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Keith T Palmer - One of the best experts on this subject based on the ideXlab platform.
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Are welders more at risk of respiratory infections
Thorax, 2016Co-Authors: David Coggon, Keith T PalmerAbstract:Welding of Metals generates a complex mix of noxious gases and Fumes,1 and has been linked with various respiratory diseases including Metal Fume fever,2 asthma,3 COPD4 and possibly bronchial carcinoma.1 ,2 In addition, there is now strong and consistent epidemiological evidence that welders are at increased risk of infectious, lobar pneumonia. Originally detected in national analyses of occupational mortality,5 the hazard was confirmed by a large case–control study of men admitted to hospitals in the English West Midlands with community-acquired pneumonia,6 and is supported by findings from more recent epidemiological investigations in the UK7 ,8 and other countries.9–11 The elevation of risk is associated specifically with recent exposure,6 and is not apparent in former welders after normal retirement age,5 ,7 suggesting that it reflects a reversible increase in susceptibility to infection. Moreover, it extends to other occupations such as furnacemen and moulders in foundries, who are exposed to Metal Fume but not to welding gases.5 ,12 It is demonstrable in men who work with ferrous Metals,6 ,12 but the involvement of other Metals cannot be ruled out. Resolution of this uncertainty with adequate statistical power is a challenge because lobar pneumonia is uncommon, and relatively few workers are exposed to Fume exclusively from …
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Pneumococcal vaccination for welders
Thorax, 2014Co-Authors: David Coggon, E Clare Harris, V. Cox, Keith T PalmerAbstract:Over the past 20 years, evidence has accumulated that occupations entailing exposure to Metal Fume (principally welders) are at increased risk of developing and dying from pneumococcal and unspecified lobar pneumonia.1–9 The hazard is apparent in people working with ferrous Metal,2 ,4 may extend to other Metals4 and is reversible following cessation of exposure.1 ,4 ,5 There are indications that the ultrafine particles in welding Fume promote adherence of pneumococci to bronchial epithelium,10 but the underlying mechanisms are not yet well established. Nevertheless, in 2011, the independent Joint Committee on Vaccination at the English Department of Health (DH) judged that the evidence of increased risk was sufficient to recommend that employers offer welders vaccination against pneumococcus.11 This was a new measure that had not previously been applied in other countries. Subsequently, on the advice of the UK Health and Safety Executive (HSE), the DH weakened its recommendation, stating only that vaccination ‘should be considered for those at risk of frequent or continuous occupational exposure to Metal Fume (e.g. welders), taking into account the exposure control measures in place’.12 Then after some delay, HSE published guidance for employers in which they were advised to …
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Infectious pneumonia in workers exposed to Metal Fume
2013Co-Authors: Keith T Palmer, David CoggonAbstract:Siderosis, the accumulation of ferric oxide particles in the lung, was described over a century ago by Zenker. Enquiries subsequently focused on the effect of this pneumoconiotic process of lung function, generally concluding that it was benign. More recently, however, it has become apparent that iron and perhaps other elements in Metal Fume influence the risk of lower respiratory tract infection. The evidence accrued has been sufficient to trigger mechanistic investigations, a reappraisal of health risks in workers exposed to Metal Fume, and recommendations for risk control. In this chapter we review the emerging evidence, with a focus on epidemiological enquiries.
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occupations exposed to respiratory sensitizers workers a comparison with deaths from asthma in mortality from infectious pneumonia in Metal
2009Co-Authors: Keith T Palmer, Paul Cullinan, Simon Rice, Terry Brown, David CoggonAbstract:Abstract Introduction National analyses of mortality in England and Wales have repeatedly shown excess deaths from pneumonia in welders. During 1979-1990 the excess was attributable largely to deaths from lobar pneumonia and pneumonias other than bronchopneumonia, limited to working-aged men, and apparent in other Metal Fume-exposed occupations. We assessed findings for 1991-2000 and compared the mortality pattern with that from asthma in occupations exposed to known respiratory sensitizers. Methods The Office of National Statistics supplied data on deaths by underlying cause among men aged 16-74 years in England and Wales during 1991-2000, including age and last held occupation. We abstracted data on pneumonia for occupations with exposure to Metal Fume and on asthma for occupations commonly reported to surveillance schemes as at risk of occupational asthma. We estimated expected numbers of deaths by applying age-specific proportions of deaths by cause in the population to the total deaths by age in each occupational group. Observed and expected numbers were compared for each cause of death.
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Inflammatory responses to the occupational inhalation of Metal Fume.
The European respiratory journal, 2006Co-Authors: Keith T Palmer, Jason Poole, David Coggon, R. Mcneill-love, Anthony J. Frew, Cathy Linaker, J. K. ShuteAbstract:Occupational exposure to Metal Fume promotes a reversible increase in the risk of pneumonia, but by mechanisms which are unclear. To investigate, the current authors measured various markers of host defence function in welders and nonwelders. Induced sputum and venous blood samples were collected from 27 welders with regular long-term exposure to ferrous Metal Fume and 31 unexposed matched controls. In sputum, the present authors measured cell counts, the soluble and cellular iron concentration, and levels of interleukin-8, tumour necrosis factor-α, myeloperoxidase, matrix Metalloproteinase-9, immunoglobulin (Ig)A, α 2 -macroglobulin and unsaturated iron-binding capacity. Blood samples were assayed for evidence of neutrophil activation and pneumococcal IgG antibodies. Welders had significantly higher iron levels and a substantially lower unsaturated iron-binding capacity in their sputum, but, despite a high iron challenge, there was a noteworthy absence of an inflammatory response. Only blood counts of eosinophils and basophils were significantly related to the extent of welding. Weak nonsignificant trends were observed for several other measures, consistent with low-grade priming of neutrophils. In conclusion, these data suggest that chronic exposure to Metal Fume blunts responsiveness to inhaled particulate matter. However, the mechanism behind the lack of detectable local inflammatory response requires further investigation.
David C Christiani - One of the best experts on this subject based on the ideXlab platform.
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Urinary Metal and polycyclic aromatic hydrocarbon biomarkers in boilermakers exposed to Metal Fume and residual oil fly ash
American journal of industrial medicine, 2005Co-Authors: Sutapa Mukherjee, Lyle J Palmer, David B Aeschliman, R S Houk, Mark Woodin, Ema G. Rodrigues, Robert A. Weker, David C ChristianiAbstract:Background Boilermakers are occupationally exposed to known carcinogens. Methods The association of urinary 1-hydroxy-pyrene (1-OHP), a biomarker of polycyclic aromatic hydrocarbon (PAH) exposure, with biomarkers of Metal exposure (vanadium, chromium, manganese, nickel, copper, and lead) in boilermakers exposed to Metal Fume from welding and dust particulates from residual oil fly ash (ROFA) was examined. A repeated measures cohort study was conducted during the overhaul of an oil-fired boiler. Twice-daily urine samples were obtained for 5 days and analyzed for cotinine, 1-OHP, and Metals. Generalized estimating equations (GEE) were used to model the multivariate relationship of 1-OHP to the explanatory variables. Results Metal and 1-OHP levels were determined for 165 urine samples from 20 boilermakers and these levels increased during the workweek. However, the 1-OHP level was not significantly associated with any individual Metal level at any time point. Conclusion This suggests that boilermakers were occupationally exposed to PAH and Metals, but 1-OHP as a PAH biomarker was unable to serve as a surrogate marker of Metal exposure for the Metals measured in this study. Am. J. Ind. Med. 47:484–493, 2005. © 2005 Wiley-Liss, Inc.
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smoking status and occupational exposure affects oxidative dna injury in boilermakers exposed to Metal Fume and residual oil fly ash
Cancer Epidemiology Biomarkers & Prevention, 2004Co-Authors: Sutapa Mukherjee, Lyle J Palmer, David B Aeschliman, R S Houk, Mark Woodin, David C ChristianiAbstract:Epidemiologic studies demonstrate increased cancer incidence among workers exposed to polycyclic aromatic hydrocarbons (PAH) and Metals, probably through cumulative oxidative DNA damage in response to carcinogens. Boilermakers are exposed to particulates of residual oil fly ash (ROFA) and Metal Fume that contain carcinogenic PAH and Metals. We conducted a repeated-measures cohort study in boilermakers during the overhaul of an oil-fired boiler to determine a possible association between the level of 8-hydroxy-2′-deoxyguanosine (8-OH-dG; an oxidative injury biomarker) and biomarkers of PAH (1-hydroxypyrene; 1-OHP) and Metal exposure. Preshift and postshift urine samples were analyzed for 8-OH-dG, cotinine, 1-OHP, and Metals. Generalized estimating equations were used to model the multivariate relationship of 8-OH-dG to the explanatory variables of interest. Biomarker levels were determined for 181 urine samples from 20 male subjects (mean age 45 years, 50% smokers). Metal and 1-OHP levels increased cross-week and were affected by smoking status. Levels of 8-OH-dG were higher in nonsmokers at the start of the workweek yet declined after occupational exposure to similar levels as in smokers. Multivariate analysis indicated that Metal × cotinine interaction terms for nickel, vanadium, chromium, and copper were significantly associated with the 8-OH-dG level, but there were differential effects depending on the Metal. This study suggests that oxidative DNA damage in boilermakers is influenced by the interaction between occupational exposures and smoking status. In addition, boilermakers may have reduced ability to repair damaged DNA after ROFA and Metal Fume exposure. This finding has clinical relevance because these exposures may increase the cancer susceptibility of boilermakers.
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1-hydroxypyrene as a biomarker of occupational exposure to polycyclic aromatic hydrocarbons (PAH) in boilermakers.
Journal of occupational and environmental medicine, 2002Co-Authors: Sutapa Mukherjee, Lyle J Palmer, Ema G. Rodrigues, Robert A. Weker, David C ChristianiAbstract:A repeated measures short-term prospective study was performed in boilermakers to determine occupational polycyclic aromatic hydrocarbon (PAH) exposure using the biomarker, 1-hydroxypyrene (1-OHP). Two work sites were studied; an apprentice school (Metal Fume exposure) and a boiler overhaul (residual oil fly ash [ROFA] and Metal Fume exposure). Pre- and postshift urine samples (n = 241; 41 male subjects) were analyzed for cotinine and 1-OHP. Descriptive statistics and generalized estimating equations were calculated. At the apprentice school cross-shift 1-OHP levels did not significantly differ. At the overhaul 1-OHP levels increased during the week in smokers and nonsmokers; in nonsmokers the 1-OHP level increased significantly postshift compared to preshift. In conclusion this study suggests that boilermakers exposed to occupational particulates are exposed to PAH. The urinary 1-OHP level may be a useful biomarker of PAH exposure in boilermakers exposed to ROFA, particularly in nonsmokers. (J.
Denyse Gautrin - One of the best experts on this subject based on the ideXlab platform.
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Is Metal Fume fever a determinant of welding related respiratory symptoms and/or increased bronchial responsiveness? A longitudinal study.
Occupational and Environmental Medicine, 2005Co-Authors: Claire Infante-rivard, Jean-luc Malo, Denyse GautrinAbstract:Background: The current prospective study investigated the hypothesis of Metal Fume fever (MFF) being a predictor for the development of respiratory symptoms and functional abnormalities. Methods: The study consisted of a pre-exposure and two follow up assessments of 286 welding apprentices during an average period of 15 months. A respiratory and a systemic symptom questionnaire, skin prick tests to common allergens and Metal salts, spirometry, and methacholine challenge tests were administered. Results: Developing at least one positive skin prick test to a Metallic salt solution was found in 11.8% of apprentices. Possible MFF (at least one of fever, feelings of flu, general malaise, chills, dry cough, Metallic taste, or shortness of breath) was reported by 39.2% of apprentices. The presence of at least one welding related respiratory symptom (cough, wheezing, or chest tightness) suggestive of welding related asthma was reported by 13.8%. MFF was significantly associated with these respiratory symptoms (OR = 4.92, 95% CI 2.10 to 11.52), after adjusting for age, atopy, smoking, physician diagnosed asthma, and symptoms of non-welding related asthma. Apprentices with possible MFF, and no welding related respiratory symptoms suggestive of welding related asthma at the first follow up, had an increased risk of developing the latter symptoms by the second follow up visit (OR = 7.4, 95% CI 1.97 to 27.45) compared with those not having MFF. MFF was not significantly associated with an increase in bronchial responsiveness. Conclusion: MFF could be a predictor for the development of respiratory symptoms but not for functional abnormalities in welders.
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is Metal Fume fever a determinant of welding related respiratory symptoms and or increased bronchial responsiveness a longitudinal study
Occupational and Environmental Medicine, 2005Co-Authors: Mariam Elzein, Jean-luc Malo, Claire Infanterivard, Denyse GautrinAbstract:Background: The current prospective study investigated the hypothesis of Metal Fume fever (MFF) being a predictor for the development of respiratory symptoms and functional abnormalities. Methods: The study consisted of a pre-exposure and two follow up assessments of 286 welding apprentices during an average period of 15 months. A respiratory and a systemic symptom questionnaire, skin prick tests to common allergens and Metal salts, spirometry, and methacholine challenge tests were administered. Results: Developing at least one positive skin prick test to a Metallic salt solution was found in 11.8% of apprentices. Possible MFF (at least one of fever, feelings of flu, general malaise, chills, dry cough, Metallic taste, or shortness of breath) was reported by 39.2% of apprentices. The presence of at least one welding related respiratory symptom (cough, wheezing, or chest tightness) suggestive of welding related asthma was reported by 13.8%. MFF was significantly associated with these respiratory symptoms (OR = 4.92, 95% CI 2.10 to 11.52), after adjusting for age, atopy, smoking, physician diagnosed asthma, and symptoms of non-welding related asthma. Apprentices with possible MFF, and no welding related respiratory symptoms suggestive of welding related asthma at the first follow up, had an increased risk of developing the latter symptoms by the second follow up visit (OR = 7.4, 95% CI 1.97 to 27.45) compared with those not having MFF. MFF was not significantly associated with an increase in bronchial responsiveness. Conclusion: MFF could be a predictor for the development of respiratory symptoms but not for functional abnormalities in welders.
David Coggon - One of the best experts on this subject based on the ideXlab platform.
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Are welders more at risk of respiratory infections
Thorax, 2016Co-Authors: David Coggon, Keith T PalmerAbstract:Welding of Metals generates a complex mix of noxious gases and Fumes,1 and has been linked with various respiratory diseases including Metal Fume fever,2 asthma,3 COPD4 and possibly bronchial carcinoma.1 ,2 In addition, there is now strong and consistent epidemiological evidence that welders are at increased risk of infectious, lobar pneumonia. Originally detected in national analyses of occupational mortality,5 the hazard was confirmed by a large case–control study of men admitted to hospitals in the English West Midlands with community-acquired pneumonia,6 and is supported by findings from more recent epidemiological investigations in the UK7 ,8 and other countries.9–11 The elevation of risk is associated specifically with recent exposure,6 and is not apparent in former welders after normal retirement age,5 ,7 suggesting that it reflects a reversible increase in susceptibility to infection. Moreover, it extends to other occupations such as furnacemen and moulders in foundries, who are exposed to Metal Fume but not to welding gases.5 ,12 It is demonstrable in men who work with ferrous Metals,6 ,12 but the involvement of other Metals cannot be ruled out. Resolution of this uncertainty with adequate statistical power is a challenge because lobar pneumonia is uncommon, and relatively few workers are exposed to Fume exclusively from …
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Pneumococcal vaccination for welders
Thorax, 2014Co-Authors: David Coggon, E Clare Harris, V. Cox, Keith T PalmerAbstract:Over the past 20 years, evidence has accumulated that occupations entailing exposure to Metal Fume (principally welders) are at increased risk of developing and dying from pneumococcal and unspecified lobar pneumonia.1–9 The hazard is apparent in people working with ferrous Metal,2 ,4 may extend to other Metals4 and is reversible following cessation of exposure.1 ,4 ,5 There are indications that the ultrafine particles in welding Fume promote adherence of pneumococci to bronchial epithelium,10 but the underlying mechanisms are not yet well established. Nevertheless, in 2011, the independent Joint Committee on Vaccination at the English Department of Health (DH) judged that the evidence of increased risk was sufficient to recommend that employers offer welders vaccination against pneumococcus.11 This was a new measure that had not previously been applied in other countries. Subsequently, on the advice of the UK Health and Safety Executive (HSE), the DH weakened its recommendation, stating only that vaccination ‘should be considered for those at risk of frequent or continuous occupational exposure to Metal Fume (e.g. welders), taking into account the exposure control measures in place’.12 Then after some delay, HSE published guidance for employers in which they were advised to …
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Infectious pneumonia in workers exposed to Metal Fume
2013Co-Authors: Keith T Palmer, David CoggonAbstract:Siderosis, the accumulation of ferric oxide particles in the lung, was described over a century ago by Zenker. Enquiries subsequently focused on the effect of this pneumoconiotic process of lung function, generally concluding that it was benign. More recently, however, it has become apparent that iron and perhaps other elements in Metal Fume influence the risk of lower respiratory tract infection. The evidence accrued has been sufficient to trigger mechanistic investigations, a reappraisal of health risks in workers exposed to Metal Fume, and recommendations for risk control. In this chapter we review the emerging evidence, with a focus on epidemiological enquiries.
-
occupations exposed to respiratory sensitizers workers a comparison with deaths from asthma in mortality from infectious pneumonia in Metal
2009Co-Authors: Keith T Palmer, Paul Cullinan, Simon Rice, Terry Brown, David CoggonAbstract:Abstract Introduction National analyses of mortality in England and Wales have repeatedly shown excess deaths from pneumonia in welders. During 1979-1990 the excess was attributable largely to deaths from lobar pneumonia and pneumonias other than bronchopneumonia, limited to working-aged men, and apparent in other Metal Fume-exposed occupations. We assessed findings for 1991-2000 and compared the mortality pattern with that from asthma in occupations exposed to known respiratory sensitizers. Methods The Office of National Statistics supplied data on deaths by underlying cause among men aged 16-74 years in England and Wales during 1991-2000, including age and last held occupation. We abstracted data on pneumonia for occupations with exposure to Metal Fume and on asthma for occupations commonly reported to surveillance schemes as at risk of occupational asthma. We estimated expected numbers of deaths by applying age-specific proportions of deaths by cause in the population to the total deaths by age in each occupational group. Observed and expected numbers were compared for each cause of death.
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Inflammatory responses to the occupational inhalation of Metal Fume.
The European respiratory journal, 2006Co-Authors: Keith T Palmer, Jason Poole, David Coggon, R. Mcneill-love, Anthony J. Frew, Cathy Linaker, J. K. ShuteAbstract:Occupational exposure to Metal Fume promotes a reversible increase in the risk of pneumonia, but by mechanisms which are unclear. To investigate, the current authors measured various markers of host defence function in welders and nonwelders. Induced sputum and venous blood samples were collected from 27 welders with regular long-term exposure to ferrous Metal Fume and 31 unexposed matched controls. In sputum, the present authors measured cell counts, the soluble and cellular iron concentration, and levels of interleukin-8, tumour necrosis factor-α, myeloperoxidase, matrix Metalloproteinase-9, immunoglobulin (Ig)A, α 2 -macroglobulin and unsaturated iron-binding capacity. Blood samples were assayed for evidence of neutrophil activation and pneumococcal IgG antibodies. Welders had significantly higher iron levels and a substantially lower unsaturated iron-binding capacity in their sputum, but, despite a high iron challenge, there was a noteworthy absence of an inflammatory response. Only blood counts of eosinophils and basophils were significantly related to the extent of welding. Weak nonsignificant trends were observed for several other measures, consistent with low-grade priming of neutrophils. In conclusion, these data suggest that chronic exposure to Metal Fume blunts responsiveness to inhaled particulate matter. However, the mechanism behind the lack of detectable local inflammatory response requires further investigation.
Sutapa Mukherjee - One of the best experts on this subject based on the ideXlab platform.
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Urinary Metal and polycyclic aromatic hydrocarbon biomarkers in boilermakers exposed to Metal Fume and residual oil fly ash
American journal of industrial medicine, 2005Co-Authors: Sutapa Mukherjee, Lyle J Palmer, David B Aeschliman, R S Houk, Mark Woodin, Ema G. Rodrigues, Robert A. Weker, David C ChristianiAbstract:Background Boilermakers are occupationally exposed to known carcinogens. Methods The association of urinary 1-hydroxy-pyrene (1-OHP), a biomarker of polycyclic aromatic hydrocarbon (PAH) exposure, with biomarkers of Metal exposure (vanadium, chromium, manganese, nickel, copper, and lead) in boilermakers exposed to Metal Fume from welding and dust particulates from residual oil fly ash (ROFA) was examined. A repeated measures cohort study was conducted during the overhaul of an oil-fired boiler. Twice-daily urine samples were obtained for 5 days and analyzed for cotinine, 1-OHP, and Metals. Generalized estimating equations (GEE) were used to model the multivariate relationship of 1-OHP to the explanatory variables. Results Metal and 1-OHP levels were determined for 165 urine samples from 20 boilermakers and these levels increased during the workweek. However, the 1-OHP level was not significantly associated with any individual Metal level at any time point. Conclusion This suggests that boilermakers were occupationally exposed to PAH and Metals, but 1-OHP as a PAH biomarker was unable to serve as a surrogate marker of Metal exposure for the Metals measured in this study. Am. J. Ind. Med. 47:484–493, 2005. © 2005 Wiley-Liss, Inc.
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smoking status and occupational exposure affects oxidative dna injury in boilermakers exposed to Metal Fume and residual oil fly ash
Cancer Epidemiology Biomarkers & Prevention, 2004Co-Authors: Sutapa Mukherjee, Lyle J Palmer, David B Aeschliman, R S Houk, Mark Woodin, David C ChristianiAbstract:Epidemiologic studies demonstrate increased cancer incidence among workers exposed to polycyclic aromatic hydrocarbons (PAH) and Metals, probably through cumulative oxidative DNA damage in response to carcinogens. Boilermakers are exposed to particulates of residual oil fly ash (ROFA) and Metal Fume that contain carcinogenic PAH and Metals. We conducted a repeated-measures cohort study in boilermakers during the overhaul of an oil-fired boiler to determine a possible association between the level of 8-hydroxy-2′-deoxyguanosine (8-OH-dG; an oxidative injury biomarker) and biomarkers of PAH (1-hydroxypyrene; 1-OHP) and Metal exposure. Preshift and postshift urine samples were analyzed for 8-OH-dG, cotinine, 1-OHP, and Metals. Generalized estimating equations were used to model the multivariate relationship of 8-OH-dG to the explanatory variables of interest. Biomarker levels were determined for 181 urine samples from 20 male subjects (mean age 45 years, 50% smokers). Metal and 1-OHP levels increased cross-week and were affected by smoking status. Levels of 8-OH-dG were higher in nonsmokers at the start of the workweek yet declined after occupational exposure to similar levels as in smokers. Multivariate analysis indicated that Metal × cotinine interaction terms for nickel, vanadium, chromium, and copper were significantly associated with the 8-OH-dG level, but there were differential effects depending on the Metal. This study suggests that oxidative DNA damage in boilermakers is influenced by the interaction between occupational exposures and smoking status. In addition, boilermakers may have reduced ability to repair damaged DNA after ROFA and Metal Fume exposure. This finding has clinical relevance because these exposures may increase the cancer susceptibility of boilermakers.
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1-hydroxypyrene as a biomarker of occupational exposure to polycyclic aromatic hydrocarbons (PAH) in boilermakers.
Journal of occupational and environmental medicine, 2002Co-Authors: Sutapa Mukherjee, Lyle J Palmer, Ema G. Rodrigues, Robert A. Weker, David C ChristianiAbstract:A repeated measures short-term prospective study was performed in boilermakers to determine occupational polycyclic aromatic hydrocarbon (PAH) exposure using the biomarker, 1-hydroxypyrene (1-OHP). Two work sites were studied; an apprentice school (Metal Fume exposure) and a boiler overhaul (residual oil fly ash [ROFA] and Metal Fume exposure). Pre- and postshift urine samples (n = 241; 41 male subjects) were analyzed for cotinine and 1-OHP. Descriptive statistics and generalized estimating equations were calculated. At the apprentice school cross-shift 1-OHP levels did not significantly differ. At the overhaul 1-OHP levels increased during the week in smokers and nonsmokers; in nonsmokers the 1-OHP level increased significantly postshift compared to preshift. In conclusion this study suggests that boilermakers exposed to occupational particulates are exposed to PAH. The urinary 1-OHP level may be a useful biomarker of PAH exposure in boilermakers exposed to ROFA, particularly in nonsmokers. (J.