Torsten Skov

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)

A phase II study of the vitamin D analogue Seocalcitol in patients with inoperable hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a common malignant tumour, which has a poor prognosis. Surgical resection can be curative but most patients are inoperable and most chemotherapy agents have minimal activity in this disease. Seocalcitol, a vitamin D analogue, induces differentiation and inhibits growth in cancer cell lines and in vivo. The vitamin D receptor is expressed in hepatocytes and more abundantly in HCC cells. In total, 56 patients with inoperable advanced HCC were included in an uncontrolled study of oral Seocalcitol treatment for up to 1 year (with possible extension for responders). The dose was titrated according to serum calcium levels. The treatment effect was evaluated by regular CT scans. Out of 33 patients evaluable for tumour response, two had complete response (CR), 12 stable disease and 19 progressive disease. The CRs appeared after 6 and 24 months of treatment, and lasted for 29 and at least 36 months (patient still in remission when data censored). Seocalcitol was well tolerated; the most frequent toxicity was hypercalcaemia and related symptoms. Most patients tolerated a daily dose of 10 μg of Seocalcitol. This is the first study showing activity, by reduction in tumour dimensions, of a differentiating agent in patients with an advanced bulky, solid tumour. Seocalcitol may have an effect in the treatment of HCC, especially in early disease when a prolonged treatment can be instituted. The survival benefit with or without tumour response should be determined in controlled studies.

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)

Different Impact of Excision Repair Cross-Complementation Group 1 on Survival in Male and Female Patients With Inoperable Non–Small-Cell Lung Cancer Treated With Carboplatin and Gemcitabine

PURPOSE The excision repair cross-complementation group 1 (ERCC1) status was assessed in patients receiving carboplatin and gemcitabine for inoperable non-small-cell lung cancer (NSCLC). We analyzed the association between the ERCC1 status and the overall survival after the chemotherapy. PATIENTS AND METHODS We retrospectively identified 163 patients with inoperable NSCLC and sufficient tumor tissue for ERCC1 analysis, who had received carboplatin and gemcitabine as first-line treatment. Immunohistochemistry was used to assess the expression of ERCC1. RESULTS One hundred sixty-three patients were included. Seventy (42%) were ERCC1 positive. Patients treated with carboplatin and gemcitabine and having ERCC1-negative tumors had a significantly increased survival when compared to patients with ERCC1-positive tumors (median survival, 12.0 months v 8.2 months; P = .02). This difference was mainly seen in men, where those with ERCC1-negative tumors had a significantly increased survival compared to men with ERCC1-positive tumors (median survival, 11.8 months v 7.9 months; P = .005). Conversely, women who were ERCC1 negative did not have a survival advantage over ERCC1-positive women. CONCLUSION We confirmed previous reports that ERCC1 expression is predictive for outcome in patients treated with carboplatin and gemcitabine. Patients with ERCC1-negative tumors had an increased survival compared to patients with ERCC1-positive tumors and this difference was mainly attributable to a survival difference among men.

ERCC1 and Ki67 in Small Cell Lung Carcinoma and Other Neuroendocrine Tumors of the Lung: Distribution and Impact on Survival

Background: Excision repair cross-complementation group 1 (ERCC1) is a key component of the platinum-DNA repair mechanism. Ki67 is associated with the clinical course of several malignancies. The associations of ERCC1 and Ki67, clinical features and survival in small cell lung carcinoma (SCLC), typical carcinoid (TC), atypical carcinoid (AC), and large cell neuroendocrine carcinoma (LCNEC) were determined. Materials and Methods: We included a consecutive series of 186 patients with SCLC treated with platinum-based chemotherapy and surgically treated patients with TC (n = 48), AC (n = 15) and LCNEC (n = 27). ERCC1 and Ki 67 were measured by immunohistochemistry and scored using published criteria. Results: The expression of ERCC1 was different among the different tumor types (p < 0.001). For patient with limited disease as well as extensive disease SCLC, no association of ERCC1 expression with survival was observed (p = 0.59). However, only 10% of SCLC tumors expressed ERCC1. For TC and AC, ERCC1 positive patients had better survival than ERCC1 negative patients. ERCC1 had no prognostic impact for LCNEC. A difference of the percentage of Ki67 LI was observed for the different tumor types (p < 0.001). The difference between TC and AC was significant (p = 0.02), as was the difference between low grade (TC+AC) and high grade NE (LCNEC + SCLC) (p < 0.001). For all included patients, a correlation between Ki67 and ERCC1 was observed (RSquare = 0.19, p < 0.001). Conclusion: ERCC1 expression in SCLC treated with platinum-based chemotherapy has no impact on survival. High expression of ERCC1 in TC might represent a clue to the failure of platinum-based therapy in these patients. ERCC1 expression has prognostic impact in lung carcinoids. Ki 67 might be considered as a supplementary test to the histopatologic classification of NE tumors.

Injuries among domestic waste collectors

Detailed information on occupational injuries and the precise number of injuries among waste collectors is missing. In this study, risk circumstances associated with injuries among waste collectors were analyzed and described. The study was carried out in a single company with 667 employees in 1993. For each injury, information was collected on date, time, type, and severity of the injury, injury circumstances, department of employment, external or internal registration, sex, year of birth and employment, type of employment, and a registration of where the injury happened. A total of 17% of the employees experienced injury. The number of injuries decreased with increasing seniority and age. Most injuries occurred outside the company area. More injuries occurred on Mondays and Thursdays, and there were peaks in the injury rate in May and September. Most often injured was the back, followed by the knees, hands, and feet. The job as a waste collector was associated with a high risk of experiencing an occupational injury and the number of injuries decreased with increasing seniority and nonsignificantly with increasing age. Moreover, a seasonal and weekly variation was observed.

Comparison of a self‐administered questionnaire and a telephone interview of 146 Danish waste collectors

Methods to collect epidemiologic data include, among other means, self-administered questionnaires and personal and telephone interviews. In some studies, these data collection methods are used simultaneously. However, little is known about the comparability of the data obtained, thus, the validity of pooling data. A self-administered questionnaire was completed by 146 waste collectors, who participated in a telephone interview 3 months later. The responses to health questions were compared. Agreement percentages and kappa values were calculated. An answer pattern shift was detected in a subgroup of questions with five answer options. Grouping the answer options diminished the shift in the answer pattern. The questions in a yes/no format generally showed no shift in the answer pattern. The study indicates that caution should be exercised when pooling data collected by self-administered questionnaire and telephone interview in epidemiological research. Some types of questions seem to be sensitive to the data collection method.

Cancer Risk and Exposures to Carcinogens in Hairdressers

A number of epidemiologic studies have focused on the risk of bladder and lung cancer in hairdressers and beauticians, and the risk of breast cancer, and bladder cancer associated with the private use of hair dyes has also been addressed. The most consistent, although by no means unequivocal, finding is the increased risk of bladder cancer in male hairdressers. The use of brillantine containing p-dimethylaminoazobenzene could be suggested as a relevant exposure. We present recent incidence data on bladder cancer in Danish hairdressers showing relative risk (RR) = 2.05 (men) and RR = 1.75 (women) in 1970-1980 and RR = 1.17 (men) and RR = 0.88 (women) in 1981-1987. Furthermore, in female hairdressers, the risk of non-Hodgkins lymphoma was increased for the whole period of 1970-1987.

Etiologic and prevention effectiveness intervention studies in occupational health

In this article a basic distinction is made between etiologic and prevention effectiveness intervention studies. Etiologic intervention studies focus on elucidating causes of disease, while the purpose of prevention effectiveness intervention studies is to study methods of prevention. The design requirements for each of these studies are very different: etiologic intervention studies usually need large study populations, large exposure contrasts, ascertainment of exposure, as well as health outcome. Ideally, randomization and blinding should also be applied. Effective preventive strategies may, on the other hand, be identified in small study populations with exposure as the only outcome measure, and randomization and blinding may be superfluous. At present, intervention studies are in great demand, and often there is a wish that etiologic questions as well as prevention effectiveness be addressed in the same study. We argue that this should not be done without careful consideration of possible conflicting design aspects.

Risk for cancer of the pharynx and oral cavity among male painters in the nordic countries

In an effort to evaluate a hypothesis raised by findings in Denmark that painters might experience an increased risk for pharyngeal and oral cancer, data were collected about these cancers among painters in Norway, Sweden, and Finland. The possible confounding effects of alcohol and tobacco were gauged by collecting data about cancer of the lung, larynx, esophagus, liver, and bladder, and about mortality from liver cirrhosis. Consistently increased risks for lung cancer among painters were found. The risks for cancer of the oral cavity and/or pharynx were increased in Norway, Sweden, and Finland, but not to the same extent as was observed in Denmark. The risks for cancer of the esophagus were slightly increased as were the risks for cancer of the liver and for cirrhosis of the liver in Denmark and Finland. The data from Norway, Sweden, and Finland could thus neither substantiate nor disprove the hypothesis that painters may experience an increased risk for cancer of the pharynx and oral cavity as a result of occupational exposures.