Lawrence W. Whitehead

Prevalence and risk factors of asthma and wheezing among US adults: an analysis of the NHANES III data

The prevalence of asthma has been on the increase in the USA and worldwide. To understand the worsening epidemiological trends of asthma, this study analysed the data from the third National Health and Nutrition Examination Survey (NHANES III) to determine the prevalence and risk factors for asthma and wheezing among US adults. This analysis used data from 18,825 US adults aged ≥20 yrs who had participated in the NHANES III project. After excluding subjects with physiciandiagnosed emphysema, a total of 18,393 subjects were included in the final analysis. The prevalence of current asthma (asthma) was 4.5% and the prevalence of wheezing in the previous 12 months (wheezing) was 16.4%. MexicanAmericans exhibited the lowest prevalence of asthma when compared with other race/ethnic groups. Multiple logistic regression analysis showed that MexicanAmericans were less likely to report asthma when compared to nonHispanic whites. Low education level, female sex, current and past smoking status, pet ownership, lifetime diagnosis of physiciandiagnosed hay fever and obesity were all significantly associated with asthma and/or wheezing. No significant effect of indoor air pollutants, as derived from the use of household heating/cooking appliances, on asthma and wheezing was observed in this study. In conclusion, this study observed racial/ethnic differences in the prevalence of asthma and wheezing and identified several important risk factors that may contribute to development and/or exacerbation of asthma and wheezing. Contrary to earlier reports, the proxy measures of indoor air pollution used in this study were not found to be associated with increased risk of asthma and wheezing.

Prevalence and risk factors of work related asthma by industry among United States workers: data from the third national health and nutrition examination survey (1988–94)

Objectives: To estimate the prevalence of work related asthma and work related wheezing in United States workers. To identify high risk industries that could be targeted for future intervention. To determine the population attributable risk of work related asthma and work related wheezing. Methods: The third national health and nutrition examination survey, 1988–1994 (NHANES III) was analyzed to determine the prevalence of work related asthma and wheezing and to identify initially defined industries at risk among United States workers aged 20 and older. Separate logistic models were developed with work related asthma and work related wheezing as outcomes. Work related asthma was defined as affirmative response to questions on self reported physician diagnosed asthma and work related symptoms of rhinitis, conjunctivitis, and asthma. Work related wheezing was defined as affirmative response to questions on self reported wheezing or whistling in the chest in the previous 12 months and work related symptoms of rhinitis, conjunctivitis, and asthma. All analyses were adjusted for age, sex, smoking, and atopy. Results: The prevalence of work related asthma was 3.70% (95% confidence interval (95% CI) 2.88 to 4.52) and the prevalence of work related wheezing was 11.46% (95% CI 9.87 to 13.05). The main industries identified at risk of work related asthma and wheeze included the entertainment industry; agriculture, forestry, and fishing; construction; electrical machinery; repair services; and lodging places. The population attributable risk for work related asthma was 36.5% and work related wheezing was 28.5%. Conclusions: The findings provide impetus for further research and actions by public health professionals which prioritise occupational asthma on the public health agenda. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace.

DNA damage in outdoor workers occupationally exposed to environmental air pollutants

Background: Health concerns about the exposure to genotoxic and carcinogenic agents in the air are particularly significant for outdoor workers in less developed countries. Aims: To investigate the association between personal exposure to a group of air pollutants and severity of DNA damage in outdoor workers from two Mexican cities. Methods: DNA damage (Comet assay) and personal exposure to volatile organic compounds, PM2.5, and ozone were investigated in 55 outdoor and indoor workers from México City and Puebla. Results: In México City, outdoor workers had greater DNA damage, reflected by a longer tail length, than indoor workers (median 46.8 v 30.1 μm), and a greater percentage of highly damaged cells (cells with tail length ⩾41 μm); in Puebla, outdoor and indoor workers had similar DNA damage. There were more alkali labile sites in outdoor than indoor workers. The DNA damage magnitude was positively correlated with PM2.5 and ozone exposure. Outdoor and indoor workers with ⩾60% of highly damaged cells (highly damaged workers) had significantly higher exposures to PM2.5, ozone, and some volatile organic compounds. The main factors associated with the highly damaged workers were ozone, PM2.5, and 1-ethyl-2-methyl benzene exposure. Conclusions: With this approach, the effects of some air pollutants could be correlated with biological endpoints from the Comet assay. It is suggested that the use of personal exposure assessment and biological endpoints evaluation could be an important tool to generate a more precise assessment of the associated potential health risks.

Pulmonary function status of workers exposed to hardwood or pine dust

Wood dusts may have substantial health impacts beyond those of nuisance dust. This project reports results linking pulmonary function changes with exposure to maple and pine dust. A cross-sectional survey of 1157 woodworkers was conducted in 1978 in accordance with NHLBI standards for respiratory epidemiologic surveys. Area dust levels were determined, permitting definition of groups exposed to estimated high, medium or low cumulative levels of dry hardwood or softwood dust. Prevalence of reduced (lower fifth percentile of normal) pulmonary function was ascertained, using prediction equations, for Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV1/FVC and Maximal Mid-expiratory Flow Rate (MMEFR). Relationships between pulmonary impairment and dust exposure were examined, adjusting for smoking status by means of the log odds ratio method. The results support an association between dry hardwood or softwood dust exposure and reduced pulmonary flow rates. The odds ratios for reduced pulmonary function, comparing low and high hardwood (maple) dust exposure, were 3.12 for FEV1/FVC and 2.14 for MMEFR. Comparing low and medium hardwood exposure, the odds ratios were 2.61 for FEV1/FVC and MMEFR. Comparison of low and high softwood (pine) dust exposure yielded odds ratios of 4.03 for FEV1/FVC and 2.45 for MMEFR. The ratios noted are significant at p less than .05.

A neurological evaluation of workers exposed to mixtures of organic solvents

Workers with long term exposure to mixtures of organic solvents below regulatory limits have been reported to experience mild, but clinically detectable, sensory or sensorimotor polyneuropathies. In conjuction with a cross sectional study of behavioural performance a clinical neurological evaluation was conducted among printers and spray painters to examine dose response relations. All 240 subjects completed an occupational history and symptom questionnaire and underwent a clinical neurological examination. On average, subjects had been employed on their current job for six years. Classification of solvent exposure for each subject was based on exposed versus non-exposed job titles and observations during an industrial hygiene walk-through or on the measured concentration of solvents in full shift personal air samples. The average full shift solvent concentration was 302 ppm for printing plant workers and 6-13 ppm for workers at other plants. Isopropanol and hexane were the major constituents. Neurological abnormalities consistent with mild polyneuropathy were found in 16% of subjects; none was clinically significant. Exposed/non-exposed comparisons showed slightly higher frequency of symptoms in the exposed subjects which was not related to solvent level. Subjects categorised as exposed during the walk- through survey also had poorer vibratory sensation measured at the foot and diminished ankle reflexes. In multiple linear regression models, however, controlling for age, sex, alcohol intake, and examiner, no significant (p less than 0.05) relation was found between solvent concentration and poor neurological function except for two point discrimination measured at the foot. This investigation has not provided evidence for dose related adverse neurological effects from exposure to moderately low levels of solvent mixtures for a relatively short duration, although this may be due to the shortness of exposure duration, the type of solvent exposure, or to selection factors.

Validation of an asthma questionnaire for use in healthcare workers.

Background: Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. Aims: To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers. Methods: An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk-through surveys and review of material safety data sheets. A cross-sectional validation study was conducted in 118 non-smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens. Results: The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test–retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach’s α ⩾ 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self-reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals. Conclusions: Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross-validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self-report is underscored.

Agonistic induction of PPARγ reverses cigarette smoke–induced emphysema

The development of emphysema in humans and mice exposed to cigarette smoke is promoted by activation of an adaptive immune response. Lung myeloid dendritic cells (mDCs) derived from cigarette smokers activate autoreactive Th1 and Th17 cells. mDC-dependent activation of T cell subsets requires expression of the SPP1 gene, which encodes osteopontin (OPN), a pleiotropic cytokine implicated in autoimmune responses. The upstream molecular events that promote SPP1 expression and activate mDCs in response to smoke remain unknown. Here, we show that peroxisome proliferator-activated receptor γ (PPARG/Pparg) expression was downregulated in mDCs of smokers with emphysema and mice exposed to chronic smoke. Conditional knockout of PPARγ in APCs using Cd11c-Cre Pparg(flox/flox) mice led to spontaneous lung inflammation and emphysema that resembled the phenotype of smoke-exposed mice. The inflammatory phenotype of Cd11c-Cre Pparg(flox/flox) mice required OPN, suggesting an antiinflammatory mechanism in which PPARγ negatively regulates Spp1 expression in the lung. A 2-month treatment with a PPARγ agonist reversed emphysema in WT mice despite continual smoke exposure. Furthermore, endogenous PPARγ agonists were reduced in the plasma of smokers with emphysema. These findings reveal a proinflammatory pathway, in which reduced PPARγ activity promotes emphysema, and suggest that targeting this pathway in smokers could prevent and reverse emphysema.

Suspended dust concentrations and size distributions, and qualitative analysis of inorganic particles, from woodworking operations

Over 100 total suspended particulate (TSP) samples were collected from hardwood and softwood machining operations at stationary sites in twelve workplaces, as a preliminary industrial hygiene survey of furniture manufacturing and related processes. Cascade impactor samples were collected to obtain particle sizing information. Using scanning electron microscopy, in combination with backscattered electron imaging and energy dispersive X-ray analysis, inorganic dust particles were detected and analyzed in randomly selected TSP samples. The highest measured dust levels were from sanding operations (4.5 mg/m3 from hardwood sanding, 3.2 mg/m3 from pine sanding) with furniture assembly and finish-milling (detailed wood working) ranging from 1.5 mg/m3 to 2.8 mg/m3. The highest TSP sample was 14.3 mg/m3 from a pine-sanding area. Size information showed no more than 1.3 mg/m3 below 5.5 micrometers or 3.3 mg/m3 below 14.1 micrometers in any cascade impactor sample. Numerous non-wood particles were found in TSP sampl...

Health effects of wood dust - relevance for an occupational standard

Wood dust is coming under increasing scrutiny as an industrial exposure posing greater risk than that of a nuisance dust. In light of this increased interest, this paper will review key reports of wood dust-related health effects, and will summarize the available information which relates exposure levels to effects. Numerous case reports exist of skin reactions and obstructive-pattern respiratory changes of either a hypersensitivity or irritant nature for various woods. Reports have also been published of apparently non-allergic obstructive respiratory effects including lung function test reductions and reduction of mucociliary clearance. Wood dust exposure also appears to be linked to the occurrence of adenocarcinoma of the nasal sinuses. Occasional reports link wood dust to other types of cancer, but these relationships are much less consistent than the association with nasal cancer. Various standards have been proposed for wood dust. Most are lower than the nuisance dust standard currently applicable in the U.S. This review of several key papers on wood dust permits some association of exposure data and effects, particularly with suppressed mucociliary clearance, from which it may be suggested from the available evidence that a standard of 2 mg/m3 total suspended wood dust, not differentiated by type of wood, would protect against observed effects except for extreme allergic hypersensitivity.

A global survey of occupational health competencies and curriculum.

Abstract The World Health Organization has identified a world-wide shortage of occupational health professionals, but evidence suggests that the work and education of these professionals vary across countries. This survey examined the professionaldeveloprnent of occupational physicians, occupational nurses, industriaL hygienists, and ergonomists in terms of practice competencies and academic curriculum. Of 89 countries that received the survey, 48 (54%) responded. Important differences in competencies and curricula were identified for all groups. More competencies were identified more frequently in deyeloped countries. Academic programs existed more often in developed countries, but curriculum contentsvaried. The study provides a concrete reference point for discussion and developtnentof competencies and curriculum.