September 2020 additions to NERDB (1)

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 261 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	42
2009	3	2020	12
unknown year	6

Last new entries

Meng H, Wang S, Guo J, et al. Cognitive impairment of workers in a large-scale aluminum factory in China: a cross-sectional study. BMJ Open. 2019;9(6):e027154. Published 2019 Jun 16. doi:10.1136/bmjopen-2018-027154

The authors’ objective was to investigate the prevalence of mild cognitive impairment and the relationship with plasma aluminum among aluminum workers. They performed a cross-sectional case-control study in the SH Aluminium Factory, China. From 910 aluminium workers on duty, 853 participated in the study. Participants with diseases which could cause cognitive impairment were excluded. These were for example cerebral vascular disease, epilepsy, brain trauma, Parkinson’s and mental diseases. Also workers using aluminium-containing drugs and mental drug use, and those with any family history of dementia in first-degree relatives were excluded.

Blood samples were collected, and plasma aluminum was measured by inductively coupled plasma-mass spectrometry. For each case, four age-matched controls were evaluated to determine the relationship between aluminum exposure and mild cognitive impairment. Conditional logistic regression was used to explore influential factors in mild cognitive impairment.

The crude prevalence of mild cognitive impairment among aluminum workers on duty was 6.21% (53 cases). There was a significant difference in plasma aluminum concentration between the two groups. In the multivariate analysis, we found that a higher level of plasma aluminum was associated with a high risk of cognitive impairment when compared with a lower aluminum level (AOR=2.24, 95% CI=1.17 to 4.26), and a high education level was a protective factor (AOR=0.36, 95% CI=0.18 to 0.70). No other factor was statistically significant.

Mild cognitive impairment is no longer a disease that is specific to elderly people. High plasma aluminum exposure might be associated with an increased risk of cognitive impairment, but a reduced risk was observed with a high education level. The cognitive function of aluminum workers on duty must be considered seriously.

Torén K, Blanc PD, Naidoo RN, et al. Occupational exposure to dust and to fumes, work as a welder and invasive pneumococcal disease risk. Occup Environ Med. 2020;77(2):57-63. doi:10.1136/oemed-2019-106175

Occupational exposures to metal fumes have been associated with increased pneumonia risk, but the risk of invasive pneumococcal disease (IPD) has not been characterized previously. The authors studied 4438 cases aged 20–65 from a Swedish registry of invasive infection caused by Streptococcus pneumoniae. The case index date was the date the infection was diagnosed. Six controls for each case, matched for gender, age, and region of residency, were selected from the Swedish population registry.

Each control was assigned the index date of their corresponding case to define the study observation period. Cases and controls were linked to the Swedish registries for socioeconomic status (SES), occupational history, and hospital discharge. A job-exposure matrix was applied to characterize occupational exposures. Conditional logistic analyses, adjusted for comorbidities and SES, were used to estimate the OR of IPD and the subgroup pneumonia–IPD, associated with selected occupations and exposures in the year preceding the index date.

This showed that welders manifested an increased risk of IPD (OR 2.99, 95% CI 2.09 to 4.30). Occupational exposures to fumes and silica dust were associated with elevated odds of IPD (OR 1.11, 95% CI 1.01 to 1.21, and OR 1.33, 95% CI 1.11 to 1.58, respectively). The risk associated with IPD with pneumonia followed a similar pattern with the highest occupational odds observed among welders and among silica dust exposed. The authors conclude that working specifically as a welder, but also occupational exposures more broadly, increase the odds for IPD. Welders, and potentially others with relevant exposures, should be offered pneumococcal vaccination

Catalani, S., Donato, F., Madeo, E., Apostoli, P., De Palma, G., Pira, E., Mundt, K. A., & Boffetta, P. (2019). Occupational exposure to formaldehyde and risk of non hodgkin lymphoma: a meta-analysis. BMC cancer, 19(1), 1245. https://doi.org/10.1186/s12885-019-6445-z

Formaldehyde is a widely used chemical and considered to be a human carcinogen. The authors report the results of a meta-analysis of studies on the relationship between occupational exposure to formaldehyde and the risk of non-Hodgkin lymphoma (NHL). They performed a systematic review and meta-analysis according to international guidelines and identified 12 reports of occupational populations exposed to formaldehyde. We evaluated inter-study heterogeneity and we applied a random-effects model. We conducted a cumulative meta-analysis and a meta-analysis according to the estimated average exposure of each study population.

The meta-analysis resulted in a summary relative risk (RR) for NHL of 0.93 (95% confidence interval 0.83–1.04). The cumulative meta-analysis suggests that higher RRs were detected in studies published before 1986, while studies available after 1986 did not show an association. No differences were found between different levels of occupational exposure. The authors conclude that notwithstanding some limitations, the results of this meta-analysis do not support the hypothesis of an association between occupational exposure to formaldehyde and risk of NHL.

Angelova-Fischer I, Soltanipoor M, Stilla T, Fischer TW, Kezic S, Jakasa I. Barrier damaging effects of n-propanol in occlusion-modified tandem repeated irritation test: Modulation by exposure factors and atopic skin disease. Contact Dermatitis. 2020;82(1):1-9. doi:10.1111/cod.13368

Recent studies provide evidence for significant and previously underestimated barrier damaging effects of repeated exposure to 60% n-propanol in healthy skin in vivo. The authors’ objective was to investigate further the cumulative effects of a range of n-propanol concentrations relevant at the workplace in healthy and atopic dermatitis (AD) individuals and study the modulation of the outcomes by co-exposure and host-related factors. Healthy adult and AD volunteers were exposed to n-propanol concentrations from 30% to 75% in occlusion-modified tandem repeated irritation test with measurements of erythema, transepidermal water loss, capacitance, and the natural moisturizing factor (NMF) levels at baseline and after 96 hours.

This showed that n-Propanol exerted significant barrier damaging effects even at the lowest concentration in both groups. Exposure to all n-propanol concentrations significantly reduced the NMF levels. Preceding low-grade trauma by occlusion/water exposure reduced the skin irritation threshold in both groups. The differences in the severity of the barrier function impairment after exposure to the same concentrations under the same conditions between the AD and control groups were significant. They concluded that the negative effects of cumulative exposure to n-propanol in healthy and atopic skin shown in the study suggest the need for a critical re-evaluation of its irritant properties in vivo.