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A longitudinal linkage study of occupation and ischaemic heart disease in the general and Māori populations of New Zealand
(PLOS, 21/01/2022) Barnes LA; Eng A; Corbin M; Denison HJ; 't Mannetje A; Haslett S; McLean D; Ellison-Loschmann L; Jackson R; Douwes J
OBJECTIVES: Occupation is a poorly characterised risk factor for cardiovascular disease (CVD) with females and indigenous populations under-represented in most research. This study assessed associations between occupation and ischaemic heart disease (IHD) in males and females of the general and Māori (indigenous people of NZ) populations of New Zealand (NZ). METHODS: Two surveys of the NZ adult population (NZ Workforce Survey (NZWS); 2004-2006; n = 3003) and of the Māori population (NZWS Māori; 2009-2010; n = 2107) with detailed occupational histories were linked with routinely collected health data and followed-up until December 2018. Cox regression was used to calculate hazard ratios (HR) for IHD and "ever-worked" in any of the nine major occupational groups or 17 industries. Analyses were controlled for age, deprivation and smoking, and stratified by sex and survey. RESULTS: 'Plant/machine operators and assemblers' and 'elementary occupations' were positively associated with IHD in female Māori (HR 2.2, 95%CI 1.2-4.1 and HR 2.0, 1.1-3.8, respectively) and among NZWS males who had been employed as 'plant/machine operators and assemblers' for 10+ years (HR 1.7, 1.2-2.8). Working in the 'manufacturing' industry was also associated with IHD in NZWS females (HR 1.9, 1.1-3.7), whilst inverse associations were observed for 'technicians and associate professionals' (HR 0.5, 0.3-0.8) in NZWS males. For 'clerks', a positive association was found for NZWS males (HR 1.8, 1.2-2.7), whilst an inverse association was observed for Māori females (HR 0.4, 0.2-0.8). CONCLUSION: Associations with IHD differed significantly across occupational groups and were not consistent across males and females or for Māori and the general population, even within the same occupational groups, suggesting that current knowledge regarding the association between occupation and IHD may not be generalisable across different population groups.
Airborne Fumigants and Residual Chemicals in Shipping Containers Arriving in New Zealand
(Oxford University Press on behalf of the British Occupational Hygiene Society, 2022-05) Hinz R; 't Mannetje A; Glass B; McLean D; Douwes J
BACKGROUND: Airborne fumigants and other hazardous chemicals inside unopened shipping containers may pose a risk to workers handling containers. METHODS: Grab air samples from 490 sealed containers arriving in New Zealand were analysed for fumigants and other hazardous chemicals. We also collected grab air samples of 46 containers immediately upon opening and measured the total concentration of volatile organic compounds in real-time during ventilation. Additive Mixture Values (AMV) were calculated using the New Zealand Workplace Exposure standard (WES) and ACGIH Threshold Limit Values (TLV) of the 8-h, time-weighted average (TWA) exposure limit. Regression analyses assessed associations with container characteristics. RESULTS: Fumigants were detectable in 11.4% of sealed containers, with ethylene oxide detected most frequently (4.7%), followed by methyl bromide (3.5%). Other chemicals, mainly formaldehyde, were detected more frequently (84.7%). Fumigants and other chemicals exceeded the WES/TLV in 6.7%/7.8%, and 7.8%/20.0% of all containers, respectively. Correspondingly, they more frequently exceeded '1' for the AMV-TLV compared to the AMV-WES (25.7% versus 7.8%). In samples taken upon opening of doors, fumigants were detected in both fumigated and non-fumigated containers, but detection frequencies and exceedances of the WES, TLV, and AMVs were generally higher in fumigated containers. Detection frequencies for other chemicals were similar in fumigated and non-fumigated containers, and only formaldehyde exceeded both the WES and TLV in both container groups. Volatile compounds in container air reduced rapidly during ventilation. Some cargo types (tyres; personal hygiene, beauty and medical products; stone and ceramics; metal and glass; and pet food) and countries of origin (China) were associated with elevated airborne chemical and fumigant concentrations. CONCLUSION: Airborne chemicals in sealed containers frequently exceed exposure limits, both in fumigated and non-fumigated containers, and may contribute to short-term peak exposures of workers unloading or inspecting containers.
Exposure to drinking water trihalomethanes and nitrate and the risk of brain tumours in young people
(Elsevier Inc, 2021-09) Zumel-Marne A; Castaño-Vinyals G; Alguacil J; Villanueva CM; Maule M; Gracia-Lavedan E; Momoli F; Krewski D; Mohipp C; Petridou E; Bouka E; Merletti F; Migliore E; Piro S; Ha M; 't Mannetje A; Eng A; Aragones N; Cardis E
Brain tumours (BTs) are one of the most frequent tumour types in young people. We explored the association between tap water, exposure to trihalomethanes (THM) and nitrate and neuroepithelial BT risk in young people. Analysis of tap water consumption were based on 321 cases and 919 appendicitis controls (10-24 years old) from 6 of the 14 participating countries in the international MOBI-Kids case-control study (2010-2016). Available historical residential tap water concentrations of THMs and nitrate, available from 3 countries for 86 cases and 352 controls and 85 cases and 343 for nitrate, respectively, were modelled and combined with the study subjects' personal consumption patterns to estimate ingestion and residential exposure levels in the study population (both pre- and postnatal). The mean age of participants was 16.6 years old and 56% were male. The highest levels and widest ranges for THMs were found in Spain (residential and ingested) and Italy and in Korea for nitrate. There was no association between BT and the amount of tap water consumed and the showering/bathing frequency. Odds Ratios (ORs) for BT in relation to both pre- and postnatal residential and ingestion levels of THMs were systematically below 1 (OR = 0.37 (0.08-1.73)) for postnatal average residential THMs higher than 66 μg/L. For nitrate, all ORs were above 1 (OR = 1.80 (0.91-3.55)) for postnatal average residential nitrate levels higher than 8.5 mg/L, with a suggestion of a trend of increased risk of neuroepithelial BTs with increasing residential nitrate levels in tap water, which appeared stronger in early in life. This, to our knowledge, is the first study on this topic in young people. Further research is required to clarify the observed associations.
Ischaemic Heart Disease and Occupational Exposures: A Longitudinal Linkage Study in the General and Māori Populations of New Zealand
(Oxford University Press on behalf of the British Occupational Hygiene Society, 2022-05) Barnes LA; Eng A; Corbin M; Denison HJ; 't Mannetje A; Haslett S; McLean D; Ellison-Loschmann L; Jackson R; Douwes J
OBJECTIVES: This study assessed associations between occupational exposures and ischaemic heart disease (IHD) for males and females in the general and Māori populations (indigenous people of New Zealand). METHODS: Two surveys of the general adult [New Zealand Workforce Survey (NZWS); 2004-2006; n = 3003] and Māori population (Māori NZWS; 2009-2010; n = 2107), with information on occupational exposures, were linked with administrative health data and followed-up until December 2018. Cox proportional hazards regression (adjusted for age, deprivation, and smoking) was used to assess associations between organizational factors, stress, and dust, chemical and physical exposures, and IHD. RESULTS: Dust [hazard ratio (HR) 1.6, 95%CI 1.1-2.4], smoke or fumes (HR 1.5, 1.0-2.3), and oils and solvents (HR 1.5, 1.0-2.3) were associated with IHD in NZWS males. A high frequency of awkward or tiring hand positions was associated with IHD in both males and females of the NZWS (HRs 1.8, 1.1-2.8 and 2.4, 1.1-5.0, respectively). Repetitive tasks and working at very high speed were associated with IHD among NZWS females (HRs 3.4, 1.1-10.4 and 2.6, 1.2-5.5, respectively). Māori NZWS females working with vibrating tools and those exposed to a high frequency of loud noise were more likely to experience IHD (HRs 2.3, 1.1-4.8 and 2.1, 1.0-4.4, respectively). Exposure to multiple dust and chemical factors was associated with IHD in the NZWS males, as was exposure to multiple physical factors in males and females of the NZWS. CONCLUSIONS: Exposures associated with an elevated IHD risk included dust, smoke or fumes, oils and solvents, awkward grip or hand movements, carrying out repetitive tasks, working at very high speed, loud noise, and working with tools that vibrate. Results were not consistently observed for males and females and between the general and Māori populations.
Lung cancer risk in painters: results from the SYNERGY pooled case-control study consortium
(BMJ Publishing Group Ltd, 2021-04) Guha N; Bouaoun L; Kromhout H; Vermeulen R; Brüning T; Behrens T; Peters S; Luzon V; Siemiatycki J; Xu M; Kendzia B; Guenel P; Luce D; Karrasch S; Wichmann H-E; Consonni D; Landi MT; Caporaso NE; Gustavsson P; Plato N; Merletti F; Mirabelli D; Richiardi L; Jöckel K-H; Ahrens W; Pohlabeln H; TSE LA; Yu IT-S; Tardón A; Boffetta P; Zaridze D; 't Mannetje A; Pearce N; Davies MPA; Lissowska J; Świątkowska B; McLaughlin J; Demers PA; Bencko V; Foretova L; Janout V; Pándics T; Fabianova E; Mates D; Forastiere F; Bueno-de-Mesquita B; Schüz J; Straif K; Olsson A
OBJECTIVES: We evaluated the risk of lung cancer associated with ever working as a painter, duration of employment and type of painter by histological subtype as well as joint effects with smoking, within the SYNERGY project. METHODS: Data were pooled from 16 participating case-control studies conducted internationally. Detailed individual occupational and smoking histories were available for 19 369 lung cancer cases (684 ever employed as painters) and 23 674 age-matched and sex-matched controls (532 painters). Multivariable unconditional logistic regression models were adjusted for age, sex, centre, cigarette pack-years, time-since-smoking cessation and lifetime work in other jobs that entailed exposure to lung carcinogens. RESULTS: Ever having worked as a painter was associated with an increased risk of lung cancer in men (OR 1.30; 95% CI 1.13 to 1.50). The association was strongest for construction and repair painters and the risk was elevated for all histological subtypes, although more evident for small cell and squamous cell lung cancer than for adenocarcinoma and large cell carcinoma. There was evidence of interaction on the additive scale between smoking and employment as a painter (relative excess risk due to interaction >0). CONCLUSIONS: Our results by type/industry of painter may aid future identification of causative agents or exposure scenarios to develop evidence-based practices for reducing harmful exposures in painters.
Neuropsychological symptoms in workers handling cargo from shipping containers and export logs
(Springer-Verlag GmbH, 2022-10) Hinz R; 't Mannetje A; Glass B; McLean D; Douwes J
PURPOSE: Acute poisonings of workers handling shipping containers by fumigants and other harmful chemicals off-gassed from cargo have been reported but (sub)-chronic neuropsychological effects have not been well studied. METHODS: This cross-sectional study assessed, using standardised questionnaires, current (past 3-months) neuropsychological symptoms in 274 container handlers, 38 retail workers, 35 fumigators, and 18 log workers, all potentially exposed to fumigants and off-gassed chemicals, and a reference group of 206 construction workers. Prevalence odds ratios (OR), adjusted for age, ethnicity, smoking, alcohol consumption, education, personality traits and BMI, were calculated to assess associations with the total number of symptoms (≥ 3, ≥ 5 or ≥ 10) and specific symptom domains (neurological, psychosomatic, mood, memory/concentration, fatigue, and sleep). RESULTS: Compared to the reference group, exposed workers were more likely to report ≥ 10 symptoms, statistically significant only for retail workers (OR 6.8, 95% CI 1.9-24.3) who also reported more fatigue (OR 10.7, 95% CI 2.7-42.7). Container handlers with the highest exposure-duration were more likely to report ≥ 10 symptoms, both when compared with reference workers (OR 4.0, 95% CI 1.4-11.7) and with container handlers with shorter exposure duration (OR 7.5, 95% CI 1.7-32.8). The duration of container handling was particularly associated with symptoms in the memory/concentration domain, again both when compared to reference workers (OR 8.8, 95% CI 2.5-31.4) and workers with the lowest exposure-duration (OR 6.8, 95% CI 1.5-30.3). CONCLUSION: Container handlers may have an increased risk of neuropsychological symptoms, especially in the memory/concentration domain. Retail workers may also be at risk, but this requires confirmation in a larger study.
Nitrate in drinking water and cancer risk: the biological mechanism, epidemiological evidence and future research
(Elsevier BV on behalf of the Public Health Association of Australia, 2022-04) Chambers T; Douwes J; 't Mannetje A; Woodward A; Baker M; Wilson N; Hales S
Occupational exposure to organic dust and risk of lymphoma subtypes in the EPILYMPH case-control study
(Nordic Association of Occupational Safety and Health, 2021-01-01) Cocco P; Satta G; Meloni F; Pilia I; Ahmed F; Becker N; Casabonne D; de Sanjosé S; Foretova L; Maynadié M; Nieters A; Staines A; 't Mannetje A; Zucca M; Ennas MG; Campagna M; De Matteis S; Benavente Y
Objectives This study aimed to estimate the risk of lymphoma and its major subtypes in relation to occupational exposure to specific organic dusts. Methods We explored the association in 1853 cases and 1997 controls who participated in the EpiLymph case-control study, conducted in six European countries in 1998-2004. Based on expert assessment of lifetime occupational exposures, we calculated the risk of the major lymphoma subtypes associated with exposure to six specific organic dusts, namely, flour, hardwood, softwood, natural textile, synthetic textile, and leather, and two generic (any types) groups: wood and textile dusts. Risk was predicted with unconditional regression modeling, adjusted by age, gender, study center, and education. Results We observed a 2.1-fold increase in risk of follicular lymphoma associated with ever exposure to leather dust [95% confidence interval (CI) 1.01-4.20]. After excluding subjects who ever worked in a farm or had ever been exposed to solvents, risk of B-cell lymphoma was elevated in relation to ever exposure to leather dust [odd ratio (OR) 2.2, 95% CI 1.00-4.78], but it was not supported by increasing trends with the exposure metrics. Risk of Hodgkin lymphoma was elevated (OR 2.0, 95% CI 0.95-4.30) for exposure to textile dust, with consistent upward trends by cumulative exposure and three independent exposure metrics combined (P=0.023, and P=0.0068, respectively). Conclusions Future, larger studies might provide further insights into the nature of the association we observed between exposure to textile dust and risk of Hodgkin lymphoma.
Pesticide exposure in New Zealand school-aged children: Urinary concentrations of biomarkers and assessment of determinants
(Elsevier Ltd, 2022-05) Li Y; Wang X; Feary McKenzie J; 't Mannetje A; Cheng S; He C; Leathem J; Pearce N; Sunyer J; Eskenazi B; Yeh R; Aylward LL; Donovan G; Mueller JF; Douwes J
This study aimed to assess pesticide exposure and its determinants in children aged 5-14 years. Urine samples (n = 953) were collected from 501 participating children living in urban areas (participant n = 300), rural areas but not on a farm (n = 76), and living on a farm (n = 125). The majority provided two samples, one in the high and one in the low spraying season. Information on diet, lifestyle, and demographic factors was collected by questionnaire. Urine was analysed for 20 pesticide biomarkers by GC-MS/MS and LC-MS/MS. Nine analytes were detected in > 80% of samples, including six organophosphate insecticide metabolites (DMP, DMTP, DEP, DETP, TCPy, PNP), two pyrethroid insecticide metabolites (3-PBA, trans-DCCA), and one herbicide (2,4-D). The highest concentration was measured for TCPy (median 13 μg/g creatinine), a metabolite of chlorpyrifos and triclopyr, followed by DMP (11 μg/g) and DMTP (3.7 μg/g). Urine metabolite levels were generally similar or low compared to those reported for other countries, while relatively high for TCPy and pyrethroid metabolites. Living on a farm was associated with higher TCPy levels during the high spray season. Living in rural areas, dog ownership and in-home pest control were associated with higher levels of pyrethroid metabolites. Urinary concentrations of several pesticide metabolites were higher during the low spraying season, possibly due to consumption of imported fruits and vegetables. Organic fruit consumption was not associated with lower urine concentrations, but consumption of organic food other than fruit or vegetables was associated with lower concentrations of TCPy in the high spray season. In conclusion, compared to other countries such as the U.S., New Zealand children had relatively high exposures to chlorpyrifos/triclopyr and pyrethroids. Factors associated with exposure included age, season, area of residence, diet, in-home pest control, and pets.
Recall of mobile phone usage and laterality in young people: The multinational Mobi-Expo study.
(Elsevier B.V., 26/04/2018) Goedhart G; van Wel L; Langer CE; de Llobet Viladoms P; Wiart J; Hours M; Kromhout H; Benke G; Bouka E; Bruchim R; Choi K-H; Eng A; Ha M; Huss A; Kiyohara K; Kojimahara N; Krewski D; Lacour B; 't Mannetje A; Maule M; Migliore E; Mohipp C; Momoli F; Petridou ET; Radon K; Remen T; Sadetzki S; Sim M; Weinmann T; Cardis E; Vrijheid M; Vermeulen R
OBJECTIVE: To study recall of mobile phone usage, including laterality and hands-free use, in young people. METHODS: Actual mobile phone use was recorded among volunteers aged between 10 and 24 years from 12 countries by the software application XMobiSense and was compared with self-reported mobile phone use at 6 and 18 months after using the application. The application recorded number and duration of voice calls, number of text messages, amount of data transfer, laterality (% of call time the phone was near the right or left side of the head, or neither), and hands-free usage. After data cleaning, 466 participants were available for the main analyses (recorded vs. self-reported phone use after 6 months). RESULTS: Participants were on average 18.6 years old (IQR 15.2-21.8 years). The Spearman correlation coefficients between recorded and self-reported (after 6 months) number and duration of voice calls were 0.68 and 0.65, respectively. Number of calls was on average underestimated by the participants (adjusted geometric mean ratio (GMR) self-report/recorded = 0.52, 95% CI = 0.47-0.58), while duration of calls was overestimated (GMR=1.32, 95%, CI = 1.15-1.52). The ratios significantly differed by country, age, maternal educational level, and level of reported phone use, but not by time of the interview (6 vs. 18 months). Individuals who reported low mobile phone use underestimated their use, while individuals who reported the highest level of phone use were more likely to overestimate their use. Individuals who reported using the phone mainly on the right side of the head used it more on the right (71.1%) than the left (28.9%) side. Self-reported left side users, however, used the phone only slightly more on the left (53.3%) than the right (46.7%) side. Recorded percentage hands-free use (headset, speaker mode, Bluetooth) increased with increasing self-reported frequency of hands-free device usage. Frequent (≥50% of call time) reported headset or speaker mode use corresponded with 17.1% and 17.2% of total call time, respectively, that was recorded as hands-free use. DISCUSSION: These results indicate that young people can recall phone use moderately well, with recall depending on the amount of phone use and participants' characteristics. The obtained information can be used to calibrate self-reported mobile use to improve estimation of radiofrequency exposure from mobile phones.
Wireless phone use in childhood and adolescence and neuroepithelial brain tumours: Results from the international MOBI-Kids study
(Elsevier Ltd, 2022-02) Castaño-Vinyals G; Sadetzki S; Vermeulen R; Momoli F; Kundi M; Merletti F; Maslanyj M; Calderon C; Wiart J; Lee A-K; Taki M; Sim M; Armstrong B; Benke G; Schattner R; Hutter H-P; Krewski D; Mohipp C; Ritvo P; Spinelli J; Lacour B; Remen T; Radon K; Weinmann T; Petridou ET; Moschovi M; Pourtsidis A; Oikonomou K; Kanavidis P; Bouka E; Dikshit R; Nagrani R; Chetrit A; Bruchim R; Maule M; Migliore E; Filippini G; Miligi L; Mattioli S; Kojimahara N; Yamaguchi N; Ha M; Choi K; Kromhout H; Goedhart G; 't Mannetje A; Eng A; Langer CE; Alguacil J; Aragonés N; Morales-Suárez-Varela M; Badia F; Albert A; Carretero G; Cardis E
In recent decades, the possibility that use of mobile communicating devices, particularly wireless (mobile and cordless) phones, may increase brain tumour risk, has been a concern, particularly given the considerable increase in their use by young people. MOBI-Kids, a 14-country (Australia, Austria, Canada, France, Germany, Greece, India, Israel, Italy, Japan, Korea, the Netherlands, New Zealand, Spain) case-control study, was conducted to evaluate whether wireless phone use (and particularly resulting exposure to radiofrequency (RF) and extremely low frequency (ELF) electromagnetic fields (EMF)) increases risk of brain tumours in young people. Between 2010 and 2015, the study recruited 899 people with brain tumours aged 10 to 24 years old and 1,910 controls (operated for appendicitis) matched to the cases on date of diagnosis, study region and age. Participation rates were 72% for cases and 54% for controls. The mean ages of cases and controls were 16.5 and 16.6 years, respectively; 57% were males. The vast majority of study participants were wireless phones users, even in the youngest age group, and the study included substantial numbers of long-term (over 10 years) users: 22% overall, 51% in the 20-24-year-olds. Most tumours were of the neuroepithelial type (NBT; n = 671), mainly glioma. The odds ratios (OR) of NBT appeared to decrease with increasing time since start of use of wireless phones, cumulative number of calls and cumulative call time, particularly in the 15-19 years old age group. A decreasing trend in ORs was also observed with increasing estimated cumulative RF specific energy and ELF induced current density at the location of the tumour. Further analyses suggest that the large number of ORs below 1 in this study is unlikely to represent an unknown causal preventive effect of mobile phone exposure: they can be at least partially explained by differential recall by proxies and prodromal symptoms affecting phone use before diagnosis of the cases. We cannot rule out, however, residual confounding from sources we did not measure. Overall, our study provides no evidence of a causal association between wireless phone use and brain tumours in young people. However, the sources of bias summarised above prevent us from ruling out a small increased risk.
Wood Dust in Joineries and Furniture Manufacturing: An Exposure Determinant and Intervention Study.
(1/05/2017) Douwes J; Cheung K; Prezant B; Sharp M; Corbin M; McLean D; 't Mannetje A; Schlunssen V; Sigsgaard T; Kromhout H; LaMontagne AD; Pearce N; McGlothlin JD
OBJECTIVES: To assess wood dust exposures and determinants in joineries and furniture manufacturing and to evaluate the efficacy of specific interventions on dust emissions under laboratory conditions. Also, in a subsequent follow-up study in a small sample of joinery workshops, we aimed to develop, implement, and evaluate a cost-effective and practicable intervention to reduce dust exposures. METHODS: Personal inhalable dust (n = 201) was measured in 99 workers from 10 joineries and 3 furniture-making factories. To assess exposure determinants, full-shift video exposure monitoring (VEM) was conducted in 19 workers and task-based VEM in 32 workers (in 7 joineries and 3 furniture factories). We assessed the efficacy of vacuum extraction on hand tools and the use of vacuum cleaners instead of sweeping and dry wiping under laboratory conditions. These measures were subsequently implemented in three joinery workshops with 'high' (>4 mg m-3) and one with 'low' (<2 mg m-3) baseline exposures. We also included two control workshops (one 'low' and one 'high' exposure workshop) in which no interventions were implemented. Exposures were measured 4 months prior and 4 months following the intervention. RESULTS: Average (geometric means) exposures in joinery and furniture making were 2.5 mg m-3 [geometric standard deviations (GSD) 2.5] and 0.6 mg m-3 (GSD 2.3), respectively. In joinery workers cleaning was associated with a 3.0-fold higher (P < 0.001) dust concentration compared to low exposure tasks (e.g. gluing), while the use of hand tools showed 3.0- to 11.0-fold higher (P < 0.001) exposures. In furniture makers, we found a 5.4-fold higher exposure (P < 0.001) with using a table/circular saw. Laboratory efficiency experiments showed a 10-fold decrease in exposure (P < 0.001) when using a vacuum cleaner. Vacuum extraction on hand tools combined with a downdraft table reduced exposures by 42.5% for routing (P < 0.1) and 85.5% for orbital sanding (P < 0.001). Following intervention measures in joineries, a borderline statistically significant (P < 0.10) reduction in exposure of 30% was found in workshops with 'high' baseline exposures, but no reduction was shown in the workshop with 'low' baseline exposures. CONCLUSIONS: Wood dust exposure is high in joinery workers and (to a lesser extent) furniture makers with frequent use of hand tools and cleaning being key drivers of exposure. Vacuum extraction on hand tools and alternative cleaning methods reduced workplace exposures substantially, but may be insufficient to achieve compliance with current occupational exposure limits.

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