Document q3BLoM3ONGo2ZOg8kb6BNB3LK

FILE NAME Brakes BRK DATE 1981 DOC BRK309 DOCUMENT DESCRIPTION Report - Mt Sinai School of Medicine Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Exposed to Asbestos ~~ Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos Principal Investigator William J. Nicholson Ph.D. \ y, Va \ ENVIRONMENTAL SCIENCES LABORATORY MOUNT SINAI SCHOOL OF MEDICINE OF THE CITY UNIVERSITY OF NEW YORK -- -- Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos Authors William J. Nicholson Susan M. Daum M.D. Ph.D. William V. Lorimer M.D. Henry Velez M.D. Ruth Lilis M.D. Irving J. Selikoff M.D. Albert Miller M.D. Henry A. Anderson M.D. S. Alf Fischbein M.D. Edwin C. Holstein M.D. William N. Rom M.D. M.P.H. Kenneth D. Rosenman M.D. James D. Todaro M.D. Wei Cheng M.D. Veetai Li B.S. Diane Tarr B.A. ENVIRONMENTAL SCIENCES LABORATORY MOUNT SINAI SCHOOL OF MEDICINE OF THE CITY UNIVERSITYUNIVERSITY OF NEW YORK \ ACKNOWLEDGEMENTS This study involved the cooperative effort of a large number of indivi- duals of the Environmental Sciences Laboratory The clinical examina- tions were under the direction of Susan M. Daum M.D. William V. Lorimer M.D. and Henry Velez M.D Other examining physicians inclu- ded Drs Henry A. Lilis William V. Anderson Alf Fischbein Edwin C. Holstein Ruth Rom Kenneth D. Rosenman Irving J. Selikoff and James D. Todaro The pulmonary function laboratory was under the direction of Dr. Mark Geiger and Albert Miller with Joann Haas Frances assistance from Raphael Warshaw Perez Diane Monahan and Blanca Solano were the capable laboratory technicians rays were read by Drs Daum Lilis Selikoff and nan Cheng The organization of the data files and the preparation of the various analyses were performed by Veetai Li and Diane Tarr Mary Bell Valerie Josephson Shirley Levine Veetai Li Amy Manowitz and Diane Tarr conducted the occupa- tional history interviews Scheduling was the responsibility of Ernest Dobbs Selma Annenberg and Sidney Sibel typed this manuscript With- out the close cooperation of all of the above this study would not have been possible TABLE OF CONTENTS ae sce ee eee : Materials and Methods See ee ee eee ee ee eee tenes Study population 2... 0c. eee cece cc eee eee ra Examination locations and protocols bee eee eee Results wae See ee eee ee eee eee nee : Occupational histories ee scene wees Leee wee nee : . ray abnormalities 0.2... ccc ccc ccc ee ccccee. Age standardization of ray readings See e eens Smoking standardization of ray abnormalities Standardized ray abnormalities by work activity Autobody repair and undercoating ...... ...... e eee cease Effect of previous shipyard employment see eee coe Evidence of malignancy See eae ec caes Pulmonary function te ccc es ee cee ct ece eee s eteetenveeeees Principal spirometric tes ec ccct ceces ce ccceecceues Measures of small airway flo ccc cecew eececas Possible effects from mechanic garage equipment Autobody rep..a .. ci ecer eee ee eee Pr re an Correlations between ray abnormalities and pulmonary function tests See c eee n nee Comparison with other populations wees Physical examination results teens cece eee ees teen Laboratory finding.s . cc cee eee ee cece e te ee e ns Nickel concentration in welders bene eee Asbestos exposure data see eew ee eee eee tance published Review of results rary : Measurements in New York City facilities Estimates of study population exposure tee eee .- Summary eevee beeen SS Referecn e ec eee ces e ee eee rar ae ee ee tenes Appendix .. e ccc cece ccc cece eee cece ene cee eee e pee ee eeeeee 1 225 225 225 12 12 17 26 28 29 36 38 41 41 41 46 52 59 60 60 65 74 74 86 86 90 93 93 97 100 INTRODUCTION Several investigations have indicated that significant asbestos expo- sure may occur during brake maintenance and 1979 Rohl et al 1976 Hickish and Knight repair 1970 work Nicholson Limited studies have suggested that exposure may be associated with the risk of asbes- induced disease including both pulmonary asbestosis and asbes- associated cancer Lorimer et al 1976 Greenberg and Davies 1974 These limited reports do not however indicate whether the risk of associated disease of importance because over one is common or uncommon The question is million workers are regularly or inter- mittently engaged in vehicle maintenance work in the United States at this time Bureau of Labor Statistics 1979 Additionally a large number of other workers were formally engaged in such work in the past and now are either retired or employed otherwise It is estimated that 4,940,000 individuals are currently alive with such current or past employment Nicholson et al 1982 There are several sources of asbestos exposure to garage mechanics and automobile repairmen First of course is that the asbestos exposure from the debris of brake or clutch lining wear particularly when the brake or clutch housing are cleaned using a high pressure air hose Second garage mechanics of autobody filler and may be at finally risk from exposures during the use asbestos dust can be disseminated during mixing and application of undercoating materials each of which has contained the fiber in previous years In order to determine the extent of the asbestos risk from garage maintenance work NIOSH has contracted with the Environmental Sciences Laboratory to conduct a clinical examination of garage mech- anics The examination was to focus specifically upon those manifesta- tions of function asbestos disease such as ray deficits that would elucidate abnormalities the possible and pulmonary effects from exposure to asbestos in garage cmployment MATERIALS AND METHODS STUDY POPULATION The study population for this project consisted of members of the following work union groups who routinely performed brake maintenance repair 1 Local 259 of the United Automobile Workers UAW whose members were employed in commercial garages in New York New Jersey and Connnecticut Also included were all pensioners maintaining vested rights in a program administered by the Local 2 Local 246 of the Service Employees International Union SEIU employed in New York City municipal garages The unexposed of control population for the above brake workers consisted 1 Local 259 members and pensioners employed currently or previously in parts warehouses New York City and amphibious vehicle con- struction in Stamford Connecticut and Schenectady New York 2 District Council 37 DC 37 Municipal State and Federal Employees Union members employed in New York City as motor vehicle operators or traffic device repairmen The above groups were selected prior to the beginning of the project as the study and control groups for determining the effects of possible asbestos exposure on workers engaged in brake maintenance and repair work The control groups were chosen because of membership in the same union and similar employment circumstances but without brake mainten- ance work As the study control population had had progressed it was found that many of the exposure to asbestos in other circumstances such as shipyard work and that fewer DC 37 members were participating in the examination than was initially expected Thus in consultation with the project officer it was decided to add the rays to be taken in examinations of Local to the control groups 595 UAW members em- ployed in production maintenance jobs in an automobile body construction facility in Linden New Jersey These workers were to be examined for effects of lead exposure associated with their work in an examination April 7-10 1980. An analysis of their work activities had indicated that their current employment provided only limited opportu- nity for asbestos exposure The decision to include this group was made prior to the April examination In order dividuals to reflect the effects of asbestos with ten years of employment in exposure only those ina particular trade were considered for examination In the case of the UAW members this con- sisted of all individuals with ten years of union membership For SEIU members who were classified as mechanics in the New York City Civil Service Employees categorization five years of prior automobile main- tenance work were required criteria of five years of in order to obtain such a status Thus union membership identified individuals the who had at least ten years of employment in garage work as a mechanic or apprentice Table affiliation of all the examinations 1 lists the individuals distribution by seniority date and union who were invited and who participated in The response was limited by several circumstances One was the dis- tance many individuals had to travel in order to reach an examination site For example both Local 259 and DC 37 Headquarters at which most examinations were held are located in lower Manhattan whereas most study participants lived in Brooklyn or Queens Many lived at even greater distances in Westchester or Nassau County N.Y. or in New Jersey Examination sites were arranged to accomodate as many of the study population as possible but many individuals still lived at considerable distance from a site Another factor was that most shops organized by these unions are relatively small 79 workers in shops employing fewer than 30 members of the population only sixth of whom would have been employed for longer than ten years ~ t Let OTT ce ae BCE 99% (6 sopfuvoe the motor ysnouTe workesgarage workers c particpated invited 262 invited OZ 10.0-19.9 20.-9 aoubUSqTe 187 more UOFISETe 892 Percentage Percntage uotun 43. 293 AJTOFUS 37.9 Retires Aq Percentage Percntage JguowATdus joPercentage Because indivduals employed yearsThesinalthoug time stado 9 S eS O < f6 27 eo*OFYyeA 34 USTS yao 203m TO 767 9ZE 43.3 paqut svn 15.9 15.9 8Z 69 ( ) ) GY GTt ( OTT 28.2 (7 <S) (9T?) 902 9C particular employed as longer employment employment city usually the distrbutions for particpating payTut 92% 61 oy 9L9 S6E uey I s oT a3 POIFUPT svi AOF 892 A3~O sowy stm 892 Se AYO YyIFs HTYS oYyR-Aq qof Jo AODZuoT pue years was particpang syy ut szT o20M ouq sTenpraut SUOTIVWEXS asequoIs0g osLRUDIGg ; 5 pazoeypjr CT 6 e1oul ARTOUaS 6T-0 67-0 So0ATIOY 6<-0 oaes > Ad x OT 07 OF Ov TER0L jo ur aenvog owrq 3 aae rt The contact with individuals in these shops was by mail with letters from the Union President and Dr. Irving J. Selikoff of Mount Sinai School of Medicine followed by a phone call from Mount Sinai person- nel In the larger Union health and shops safety where the program was also described by the representative and attendance encouraged greater participation resulted Finally only one examination was held at each of the sites outside of Manhattan and those unable to attend on a given day could only be accomodated These factors led to a particularly low at a clinic in response of the New York City 264 individuals invited cipated to the examination versus 53.4 at the site in Long Island where large shops of Condec only 23.8 parti- Information was obtained by phone and from the return mailer of the reasons for participation These are tabulated in Table 2. It also was found that of those sent invitations 2.1-5.3 were unde- liverable by the post office EXAMINATION LOCATIONS AND PROTOCOL Examinations were through February held 1980 at approximately at a variety of monthly intervals sites chosen for from May 1978 their conven- ience These to the residence or employment included the union headquarters location of Local of the participants 259 UAW in New York City and Schenectady New York the Community Center Stamford Con- necticut the headquarters of DC 37 State County and Municipal Em- ployees Union in New York City the Paterson Clinic Paterson New Jersey the Multiphasic Medical Center Hempstead Long Island and Mount Sinai School of Medicine New York City For those locations without ray facilities portable units were obtained In each lo- cation spirometry stations were were established ment of the Pulmonary Function Laboratory using field survey equipof Mount Sinai School of Medicine Laboratory examining and interview stations established in the available space in all facilities were easily Appendix 1 is the form used for all examinations The examinations consisted of a complete occupational history with detailed descriptions Table 2 Reasons given for participation in examinations Do not wish to participate Not interested Too busy at this time Inconvenient time Recent examination Current illness injury or incapacitation Illness or death in family Too far to come or moved away Miscellaneous health reasons Telephone response 20 20 20 7 5 Mail response 175 5 3 3 4 5 Un 1 of work activities that could descriptions of work practices affect the health of the during brake maintenance individual and repair work and the use of personal protection devices Special care was taken to elicit information on previous exposures to asbestos and other dusts that might be pneumoconiotic The 1 2 3 4 5 6 7 8 clinical examination tests and procedures complete medical history current and past uses of medications current and past symptoms ; physical examination consisted of complete blood count including a differential count on uals with an abnormal white cell count 20 channel blood chemistry analysis pulmonary function tests including determination of volume characteristics 14 x 17 inch full size anterior chest ray individ- complete All chest rays laboratory results and examination findings were reviewed immediately for conditions that might require urgent atten- tion If such conditions were found the patient was notified and if he wished his personal physician was called The radiographs were subsequently interpreted using the ILO U International Classification of Pneumoconioses Parenchymal changes of 1/0 or greater were con- sidered abnormal as were pleural thickening pleural plaques and pleural calcification Additionally other abnormal disease conditions were noted See Appendix 2. Predicted Miller et values for al 1980 spirometry of data of were based upon the revised analysis by Morris Koski and Johnson 1971 The criteria for individual spirometric abnormalities are listed in Table 3. After interpretation of the rays and review of all laboratory and clinical findings a report and letter were prepared and sent to each participant The two most important parameters for the assessment of health effects from asbestos exposure are the manifestation of small irregular opacities on an interpretable ray and restrictive pulmonary Table 3 Criteria for normality of spirometry FVC FEV MMF FEV1 FVC > 80 of predicted > 80 of predicted > 75 of predicted age age age 29 30-59 60 .75 .70 .65 FVC predicted = 0.147 x Height in - 0.025 x Age yr - 4.241 FEV predicted = 0.094 x Height in i 0.032 x Age yr - 1.426 For Blacks the predicted values were 89 of the above MMF predicted 0.044 x Height in - 0.046 x Age yr + 2.806 For Blacks the same values were observed ) From Miller Thornton Smith and Morris Am J. Ind Med 55-68 1980 function deficits Of the 916 individuals from the four groups listed above who participated in the examinations readable rays were avail- able on 860 individuals and interpretable pulmonary function tests on 883. The 6.1 unsatisfactory rays stemmed from the use of portable ray facilities that did not have processing facilities immediately available In one examination a light leak developed in the ray cassette holder that rendered 30 rays unreadable 24 from SEIU mem- bers and 6 from DC 37 members Because of the extensive travel in- volved few with unreadable rays from the examination took advantage of the availability of another ray at a later examination The distributions by union with valid rays and affiliation and work activity pulmonary function tests are of participants shown below in Tables 6 and 7 ray developing facilities were not available for films taken by the portable units and by two of the fixed installations used in this survey The unavailability of a film for review at the time it was taken led to a less than desired quality for the readable rays Both over- and under penetrated films present difficulties in the interpretation of the minimal changes seen with low level asbestos exposure Thus a greater degree of inter- and observer variability exists with the interpretation of the films of this survey by the physicians reading the rays than with films taken by the same technician with the same equipment and continuously monitored for quality Following the completion of the examinations all rays from all examinations were intermixed masked and identified with a coded number If multiple films of the same individual were taken these were labeled with a single number and designated as A B C etc. These films were read as group individually by three experienced readers who were free to utilize the best A film for the determi- nation of an ray reading Results for the three readers and that of the individual who read the rays following each examination were entered on a code sheet for each participant The results of the four readings were then averaged using the following criteria 10 1 All parenchymal readings within given categories rounded irreg- ular and combined were averaged utilizing the ILO C twelve point scale If the average came exactly half between two values as is possible with an even number of readers the of the three readers who read the entire group of rays time determined whether one averaged up or down values at one 2 ; If the reading of one individual differed by three units from that of the average of the others all readers read that particular film The readers were told that a disagreement existed on parenchymal readings but no other information was provided If the subsequent reading brought the outlying interpretation into closer agreement the average of the second readings was utilized If a disagreement of the interpreted by the same magnitude still persisted entire group of readers and a the ray consensus was ob- tained This occurred for fewer than five rays 3 If a disagreement existed among the readers as to whether or not pleural changes existed such films were also read with the specification that a disagreement existed with respect to in- terpretation of the pleura Following a second interpretation a determination was based upon the average of the second reading If an ray was interpreted as normal by two individuals and abnormal by two others the interpretations of the same three readers as before determined the overall classification Approximately 110 rays read early in the sequence were reintroduced into the group at a later time ity of the individual readers as described above were used to provide information on reproducibilFor this analysis no second readings Table 4 shows the distribution of dif- ferences of parenchymal and pleural readings of each of the four read- ers along with the average score of the parenchymal readings for each individual based on a 12 point scale As can be seen both the inter- observer reproducibility and observer comparability of readers is well within similar variations determined by other interpretation groups Rossiter Table 12 for the category 1972 Glover Bevan results of individual Cotes et al 1980 See and averaged readings by job 11 Table 4 The variability and reproducibilitoyf three ray readers participating in this study * Reader 1. Subcategory difference Second reading - first reading -3 -2 -1 0 1 2 3 _ 0 4 13 93 11 1 0 82 Average Standard deviation score First reading 0.77 2.40 Second reading 2.241 0 5 20 66 10 4 0 56 Average Standard deviation 0.83 score First reading 2.67 Second reading 2.55 3 3 8 13 63 14 5 0 57 Average Standard deviation 1.01 score First reading 2.51 Second reading 2.38 ( ) = Number of films read as 0/0 both times 1 / = 1 2 etc. 12 OCCUPATIONAL HISTORIES A careful review of all jobs each person held revealed that many exam- inations participants had previously been employed in a job with poten- tial for significant asbestos exposure This is shown in Table 5 for each were union group that participated in utilized for analysis Overall the examination or 21.5 of the study whose rays participants had an identified or highly probable exposure to asbestos in previous employment or military service The percentages were particularly high in the groups that included men with skills as welders vehicle con- struction and city maintenance mechanics Here asbestos exposure in shipyards or during the welding and cutting of high temperature equip- ment insulated with asbestos was identified Of the 234 with identi- fied or possible asbestos exposure and readable rays 87 8.9 of all rays were of men previously employed in shipyards In order to eliminate any confounding exposure in the analysis of brake work the health effects of individuals with identified and possible exposures to asbestos and other dusts were analyzed separately according to the four broad exposure categories of Table 5 direct occupational asbestos exposure shipyard and heating trades possible asbestos exposure and exposure to other dusts In the direct occupational category were those individuals that insulated pipes worked in asbestos manufactur- ing operations or had similar exposures Among those classified in shipyard or heating trades were those with any shipyard employment or work that involved the repair installation or maintenance of boiler room equipment or equivalent exposures Also included in this cate- gory were a group of men 12 that insulated mufflers with asbestos or installed brake linings on continuous basis during the construction of amphibious vehicles An individual was classified in the category with the highest potential asbestos exposure as ordered above irrespective of the total employ- ment time in that category It should be noted that while every care was utilized in attempting to elicit a past asbestos exposure this may 13 Table 5 The distribution by union affiliation and type of work activity of study participants Type of work activity No identified asbestos exposure or garage work Garage employment but no brake work Brake work Other dust exposure Possible asbestos exposure ; Union affiliation UAW 259 Maint Const UAW 595 DC 37 14 3.9 70 55.6 85 69.1 82 2 - 23.0 1.6 28 28.9 18 18.6 217 61.0 7 2.0 2 - 1.6 3 2.4 18 14.6 18 18.6 1 1.0 14 3.9 23 18.3 11 8.9 13 13.4 Shipyard heating trades 22 6.2 262 20.6 Direct asbestos exposure - - insulation factory work Totals 356 126 5 4.1 4 3.3 123 17 17.5 2 2.1 97 Totals with other possible asbestos exposure 36 10.1 372 29.4 20 16.3 32 33.0 SETU 246 Totals 8 2.4 205 22 6.5 124 213 63.2 450 7 36 2.1 22 83 6.5 61 18.1 4 1.2 131 10 337 1039 7 25.8 224 21.5 ( ) - Percentage of union members in job category 1 Four men had missing occupational histories and These were excluded from further analysis Ten of these 26 individuals insulated mufflers and 2 continuously installed brakes during amphibious vehicle construction Their other asbestos exposure occurred as part of the job under study These were not included in totals other possible asbestos exposure In subsequent analysis however they were included in the category of shipyard heating trades 14 not have been successful in every instance due to inadequate recall of the worker or because an asbestos exposure may have occurred without his knowledge The large number of workers with identified exposures suggests the possible scope of the problem Such unidentified expo- sures would however contribute proportionately to the abnormalities found in both study In the the exposed brake workers and unexposed groups under analysis that follows workers will be classified accord- ing to their asbestos exposure irrespective of their union affiliation or job classification at recruitment 4 It is striking that 8.9 of all participants had previous employment in the shipbuilding and ship repair industry As approximately 45 of the study participants were over age 55 many had opportunity for employment in one of the several New York area shipyards that operated during and after World War II Brooklyn Navy Yard the Hoboken yards of Todd and Bethlehem Steel Approximately 4,500,000 men and women were employed in ship construction and repair during World War II Nicholson Perkel and Selikoff 1982 This constituted 9.4 of the agricultural national male work force in 1943 but a much smaller percentage was employed after World War II -0.5 Bureau of Labor Statis- tics 1979 Thus the finding of such a large number with shipyard employment in this study is understandable and provides an opportunity to evaluate the effects of past short shipyard work as well as that of garage employment Tables 6 and 7 display the distributions by work activity of those for whom interpretable rays are available and for whom valid pul- monary function tests were obtained As can be seen lower of readable rays were available for DC 37 and SEIU 246 percentages members be- cause of the previously mentioned loss of 30 rays The individuals involved however were randomly scattered among the different exposure categories The percentage of individuals with valid pulmonary function tests 96.4 compares favorably with other surveys Again those with missing tests are randomly distributed among all occupational categories 15 6 Table Table The distributions and percentages of readable rays by union affiliations and type of work activity Type of work activity UAW 259 Union affiliation Maint Const UAW 595 DC 37 No identified asbestos exposure or garage work 14 100.0 67 95.7 85 100.0 25 100.0 Garage employment but no brake work 81 2 98.8 100.0 - 14 77.8 Brake work 214 2 98.6 100.0 - 18 100.0 Other dust exposure 7 3 100.0 100.0 18 100.0 0 0.0 Possible asbestos exposure ; 14 100.0 21 91.3 11 100.0 9 81.8 Shipyard heating trades 22 26 100.0 100.0 Direct asbestos exposure - - insulation factory work Totals 352 98.8 121 96.0 5 100.0 4 100.0 123 100.0 13 76.5 1 50.0 80 87.0 SEIU 246 8 100.0 Totals 202 98.5 19 86.4 116 93.5 187 87.8 421 93.6 7 100.0 35 97.2 20 90.9 77 92.8 57 93.4 123 94.0 4 100.0 9 90.0 302 89.6 983 94.6 ( ) = Percentage of category with readable ray am 16 Table 7 The distribution of valid pulmonary function tests by union affiliation and type of work activity-2 Type of work activity Union UAW 259 Maint Const affiliation DC 37 SEIU 246 No identified asbestos exposure or garage work 13 92.9 69 98.6 25 9.2 8 100.0 Garage employment but no brake work 80 97.6 2 100.0 18 100.0 22 100.0 Brake work 211 97.2 2 00.0 17 94.4 206 96.7 Other dust exposure 100.0 100.0 67.37 67.37 100.0 100.0 7 100.0 Possible asbestos exposure 14 100.0 23 100.0 11 100.0 20 90.9 Shipyard heating trades 21 95.5 262 100.0 17 100.0 56 91.8 Direct asbestos exposure - insulation factory work ~ 1 4 50.0 100.0 Totals 346 97.2 124 98.4 89 96.7 323 95.8 Totals 115 95.8 122 98.4 436 96.9 17 94.4 68 97.1 120 95.2 5 83.3 883 96.4 ( ) = Percentage of category with valid pulmonary function test 1 Two men with valid pulmonary function tests had missing occupational historics No pulmonary function tests were performed at the Linden New Jersey examination of UAW 595 members 17 RAY ABNORMALITIES Tables 8a and abnormalities 8b list the according to averaged the ILO readings for the C International parenchymal ray Classification of Pneumoconioses for the various asbestos groups established in this survey Seven hundred and ninety of 983 readable rays were classified as having 0/0 or 0/1 readings for parenchymal fibrosis One hundred and seventy were classified in category 1 0-1 and seven were classified as having 1-2 abnormalities Of those with normal pleura 735 changes For those of 871 84.5 were also normal for with abnormal pleura the percentage parenchymal with normal parenchyma was much less categorized as 0/0 or 0/1 Only 64 of 113 56.6 of the readings were Tables 9a and 9b list the pleural abnormalities according to the se- verity extent and thickness of pleural thickening and whether or not calcification or pleural plaques were seen The greatest proportion of pleural Pleural abnormalities calcification consisted of was seen only pleural thickening infrequently being 89 of 113 identified on only 12 rays including eight for which pleural thickening was also noted Pleural plaques were seen on 38 rays including 16 for which pleural thickening was also identified and one with pleural calci- fication The degree Of those with pleural of pleural thickening abnormalities was relatively minor 42 had the lowest category of extent and thickness A Twenty were categorized as either A or B The more severe confined to individuals examples of pleural thickening were largely who had either direct asbestos exposure or had previously been employed in shipyards Tables 10 and 11 list the percentages in the different occupational categories according to the type of ray abnormality As can be seen with with from Table 11 the percentage with any abnormality among those garage employment is 24.2 compared to 18.8 among individuals no stated asbestos exposure or garage employment Corresponding percentages for parenchymal abnormalities are 19.0 vs. 15.3 and for pleural abnormalities 8.4 vs. 8.9 respectively for those with garage 18 </Z 0 0 o 0 0 9 t 0 T AYTIOR 3Y7 XO 0 T Normal T pleura 0 0) 0 T AZ0Z3 Z/% UO FICK SACY UV perytso OSTe OF t/Z o < Profusion Profusion of small irregular opacities opacities Type SoT}redo euAyIUSeVg UBATS uosrzed2/S33snNp2/3 OYerHG4OM activity Normal X ray v4 1/0 1/1 t e 0 2/1 2/2 e work activy asbestos 0 oremployment O/T SoTtj[ewiug28 Garage brake oansdxopxedrys eTqeL Aex-x Brake exposure t/0 < ot 9 ZL Zz 0 7] LT 143 <l 37 y 6 10 17 LZ OTT Ll A Lo 0 S@ ^' 3 a) 92 AO -a-t 'S-a Se soy g o i3 yonns fatqry OTdEF gse 0 1 0} 0 OR UE our 1 TOMOT ut st 2oTJO 0 avySty [eudsaed 0AzoYze. asbetos Savy 0 exposure 30 23 09 907 OL O < 0 G 0 ut yo & Azovjeo w)ork 267 9 insdoyvseaunqaslodxs i0ndviual i0npAerrosqoseny category oansdx 0SosOvjtaaqzs0e8o activty roIOA other sansod YAOM Soper exposure 5 pue Oe YAOM Q{z0m YAOM Fo Jou 1 v9 FO p[Nom UT UOT yom 468 zoqun is categorization 4IOM an in lower category to syy exposure not ou given category oyerq pueygof ve On clasifed ex- rsq3z0 19 category The Z/z AZoM 07 work ewAyouiegt/t FUTpAOsa"ats identfied activy Z/l garage SoTIeEwaug employment Jo employment G3 No brakeOther eTWqeL 4ei-y ae exposure exposure asbestos Teudyosed asbestosheatiangsbestos jo Azovsejca factory pue categorizaton aqunu exposure ogy worker 8} 0 0 0 0 0 0 0 0 Tt 0 0 0 0 0 T 0 0 0 8) 6) 0 6 8) rA t I re) 8) Tt ie) 4 em) X39 potfselTAxo8a vO OAPY je 0 0 Parenchyma "Sysnp OST? 34tem wosad 0 2/2 < UT e TOYO 2/3 2/3 I 9 2 % 9 7] I TENptaru 6 6 <9 0 < OL To 1 8-9 se sojaqse szayx0K 0 ral 0 ozqeque o3 0 Fe T 0 ayy ut oy} ansodx pzedtys z ZT 2 OL 60 z tt YDNS tamoT 0 0 0 St 0 atqe2qa0ySry AQLTIOV Axogjzeas OL exposure <Z fe) 9 Z T 6 2G} 0 UT e 0 YIom 32 ansodx sotazSqyes work dansodx 0AzojseF O8er3 35 work not activy assobjetqosse asbetos 3other clasifed 0 sutqeoy category work zo YIOM is that lower would other shipyard lolwow Sapery (YA0m YOM Jo 1 MOT Fo 0 0 ou 2 given category category *pury oj e.g. sansod the have have ex- ex- Teaneatganbertd AVTIOR categorycategory ZO YTOM OF Normal Normal 193 activty pleura pleura rac Fo asbeto (1/9-0) 27 souyt 5 eG exposure pue exposure exposure exposure 4uayx LV trades exposure factory Teuzrouqy1 pue [UWION 64 califcation pleural clasifed table Fo odd S I CE)EL t CE)CT (DT z (73S a) (8)z parenchyma parenchyma ( 0-0 ) rs) ac ording 0 work 6 0 0 0 0 fs) Pleural T and thickness thickness thickness of pleural 8 0 abnormality thickening 6) 0 oO T 0 8) B2 3 t Cl e) <0 0< ff) 0 t < c t 0 Z 8 8) 1 0 9 % z(E}Il A ( <)6 0 (Z) (S$) re) 0 L S ^' 3 LZ 0 I Tt 00 S bot Lov Lg OE 0 ce 62 Sel shipyard indvual alsopavdrus an prbesreantke worker would ntohictkeng hthiackenvige coattheegrory(oqt2h0emr shipyard workers workers AsnD also ON sancdxo aeieg CH ByCIg zsy79 sjarsog 4o0rIg STEROL AtoZaze5"S3smp SaTr0Zjed ve AoyYZO UT Fo +O ansodxsojaqse soyqse of ou of oaey Sansodz sanodxs Pleural saey califcaton califcation ostTe califton sxoysm 0 BsALY ptno uats Jou vc p[Nom -8's ut 0 AoyIOM TENPApUT0 Ue OYEAG & pxeAdtys SatueysqSUOTQPS[ PSTyIse[o ~eznartd SB JYeYy Yons aTqey ayy [ St UT wotyeis satz08je5AYLTIOe yRIm Tayo woszadMOT "YIOM YRTA e quesozd quesrad YFTOOM tart SyseIeq no asbetosasbetos ofothercategory asbestos asbestos in categories asbeto= = = ur [( |yq syW ide ] ) Iz Sy AeMOT tO ut Na 4x0832 SsTiogajze Teanztgonberd (ty (27 (2)z cA ) (1)z C7) (Tt) Tt (6)91 Sasnp e& ToyIO UL Fo XO (1) The category of sinodx soyagqse soyqsz X ray abnormalities abnormalites abnormalities abnormalites acording (1) 0 work 09 ou 02 ZO YAOM ART Abnormal OF Normal 13 activty pleura Teane[d pleura Jo work (</Z-O1} souyt Le TV cuAqsonzed work Aeai-y pue exposure exposure exposure 4uspny IV terxapdoseusre exposure 13 eanoytd re) 0 0 0 o Pleural Pleural Extent and thickness thickness of pleural pleural abnormality abnormality thickening thickening (i) eil}t 0 0 0 0 (tle (1) 1 <3 c 0 1 [t]z (ej[t] 0) {139 00 2 <3 ra ) 0 i 0 00 2(Zi1]s QU -- rit]le 0 {t] 0 < tt}y 0 0 It Lt 9 tT 0 Z T <l 64 vaey dinsodx sanodxs p[nom oaey califton califcatonAsyjO Pleural ] daeYy plaque usat? JOU e PTNOM 4 GI Tenpratu] AOYAG 4 ] t ue OYetq vw 0 "SULTaAIYR 5se 4vy ] yons 4 |8y3 PoTJSseO [Leaznotd pue st UT AQTatyJoOe pue 49 ernetd 2 3 7 9 1 6 1 tA 21 wZTa 9 vuosrzod 16 ( califcation , YRITM e ] SaTz0oe. thickeng yuesoad Quasead present presnt thickenig (3204 yAon ay ONCLAG Fo se that presnt oansdyawould exposure indviual worker indvual exposur exposure given could othercategory table shipyard workers would , shipyard of Fo ON oferg also have arnsodxa atqrsog adfy ov a8erg xs74I0 category category category asbestos categories = = = ({ 4o5atd exposure f]jfig z categoriesother UT categories any ay sy TOACT uO ut Toquny Number acording Les gL TZ ce iL ut 6 <@I 86 exposureNo Aea-y Of yo YION ST4eL Brake OtherOther pus no[d L garge C work Z work eanopd yeuzroy I exposure AGi~X OT %a s Lt 20 0 9 Il SOS 0 - 9.9 eli 6 ralm2 6 T LIL LY we? = % d Lz 81 S4 cz 27 Z 17 3 S27 OT gt C9 eT t Lit 49 =45 9 0 - vi] 17 I t 4.< 3 fe) - re) - i %3 0 116 ~ %S G 320 15.2 320 t LT 3 99 5.5 9 11 5 ZL ral Zo" Zz 2 Ae 0.7 5.5 2.6 UL 6 O <L CS EL % ZOSL 5.7 L249 29S 77.1 17.1 17.1 L8 OzE 1Z i <G%8 6L S ho SEL SL L2 89 7 AzojeSurqpnst) Posible 68.8 oansdx Soper} 123(YOM 54.2 54.2 YAO 5 YOM yom vinsodx sojaqse Sutjey g factoryexposure 753.56 5.6 T2TY.2 OOyeNIQ oyerg %% OTQsog przeAdtys 983 STCIO] a ur zaqunyN Azogajzeo Z0Z es Ott | To? SE iL ral 6 86 tayeas zo/pue greatr 1/0 parenchymal greatparenchymal parenchymal Io se exposure 19.0AQTIOSexposure 102 ACT-~Y tanei13 19.0 % Aex-~X pue 20 work O/T 20.7 Jo work ; exposure 18.5 HAO % OF pue 17.1 exposure exposure 21.Zajev028 Jo % O/T APTIOR YrOK b7 LI 8 %0 6S UT 1/0 ct parenchymal greater parenchymal parenchymal 9 1 greater parenchymal et parenchymal parenchymal parenchymal parenchymal greater and or %L 6c1 eT % 8 oS 8T 8.4 40 24.2 g 6 Le 11.0 ty27 12 z S2 Tor 72 92 547 Le GE 77 ove SZ 6 9ST 8 49 28 2S" tT 6 22.9 8 Z LS %S Cl OT %C" I 11.4 eeZz %S cit UT bes 1 27.6 bl % L 44 28 we Te 9 25.2 % vaG 0% BL 35.8 OT 9% LT OZ % EE 78TST | uoT@e[RsuT) ainsodx ainsodxa Soper (Yz0n ansodx sojeqs YA04 NAOM YOM OFYeLQ YAOM sainodxa sojaqse sutqey ATOJIVZ soqase predrys stqsog paq2s a8eis a3ezs ON oyerg ysap oN 20 TLV rsyIO 4oa1tg STROL 24 employment compared to those with no such employment or no stated asbestos exposure The minimal overall differences between these two groups are more manifest in parenchymal abnormalities there being little difference in the percentages of pleural abnormalities On the other hand significant differences exist in the percentages of pleural abnormalities among those employed in work having direct asbestos exposure or shipyard employment and those only employed in garage work or having no asbestos exposure We will thus utilize both parenchymal and pleural abnormalities to characterize the various exposed groups 4 Other criteria could have been utilized for the determination of an abnormal ray For example we could have required that all four readers read an ray as abnormal before it would be so categorized or that an averaged reading of 1/1 be required for the establishment of parenchymal fibrosis or that pleural plaques not constitute an abnor- mality To investigate whether more stringent criteria for abnormal- ities would have altered the analysis the overall results were cal- culated with the criteria for abnormality being an ray categorized as 1/1 or greater and the presence of pleural thickening of calcifica- tion plaques were not considered abnormal These data are shown in the last column of Table 11 and demonstrate the identical trends that were present in the data with less stringent criteria for abnormal- ities Table 12 shows the distribution of abnormal rays for each reader according to work category While different percentages of abnormal rays were obtained by the various readers the trends according to work activity were highly consistent Those engaged in brake work had a higher percentage of abnormalities compared to those who did not and those with other asbestos exposures had the greatest percentage of abnormalities according to all four readers Thus the overall ray results are relatively independent of the individual readers and inde- pendent of the criteria for abnormality established 25 8 7Z 9 1Z Z LE $ 97 6 92 S[TzZq05 (<86/847Z) (1s6/Z1z) (186/S9<) (186/097) (186/47) 3 Z3YAO asnp 62 (S </8) 8z abnormalites HLS (SE/8T) TTL (S </9) SZ(S/6) indvual indvidual Te *szoptdAno} AzoS397e5 Garge Shipyard Posible Other Fo category B categorycategory category (9L/1) SS^('92/872) EE (24/92) gce(L/9%) Garage Heavy Heavy aye Shipyard L' Shipyard Posible ele exposure Shipyard SOtTJ[ewsouq ( 10/421 29/16 4/9 42/12 17/6 10/35 21/16 ) gor 7 y ZL 29/16 7 44.4 yoy 4/123 35.8 35.8 24/77 31.2 <- <(E Avca- 9TGPL FO .TEnp got 84/421 Latour 21/16 0SZ 73 42/12 17/76 6SZ 33.6 oSequsASg ( ( 4/9 38.2 26/7 47/123 ( 092 00Z 38.2 <SZ 22 32/16 32/16 30/16 3/9 46/123 ) 26/7 ( 8 et 3 91 46/123 26/7 < t ON Aupesy paseroayeuTpeoz T z < 4 26 Age standarization of ray readings Inasmuch as the prevalence of ray abnormalities reflects various assaults to the lung separate from that under study that accrue overtime it is necessary to consider age in comparisons of groups exposed to asbestos in different circumstances Any age effect can in part be due to unknown exposures to various dusts including asbestos the opportunities for which increase with time Additionally any related changes progress with time and the manifestation of rela- tively minor exposures early in life can be significant in later years As discussed previously a selection criteria for the exposed and control groups resulted in study populations that had similar age distributions However to more accurately take into account any age effect the overall percentages of ray abnormalities were standard- ized to the age distribution of all 983 individuals for whom readable rays were available using equation 1 A standardized percentage P was calculated std = T 1 std 7 P. N./983 N./983 Where P. is the percentage of abnormal rays in the ith age category of the group of interest and N the number of all 983 individuals in the ith age group For a group having an age cell with no data insulation other standardization was based on those cells with data using equation 2 Pstd Pstd = P avail i T NN 983 PN PN PN all i T PN PN / PN PPNN avail i 2 Where Pi category again equals of the group the percentage of abnormal rays in the ith age of interest and /the number of all 983 indi- viduals in the ith rays among all 983 age category T is the percentage individuals in the ith age category of abuormal These over- all standardized percentages are shown in Table 13. The difference between the individuals performing brake work and those with no identi- fied asbestos exposure remains while the percentage of abnormalities in those employed in a garage but not engaged in brake repair work bs SE l'2 Ll'y 13 L OL tL 9 9 4 < 9 9 'l F F 13 F F F 3 F PercntagePercntage of ray abnormalites acording acording work activity age 97E Z'SZ aTqey s Percentage 40 40-49 percntage,, (20/8) (907/96) Totals activity Aq STPROL, 40 40-49 Zz 50-59 50-59 60-69 60-69 62 > Z1E( /92) Totals Age percentage,, percentage,, a10m skex-X garge 2.1 ol< EEE (9/2) 7/47 7/47 15.7 9 8Z 13/65 ) (S/Z) 14/37 14/37 ECE 2/6 Oot ( 38/202 38/202 Oot 24.3 oly o[qrpeoxr employment work 69-09 (E/9T) 0.0 (S3/T<) 21.2 4.1 ( (91/ <) 7 8 21.2 - 25.0 0/11 6% 25.6 22.9 22.9 < 2<8.6< St 21.2 Evee 18.6 - woyA AO} 23.6 2.5 SUTpi0D3Zework G 0 0.0 (ST/8E<) STeNPALUT work a5y 6S-0S ) (S9/<T) 19/107 ( 38/15 ) 31/85 31/85 L921/5 cE ( 96/406 96/406 OR (S/Z) 08z 10.7 C96 exposureasbestos 67-04 641(L9/L) 2/1 18.2 (070 16.7 (01/6T) 33.333.3 Z St ( 33.3 (61/S) 2.9 2 .9 - - 7.2 [[e FO asbestos WoOTANGSIp ( ey (4/@) 5/19 20.0 0 SZ 1 /31 ) (75/9) 3/16 3/16 - 60.0 Cot/*) 24/77 35.8 - OL heating 4.6 YAM ; ) SOJqSe oansdx aserl YAOM 16.9 paljTuep 36/213 avilabe pazteus distrbuion ansodxa Xsoqzagse rays were soyqse of 14/134 x0 Fo distribution distribution ( 28.0 82/235 ( ; ON ayerg Apog readble (ytom ase 4.4 sy 4/9 25.2 32.6 02 avilabe STeIOL t 28 decreases to somewhat below the level of those unexposed otherwise The percentages of abnormalities among those with other asbestos expo- sure remain significantly different from those unexposed If we consider the percentage of ray abnormalities a manifestation of a normal distribution with a variance reflected by the number of abnormal rays the respective standard deviations in the final column of Table 13 are calculated While the percentage of abnormal rays in each of the job categories of Table 13 has a large uncertainty associ- ated with it because of the limited number of individuals in a work activity other than brake work yields a remarkable consistency the pattern of observed percentages The two groups with no identified asbestos exposure garage controls and garage workers with no brake or body work have the lowest percentages of abnormalities the various activities with ages and brake probable asbestos exposure have the highest percent- workers are intermediate Individuals with other dust exposure appear to be unaffected by such materials the result of the relatively short exposure times or This is probably the marginal expo- sure circumstances The other dusts included coal 23 men silica 9 men and other dusts 3 men Five of the other dust exposures were for longer than ten years One of the five had an abnormal ray The average exposure of the other 30 was 3.2 years In subsequent analysis these 35 individuals will be characterized by their garage or garage employment One notable feature of Table percentage of abnormal rays among the 32 individuals 13 is the high who worked for some time in auto body repair repair and undercoating work See subsequent sections on auto body Smoking standardization of ray abnormalities Smoking has been identified as exacerbating the malignant effects of asbestos Death rates from asbestosis among 20+ cigarette smokers are 2.8 times greater than among nonsmokers Hammond Selikoff and Seidman 1979 and both parenchymal and pleural ray abnormalities have been reported as more common among current and smokers than nonsmokers Weiss 1971 Rossiter and Harries 1979 Weiss Levin and 29 Goodman 1981 An effect malitics was also found in abnormalities found more of smoking on the prevalence of ray abnorthis study with both parenchymal and pleural among smokers than nonsmokers and more frequently among current smokers than smokers The data for the overall ray readings are shown in Table age standardized 14a Table 14b lists the percentage distribution of smoking histories ac- cording to job category As the unexposed group contains 25 more current smokers than where possible should the other exposure be standardized for groups the ray results cigarette smoking as well as for age This can be done for major work categories but is unreliable for most subcategories because of the absence of data in some smoking- age cells The standardization procedure follows that of age standard- ization and utilizes the overall smoking historics of the study group 31.6 were smokers ; 42.4 , smokers ; and 26.0 nonsmokers Standardized ray abnormalities by work activity Table 15 lists the age and smoking standardized percentages of ray abnormalities among those with no identified asbestos exposure those engaged in brake maintenance and repair and those with probable asbes- tos exposure including auto body repair work The overall percentage of abnormal rays among individuals with differs significantly from those unexposed probable asbestos exposure 0.005 two sided The difference is particularly significant 0.0002 for pleural abnor- malities This occurs because pleural abnormalities often appear from relatively low asbestos exposures and can exceed parenchymal abnormal- ities in prevalence at long times from onset of exposure See Anderson et al 1976 e.g. As many of the individuals in this probably exposed category worked during World War II in shipyards we are observing effects in this group after 35 years from onset of exposure Table 16 lists the age and smoking standardized percentages of abnormalities according to garage activity and union There is relatively little difference between the percentages of abnormal ray for the auto workers of UAW Local 259 while a large and significant p < 0.05 30 Age standardized percentagoef ray abnormalities according to smoking history all exposure categories Smoking History Abnormality Pleural Parenchymal Any Smokers 14.0 26.3 32.6 smokers 11.2 16.0 22.9 Nonsmokers 9.1 13.9 20.4 Smoking standardized 11.5 18.8 25.3 Table 14b Percentages of distributioonf smoking histories according to job category No exposure including mechanic garage work Smokers 39.1 smokers 39.1 Nonsmokers 21.7 Brake work 29.1 43.1 27.8 Probable asbestos exposure 31.8 42.0 26.1 31 Table 15 The age and smoking standardized percentages of ray abnormalities according to exposure category Exposure category No identified asbestos exposure Pleural 8.4 - 1.6 garage work Garage work but no brake work 10.4 2.3 6.6 2.2 Brake work Probable asbestos exposure including body work 7.2 19.8 - 2.7 Parenchymal 15.8 - 2.1 17.0 - 2.8 14.4 - 3.5 19.3 - 2.2 19.9 - 2.7 Any 20.1 - 21.9 - 17.8 - 24.4 - 2.5 32.5 - 32 Table 16 Age and smoking standardized percentages of ray abnormalities for different groups of garage workers according to work activity Work activity Brake work2 No brake work UAW 259 19.8 - 3.0 17.3 3.3 Percentage of participants 3 with other asbestos exposure 15.1 UAW 595 Group DC 37 SEIU 21.7 4.4 28.9 - 4.0 18.7 4.7 16.3 25.8 Overall 24.4 - 2.5 20.1 - 2.5 21.5 1 Standardized age and smoking distribution of all 983 men for whom readable rays were available 2 No identified asbestos exposure 3 Does not include 12 individuals with asbestos exposure during amphibious vehicle construction 36 Among those members of Local 259 of the UAW who were examined 27 had been examined previously Lorimer 1976 Table 19 shows the compari- son of the two sets of readings for these individuals Of the 27 pairs of rays read ten received identical readings The 1979/1980 reading was one subcategory higher than that of 1974 in seven in six it was one subcategory less 1979-80 and three were One reading was two subcategories two subcategories higher in lower Thus the overall read- ings were very similar between the two periods of time and there was no evidence for any progression of fibrosis among the small group of individuals examined in two periods of time Auto body repair and undercoating work The highest percentage of ray abnormalities in any group observed in this study was among men employed in auto body shops for varying periods of time 38.6 versus 24.5 for brake workers and 18.6 for garage workers who did no brake work While relatively few men were in the category the percentage of abnormalities was significantly higher than garage workers who did no brake repair 0.05 sided The average time of employment of the group in body shops was 13.3 years Of those employed more than 20 years 5 of 7 71 had abnormal rays In past years asbestos was commonly plastic auto body fillers used for used dent as a reinforcing agent in patching Extensive dust exposure asbestos was common as the material exposure is unknown because was sanded smooth no fiber counts are The extent of available from such operations Fortunately with the increased awareness of asbestos hazards and with the introduction of the occupational asbestos stand- ard most manufacturers removed asbestos from their formulations In a current 1981 259 members no analysis asbestos of six compounds used in shops employing UAW was identified However while current asbes- tos risks no longer exist in these shops at least to our knowledge persons exposed previously should be made aware of their asbestos exposure the ette smoking risk associated with and the desirability it the synergistic effect of cigarof appropriate medical surveillance 37 Table 19 1974 reading 0/0 0/1 1/0 1/1 1/2 Comparison of ray readings of garage employees 1974-1979 0/1 6 5 0 0 0 1979/1980 Reading 0/1 1/0 1/1 2 0 0 4 4 1 0 0 0 3 0 0 0 0 1 1/2 0 0 0 1 0 38 Automobile undercoating materials also contained asbestos as forcement fiber and disease had been suggested in individuals principally in undercoating work Thirteen men were identified a rein- engaged in this study three shops with significant periods of undercoating work Of the group had abnormal rays but two of the three also work in body Thus we have insufficient data to evaluate a risk from this activity in this population Parenthetically numerous other men re- ported having occasionally one to two times per year applied under- coating materials sis In all cases These where individuals were not segregated in any analyundercoating was done mixed compounds were utilized It would be expected that the spraying of such material would not lead to the release of high concentrations of resirable asbestos material fibers on shop However the grinding underfoot of dry sprayed floors could release the encapsulated fibers Effect of previous shipyard employment Of the 983 individuals with readable employed some period of time in a War II Overall 39.1 of the rays rays 87 had been previously shipyard generally during World of this group were abnormal On an age standardized basis 28.6 were abnormal compared to 20.5 for all groups unexposed to asbestos control group garage workers with no brake or body work exposure and those exposed only to other dusts Because of the relatively small number of cases the difference between these percentages is not significant at 0.05 level Tables 20 and 21 show the number and percentages of shipyard employment and time of abnormal since onset rays according to years of shipyard work To the extent possible age standardized percentages have been calculated for each exposure category although with the small numbers in a given time cell the procedure has large statistical uncertainties The average time of employment of all 87 individuals in shipyard work was five years As few 15 worked longer than ton years the data in Table 20 on the trend according to shipyard employment are unstable because of the small numbers in longer term employment categories In Table 21 however a significant trend with years since onset of shipyard employ- ment is seen On an age standardized basis 37.9 of those with more 39 Number and percentage of ray abnormalities according to years of shipyard employment Parenchymal reading Years of shipyard employment 0-4.9 5-9.9 10-14.9 15-19.9 Totals Normal pleura 0 31 14 4 4 53 1 340 2 9 2 100 0 1 0 7 , 1 8 2 1 Any abnormality Age standardized percentage of abnormality 20 39.2 27.2 Abnormal pleura 1 4 2 0 0 0 7 33.3 24.7 4 50.0 45.5 1 0 0 3 42.9 37.1 13 10 1 34 39.1 28.6 40 Table 21 The number and percentage of ray abnormalities according to years from onset of shipyard employment Parenchymal abnormality < 10 Years since onset of employment 10-19.9 20-29.9 20-29.9 30-39.9 40+ Totals Normal pleura 0 3 3 12 33 2 53 1 U 0 2 7 0 9 2 0 0 0 1 0 1 Abnormal pleura 0 0 0 2 9 2 13 1 0 0 0 9 1 10 2 0 0 0 1 0 1 Any abnormality Age standardized percentage of abnormality 0 0.0 - 0 0.0 - 4 25.0 19.2 27 45.0 3 60.0 34 39.1 36.6 47.6 37.9 28.6 as ~ Age standardized percentage of those 30 or more years from onset of shipyard employment 41 than 30 years from onset of shipyard employment had This percentage is different from that of unexposed 0.02 sided level of significance abnormal rays individuals at a It is possible to compare the results of the prevalence of abnormal rays among different shipyard populations 30 years or more from onset of employment The finding here of 17 more ray abnormalities compared to controls among former shipyard workers employed for an average of five years is in agreement with studies of the effects of term shipyard employment employed for more than 20 years In a study of ship repair workers 87 of the rays of those 30 or more years from onset of employment were abnormal Selikoff Lilis 1980 The percentages of abnormal rays in the Nicholson two groups and are approximately in the ratio of the periods of employment Evidence of malignancy In any ray screening of a population of this size it unexpected that a chest malignancy would be identified would not be Such was the case with one individual in this study He was referred to the chest service at Mount Sinai Hospital for follow diagnosis His broncho- genic carcinoma was in poor condition not operable and while alive two years later Parenthetically at examination his CEA level was was 1.3 nanogram and his sputum analysis showed moderate atypia but no malignant cells present PULMONARY FUNCTION TESTS Principal spirometric tests Tables 22 23 24 and 25 show the mean values of forced vital capacity as a percent of that predicted 100 x PFVC volume in 1 second as a percent of forced vital FVC the forced expiratory volume in 1 second the forced expiratory expiratory capacity 100 as a percent x FEV of that predicted tween 25 100 x FEV and 75 of PFEV forced and vital the maximal midexpiratory flow becapacity as a percent of that pre- ~N c SuTyousyPeZTpavujs TFL" Forced C'IFE capacity as Table T 9 LF of predicted predicted predicted of (SZ) Curent smokers (S) staed work 9 7 94.1 $*s6Z6 T employment -UON 6SE6Z" 45 no employentbrake Garage or (149) 93.6 128 (Sl) including including 6 9 work 93.0 12 brake LFL F8s Garage 9S including employment Al identified smokers (8l} Non smokers 1.9 ) l9o.r2 2.6 1.2 181 98.2 1.4 O 4.6 ) CTE 4.5 46 HS SIT OU 1.2SALTY 30uU aTqezfaqteq p[noms 943 ouq Smoking standardized,, standrized,, ut standrized,, MoT 1.2 saysty 95.7 @& satz08o3e91.5 1.5 e 91.3 satzoyeut *pury ut 0.7 0.7 SOUoqse ptrea 49430 2.4 92.9ytm ay ue ug 02 tv 63 asbestos asbestos TLfi - of (Sy) 94.0 (21) 1.5 ) 100.8 (2) #0 1.1 eansodx asbetos SYsnp - 8 2.7 96.1 Posible 1.6 A0y}JO heating Shipyard [nzSuteaw woTINGAastp sayou-xq trades 93.0 37 18.9 2.0 5)6 10.5 ainscedxa Ato$8ajzeo soyagse insulation heating 7F0'Cs Ssopeay 3.2 Suryous Shipyard -tomoz ptnos the distrbuion smokers STENPAUT category valid pulmonary function AxoJazr Axovaqe dansodx stoxam to meanigful pulmonary Kz0435e3 distrbution distrbution A0Ita $%g9- %% smokers smokers test would ONeaigq categorization an indvual given function have UOTRLZACBa2eD clasifed ASYqRO work lower indvual oansdx paedtys activty table that given not category asbestos ytom category meanigful meaningful Non activity such the table ytoan pus all the 19.1 ) ut aq o7 ayy FO 95.8 - aeYy ayy XO zy osz{e ut De YAOM ayy FO 04 *-8+a UT 03 . "YAO" 1 & MOJ Sz Fo would se worker worker would ( low the in UL vacg yous 43 MOT UT OU exerq vital suryowsyPeztpiuqs 60F8L2 forced HL job 8! category (S%) Curent smokers smokers quaod Sutpacoe asbetos e se (9Ag/Garage exposure ptsloudoas AxgaGarge no employent <@ UT 0OL) pue Z 6 wwoorrkk 1FE9L 1.4 45 = body ( <9) 1.3 36 workwork 7 LLF 0.8 128128 smoking smoking history % Ex smokers (ZE) smokers 7.3 1.7 ) - ' = 74.7 1.7 ) - 6 0.6 182 S79.L0 oe - eAeY & TeYysTYy Sv SaTiogjep[Nom "38s puey peTytspo saTro8zestandrized,,uoszad standardized,, ZounzZ z9yQO ut UdATS e a3 soyaqse ew UD UL f'a t o1 7.8 sanodxsynp pryea \ fo fatqe2 TenptaTu0.478.4 ue su. FOAYOO savy ut 9Tqey owNToA Aqtoedsincluding AtojeidxaTeqta asbestos of pods0F paor0g Fo 1.9 SoYqse identifed posible (9 <) (821) (21) 1.1 (19) (7%) (SE) CZ) ) 75.7 Fo Vey. wanoy OSTe YOns pynos 02 st TnySuresaw 76.2 asbetos exposure 24 75.5 1.7 - ) AxoVaqv. asbetos 1.9 ATIOR aAinsodx Shipyard szayom exposure ) 0.7 aTqtsod soq1.se1 72.7 AT08aqevd aznsodx predtys erorexposure work 5.6 YA04 pue the indvuals mean meanigful eror sanodxa soyqse pAvueys number indivduals indviduals category ADOG distrbuion smokers al pulmonary pulmonary . szayoug) woljqeztso valid Standardized in smoking the with 31.6 % smokerssmokers 42.4 distribution smokers 26 1.0 "S'a 18 ut oq e& 03 - 32 sepxqz 76.4 azsyIO FO Jo "YIOM YAOM - ( ayerq savy sy Fo Jo UT oj fo(Yo ou se ) MoT TE Zou aey yons zoqun CoOL atqeq function function function pulmonary fatqer s as ) P[nom P[NOM our Tayz0MK would have no ut ayQ 44 SUT expiration according to and smoking FEV category acording AOU ) to smokingand history Smoking Forced SaTI0gjLvo = standrize,, work (SZ) (6) Curent smokers (2S) - smokers Non payotperd standrized,, standrized,, sojaqse garge @ <FS" 98.1 2.2 10.3 ( or jyey Ort 701 101.3 10.1 LOI LOT Azeuowynd 1.9 Garge Jo work (@7) 91.8 2.9 ( <8) 97.6 3.3 (1) a ey p[nom Teytom standrized,, standrized,, UT @ 1.6 puey - Asyjo 03 e 97.6 sy uQ employent 105.2 Juesiod including sanodxe0.8 e 95.9 1.3 <<F9L6 1.4 108.0 105.2 0.8 se yo 102.8 puos 1.3 PTQeL identifed duo 52 worznatysp 103.1 Posible exposure 4.0 9.3 3.1 3.7 2.0 sxoyasom aumypoA asbetos 98.8 749L6 UT work employment and posible 97.0 2.4 98.8 heating O 108.0 LOL (19) 101.8 2.0 9 pryTea prned f*a-t T sary 100.6 YyITA 97.6 3.4 OSTfi [Te aay arate! IO Fo ao 110.4 102.8 O *S-a yaom aq 32 eyoag 3.5 UL 101.7 101.7 2.0 ut 103.1 03 1.8 se 12.5 sayou-xq eTqtsod 135.1 sainodxs 2 Sutyows oansodxa =sapezq factory dorqerdxs 5.1 AzoSaqed 101.3 pazeAdiys the mean ytom pue indvuals in of evinsodx sojadse Sutzeoy sojyqse posaoy eror To in category category meanigful distrbuion meanigfulNon meanigful valid pulmonary tes test WoTAecz0say. 26.0 function vInsodx 31.6 pulmonary function Standardized smoking 5.1 5.1 YAOM yous A0rz9 AOYIO dy. ayy FO fa[qza {%g UT Fo o2 Oe T Le azqey MOF e& To DAVY ayy function You om ur ==n ut categorizatn smokers categorization categorization - work activty is that given category category would category would have have ADT asusry s us CG 9 8 8 f 4 sutyougzpPetrpueqs eF1L'S6 <FS08 91F9<6 8003 Aytoeds (61) acording to (7) $ 9 < 9 9 % Texta asbetos smokers exposure exposureposaoz xposureexposure employmentGarge jo Garage Garage with ) S F8CIT Curent Curent body 78.0 5.9 30 pue Garage employment S% brake %G% Garge PTqeL Gargeincluding usemjaq All All identifed mots asbestos asbetos asbetos & Azoqeaxtd PosibleSe $ S < 9 9 2 FET6 ESL 2.9 1 0 posible (OE) COIL) (IL) S$ S 6 S 4.1 58 asbestos exposure 7.1 23 25 SF0L8 <49 68 ou Smoking Smoking History (1) Ex $ 9 Ex smokers F601 13.8 78.3 6.3 32 8 9 S L S 98.4 2.6 149 oARY JOU aTqey atqe} P[NOM ay. oy. p[nom ut "389 ut Smoking Smoking standrized,, uot standrized,, standrized,, oOUunZ Be standrize,,95.1 95.1 e ) 3.5- ut 3.6 [enptau 80.5 1.6 ) 20430 ) (%40'9% 93.6 - ue -8.3 80.0 (8S) ( <Z) ( < <) (Z) Sszayou-c 2.8 89.2 4.8 65 [Te jo yeYy a*tSsinp YONS ST 89.0 89.0 5.2 10.1 1.5( ) 82.6 8.6 23 ART IOe 42 he eo ty -6.5 ( 3.4 87.0 87.0 89.6 5.7 89.6 ) yzom saoyus-xg eTqtsod einsodxa Peds10F Soperzq factory STENPAUL ( 123.3 ayL work 26.9 yzox pue mean indviuals meanigful indvuals ansodxa soyaqse soygse ArOBazeD ansodxa category Burqeoy szayi0M indviuals %g- few category to category Apoq distribution distrbution smokers al pulmonary pulmonary test uotqez0$9r"d valid function %% function Standardized smoking 104.9 eqy 09 FO YIOM AaMOT 3.4 AOAD ayy o3 ut Jo Fo 03 3s YAOM TE B MOT JO ayeaq test Jayjo se z= = tt szayous) the with no preAdtyus smokers 42.4 Non pulmonary 31.6 ( categorization smokers that category te category category would have a ev yons 46 dicted 100 x PMMF according to job The prediction equations used were those category and smoking history of Miller et al 1980 See Table 3 The distribution of these parameters is shown in Tables 26 27 28 29. With the exception of auto body workers and garage workers who do not work with brakes there are no differences between the means or in the distributions of the three principal spirometric test results PFVC FEV PFEV1 , FEV1 ) including those with possible past for all exposure other groups to asbestos of workers While there are some differences between category subgroups these are the various job categories in smoking largely the result of statistical varia- tions The more identical results stable for the smoking standardized data show virtually unexposed control population brake workers and individuals exposed or possibly exposed to asbestos These data are shown in Table 30. This might be anticipated as only marginal differences individuals were seen in the in different work percentage of ray abnormalities among categories As forced vital capacity is usually a less sensitive determination of asbestos changes than the presence of ray abnormalities and forced expiratory volume in one second relates to exposures other than asbestos the absence of a definite trend among the groups with varying asbestos exposure is not unexpected see section on measures of small airway disease for a discussion of PMMF Measures of small airway disease As was seen in Tables 22-24 with the exception of mechanic garage workers and those men engaged in auto body work no differences existed in the means of the spirometric test results between the three major occupational groups studied those unexposed to asbestos or to garage work those engaged in brake work and those with a probable asbestos exposure However in the case of FNNF Table 25 individuals with an identified asbestos exposure had a lower smoking standardized mean compared to those in the other two categories although not at a 0.05 level of significance The unexposed control group had the highest mean values followed closely by mechanics engaged in brake work Those with identified and possible exposure to asbestos had interme- 47 Table 26 The distribution of forced vital capacity x as a percentagoef that predicted 100 PFVC by job category and smoking history Job category 60 100 x FVCP 60-79.9 80-99.9 100+ No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work 0 0.0 5.6 5.6 1 0.8 0 0.0 5 11.1 7 19.4 20 15.6 0 0.0 29 64.4 23 63.9 67 52.3 11 91.7 11 24.4 4 11.1 40 31.3 1 8.3 No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work smokers 0 0.0 4 8.5 2 6.7 9 20.9 2 1.1 21 11.5 1 6.7 1 6.7 27 57.5 16 37.2 75 41.2 10 66.7 16 34.0 16 37.2 84 46.2 3 20.0 No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work ) Percentage Nonsmokers . 0 0.0 3 12.0 0 0.0 4 13.8 2 1.7 7 5.9 0 0.0 0 0.0 11 44.0 16 55.2 59 50.0 4 80.0 11 44.0 9 31.0 50 42.4 1 20.0 48 The distribution of forced expiratory volume in one second as a percentage of forced vital capacity 100 x FEV1 FVC according to job category and smoking history Job category No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work ) percentage 100 FEV./FVC FEV./FVC 55 55-64.9 65-74.9 75-84.9 85+ Smokers 0 7 0.0 15.6 0 0.0 4 11.1 4 3.1 11 8.6 1 8.3 0 0.0 12 26.7 10 27.8 42 32.8 3 25.0 17 37.8 9 20.0 18 50.0 4 11.1 53 41.4 18 14.1 8 66.7 0 0.0 Smokers 3 6.4 3 6.4 3 7.0 2 4.7 1 0.6 9 5.0 1 6.7 0 0.0 8 17.0 14 32.6 35 29.2 6 40.0 23 48.9 18 41.9 99 54.4 6 40.0 10 21.3 6 14.0 38 20.9 2 13.3 Nonsmokers 0 0.0 1 4.0 2 6.9 2 6.9 0 0.0 0 0.0 0 0.0 1 20.0 2 8.0 5 17.2 26 22.0 0 0.0 19 76.0 15 51.7 64 54.2 3 60.0 3 12.0 5 17.2 28 23.7 I 20.0 49 The distribution of forced expiratory volume in one second to that predicted 100 x FEV PFEV ) b| yjob category and smoking history Job category 60 100 x FEV PFEV 60-79.9 60-79.9 80-99.9 80-99.9 100+ No identified asbestos exposure or garage work Smokers 0 0.0 5 11.1 Garage employment but no brake work 1 2.8 6 16.7 Brake work 2 1.6 14 8.6 Body work 1 8.3 0 0.0 No identified asbestos exposure or garage work smokers 2 4.3 2 4.3 Garage employment but no brake work 4 9.3 3 7.0 Brake work 2 1.1 9 5.0 Body work . 1 6.7 1 6.7 No identified asbestos exposure or garage work Nonsmokers 0 0.0 0 0.0 Garage employment but no brake work 1 . 3.5 1 ( 3.5 Brake work 1 0.9 4 3.4 Body work 0 0.0 0 0.0 (= percentage 19 42.2 20 55.6 57 44.5 7 58.3 21 46.7 9 25.0 58 45.3 4 33.3 15 31.9 17 9.5 41 22.5 6 40.0 28 59.6 19 44.2 130 71.4 46.7 46.7 7 28.0 9 31.0 29 24.6 3 60.0 18 72.0 18 62.1 84 71.2 2 40.0 50 Table 29 of The distribution forced expiratory flow between 25 and 75 of forced vital capacity as a percent of that predicted 100 ^ MMF PMMF according to job category and smoking history Job category 60 100 x PHMF 60-74.9 75-89.9 90-104.9 105+ No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Smokers 10 9 25.6 23.1 9 30.0 9 30.0 37 " 33.6 16 14.6 2 18.2 3 27.3 3 7.7 13.3 13.3 19 17.3 18.2 18.2 5 12.8 10.0 10.0 14 12.7 1 9.1 12 30.8 16.9 16.9 24 21.8 3 27.2 No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Smokers 7 16.7 12 36.4 14 9.3 4 36.4 5 11.9 5 15.2 17 11.3 1 9.1 16.7 16.7 5 15.2 33 22.0 5 45.5 11.9 11.9 3 9.1 31 20.7 0 0.0 18 42.9 8 24.2 51 36.7 1 9.1 No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work ( ) = percentage Nonsmokers 0 0.0 3 15.8 3 12.5 5 20.8 1 1.1 11 12.2 1 25.0 ] 25.0 5.3 5.3 5 20.8 16 17.8 1 25.0 5.3 5.3 6 25.0 21 23.3 0 0.0 14 73.7 5 20.8 41 45.6 ] 25.0 51 Table 30 Smoking standardized,, means and percentages of abnormal pulmonary function tests by job category Job category No identifiedasbestos exposure or garage work Mean value 100 x PFVC 95.7 - 1.2 Garage employment but no brake work 91.3 1.5 Brake work , 96.9 - 0.7 Body work Definite and possible asbestos exposure 92.9 - 2.4 96.1 - 1.1 Percent 2 10.2 - 2.9 23.2 - 4.7 10.9 - 1.6 5.7 - 4.0 13.1 - 2.6 No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Definite asbestos and possible exposure 100 ^ PFEV1 102.6 - 1.6 ; 97.6 1.9 105.2 - 0.8 97.6 - 3.4 102.8 - 1.3 7.2 - 3.2 14.9 - 4.9 7.1 - 1.3 8.3 - 4.8 8.7 - 2.1 No identified asbestos exposure or garage work Garage employment but no brake work 100 x PMMF 95.1 - 3.5 80.5 - 3.6 31.6 - 5.4 49.5 - 7.5 Brake work 93.6 - 1.6 27.5 - 2.8 Body work 80.0 - 8.8 46.6 - 13.5 Definite asbestos and possible exposure 89.0 - 2.8 43.9 5.2 1 Standardized to the smoking distribution of all with valid pulmonary function test Smokers 31.6 smokers 42.4 Nonsmokers 26.0 Abnormal and less is less than 75 than 80 for 100 for 100 x PFVC x MMF PMMF and 100 FEV PFLV x FEV PFLV 52 diate values and those mechanic garage workers the lowest values The difference between the mechanic and mechanic garage workers is significant at the 0.001 sided level See section on possible health effects of mechanic garage employment The same difference was seen in auto body repair workers but because of the smaller number of individuals it did not achieve significance at the 0.05 level 0.12 Possible effects from mechanic garage employment For the principal three individuals with garage spirometric tests as well as for MMF employment but who did not engage in PMMF brake maintenance work had significantly lower means and a greater percent- age of abnormal pulmonary function results than either controls brake workers or those with possible exposure to asbestos otherwise We investigated whether this may be the result of the greater percentage of blacks and Hispanics employed in this category compared to other job activities coupled with improper pulmonary function standards for these groups Table 31 shows the percentage of individuals in the various job categories according to their race As can be seen among those with garage employment but no brake work more than 40 were black or Hispanic compared to 28 of those with no identified asbestos exposure and 16 of those who worked in brake maintenance and repair To the extent possible we took into account the known differences between black and white populations in the predicted standards for forced vital capacity and forced expiratory volume in one second black normals were 89 of those of whites For MF the same prediction parameters were used for blacks and whites as there appears little racial difference in flow rates Schoenberg et al , 1978 However data on these standards are relatively limited and they may not be fully Table accurate 32 shows For Hispanics we used the overall spirometric the same criteria data according to as for race whites As can be seen the means for PFVC and FEV PFEV are generally lower than the white population for the black population in all smoking categories The smoking standardized difference is significant at the 0.01 level sided for PFVC On the other hand the data for the Hispanic 53 Table 31 The distribution and percentages by race according to the work activity of study participants who had valid pulmonary function tests Race Type of work activity No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Identified and possible asbestos exposure Totals White 89 76.1 63 58.9 356 83.4 24 75.0 177 88.9 709 86.3 Black 19 16.2 40 37.4 56 13.1 6 18.7 19 9.5 140 17.0 Hispanic 9 7.7 4 3.7 15 3.5 2 6.3 3 1.5 33 4.0 54 The means of spirometric tests by race Race White Black1 Hispanic Current smokers 93.0 222 91.2 53 96.9 9 Smoking history smokers 100 x PFVC 97.4 300 89.9 51 94.4 17 Nonsmokers 99.6 187 96.5 36 81.6 7 Smoking standardized 96.6 92.0 91.9 . White Black1 Hispanic 96.2 220 98.4 53 105.0 5.3 9 100 ^ FEV PFEV1 104.9 300 110.0 186 100.4 51 106.8 36 101.7 17 95.3 7 103.5 101.4 101.1 White Black Hispanic 77.5 197 . 83.5 44 95.9 100 x PMMF 92.7 248 102.9 144 89.8 40 95.5 24 94.1 113.3 5 90.6 89.3 3.0 99.7 1 PFVC and PFEV for blacks were 0.89 that for whites 2 Standardized to the smoking distribution of all with valid pulmonary function tests Smokers 31.6 smokers 42.4 Nonsmokers 26.0 55 population is similar to that of whites with the exception of the nonsmoking group which is comprised of only six individuals Thus the use of the same prediction function for Hispanics as for whites would appear to be a correct procedure but the prediction correction for blacks remains in question Table 33 depicts the means of PFVC and FEV whites by smoking history and job category and PFEV Table for blacks and 34 the smoking standardized means by race and job category Too few Hispanics were available for this analysis As can be seen the deficits for those categorized as garage employees but who do no brake repair or mainten- ance work exist for both racial groups However it is particularly notable for the blacks where the means of PFVC and FEV PREV for brake garage workers are 10 lower than for blacks employed in other jobs The pulmonary function deficits in this group largely account for the lower values seen for blacks overall in Table 32 and suggest that proper normal spirometry parameters were used The origin of these deficits is not clear The group is largely com- prised of car jockeys auto polishers and new car preparation men There was considerable movement of individuals among these jobs and often a person would do all three They are employed in the same facilities as the brake workers Also included are a small group of skilled mechanics who would perform difficult mechanical or electrical repairs parts department personnel and a few men in DC 37 who were dispatchers working out of the repair area Table 35 lists the spirometric data for the three groups in commercial garages compared to those engaged in brake work those exposed to asbestos otherwise or the unexposed control group As can be seen the deficits are associ- ated with the group working as car jockeys or car preparation men and those employed in auto body shops The differences in the smoking standardized means for PFVC and TEV vehicle preparation men and mechanics PFEV between the car jockey- including those who do brake work are significant at 0.01 sided * so / 8 9 SmokingSmoking standrized means Smoking spirometricrace according according OOT 7 tests category L*ES <8 9CF6 C6 6Z1FL9 activty activty 0 asbetos x 94.7 1794106 SHOeLT 9726' Lt6 <7FO 6OF1T LeFl gof Soy Whites SURO} asbestos 96.2 1.3 cot 86 SOL 102.9 Cor SOL exposure garage work 001 Garage employment 0} paztTieujys EuTpIOD5e 11.6 94.3 . <14296 L1Et'46 8 OFS" 9.0 <7+9'S6 83.5 240" S6 S 7FL8 surTyous OO L6 Blacks YIOM 86.2 SO}GSe V8ers YIOM DSTFIZUODT quomfzdwasanodxs 9857..04 TO oYeAG yaom 90.1 ou ad T ON asese9 yng OYeIg Apog ytom sojqse o8ez3 93.9YOM petFTiuopt ainsodxazo 66.1- YrOM ytom OM ON odes JN OYLAG Apog 57 Table 34 Pulmonary function results of garage workers who do not repair brakes according to work activity and smoking history Pulmonary function parameter Current Smoker . smokers smokers Mechanical Parts Department PFVC FEV PFEV MMF / PMMF 88.8 3.4 98.8 4.3 106.1 105.3 1.4 110.7 6.5 80.7 7.5 95.2 100.1 12.1 Auto body repair work PFVC FEV PFEV MMF / PMMF 93.0 2.8 95.9 5.5 82.3 8.8 92.8 96.9 71.4 92.9 4.5 100.6 6.5 91.3 New vehicle preparation jockey polisher PFVC FEV PFEV MMF / PMMF 83.6 4.7 87.0 5.2 10.6 88.5 3.1 93.7 4.0 81.0 8.2 96.9 6.6 108.3 6.9 15.3 58 Table 35 Smoking Smoking 1 standardized standardized pulmonary function function results garage workers who do not repair brakes compared to other groups of Job category PFVC No identified asbestos exposure or garage work 102.6 Brake work 96.9 Parts department Body work Vehicle preparation car jockeys car polishers Definite asbestos and possible exposure 97.5 92.9 89.1 96.1 FEF PFEV 102.6 105.2 104.2 97.6 95.4 102.8 MMF PMMF 95.1 93.6 90.9-6.4 80.0 82.9 89.0 Standardized Standardized to the ary function test smokers 26.0 smoking distribution of all with valid pulmonSmokers 31.6 smokers 42.4 Non- 59 To the extent that occupational factors may be associated with these deficits the possibility exists that greater exposure to automobile exhaust among individuals in this group has contributed to these find- ings A greater exposure could arise if the mechanics generally worked on cars with engines off or if on with exhaust hoses attached That auto exhaust may be contributory is suggested by the data of Ayers et al 1973 who have observed significant pulmonary deficits among bridge and tunnel workers who are licavily exposed to automobile exhaust during the course of their work in the bridges and tunnels in and around New York City There deficits in forced vital capacity of % for nonsmokers and 13 for smokers compared to a normal population smoking not specified were seen Greater deficits were seen for various measures of airway flow The association of automobile exhaust with the deficits in pulmonary function among a limited group of garage workers is of course only suggestive For a definitive association to be demonstrated it is necessary that a detailed study be made of the work activities and the exposures of this group of workers in order to determinief they do have significantly more exposure to auto ex- haust than do garage mechanics Auto body repair Workers who were engaged in auto body repair had mean values for the various spirometric tests that were considerably lower than those of garage mechanics unexposed controls and even the groups exposed to asbestos otherwise Because of the few individuals in this group the differences between the auto body workers and garage mechanics only achieve sided statistical significance for FEV1 to asbestos and other dusts which could primarily PFEV 1. In affect FVC addition the auto body shop workers are exposed to solvents from paints and fillers and welding fumes The manifestations of disease seen in both the rays and the pulmonary function tests in the limited populations observed in this study Warrant further definiation Similarly an industrial hygiene survey of the materials to which auto body repairmen are ex- posed is also necessary 60 Correlations between ray abnormalities and pulmonary function tests Table 36 lists three pulmonary function results according to the ray reading of the individuals Two criteria were utilized for ray abnormality a 1/0 or greater parenchymal reading and any pleural change including the presence of diaphragmatic plaques and a 1/1 or greater parenchymal reading and pleural thickening or calcification The presence only of a diaphramatic plaque was not considered abnormal in the latter criterion The results show that in general those with abnormal rays have lower pulmonary function than those with normal rays This function means is evident for smokers and for the nonsmokers however smokers are the same The pulmonary for those with abnormal rays as for those with normal rays This is to be ex- pected ficant as minimal asbestos effects can be seen on ray before signideficits in FVC occur However even minimal asbestos effects can be exacerbated by smoking leading to the deficits seen in Table 36. The data of Table 36 are consistent with the previous discussed data suggesting a greater percentage of ray abnormalities among current and previous smokers compared to nonsmokers Also as ex- pected the pulmonary deficits in those with abnormal rays are great- er when the criteria for abnormality is more stringent Comparisons with other populations Table 37 provides a comparison between pulmonary function results measured in this study and those determined in a study of the general population of Michigan Miller et al 1980 For this comparison the mechanic garage workers are excluded because of factors that may be unique to that group The studies overlapped considerably in time and the same technical personnel were used in each The field dates for the Michigan survey were February 1978 through December 1979 and for this study May 1978 through February 1980. The purpose of the Michi- gan survey was to measure levels of polybrominated biphenyls in blood and adipose tissue and to evaluate other health indicators The group was chosen by a random selection process using Michigan phone numbers Predicted values utilized the regression equations for the data of 61 Table 36 Spirometric parameter x 100 The means reading of spirometric values according to ray and smoking history using two criteria for ray abnormality ray reading Normal / Pl.Th. Abnormal or Pqs Normal Abnormal 1/1 or Th PFVC FEV PFEV1 MMF PMMF 92.7 176 97.2 175 80.3 152 91.6 84 94.0 83 76.1 73 94.011.0 213 96.8 212 80.7 190 89.2 43 89.0 42 69.5 35 PFVC FEV PFEV1 MMF PMMF 97.2 264 105.211.1 264 92.4 216 92.4 81 98.7 81 89.4 62 98.1 299 104.11.0 299 91.6 243 90.1 43 96.1 43 91.3 34 PFVC FEV PFEV1 MMF / PMMF 98.5 173 98.3 48 108.8 172 110.2 48 101.0 127 105.3 37 ( ) = Number in category 99.8 191 108.5 190 101.9 144 99.2 24 108.6 24 107.6 17 Table 37 A comparison of spirometric results in this cohort with those observed in the general population of of Michigan* Smoking history Observation group This study excluding mechanic garage workers Michigan general population Blacks Whites Whites Smokers smokers Nonsmokers 100 x PFVC 96.5 93.7 98.2 94.3 98.6 101.1 94.7 97.3 99.2 Smokers smokers Nonsmokers 100 104.1 102.4 106.7 PFEV1 95.5 104.8 110.2 196.1 101.6 105.8 Smokers smokers Nonsmokers 100 x PMMF 90.2 90.8 98.9 76.5 95.5 106.6 80.5 88.2 97.6 * Predicted values were obtained from the data of Morris et al 63 Morris et al 1971 As can be seen the data for the whites in this study compare very favorably with Michigan white males Had the mechanic garage workers been included mean values from % to % lower would have been obtained c.f. Table 30 A variety of different research groups have produced regression equations for pulmonary function parameters on the basis of measurements on normal populations The equations of Kory et al 1961 Cherniak and Raber 1972 and Morris Koski and Johnson 1971 particularly have gained widespread acceptance for comparative purposes The populations utilized and the criteria for acceptable data are shown in Table 38 for these three studies along with five others that have also established regression equations for normal populations and this study As can be seen only two of these research groups included only nonsmokers in the study group A third included individuals who smoked for less than six months and one included individuals who were smokers of less than pack years of cigarettes In some cases averages of best efforts were utilized in others values for all parameters were taken from the flow volume curve of the best effort as determined by forced vital capacity Of most importance a considerable diversity exists in the age distributions of the study populations selected Values for FVC and FEV increase until about age 25 then remain relatively unchanged until about age 35 and thereafter declining steadily with age Be- cause of this complexity regression equations based upon a wide range of ages and utilizing only a single linear term to account for age can be significantly in error The errors are such as to produce overesti- mates of pulmonary functions for young and older groups and underesti- mates for those in the middle years see e.g. Schoenberg et al 1978 As the population in this study is largely between the ages of 40 and 70 most regression equations are likely to understate the values for these parameters Additionally lower predicted values will clearly be obtained from populations that include smokers or from studies that include averages of several expiratory efforts rather than the maximal ones The use of standards from such populations can lead to underestimates of effect from agents in the workplace that can affect pulmonary function - ~t 02 STeM-poys 38 SLTON-PeagspoyIdAs0 SULTOD Supoy aspen Aa} jeag owo.t ppepp Table sup oS LL, pds qn pay OO PON 1 for ~OGRAXY o? got UO Tat Add 3901Td 2904}d qoIarg JV0AT qIDIATG FART IID 49843V Min MOT] G G indviuals JO Auv JAOF Jo | JAOjsJa Non 2 After smokers Jo Best effort Tumzou, 20-84so 0id ASoy cigs 6mo ) ASog Ysoy 3808 After Jo soypns (4 OFN15-79 jo steyaq. < G Zz 4 S Z < Be (oug SLdeL [uTerszao 18-618-6 ponuy SAYOWUKs< dy2 SLDyOusUN $1OyYusUdN 2 Best efort flow SADYOU-HAfte>r) After ou) 20-74 1035 25-7425-74 agu BVE Non 66 5 Best 5 Get Direct Aoy eVyAaszo 21-71 oguy 78-O Non smokers 2 9L-0% 9L-S% +1L-12 Direct ayy 26-70 (206) Joqun 26-70poqysaPuy LTS OL8 rat oy cCOT oct 6VT COT AaLToy Jaqey je [ Je ye y {U0 99 Apnas ya Spas yepurog ucspuy f104 suoley Sftioy seg Spy 65 In this study valid pulmonary function tests exist for 163 nonsmokers in other than the mechanic garage group The previous discussion has indicated their pulmonary function parameters FVC FEV compare favorably with the group studied by Morris Koski and and MMF Johnson It is instructive studies of normal to utilize the regression equations from the above populations to obtain other comparative data The various regression equations utilized are shown in Table 39 and the percent ratios of observed to predicted spirometry parameters are listed in Table 43 As can be seen the values obtained for PFVC and FEV1 PFEV1 are in excess of 1.00 for all regression equations This is the result of the inclusion of smokers among comparative groups the use of averages of several efforts or the underprediction resulting from the broad age distributions utilized for the regression equa- tions High values of FEV PFEV result in part from an extrapolated origin of exp^>ration c.f. Table 39 The values for PMMF FEF50 / PFEF 50 and FEF PFEF75 are less than tions of Cherniak and Knudson This is 1.00 for the prediction equa- the result of their use of the maximum flow value obtained in any effort rather than the flow in the effort with maximum FVC It is generally found that lower flow rates are obtained during the achievement of a maximal FVC The Morris Koski and Johnson equations would appear to give the best comparison for FVC and MMF because a large proportion above age 30 only nonsmokers were studied of their population and the best effort was was utilized The very complicated equation of Schoenberg which was developed to properly take account of age is limited by the relatively few individuals over age 30 and the use of averages of efforts Regression equations for the various spirometric parameters obtained from data on the 163 white nonsmokers tested in this survey are listed in Table 41. Because only three individuals were under age 30 only the linear dependence on age could be established PHYSICAL EXAMINATION RESULTS Table 42 lists the number and percentage of abnormalities found on physical examination according to job category and organ system The only 66 Table 39 The parameters in regression equations for the prediction of spirometric functions in nine studies Study x Ht in ^ Age yrs Constant Morris et al Miller et al Cherniak & Raber Knudson et al Ferris et al Kory et al Bass Higgens & Keller FVC 0.148 0.147 0.12102 0.1651 0.11684 0.13208 0.159 0.15748 -0.025 -0.026 -0.01357 -0.029 -0.027 -0.022 -0.023 -0.024 -4.241 -4.053 -3.18373 -5.459 -2.79 -3.60 -5.72 -5.38 Morris et al Miller et al Cherniak & Raber Knudson & Keller Ferris et al Kory et al Higgens & Keller FEV1 0.092 0.094 0.09107 0.13208 0.07366 0.09398 0.11684 -0.032 -0.032 --0.0232 -0.027 -0.028 -0.028 -0.028 -1.260 -1.426 -1.50723 -4.203 -0.70 -1.59 -3.18 Morris et al Miller et al Cherniak & Raber Knudson et al Higgens& Keller Cherniak & Raber Knudson et al Higgens & Keller Michigan Cherniak & Raber Knudson et al Michigan 0.047 0.044 0.05948 0.1143 0.05588 FEF50 0.06526 0.069 0.069 0.0635 0.10255 FEF75 0.0903 0.044 0.0497 -0.045 -0.046 -0.037 -0.031 -0.044 +2.513 +2.806 +2.61187 -1.864 +1.89 -0.03049 -0.015 -0.037 -0.0252 +2.40337 -5.4 +1.577 -1.1121 -0.01987 -0.012 -0.02895 +2.72554 -4.143 0.03562 67 The ten ad the means the means to predicted to predicted equations equations studies 0S d d /~ Study . t O ? FEV1 F = ( Moris 101.7 10.0 10.0 MMF x100 PMMF % F = 107.3 -2.6 Cherniaketal 108.9 OF 1.1 9 Z 104.8 104.8 76.3 Knudson al 1.2 = 109.7 109.7 85.0 / 108.9 1.3 090T 790T 0? al 122.7 128.3 128.3 Feris etJo t Kel r 1.3 ZT 111.5 111.5 1.2 1.2 ; x = = 3 # SchoenbrgHigens 131.511.3 111.2 106.4 - # = e Michigan 11.3 1.3 T'TIT 0T 11.2 1.3 1.3 STIT Tit etJO | MichganSOTIST T T T T T Z T < T f t o T C T C L x | = = = Fe =e ze sul (OTX) OAd/OA 2TOT ZOT <SOT 680T L2eT 7S8OT C6T Set ELIT ' qaqey AoToN Te "Te y *T@ Te Te Jo Ao 38 49 Jo +Te yo y APNAS STIAON ATIK AepusD uoSsPNUy STisog fsr0y seg suolsty Barquoys UCSTYITR | 68 Table 41 Prediction equations determined for various spirometric parameters from 163 nonsmoking whites in this study Parameters FVC FEV . MMF FEF 50 FEF Regression equation 0.0136 x Ht - 0.0267 x Age 0.0858 x Ht - 0.0270 x Age 0.0159 x Ht - 0.0289 x Age - 0.0033 x Ht - 0.0259 x Age 0.0060 x Ht - 0.0196 x Age 3.29 0.792 4.017 6.124 2.093 2.093 2 R 0.43 0.43 0.09 0.04 0.12 1 No mechanical garage workers are included However there were no other exclusions based on health information.or job 69 Cyanosi examined system (7) (7T) (9%) exposure exposure exposure ( <) work work ( <t) (3) work extremites extremites extremites T ET 8.7 ( ) 9 T 9.6 12 p'T < 8 6.0 3 3.2 io (4Z) (CT) (Z <) (S%) 8.4 ( (0) (OL) 8.1 9 (LE) 8.6 8.6 punos kio0sei. Joints Joints 0 9 Z22 983 O0T 11.5 ( ) < 2 18.4 23 6 6 10.0 10.0 gol S^'tiT[ewxzouq *STENPAU Thyroid 09 (ZT) (7) (6) ( <Z) 0.0 ( (Z) (0) 2.4 2 (OT) 0.0 4.9 Thyroid 0.0 cy Lymphatics Z < 8 "ST 11.2 ( ) o 0 0.0 0 < 6 2.3 2.3 jo TIT" SUTpaoje aT * UO 18.7 qed. WoT Cardic Dry Aequnupue rales ( <) (6) ( <T) 2.9 ( (0) (ZT) 4.8 6 (81) 5.8 5.8 suop 12.4 L 8 2 7 8 S*T 17.3 ( ) @ tT 9.3 10 < 2 9.9 9.9 Jou IeUTMxs Gastrointestinal,, Sev osejuAd 8.3 TeosAyd abnormality 52.0 SUL Jo ) indviduals azoquny of Aytqewroug A1q OB = Number Number abnormality . ~Teurwmopaqy ue3io squypor UTHS sokq yanox PTosyL 4saU9 TPreD fay ( ) 70 circumstance in which a statistically significant greater percentage of abnormalities is found is for abnormal lymph glands among the population serving as an unexposed control With the number of subcategories established in Table 42 such a finding would be expected on the basis of chance alone We attribute no significance to it Table 43 shows the number and percentage of individuals with rales or finger clubbing according to their ray reading A greater percentage of individuals with abnormal rays have dry rales than do individuals with normal rays The numbers however are so small that the data do not achieve significance There was no correlation of finger club- bing with ray findings Overall rales were observed in 4.8 of the entire study group and clubbing in 2.6 compared to 25.2 with abnormal rays or 13.1 if more stringent ray reading criteria were utilized c.f. Table 11 Thus in contrast to earlier data from Great Britain British Occupational Hygiene Committee 1968 it would appear that the presence of ray abnormalities is a considerably more sensitive parameter than rales or restrictive pulmonary the categorization of asbestos disease This function has also deficits for been seen in several other asbestos groups including shipyard workers to be published and chemical or oil refinery maintenance employees Lilis et al 1980 Data for the blood pressures are shown in Table 44 according to age job category and race blood pressures of the As can be seen the systolic and diastolic blacks are significantly above those of the whites Systolic pressures increase from 5 to 7 percent per decade and diastolic from 2 to 3 percent each decade with the rates of increase being greater for blacks than whites The analyses of the age stand- ardized blood pressures according to smoking history or job category are shown in Table 45. White cigarette smokers appear to have somewhat lower blood pressures but this could be artifactual as it is not reflected in blacks No significant differences are seen in the analy- sis of blood pressures according to work activity 71 Table 43 The number and percentagoef individuals with rales and finger clubbing according to ray reading Rales present Clubbing present Both rales and clubbing present ray reading Normal 30 4.3 Abnormal 17 6.9 16 2.6 6 2.7 3 0.5 1 0.5 * The cases with both rales and clubbing are included in the separate categories as well 72 (1) (6) (10) White White Black (19) (12) (3) 29 #12.0 2.6 5.1 6.1 3.9 +++ + 29 120.0 123.2 126.6 126.6 126.6 - 67 128.0 presure presure presure 1.8 + + 131.8 32..05 (( 23 123.2 presu 142.9 -1.6 142.9 4.0 4.0 (2) 152.2 standrized 16.5 blod 3.0 3.3 2.7 4.0 6.8 1.6 + 135.4 135.4 -0.6 0.6 + 2.6 1.1 diastolic Systolic Diastolic 4&4 standrized standrized -5 137.0 134.0 142.7 15 .4 \O 6 et 143.2 Table race 81.3 +1 +t + +1 In presure pressure pressure pressure 7 leony cn (13) 81.3 - 85.3 -2.0 and 1.0 al: by 81.3 83.1 83.1 23 23 23 3.8 85.6 85.6 -0.6 283 + 85.8 85.8 -0.8 170 90.4 1.0 1.7 41 89.1 93.3 + 2.2 28 81.3 sytolic 69 89.3 N 93.5 -5.0 12 84.6 123.4 89.3 - 13 The 126 3 1 0.4 ized ON 29 49 OD a standr - - Age of 4g Age 20 SO t / oN N 39 49 - = - 20 30 49 ized rada 69 a - 60 70+ Age 73 Table 45 5 Age standardized systolic and diastolic blood pressures according to race smoking history and job category Race Smoking history White Black Smokers smokers Nonsmokers Smokers smokers Nonsmokers 131.5 - 1.3 137.3 - 1.0 135.6 - 1.4 140.8 - 3.3 143.4 - 2.2 141.7 - 3.8 Diastolic 82.9 - 0.8 88.5 - 2.1 85.3 - 0.6 90.0 - 1.6 84.8 - 0.7 86.3 - 2.3 Job category White Black No identified exposure Garage work but no brakes 140.1 - 2.5 136.1 - 2.7 150.4 - 5.3 139.4 - 4.0 Brake work 134.5 - 1.0 140.5 - 2.7 Asbestos exposure oo No identified exposure Garage work but no brakes 135.5 1.4 . 149.6 - 5.2 Diastolic 85.1 - 1.2 89.9 - 3.6 85.5 - 87.8 - Brake work 84.4 - 0.6 87.0 - Asbestos exposure 84.4 - 0.6 94.9 - 2.4 ay 74 LABORATORY FINDINGS The data on the blood analyses CBC and SMA are shown in Tables 46 and 47. No unusual findings are present for any parameter The means of the various parameters according to job category are listed in Table 48 and do not show anything remarkable Tables 49 and 50 show the results of the analysis of sputum specimens for abnormal cytology and the blood analysis for carcinogenic embryonic antigen CEA They show no findings suggestive of neoplasia most values are within the normal range Further there is no difference in the distribution of either parameter for the different job categories MRC RESPIRATORY SYMPTOMS The principal results of the respiratory symptoms questionnaire are shown in Tables 51 52 and 53. Tables 51 and 52 show the expected correlation with cigarette smoking In Table 53 the smoking stand- ardized percentages of chronic bronchitis and shortness of breath categories are listed for different job categories NICKEL CONCENTRATIONS IN WELDERS As part of a study to assess effects on welders plasma nickel concen- trations were measured in twelve welders in the control group engaged in amphibious vehicle construction The results are shown in Table 54 and indicate that the particular group within this study had higher nickel concentrations than a group of 62 welders in a large shipyard and ten times the concentration of hospital controls no physio- logical effects can be associated with such concentrations the toxic and potentially carcinogenic effects of nickel would suggest identifi- cation of the exposure source and implementation of abatement measures 75 Table 46 The distribution of blood count values CBC Analysis Range See headings . for concentration unit Individuals within range Number Percentage White blood cell count thousands 3.9-11.3 < 3.00 3.00 - 4.99 5.00 -6.99 -6.99 7.00-8.99 7.00-8.99 7.00-8.99 9.00 -10.99 11.00 1 70 342 308 124 39 0.1 7.9 38.7 34.9 14.0 3.1 Red blood cell count millions < 4.25 4.25 -4.74 -4.74 4.755.24 4.755.24 4.755.24 5.25 -5.74 -5.74 | 5.75 - 6.24 > 6.25 5 130 462 228 34 12 4.3-6.3 2.0 14.7 52.3 25.8 3.8 1.4 13.0 13.0 - 13.9 14.0 - 14.9 15.0 - 15.9 16.0 - 16.9 17.0 - 17.9 > 18.0 Hemoglobin gm 12 54 237 335 186 54 6 12.9-18.2 1.4 6.1 26.8 37.9 21.0 6.1 0.7 37.5 37.5 -39.9 40.0 -42.4 42.5-44.9 42.5-44.9 45.0 -47.4 47.5-49.9 47.5-49.9 50.0 -52.4 52.5 Hematocrit percent 4 13 92 245 308 154 53 15 38.9-54.9 0.5 1.4 10.4 27.7 34.8 17.4 6.0 1.7 [ ] = Laboratory normal range 76 Table 47 The distribution of concentrations of various blood components SMA Analysis Range See headings for concentration unit Within range Number Percentage Glucose mg 65-125 < 80 80 - 99 100 - 119 120 - 139 140 - 159 > 160 46 415 294 61 25 47 5.0 46.8 33.2 6.9 2.8 3.5 nitrogen ng 8-25 < 10 10 - 14 15 - 19 20 - 24 > 25 44 250 420 150 22 5.0 28.2 47.4 16.9 2.5 Creatinine dl 0.7-1.5 < 0.80 0.80 - 0.99 1.00 - 1.19 1.20 - 1.39 1.401.59 1.401.59 1.401.59 > 1.60 5 113 339 315 89 22 0.6 12.8 38.4 35.6 10.0 2.5 Sodium meq 135-145 < 138 138 - 139 140 - 141 142 - 143 144 ---- 145 146 ~ 147 > 148 14 102 234 237 125 76 98 1.6 11.5 26.4 26.7 14.1 8.6 11.1 Potassium meq 3.5-5.0 < 3.00 -3.50 4.00 4.50 -4.99 3.00 3.49 3.99 4.49 -4.99 5".00 5 38 222 . 451 209 56 0.6 4.3 25.2 39.8 23.7 6.2 Table 47 continued continued Range See headings for concentration unit Within range Number Percentage Chloride meq 95-107 < 100 100.0 - 102.4 102.5 -- 104.9 105.0 - 107.4 107.5 - 109.9 > 110.0 50 215 212 229 88 92 5.6 24.3 23.9 25.8 9.9 10.4 Carbon dioxide meg 24-32 < 25.0 25.0 = 27.4 27.5 - 29.9 30.0 - 32.4 32.5 39 238 310 244 55 4.4 26.9 35.0 27.5 6.2 Uric acid mg 3.5-9.0 < 4.0 4.0 5.9 6.0 8.0 - 7.9 9.9 > 10.0 24 376 392 88 6 2.7 42.4 44.2 9.9 0.8 Calcium mg 8.5-10.5 < 9.0 9.0 - 9.9 10.0 10.9 > 11.0 16 510 340 17 1.8 57.8 38.5 1.9 Inorganic phosphate mg 2.0-4.5 < 2.00 2.50 3.00 3.50 -3.99 > 2.00 2.49 2.99 3.49 -3.99 4.00 16 134 331 280 92 33 1.8 15.1 37.4 31.6 10.4 3.8 Total protein dl 6.0-8.5 < 6.50 7.00 7.50 8.00 - > 6.50 6.90 7.49 7.99 8.49 8.50 26 197 401 197 55 7 2.9 22.3 45.4 22.3 6.2 0.8 78 Table 47 continued Range See headings for concentration unit Within range Number Percentage Albumin dl 3.0-5.5 3.50 - 3.99 4.00 - 4.49 4.50 -4.99 -4.99 5.00 ~ 5.49 18 439 398 29 2.0 49.7 45.0 3.3 Cholesterol mg 140-330 < 150 150 ~- 174 175 - 199 200 - 249 250 - 299 300 13 . 66 162 443 178 24 1.5 7.4 18.3 50.0 20.1 2.7 Creatine phosphokinase L 0-225 < 50 50 - 74 75 - 99 100 - 149 150 - 199 200 - 249 250 - 299 300 52 162 196 258 104 49 22 43 5.9 18.3 22.1 29.0 11.7 5.6 2.5 4.9 79 and exposure Definte posibleasbetos roo wt wT Aamaan N ADONAMNOANDANDOODOWOAROON a OOrN7DTDOMNDOCC OG COVQ ON CO OC N 0 0C 0T YC T +1 Fl th 4) th ae Fl Ft th et ot ti tb tl ti eh tt af +i tt +l tt ti mam Table 48 DHOOM NH DOH os Table Table On RE AWN aaa) NEYO 2 ' 8 mMOMMOOMOCANTOMM RSONO OW T.ADa OA AN eH ed wT red rd wz oc Ct MH NTN OS et rd _ mt ot rH 4 of ory conetrais 9& cate job and to 4Tab8le parmetrsacording count compnets blod of blod values varLous mean the an wn rt N ~ NAN rt DODH OTD N HF A Tr CON TO O WAROA NMm N WYO Sn a Oo0c0en DMVMVOC C 9 O0 D 0V HF G CHD OO C D +E 4d af tt Fh te Ft Fb tt se ef +) tho at tt gt th +t th tt ot +1 identifed exposure work work work own w coal oy ST UA fan) TH ASDT Hr OO M TDANA T NH N TOIAH SS 0.20 co 7.14 retest 7.14 ed - 0.19 Tt 0.19 ri - 7.40 7.40 7.40 - 0.09 0.09 0.09 rt +cyment no work empl but brake arage 6.20 2.2 111.0 wy 4.4 a a 104.9 104.9 oy HO 104 4.4 10. 4.9 D9 N 1.8 0.4 ee 16.2 ne 16.2 0.2 0.01 0.01 Ft el Fi 1.18 1.18 Fh Fh - 0.01 0.01 ad tt ad 1.15 1.15 el +h - 0.01 0.01 0.3 0.2 ONE 0.2 8 ' ' 0.2 LS ed ow 28.5 28.5 28.5 28.5 ct 6.42 ed 105.2 tT 105.1 HA aN UT Om DD 105.1 105.1 0.3 eS - 0.3 oS wT 0.14 oH - tout UD OT -0.2 0.1 0.01 .1 mM 6.43 fy ed Od os 07 6.43 0.17 rt 0.59 or work No exposure garge 0.02 4.41 + 0.05 AT 7.29 toa) 4.41 0.03 4.47 222.7 Om 1.9 NYO +t oth Hl ab th tl as tt th -3.6 tf ti te 222.2 222.2 222.2 +l ti tt 1.9 1.9 moO 22.3 aoa 21.0 oo 22. HR DOI 22.3 3 0.6 WMI 177.7 177 177.9 . 177.9 2 9 .0 etwt 177.7 ~t 3.6 177.9 2.02.0 et 177.7 rt - 177.9 2.0 a st u a ad oh x Qo. u a a) od is ces 3 UU wt a TU UV Qh Let 6 we for won mG WO Oa Gt of OD GO DQ Dery ado beet ow he bk OO eT be fsUa A OO I a wu a baad oO c aa a C3 C.. any ro) Xe aa) net o ou coal ad OQ fe a be ond fo DS oY Gee ag et et OF st wt Se GL Vv be at TE ort et ns oF Fe Ga et GO toe oe OF Ma ea bt ed ON aT Om & a Ol nen ow a} 2 i) & By] io) fe a + en onl fa) re) wy Ww cc as DO od 2 G6L-S (00) 0 (00) t (Z0) 0(090) i (10) 6 distrbution distributiondistrbution = sputum cytology cytology results results and CEA concentrations conetraions suoTtzeq /usourn)Va) 6 6-S = Sputum g cytology 1 (@" <) g (1' <) 8c Ce") = 4 5-9.9 98) ( < (0 Category 1 2 26) CTT 3 6Ly acal e838 pue Garage cxposure cxposure ) 23.3 0.0 ( 9 10 51.2 < af 9 2.7 (tewrou 8 with A8ojzo poxzrsto) brakes ) 14.6 3.6 ( 4.2 but 43.6 14.6 03 38.2 ( era ff AD 34.0 1.5 withrepair umands z 19.5 1.5 ( ) ZZ TZ 9 ce tS) C7 3.2 erdAqe exposure 37.2 1.2 ou (9 (9 I Lt 6E) HZ 4) 06 (0S) ee sO) 79OT (024) sTao exposure ersTdAp( AaTqTs to ogy ZO OT4sepdjou 3nd YPIA 20 etdAge atypia oansdxy ASOTJAD YION PUL erdize soequaid , ajezopy atypia considerdconsiderd considerd normal = TewIoN aepnsyprty ) atypia soieds dysplasia oN efeary ou oeryoyeig STEROL ( ) Tf+z ce te 81 6 61-ST 0 (0 0) if ( < 0) 0 (00) t(1 90) distribution distributionPUR sputum sputum cytology cytology results results = distrbuionVHD 66-S Sputum Sputum cytology cytology 9 (4%) SUOT]EAQBIDCategory G> 2 (8) 36S gt 4 AZO83}eDpue 36.7 39.5 ) 22.6 22.6 ( 1.1 sqpnsez smokers ASoT,ADSuTouUs AscTo 9TGeL ) 24.8 2.8 44.7 0} 34.8 24.8 ( AD 1.4 unydsSuTpAose wngnds Z OL ) 64716.4 12%1.4 Jo =~ = percntags ) 19.7 1.8 41.0 37.3 19.7 ( cytology dysplasi oe Zuryoug cep felitsy SINOU-XY STGYOUN CEA conetraions = s^'(ee) (< < 96) 93.2 93.2 0.8 97.8 97.8 0.3 Sat 97.3 0.0 ou C0" 96.3 96.3 0.4 0.4etsdkp3o AZOTYADorqseptdqow zo vtdAqze sa cquo isd Tewroy azeqtnBoy etdAqe pry aqerop y = ST2zOL { ) +t +7 -oy 82 Table 51 The number and percentage shortness of breath MRC of individuals with reported according to smoking category MRC shortness of breath category Smoking category Smokers Exsmokers Nonsmokers None Walking fast or up a slight hill Walking with of own age others Walking at own pace Total 199 72.6 51 18.6 10 3.6 14 5.1 274 274 76.3 55 15.3 19 5.3 11 3. 359 181 82.6 28 12.8 6 2.7 4 1.8 219 ( ) = percentage 83 Table 52 The number and percentage of individuals reporting symptoms of chronic bronchitis MRC according to smoking category Chronic bronchitis Yes No Totals Smokers Smoking category smokers smokers 80 29.1 34 9.5 21 9.5 195 70.9 325 90.5 199 90.5 2.75 359 220 84 symptos symptosnumber smoking standraized standraized percentage individuals reporting Category Category OF Sz/ Smokers Smokers C72) smokers smokers OS/S Non smokers smokers ASyous o0N Jo workwork workeg Garage work exposure SlayousxXq ( 7/36 19.4 67/7 (6S) 2/402/40 g3/ot (HT) 7.4 2/27 posible 9/0Z25/69 9C/L (7 6T) 10/8 10/88 10/88 69/82 (oa6) 5/50 5/50 Jo body pues work 10 oTqPsod agequored percntagepercntage ULOM ainsodxa nq YATA pue vansodx uaton sul, Azogazeg OVA y10n yzloa ayedagz sayerq poq poTyrIup sojcqse sojzqse gor ox a8vaeg ou edvavyayeag = ogny ) 85 Table 54 amphibiousamphibious Nickel concentrations in the plasma of | vehicle construction welders compared to other groups Group Vehicle welders Shipyard welders Hospital controls No. of individuals 12 62 15 Plasma nickel concentrations liter man BLES Median _ Range Mean - SD 11.8 5.4 - 14.3 10.8 - 3.2 2.5 0.5 ~ 15.3 3.1 - 3.3 0.7 0.5 - 2.6 1.0 - 0.7 86 ASBESTOS EXPOSURE DATA REVIEW OF PUBLISHED RESULTS Review of fiber concentration data for brake work A variety of measurements have been made of asbestos air concentrations during brake lining repair and maintenance activities in the United States and Great Britain These include both term sampling over a working day to obtain information on weighted average exposures to workers and short sampling to document the concentrations during various work practices The largest set of samples of brake maintenance work is that obtained by NIOSH during the years 1975 through 1976 where 283 samples were taken in five brake repair facilities including 152 over a one week period in one facility documenting both term weighted average TWA exposures and asbestos concentrations in specific brake repair activities NIOSH 1972-1976 Unfortunately no documentation exists as to the number of brake jobs performed in a facility or by workmen during sampling periods or on the work practices utilized during the repair and maintenance work Table 55 summarizes the data on weighted lining material exposures over a sampling period for men changing punching out rivets riveting linings to shoes and working in the parts department Table 56 lists general area samples taken during the course of a day These data demonstrate that in general the term asbestos exposures of garage employees are below 0.5 ml However during the air blowing of drums punching out of rivets and riveting asbestos concentrations can be considerably higher Further area samples taken distant from the location of brake repair show widespread dissemination of airborne asbestos with concentrations up to 1.3 ml found to be present More limited data 800 available tain tain Mickish Mickish Mickish and Kniglu Kniglu Kniglu 1970 2 1970 from industry sources In Great Bri- of Ford the Ford Motor Motor Motor Motor Company Company have providprovid- provid- ed information on both long and short sampling during different 87 ucvoyK - repair personal maintenace maintenace brake 9e % TE't OT*O ZO potaze d S9qse 16 oSxUePALUgT NIOM 19761976 Jo 1976 1976 SpTeraoqy cg OLETZUWZurpaxe 8TdeL 1975 4 Supury 1 LTO-T"O ZT" 700O 0.04 pue yeuoszd afedsrz S]os Supsmyg Jo wa9j7-Juo oY sotdues ZeqUN yo go Te T T c yO seTduvs 9T TZ < Ports Man zoquny H (945T) (946t) (S461) 1.21 5 ' 9 0.03-0.16 0.03-0.16 SRGAET SELTA03VN LO9-TL RRS ZoL-<6O ULNA Pyaeg T2 T 9TC-c0O CuiYd Z G (2320p SUTYoUrg duroedy poystTqndua id iA tT S T "OL6T-S) 7T TT T et @ HSOIN (2461) toig y Vv Vv q a 88 UPON samples pofaoc Sojsde (Tu/sreqTz) SUTLT srvaseSuptdwes A ( 30 B) 95 (C ) sury ?T9PL ( vores F 1 ( ) ) NIOSH NIOSH . Jo zoquny satdies w8ra9 and maintenace maintenance work lining B O vE"T-<0" 0.1-0.7 0.04 cGO 1006 6C-9C o6n 3 eo C3 "a 8T 9 T T [ z 3 oO 1 uy orf re pe bo} ion cs bao} . i 6T-ZL6T) Of 66 % T T HSOLK (9161) (916) (9464) (S460) (946%) (2461) V 9 a 4 <kozy 89 20 cirumstance Aproximate Aproximate samples Asbestos Asbetos fibers conetraions conetraions cirumstance oyeaq interval u TT samples AonzA Range Range yonr sopTAzos ml Meanskeq < QOULBITEW side StaicSHAQ 3Enp car cloud Wnap BUPAND JO Personal Personal SuoTIeAUsOLS SUTMOTA engaed cleanig aTqrL ATe Personal AeqyTy SUTAOUT zaquny soTdurs sojaqse sdTAIOS Time StaicStatic Time w1rsj-3uo0y From: car cS @ 89 9 60 2 samples 480 cT-Se brake T "0 60 L , ^' 4 ) T weighted average above samples and SaTcues , 42> SAD O. and SyeAGg aTdurs Knight Knight Knight OcupAn oT3e5 OA.a oF3e5 Aavqo propo uu Knight brake 80O ES' T SL O T@-LT ET 0.68 vehicles g00 0~-10O serviced sotTduvs truck service om} T y oaoge Jo service a8rdae cleaning OO < 1.83 fg nearby o[cus poqustom 1970 fYSTOH 17-21 Hyg O73vas 1970 tmory 90 brake repair activities These are shown in Table 57 The work prac- tices sampled by Hickish and Knight appeared typical of those of past years with the drum dust being removed by air blowing During the full course of brake service air concentrations of from 0.4 to 3.6 il were found More recent information has been supplied by Raybestos Marsh 1979 These show that during the course of well controlled brake repair work with of 0.02 to 0.3 ml may exhaust ventilation utilized occur during the course of a asbestos exposures brake job Short asbestos concentrations during specific work activities have been measured by several These are shown in Table groups 58 in both automotive and truck servicing They demonstrate that short asbestos concentrations during brake maintenance work can be high However because they comprise only a portion of the work involved in brake maintenance the TWA concentrations are generally much lower Clearly reduction of these peak exposures by engineering controls or by work practices can significantly reduce TWA exposures Two sets of data on the time course of asbestos concentrations exist The measurements short dust of total dust by Lee indicate that after air blowing concentrations are high but fall within minutes to lower values The data on fiber counts by Rohl indicate that measur- able concentrations of asbestos persists in the workplace for as long as 15 minutes after air blowing as far as 75 feet away These data coupled with the previous information on asbestos concentrations in general garage areas indicate that a general level background contamination of asbestos can exist throughout a garage where brake repair is conducted MEASUREMENTS IN NEW YORK CITY FACILITIES FACILITIES FACILITIES 1979 During 1979 NIOSH made measurement at three New York City facilities employing workers who attended examinations in this survey These were the repair shops of the Departments of Sanitation Transporation and Police The results are shown in Table 59. They are similar to those 91 Activ y Short Activity Activty =. aTFGoWIne blowing blowing blowing sepdwes SuyanpBrushing drums drums of 8S (Tuw/J) lings lings Fo SuofIesj9TIRL oxeid por exhaustexhaust JsoyOqsy pyounsdy Bevling Apnjg Axeuns Rivetng and 1972-76 1972-76 1979 Marsh Rohl et al 1976 616 Rohl 1976 [YOY et al TYyoY ysary yo Sutsnag SUTMOTWoly woly Aaty Jsnp Ssuniap Asnd im wt oO Q ew oo 4 mm elo l NOMS i?) {1 Go or "ANNO 0.02-0.4 cD oN ~N i ~ OD N on} oN ! Gy ms 9L6T 9/6T GL6T QL6T 23.7-2.0 TeEL6T TB 5 37.3 38 32 2 38 1.9-2.0 [yOu use TYyoOY [YoY TYOY 3 2.4-3.6 RZenvwuxXa feferSc GUY Lay Pood azcod PoAag 92 Table 59 Long and short and maintenance work in sampling New York of brake lining repair City garage facilities Activity Sampling time fiber concentration ml Sample TWA Brake change After finishing Wet brushing of Area sample Area sample job dust Department of Sanitation 136 190 10 395 390 0.33 0.12 0.54 0.06 0.05 0.21 0.21 Department of Transporation Brake mechanic 1 ' Brake mechanic 2 Brake mechanic 3 Wet brushing of dust mechanics 1,2,3 150 196 175 194 135 3 3 9 0.15 0.30 0.31 0.26 0.24 2.62 2.22 0.87 0.23 0.23 0.02.288 Brake mechanic 1 Brake mechanic 2 Brake mechanic 3 Dry brushing of dust Police Department 129 68 124 177 47 12 21 0.20 0.21 0.34 0.08 0.03 0.81 0.61 0.20 0.20 0.19 discussed previously TWA about 0.20 ml During exposures during a either wet or dry concentrations could exceed 2 ml full brake job averaged brushing of brake dust ESTIMATES OF STUDY POPULATION EXPOSURE TWA exposures during tween 0.2 to 0.7 ml automobile brake maintenance ranged if brushing or air blowing of brake generally be- dust occurred Prior to 1950 riveted brake linings were used and somewhat higher concentrations may have occurred Table 60 lists the distribution of brake about jobs per week one every two done days by U.A.W. for those Local 259 members who do brake work The average is If the exposure during the 1-2 hours required for a job is 1 ml an approxinate TWA exposure exposure limit of would from the be 1 other ml jobs 1.5 or about 0.1 ml would add slightly to this General garage but the upper average exposure for the commercial garage mechanics examined in this study mechanics employed by would be 0.2 ml For the S.E.1.U. the City higher average exposures Local would 246 have occurred from the riveting drilling and grinding that was done on large truck brake assemblies However these high exposure work acti- vities would only require a few minutes of work As with commercial garage workers few City employees worked on a brake job as often as daily Thus even with the intermittently higher exposures experienced members by S.E.I.U. the average exposure for the group over time is unlikely to exceed 0.5 ml The clinical examination of garage employees engaged in maintenance of vehicles indicate the following results the repair and 1 A greater prevalence of ray abnormalities is found among garage Mechanics who repaired brakes than among blue collar controls 01 garage workers who do not engage in brake or auto body work The age standardized greater 0.05 percentage of in those with abnormalitics is 30 or more years significantly of employment 74 JO ytoneyrq Worzy a8evquorag Wow 9T Ty 9T i Le OOT Jo Sdous FO EcoVW~ISO AoqunN 09 EC be tL 9 2 9% ZLT AduenbxZSTQPL [TLo0g wom: mechanics Jo mM Teuosapd sqof personel Sjaed VY A UE ayevaq dIOW Yjuow/T WIOA (90 woyngspaq 172 Teuoszd quol/~ ouypsuo) Jo XO yo a/ ueyQ |DYvAG azquny oDUOp Avp/T 9-T T ssoy ou STPIOY, Bae wre ROM Tee ame te ee er ee ee ee compared to workers with lesser service in commercial garage workers exposed on The increased prevalence average to less than 0.2 ml was not statistically significant while a significant excess is seen in workers who had occasion to grind and machine brake linings prior to installation of ray abnormalities is in on larger vehicles The prevalence accord with estimates of asbestos exposure in the different circumstances The prevalence of ray abnormalities among workers in auto body shops was particularly high and although the number of such individuals was limited also achieved a level of significance at 0.05 The higher percentage of abnormalities in this group can be attributed to the past sanding of auto body fillers containing asbestos Individuals who had previous employment in shipyards averaging five years in duration also had a greater percentage of abnormal rays The percentage age standardized percentage was significantly greater in those whose shipyard employment began 30 or more years previously The pulmonary function results of brake work are no different from garage mechanics engaged in garage workers and other general population controls less sensitive measures of As the asbestos major spirometric tests are exposure than rays this finding is in accord with the low exposures of the groups under study 5 Cac jockeys new vehicle preparation men and auto body shop work- crs have significantly TEV ' and MF compared lation controls reduced pulmonary function to other garage workers and tests FVC , general popu- The auto body shop employees had exposure to asbestos and a var- iety of solvents The causal exposure among the car vehicle Preparation men is uncertain The role of automobile exhaust should be investigated 96 Pulmonary function deficits correlated with ray abnormalities Greater percentages of ray abnormalities and pulmonary function deficits were seen among current and former smokers than among smokers No unusual physical examination of laboratory findings were identified As in other studies a high prevalence of hypertension was observed among blacks which was not correlated with any job category A small group of welders in amphibious vehicle construction showed significantly elevated plasma concentrations of nickel 97 REFERENCES Anderson H.A. Lilis I.J. Household 311-323 1976 R. Daum S.M. Fischbein A.S. and Selikoff asbestos neoplastic risk Ann N.Y. Acad Sci Ayres S.M. Evans R. Licht D. Griesbach J. Reimold F. Ferrand E. and Criscitiello A. Health effects of expsoure to high concentrations of automotive emissions Arch Envir Health 168-178 1973 Bass H. The flow volume loop normal standards and abnormalities in chronic obstructive pulmonary disease Chest 171-176 1973 British Occupational Hygiene Society Hygiene asbestos dust Ann Occup Hyg 47-69 standard for chrysotile Bureau of 1909-1978 ton D.C. Labor Statistics Employment and BLS Bulletin 1312-11 Government 1979 earnings United States Printing Office Washing- Cherniak R.M. and Raber tion using an automated 38-46 1972 M.F. wedge Normal standards for ventilatory spirometer Am Rev. Respir funcDis Ferris B.D. Anderson D.O. and Zickmantel screening tests of pulmonary function Amer 1965 R. Prediction values for Rev. Resp Dis 252-261 Glover J.R. Bevan Lowe C. McDermott dust in North Wales C. Cotes J. Elwood P. Hodges N. Kell R. M. and Oldham P. Effects of exposure to slate Brit J. Indus Med 152-162 1980 Greenberg M. and Davies T.A. Brit J. Indus Med 91-104 1974 Mesothelioma Register 1967-1968 Hammond cigarette 1979 E.C. Selikoff I.J. and smoking and death rates Seidman Ann N.Y. H. Asbestos exposure Acad Sci 473-490 Hickish D.E. and Knight K.L. Exposure to maintenance Ann Occup Hyg 17-21 1970 asbestos during brake Higgins M.W. and Keller J.B. Seven measures of ventilatory lung function Population values and a comparison of their ability to discriminate between persons with and without chronic respiratory symptoms and disease Tecumset Michigan Am Rev. Respir Dis 258-272 1973 Knight M.L. and Hickish D.E. Investigations into alternative forms of control for dust generated during the cleaning of brake assemblies and drums Ann Occ Hyg 37-39 1970 98 Knudson R.J. mal expiratory effects of age Slatin R.C. Lebowitz M.D. and Burrows B. The maxi- volume curve Normal standards variability and Am Rev. Respir Dis 587-600 1976 Kory R.C. Callahan R. Boren Administration Cooperative Clinical Spiromety in Normal Man H.G. and Snyer J.D. The Veterans Study of Pulmonary Function I. Am J. Med 243-258 1961 Lee G.L. Removing dust from brake assemblies during servicing - alternative cleaning methods Ann Occ Hyg 33-36 1970 Lilis R. Daum S. Anderson H. Andrews G. and Selikoff I.J. Asbestosis among maintenance workers in the chemical industry and in oil refinery workers In J.C. Wagner and W. Davis eds Biological Effects of Mineral Fibres IARC Scientific Pub No. 30 Lyon pp 795-810 1980 Lorimer W.V. Rohl A.N. Miller A. I.J. Asbestos exposure of brake repair Mt. Sinai J. Med 207-218 1976 Nicholson workers in W.J. and Selikoff the United States Marsh J. Unpublished Personal Communication data 1979 of Manhattan Corporation Miller A. Thornton J.C. Smith H. and Morris J.F. Spirometric abnormality in a normal male reference population further analysis of the 1971 Oregon study Am J. Indus Med 55-68 1980 Morris healthy J.R. Koski A. and nonsmoking adults Johnson L.D. Spirometric standards for Am Rev. Respr Dis 57-67 1971 National Institute for Occupational Safety Personal Communication Ralph Zumwalde and Health 1972-1976 National Institute for Occupational Safety and Health Industrial Hygiene Survey Report Police Brake Servicing May 12 1979 of the New York City Sanitation Traffic and Facilities Queens New York Cincinnati Ohio Nicholson W.J. Perkel G. and to asbestos population at risk Am J. Ind Med 259-311 1982 Selikoff I.J. Occupational exposure and projected mortality - 1980-2030 Rohl A.N. Langer sure during brake 110-128 1976 A.M. Wolff M.S. and lining maintenance Weisman 11 and repair Asbestos Envir expoRes Rossiter C.E. and Harries Study survey of the sample Indus Med 281-291 1979 P.G. U.K. Naval Dockyards Asbestosis population aged 50-59 years Brit J. Rossiter C.E. Initial repeatability trials of Classification of the radiographic appearances Brit J. Industr Med 407-419 1972 the of Cincinnati pneumoconioses 100 APPENDIX I Name Name Name Name Address Telephone BRAKE REPAIR . AND MAINMAINTETNANCE ENANCE WORKERS WORKERS SURVEY No. No. Date Date Date Date Union Local # Street City Date of Birth Name of Physician optional Address x URINE Albumin ar reterennin eee Protein ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMEENTLALVIDONMELVIDONMENTAL ENETLVAIDLONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMETAL ELVIDONMENTAL ELVIDONMENTAL ELVIDONMENTAL SOLENOIS SOLENOIS SOLENOIS SOLENOIS SOLENOIS SOLENOIS SOLENOIS SOLENSOOLENOIS IS SOLENOIS SOLENSOISOLENOISSOLESNOOISLENOSIOSLESNOOLIESNOISSOLENOIS MOUNT SINAI SCHOOL OF MEDICINE OF THE SOLENOIS SOLENOIS SOLENOIS SOLENOIS SOLENOIS LABORATORT LABORATORT LABORATORT LABORATORT LABORATORT LABORATORT LABORATORT LABORATORT LABORATORT LABORATOR LABORATORT LABORATORT LABORATORT LABORATORT LABORATORLTABORATORT LABORATORTLABORATORT LABORATORLTABORATORT LABORATORT LABORATORTLABORATORTLALABORABTORT ORATORT LABORATORT CITY CITYCITY UNIVERSITY UNIVERSITY UNIVERSITY OF NEWNEW YORK VOADEVIN BRAKE CINVOIN _ SF STYL GOANEU HINO/SULSUAMO "92 WAY suey Bay AIVAS - woOpPUIGT AUYOLSTH XUaM/SdOr Puy JO ycoy IWNOTLVd o0 SWYL NI Ag MWOM HOLAIO *uopydszuaq . GNV qor | aNveE ec, seryosud) qus pot. arse veeen . ; ii !i{ | } { t i } t ) | nn eee BAUDILOUSUNVIe X 3 SIUN.OK] SNIOM BOVUS NVILE nuUdM BAHLO 20 -~ UNGRAOTUN NOWLGIUSE e SNOTADUd ROUVOs RUOM {ISV JO V9 yo odyopus acitiviton acitiviton acitviton Poa ig youd 7 et e _ ~ - ~ em emer 9 RO a _ PROTECTIVE DESCRIPTON ee DESCRIPTON 9 et arm fe ermane a a aoe See Senn meee _ |{i \ | j \ jz i{ ~~ { . + ! { '| af to | { : \| ii i i a :| _ e ers -een ee eet eee ve a _ i | || i | | be ina. - 1 . $i ~ |i e- enn -f- 3 i rte cr eee r _ we nme Poe PT - ee n . eog aei t,t t1 ont i nO " neem RA enimre FoR oanGdXxs R anere gacimantcmtin GE _ a epysod ae en ee oe e 8 erm YPTS ne__ oem BOYTAI ' net _ are Fee meee warty Tt rueTPUanCIO ee i } | etee a san ye ned wor. d 2 3 4 Last First NUTIBER Total Total Total Year first exposed to asbestos Year last exposed to asbestos occupationally occupationally occupationally occupationally number of years -subtract -subtract -subtract and months exposed to # dering period asbestos not exposed exposed exposed 80 Dates employed as Garage worker Dates performinpgerforming work work orcatch orcatchorcatch orcatch brake & Dates performing undercoating Date preforming preforming Exposed to other dusts 1-39 Yes body work . - If yes Silica Year first exposed Year last exposed Total number of years and months exposed Coal Year first exposed exposed Year last exposed Total Total number of years and years underground months exposed Year first exposed Total number number of of of years years years years years ; nor to bees & casade casade casade ce Inedlass Inedlass Inedlass family family family workwork with with with vorkey vorkey vorkey did did ? asbestos any any number of 0 | | 27 900 | 35 900 | | | 43 900 | i desl | 12 14 14 En 16 16 n naeiaianat deca. ene renee Dexa ter ees rR tee Re cern amon RESPIRATORY QUESTIONNAIRE NAME Last First Middle initial NUMSER tf tf I am like like now you going to ask you some questions to answer YES " YES " NO or NO whenever mainly about possible possiblepossible posible posible possible your chest I would COUGH 1 Do you usually cough first thing in the morning on getting up Count a cough with first smoke or on first going out of doors Exclude clearing throat or a single cough 1 - No 2 Yes 2 Do you usually cough during the day or at night Ignore an occasional cough 1 - No 2 - Yes 3 If yes Do you cough like this on most days or nights for as much as three months each year .1 - No 2. Yes Have you 1 2 been coughing like this ~ less than two years - more than two years PHLECK Do you usually bring up any phlegm morning on getting up Count phlegm with first smoke Exclude phlegm from the nose Count swallowed phlegn from your chest first or on first going out 1 - No thing in the of doors 2 Yes 5 Do you usually bring up any phlegm from your chest during the day or at night 1 - No 2 - Yes 6 : : If yes Do you bring up phlegm like this on most days or nights for as much as three months each year year 1 - No 2 Yes Have you 1 2 done so = Jess ~ nore for than than two two years years What colo -1 - 2 o- 2 3 BILD 4 -- is your sputum or phlega whitish yye ell lowlow and green grey and black brown i|5 11 12 13 ~_ 15 | ^' 16 [ 17 a en 13 ae | 19 L Column Number For night shift caployees Is your cough and phlegm production related to 1 ~ spring any season 2 - summer . 3 - fall 4 - winter 5 - all year DOES THE PHYSICIAN THINK CHRONIC BRONCHITIS : THAT THE PATIENT 1 - No No 2 ~ Yes 3 - Can't specify FULFILLS THE CRITERIA 7 In the past three years have you had a phlegm lasting for three period of increased cough and weeks or more 1 - No 2 o- Yes 8 Have you had more than one such period 1 No - Yes 9 Have you ever coughed up blood 1 No ? + Yes If yes how often 1 -- only occasionally 2 only occasionally with a severe cold 3 - sputum streaked 4 hemorrhage with blood frequently 5 - other specify other 10 Was this in the paspast t year BREATHLESSNESS 1 - 11 Are 12 13 WHEEZING WHEEZING WHEEZING at you troubled by shortness of breath when hurrying on level 1 - No 2 Do you get short of breath walking with other people of your own age 1 - No 2 - Yes Do on you have to stop level level ground for breath when walking 1 - No at your own 2 - Yes Yes pace 14 15 Does you chest chest ever sound wheezing or whistling Yes Have you If yes Do you get night or both this mostly during the day 1 - Days 2 Nights or Mostly 3 - Both ever had had attacks of shortness of breath breath with wheezing 1 No 2 Yes nte freee | | 1 32} Use of air hoses to blow out brake shoes Which years done did you bevel or machine shoes Which years done What current dust removal practice is used during brake brake or clutch jobs at your garage | 65 66 66 67 When did this begin 68 What was done before 69 CONTIUED one - HISTORY certs OCUPATINL Did you do undercoating work or were you near such work Describe 7070 RESPIRATORS HYGIENE 1. Do you wear a respirator - . 71 71 1 = No 2 = Yes What 2 What type is it mainly - Filter 2 - Cartridge 3 - Air Supply . ae 72 72 3 Do you wear it usually 1 - Usually 2 - Occasionally 3 - Infrequently . : 173 | 1 Do you eat at your work site 1 - No 2 ~- Yes 2 Do you 1- smoke No at at your your work work 2 - Yes site ? " ssi ite te 3 - Nonsmoker 3 Do you change your clothes before going home 1 - No 2 -- Yes Yes 4 Does your employer employer furnish work clothes and launder then : 1 - No 2 Yes 5 Do you have separate lockers for street and work clothes 1 - No 2 o- Les 6 Do you shower before going home 1 - No 2 Yes | /fi / / /fi//fi / / [ /fi / / 175 175 175 175 | 76 76 dpe ey | Tey nee 175175 |1ane 9ae 9199 17 If ves attacks was your breathing absolutely normal between 1 - No 2 Yes | 33 18 Does the weather Only record record affect your chest YES YES YES if if adverse weather causes chest symptoms definitely definitely definitely and regularly 34 I 19 : If yes Does make the weather make you short of breath Type of weather 1 - heat 4 | 2 ~ cold 3 dampness 38 4 - dryness : 39 5 - any extreme NASAL CATARRH 20 Do you usually have a stuffy nose or catarrah at the back of your nose in the winter No 2 Yes 21. Do you have this in the summer PHYSICIAN COMMENT Nasal catarrh 1 2 3 4 5 has no relation to chest condition aggravates cough and phlegm production from chest as described above is a cause of cough and phlegh is a separate entity - no cough and phlegm are produced by patient cannot be specified CHEST ILLNESSES 22 During the past three years have you had any chest kept you from your usual activities for as much as ilnes illness a week which has 23 If yes Did you bring up more phlegm than usual in any of these illnesses 24 , How many illnesses like this have you had in the past three years 25 Do you have a heart condition for which you are under a 1 - No doctor's care 2 - Yes if 43 | | [ | 43 | | | 45 46 46 | { 47 | If YES specify conditions and drug therapy TOBACCO SMOKING 26 Do you now smoke cigarettes " " If NO Have you ever smoked cigarettes 1 - No 2 - Yes How old were you when you started smoking regularly How old were you when you last gave up smoking cigarettes 30 31 List year person last stopped smoking How much did you smoke on the average did you inhale the cigarette smoke 32 32 What did you mostly smoke 1 - No Type 1 2 - filter - filter Size 1 - regular 2 - king size 3 - 100 millimeter Do you smoke a pipe 1 - No If NO Have you ever smoked a pipe 1 - No 35 35 How many pipefuls a day did you smoke Do you smoke cigars I - No If NO Have you ever smoked cigars 1 - No How many cigars a did you smoke Do you chew tobacco 1 - No 2 - Yes 2 - Yes 2 - Yes 2 - Yes 2 Yes 2 Yes | 59 MEDICAL HISTORY 3 +1 First MI DATE OF BIRTH NUMBER AGE Un last examined by a physician month & year illness not hospitalized other then trauma illness ( hospitalized other than trauma not hospitalized hospitalized acute illness chronic illness routine check x occupational surveillance program employment physical exam supplied by exployer -- }was your last chest ray month T2 year TTT22 | Result l - normal 2 = abnormal 3 = doesn't know [ PHYSICIAN | 26 | Code 0001 if never had chest ray Have you ever been hospitalized 1 No | 27 ~ 2 Yes Describe below DATE HOSPITAL REASON FOR FOR FOR PHYSICIAN PHYSICIAN PHYSICIAN release forms forms formsforms forms been signed had 01 34 Diverticulitis 02 Angina 35. Other GI Genitourinary specify , Any other heart condition for which you 36 Nephritis . 05 05. are under the care of a doctor specify High blood pressure Claudication 37 38 . Kidney disease indicate type Urinary infection Kidney stones Pulmonary Prostate enlargement 07. Pneumonia Blood in urine not caused 08 Protein in urine not caused 09 conditions 10 Bronchitis 43 Other genitourinary 11 Emphysema Skin 12 Bronchiectasis 44 Psoriasis 13 Pulmonary tuberculosis 14 Silicosis Asbestosis Other Pulmonary specify Eczema Other Blood 47. Acute skin specify Anemia 48 Chronic Anemia 49 Low white blood count 18 18 19 20 21 22 23 24 25 26 27 28 told by M.D. - UGIS - Hemorrhage Duodenal ulcer - told by M.D. " " UGIS " . Hemorrhage Bleeding from ulcer Other GI bleeding Hiatus hernia Hepatitis Jaundice Gall bladder disease 50 51 52 53 Problems with or bleeding blood clotting Sickle cell Thalassemia Other Blood specify 54 56 57 58 59. Require Glaucoma Cataracts Weak or lazy eye Optic neuritis Other Eye specify Cirrhosis - alcoholic . - Other 61 Impaired hearing Nasal allergies 63 Nasal polyps 64 Laryngeal polyps 65 66. Tonsilectomy Other ENT specify Nervous System 67. Seizure disorder 68 Stroke 69 Parkinson's Disease 70. Psychiatric illness 71 Other Nervous Musculoskeletal specify 72. Rheumatoid arthritis 73. Other arthritis 74 75 76 77 Back injury Degenerative disc disease Yes Neurologic involvement Bone lesions 78 Other Musculoskeletal specify General and Metabolic Thyroid disease or goiter Diabetes Gout Night sweats Fever Other specify Uterine Other CA specify ABCD pd] B == condition number Currently inactive - Active physician's care 7 * | eis fe | 1515 | \ |_ 23 { | | | \ | i t , | ^ Col 1-5 as 139 43 4 above punch E in col 6 Other year diagnosed Active underunder of physician 1515 1919 23 23 3131 35 35 39 39 above punch H in col 6 * ALCOHOL 1 Type 1 Beer 2 Wine 3 . Whisky Qw uanto itQuyantity - week _quarts pints approx approx 10 shots = 1 pint . no alcohol intake 2. 6 cans < qt 1/2 pint . 6-24 cans 1-4 quarts 2-2 pints./week pints./week . > 24 cans > 4 quarts 4 > 2 pints week . . alcoholic < year 7 alcoholic 1-5 years | . alcoholic > five years MEDICATION MEDICATION MEDICATION MEDICATIONMEDICATION MEDICATION ARE YOU CURRENTLY TAKING ANY OF THE THE FOLLOWING MEDICATIONS Diuretics water pills High Blood Pressure beds - Nitroglycerine Digitalis Other cardiac other Antihyperlipidemics Anticoagulants TB medication blood thinner . 09 Long antibiotics Short antibiotics 11 Steroids - oral 12 - Steroids - topical 1313 - dilators 1414 Insulin 1515 16 Oral diabetes meds 1818 1919 depressants 20 psychotics 2221 Sleeping pills daily 22 Have you ever had radiotherapy 24 23 convulsants 24 inflammatories 25 26 2828 29 30 30 1 Not Not taking any medication Currently Currently Currently Currently taking taking taking medication medication medication medication List medications currently being taken by number | 57 PHYSICAL EXAMINATION I HeiHgehitght a4 . at . . i Blood pressure in WeiWgeihghtt Middle initial ' 1313 | 47 47 47 Number .JS .JS .JS | 1 - male Sex 2 - female 16 | - Pulse rate er en [- | 123 123 123 | Regularity 26 J = normal 2 = irregular GENERAL APPEARANCE cee ee eee eee eee cece e cece 3 = other eeeeetneeecees 1 = well developed 2 q obese , 3 underweigunderhweigh well nourished - tae CYANOSIS peeeoeae 1 - absent 2 = lips tongue 3 appears chronically = pale = other a fingers toes ill EXTREMITIES ~ clubbing 1 No` 2 = Yes 28 | nails . ankle edema normal == 1 other 2 characterize 1 = No 2 = Yes | 31 JOINTS 1 = normal 2 abnormal If abnormal Joint code 1 = PIP = DIP = Wrist 4 = = Elbow Shoulder Knee Ankle 8 More than 3 descriptive code l swelling = redness heat heat == 34 = deformity crepitations crepitations = associated with hx of 4 ~ other trauma 33 joint description ETtb 34 J J | ! SKIN SKIN ada - el ee 1 = normal 2 = abnormality present If abnormal 1 iH seborria 2 = acne valgaris = psoriasis 3 i other describe ee EYES Pupils normal abnormal Specify Sclera icteric No Yes TTT Ee eee eee ewww eee ees e rere reseee Conjunctiva normal injected pale other eovcssereeseee Describe other 43 MOUTH normal gingival abnormality - Describe other 3 ot torh r tte re eeer seeses THYROID eee ene wae eeeeen eevee aeae een e snr enerwneseeoeeeesne 1 = normal 2 = enlarged 3 = nodular oo er ere wm ene eeveens LYMPHADENOPATHY list locations 1 = normal 2 = cervical 3 = supraclavicular 4 axillary 5 = inguinal 6 == more than 3 sites 7 = other CHEST INSPECTION sees ece ss cweer cerns ee sarerensaccvvcces i 1 = normal 2 = dullness right 3 = dullness left 4 = increased AP diameter 5 = flaring of costal margins 51 55 55 CHEST PERCUSSION 0c. : c cece cece cece tence ccc eeececueevucecuaeevcececce. = 2 = = 4= normal dullness right dullness left resonant right 5 = resonant = resonant 7 = other left bilateral . Describe other AUSCULTATION .. cece cee eee e eee are eee eee et eee eee eee nett eens 7 1 = normal breath sounds 6 6= ! wheezing and rhonchi 3 = decreased - right = decreased ~ left 7 = lenghtening of respiratory phase 8 = moist rales 4 = decreased bilaterally 9 =n other 5 = wheezing and rhonchi in a localized area Describe other RALES 1 tt none 2 = RAAL 3 = RPAL 4 = RMAL S - Base 6 = LAAL | } t 7 = LPAL 8 Base 0 = diffuse more than 3 CARDIAC PALPATION AND PERCUSSION ese = normal 2 = heart palpable in epigastrum 3 = = heart enlarged by percussion left ventrical heave 4 = right ventricular heave == displaces P.M.I. HEART SOUNDS .. eeseeeeeeesseerteseesteterteeerteeeecereee| 1= 1 = tt normal murmur distant heart sounds 4 = pII II 4 = == 3 other Describe other 63J 63 63 Jrne ABDOMEN Inspection Masses Abdominal tenderness to palpation 6 1 = none 2 = RUG 5 = umbilical 6 = LPA 4 = Epigastric Describe other_ S == other - PALPABLE LIVER not palpable palpable SCT C TT tte tet If palpable span on clavicular line ~ in cm tres ene Liver tenderness No , Yes Ce a Liver consistency i SS normal increased firmness irregular nodular other aa eee ne eee PALPABLE SPLEEN not palpable palpable oe cceecereccvcnvcconeves If palpable two dimensions by percussion cm PALPABLE KIDNEYS not palpable palpable palpablepalpable , .. left ey right eve eee 3 ewe eam awe ABDOMINAL MASSES BY PALPATION none present Location size and consistency ieee ee 79 | NEUROLOGICAL EXAMINATION Deep tendon reflexes normal hyperactive decreased absent Specify abnormality ankle knee * 11 13 MOTOR normal decreased strength Indicate muscle group wrist drop teleky sign extensor weakness 6.Babinsk6.Baibinski other involved biceps 12 wrist 14 | TREMOR . ee ee cee cece eee eee erect e eens none outstretched hands intention face other eee eas eee e een tbe ences Describe Describe " other 15 18 Col 1-9 as above punch K in col 10 SENSORY pin Arms 1 = absent 2 = present Legs 1 - absent 2 = present OTHER NEUROLOGIC 1 = none 2 = present describe 2 3 = 6= 8= Fischbein Holstein Lilis- Lorimer Rom 10 i Rosenmann 10 i Todaro ba HUMAN RESEARCH CONSENT FORM PROJECT DESCRIPTION 1. Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos NIOSH 210-77-0119-0000 2. Investigators Irving J. Selikoff M.D. and William J. Nicholson Ph.D. , Purpose To identify any human health hazards associated with - brake repair and maintenance II CONSENT TO PARTICIPATE I. , age hereby voluntarily agree to cooperate in the above named The study has been study and discussed to undergo the tests listed in Attachment A. with me and 1 have been given a copy of this document I understand that stated 1 The procedures and tests to be followed are as statedstated in Attachment A no procedures are experimental 2 Attendant discomforts and risks are as noted in Attachment A and except as noted are minimal and provision has been made for any necessary medical care and I have been told what to do if I have any reaction 3 Benefits are as indicated in the Purpose statement above Part I Item 3 ee 4. If alternative procedure advantageous to me are available they are specified in Attachment A and if they become available during the project the procedure most advantageious for me will be indicated and used or an explanation will be given to me as to use of any other procedure 5. My inquiries will be answered by the project directors or other personnel invovled in the project Telephone 212-650-5823 6 am free to terminate my consent and to discontinue participation in the project at any time without prejudice to myself 7 My identity and my relationship to any information 1 disclosed by me in completing any project questionnaire and 2 reported by me or derived from me during my participation in the above named project shall be kept confidential and will be disclosed to others without my written consent except as required by law and except that such information will be used for statistical and research purposes in such a manner that no individual can be identified I understand that if any information is found out concerning me that can endanger the health and safety of others this information will be given to the proper authority g If any of my medical records are required for purposes of this project a separate written consent for release of the records will be requested from me 9 There will be questions that I will be asked to answer and my inquifies concerning the questions will be answered by Dr. Selikoff or Dr. Nicholson 212-650-5823 .10 A report of any significant information from the study that specifically concerns me including medical information will be furnished by the project officer or his designated representative to me or to my designated physician upon completion of the study or earlier if appropriate SIGNATURE Subject's Name Date 11 INVESTIGATOR a Willal Willal Willal Php Nichols Nichols Associate Professor III Signature Signature CONSENT FOR MAINTENANCE OF RECORDS consent for Mount Sinai School of Medicine to maintain all I hereby give confidential as above records of this examination They will be completely information will be released to any physician I designate upon my written request and authorization at any time in the future and SIGNATURE Subject Name TT Date Tee IV INFORMATION REQUEST AND AUTHORIZATION FOR RELEASE OF INFORMATION I the Project addresses I named study DO NOT WISH , hereby request and authorize __ oe Director to inform the following physicians whose names and have entered below of any significant findings from the above concerning me DO NOT LEAVE BLANK WRITE NO WHERE YOU TO GIVE A NAME AND ADDRESS , 1. My personal physician Dr. Street _ en City State _. 2. Other physician Dr. Street City _ | State __ __ OTS EIEN OES OP rR ee eeeen eo. ATTACHMENTA Investigation of Health Hazards in Brake Lining Lining Repairs Maintenance Workers Occupationally Exposed to Asbestos NIOSH 210-77-0119-0002010-77-0119-0000 and The procedures and tests which involve human subjects in conduct of this project are as follows Blood tests Urine analysis Sputum cytology Chest ray . PulmonaryPulmonary function tests Physical examination Each of the above provides important information for the evaluation health status There is minor discomfort associated with the of blood from the arm The draving draving sputum cytology involves coughing up phlegm from the throat into a container which isis provided The pulmonary function test involves a maximum breathing effort e 3 RRighits ghts under the Privacy Act of 1974 TiTitle tle 5 United States Code Section Section Section 552 TheThe information required to be given to me under the Privacy Act of 1974 is as follows 1 ) Authority for collecting information is the Occupational Safety and Health Act of 1970 The 2 ) The principal purpose of this study is as stated in in Section Section Section Section SectionSection Section Item 3 3 Routine use of this informationinformation is in developing criteria and programs for a safe and healthy place of employment 4 I do not have to furnish any information I do not wish to Nothing happens to me as a result of my not providing whether all or in part of that requested except that terminated from the project information I may be Brakeworkers Occupational History Asbestos Exposure Code Work Practice Primary Code 1. Brake work Greater than 1 job per 6 months or garage procedures which would result in heavy direct exposure e.g. brake work clutch work or front end work which involves the air blowing of asbestos containing debris 2 Garage not directly involving brakes but where other exposure to asbestos could occur in the facility i.e. brake work done elsewhere at the work site 2A 2B Body repair work involving an asbestos Undercoating work on a regular basis.. filler 3 Heavy occupational exposure activity would normally raise visible dust factories insulation work 4 Indirect asbestos exposure e.g. in shipyard work taping by painters construction work near spraying of asbestos or insulation work work in plumbing and heating trades with asbestos exposure 5 Low indirect exposures possible indirect or very occasional direct Brake Work Codes Secondary Code For a Primary Code of 1 only Frequency A day or greater ACA 14AACA - 4 jobs per week 14 14 jobs per month 15 15 jobs months Code Tertiary a Tertiary 0 No grinding or beveling 1 Some grinding or beveling Sample Entry 1 B 1 200 200 ,7 ENVIRONMENTAL Interational sy ceaRe SMAL eM, aw Type ST SO Tee ELE ALISUBN[AKOT LT ay ALIO * Pears SHL ape AO 3ata SNIDGaWOm20re iE~ F. AC Pelperse n a 0Lemy ea a > 2/1 U ha3 y ap aerme 2/2/3 . SCIENS LABORTY SCIENS SCIENCS SCIENCES UNIVERSITY | apci5 | THE WUNnad bapo ] Sop tra i NOLVIHDVO yduig Radiogrphs 4 Sea ear ma >cm 51 & SIy. - Radiographs P6acumocnioseSpel=aSonesoof IRREGULAR YU Prefusio OPACITES OPACITES OPACITIES !! | y TypsTyps Zones aus H DEFINED . ope a:rasudyour arg esorugwn SULIDVdOaOUV a ak | | p | Z LY / f Jo VIWS SULIDVUd[Oenars pautnguebarsnjadg v4 LS _ sydezoip2y papeey s2uoz i eee ; // / SHLIOVU y WVTNOBUE ee Fucisnjosy jo ' |, | || ! TIVNS ee ali y | r CoNeyisl} a sauoz fo; bao GRaNO- SRILDVdO Miva pe iI ot i| TIVNKS ay fp paro ~ | ! i| Popo 7 / !A i | / i ;i 2/1 3/2 s1z7q a eo tL er c AGE RQ ~~ Tm . up id ys eya i xd -s 2 oe ob 8 i t * uM 1 vo de Premmocenic .- Premocenic Premocenic Premmocenic Premmocenic 98 1 it ! , ~ boa ' >, u 1 G } 1 o vy R ) i pe Yo ey bapenods podercnayg 4 vA ~ \ po2O0 wie GA 1} ~ Le an a3 a F dofea) ve at y ow; edpirot couric] a 4 . wie tie ~ Ot ' ' ~ -_ 2o8fggonlee 3 - 10791 / |T th ec-/mp one mew ue vray Wet ae & 4 di +_ [ . ca Way