Occupational Environmental Medicine · Respiratory health ofworkers exposed to lowlevels ofchromium...
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Occupational and
Environmental MedicineAdopted as the Journal of the Faculty of
Occupational Medicine of the Royal College ofPhysicians of London
Editor: Anne Cockcroft (United Kingdom)Technical Editor: Judith HaynesEditorial Assistant: Rachel HarveyEditorial Board:T C Aw (United Kingdom) R McNamee (United Kingdom) D C Snashall (United Kingdom)F J H Van Dijk (Holland) J Myers (South Africa) 0 Svane (Denmark)
J S Evans (United States) B Nemery (Belgium) G Theriault (Canada)RM Harrison (United Kingdom) T Okubo (Japan) KM Venables (United Kingdom)J Jeyaratnam (Singapore) L Rosenstock (United States) Editor, British MedicalJournalF Kauffmann (France) M Sim (Australia)R L Maynard (United Kingdom) M Singal (United States)
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Respiratory health of workers exposed to low levels of chromium in stainless steel production
these workers can be explained partly, but nottotally, by the differences in age and smokinghabits between the groups. It is also probablethat there is a causal correlation between our
findings and both the higher dust exposures
during the first years of mine operation andthe fibrous minerals in the waste rock of themine.
Radiological parenchymal abnormalitiesand plaques classified according to ILO rec-
ommendations were not common in our
study. Small opacities were more frequentlyobserved in the radiographs of the workersexposed to chromite than in the radiographs ofthe other groups. This finding agrees with theidea that early exposure to fibrous materials is a
factor contributing to the pulmonary effects.An increased risk of lung cancer has been
found among workers in the production ofchromates and chromate pigments, as well as
in chromium plating, although no conclusivedata are available on lung cancer in fer-rochromium production.202' No cases of lungcancer were found in this study. However, riskof cancer could not be excluded because thefollow up time was short and the exposedgroup young and small.No cases of chromium asthma were found
in this study. It was recently reported thatmortality from non-malignant diseases of therespiratory system was not increased (stan-dardised mortality ratio (SMR 0O88)) among
production workers in stainless steel produc-tion.2'
ConclusionsAn average exposure time of 18 years in mod-ern ferrochromium and stainless steel produc-tion and low exposure to dusts containing Cr+6or Cr+3 does not lead to any respiratorychanges detectable by lung function tests or
radiography or to any increase in symptoms ofrespiratory diseases. The process chain understudy is unique; however, the results are alsoapplicable to other production facilities wherethe exposures to different chromium com-
pounds are equally low.The lung function test results were lower
and the occurrence of radiological findingswas more frequent among the workers fromthe chromium mine than among the controls.The difference was partly caused by differ-ences in age and smoking habits, but evidentlyalso partly by higher exposures more than twodecades ago, when the mine operations were
started, and by the fibrous components of thedust.
Because the follow up time was limited, we
are planning a reinvestigation after five years,
although there are no personal needs or
expected benefits to individual workers. Themain reason is to collect new information andto confirm the present results.
This study was conducted with financial support from theFinnish Work Environment Fund.
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Rejected manuscriptsFrom February 1994, authors whose sub- be returned to them.The Joumnal will destroymitted articles are rejected will be advised of remaining copies of the article but corres-the decision and one copy of the article, pondence and reviewers' comments will betogether with any reviewers' comments, will kept.
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Lin, Dimich-Ward, Chan-Yeung
lower in patients with RCA than in sawmillworkers. The prevalence of smokers amongasthmatic patients has been reported to be lowat 20%.3 This is not an unusual finding inasthmatic patients as they are characterized bynon-specific bronchial hyperresponsivenessand may not take up smoking or may have hadto give up smoking when they developedasthma. As expected, we found that smokingwas associated with a higher rate of decline inFEVI as in the study by Peat and Frew.219However, Ulrik et a13 were unable to show theeffect of smoking on lung function in 180adult asthmatic patients over 10 years of fol-low up. They attributed the negative finding toa small number of smokers in their series.The limitations of this study are that many
subjects were lost to follow up. There werealso differences in the duration and of followup among the groups. Subjects who wereexcluded were younger and had better initialFEV, otherwise they were similar in bothgroups. It is likely that there is a selection biasand that healthier subjects were excluded fromthis study among both patients and controls.
In conclusion, we found that patients withRCA who continued to be exposed to cedardust had a greater rate of decline in FEV1 andpatients with RCA who avoided the exposureafter the diagnosis showed a similar rate ofdecline in FEV, compared with sawmill work-ers. Removal of patients with asthma from thespecific sensitiser that caused their symptomsis important in the prevention of excessivedecline in lung function and development ofchronic airflow limitation.
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Vancouver styleAll manuscripts submitted to Occup EnvironMed should conform to the uniformrequirements for manuscripts submitted tobiomedical journals (known as theVancouver style.)
Occup Environ Med, together with manyother international biomedical journals, hasagreed to accept articles prepared in accor-dance with the Vancouver style. The style(described in full in the BMJ, 24 February1979, p 532) is intended to standardizerequirements for authors.
References should be numbered consec-utively in the order in which they are firstmentioned in the text by Arabic numeralsabove the line on each occasion the refer-ence is cited (Manson' confirmed otherreports2 5. . .). In future references topapers submitted to Occup Environ Med
should include: the names of all authors ifthere are seven or less or, if there are more,the first six followed by et al; the title ofjournal articles or book chapters; the titlesof journals abbreviated according to thestyle of Index Medicus; and the first and finalpage numbers of the article or chapter.Titles not in Index Medicus should be givenin full.
Examples of common forms of refer-ences are:
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Occupational and Environmental Medicine and theelectronic age
OEM has an Email address which [email protected]. We wel-come contact by Email, including letters tothe editor. Some of our reviewers alreadysend us their reports by Email, helping tospeed up the peer review process.We are moving towards electronic pub-
lishing and for some months now we havebeen asking authors to send us their revisedpapers on disk as well as a hard copy. I amdelighted to report that nearly all ourauthors are managing to comply with this
request; far more than for other specialistjournals in the BMJ Publishing group.Oddly enough, the few authors who havenot sent us a disk version of their revisedpapers have been almost exclusively fromthe United Kingdom. I would be interestedin suggestions for why this might be.Perhaps United Kingdom based authorsread our correspondence and instructionsless assiduously? Watch for revisedInstructions to Authors.
The Editor
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43 Heineman EF, Zahm SH, McLaughlin JK, Vaught JB,Hrubec Z. A prospective study of tobacco use and multi-ple myeloma: evidence against an association. CancerCauses Control 1992;3:391-2.
44 Tajima K. The 4th nationwide study of adult T-cellleukemia/lymphoma in Japan: estimates of risk of ATLand its geographic and clinical features. Int Cancer1990;45:237-43.
45 Bourguet CC, Grufferman S, Delzell E, DeLong ER,Cohen HJ. Multiple myeloma and family history of can-cer. Cancer 1985;56:2133-9.
Correspondence and editorialsOccupational and Environmental Medicine wel- minimum. Letters are accepted on thecomes correspondence relating to any of the understanding that they may be subject tomaterial appearing in the journal. Results editorial revision and shortening.from preliminary or small scale studies may The journal also publishes editorials whichalso be published in the correspondence are normally specially commissioned. Thecolumn if this seems appropriate. Letters Editor welcomes suggestions regardingshould be not more than 500 words in length suitable topics; those wishing to submit anand contain a minimum of references. Tables editorial, however, should do so only afterand figures should be kept to an absolute discussion with the Editor.
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Book reviews
regarded as its originator, that the dose-response curve need not always be monoto-nic. In other words, the one way relation,apart from instances of threshold, usuallythought to show that an increase in doseleads to an increased effect in the samedirection, may not be correct and that morecomplex patterns may occur in practice.We are treated to many attempts to show
non-monotonic-that is, U, J and B or bellshaped relations, in which a very low to lowdose of a chemical toxicant or radiation pro-duces a beneficial effect on cells (enhancedresistance), animals (better survival thanuntreated controls in long term toxicitytests), and people (less neoplasia induced byradiation), whereas higher doses produceharmful effects. There is a wordy attempt tobolster this by philosophising about breach-ing the conventional Kuhnian paradigm (aharmful heuristic in this instance).The basic concept is very important scien-
tifically, because of what it can show aboutresponses to injury-for example, activatedrepair enzymes, heat shock proteins, changesin cell kinetics-and, as well shown here, thedifferent ways of analysing and modellinglaboratory and epidemiological data do showup misleading assumptions and hiddenerrors in many conventional and superficialevaluations. There is also a strong themethat United States Government style quanti-tative dose-response calculations for chemi-cal toxicity, which ignore the complex shapeof low dose responses, are liable to givequite erroneous risk predictions, even beforeignoring the biological barriers involved inextrapolation between species. That shouldnot be news in Europe, where we have longdistrusted those who, like Trollope'sMr Minusex "never thought but alwayscounted".The general standard of presentation and
dialectic is high, but some contributors seemignorant of modern receptor pharmacology,especially the concept of the partial agonist,and others overlook the dangers of uncon-trolled molecular and cellular reactionmechanisms when arguing for the seeming"stimulation" of health by very low doses ofchemicals and radiation.
There are many examples here of thediverse shapes of quantal and quantitativedose-response relations in the laboratory,the clinic, and the factory. In this way itaffords an excellent training in the problemsof analysing and interpreting results. Thatalone would be a good reason for buying thebook, and another is its exemplification ofthe need to look hard at the complexity ofbiological findings. It also shows the stupid-ity of trying to force all toxicological datainto the legislative convenience of a uniformmodel. However, it does so with a solemnityand persistence that should be unnecessaryfor any rational biologist. Perhaps theBELLE has had her ball and now can seek abetter balance?
A D DAYAN
Advances in Occupational Medicine andRehabilitation, Vol 1, No 2. Update onBenzene. Edited by M IMBRIANI, SGHITTORI, G PEZZAGNO, E CAPODAGLIO. (Pp265.) 1995. Pavia 27100, Italy: FondazioneSalvatore Maugeri Edizioni and PI-MEPress. ISBN: 88-7963-038-5.
This is the second publication of a quarterlyseries. The issue of setting limits for benzeneexposure in the workplace and the environ-
ment is both topical and controversial, sothe timing of this volume is appropriate. Thebook consists of 22 chapters, all written bydifferent contributors, with the aim of pro-viding an update on the current state ofknowledge about the effects of benzene. Thefirst four chapters review exposures in theworkplace, in ambient and in indoor air, andthrough environmental tobacco smoke, andthe factors which affect the biological levelsof benzene in humans. Chapter 5, thelongest in the volume, surveys studies onhuman leukaemogenesis induced by ben-zene, and includes descriptions of the patho-physiology, human studies, the controversialrisk assessments carried out on data fromrubber manufacturing workers, animal stud-ies, metabolism, and a long section of cyto-genetic changes. Several of the later chapterscontain material which overlap with chapter5 although Paustenbach's contribution onthe acute and chronic effects in humans is agood summary of the epidemiological workto date.
Other chapters cover experimental stud-ies, and haematological changes and 11chapters report various aspects of biologicalmonitoring and biomarkers. The topics ofrisk assessment and pharmacokinetics arebarely touched upon in this book, and yetthese are the areas of research in which thereis much work being currently carried out.The volume begins well with an attempt tocoordinate the chapters. However, by themiddle of the book there has begun to beobvious repetition and overlap and the sec-ond half consists of a series of papers onmore specialist topics. The volume would beof more use to the reader if it had beenstructured more formally and the articlesgrouped under definite headings. It is notclear whether the editors intended it to beliterally an update in that they assume thereader to have considerable knowledge ofthe topic or whether they wished it to be athorough review. The chapters vary in theirachievements towards these two differentaims. Someone with little knowledge of theeffects of benzene would obtain a ratherpatchy picture from this book. However,there is no doubt that sections of it would beuseful to those with an interest in this spe-cialist area. The reader would also need tobe aware that this volume is probablyalready out of date and likely to becomeeven more so very quickly. There are alreadyseveral new studies reported in the scientificliterature and in particular, the recentlycommissioned European Union risk charac-terisation will soon be available.
LESLEY RUSHTON
NOTICES
Diagnostic approaches to lymphoprolif-erative disorders. 24-28 March 1997.The Grand Wailea Resort and Spa,Maui, Hawaii
This continuing medical education course issponsored by Scripps Clinic and ResearchFoundation and designed for haematologists,oncologists and pathologists who are involvedin the histological diagnosis or clinical evalua-tion of patients with malignancies of the lym-phopoietic system. The course will offer 26credit hours of category 1 CME credit.
For further information contact:Department of Academic Affairs, 403C,Scripps Clinic and Research Foundation,10666 N Torrey Pines Road, La Jolla, CA92037, USA. Tel (619) 554-8556; Fax(619) 554-6310.
12th International Symposium:Epidemiology in Occupational HealthISEOH 1997. 16-19 September 1997.Harare, Zimbabwe
This symposium is organised by theNational Social Security Authority ofZimbabwe, and the National Centre forOccupational Health, South Africa, onbehalf of The Scientific Committee onOccupational Epidemiology (ICOH).The conference aims to bring together
people working in occupational epidemiolo-gy globally and to discuss methodologicalissues and practical applications of theirresearch. The programme will includekeynote lectures, oral presentations andposters. The conference will be held insouthern Africa, where new developmentand social challenges provide fertile groundfor advances in occupational health. Welook forward to seeing you in the warm andfriendly city of Harare in Zimbabwe!
For further information, contact: Ms MMashingaidze, Att: ISEOH, National SocialSecurity Authority, Box CY 1387,Causeway, Harare, Zimbabwe. Tel 263-4-728 931/722 047-9/723 822-4, Fax 263-4-796 320.
Sixth International Symposium onNeurobehavioural Methods and EffectsIn Occupational and EnvironmentalHealth. 15-18 October, 1997. Shanghai,China.
The symposium is organised by the SanlianAccident Prevention Institute and theShanghai Medical University.
For further information send a fax to: TheSecretariat, 6th International Symposium onNeurobehavioural Methods and Effects inOccupational and Environmental Health,Sanlian Accident Prevention Institute,Hefei, Anhui province, PR China. Fax: +86-5515319266.
International Course on ModernEpidemiology, 12-15 May, 1997.Lunteren, The Netherlands.
This advanced course is about the principlesof epidemiological research. The lecturer isKJ Rothman. Among others, the topics willbe: case-control research principles, interac-tion in aetiology, statistics v epidemiologicalanalyses. Enrolment is open to researcherswith a basic knowledge of epidemiology andbiostatistics and at least some work experi-ence. Closing date for enrollment is 13January 1997. Course fee is DFL 1895,including a single room with shower and toi-let, breakfast, lunches, dinner, coffee or teaduring breaks, the textbook ModemEpidemiology, and other course materials.
For further information please contact:Mrs Astrid van Alst, course secretary,Department of Epidemiology, University ofNijmegen, PO Box 9101, NL-6500 HBNijmegen, The Netherlands. Tel.+31-24-3619132; Fax. +31-24-3613505;E-mail: A.vanAlstgmie.kun.nl
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