Lewis Pepper

An Official American Thoracic Society Statement: Diagnosis and Management of Beryllium Sensitivity and Chronic Beryllium Disease

RATIONALE Beryllium continues to have a wide range of industrial applications. Exposure to beryllium can lead to sensitization (BeS) and chronic beryllium disease (CBD). OBJECTIVES The purpose of this statement is to increase awareness and knowledge about beryllium exposure, BeS, and CBD. METHODS Evidence was identified by a search of MEDLINE. The committee then summarized the evidence, drew conclusions, and described their approach to diagnosis and management. MAIN RESULTS The beryllium lymphocyte proliferation test is the cornerstone of both medical surveillance and the diagnosis of BeS and CBD. A confirmed abnormal beryllium lymphocyte proliferation test without evidence of lung disease is diagnostic of BeS. BeS with evidence of a granulomatous inflammatory response in the lung is diagnostic of CBD. The determinants of progression from BeS to CBD are uncertain, but higher exposures and the presence of a genetic variant in the HLA-DP β chain appear to increase the risk. Periodic evaluation of affected individuals can detect disease progression (from BeS to CBD, or from mild CBD to more severe CBD). Corticosteroid therapy is typically administered when a patient with CBD exhibits evidence of significant lung function abnormality or decline. CONCLUSIONS Medical surveillance in workplaces that use beryllium-containing materials can identify individuals with BeS and at-risk groups of workers, which can help prioritize efforts to reduce inhalational and dermal exposures.

Beryllium sensitization and lung function among former workers at the Nevada Test Site.

BACKGROUND Beryllium use at the Nevada Test Site (NTS) was not acknowledged until the late 1990s. Subsequently, the ongoing U.S. DOE funded medical screening program, which began in 1998, started testing former workers of the NTS for beryllium sensitization (BeS) in 2001 to identify individuals who may be at higher risk of developing chronic beryllium disease (CBD). METHODS An observational study was conducted to identify work-related factors associated with the odds of having BeS. Work history questionnaires were administered and principal components analysis was used to identify categories of related tasks associated with BeS. RESULTS Of the 1,786 former workers tested for BeS, 23 had a confirmed positive result. An increased risk of BeS was found among workers who performed cleanup (OR = 2.68, 95% CI: 1.10, 6.56) and those who worked in Building B where beryllium parts were machined (OR = 2.52, 95% CI: 1.02, 6.19), though no significant increased risk was found when categories of related tasks were used. Additionally, the number of years worked at the NTS was associated with increased risk of BeS. There was no difference in pulmonary function, chest X-ray abnormalities, or respiratory symptoms between those who were sensitized and normal. CONCLUSIONS The prevalence of BeS among former workers of the NTS who participated in our screening program was 1.3%. Former workers who performed specific job tasks may be at greater risk of developing BeS.

Personal Exposure, Behavior, and Work Site Conditions as Determinants of Blood Lead Among Bridge Painters

Bridge painters are exposed to lead during several job tasks performed during the workday, such as sanding, scraping, and blasting. After the Occupational Safety and Health Administration standard was passed in 1993 to control lead exposures among construction workers including bridge painters, this study was conducted among 84 bridge painters in the New England area to determine the significant predictors of blood lead levels. Lead was measured in personal air and hand wipe samples that were collected during the 2-week study period and in blood samples that were collected at the beginning and at the end of the study period. The personal air and hand wipe data as well as personal behaviors (i.e., smoking, washing, wearing a respirator) and work site conditions were analyzed as potential determinants of blood lead levels using linear mixed effects models. Our results show that the mean air lead levels over the 2-week period were the most predictive exposure measure of blood lead levels. Other individual-level significant predictors of blood lead levels included months worked on bridge painting crews, education, and personal hygiene index. Of the site-level variables investigated, having a containment facility on site was a significant predictor of blood lead levels. Our results also indicate that hand wipe lead levels were significantly associated with higher blood lead levels at the end of the study period compared with the beginning of the study period. Similarly, smoking on site and respirator fit testing were significantly associated with higher blood lead levels at the end of the study period. This study shows that several individual-level and site-level factors are associated with blood lead levels among bridge painters, including lead exposure through inhalation and possible hand-to-mouth contact, personal behaviors such as smoking on site, respirator fit testing, and work site conditions such as the use of better containment facilities. Accordingly, reduction in blood lead levels among bridge painters can be achieved by improving these workplace practices.

Task-Based Lead Exposures and Work Site Characteristics of Bridge Surface Preparation and Painting Contractors

This study of bridge painters working for small contractors in Massachusetts investigated the causes of elevated blood lead levels and assessed their exposure to lead. Bridge work sites were evaluated for a 2-week period during which personal and area air samples and information on work site characteristics and lead abatement methods were gathered. Short-duration personal inhalable samples collected from 18 tasks had geometric means (GM) of 3 μg/m3 to 7286 μg/m3. Full-shift, time-weighted average (TWA) inhalable samples (⩾6 hours) collected from selected workers and work sites had GMs of 2 μg/m3 to15,704 μg/m3; 80% of samples exceeded the permissible exposure limit (PEL) of 50 μg/m3, on average by a factor of 30. Area inhalable samples collected from three locations ranged from 2 μg/m3 to 40,866 μg/m3 from inside the containment, 2 μg/m3 to 471 μg/m3 from a distance of <6 meters, and 2 μg/m3 to 121 μg/m3 from >6 meters from the containment. Seventy nine percent of the area samples from inside the containment exceeded the PEL on average by a factor of 140. Through observations of work site characteristics, opportunities for improving work methods were identified, particularly the institution of engineering controls (which were only occasionally present) and improvement in the design and construction of the containment structure. The high levels of airborne lead exposures indicate a potential for serious exposure hazard for workers and environmental contamination, which can be mitigated through administrative and engineering controls. Although these data were collected over 10 years ago, a 2005 regulatory review by the Occupational Safety and Health Administration (OSHA) of its lead in construction standard reported that elevated lead exposures and blood lead levels, high occurrence of noncompliance with the lead standard, and nonimplementation of newer technology especially among small painting firms employing <10 workers are still widespread. As a result, the findings of this study are still quite germane even a decade after the introduction of the new OSHA standard.

Downsizing and social cohesion: the case of downsizing survivors.

Organizational downsizing was a pervasive feature of the U.S. economy during the 1980s and 1990s. A long-standing public health literature recognizes that unemployment and job loss may adversely affect health, but there has been little attention to date on the impact of downsizing upon those who survive job cuts and continue to work in downsized firms. Drawing on research with survivors of downsizing carried out by the U.S. Department of Energy, this article identifies a variety of social and psychological consequences of downsizing that fundamentally destabilize the work environment and work experience for remaining employees. Evidence from this research suggests that the work climate of the post-downsizing environment is laden with suspicion and conflict, and that survivors show feelings of demoralization, sadness, anxiety, and disorientation. A critical factor influencing these responses, we argue, is not downsizing—which is the exposure faced by those who lose their jobs—but the loss of social cohesion that downsizing ultimately represents to survivors. We conclude that addressing the trauma of downsizing for survivors will require providing employees with more genuine opportunities to participate in workplace governance.