Effects of Interventions to Prevent Work-Related Asthma, Allergy, and Other Hypersensitivity Reactions in Norwegian Salmon Industry Workers (SHInE): Protocol for a Pragmatic Allocated Intervention Trial and Related Substudies

Background: Workers in the salmon processing industry have an increased risk of developing respiratory diseases and other hypersensitivity responses due to occupational exposure to bioaerosols containing fish proteins and microorganisms, and related allergens. Little is known about effective measures to reduce bioaerosol exposure and about the extent of skin complaints among workers. In addition, while identification of risk factors is a core activity in disease prevention strategies, there is increasing interest in health-promoting factors, which is an understudied area in the salmon processing industry. Objective: The overall aim of this ongoing study is to generate knowledge that can be used in tailored prevention of development or chronification of respiratory diseases, skin reactions, protein contact dermatitis, and allergy among salmon processing workers. The main objective is to identify effective methods to reduce bioaerosol exposure. Further objectives are to identify and characterize clinically relevant exposure agents, identify determinants of exposure, measure prevalence of work-related symptoms and disease, and identify health-promoting factors of the psychosocial work environment. Methods: Data are collected during field studies in 9 salmon processing plants along the Norwegian coastline. Data collection comprises exposure measurements, health examinations, and questionnaires. A wide range of laboratory analyses will be used for further analysis and characterization of exposure agents. Suitable statistical analysis will be applied to the various outcomes of this comprehensive study. Results: Data collection started in September 2021 and was anticipated to be completed by March 2023, but was delayed due to the COVID-19 pandemic. Baseline data from all 9 plants included 673 participants for the health examinations and a total of 869 personal exposure measurements. A total of 740 workers answered the study’s main questionnaire on demographics, job characteristics, lifestyle, health, and health-promoting factors. Follow-up data collection is not completed yet. Conclusions: This study will contribute to filling knowledge gaps concerning salmon workers’ work environment. This includes effective workplace measures for bioaerosol exposure reduction, increased knowledge on hypersensitivity, allergy, respiratory and dermal health, as well as health-promoting workplace factors. Together this will give a basis for improving the work environment, preventing occupational health-related diseases, and developing occupational exposure limits, which in turn will benefit employees, employers, occupational health services, researchers, clinicians, decision makers, and other stakeholders.publishedVersio

Cooks, work environment and health: Experimental studies of exposure to cooking fumes, and epidemiological investigations in a cohort

Kokker, arbeidsmiljø og helse -Eksperimentelle studier av eksponering for stekeos, og epidemiologiske undersøkelser i en kohort Allerede i de Hippokratiske tekstene fra omtrent 400 år f. kr., fremholdes det at frisk luft og en sunn diett er blant de viktigste forutsetningene for god helse. Nå, over 2 400 år senere kan vi lese på nettsidene til verdens helseorganisasjon (WHO) at omtrent 7 millioner for tidlige dødsfall årlig kan knyttes til luftforurensning, og at luftforurensning er den miljøfaktoren som har størst betydning for sykdomsbelastningen på verdensbasis. WHO sine beregninger har også vist at innendørs luftforurensning har omtrent like store negative konsekvenser for folkehelsen som luftforurensning i ytre miljø. Samtidig som sunn mat er viktig for god helse, så er tilbereding av mat anerkjent som en av de viktigste kildene til innendørs forurensning. En relativt ny studie av et utvalg av den urbane befolkningen i storbyer i Europa og Australia, viste at stekeos sannsynligvis er den viktigste kilden til forurensninger som påvirker luftveiene. Stekeos består blant annet av fett og fettsyrer i dråper som er så små at de kan pustes helt ned i lungene. I de siste 10-20 årene har det vært økende interesse knyttet til spesifikke helseskadelige og kreftfremkallende stoffer som kan finnes i stekeos, slik som blant annet aldehyder, polysykliske aromatiske hydrokarboner (PAH) og heterosykliske aminer. Tidligere studier har vist en økt forekomst av ulike typer luftveisplager, for eksempel rhinitt, astma og emfysem, blant personer som daglig utsettes for stekeos. Det er derfor grunn til å tro at innendørs luftforurensning fra matlaging kan bidra til å forårsake og/eller forverre luftveissykdommer, særlig hos kokker som daglig arbeider med steking av mat. Flere europeiske undersøkelser har vist økt dødelighet blant kokker, sammenholdt med befolkningen forøvrig. Tall fra statistisk sentralbyrå har vist at kokker er en av yrkesgruppene i Norge som har lavest forventet levealder. I dette prosjektet har vi både undersøkt mulige effekter av kortvarig eksponering for stekeos hos 24 frivillige forsøkspersoner, og samlet informasjon omkring arbeidsmiljøforhold og helse hos kokker i Midt-Norge. Informasjonen vi fikk fra kokkene som deltok i våre epidemiologiske undersøkelser, viste at ulike arbeidsmiljøfaktorer som kan gi økt eksponering for stekeos, er assosiert med en økt forekomst av luftveisplager. Det viste seg også at ugunstig arbeidstidsordninger var den vanligste angitte grunnen til å slutte i kokkeyrket. I de eksperimentelle undersøkelsene var det også enkelte tendenser i resultatene som kunne tyde på en reaksjon i luftveiene etter eksponering for stekeos, men dette var basert på få deltakere og er beheftet med en del usikkerhet, slik at disse mønstrene kan også ha oppstått som følge av tilfeldigheter. Samlet sett tyder våre undersøkelser på at yrkeseksponering for stekeos medfører økt risiko for luftveisplager, samtidig som organisatoriske arbeidsmiljøforhold ser ut til å ha større innvirkning på hvor lenge en kokk velger å forbli i yrket. Våre funn støtter opp under at det å redusere eksponeringen for stekeos så mye som mulig vil kunne forebygge luftveisplager hos kokker. Sett i sammenheng med eksisterende kunnskap, vil vi hevde at å forebygge eksponering for stekeos er viktig for å oppnå sunne arbeidsmiljø i profesjonelle kjøkken, noe som på lang sikt kan bidra til å motvirke den økte sykelighet og dødelighet som har vært observert blant kokker

Work environment factors and respiratory complaints in Norwegian cooks

Purpose Norwegian cooks exhibit relatively high mortality, particularly from respiratory diseases. Both occupational hazards and lifestyle factors have been suggested as possible explanations. Negative health effects from exposure to cooking fumes are well documented in non-Western populations, and it has been claimed that cooking fumes in Western style cooking might be substantially different. We hypothesise that exposure to cooking fumes contributes to respiratory diseases also in professional cooks in Western countries. The aim of this study was to elucidate if specific work environment factors related to cooking fume exposure are determinants for respiratory morbidity in Norwegian cooks. Methods We surveyed specific work environment factors and respiratory complaints in 553 subjects that were currently working as skilled cooks. Inclusion was based on the register of people that had graduated as skilled cooks in central Norway between 1988 and 2008. Determinants for the occurrence of respiratory complaints were explored by logistic regression. Results Overall, 17.2% of subjects reported respiratory complaints at work, while 8.1% had chronic bronchitis. Those who performed frying for over half of their workday exhibited an increased odds ratio for having chronic bronchitis of 2.5 (95% CI 1.2–5.3). Using gas for frying and using a fryer in the kitchen were also related to the occurrence of respiratory complaints. Conclusions This study in Norwegian cooks demonstrates a relationship between the extent of frying and the occurrence of work-related respiratory complaints. Therefore, reducing exposure to cooking fumes could reduce respiratory complaints in cooks, and potentially help alleviate excess morbidity and mortality in this occupation

Urinary 8-oxo-7, 8-dihydro-2′-deoxyguanosine concentrations after frying of bacon, a pilot study

Cooking fumes contain compounds that may give rise to oxidative stress and mutations when inhaled. The aim of this study was to evaluate if cooking fumes from frying of bacon induce oxidative stress by measurement of urinary 8-oxo-7,8-dihydro-2 deoxyguanosine, a marker of oxidatively damaged DNA. Three non-smoking women fried bacon for 3 h. Urine samples were taken as early morning void at the same time on four days; the morning before frying, the morning after first frying, the morning after three days of frying and one week after first urine sample. 8-Oxo-7,8-dihydro-2 deoxyguanosine, 1-hydroxypyrene and 2-hydroxyphenanthrene, metabolites of polycyclic aromatic hydrocarbons, were measured by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS). 8-Oxo-7,8-dihydro-2 deoxyguanosine correlated weakly with concentrations of 1-hydroxypyrene (r = 0.31, p = 0.042), but it did not correlate with 2-hydroxyphenanthrene (r = −0.074; p = 0.64). Average urinary 8-oxo-7,8-dihydro-2 deoxyguanosine concentrations increased from the day before frying (16.3 ± 4.2 nmol/L) to the third day of frying (26.2 ± 10.2 nmol/L), although not statistically significantly. Our pilot study shows that frying of bacon may result in increased oxidative stress which further emphasises the possible carcinogenic potential of cooking fumes

Inflammatory Markers in Blood and Exhaled Air after Short-Term Exposure to Cooking Fumes

Cooking fumes contain aldehydes, alkanoic acids, polycyclic aromatic hydrocarbons, and heterocyclic compounds. The inhalation of cooking fumes entails a risk of deleterious health effects. The aim of this study was to see if the inhalation of cooking fumes alters the expression of inflammatory reactions in the bronchial mucosa and its subsequent systemic inflammatory response in blood biomarkers. Twenty-four healthy volunteers stayed in a model kitchen on two different occasions for 2 or 4h. On the first occasion, there was only exposure to normal air, and on the second, there was exposure to controlled levels of cooking fumes. On each occasion, samples of blood, exhaled air, and exhaled breath condensate (EBC) were taken three times in 24h and inflammatory markers were measured from all samples. There was an increase in the concentration of the d-dimer in blood from 0.27 to 0.28mg ml(1) on the morning after exposure to cooking fumes compared with the levels the morning before (P-value 0.004). There was also a trend of an increase in interleukin (IL)-6 in blood, ethane in exhaled air, and IL-1 in EBC after exposure to cooking fumes. In a sub-analysis of 12 subjects, there was also an increase in the levels of ethaneufrom 2.83 parts per billion (ppb) on the morning before exposure to cooking fumes to 3.53 ppb on the morning after exposure (P 0.013)uand IL-1ufrom 1.04 on the morning before exposure to cooking fumes to 1.39 pg ml(1) immediately after (P 0.024). In our experimental setting, we were able to unveil only small changes in the levels of inflammatory markers in exhaled air and in blood after short-term exposure to moderate concentrations of cooking fumes

Work environment factors and work sustainability in Norwegian cooks

Objectives: Cooks have increased morbidity and mortality. A high turnover has also been reported. We aimed to elucidate work environment and work sustainability in Norwegian cooks. Material and Methods: A questionnaire inquiring about working conditions and work participation was sent to 2082 cooks who had qualified from 1988 onwards. Of these, 894 responded. Time at work was analyzed with Kaplan-Meier plots and possible determinants for quitting work as a cook was analyzed with Cox regression. Results: The median time at work was 16.6 years. There were differences in sustainability between types of kitchens for both sexes (p = 0.00). The median time in the profession was 9.2 years for the cooks in restaurants, while the cooks in institutions and canteens showed a substantially higher sustainability with 75.4% still at work after 10 years, and 57% still at work after 20 years in the profession. Of those still at work as a cook, 91.4% reported a good or very good contentment, and the 67.4% who expected to stay in the profession the next 5 years frequently answered that excitement of cooking, the social working environment, and the creative features of cooking were reasons to continue. Musculoskeletal complaints were the most common health-related reason for leaving work as a cook, while working hours was the most common non-health-related reason. Conclusions: There are significant differences in work sustainability between the cooks in the different types of kitchens. The identified determinants for length of time in the occupation can be used for preventive purposes