Journal of Occupational Medicine and Toxicology最新文献

Background: Exposure to workplace chemicals can pose serious risks to reproductive health. The European Union's Pregnant Workers Directive requires risk assessments but lacks clear guidelines for assessing chemical reproductive hazards in workplaces.

Aims: This study aims to review how EU member states implement the Pregnant Workers Directive by analysing national guidance documents and relevant literature.

Methods: A qualitative review was conducted, combining a systematic literature search with outreach to EU national experts to gather relevant guidance documents. Thematic synthesis identified guiding principles for implementing maternity protection for chemical exposures.

Results: Two main themes were identified: the need for a broad perspective and for certainty in risk assessment. The broad perspective stresses the importance of considering all reproductive hazards, not limited to those listed in the EU Directive and inclusion of male workers and the preconception period, and the potential adverse socio-economic consequences of applied protective measures. The need for certainty highlights the challenges in reliable risk assessments, due to lack of knowledge about chemicals' hazardous properties, dose-response relationships and the level of worker exposure. These themes reveal the complexity of implementing effective maternity protection and the need for improved guidelines across the EU.

Conclusions: This study calls for a unified approach to reproductive health protection, extending beyond pregnancy to include also preconception and paternal exposures. The findings highlight the need to support practitioners in the risk assess process at workplaces in the EU by providing a framework for the assessment of reproductive hazards and determining protective measures.

Background: Engineered stone (ES), a material that has become widespread for its use in kitchen and bathroom countertops since the 1980s, is composed of over 90% crystalline silica by weight, significantly exceeding the silica content of natural stones such as granite (40-50%) and marble (< 10%). Workers fabricating ES are exposed to dangerously high levels of respirable crystalline silica (RCS) and other toxic chemicals, which increases the risk of developing silicosis and other lung and systemic diseases. The purpose of this review is to explore the epidemiology, occupational risks, regulatory gaps, diagnostic evaluation, and clinical challenges associated with ES dust exposure.

Main body: ES silicosis was first described in the early 2010s among ES countertop workers in Spain, Italy, and Israel. Since then, hundreds of cases have emerged worldwide, namely in China, Australia, the United States, the United Kingdom, and Belgium. Silicosis from ES dust is accelerated and diagnosed after 7-19 years of exposure, often affecting young individuals (median age 33-55 years) from marginalized or immigrant communities. Morbidity and mortality are poor, with high rates of lung transplantation and death. Industrial hygiene air sample monitoring data shows that despite engineering controls such as wet saws and exhaust ventilation, exposure to respirable crystalline silica when cutting ES frequently exceeds safe exposure levels. Diagnostic evaluation and treatment are clinically challenging due to delayed medical screening, misdiagnosis, and lack of treatment options.

Conclusions: This review underscores the urgent need for enhanced occupational safety regulations, active screening, and healthcare support to address the rising burden of ES silicosis among vulnerable worker populations globally.

Background: Case reports implicate disulfiram treatment in causing parkinsonism, but these observations lack epidemiological confirmation. Aim of the present study was to estimate the risk of incident parkinsonism associated with disulfiram dispensing in a large Italian population.

Methods: In this observational cohort study, administrative data were used, linking records at the individual level from civic registries, population census, mortality registers, hospital admissions, archives of drug prescriptions, and direct ambulatory drug distribution. Participants included all residents in the Piedmont region of Italy aged ≥ 40 years participating in 2011 census, still resident and alive at the beginning of 2013, followed-up from 2013 to 2019. The outcome was incident parkinsonism identified through multiple prescriptions of levodopa or a hospital admission for Parkinson's disease or atypical parkinsonism. Exposure to disulfiram and to neuroleptics was assessed through regional drug prescription archives. The association between disulfiram and parkinsonism onset was assessed using Cox proportional hazards models, adjusted for gender, age and neuroleptic use.

Results: The study population included 2,498,491 individuals (mean age: 62 years). During follow-up, 19,072 parkinsonism cases were identified, 8 of whom had been prescribed disulfiram. Exposure to disulfiram was associated with a three-fold increased risk of parkinsonism (HR = 3.10, 95% CI = 1.55-6.21) that remained significant when adjusted for neuroleptic use (HR = 2.04, 95% CI = 1.01-4.10). The association was stronger among persons unexposed to neuroleptics and among those with more than four disulfiram prescriptions.

Conclusions: These results support the hypothesis that disulfiram may cause parkinsonism. Clinicians and drug regulatory agencies should consider parkinsonism when assessing the risks and benefits of disulfiram use.

The safety assessment of combined exposure to xenobiotics has been an emerging topic for several years. Methodologies and approaches for cumulative risk assessment (CRA) are being developed primarily for the dietary risk assessment of pesticides, thus focusing only on consumer exposure. However, as highlighted in recent years, non-dietary exposures, such as those encountered by professionals in agricultural settings, may pose a significant risk due to their higher levels compared to dietary exposure. Despite this, existing methodologies for cumulative risk assessment (CRA) have not adequately addressed this critical aspect. In the EU, even if several legislations highlight the need to address the non-dietary CRA, no legal requirements are in place yet, therefore, there are no harmonized methodologies and approaches currently available. In a first step to fill this gap, this study is aimed at exploring CRA methodology applied to non-dietary exposure to pesticide in agricultural settings, specifically targeting operators, re-entry workers, and bystanders. The primary objective of the study was to verify the feasibility of an electronic register of plant protection treatments as data source for identifying and characterizing in field mixtures and consequently estimating cumulative non-dietary systemic exposure in real life. The relevant active substances selected for this investigation were those listed in foetal craniofacial alterations cumulative assessment groups (CAGs), established by the European Food Safety Authority (EFSA) for dietary CRA. Exposures to pesticides were estimated using European Union agreed mathematical models. The preliminary findings of this investigation effectively revealed the value of the register of treatments in assessing real-life plant protection products (PPP) usage in professional agricultural settings. In conclusion, the study provides encouraging insights into using the pesticide dietary CRA approach for non-dietary risk assessment in agricultural settings, underlining the necessity for further research and investigation of its feasibility for the evaluation of other acute effects but also for long-term effects related CAGs.

Background: Herbicides are a group of substances used to control undesired vegetation in both agricultural and non-agricultural settings. They are recorded as the most consumed class among other pesticides, reaching nearly two million tons worldwide. Despite their effectiveness in weed control, the extensive utilization of herbicides has raised concerns regarding adverse effects on human health. However, comprehensive reviews addressing herbicide-related human health risks remain limited. This work aims to compile scientific evidence and possible underlying mechanisms to emphasize the hazards that need to be acknowledged, as well as to explore novel strategies for minimizing the impact on human health.

Method: Scientific data on herbicide-related human health risks, including human-related data and non-human experimental research, were retrieved from databases such as PubMed, Scopus, and Google Scholar. Pre-determined eligibility criteria were applied to select the final studies.

Result: A narrative summary of evidence-based human incidence and laboratory experiments is presented to organize and highlight key findings. This indicates the life-threatening nature of herbicide exposure in humans, ranging from acute toxicity to the development of chronic diseases at any stage of life.

Conclusion: Herbicidal chemicals can harm individuals through various pathways, especially by inducing oxidative stress or directly disrupting molecular and cellular processes. Despite some conflicting findings, effective mitigation strategies are urgently needed to promote a safer society and protect human well-being.

Background: Few studies have been conducted on women of childbearing age with chronic mercury poisoning caused by mercury vapor exposure.

Methods: Occupational exposure, clinical symptoms and signs, laboratory tests, auxiliary examinations, treatment, and follow-up of 31 female workers with chronic mercury poisoning from a mercury thermometer processing factory who received inpatient treatment at our hospital between September 2021 and August 2022 were analyzed.

Results: In 31 female workers of childbearing age (23-43 years) who were chronically exposed to mercury vapor (3-31 months), urinary mercury levels exceeded the normal range. The clinical manifestations were primarily neurological (96.77%). Renal pathology of the two female workers suggested membranous nephropathy in the first stage. Some female workers experienced menstrual abnormalities, anxiety, depression, and sleep disorders. Treatment was mainly chelation therapy supplemented with antioxidants and other symptomatic supportive treatments. All patients achieved good results after discontinuing exposure to mercury vapor and receiving treatment. However, follow-up after discharge revealed that some female workers still had insomnia.

Conclusions: Occupational mercury vapor exposure is hazardous to female workers of childbearing age and increases the risk of adverse effects on their reproductive health. Occupational protection and prevention of mercury exposure in female workers of reproductive age must be emphasized.

Background: Understanding the nature and consequences of hazards and risks in the workplace is critical to protecting people from harm.

Educational case study: We review the fictional example of "Indiana" Jones as an educational vector to illustrate principles of occupational medicine in real-world scenarios.

Conclusion: After reviewing the Jones saga regarding potential hazards (physical - biological - chemical - psychosocial), we provide a practical outlook on the workplace health for readers with a non-occupational medicine background.

Background: Silicosis remains a major occupational health challenge in India. This review systematically examines the prevalence, risk factors, regional differences, and diagnostic tools specific to India's high-risk industries. Additionally, it assesses policy gaps and offers insights from diverse clinical and qualitative studies, aiming to inform targeted public health interventions and support the development of effective occupational health policies.

Methods: For this review, data were extracted for each study, including author, location, design, study aims, sample size and characteristics, participant age, duration of silica exposure, diagnostic criteria, and primary outcomes. As an add-on analysis included, a random-effects meta-analysis was used to estimate the pooled prevalence of silicosis and assess variability among studies. The review also included qualitative analyses on awareness, diagnostic tools (e.g., CC16 protein), and differences in prevalence across various occupational groups and regions within India.

Results: The review initially identified 263 articles, narrowed down to 49 eligible studies on silicosis in India after exclusions and quality assessment. Among these, 11 prevalence studies (total sample size: 2072) showed an average silicosis rate of 31.39%. Specific studies reported high rates, including 52% among Rajasthan mine workers and 69.1% among Khambhat agate workers. Additionally, screening tools, like CC16 protein levels, showed promise for early diagnosis, while qualitative studies highlighted gaps in awareness and regulatory practices. Meta-analysis revealed a significant pooled prevalence (25.98%) and marked variability (I² = 98.86%), underscoring the need for targeted interventions and worker protections.

Conclusions: This review of current knowledge on silicosis in India finds silicosis highly prevalent among workers in mining and stone industries, with gaps in regulatory enforcement and awareness. Biomarkers like CC16 offer the potential for early diagnosis, underscoring the need for preventive measures. Policy recommendations include stricter dust exposure limits, enhanced workers' education, routine screening, and improved access to protective equipment and health monitoring to reduce the risk of silicosis and health disparities in vulnerable occupational groups.

Introduction: Chronic exposure to pesticides causes various adverse health effects, mainly at a neurological level. However, there is little evidence focused on liver tissue injury and transaminase activity as indicators of effect.

Methods: A cross-sectional study was designed based on medical-occupational records of workers from an agro-export company in Peru to associate the levels of butyrylcholinesterase (BChE) transaminases (ALT and AST). Occupational medical records were reviewed to obtain demographic and occupational information and laboratory values of BChE activity and transaminases.

Results: We evaluated 459 records, and 69.9% were men. The mean age was 34.9 ± 11.5 years. BChE, ALT, and AST levels were 6238.8 ± 709.1 U/l, 34.4 ± 12.5 U/l, and 22.4 ± 8.5 U/l, respectively. The proportion of inhibited BCHE and elevated transaminase levels was 15.3% and 21.6%, respectively. We found a significant association between BChE inhibition and elevation of transaminases (AST: PR = 0.798, 95%CI: 0.716-0.889; ALT: PR = 0.419, 95%CI: 0.239-0.736).

Conclusion: The potential usefulness of transaminases is shown as a biomarker of exposure and monitoring in occupational health programs for the agro-industry.

Background: Hazardous noise exposure is an important health concern in many workplaces and is one of the most common work-related injuries in the United States. Dental professionals are frequently exposed to high levels of occupational noise in their daily work environment. This noise is generated by various dental handpieces such as drills, suctions, and ultrasonic scalers. Prolonged exposure to such noise levels is known to have adverse effects on hearing health. Despite the prevalence of occupational noise in dentistry, there is a paucity of research specifically examining the prevalence of hearing loss and tinnitus in dental professionals.

Methods: To evaluate the prevalence of hearing loss and tinnitus, data were collected from 60 dental professionals, including participant demographics and audiometric thresholds. Thresholds were compared to the age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017).

Results: Results showed that 15-25% of males and 13-18% of females had hearing thresholds that exceeded 95th percentile limits based on the ISO normative age- and sex-distributions. Tinnitus was reported in 40% of the participants.

Conclusion: This study is the first to examine the characteristics and prevalence of auditory dysfunctions in dental professionals compared to the ISO normative age and sex distributions of hearing status. Findings from this study highlight the need for increasing the awareness of occupational noise hazards among dental professionals and the importance of routine audiological monitoring.