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Khoshakhlagh AH, Mohammadzadeh M, Ghobakhloo S, Cheng H, Gruszecka-Kosowska A, Knight J. Health risk assessment from inhalation exposure to indoor formaldehyde: A systematic review and meta-analysis. JOURNAL OF HAZARDOUS MATERIALS 2024; 471:134307. [PMID: 38678702 DOI: 10.1016/j.jhazmat.2024.134307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/21/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
This systematic review and meta-analysis investigated studies on formaldehyde (FA) inhalation exposure in indoor environments and related carcinogenic (CR) and non-carcinogenic (HQ) risk. Studies were obtained from Scopus, PubMed, Web of Science, Medline, and Embase databases without time limitation until November 21, 2023. Studies not meeting the criteria of Population, Exposure, Comparator, and Outcomes (PECO) were excluded. The 45 articles included belonged to the 5 types of sites: dwelling environments, educational centers, kindergartens, vehicle cabins, and other indoor environments. A meta-analysis determined the average effect size (ES) between indoor FA concentrations, CR, and HQ values in each type of indoor environment. FA concentrations ranged from 0.01 to 1620 μg/m3. The highest FA concentrations were stated in water pipe cafés and the lowest in residential environments. In more than 90% of the studies uncertain (1.00 ×10-6 1.00 ×10-4) due to FA inhalation exposure was reported and non-carcinogenic risk was stated acceptable. The meta-analysis revealed the highest CR values due to inhalation of indoor FA in high-income countries. As 90% of the time is spent indoors, it is crucial to adopt effective strategies to reduce FA concentrations, especially in kindergartens and schools, with regular monitoring of indoor air quality.
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Affiliation(s)
- Amir Hossein Khoshakhlagh
- Department of Occupational Health Engineering, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahdiyeh Mohammadzadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Safiye Ghobakhloo
- Department of Environmental Health Engineering, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Hefa Cheng
- MOE Key Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Agnieszka Gruszecka-Kosowska
- AGH University of Krakow, Faculty of Geology, Geophysics, and Environmental Protection, Department of Environmental Protection, Al. Mickiewicza 30, 30-059, Krakow, Poland
| | - Jasper Knight
- School of Geography, Archaeology & Environmental Studies, University of the Witwatersrand, Johannesburg 2050, South Africa
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Ebrahimi V, Yarahmadi R, Salehi M, Ashtarinezhad A. Exposure assessment to BTEX in the air of nail salons in Tehran city, Iran. Heliyon 2023; 9:e18195. [PMID: 37519745 PMCID: PMC10375791 DOI: 10.1016/j.heliyon.2023.e18195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
The nail salon industry has grown considerably, but there are serious concerns about the health risks associated with working in this field. Therefore, the purpose of this study was to investigate the exposure of nail technicians to BTEX. A cross-sectional study was conducted on 49 salons, and NIOSH Method 1501 was used to measure the concentration of BTEX in the breathing zone of technicians. The EPA method was used to assess health risks. Statistical analysis was conducted using SPSS software. The mean concentrations of toluene were (82.65 ± 198.84µg/m3)µg/m3, followed by benzene (10.58 ± 9.62µg/m3), p-xylenes (20.77 ± 37.79µg/m3), o-xylene (13.79 ± 25.70µg/m3), and ethylbenzene (29.35 ± 58.26µg/m3) , that lower than the permissible exposure limits suggested by NIOSH. Among the BTEX, toluene (82.65 ± 198.84µg/m3) has the most concentration in the nail salons. It was also discovered through multiple linear regression analysis that humidity had a significant effect on increasing the concentration of toluene (Beta = 0.50, P-value = 0.001) and ethylbenzene (Beta = 0.16, P = 0.049), while there was a considerable association between the number of services performed and benzene concentration (Beta = 0.34, P = 0.010). The average inhalation lifetime cancer risk for benzene (4.9 × 10 -5±4.5 × 10-5) was higher than the recommended value set by the US EPA. Although the concentrations of BTEX were lower than the maximum permissible limits, the results of the cancer risk assessment for benzene showed that working in nail salons with poor ventilation is hazardous. Therefore, exposure can be minimized by ensuring appropriate ventilation in the workplace and using safe products.
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Affiliation(s)
- Vida Ebrahimi
- Department of Occupational Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Yarahmadi
- Air Pollution Research Center, Department of Occupational Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Salehi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Ashtarinezhad
- Air Pollution Research Center, Department of Occupational Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Pemberton MA, Kreuzer K, Kimber I. Challenges in the classification of chemical respiratory allergens based on human data: Case studies of 2-hydroxyethylmethacrylate (HEMA) and 2-hydroxypropylmethacrylate (HPMA). Regul Toxicol Pharmacol 2023; 141:105404. [PMID: 37105297 DOI: 10.1016/j.yrtph.2023.105404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 04/29/2023]
Abstract
Occupational asthma resulting from workplace exposure to chemical respiratory allergens is an important disease. No widely accepted or formally validated tests for the identification of chemical respiratory sensitizers. Consequently, there is a heavy reliance on human data from clinical examinations. Unfortunately, however, although such investigations are critical for the diagnosis of occupational asthma, and in guiding remedial actions, they do not reliably identify specific chemicals within the workplace that are the causative agents. There are several reasons for this, including the fact that specific inhalation tests conducted as part of clinical investigations are frequently performed with complex mixtures rather than single substances, that sometimes inhalation challenges are conducted at concentrations above the OEL and STEL, where effects may be confounded by irritation, and that involvement of immune mechanisms cannot be assumed from the observation of late asthmatic reactions. Further, caution should be taken when implicating substances on lists of "recognised" asthmagens unless they have undergone a formal weight of evidence assessment. Here the limitations of clinical investigations as currently performed for the purposes of regulatory classification and decision making are explored by reference to previously published case studies that implicate 2-hydroxyethylmethacrylate (HEMA) and/or 2-hydroxypropylmethacrylate (HPMA) as respiratory allergens.
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Affiliation(s)
| | | | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Pattavina F, Wachocka M, Tuti F, Boninti F, Santi R, Grossi R, Laurenti P. From hazard identification to risk assessment: The role of the prevention technician in the carcinogenic risk assessment for formaldehyde. Front Public Health 2023; 11:960921. [PMID: 37124772 PMCID: PMC10140350 DOI: 10.3389/fpubh.2023.960921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 03/06/2023] [Indexed: 05/02/2023] Open
Abstract
The Prevention Technician in the Environment and Workplaces (PTEW) is a health professional who works in the identification, assessment, and management of risk in living and working places. The PTEW implements specific corrective actions at reducing exposure levels to chemicals such as formaldehyde. The aim of this report was to update the formaldehyde risk assessment document (RAD). The risk assessment process was divided into three steps as follows: (1) preliminary data collection, (2) an on-site visit to identify the use patterns and process, and (3) application of the algorithm to calculate the exposure levels of healthcare workers. In addition, with the introduction of closed-circuit systems, 23 devices were evaluated to identify possible airborne dispersion of formaldehyde. The algorithm was applied in 31 hospital units and the results allowed us to classify the staff in two levels of exposure for each hospital unit; healthcare workers were classified as "exposed" or "potentially exposed." Most of the HCWs are categorized as potentially exposed, and only workers working in laboratories are considered to be exposed. The results showed that devices must be used properly according to the user manual. To increase the level of worker safety, we have proposed to introduce closed-circuit safe handling systems and keeping the duration and intensity of exposure at the lowest possible levels according to the "ALARA" principle. The assignment of the Italian PTEW is to achieve excellence in the levels of health and safety of patients and hospital workers by pursuing a shared mission: improving the quality of public health.
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Affiliation(s)
- Fabio Pattavina
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- *Correspondence: Fabio Pattavina,
| | - Malgorzata Wachocka
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Federica Boninti
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Santi
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Grossi
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Patrizia Laurenti
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
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Cammalleri V, Pocino RN, Marotta D, Protano C, Sinibaldi F, Simonazzi S, Petyx M, Iavicoli S, Vitali M. Occupational scenarios and exposure assessment to formaldehyde: A systematic review. INDOOR AIR 2022; 32:e12949. [PMID: 34708443 PMCID: PMC9298394 DOI: 10.1111/ina.12949] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 05/25/2023]
Abstract
The objectives of the systematic review were to: identify the work sectors at risk for exposure to formaldehyde; investigate the procedures applied to assess occupational exposure; evaluate the reported exposure levels among the different settings. An electronic search of Pubmed, Scopus, Web of Science and ToxNet was carried out for collecting all the articles on the investigated issue published from January 1, 2004 to September 30, 2019. Forty-three papers were included in the review, and evidenced a great number of occupational scenarios at risk for formaldehyde exposure. All the included studies collected data on formaldehyde exposure levels by a similar approach: environmental and personal sampling followed by chromatographic analyses. Results ranged from not detectable values until to some mg m-3 of airborne formaldehyde. The riskiest occupational settings for formaldehyde exposure were the gross anatomy and pathology laboratories, the hairdressing salons and some specific productive settings, such as wooden furniture factories, dairy facilities and fish hatcheries. Notice that formaldehyde, a well-known carcinogen, was recovered in air at levels higher than outdoor in almost all the studied scenarios/activities; thus, when formaldehyde cannot be removed or substituted, targeted strategies for exposure elimination or mitigation must be adopted.
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Affiliation(s)
- Vittoria Cammalleri
- Department of Public Health and Infectious DiseasesUniversity of Rome “La Sapienza”RomeItaly
| | - Roberta Noemi Pocino
- Department of Public Health and Infectious DiseasesUniversity of Rome “La Sapienza”RomeItaly
| | - Daniela Marotta
- Department of Public Health and Infectious DiseasesUniversity of Rome “La Sapienza”RomeItaly
| | - Carmela Protano
- Department of Public Health and Infectious DiseasesUniversity of Rome “La Sapienza”RomeItaly
| | - Federica Sinibaldi
- Department of Anatomical Histological Medical Legal Sciences and Locomotor ApparatusUniversity of Rome “La Sapienza”RomeItaly
| | - Stefano Simonazzi
- Department of Anatomical Histological Medical Legal Sciences and Locomotor ApparatusUniversity of Rome “La Sapienza”RomeItaly
| | - Marta Petyx
- Department of Occupational and Environmental Medicine, Epidemiology and HygieneINAIL ResearchRomeItaly
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and HygieneINAIL ResearchRomeItaly
| | - Matteo Vitali
- Department of Public Health and Infectious DiseasesUniversity of Rome “La Sapienza”RomeItaly
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Adamović D, Čepić Z, Adamović S, Stošić M, Obrovski B, Morača S, Vojinović Miloradov M. Occupational Exposure to Formaldehyde and Cancer Risk Assessment in an Anatomy Laboratory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111198. [PMID: 34769715 PMCID: PMC8583012 DOI: 10.3390/ijerph182111198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/17/2022]
Abstract
Dissecting a human cadaver is an irreplaceable practice in general training of medical students. Cadavers in anatomy laboratories are usually preserved in formalin, an embalming fluid whose basic component is formaldehyde (FA). The aim of this study is to assess the cancer risk of employees and students that are exposed to FA based on the results of three monitoring campaigns, as well as to suggest permanent solutions to the problem of FA exposure based on the results obtained. Three sampling campaigns of formaldehyde concentration in indoor environments were conducted at five different locations at the Anatomy Department of the Faculty of Medicine with the purpose of assessing permanent employees’ and medical faculty first year students’ exposure to FA. Indoor air was continuously sampled during 8 h of laboratory work and analyzed in accordance with the NIOSH Method 3500. Exceeding of the 8 h time-weighted average (8 h TWA) values recommended by Occupational Safety and Health Administration (OSHA) of 0.75 ppm was recorded in 37% of the samples during the three-month monitoring campaign. Cancer risk assessment levels for permanent employees were in the range from 6.43 × 10−3 to 8.77 × 10−4, while the cancer risk assessment levels for students ranged from 8.94 × 10−7 to 1.83 × 10−6. The results of the research show that cancer risk assessment for employees is several thousand times higher than the limit recommended by the EPA (10−6) and point to the importance of reducing exposure to formaldehyde through the reconstruction of the existing ventilation system, continual monitoring, the use of formaldehyde-free products, and plastination of anatomical specimens.
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Affiliation(s)
- Dragan Adamović
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
| | - Zoran Čepić
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
- Correspondence: ; Tel.: +381-64-200-4875
| | - Savka Adamović
- Department of Graphic Engineering and Design, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Milena Stošić
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
| | - Boris Obrovski
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
| | - Slobodan Morača
- Department of Industrial Engineering and Engineering Management, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Mirjana Vojinović Miloradov
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
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