Occupational exposure to organic solvents and long-term nervous system damage detectable by brain imaging, neurophysiology or histopathology

Impact of air pollution and climate change on mental health outcomes: an umbrella review of global evidence

The impact of air pollution and climate change on mental health has recently raised strong concerns. However, a comprehensive overview analyzing the existing evidence while addressing relevant biases is lacking. This umbrella review systematically searched the PubMed/Medline, Scopus and PsycINFO databases (up to June 26, 2023) for any systematic review with meta-analysis investigating the association of air pollution or climate change with mental health outcomes. We used the R metaumbrella package to calculate and stratify the credibility of the evidence according to criteria (i.e., convincing, highly suggestive, suggestive, or weak) that address several biases, complemented by sensitivity analyses. We included 32 systematic reviews with meta-analysis that examined 284 individual studies and 237 associations of exposures to air pollution or climate change hazards and mental health outcomes. Most associations (n=195, 82.3%) involved air pollution, while the rest (n=42, 17.7%) regarded climate change hazards (mostly focusing on temperature: n=35, 14.8%). Mental health outcomes in most associations (n=185, 78.1%) involved mental disorders, followed by suicidal behavior (n=29, 12.4%), access to mental health care services (n=9, 3.7%), mental disorders-related symptomatology (n=8, 3.3%), and multiple categories together (n=6, 2.5%). Twelve associations (5.0%) achieved convincing (class I) or highly suggestive (class II) evidence. Regarding exposures to air pollution, there was convincing (class I) evidence for the association between long-term exposure to solvents and a higher incidence of dementia or cognitive impairment (odds ratio, OR=1.139), and highly suggestive (class II) evidence for the association between long-term exposure to some pollutants and higher risk for cognitive disorders (higher incidence of dementia with high vs. low levels of carbon monoxide, CO: OR=1.587; higher incidence of vascular dementia per 1 μg/m3 increase of nitrogen oxides, NOx: hazard ratio, HR=1.004). There was also highly suggestive (class II) evidence for the association between exposure to airborne particulate matter with diameter ≤10 μm (PM10) during the second trimester of pregnancy and the incidence of post-partum depression (OR=1.023 per 1 μg/m3 increase); and for the association between short-term exposure to sulfur dioxide (SO2) and schizophrenia relapse (risk ratio, RR=1.005 and 1.004 per 1 μg/m3 increase, respectively 5 and 7 days after exposure). Regarding climate change hazards, there was highly suggestive (class II) evidence for the association between short-term exposure to increased temperature and suicide- or mental disorders-related mortality (RR=1.024), suicidal behavior (RR=1.012), and hospital access (i.e., hospitalization or emergency department visits) due to suicidal behavior or mental disorders (RR=1.011) or mental disorders only (RR=1.009) (RR values per 1°C increase). There was also highly suggestive (class II) evidence for the association between short-term exposure to increased apparent temperature (i.e., the temperature equivalent perceived by humans) and suicidal behavior (RR=1.01 per 1°C increase). Finally, there was highly suggestive (class II) evidence for the association between the temporal proximity of cyclone exposure and severity of symptoms of post-traumatic stress disorder (r=0.275). Although most of the above associations were small in magnitude, they extend to the entire world population, and are therefore likely to have a substantial impact. This umbrella review classifies and quantifies for the first time the global negative impacts that air pollution and climate change can exert on mental health, identifying evidence-based targets that can inform future research and population health actions.

Monopeptide-Based Powder Gelators for Instant Phase-Selective Gelation of Aprotic Aromatics and for Toxic Dye Removal

Through a combinatorial screening of 35 possible phase-selective monopeptide-based organogelators readily made at low cost, we identified five of them with high gelling ability toward aprotic aromatic solvents in the powder form. The best of them (Fmoc-V-6) is able to instantly and phase-selectively gel benzene, toluene, and xylenes in the presence of water at room temperature at a gelator loading of 6% w/v. This enables the gelled aromatics to be separated by filtration and both aromatics and the gelling material to be recycled by distillation. We also identified Fmoc-I-16 as the best gelator for benzyl alcohol, and the corresponding organogel efficiently removes toxic dye molecules by 82-99% from their highly concentrated aqueous solutions. These efficient removals of toxic organic solvents and dyes from water suggest their promising applications in remediating contaminated water resources.

A case of acute organic solvent poisoning during epoxy coating

Background

In the construction industry, maintaining health and safety of workers often challenging. Among the workers at construction sites, painters are at particular risk of respiratory diseases and neurotoxicity. However, in Korea there is weak enforcement of workers' health and safety practices in the construction industry in Korea. Poisonings frequently occur at (semi)closed construction sites. In this study, we report a case of acute organic solvent poisoning during construction site painting.

Case presentation

A 71-year-old man was found unconscious at a construction site and immediately transferred to the emergency room. The consciousness level was 'stupor state' and the body temperature was hypothermic, at 32 degrees (Celsius). There were no acute brain or cardiac lesions that would have accounted for the faintness. In addition, blood and urine tests did not indicate a cause of loss of consciousness. He had been painting epoxy to waterproof the basement floor before fainting. According to exposure simulation, the patient was overexposed to various organic solvents, such as approximately 316–624 ppm toluene during the work before fainting. Considering the ventilation status of the workplace and the status of no protection, it is considered that exposure through the respiratory tract was considerable.

Conclusions

The patient in this case lost consciousness during the epoxy coating in a semi-enclosed space. It can be judged as a result of acute poisoning caused by organic solvent exposure and considered to be highly related to work environment.

Epileptic seizures and occupational exposure to solvents: a cases series

INTRODUCTION

Organic solvents (OS) are substances with well-known nervous system tropism. Long-term exposure can cause several neurological and neuropsychic manifestations (mainly toxic encephalopathy). A potential causal relation between epileptic seizures and exposure to OS remains controversial.

METHODS

We report seven cases of patients with no neurological history who had been professionally exposed to OS and who had at least one epileptic seizure after exposure. Selection of these cases was based on medical records of patients who were referred to the occupational health department of Charles Nicolle Hospital of Tunis during the period from January 1, 2010 to December 31, 2014.

RESULTS

Cases studies concerned five men and two women aged between 29 and 46. Professional seniority ranged from 2 to 31 years. In all cases, epileptic seizures occurred after exposure to a mixture of solvents. It was concluded, according to workplace inspections, that there was an important daily and direct OS exposure. Working conditions were considered as defective. Six cases had generalized seizures, one patient presented with status epilepticus. Illness onset occurred between one and nine years after the beginning of exposure to OS.

CONCLUSION

These cases suggest a possible relationship between OS exposure and onset of epilepsy.

Chronic solvent-induced encephalopathy: course and prognostic factors of neuropsychological functioning

PURPOSE

Working in conditions with daily exposure to organic solvents for many years can result in a disease known as chronic solvent-induced encephalopathy (CSE). The aims for this study were to describe the neuropsychological course of CSE after first diagnosis and to detect prognostic factors for neuropsychological impairment after diagnosis.

METHODS

This prospective study follows a Dutch cohort of CSE patients who were first diagnosed between 2001 and 2011 and underwent a second neuropsychological assessment 1.5-2 years later. Cognitive subdomains were assessed and an overall cognitive impairment score was calculated. Paired t tests and multivariate linear regression analyses were performed to describe the neuropsychological course and to obtain prognostic factors for the neuropsychological functioning at follow-up.

RESULTS

There was a significant improvement on neuropsychological subdomains at follow-up, with effect sizes between small and medium (Cohen's d 0.27-0.54) and a significant overall improvement of neuropsychological impairment with a medium effect size (Cohen's d 0.56). Prognostic variables for more neuropsychological impairment at follow-up were a higher level of neuropsychological impairment at diagnosis and having a comorbid diagnosis of a psychiatric disorder at diagnosis.

CONCLUSIONS

Results are in line with previous research on the course of CSE, stating that CSE is a non-progressive disease after cessation of exposure. However, during follow-up the percentage patients with permanent work disability pension increased from 14 to 37%. Preventive action is needed in countries where exposure to organic solvents is still high to prevent new cases of CSE.

The neuro-ophthalmological effects related to long-term occupational exposure to organic solvents in painters

PURPOSE

Organic solvents are widely used in many industries, and usually, exposure occurs with mixtures of solvents. Organic solvent mixtures are known for their ability to affect tissues of high lipid content including the myelin sheath in the nervous system. The purpose of this work was to study the evidence that long-term (more than 10 years) exposure to organic solvent mixtures among painters can induce neuro-ophthalmological effects on the function of retinal ganglion cells and the optic tract.

METHODS

Twenty workers with long-term occupational exposure to mixed organic solvents were compared to 40 control subjects. The controls were matched for age, gender, and demographic characteristics but were not occupationally exposed to any known organic solvents, using the following comparators: visual evoked potential (VEP), electroretinogram (ERG), color vision (CV), and contrast sensitivity (CS) testing. Environmental monitoring was done in the work environment with consideration to the American Conference of Governmental Industrial Hygienists Threshold Limit Values (ACGIH-TLVs).

RESULTS

The exposed group had significantly longer latency and higher amplitude of VEP waves especially P100, higher Color Confusion Index (CCI), especially affecting the blue-yellow spectrum, and lower Log CS. There was no significant difference between exposed and nonexposed groups in full-field flash ERG response; however, in the pattern ERG, the exposed group had significantly longer latency of P50, which reflects changes in the retinal ganglion cell.

CONCLUSION

Long-term occupational exposure to mixed organic solvents appeared to affect the optic tract functions in the form of increasing latency of VEP response, affecting the quality of CV and decreasing CS. It also affects the retinal ganglion cell layer with increased latency of P50 of the pattern ERG response.

Symptoms of Neurotoxicity among Carpenters Living in Rural Ecuador: A Population-based Study (The Atahualpa Project)

Background:

There is no information on the prevalence of symptoms related to neurotoxicity among carpenters working in underserved populations. To assess the magnitude of the problem, we conducted a population-based study in Atahualpa, a rural Ecuadorian village, where most men work as carpenters under poor safety conditions.

Methods:

All men aged 40–75 years living in Atahualpa were identified during a door-to-door survey and evaluated with a general demographic questionnaire, the Q16 questionnaire, the depression axis of the Depression Anxiety Stress Scale-21, and the Montreal Cognitive Assessment (MoCA).

Results:

Among 230 participants, 63% were carpenters. Seventy participants (30%) had a positive Q16 questionnaire (≥6 points), which suggested neurotoxicity. In a logistic regression model adjusted for age, education, alcohol intake, symptoms of depression, and MoCA score, the proportion of Q16 positive persons was 39.1% for carpenters and 15.9% for noncarpenters (odds ratio: 3.53, 95% confidence interval: 1.75–7.15, P < 0.0001). In a generalized linear model, adjusted mean scores in the Q16 questionnaire were 4.9 for carpenters and 3.6 for noncarpenters (β: 1.285, standard error: 0.347, P < 0.0001). There was no correlation between scores in the Q16 questionnaire and the MoCA (Pearson correlation coefficient = −0.02), and the only significant covariate in the multivariate linear model was age, with every 10 years of age difference contributing 0.64 points in the Q16 questionnaire.

Conclusion:

This study shows a high prevalence of symptoms associated with neurotoxicity among carpenters after adjusting for a number of confounders. Long-term exposure to toxic solvents is the most likely explanation to this finding.

Emerging various environmental threats to brain and overview of surveillance system with zebrafish model

Pathologies related to neurotoxicity represent an important percentage of the diseases that determine the global burden of diseases. Neurotoxicity may be related to the increasing levels of potentially neurotoxic agents that pollute the environment, which generates concern, since agents that affect children may increase the incidence of neurodevelopmental disorders, affecting the quality of life of future citizens. Many environmental contaminants have been detected, and many of them derive from several human activities, including the mining, agriculture, manufacturing, pharmaceutical, beverage and food industries. These problems are more acute in third world countries, where environmental regulations are lax or non-existent. An additional major emerging problem is drug contamination. Periodic monitoring should be performed to identify potential neurotoxic substances using biological tests capable of identifying the risk. In this sense the fish embryo test (FET), which is performed on zebrafish embryos, is a useful, reliable and economical alternative that can be implemented in developing countries.

Central nervous system diseases of organic solvents exposed workers based on nationwide medical surveillance-data in Korea

BACKGROUND

New light is being shed on the relationship between chronic neurotoxicity of the central nervous system (CNS) and exposure to low-level organic solvents (OS). However, there are few longitudinal studies with a large sample size.

METHODS

A cohort of OS-exposed male workers was selected who had undergone an OS-associated specialized medical check-up at least once between 2000 and 2004 in Korea. The standardized admission ratios (SAR) for CNS diseases were calculated with reference to the Korean adult male population. Adjusted relative risks (ARR) were also estimated in comparison to noise-exposed male workers.

RESULTS

There were 238,574 OS-exposed workers, yielding 954,772 person-years of exposure. OS-exposed workers were at elevated risk of "other extrapyramidal and movement disorders" (G25) with a SAR = 2.95 (95% CI: 1.41-5.42) and "systemic atrophies primarily affecting the CNS" (G10-G13) SAR = 2.08 (95% CI: 1.03-3.74). There were no significant differences between the OS-exposed workers and noise-exposed workers.

CONCLUSIONS

A limited number of CNS diseases identified through hospital admissions data and short observation periods reduced statistical power to determine effect size. OS exposure was positively associated with "other extrapyramidal and movement disorder and systemic atrophies primarily affecting the CNS.

Occupation and the risk of chronic toxic leukoencephalopathy

Among the hundreds of environmental insults capable of inducing nervous system injury, a small number can produce clinically significant damage to the brain white matter. The use of magnetic resonance imaging (MRI) in affected individuals has greatly illuminated this previously obscure area of neurotoxicology. Toxic leukoencephalopathy has acute and chronic forms, in both of which cognitive dysfunction is the major clinical manifestation. Chronic toxic leukoencephalopathy (CTL) has been most thoroughly described in individuals with intense and prolonged exposure to leukotoxins, but the consequences of lesser degrees of exposure are not well understood. Rare cases of CTL have been reported in workers exposed to culpable leukotoxins, but study of this syndrome is hindered by many confounds such as uncertain level of toxin exposure, the presence of multiple toxins, vague dose-response relationship, comorbid medical or neurologic disorders, psychiatric illness, and legal issues. The risk of CTL in workers is low, although it is not possible to determine quantitative risk estimates. More knowledge can be expected with the application of advanced MRI techniques to the assessment of workers who may have been exposed to known or potential leukotoxins. Preventive measures for avoiding workplace CTL will be informed by clinical assessment involving the use of advanced neuroimaging and neuropsychologic evaluation in combination with accurate measurement of leukotoxin exposure.

Exposición a COVs en fábricas de muebles de dos poblaciones del norte de Colombia

<p><strong>Objetivos</strong> Evaluar la exposición a compuestos orgánicos volátiles (COVs) en trabajadores de fábricas artesanales de mueblesde dos poblaciones de Sucre (Sincelejo y Sampués), Norte de Colombia. Determinar posibles signos y/o síntomas relacionados con la exposición a estos contaminantes.</p><p><strong>Métodos </strong>Estudio transversal analíticocon aplicación de una encuesta. La población objetivo estuvo conformada por 66 individuos, 41 expuestos y 25 controles. Se tomaron muestras personales para las concentraciones de benceno, tolueno, etilbenceno y xilenos (en ambos grupos) y se contrastó con posibles efectos en la salud atribuidos a estos contaminantes.</p><p><strong>Resultados </strong>Las concentraciones de benceno, tolueno y m/p-xileno fueron mayores en el grupo expuesto (9,5 mg/m³, 8,1 mg/m³ y 12,1 mg/m³) en comparación con el grupo control(0,2 mg/m³, 0,3 mg/m³ y 0,03 mg/m³).Dolor muscular 82,9 % (RP=3,8; IC95%:1,2-11,8) y somnolencia 65,9 % (RP=4,9; IC95%:1,7-14,7)estuvieron asociados a mayor exposición (p&lt; 0,05). Factores como el uso de mezclas solventes (thinner) en el trabajo y el tráfico vehicularpueden contribuir a estos resultados.</p><p><strong>Conclusiones </strong>La contribución de diversas fuentes aumenta la exposición personal a los COVs, de los trabajadores de las fábricas artesanales de muebles en el Norte de Colombia. Adicionalmente, el uso excesivo de estos compuestos puede estar generando efectos adversos en la salud de los trabajadores.</p>

Ultrasound-assisted dynamic extraction coupled with parallel countercurrent chromatography for simultaneous extraction, purification, and isolation of phytochemicals: application to isoflavones from red clover

A novel procedure comprising ultrasonic-assisted dynamic extraction (UADE) coupled with two countercurrent-chromatography systems (parallel countercurrent chromatography, PCCC) was developed. This technique offers the possibility for simultaneous extraction, solvent configuration, purification, and isolation of target compounds. This new approach was applied to the fractionation and purification of isoflavones from red clover. The two-phase solvent system was prepared by automating the equipment. The lower aqueous phase of the two-phase solvent system was used as the UADE solution and as the mobile phase for PCCC. After the extraction and purification steps, the purified sample was pumped into the countercurrent chromatography 1 (CCC1) column for the first isolation step. During CCC1 separation, the sample was enriched and purified and then pumped into the CCC2 column for the second isolation step. After completion of the first cycle of UADE-PCCC steps, the second-cycle experiments were performed. Using this sequence, five target compounds, daidzein, prunetin, genistein, irilone, and maackiain, with >95.31 % purity were successfully extracted and isolated using the two-phase solvent system of n-hexane-ethyl acetate-ethanol-water (0.623:1.00:0.99:1.246, v/v). With this instrumental setup, scientific and systematic extraction and isolation of natural products was achieved, and this technique has great potential for industrial application. Graphical Abstract Simplified schematic of instrumental setup of UADE combined with two HSCCC instruments.

Tremor secondary to neurotoxic exposure: mercury, lead, solvents, pesticides

Lead, mercury, solvents, and pesticide exposures are common in certain occupations and may cause nervous system dysfunction. Tremors may be the herald manifestation among a constellation of acute toxicity signs and symptoms. However, since tremors may also be the only sign on clinical presentation and since tremors also occur in other diseases, relating tremors to a specific occupational exposure can be challenging. Diagnosis of tremor etiology must be based on other findings on physical exam, laboratory results, and/or imaging. Discerning whether the tremor resulted from the occupational environment versus other etiologies requires knowledge of potential exposure sources, additional detail in history taking, and support of other health and industrial professionals. Reduction or removal from the exposure source remains the key first step in treating patients suffering from tremor that had resulted from occupational exposure toxicity.

Neurobehavioral effects of occupational exposure to organic solvents among male printing workers in Hong Kong

The objective of this study was to investigate the neurobehavioral effects of long-term occupational exposure to low levels of organic solvent among male printing workers in Hong Kong. A total of 115 printing workers exposed to organic solvents were recruited from the printing divisions of 3 printing factories, and 101 workers from the binding divisions of the same factories constituted the comparison group. Active and passive samplings were used to assess the occupational exposures to solvents. The World Health Organization Neurobehavioral Core Test Battery (WHO-NCTB) was applied to assess the neurobehavioral functions. Both active and passive sampling results showed that solvent levels were higher in the printing divisions than the binding divisions. The scores of Digit Symbol and Pursuit Aiming were poorer among workers in the printing divisions (all p values < .05). There were no significant differences found between the 2 divisions for other WHO-NCTB tests. The scores of Digit Symbol and Pursuit Aiming showed exposure-response relationship with various solvent exposure indices. Prolonged occupational exposure to low levels of organic solvents was associated with adverse neurobehavioral effects among male printing workers in Hong Kong.

Neurotoxicity of solvents

Worldwide, several hundred million tons of organic solvents are used annually in household, industry, and other occupational settings. Millions of workers are regularly exposed to organic solvents considered neurotoxic. Acute neurotoxicity due to high exposure of solvent is usually evident, but the nature of long-term effects, such as chronic solvent encephalopathy (CSE), has raised uncertainty even among experts. Earlier studies were criticized for their methodology, mainly epidemiologic studies or investigations of exposed groups with many possible confounders and inadequate exposure assessment. However, an increasing number of studies have been performed since, also on workers with defined CSE based on differential diagnostics. During the last decade, evidence has emerged to enable identification of CSE, a necessity for the early recognition and prevention of progression of dysfunction and disability. Selected chemicals are presented here due to their widespread use, neurotoxic potential, and ability to cause solvent encephalopathy. Constant introduction of new chemicals may introduce new hazardous chemicals or known chemicals may reveal new health effects. It is important to keep an open mind for new findings of solvent-related neurobehavioral effects.

Toluene abuse and white matter: a model of toxic leukoencephalopathy

The brain is the primary target of toluene (methylbenzene), the major solvent in spray paint and a constituent of many other easily obtained commercial and industrial products. The effects of acute intoxication can be dramatic and the lasting adverse effects of inhalants may be highly injurious. Mental status alterations range from acute confusional state to coma. Toluene abuse effects on white matter are demonstrable neuroradiologically and neuropathologically, and have important neurobehavioral consequences.

Chronic solvent-induced encephalopathy: European consensus of neuropsychological characteristics, assessment, and guidelines for diagnostics

INTRODUCTION

The presence of neuropsychological impairment is a hallmark of chronic solvent-induced encephalopathy (CSE), and using clinical neuropsychological procedures to generate a valid assessment of the condition is crucial for its diagnosis. The goals of this consensus document are to provide updated knowledge of the neuropsychological characteristics of CSE and to provide internationally acceptable guidelines for using neuropsychological assessments in the process of diagnosing patients who are suspected of having CSE.

MATERIALS AND METHODS

A European working group that was composed of experts in the field of the clinical diagnosis of CSE met at several round-table meetings and prepared this report. The first section of the consensus paper addresses a review of the relevant literature that was published between 1985 and March 2012. The second section addresses recommendations for the clinical neuropsychological assessment of patients who are suspected of having CSE.

RESULTS

The literature review indicates that the most common neuropsychological impairments in CSE patients are within the domains of attention, particularly the speed of information processing, memory, and motor performance. It appears that the influence of CSE on memory processes mainly involves immediate recall and generally involves verbal, visual and visuospatial material. In the second section, six recommendations are presented regarding important functional domains for the neuropsychological diagnostic process of CSE that relate to the evaluation of neuropsychological impairment, the assessment and evaluation of symptoms, differential diagnostic considerations, the reliability and validity of neuropsychological test results, and the retesting of patients.

DISCUSSION AND CONCLUSIONS

These recommendations will contribute to the improvement of the process for accurately diagnosing CSE, better counselling for CSE patients, the comparability of epidemiological data between countries, and finally, by raising awareness, these recommendations will contribute to combating the adverse health effects of occupational exposure to solvents.

The role of exhaust ventilation systems in reducing occupational exposure to organic solvents in a paint manufacturing factory

This paper presents the successful design and implementation of several exhaust ventilation systems in a paint manufacturing factory. The ventilation systems were designed based on American Conference of Governmental Industrial Hygienists recommendations. The duct works, fans, and other parts were made and mounted by local manufacturers. The concentrations of toluene and xylene as the common solvents used in paint mixing factories were measured to evaluate the role of ventilation systems in controlling the organic solvents. Occupational exposure to toluene and xylene as the major pollutants was assessed with and without applying ventilation systems. For this purpose, samples were taken from breathing zone of exposed workers using personal samples. The samples were analyzed using Occupational Safety and Health Administration analytical method No.12. The samples were quantified using gas chromatography. The results showed that the ventilation systems successfully controlled toluene and xylene vapors in workplace, air well below the recommended threshold limit value of Iran (44.49 and 97.73 ppm, respectively). It was also discovered that benzene concentration in workplace air was higher than its allowable concentrations. This could be from solvents impurities that require more investigations.

Occupational solvent exposure and brain function: an fMRI study

BACKGROUND

Deficits in cognitive function have been demonstrated among workers chronically exposed to solvents, but the neural basis for these deficits has not been shown.

OBJECTIVES

We used functional magnetic resonance imaging (fMRI) to compare pathophysiological changes in brain function between solvent-exposed and control workers.

METHODS

Painters, drywall tapers, and carpenters were recruited from the International Union of Painters and Allied Trades, District Council 9 in New York City and District Council 21 in Philadelphia, Pennsylvania, and from the Carpenters Union in New Jersey. Twenty-seven solvent-exposed and 27 control subjects of similar age, education, and occupational status completed the N-Back working memory test during fMRI. After controlling for confounders (age; lifetime marijuana, cocaine, and alcohol use; blood lead; symptoms of depression; verbal intelligence), voxelwise group analysis and regional activation levels were compared and then correlated with an index of lifetime solvent exposure.

RESULTS

Solvent-exposed workers' performance on the N-Back was significantly worse than that of controls. Activation of the anterior cingulate, prefrontal, and parietal cortices--areas serving working memory function and attention--was also significantly lower for solvent-exposed workers relative to controls. After controlling for confounders, we observed a negative correlation between lifetime solvent exposure and activation in these same regions among the solvent-exposed workers.

CONCLUSIONS

This study is one of the few to document neural structures affected by exposure to solvents. Our findings provide a biological mechanism for the neurobehavioral deficits in working memory and attention that have previously been reported by other groups studying the effects of chronic exposure to solvents. These imaging markers, which are consistent with the neurobehavioral measures in our subject population, are consistent with altered brain pathology caused by prolonged exposure to solvent mixtures during construction work.

Neurobehavioral Effects of Acute Exposure to Aromatic Hydrocarbons

This article reports the results of neurobehavioral tests on representative aromatic constituents, specifically C9 to C11 species. The testing evaluated effects in several domains including clinical effects, motor activity, functional observations, and visual discrimination performance. Exposures ranging from 600 to 5000 mg/m3, depending on the molecular weights of the specific aromatic constituents, produced minor, reversible effects on the central nervous system (CNS), particularly in the domains of gait and visual discrimination. There was little evidence of effects at lower exposure levels. There was some evidence of respiratory effects at 5000 mg/m3 in 1 study, and there were also minor changes in body weight and temperature. The CNS effects became less pronounced with repeated exposures, corresponding to lower concentrations in the brain of 1 representative substance, 1,2,4-trimethyl benzene (TMB). At high exposure levels, the alkyl benzenes apparently induced their own metabolism, increasing elimination rates.

Neurobehavioral Effects of Cyclohexane in Rat and Human

The neurobehavioral effects of inhaled cyclohexane in rats and humans are investigated to define relationships between internal doses and acute central nervous system effects. Rats are exposed for 3 consecutive days at target concentrations of 0, 1.4, 8, and 28 g/m3, 8 h/d. Measurements include standardized observational measures, spontaneous motor activity assessments, and learned visual discrimination performance. Cyclohexane concentrations in blood and brain are measured to assess internal exposure. Human volunteers are exposed for 4 hours to 86 or 860 mg/m3 in 2 test sessions. Neurobehavioral effects are measured using a computerized neurobehavioral test battery. In rats, there are slight reductions in psychomotor speed in the high-exposure group but minimal central nervous system effects. In humans, there are no significant treatment-related effects at the levels tested.

Symptoms of chronic solvent encephalopathy: Euroquest questionnaire study

The aim was to study the symptomatology of chronic solvent encephalopathy (CSE), and the persistence of the symptoms. We examined how Euroquest, a neurotoxic symptom questionnaire, distinguished workers with verified CSE from unexposed employees, and evaluated symptom cut-off for CSE. Another aim was to study the effect of age on the responses. CSE cases confirmed at the Finnish Institute of Occupational Health had completed Euroquest either before their first investigation procedure (CSE-1 group, n=33), or before attending a routine control for previously diagnosed CSE (CSE-2, n=43). Non-exposed carpenters served as referents (n=292). We studied responses to single questions and to symptom domains. The domain with the highest AUC (area under the ROC: Receiver Operating Characteristic Curve) value was chosen to study cut-off points. CSE groups reported nearly all 59 symptoms more frequently than the carpenters. There was only little difference between younger and older carpenters. CSE-1 reported 12 symptoms more often than CSE-2, but no significant differences were found in the memory and concentration domain, which had the highest AUC, above 0.9. Using a three out of 10 symptoms cut-off point, 97% of the CSE-1 cases and 80% of the carpenters were classified correctly. At a four-symptom cut-off, the sensitivity was 93% and specificity 87%. The memory and concentration as core symptoms distinguished CSE cases from unexposed workers and remain, even after cessation of exposure. The effect of age on Euroquest was minor. Euroquest is recommended for the screening of CSE in solvent-exposed work-force and in the diagnostic process of CSE. We propose three memory and concentration symptoms as cut-off to minimize under-detection.

Magnetic resonance imaging in occupational chronic solvent encephalopathy

PURPOSE

The aim of this study was to characterize the magnetic resonance imaging (MRI) findings in chronic solvent encephalopathy (CSE) patients and to study whether the findings are associated with solvent exposure indices.

METHODS

The brain MRI scans of 71 CSE patients were independently re-evaluated and rated by two experienced neuroradiologists. All the work tasks were analyzed and the chemical composition of lifetime exposure was categorized.

RESULTS

The MRI scans of 27/71 CSE patients (38%) were classified as abnormal. Brain atrophy in any brain area was found in 17/71 CSE patients (24%). Abnormal white matter hyperintensities (WMH) were found in 20/71 CSE patients (28%). Cerebral and cerebellar brain atrophy was associated with the duration of exposure in years, and vermian atrophy was associated with alcohol consumption. Periventricular and brainstem WMH were related to age.

CONCLUSIONS

Slight brain atrophy is associated with CSE and there is a correlation between brain atrophy and the duration of exposure in years. However, all the MRI findings in CSE are non-specific and thus MRI is useful mainly in the differential diagnosis of CSE.

Symptom screening in detection of occupational solvent-related encephalopathy

OBJECTIVES

Sensitive and easily applicable methods are needed for early detection of central nervous system adverse effects related to occupational solvent exposure. The present study evaluates how symptom screening works in practice.

METHODS

A cross-sectional questionnaire survey was conducted on 2,000 construction workers, including painters and carpenters, in Finland. Scores were calculated for symptoms relevant for chronic solvent encephalopathy (CSE). Responses on exposure and health were compared between subjects with high score (N = 28) and all other respondents. The respondents with the highest scores, regardless of their occupation and exposure, were invited for clinical examination to investigate the aetiologies of the symptoms. If the examination resulted in a suspicion of CSE, a multidisciplinary differential diagnostic follow-up procedure was performed.

RESULTS

The respondents with highest symptom scores were more exposed to solvents than those with lower scores (P < 0.001) and reported more often physician-diagnosed diseases, especially psychiatric disorders (P < 0.001). They also consumed more alcohol (P = 0.005) and were more often unemployed or unable to work (P < 0.001). In the clinical examination, sleep disturbances, somatic disorders, depression, unemployment, and alcohol use were commonly found in addition to considerable solvent exposure history and clinical neurological findings. Further examinations and a diagnostic follow-up verified three cases of encephalopathy. One case was a CSE, an occupational disease. The other two encephalopathy cases had multifactorial aetiology including solvents.

CONCLUSIONS

Screening in active workforce for symptoms of cognitive dysfunction identifies highly solvent-exposed workers and also reveals occupational and non-occupational cases of encephalopathy. Evaluation of differential diagnostic conditions is essential in the detection of CSE. A stepwise model is proposed.

Cerebral impairment in chronic solvent-induced encephalopathy

OBJECTIVE

Worldwide, many workers experience occupational exposure to organic solvents, which may induce chronic solvent-induced encephalopathy (CSE). Disturbances within the frontostriatothalamic (FST) circuitry might explain the symptomatology of CSE. We tested the hypothesis of FST circuitry abnormalities in CSE, as well as associations with performance of psychomotor speed, attention, and solvent exposure. To detect preclinical, solvent-related effects, we also studied the FST circuitry in solvent-exposed, but asymptomatic workers.

METHODS

Ten CSE patients, 10 asymptomatic but solvent-exposed house painters (EC), and 11 nonexposed asymptomatic carpenters were included. Dopamine D(2) receptor (D2R) binding, central nervous system tissue metabolites, and fractional anisotropy were measured within the FST circuitry, using single-photon emission computed tomography, magnetic resonance spectroscopy, and diffusion tensor imaging. Performance of psychomotor speed and attention, and severity of solvent exposure were assessed.

RESULTS

Striatal D2R binding was reduced in CSE. In the solvent-exposed asymptomatic patients, striatal D2R binding and levels of N-acetylaspartate + N-acetylaspartyl-glutamate in frontal gray matter were reduced. In both exposed groups, a trend was seen for reduced choline in frontal gray matter. In CSE, the fractional anisotropy in the thalamus, caudate nucleus, and striatal D2R binding significantly predicted reduced performance of attention and psychomotor speed. In CSE, striatal D2R binding showed a negative correlation with solvent exposure.

INTERPRETATION

This is the first study in CSE showing pronounced disturbances within the FST circuitry that are related to the clinical findings and to exposure severity to solvents. The comparable, but milder, abnormalities within the FST circuitry in the exposed asymptomatic workers may imply a presymptomatic phase of CSE.

Quantitative EEG in occupational chronic solvent encephalopathy

The aim of this study was to characterize the quantitative analyzed EEG (electroencephalogram) findings (qEEG) in chronic solvent encephalopathy (CSE) patients and study whether the qEEG findings associate with the duration and intensity of the solvent exposure. Also, the diagnostic value of qEEG in CSE is discussed. The EEG of 47 male CSE patients was analyzed. The laboratory’s own reference EEG values of 24 healthy male subjects formed the laboratory control group. We also used an age-matched control group of 100 male blue-collar workers without occupational solvent exposure. The main finding of our study was that the power of the frontal theta band is increased in the CSE patient group compared with the laboratory control group. This suggests that the frontal cortex may be susceptible to the noxious effects of solvents. However, this difference was not seen in comparison with the matched control group, and thus, the connection with solvent effects remains uncertain. The variables indicating the level of solvent exposure did not associate with the power of the theta activity in the frontal area. Because of the small amount and unspecificity of the observed abnormalities, qEEG cannot be recommended to be used in the clinical diagnostics of solvent encephalopathy.

The impact of solvent mixtures on neurobehavioral performance: conclusions from epidemiological data

The review of epidemiological studies investigating the neurobehavioral effects of occupational exposure to solvent mixtures sought to contribute to the following issues: (1) Identification of affected cognitive and motor functions. (2) Identification of sensitive neuropsychological tests. (3) Analysis of exposure-effect relationships. The approach was based on the meta-analytical method of effect size estimates. Fifty-three groups from occupational studies were included in the meta-analysis. Forty-eight neuropsychological performance variables could be analyzed as they were included in at least three studies. Seventeen articles provided detailed information on the constituents of mixtures, thereby enabling the computation of an exposure index that allowed the comparison of different mixtures. Significant negative effect sizes were obtained for 12 test variables measuring attention, memory, motor performance and constructional abilities. The greatest proportion of lower performance scores in the exposed groups was shown by different tests of attention: significant effect sizes between d=-0.16 and -0.46 were calculated. Tests of cognitive processing speed, response alternation and inhibition seemed to be sensitive tools for the detection of poorer performance. Exposure-effect relationships were mainly characterized by inconsistent patterns. Crude and inappropriately calculated exposure measures were blamed for this outcome. A healthy worker effect was suggested more consistently: studies examining groups with longer exposure duration obtained smaller effect sizes. Indications of confounding were observed; however, they did not seem sufficient to question consistent effect size patterns. Paying greater attention to the measurement of exposure and including measures of confounding is advisable for future studies and would enhance the explanatory power of cross-sectional studies and meta-analyses.

Review of the Toxicology of Mineral Spirits

This review of the toxicology of mineral spirits covers studies of the major classes of mineral spirits and several toxicologically important mineral spirit constituents. This review cites data from numerous previously unpublished animal toxicology studies conducted on mineral spirits during the past 30 years, expanding the existing database on the toxicology of this group of hydrocarbon solvents. The data can be used to better evaluate the potential effects associated with exposure to these materials, including health and environmental reviews such as the U.S. Environmental Protection Agency High Production Volume (HPV) chemical program and the Organization for Economic Cooperation and Development (OECD) HPV Screening Information Data Set (SIDS) program. The majority of animal toxicology studies in the available literature were conducted on mineral spirits categorized as ASTM D235 Type I Class A (149°C to 213°C boiling range; 8% to 22% aromatics) and demonstrate that Type I Class A mineral spirits have a low order of acute toxicity and do not produce significant systemic effects. Some additional studies conducted with ASTM D235 Type II Class C mineral spirits (177°C to 213°C boiling range; <2% aromatics) suggest that Type II Class C mineral spirits have similar toxicity to Type I Class A mineral spirits, though there is some evidence that Type II, Class C mineral spirits have a lesser degree of central nervous system (CNS) effects than the higher aromatic containing Type I Class A materials. In addition, toxicity data on selected chemical constituents of mineral spirits (e.g., n-nonane, n-decane, n-undecane) indicate that these chemicals have similar toxicological properties to mineral spirits. Overall, the data showed that mineral spirits have a low order of acute toxicity and do not appear to produce toxicologically relevant systemic effects. Ongoing studies are evaluating the concerns associated with chronic low-level exposure and central nervous system effects.

Model studies for evaluating the neurobehavioral effects of complex hydrocarbon solvents

To evaluate the neurobehavioral effects of hydrocarbon solvents and to establish a working model for extrapolating animal test data to humans, studies were conducted which involved inhalation exposure of rats and humans to white spirit (WS). The specific objectives of these studies were to evaluate the behavioral effects of exposure to WS in rats and humans and to determine relationships between internal levels of exposure and behavioral effects. In both animals and volunteers, methods for assessment of similar functional effects were used to enable interspecies comparisons. A battery of tests including standardized observational measures, spontaneous motor activity assessments and learned visual discrimination performance was utilized in rat studies to evaluate acute central nervous system (CNS) depression. Groups of rats were exposed to WS at target concentrations of 0, 600, 2400 or 4800mg/m(3), 8h/day for 3 consecutive days. Blood and brain concentrations of two WS constituents; 1,2,4-trimethylbenzene (TMB) and n-decane (NDEC), were used as biomarkers of internal exposure. In a volunteer study, 12 healthy male subjects were exposed for 4h to either 57 or 570mg/m(3) WS in two test sessions spaced 7 days apart, and neurobehavioral effects were measured using a computerized neurobehavioral test battery. Blood samples were taken at the end of the exposure period to measure internal concentrations of TMB and NDEC. Results of the behavioral tests in rats indicated WS-induced changes particularly in performance and learned behavior. In humans, some subtle performance deficits were observed, particularly in attention. The behavioral effects were related to concentrations of the WS components in the central nervous system. These studies demonstrated a qualitative similarity in response between rats and humans, adding support to the view that the rodent tests can be used to predict levels of response in humans and to assist in setting occupational exposure levels for hydrocarbon solvents.

Assessment of potential hazards during the process of house building in Estonia

The aim of this study was to evaluate new working conditions in the construction industry in Estonia. Three construction sites were investigated: a dwelling house at the stage of renovation, a warehouse at the stage of excavation and preparation work, and a hotel, where we examined the working conditions of the finishers. Microclimate: air temperature, relative humidity and air velocity were determined at every workplace. Full-shift personal exposure measurements of dust and gas exposure were performed among 97 construction workers in breathing zone air. The concentration of lead in the air was analysed by AAS. Vapours of benzene, styrene and toluene concentrations were determined by gas chromatography. The noise level was measured with the help of the sound-level meter at every workplace. All microclimatic indices were sometimes below or above exposure standards for indoor work. High levels of airborne dust and increased concentrations of lead were observed during repair work. Low concentrations of organic solvents in the air were determined when using paints and some synthetic substances. The noise level exceeded the permitted limit when an excavator and powerful electric appliances were used. A questionnaire determined the prevalence of subjectively experienced musculoskeletal strain in 30% of workers. The working conditions in the construction industry in Estonia are approaching European level. However, it is necessary to improve working conditions permanently by the use of new harmless materials, personal protective equipment, and through influencing worker health by permanent education and medical watch. We consider that questionnaires are very important in the control of the work environment, in subjective health assessments, and as a source of useful proposals to improve working conditions.

Validation of a method for acute and subchronic exposure of cells in vitro to volatile organic solvents

In vitro assessment of organic solvents can be problematic as the volatile nature of these compounds makes maintaining a constant exposure level difficult. However, a stable exposure level must be maintained if reliable dose response data are to be obtained. Here we describe a gas-tight glass exposure system which allows prolonged exposure of cultured cells to constant concentrations of volatile organic solvents. The system permits convenient sampling of gas and liquid phases for reliable quantification of solvent concentration. We determined medium/air partition coefficients (K) for toluene, n-hexane and methyl ethyl ketone which can be used to calculate liquid phase solvent exposure levels in an in vitro system specifically designed for organic solvent exposure. Cultured cells were exposed to these compounds for five days and toxicity assessed by trypan blue exclusion. Headspace gas chromatography was used to determine K in RPMI-1640 and EMEM tissue culture medium at 37 degrees C. The presence of cells in the system at levels normally used in in vitro exposure systems did not significantly alter solvent partitioning. Equilibrium liquid phase solvent concentrations were measured by gas chromatography for two of the compounds to confirm that exposure levels calculated using K were correct. Results show that sub-chronic exposure to volatile organic solvents causes a dose dependent decrease in Jurkat T-cells and SH-SY5Y viability. Solvent potency increased with lipophilicity (n-hexane>toluene>MEK).

Model studies for evaluating the acute neurobehavioral effects of complex hydrocarbon solvents I. Validation of methods with ethanol

As a preliminary step to evaluating the acute neurobehavioral effects of hydrocarbon solvents and to establish a working model for extrapolating animal test data to humans, joint neurobehavioral/toxicokinetic studies were conducted which involved administering ethanol to rats and volunteers. The specific objectives of the present studies were to evaluate the acute central nervous system (CNS) effects of ethanol in rats and humans and to assess relationships between internal levels of exposure and behavioral effects. A more general objective was to validate a battery of neurobehavioral tests that could be used to carry out comparative studies in both species. Accordingly, a range of tests including standardized observational measures, spontaneous motor activity assessments and learned visual discrimination performance was utilized in rat studies to evaluate acute CNS effects. Groups of rats were given ethanol at levels of approximately 0.5, 1.0 or 2.0g/kg, with blood level measurements to verify internal doses. In a volunteer study, 12 healthy male subjects were given 0.65g/kg ethanol, a level approximating the limit for motor vehicle operation in The Netherlands, and neurobehavioral effects were measured prior to and 1 and 3h after ethanol administration, with a computerized neurobehavioral test battery. Blood and air measurements were made to quantify internal doses. Results of the behavioral tests in rats provided evidence of ethanol-induced changes in neuromuscular, sensori-motor, and activity domains. There were also significant changes in visual discrimination, particularly in the areas of general measures of responding and psychomotor speed. In humans there were small but statistically significant effects on learning and memory, psychomotor skills and attention. However, the effects were subtle and not all parameters within given domains were affected. These studies demonstrated a qualitative similarity in response between rats and humans.

Cognitive functioning in patients with suspected chronic toxic encephalopathy: evidence for neuropsychological disturbances after controlling for insufficient effort

OBJECTIVES

Chronic toxic encephalopathy (CTE) caused by long term occupational exposure to organic solvents is still a controversial disorder. Neuropsychological testing is the cornerstone for diagnosing the syndrome, but can be negatively influenced by motivational problems. In this nationwide study, we investigated the neuropsychological functioning and psychological symptoms of a large group of patients with suspected CTE, and ruled out alternative explanations for their complaints, including suboptimal performance due to insufficient effort.

METHODS

We studied participants with suspected CTE (n = 386) who were referred for further diagnosis to the Netherlands Centre of Occupational Diseases in the period 1998-2003 and who had completed the entire diagnostic protocol. Patients were excluded if there was the slightest suspicion that test performance had been negatively influenced by insufficient effort (n = 221), or if comprehensive assessment identified an alternative diagnosis (n = 80). Insufficient effort was defined by a combination of three indices. The neuropsychological test scores of the patient group (n = 85) were compared with those of a control group of building trade workers matched for sex, age, and educational level (n = 35).

RESULTS

The patient group had significantly more psychological complaints and performed significantly worse than the control group on tests of speed of information processing and memory and learning. However, only a small percentage of the patients had clearly abnormal scores for cognitive speed (9%) or memory (8%). Attention, verbal abilities, and constructional functions were not disturbed. Exposure duration and cognitive complaints were significantly correlated, whereas the correlation between exposure duration and neuropsychological domain scores was not significant.

CONCLUSIONS

Insufficient effort was present in a substantial part of the patient group. After minimising the likelihood that insufficient effort negatively influenced neuropsychological scores, we still found neuropsychological deficits in speed of cognitive processing and memory; however, these scores were clearly abnormal only in a minority of patients with suspected CTE. Screening instruments should focus on these domains.

Neurological Effects of White Spirit: Contribution of Animal Studies during a 30-Year Period*

Numerous studies have suggested that long-term occupational exposure to white spirit may cause chronic toxic encephalopathy (WHO 1996). This review summarizes the chronic nervous system effects of white spirit in animal studies during a 30-year period. First, routine histopathology was consistently unable to reveal adverse peripheral or central nervous system effects after inhalation of white spirit. Second, neurobehavioural studies in animals showed no adverse effect after inhalation of white spirit with a high content of aromatics in contrast to what was found with products with a low content. Third, white spirit with a high content of aromatics induced adverse neurochemical changes at inhalation of 400 ppm and possibly already at 100 ppm. In the studied parameters, white spirit with a low content of aromatics showed no clear adverse neurochemical effects at inhalation of 400 ppm, but the neurophysiological tests showed adverse effects at this level. Fourth, neurophysiological methods may be more sensitive than histopathological, neurobehavioural and neurochemical methods. Overall, white spirit with a high and a low content of aromatics showed no overt difference in long-term effects in animals, taking all studied end-points into account. The differences in sensitivity of the test methods should be taken into consideration if new toxicological studies are conducted on this type of solvents.

A proposed methodology for setting occupational exposure limits for hydrocarbon solvents

Occupational exposure limit (OEL) development for hydrocarbon solvents is complicated because most of these solvents have complex compositions and only a few representative constituents have been studied in detail. A proposed solution to this problem is to group constituents with similar physical, chemical, and toxicological properties and to assign "guidance values" to each group. A unique OEL can then be calculated for each solvent, using a reciprocal calculation procedure (RCP) based on the liquid composition. This procedure follows the American Conference of Governmental Industrial Hygienists' (ACGIH) generic advice for complex mixtures and is recommended by the U.K. Health and Safety Executive for OEL calculations by hydrocarbon solvent manufacturers. The RCP is justified, as the toxicological properties of the constituents are additive and the differences between the vapor and liquid compositions do not substantially affect the calculated exposure limits. The guidance values are based principally on acute central nervous system depression and eye and respiratory tract irritation, effects that are the most sensitive indicators of hydrocarbon solvent exposure. One benefit of this procedure is that it is a relatively simple but practical procedure that requires limited compositional information. Further, it provides OEL recommendations that are consistent with occupational experience and current regulatory advice. Groupings and guidance values are proposed, and sample calculations are provided.

Long-term exposure to solvents impairs vigilance and postural control in serigraphy workers

OBJECTIVES

To investigate the effects of solvent exposure (mainly aromatic hydrocarbons) on central regulation of vigilance and postural control, particularly in occasional difficult situations that provide sensorial conflicts.

METHODS

Twenty-two workers occupationally exposed to solvents for an average of approximately 6 years and 21 controls were compared by the use of a questionnaire on their state of vigilance and quality of sleep and on performance measurements of postural control under six different sensorimotor conditions. Their current median exposure levels to aromatic hydrocarbons was 80.1 mg/m(3).

RESULTS

Exposed workers reported reduced alertness but not disturbance of sleep quality compared with controls. Moreover, they had the worst postural performance in all sensory conditions and demonstrated a reduced ability to resolve sensory conflict situations. The precision of stance was clearly affected by solvent exposure in contrast with energy consumption required to regulate proper balance control.

CONCLUSIONS

The depressive effect of aromatic hydrocarbon exposure on cortical and subcortical structures controlling vigilance and postural stability could lead to increased risk of occupational accident, especially due to falls. The detection of central neurotoxic effects by posturographic and vigilance tests could be useful in preventive strategies.

Occupational prolonged organic solvent exposure in shoemakers: brain MR spectroscopy findings

Our purpose was to investigate, by magnetic resonance (MR) spectroscopy, the metabolite changes in the brains of subjects in the shoemaking industry who had been chronically exposed to organic solvents. A total of 49 male subjects and 30 age-matched healthy volunteers underwent detailed neurological and psychiatric examinations. All subjects had long-echo [repetition time (TR) 2000 ms, echo time (TE) 136 ms] single-voxel MR spectroscopy. Voxels (15 x 15 x 15 mm(3)) were placed in the parietal white matter, thalamus, and basal ganglia. N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were calculated. There was no significant difference between the study subjects and the control group in NAA/Cr ratios obtained from thalamus, basal ganglia, and parietal white matter. Cho/Cr ratios in thalamus, basal ganglia, and parietal white matter were found to be significantly increased compared to controls. There was a positive correlation between basal ganglia Cho/Cr ratio and duration of exposure (r = 0.63). MR spectroscopy should be performed to reveal metabolite changes and determine the degree of brain involvement in solvent-related industry workers.

Does Occupational Exposure to Organic Solvents Affect Colour Discrimination?

This review assesses the evidence regarding the effects of occupational exposure to organic solvents on colour discrimination and investigates exposure-response relationships and reversibility. This review also considers the current state of knowledge of the possible mechanisms underlying changes in colour vision, and the human health significance of any reported changes. Among the commonly used organic solvents, styrene has been investigated the most thoroughly. Studies of styrene-exposed workers in Germany, Italy and Japan provide a sufficiently consistent body of evidence to support a robust conclusion that styrene does cause an impairment of colour discrimination relative to age-matched controls. Generally, the impairment of colour discrimination observed in styrene-exposed workers tends to be of the tritan (blue-yellow) type, although some cases of red-green impairment have also been found. The limited information available on exposure-response relationships indicates that the effects on colour discrimination would not be expected at 8-hour time weighted average (8 h TWA) exposures <20 ppm, although a precise threshold cannot be determined. The data on reversibility are limited and inconclusive. The results from the most rigorous study in which this aspect was investigated point to a reversibility of effects after a 4-week exposure-free period, whereas results from a study with limitations suggest a persistence of effect. The effects of toluene, tetrachloroethylene or mixed solvent exposure have also been investigated, although the information available is generally less reliable than for styrene. For toluene, it can be confidently concluded that this solvent does not have an acute effect on colour discrimination, even when exposures are relatively high (50-150 ppm 8 h TWA, and 290-360 ppm 30 minutes TWA). However, studies are inconclusive on whether long-term or repeated exposure to toluene can cause a persistent impairment of colour discrimination. There are few studies that have specifically investigated the effects of tetrachloroethylene on colour discrimination. Among these studies, none has examined the potential for any acute effects of this solvent vapour. A large-scale study in Japanese workers showed no effects of long-term exposure to tetrachloroethylene concentrations in the region of 12-13 ppm. However, the test methodology used was relatively insensitive to changes in colour discrimination, hence the results do not provide reassurance for an absence of subtle effects. A study in Italian dry-cleaners suggested a slight impairment of colour discrimination relative to controls, associated with relatively low exposures to tetrachloroethylene (mean 8 h TWA exposure approximately 6 ppm). The studies concerning the effects of mixed solvent exposure on colour discrimination are based on workers exposed to solvents in paints and lacquers, workers from the printing and petrochemical industries, people working in or living near to microelectronics factories and children exposed to solvents prenatally. However, these studies are subject to design limitations or methodological irregularities, such that no conclusions regarding the effects of mixed solvent exposure on colour discrimination can be drawn. Overall, the only credible evidence for an effect of solvents on colour discrimination derives from the studies on styrene. Because of limitations in the data for other solvents it is not possible to determine whether the evidence for styrene reflects a generic property of solvents. The mechanisms of styrene-induced effects on colour discrimination have not been properly investigated and can only be the subject of speculation. One conclusion that can be drawn is that pathological changes to the ocular system, such as changes to the lens, are unlikely to be involved. This is because there is an absence of convincing evidence for such changes from medical examinations conducted in epidemiological studies of solvent-exposed workers. Also, it seems unlikely that effects on colour discrimination are a nonspecific consequence of more generalised CNS depression, given that styrene-induced effects on colour discrimination appear to occur below the threshold for narcotic effects. The effects of styrene on colour discrimination are subtle and involve an impairment of the ability to discriminate accurately between closely related shades of the same colour rather than 'colour blindness'. There is no valid basis for using colour discrimination as a marker for other forms of solvent-induced neurotoxicity.

Hazard and risk assessment of industrial chemicals in the occupational context in Europe: some current issues

This paper is about industrial chemicals, the manner in which their toxicity is assessed and the use of such assessments in regulatory decision-making. It begins with general points concerning toxicological data availability and hazard identification, then moves on to risk assessment and occupational exposure limits, and finally looks briefly at three specific toxicological issues, asthma, chronic toxic encephalopathy, and "low toxicity" dust effects on the lung, where the science is far from resolved. The overall purpose of the paper is to raise, or perhaps to act as a reminder of a number of issues of particular relevance to industrial chemicals and the occupational setting, and hopefully to prompt further thinking and perhaps some new initiatives directed at the areas in question.