eyaratnam J

Chronic neurobehavioural effects of elemental mercury in dentists.

Neurobehavioural tests were performed by 98 dentists (mean age 32, range 24-49) exposed to elemental mercury vapour and 54 controls (mean age 34, range 23-50) with no history of occupational exposure to mercury. The dentists were exposed to an average personal air concentration time weighted average (TWA) of 0.014 (range 0.0007-0.042) mg/m3 for a mean period of 5.5 (range 0.7-24) years and had a mean blood mercury concentration of 9.8 (range 0.6-57) micrograms/l. In neurobehavioural tests measuring motor speed (finger tapping), visual scanning (trail making), visuomotor coordination and concentration (digit symbol), verbal memory (digit span, logical memory delayed recall), visual memory (visual reproduction, immediate and delayed recall), and visuomotor coordination speed (bender-gestalt time), the performance of the dentists was significantly worse than that of the controls. The dentists scored 3.9 to 38.9% (mean 13.9%) worse in these tests. In trail making, digit span, logical memory delayed recall, visual reproduction delayed recall, and bender-gestalt time test scores were more than 10% poorer. In each of the tests in which significant differences were found and in the block design time, the performance decreased as the exposed dose (product of the TWA of air mercury concentrations and the years of exposure) increased. These results raise the question as to whether the current threshold limit value of 0.050 mg/m3 (TWA) provides adequate protection against adverse effects of mercury.

Chronic neurobehavioural effects of toluene

Neurobehavioural tests were undertaken by 30 female workers exposed to toluene and matched controls with low occupational exposure to toluene. The environmental air levels (TWA) of toluene was 88 ppm for the exposed workers and 13 ppm for the controls. The toluene in blood concentrations for the exposed workers was 1.25 mg/l and for the controls 0.16 mg/l. Statistically significant differences between workers exposed to toluene and controls in neurobehavioural tests measuring manual dexterity (grooved peg board), visual scanning (trail making, visual reproduction, Benton visual retention, and digit symbol), and verbal memory (digit span) were observed. Further, the performance at each of these tests was related to time weighted average exposure concentrations of air toluene. The workers exposed to toluene had no clinical symptoms or signs. The question arises as to whether these impairments in neurobehavioural tests are reversible or whether they could be a forerunner of more severe damage.

Neuropsychological studies on lead workers in Singapore.

The neuropsychological performance of a group of 49 workers occupationally exposed to lead was compared with a matched control group of 36 non-exposed workers. The psychometric measurements were composed of tests covering a broad range of different neuropsychological functions, particular emphasis being given to perceptual motor ability and attention concentration functioning. A questionnaire to assess subjective symptoms in mood, sleep disturbance, poor concentration and forgetfulness, somatic complaints, and social passivity was also included in the battery of tests. Compared with the controls, the performance of the lead workers was found to be significantly poorer for digit symbol, Bourdon-Wiersma, trail making test (part A), Santa Ana test, flicker fusion, and simple reaction time. In terms of subjective symptoms the exposed group also reported significantly more complaints of anxiety and depressed mood, poor concentration and forgetfulness, and other somatic complaints. These differences were observed among lead workers with a mean blood lead value of 2.35 mumol/l (SD 0.7).

Neurophysiological studies on workers exposed to lead.

Nerve conduction and somatosensory evoked potential studies were undertaken on 46 workers exposed to a combination of organic and inorganic lead. In addition electroencephalograms were carried out on 20 of the workers; the results were compared with those obtained for workers not exposed to lead. The workers exposed to lead had a mean blood lead concentration of 2.35 mumol/l (48.7 micrograms/100 ml), whereas the concentration for workers not exposed to lead was 0.76 mumol/l (15.8 micrograms/100 ml). The mean maximum motor conduction velocities of the median and the posterior tibial nerves were significantly lower in the workers exposed to lead than in the controls. Similarly, the distal latency for these two nerves was significantly prolonged for the workers exposed to lead. No significant differences for the two groups of workers were seen in the nerve conduction and distal latency measurements of the median (sensory) and the sural nerves. The EEG studies of the 20 workers exposed to lead showed no abnormalities. The somatosensory evoked potential of the median (sensory) and posterior tibial nerves were significantly prolonged when measured at the negative and positive deflections. The results suggest that, in addition to nerve conduction velocities, somatosensory evoked potential and distal latency are suitable measurements to detect subclinical neurological damage among workers exposed to lead. As these changes were seen at blood lead concentrations of 2.35 mumol/l (48.7 micrograms/100 ml) there may be a need for more stringent monitoring of workers exposed to lead.

Airway responsiveness of firefighters after smoke exposure

Ventilatory function and airway reactivity of 20 firefighters were studied one hour before and one hour after exposure in a smoke chamber. None showed an increase in airway reactivity to inhaled histamine before exposure. Eight (80%) of the regular firefighters, however, had an increase in airway reactivity after exposure in the smoke chamber. After six hours, three of the firefighters still had increased airway reactivity. All were non-reactive after 24 hours but the ventilatory function of the three firefighters who were reactive after six hours did not return to baseline values. The duration of service as a firefighter is the major contributing factor to the change in airway reactivity. This increase in airway responsiveness among regular firefighters suggests that some form of chronic epithelial injury is needed before an increase in airway responsiveness is seen.

Postural stability of workers exposed to lead.

OBJECTIVE--To detect, with a computerised postural sway measurement system, any significant deviation of postural sway parameters among lead workers compared with a control group. METHODS--Postural stability was investigated with a computerised postural sway measurement system in 60 workers exposed to lead with a duration of exposure of 84 (range 3-366) months and 60 controls. Sway parameter data were collected with an Advanced Mechanical Technology computerised biomechanics platform system. RESULTS--The mean current blood lead concentration was 36.0 (range 6.4 to 64.5) micrograms/dl for the exposed workers and 6.3 (range 3.1 to 10.9) micrograms/dl for the 14 controls. There was no significant difference between the groups for the postural sway parameters obtained when the eyes were open. Significant differences were found for Xs, Ys (SDs of the coordinates of the centre of pressure); Xm, Ym (mean deviation of the coordinates of the centre of pressure); Rm (average displacement of Xi, Yi, from Xo, Yo); L (length of sway path); Vel (mean velocity of the centre of pressure along its path); Ao (area included within the path of the centre of pressure); Ae (95% confidence elliptical area). The Romberg ratios (the relation between eyes closed and open) for the Vel, L, Ao and Ae of the exposed workers were also significantly different from the controls. CONCLUSION--The study showed that workers exposed to lead had significantly poorer postural stability than the controls. Lead may affect certain parts of the whole sensory neural axis resulting in postural instability when the visual input is cut off. Based on current blood lead concentrations, we were not able to obtain any significant association with the postural sway parameters.

BIOLOGICAL MONITORING FOR OCCUPATIONAL EXPOSURE TO TOLUENE

A study was undertaken to examine the relationship between exposure of workers to toluene in the work environment and biological indicators of toluene exposure. The biological indicators studied were toluene in expired air, toluene in blood obtained by the finger prick method, and urinary hippuric acid. The study was undertaken in a factory in Singapore that manufactures speakers for audio systems. A total of 86 female workers exposed to toluene at the workplace and a control group of workers not exposed to toluene were examined. All of them were teetotalers, were nonsmokers, and gave no history of chronic drug usage. The 8-hr time-weighted average exposure level of toluene ranged from 1.6 ppm to 263 ppm. The study showed the expected toluene levels in finger prick blood was 1.4 micrograms/mL after an 8-hr exposure to 100 ppm of toluene. Toluene concentration in expired air of 16 ppm after an 8-hr exposure to 100 ppm compared favorably with other studies. The toluene in blood/expired air ratio was observed to be lower than in other studies. In this study, the expected urinary hippuric acid level for a 100-ppm exposure to toluene was 2.7 g/g creatinine. This level is higher than that recorded in other studies. The results showed that at low levels of toluene, urinary hippuric acid is not a valuable indicator of exposure. Toluene in expired air is the most reliable biological indicator of exposure to toluene.

Cumulative concentrations of blood lead and postural stability.

OBJECTIVE: To study the association in a group of battery manufacturing workers between computerised postural sway parameters and present concentrations of blood lead (PPb), index of cumulative blood lead years (CBI), and cumulative blood lead at different years of exposure (CPbYs). METHODS: Postural stability was investigated with a computerised postural sway measurement system in 60 workers exposed to lead with exposure duration of 84 (range 3-366) months and in 60 control subjects. An index of CBIs in 55 workers (previous blood lead results of five workers were not available) and CPbYs were computed for each worker by calculating the area under the curve of concentrations of blood lead against time. RESULTS: The mean (SD) PPb was 36.0 (11.7) (range 6.4 to 64.5) micrograms/dl for the exposed workers and 6.3 (2.4) (range 3.1-10.9) micrograms/dl for the 14 randomly selected control subjects. Significant differences between groups for the postural sway parameters obtained when the eyes were closed were found for length of sway path (L); mean velocity of the centre of pressure along its path (Vel); area included within the path of the centre of pressure (Ao); 95% confidence elliptical area (Ae). The Romberg ratio (the relation between eyes closed and open) for the Vel, L, Ao, and Ae of the exposed group were also significantly different from those of the controls. The postural sway parameters (eyes closed) were not significantly correlated with PPb or CBI. However, the cumulative blood lead for the past two years before the postural sway assessment, CPbY2, was significantly correlated with all the postural sway parameters. CONCLUSION: The study showed that workers exposed to lead had significantly poorer postural stability than a control group. Lead may affect certain parts of the somatosensory system resulting in postural instability when the visual input is cut off. The CPbY2 was significantly positively correlated with most of the postural sway parameters. Effects of lead on postural stability may be related to recent increases in blood lead concentration among the exposed workers rather than to cumulative body burden.

Blood cholinesterase levels among agricultural workers in four Asian countries.

In this study whole blood cholinesterase activities were determined (tintometric method) of agricultural pesticide users exposed to organophosphorus compounds in Indonesia, Malaysia, Sri Lanka and Thailand. Analysis of the data demonstrated a universal relationship between cholinesterase levels and the time between the last exposure to organophosphorus compounds and the day of blood collection for cholinesterase determination. It is suggested that it takes approximately 5 days before whole blood cholinesterase levels revert to their normal values. No relationship between whole blood cholinesterase levels and the sex of pesticide users was demonstrated except in Sri Lanka where female sprayers had lower values. It is suggested that these lower values are associated with the anaemic status of female agricultural workers. No relationship between whole blood cholinesterase level and age was demonstrated. The measurement of pre-exposure cholinesterase values is essential for comparison of values after pesticide application.

A discriminant analysis of neuropsychological effect of low lead exposure.

The purpose of this study is to determine the contribution of psychological tests in discriminating neuropsychological effects of low lead exposure. The sample consists of 49 workers occupationally exposed to lead and a control group of 36 non-exposed workers. Their performance on various neuropsychological measures was subject to a discriminant analysis using the SPSS DISCRIMINANT subprogramme. The results indicate that simple reaction time, Digit Symbol (WAIS) and Trail-Making Test (Part A) provide the best combination of tests for the detection of neurotoxic effect of low lead exposure.