupational solvents. METHODS: This cross sectional study evaluated retired male workers, 62-74 years of age, including 89 people with previous long-term occupational exposure to solvents (67 retired painters and 22 retired aerospace manufacturing workers), and 126 retired carpenters with relatively minimal previous exposure to solvents. Subjects completed a standardised neuropsychological evaluation and psychiatric interview, structured interviews for histories of occupational exposure and alcohol consumption, and questionnaires assessing neurological and depressive symptoms. RESULTS: By comparison with the carpenters, the painters on average reported greater cumulative alcohol consumption and had lower scores on the WAIS-R vocabulary subtest, usually presumed to reflect premorbid intellectual functioning. These findings, however, were not sufficient to account for the other study findings. Controlling for age, education, vocabulary score, and alcohol use, the painters had lower mean scores on test measures of motor, memory, and reasoning ability; and a subgroup of aerospace workers with moderate to high cumulative exposure to solvents (n = 8) had lower mean scores on measures of visuomotor speed, and motor, attention, memory, and reasoning ability. Subjects were more likely to have an increased number of relatively abnormal test scores (three or more outlier scores on 17 test measures) among both the painter group (odds ratio (OR), 3.1; 95% confidence interval (95% CI) 1.5 to 6.2) and the subgroup of aerospace workers with higher cumulative exposure (OR 5.6; 95% CI 1.0 to 38). The painters, but not the aerospace workers, reported significantly more neurological and depressive symptoms. CONCLUSIONS: The findings are consistent with residual central nervous system dysfunction from long-term exposure to organic solvents, persisting years after the end of exposure.

 

     

A case-referent study on neuropsychiatric disorders among workers exposed to solvents.

Published reports give justification for the belief that long-term exposure to solvents might induce chronic but nonspecific neuropsychiatric conditions. This case-referent study of data from a regional Swedish pension fund register indicated a risk ration of 1.8 in regard to nonspecific neuropsychiatric disorders among workers such as painters, varnishers and carpetlayers who are exposed to solvents as compared to workers not so exposed. Moreover a dose-response relationship seems to exist between exposure in terms of occupational years and neuropsychiatric conditions, the result being that persons affected are considered eligible for disability pensions.     

Chronic toxic encephalopathy among house painters with disability pension

Among a group of 14 painters accorded a disability pension, 11 showed signs and symptoms of slight encephalopathy. Five of these 11 painters previously had been pensioned with a diagnosis of musculoskeletal disease, while the encephalopathy was unrecorded in the disability pension records. The combined effect of the two diseases may have caused the disability. We considered occupational solvent exposure the most probable cause of the encephalopathy in four of these five painters. This study indicates that case-referent studies based on diagnoses from disability pension registers may lead to underestimation of the risk of toxic encephalopathy.     

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.     

Development of alcoholism: interaction between heavy adolescent drinking and later low sense of control over work

The combined effects of heavy use of alcohol in late adolescence and later unfavourable psychosocial work-environment may contribute to the development of alcoholism. Data on circumstances during childhood and adolescence, including alcohol use, history of police and/or childcare contacts, and emotional stability, were collected for 49 323 young men, born during the period 1949-1951, at the time of enlistment for compulsory military training in 1969/1970. On the basis of census data on occupation in 1975, all individuals were classified into groups with regard to the level of work-control (i.e. participation in decision-making, variation in job task, etc.) in accordance with a job exposure matrix. The background of those men who acquired a diagnosis of alcoholism according to in-patient psychiatric care registers in 1976-1983 was examined in relation to their alcohol consumption in adolescence and the nature of their subsequent work environment. It was found that young men with heavy alcohol consumption had an increased risk of developing alcoholism if they later worked in an environment characterized by low control. This finding was not due to selection of heavy drinkers into low control jobs. Similar results were obtained when data from blue-collar workers were analysed separately.     

Health care utilization of families of carpenters with alcohol or substance abuse-related diagnoses

BACKGROUND: Patterns of health care utilization of families of carpenters with and without alcohol and/or substance abuse related diagnoses (ASRD) were compared. METHODS: Utilization data for families of 13,657 carpenters for a 10 year period were analyzed. Concordance of diagnoses among family members was assessed and proportionate utilization ratios were used to compare the experiences of families of carpenters with and without ASRD. RESULTS: Twenty-eight percent of the spouses with ASRD had a carpenter spouse with a similar diagnosis. Twenty-four percent of the families with a child with ASRD had a parent with one of these diagnoses compared to 9.4% of families without any children with ASRD (P < 0.0001). Families of carpenters with alcohol or ASRD also had different patterns of health care utilization. CONCLUSIONS: Utilization patterns were influenced to a significant degree by concordant diagnoses among spouses and children. Excess mental health care was seen among families of carpenters with ASRD above their care for substance abuse treatment.     

Study of the electrical impedance of blood from house painters

Summary Using a four-electrode technique the electrical impedance was measured at 150 kHz (100 A) on whole blood samples from 13 male house painters (age 19–49 years; median 35 years) exposed occupationally to vapors from alkyd paints containing organic solvents and from a control group of 7 healthy unexposed men (age 27–53 years; median 37 years). The blood impedance of the two groups was monitored prior to and 9 days after an initial administration of acetylsalicylic (600 mg). The resistivity calculated from the impedance of whole blood from the painters remained significantly higher than the corresponding values for the controls. The hematological values for the two groups were within normal ranges, although the painters had significantly higher platelet counts than the controls. Effects of long-term exposure of the painters to volatile solvents are discussed.     

Risk of neuropsychiatric disability among painters in the United States

Scandinavian studies have suggested that working with solvents is associated with chronic neuropsychiatric disease. In the United States the Social Security Administration's records of white male recipients of disability compensation were used in a case-referent study on this topic. The cases were defined as men with any one of several neuropsychiatric diseases, and the referents as men with other disabling conditions. The men were considered exposed if they had worked as a painter prior to disability and unexposed if they had worked as a bricklayer. A job-exposure matrix verified the painters' potential exposure to solvents and the bricklayers' lack of potential exposure. The painters had a significant excess of neuropsychiatric disability [adjusted odds ratio (OR) 1.42, 95% confidence interval (95% CI) 1.04-1.94]. Construction painters had an excess of neuropsychiatric disability [OR 1.47 (95% CI 1.07-2.02)] in contrast to spray painters [OR 0.77 (95% CI 0.38-1.54)]. The limitations of the data are discussed, including potential diagnosis bias and exposure misclassification.     

Occupational solvent exposure and neuropsychiatric disorders

Long-term exposure to solvents has been shown to induce neuropsychiatric disorders in workers. In this case-referent study the cases comprised 374 construction workers who had been awarded a disability pension due to a neuropsychiatric disorder in 1978-1980. Their matched referents were selected from construction workers who had been granted a pension due to o ther diseases in the same three-year period. The results of this study indicate that solvent exposure increases the risk of being prematurely pensioned due to neuroses, but early pensioning due to alcoholism or other neuropsychiatric disorders is not increased by solvent exposure. This same conclusion has been reached in earlier studies on this matter in other countries.     

Effect of painting work on alcoholic liver dysfunction]

The effect of painting on alcoholic liver dysfunction was investigated. The subjects were male workers engaged in small-scale enterprises under contract to with heavy industries. Painting involved metal cleaning and painting, and the air concentrations of organic solvents were frequently high. The study population consisted of 1,157 male workers over 40 yr of age. Of them, 85 were painters engaged for a mean duration of 20.9 +/- 9.8 yr. There was no significant difference in GOT and GPT between painters who did not drink and non-painters who did not drink, but GOT and GPT were significantly higher in painters drinking several days a week than in non-painters. A past history of hepatitis affected GOT, GPT and gamma-GTP. Painting, daily alcohol consumption, drinking frequency and body mass index affected gamma-GTP. A questionnaire survey of hepatitis was also conducted in 206 male workers (age range 18-67 yr). Of them, 134 were painters (mean duration of painting, 16.8 +/- 10.4 yr). This questionnaire survey showed that 13 painters (9.6% of the painters) and two non-painters (2.6% of the non-painters) had a history of hepatitis. Of the 13 painters, five painters had a history of hepatitis C and four had a history of alcoholic hepatitis. All of these 13 painters had the habit of drinking. This study indicated that painting had little effect on the liver function in painters not drinking, but increased alcoholic liver dysfunction in painters with the drinking habit.     

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.     

Back pain and heavy physical work: a comparative study of concrete reinforcement workers and maintenance house painters.

In an investigation of the effect of heavy physical work on the back 217 concrete reinforcement workers aged 25-54 and a reference group of 202 house painters of similar age were interviewed about their back symptoms. Data on occupational history, accidents, and leisure time activities were collected with a questionnaire. The cumulative incidence rate of sciatic pain was significantly higher among the reinforcement workers than the painters. As regards the occurrence of lumbago and non-specific back pain, however, the groups were alike. In both occupational groups sciatic pain during the previous 12 months was associated with earlier back accidents (odds ratio 2.8, 95% confidence interval 1.8-4.5). The accident rate of the reinforcement workers was higher than that of the painters, and this difference seemed to explain their higher rate of sciatic pain.     

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.     

Alcohol and mortality in the Italian rural cohorts of the Seven Countries Study.

The relation of alcohol consumption to mortality is examined using the data of the Italian rural cohorts of the Seven Countries Study, a prospective investigation of factors related to cardiovascular disease (CVD). The present analysis includes 1536 men aged 45-64, whose dietary habits and food consumption, including alcoholic beverages, were measured in 1965. Of them, 463 men died in a follow-up period of 15 years. The analysis shows a J-shaped relationship between alcohol consumption, expressed as percentage of total daily energy intake, and both overall mortality and cardiovascular mortality; this J-shaped relationship is evident even after adjusting for age, cigarette smoking and occupation. The inverse relationship for consumption of small quantities of alcohol, which is represented by the left side of the J-curve, is no longer significant when all men with previous cardiovascular manifestations are excluded from the analysis, yet it is never completely eliminated.