Niels Ebbehøj

Collection of domestic waste. Review of occupational health problems and their possible causes.

During the last decade, a growing interest in recycling of domestic waste has emerged, and action plans to increase the recycling of domestic waste have been agreed by many governments. A common feature of these plans is the implementation of new systems and equipment for the collection of domestic waste which has been separated at source. However, only limited information exists on possible occupational health problems related to such new systems. Occupational accidents are very frequent among waste collectors. Based on current knowledge, it appears that the risk factors should be considered as an integrated entity, i.e. technical factors (poor accessibility to the waste, design of equipment) may act in concert with high working rate, visual fatigue due to poor illumination and perhaps muscle fatigue due to high work load. Musculoskeletal problems are also common among waste collectors. A good deal of knowledge has accumulated on mechanical load on the spine and energetic load on the cardio-pulmonary system in relation to the handling of waste bags, bins, domestic containers and large containers. However, epidemiologic studies with exposure classification based on field measurement are needed, both to further identify high risk work conditions and to provide a detailed basis for the establishment of occupational exposure limits for mechanical and energetic load particularly in relation to pulling, pushing and tilting of containers. In 1975, an excess risk for chronic bronchitis was reported for waste collectors in Geneva (Rufèner-Press et al., 1975) and data from the Danish Registry of Occupational Accidents and Diseases also indicate an excess risk for pulmonary problems among waste collectors compared with the total work force. Surprisingly few measurements of potentially hazardous airborne exposures have been performed, and the causality of work-related pulmonary problems among waste collectors is unknown. Recent studies have indicated that implementation of some new waste collection systems may result in an increased risk of occupational health problems. High incidence rates of gastrointestinal problems, irritation of the eye and skin, and perhaps symptoms of organic dust toxic syndrome (influenza-like symptoms, cough, muscle pains, fever, fatigue, headache) have been reported among workers collecting the biodegradable fraction of domestic waste. The few data available on exposure to bio-aerosols and volatile compounds have indicated that these waste collectors may be simultaneously exposed to multiple agents such as dust containing bacteria, endotoxin, mould spores, glucans, volatile organic compounds, and diesel exhaust. Several studies have reported similar health problems as well as high incidence rates of pulmonary disease among workers at plants recycling domestic waste.(ABSTRACT TRUNCATED AT 400 WORDS)

Sorting and recycling of domestic waste. Review of occupational health problems and their possible causes

In order to reduce the strain on the environment from the deposition of waste in landfills and combustion at incineration plants, several governments throughout the industrialized world have planned greatly increased recycling of domestic waste by the turn of the millennium. To implement the plans, new waste recycling facilities are to be built and the number of workers involved in waste sorting and recycling will increase steadily during the next decade. Several studies have reinforced the hypothesis that exposure to airborne microorganisms and the toxic products thereof are important factors causing a multitude of health problems among workers at waste sorting and recycling plants. Workers at transfer stations, landfills and incineration plants may experience an increased risk of pulmonary disorders and gastrointestinal problems. High concentrations of total airborne dust, bacteria, faecal coliform bacteria and fungal spores have been reported. The concentrations are considered to be sufficiently high to cause adverse health effects. In addition, a high incidence of lower back injuries, probably due to heavy lifting during work, has been reported among workers at landfills and incineration plants. Workers involved in manual sorting of unseparated domestic waste, as well as workers at compost plants experience more or less frequent symptoms of organic dust toxic syndrome (ODTS) (cough, chest-tightness, dyspnoea, influenza-like symptoms such as chills, fever, muscle ache, joint pain, fatigue and headache), gastrointestinal problems such as nausea and diarrhoea, irritation of the skin, eye and mucous membranes of the nose and upper airways, etc. In addition cases of severe occupational pulmonary diseases (asthma, alveolitis, bronchitis) have been reported. Manual sorting of unseparated domestic waste may be associated with exposures to large quantities of airborne bacteria and endotoxin. Several work functions in compost plants can result in very high exposure to airborne fungal spores and thermophilic actinomycetes. At plants sorting separated domestic waste, e.g. the combustible fraction of waste composed of paper, cardboard and plastics, the workers may have an increased risk of gastrointestinal symptoms and irritation of the eyes and skin. At such plants the bioaerosol exposure levels are in general low, but at some work tasks, e.g. manual sorting and work near the balers, exposure levels may occasionally be high enough to be potentially harmful. Workers handling the source-sorted paper or cardboard fraction do not appear to have an elevated risk of occupational health problems related to bioaerosol exposure, and the bioaerosol exposure is generally low.(ABSTRACT TRUNCATED AT 400 WORDS)

A survey of exposures related to recognized occupational contact dermatitis in Denmark in 2010

Skin diseases are the most commonly recognized occupational diseases in Denmark, and occupational contact dermatitis (OCD) comprises ∼95% of all cases.

Polychlorinated biphenyls (PCBs) in indoor air originating from sealants in contaminated and uncontaminated apartments within the same housing estate

Twenty-four congeners of polychlorinated biphenyls (PCBs) were measured in 83 air samples and 20 elastic sealants samples of apartments with PCB-containing sealants. In addition, PCBs were measured in 21 air samples from reference apartments located in an uncontaminated section of the same estate. The PCB(tot) levels in the air of the contaminated section were 168-3843 ng m(-3) (mean: 1030 ng m(-3)), while the mean levels in the reference apartments were 6.03 ng m(-3). The sum of the 24 measured PCB congeners in sealants from the contaminated section was 187-221680 mg kg(-1). Principal component analysis revealed four groups among the sealant samples with different congener compositions, only two of which were clearly similar to known PCB mixtures, while two were not. Significant correlations and intercorrelations were observed between the lower chlorinated congeners in air and sealant, e.g. for PCB 28(air) and 28(seal) (p=0.04) and for PCB 28(air) and 52(air), 52(seal). However, no correlation was observed between the lower chlorinated congeners and the sums of PCB (∑PCB(6) or ∑PCB(24)) or the higher chlorinated congeners. Analysis of air concentrations in relation to questionnaire data indicated that the indoor air levels could be reduced by increased cleaning and airing frequencies.

Plasma polychlorinated biphenyls in residents of 91 PCB-contaminated and 108 non-contaminated dwellings-an exposure study.

BACKGROUND In the1950s-1970s polychlorinated biphenyls (PCBs) were used in several countries as plasticizers in elastic sealants in buildings. OBJECTIVE The primary objective was to study whether residents of PCB-contaminated dwellings had higher plasma levels of PCBs than their neighbours in non-contaminated dwellings. The secondary objective was to study possible associations between concentrations of PCBs in the indoor air and in the plasma of residents. METHODS Stratified cross-sectional study of residents of a housing estate with four sections, of which only one section had PCB-containing sealants. The determination of 27 PCB congeners in plasma was performed among 134 exposed and 139 non-exposed residents. Air measurements were conducted in 104 flats. RESULTS Significant differences in plasma PCBs between exposed versus non-exposed were found for most of the lower chlorinated and many of the higher chlorinated congeners. The median of sum of 27 PCBs was approximately four times higher in exposed compared with non-exposed residents. The elevated PCB concentrations persisted in multivariable analyses controlling for relevant cofactors. We found significant correlations between PCB indoor air concentrations and the PCB concentration in the plasma of the residents for ten of the lower chlorinated congeners. CONCLUSION Our study confirms that indoor air exposure to PCBs from PCB containing sealants may result in a considerable internal PCBs exposure of the residents. For the first time we were able to demonstrate that the internal exposure to low chlorinated PCBs is significantly associated with the indoor air concentration of these congeners.

Multidimensional intervention and sickness absence in assistant nursing students.

BACKGROUND When handling patients, nursing assistant (NA) students and nurse students are frequently exposed to risk factors for low back pain (LBP) including sudden loads and twisting and bending of the spine. Furthermore, LBP is a major cause of sickness absence. AIMS To ascertain if a multidimensional prevention programme combining physical training, patient transfer technique and stress management prevents sickness absence and LBP in NA students. METHODS The study was a 14-month cluster randomized controlled study. The participants were NA students from 37 randomly selected classes located at two schools of health and social care in Copenhagen, Denmark. The participants completed a comprehensive questionnaire regarding sickness absence, LBP and psychosocial factors on commencement and after completion of the study. RESULTS Of 766 female NA students, 668 (87%) completed the baseline questionnaire. Sickness absence during the study period increased in both groups but the increase was significantly lower in the intervention group than the control group, mean (standard deviation) number of days 12 (20) versus 18 (34), P < 0.05. The intervention group reported no change in the mean level of general health perception, energy/fatigue or psychological well-being at follow-up, while the control group reported a decline on those scales. There were no significant differences in the prevalence of LBP at follow-up between the intervention and control group. CONCLUSIONS Compared to the control group, the intervention group had significantly less sickness absence. The intervention had no preventive effect on LBP prevalence.

Evidence‐based training as primary prevention of hand eczema in a population of hospital cleaning workers

Skin disorders accounted for one third of all recognised occupational diseases in Denmark in 2010. Wet work is a risk factor for the development of occupational hand eczema. The consequences of occupational hand eczema include sick leave, loss of job and impaired quality of life.

What do patients with occupational hand eczema know about skin care

The aim of the present study was to examine the knowledge of skin care and treatment of hand eczema (HE) in a sample of patients with newly reported occupational HE.

Two‐year follow‐up survey of patients with allergic contact dermatitis from an occupational cohort: is the prognosis dependent on the omnipresence of the allergen?

Skin diseases are the most frequently recognized occupational diseases in Denmark. The prognosis for occupational contact dermatitis is often poor.

Pulmonary toxicity following exposure to a tile coating product containing alkylsiloxanes. A clinical and toxicological evaluation.

Abstract Context. Coating products are widely used for making surfaces water and dirt repellent. However, on several occasions the use of these products has been associated with lung toxicity. Objective. In the present study, we evaluated the toxic effects of an aerosolized tile-coating product. Methods. Thirty-nine persons, who reported respiratory and systemic symptoms following exposure to the tile-coating product, were clinically examined. The product was analysed chemically and furthermore, the exposure scenario was reconstructed using a climate chamber and the toxicological properties of the product were studied using in vivo and by in vitro surfactometry. Results. The symptoms developed within few hours and included coughing, tachypnoea, chest pain, general malaise and fever. The physical examination revealed perihilar lung infiltrates on chest radiograph and reduced blood oxygen saturation. The acute symptoms resolved gradually within 1–3 days and no delayed symptoms were observed. By means of mass spectrometry and X-ray spectroscopy, it was shown that the product contained non-fluorinated alkylsiloxanes. The exposure conditions in the supermarket were reconstructed under controlled conditions in a climate chamber and particle and gas exposure levels were monitored over time allowing estimation of human exposure levels. Mice exposed to the product developed symptoms of acute pulmonary toxicity in a concentration-and time-dependent manner. The symptoms of acute pulmonary toxicity likely resulted from inhibition of the pulmonary surfactant function as demonstrated by in vitro surfactometry. Among these patients only a partial association between the level of exposure and the degree of respiratory symptoms was observed, which could be because of a high inter-individual difference in sensitivity and time-dependent changes in the chemical composition of the aerosol. Conclusion. Workers need to cautiously apply surface coating products because the contents can be highly toxic through inhalation, and the aerosols can disperse to locations remote from the worksite and affect bystanders.