A meta-analytical approach to neurobehavioural effects of occupational toluene exposure.

Twenty-two studies investigating neurobehavioural effects of toluene were reviewed. Repeatedly applied neuropsychological performance tests and appropriately documented results allowed to include 10 of the studies into a meta-analysis based on effect sizes. Mean exposure level of the studies was 57ppm (range 20-117ppm) toluene. Five of the six analyses of neuropsychological tests obtained effect sizes suggesting a negative impact of toluene, but for none of the analyses a significant effect size was estimated at averaged exposure levels between 33 and 89ppm. The tests represented the psychological domains of attention and constructional performance. Additionally, the relation between exposure conditions (level of exposure, length of exposure), potential confounders (age, verbal intelligence), and effect sizes was analysed. Only pre-exposure intellectual capacity showed a consistent relation to effect sizes. The study suggests that homogenisation of study groups with respect to intelligence, cultural background and practice trials is important when investigating low-level exposure. Efforts to homogenize studies should be completed by a thorough documentation of feasible influences.