Diane C. Mitchell

Pneumoconiosis from Agricultural Dust Exposure among Young California Farmworkers

Background Agricultural workers are exposed to airborne pollutants, including organic and inorganic (mineral) dusts. Objectives Lung autopsy specimens from consecutive coroner’s cases of Hispanic males in Fresno County, California, (n = 112) were obtained to determine whether mineral dust exposure in agricultural work leads to pneumoconiosis. Methods The left lung was fixed by inflation. We evaluated airway and parenchymal pathology using standardized diagnostic criteria and semiquantitative grading schemata, including the grading of small airways for fibrosis and birefringent mineral dust particles. We analyzed lung dust burden on a subset of 37 lungs following bleach digestion, using scanning electron microscopy (SEM), X-ray spectrometry (XRS) and image analysis, and by X-ray diffraction for crystalline silica (CSi). Farmworkers comprised 51.5% and nonfarmworkers 48.5% of the samples. Results Proximal airways demonstrated little mineral dust accumulation, but membranous and respiratory bronchioles had wall thickening, remodeling, and inflammation associated with carbonaceous and mineral dust deposition. These changes were independently associated with agricultural work, cigarette smoking, and increased age. Mineral dust small airways disease, pneumoconiosis (macules and nodules), and pathologic changes consistent with chronic bronchitis, emphysema, and interstitial fibrosis predominated in farmworkers compared with nonfarmworkers. CSi, determined gravimetrically, and aluminum silicate particles, determined by SEM/XRS, were increased in the lungs of farmworkers compared with nonfarmworkers and were significantly (p < 0.05) associated with small airway disease and pneumoconiosis. Conclusion Mineral dust exposure is associated with increased small airway disease and pneumoconiosis among California farmworkers; however, the clinical significance and natural history of these changes remains to be determined.

Agricultural Dust Exposure and Respiratory Symptoms Among California Farm Operators

Objective:To study whether dust exposure in California agriculture is a risk factor for respiratory symptoms. Methods:A population-based survey of 1947 California farmers collected respiratory symptoms, occupational and personal exposures. Associations between dust and respiratory symptoms were assessed by logistic regression models. Results:The prevalence of persistent wheeze was 8.6%, chronic bronchitis 3.8%, chronic cough 4.2%, and asthma 7.8%. Persistent wheeze was independently associated with dust in a dose–response fashion odds ratio, 1.2 (95% confidence interval[CI] = 0.8–2.0) and 1.8 (95% CI = 1.1–3.2) for low and high time in dust. A borderline significant association between chronic bronchitis and dust exposure was found. Asthma was associated with keeping livestock, but not with dust exposure. Conclusions:Occupational dust exposure among California farmers, only one third of whom tended animals, was independently associated with chronic respiratory symptoms.

Occupational exposure to particulate matter and endotoxin for California dairy workers

Occupational exposure of dairy workers to particulate matter (PM) and endotoxin has been considered by some to be of potential concern. This paper reports personal exposure concentrations of PM (μg/m3) and endotoxin (EU/m3) for 226 workers from 13 California dairies. Arithmetic mean personal concentrations for PM2.5, inhalable PM and endotoxin were 48 μg/m3 (N = 222), 987 μg/m3 (N = 225) and 453 EU/m3 (N = 225), respectively. Using mixed effects models, time spent re-bedding of freestall barns versus any other job conducted on a dairy led to the highest exposure for PM2.5, inhalable PM, and endotoxin. Personal exposure concentrations were found to be greater than those reported for ambient area based concentrations at the same dairies. A pseudo R-square approach revealed that one area based measure combined with time spent performing tasks explained a significant portion of variation in personal exposure concentrations.

Acute Pulmonary Function Change Associated With Work on Large Dairies in California

Objective: To study whether dairy workers in California have lower baseline and greater cross-shift decrements in lung function than control employees. Methods: A cross-sectional study of 210 dairy and 47 control workers who completed questionnaires and spirometry before and after the work shift. Results: Dairy work was associated with mean baseline differences of −0.132 L (P = 0.07) and −0.131 L (P = 0.13) in forced expiratory volume in 1 second and forced vital capacity, respectively, compared with control employees, adjusting for age, height, smoking status, and days back at work since last day off. Dairy work was associated with a mean cross-shift difference of −65.2 mL (P = 0.02) and −103.1 mL (P < 0.01) in forced expiratory volume in 1 second and forced vital capacity, respectively, adjusting for smoking status and work-shift time. Conclusions: Dairy work in California was associated with mild acute airway obstruction. The unclear long-term effect of dairy work in California merits further investigation.

Activation of inflammatory responses in human U937 macrophages by particulate matter collected from dairy farms: an in vitro expression analysis of pro-inflammatory markers

BackgroundThe purpose of the present study was to investigate activation of inflammatory markers in human macrophages derived from the U937 cell line after exposure to particulate matter (PM) collected on dairy farms in California and to identify the most potent components of the PM.MethodsPM from different dairies were collected and tested to induce an inflammatory response determined by the expression of various pro-inflammatory genes, such as Interleukin (IL)-8, in U937 derived macrophages. Gel shift and luciferase reporter assays were performed to examine the activation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and Toll-like-receptor 4 (TLR4).ResultsMacrophage exposure to PM derived from dairy farms significantly activated expression of pro-inflammatory genes, including IL-8, cyclooxygenase 2 and Tumor necrosis factor-alpha, which are hallmarks of inflammation. Acute phase proteins, such as serum amyloid A and IL-6, were also significantly upregulated in macrophages treated with PM from dairies. Coarse PM fractions demonstrated more pro-inflammatory activity on an equal-dose basis than fine PM. Urban PM collected from the same region as the dairy farms was associated with a lower concentration of endotoxin and produced significantly less IL-8 expression compared to PM collected on the dairy farms.ConclusionThe present study provides evidence that the endotoxin components of the particles collected on dairies play a major role in mediating an inflammatory response through activation of TLR4 and NF-κB signaling.

Particulate matter, endotoxin, and worker respiratory health on large Californian dairies

Objective: To assess respiratory exposures and lung function in a cross-sectional study of California dairy workers. Methods: Exposure of 205 dairy and 45 control (vegetable processing) workers to particulate matter and endotoxin was monitored. Pre- and postshift spirometry and interviews were conducted. Results: Geometric mean inhalable and PM2.5 concentrations were 812 and 35.3 &mgr;g/m3 versus 481.9 and 19.6 &mgr;g/m3, respectively, for dairy and control workers. Endotoxin concentrations were 329 EU/m3 or 1122 pmol/m3 and 13.5 EU/m3 or 110 pmol/m3, respectively, for dairy and control workers. In a mixed-effects model, forced vital capacity decreased across a work shift by 24.5 mL (95% confidence interval, −44.7 to −4.3; P = 0.018) with log10 (total endotoxin) and by 22.0 mL (95% confidence interval, −43.2 to −0.08; P = 0.042) per hour worked. Conclusions: Modern California dairy endotoxin exposures and shift length were associated with a mild acute decrease in forced vital capacity.

Heat strain, volume depletion and kidney function in California agricultural workers

Background Agricultural work can expose workers to increased risk of heat strain and volume depletion due to repeated exposures to high ambient temperatures, arduous physical exertion and limited rehydration. These risk factors may result in acute kidney injury (AKI). Methods We estimated AKI cumulative incidence in a convenience sample of 283 agricultural workers based on elevations of serum creatinine between preshift and postshift blood samples. Heat strain was assessed based on changes in core body temperature and heart rate. Volume depletion was assessed using changes in body mass over the work shift. Logistic regression models were used to estimate the associations of AKI with traditional risk factors (age, diabetes, hypertension and history of kidney disease) as well as with occupational risk factors (years in farm work, method of payment and farm task). Results 35 participants were characterised with incident AKI over the course of a work shift (12.3%). Workers who experienced heat strain had increased adjusted odds of AKI (1.34, 95% CI 1.04 to 1.74). Piece rate work was associated with 4.24 odds of AKI (95% CI 1.56 to 11.52). Females paid by the piece had 102.81 adjusted odds of AKI (95% CI 7.32 to 1443.20). Discussion Heat strain and piece rate work are associated with incident AKI after a single shift of agricultural work, though gender differences exist. Modifications to payment structures may help prevent AKI.

Cage Versus Noncage Laying-Hen Housings: Respiratory Exposures

ABSTRACT The objective of this study was to compare the personal respiratory exposures of poultry workers in three different types of layer housing under commercial production conditions. Workers were randomly assigned to each of conventional cage, enriched cage, and aviary barns in a crossover repeated-measures design for three observation periods over the hens’ lifetime. Inhalable and fine particulate matter (PM) and endotoxin in both size fractions were assessed by personal and area samplers over the work shift. Concentrations of inhalable PM, PM2.5 (PM with an aerodynamic diameter <2.5 μm), and endotoxin in both size fractions were higher in aviary than either the conventional or enriched barns. Geometric means (95% confidence intervals [CIs]) of inhalable PM and endotoxin for the aviary, conventional, and enriched barns were 8.9 (6.8–11.5) mg/m3 and 7517.9 (5403.2–10,460.2) EU/m3, 3.7 (2.8–4.8) mg/m3 and 1655.7 (1144.6–2395.2) EU/m3, 2.4 (1.8–3.3) mg/m3 and 1404.8 (983.3–2007.0) EU/m3, respectively. Area samplers recorded a lower mean inhalable PM concentration and higher PM2.5 concentration than personal samplers. Ammonia concentrations were low throughout three monitoring seasons. These findings show that the aviary barns pose higher respiratory exposures to poultry workers than either conventional or enriched barns.

Cage Versus Noncage Laying-Hen Housings: Worker Respiratory Health

ABSTRACT The objective of this study was to compare respiratory health of poultry workers in conventional cage, enriched cage and aviary layer housing on a single commercial facility, motivated by changing requirements for humane housing of hens. Three workers were randomly assigned daily, one to each of conventional cage, enriched cage, and aviary housing in a crossover repeated-measures design for three observation periods (for a total of 123 worker-days, eight different workers). Workers’ exposure to particles were assessed (Arteaga et al. J Agromedicine. 2015;20:this issue) and spirometry, exhaled nitric oxide, respiratory symptoms, and questionnaires were conducted pre- and post-shift. Personal exposures to particles and endotoxin were significantly higher in the aviary than the other housings (Arteaga et al., 2015). The use of respiratory protection was high; the median usage was 70% of the shift. Mixed-effects multivariate regression models of respiratory cross-shift changes were marginally significant, but the aviary system consistently posted the highest decrements for forced expiratory volume in 1 and 6 seconds (FEV1 and FEV6) compared with the enriched or conventional housing. The adjusted mean difference in FEV1 aviary − enriched cage housing was −47 mL/s, 95% confidence interval (CI): (−99 to 4.9), P = .07. Similarly, for FEV6, aviary − conventional housing adjusted mean difference was −52.9 mL/6 s, 95% CI: (−108 to 2.4), P = .06. Workers adopting greater than median use of respiratory protection were less likely to exhibit negative cross-shift pulmonary function changes. Although aviary housing exposed workers to significantly higher respiratory exposures, cross-shift pulmonary function changes did not differ significantly between houses. Higher levels of mask use were protective; poultry workers should wear respiratory protection as appropriate to avoid health decrements.

A survey of particulate matter on california dairy farms.

Over the past 30 yr, individual California dairy operations have grown in size; however, little is known about the distribution and determinants of particulate matter (PM) concentrations on these dairies. Elevated exposure to PM is associated with respiratory and cardiovascular health effects, particularly in occupational settings. The purpose of this study was to quantify the concentrations of PM and all inhalable PM (0-100 µm) on California dairies. Samplers were placed at various locations (e.g., milking parlor, grain storage area, drylot corral, and freestall barns) on 13 different dairies to collect PM and all inhalable PM during the 2008 summer months. The PM and all inhalable PM concentrations varied between different areas on a dairy and from dairy to dairy. Geometric mean concentrations for PM and inhalable PM were 24 µg m (range, 2-116 µg m) and 332 μg m (range, 74-1690 µg m). A key variable for explaining variation in PM concentrations with a mixed effects model was regional background ambient concentrations of PM No significant differences were observed in mean concentrations between upwind and downwind fence line concentrations (adjusted geometric mean ratio [AGMR] = 0.7; 95% CI, 0.4-1.3), although significant differences were found between upwind and central location mean values (AGMR = 0.5; 95% CI, 0.3-0.8; < 0.01). These results indicate dairy PM sources and, thus, elevated occupational exposure. Covariates, such as the age of the dairy and number of cows in the freestall barn and drylot corral, were important variables in explaining PM concentration variability. Levels of PM were lower compared with dairies in other U.S. states and other countries.