Ralph Nilsson

Asthma, rhinitis, and dermatitis in workers exposed to reactive dyes.

A survey was conducted at 15 textile plants with dyehouses in western Sweden. Employees with a history of work related rhinitis, asthma, or skin symptoms were offered a clinical and immunological investigation including skin prick tests, skin patch tests, and radioallergosorbent tests (RASTs) to detect specific allergy to reactive dyes. Among the 1142 employees, 162 were exposed to reactive dyes and 10 of these (6%) reported work related respiratory or nasal symptoms. An allergy to reactive dyes could be confirmed in five (3%, 95% confidence interval 1-7%). All but one had been exposed to reactive dyes for one year or less before the onset of symptoms. Positive RASTs could be detected in four of the five patients. All of the RAST positive patients were positive to remazol black B, but six out of eight additional remazol dyes also elicited positive results. RAST and RAST inhibition showed a cross reactivity between some of the dyes. Seven persons with work related dermatitis and three with urticaria or Quincke oedema were found. In one patient contact dermatitis to a monoazo dye was shown, but no positive patch test reactions to reactive dyes. IgE-mediated allergy to reactive dyes seems to be an important cause of respiratory and nasal symptoms among dyehouse employees exposed to dust from reactive dyes.

Genotoxic effects in workers exposed to low levels of benzene from gasoline

To study genotoxic effects of exposure to low levels of benzene, single-strand breaks (SSB) in DNA of leukocytes and urinary levels of the oxidative DNA adduct 8-hydroxydeoxyguanosine (8OHdG) were determined in 33 men occupationally exposed to benzene from gasoline and in 33 controls. The average exposure to benzene over a shift was determined by personal air sampling in the breathing zone. The 8-hr time-weighted average exposure to benzene was 0.13 ppm (mean value, range 0.003-0.6 ppm). Exposed workers had a significant increase of SSB (p = 0.04) over the shift compared with controls. Storage time of the samples seemed to affect the results. An analysis of samples with the same storage time showed a nonsignificant increase among the workers compared with controls. Urinary 8OHdG increased over the shift among the exposed workers but not among the controls. The highest values among the exposed workers were seen in late evening, with a slight decrease the next morning. Multiple linear analysis adjusting for smoking habits showed a significant association between the exposure level of benzene during the shift and the increase of 8OHdG in the urine over the shift among exposed workers (p = 0.02). These findings indicate a genotoxic effect in humans of benzene at relatively low exposure levels, that is, about 0.1 ppm (0.3 mg/m3).

Increased urinary excretion of 8-hydroxydeoxyguanosine in engine room personnel exposed to polycyclic aromatic hydrocarbons

Background: Previous investigations indicate that engine room personnel on ships are exposed to polycyclic aromatic hydrocarbons (PAH) from oil and oil products, with dermal uptake as the major route of exposure. Several PAH are known carcinogens and mutagens. Aims: To investigate the urinary excretion of a marker for oxidative DNA damage, 8-hydroxydeoxy-guanosine (8OHdG), in engine room personnel, and to study the association between 8OHdG and 1-hydroxypyrene (1OHP), a biological marker for PAH exposure. Methods: Urine samples were collected from engine room personnel (n = 36) on 10 Swedish and Norwegian ships and from unexposed controls (n = 34) with similar age and smoking habits. The exposure to oils, engine exhaust, and tobacco smoke 24 hours prior to sampling was estimated from questionnaires. The urinary samples were frozen for later analyses of 8OHdG and 1OHP by high performance liquid chromatography. Results: Excretion in urine of 8OHdG (adjusted to density 1.022) was similar for controls (mean 18.0 nmol/l, n = 33), and for those who had been in the engine room without skin contact with oils (mean 18.7 nmol/l, n = 15). Engine room personnel who reported skin contact with oil had increased excretion of 8OHdG (mean 23.2 nmol/l, n = 19). The difference between this group and the unexposed controls was significant. The urinary levels of ln 1OHP and ln 8OHdG were significantly correlated, and the association was still highly significant when the effects of smoking and age were accounted for in a multiple regression analysis. Conclusion: Results indicate that exposure to PAH or possibly other compounds from skin contact with oils in engine rooms may cause oxidative DNA damage.

Assessment of exposure to polycyclic aromatic hydrocarbons in engine rooms by measurement of urinary 1-hydroxypyrene

OBJECTIVE: Machinists have an increased risk of lung cancer and bladder cancer, and this may be caused by exposure to carcinogenic compounds such as asbestos and polycyclic aromatic hydrocarbons (PAHs) in the engine room. The aim of this study was to investigate the exposure of engine room personnel to PAHs, with 1-hydroxypyrene in urine as a biomarker. METHODS: Urine samples from engine room personnel (n = 51) on 10 ships arriving in different harbours were collected, as well as urine samples from a similar number of unexposed controls (n = 47) on the same ships. Urinary 1-hydroxypyrene was quantitatively measured by high performance liquid chromatography. The exposure to PAHs was estimated by a questionnaire answered by the engine room personnel. On two ships, air monitoring of PAHs in the engine room was performed at sea. Both personal monitoring and area monitoring were performed. The compounds were analysed by gas chromatography of two types (with a flame ionisation detector and with a mass spectrometer). RESULTS: Significantly more 1-hydroxypyrene was found in urine of personnel who had been working in the engine room for the past 24 hours, than in that of the unexposed seamen. The highest concentrations of 1-hydroxypyrene were found among engine room personnel who had experienced oil contamination of the skin during their work in the engine room. Stepwise logistic regression analysis showed a significant relation between the concentrations of 1-hydroxypyrene, smoking, and estimated exposure to PAHs. No PAHs were detected in the air samples. CONCLUSION: Engine room personnel who experience skin exposure to oil and oil products are exposed to PAHs during their work. This indicates that dermal uptake of PAHs is the major route of exposure.

Leukaemia, lymphoma, and multiple myeloma in seamen on tankers

OBJECTIVES: To investigate the risk of lymphatic and haematopoietic malignancies in deck crew on tankers exposed to cargo vapours. METHODS: The study design was as a nested case-referent study in two cohorts of male Swedish seamen 20-64 years of age at the national census 1960 (n 13,449) and 1970 (n 11,290), respectively. Cases were detected by record linkage with the Swedish Cancer Register 1961-79 and 1971-87, respectively. For each case, three to five age matched referents from the population were selected. Exposure was assessed from data in the Swedish Registry of Seamen and from a register of Swedish ships. RESULTS: Seamen in the 1970 cohort, who had been exposed to cargo vapours for at least one month on chemical or product tankers, had an increased risk of lymphatic and haematopoietic malignancies (Mantel-Haenszel odds ratio (OR) 2.6, 95% confidence interval (95% CI) 1.1 to 5.9)) with a significant exposure-response relation (conditional logistic regression analysis, p = 0.04). The ORs were increased for both lymphoma (3.2), multiple myeloma (4.0), and leukaemia (1.6), but the increase was only significant for non-Hodgkins lymphoma (OR 3.3, 95% CI 1.1 to 10.6). There were no significantly increased risks for the 1960 cohort or for seamen exposed only on crude oil tankers, but these groups had few exposed cases and low cumulative exposure to benzene and other light petroleum products. CONCLUSIONS: Seamen exposed to cargo vapours from gasoline and other light petroleum products on chemical or product tankers had an increased incidence of lymphatic and haematopoietic malignancies. One possible cause is exposure to benzene during loading, unloading, and tank cleaning operations.

Cancer incidence of workers in the Swedish petroleum industry

OBJECTIVES: To estimate the risk of cancer due to occupational exposure to petroleum products in the Swedish transport and refinery industries. METHODS: In a retrospective cohort study the cancer incidence in 4128 men and 191 women, who had worked for at least one year in the petroleum industry, was compared with the incidence in the general population. The job titles and employment times for each person were found in personal files in the industries. The men had on average worked in jobs exposed to petroleum for 11.6 years at the end of the observation period. The cases of cancer were identified by record linkage with the Swedish cancer register. RESULTS: In total there were 146 cases of cancer v 157.6 expected (standardised mortality ratio (SMR) 0.93 90% confidence interval (90% CI) 0.80 to 1.1). Operators at refineries had an increased risk of leukaemia (6 cases v 1.7 expected, 90% CI of relative risk (RR) 1.5 to 7.0). Five of the six cases had started to work at the refineries in the 1950s or later. No other significantly increased risk of cancer was found. Distribution workers had a decreased incidence of lung cancer (no cases, 90% CI of RR 0 to 0.4). CONCLUSIONS: Operators at Swedish refineries had an increased risk of leukaemia. A possible cause is exposure to benzene. There was no increased risk of leukaemia in distribution workers. Distribution workers had a decreased risk of lung cancer.

Telemedical Maritime Assistance Service (TMAS) to Swedish merchant and passengers ships 1997-2012.

BACKGROUND Telemedical Maritime Assistance Service (TMAS) for seafarers and traveling passengers is important and can be crucial for the optimal medical treatment on board ships. The aim of this study was to analyse and to compare the data from consultations and evacuations from merchant ships and passenger ferries for possible improvements. MATERIALS AND METHODS Data for seafarers from 1997, 2002 and 2007 and for passengers on Swedish ferries for the years 2007, 2009, 2011 and 2012 from the Swedish Radio Medical were studied. Symptoms and diseases were classified according to the International Classification for Primary Care (ICPC-2). The distribution of symptoms, accidents and diseases, treatments/actions taken, evacuations and the communication forms were analysed. RESULTS One thousand ninety-five contacts for seafarers from merchant ships and 651 passenger patients from Swedish ferries were analysed. While the evacuations for the seafarers gradually decreased over the years from 18% in 1997 to 14% in 2007, still 39.5% of the passenger patient contacts were evacuated mainly by helicopters and 70 patients were picked up by an ambulance on the quay. Accidents were 20% for seafarers and 25% for passengers of the contacts. Evacuations for passengers were mainly in the diagnostic groups: unspecific (A), digestive (D), cardiology (K), musculoskeletal (L) and neurology (N). The use of VHF, radio communications and fax machines have been greatly reduced while the use of e-mail and satellite phone increased. CONCLUSIONS No significant differences in reasons for contact or actions over the years have been identified. The evacuations of seafarers decreased over the years but was stable among the passenger patients (39%). The circumstances and reasons behind the evacuations should be analysed for prevention. Standard forms and digital images for documentation can facilitate knowledge exchange and further studies.