Cora Roelofs

Epigenetic profiles distinguish pleural mesothelioma from normal pleura and predict lung asbestos burden and clinical outcome

Mechanisms of action of nonmutagenic carcinogens such as asbestos remain poorly characterized. As pleural mesothelioma is known to have limited numbers of genetic mutations, we aimed to characterize the relationships among gene-locus-specific methylation alterations, disease status, asbestos burden, and survival in this rapidly fatal asbestos-associated tumor. Methylation of 1505 CpG loci associated with 803 cancer-related genes were studied in 158 pleural mesotheliomas and 18 normal pleura. After false-discovery rate correction, 969 CpG loci were independently associated with disease status (Q < 0.05). Classifying samples based on CpG methylation profile with a mixture model approach, methylation classes discriminated tumor from normal pleura (permutation P < 0.0001). In a random forests classification, the overall misclassification error rate was 3.4%, with <1% (n = 1) of tumors misclassified as normal (P < 0.0001). Among tumors, methylation class membership was significantly associated with lung tissue asbestos body burden (P < 0.03), and significantly predicted survival (likelihood ratio P < 0.01). Consistent with prior work, asbestos burden was associated with an increased risk of death (hazard ratio, 1.4; 95% confidence interval, 1.1-1.8). Our results have shown that methylation profiles powerfully differentiate diseased pleura from nontumor pleura and that asbestos burden and methylation profiles are independent predictors of mesothelioma patient survival. We have added to the growing body of evidence that cellular epigenetic dysregulation is a critical mode of action for asbestos in the induction of pleural mesothelioma. Importantly, these findings hold great promise for using epigenetic profiling in the diagnosis and prognosis of human cancers.

A qualitative investigation of Hispanic construction worker perspectives on factors impacting worksite safety and risk

BackgroundHispanic workers have higher rates of injury and death on construction worksites than workers of other ethnicities. Language barriers and cultural differences have been hypothesized as reasons behind the disparate rates.MethodsWe conducted two series of focus groups with union and non-union Hispanic construction workers to ask them about their perceptions of the causes for the unequal rates. Spanish transcripts were translated and coded in QSR NVivo software for common themes.ResultsWorkers reported a difficult work environment characterized by supervisor pressure, competition for jobs and intimidation with regard to raising safety concerns. Language barriers or cultural factors were not strongly represented as causative factors behind the rates.ConclusionThe results of this study have informed the development of an intervention trial that seeks to prevent falls and silica dust exposure by training contractors employing Hispanic construction workers in the elements of safety leadership, including building respect for their Hispanic workers and facilitating their participation in a safety program.

Results from a community-based occupational health survey of Vietnamese-American nail salon workers.

A community-university collaborative partnership assessed self-reported work-related health effects and environmental factors in Boston’s Vietnamese immigrant community via an interviewer-assisted survey. Seventy-one nail technicians responded. Musculoskeletal disorders, skin problems, respiratory irritation and headaches were commonly reported as work-related, as were poor air quality, dusts and offensive odors. The reporting of a work-related respiratory symptom was significantly associated with the reporting of exposure factors such as poorer air quality. Absence of skin disorders was associated with glove use and musculoskeletal symptoms were associated with years worked as a nail technician. Work-related health effects may be common in nail salon work. Chemical and musculoskeletal hazards should be reduced through product and equipment redesign.

Prevention Strategies in Industrial Hygiene: A Critical Literature Review

Little is known of the extent of use of industrial hygiene prevention and control strategies in actual workplaces. The recent occupational safety and health literature was identified as a potential source for identifying which strategies are being utilized and evaluated as a means of controlling or preventing chemical hazards. Using preestablished selection criteria, the peer-reviewed industrial hygiene literature 1994-1999 was searched for articles describing prevention and control strategies for chemical hazards in actual workplaces. Ninety-two articles were found and categorized by the type of strategy discussed, whether strategies were implemented and evaluated, and by several other categories. Almost three-quarters discussed engineering control strategies, mostly local exhaust ventilation. Administrative strategies, including housekeeping, personal hygiene, and medical surveillance, appeared in about half the articles. Personal protective equipment was considered in one-third of the articles, and primary prevention strategies, such as material substitution, were considered in one-quarter. Intervention effectiveness was not consistently evaluated in these articles. In response to these findings, recommendations are made to improve the evaluation and promotion of effective prevention and control strategies.

Asbestos burden predicts survival in pleural mesothelioma

Background Malignant pleural mesothelioma (MPM) is a rapidly fatal asbestos-associated malignancy with a median survival time of < 1 year following diagnosis. Treatment strategy is determined in part using known prognostic factors. Objective The aim of this study was to examine the relationship between asbestos exposure and survival outcome in MPM in an effort to advance the understanding of the contribution of asbestos exposure to MPM prognosis. Methods We studied incident cases of MPM patients enrolled through the International Mesothelioma Program at Brigham and Women’s Hospital in Boston, Massachusetts, using survival follow-up, self-reported asbestos exposure (n = 128), and a subset of cases (n = 80) with quantitative asbestos fiber burden measures. Results Consistent with the established literature, we found independent, significant associations between male sex and reduced survival (p < 0.04), as well as between nonepithelioid tumor histology and reduced survival (p < 0.02). Although self-reported exposure to asbestos was not predictive of survival among our cases, stratifying quantitative asbestos fiber burden [number of asbestos bodies per gram of lung (wet weight)] into groups of low (0–99 asbestos bodies), moderate (100–1,099), and high fiber burden (> 1,099), suggested a survival duration association among these groups (p = 0.06). After adjusting for covariates in a Cox model, we found that patients with a low asbestos burden had a 3-fold elevated risk of death compared to patients with a moderate fiber burden [95% confidence interval (CI), 0.95–9.5; p = 0.06], and patients with a high asbestos burden had a 4.8-fold elevated risk of death (95% CI, 1.5–15.0; p < 0.01) versus those with moderate exposure. Conclusion Our data suggest that patient survival is associated with asbestos fiber burden in MPM and is perhaps modified by susceptibility.

Exposure Assessment in Nail Salons: An Indoor Air Approach

Due to the complexity of the nail salon work environment, traditional approaches to exposure assessment in this context tend to mischaracterize potential hazards as nuisances. For this investigation, a workable “indoor air” approach was devised to characterize potential hazards and ventilation in Boston, Massachusetts area nail salons which are primarily owned and staffed by Vietnamese immigrants. A community-university partnership project recruited salons to participate in a short audit which included carbon dioxide measurements and evaluation of other air quality metrics. Twenty-two salons participated. Seventy-three percent of the salons had spot carbon dioxide measurements in excess of 700 ppm, the level corresponding to a ventilation rate recommended for beauty salons. Fourteen salons (64%) did not have a mechanical ventilation system to provide fresh air and/or exhaust contaminated air. The lack of adequate ventilation is of significant concern because of the presence of potentially hazardous chemicals in salon products and the common self-report of symptoms among nail technicians. Community and worker health may be improved through adoption of recommended ventilation guidelines and reduction in the hazard potential of nail products.

Results of a community-based survey of construction safety climate for Hispanic workers

Abstract Background: Hispanic construction workers experience high rates of occupational injury, likely influenced by individual, organizational, and social factors. Objectives: To characterize the safety climate of Hispanic construction workers using worker, contractor, and supervisor perceptions of the workplace. Methods: We developed a 40-item interviewer-assisted survey with six safety climate dimensions and administered it in Spanish and English to construction workers, contractors, and supervisors. A safety climate model, comparing responses and assessing contributing factors was created based on survey responses. Results: While contractors and construction supervisors’ (n = 128) scores were higher, all respondents shared a negative perception of safety climate. Construction workers had statistically significantly lower safety climate scores compared to supervisors and contractors (30·6 vs 46·5%, P<0·05). Safety climate scores were not associated with English language ability or years lived in the United States. Conclusions: We found that Hispanic construction workers in this study experienced a poor safety climate. The Hispanic construction safety climate model we propose can serve as a framework to guide organizational safety interventions and evaluate safety climate improvements.

The Boston Safe Shops Model: An Integrated Approach to Community Environmental and Occupational Health

Small, immigrant-owned businesses, such as auto repair shops and nail salons, often face barriers to environmental and occupational health compliance and may be a source of neighborhood pollution complaints. The Boston Public Health Commission established the Safe Shops Project to improve safety and environmental practices in such businesses using a community partnership model that incorporates enforcement inspection findings, worker training, technical assistance, and referral to health care and business resources. This integrated technical assistance approach has led to improved occupational health and environmental conditions, adoption of pollution prevention technologies, novel problem-solving, and dozens of health screenings and insurance referrals for workers and their neighbors.

Latency attention deficit: Asbestos abatement workers need us to investigate

Little is known of the impact of asbestos on the health of the workers in the United States who have removed or abated asbestos from buildings following recognition of its adverse effects on health. The United States does not have a national occupational health surveillance network to monitor asbestos-related disease and, while the United States Occupational Health and Safety Administration has a strong and detailed asbestos standard, its enforcement resources are limited. A significant proportion of asbestos abatement workers are foreign-born, and may face numerous challenges in achieving safe workplaces, including lack of union representation, economic vulnerability, and inadequate training. Public health surveillance and increased and coordinated enforcement is needed to monitor the health and exposure experiences of asbestos-exposed workers. Alarming disease trends in asbestos removal workers in Great Britain suggest that, in the United States, increased public attention will be necessary to end the epidemic of asbestos-related disease.Little is known of the impact of asbestos on the health of the workers in the United States who have removed or abated asbestos from buildings following recognition of its adverse effects on health. The United States does not have a national occupational health surveillance network to monitor asbestos-related disease and, while the United States Occupational Health and Safety Administration has a strong and detailed asbestos standard, its enforcement resources are limited. A significant proportion of asbestos abatement workers are foreign-born, and may face numerous challenges in achieving safe workplaces, including lack of union representation, economic vulnerability, and inadequate training. Public health surveillance and increased and coordinated enforcement is needed to monitor the health and exposure experiences of asbestos-exposed workers. Alarming disease trends in asbestos removal workers in Great Britain suggest that, in the United States, increased public attention will be necessary to end the epidemic of asbestos-related disease. Am. J. Ind. Med. 58:1231–1234, 2015.

Trade unions and cleaner production: perspectives and proposals for action.

Despite their reputation for linking progress and security to dirty smokestacks, many trade unions around the world have designed and fought for sophisticated environmental policies—many of which promote a radical restructuring of production in order to prevent environmental harm. This article surveys trade union perspectives on cleaner production and offers examples of trade union action for cleaner production in the United States and around the world. Two general conceptual frameworks arising out of union writing on the subject—the “Transition Position” and the European-based “Harmony of Interests”—are elaborated. The article concludes with recommendations for employee participation in pollution prevention activities and ideas for a trade union agenda on cleaner production.