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Mortality in a Swedish rubber tire manufacturing plant: occupational risks or an "unhealthy worker" effect?

BACKGROUND: In this cohort study a classification of 12 work categories, with specified common exposures, is used to evaluate the mortality among workers in a Swedish rubber tire plant. METHODS: Mortality among the cohort members is compared with expected values from national rates. Standardized mortality ratios (SMR) were calculated for the total cohort, for sub-cohorts and with the inclusion of a latency requirement. RESULTS: Male workers had increased risks for total mortality, circulatory death, respiratory death, mental disorders, epilepsy, injuries/poisoning, and for alcohol-related death. Many risks were noted among workers exposed to dust, fumes, or vapor. No trend in risk with increasing duration of employment was seen. DISCUSSION: Some established risks for rubber workers could be related to some specified work categories. The highest risks were noted among workers having a very short duration of employment indicating a possible "unhealthy worker effect" associated with life-style factors or to tasks offered to unskilled workers.

Adult↗

An evaluation of the associations of leukemia and rubber industry solvent exposures.

Excessive leukemia mortality has appeared consistently in epidemiological studies of British and U.S. rubber industry workers. Attempts to identify causative factors have focused on exposure to benzene and other solvents. Interpretations of findings from these studies have often been influenced by expectations of a benzene/nonlymphocytic leukemia association, seen from previous work in other settings. However, data from the rubber industry studies have not been consistent with this expectation, as lymphocytic and nonlymphocytic leukemia have shown similar mortality excesses. Data from a small case-control study of lymphocytic leukemia are presented to illustrate an approach that considers multiple solvent exposures. The associations with lymphocytic leukemia risk observed for a number of solvents, most notably carbon tetrachloride and carbon disulfide, were stronger than those detected for benzene.

Adult↗

Mortality among rubber workers: VII. Aerospace workers.

This study evaluated cause-specific mortality among 3,161 men who were employed in the aerospace division of a rubber manufacturing company. Compared to other production workers at the plant, aerospace workers in deicer and fuel cell manufacturing jobs experienced a 60% excess of deaths from lung cancer. Deicer and fuel cell workers who were under 65 years of age had lung cancer rates that were approximately twice those of other rubber workers of comparable age. Aerospace division employees also had elevated rates of bladder cancer, leukemia, lymphoma, and multiple myeloma. However, detailed analyses suggested that, with the exception of lung cancer, these cancer excesses were not likely to be attributable to employment in the aerospace division.

Adult↗

Mortality among rubber workers: IX. Curing workers.

This research examined mortality among 1,152 white male production workers employed in the tire-curing department of a large rubber manufacturing plant. To determine whether these men had any cause-specific mortality excesses, their experience was compared with that of both the U.S. white male general population and a group of production workers at the same plant who had not worked in the curing division. Both types of comparisons indicated that the curing workers experienced excess mortality from lung cancer. There were 45 deaths from lung cancer among curing workers compared to 24.6 expected based on the age- and calendar period-specific rates of other rubber workers. In addition, the mortality rate ratio for pneumonia was 2.2 for curing relative to noncuring workers. These findings are consistent with the results of other studies and suggest that occupational exposures may have contributed to the development of pulmonary disease among curing workers.

Age Factors↗

Occupational epidemiology in the rubber industry: implications of exposure variability.

The variability of exposure has important implications for the design of occupational epidemiologic studies. To assess the influence of this variability in the rubber industry, the efficiency of different schemes for classification of exposure to particulates, cyclohexane-soluble contaminants, and solvents was assessed. Groupings based on job title, plant, factors affecting exposure, published classifications, and the International Standard Classification of Occupations of the International Labor Organization (ISCO-ILO) were compared. Statistical parameters for contrast in average exposure between groups and precision of average exposure within groups were developed to enable comparison of the efficiency of different classification schemes. Grouping of exposure to particulates and dermal exposure appeared to be less efficient than grouping of exposure to solvents. Grouping of solvent exposure using occupational title groups, existing classification schemes, and schemes based on factors affecting exposure showed comparable high resolution in exposure levels. Even the most detailed grouping schemes based on the combination of plant and occupational title group showed relatively modest resolution in particulate and dermal exposure levels. Groupings based on factors affecting exposure showed similar resolution for these exposures, but had higher precision due to having fewer groups. Application of optimal exposure grouping strategies will benefit new research on cancer among rubber workers. Eventually, this might resolve the situation in which a complete industry was included on the list of proven human carcinogens.

Analysis of Variance↗

Long term review of the results of rubber band ligation of haemorrhoids.

A long term assessment (mean 4.8 years) of the value of rubber band ligation treatment for haemorrhoids has been obtained by a questionnaire answered by 125 of 147 patients. Eighty-nine per cent of patients were cured or satisfied with the results of treatment, although complete absence of symptoms was only obtained in 44 per cent. Further conservative treatment (rubber band ligation or manual dilatation) was required in 12 per cent and only 3 (2 per cent) have had a haemorrhoidectomy. Similar results were obtained for patients with the additional symptoms of pain and irritation, the presence of large skin tags and for the majority of third degree piles.

Dilatation↗

Mutagenicity of airborne particulates in the rubber industry.

The aim of this work was to evaluate the mutagenic activity of airborne particulate matter in the rubber industry. Air was sucked through Whatman glass-fibre filters with Staplex pumps and adsorbed substances and fume particles were extracted with acetone or toluene for 2 h in a ultrasonic cleaner. After separation of the insoluble solid phase by filtration, solvent was evaporated at a temperature of 70 degrees C in an argon atmosphere. The residue was stored at -20 degrees C. Mutagenicity was determined by the Salmonella plate incorporation assay with the tester strain TA98 and activity is related either to the weight of aerosol (rev mg-1) or to the volume of atmospheric sample (rev m-3). The fumes emitted from the tyre tread line, calender feeding, and tyre vulcanizing processes, showed the highest mutagenic activity (55-211 rev mg-1, + S9). At these and at other workplaces (extruder mill, carbon black station, mixer loading), mutagenic activity related to the volume of air was in the range of 22-158 rev m-3, + S9. The results indicate the need to reduce and monitor mutagenic contamination in order to increase the safety of work in the rubber industry.

Air Pollutants, Occupational↗

Hydroxyapatite moldable formulation using natural rubber latex as binder.

A simple but efficient processing method for shaping intricate bioceramic green bodies has been developed by using natural rubber latex as binder. Different shapes of hydroxyapatite Ca10(PO4)6(OH)2 (HAP) were molded from a composite formulation containing wet precipitated HAP, natural rubber latex (NRL), and a stabilizer. On controlled heat treatment followed by sintering, dense shapes of HAP contours were obtained. The thermal degradation profile of HAP-NRL composites shows that NRL degrades slowly without any abrupt exotherm. The results of energy dispersive X-ray analysis together with inductively coupled plasma (ICP) analysis indicate that the inorganic residue of NRL does not contain any heavy element. The sintered density of the samples increased with increased HAP content in the formulation and percentage shrinkage reduced accordingly. On varying the HAP content in the formulation from 35 to 95 wt %, the compositions with 85, 90, 92, and 95 wt % HAP showed better flexural strength in the range 40-54 MPa and a flexural modulus value in the range 36-50 GPa. The fracture morphology, as observed by the scanning electron microscope confirms that with increased HAP content in the formulation the sample microstructure attains higher uniformity. The Vickers microhardness for the samples sintered at two different temperatures (1150 and 1250 degrees C) showed that hardness increases with increase in the sintering temperature with a maximum for the highest HAP loaded formulation.

Biocompatible Materials↗

Leaching of zinc compound from rubber stoppers into the contents of automatic atropine injectors.

This report describes how a material within the cartridge of an automatic injector contaminated its contents. On prolonged storage, a formulation that contained atropine produced lethality in mice. The toxic material originated from zinc compounds that were present in the rubber stopper and plunger of the container and that subsequently leached into the formulation. The contents of cartridges that contained greater than or equal to 0.75 mg/mL of solubilized zinc were lethal to at least 20% of the mice tested; those that contained 0.42 mg/mL showed no lethality. The problem resulted from the physicochemical properties of the rubber, not the concentration of zinc used in the vulcanization process.

Animals↗

Migration of nitrosamines from rubber products--are balloons and condoms harmful to the human health?

Studies performed in 2001 and 2003 surveyed the release of carcinogenic nitrosamines and nitrosatable substances from rubber toy balloons by extraction with artificial saliva and gas chromatography-thermal energy analysis (GC-TEA). 81% of the 16 in 2001 sampled balloons and 93% of the 14 in 2003 sampled balloons released nitrosamines above the recommended level in Germany of 10 mug per kg material. Furthermore, 32 rubber condom samples collected in 2004 from the German market were surveyed for nitrosamines by determining the amount migrating into an artificial sweat test solution. The levels released from condoms varied from < 10 to 660 mug per kg material (i. e., up to 1.4 mug nitrosamines per condom). In a model calculation, not considering the differences that may exist in the resorption rate, we have calculated that the exposure from condoms may exceed the exposure from food 1.5-3 fold. To our knowledge so far no legal binding legislation exists worldwide concerning nitrosamine migration from toy balloons or condoms.

Carcinogens↗

Sister chromatid exchanges and chromosome aberrations in rubber workers.

Sister chromatid exchanges and chromosomal aberrations were studied in peripheral blood lymphocytes of 55 rubber workers (from two different plants) and 35 controls mainly employed in office jobs. In both plants an increased frequency of SCEs (P less than 0.05 for plant A and P less than 0.01 for plant B) was detected in nonsmoking rubber workers as compared with nonsmoking referents. When the SCEs of worker groups belonging to the different job categories were compared with referents, the only groups showing statistically significant increases in SCEs were the smoking workers from the weighing and mixing departments of factory A and the nonsmoking weighers of factory B. A slight increase in the SCE frequencies was seen especially among smoking workers employed in the chemical mixing departments. The frequency of structural chromosome aberrations was not significantly increased in the occupational groups studied, the only exception being the small group of nonsmoking weighers in plant B. Among both the exposed workers and the controls, smokers had a higher mean SCE frequency than nonsmoking referents. This difference was significant between the exposed smokers and nonsmokers of plant A (P less than 0.01) and between smoking and nonsmoking controls for plant B (P less than 0.001). In addition, the chromosome aberration frequency of smoking controls of plant A was significantly higher (P less than 0.01 when gaps excluded and P less than 0.05 when gaps included) than that of nonsmoking referents. Also, smokers among controls for plant B had an increased frequency of aberrations in their cultured blood lymphocytes when compared with nonsmokers. This difference was significant (P less than 0.05) when gaps were excluded.

Chromosome Aberrations↗

Rubber emboli.

OBJECTIVE: To investigate the potential for embolisation, due to the piercing of suspect rubber seals ('coring') of intravenous (IV)-solution bottles by the sharp (plastic, non-patient end) spike of commonly used infusion sets. METHODS: The suspect seals of 50 bottles were pierced with an infusion-set spike and the respective solutions were examined for visible particles, filtered and the filtrate examined both macroscopically and microscopically. As controls, 36 IV-solution bottles of other brands with pierced seals and 10 units of the suspect brand with unpierced seals were examined in the same way. RESULTS: Macroscopic and microscopic particles (maximum longest axis > 1 mm), including fibrils, were invariably present in the solutions from bottles with pierced suspect seals, but no such debris was detected in the control solutions. CONCLUSIONS: The defectively packaged solutions (from B. Braun) have been used extensively in at least 21 different countries during the past decade and, unknown to clinicians, constituted a source of potential rubber emboli. The multinational manufacturer responsible has largely rectified the fault. Discovery of such defects requires prompt reporting to relevant government departments and the manufacturer, so that appropriate action may be taken nationally and internationally. Good manufacturing practice and drug regulatory surveillance should extend to the way in which the final packaged forms are used.

Drug Contamination↗

Field comparison of inhalable aerosol samplers applied in the european rubber manufacturing industry.

Several studies have been done in Europe to evaluate exposure to dust and fumes in the rubber industry. However, different aerosol sampling devices have been used which perform differently depending on the environmental conditions and particle size distribution. To compare measurements of rubber dust and fumes among countries and surveys we initiated a field comparison of personal inhalable samplers using a novel reference inhalable aerosol sampler (CALTOOL). Measurements were done in four factories in the Netherlands, Sweden, Poland and Germany in the mixing and milling and curing department. The Seven-hole sampler, PAS-6 sampler, Millipore (25 and 37 mm) cassette, IOM sampler and a Polish sampler were mounted on the reference CALTOOL device and used simultaneously. All samplers except the IOM sampler under-sampled inhalable dust. To compare measurements from different studies and countries, correction factors should be applied to all but the IOM sampler, which was the only sampler that performed similar to the CALTOOL sampler.

Aerosols↗

Wastewater from the manufacture of rubber vulcanization accelerators: characterization, downstream monitoring and chemical treatment.

The content of wastewater resulting from the manufacture of rubber antioxidants and accelerators by a factory situated in the Ebro basin (Spain) has been determined using gas chromatography-mass spectrometry (GC-MS) and gas chromatography-flame ionization detection (GC-FID). The change in the pollutants was studied in the riverbed via two modules which continuously gathered pollutants on various solid supports (activated carbon and XAD-2 resins). These modules were located in Bocal Station, lying a further 100 km downstream from the factory, and from the Zaragoza water supply. Forty-six different compounds were identified at Bocal Station, the majority resulting from the production of rubber additives. Due to the immunity of different waste substances, and to the toxic nature of some, we studied their reaction when subjected to techniques of chemical oxidation using ozone.

Antioxidants↗

Mandibular complete denture impressions with fluid wax or polysulfide rubber: a comparative study.

Some authors have stated that wax cannot be used to make impressions for complete dentures, while others have found that wax has some advantages over elastomeric impression materials. The purpose of this study was to compare mandibular impressions made with a fluid wax to those made with light-body polysulfide rubber. Fifteen maxillary and mandibular complete dentures were made using fluid wax as a final impression material. For comparison, 15 maxillary and mandibular complete dentures were made using light-body polysulfide rubber. The number of adjustments required over 1 year was recorded. No statistical difference in adjustments was noted between the two groups.

Aged↗

A conductive rubber footswitch design for gait analysis.

The performance of a footswitch which uses conductive rubber modules in foam, sandwiched between two brass shims in the form of an inner sole placed between the foot and the shoe is reported. Contact switching force decreases with module density, whilst position of the conductivity plugs in the footswitch is irrelevant. Comments on the construction of a footswitch using these modules are made, in particular no modification of the conductive rubber is needed and a density throughout greater than 4 modules per square inch leads to threshold switch forces of 30 N and less which is totally acceptable for gait analysis use without fears of contact being made whilst inserting and positioned in the subject's shoe.

Gait↗

Mutagenicity in urine of workers in rubber industry.

Epidemiological studies have shown that those who work in rubber industry have an increased risk of cancer. In the working environment they are exposed, probably, to several hundred different chemicals some of them being known or suspected carcinogens and mutagens. The bacterial fluctuation test was used to detect the mutagenicity in the urines of exposed workers. A group of unexposed office clerks served as controls. Both groups consisted of smokers and non-smokers, and that was taken into consideration in the results. Rubber workers, either smokers or non-smokers, exhibited significantly higher mutagenic activity in their urine than the occupationally unexposed controls when the base-pair substitution strain E. coli WP2 uvrA was used as indicator organism. Use of the frameshift strain S. typhimurium TA98 revealed increased mutagenicity in the urine of occupationally exposed smokers, nonsmokers and unexposed smokers. The extent of mutagenicity in the urine of workers who smoked suggested a synergistic effect of smoking and occupational exposure. The bacterial fluctuation test with urine samples as sources of mutagenicity is able to detect chemical exposure if the excreted compounds are still in active form or can be activated. The method can be used to identify hazardous working conditions long before the manifestation of possible pathological changes in exposed individuals.

Escherichia coli↗

N-nitrosamines and nitrosatable compounds in rubber nipples and pacifiers.

Rubber nipples and pacifiers were analysed for volatile N-nitrosamines using gas chromatography-thermal energy analysis after extraction with 'artificial saliva'. All of the 17 samples tested were found to contain at least two of the following: N-nitrosodimethylamine, N-nitrosodiethylamine, N-nitrosodibutylamine and N-nitrosopiperidine. Total volatile N-nitrosamine levels up to 19.7 micrograms/kg rubber were found, with a mean content of 7.3 micrograms/kg. Nitrosatable compounds, measured as N-nitrosamines after nitrosation, were detected in 15 of the 17 samples to total levels up to 13.7 mg/kg, the mean being 5.0 mg/kg.

Humans↗