July 2020 additions to NERDB

NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Airtable.

More information on this database on the NERDB page

On the website we will publish from this month on regular updates on new disease – exposure combinations we added to the database. Currently, we have 253 entries. Ordered by year in which the abstract is published

1977	1	2010	11
1988	1	2011	10
1995	3	2012	10
1997	1	2013	13
1999	2	2014	19
2002	1	2015	27
2005	2	2016	21
2006	1	2017	35
2007	2	2018	30
2008	5	2019	37
2009	3	2020	9
unknown year	6

Last new entries

Yusuf, B. S., Segaren, N., Segaren, N., & Di Mascio, L. (2020). Barista’s fracture: a new occupational hazard. JRSM open, 11(5), 2054270420918493. https://doi.org/10.1177/2054270420918493

Stress fracture of the clavicle is a rare injury usually occurring in high-level athletes. It is typically a result of repetitive sporting activity or unusual strain. We present the first case of an occupational clavicle stress fracture in a young female barista. The patient initially presented with insidious onset clavicular pain. There was no history of trauma, and an undisplaced fracture was present on the plain radiograph but overlooked by the emergency physicians. Two weeks later, the patient presented again with worsening symptoms, and a displaced fracture of the clavicle was diagnosed on plain radiograph. A thorough occupational history revealed the cause of her pain, which was the mechanical activity of coffee tamping, and the fracture went on to unite with no further complications. No other cause was found on investigations including magnetic resonance imaging. The fracture healed with the cessation of coffee tamping. This case highlights a previously unrecognized occupational hazard of coffee tamping as a potential cause of stress fracture of the clavicle

Cummings KJ, Stanton ML, Kreiss K, et al Work-related adverse respiratory health outcomes at a machine manufacturing facility with a cluster of bronchiolitis, alveolar ductitis and emphysema (BADE) Occupational and Environmental Medicine 2020;77:386-392.

The authors present four machine manufacturing facility workers with a novel occupational lung disease of uncertain aetiology. This disease is characterized by lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE). They aimed to evaluate current workers’ respiratory health in relation to job category and relative exposure to endotoxin, which is aerosolized from in-use metalworking fluid.

They used a questionnaire and spirometry at baseline and a 3.5-year follow-up. Endotoxin exposures were quantified for 16 production and non-production job groups. Forced expiratory volume in one second (FEV₁) decline ≥10% was considered excessive.

Among 388 (89%) baseline participants, SMRs (standardized mortality rates) were elevated for wheeze (2.5 (95% CI 2.1 to 3.0)), but not obstruction (0.5 (95% CI 0.3 to 1.1)). Mean endotoxin exposures (range: 0.09-28.4 EU/m³) were highest for machine shop jobs. Higher exposure was associated with exertional dyspnoea (aPR=2.8 (95% CI 1.4 to 5.7)), but not lung function. Of 250 (64%) follow-up participants, 11 (4%) had excessive FEV₁ decline (range: 403-2074 mL); 10 worked in production. Wheeze (aPR=3.6 (95% CI 1.1 to 12.1)) and medium (1.3-7.5 EU/m³) endotoxin exposure (aPR=10.5 (95% CI 1.3 to 83.1)) at baseline were associated with excessive decline. One production worker with excessive decline had BADE on subsequent lung biopsy.

Lung function loss and BADE were associated with production work. Relationships with relative endotoxin exposure indicate work-related adverse respiratory health outcomes beyond the sentinel disease cluster, including an incident BADE case. Until causative factors and effective preventive strategies for BADE are determined, exposure minimization and medical surveillance of affected workforces are recommended.

Iijima, Y., Tateishi, T., Tsuchiya, K., Sumi, Y., Akashi, T., & Miyazaki, Y. (2020). Pneumoconiosis Caused by Inhalation of Metallic Titanium Grindings. Internal medicine (Tokyo, Japan), 59(3), 425–428. https://doi.org/10.2169/internalmedicine.2431-18

A 61-year-old man was referred to our hospital with dyspnea and an abnormal lung shadow. His occupational history, pathological findings, and an elemental analysis led to a definitive diagnosis of pneumoconiosis induced by titanium grindings. The patient experienced gradual improvement solely by avoiding titanium grindings. Titanium-induced lung disease is very rare, and most of these cases are caused by inhalation of titanium dioxide (TiO₂), which is included in a wide range of commercially available products, such as paints, pigments, and cosmetics. However, industrial workers can also develop lung diseases due to the inhalation of metallic titanium materials during metal grinding.