Cancer risk among artistic painters

An association between bladder cancer and employment as an artistic painter was found in two study populations. A proportionate mortality analysis of death certificates of professional artists indicated a greater than twofold excess for bladder cancer mortality among painters. This association was further investigated in a large case-control interview study of bladder cancer patients where an overall relative risk estimate of 2.5 was found among artistic painters. Excess deaths from leukemia and arteriosclerotic heart disease also occurred in the proportionate mortality study. Information was not available to determine exposure to specific substances that may have been responsible for these observations; however, efforts should be made to limit exposure to art materials known to be hazardous.     

Cancer risks in painters: study based on the New Zealand Cancer Registry.

Painters are exposed to a range of complex chemical mixtures which include organic solvents and dye products with known carcinogenic and mutagenic potential. Trade painters or those manufacturing paints and coatings have increased rates of non-malignant diseases and cancers; including lung cancer, acute leukaemia, bladder cancer, and cancers of the oesophagus, larynx, biliary system, liver, skin, and large bowel. A series of case-control studies of painters, based on the New Zealand Cancer Registry, are presented. These concerned 19,904 male patients registered for the period 1980-4 who were aged 20 or older at the time of registration. For each cancer site studied, the registrants for all other cancer sites formed the control group. Three cancer sites were associated with work as a painter--namely, bladder tumours (odds ratio (OR) 1.52, 95% confidence interval (95% CI) 1.00-2.31), kidney and other urothelial tumours (OR 1.45, 95% CI 0.85-2.50), and multiple myeloma (OR 1.95, 95%, CI 1.05-3.65). Risks for multiple myeloma were greater among car or spray painters and signwriters (OR 2.81) compared with construction and general painters (OR 1.80). No increased risk was found for leukaemia or for respiratory, biliary, skin, or gastrointestinal cancers.     

Cancer risks in painters: study based on the New Zealand Cancer Registry

Painters are exposed to a range of complex chemical mixtures which include organic solvents and dye products with known carcinogenic and mutagenic potential. Trade painters or those manufacturing paints and coatings have increased rates of non-malignant diseases and cancers; including lung cancer, acute leukaemia, bladder cancer, and cancers of the oesophagus, larynx, biliary system, liver, skin, and large bowel. A series of case-control studies of painters, based on the New Zealand Cancer Registry, are presented. These concerned 19,904 male patients registered for the period 1980-4 who were aged 20 or older at the time of registration. For each cancer site studied, the registrants for all other cancer sites formed the control group. Three cancer sites were associated with work as a painter--namely, bladder tumours (odds ratio (OR) 1.52, 95% confidence interval (95% CI) 1.00-2.31), kidney and other urothelial tumours (OR 1.45, 95% CI 0.85-2.50), and multiple myeloma (OR 1.95, 95%, CI 1.05-3.65). Risks for multiple myeloma were greater among car or spray painters and signwriters (OR 2.81) compared with construction and general painters (OR 1.80). No increased risk was found for leukaemia or for respiratory, biliary, skin, or gastrointestinal cancers.     

Bladder cancer and occupation: a report from the Belgian case-control study on bladder cancer risk

BACKGROUND: The aim of this study was to add to the data on associations between occupation and bladder cancer thereby strengthening the case for focused research on specific occupational categories. METHODS: Two hundred two cases and 390 controls participated in this population-based case-control study. Age, sex, smoking, and education adjusted odds ratios (ORs) were calculated for each occupation by unconditional logistic regression. RESULTS: The occupational group of domestic helpers, cleaners, and launderers exhibited a significantly elevated risk of bladder cancer. Elevated non-significant risks (OR > 1.5) were observed for painters and varnishers, electronic equipment assemblers, general laborers, building finishers, carpenters and joiners, architects and engineers, and textile and garment workers. CONCLUSIONS: This study suggests that domestic helpers, cleaners, and launderers probably experience an increased risk of bladder cancer. Although no other occupations showed significantly increased risks, the non-significantly elevated risks for painters, carpenters, and textile workers could be confirmed by results from earlier studies.     

Cohort mortality study of 57,000 painters and other union members: a 15 year update

OBJECTIVES: To study mortality patterns in the largest existing cohort of painters. METHODS: 15 years of follow up were added to a study of 42,170 painters and 14,316 non-painters based on union records. There were 23,458 deaths, compared with 5313 in the earlier follow up. RESULTS: Comparisons with the United States population showed significantly increased rates in painters for lung cancer (standardised mortality ratio (SMR) 1.23, 95% confidence interval (95% CI) 1.17 to 1.29), bladder cancer (SMR 1.23, 95% CI 1.05 to 1.43), liver cancer (SMR 1.25, 95% CI 1.03 to 1.50), and stomach cancer (SMR 1.39, 95% CI 1.20 to 1.59). However, in direct comparisons with non-painters only the excesses for lung cancer (SRR 1.23, 95% CI 1.11 to 1.35, increasing to 1.32, 95% CI 16 to 1.93 with 20 years latency) and bladder cancer (SRR 1.77, 95% CI 1.13 to 2.77) were confirmed. Some confounding by smoking may affect these two outcomes, particularly with external referents. Cirrhosis of the liver was increased for both painters and non-painters (SMRs 1.21, 95% CI 1.07 to 1.35, and 1.26, 95% CI 1.03 to 1.51, respectively), possibly indicating high alcohol consumption. Suicide (SMR 1.21, 95% CI 1.05 to 1.38) and homicide (SMR 1.36, 95% CI 1.04 to 1.75) were increased for painters but not for non-painters; neuropsychiatric diseases have been associated with painters in earlier studies. CONCLUSIONS: The results suggest modest occupational risks for lung and bladder cancer; these results are consistent with existing publications. The International Agency for Research on Cancer has classified painting as an occupation definitely associated with cancer.       

Bladder cancer and occupation: a case-control study in northern Italy.

OBJECTIVES--A hospital based case-control study was conducted between 1992 and 1993 in the province of Brescia, a highly industrialised area in northern Italy, to evaluate occupational risk factors of bladder cancer. METHODS--The study evaluated 355 histologically confirmed cases of bladder cancer (275 men, 80 women) and 579 controls affected by urological non-neoplastic diseases (397 men, 182 women). Lifetime occupational history, smoking and drinking habits, and sociodemographic characteristics were recorded by means of a structured questionnaire. Odds ratios (ORs) were computed with adjustment for age, smoking, alcohol and coffee consumption, education, and place of residence. RESULTS--A significant (P < 0.05) increase of risk of bladder cancer were found in men for labourers in the construction industry (OR 2.1, 95% confidence interval (95% CI) 1.1-3.9) and for recreational and cultural services (OR 5.0, 95% CI 1.3-18.9). Increased risks, although not significant, were found for various other occupations and industries such as machinery mechanics, metal processers and polishers, blacksmiths, gunsmiths, painters; for transport workers, an increased risk with increasing duration of employment was found. CONCLUSIONS--Occupational exposures seem to contribute to bladder cancer risk in the area under study.     

Disability, mortality, and incidence of cancer among Geneva painters and electricians: a historical prospective study.

The 1916 painters and the 1948 electricians who resided in the Canton of Geneva at the time of the 1970 census were identified and followed up to 1984. During the study period 121 disability pensions were awarded to painters and 59 to electricians. Age standardised incidence of disability per 1000 man-years at risk was higher among painters than among electricians for all neuropsychiatric causes (1.23/1000 and 0.68/1000, respectively) and for all other causes (5.50/1000 and 3.41/1000, respectively). No case of presenile dementia was diagnosed among painters. There was inadequate evidence to indicate that the higher risk of neuropsychiatric disability for painters might have been due to their occupational exposure to organic solvents. A possible toxic effect of these substances on the central nervous system was confounded with alcoholism which was associated with disability from neuropsychiatric disease in 12 of 20 painters and in only one of 10 electricians. Mortality and incidence of cancer were assessed among both cohorts and compared with the expected figures calculated from Geneva rates. Among painters there was a significant increase in overall mortality (O = 254, E = 218.5), in mortality from all cancers (O = 96, E = 75.4), and in incidence from all cancers (O = 159, E = 132.0). For the specific cancer sites, there was a significant excess risk for lung cancer (mortality: O = 40, E = 23.0), which was possibly related to occupational exposure to asbestos and to zinc chromate, although cigarette smoking was not controlled. The significant excesses of biliary tract cancer and of bladder cancer were in accordance with previous observations among painters from other countries. There was also a significant increase in incidence from testicular cancer (O=5, E=1.6), which has not been reported before. For causes of death other than cancer the excesses for alcoholism (O=5, E=0.8). for liver cirrhosis (O=14, E=8.8), for motor vehicle accidents (O=12, E=5.9), and for cerebrovascular disease when allowing for ten years of latency (O=8, E=4.0), were consistent with a probable increased risk of alcohol abuse. Among electricians overall mortality was similar to that expected (O=137, E=139.0). No significant excess risk was found for all cancers or for any specific cancer site. Because of the small number of expected deaths the statistical power was low for the assessment of a possible risk for leukaemia or for brain tumour.     

Disability, mortality, and incidence of cancer among Geneva painters and electricians: a historical prospective study

The 1916 painters and the 1948 electricians who resided in the Canton of Geneva at the time of the 1970 census were identified and followed up to 1984. During the study period 121 disability pensions were awarded to painters and 59 to electricians. Age standardised incidence of disability per 1000 man-years at risk was higher among painters than among electricians for all neuropsychiatric causes (1.23/1000 and 0.68/1000, respectively) and for all other causes (5.50/1000 and 3.41/1000, respectively). No case of presenile dementia was diagnosed among painters. There was inadequate evidence to indicate that the higher risk of neuropsychiatric disability for painters might have been due to their occupational exposure to organic solvents. A possible toxic effect of these substances on the central nervous system was confounded with alcoholism which was associated with disability from neuropsychiatric disease in 12 of 20 painters and in only one of 10 electricians. Mortality and incidence of cancer were assessed among both cohorts and compared with the expected figures calculated from Geneva rates. Among painters there was a significant increase in overall mortality (O = 254, E = 218.5), in mortality from all cancers (O = 96, E = 75.4), and in incidence from all cancers (O = 159, E = 132.0). For the specific cancer sites, there was a significant excess risk for lung cancer (mortality: O = 40, E = 23.0), which was possibly related to occupational exposure to asbestos and to zinc chromate, although cigarette smoking was not controlled. The significant excesses of biliary tract cancer and of bladder cancer were in accordance with previous observations among painters from other countries. There was also a significant increase in incidence from testicular cancer (O=5, E=1.6), which has not been reported before. For causes of death other than cancer the excesses for alcoholism (O=5, E=0.8). for liver cirrhosis (O=14, E=8.8), for motor vehicle accidents (O=12, E=5.9), and for cerebrovascular disease when allowing for ten years of latency (O=8, E=4.0), were consistent with a probable increased risk of alcohol abuse. Among electricians overall mortality was similar to that expected (O=137, E=139.0). No significant excess risk was found for all cancers or for any specific cancer site. Because of the small number of expected deaths the statistical power was low for the assessment of a possible risk for leukaemia or for brain tumour.     

Adverse reproductive outcomes among male painters with occupational exposure to organic solvents

Objectives

To assess the risks of reproductive disorders and birth defects in offspring of male painters with exposure to organic solvents, and to determine the shape of the dose‐response relationship.

Methods

Random samples of painters and carpenters were drawn from workers affiliated with the Dutch Trade Union for Construction Workers, the Netherlands, 2001. Information on reproductive outcomes, occupational exposures, and lifestyle habits was retrospectively obtained through self‐administered questionnaires filled in by 398 painters exposed to organic solvents in paints, thinners, and cleansers in the period of three months before the last pregnancy, and 302 carpenters with little or no exposure to solvents. A statistical model was used to estimate quantitative exposure measures.

Results

Workers employed as painters at three months before pregnancy had an increased risk (odds ratio 6.2, 95% CI 1.4 to 27.9) of congenital malformations in offspring compared to carpenters. There was a positive exposure‐response trend with increasing exposure to organic solvents based on quantitative model predicted exposure estimates using toluene as a marker. There was some indication of an increased risk of functional developmental disorders in offspring among painters with intermediate and high model predicted exposure. The risk of low birth weight children seemed to be slightly increased among painters as well. Results for other reproductive outcomes (time to pregnancy, spontaneous abortion, and preterm birth) did not show increased risks.

Conclusion

This study showed a positive association between paternal occupational exposure to organic solvents and congenital malformations in offspring. However, the small numbers of cases, especially when examining different exposure levels, as well as the self‐reported nature of exposure and outcome variables, may hamper interpretation of the results.     

膀胱肿瘤切除术后尿路感染病原学和危险因素

目的观察膀胱肿瘤切除术后患者尿路感染发生情况与病原学特征,分析诱发尿路感染的危险因素,并提出合理且具备针对性的冲洗对策,为未来膀胱肿瘤切除术后尿路感染的预防提供合理参考。方法回顾性分析连云港市第一人民医院2016年1月-2019年1月接受经尿道膀胱肿瘤切除术治疗的451例膀胱肿瘤患者的临床资料,收集患者病例资料,全部患者术后均定期取尿液标本进行细菌培养,参照相关标准判定患者尿路感染情况,记录患者一般情况,包括一般人口学资料(性别、年龄、体质量、受教育程度等),同时记录患者糖尿病的疾病合并情况,将术后尿路感染可能的危险因素纳入初步分析,Logistic多因素回归分析膀胱肿瘤切除术后发生尿路感染的危险因素。结果451例膀胱肿瘤切除术患者术后第3天尿液中细菌培养阳性例数为80例,阳性率为17.74%,在使用抗菌药物后,患者尿液中细菌培养阳性率逐渐降低,各时点尿液细菌阳性培养率比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析检验证实,高龄、血糖水平控制不佳、术前留置导尿管、多发肿瘤是膀胱肿瘤切除术后尿路感染的危险因素(OR>1,P<0.05);80例术后尿液细菌培养阳性患者共分离出87株菌株,其中革兰阴性菌66株占75.86%,革兰阳性球菌21株占24.14%。结论膀胱肿瘤切除术后患者有较高的尿路感染风险,革兰阴性菌是主要的感染病原菌,年龄、基础疾病、肿瘤位点、术前导尿管留置等是影响因素,这类患者应引起临床高度重视。     

Neuropsychiatric disorders among solvent-exposed workers

This case-control study was undertaken to determine whether exposure to organic solvents, as experienced by Dutch painters, causes an increased risk of disability due to neuropsychiatric disorders. Cases and controls were selected from the Dutch Painters' and Construction Workers' Organizations. Cases were defined as male persons receiving disability benefits due to neuropsychiatric disorders. The controls consisted of a random sample of 1000 male persons from the total study population. Cases (n = 252) and controls (n = 822) participated in our study by returning the completed questionnaires. The questionnaire was used to collect information about occupational history and the presence of potentially confounding factors. The adjusted Odds Ratio for the total group of neuropsychiatric disorders did not reach a statistically significant level (OR = 1.17; P less than 0.30). Although a stronger association was suggested between "neuroses" (ICD 300) and exposure to organic solvents (OR = 2.30; P less than 0.05), there are indications that this relationship is merely the result of classification bias. The results of this study do not confirm, but also do not completely exclude, that Dutch painters are at increased risk of being prematurely disabled due to neuropsychiatric disorders.     

Neuropsychological symptoms in Chinese male and female painters: an epidemiological study in dockyard workers

OBJECTIVES: To study the prevalences of neuropsychological symptoms in male and female dockyard painters in China and to compare them with those in British dockyard painters. METHODS: All 116 painters were identified, active and retired, who had been employed in two Chinese dockyards for at least 1 year together with a matched random sample of 263 dockyard non-painters. Neuropsychological and personality questionnaires that we had used previously in a study of United Kingdom dockyard painters were used, translated into Chinese. Neuropsychological symptoms in painters and controls were compared, adjusting for age, educational level, smoking, alcohol intake, and personality. RESULTS: The response rate was 94% for painters and 97% for controls. Highly significant excesses of symptoms were found in painters, suggestive of neuropsychological dysfunction. Both male and female painters showed higher relative risks than were found in similar tradespeople in the United Kingdom. The relative risk increased with increasing score of both neurological and psychological symptoms. Relative risk of having a high symptom score, compared with controls and adjusted for confounders, was 6.61 (95% confidence interval (95% CI) 2.36 to 18.50) for 2-15 years exposure, 14.88 (5.74 to 38.56) for 16-22 years and 9.42 (3.97 to 22.36) for > or = 22 years. CONCLUSION: These results indicate that neuropsychological symptoms are associated with heavy exposure to painting work in China, and that the phenomenon is likely to be found worldwide wherever there is such exposure to solvent based paints. The high response rate in this study answers a possible criticism of the earlier United Kingdom study.

 

     

A cohort mortality study of painters and allied tradesmen

A cohort study was conducted of the membership of a large international union of painters and allied tradesmen. The union membership consisted of both painters and associated trades such as glaziers and tile and carpet layers. The study examined the mortality experience of 57 175 current and former union members in four states (California, Missouri, New York, and Texas) in the United States (US) from 1975 through 1979. No excess mortality was observed for the total union membership when compared to that of all US white males. When the study population was subdivided by the trade affiliation, members of locals comprised primarily of painters exhibited a significant elevation in mortality from all malignant neoplasms, lung cancer, and stomach cancer, compared to all US white males. To reduce the impact of potential nonoccupational differences between the study population and all US white males, the data were also analyzed using the entire cohort as the standardization population. Significant elevations continued to be observed for all malignant neoplasms and lung cancer among the membership of painting locals compared to other locals. In addition there was a statistically significant difference in mortality from leukemia and cancer of the bladder observed between the groups.     

A cluster of lead poisoning among consumers of Ayurvedic medicine

Abstract

In an epidemiologic study, the mortality patterns of commercial painters in The Netherlands were investigated. The hypothesis that painters are at an increased risk of cancer, especially lung cancer, was tested in collaboration with the Dutch Social Fund for painters. This fund manages the pensions of Dutch painters. In the group of painters eligible for pensions, 9,812 deaths were observed between 1980 and 1992. Proportionate mortality ratios were calculated. The results support previous findings of an increased risk of lung cancer in painters. Although no statement can be made about the actual causal agent, the authors believe that the sanding down of old paint layers may expose painters to particulates that contain carcinogens such as lead chromates and asbestos. The decreased risks of mortality from some neoplasms and circulatory and digestive problems, pneumoconiosis, and “other causes” observed in the painters lack a plausible explanation. Chance or the known limitation of proportionate mortality ratio analysis might playa role.     

Respiratory symptoms and diseases among construction painters

Objective: To study the self-reported prevalence of respiratory symptoms and diseases among construction painters and estimate the potential risk for this group compared with a representative group of carpenters sharing the construction work environment but without significant exposure to paint. Methods: A questionnaire study was conducted on 1,000 male Finnish construction painters and 1,000 carpenters (mean response rate 60.5%). Symptoms and diseases of the respiratory tract were studied, by logistic regression modelling, in relation to occupation and duration of painting experience. Age, atopy and smoking habits were taken into account. Results: The painters reported more asthma-like, rhinitis, laryngeal and eye symptoms than the carpenters [odds ratio (OR) 1.4–1.8]. The difference in the prevalence of asthma between the occupations was not statistically significant, but the painters with 1–10 years of painting experience had a threefold risk of asthma compared with the carpenters. Chronic bronchitis was linked to painting occupation [OR 1.9, 95% confidence interval (CI) 1.2–3.0] and to the duration of exposure; OR (CI) for over 30 years of painting was 2.2 (1.2–4.0). Occupation was not associated with allergic rhinitis or conjunctivitis. Conclusions: The results indicate a higher risk for respiratory symptoms and chronic bronchitis among construction painters than among carpenters.     

Health effects of solvent exposure among dockyard painters: mortality and neuropsychological symptoms

OBJECTIVES: To study mortality and prevalence of neuropsychological symptoms among a cohort of painters known to have been heavily exposed to organic solvents. METHODS: A mortality study of 1292 male painters who had worked in a dockyard in Scotland for > or = 1 year between 1950 and 1992 comprised a nested cross sectional study of 953 surviving painters from the cohort and 953 male non-painters randomly selected from the local population and a case-control study of those with high symptom scores. Mortality, symptoms, and risks associated with painting, adjusting for age, education, smoking, alcohol, and personality were measured. RESULTS: The proportional mortality ratio for all cancers was not increased significantly (110 (95% confidence interval (95% CI) 84 to 143), except for a possible excess of deaths from ischaemic heart disease (132, 105 to 164). Standardised mortality ratios were not significantly increased. Among the 260 surviving painters and 539 community controls who responded to the questionnaire there was a significant excess of symptoms among painters; adjusted relative risk (RR) increased significantly with increasing symptom score. These RRs suggested an exposure-response relation; for a high score (12-22) for all symptoms RR was 2.27 (1.20 to 4.30) for 1-4 years of exposure, 2.42 (1.18 to 4.95) for 5-9 years, 2.89 (1.42 to 5.88) for 10-14 years, and 3.41 (1.82 to 6.36) for 15-41 years, compared with controls. In multivariate analyses, painting exposure, and aging were associated with high symptom scores and there was again an increased risk relative to time worked as a painter. CONCLUSION: This study supports the hypothesis that heavy and prolonged exposure to paint solvents leads to neuropsychological ill health.

 

     

Lung cancer risk in painters: a meta-analysis

We conducted a meta-analysis to quantitatively compare the association between occupation as a painter and the incidence or mortality from lung cancer. PubMed and the reference lists of pertinent publications were searched and reviewed. For the meta-analysis, we used data from 47 independent cohort, record linkage, and case-control studies (from a total of 74 reports), including > 11,000 incident cases or deaths from lung cancer among painters. Three authors independently abstracted data and assessed study quality. The summary relative risk (meta-RR, random effects) for lung cancer in painters was 1.35 [95% confidence interval (CI), 1.29-1.41; 47 studies] and 1.35 (95% CI, 1.21-1.51; 27 studies) after controlling for smoking. The relative risk was higher in never-smokers (meta-RR = 2.00; 95% CI, 1.09-3.67; 3 studies) and persisted when restricted to studies that adjusted for other occupational exposures (meta-RR = 1.57; 95% CI, 1.21-2.04; 5 studies). These results support the conclusion that occupational exposures in painters are causally associated with the risk of lung cancer.     

Cancer risk assessment for health care workers occupationally exposed to cyclophosphamide

In the present study a cancer risk assessment of occupational exposure to cyclophosphamide (CP), a genotoxic carcinogenic antineoplastic agent, was carried out following two approaches based on (1) data from an animal study and (2) data on primary and secondary tumors in CP-treated patients. Data on the urinary excretion of CP in health care workers were used to estimate the uptake of CP, which ranged from 3.6 to 18 g/day. Based on data from an animal study, cancer risks were calculated for a health care worker with a body weight of 70 kg and a working period of 40 years, 200 days a year (linear extrapolation). The lifetime risks (70 years) of urinary bladder cancer in men and leukemias in men and women were found to be nearly the same and ranged from 95 to 600 per million. Based on the patient studies, cancer risks were calculated by multiplication of the 10-year cumulative incidence per gram of CP in patients by the estimated mean total uptake in health care workers over 10 years, 200 days a year. The risk of leukemias in women over 10 years ranged from 17 to 100 per million using the secondary tumor data (linear extrapolation). Comparable results were obtained for the risk of urinary bladder tumors and leukemias in men and women when primary tumor data were used. Thus, on an annual basis, cancer risks obtained from both the animal and the patient study were nearly the same and ranged from about 1.4 to 10 per million. In The Netherlands it is proposed that, for workers, a cancer risk per compound of one extra cancer case per million a year should be striven for (target risk) and that no risk higher than 100 per million a year (prohibitory risk) should be tolerated. From the animal and the patient study it appears that the target risk is exceeded but that the risk is still below the prohibitory risk.     

Effects within the week on forced vital capacity are correlated with long term changes in pulmonary function: reanalysis of studies on car painters exposed to isocyanate.

OBJECTIVES--To examine if car painters who work with polyurethane paints that contain hexamethylenediisocyanate (HDI) and hexamethylenediisocyanate biuret trimer (HDI-BT) develop acute as well as chronic impairment of lung function. METHODS--In this study data were reanalysed from two earlier studies on a group of car painters to see if a decrease in lung function within the week is a marker of vulnerability in those workers. Data on changes in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) within the week were available for 20 car painters who were also examined six years later. RESULTS--10 men showed a decline in FVC within the week. There were no significant differences in age, duration of employment, exposures during the follow up period, or smoking between car painters who had decline in lung function within the week and car painters who had not. A significant correlation was found between the change in FVC within the week and the long term (six year) change in FVC, standardised for the effects of aging and smoking, and adjusted for the number of peak exposures. CONCLUSIONS--The results suggest that the decrease in FVC within the week might serve as a guide to identify car painters at risk of a further decrement in lung function above the effects of aging, smoking, and exposure.