Annals of Occupational and Environmental Medicine

Review

Very Long (> 48 hours) Shifts and Cardiovascular Strain in Firefighters: a Theoretical Framework: BongKyoo Choi, Peter L Schnall, Marnie Dobson, Javier Garcia-Rivas, HyoungRyoul Kim, Frank Zaldivar, Leslie Israel, Dean Baker; Ann Occup Environ Med 2014;26:5-5. Published online March 6, 2014; DOI: https://doi.org/10.1186/2052-4374-26-5

Shift work and overtime have been implicated as important work-related risk factors for cardiovascular disease (CVD). Many firefighters who contractually work on a 24-hr work schedule, often do overtime (additional 24-hr shifts) which can result in working multiple, consecutive 24-hr shifts. Very little research has been conducted on firefighters at work that examines the impact of performing consecutive 24-hr shifts on cardiovascular physiology. Also, there have been no standard field methods for assessing in firefighters the cardiovascular changes that result from 24-hr shifts, what we call “cardiovascular strain”. The objective of this study, as the first step toward elucidating the role of very long (> 48 hrs) shifts in the development of CVD in firefighters, is to develop and describe a theoretical framework for studying cardiovascular strain in firefighters on very long shifts (i.e., > 2 consecutive 24-hr shifts). The developed theoretical framework was built on an extensive literature review, our recently completed studies with firefighters in Southern California, e-mail and discussions with several firefighters on their experiences of consecutive shifts, and our recently conducted feasibility study in a small group of firefighters of several ambulatory cardiovascular strain biomarkers (heart rate, heart rate variability, blood pressure, salivary cortisol, and salivary C-reactive protein). The theoretical framework developed in this study will facilitate future field studies on consecutive 24-hr shifts and cardiovascular health in firefighters. Also it will increase our understanding of the mechanisms by which shift work or long work hours can affect CVD, particularly through CVD biological risk factors, and thereby inform policy about sustainable work and rest schedules for firefighters.

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Original Article

Change of Urinary Trans, Trans-Muconic Acid before and after Turnaround Process in a Petrochemical Plant: Seung Hyun Kim, Ji Ung Park, Jai Dong Moon; Korean Journal of Occupational and Environmental Medicine 2008;20(4):335-342. Published online December 31, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.4.335

Abstract PDF

OBJECTIVES
This study was performed to estimate the exposure to benzene, one of the most serious health hazards, in four phases of a turnaround in a petrochemical company, and to evaluate the suitability of trans,trans-muconic acid (tt-MA) to act as a biomarker of exposure to low benzene levels.
METHODS
tt-MA was determined in 152 urine samples collected in 4 phases ('before daily work', 'after daily work', 'purge', and 'inspection' of turnaround work) from 19 exposed workers involved in turnaround work and 19 clerical workers. The ambient benzene levels were monitored simultaneously during the 'purge' process of turnaround work in the exposed group.
RESULTS
The median urinary tt-MA for the 4 phases was 0.046 mg/L, 0.082 mg/L, 0.507 mg/L, and 0.468 mg/L in the exposed group and 0.050 mg/L, 0.065 mg/L, 0.269 mg/L, and 0.331 mg/L in the clerical workers, respectively. The median urinary tt-MA for the exposed group was significantly higher than that of the clerical workers during the purge process (P<0.05). In the exposed group, median urinary tt-MA for the 'before daily work' phase was significantly lower than that of the other three phases (P<0.05). Even in the clerical workers, the urinary tt-MA level for the 'before daily work' phase was significantly lower than that of the turnaround (P<0.05). There was a very significant correlation between urinary tt-MA levels and ambient benzene levels (r(s) = 0.795, P<0.01).
CONCLUSION
The turnaround process increased the benzene exposure for all workers, even the clerical workers, in a petrochemical company handling benzene. Urinary tt-MA was found to be suitable as a biomarker for the exposure to low-level benzene.

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Estimating Benzene Exposure Level over Time and by Industry Type through a Review of Literature on Korea
Donguk Park, Sangjun Choi, Kwonchul Ha, Hyejung Jung, Chungsik Yoon, Dong-Hee Koh, Seunghun Ryu, Soogeun Kim, Dongmug Kang, Kyemook Yoo
Safety and Health at Work.2015; 6(3): 174. CrossRef
The Relationship between Exposure to Benzene and the Excretion of Urinary Trans, Trans-muconic Acid in Petrochemical Factory Turnaround Process Workers
Seung Min Lee, Jong Uk Won, Chi Nyon Kim, Jaehoon Roh
Journal of Korean Society of Occupational and Environmental Hygiene.2014; 24(1): 52. CrossRef

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Original Article

Effect of Cumulative Blood Lead and Cumulative Blood ZPP as Lead Body Burden on Renal Lead Biomarkers: Gang Ho Yoon, Nam Soo Kim, Jin Ho Kim, Hwa Sung Kim, Byung Kook Lee; Korean Journal of Occupational and Environmental Medicine 2006;18(4):298-306. Published online December 31, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.4.298

Abstract PDF: OBJECTIVE: To evaluate the possibility of cumulative blood lead and blood ZPP as surrogates of lead body burden and to investigate their association with renal function as an index of lead body burden.
METHODS
The study subjects comprised 678 lead workers with past blood lead and blood ZPP data from their employment. Cumulative blood and ZPP were calculated by accumulating the every year mean value of both indices from the new employment since 1983. To assess the cumulative data of lead workers who started their lead work before 1983, the years before 1983 were simulated with the first available data from 1983. Study variables for lead body burden were tibia bone lead and DMSA chelatable lead, whereas those for current lead biomarkers were blood lead and blood ZPP. BUN and serum creatinine were selected as clinical renal biomarkers, while NAG (N-acetyl-D-glucosamine) and RBP (Retinol binding protein) were selected as early renal biomarkers.
RESULTS
The association between cumulative blood lead and blood ZPP with tibia bone lead was statistically significant with determinant coefficients (r(2)) of 0.72 and 0.567, respectively, and their relationships were better explained by the curvilinear regression model. In multiple regression analysis of current lead biomarkers on the renal biomarkers after controlling for possible confounders (age, sex, job duration, smoking and drinking status), blood lead was associated only with log-transformed NAG, whereas blood ZPP was associated with 3 other renal biomarkers. On the other hand, in multiple regression analysis of biomarkers of lead body burden on renal biomarkers after controlling for possible confounders (age, sex, job duration, smoking and drinking status), cumulative blood ZPP and tibia bone lead were associated with all 4 renal function biomarkers, whereas cumulative blood lead and DMSA chelatable lead were associated with 3 renal biomarkers except BUN.
CONCLUSION
Cumulative blood and ZPP were demonstrated to be good surrogates of lead burden. Furthermore, the cumulative blood ZPP was confirmed to have a better association than the cumulative blood lead.

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Original Article

Urinary Excretion of Thiodiglycolic Acid According to Sampling Time in Workers Exposed to Vinyl Chloride Monomer: Hyun Soo Kim, Chi Nyon Kim, Jong Uk Won, Bong Suk Cha, Kyung Jong Lee, Jaehoon Roh; Korean Journal of Occupational and Environmental Medicine 2006;18(2):138-145. Published online June 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.2.138

Abstract PDF

OBJECTIVES
The study was performed to investigate the changes of urinary thiodiglycolic acid (TDGA) concentration in workers exposed to vinyl chloride monomer (VCM) according to the time of sampling urine.
METHODS
The personal exposure to airborne VCM was assessed and urinary TDGA concentration was sampled in 31 workers employed in a VCM and polyvinyl chloride (PVC) manufacturing factory. Urinary TDGA was sampled three times: before the start of the shift after 3 days off (TDGA1), after the end of the first-day shift (TDGA2) and before starting the following day shift after completing the oneday shift (TDGA3). Urinary TDGA in 30 workers who had not been exposed to airborne VCM was sampled after the end of the shift. A gas chromatography/pulsed flame photometric detector (GC/PFPD) was utilized to analyze TDGA concentration in urine after the urine was methylated with trimethylsilyldiazomethane(2.0M in diethyl ether).
RESULTS
The creatinine level was 0.179+/-0.271 mg/g in the control workers and 0.218+/-0.443 mg/g in the workers before the start of the shift after 3 days off (TDGA1), showing no significant difference (p=0.7035). Urine samples were compared according to sampling time in order to investigate the change of urinary TDGA concentration in the case of continuous exposure to airborne VCM. In VCM-exposed workers, urinary creatinine concentration was 0.434+/-0.623 mg/g in TDGA2 and 0.767+/-1.056 mg/g in TDGA3, which indicated a gradual but significant increase (p=0.024). In terms of the statistical correlation between airborne VCM and urinary TDGA to evaluate exposure dose per day, of the three urinary TDGA concentrations, TDGA3 showed the highest degree of regression (R(2)=0.4215) with 8h-TWA airborne VCM concentration.
CONCLUSION
Based on this result, the excretion half-life of urinary TDGA was assumed to be less than 3 days, because the concentration of urinary TDGA at 3 days after exposure to airborne VCM was decreased to the level of urinary TDGA concentration in the control workers. The concentration of urinary TDGA increased in the case of continuous shift, due to the accumulation of residual metabolites of TDGA. It was considered that TDGA3 can be applied as a useful biological index to evaluate the exposure dose of airborne VCM during one day because TDGA3 showed the highest correlation with the exposure dose of airborne VCM in the previous shift day.

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Assessment of urinary thiodiglycolic acid exposure in school-aged children in the vicinity of a petrochemical complex in central Taiwan
Po-Chin Huang, Li-Hsuan Liu, Ruei-Hao Shie, Chih-Hsin Tsai, Wei-Yen Liang, Chih-Wen Wang, Cheng-Hsien Tsai, Hung-Che Chiang, Chang-Chuan Chan
Environmental Research.2016; 150: 566. CrossRef

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Original Article

The Effect of ALAD and VDR Polymorphism on the Hematopoietic Biomarkers in Lead Exposed Workers: Sung Soo Lee, Nam Soo Kim, Jin Ho Kim, Yong Bae Kim, Young Hwangbo, Hwa Sung Kim, Kyu Dong Ahn, Byung Kook Lee; Korean Journal of Occupational and Environmental Medicine 2005;17(4):343-351. Published online December 31, 2005; DOI: https://doi.org/10.35371/kjoem.2005.17.4.343

Abstract PDF: OBJECTIVES
This study was conducted with new workers who entered lead industries from 1992 to 2001 to evaluate the genetic susceptibility of ALAD (delta-aminolevulinic acid dehydratase) and VDR (vitamin D receptor) gene on health effect of lead exposure.
METHODS
Among the subjects of the database of lead industries at the Soonchunhyang University Institute of Industrial Medicine, only new workers were selected for this study. The total of eligible workers for this category was 3,540 workers, including non lead exposed workers of same lead industries. From stored blood in specimen bank of Soonchunhyang University, genotype of ALAD and VDR were measured using PCR method. Variables for this study were blood lead as an index of lead exposure, ZPP (zinc protoporphyrin in blood), urine ALA (delta-aminolevulinic acid), and hemoglobin as an index of hematopoietic effect of lead. Information on sex, job duration, and weight were collected for personal information. The data were analyzed using SAS (version 8.2) with descriptive analysis of t-test and multiple regression analysis.
RESULTS
Among 3,540 new employed study subjects during period of 1992-2001, 3,204 workers (90.5%) had ALAD genotype 1-1, while 336 workers (9.5%) had variant type of ALAD (1-2 or 2-2). For VDR genotype, 2,903 workers (89.7%) out of total tested 3,238 workers were belonged to type bb and 335 workers (10.5%) were type bB or BB. The distribution of genotype of ALAD and VDR were not different according to the job duration in male workers, but were different in female workers. The effect of ALAD and VDR genotype on blood lead were positively significant in the analysis of all cumulative data of new employed workers for 10 years. The effect of VDR genotype on blood lead were stronger than that of ALAD. While the variant ALAD gene made decrease of mean ZPP and ALA in urine after controlling for blood lead and other covariate, the variant VDR gene made increased the mean ZPP and ALA in urine in all cumulative data analysis and cross sectional analysis by job duration. For hemoglobin, ALAD and VDR genotype did not affect the mean value.
CONCLUSIONS
From the above our results, we found that ALAD and VDR genotype exerted significant effect in various way. We confirmed that the finding of a cross sectional study of protective effect of variant ALAD on the effect of blood lead on blood ZPP in our retrospective study design. It was found that VDR did not exert protective effect for lead exposure as the variant ALAD did.

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Original Article

Associations between Lead Exposure and Dose and Protein Kinase C Activation in Erythrocytes Among Lead Workers: Kyu Yoon Hwang, Young Hwangbo, Hyun Cheol Ahn, Yong Bae Kim, Gap Soo Lee, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee; Korean Journal of Occupational and Environmental Medicine 2001;13(4):369-375. Published online December 31, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.4.369

Abstract PDF: OBJECTIVES
Protein kinase C(PKC), a calcium and phospholipid dependent enzyme, is activated by lead in vitro at picomolar concentrations. However, the effect of lead on PKC has never been studied in a human population. The purpose of the study was to evaluate whether lead exposure was associated with PKC mediated-phosphorylation in erythrocytes among lead workers.
METHODS
Two hundred and twelve lead workers were studied. To determine the levels of phosphorylation in vivo, an in vitro back phosphorylation technique was used by adding PKC and gamma-32P to preparations of erythrocyte membranes. We measured back phosphorylations of erythrocyte membrane proteins, spectrin, and 52 kDa and 48 kDa, as an indirect measure of PKC activation in vivo.
RESULTS
The mean(SD) age and exposure duration was 39.1(10.0) years and 8.1(6.5) years, respectively. Tibial lead ranged from 0.8 to 290.8 microgram Pb/g bone mineral with a mean(SD) of 34.4(35.2) microgram Pb/g bone mineral. The means(SD) of back phosphorylation levels of the three proteins were 540.7(304.1), 198.6(78.2), and 247.7(83.3) photostimulated luminescence units(PSL), respectively, by phosphoimager. After adjustment for potential confounding factors, tibial lead and exposure duration were significantly and inversely associated with back phosphorylation levels. One unit of increase in tibial lead(1 microgram Pb/g bone mineral) is associated with a decline in spectrin, band 4.9 52 kDa, and band 4.9 48 kDa back phosphorylation levels by 1.4(P<0.05), 0.34(P<0.05), and 0.47(P<0.01), respectively. However, there were no associations between the back phosphorylation levels and either blood lead or ZPP levels.
CONCLUSIONS
These findings suggest that the PKC activity in erythrocytes is increased by chronic lead exposure and that erythrocyte membrane protein phosphorylation may be a biomarker of lead exposure.

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Original Article

The Effect of ALAD Polymorphism on the Relationship of Blood and Bone Lead with Hematologic Biomarkers in Lead Exposed Workers: Hwa Sung Kim, Sung Soo Lee, Yong Bae Kim, Young Hwangbo, Gap Soo Lee, Kyu Dong Ahn, Bong Ki Jang, Byung Kook Lee; Korean Journal of Occupational and Environmental Medicine 2001;13(1):75-86. Published online March 31, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.1.75

Abstract PDF: OBJECTIVES
To evaluate the effect of ALAD polymorphism on the relationship of blood and bone lead with hematologic biomarkers in lead exposed workers, 450 lead exposed workers and 85 non-lead exposed workers were selected.
METHODS
Blood lead and tibia bone lead were selected as parameters of lead exposure and blood ZPP, urinary ALA (ALAU), hemoglobin (Hb) and hematocrit (Hct) were chosen as parameters of hematologic effect of lead exposure. Genotype of each subject was assayed and expressed as ALAD1 and ALAD2. Demographic information such as sex, age and personal habit of smoking and drinking were collected. Job duration of lead exposed workers was also obtained.
RESULTS
The overall prevalence of the variant allele, ALAD2 in lead exposed workers was 9.6 %(43 out of 450 lead workers) which was not differed from control workers (9.4 % : 8 out of 85). The means of tibial lead and blood ZPP in lead workers with ALAD2 were lower than those of lead workers with ALAD1, but the differences were not statistically significant. After adjusting for possible confounders (sex, job duration, BMI, drinking and smoking status) only blood lead and bone lead contributed negatively to the level of hemoglobin with statistical significance without any contribution of ALAD genotype. On the other hand, no significant effect of blood lead, bone lead and ALAD genotype were observed on the level of hematocrit after controlling possible confounder. ALAD genotype in the multiple regression analysis of blood lead and bone lead with log transformed urinary ALA (LogALAU) after adjusting for possible confounders showed significant main and interaction effect on LogALAU simultaneously, which resulted lower LogALAU in lead exposed workers of ALAD2 than ALAD1. It was also observed only main effect of ALAD gene type on blood ZPP after adjusting possible confounder resulting lower ZPP in lead workers of ALAD2 than ALAD1.
CONCLUSIONS
With above results, it was found that ALAD polymorphism did not affect on the level of hemoglobin and hematocrit, but ALAD polymorphism made significant effect on the association of blood and bone lead with urinary ALA and blood ZPP. The lower urinary ALA and blood ZPP in ALAD2 lead workers suggested that ALAD2 genotype may be supportive for the protective effect of lead.

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Original Article

Biomarkers of Susceptibility in Bladder Carcinogenesis: Sue Kyung Park, Hae Won Jung, Dae Hee Kang, Keun Young Yoo, Soo Hun Cho; Korean Journal of Occupational and Environmental Medicine 1997;9(2):341-356. Published online June 30, 1997; DOI: https://doi.org/10.35371/kjoem.1997.9.2.341

Abstract PDF: Owing to the development of molecular biological techniques to identify new biomarkers of bladder cancer, the information obtained from the studios in which newly developed biomarkers are applied potentially useful in screening of general population, diagnosis of patients, predicting biological behavior and prognosis, and exposure assessments. Despite of rapid development there are a few review about the biomarkers in bladder cancer from which grogs summary of results as well as their optimal function can be considered. This study was carried out in biomarkers of bladder cancer by reviewing the literature to assess the usefulness and stapes of researches for biomarkers of bladder cancer on high risk groups, general population and patients. The biomarkers of bladder cancer were classified by Weinstein's model of carcinogenesis, simple classification of exposure-discase in classical epidemiology, classification by conception of exposure-disease continuum on molecular epidemiology, and application of biomarkers. Two biomarkers, N-acetylation enzyme and Glutathion S-transferase, which had been studied extensively in molecular epidemiology were selected and reviewed. Although the generalization, prediction and diagnosis of bladder cancer based on a single biomarker give rise to trouble due to intravariation of bladder tumor and heterogeneity of biomarkers variation, searching for more specific tumor markers may accurately lead better prediction of prognosis and better estimation of treatment response. The usefulness of both N-acetylation enzyme and glutathion 5-transferase in high-risk groups who have exposes to carcinogen may be more valuable. However more informations are neede in order to apply these biomarkers in clinical practices in further studies.

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Original Article

The Measurement of IL-1, 8, TNF for the Diagnosis of Pneumoconiosis: Young Lim, Kyoung Ah Kim, Im Goung Yun; Korean Journal of Occupational and Environmental Medicine 1997;9(1):17-25. Published online February 28, 1997; DOI: https://doi.org/10.35371/kjoem.1997.9.1.17

Abstract PDF

Many acute and chronic lung diseased including pneumoconiosis are characterized by the presence of increased numbers of activated macrophages. These macrophages generate several inflammatory cell chemoattractants, by which neutrophil migrate from vascular compartment to the alveolar space. Recruited neutrophils secrete toxic oxygen radicals or proteolytic enzymes and induce inflammatory response. Continuing inflammatory response results in alteration of the pulmonary structure and irreversible fibrosis. Recently, a polypeptide with specific neutrophil chemotactic activity, interleukin-8 (IL-8), has been cloned and isolated from a number of cells such as: monocytes, macrophages and fibroblasts. IL-1 and/or TNF-alpha preceded for the synthesis of IL-8, and we already observed high level of IL-1 and TNF-alpha in vivo experiments. So we hypothesized that IL-8 might play a central role in the pathogenesis of pneumoconiosis. In order to evaluate the clinical utility of IL-1, IL-8, TNF as a biomarker in the early diagnosis of pneumoconiosis, we investigated the increase of IL-1, 8, TNF in the pneumoconiotic patient and the significant (p<0.05) correlation between IL-8 level and progression of pneumoconiosis.

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The Effects of Air-borne Particulate Matters on the Alveolar Macrophages for the TNF-α and IL-1β Secretion
Tian Zhu Li, Soo-Jin Lee, Se-Jong Park, Byung-Joon Chang, Jong-Hwan Lee, Kil-Soo Kim, Myoung-Heon Lee, Nong-Hoon Choe
Tuberculosis and Respiratory Diseases.2006; 60(5): 554. CrossRef

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