Occupational medicine is the branch of clinical medicine most active in the field of occupational health. Occupational health physicians work closely with the occupational health team which consists of Occupational Health Nursing Professional, Industrial Hygienists, Biostatisticians, Public Health Specialists, and Biomedical Engineers (namely those specializing in Ergonomics). In the United States it is one of the three medical specialties (also including aerospace medicine and public health and general preventive medicine) encompassed by the American Board of Medical Specialties recognized specialty of preventive medicine. Its principal role is the provision of health advice to organisations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained. Occupational physicians must have a wide knowledge of clinical medicine and be competent in a number of important areas.

Occupational health should aim at: the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention among workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; placing and maintenance of a worker in an occupational environment adapted to his physiological and psychological equipment and, to summarise, the adaption of work to man and of each man to his job.

Areas of focus

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Occupational hazards to health

Occupationally related disease and ill-health are an important cause of morbidity and mortality in the world. The occupational health team must be aware of the work hazards, understand how to assess the risks in a particular workplace and how these should be controlled, as well as be able to recognise, treat and control occupational disease should it occur.

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Wichita Falls, TX has opening for Occupational Med :: Texas :: Enterprise Medical Service
Replace a very well established Occupational Medicine Physician that has been there many years, but is leaving due to wife's career. Position would be employed by a large multi-specialty group, ready
Occupational Medicine Need for Decatur, IL :: Illinois :: Enterprise Medical Service
Need is a dedicated Occupational Medicine position. Salaried position with full benefits. Outpatient with phone call of 1:3. Caterpillar is one of many of the large industries in town. 4 Fortune
Close proximity to Portland :: Oregon :: Enterprise Medical Service
Terrific hospital employed Urgent Care/OCC MED opportunity in Woodburn, OR. Clinic is open 8A to 8P, 7 days per week. Clinic currently has 3 physicians and 2 mid-level providers. Physicians are typically

American Journal of Industrial Medicine

Occupational injuries among emergency responders
Audrey A. Reichard, Larry L. Jackson Thu, 05 Nov 2009 13:16:00 -0000
Emergency responders frequently incur injuries while providing medical, fire, and law enforcement services. National surveillance systems provide fragmented perspectives on responder injuries because they omit specific classes of workers (e.g., government or volunteers); they report only selected injuries; and employment information is incomplete.We characterized injuries among emergency medical services (EMS), firefighting, and police occupations by using data from the National Electronic Injury Surveillance System - Occupational Supplement (NEISS-Work) for injuries treated in U.S. hospital emergency departments in 2000-2001.Sprains and strains were the leading injury (33-41%) among EMS, firefighter, and police occupations. Police officers and career firefighters had the highest injury rates (8.5 and 7.4 injuries per 100 full-time equivalent workers, respectively).The physical demands of emergency response are a leading cause of injuries that may benefit from similar interventions across the occupations. To assess risk, improved exposure data need to be acquired, particularly for volunteers. Am. J. Ind. Med. Published 2009 Wiley-Liss, Inc.
Agricultural tractor overturn deaths: Assessment of trends and risk factors
John R. Myers, Kitty J. Hendricks Thu, 05 Nov 2009 13:17:00 -0000
Tractor overturn deaths have been recognized as a public health concern for decades. Studies have reported on the hazards associated with tractor overturns, but none have reported on trends in tractor overturn fatality rates in the United States (US).Tractor overturn fatality data from the Bureau of Labor Statistics Census of Fatal Occupational Injuries were used in Poisson regression models to: identify risk factors associated with overturn fatalities; examine trends in tractor overturn fatality rates between 1992 and 2007; and assess trends in overturn fatality rates for specific risk factors.Characteristics found to be associated with tractor overturn fatality rates were age, type of farm, region, and the victim's relationship to the farm (P < 0.0001). Older age groups, crop farms, farms in the Midwest and Northeast, and family workers all had higher fatal tractor overturn risks. Overall, tractor overturn fatality rates declined 28.5% between 1992 and 2007. Significant decreases in tractor overturn fatality rates were found for the Northeast and South regions, hired workers, crop farms, and in every age group except those less than 25 years of age.Tractor overturn fatality rates decreased between 1992 and 2007. These decreases were not consistent between different categories of the agricultural workforce or regions of the US. Changes in tractor overturn fatality rates may be partially explained by increases in the prevalence of ROPS on farm tractors in the US. ROPS promotion programs are needed to reduce tractor overturn fatalities, especially among those subpopulations at highest risk. Am. J. Ind. Med. Published 2009 Wiley-Liss, Inc.
Effectiveness of the training program for workers at construction sites of the high-speed railway line between Torino and Novara: Impact on injury rates
A. Bena, P. Berchialla, M.E. Coffano, M.L. Debernardi, L.G. Icardi Wed, 28 Oct 2009 09:46:00 -0000
There are very few published studies evaluating the impact of safety and health training on injury outcomes in the construction industry. The aim of this study was to assess the impact of the training program on injury rates at a major railway construction project.The population consisted of 2,795 workers involved in a safety training program at the construction sites of the high-speed railway line Torino-Novara. Two types of analyses were carried out in order to assess the effectiveness of the training program in reducing the number of injuries: (i) a pre-post analysis, which took into account the fact that workers were enrolled at different times and the training intervention did not occur at the same time for all subjects; (ii) an interrupted time-series model, which corrected for the time trend and considered the autocorrelation between individual observations.Twenty-nine percent of workers who spent at least 1 day at the construction sites attended at least one training module. Pre-post analysis: At the end of the training program, the incidence of occupational injuries had fallen by 16% after the basic training module and by 25% following the specific modules. Time-series model: Training led to a 6% reduction in injury rates, which was not statistically significant.The training program that was implemented had a moderately positive impact on the health of workers. Further studies are being conducted to obtain a more complete assessment of the actual effectiveness of the program in reducing the incidence of injuries. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.
Incidence of tuberculosis and HIV and progression of silicosis and lung function impairment among former basotho gold miners
Harriet H. Park, Brendan V. Girdler-Brown, Gavin J. Churchyard, Neil W. White, Rodney I. Ehrlich Wed, 28 Oct 2009 09:46:00 -0000
Pulmonary tuberculosis and HIV incidence, mortality, and the progression of silicosis and lung function impairment are described over a 1-year period in migrant ex-gold miners from Lesotho.Seven hundred seventy-nine Basotho miners were followed for 1 year starting 18 months after lay-off from a South African gold mine in 1998. At baseline and follow-up, they underwent a respiratory symptom interview, physical examination, HIV test, chest radiograph, and spirometry.Five hundred thirteen of 779 (65.9%) participants attended both baseline and follow-up visits. HIV incidence was 5.4/100 person-years (95% CI: 3.4-8.2). Prevalence of silicosis (ILO score [ge]1/1) was 26.6% at baseline and 27.0% at follow-up. Active tuberculosis diagnosed at baseline was a strong predictor of radiological progression of silicosis. Lung function as measured by FEV1 declined an average of 91 ml between visits (95% CI: 67-116 ml). Calculated minimum incidence of tuberculosis was 3,085/100,000/years (95% CI: 1,797-4,940) at follow-up. Of those seen at baseline, 18 died before their scheduled follow-up visit (mean age: 51 years).High rates of mortality and of HIV infection and pulmonary tuberculosis were found in this cohort after leaving the South African goldmines. Continuing lung function loss was also apparent. A partnership between the South African mining industry and governments in labor-sending areas of Southern Africa is needed to provide continuity of care and access to HIV and tuberculosis treatment and prevention services. Active silicosis surveillance and an improved statutory compensation system are also needed. These findings can serve as a baseline against which the impact of such interventions can be assessed. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.
Effectiveness of an occupational health intervention program to reduce whole body vibration exposure: An evaluation study with a controlled pretest-post-test design
Ivo J.H. Tiemessen, Carel T.J. Hulshof, Monique H.W. Frings-Dresen Wed, 28 Oct 2009 09:46:00 -0000
An effective intervention program aiming to reduce whole body vibration (WBV) exposure at work will reduce the number of low back complaints in the near future.An evaluation study with a controlled pretest-post-test design. Nine companies and 126 drivers were included in the study. Cluster randomization on company level divided the drivers and their employers in an intervention group and a "care-as-usual" group. At baseline (T0) and intervention program was implemented and evaluated after 7 months (T1). The main outcome measure was WBV exposure. Process measures included knowledge, attitude, and (intended) behavior towards reduction of WBV exposure for the drivers and knowledge and WBV policy for the employers.At T1, no significant reduction was found in WBV exposure within both groups compared with T0.Probably due to poor to moderate compliance, the intervention program was not effective in reducing the WBV exposure on group level but small reductions in WBV exposure are possible when intervention compliance is high. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.
Farmer exposure to organic solvents during the maintenance and repair of farm machinery: A pilot study
Terry L. Bunn, Youcheng Liu, Kiyoung Lee, Medearis Robertson, Lei Yu Wed, 28 Oct 2009 09:47:00 -0000
The maintenance/repair of farm machinery is a common farming activity. Dermal exposure to organic solvents has not been well documented. A pilot study was conducted to characterize exposure to organic solvents.A survey questionnaire was administered to 31 Kentucky farmers in 2008. Dermal exposure assessment was conducted in 10 farmers while farmers performed farm machinery maintenance/repair tasks using a solvent sampling patch. Benzene, toluene, xylene, and n-hexane were analyzed.All four organic solvents were identified from the samples with toluene (<0.5-36,000 µg/patch) and xylene (15-5,700 µg/patch) at significantly higher levels. Twenty-six farmers reported the use of personal protective equipment <50% of their time repairing/maintaining farm machinery on the questionnaire; only two farmers wore gloves during the exposure assessment.Farmers routinely use solvent products for farm machinery maintenance/repair. Dermal exposure to organic solvents is a potential hazard. Further studies to characterize and evaluate exposure in larger samples of farmers are needed. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

International Archives of Occupational and Environmental Health

Asthma and lower respiratory symptoms in New York State employees who responded to the World Trade Center disaster
Wed, 04 Nov 2009 19:54:15 -0000
Abstract Purpose  To investigate whether New York State employees who responded to the World Trade Center disaster were more likely to report asthma or lower respiratory symptoms (LRS; cough, wheeze, chest tightness, shortness of breath) than non-exposed employees, 2 years post-September 11. Methods  Participants (578 exposed, 702 non-exposed) completed mailed questionnaires in 2003. A unique exposure assessment method was used; exposure scores were divided at the mean (at/below, above). Poisson regression was used. Results  Exposure was associated with LRS, but not asthma. Participants with exposure scores at/below the mean had a twofold increased risk of most LRS. Those with scores above the mean had a three to fourfold increased risk. For scores above the mean, the magnitude of effect was consistently higher for smoke exposure. Conclusions  Moderately exposed responders may experience health impacts from exposures in later stages of a disaster. Exposure to smoke may have had a greater lower respiratory impact than resuspended dust. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0474-xAuthors Matthew P. Mauer, New York State Department of Health Bureau of Occupational Health, Center for Environmental Health Flanigan Square, Room 230, 547 River Street Troy NY 12180 USAMichele L. Herdt-Losavio, New York State Department of Health Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health Troy NY USAG. Anders Carlson, New York State Department of Health Division of Environmental Health Investigation, Center for Environmental Health Troy NY USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131
Gender moderates the health-effects of job strain in managers
Tue, 03 Nov 2009 21:14:40 -0000
Abstract Purpose  To investigate cross-sectional associations between main, interactive and gender-dependent effects of the demand–control–support (DCS) model and subjective health in managers. Methods  Data of 424 German, Austrian and Swiss managers were collected at leadership seminars and through presentation of the study at meetings of staff managers and senior executives. Hierarchical regression models controlling for age, hierarchy and non-linear relationships were computed to assess associations between main, interactive and gender-dependent effects of the DCS dimensions (measures of job demands, job control, social support) and subjective health (measures of self rated health and psychosomatic complaints). Results  Social support was associated with both indicators of subjective health. Inconsistent results were obtained for the main effects of job demands and job control. Concerning the interaction effects of the model, a significant three-way interaction was observed: high job control and high social support seem to buffer the adverse health effects of high job demands. This interaction was moderated by gender. Female managers experience more psychosomatic complaints working in high demand, low control, low support settings than their male colleagues. While women seem to experience a higher buffering effect from social support than from job control, male managers may benefit equally from social support and job control. Conclusions  In managers, gender moderates the health-related effects of the psychosocial work environment. The gender-dependent effects of the DCS model may play a crucial role in the understanding of female managers’ adverse health perceptions. Increasing social support for female managers may help to overcome gender inequalities in management positions. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0477-7Authors M. C. Gadinger, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyJ. E. Fischer, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyS. Schneider, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyD. D. Terris, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyK. Krückeberg, Henley Management College Grennlands, Henley-on-Thames Oxfordshire RG9 3AU UKS. Yamamoto, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyG. Frank, Medical Practice for General Medicine Uferstrasse 60 69120 Heidelberg GermanyW. Kromm, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131
Focusing ethical dilemmas of evidence-based practice in SMF-exposed MRI-workers: a qualitative analysis
Tue, 03 Nov 2009 21:14:37 -0000
Abstract Purpose  To analyze ethical dilemmas for occupational health physicians and other stakeholders involved in the implementation of a surveillance program in workers exposed to static magnetic fields (SMF) used in magnetic resonance imaging. Methods  The ethical analysis was carried out according to the model proposed by Westerholm and others, which takes into account two elements: (i) the stakeholders involved in the decision process and (ii) the ethical principles of beneficence, autonomy and justice. The analysis is based on the assessment of ethical costs (violating the consistent principle) and ethical benefits (fulfillment of the consistent principle) for workers, employers, occupational health physicians, community, workers’ representatives and medical inspectors. Results  According to the European Directive 2004/40/EC (Official Journal of the European Union, Luxemburg), employers must ensure that health surveillance is carried out to prevent adverse health effects in SMF-exposed workers. However, limited scientific evidence on health effects from SMF influences the decision of undertaking appropriate health surveillance. The uncertainties entail a number of ethical conflicts, such as the choice of reliable indicators, the interpretation of abnormal data, the complexity of the decision-making process resulting in a fitness judgment and the diversion of funds for more effective practices. Conclusions  The analysis shows that the decision-making process aiming at the provision of evidence-based health surveillance to SMF-exposed workers is characterized by controversial ethical costs and ethical benefits for workers and the other stakeholders. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0476-8Authors Giuliano Franco, Università di Modena e Reggio Emilia Dipartimento di Medicine e delle specialità mediche Largo del Pozzo 71-41100 Modena ItalyErika Mora, Università di Modena e Reggio Emilia Dipartimento di Medicine e delle specialità mediche Largo del Pozzo 71-41100 Modena ItalyRiccardo Perduri, Università di Modena e Reggio Emilia Dipartimento di Medicine e delle specialità mediche Largo del Pozzo 71-41100 Modena Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131
Work-related fatigue: the specific case of highly educated women in the Netherlands
Tue, 03 Nov 2009 21:14:35 -0000
Abstract Purpose  This study aims to establish the prevalence of high work-related fatigue (need for recovery, NFR) among employees and to explain group differences categorized by gender, age, and education. The study particularly aims to clarify prevalence and explanatory factors in highly educated women. Methods  In 2005 and 2006, large representative samples of 80,000 Dutch employees (net response rate 33.0%; N = 47,263) received the Netherlands working conditions survey questionnaire. First, we calculated the prevalence of high NFR for men and women with different age and education levels. The average prevalence of high NFR was 28.8% and was highest among highly educated women (35.2%) in particular those aged 50–64 years (40.3%). Second, logistic regression analyses were used to compare subgroups’ NFR in relation to situational factors, working conditions, and health. Three comparisons were made: (1) highly educated women versus men; (2) highly educated versus lower educated women and; (3) older highly educated versus younger highly educated women. Results  The situational, working conditions and health factors in our model did not explain the gender differences among highly educated employees (OR = 1.37; CI = 1.3–1.5, adjusted for all factors OR = 1.32; CI = 1.2–1.5). Despite that lower autonomy and workplace violence explained highly educated women’s NFR, working fewer hours counterbalanced this. Time pressure in work largely explained the differences in NFR among women at different education levels (crude OR 1.44; CI = 1.4–1.5, adjusted OR 1.14; CI = 1.0–1.3). In the age comparison, lower health ratings, more adverse working conditions, and working as a teacher explained older highly educated women’s high prevalence of high NFR (crude OR 1.32; CI = 1.2–1.5, adjusted OR 0.94; CI = 0.8–1.2). Conclusion  NFR has high prevalence in highly educated women (35.2%) in particular those aged 50–64 years (40.3%). Our model did not explain gender differences in NFR, because working fewer hours counterbalanced the effects of lower autonomy and external workplace violence. Our model, in particular time pressure, largely explained differences in NFR between women at different education levels. Age differences in the prevalence of high NFR among highly educated women’s were fully explained by our model. Main factors were lower health ratings, adverse working conditions, and working as a teacher. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0481-yAuthors Petra Verdonk, Maastricht University Caphri, Social Medicine Universiteitssingel 40 P.O. Box 616 6200 MD Maastricht The NetherlandsWendela E. Hooftman, TNO Quality of Life, Division Work and Employment Polarisavenue 151 P.O. Box 718 2130 AS Hoofddorp The NetherlandsMarc J. P. M. van Veldhoven, Tilburg University Human Resource Studies Warandelaan 2 P.O. Box 90153 5000 LE Tilburg The NetherlandsLouise R. M. Boelens, Bureau Boelens Willem Barentszstraat 56 3572 PL Utrecht The NetherlandsLando L. J. Koppes, TNO Quality of Life, Division Work and Employment Polarisavenue 151 P.O. Box 718 2130 AS Hoofddorp The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131
Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case–control study
Tue, 03 Nov 2009 11:09:10 -0000
Abstract Purpose  Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case–control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer. Methods  Of 58 patients, 31 diagnosed with sinonasal adenocarcinoma (cases) between 1973 and 2007 were identified and underwent standardized interview on clinical data. A total of 85 patients diagnosed over the same period with carcinoma of the oral cavity served as controls. Results  The ethmoid was confirmed as the predominant site of adenocarcinoma associated with wood dust exposure, whereas the nasal cavity was most commonly affected in patients denying any exposure to wood dust. Cases were significantly engaged in mainly woodworking occupations compared to controls. The main initial clinical symptoms were nasal obstruction 6 months (71%) and epistaxis 4 years (41.9%) prior to diagnosis. Hardwood dust from beech and oak proved to be the most common occupational exposure, with a mean exposure period of 32.3 years and a latency of 43.5 (34–58) years. Conclusions  Our investigation confirms the importance of regular screenings for persons exposed to wood dust even years after the end of occupational or private exposure. Banal clinical symptoms such as epistaxis and nasal obstruction might be predictive, requiring early and thorough investigation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0479-5Authors Susanne Ingrid Mayr, Friedrich-Alexander University of Erlangen-Nuremberg Department of Otolaryngology, Head and Neck Surgery Waldstraße 1 91054 Erlangen GermanyKamber Hafizovic, Friedrich-Alexander University of Erlangen-Nuremberg Department of Otolaryngology, Head and Neck Surgery Waldstraße 1 91054 Erlangen GermanyFrank Waldfahrer, Friedrich-Alexander University of Erlangen-Nuremberg Department of Otolaryngology, Head and Neck Surgery Waldstraße 1 91054 Erlangen GermanyHeinrich Iro, Friedrich-Alexander University of Erlangen-Nuremberg Department of Otolaryngology, Head and Neck Surgery Waldstraße 1 91054 Erlangen GermanyBirgitta Kütting, Friedrich-Alexander University of Erlangen-Nuremberg Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine Schillerstr. 25 91054 Erlangen Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131
Exposure of children to polycyclic aromatic hydrocarbons in Mexico: assessment of multiple sources
Tue, 03 Nov 2009 11:09:09 -0000
Abstract Purpose  Biological monitoring of polycyclic aromatic hydrocarbons (PAHs) has expanded rapidly since urinary 1-hydroxypyrene (1-OHP) was suggested as a biological index for pyrene. Taking into account that pyrene is often present in PAHs mixtures, 1-OHP has also been considered an indirect indicator of exposure to these mixtures. Sources of PAHs in developing countries are numerous; however, exposure of children to PAHs has not been studied in detail. Therefore, the aim of this study was to assess exposure of children to PAHs in different scenarios: (a) children living next to highways with heavy traffic; (b) sanitary landfill; (c) brick kiln communities and (d) children exposed to biomass combustion. Methods  A total of 258 children (aged 3–13) participated in the study. The analyses were performed by HPLC with fluorescence detector. Urinary 1-OHP concentrations were then adjusted by urinary creatinine. Results  The highest levels of 1-OHP in this study were found in children exposed to biomass combustion (mean value 3.25 μmol/mol creatinine), but exposure was also detected in children living in communities with brick kiln industry (mean 0.35 μmol/mol creatinine), or in a community next to a sanitary landfill (with waste combustion) (0.30 μmol/mol creatinine) and in children exposed to traffic (mean value 0.2 μmol/mol creatinine and 0.08 μmol/mol creatinine). Conclusions  Considering our results and taking into account that millions of children in Mexico are living in scenarios similar to those studied in this work, the assessment of health effects in children exposed to PAHs is urgently needed; furthermore, PAHs have to be declared contaminants of concern at a national level. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0482-xAuthors Rebeca I. Martínez-Salinas, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoM. Elena Leal, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoLilia E. Batres-Esquivel, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoGabriela Domínguez-Cortinas, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoJacqueline Calderón, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoFernando Díaz-Barriga, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoIván N. Pérez-Maldonado, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. Mexico Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Occupational Therapy International

Post-stroke fatigue: qualitative study of three focus groups
Nancy A. Flinn, Jan E. Stube Mon, 28 Sep 2009 05:18:00 -0000
Fatigue affects many persons after cerebrovascular accident, particularly those with mild stroke. A qualitative methodology using focus groups with 19 community-living post-stroke survivors was utilized to explore the occupational impact of fatigue as communicated by the participants. Although self-report of a small sample of the United States' post-stroke population will have limitations in generalizability, this study identifies specific health-related quality of life issues that can occur with post-stroke fatigue. The participants felt unprepared for the fatigue phenomenon and struggled to adapt, with fatigue having a debilitating influence upon daily occupational performance and roles, including social participation, return to work, driving, reading and sleeping. The participants indicated that exercise (such as walking and water aerobics) and use of assistive technology were helpful strategies in reducing fatigue. The occupational performance and role impact identified by participants in this study can inform the design of effective occupational therapy interventions and further quantitative study of persons with post-stroke fatigue. Copyright © 2009 John Wiley & Sons, Ltd.
Occupational therapy students' attitudes towards inclusion education in Australia, United Kingdom, United States and Taiwan
Keli Mu, Ted Brown, Claudia G. Peyton, Sylvia Rodger, Yan-Hua Huang, Chin-Yu Wu, Callie Watson, Karen Stagnitti, Eve Hutton, Jackie Casey, Chia Swee Hong Fri, 21 Aug 2009 06:45:00 -0000
This international, cross-cultural study investigated the attitudes of occupational therapy students from Australia, United Kingdom, United States and Taiwan towards inclusive education for students with disabilities. The possible impact of professional education on students' attitudes was also explored. A total of 485 students from 11 entry-level occupational therapy education programmes from Australia, the United Kingdom, the United Sates and Taiwan participated in the study. Among them, 264 were freshmen (first-year students) and 221 were seniors (final-year students). Data collected from a custom-designed questionnaire were analysed both quantitatively and qualitatively.In general, the occupational therapy students reported having positive attitudes towards inclusion. Considerable differences, however, existed among the student groups from the four countries. Professional education appeared to have a significant impact on students' attitudes towards inclusion from first year to senior year. Although students were in favour of inclusion, they also cautioned that their support for inclusive practices depended on various factors such as adequate preparation, support and assistance to students with disabilities.Limitations of the study included the small, convenience sample and different degree structures of the participating programmes. Future research studies need to compare occupational therapy students' attitudes with students from other health care professions. A longitudinal study on the impact of the professional education programme on students' attitudes towards inclusive education is warranted. Copyright © 2009 John Wiley & Sons, Ltd.
Identifying indicators of well-being for caregivers of children with disabilities
Elizabeth Larson Mon, 17 Aug 2009 08:39:00 -0000
This study identified key indicators of well-being for caregivers of children with disabilities, Thirty-nine caregivers completed life satisfaction and psychological well-being (WB) measures, and qualitative interviews. Data analysis included descriptive statistics of WB measures and categorical analysis of qualitative data. Data triangulation was achieved by importing theoretically derived codes for initial qualitative coding and quantitizing qualitative categories. Core indicators focused on positive family functioning and a reasonable family lifestyle, caregiver's personal growth and capacity to manage life demands, and the importance of daily balance. Study limitations included no standardized assessments of the child with disabilities' functioning, and the inclusion of caregivers with a range of years of experience. Findings suggest therapists need to attend to how interventions foster or impede positive family functioning and assist caregivers in balancing daily occupations to support capacity to caregiving. Future research should examine how well-being varies over time as caregivers adapt from initial and later caregiving. Copyright © 2009 John Wiley & Sons, Ltd.

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Williams, N.

pubmed: 0355-3140

The interplay between physical activity at work and during leisure time - risk of ischemic heart disease and all-cause mortality in middle-aged Caucasian men.
Holtermann A, Mortensen OS, Burr H, Søgaard K, Gyntelberg F, Suadicani P Related Articles The interplay between physical activity at work and during leisure time - risk of ischemic heart disease and all-cause mortality in middle-aged Caucasian men. Scand J Work Environ Health. 2009 Oct 21;:466-474 Authors: Holtermann A, Mortensen OS, Burr H, Søgaard K, Gyntelberg F, Suadicani P OBJECTIVE: Our aim was to test the hypothesis that a high level of physical activity during leisure time increases the risk of ischemic heart disease (IHD) mortality among men with high physical work demands. METHODS: We carried out a 30-year follow-up of the Copenhagen Male Study of 5249 caucasian, male workers aged 40-59 years; 274 men with overt cardiovascular disease were excluded from the follow-up. RESULTS: During the follow-up period, 591 men (11.9%) died from IHD. Cox analyses of men with low (N=1236), medium (N=2651), and high (N=858) physical work demands showed that those with high demands had a higher risk of IHD mortality compared to men with low demands [age-adjusted hazard ratio 1.51, 95% confidence interval (95% CI) 1.18-1.94]. In all three groups, men with a low level of physical activity during leisure time had a higher risk of IHD than men with a medium or high level. Overall, the age-adjusted hazard ratio for IHD mortality associated with a high level of leisure time physical activity was 0.49 (95% CI 0.34-0.70). Among workers with high physical work demands, the hazard ratio for IHD mortality (adjusted for confounders) was 0.82 (95% CI 0.42-1.56) for a high level of leisure time physical activity and 0.62 (95% CI 0.40-0.97) for a moderate level. CONCLUSION: We did not find support for the hypothesis that a high level of physical activity during leisure time increases the risk of IHD mortality among men with high physical work demands and with no pre-existing clinical cardiovascular disease. In contrast, moderate and high levels of activity during leisure time seemed to be protective against IHD mortality among people with medium and high physical activity at work. PMID: 19851700 [PubMed - as supplied by publisher]
Fate of abstracts presented at an International Commission on Occupational Health (ICOH) congress - followed by publication in peer-reviewed journals?
Rollin L, Darmoni S, Caillard JF, Gehanno JF Related Articles Fate of abstracts presented at an International Commission on Occupational Health (ICOH) congress - followed by publication in peer-reviewed journals? Scand J Work Environ Health. 2009 Oct 9;:461-465 Authors: Rollin L, Darmoni S, Caillard JF, Gehanno JF OBJECTIVES: Presentations at international meetings offer an excellent way to disseminate current research findings. One measure of the quality of research is its subsequent publication. Our study aimed to determine the publication rate of abstracts presented at a congress of the International Commission of Occupational Health (ICOH), and to identify predictive factors of publication and differences between presented abstracts and -subsequently published papers. METHODS: We identified a random sample of 318 abstracts presented at the 2000 ICOH meeting from the book of abstracts. Using Medline and Embase, we assessed their publication rate in the period ranging from 1998 to 2006 and investigated the factors associated with publication rate. RESULTS: Of 318 abstracts originating from 51 countries, 105 articles [33%, 95% confidence interval (95% CI) 27-38)] were subsequently published in 67 journals indexed in Medline or Embase. Mean time to publication was 17 months (95% CI 13-21). Multivariate analysis revealed that abstracts with quantitative data and written by authors originating from developed countries were significantly more published. From the time of abstract presentation to publication in a peer-reviewed journal, both the study sample size and the first author frequently changed (respectively 25% and 29%), but the overall conclusions remained stable, except in one case. CONCLUSIONS: Most of the abstracts presented at the 2000 ICOH congress were not subsequently published as full research reports. If this is the case for most abstracts submitted to conferences, this may limit the ability of a reader to judge the validity, reliability, and generalizability of the research presented. Caution is advised when referencing or generalizing from abstracts that have not been subsequently published in full. PMID: 19851699 [PubMed - as supplied by publisher]

Annals of Occupational Hygiene - current issue

Data Sharing, Federal Rule of Evidence 702, and the Lions in the Undergrowth
Ogden, T. Many concerns would find it useful to have a publicly available database recording exposures to particular substances, with contextual information. The European Union's Registration, Evaluations, Authorisation, and restriction of Chemicals regulation has increased interest in this. It has been suggested that journals should require detailed publication of exposure data with papers. But there are problems for researchers, for whom the data are a valuable resource which has been obtained with effort and often ingenuity. The publication could also raise problems of confidentiality and liability, and those who have to put the effort in publication are not those who benefit. Also, there are the problems of hostile critics misusing the information—for example, industry reanalysing data to counter any regulatory implications of a study—and this raises serious wider issues of editorial policy. Two books have recently given examples of industry misuse of science, ‘Doubt is their product’ by David Michaels and ‘Defending the indefensible’ by McCullogh and Tweedale. Michaels gives examples of hostile data reanalysis, and among other things, he discusses the impact on journals of US Federal Rule of Evidence 702, which encourages expert witnesses to try to get their testimony material into peer-reviewed journals. This certainly lies behind some submissions to this journal, and Michaels says that it has led to the creation of peer-reviewed journals which have strong industry influence. On the other hand, work funded by industry is not always wrong, papers from other sources are not always free from bias, and the problem for journals is to continue to apply consistent scientific standards in a sea of conflicting interests. It does not seem feasible or desirable for journals to insist on the publication of all the underlying data, although researchers might be encouraged to form consortia to share data.
Trends in Wood Dust Inhalation Exposure in the UK, 1985-2005
Galea, K. S., Van Tongeren, M., Sleeuwenhoek, A. J., While, D., Graham, M., Bolton, A., Kromhout, H., Cherrie, J. W. Objectives: Wood dust data held in the Health and Safety Executive (HSE) National Exposure DataBase (NEDB) were reviewed to investigate the long-term changes in inhalation exposure from 1985 to 2005. In addition, follow-up sampling measurements were obtained from selected companies where exposure measurements had been collected prior to 1994, thereby providing a follow-up period of at least 10 years, to determine whether changes in exposure levels had occurred, with key staff being interviewed to identify factors that might be responsible for any changes observed. Methods: Analysis of the temporal trend in exposure concentrations was performed using Linear Mixed Effect Models on the log-transformed NEDB data set and expressed as the relative annual change in concentration. Results: For the NEDB wood dust data, an annual decline of geometric mean (GM) exposure of 8.1% per year was found based on 1459 exposure measurements collected between 1985 and 2003. This trend was predominantly observed in data from inspection visits (measurements collected on a mandatory basis by a Specialist HSE Inspector) (n = 1009), while data from representative surveys (measurements collected on a voluntary basis to provide information on current practices and exposures) remained relatively stable. Ten follow-up surveys in individual workplaces in 2004–2005 resulted in 70 new measurements and for each of the companies resurveyed, the GM of the wood dust exposure decreased between sampling surveys. Conclusion: Analysis of the temporal trend in UK wood dust exposure concentrations revealed declines of 8% per annum. Interviews with key long-serving employees and management suggest that factors such as technological changes in production processes, response to new legislation, and enforcement agency inspections, together with global economic trends, could be linked to the downward trends observed.
Beryllium Decontamination with Different Solvents on Different Structures
Dufresne, A., Dion, C., Viau, S., Perrault, G. The objective of the present work was to estimate the efficiency of moistened wipes in removing beryllium with different solutions including CitranoxTM, AlconoxTM, NaCl 5%, ResolveTM, and LedizolvTM on various types of surfaces such as unpainted metal, wood frames, painted metal, concrete, painted concrete, and PlexiglasTM from three different occupational settings. Of the three plants that were investigated, only surfaces in the aluminium smelter were decontaminated down to the clearance reference level of 0.2 µg 100 cm–2, with all the solvents used. In the machine tooling and milling department, the clearance level of 0.2 µg 100 cm–2 was reached after the three decontaminations, with all the solvents. In the machine plant for the military, aerospace, and telecommunications industries, the beryllium concentrations on the concrete wall, before decontamination with the high-pressure gun, were usually >3 µg 100 cm–2, and concentrations as high as 31 µg 100 cm–2 were measured. After the high-pressure cleanup, the beryllium concentrations were sometimes reduced by a factor of 10, but never reached the clearance level. Beryllium compounds that had adhered to most types of structures that we attempted to decontaminate were reduced to below the clearance reference value except on concrete floors. There did not seem to be any difference between the decontamination actions for all the solvents used in this study.
Quantification and Statistical Modeling--Part I: Breathing-Zone Concentrations of Monomeric and Polymeric 1,6-Hexamethylene Diisocyanate
Fent, K. W., Gaines, L. G. T., Thomasen, J. M., Flack, S. L., Ding, K., Herring, A. H., Whittaker, S. G., Nylander-French, L. A. We conducted a repeated exposure-assessment survey for task-based breathing-zone concentrations (BZCs) of monomeric and polymeric 1,6-hexamethylene diisocyanate (HDI) during spray painting on 47 automotive spray painters from North Carolina and Washington State. We report here the use of linear mixed modeling to identify the primary determinants of the measured BZCs. Both one-stage (N = 98 paint tasks) and two-stage (N = 198 paint tasks) filter sampling was used to measure concentrations of HDI, uretidone, biuret, and isocyanurate. The geometric mean (GM) level of isocyanurate (1410 µg m–3) was higher than all other analytes (i.e. GM < 7.85 µg m–3). The mixed models were unique to each analyte and included factors such as analyte-specific paint concentration, airflow in the paint booth, and sampler type. The effect of sampler type was corroborated by side-by-side one- and two-stage personal air sampling (N = 16 paint tasks). According to paired t-tests, significantly higher concentrations of HDI (P = 0.0363) and isocyanurate (P = 0.0035) were measured using one-stage samplers. Marginal R2 statistics were calculated for each model; significant fixed effects were able to describe 25, 52, 54, and 20% of the variability in BZCs of HDI, uretidone, biuret, and isocyanurate, respectively. Mixed models developed in this study characterize the processes governing individual polyisocyanate BZCs. In addition, the mixed models identify ways to reduce polyisocyanate BZCs and, hence, protect painters from potential adverse health effects.
Quantification and Statistical Modeling--Part II: Dermal Concentrations of Monomeric and Polymeric 1,6-Hexamethylene Diisocyanate
Fent, K. W., Trelles Gaines, L. G., Thomasen, J. M., Flack, S. L., Ding, K., Herring, A. H., Whittaker, S. G., Nylander-French, L. A. We conducted a quantitative dermal and inhalation exposure assessment of monomeric and polymeric 1,6-hexamethylene diisocyanates (HDI) in 47 automotive spray painters from North Carolina and Washington State. We report here the use of linear mixed modeling (LMM) to identify the primary determinants of dermal exposure. Dermal concentrations of HDI, uretidone, biuret, and isocyanurate were significantly higher in 15 painters who did not wear coveralls or gloves (N = 51 paint tasks) than in 32 painters who did wear coveralls and gloves (N = 192 paint tasks) during spray painting. Regardless of whether protective clothing was worn, isocyanurate was the predominant species measured in the skin [geometric mean (GM) = 33.8 ng mm–3], with a 95% detection rate. Other polyisocyanates (GM ≤ 0.17 ng mm–3) were detected in skin during <23% of the paint tasks. According to marginal R2 statistics, mixed models generated in this study described no <36% of the variability in dermal concentrations of the different polyisocyanates measured in painters who did not wear protective clothing. These models also described 55% of the variability in dermal concentrations of isocyanurate measured in all painters (N = 288 paint tasks). The product of analyte-specific breathing-zone concentration (BZC) and paint time was the most significant variable in all the models. Through LMM, a better understanding of the exposure pathways governing individual polyisocyanate exposures may be achieved. In particular, we were able to establish a link between BZC and dermal concentration, which may be useful for exposure reconstruction and quantitatively characterizing the protective effect of coveralls and gloves. This information can be used to reduce dermal exposures and better protect automotive spray painters from potential adverse health effects.
Guidance Values for Surface Monitoring of Antineoplastic Drugs in German Pharmacies
Schierl, R., Bohlandt, A., Nowak, D. Objectives: Antineoplastic drugs are widely used in anticancer therapy due to their cytotoxic activity but many of them are classified as carcinogenic, mutagenic, or teratogenic to humans. In order to evaluate personal exposure, surface monitoring has been successfully applied for several years. In this study, we present a statistical description of our data set from 102 German pharmacies and propose ‘threshold guidance values (TGVs)’ to facilitate interpretation of monitoring results. Methods: Our database included 1008 results for platinum (PT) and 1237 for 5-fluorouracil (FU) collected in 102 pharmacies in Germany. Wipe sampling on site was performed with one validated procedure. PT concentrations were measured by voltammetry and FU by gas chromatography/mass spectrometry. Data were stratified into 10 locations and statistically evaluated. Results: Contamination was detected on all surfaces in the pharmacies with high levels on storage shelves and floors. The median values for the different locations ranged from 0.20 to 1.70 pg cm–2 (mean: 0.57 pg cm–2) for PT and from 2.50 to 10.00 pg cm–2 (mean: 5.34 pg cm–2) for FU. The mean 75th percentiles were 3.92 pg cm–2 (PT) and 28.90 pg cm–2 (FU). The TGV 1 value was set at the median value and results below demonstrate good working practices. Contaminations above the TGV 2, which was assigned at the 75th percentile, show a clear need for optimizing the handling procedures. Conclusions: The introduction of TGVs helps to reduce occupational exposure and allows pharmacy personnel to benchmark their own contamination levels. This provides a basis for improvement in occupational safety precautions and for regular contamination controls.

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