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In this study, we present quantitative exposure-response data on silica exposure in male Swedish iron foundry workers receiving inpatient care for cardiovascular, cerebrovascular, and respiratory morbidity. The study show a significantly increased COPD risk at cumulative silica exposures that correspond to TWA silica below the Swedish OEL of 0.1 mg/m3. ObjectiveWe present quantitative exposure-response data on silica exposure in male Swedish iron foundry workers for cardiovascular, cerebrovascular, and respiratory morbidity.MethodsThis research is a cohort study of 2063 male Swedish iron foundry workers. From the Swedish National Patient Registers, data on morbidity incidence were retrieved. A historical measurement database of 1667 respirable silica exposure measurements from 10 Swedish iron foundries was used to calculate the cumulative exposure dose for each worker.ResultsIncreased morbidity risk for the whole group of foundry workers was determined for ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), bronchitis, and pneumonia. In addition, an increased risk for COPD at cumulative silica exposures ranging from 0.11 to 0.84 mg/m3 year is presented.ConclusionsThe study presents a significantly increased COPD risk at cumulative silica exposures below the Swedish occupational exposure limit.

OBJECTIVE: The mortality and morbidity pattern for respiratory diseases was determined in a cohort of 1,752 Swedish foundry workers, particularly for respirable silica dust exposure. METHODS: The morbidity follow-up in the Swedish National Non-primary Outpatient Register covered 2001 to 2017 (NPR; specialist not in care patients), the mortality from the National Causes of Death Register covered 2001 to 2017. Cumulative exposures to silica and dust were determined. RESULTS: The morbidity in COPD showed significantly increased risk for all exposure groups, as did silicosis in the high exposure group, these cases corresponded to silica exposure levels below 0.05 mg/m3. The mortality of all causes and respiratory diseases was significantly increased by cumulative silica exposure in the high exposure group. CONCLUSIONS: Significantly increased morbidity for respiratory diseases and COPD was determined at silica exposure levels below the current Swedish OEL.

OBJECTIVE: Rheumatoid arthritis (RA) is an inflammatory disease with unknown etiology. This study examines if silica dust exposure increases the risk for seropositive and seronegative RA. METHODS: A nationwide registry case-control study was conducted that included all cases of RA in Sweden between 2005 and 2016. In total, 31,139 cases with two matched controls were included. A JEM was used to estimate exposure. RESULTS: Silica dust exposure was associated with a statistically significant increase in odds ratio (OR) for seropositive (OR 1.22, 95% CI 1.05 to 1.40) and seronegative (OR 1.23, 95% CI 1.04 to 1.46) RA among men. CONCLUSION: This study found an increased OR for RA in silica-exposed men. The OR was equal for seropositive and seronegative RA. These findings further support the hypothesis that silica dust may be a trigger for RA.

OBJECTIVE: Rheumatoid arthritis (RA) is an inflammatory disease with unknown etiology. This study examines if silica dust exposure increases the risk for seropositive and seronegative RA. METHODS: A nationwide registry case-control study was conducted that included all cases of RA in Sweden between 2005 and 2016. In total, 31,139 cases with two matched controls were included. A JEM was used to estimate exposure. RESULTS: Silica dust exposure was associated with a statistically significant increase in odds ratio (OR) for seropositive (OR 1.22, 95% CI 1.05 to 1.40) and seronegative (OR 1.23, 95% CI 1.04 to 1.46) RA among men. CONCLUSION: This study found an increased OR for RA in silica-exposed men. The OR was equal for seropositive and seronegative RA. These findings further support the hypothesis that silica dust may be a trigger for RA.

PURPOSE: Cobalt exposure is known to cause adverse effects on health. A major use of cobalt is in the manufacture of hard metal. Exposure can lead to asthma, hard metal lung disease, contact allergy and increased risk of cancer. Cobalt is mainly absorbed from the pulmonary tract, however penetration through skin may occur. The relationships between exposure to inhalable cobalt in air and on skin and the uptake in blood and urine will be investigated, as well as the association between dermal symptoms and dermal exposure. METHODS: Cobalt exposure in 71 workers in hard metal production facilities was measured as inhalable cobalt in the breathing zone and cobalt found on skin with acid wash. Uptake of cobalt was determined with concentrations in blood and urine. Correlations between exposure and uptake were analysed. RESULTS: Inhalable cobalt in air and cobalt in blood and urine showed rank correlations with coefficients 0.40 and 0.25. Cobalt on skin and uptake in blood and urine presented correlation coefficients of 0.36 and 0.17. Multiple linear regression of cobalt in air and on skin with cobalt in blood showed regression coefficients with cobalt in blood (β = 203 p < 0.0010, and β = 0.010, p = 0.0040) and with cobalt in urine (β = 5779, p = 0.0010, and β = 0.10, p = 0.60). CONCLUSIONS: Our data presents statistically significant correlations between exposure to cobalt in air with uptake of cobalt in blood and urine. Cobalt on skin was statistically significant with cobalt in blood but not with urine.

PURPOSE: Cobalt exposure is known to cause adverse effects on health. A major use of cobalt is in the manufacture of hard metal. Exposure can lead to asthma, hard metal lung disease, contact allergy and increased risk of cancer. Cobalt is mainly absorbed from the pulmonary tract, however penetration through skin may occur. The relationships between exposure to inhalable cobalt in air and on skin and the uptake in blood and urine will be investigated, as well as the association between dermal symptoms and dermal exposure. METHODS: Cobalt exposure in 71 workers in hard metal production facilities was measured as inhalable cobalt in the breathing zone and cobalt found on skin with acid wash. Uptake of cobalt was determined with concentrations in blood and urine. Correlations between exposure and uptake were analysed. RESULTS: Inhalable cobalt in air and cobalt in blood and urine showed rank correlations with coefficients 0.40 and 0.25. Cobalt on skin and uptake in blood and urine presented correlation coefficients of 0.36 and 0.17. Multiple linear regression of cobalt in air and on skin with cobalt in blood showed regression coefficients with cobalt in blood (β = 203 p < 0.0010, and β = 0.010, p = 0.0040) and with cobalt in urine (β = 5779, p = 0.0010, and β = 0.10, p = 0.60). CONCLUSIONS: Our data presents statistically significant correlations between exposure to cobalt in air with uptake of cobalt in blood and urine. Cobalt on skin was statistically significant with cobalt in blood but not with urine.

PURPOSE: Cobalt exposure is known to cause adverse effects on health. A major use of cobalt is in the manufacture of hard metal. Exposure can lead to asthma, hard metal lung disease, contact allergy and increased risk of cancer. Cobalt is mainly absorbed from the pulmonary tract, however penetration through skin may occur. The relationships between exposure to inhalable cobalt in air and on skin and the uptake in blood and urine will be investigated, as well as the association between dermal symptoms and dermal exposure. METHODS: Cobalt exposure in 71 workers in hard metal production facilities was measured as inhalable cobalt in the breathing zone and cobalt found on skin with acid wash. Uptake of cobalt was determined with concentrations in blood and urine. Correlations between exposure and uptake were analysed. RESULTS: Inhalable cobalt in air and cobalt in blood and urine showed rank correlations with coefficients 0.40 and 0.25. Cobalt on skin and uptake in blood and urine presented correlation coefficients of 0.36 and 0.17. Multiple linear regression of cobalt in air and on skin with cobalt in blood showed regression coefficients with cobalt in blood (β = 203 p < 0.0010, and β = 0.010, p = 0.0040) and with cobalt in urine (β = 5779, p = 0.0010, and β = 0.10, p = 0.60). CONCLUSIONS: Our data presents statistically significant correlations between exposure to cobalt in air with uptake of cobalt in blood and urine. Cobalt on skin was statistically significant with cobalt in blood but not with urine.

PURPOSE: Cobalt exposure is known to cause adverse effects on health. A major use of cobalt is in the manufacture of hard metal. Exposure can lead to asthma, hard metal lung disease, contact allergy and increased risk of cancer. Cobalt is mainly absorbed from the pulmonary tract, however penetration through skin may occur. The relationships between exposure to inhalable cobalt in air and on skin and the uptake in blood and urine will be investigated, as well as the association between dermal symptoms and dermal exposure. METHODS: Cobalt exposure in 71 workers in hard metal production facilities was measured as inhalable cobalt in the breathing zone and cobalt found on skin with acid wash. Uptake of cobalt was determined with concentrations in blood and urine. Correlations between exposure and uptake were analysed. RESULTS: Inhalable cobalt in air and cobalt in blood and urine showed rank correlations with coefficients 0.40 and 0.25. Cobalt on skin and uptake in blood and urine presented correlation coefficients of 0.36 and 0.17. Multiple linear regression of cobalt in air and on skin with cobalt in blood showed regression coefficients with cobalt in blood (β = 203 p < 0.0010, and β = 0.010, p = 0.0040) and with cobalt in urine (β = 5779, p = 0.0010, and β = 0.10, p = 0.60). CONCLUSIONS: Our data presents statistically significant correlations between exposure to cobalt in air with uptake of cobalt in blood and urine. Cobalt on skin was statistically significant with cobalt in blood but not with urine.

OBJECTIVE: To study the relationship between inhalable dust and cobalt and respiratory symptoms, lung function, exhaled nitric oxide in expired air and CC16 in the Swedish hard metal industry. METHODS: Personal sampling of inhalable dust and cobalt, medical examination including blood sampling was performed for 72 workers. Exposure-response relationships was determined using logistic, linear and mixed model analysis. RESULTS: The average inhalable dust and cobalt concentrations were 0.079 and 0.0017 mg/m, respectively. Statistically significant increased serum levels of CC16 were determined when the high and low cumulative exposures for cobalt were compared. Non-significant exposure-response relationships was observed between cross-shift inhalable dust or cobalt exposures and asthma, nose dripping and bronchitis. CONCLUSIONS: Our findings suggest an exposure-response relationship between inhalable cumulative cobalt exposure and CC16 levels in blood, which may reflect an injury or a reparation process in the lungs., Funding Agencies:Örebro University ORU 2.2.1-4060/2013ALF ALFGBG-872511

Objective: To determine whether occupational exposure to silica dust causes an increased risk of developing Crohn's disease (CD) and ulcerative colitis (UC). Design: Case-control study of CD (K50) and UC (K51) from 2007 through 2016. Controls were matched to cases (2:1) based on age, sex and county at the time of diagnosis. A job exposure matrix was used to estimate the occupational silica exposure of all cases and controls. Setting: Medical and occupational data from the National Outpatient Register were used to implement a case-control analysis, while the two controls used for each case were selected from the National Register of the Total Population. Participants: All men and women aged 20-65 years old who were diagnosed with CD (K50) and UC (K51) during the years of study were included and assigned two controls, resulting in 58 136 cases and 116 272 controls. Main outcomes: Silica dust exposure correlates with an increased risk of developing UC in men and CD in women. Results: The prevalence of UC was significantly higher in the group exposed to silica dust (OR 1.13, 95% CI 1.06 to 1.21) than in controls, particularly in individuals with over 5 years exposure. When stratified by sex, a significantly increased OR was detected for men (OR 1.33, 95% CI 1.05 to 1.22). This trend was also consistent with longer exposure times. The prevalence of UC was not increased in exposed women. The prevalence of CD was significantly increased among exposed women (OR 1.29, 95% CI 1.01 to 1.65), but not for exposed men. Conclusions: Silica dust exposure correlates with an increased risk of developing UC, especially in men, and the risk seems to increase with the duration and degree of exposure. Conversely, silica dust exposure correlates positively with the risk of developing CD in women., Funding Agency:Region Örebro County

OBJECTIVE: Occupational quartz exposure is a health risk, with increased risk of developing lung, autoimmune diseases, and elevated mortality in cardiovascular diseases. METHODS: The population was obtained from the period 2005 to 2016 and consisted of 5237 cases of patients with atrial fibrillation (AF). Quartz exposure information was obtained through a Swedish job exposure matrix. RESULTS: The risk of developing AF was increased for the quartz-exposed male population who were within a year of having commenced employment OR 1.54; (95% CI 1.06-2.24); this increased in the age group 20 to 55 (OR 2.05; CI 95% 1.02-4.10). CONCLUSION: Our main conclusion is that quartz dust exposure may be related to increased risk of AF in high exposed (above 0.05 mg/m mean quartz dust) in men aged 20 to 55 years., Funding Agency:Department of Occupational and Environmental Medicine, Örebro University Hospital

OBJECTIVE: This study was to investigate the acute effects of hand-arm vibrations on the nerve functions of the hands, and the impact of the grip force applied to the vibrating tool during exposure. METHODS: Grip strength and perception of vibration, touch, and temperature were evaluated using QST before and after vibration exposure in 21 occupationally unexposed individuals. The procedure was performed twice, with a higher grip force being applied during exposure on the second occasion. RESULTS: Vibration perception was significantly impaired after both exposures. Grip strength, perception of touch and temperature were only significantly affected after the high grip force exposure. CONCLUSIONS: Exposure to hand-arm vibrations has acute effects on hand nerve function that are sensitive to the grip force applied during exposure., Funding Agency:Department of Occupational and Environmental Medicine, Örebro University Hospital

OBJECTIVES: The most pronounced occupational exposure routes for lead (Pb) are inhalation and gastrointestinal uptake mainly through hand-to-mouth behaviour. Skin absorption has been demonstrated for organic Pb compounds, but less is known about inorganic Pb species. Several legislative bodies in Europe are currently proposing lowering biological exposure limit values and air exposure limits due to new evidence on cardiovascular effects at very low blood Pb levels. In light of this, all exposure routes in occupational settings should be revisited to evaluate how to lower the overall exposure to Pb. METHODS: The aim of the study was to investigate the possible exposure routes in workers operating computer numerical control-machines in a brass foundry and specifically to understand if metal cutting fluids (MCFs) used by the workers could lead to skin absorption of Pb. The different bronze alloys at the facility may contain up to 20% Pb. After obtaining written informed consent from the workers (n = 7), blood, skin wipes, and personal air samples were collected. In addition, MCFs used on the day of exposure measurements were collected for in vitro skin absorption studies using stillborn piglet skin mounted in static Franz diffusion cells (n = 48). All samples were analysed for Pb content using inductively coupled plasma mass spectrometry. RESULTS: Pb air concentration (<0.1-3.4 µg m-3) was well below the Swedish occupational exposure limit value. Blood Pb was in the range of <0.72-33 µg dl-1, and Pb on skin surfaces, after performing normal work tasks during 2 h, was in the range of 0.2-48 µg cm-2. Using the MCFs in diffusion cells showed that skin absorption had occurred at very low doses, and that up to 10% of the Pb content was present in the skin after 24 h exposure. Using these results in the US EPA adult lead model, we could estimate a contribution to blood Pb from the three exposure routes; where hand-to-mouth behaviour yielded the highest contribution (16, Funding Agencies:Region Örebro County, Sweden OLL-689821Institute of Environmental Medicine

Objective: To investigate whether low molecular organic biomarkers could be identified in blood samples from vibration exposed workers using a metabolomics. Methods: The study population consisted of 38 metalworkers. All participants underwent a standardized medical examination. Blood samples were collected before and after work shift and analyzed with gas chromatography time-of-flight mass spectrometry. Multivariate modeling (orthogonal partial least-squares analysis with discriminant analysis [OPLS-DA]) were used to verify differences in metabolic profiles. Results: Twenty-two study participants reported vascular symptoms judged as vibration-related. The metabolic profile from participants with vibration-induced white fingers (VWF) was distinctly separated from participants without VWF, both before and after vibration exposure. Conclusion: Metabolites that differed between the groups were identified both before and after exposure. Some of these metabolites might be indicators of health effects from exposure to vibrations. This is the first time that a metabolomic approach has been used in workers exposed to vibrations., Funding Agency:Region Örebro County OLL-554271

OBJECTIVE: To study the impact of occupational silica exposure on the incidence rates of sarcoidosis and rheumatoid arthritis (RA) in a cohort of exposed workers in Swedish iron foundries. DESIGN: The prevalence of sarcoidosis and RA in a cohort of silica exposed workers was compared with the prevalence in the general Swedish population in this register study. A mixed model was used to calculate silica exposure, and individual silica exposures were used to compute dose responses. SETTING: Personnel records from 10 iron foundries were used to identify workers whose employment began before 2005 which was then linked to the national non-primary outpatient visits register. PARTICIPANTS: The final cohort consisted of 2187 silica-exposed male workers who had been employed for at least 1 year and were still alive without having emigrated when the follow-up study began. The cohort's employment period covers 23 807 person-years at risk. MAIN OUTCOME: The presented results indicate that moderate to high levels of silica exposure increase risks for sarcoidosis and seropositive RA. RESULTS: Mean levels of airborne silica dust in the foundries decreased significantly between the 1970s and 2000s. Incidence rates of sarcoidosis (3.94; 95% CI 1.07 to 10.08) and seropositive RA (2.59; 95% CI 1.24 to 4.76) were significantly higher among highly exposed individuals. CONCLUSION: Our results reveal increased risks for sarcoidosis and seropositive RA among individuals with high exposure to silica dust (>0.048 mg/m(3)) compared with non-exposed and less-exposed groups., Funding Agency:Region, Örebro County OLL-554311

Work with vibrating tools is common in many industries. Exposure to hand-arm vibrations is associated with a risk of hand injury in the form of: Vascular disorders, nerve malfunction, and effects on the musculoskeletal system. The aim of this study was to investigate the prevalence of hand-arm vibration symptoms among employees at a mechanical company, as well as to follow-up with patients presenting symptoms and evaluate the effects of certain proposed measures. We found that 21% of the employees were judged to have vibration-related problems even though the exposure to vibrations was judged to be relatively low. There seems to be an over-representation of Carpal tunnel syndrome among participants; this may suggest that ergonomic conditions at the investigated company, such as grinding with flexed wrists, are unfavorable. Relevance to industry: Regular screening for early signs of vibration-related damage, even if workers are subject to only moderate vibration exposure, is an important part of preventing the aggravation of health problems., Funding Agency:Region Örebro County