Evaluation on the Sex-Specific Association Between Cigarette Smoke Exposure and Inflammation Markers-C-Reactive Protein and White Blood Cell Count

INTRODUCTION

Cigarette smoke increases peripheral white blood cell (WBC) count. However, the dose-dependent association between smoking and C-reactive protein (CRP), an important inflammatory marker, has been reported as inconsistent.

AIMS AND METHODS

Here, we evaluated the associations between smoking and CRP using both smoking questionnaires and urine cotinine as exposure markers. The Korea National Health and Nutrition Examination Survey data were used for analyzing the associations. Multiple regression analyses were performed to examine the associations between cigarette smoke exposure, as assessed by questionnaires and urine cotinine, and health effects, as measured by CRP and WBC count, controlling for potential confounders. The confounders, including age, sex, body mass index, blood pressure, cholesterol, glucose, alanine aminotransferase, and uric acid, were selected a priori based on the literature.

RESULTS

A total of 11 435 participants were included for analysis. For the exposure-response relationship, the results indicated a significant increase in CRP levels in male smokers compared to male nonsmokers (p = .002), whereas no significant increase was found in female smokers compared to female nonsmokers (p = .680). For the dose-response relationship, a significant positive association was observed between urine cotinine and CRP in male smokers (p = .018), whereas no significant association was found in female smokers (p = .508). WBC count consistently showed significant exposure-response and dose-response relationships in both sexes.

CONCLUSIONS

WBC count was found to be a consistent effect marker of cigarette smoke exposure, while the association between CRP level and smoking was inconsistent and varied by sex. The sex-specific response to cigarette smoke exposure warrants further exploration in future studies.

IMPLICATIONS

Cigarette smoke exposure is known to increase inflammation and has been thought to increase CRP, a significant inflammation marker. However, recent studies have reported conflicting results regarding the dose-dependent association between cigarette smoke exposure and CRP. This study found that the association between smoking and CRP is inconsistent and varies by sex, showing significant exposure response in men but not in women. Furthermore, the study suggests that WBC count is a more consistent marker for cigarette smoke exposure.

Development of occupation-based exposure matrix of lead for Korean workers: challenges and opportunities

OBJECTIVES

Industry- and occupation-based carcinogen exposure matrices play a pivotal role in preventing occupational cancer. While the Korean CARcinogen EXposure (K-CAREX) has been developed in recent years to assess exposure prevalence and intensity by industry, the feasibility of constructing an occupation-based exposure matrix remains unexplored. Hence, the objective of this study is to explore the potential of combining the nationwide work environment measurement database (WEMD) and the special health examination database (SHED) to develop a comprehensive occupation-based exposure matrix.

METHODS

The WEMD provides information on airborne lead measurements, including industry codes, but it does not include data related to occupations. In contrast, the SHED contains information on both occupation and blood lead levels. By integrating these 2 databases, we attempted to assess airborne lead exposure levels by occupation. Additionally, we performed a rank correlation analysis to compare the airborne exposure levels with corresponding blood lead levels according to occupation.

RESULTS

A total of 35 425 workers who both wore air samplers for lead and underwent special health examinations for lead were extracted between 2019 and 2021. An occupation-based exposure matrix was developed to evaluate the intensity of lead exposure across a range of occupations, encompassing 51 minor occupations and 70-unit occupations. Rank correlation analyses showed strong positive correlations between airborne lead and blood lead measurements according to occupation.

CONCLUSIONS

Our study findings suggest that combining 2 nationwide surveillance databases can be an effective approach for creating an occupation-based exposure matrix. However, our results also highlight several limitations that need to be addressed in future studies to improve the accuracy and reliability of such matrices.

Assessment of Occupational Health Risks for Maintenance Work in Fabrication Facilities: Brief Review and Recommendations

Background

This study focuses on assessing occupational risk for the health hazards encountered during maintenance works (MW) in semiconductor fabrication (FAB) facilities.

Objectives

The objectives of this study include: 1) identifying the primary health hazards during MW in semiconductor FAB facilities; 2) reviewing the methods used in evaluating the likelihood and severity of health hazards through occupational health risk assessment (OHRA); and 3) suggesting variables for the categorization of likelihood of exposures to health hazards and the severity of health effects associated with MW in FAB facilities.

Methods

A literature review was undertaken on OHRA methodology and health hazards resulting from MW in FAB facilities. Based on this review, approaches for categorizing the exposure to health hazards and the severity of health effects related to MW were recommended.

Results

Maintenance workers in FAB facilities face exposure to hazards such as debris, machinery entanglement, and airborne particles laden with various chemical components. The level of engineering and administrative control measures is suggested to assess the likelihood of simultaneous chemical and dust exposure. Qualitative key factors for mixed exposure estimation during MW include the presence of safe operational protocols, the use of air-jet machines, the presence and effectiveness of local exhaust ventilation system, chamber post-purge and cooling, and proper respirator use. Using the risk (R) and hazard (H) codes of the Globally Harmonized System alongside carcinogenic, mutagenic, or reprotoxic classifications aid in categorizing health effect severity for OHRA.

Conclusion

Further research is needed to apply our proposed variables in OHRA for MW in FAB facilities and subsequently validate the findings.

Evaluation of Temporal Trends of Lead Exposure in Korean Workers Using Workplace Monitoring Data

BACKGROUND

Lead, which is widely used in various industrial settings, is a major health hazard for manufacturing workers. Therefore, control of lead exposure has been implemented in an effort to prevent lead-related health problems. In this study, our aim was to evaluate temporal trends in occupational lead exposure in Korean lead workers using data from monitoring of workplace exposure.

METHODS

A nationwide work environment monitoring database, data from a work environment monitoring institution, and data extracted from a review paper were utilized. Different versions of standard industrial classification codes were aligned with the 10th Korean Standard Industrial Classification, which is generally consistent with the 4th revision of the International Standard Industrial Classification. The multiple data sources were combined and temporal trends over the period from 1994-2021 were estimated. In addition, separate estimation of temporal trends in the storage battery manufacturing industry over the period from 1987-2021 was also performed.

RESULTS

A total of 444,296 personal airborne lead measurements were used for the estimation process. The temporal trends in occupational exposure to lead declined by -6% annually over the study period. In particular, levels of lead exposure in the storage battery manufacturing industry showed a steeper decline of -12% annually.

CONCLUSIONS

Findings of our study showed that occupational exposure to lead declined over the period from 1994 to 2021 in Korea. However, adverse effects of exposure to lead on health should be regarded with caution. The results will be useful in conduct of epidemiological studies examining lead-related effects on health.

Characteristics of Peak Exposure of Semiconductor Workers to Extremely Low-Frequency Magnetic Fields

OBJECTIVES

Peak exposure to extremely low-frequency magnetic fields (ELF-MF) among semiconductor workers was characterized by type of factory, operation, and job.

METHODS

A portable EMDEX meter was used to monitor the ELF-MF exposure of 117 semiconductor workers who are involved in wafer fabrication (fab) and assembly operations. ELF-MF measurements were logged every 3 s and categorized by process and job or activity during working hours. Two values of 0.5 and 1 μT were adopted subjectively as cutoff values of peak exposure levels based on a literature review.

RESULTS

All semiconductor workers who were involved in diffusion, ion implanter operation, module, and chip test were exposed to ELF-MF higher than 0.5 μT during their entire working time. Engineers who maintained electric facilities in the semiconductor operations were exposed to the highest ELF-MF peak levels (2.5 μT on average above 0.5 μT and 3.6 μT on average above 1 μT). Operators working in chip testing showed the highest daily contribution of their peak levels to their daily average ELF-MF exposure levels (98.1% and 83.9%). In contrast, chemical mechanical planarization engineers, wafer test operators, and administrative workers outside clean rooms showed average exposure to less than 0.5 μT and a low proportion of duration of time exposed above either the 0.5 μT or 1 μT peak level points, along with a low daily contribution of peak exposure levels (16.0, 11.9, and 18.7%).

CONCLUSIONS

Most of the activities and working locations next to machines generating ELF-MF in semiconductor operations showed high contributions of ELF-MF peak exposure to daily exposure dose despite their relative minor fraction of workers' daily time.

Characteristics of workers' compensation claim applications for COVID-19 infections in South Korea

This study aimed to identify the major industries and jobs with the highest proportion of workers' compensation (WC) claims for COVID-19, characterize COVID-19 WC claims in terms of their demographic properties and disease severity, and identify factors influencing the approval of COVID-19 WC claims as occupational disease. A total of 488 workers who submitted COVID-19-related claims to the Korea Workers' Compensation and Welfare Service (KWCWS) from January 2020 to July 2021 were analyzed. A Fisher's exact test was employed to associate the severity of COVID-19 infection with demographic properties. The highest proportion of all COVID-19 WC claims compensated as occupational disease (N=462) were submitted by healthcare workers (HCW=233, 50%), while only 9% (N=41) of the total originated from manufacturing industries. The 5% (N=26) of the COVID-19 WC claims accepted were evaluated as severe (N=15) and acute respiratory distress syndrome (N=9). A total of 71% (N=329) of the COVID-19 patients compensated (N=462) were from workplaces with infection clusters. A total of 26 WC cases were rejected for various reasons, including unclear infection routes, infection at private gatherings (including within families), no diagnosis, and more. Given our findings, we suggest an official system should be established to detect and compensate more job-associated infectious diseases like COVID-19.

Characteristics of COVID-19 infection clusters occurring among workers in several Asia-Pacific countries

The types of workplaces and occupations with coronavirus 2019 (COVID-19) clusters vary between countries and periods. We aimed to characterize major occupational groups with mass outbreaks of COVID-19 infections in several Asia-Pacific countries. Data on the major occupations or workplaces reporting COVID-19 cases in workplaces from January 2020 to July 2021 was collected from industrial hygiene professionals in nine countries. The proportion of workers accounted for 39.1 to 56.6% of the population in each country. The number of workers covered in the national statistics varies among nations based on their definition of a worker. None of the countries examined here have systematically collected occupational data on COVID-19 illnesses and deaths classified by type of industry, occupation, or job. Most countries experienced COVID-19 clusters among health and social care workers (HSCW) in hospitals or long-term care facilities. The types of occupations or workplaces with virus clusters in some participating countries included prisons, call centers, workplaces employing immigrants, garment facilities, grocery stores, and the military, which differed among countries, except for a few common occupations such as HSCW and those populated by immigrants. Further study is necessary in order to seek ways to control infection risks, including revisions to industrial-health-related laws.

Two Semiconductor Companies' Financial Support Compensation (FSC) Programs for Semiconductor Workers with Suspected Work-Related Diseases (WRDs)

This study described two companies’ financial compensation programs for semiconductor workers with suspected work-related diseases (WRDs) and discussed the major related issues. The key contents of the programs found on the websites opened by two semiconductor companies (Samsung and SK Hynix) were cited. In order to select the suspected WRDs for the FSC, all available epidemiologic studies related to health problems conducted in the semiconductor industry were reviewed. Most program contents are similar, although the amount of financial compensation and a few types of disease available for compensation differ between the companies. The group of cancer, rare disease, childhood rare disease among children born to semiconductor workers (hereafter selected diseases among offspring), and fetal loss, including spontaneous abortion (SAB) and stillbirth, were considered for compensation. An employment duration of longer than one year on a semiconductor production line is required for FSC for cancer or rare disease. The FSC for SAB and offspring disease require a period of employment longer than one month, either before three months prior to conception or between conception and childbirth. The maximum amount of compensation per type of cancer and rare disease was fixed based on the medical treatment fee. The FSC programs of the two companies have been operated successfully to date. These programs are arguably considered to contribute to resolving the conflict between companies and workers with WRDs.

Review of Inhalation Health Risks Involving Chloromethylisothiazolinone (CMIT) and Methylisothiazolinone (MIT) Used as Disinfectants in Household Humidifiers

The association between lung injury and exposure to humidifier disinfectant (HD) containing a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) has been controversial in South Korea. This study conducts a literature review in order to evaluate the likelihood of CMIT/MIT reaching the lower part of the respiratory tract and causing lung injury. A literature review focused on the inhalation risk of HD containing a mixture of CMIT and MIT. The major contents included the physicochemical properties of CMIT and MIT contained in HDs and methodological reviews on substance analysis, toxicity tests and clinical cases. HD products marketed in South Korea have been reported to contain approximately 1-2% CMIT and 0.2-0.6% MIT along with magnesium nitrate (20-25%), magnesium chloride (0.2-1.0%), and water (70-75%). The types of CMIT and MIT dispersed into the air and deposited in the respiratory tract are assumed to be either gaseous substances or nanoparticles mixed with magnesium salts. The result of the literature review including clinical cases of lung injury among CMIT/MIT HD product users, demonstrated that these chemicals likely reach the lower respiratory tract and accordingly cause lung injury. A number of humidifier disinfectant-associated lung injury cases with clinical evidence should be prioritized in risk assessment of HD containing CMIT and MIT, even though there might be insufficient evidence in all related areas, including inhalation exposure assessment studies, animal testing, and epidemiological studies.

Screw-and-cement–retained prosthesis versus cement-retained prosthesis: Which is more appropriate for the upper premolar area?

Background/purpose

The narrow alveolar ridge in the maxillary premolars area limits the angle of implant placement and the shape of the prosthesis. The aim of this study was to evaluate which implant prosthesis, screw-and-cement-retained prosthesis (SCRP) or cement-retained prosthesis (CRP), was more suitable for the maxillary premolar area.

Materials and methods

We conducted virtual implantation on 58 implant images from 47 patients obtained using cone beam computed tomography (CBCT). The width and buccal inclination of the alveolar bone, the angulation of the implant fixture, and the angulation of abutment were measured and calculated.

Results

We determined that SCRP was feasible in 52% and 78.8% of first and second premolar areas, respectively. There was a positive relationship between the feasibility of SCRP and the premolar region in general (P = 0.031), although SCRP was more likely to be a possibility in the second premolar area. On multiple logistic regression analysis, the difference in the angle between the axis of the prosthesis and the axis of the alveolar bone (RA) was significantly associated with the type of prosthesis (P = 0.001). The RA was significantly higher for CRP implants (OR = 1.885; 95% CI: 1.31 to 2.70).

Conclusion

SCRP is not always feasible in the maxillary premolar area, especially in the first premolar area. If the difference between the angle of the axis of the prosthesis and the axis of the alveolar bone is large, it may be necessary for the clinician to consider CRP in the treatment planning stage.

Vehicle Load Estimation Using the Reaction Force of a Vertical Displacement Sensor Based on Fiber Bragg Grating

Accurately calculating the vehicle load acting on a bridge at any one time is crucial to determining the integrity and safety of the bridge. To ensure this integrity and safety, information on the types, characteristics, and load of vehicles that regularly cross the bridge is very important in terms of its structural adequacy and maintenance. In this study, the vehicle load that a bridge will be subjected to was estimated using the reaction force response at the support. To estimate this response to the reaction force, a vertical displacement sensor, developed based on Fiber Bragg Grating (FBG), was applied to the Eradi Quake System (EQS), a commercially available bridge bearing. This vertical displacement sensor can measure the vertical load and has the advantage of being easy to attach and detach. To verify the performance and accuracy of this sensor, this study conducted numerical analysis and vehicle loading tests. It found that the vehicle load can be estimated from the reaction force response, as measured by the vertical displacement sensor on the bridge.

Correlation between levels of airborne endotoxin and heavy metals in subway environments in South Korea

This study aimed to evaluate the exposure levels and variation in airborne endotoxin and heavy metals such as aluminum, chromium (Cr), iron (Fe), manganese (Mn), nickel (Ni), zinc, and lead (Pb) in the three different South Korean subway environments (driver room, station office, and underground tunnel) and identify subway characteristics influencing endotoxin and heavy metals levels. Air samples were collected and analyzed using the kinetic Limulus Amebocyte Lysate assay and inductively coupled plasma mass spectrometers. The geometric mean was determined for endotoxin levels (0.693 EU/m³). It was also found that Fe (5.070 µg/m³) had the highest levels in subway environments while Pb (0.008 µg/m³) had the lowest levels. Endotoxin levels were higher in the underground tunnel and lower in the station office; the total heavy metal levels showed the same pattern with endotoxin levels. Endotoxins and total heavy metal levels were higher in the morning than at night. Positive correlations were found between endotoxin and Cr, Fe, Mn, and Ni levels. Given the correlation between airborne endotoxins and heavy metals, further studies with larger sample sizes are needed to identify the correlation between levels of airborne endotoxin and heavy metals.

Recommendation for the establishment of a poison control center at the Korea Disease Control and Prevention Agency

There is currently no governmental body in South Korea resembling the type of poison center (PC) recommended by the World Health Organization (WHO). All Organization for Economic Cooperation and Development (OECD) member countries except for South Korea maintain such a PC tasked with both preventing poisoning accidents and supporting the prompt treatment of poisoned patients. Such a PC could very possibly have allowed the country to more promptly recognize the widespread wave of humidifier disinfectant (HD) associated health effects, including fatal lung injury and death, that lasted started roughly in 2000 and continued through 2011. Despite this chemical poisoning tragedy, South Korea still lacks a surveillance system to monitor health effects caused by the use and consumption of materials that include products containing chemicals, foodborne pathogens, drugs, pesticides, etc. There have been no legal procedures for examining the potential risk of products or materials manufactured by industry. The reporting of national poisoning data or causes of poisoning, which is near ubiquitous in advanced countries with a PC, has not taken place We recommend that a PC should be established within the Korea Disease Control and Prevention Agency (KDCA). In addition, in order to perform surveillance of poisoning cases across the country, a certain number of regional PCs, including at large hospitals, will also be necessary.

Properties of Polyhexamethylene Guanidine (PHMG) Associated with Fatal Lung Injury in Korea

The use of humidifier disinfectant (HD) has been determined to be associated with lung injuries (HDLI) in Korea. Although HD brands containing polyhexamethylene guanidine (PHMG) oligomers have been found to cause more HDLI compared to brands containing other disinfectants, the physicochemical properties of PHMG have been poorly defined. We aimed to quantify the PHMG dissolved in HD brands, characterize the number-average (Mn) and weight-average (Mw) molecular masses, and identify the polymerization degree of PHMG. Analysis of the PHMG oligomers was performed using a matrix-assisted laser desorption/ionization time-of-flight mass spectrometer (MALDI-TOF MS) operated in positive-ion reflectron mode. Eight brands of HD containing PHMG were identified. The PHMG concentrations in these brands ranged from 160 to 37,200 ppm (mean = 3100.9 ppm). Concentration was a significant variable among and within HD brands. The degree of PHMG oligomerization fell within the range of two to four. The averages of Mn and Mw were 517.2 g/mol (range: 422-613 g/mol) and 537.3 g/mol (range: 441.0-678.0 g/mol), respectively. Based on the average molecular weight and the degree of polymerization, the PHMG examined here could be regarded as oligomers, which may be associated with the highest proportion of HDLI being caused by PHMG.

Non-Contact Water Level Response Measurement of a Tubular Level Gauge Using Image Signals

The occurrence of excessive fluid sloshing during an earthquake can damage structures used to store fluids and can induce secondary disasters, such as environmental destruction and human casualties, due to discharge of the stored fluids. Thus, to prevent such disasters, it is important to accurately predict the sloshing behavior of liquid storage tanks. Tubular level gauges, which visually show the fluid level of a liquid storage tank, are easy to install and economical compared to other water level gauges. They directly show the fluid level and can be applied for various fluids because they can be constructed with various materials according to the fluid characteristics and the intended use. Therefore, in this study, the shaking table test was conducted to verify the validity of the method for measuring the water level response of the tubular level gauge installed on a liquid storage tank using image signals. In addition, image enhancement methods were applied to distinguish between the float installed in the tubular level gauge and the gray level of the background.

Family-based case-control study of exposure to household humidifier disinfectants and risk of idiopathic interstitial pneumonia

Background

In Korea, several household humidifier disinfectants (HDs) were clinically confirmed to cause HD-associated lung injury (HDLI). Polyhexamethylene guanidine (PHMG) phosphate is the main ingredient of the HDs found to be associated with lung disease. However, the association of HDs with other interstitial lung disease including idiopathic interstitial pneumonia (IIP) is not clear. We examined the relationship between HD exposure and IIP in a family-based study.

Methods

This case-control study included 244 IIP cases and 244 family controls who lived with the IIP patients. The IIP cases were divided into two groups, HDLI and other IIP, and were matched to family controls based on age and gender. Information on exposure to HDs was obtained from a structured questionnaire and field investigations. Conditional logistic regression was used to estimate odds ratio (ORs) and their corresponding 95% confidence interval (CI), investigating the association of HD-related exposure characteristics with IIP risk.

Results

The risks of IIP increased two-fold or more in the highest compared with the lowest quartile of several HD use characteristics, including average total use hours per day, cumulative sleep hours, use of HD during sleep, and cumulative exposure level. In analyses separated by HDLI and other IIP, the risks of HDLI were associated with airborne HD concentrations (adjusted OR = 3.01, 95% CI = 1.34–6.76; Q₄ versus Q₁) and cumulative exposure level (adjusted OR = 3.57, 95% CI = 1.59–8.01; Q₄ versus Q₁), but this relationship was not significant in the patients with other IIP. In comparison between HDLI and other IIP, the odds ratios of average total use hours, cumulative use hours, and cumulative sleeps hours was higher for other IIP.

Conclusion

The use of household HDs is associated not only with HDLI but also with other IIP.

Humidifier disinfectant and use characteristics associated with lung injury in Korea

Since around the year 2000, hundreds of people in Korea have developed humidifier disinfectant-associated lung injury (HDLI). We collected all HD exposure-related information from the field investigations into the locations in which the 1199 registered patients had used HD. Among the people who registered, 38% (1st round = 214, 2nd = 73, 3rd = 166) were confirmed as HDLI patients. Children aged under eight years old made up the highest proportion of HDLI cases (N = 279, 62%), followed by pregnant women (N = 31, 7%). One hundred thirty-three (29%) of the confirmed HDLI patients died. Fifty-seven percent of HDLI patients (N = 259) developed HDLI after <1 year of HD use. The number of HDLI patients who used only the Oxy Saksak HD brand was found to be 176 (39%), followed by the brands Cefu (N = 27, 6%) and Aekyung (N = 22, 5%). HD products containing only polyhexamethylene guanidine phosphate (PHMG-P) were the most frequently used among HDLI patients (N = 234, 52%), followed by oligo (2-(2-ethoxy)ethoxyethyl) guanidinium (PGH) (N = 27, 6%) and a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (N = 26, 6%). The average PHMG-P inhalation level estimated from the patient group classified as suffering lung injury definitely associated with HD use was 145.1 μg/m³ (N = 91, SD = 395.1 μg/m³ ), higher than levels estimated from both the probable and possible HDLI patient groups. In conclusion, HD exposure-related variables, including type of HD brand and estimated inhalation HD level, were associated with the risk of HDLI.

Characterization of Levels of Extremely Low Frequency Magnetic Fields Emitted From Portable Hand-Held Fans

This study aims to assess the levels of extremely low frequency magnetic fields (ELF-MF) emitted from portable hand-held fans (HHFs) and their principal frequency and to identify factors influencing these levels. We collected a total of eleven models of HHF and monitored the ELF-MF as a function of fan speed and distance from the fan. EMDEX II was used to monitor the ELF-MF. An SMP2 EMF-meter equipped with a P400 field probe was used to determine the levels of ELF-MF and the frequency spectrum. Ten of the fans, excluding only one bladeless-fan model, emitted a high level of ELF-MF near the source of the HHF direct-current motor. The maximum measured level of ELF-MF ranged from 14.07 to 218.7 µT. All measurements of the ELF-MF taken within 10 cm from the HHFs showed values higher than 1.0 µT. ELF-MF levels were found to decrease markedly with distance, regardless of the HHF product. The level of ELF-MF rose noticeably with increased fan speed. The speed of and distance from the HHF significantly influenced the level of ELF-MF. All principal frequencies ranged from 1 to 300 Hz, which falls in the typical range of ELF. Bioelectromagnetics. 2019;40:569-577. © 2019 Bioelectromagnetics Society.

Estimation of Lead Exposure Prevalence in Korean Population through Combining Multiple Experts' Judgment based on Objective Data Sources

Objective

Estimating carcinogen exposure prevalence is important for preventing occupational cancers. To develop the Korean version of CARcinogen EXposure (CAREX), a carcinogen surveillance system used in many countries, we estimated lead exposure prevalence in the Korean working population.

Methods

We used three Korean nationwide data sources to obtain objective database-derived prevalences of lead exposure across industries: airborne lead measurement data from the work environment measurement database (WEMD), blood lead measurement data from the special health examination database (SHED), and lead exposure prevalence computed using data from the work environment condition survey (WECS), which is a nationwide occupational exposure survey. We also asked a panel of 52 experts with ≥20 years of experience in industrial hygiene practice for their judgment about lead exposure prevalence across industries after they reviewed the database-derived prevalences computed from the three exposure databases. We developed and compared various estimation methods for combining the experts' judgments. The 2010 census was used as the reference population to estimate the number of lead-exposed workers in 228 industries by multiplying the exposure prevalence by the number of workers in each industry.

Results

The database-derived prevalences of lead exposure in the 228 industries were calculated using data collected between 2009 and 2011 from the WEMD and SHED and from the 2009 WECS. From the various estimation methods assessed, the median values of experts' responses were selected as our estimates of lead exposure prevalence in each industry. As a result, it was estimated that 129,250 Korean workers were exposed to lead in 2010.

Conclusions

Based on objective databases, we developed a method for estimating exposure prevalence for the CAREX system by combining experts' judgments. This work may offer an unbiased approach to the development process that accounts for the uncertainty in exposure.

Combining Lead Exposure Measurements and Experts' Judgment Through a Bayesian Framework

Objectives

CARcinogen EXposure (CAREX) is a carcinogen-surveillance system employed in many countries. To develop Korean CAREX, the intensity of exposure to lead, as an example, was estimated across industries.

Methods

Airborne-lead measurement records were extracted from the work-environment measurement database (WEMD), which is a nationwide workplace-monitoring database. Lead measurements were log-transformed; then, the log-transformed geometric means (LGMs) and log-transformed geometric standard deviations (LGSDs) were calculated for each industry. However, the data of many industries was limited. To address this shortcoming, experts' judgments of the lead exposure levels across industries were elicited. Experts provided their estimates of lead exposure levels as the boundary of the 5th and 95th percentiles, and it is assumed that these estimates are based on the log-normal distributions of exposure levels. Estimates of LGM and LGSD were extracted from each expert's response and then combined to quantify the experts' prior distribution. Then, the experts' prior distributions for each industry were updated with the corresponding LGMs and LGSDs calculated from the WEMD data through a Bayesian framework, yielding posterior distributions of the LGM and LGSD.

Results

The WEMD contains 83035 airborne-lead measurements that were collected between 2002 and 2007. A total of 17 occupational-hygiene professionals with >20 years of experience provided lead exposure estimates. In industries where measurement data were abundant, the measurement data dominated the posterior exposure estimates. For example, for one industry, 'Manufacture of Accumulator, Primary Cells, and Primary Batteries,' 1152 lead measurements [with a geometric mean (GM) of 14.42 µg m-3 and a geometric standard deviation (GSD) of 3.31] were available and 15 experts' responses (with a GM of 7.06 µg m-3 and a GSD of 4.15) were collected, resulting in a posterior exposure estimate of 14.41µg m-3 as the GM with a GSD of 3.31. For industries with a limited number of measurements available in the WEMD, experts' decisions played a significant role in determining the posterior exposure estimates. For example, for the 'Manufacture of Weapons and Ammunition' industry, 15 lead measurements (with a GM of 6.45 µg m-3 and a GSD of 3.37) were available and seven experts' responses (with a GM of 3.28 µg m-3 and a GSD of 4.54) were obtained, resulting in a posterior exposure estimate of 5.42 µg m-3 as the GM with a GSD of 3.73.

Conclusions

The proposed method for estimating the intensity of exposure to carcinogens may introduce an unbiased approach to the development process by simultaneously utilizing both prior knowledge of experts and measurement data. In addition, it supplies a framework for future updates.

Association of high-level humidifier disinfectant exposure with lung injury in preschool children

BACKGROUND

Children aged ≤6years reportedly account for 52% of victims of humidifier disinfectant-associated lung injuries.

OBJECTIVES

To evaluate the association of humidifier disinfectants with lung injury risk among children aged ≤6years.

METHODS

Patients with humidifier disinfectant-associated lung injuries (n=214) who were clinically evaluated to have a definite (n=108), probable (n=49), or possible (n=57) association with humidifier disinfectants as well as control patients (n=123) with lung injury deemed unlikely to be associated with humidifier disinfectant use were evaluated to determine factors associated with increased risk of humidifier disinfectant-associated lung injury using unconditional multiple logistic regression analysis.

RESULTS

For estimated airborne humidifier disinfectant concentrations, risk of humidifier disinfectant-associated lung injury increased ≥two-fold in a dose-dependent manner in the highest quartile (Q4, 135-1443μg/m³) compared with that in the lowest quartile (Q1, ≤33μg/m³). Registered patients using more than two humidifier disinfectant brands were at an increased risk of humidifier disinfectant-associated lung injury (adjusted OR, 2.2; 95% confidence interval, 1.3-3.8) compared with those using only one brand. With respect to the duration of humidifier disinfectant use, risk of humidifier disinfectant-associated lung injury increased ≥two-fold in the lowest quartile (≤5months) compared with that in the highest quartile (≥14months; adjusted OR 0.3; 95% confidence interval, 0.2-0.6).

CONCLUSIONS

Younger children are more vulnerable to HDLI when exposed to HD chemicals within short period in early life.

Types of household humidifier disinfectant and associated risk of lung injury (HDLI) in South Korea

From 2002 through 2015, hundreds of people died of fatal lung injuries associated with the use of humidifier disinfectants (HDs) in Korea. Several chemical disinfectants used for household humidifiers were later clinically confirmed to cause HD-associated lung injury (HDLI). The aim of this study is to evaluate the registered lung disease cases and to compare the distribution of HDLI patients, including deaths, by HD use characteristics including types of HD and HD brands categorized by age group. A total of 530 registered were clinically examined through two rounds of investigations conducted from July 2013 until April 2015. Information on HD use was obtained from a structured questionnaire and home investigations. Approximately one-half of the patients (n=221) were clinically confirmed to be associated with the use of HDs. Pregnant women (n=35, 16%) and pre-school children≤6years old (n=128, 58%) accounted for most of the HD-associated lung injury patients (n=163, 74%). Sixty-seven percent of HDLI patients developed HDLI after less than one year of HD use. HD products containing polyhexamethylene guanidine phosphate (PHMG) were the most frequently used among confirmed HDLI patients (n=123, 55.7%), followed by oligo (2-(2-ethoxy) ethoxyethyl guanidinium (PGH) (n=24, 10.9%) and a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (n=3, 1.4%). Other HDs did not appear to be linked to HDLI. The majority of the HDLI patients (n=85, 38.5%) was found to use only Oxy Saksak® products containing PHMG. The development of HDLI was clinically found to be associated with the use of several HD products containing PHMG and PGH, and to lesser extent, CMIT/MIT.

Effects of a mixture of chloromethylisothiazolinone and methylisothiazolinone on peripheral airway dysfunction in children

BACKGROUND

Children who were only exposed to a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) as humidifier disinfectant (HD) components were evaluated for humidifier disinfectant-associated lung injury (HDLI) from 2012. This study was to evaluate the pulmonary function using, impulse oscillometry (IOS) for children exposed to a mixture of CMIT/MIT from HD.

METHODS

Twenty-four children who were only exposed to a mixture of CMIT/MIT, with no previous underlying disease, were assessed by IOS. Diagnostic criteria for HDLI were categorized as definite, probable, possible, or unlikely. Home visits and administration of a standardized questionnaire were arranged to assess exposure characteristics.

RESULTS

Definite and probable cases showed higher airborne disinfectant exposure intensity during sleep (32.4 ± 8.7 μg/m3) and younger age at initial exposure (3.5 ± 3.3 months) compared with unlikely cases (17.3 ± 11.0 μg/m3, p = 0.026; 22.5 ± 26.2 months, p = 0.039, respectively). Reactance at 5 Hz was significantly more negative in those with high-density exposure during sleep (mean, -0.463 kPa/L/s vs. low density, -0.296, p = 0.001). The reactance area was also higher with high-density exposure during sleep (mean, 3.240 kPa/L vs. low density, 1.922, p = 0.039). The mean bronchodilator response with high-density exposure was within the normal range for reactance.

CONCLUSIONS

Significant peripheral airway dysfunction were found in children with high levels of inhalation exposure to a mixture of CMIT/MIT during sleep. Strict regulation of a mixture of CMIT/MIT exposure were associated with positive effects on lung function of children.

Estimating retrospective exposure of household humidifier disinfectants

We conducted a comprehensive humidifier disinfectant exposure characterization for 374 subjects with lung disease who presumed their disease was related to humidifier disinfectant use (patient group) and for 303 of their family members (family group) for an ongoing epidemiological study. We visited the homes of the registered patients to investigate disinfectant use characteristics. Probability of exposure to disinfectants was determined from the questionnaire and supporting evidence from photographs demonstrating the use of humidifier disinfectant, disinfectant purchase receipts, any residual disinfectant, and the consistency of their statements. Exposure duration was estimated as cumulative disinfectant use hours from the questionnaire. Airborne disinfectant exposure intensity (μg/m(3)) was estimated based on the disinfectant volume (ml) and frequency added to the humidifier per day, disinfectant bulk level (μg/ml), the volume of the room (m(3)) with humidifier disinfectant, and the degree of ventilation. Overall, the distribution patterns of the intensity, duration, and cumulative exposure to humidifier disinfectants for the patient group were higher than those of the family group, especially for pregnant women and patients ≤6 years old. Further study is underway to evaluate the association between the disinfectant exposures estimated here with clinically diagnosed lung disease.

PRACTICAL IMPLICATIONS

Retrospective exposure to household humidifier disinfectant as estimated here can be used to evaluate associations with clinically diagnosed lung disease due to the use of humidifier disinfectant in Korea. The framework, with modifications to account for dispersion and use patterns, can also be potentially adapted to assessment of other household chemical exposures.

Association of cadmium with diabetes in middle-aged residents of abandoned metal mines: the first health effect surveillance for residents in abandoned metal mines

OBJECTIVE

The aim of this study was to determine the association between urinary cadmium (U-cd) concentration and diabetes in middle-aged Korean residents of abandoned mines using the first Health Effect Surveillance for Residents in Abandoned Metal mines (HESRAM).

METHODS

This study was cross-sectional study conducted on 719 residents between 40-70 years in 38 abandoned metal mines in Korea. Data was collected by HESRAM from 2008 to 2011. The correlation coefficient of U-cd and fasting blood glucose, odds ratio in urinary cadmium tertiles and diabetes prevalence was analyzed according to the sex category.

RESULTS

The correlation coefficient U-cd concentration and fasting blood glucose was 0.182 in male. Logistic regression analysis in male revealed a third tertile odds ratio of U-cd (2 μg/g creatinine < U-cd) while diabetes prevalence was 1.81 (95 % CI 1.05-3.12) with adjusted age, BMI, smoking and alcohol consumption, region, family income. On the other hand, the odds ratio for third tertile of U-cd (3 μg/g creatinine < U-cd) between diabetes prevalence in female was 1.39 (95 % CI 0.52-3.72) in addition to adjusted menopausal status.

CONCLUSIONS

Environmental exposure to cadmium in abandoned mine residents was associated with diabetes in male. Closed monitoring and periodic evaluation of the health effects of chronic environmental exposure on abandoned mines residents will be needed.

Occupational Exposure to Diesel Particulate Matter in Municipal Household Waste Workers

OBJECTIVE

The purposes of this study were to determine the following: 1) the exposure levels of municipal household waste (MHW) workers to diesel particulate matter (DPM) using elemental carbon (EC), organic carbon (OC), total carbon (TC), black carbon (BC), and fine particulate matter (PM 2.5) as indicators; 2) the correlations among the indicators; 3) the optimal indicator for DPM; and 4) factors that influence personal exposure to DPM.

METHODS

A total of 72 workers in five MHW collection companies were assessed over a period of 7 days from June to September 2014. Respirable EC/OC samples were quantified using the thermal optical transmittance method. BC and PM 2.5 were measured using real-time monitors, an aethalometer and a laser photometer. All results were statistically analyzed for occupational and environmental variables to identify the exposure determinants of DPM.

RESULTS

The geometric mean of EC, OC, TC, BC and PM 2.5 concentrations were 4.8, 39.6, 44.8, 9.1 and 62.0 μg/m3, respectively. EC concentrations were significantly correlated with the concentrations of OC, TC and BC, but not with those of PM 2.5. The exposures of the MHW collectors to EC, OC, and TC were higher than those of the drivers (p<0.05). Workers of trucks meeting Euro 3 emission standard had higher exposures to EC, OC, TC and PM 2.5 than those working on Euro 4 trucks (p<0.05). Multiple regression analysis revealed that the job task, European engine emission standard, and average driving speed were the most influential factors in determining worker exposure.

CONCLUSIONS

We assessed MHW workers' exposure to DPM using parallel sampling of five possible indicators. Of these five indicators, EC was shown to be the most useful indicator of DPM exposure for MHW workers, and the job task, European emission standard, and average driving speed were the main determinants of EC exposure.

Relationship between Exposure to Household Humidifier Disinfectants and Risk of Lung Injury: A Family-Based Study

Background

In South Korea, a cluster of acute lung disease patients included lung injury disease suspected of being caused by the use of humidifier disinfectants. We examined the relationship between humidifier disinfectant exposure and clinically diagnosed humidifier disinfectant-associated lung injury (HDLI) in a family-based study.

Methods

This case-control study included 169 clinically confirmed HDLI cases and 303 family controls who lived with the HDLI patients. A range of information on exposure to humidifier disinfectants was obtained using a structured questionnaire and field investigations. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression models that were adjusted for age, sex, presence of a factory within 1 km of residence, and the number of household chemical products used.

Results

HDLI risk increased approximately two-fold or more among the highest quartile compared with the lowest quartile in terms of the hours sleeping in a room with an operating humidifier treated with disinfectant (adjusted OR = 2.0, 95 % CI = 1.1-3.7), average hours of disinfectant-treated humidifier use per day (adjusted OR = 2.1, 95 % CI = 1.0-4.5), airborne disinfectant intensity (adjusted OR = 2.6, 95% CI = 1.2-5.3), and cumulative disinfectant inhalation level (adjusted OR = 2.0, 95% CI = 1.0-4.1). HDLI risk increased as the distance of the bed from humidifier gets shorter; compared with longer distance (> 1 m), the odds ratio was 2.7 for 0.5 to 1 m (95 % CI = 1.5-5.1) and 13.2 for <0.5 m (95 % CI = 2.4-73.0).

Conclusions

The use of household humidifier disinfectants was associated with HDLI risk in a dose-response manner.

Blood levels of cadmium and lead in residents near abandoned metal mine areas in Korea

We analyzed national data on blood lead levels (BLL) and blood cadmium levels (BCL) in residents living near 38 abandoned metal mining areas (n = 5,682, 18-96 years old) in Korea that were collected by the first Health Effect Surveillance for Residents in Abandoned Metal mines (HESRAM) from 2008 to 2011. The geometric mean BCL and BLL were 1.60 μg/L (95 % CI = 1.57-1.62 μg/L) and 2.87 μg/dL (95 % CI = 2.84-2.90 μg/dL), respectively, notably higher than levels in the general population in Korea and other countries. We found significantly higher BLL and BCL levels in people living within 2 km of an abandoned metal mine (n = 3,165, BCL = 1.87 μg/L, BLL = 2.91 μg/dL) compared to people living more than 2 km away (n = 2,517, BCL = 1.31 μg/L, BLL = 2.82 μg/dL; P < 0.0001) and to the general population values reported in the literature.

Developing estimates of frequency and intensity of exposure to three types of metalworking fluids in a population-based case-control study of bladder cancer

BACKGROUND

A systematic, transparent, and data-driven approach was developed to estimate frequency and intensity of exposure to straight, soluble, and synthetic/semi-synthetic metalworking fluids (MWFs) within a case-control study of bladder cancer in New England.

METHODS

We assessed frequency using individual-level information from job-specific questionnaires wherever possible, then derived and applied job group-level patterns to likely exposed jobs with less information. Intensity estimates were calculated using a statistical model developed from measurements and determinants extracted from the published literature.

RESULTS

For jobs with probabilities of exposure≥0.5, median frequencies were 8-10 hr/week, depending on MWF type. Median intensities for these jobs were 2.5, 2.1, and 1.0 mg/m3 for soluble, straight, and synthetic/semi-synthetic MWFs, respectively.

CONCLUSIONS

Compared to case-by-case assessment, these data-driven decision rules are transparent and reproducible and may result in less biased estimates. These rules can also aid future exposure assessments of MWFs in population-based studies.

Estimation of the probability of exposure to machining fluids in a population-based case-control study

We describe an approach for estimating the probability that study subjects were exposed to metalworking fluids (MWFs) in a population-based case-control study of bladder cancer. Study subject reports on the frequency of machining and use of specific MWFs (straight, soluble, and synthetic/semi-synthetic) were used to estimate exposure probability when available. Those reports also were used to develop estimates for job groups, which were then applied to jobs without MWF reports. Estimates using both cases and controls and controls only were developed. The prevalence of machining varied substantially across job groups (0.1->0.9%), with the greatest percentage of jobs that machined being reported by machinists and tool and die workers. Reports of straight and soluble MWF use were fairly consistent across job groups (generally 50-70%). Synthetic MWF use was lower (13-45%). There was little difference in reports by cases and controls vs. controls only. Approximately, 1% of the entire study population was assessed as definitely exposed to straight or soluble fluids in contrast to 0.2% definitely exposed to synthetic/semi-synthetics. A comparison between the reported use of the MWFs and U.S. production levels found high correlations (r generally >0.7). Overall, the method described here is likely to have provided a systematic and reliable ranking that better reflects the variability of exposure to three types of MWFs than approaches applied in the past. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a list of keywords in the occupational histories that were used to link study subjects to the metalworking fluids (MWFs) modules; recommendations from the literature on selection of MWFs based on type of machining operation, the metal being machined and decade; popular additives to MWFs; the number and proportion of controls who reported various MWF responses by job group; the number and proportion of controls assigned to the MWF types by job group and exposure category; and the distribution of cases and controls assigned various levels of probability by MWF type.].

Assessment of noise measurements made with a continuous monitoring in time

The World Health Organization has stated that hearing loss is one of the top 10 health problems worldwide and that noise-induced hearing loss is the leading occupational disease. This work evaluated the noise exposure levels of several job categories for 24-h periods over 7 days to determine the contribution of each microenvironment to total noise exposure. The noise exposure levels of 47 individuals were continuously measured using personal noise dosimeters in metropolitan Seoul, Korea. Participants ranged in age from 20 to 50 yr and represented eight occupational groups. Participants were asked to attach the noise dosimeters and complete a time-activity diary 24 h a day for 7 days. The average Leq 24 h,w among these individuals was 74 dBA, which ranged from 64 to 96 dBA. The average Leq 24 h,w was highest for Korean traditional music apprentices, followed by heavy equipment operators, firefighters, service workers, office workers, industrial hygienists, graduate and undergraduate students, and housewives (89, 77, 76, 76, 75, 71, 71, and 71 dBA, respectively, p < 0.001). 38 (80.9%) were exposed to noise levels greater than 70 dBA, which corresponds to the World Health Organization's exposure limit.

Assessment of the levels of airborne bacteria, Gram-negative bacteria, and fungi in hospital lobbies

Aims: We assessed the levels of airborne bacteria, Gram-negative bacteria (GNB), and fungi in six hospital lobbies, and investigated the environmental and hospital characteristics that affected the airborne microorganism levels. Methods: An Andersen single-stage sampler equipped with appropriate nutrition plate agar was used to collect the samples. The three types of microorganisms were repeatedly collected at a fixed location in each hospital (assumed to be representative of the entire hospital lobby) from 08:00 through 24:00, with a sampling time of less than 5 min. Temperature and relative humidity were simultaneously monitored. Results: Multiple regression analysis was used to identify the major factors affecting microorganism levels. The average levels of bacteria (7.2 × 10² CFU/m³), GNB (1.7 × 10 CFU/m³), and fungi (7.7 × 10 CFU/m³) indicated that all hospital lobbies were generally contaminated. Season was the only factor that significantly affected the levels of all microorganisms (p < 0.0001), where contamination was the highest during the summer, significantly higher than during the winter. Other significant factors varied by microorganism, as follows: airborne bacteria (number of people in the lobby, sampling time), GNB (scale of hospital), and fungi (humidity and air temperature). Conclusions: Hospital lobby air was generally contaminated with microorganisms, including bacteria, GNB, and fungi. Environmental factors that may significantly influence the airborne concentrations of these agents should be managed to minimize airborne levels.

An assessment of dust, endotoxin, and microorganism exposure during waste collection and sorting

This study was conducted to assess inhalation exposure to dust, endotoxin, and microorganisms (including viable bacteria, Gram-negative bacteria [GNB], and fungi) during waste collection and sorting; to identify factors affecting this exposure; and to estimate the gastrointestinal exposure to microorganisms. A total of 48 or 49 workers involved in collecting and sorting waste from households or the street were studied. Each worker carried two personal samplers in which filters were placed in the breathing zone for estimation of inhalation exposure. To assess the possibility of gastrointestinal exposure, microorganisms on the workers' faces were collected before and after work and compared with those collected from office workers. Inhalation exposure levels were categorized according to job title, waste type handled, and working conditions and were compared using analysis of variance. Multiple regression models were developed to identify those factors that substantially affected inhalation exposure. The average exposure level to total dust was 0.9 mg/m3 (range = 0.05 to 4.51 mg/m3), and the average exposure to endotoxin was 1123 EU/m3. The average respective exposure levels to bacteria, GNB, and fungi each exceeded 10(4) colony forming units (CFU)/m3. The multiple regression models found several factors that significantly explained the variation in levels of inhalation exposure to endotoxin and microorganisms; namely, sex (dust, bacteria, and GNB), job title (GNB and fungi), collection day (dust, bacteria, and GNB), temperature (endotoxin and GNB), humidity (endotoxin and fungi), and region (endotoxin) were significantly associated with exposure to these agents. In addition, the workers' faces were highly contaminated with microorganisms. In conclusion, inhalation exposure to endotoxin and microorganisms was high during waste collection and sorting, which may place workers at risk of developing various health problems, including respiratory complaints.

A survey for rhinitis in an automotive ring manufacturing plant

We report findings regarding otolaryngologist-confirmed rhinitis, current exposure to MWF aerosols, fungi, and endotoxins for workers in a plant manufacturing automobile piston rings. Questionnaire data showed that 61.5% of 187 workers exhibited rhinitis-related symptoms. Rhinitis was confirmed in 99 of 115 workers whom were medically examined. Otolaryngologist-confirmed rhinitis was present in 10 of 19 grinding workers (52.6%), 67 of 142 production workers (47.2%), and 22 of 26 quality control (QC) workers (84.6%). These rates are much higher than the rates of rhinitis-related symptoms in automobile plants and other occupational settings and quite high even allowing for the common occurrence of rhinitis in the general population. We found that rhinitis could develop even in workers exposed to less than 0.5mg/m(3) MWF aerosol. The average exposure to fungi exceeded 10 x 10(3) CFU/m(3), a level higher than that reported for other automobile plants. Although we were unable to identify significant risk factors for rhinitis using only the physician-confirmed rhinitis cases, this study concludes that exposure to MWF aerosol, which would include microbes and metals, could contribute to a high occurrence of rhinitis in grinding and production workers. Forty-nine workers (63.6%) of 77 rhinitis patients in grinding and production operations were determined to handle synthetic MWF directly. For QC workers, for whom the prevalence of physician-confirmed rhinitis was highest, exposure to a low level of MWF aerosol, including specific microbe species we couldn't identify, bright light, dry air, and certain work characteristics during inspection are possible risk factors for development of rhinitis. Further studies including identification of fungi species should be conducted so a firm conclusion can be made regarding the development of rhinitis in QC manufacturing plant workers.

Characteristics of PM10, PM2.5, CO2 and CO monitored in interiors and platforms of subway train in Seoul, Korea

This study was performed to investigate the concentration of PM(10) and PM(2.5) inside trains and platforms on subway lines 1, 2, 4 and 5 in Seoul, KOREA. PM(10), PM(2.5), carbon dioxide (CO(2)) and carbon monoxide (CO) were monitored using real-time monitoring instruments in the afternoons (between 13:00 and 16:00). The concentrations of PM(10) and PM(2.5) inside trains were significantly higher than those measured on platforms and in ambient air reported by the Korea Ministry of Environment (Korea MOE). This study found that PM(10) levels inside subway lines 1, 2 and 4 exceeded the Korea indoor air quality (Korea IAQ) standard of 150 microg/m(3). The average percentage that exceeded the PM(10) standard was 83.3% on line 1, 37.9% on line 2 and 63.1% on line 4, respectively. PM(2.5) concentration ranged from 77.7 microg/m(3) to 158.2 microg/m(3), which were found to be much higher than the ambient air PM(2.5) standard promulgated by United States Environmental Protection Agency (US-EPA) (24 h arithmetic mean: 65 microg/m(3)). The reason for interior PM(10) and PM(2.5) being higher than those on platforms is due to subway trains in Korea not having mechanical ventilation systems to supply fresh air inside the train. This assumption was supported by the CO(2) concentration results monitored in tube of subway that ranged from 1153 ppm to 3377 ppm. The percentage of PM(2.5) in PM(10) was 86.2% on platforms, 81.7% inside trains, 80.2% underground and 90.2% at ground track. These results indicated that fine particles (PM(2.5)) accounted for most of PM(10) and polluted subway air. GLM statistical analysis indicated that two factors related to monitoring locations (underground and ground or inside trains and on platforms) significantly influence PM(10) (p<0.001, R(2)=0.230) and PM(2.5) concentrations (p<0.001, R(2)=0.172). Correlation analysis indicated that PM(10), PM(2.5), CO(2) and CO were significantly correlated at p<0.01 although correlation coefficients were different. The highest coefficient was 0.884 for the relationship between PM(10) and PM(2.5).

Association between use of synthetic metalworking fluid and risk of developing rhinitis-related symptoms in an automotive ring manufacturing plant

The main objective of this study was to determine the association between synthetic metalworking fluid (MWF) and rhinitis-related symptoms. At a plant manufacturing piston rings for automobiles, we interviewed grinders (19) and manufacturing workers (142) in operations where synthetic or semisynthetic MWF is handled, and administrative office workers (44) regarding the principal symptoms of rhinitis (nasal stuffiness, runny nose, anosmia, nasal itchiness, rhinorrhea, headache, epistaxis, and post-nasal drip). In addition, we assessed the current exposure of workers handling MWF to MWF aerosols, fungi, and endotoxins. Logistic regression analysis was used to examine the association between MWF surrogates indicative of MWF exposure and each rhinitis-related nasal symptom. Odds ratios (ORs) and 95% confidence intervals were adjusted for sex, age, smoking habit, and duration of employment. Among grinders handling synthetic MWF, the frequency of complaints of the dominant symptoms was 66.7% for nasal stuffiness, 77.8% for anosmia, 77.8% for runny nose, and 50.0% for headache. These rates are quite high even allowing for the common occurrence of rhinitis in the general population. Twenty eight of 34 grinding and manufacturing workers (82.4%) sampled were exposed to MWF mist above the threshold limit of 0.2 mg/m(3) listed as a notice of intended change by the American Conference for Governmental Industrial Hygienists (ACGIH). The percentage of workers exposed to MWF mist >0.5 mg/m(3) was 17.6%. Most workers were exposed to fungi levels >103 CFU/m(3). All exposures to endotoxins were <50 EU/m(3). Logistic regression analysis found that use of synthetic MWF was significantly associated with excess risk of nasal stuffiness (OR 3.5), nasal itchiness (OR 2.0), and runny nose (OR 2.1). The use of semi-synthetic MWF had little or no impact on the risk of developing rhinitis-related nasal symptoms. Grinding workers handling synthetic MWF had an increased risk of nasal stuffiness (OR 7.9), anosmia (OR 23.2), nasal itchiness (OR 8.3), runny nose (OR 20.4), post nasal drip (OR 18.4), and headache (OR 7.4) compared to administrative workers. Synthetic MWF may play an important role in the development of the dominant symptoms of rhinitis. Further study is needed to establish the risk of rhinitis or rhinitis-related symptoms according to MWF type.

Selecting high-risk micro-scale enterprises using a qualitative risk assessment method

Micro-scale enterprises (MSEs) with less than 5 employees are subject to be covered by the scheme of the regular workplace environmental inspection and medical health examination from 2002 in Korea. Due to limited resources as well as vast number of enterprises to be covered, there is an urgent need to focus these efforts to only those high-risk MSEs. To identify them, a qualitative risk assessment methodology was developed combining the hazardous nature of chemicals and exposure potentials as modeled by the HSE and the risk categorization technique by the AIHA. Risk Index (RI) was determined by combining characteristics specific to chemicals and scale of use of the chemicals. The method was applied to 514 MSEs that were selected from a random sample of 4000 MSEs. A total of 170 out of 514 MSEs studied were included in the final analysis. Current status and characteristics of MSEs were identified and RI was assigned to chemicals in each industry. Based on the distribution of RIs, the high-risk MSEs were selected. These include: wood and products of wood, chemicals and chemical products, basic metals, other machinery and equipment, motor vehicles, trailer and semi-trailer manufacturing, and furniture manufacturing. Since these MSEs are high-risk ones, more attentions should be focused on them. This method can be applied to other workplaces with no previous history of quantitative workplace inspections.

Loss of straight metalworking fluid samples from evaporation during sampling and desiccation

Straight metalworking fluids (MWFs) were used to evaluate the potential for the loss of MWF mass from filters. Two methods were used to study the stability of MWF mass on filter media. The first was to spike known amounts of MWF onto polyvinyl chloride (PVC) filters, store the filters over silica gel desiccant, and take repeated gravimetric measurements of the filters at intervals of 1, 2, and 3 days. An MWF aerosol mist was generated in a test chamber and collected on PVC filters for the second experimental method. Additional clean air was drawn through a subset of filters (range 0.02-0.48 m(3)), which were then stored over silica gel prior to weighing. Losses due to desiccation were found in filters that had not been exposed to airflow, as well as for filters after aspiration. The losses occurring in spiked filters (range of mean 2.6-15.2%) were higher than those in collected filters (range 0.7-8.1%). The MWF aerosol mass collected on PVC filters decreased with the increasing volume of clean air passing through the filter. In a multiple regression model, to predict the loss of collected MWF due to desiccation, loading mass, fresh MWF, and air passing time of 10 min were significant predictors (p=.0001, R(2)=.374). In particular, only air passage of 10 min was significantly higher (2.13%) than the reference air passage (p=.0054). The investigators concluded that MWF aerosol collected on PVC filters may be lost to evaporation under conditions typical of shipment, storage, and desiccation of sample filters, and with airflow through the filter.

Effect on blood lead of airborne lead particles characterized by size

Worker exposure to airborne lead particles was evaluated for a total of 117 workers in 12 work-places of four different industrial types in Korea. The particle sizes were measured using 8-stage cascade impactors worn by the workers. Mass median aerodynamic diameters (MMAD) were determined by type of industry and percentage of lead particles as a fraction of airborne lead (PbA) concentration was determined by particle size. Blood lead (PbB) levels of workers who matched airborne lead samples were also examined. A Scheffé's pairwise comparison test showed that MMAD and the fractions of each of respirable particles and lead particles < or =1 microm relative to PbA varied greatly by the type of industry. The concentrations of lead particles < or =1 microm, which the Center for Policy Alternatives model assumes is relatively constant at 12.5 microg/m3, increased with increasing PbA concentration. In addition, a better correlation was detected between concentrations of particles < or =1 microm and concentrations of respirable lead particles (r = 0.82) than that between concentrations of small particles and PbA (r = 0.61). A simple linear regression indicated that PbB correlated better with respirable lead concentration (r2 = 0.35, P = 0.0001) than with PbA concentration and had a higher slope coefficient. Controlling for respirable lead concentration reduced the partial correlation coefficient between PbA concentration and PbB level from 0.56 to 0.20 (P = 0.053). The results indicate that the contribution of respirable lead particles to lead absorption would be greater than that of PbA. This study concludes that the measurement of PbA only may not properly reflect a worker's exposure to lead particles with diverse characteristics. For the evaluation of a worker's exposure to various types of lead particles, it is recommended that respirable lead particles as well as PbA be measured.