Stig Hagberg

Health effects of working in pulp and paper mills : exposure, obstructive airways diseases, hypersensitivity reactions, and cardiovascular diseases

Workers in the pulp and paper industry are exposed to different substances, such as hydrogen sulfide and other reduced sulfur compounds, chlorine, chlorine dioxide, sulfur dioxide, terpenes, and paper dust. The exposure level depends on the process, i.e., sulfite, sulfate, groundwood, bleachery, or paper production. Hitherto, exposures have been poorly described and more studies are certainly needed. Workers with repeated exposure peaks to chlorine, e.g., bleachery workers, seem to have an impaired lung function and an increased prevalence of respiratory symptoms. Exposure to high levels of paper dust, (> 5 mg/m3) causes impaired lung function. Therefore, exposure to respiratory irritants is an important, and probably overlooked, occupational risk among certain groups of pulp and paper workers. Some studies indicate that sulfate workers with high exposure to reduced sulfur compounds have an increased mortality due to ischemic heart disease. However, before any definite conclusions can be drawn, the impact of important confounders, such as shift-work and smoking habits have to be further evaluated.

Incidence of asthma among workers exposed to sulphur dioxide and other irritant gases

The aim of the present study was to investigate whether repeated peak exposure (gassings) to sulphur dioxide (SO2) and other irritant gases increases the risk of new-onset asthma. A questionnaire was sent to 4,112 sulphite workers, of whom 1,919 completed the questionnaire and 396 completed the short-form questionnaire, which was sent out as a last reminder. A sample of 130 nonrespondents completed a telephone interview using the short-form questionnaire. The incidence of adult-onset, physician-diagnosed asthma during employment duration was analysed in relation to exposure to SO2 and gassings giving rise to respiratory symptoms. Incidence rates, as well as incidence rate ratios with 95% confidence interval (CI), were calculated. Further Cox regression models were used allowing assessment of hazard ratios (HR) stratified for sex and adjusted for atopy, smoking habits and age. The incidence rate for asthma among sulphite mill workers reporting gassings of SO2 was 6.2 out of 1,000 person-yrs, compared with 1.9 out of 1,000 person-yrs among subjects unexposed to SO2 and any gassings (HR (95% CI) 4.0 (2.1–7.7)). Among males reporting gassings to SO2, the HR (95% CI) for asthma was 5.8 (2.6–13) compared with unexposed males. In conclusion, repeated peak exposure to sulphur dioxide increased the incidence of asthma during work in sulphite pulp mills, which supports the hypothesis of irritant-induced asthma.

Prevalence of asthma and exhaled nitric oxide are increased in bleachery workers exposed to ozone.

The aims of the present study were to determine whether exposure to high peaks of ozone resulted in an increased prevalence of asthma or respiratory symptoms among bleachery workers and whether nitric oxide (NO) was elevated in the exhaled air of these workers. Bleachery workers (n=228) from three Swedish pulp mills who had been exposed to ozone, together with 63 unexposed control subjects, were investigated by means of spirometry, Phadiatop®, exhaled and nasal NO and answers to a questionnaire concerning respiratory symptoms and exposure. Exposure to an ozone peak that gave rise to respiratory symptoms was defined as a “gassing”. Bleachery workers reporting four or more gassings involving ozone had an increased prevalence of adult-onset asthma, wheeze, and current asthma symptoms. They also had a higher median concentration of exhaled NO in comparison with those who reported no such gassings (19.2 versus 15.7 parts per billion). No such associations were found in respect of nasal NO. The results from this study show that bleachery workers who have been repeatedly exposed to ozone gassings have an increased prevalence of adult-onset asthma. The results also indicate exhaled nitric oxide may be a marker of airway inflammation in bleachery workers who have been exposed to high peaks of ozone.

Exposure to Volatile Methacrylates in Dental Personnel

Abstract Dental personnel are exposed to acrylates due to the acrylic resin-based composites and bonding agents used in fillings. It is well known that these compounds can cause contact allergy in dental personnel. However, in the 1990s, reports emerged on asthma also caused by methacrylates. The main volatile acrylates in dentistry are 2-hydroxyethyl methacrylate and methyl methacrylate. The aim of this study was to quantify the exposure to these acrylates in Swedish dental personnel. We studied the exposure to 2-hydroxyethyl methacrylate and methyl methacrylate in five randomly selected public dental clinics and at the Faculty of Odontology at Göteborg University. In total, 21 whole-day and 46 task-specific short-term (1–18 min) measurements were performed. The median 8-hour time-weighted averages were 2.5 μ g/m3 (dentists) and 2.9 μ g/m3 (dental nurses) for 2-hydroxyethyl methacrylate, and 0.8 μ g/m3 (dentists) and 0.3 μ g/m3 (dental nurses) for methyl methacrylate. The maximum short-term exposure levels were 79 μ g/m3 for 2-hydroxyethyl methacrylate and 15 μ g/m3 for methyl methacrylate, similar in dentists and dental nurses. The observed levels are much lower than in complete denture fabrication. We found only one previous study in dentistry and it showed similar results (though it reported short-term measurements only). Irritant effects would not be expected in healthy people at these levels. Nevertheless, occupational respiratory diseases due to methacrylates may occur in dental personnel, and improvements in the handling of these chemicals in dentistry are warranted. This includes better vials for the bonding agents and avoiding evaporation from discarded materials.