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  • 1.
    Alhamdow, Ayman
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lindh, Christian
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Hagberg, Jessika
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Graff, Pål
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; National Institute of Occupational Health, Oslo, Norway.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Krais, Annette M.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Albin, Maria
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Centre for Occupational and Environmental Medicine (CAMM), Stockholm County Council, Stockholm, Sweden.
    Gustavsson, Per
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine (CAMM), Stockholm County Council, Stockholm, Sweden.
    Tinnerberg, Håkan
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Broberg, Karin
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    DNA-methylation of the cancer-related genes F2RL3 and AHRR is associated with occupational exposure to polycyclic aromatic hydrocarbons2018In: Carcinogenesis, ISSN 0143-3334, E-ISSN 1460-2180, Vol. 39, no 7, p. 869-878Article in journal (Refereed)
    Abstract [en]

    Some polycyclic aromatic hydrocarbons (PAH) are known carcinogens and workplace PAH exposure may increase the risk of cancer. Monitoring early cancer-related changes can indicate whether the exposure is carcinogenic. Here, we enrolled 151 chimney sweeps, 152 controls, and 19 creosote-exposed male workers from Sweden. We measured urinary PAH metabolites using LC/MS/MS, the cancer-related markers telomere length (TL) and mitochondrial DNA copy number (mtDNAcn) using qPCR, and DNA methylation of lung cancer-related genes F2RL3 and AHRR using pyrosequencing. The median 1-hydroxypyrene (PAH metabolite) concentrations were highest in creosote-exposed workers (8.0 μg/g creatinine) followed by chimney sweeps (0.34 μg/g creatinine) and controls (0.05 μg/g creatinine). TL and mtDNAcn did not differ between study groups. Chimney sweeps and creosote-exposed workers had significantly lower methylation of AHRR CpG site cg05575921 (88.1% and 84.9%, respectively) than controls (90%). Creosote-exposed workers (73.3%), but not chimney sweeps (76.6%) had lower methylation of F2RL3 cg03636183 than controls (76.7%). Linear regression analyses showed that chimney sweeps had lower AHRR cg05575921 methylation (B=-2.04; P<0.057, adjusted for smoking and age) and lower average AHRR methylation (B=-2.05; P<0.035), and non-smoking chimney sweeps had lower average F2RL3 methylation (B=-0.81; P<0.042, adjusted for age) compared with controls. These cancer-related markers were not associated with urinary concentrations of PAH metabolites. In conclusion, although we found no associations with PAH metabolites in urine (short-term exposure), our results suggest dose-response relationship between PAH exposure and DNA hypomethylation of lung cancer-related loci. These findings indicate that further protective measures should be taken to reduce PAH exposure.

  • 2. Andersson, Eva
    et al.
    Persson, Bodil
    Bryngelsson, Ing-Liss
    Magnuson, Anders
    Torén, Kjell
    Wingren, Gun
    Westberg, Håkan
    Örebro University, School of Health and Medical Sciences.
    Cohort mortality study of Swedish pulp and paper mill workers-nonmalignant diseases2007In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 33, no 6, p. 470-478Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems.

    Methods The cohort of 18 163 men and 2 291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented.

    Results There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98–1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90–0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12–1.32) and SMR 1.11 (95% CI 1.02–1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07–1.54), paper production (SMR 1.26, 95% CI 1.06–1.49), and maintenance (SMR 1.16, 95% CI 1.02–1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased.

    Conclusions Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).

  • 3.
    Andersson, Lena
    et al.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden; Man-Technology-Environment Research Centre (MTM), Department of Science, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Ngo, Yen
    Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Ohlson, Carl-Göran
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Medicines, Örebro University, Örebro, Sweden; Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Exposure assessment and modeling of quartz in Swedish iron foundries for a nested case-control study on lung cancer2012In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 9, no 2, p. 110-119Article in journal (Refereed)
    Abstract [en]

    Exposure assessment of quartz in Swedish iron foundries was performed based on historical and present measurement data. To evaluate the exposure response relationship between quartz exposure and lung cancer, we modeled quartz exposure from our database of measurements using determinants job title, time period and company. Based on these modeled exposure data, we conducted a nested case– control evaluation.

    In our database, the overall individual daily time-weighted average (TWA) quartz concentrations of current and historical data varied between 0.0018 and 4.9 mg/m3, averaging 0.083 mg/m3. The job titles with mean TWAs for the whole study period exceeding the European Union recommended occupational exposure limit of 0.05 mg/m3 were fettlers (0.087 mg/m3), furnace and ladle repair (0.42 mg/m3) and maintenance (0.054 mg/m3) workers.

    The mixed model analysis demonstrated significant determinants on the job level for furnace and ladle repair (β=4.06; 95% CI 2.78-5.93). For all jobs significantly higher exposure levels occurred only during the first time period, 1968-1979 (β=2.08; 95% CI 1.75-2.47), and a decreasing but not significant trend was noted for the three following 10 year time periods up to 2006 (β=1.0, 0.96 and 1, respectively). Two iron foundries had significantly higher quartz concentration levels than the others (β=1.31; 95% CI 1.00-1.71 and β=1.63; 95% CI 1.00-2.65, respectively). The individual cumulative quartz exposure measures were categorized in low, medium and high exposure (0.5-<1, 1-1.9 and ≥2 mg/m3 *years, respectively).

    In the nested case-control analysis, we found the highest odds ratios of lung cancer (OR 1.17; 95% CI 0.53-2.55) for the medium exposure group. No dose– response trend or significantly increased risk was determined for our high exposed group (≥2 mg/m3), representing 40 years of exposure at >0.05 mg/m3 of quartz. To conclude, certain foundry workers are still exposed to high levels of quartz, but an increased risk of lung cancer caused by quartz exposure in these Swedish iron foundries could not be confirmed at our exposure levels.

  • 4. Andersson, Lena
    et al.
    Bryngelsson, Ing-Liss
    Ohlson, Carl-Göran
    Nayström, Peter
    Lilja, Bengt-Gunnar
    Westberg, Håkan
    Örebro University, School of Health and Medical Sciences.
    Quartz and dust exposure in Swedish iron foundries2009In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 6, no 1, p. 9-18Article in journal (Refereed)
    Abstract [en]

    Exposure to respirable quartz continues to be a major concern in the Swedish iron foundry industry. Recommendations for reducing the European occupational exposure limit (EU-OEL) to 0.05 mg/m3 and the corresponding ACGIH® threshold limit value (ACGIH-TLV) to 0.025 mg/m3 prompted this exposure survey. Occupational exposure to respirable dust and respirable quartz were determined in 11 Swedish iron foundries, representing different sizes of industrial operation and different manufacturing techniques. In total, 436 respirable dust and 435 respirable quartz exposure measurements associated with all job titles were carried out and are presented as time-weighted averages. Our sampling strategy enabled us to evaluate the use of respirators in certain jobs, thus determining actual exposure. In addition, measurements using real-time dust monitors were made for high exposure jobs. For respirable quartz, 23% of all the measurements exceeded the EU-OEL, and 56% exceeded the ACGIH-TLV. The overall geometric mean (GM) for the quartz levels was 0.028 mg/m3, ranging from 0.003 to 2.1 mg/m3. Fettler and furnace and ladle repair operatives were exposed to the highest levels of both respirable dust (GM = 0.69 and 1.2 mg/m3; range 0.076-31 and 0.25-9.3 mg/m3 and respirable quartz (GM = 0.041 and 0.052 mg/m3; range 0.004-2.1 and 0.0098-0.83 mg/m3. Fettlers often used respirators and their actual quartz exposure was lower (range 0.003-0.21 mg/m3, but in some cases it still exceeded the Swedish OEL (0.1 mg/m3. For furnace and ladle repair operatives, the actual quartz exposure did not exceed the OEL (range 0.003-0.08 mg/m3, but most respirators provided insufficient protection, i.e., factors less than 200. In summary, measurements in Swedish iron foundries revealed high exposures to respirable quartz, in particular for fettlers and furnace and ladle repair workers. The suggested EU-OEL and the ACGIH-TLV were exceeded in, respectively, 23% and 56% of all measurements regardless of the type of foundry. Further work on elimination techniques to reduce quartz concentrations, along with control of personal protection equipment, is essential.

  • 5.
    Andersson, Lena
    et al.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Burdorf, Alex
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Estimating trends in quartz exposure in Swedish iron foundries: predicting past and present exposures2012In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 56, no 3, p. 362-372Article in journal (Refereed)
    Abstract [en]

    Background: Swedish foundries have a long tradition of legally required surveys in the work place that, from the late 1960s onwards, included measurements of quartz. The availability of exposure data spanning almost 40 years presents a unique opportunity to study trends over that time and to evaluate the validity of exposure models based on data from shorter time spans. The aims of this study were (i) to investigate long term trends in quartz exposure over time, (ii) using routinely collected quartz exposure measurements to develop a mathematical model that could predict both historical and current exposure patterns, and (iii) to validate this exposure model with up-to-date measurements from a targeted survey of the industry.

    Methods: Eleven foundries, representative of the Swedish iron foundry industry, were divided into three groups based on the size of the companies, i.e. the number of employees. A database containing 2333 quartz exposure measurements for 11 different job descriptionswas used to create three models that covered time periods which reflected different work conditions and production processes: a historical model (1968– 1989), a development model (1990–2004), and a validation model (2005–2006). A linear mixed model for repeated measurements was used to investigate trends over time. In all mixed models, time period, company size, and job title were included as fixed (categorical) determinants of exposure. The within- and between-worker variances were considered to be random effects. A linear regression analysis was erformed to investigate agreement between the models. The average exposure was estimated for each combination of job title and company size.

    Results: A large reduction in exposure (51%) was seen between 1968 and 1974 and between 1975 and 1979 (28%). In later periods, quartz exposure was reduced by 8% per 5 years at best. In the first period, employees at smaller companies experienced ~50%higher exposure levels than those at large companies, but these differences became much smaller in later years. The furnace and ladle repair job were associated with the highest exposure, with 3.9–8.0 times the average exposure compared to the lowest exposed group. Without adjusting for this autonomous trend over time, predicting early historical exposures using our development model resulted in a statistically significant regression coefficient of 2.42 (R2 5 0.81), indicating an underestimation of historical exposure levels. Similar patterns were seen for other historical time periods. Comparing our development model with our validation model resulted in a statistically significant regression coefficient of 0.31, indicating an overestimation of current exposure levels.

    Conclusion: To investigate long-term trends in quartz exposure over time, overall linear trends can be determined by using mixed model analysis. To create individual exposure measures to predict historical exposures, it is necessary to consider factors such as the time period, type of job, type of company, and company size. The mixed model analysis showed systematic changes in concentration levels, implying that extrapolation of exposure estimates outside the range of years covered by measurements may result in underestimation or overestimation of exposure.

  • 6.
    Hagenbjörk-Gustafsson, Annika
    et al.
    Umeå Univ, Umeå, Sweden.
    Tornevi, Andreas
    Umeå Univ, Umeå, Sweden.
    Andersson, Eva M.
    Dept Occupat & Environm Med, Sahlgrenska Univ Hosp & Acad, Univ Gothenburg, Gothenburg, Sweden.
    Johannesson, Sandra
    Dept Occupat & Environm Med, Sahlgrenska Univ Hosp & Acad, Univ Gothenburg, Gothenburg, Sweden.
    Bellander, Tom
    Inst Environm Med, Karolinska Inst, Stockholm, Sweden; Ctr Occupat & Environm Med, Karolinska Inst, Stockholm, Sweden .
    Merritt, Anne-Sophie
    Inst Environm Med, Karolinska Inst, Stockholm, Sweden; Ctr Occupat & Environm Med, Karolinska Inst, Stockholm, Sweden .
    Tinnerberg, Håkan
    Dept Occupat & Environm Med, Lund Univ, Lund, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Dept Occupat & Environm Med, Örebro Univ Hosp, Örebro, Sweden.
    Forsberg, Bertil
    Man Technol Environm MTM Res Ctr, Univ Örebro, Örebro, Sweden.
    Sallsten, Gerd
    Dept Occupat & Environm Med, Sahlgrenska Univ Hosp & Acad, Univ Gothenburg, Gothenburg, Sweden.
    Determinants of personal exposure to some carcinogenic substances and nitrogen dioxide among the general population in five Swedish cities2014In: Journal of Exposure Science and Environmental Epidemiology, ISSN 1559-0631, E-ISSN 1559-064X, Vol. 24, no 4, p. 437-443Article in journal (Refereed)
    Abstract [en]

    Environmental levels of airborne carcinogenic and related substances are comparatively better known than individual exposure and its determinants. We report on a personal monitoring program involving five Swedish urban populations. The aim of the program was to investigate personal exposure to benzene, 1,3-butadiene, formaldehyde, and nitrogen dioxide (NO2). The measurements were performed among 40 inhabitants during seven consecutive days, in one urban area each year, during 2000-2008. The estimated population exposure levels were 1.95 mu g/m(3) for benzene, 0.56 mu g/m(3) for 1,3-butadiene, 19.4 mu g/m(3) for formaldehyde, and 14.1,mu g/m(3) for NO2. Statistical analysis using a mixed-effects model revealed that time spent in traffic and time outdoors contributed to benzene and 1,3- butadiene exposure. For benzene, refueling a car was an additional determinant influencing the exposure level. Smoking or environmental tobacco smoke were significant determinants of exposure to NO2, benzene, and 1, 3-butadiene. Those with a gas stove had higher NO2 exposure. Living in a single-family house increased the exposure to formaldehyde significantly. In a variance component model, the between-subject variance dominated for 1,3-butadiene and formaldehyde, whereas the between-city variance dominated for NO2. For benzene, the between-subject and between-cities variances were similar.

  • 7.
    Hardell, Lennart
    et al.
    Örebro University, Department of Natural Sciences.
    Carlberg, M.
    Ohlson, C-G
    Westberg, Håkan
    Örebro University, Department of Natural Sciences.
    Eriksson, M.
    Hansson Mild, Kjell
    Örebro University, Department of Natural Sciences.
    Use of cellular and cordless telephones and risk of testicular cancer2007In: International Journal of Andrology, ISSN 0105-6263, E-ISSN 1365-2605, Vol. 30, no 2, p. 115-122Article in journal (Refereed)
    Abstract [en]

    A case-control study on testicular cancer included use of cellular and cordless telephones. The results were based on answers from 542 (92%) cases with seminoma, 346 (89%) with non-seminoma, and 870 (89%) controls. Regarding seminoma the use of analog cellular phones gave odds ratio (OR) = 1.2, 95% confidence interval (CI) = 0.9-1.6, digital phones OR = 1.3, CI = 0.9-1.8, and cordless phones OR = 1.1, CI = 0.8-1.5. The corresponding results for non-seminoma were OR = 0.7, CI = 0.5-1.1, OR = 0.9, CI = 0.6-1.4, and OR = 1.0, CI = 0.7-1.4, respectively. There was no dose-response effect and OR did not increase with latency time. No association was found with place of keeping the mobile phone during standby, such as trousers pocket. Cryptorchidism was associated both with seminoma (OR = 4.2, CI = 2.7-6.5) and non-seminoma (OR = 3.3, CI = 2.0-5.6), but no interaction was found with the use of cellular or cordless telephones.

  • 8.
    Julander, Anneli
    et al.
    Örebro University, Department of Natural Sciences.
    Karlsson, Marie
    Örebro University, Department of Natural Sciences.
    Hagström, K.
    Örebro University, Department of Natural Sciences.
    Ohlson, C.-G.
    Engwall, Magnus
    Örebro University, Department of Natural Sciences.
    Bryngelsson, I.-L.
    Westberg, Håkan
    Örebro University, Department of Natural Sciences.
    van Bavel, Bert
    Örebro University, Department of Natural Sciences.
    Polybrominated diphenyl ethers: plasma levels and thyroid status of workers at an electronic recycling facility2005In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 78, no 7, p. 584-592Article in journal (Refereed)
    Abstract [en]

    Objectives: Personnel working with electronic dismantling are exposed to polybrominated diphenyl ethers (PBDEs), which in animal studies have been shown to alter thyroid homeostasis. The aim of this longitudinal study was to measure plasma level of PBDEs in workers at an electronic recycling facility and to relate these to the workers’ thyroid status. Methods: PBDEs and three thyroid hormones: triiodothyronine (T3), thyroxin (T4) and thyroid stimulating hormone (TSH) were repeatedly analysed in plasma from 11 workers during a period of 1.5 years.Results: Plasma levels of PBDEs at start of employment were <0.5–9.1 pmol/g lipid weight (l.w.). The most common congener was PBDE #47 (median 2.8 pmol/g l.w.), followed by PBDE #153 (median 1.7 pmol/g l.w.), and PBDE #183 had a median value of <0.19 pmol/g l.w. After dismantling the corresponding median concentrations were: 3.7, 1.7 and 1.2 pmol/g l.w., respectively. These differences in PBDE levels were not statistically significant. PBDE #28 showed a statistically significantly higher concentration after dismantling than at start of employment (P=0.016), although at low concentrations (start 0.11 pmol/g l.w. and dismantling 0.26 pmol/g l.w.). All measured levels of thyroid hormones (T3, T4 and TSH) were within the normal physiological range. Statistically significant positive correlations were found between T3 and #183 in a worker, between T4 and both #28 and #100 in another worker and also between TSH and #99 and #154 in two workers. Conclusions: The workers’ plasma levels of PBDEs fluctuated during the study period. Due to small changes in thyroid hormone levels it was concluded that no relevant changes were present in relation to PBDE exposure within the workers participating in this study.

  • 9.
    Klasson, Maria
    et al.
    Örebro University, School of Health Sciences. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Pettersson, Carin
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Husby, Bente
    Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Arvidsson, Helena
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Occupational Exposure to Cobalt and Tungsten in the Swedish Hard Metal Industry: Air Concentrations of Particle Mass, Number, and Surface Area2016In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 60, no 6, p. 684-699Article in journal (Refereed)
    Abstract [en]

    Exposure to cobalt in the hard metal industry entails severe adverse health effects, including lung cancer and hard metal fibrosis. The main aim of this study was to determine exposure air concentration levels of cobalt and tungsten for risk assessment and dose-response analysis in our medical investigations in a Swedish hard metal plant. We also present mass-based, particle surface area, and particle number air concentrations from stationary sampling and investigate the possibility of using these data as proxies for exposure measures in our study. Personal exposure full-shift measurements were performed for inhalable and total dust, cobalt, and tungsten, including personal real-time continuous monitoring of dust. Stationary measurements of inhalable and total dust, PM2.5, and PM10 was also performed and cobalt and tungsten levels were determined, as were air concentration of particle number and particle surface area of fine particles. The personal exposure levels of inhalable dust were consistently low (AM 0.15mg m(-3), range <0.023-3.0mg m(-3)) and below the present Swedish occupational exposure limit (OEL) of 10mg m(-3) The cobalt levels were low as well (AM 0.0030mg m(-3), range 0.000028-0.056mg m(-3)) and only 6% of the samples exceeded the Swedish OEL of 0.02mg m(-3) For continuous personal monitoring of dust exposure, the peaks ranged from 0.001 to 83mg m(-3) by work task. Stationary measurements showed lower average levels both for inhalable and total dust and cobalt. The particle number concentration of fine particles (AM 3000 p·cm(-3)) showed the highest levels at the departments of powder production, pressing and storage, and for the particle surface area concentrations (AM 7.6 µm(2)·cm(-3)) similar results were found. Correlating cobalt mass-based exposure measurements to cobalt stationary mass-based, particle area, and particle number concentrations by rank and department showed significant correlations for all measures except for particle number. Linear regression analysis of the same data showed statistically significant regression coefficients only for the mass-based aerosol measures. Similar results were seen for rank correlation in the stationary rig, and linear regression analysis implied significant correlation for mass-based and particle surface area measures. The mass-based air concentration levels of cobalt and tungsten in the hard metal plant in our study were low compared to Swedish OELs. Particle number and particle surface area concentrations were in the same order of magnitude as for other industrial settings. Regression analysis implied the use of stationary determined mass-based and particle surface area aerosol concentration as proxies for various exposure measures in our study.

  • 10.
    Klasson, Maria
    et al.
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lindberg, Magnus
    Örebro University, School of Medical Sciences. Department of Dermatology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Arvidsson, Helena
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Pettersson, Carin
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Husby, Bente
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Biological monitoring of dermal and air exposure to cobalt at a Swedish hard metal production plant: does dermal exposure contribute to uptake?2017In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 77, no 4, p. 201-207Article in journal (Refereed)
    Abstract [en]

    Background: Occupational exposure to cobalt is well established in hard metal manufacture. Cobalt is known to cause contact allergy, asthma, hard metal lung disease, and lung cancer. The relationship between skin exposure and uptake determined in blood has not been extensively investigated.

    Objective: To examine whether skin and inhalable air exposure to cobalt contributes to uptake, determined as cobalt in blood, in a hard metal manufacturing factory.

    Methods: The amount of cobalt on the skin found with an acid wash technique, the air concentrations of inhalable cobalt and cobalt blood concentrations were determined and correlated in exposed workers.

    Results: We found a significant rank correlation for cobalt concentrations on the skin, in inhalable air, and in blood (0.376-0.498). Multiple linear regression showed significant regression coefficients for cobalt skin exposure and blood (B = 0.01, p < 0.05) and for inhalable cobalt in air and blood (B = 49.1, p < 0.001). According to our model based on data from the regression analyses, a twofold increase in skin exposure levels at different air concentrations caused a 3 - 14% increase in blood levels.

    Conclusions: Our data suggest that skin exposure to cobalt in the hard metal industry could affect the total uptake at the same order of magnitude as air exposure.

  • 11.
    Landberg, Hanna E.
    et al.
    Department of Occupational and Environmental Medicine, Institute of Laboratory Medicine, University Hospital, Lund, Sweden.
    Axmon, Anna
    Department of Occupational and Environmental Medicine, Institute of Laboratory Medicine, University Hospital, Lund, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Örebro University Hospital. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Tinnerberg, Håkan
    Department of Occupational and Environmental Medicine, Institute of Laboratory Medicine, University Hospital, Lund, Sweden.
    A Study of the Validity of Two Exposure Assessment Tools: Stoffenmanager and the Advanced REACH Tool2017In: Annals of work exposures and health, ISSN 2398-7308, Vol. 61, no 5, p. 575-588Article in journal (Refereed)
    Abstract [en]

    The use of exposure modelling tools for estimating chemical airborne exposure has increased since the European Union's REACH legislation for safe use of industrial chemicals came into force. Two tools that European Chemicals Agency recommends are Stoffenmanager® and the Advanced REACH Tool (ART). The aim of this study was to investigate the validity of these two exposure modelling tools by comparing the lack of agreement between estimated and measured exposure. We examined the airborne chemical exposure at companies in seven different types of industries: wood, printing, foundry, spray painting, flour milling, chemical industry, and plastic moulding industry. The inhalable exposure of liquids or powders at two to three situations at each company was modelled with both tools and measured. To study the validity of the tools, the mean differences and precisions (lack of agreement) of exposures from both situations handling liquids and powders were calculated by using the 50th percentile outcome of the tools and the geometric mean of the measured exposure (all data were ln transformed). For Stoffenmanager, the mean difference and precision of the situations concerning liquids were 0.22 ± 1.0 and for powders -0.024 ± 0.66. It was also shown that Stoffenmanager overestimated low exposures and underestimated high exposures. Stoffenmanager showed higher agreement with the measured exposure in the wood and flour mill industries than in foundry and the plastic moulding industry. For ART, the mean difference and precision of liquids were -0.55 ± 0.88 and for powders -1.4 ± 1.6. ART showed lower agreement with the measured exposure in the wood industry.

  • 12.
    Landberg, Hanna E.
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
    Hedmer, Maria
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Tinnerberg, Håkan
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden.
    Evaluating the Risk Assessment Approach of the REACH Legislation: A Case Study2019In: Annals of Work Exposures and Health, ISSN 2398-7308, Vol. 63, no 1, p. 68-76Article in journal (Refereed)
    Abstract [en]

    Risk assessments based on occupational exposure to chemicals have increased since REACH (European regulation on Registration, Evaluation, Authorization, and restriction of Chemicals) came into force. The European Chemicals Agency (ECHA) recommends that chemical exposure could be calculated using exposure models and that parameters used to calculate the exposure scenario (ES) should be communicated in extended safety data sheets (e-SDS) as workplace instructions which downstream users are obligated to follow. We aimed to evaluate REACH's risk assessment approach using the Stoffenmanager((R)) 6.1, the Advanced REACH Tool 1.5 (ART), and the European Centre for Ecotoxicology and Toxicology of Chemicals' targeted risk assessment (ECETOC TRA 3.1) exposure models. We observed 239 scenarios in three companies handling chemicals using 45 e-SDS. Risk characterization ratios (RCRs) were calculated by dividing estimated exposures by derived no-effect levels (DNELs). Observed RCRs were much lower than registered RCRs, indicating lower exposures. However, about 12% of the observed ES still had RCRs > 1, after adjustment for control measures and personal protections described in the ES, when using Stoffenmanager((R)). The ES with observed RCRs > 1 were the same by Stoffenmanager((R)) and ART, but not by ECETOC TRA. Stoffenmanager and ART identified 25 adjusted scenarios with RCR > 1, while ECETOC TRA gave RCR < 1 for the same scenarios. The ES with RCR > 1 were significantly associated to chemicals with higher vapour pressure and lower DNELs than ES with RCR < 1 by Stoffenmanager((R)). The correlations between observed and registered RCRs were lower than those between RCRs calculated from the different models themselves; ECETOC TRA had the lowest correlation with the registered ES. These results put in question the generic ES recommended under the REACH legislation. Downstream users may get better estimates by assessing their own ES, especially for chemicals with low DNELs and high vapour pressure.

  • 13.
    Landberg, Hanna E.
    et al.
    Department of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden.
    Westberg, Håkan
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Tinnerberg, Håkan
    Department of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden.
    Evaluation of risk assessment approaches of occupational chemical exposures based on models in comparison with measurements2018In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 109, p. 412-420Article in journal (Refereed)
    Abstract [en]

    Risk assessments of chemicals in work places are needed to protect workers' health and safety. Several different strategies can be used for conducting risk assessments. The aim of this study was to investigate approaches to risk assessment of chemicals based on exposure assessment models relative to occupational exposure limits values (OELs) and derived no-effect levels (DNELs) and in comparison with measurements relative to OELs. A second aim was to evaluate the modelled recommended outcome and compare it with measurements of exposure. In this study, 29 situations were assessed with ECETOC TRA, Stoffenmanager (R) 5.1 and ART. Personal exposure measurements were also performed. The percentage of measured exposure exceeding the recommended output was calculated to investigate the level of conservatism. All the modelled exposures were compared with OELs and DNELs where possible, and the GM of the measured exposure was compared with OELs (risk quotas). For ECETOC TRA, 31% of measured exposure exceeded modelled exposure. For Stoffenmanager (R) it was 17% and for ART and ART B it was 3% and 0% respectively. Hence, according to our data, ECETOC TRA is the least conservative. An investigation of the risk quotas showed that ECETOC TRA had 4 false safe situations, meaning the risk was low when the model was used but was high when measurements were used. This may lead to underestimating risks. All models had an elevated proportion, ECETOC TRA and ART the highest, of false unsafe situations meaning the risk was low when measurements were used but high when models were used.

  • 14.
    Liljelind, I.
    et al.
    Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Norberg, C.
    Örebro University Hopital, Örebro, Sweden; Department of Natural Sciences, Örebro University, Örebro, Sweden.
    Egelrud, L.
    IVL Swedish Environm Res Inst Ltd, Stockholm, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Örebro University Hospital, Örebro, Sweden.
    Eriksson, K.
    Dept Occupat & Environm Med, Umeå Univ Hosp, Umeå, Sweden.
    Nylander-French, L. A.
    Dept Environm Sci & Engn, Gillings Sch Global Publ Hlth, Univ N Carolina, Chapel Hill NC, USA.
    Dermal and Inhalation Exposure to Methylene Bisphenyl Isocyanate (MDI) in Iron Foundry Workers2010In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 54, no 1, p. 31-40Article in journal (Refereed)
    Abstract [en]

    Diisocyanates are a group of chemically reactive agents, which are used in the production of coatings, adhesives, polyurethane foams, and parts for the automotive industry and as curing agents for cores in the foundry industry. Dermal and inhalation exposure to methylene bisphenyl isocyanate (MDI) is associated with respiratory sensitization and occupational asthma. However, limited research has been performed on the quantitative evaluation of dermal and inhalation exposure to MDI in occupationally exposed workers. The objective of this research was to quantify dermal and inhalation exposure levels in iron foundry workers. Workers involved in mechanized moulding and mechanized production of cores were monitored: 12 core makers, 2 core-sand preparers, and 5 core installers. Personal breathing-zone levels of MDI were measured using impregnated filter sampling. Dermal exposure to MDI was measured using a tape-strip technique. Three or five consecutive tape-strip samples were collected from five exposed skin areas (right and left forefingers, left and right wrists, and forehead). The average personal air concentration was 0.55 mu g m(-3), 50-fold lower than the Swedish occupational exposure limit of 30 mu g m(-3). The core makers had an average exposure of 0.77 mu g m(-3), which was not significantly different from core installers' and core-sand preparers' average exposure of 0.16 mu g m(-3) (P = 0.059). Three core makers had a 10-fold higher inhalation exposure than the other core makers. The core makers' mean dermal exposure at different skin sites varied from 0.13 to 0.34 mu g while the two other groups' exposure ranged from 0.006 to 0.062 mu g. No significant difference was observed in the MDI levels between the skin sites in a pairwise comparison, except for left forefinger compared to left and right wrist (P < 0.05). In addition, quantifiable but decreasing levels of MDI were observed in the consecutive tape strip per site indicating MDI penetration into the skin. This study indicates that exposure to MDI can be quantified on workers' skin even if air levels are close to unquantifiable. Thus, the potential for uncured MDI to deposit on and penetrate into the skin is demonstrated. Therefore, dermal exposure along with inhalation exposure to MDI should be measured in the occupational settings where MDI is present in order to shed light on their roles in the development of occupational isocyanate asthma.

  • 15.
    Löfstedt, Håkan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Westerlund, Jessica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Graff, Pål
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Mölleby, Göte
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Olin, Anna-Carin
    Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Kåre
    Umeå University, Umeå, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology.
    Respiratory and ocular symptoms among employees at Swedish indoor swimming poolsManuscript (preprint) (Other academic)
  • 16.
    Löfstedt, Håkan
    et al.
    Örebro University, School of Health Sciences. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Westerlund, Jessica
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Graff, Pål
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Mölleby, Göte
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Olin, Anna-Carin
    Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Kåre
    Department of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Respiratory and Ocular Symptoms Among Employees at Swedish Indoor Swimming Pools2016In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 58, no 12, p. 1190-1195Article in journal (Refereed)
    Abstract [en]

    Background: This study investigated trichloramine exposure and prevalence of respiratory and ocular symptoms among Swedish indoor swimming pool workers.

    Methods: Questionnaires were distributed to pool workers and referents. Lung function and fraction of exhaled nitric oxide (FeNO) were measured before and after work. Exposure to trichloramine and trihalomethanes was measured over work shifts.

    Results: The mean personal trichloramine exposure was 36g/m(3). Significantly more exposed workers reported ocular and nasal symptoms. There were significant differences between groups in FeNO change following work, with exposed showing increased FeNO, which grew when analyses included only nonsmokers.

    Conclusions: The findings indicate that indoor swimming pool environments may have irritating effects on mucous membranes. FeNO data also indicate an inflammatory effect on central airways, but the clinical relevance is unclear. Low trichloramine levels found in this study were not associated with health effects.

  • 17.
    Marsh, Gary M.
    et al.
    Department of Biostatistics, Center for Occupational Biostatistics and Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Buchanich, Jeanine M.
    Department of Biostatistics, Center for Occupational Biostatistics and Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Zimmerman, Sarah
    Department of Biostatistics, Center for Occupational Biostatistics and Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Liu, Yimeng
    Department of Biostatistics, Center for Occupational Biostatistics and Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Balmert, Lauren C.
    Department of Preventative Medicine, Feinberg School of Medicine, University of Northwestern St. Paul , Roseville MN, United States.
    Graves, Jessica
    Department of Biostatistics, Center for Occupational Biostatistics and Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Kennedy, Kathleen J.
    Division of Environmental and Occupational Health Sciences, University of Illinois, Chicago IL, United States.
    Esmen, Nurtan A.
    Division of Environmental and Occupational Health Sciences, University of Illinois, Chicago IL, United States.
    Moshammer, Hanns
    Department of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria.
    Morfeld, Peter
    Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany.
    Erren, Thomas
    Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany.
    Groß, Juliane Valérie
    Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany.
    Yong, Mei
    Institute for Occupational Medicine and Risk Assessment, Evonik Industries AG, Essen, Germany.
    Svartengren, Magnus
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    McElvenny, Damien
    Institute of Occupational Medicine, Edinburgh, United Kingdom.
    Cherrie, John W.
    Institute of Occupational Medicine, Edinburgh, United Kingdom.
    Mortality Among Hardmetal Production Workers: Pooled Analysis of Cohort Data From an International Investigation2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 12, p. e342-e364Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Based on a pooled analysis of data from an international study, evaluate total and cause-specific mortality among hardmetal production workers with emphasis on lung cancer.

    METHODS: Study members were 32,354 workers from three companies and 17 manufacturing sites in five countries. We computed standardized mortality ratios and evaluated exposure-response via relative risk regression analysis.

    RESULTS: Among long-term workers, we observed overall deficits or slight excesses in deaths for total mortality, all cancers, and lung cancer and found no evidence of any exposure-response relationships for lung cancer.

    CONCLUSIONS: We found no evidence that duration, average intensity, or cumulative exposure to tungsten, cobalt, or nickel, at levels experienced by the workers examined, increases lung cancer mortality risks. We also found no evidence that work in these facilities increased mortality risks from any other causes of death.

  • 18.
    Nilsson, Helena
    et al.
    Örebro University, School of Science and Technology.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Rotander, Anna
    Örebro University, School of Science and Technology.
    van Bavel, Bert
    Örebro University, School of Science and Technology.
    Lindström, Gunilla
    Örebro University, School of Science and Technology.
    Bryngelsson, Ing-Liss
    Westberg, Håkan
    Örebro University, School of Science and Technology.
    Professional ski waxers' exposure to PFAS and aerosol concentrations in gas phase and different particle size fractionsManuscript (preprint) (Other academic)
  • 19.
    Nilsson, Helena
    et al.
    Örebro University, School of Science and Technology.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Rotander, Anna
    Örebro University, School of Science and Technology.
    van Bavel, Bert
    Örebro University, School of Science and Technology.
    Lindström, Gunilla
    Örebro University, School of Science and Technology.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Örebro University Hospital.
    Biotransformation of fluorotelomer compound to perfluorocarboxylates in humans2013In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 51, p. 8-12Article in journal (Refereed)
    Abstract [en]

    Levels of perfluorocarboxylates (PFCAs) in biological compartments have been known for some time but their transport routes and distribution patterns are not properly elucidated. The opinions diverge whether the exposure of the general population occurs indirect through precursors or direct via PFCAs. Previous results showed that ski wax technicians are exposed to levels up to 92 000 ng/m(3) of 8:2 fluorotelomer alcohol (FTOH) via air and have elevated blood levels of PFCAs. Blood samples were collected in 2007-2011 and analyzed for C(4)-C(18) PFCAs, 6:2, 8:2 and 10:2 unsaturated fluorotelomer acids (FTUCAs) and 3:3, 5:3 and 7:3 fluorotelomer acids (FTCAs) using UPLC-MS/MS. Perfluorooctanoic acid (PFOA) was detected in levels ranging from 1.90 to 628 ng/mL whole blood (wb). Metabolic intermediates 5:3 and 7:3 FTCA were detected in all samples at levels up to 6.1 and 3.9 ng/mL wb. 6:2, 8:2 and 10:2 FTUCAs showed maximum levels of 0.07, 0.64 and 0.11 ng/mL wb. Also, for the first time levels of PFHxDA and PFOcDA were detected in the human blood at mean concentrations up to 4.22 ng/mL wb and 4.25 ng/mL wb respectively. The aim of this study was to determine concentrations of PFCAs and FTOH metabolites in blood from ski wax technicians.

  • 20.
    Nilsson, Helena
    et al.
    Örebro University, School of Science and Technology.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Rotander, Anna
    Örebro University, School of Science and Technology.
    van Bavel, Bert
    Örebro University, School of Science and Technology.
    Lindström, Gunilla
    Örebro University, School of Science and Technology.
    Westberg, Håkan
    Örebro University, School of Science and Technology.
    Biotransformation of fluorotelomer compund to perfluorocarboxylates in humansManuscript (preprint) (Other academic)
  • 21.
    Nilsson, Helena
    et al.
    Örebro University, School of Science and Technology.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Rotander, Anna
    Örebro University, School of Science and Technology.
    van Bavel, Bert
    Örebro University, School of Science and Technology.
    Lindström, Gunilla
    Örebro University, School of Science and Technology.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Örebro University Hospital, Örebro, Sweden.
    Inhalation exposure to fluorotelomer alcohols yield perfluorocarboxylates in human blood?2010In: Environmental Science and Technology, ISSN 0013-936X, E-ISSN 1520-5851, Vol. 44, no 19, p. 7717-7722Article in journal (Refereed)
    Abstract [en]

    Levels of perfluorinated carboxylates (PFCAs) in different environmental and biological compartments have been known for some time, but the routes of exposure still remain unclear. The opinions are divergent whether the exposure to general populations occurs mainly indirect through precursor compounds or direct via PFCAs. Previous results showed elevated blood levels of PFCAs in ski wax technicians compared to a general population. The objective of this follow-up study was to determine concentrations of PFCAs, perfluorosulfonates (PFSAs), and fluorotelomer alcohols (FTOHs), precursor compounds that are known to degrade to PFCAs, in air collected in the breathing zone of ski wax technicians during work. We collected air samples by using ISOLUTE ENV+ cartridges connected to portable air pumps with an air flow of 2.0 L min(-1). PFCAs C5-C11 and PFSAs C4, C6, C8, and C10 were analyzed using LC-MS/MS and FTOHs 6:2, 8:2, and 10:2 with GC-MS/MS. The results show daily inhalation exposure of 8:2 FTOH in mu g/m(3) air which is up to 800 times higher than levels of PFOA with individual levels ranging between 830-255000 ng/m(3) air. This suggests internal exposure of PFOA through biotransformation of 8:2 FTOH to PFOA and PFNA in humans.

  • 22.
    Nilsson, Helena
    et al.
    Örebro University, School of Science and Technology.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Rotander, Anna
    Örebro University, School of Science and Technology.
    van Bavel, Bert
    Örebro University, School of Science and Technology.
    Lindström, Gunilla
    Örebro University, School of Science and Technology.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Professional ski waxers' exposure to PFAS and aerosol concentrations in gas phase and different particle size fractions2013In: Environmental science. Processes & impacts, ISSN 2050-7887, Vol. 15, no 4, p. 814-822Article in journal (Refereed)
    Abstract [en]

    Previous reports show that professional ski waxers have elevated blood levels of perfluorinated substances (PFAS) such as perfluorooctanoate (PFOA) and are exposed to very high concentrations of PFAS in air during ski waxing. Aerosol exposure increases the risk of cardiovascular disease, and PFOA is a potential hormonal disruptor and carcinogen, and can affect the fatty acid metabolism. Animal studies have shown that 8: 2 FTOH can undergo biotransformation to PFOA. For the first time, this study presents an occupational scenario of professional ski waxers who are exposed to extremely high dust levels as well as per-and polyfluorinated compounds. Personal and fixed measurements of total aerosol, inhalable and respirable fractions were performed during World Cup events 2007-2010. The occupational exposure limit (OEL) is exceeded in 37% of the personal measurements with concentrations up to 15 mu g m(-3) in air. There are differences between personal and area total aerosol concentrations with levels from personal measurements twice as high as those from the area measurements. The personal levels for FTOH ranged up to 996 mg m(-3) (mean = 114 mu g m(-3)) and for PFOA up to 4.89 mu g m(-3) (mean = 0.53 mu g m(-3)) in ENV+ sorbent samples as compared to the general exposure levels from air reaching only low ng m(-3) (<30 ng m(-3)) levels. FTOHs were not detected in aerosols but PFOA showed an average level of 12 mu g m(-3) (range = 1.2-47 mu g m(-3)). The ski waxers' exposure to paraffin fumes and PFAS is not in compliance with the occupational exposure standards and by far exceed the general populations' exposure. Preventive measures must be taken to minimize the exposure in this occupational group.

  • 23.
    Nilsson, Helena
    et al.
    Örebro University, School of Science and Technology.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Rotander, Anna
    Örebro University, School of Science and Technology.
    van Bavel, Bert
    Örebro University, School of Science and Technology.
    Lindström, Gunilla
    Örebro University, School of Science and Technology.
    A time trend study of significantly elevated perfluorocarboxylate levels in humans after using fluorinated ski wax2010In: Environmental Science and Technology, ISSN 0013-936X, E-ISSN 1520-5851, Vol. 44, no 6, p. 2150-2155Article in journal (Refereed)
    Abstract [en]

    A time trend study focusing on ski waxing technicians' exposure to perfluorinated chemicals (PFCs) from fluorinated wax fumes was performed in 2007/2008. Levels of eight perfluorocarboxylates and three perfluorosulfonates were analyzed in monthly blood samples from eight technicians, Samples were collected before the ski season, i.e., preseason, then at four AS World Cup competitions in cross country skiing, and finally during an unexposed 5-month postseason period. The perfluorinated carboxylates perfluoroheptanoic acid (PFHpA), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) bioaccumulate, and continued exposure may contribute to elevated levels in ski technicians compared to the general population. The wax technicians' median blood level of PFOA is 112 ng/mL compared to 2.5 ng/mL in the general Swedish population. A significant correlation was found between number of working years and levels of perfluorocarboxylates. The PFOA levels in three technicians with "low" initial levels of PFOA (< 10.0 ng/mL in preseason blood) increased by 254, 134, and 120%, whereas five technicians with "high" initial levels (> 100 ng/mL in preseason sample) were at steady state. PFHxA is suggested to have a short half-life in humans relative the other perfluorocarboxylates. The levels of perfluorosulfonates were unaffected by the wax exposure.

  • 24.
    Svartengren, Magnus
    et al.
    Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University, Örebro, Sweden.
    Marsh, Gary
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Buchanich, Jeanine
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Zimmerman, Sarah
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Kennedy, Kathleen
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago IL, United States.
    Esmen, Nurtan
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago IL, United States.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Cancer Incidence Among Hardmetal Production Workers: The Swedish Cohort2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 12, p. e365-e373Article in journal (Refereed)
    Abstract [en]

    The cancer incidence was determined for 3713 workers from three plants from 1958 to 2011. The exposure measures were ever/never exposed, duration, cumulative, and mean cobalt concentrations.The incidence of all malignant neoplasms was increased at one plant, but standardized incidence ratio (SIR) was 0.96 for all workers. Lung cancer incidence was increased for all workers, SIR 1.38 (1.01 to 1.85). The lung cancer incidence was associated with shorter employment time and showed no exposure-response. There was decreased incidence for skin cancer. Increased lip cancer incidence found at one of the production plants might be related to diagnostic intensity.Lung cancer incidence showed no correlation to cobalt exposure based on internal comparison. The increased SIR for all workers might be associated with other factors.

  • 25.
    Westberg, Håkan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Andersson, Lena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bryngelsson, Ing-Liss
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ngo, Yen
    Swedish Institute for Infectious Disease Control, Nobels väg 18, SE-171 82 Solna, Sweden.
    Ohlson, Carl-Göran
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Cancer morbidity and quartz exposure in Swedish iron foundriesManuscript (preprint) (Other academic)
  • 26.
    Westberg, Håkan
    et al.
    Örebro University, School of Science and Technology. Örebro University Hospital.
    Andersson, Lena
    Örebro University, School of Science and Technology.
    Bryngelsson, Ing-Liss
    Swedish Institute for Infectious Disease ControlSolnaSweden.
    Ngo, Yen
    Department of Clinical Medicines, Örebro University, Örebro, Sweden.
    Ohlson, Carl-Göran
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Cancer morbidity and quartz exposure in Swedish iron foundries2013In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, no 5, p. 499-507Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine cancer morbidity amongst Swedish iron foundry workers with special reference to quartz exposure. In addition to respirable dust and quartz, phenol, formaldehyde, furfuryl alcohols, polycyclic aromatic hydrocarbons (PAHs), carbon black, isocyanates and asbestos are used or generated by foundry production techniques and exposure to any of these substances could have potentially carcinogenic effects. Cancer morbidity between 1958 and 2004 was evaluated in a cohort of 3,045 male foundry workers employed for > 1 year between 1913 and 2005. Standardised incidence ratios (SIRs) with 95 % confidence intervals (95 % CI) were determined by comparing observed numbers of incident cancers with frequencies in the Swedish cancer register. Exposure measures were assessed using information from the personal files of employees and modelling quartz measurement based on a database of 1,667 quartz measurements. Dose responses for lung cancer were determined for duration of employment and cumulative quartz exposure for latency periods > 20 years. Overall cancer morbidity was not increased amongst the foundry workers (SIR 1.00; 95 % CI, 0.90-1.11), but the incidence of lung cancer was significantly elevated (SIR 1.61; 95 % CI, 1.20-2.12). A non-significant negative dose response was determined using external comparison with a latency period of > 20 years (SIR 2.05, 1.72 1.26 for the low, medium and high exposure groups), supported by internal comparison data (hazard ratios 1, 1.01, 0.78) for the corresponding groups. For cancers at sites with at least five observed cases and a SIR > 1.25, non-significant risks with SIRs > 1.5 were determined for cancers of the liver, larynx, testis, connective muscle tissue, multiple myeloma plasmacytoma and lymphatic leukaemia. A significant overall risk of lung cancer was determined, but using external and internal comparison groups could not confirm any dose response at our cumulative quartz dose levels.

  • 27.
    Westberg, Håkan
    et al.
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Marsh, Gary
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Buchanich, Jeanine
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Zimmerman, Sarah
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Kennedy, Kathleen
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago IL, United States.
    Esmen, Nurtan
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago IL, United States.
    Svartengren, Magnus
    Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Mortality Among Hardmetal Production Workers: The Swedish Cohort2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 12, p. e263-e274Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The mortality pattern was determined in a cohort of 16,999 white and blue-collar workers in the Swedish hardmetal industry, particularly for cobalt exposure and lung cancer.

    METHODS: The mortality follow-up analysis in the Swedish Mortality register covered the period from 1952 to 2012. The exposure measures were ever/never exposed, duration of exposure, cumulative, and mean cobalt concentrations.

    RESULTS: The mortality of all causes was significantly increased, highly associated with the short-term employed workers. A negative exposure-response was found for lung cancer and duration of exposure. An exposure-response was determined for cumulative and mean cobalt exposures analyzed by quartiles, but not for exposure classes. Internal comparison analysis using proportional hazard showed no exposure-response.

    CONCLUSIONS: The cohort lung cancer mortality showed no correlation to cobalt, nickel, or tungsten exposure.

  • 28.
    Westberg, Håkan
    et al.
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Marsh, Gary
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Kennedy, Kathleen
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago IL, United States.
    Buchanich, Jeanine
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Zimmerman, Sarah
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Esmen, Nurtan
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago IL, United States.
    Svartengren, Magnus
    Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Mortality Among Hardmetal Production Workers: Swedish Measurement Data and Exposure Assessment2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 12, p. e327-e341Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mortality pattern was determined in a cohort of 16,999 white and blue-collar workers in the Swedish hardmetal industry. Exposure assessment for cobalt is presented.

    METHODS: A historical database (1970 to 2012) of personal and area measurements of cobalt, tungsten, and nickel in the Swedish hardmetal industry was created. Log linear and exponential modeling of cobalt concentrations based on time period, job, and site was performed, and cumulative and mean exposures were calculated.

    RESULTS: Some 37% of the personal cobalt measurements exceeded 0.02 mg/m, mostly for powder production, pressing, and shaping. The log linear regression showed statistical differences (P < 0.05) between sites, time periods, and jobs. Some 1.6% of the cobalt cumulative exposures for blue-collar workers exceeded 0.4 mg/m years.

    CONCLUSION: Low levels of cumulative and mean exposures were determined.

  • 29.
    Westberg, Håkan
    et al.
    Örebro University, School of Health and Medical Sciences.
    Egelrud, Liselott
    Ohlson, Carl-Göran
    Örebro University, School of Health and Medical Sciences.
    Hygerth, Mona
    Lundholm, Cecilia
    Exposure to nitrous oxide in delivery suites at six Swedish hospitals2008In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 81, no 7, p. 829-836Article in journal (Other academic)
    Abstract [en]

    OBJECTIVE: This study presents occupational peak and average exposures to nitrous oxide in delivery suites in six Swedish hospitals and evaluates different scavenging techniques. METHODS: Exposure measurements based on four consecutive 2-h samples (n = 111) were used to calculate 8-h time-weighted averages (8-h TWAs) for 36 midwives and assistant midwives. Short-term (15 min) samples to study peak exposure were also included in the monitoring program. Diffusive samplers were used for monitoring, and analyzed by thermal desorption and gas chromatography-mass spectrometry (GC-MS). The effect on exposure of different types of scavenging systems was studied by mixed model analysis. RESULTS: The 8-h TWA (n = 36) nitrous oxide concentrations varied between 2.5 and 260 mg/m3, and the geometric means for all the 8-h TWAs was 17 mg/m3 for the midwives and 42 mg/m3 for the assistant midwives. Around 25% of all the 8-h TWAs exceeded the American Conference of Industrial Hygienists' (ACGIH) threshold limit value (TLV-TWA) of 90 mg/m3 (50 ppm). For the short-term samples (n = 29) the nitrous oxide levels varied between 19 and 4,200 mg/m3, and 14% exceeded the Swedish occupational exposure ceiling limit value of 900 mg/m3. The 8-h TWAs were four times higher when the non-ventilated and ventilated simple masks were compared to the double mask (P = 0.02). This trend, although not statistically significant, was also seen for the short-term samples. CONCLUSION: A diffusive sampling method and a GC-MS analytical technique was used for long- and short-term sampling of nitrous oxide. A large number of TWAs exceeded the ACGIH-TLV. Mask connected to scavenging systems significantly reduced the exposures. Furthermore, using a forced general air ventilation system in addition to improved work and delivery routines for the staff and the mother-to-be substantially improved the air quality in the delivery suites.

  • 30.
    Westberg, Håkan
    et al.
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine Örebro University Hospital, Örebro, Sweden.
    Hedbrant, Alexander
    Örebro University, School of Medical Sciences.
    Persson, Alexander
    Örebro University, School of Medical Sciences.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Sweden.
    Johansson, Anders
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Sweden.
    Ericsson, Annette
    Örebro University, School of Health Sciences. Department of Occupational and Environmental Medicine.
    Sjögren, Bengt
    Work Environment Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Stockfelt, Leo
    Department of Occupational and Environmental Medicine, University of Gothenburg, Sweden.
    Särndahl, Eva
    Örebro University, School of Medical Sciences.
    Andersson, Lena
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine.
    Inflammatory and coagulatory markers and exposure to different size fractions of particle mass, number and surface area air concentrations in Swedish iron foundries, in particular respirable quartz2019In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study the relationship between inhalation of airborne particles and quartz in Swedish iron foundries and markers of inflammation and coagulation in blood.

    METHODS: Personal sampling of respirable dust and quartz was performed for 85 subjects in three Swedish iron foundries. Stationary measurements were used to study the concentrations of respirable dust and quartz, inhalable and total dust, PM10 and PM2.5, as well as the particle surface area and the particle number concentrations. Markers of inflammation, namely interleukins (IL-1β, IL-6, IL-8, IL-10 and IL-12), C-reactive protein, and serum amyloid A (SAA) were measured in plasma or serum, together with markers of coagulation including fibrinogen, factor VIII (FVIII), von Willebrand factor and D-dimer. Complete sampling was performed on the second or third day of a working week after a work-free weekend, and follow-up samples were collected 2 days later. A mixed model analysis was performed including sex, age, smoking, infections, blood group, sampling day and BMI as covariates.

    RESULTS: The average 8-h time-weighted average air concentrations of respirable dust and quartz were 0.85 mg/m3 and 0.052 mg/m3, respectively. Participants in high-exposure groups with respect to some of the measured particle types exhibited significantly elevated levels of SAA, fibrinogen and FVIII.

    CONCLUSIONS: These observed relationships between particle exposure and inflammatory markers may indicate an increased risk of cardiovascular disease among foundry workers with high particulate exposure.

  • 31.
    Westerlund, Jessica
    et al.
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Löfstedt, Håkan
    Örebro University, School of Health Sciences. Department of Occupational and Environmental Medicine.
    Eriksson, Kåre
    Department of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine.
    Graff, Pål
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway.
    Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools2019In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 16, no 1, p. 78-88Article in journal (Refereed)
    Abstract [en]

    Personnel in swimming pool facilities typically experience ocular, nasal, and respiratory symptoms due to water chlorination and consequent exposure to disinfection by-products in the air. The aim of the study was to investigate exposure to trichloramine and trihalomethanes (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) from the perspective of adverse health effects on the personnel at Swedish habilitation and rehabilitation swimming pools. The study included ten habilitation and rehabilitation swimming pool facilities in nine Swedish cities. The study population comprised 24 exposed swimming pool workers and 50 unexposed office workers. Personal and stationary measurements of trichloramine and trihalomethanes in air were performed at all the facilities. Questionnaires were distributed to exposed workers and referents. Spirometry, fraction of exhaled nitric oxide (FENO) and peak expiratory flow (PEF) were measured. Personal and stationary measurements yielded trichloramine levels of 1-76 µg/m3 (average: 19 µg/m3) and 1-140 µg/m3 (average: 23 µg/m3), respectively. A slightly higher, but not significant, prevalence of reported eye- and throat-related symptoms occurred among the exposed workers than among the referents. A significantly increased risk of at least one ocular symptom was attributed to trichloramine exposure above the median (20 µg/m3). Lung function (FVC and FEV1) was in the normal range according to the Swedish reference materials, and no significant change in lung function before and after shift could be established between the groups. Average FENO values were in the normal range in both groups, but the difference in the values between the exposed workers and referents showed a significant increase after shift. Hourly registered PEF values during the day of the investigation did not show any unusual individual variability. In conclusion, the increased risk of developing at least one ocular symptom at personal trichloramine concentrations over 20 µg/m3 combined with an increase in the difference in FENO during the work shift of the exposed workers should not be neglected as an increased risk of respiratory inflammation in the habilitation and rehabilitation swimming pool environment.

  • 32.
    Westerlund, Jessica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Graff, Pål
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology.
    Eriksson, Kåre
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Löfstedt, Håkan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Occupational Exposure to Trichloramine and Trihalomethanes in Swedish Indoor Swimming Pools: Evaluation of Personal and Stationary Monitoring2015In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 59, no 8, p. 1074-1084Article in journal (Refereed)
    Abstract [en]

    Introduction: Chlorination is a method commonly used to keep indoor swimming pool water free from pathogens. However, chlorination of swimming pools produces several potentially hazardous by-products as the chlorine reacts with nitrogen containing organic matter. Up till now, exposure assessments in indoor swimming pools have relied on stationary measurements at the poolside, used as a proxy for personal exposure. However, measurements at fixed locations are known to differ from personal exposure.

    Methods: Eight public swimming pool facilities in four Swedish cities were included in this survey. Personal and stationary sampling was performed during day or evening shift. Samplers were placed at different fixed positions around the pool facilities, at similar to 1.5 m above the floor level and 0-1 m from the poolside. In total, 52 personal and 110 stationary samples of trichloramine and 51 personal and 109 stationary samples of trihalomethanes, were collected.

    Results: The average concentration of trichloramine for personal sampling was 71 mu g m(-3), ranging from 1 to 240 mu g m(-3) and for stationary samples 179 mu g m(-3), ranging from 1 to 640 mu g m(-3). The air concentrations of chloroform were well below the occupational exposure limit (OEL). For the linear regression analysis and prediction of personal exposure to trichloramine from stationary sampling, only data from personal that spent > 50% of their workday in the pool area were included. The linear regression analysis showed a correlation coefficient (r (2)) of 0.693 and a significant regression coefficient beta of 0.621; (95% CI = 0.329-0.912, P = 0.001).

    Conclusion: The trichloramine exposure levels determined in this study were well below the recommended air concentration level of 500 mu g m(-3); a WHO reference value based on stationary sampling. Our regression data suggest a relation between personal exposure and area sampling of 1:2, implying an OEL of 250 mu g m(-3) based on personal sampling.

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