Occupational_Medicine RSS : Gourt

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

Dearborn, MI needs FM provider for Clinic :: Michigan :: Enterprise Medical Service

Clinic in Dearborn, MI is seeking an Occupational Medicine provider to do Family Medicine in Clinic. Currently there are 60 Occupational Medicine providers and only one is doing Family Medicine. Work

Live, Work and Play in Ashland, OH :: Ohio :: Enterprise Medical Service

Healthcare system is seeking a full time Occupational Medicine provider to fill the position that part time providers currently hold. Hours are Monday - Friday, 8a - 5p. Very attractive compensation

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

Work in Northeastern Ohio :: Ohio :: Enterprise Medical Service

Physician owned and run since 1999 is looking for Primary care docs and Occ-Med providers. Full range of urgent care and occupational health services, including physical therapy and rehabilitation. Currently

North East Missouri :: Missouri :: Enterprise Medical Service

Occupational Medicine specialist need in NE Missouri due to growth. This hospital employed position will work out newly constructed medical office building on campus of new state-of-art 100 bed facility

Call for location :: Iowa :: Medical Doctor Associates

Several Iowa licensed providers needed for clinics in various sites throughout the state. Due to staff vacancies, these positions are both locums and temp to perm. To be considered for these positions,

Call for location :: Missouri :: Medical Doctor Associates

Primary care locums physicians needed statewide in Missouri. These are full-time locums positions available in multiple locations with assignments frequently available in locations within 80 miles of

Call for location :: Mississippi :: Medical Doctor Associates

OPPORTUNITY AVAILABLE for a primary care physician in northwest Mississippi. Physicians with permanent placement interests are our preferred candidates, however, locums candidates will also be considered.

Call for location :: Tennessee :: Medical Doctor Associates

Opportunities for physicians in outpatient medicine in Tennessee. We need locums physicians who can help out for 2 to 4 weeks at various locations around the state. Generally the positions can open

Call for location :: Colorado :: Medical Doctor Associates

OPPORTUNITY AVAILABLE in Northeast Colorado for a Part-time Primary Care Physician. Commutable from Denver. Physician needed to provide coverage for out-patient clinic one to two weekdays per week on

Call for location :: Tennessee :: Medical Doctor Associates

Opportunity for a Physician in Outpatient Medicine in East Central Tennessee (near Crossville). Hours are Monday through Friday, days. You may transition to a permanent position if there is mutual interest

Bullhead City :: Arizona :: Community Health Systems

Seeking BE or BC Occupational Medicine physician willing to do Primary Care which will include seeing toddlers to seniors. Physician will join a hospital owned clinic. This clinic will be a new partnership

Not Disclosed :: Indiana :: Locum Medical Group

A hospital in northern Indiana is seeking a permanent Occupational Medicine Practitioner. Candidates must be board certified or board eligible in Occupational Medicine. Compensation package includes:

Not Disclosed :: Ohio :: Locum Medical Group

A hospital-owned practice in Northeast Ohio is seeking a permanent Occupational Medicine physician. This is an established practice that is seeking a replacement for a physician who is retiring. The

Not Disclosed :: Texas :: Locum Medical Group

A clinic in the north Houston, Texas area is currently searching for Occupational Medicine coverage to begin September 8th, 2009 and continue until a permanent candidate is found. Standard hours are Monday-Friday

Massillon :: Ohio :: Community Health Systems

Affinity Medical Center is seeking to recruit a BC/BE Occupational Medicine Physician to join an established practice, replacing a physician who is retiring. The position is Monday through Friday during

OM 172748 :: California :: Carson Kolb Healthcare Group

SOUTHERN CALIFORNIA OCCUPATIONAL MEDICINE FOUR DAY WORK WEEK IMMEDIATE NEED FOR AN OCCUPATIONAL MEDICINE PHYSICIAN IN A GROWING MARKET Join a leading, National provider of Occupational Medicine and

Joplin :: Missouri :: St. John's Clinic

Seeking, motivated, and congenial Board Certified Occupational Medicine physician for a thriving community. Competitive compensation with a comprehensive benefit package; including

Boston :: Massachusetts :: New England Physician Recruitment Center

Occupational Medicine physician needed for hospital-based practice in western Massachusetts. Outpatient only; Monday-Friday. Practice includes pre-placement, DOT, and annual exams, as well as treatment

Evaluation of three ergonomic measures on productivity, physical work demands, and workload in gypsum bricklayers

This study evaluated the effects of a combination of three ergonomic measures designed to reduce the risk of low back complaints among gypsum bricklayers. The measures focused on optimizing working height and reducing carrying distances.A within-subjects (N = 10) controlled field study was used to compare the effects of working with the ergonomic measures with those of working with conventional working methods at the worksite during the course of a full working day. Productivity, work demands, and workload were assessed.No effects were found on productivity, total work time, duration of tasks, duration of carrying, or energetic or biomechanical workload. However, the duration and frequency of working between knee and hip height during a working day increased by 25% and 15%, respectively, due to the ergonomic measures. During the finishing task, the duration and frequency of working below knee level decreased significantly by 4 min and 71 times, respectively.The limited impact of the ergonomic measures argues for additional measures to reduce the risk of low back complaints. Am. J. Ind. Med. © 2010 Wiley-Liss, Inc.

Impact of musculoskeletal and medical conditions on disability retirement - a longitudinal study among construction roofers

To assess the intersection of work demands, chronic medical and musculoskeletal conditions, aging, and disability, we initiated a longitudinal study of construction roofers who were current union members between the ages of 40 and 59.Participants were asked about the presence of medical conditions and musculoskeletal disorders; the Work Limitations Questionnaire, the SF-12, and other validated assessments of social and economic impact of injury were included.Factors at baseline that predicted leaving for a health-related reason were older age, lower physical functioning, work limitations, and having missed work. Those who left roofing for a health-related reason were much more likely to have a lower economic score at the 1 year interview.Medical and musculoskeletal conditions are strongly associated with work limitation, missed work, and reduced physical functioning; these factors are also associated with premature departure from the workforce. Am. J. Ind. Med. © 2010 Wiley-Liss, Inc.

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Scopoli's work in the field of mercurialism in light of today's knowledge: Past and present perspectives

The Idrija Mercury Mine (1490-1994) appointed its first physician, Joannes Antonius Scopoli, in 1754. Most of his descriptions of mercurialism are still relevant today. This study highlights Scopoli's observations on the interaction between elemental mercury (Hg°) and alcohol, on the appearance of lung impairment, insomnia, and depressive mood in mercurialism. This presentation is based on Scopoli's experiences presented in his book, De Hydrargyro Idriensi Tentamina (1761), current knowledge, and our own experience acquired through health monitoring of occupational Hg° exposure. Some studies have confirmed Scopoli's observation that alcohol enhances mercurialism and his hypothesis that exposure to high Hg° concentrations causes serious lung impairment. Neurobiological studies have highlighted the influence of Hg° on sleep disorder and depressive mood observed by Scopoli. Although today's knowledge provides new perspectives of Scopoli's work on mercurialism, his work is still very important and can be considered a part of occupational medicine heritage. Am. J. Ind. Med. © 2010 Wiley-Liss, Inc.

Using community-based participatory research to design and initiate a study on immigrant worker health and safety in San Francisco's Chinatown restaurants

Restaurant workers have among the highest rates of work-related illness and injury in the US, but little is known about the working conditions and occupational health status of Chinese immigrant restaurant workers.Community-based participatory research (CBPR) was employed to study restaurant working conditions and worker health in San Francisco's Chinatown. A community/academic/health department collaborative was formed and 23 restaurant workers trained on research techniques and worker health and safety. A worker survey instrument and a restaurant observational checklist were collaboratively developed. The checklist was piloted in 71 Chinatown restaurants, and the questionnaire administered to 433 restaurant workers.Restaurant workers, together with other partners, made substantial contributions to construction of the survey and checklist tools and improved their cultural appropriateness. The utility of the checklist tool for restaurant-level data collection was demonstrated.CBPR holds promise for both studying worker health and safety among immigrant Chinese restaurant workers and developing culturally appropriate research tools. A new observational checklist also has potential for restaurant-level data collection on worker health and safety conditions. Am. J. Ind. Med. © 2010 Wiley-Liss, Inc.

Case-control study of pleural mesothelioma in workers with social security in Mexico

Environmental and occupational exposure to asbestos in Mexico in the past has been a cause of deaths and health damages. Its magnitude is unknown to date. Our objective was to identify the proportion of cases of malignant pleural mesothelioma (MPM) that can be attributed to and occupational exposure to asbestos.We carried out a case-control study of MPM in 472 workers insured by the Mexican Institute of Social Security, all Valley of Mexico residents, with 119 incident cases and 353 controls. Cases were histologically confirmed. Participants were questioned concerning their occupational history and sociodemographic data. Assignment to one of the four exposures was performed qualitatively by an expert hygienist. Odds ratios (ORs) and attributable risks (ARs) were calculated using a non-conditional logistic regression model.A total of 80.6% of cases and 31.5% of controls had occupational exposure to asbestos. ORs were adjusted for age and gender and by exposure category, and exhibited an increase with probability of exposure as follows: 3.7(95% CI 1.3-10.4) for the likely category and 14.3(95% CI 8-26) for the certain category; AR in the group occupationally exposed to asbestos was 83.2%, and the population AR was 44%.Our results show that the relationship between industrial uses of all forms of asbestos is generating an increase in mesothelioma-related diseases and deaths among Mexican workers. As a public health policy, Mexico should prohibit the use of asbestos in all production processes with the aim of controlling the epidemic and preventing the occurrence of new cases of MPM. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Follow-up of neck and shoulder pain among sewing machine operators: The Los Angeles garment study

The aim of the present study is to explore factors affecting or modifying self-reported neck/shoulder pain in sewing machine operators.We investigated self-report neck/shoulder pain in 247 workers who participated in a 4-month prospective intervention study for musculoskeletal disorders. All participants were immigrants. We examine the influence of individual and work-related factors on changes in neck/shoulder pain during follow-up employing linear mixed models with time-spline functions.We observed a dramatic decline (72%) in self-reported pain intensity in the first month of follow-up, followed by a small increase from the first to fourth month (4% per month). Workers who perceived and reported their physical workload as high or worked overtime experienced less overall pain reduction. Higher baseline pain intensity, being of Hispanic ethnicity (vs. Asian), and taking cumulative daily rest time during work of 35 min or more allowing for muscles to rest were associated with a larger pain reduction in the first month, but not thereafter.Our findings indicate that some work-related factors may be of clinical relevance for reducing neck/shoulder pain. Having lower physical workloads and less overtime work should be considered when treating patients or planning workplace interventions for managing work-related musculoskeletal disorders in this underserved immigrant population. Am. J. Ind. Med. 2009. © 2009 Wiley-Liss, Inc.

Airways obstruction among older construction and trade workers at Department Of Energy nuclear sites

A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former workers participating in medical screening programs at Department of Energy (DOE) nuclear weapons facilities through September 2008 was undertaken.Participants provided a detailed work and exposure history and underwent a respiratory examination that included a respiratory history, respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by International Labour Office (ILO) criteria, and spirometry. Statistical models were developed to generate group-level exposure estimates that were used in multivariate logistic regression analyses to explore the risk of COPD in relation to exposures to asbestos, silica, cement dust, welding, paints, solvents, and dusts/fumes from paint removal. Risk for COPD in the study population was compared to risk for COPD in the general US population as determined in National Health and Nutrition Examination Survey (NHANES III).The age-standardized prevalence ratio of COPD among DOE workers compared to all NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and duration of DOE employment. Statistically significant associations were observed for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks associated with exposures to paints, solvents, and removal of paints.Our study of construction workers employed at DOE sites demonstrated increased COPD risk due to occupational exposures and was able to identify specific exposures increasing risk. This study provides additional support for prevention of both smoking and occupational exposures to reduce the burden of COPD among construction workers. Am. J. Ind. Med. 2009. © 2009 Wiley-Liss, Inc.

Hearing problems among a cohort of nationally certified EMS professionals

The objectives of this study were to estimate the prevalence of hearing problems among a national cohort of emergency medical service (EMS) professionals, determine factors associated with hearing problems, and estimate the percentage of EMS professionals who utilize hearing protection.Utilizing results from a questionnaire, individuals who reported hearing problems were compared to individuals who had not. Multivariable logistic regression was performed to identify variables associated with hearing problems. Finally, items regarding use of hearing protection were assessed to estimate the percentage of usage among EMS professionals.In total, 1,058 (57%) participants responded to the questionnaire. Of those, 1,024 (97%) who completed the hearing problems question were utilized for analysis. There were 153 (14.9%) cases of self-reported hearing problems. The final logistic regression model included lifetime occupational noise exposure 0.99 (95% CI = 0.9997-1.0002), report of previous back problems (odds ratio (OR) = 2.74, 95% CI = 1.8340-4.1042), large community size (OR = 1.67, 95% CI = 1.1211-2.4843), and minority status (OR = 0.61, 95% CI = 0.3719-0.9867). Finally, 213 (20.8%) individuals reported utilizing some form of hearing protection at their main EMS job.The results from this analysis are the first national estimates of the prevalence of self reported hearing problems among EMS professionals. This study was also the first to estimate the percentage of EMS professionals who self reported the utilization of hearing protection. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Occupational factors and risk of Parkinson's disease: A population-based case-control study

Parkinson's disease (PD) has been associated with various workplace factors, but the evidence is inconsistent.To estimate the risk of PD associated with various jobs and workplace exposures.We conducted a population-based, case-control study of 404 incident PD cases and 526 age and sex-matched controls, collecting self-reported work histories including job titles and exposures to various industrial toxicants. Relative risks of PD from these exposures were estimated with odds ratios (OR) and 95% confidence intervals (CI) using logistic regression.Risk was not significantly affected by farming work, by metal work, or by exposure to pesticides, metals, or solvents.These findings do not provide support for the hypothesis that workplace factors affect the risk of PD. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Effects of self-reported health conditions and pesticide exposures on probability of follow-up in a prospective cohort study

We investigated the potential for selection bias due to non-participation in the follow-up of a large prospective cohort study.Licensed pesticide applicators (52,395 private; 4,916 commercial) in the Agricultural Health Study provided demographic, health, and pesticide exposure information at enrollment (1993-1997) and in a 5-year follow-up telephone interview. Factors associated with non-participation in the follow-up were identified using multiple logistic regression. Potential for selection bias was evaluated by comparing exposure-disease associations between the entire cohort and the follow-up subset.Sixty-six percent of private and 60% of commercial applicators completed the follow-up interview. Private and commercial applicators who did not complete the follow-up reported at enrollment younger age, less education, lower body mass index, poorer health behaviors but fewer health conditions, and lower pesticide use. Estimates of exposure-disease associations calculated with and without non-participants did not indicate strong selection bias.Differences between non-participants and participants in the follow-up interview were generally small, and we did not find significant evidence of selection bias. However, the extent of bias may depend on the specific exposure and outcome under study. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

South Africa's export trade in asbestos: Demise of an industry

South Africa's export of each of its three types of asbestos, crocidolite, amosite, and chrysotile, and the total amounts to 84 countries in metric tonnes is examined over a 24-year period, 1980-2003.For convenience, the countries are divided into nine world regional groups, Europe, Eastern Europe, North America with the Caribbean, South America, Africa, Middle East, Far East, South Asia, and Oceania.The three greatest importing countries of total asbestos in metric tonnes were all in the Far East region, ranging from Japan, South Korea to Thailand, and followed by USA and Italy. All exports to all countries diminished steadily as the South African trade came virtually to an end by 2003, due to ever increasing international pressure.The export trade has changed significantly since 1960 from being dominantly to European countries to being directed in recent years to the Far East, with serious implications for asbestos-related ill-health in those countries. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Costs by industry and diagnosis among musculoskeletal claims in a state workers compensation system: 1999-2004

Musculoskeletal disorders (MSDs) are a tremendous burden on industry in the United States. However, there is limited understanding of the unique issues relating to specific industry sectors, specifically the frequency and costs of different MSDs.Claim data from 1999 to 2004 from the Ohio Bureau of Workers' Compensation were analyzed as a function of industry sector (NAICS industry-sector categories) and anatomical region (ICD-9 codes).Almost 50% of the claims were lumbar spine (26.9%) or hand/wrist (21.7%). The majority of claims were from manufacturing (25.1%) and service (32.8%) industries. The industries with the highest average costs per claim were transportation, warehouse, and utilities and construction. Across industries, the highest costs per claim were consistently for the lumbar spine, shoulder, and cervical spine body regions.This study provides insight into the severity (i.e., medical and indemnity costs) of MSDs across multiple industries, providing data for prioritizing of resources for research and interventions. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Agricultural tractor overturn deaths: Assessment of trends and risk factors

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.

Stressors, resources, and well-being among Latino and White warehouse workers in the United States

Social forces and cultural factors may contribute to Latino and White workers experiencing similar jobs differently. This study examines the psychosocial stressors and resources experienced by Latino and White workers in manual material handling jobs in the US and the effects of these stressors and resources on worker well-being.Fifty-nine Latino warehouse workers were matched with White workers by job title, job tenure, and warehouse facility. Matched sample t tests and linear regression analyses models were conducted.Results reveal similar psychosocial stressors and resources for both groups. However, Latino workers reported better well-being. For Latino workers, social resources at work such as management fairness and supervisor support have a stronger relationship with well-being. For White workers wage fairness is the most significant predictor for well-being.These differential results challenge us to consider how cultural factors, expectations and the prior work history of Latino workers may influence their experience of work and the effect of work on health. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

Traumatic occupational injuries in Hispanic and foreign born workers

Hispanic and foreign-born workers suffer high rates of occupational fatality. Reasons for this are not well understood. Our aim was to gather information about the details related to severe, non-fatal occupational injuries in this vulnerable population.Eight years of data were obtained from an urban trauma center. In addition, medical consultations of individuals admitted for an occupational injury during an 8-month period are reported.Hispanics were more highly represented than expected; their number of injuries steadily rose. Hispanics were more likely to be injured by machinery and hand tools. Workers reported hazardous working conditions, lack of workers compensation, short time in current employment, and not working in their usual job.Trauma systems can provide a glimpse of risk factors for severe injuries in vulnerable workers. We recommend greater use of this data source, follow backs, long-term follow up of individuals, and improvement of surveillance of vulnerable working populations. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies

This systematic review was designed and conducted in an effort to evaluate the evidence currently available for the many suggested risk factors for work-related musculoskeletal disorders.To identify pertinent literature we searched four electronic databases (Cinahl, Embase, Medline, and The Cochrane Library). The search strategies combined terms for musculoskeletal disorders, work, and risk factors. Only case-control or cohort studies were included.A total of 1,761 non-duplicated articles were identified and screened, and 63 studies were reviewed and integrated in this article. The risk factors identified for the development of work-related musculoskeletal disorders were divided and organized according to the affected body part, type of risk factor (biomechanical, psychosocial, or individual) and level of evidence (strong, reasonable, or insufficient evidence).Risk factors with at least reasonable evidence of a causal relationship for the development of work-related musculoskeletal disorders include: heavy physical work, smoking, high body mass index, high psychosocial work demands, and the presence of co-morbidities. The most commonly reported biomechanical risk factors with at least reasonable evidence for causing WMSD include excessive repetition, awkward postures, and heavy lifting. Additional high methodological quality studies are needed to further understand and provide stronger evidence of the causal relationship between risk factors and work-related musculoskeletal disorders. The information provided in this article may be useful to healthcare providers, researchers, and ergonomists interested on risk identification and design of interventions to reduce the rates of work-related musculoskeletal disorders. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Effort-reward imbalance at work and self-rated health of Las Vegas hotel room cleaners

This study investigates the relationship between effort-reward-imbalance (ERI) at work and self-rated health (SF-36) among 941 Las Vegas hotel room cleaners (99% female, 84% immigrant).Logistic regression models adjust for age, health behaviors, physical workload and other potential confounders.50% reported ERI and 60% poor or fair general health. Significant associations were found between ERI and all SF-36 health measures. Workers in the upper quartile of the efforts/rewards ratio were 2-5 times more likely to experience poor or fair general health, low physical function, high levels of pain, fatigue, and role limitations due to physical and mental health problems.The cross-sectional design limits causal interpretation of these associations. However, the development of interventions to reduce ERI and to improve general health among room cleaners deserves high priority considering that both high ERI and low self-rated health have predicted chronic diseases and mortality in prospective studies. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

Immigration, employment relations, and health: Developing a research agenda

International migration has emerged as a global issue that has transformed the lives of hundreds of millions of persons. Migrant workers contribute to the economic growth of high-income countries often serving as the labour force performing dangerous, dirty and degrading work that nationals are reluctant to perform.Critical examination of the scientific and "grey" literatures on immigration, employment relations and health.Both lay and scientific literatures indicate that public health researchers should be concerned about the health consequences of migration processes. Migrant workers are more represented in dangerous industries and in hazardous jobs, occupations and tasks. They are often hired as labourers in precarious jobs with poverty wages and experience more serious abuse and exploitation at the workplace. Also, analyses document migrant workers' problems of social exclusion, lack of health and safety training, fear of reprisals for demanding better working conditions, linguistic and cultural barriers that minimize the effectiveness of training, incomplete OHS surveillance of foreign workers and difficulty accessing care and compensation when injured. Therefore migrant status can be an important source of occupational health inequalities.Available evidence shows that the employment conditions and associated work organization of most migrant workers are dangerous to their health. The overall impact of immigration on population health, however, still is poorly understood and many mechanisms, pathways and overall health impact are poorly documented. Current limitations highlight the need to engage in explicit analytical, intervention and policy research. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Oscillating migration and the epidemics of silicosis, tuberculosis, and HIV infection in South African gold miners

Hundreds of thousands of men from rural areas of South Africa and neighboring countries have come to seek work in the gold mines. They are not immigrants in the usual sense as they work for periods in the mines, go home, and then return. This is termed oscillating or circular migration. Today we have serious interrelated epidemics of silicosis, tuberculosis, and HIV infection in the gold mining industry.This article discusses the role of oscillating migration in fuelling these epidemics, by examining the historical, political, social, and economic contexts of these diseases.The impact of silicosis, tuberculosis, and HIV infection extends beyond individual miners to their families and communities.Failure to control dust and tuberculosis has resulted in serious consequences decades later. The economic and political migrant labor system provided the foundations for the epidemics seen in southern Africa today. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Invisible work, unseen hazards: The health of women immigrant household service workers in Spain

Household service work has been largely absent from occupational health studies. We examine the occupational hazards and health effects identified by immigrant women household service workers.Exploratory, descriptive study of 46 documented and undocumented immigrant women in household services in Spain, using a phenomenological approach. Data were collected between September 2006 and May 2007 through focus groups and semi-structured individual interviews. Data were separated for analysis by documentation status and sorted using a mixed-generation process. In a second phase of analysis, data on psychosocial hazards were organized using the Copenhagen Psychosocial Questionnaire as a guide.Informants reported a number of environmental, ergonomic and psychosocial hazards and corresponding health effects. Psychosocial hazards were especially strongly present in data. Data on reported hazards were similar by documentation status and varied by several emerging categories: whether participants were primarily cleaners or carers and whether they lived in or outside of the homes of their employers. Documentation status was relevant in terms of empowerment and bargaining, but did not appear to influence work tasks or exposure to hazards directly.Female immigrant household service workers are exposed to a variety of health hazards that could be acted upon by improved legislation, enforcement, and preventive workplace measures, which are discussed. Am. J. Ind. Med. 2009. © 2009 Wiley-Liss, Inc.

Pregnancy outcomes in female hairdressers

Abstract Purpose The hairdressing occupation may entail exposure to a wide range of chemical products, psychosocial and physical stress. All these factors may affect the health of a pregnant hairdresser and her offspring. Our aim was to analyse whether employment in this profession is associated with adverse reproductive effects. Method Female hairdressers working in the 248 hairdressing salons in Alicante (Spain), who became pregnant for the first time after 1990 were included (n = 94). The incidence of spontaneous abortions, number of children born and their birth weight and preterm delivery among hairdressers was compared with a control group of shop assistants and office workers (n = 138). Information was collected through personal interviews at their work place. A structured questionnaire was used gathering information concerning exposure variables including the use of chemical products, ventilation at the salons, work-related stress and hours of standing work. In addition, socio-demographic factors and smoking information were obtained. Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were calculated using logbinomial regression. Results Hairdressers showed a non-significant increased risk of spontaneous abortions (RR = 1.6, 95%CI 0.9–2.7). There were no differences in preterm delivery and birth weight of the children born of mothers in the two groups. Among hairdressers, the RR of spontaneous abortion among those with high perceived work-related stress was 2.4 (95%CI: 0.2–28.3) relative to those with low or normal perceived stress. Conclusions A slightly increased risk of spontaneous abortion among hairdressers was found, mainly associated with perceived work-related stress. Observed results deserve further research. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-010-0517-3Authors Elena Ronda, University of Alicante Public Health Research Group Carretera San Vicente del Raspeig s/n 03690 Alicante SpainBente E. Moen, University of Bergen Department of Public Health and Primary Health Care, Occupational and Environmental Medicine Bergen NorwayAna M. García, Occupational Health Research Centre (CiSAL) Barcelona SpainJosé Sánchez-Paya, Preventive Medicine Service, Alicante General Hospital Alicante SpainValborg Baste, University of Bergen Department of Public Health and Primary Health Care, Occupational and Environmental Medicine Bergen Norway Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Latest status of cadmium accumulation and its effects on kidneys, bone, and erythropoiesis in inhabitants of the formerly cadmium-polluted Jinzu River Basin in Toyama, Japan, after restoration of rice paddies

Abstract Purpose The cadmium-polluted Jinzu River Basin in Toyama, Japan, where nephropathy and itai-itai disease were endemic among resident farmers decades ago, has been almost completely restored. The aim of this study is to investigate whether inhabitants there would still exhibit cadmium accumulation and its effects on kidneys, bones, and erythropoiesis. Methods We performed a cross-sectional study of 150 subjects from the polluted area and 144 controls from the same prefecture. Participants included female inhabitants from 34 to 74 years of age who underwent examinations to gather anthropometrical and medical information, obtain rice, blood and urine samples, and measure bone mineral density. Results Cadmium concentration in rice from the polluted area was lower than the level in the control area. Blood and urinary cadmium and urinary β2-microglobulin levels were higher in subjects from the polluted area than controls, and the urinary β2-microglobulin was independently affected by urinary cadmium. Bone mineral density did not differ between the two areas, but it was affected by renal tubular function in subjects from the polluted area. Serum bone alkaline phosphatase was lower in subjects from the polluted area compared to controls. We detected three cases of cadmium nephropathy among the subjects. One of them suffered from a renal anemia type of itai-itai disease. Conclusion Inhabitants in the formerly polluted area still had high cadmium accumulations and showed a characteristic natural history of chronic cadmium toxicity, indicating that the risk remains for developing nephropathy or itai-itai disease in the future. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-010-0510-xAuthors Hyogo Horiguchi, Jichi Medical University Division of Environmental Medicine, Center for Community Medicine 3311-1 Yakushiji Shimotsuke, Tochigi 329-0498 JapanKeiko Aoshima, Hagino Hospital 315-1 Haginoshima, Fuchu-machi Toyama 939-2723 JapanEtsuko Oguma, Jichi Medical University Division of Environmental Medicine, Center for Community Medicine 3311-1 Yakushiji Shimotsuke, Tochigi 329-0498 JapanSatoshi Sasaki, The University of Tokyo Department of Social and Preventive Epidemiology, School of Public Health 7-3-1 Hongo, Bunkyo-ku Tokyo 113-0033 JapanKayoko Miyamoto, Jichi Medical University Division of Environmental Medicine, Center for Community Medicine 3311-1 Yakushiji Shimotsuke, Tochigi 329-0498 JapanYoko Hosoi, Jichi Medical University Division of Environmental Medicine, Center for Community Medicine 3311-1 Yakushiji Shimotsuke, Tochigi 329-0498 JapanTerutaka Katoh, Toyama Medical and Pharmaceutical University Department of Public Health, Faculty of Medicine 2630 Sugitani Toyama 960-0194 JapanFujio Kayama, Jichi Medical University Division of Environmental Medicine, Center for Community Medicine 3311-1 Yakushiji Shimotsuke, Tochigi 329-0498 Japan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Biological effect markers in exhaled breath condensate and biomonitoring in welders: impact of smoking and protection equipment

Abstract Purpose The objective of this study was to investigate the effect of welding as well as the impact of smoking and protection measures on biological effect markers in exhaled breath condensate. Additionally, biomonitoring of chromium, aluminium and nickel in urine was performed to quantify internal exposure. Methods Exhaled breath condensate (EBC) and urine samples of 45 male welders and 24 male non-exposed control subjects were collected on Friday pre-shift and after 8 h of work post-shift. In EBC, biological effect markers such as malondialdehyde, nitrite, nitrate, 3-nitrotyrosine, tyrosine, hydroxyproline, proline, H2O2 and pH-value were measured while aluminium, nickel, and chromium were measured in the urine samples. Results Although internal exposure to aluminium, nickel and chromium in this study was low, welders showed significantly increased concentrations of all these parameters at baseline compared to non-exposed controls. Moreover, welders had higher nitrate concentrations in EBC at baseline and after shift. Nitrate concentration was considerably lower after shift if personal protection equipment was used. H2O2 was increased only when subjects smoked during shift. Conclusion It has been shown that welding-associated long-term and short-term health effects could be detected in a population of welders. The results also showed that using personal protection equipment is of high importance and H2O2 may be an effect marker associated with smoking rather than with welding fumes, while nitrate in EBC seems to be sensitive to welding fume exposure. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-010-0516-4Authors Monika Gube, RWTH Aachen University Institute for Occupational and Social Medicine, Medical Faculty Pauwelsstraße 30 52074 Aachen GermanyJoachim Ebel, RWTH Aachen University Institute for Occupational and Social Medicine, Medical Faculty Pauwelsstraße 30 52074 Aachen GermanyPeter Brand, RWTH Aachen University Institute for Occupational and Social Medicine, Medical Faculty Pauwelsstraße 30 52074 Aachen GermanyThomas Göen, RWTH Aachen University Institute for Occupational and Social Medicine, Medical Faculty Pauwelsstraße 30 52074 Aachen GermanyKarl Holzinger, RWTH Aachen University ISF, Welding and Joining Institute Pontstraße 49 52062 Aachen GermanyUwe Reisgen, RWTH Aachen University ISF, Welding and Joining Institute Pontstraße 49 52062 Aachen GermanyThomas Kraus, RWTH Aachen University Institute for Occupational and Social Medicine, Medical Faculty Pauwelsstraße 30 52074 Aachen Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Activities of occupational physicians for occupational health services in small-scale enterprises in Japan and in the Netherlands

Abstract Objectives Occupational health service (OHS) for small-scale enterprises (SSEs) is still limited in many countries. Both Japan and the Netherlands have universal OHS systems for all employees. The objective of this survey was to examine the activities of occupational physicians (OPs) in the two countries for SSEs and to investigate their proposals for the improvement of service. Methods Questionnaires on types and sizes of the industries they serve, allocation of service hours (current and desired), sources of information for occupational health activities etc. were mailed in 2006 to 461 and 335 Japanese and Dutch OPs, respectively, who have served in small- and medium-scale enterprises. In practice, 107 Japanese (23%) and 106 Dutch physicians (32%) replied, respectively. Results and Conclusions Total service time per month was longer for OPs in the Netherlands than OPs in Japan. Japanese OPs spent more hours for health and safety meetings, worksite rounds, and prevention of overwork-induced ill health (14–16% each). Dutch OPs used much more hours for the guidance of absent workers (48%). Thus, service conditions were not the same for OPs in the two countries. Nevertheless, both groups of OPs unanimously considered that employers are the key persons for the improvement of OHS especially in SSEs and their education is important for better OHS. The conclusions should be taken as preliminary, however, due to study limitations including low response rates in both groups of physicians. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-010-0514-6Authors Jiro Moriguchi, Kyoto Industrial Health Association (Mibu Office) 4-1 Mibu-Sujakucho, Nakagyo-ku Kyoto 604-8871 JapanMasayuki Ikeda, Kyoto Industrial Health Association (Kyoto Office) Kyoto 604-8472 JapanSonoko Sakuragi, Kyoto Industrial Health Association (Mibu Office) 4-1 Mibu-Sujakucho, Nakagyo-ku Kyoto 604-8871 JapanKazuo Takeda, Kyoto Industrial Health Association (Kyoto Office) Kyoto 604-8472 JapanTakashi Muto, Dokkyo Medical University Department of Public Health Tochigi 321-0293 JapanToshiaki Higashi, University of Occupational and Environmental Health, Japan Department of Work Systems and Health, Institute of Industrial Ecological Sciences Kitakyushu 807-8555 JapanAndré N. H. Weel, Netherlands Society of Occupational Medicine Centre of Excellence 3500 GC Utrecht the NetherlandsFrank J. van Dijk, University of Amsterdam Coronel Institute of Occupational Health, Academic Medical Center 22700 Amsterdam the Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Illness perceptions and work participation: a systematic review

Abstract Purpose Self-regulatory processes play an important role in mediating between the disease and the health outcomes, and potentially also work outcomes. This systematic review aims to explore the relationship between illness perceptions and work participation in patients with somatic diseases and complaints. Methods The bibliographic databases Medline, PsycINFO and Embase were searched from inception to March 2008. Included were cross-sectional or longitudinal studies, patients with somatic diseases or complaints, illness perceptions based on at least four dimensions of the common sense model of self-regulation, and work participation. Results Two longitudinal and two cross-sectional studies selected for this review report statistically significant findings for one or more illness perception dimensions in patients with various complaints and illnesses, although some dimensions are significant in one study but not in another. Overall, non-working patients perceived more serious consequences, expected their illness to last a longer time, and reported more symptoms and more emotional responses as a result of their illness. Alternatively, working patients had a stronger belief in the controllability of their condition and a better understanding of their disease. Conclusions The limited number of studies in this review suggests that illness perceptions play a role in the work participation of patients with somatic diseases or complaints, although it is not clear how strong this relationship is and which illness perception dimensions are most useful. Identifying individuals with maladaptive illness perceptions and targeting interventions toward changing these perceptions are promising developments in improving work participation. Content Type Journal ArticleCategory Review ArticleDOI 10.1007/s00420-010-0506-6Authors J. L. Hoving, University of Amsterdam Coronel Institute of Occupational Health, Research Center for Insurance Medicine, Academic Medical Center P.O. Box 22660 1100 Amsterdam The NetherlandsM. van der Meer, University of Amsterdam Coronel Institute of Occupational Health, Research Center for Insurance Medicine, Academic Medical Center P.O. Box 22660 1100 Amsterdam The NetherlandsA. Y. Volkova, University of Amsterdam Coronel Institute of Occupational Health, Research Center for Insurance Medicine, Academic Medical Center P.O. Box 22660 1100 Amsterdam The NetherlandsM. H. W. Frings-Dresen, University of Amsterdam Coronel Institute of Occupational Health, Research Center for Insurance Medicine, Academic Medical Center P.O. Box 22660 1100 Amsterdam The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

New-onset adult asthma in relation to damp and moldy workplaces

Abstract Objective Damp and moldy indoor environments aggravate pre-existing asthma. Recent meta-analyses suggest that exposure to such environments may also induce new-onset asthma. We assessed the probability of molds being the cause of asthma in a patient series examined because of respiratory symptoms in relation to workplace dampness and molds. Methods Altogether 694 such patients had been clinically assessed between 1995 and 2004. According to their histories, they had all been exposed to molds at work and had suffered from work-related lower respiratory symptoms. The investigations had included specific inhalation challenge (SIC) tests with mold extracts and serial peak expiratory flow (PEF) recordings. Using internationally recommended diagnostic criteria for occupational asthma (OA), we categorized the patients into three groups: probable, possible, and unlikely OA (156, 45, and 475 patients, respectively). The clinical details of 258 patients were analyzed, and their levels of microbial exposure were evaluated. Results The agreement between the serial PEF recordings and SIC tests (both being either positive or negative) was 56%. In the group of probable OA, mold sensitization was found in 20%. The level of exposure and sensitization to molds was associated with probable OA. At 6 months, the follow-up examinations of 136 patients with probable OA showed that the symptoms were persistent, and no improvement in spirometry was noted despite adequate treatment. Only 58% of the patients had returned to work. Conclusions Exposure to damp and moldy workplaces can induce new-onset adult asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-010-0507-5Authors Kirsi Karvala, Finnish Institute of Occupational Health (FIOH) Occupational Medicine Team Topeliuksenkatu 41 a A 00250 Helsinki FinlandElina Toskala, Finnish Institute of Occupational Health Control of Hypersensitivity Diseases Team Helsinki FinlandRitva Luukkonen, Finnish Institute of Occupational Health Statistical Services Team Helsinki FinlandSanna Lappalainen, Finnish Institute of Occupational Health Good Indoor Environment Theme Helsinki FinlandJukka Uitti, Finnish Institute of Occupational Health Occupational Medicine Team Tampere FinlandHenrik Nordman, Finnish Institute of Occupational Health (FIOH) Occupational Medicine Team Topeliuksenkatu 41 a A 00250 Helsinki Finland Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Validity and reliability of the effort-reward imbalance questionnaire in a sample of 673 Italian teachers

Abstract Purpose This study explores the explicative potential of effort-reward imbalance Model to unveil the dimensions involved in teacher stress process and analyses the psychometric characteristics of the Italian version of the ERI Questionnaire (Siegrist, J Occup Health Psychol 1:27–43, 1996) with respect to a homogeneous occupational group: Italian school teachers. Methods The Italian version of the ERI Questionnaire was submitted to 673 teachers randomly drawn from a cross-section of school types. Internal consistency, reliability, discriminative validity, and factorial structure were evaluated. Predictive validity was explored with respect to a measure of perceived strain, the Crown–Crisp Experiential Index. Discriminative validity was explored with respect to age, gender, education, type of school, the presence/absence of physical pains in the last 12 months before the survey, and teachers’ intention to leave the profession. Results Item-total correlations are for all items included between 0.30 and 0.80 (p < 0.01). Mean inter-item correlation is 0.26. Cronbach’s alpha for the whole questionnaire reaches the value of 0.89. The factor analysis identified four reliable factors that accounted for 44.8 per cent of the total variance and which confirmed the basic structure emerged from previous studies yet highlighting two instead of three different components for reward. Higher efforts (T = −3.82, p < 0.001) and both lower material (T = 3.23, p < 0.001) and immaterial rewards (T = 3.17, p < 0.005) characterised the group of teachers, which reported to suffer for physical pains. Higher efforts (T = −5.26, p < 0.001), higher overcommitment (T = −3.15, p < 0.005), and both lower material (T = 4.63, p < 0.001) and immaterial rewards (T = 4.00, p < 0.001) were observed in the group of teachers inclined to give up the job. Multiple regression analyses have highlighted that higher efforts, higher overcommitment, and lower rewards are significantly predictive of higher levels of free-floating and somatic anxiety as well as depression and global psychological strain. Conclusions This preliminary analysis of the reliability and validity of the Italian version of the ERI Questionnaire reveals that it constitutes a useful and reliable measure to analyse work-related stress with respect to the school setting. The validity of the ERI model to describe the dimensions involved in teacher’s stress and to highlight those associated to leaving intentions and to several physical and psychological strain outcomes in Italian school teachers has been confirmed. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-010-0512-8Authors Maria Clelia Zurlo, University of Naples “Federico II” Department of Relational Sciences Via Porta di Massa n.1 80133 Naples ItalyDaniela Pes, University of Naples “Federico II” Department of Relational Sciences Via Porta di Massa n.1 80133 Naples ItalyJohannes Siegrist, University of Düsseldorf Institute of Social Medicine Düsseldorf Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey

Abstract Objectives Doctors, the major workforce in hospitals, are doing heavy emotional and physical work which may lead to depressive symptoms. However, in China, few studies are available pertaining to the prevalence and associated factors of depressive symptoms among doctors. The aim of this study was to evaluate the prevalence of depressive symptoms and to explore its associated factors among Chinese doctors in public hospitals. Methods This cross-sectional study was performed during the period of September/October 2008. The study population comprised of 1,890 doctors registered and working in the 20 national hospitals in Liaoning province, northeast of China. A questionnaire that comprised depressive symptoms assessed by the Chinese Version of the Center for Epidemiologic Studies Depression Scale (CES-D), demographic factors, work conditions, occupational stress, and coping strategies was distributed to these doctors. A total of 1,488 effective respondents became our subjects (effective response rate 78.7%). Multivariate logistic regression was used to explore the factors related to depressive symptoms. Results The prevalence of depressive symptoms among doctors was 65.3%. Multivariate logistic analyses showed that high role insufficiency (OR 2.15, 95% CI 1.66–2.78), worse doctor–patient relationship (OR 2.07, 95% CI 1.62–2.64), having a chronic disease (OR 1.73, 95% CI 1.31–2.27), serious role boundary (OR 1.54, 95% CI 1.21–2.00), and role overload (OR 1.42, 95% CI 1.11–1.81) were positively associated with depressive symptoms; whereas adequate rational coping (OR 0.58, 95% CI 0.45–0.76) and social support (OR 0.75, 95% CI 0.57–0.98) were negatively associated with depressive symptoms. Conclusions Most Chinese doctors probably have depressive symptoms. Role insufficiency, doctor–patient relationship, and rational coping seemed to be crucial in relation to depressive symptoms. Efficient interventions such as taking further education course, improving communications with patients, and improving the ability of rational coping should be considered by health administrators aiming at improving the quality of Chinese doctors’ mental health from the view point of depressive symptoms. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-010-0508-4Authors Jia-Na Wang, China Medical University Department of Social Medicine, School of Public Health No. 92 Beier Road Heping District, Shenyang 110001 Liaoning People’s Republic of ChinaWei Sun, China Medical University Department of Social Medicine, School of Public Health No. 92 Beier Road Heping District, Shenyang 110001 Liaoning People’s Republic of ChinaTie-Shuang Chi, China Medical University Department of Social Medicine, School of Public Health No. 92 Beier Road Heping District, Shenyang 110001 Liaoning People’s Republic of ChinaHui Wu, China Medical University Department of Social Medicine, School of Public Health No. 92 Beier Road Heping District, Shenyang 110001 Liaoning People’s Republic of ChinaLie Wang, China Medical University Department of Social Medicine, School of Public Health No. 92 Beier Road Heping District, Shenyang 110001 Liaoning People’s Republic of China Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Rewarding and unrewarding aspects of deployment to Iraq and its association with psychological health in UK military personnel

Abstract Purpose Research into how individuals perceive their deployment experiences is important for understanding the association between stressful events and subsequent positive or negative effects. This study examines perceptions among UK military personnel with regard to rewarding and unrewarding aspects of deployment in Iraq. Methods Analyses were carried out on 5,573 UK military personnel who had deployed to Iraq between 2003 and 2006. Information on socio-demographic and military characteristics; deployment experiences, including perceptions of rewarding and unrewarding aspects of Service; and information on current health, were collected with questionnaires. Associations between deployment and health factors, and participants’ perceptions of Service were examined. Results The rewarding aspects of deployment were related to military tasks such as “doing the job you were trained to do”, “teamwork/comradeship” and altruistic aspects such as “helping local people”. The unrewarding aspects were “being separated from family and friends” and “quality of supply and equipment”. Although there was general agreement on the aspects that mattered to most Service personnel, there were differences associated with operation deployed to, enlistment type, rank, Service and psychological health. Those with a psychological problem were more likely to find most military aspects of deployment unrewarding but were more likely to find helping the local population and working with other coalition forces rewarding. Conclusions This study demonstrates how the perceptions of deployment, in terms of rewarding and unrewarding aspects, are shaped by Service characteristics, mental health and operation deployed to. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0504-8Authors Josefin Sundin, King’s College London Academic Centre for Defence Mental Health, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre 10 Cutcombe Road London SE5 9RJ UKNicola T. Fear, King’s College London Academic Centre for Defence Mental Health, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre 10 Cutcombe Road London SE5 9RJ UKLisa Hull, King’s College London King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry London UKNorman Jones, King’s College London Academic Centre for Defence Mental Health, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre 10 Cutcombe Road London SE5 9RJ UKChristopher Dandeker, King’s College London King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry London UKMatthew Hotopf, King’s College London King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry London UKSimon Wessely, King’s College London King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry London UKRoberto J. Rona, King’s College London King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry London UK Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Occupational silica exposure as a risk factor for scleroderma: a meta-analysis

Abstract Objectives Among potential environmental risk factors for systemic sclerosis (SSc), occupational exposures have received some attention. In this meta-analysis, we examined the association between SSc and occupational exposure to silica. Methods We searched Medline, Toxline, BIOSIS, and Embase (1949 and November 2009) for original articles published in any language. Sixteen studies are included in the analysis, of which, 3 are cohort studies, 9 case–control and 4 are of other designs. The combined estimator of relative risk (CERR) and 95% confidence interval (CI) were calculated using fixed or random effect models. Results Significant heterogeneity was detected (I 2 = 97.2%; P < 0.01), and the CERR was 3.20 (95% CI, 1.89–5.43). The CERR for studies in females was 1.03 (95% CI, 0.74–1.44) and was 3.02 (95% CI, 1.24–7.35) for males. The CERR for case–control studies was 2.24 (95% CI, 1.65–3.31) and was 15.49 (95% CI, 4.54–52.87) for cohort studies. Conclusions The findings suggest that silica exposure may be a significant risk factor for developing SSc and specifically in males. Further observational studies examining the role of occupational silica exposure in the context of other risk factors are needed. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0505-7Authors Zachary D. McCormic, University of Toledo College of Medicine 3120 Glendale Ave Toledo OH 43614 USASura S. Khuder, University of Toledo College of Arts & Sciences Toledo OH USABishwa K. Aryal, University of Toledo College of Medicine 3120 Glendale Ave Toledo OH 43614 USAApril L. Ames, University of Toledo College of Arts & Sciences Toledo OH USASadik A. Khuder, University of Toledo College of Medicine 3120 Glendale Ave Toledo OH 43614 USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Contact allergy to thiurams: multifactorial analysis of clinical surveillance data collected by the IVDK network

Abstract Purpose To analyse the association between occupation (represented by job title) and contact allergy to thiuram vulcanising agents based on data of a clinical registry (IVDK, www.ivdk.org). Methods Clinical, demographic and allergy patch test data of all patients tested between 1992 and 2006 with the thiuram mix (1% in petrolatum) as part of the baseline series was analysed (n = 121,051). Poisson regression analysis was used to quantify the association between different occupations (and other relevant factors) and a positive patch test reaction to the thiuram mix. Furthermore, the time trend of sensitisation prevalence was analysed in high-risk occupational subgroups identified. Results In comparison to a largely unexposed reference group (office workers and teachers), rubber manufacturers had a significantly elevated risk (prevalence ratio (PR): 5.1, 95% confidence interval (CI) 2.0–10.5). However, health care workers such as physicians and dentists (PR: 3.8, 95% CI: 3.0–4.8) or nursing staff (PR: 3.0, 95% CI: 2.5–3.6) as well as meat and fish processors (PR 3.5, 95% CI: 2.2–5.3) and cleaners (PR 3.1, 95% CI: 2.5–3.8) were found to have a high sensitisation risk as well. In case of health care workers, a significant downward trend during the study period was observed; while in food processors and cleaners, sensitisation prevalence remained largely stable. Conclusion The adjusted multifactorial analysis identified occupations yet unknown to be associated with elevated thiuram contact allergy risk, e.g., food processors and cleaners. Thus, (i) further in-depth research can be targeted and (ii) efforts to prevent sensitisation to thiurams focussed, e.g., by limiting thiuram concentrations in products to a residual level which is technically inevitable. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0503-9Authors Wolfgang Uter, University of Erlangen/Nürnberg Department of Medical Informatics, Biometry and Epidemiology Waldstr. 6 91054 Erlangen GermanyJanice Hegewald, University of Erlangen/Nürnberg Department of Medical Informatics, Biometry and Epidemiology Waldstr. 6 91054 Erlangen GermanyAnnette Pfahlberg, University of Erlangen/Nürnberg Department of Medical Informatics, Biometry and Epidemiology Waldstr. 6 91054 Erlangen GermanyHolger Lessmann, University of Göttingen Information Network of Departments of Dermatology von-Siebold-Str. 3 37075 Göttingen GermanyAxel Schnuch, University of Göttingen Information Network of Departments of Dermatology von-Siebold-Str. 3 37075 Göttingen GermanyOlaf Gefeller, University of Erlangen/Nürnberg Department of Medical Informatics, Biometry and Epidemiology Waldstr. 6 91054 Erlangen Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Association of work related chronic stressors and psychiatric symptoms in a Swiss sample of police officers; a cross sectional questionnaire study

Abstract Purpose (1) To identify work related stressors that are associated with psychiatric symptoms in a Swiss sample of policemen and (2) to develop a model for identifying officers at risk for developing mental health problems. Method The study design is cross sectional. A total of 354 male police officers answered a questionnaire assessing a wide spectrum of work related stressors. Psychiatric symptoms were assessed using the “TST questionnaire” (Langner in J Health Hum Behav 4, 269–276, 1962). Logistic regression with backward procedure was used to identify a set of variables collectively associated with high scores for psychiatric symptoms. Results A total of 42 (11.9%) officers had a high score for psychiatric symptoms. Nearly all potential stressors considered were significantly associated (at P < 0.05) with a high score for psychiatric symptoms. A significant model including 6 independent variables was identified: lack of support from superior and organization OR = 3.58 (1.58–8.13), self perception of bad quality work OR = 2.99 (1.35–6.59), inadequate work schedule OR = 2.84 (1.22–6.62), high mental/intellectual demand OR = 2.56 (1.12–5.86), age (in decades) OR = 1.82 (1.21–2.73), and score for physical environment complaints OR = 1.30 (1.03–1.64). Conclusions Most of work stressors considered are associated with psychiatric symptoms. Prevention should target the most frequent stressors with high association to symptoms. Complaints of police officers about stressors should receive proper consideration by the management of public administration. Such complaints might be the expression of psychiatric caseness requiring medical assistance. Particular attention should be given to police officers complaining about many stressors identified in this study’s multiple model. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0500-zAuthors Marc Arial, Lausanne University and Geneva University Institute for Work and Health Bugnon 21 CH-1011 Lausanne SwitzerlandViviane Gonik, Lausanne University and Geneva University Institute for Work and Health Bugnon 21 CH-1011 Lausanne SwitzerlandPascal Wild, Lausanne University and Geneva University Institute for Work and Health Bugnon 21 CH-1011 Lausanne SwitzerlandBrigitta Danuser, Lausanne University and Geneva University Institute for Work and Health Bugnon 21 CH-1011 Lausanne Switzerland Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Asbestos exposure and malignant lymphoma: a multicenter case–control study in Germany and Italy

Abstract Aims To analyze the relationship between asbestos exposure and malignant lymphoma in a multicenter case–control study conducted in Germany and Italy according to a common core protocol. Methods Male and female patients with malignant lymphoma (n = 1,034) between 18 and 80 years of age were prospectively recruited in six study areas in Germany (Ludwigshafen/Upper Palatinate, Heidelberg/Rhine-Neckar-County, Würzburg/Lower Frankonia, Hamburg, Bielefeld/East Westphalia, and Munich) and in two study areas in Sardinia, Italy (Cagliari and Nuoro provinces). A total of 1,173 population control subjects were drawn from population registers. In a structured personal interview, we elicited a complete occupational history, including every occupational period that lasted at least 1 year. On the basis of job task-specific supplementary questionnaires, trained experts assessed the exposure to asbestos. As a measure of cumulative asbestos exposure on a time by intensity scale, fiber-years were calculated. 12 cases (1.2%) and 12 control subjects (1.0%) had a cumulative asbestos exposure of more than 2.6 fiber-years (highest exposure category according to the 90th percentile of exposed control subjects). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression analysis adjusted for age, sex and study region. Patients with specific lymphoma sub-entities were additionally compared with the entire control group. Results We observed no statistically significant association between cumulative asbestos exposure and the risk of any lymphoma subtype. An elevated risk was found for the association between exposure to more than 2.6 fiber-years and multiple myeloma (OR = 6.0; 95% CI 1.4–25.1); however, numbers were small (n = 3 cases, all of them from Italy; n = 12 control subjects). Conclusions Our study does not support an association between asbestos exposure and risk of malignant lymphoma. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0502-xAuthors Andreas Seidler, Federal Institute of Occupational Safety and Health (BAuA) Nöldnerstr. 40-42 10317 Berlin GermanyNikolaus Becker, Cancer Research Center (DKFZ) Division of Cancer Epidemiology Heidelberg GermanyAlexandra Nieters, Cancer Research Center (DKFZ) Division of Cancer Epidemiology Heidelberg GermanyRolf Arhelger, University of Gießen Institute of Occupational and Social Medicine Giessen GermanyBirte Mester, Johann Wolfgang Goethe-University Institute of Occupational Medicine Frankfurt/Main GermanyKarin Rossnagel, Federal Institute of Occupational Safety and Health (BAuA) Nöldnerstr. 40-42 10317 Berlin GermanyEvelin Deeg, Cancer Research Center (DKFZ) Division of Cancer Epidemiology Heidelberg GermanyGine Elsner, Johann Wolfgang Goethe-University Institute of Occupational Medicine Frankfurt/Main GermanyMassimo Melis, University of Cagliari Department of Public Health, Occupational Health Section Cagliari ItalySimonetta Sesler, University of Cagliari Department of Public Health, Occupational Health Section Cagliari ItalyGiuseppe Avataneo, University of Cagliari Department of Public Health, Occupational Health Section Cagliari ItalyMichele Meloni, University of Cagliari Department of Public Health, Occupational Health Section Cagliari ItalyPierluigi Cocco, University of Cagliari Department of Public Health, Occupational Health Section Cagliari Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Assaults against nurses of general and psychiatric hospitals in Taiwan

Abstract Purpose Nurses are at risk of occupational assaults. However, the incidence and effects have not been documented among nurses in Taiwan. We aimed to study the incidence of assaults and their effects, including quality of life and job-related stress among nurses. Methods A cross-sectional study was conducted to understand the incidence of work-related assaults in nurses. Job content questionnaire was used to determine the job control, psychological demands at work, and workplace support in these nurses. Quality of life was assessed by short form-36 (SF-36). Results A total of 842 nurses satisfactorily completed the questionnaire, including 375 from general hospitals and 467 from psychiatric hospitals. A total of 237 (28.1%) reported to have experienced physical and/or verbal assaults in past 6 months. Experiences of sexual assault or verbal abuse were risk factors for feeling threatened by potential attacks. Nurses who felt threatened by potential attacked scored lower in general health, mental health, and vitality by SF-36, and had higher psychological demands at work, lower job control, and lower workplace support. Conclusion We conclude that nurses in general and psychiatric hospitals had high risk of assaults. Worksite assaults caused nurses to feel threatened, and such an effect was likely to cause increased job stress and decreased quality of life. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0501-yAuthors Judith Shu-Chu Shiao, National Taiwan University (NTU) & NTU Hospital Department of Nursing, College of Medicine Taipei TaiwanYuntin Tseng, National Cheng Kung University Department of Environmental and Occupational Health, College of Medicine Tainan TaiwanYueh-Tzu Hsieh, Chang Hwa University of Medical Technology Department of Nursing Tainan County TaiwanJui-Yeh Hou, Chang Hwa University of Medical Technology Department of Nursing Tainan County TaiwanYawen Cheng, National Taiwan University Department of Health Policy and Management Taipei TaiwanYueliang Leon Guo, National Taiwan University (NTU) & NTU Hospital Department of Environmental and Occupational Medicine, College of Medicine Rm 339, 17 SyuJhou Road Taipei 100 Taiwan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Heart rate variability assessment in Japanese workers recovered from depressive disorders resulting from job stress: measurements in the workplace

Abstract Purpose The purpose of this study is to clarify workers’ autonomic nerve balance after long-term sick leave due to depressive disorders resulting from job stress compared with healthy workers. Methods The participants were 28 Japanese male workers recovered from depressive disorders and 75 healthy male workers. For each participant, the lifestyle and the fatigue within 1 month were assessed by a checklist. Heart rate variability (HRV) was measured at the workplace by acceleration plethysmography (APG). HRV was assessed by the coefficient of variation of rate intervals (CV), the spectral components in the high- and low-frequency areas represented by the normalized HF and LF (nHF and nLF), and the ratio of LF to HF components (LF/HF). Results There was no significant difference in individual lifestyle and fatigue symptoms between the recovered and the healthy workers. The former workers showed significantly lower CV, higher nLF and log10LF/HF, and lower nHF that represent the predominance of sympathetic activity in comparison with the healthy workers. Moreover, the recovered workers who discontinued medications indicated significantly higher nLF and log10LF/HF, and lower nHF compared to the recovered workers who continued their medications. Conclusions Recovered workers in the workplace tended to show the depressive HRV feature that is the dominant sympathetic activity compared with the healthy workers. They might still be showing job stress that was not detected by the checklist. HRV analyses by APG in addition to questionnaire has the potential to become an effective approach for assessing workers’ job stress to prevent repeated absences. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0499-1Authors Mikio Takada, Nagoya City University Graduate School of Medical Sciences Department of Occupational and Environmental Health 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya Aichi 467-8601 JapanTakeshi Ebara, Nagoya City University Graduate School of Medical Sciences Department of Occupational and Environmental Health 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya Aichi 467-8601 JapanMichihiro Kamijima, Nagoya City University Graduate School of Medical Sciences Department of Occupational and Environmental Health 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya Aichi 467-8601 Japan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Correlates shift work with increased risk of gastrointestinal complaints or frequency of gastritis or peptic ulcer in H. pylori-infected shift workers?

Abstract Aim There is an ongoing discussion whether work under shift work conditions enhances the ulcerogenic potential of Helicobacter pylori infections. This may be induced by a disruption of the circadian rhythm. The present study assessed whether there is an association between H. pylori infection and an increased risk of gastrointestinal complaints or frequency of gastritis or peptic ulcer in H. pylori-infected shift workers. Methods We analyzed 615 workers divided in shift and daytime. Upper gastrointestinal diseases, medication or operation, unspecific gastrointestinal complaints, smoking habits, subjective job strain and private stress factors were monitored. The H. pylori status was analyzed using IgA and IgG antibody concentration in blood and qualitative ELISA for feces. Results It was observed that 27.6% of all workers, 34.6% of the shift workers and 16% of daytime workers were Hp positive (P = 0.004). Shift workers reported reflux or pyrosis less frequently than daytime workers. No increased lifetime prevalence for gastritis, ulcus or eradication therapy was found for shift workers. Analysis revealed a weak regression between age and Hp-positive gastritis or upper gastrointestinal complaints, smoking habits were a major confounding factor for ulcus disease. Clinical manifestation of gastritis or ulcus disease did not correlate with shift work or especially shift work including night work. Conclusions As a result of the present study, it cannot be confirmed that there is a causal connection between shift work and upper or unspecific gastrointestinal complaints or gastritis or peptic ulcer in dependency of a H. pylori colonization. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0495-5Authors Anke van Mark, University of Lübeck Institute of Occupational Medicine Ratzeburger Allee 160 23538 Lübeck GermanyMichael Spallek, European Research Society for Environment and Health in Transportation (EUGT) e. V. 14195 Berlin GermanyDavid A. Groneberg, Free University and Humboldt-University Institute of Occupational Medicine, Charité—Universitätsmedizin Berlin 14195 Berlin GermanyRichard Kessel, University of Lübeck Institute of Occupational Medicine Ratzeburger Allee 160 23538 Lübeck GermanyStephan W. Weiler, AUDI AG 85045 Ingolstadt Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

A population-based study of blood lead levels in relation to depression in the United States

Abstract Purpose Lead is a known neurotoxicant. Several studies have suggested that occupational exposure to lead may lead to depression, anxiety and other psychiatric illness, but few studies have examined environmental lead exposure and depression. We evaluated the relationship between blood lead levels (BLL) and depression in a sample representative of the US population. Methods We analyzed data from 4,159 adults ages ≥20 who participated in the 2005–2006 cycle of the National Health and Nutrition Examination Survey (NHANES). Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9). Relative risks were calculated using Poisson regression, and odds ratios were calculated with ordinal logistic regression using SUDAAN, controlling for pertinent covariates. Results The risk of depression was only slightly elevated with increasing blood lead levels when lead was modeled as a categorical variable, with adjusted relative risks of 1.16 (95% confidence interval (CI) = 0.99–1.36), 1.20 (CI = 1.07–1.36) and 1.16 (CI = 0.87–1.54) for 0.89–1.40 μg/dL, 1.41–2.17 μg/dL and >2.17 μg/dL, respectively, when compared to 0–0.88 μg/dL using Poisson regression. Similar results were obtained with ordinal logistic regression. Analyses using BLL as a continuous variable did not show a significant relationship with depression. Conclusions This cross-sectional study did not provide consistent evidence for an association between environmental lead exposure and depression within the investigated blood lead levels. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0497-3Authors Natalia I. Golub, University of Rochester School of Medicine and Dentistry Department of Community and Preventive Medicine 601 Elmwood Avenue Box 644 Rochester NY 14642 USAPaul C. Winters, University of Rochester School of Medicine and Dentistry Department of Family Medicine 1381 South Avenue Rochester NY 14620 USAEdwin van Wijngaarden, University of Rochester School of Medicine and Dentistry Department of Community and Preventive Medicine 601 Elmwood Avenue Box 644 Rochester NY 14642 USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Factors impacting on the excess arseniasis prevalence due to indoor combustion of high arsenic coal in a hyperendemic village

Abstract Background A few villages in Southwest Guizhou, China represented a unique case of arseniasis due to indoor combustion of high arsenic-content coal. The present study is aimed to analyze the contribution of possible factors or of their combination to excess prevalence of arseniasis in the exposed population. Methods An epidemiological investigation was conducted in all the members of three large ethnic, patrilineal clans in one of the hyperendemic villages (702 residents in 178 families, including 408 Han and 294 Hmong) where farmers of different ethnic origin have been living together in the same village for generations. A multilevel model logistic regression analysis was performed. Results The arseniasis prevalence was found to associate with the duration of As indoor exposure (years of high As coal burning and of poorly ventilated traditional stove using) and is largely dependent on the subject’s ethnicity and clan consanguinity, too. The prevalence of arseniasis in ethnic Han residents was significantly higher than that in their Hmong neighbors (35.0 vs 4.8% OR = 15.18, 95% CI = 3.45–67.35). Notable variances of arseniasis prevalence were observed not only between the ethnic Han clans (G1, G3, and B) and Hmong clan P, but also between different lineages (G1 and G2) inside the ethnic Han clan. Smokers suffered more frequently from arseniasis than non-smokers (47.3 vs 15.7% OR = 5.42, 95% CI = 2.25–12.93). Conclusions Arseniasis prevalence in this unique exposure case was impacted by an array of multiple factors. Besides a long-term indoor exposure to As, the ethnicity or the clan consanguinity of exposed subjects may play an important role, too. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0494-6Authors Guo-Fang Lin, Chinese Academy of Sciences Shanghai Institutes for Biological Sciences, Institute of Plant Physiology and Ecology 200032 Shanghai ChinaHong Meng, Second Military Medical University Department of Health Statistics 200433 Shanghai ChinaHui Du, Prefecture Center for Disease Prevention and Control of Southwest Guizhou Buyi and Miao Ethnic Autonomous Prefecture 562400 Xingyi Guizhou ChinaHong-Chao Lu, Prefecture Center for Disease Prevention and Control of Southwest Guizhou Buyi and Miao Ethnic Autonomous Prefecture 562400 Xingyi Guizhou ChinaYun-Shu Zhou, Prefecture Center for Disease Prevention and Control of Southwest Guizhou Buyi and Miao Ethnic Autonomous Prefecture 562400 Xingyi Guizhou ChinaJi-Gang Chen, Chinese Academy of Sciences Shanghai Institutes for Biological Sciences, Institute of Plant Physiology and Ecology 200032 Shanghai ChinaKlaus Golka, Leibniz Research Centre for Working Environment and Human Factors (IfADo) 44139 Dortmund GermanyJia-Chun Lu, Guangzhou Medical College Department of Epidemiology, State Key Lab of Respiratory Disease 510182 Guangzhou Guangdong ChinaJian-Hua Shen, Chinese Academy of Sciences Shanghai Institutes for Biological Sciences, Institute of Plant Physiology and Ecology 200032 Shanghai China Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Can we explain the exposure variability found in hand-arm vibrations when using angle grinders? A round robin laboratory study

Abstract Objectives To quantify variance components of hand-arm vibration exposure from data collected in a laboratory study of four different angle grinders. Methods Four different angle grinders were sent to seven laboratories for grinding tests by three operators at each laboratory. Vibration in both the throttle and support handles was measured. For one grinder, the experimental set-up was repeated and two measurements were collected for that specific grinder. Results At least one-third of the estimated variability is attributable to the wheel and less than one-third to the operator. In repeated experiments, between-occasion, operator and wheel factors explained 4, 29 and 17% of the total variability, respectively. Conclusions Since measured vibrations in the support and throttle handles are significantly differed, measurements should be taken at both locations. Factors influencing vibration variability include the presence/absence of an auto balance unit, wheel and operator, but other factors remain to be elucidated. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0498-2Authors I. Liljelind, Umeå University Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine 901 87 Umeå SwedenJ. Wahlström, Umeå University Hospital Occupational and Environmental Medicine 901 85 Umeå SwedenL. Nilsson, Umeå University Department of Mathematics and Mathematical Statistics 901 87 Umeå SwedenM. Persson, Atlas Copco Tools AB Sweden 105 23 Stockholm SwedenT. Nilsson, Umeå University Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine 901 87 Umeå Sweden Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Need for recovery from work in relation to age: a prospective cohort study

Abstract Purpose To investigate the impact of increasing age on the need for recovery (NFR) over time among day workers Methods The study is based on data from the first 2 years of follow-up of the Maastricht Cohort Study (n = 7,734). To investigate whether age predicted the onset of elevated NFR, multivariate survival analyses were conducted Results The highest levels of NFR were observed in the age group of 46–55 years. The relative risk for developing elevated NFR was highest in the age groups 36–45 years (RR 1.30; 1.07–1.58) and 46–55 years (RR 1.25; 1.03–1.52) in men and 46–55 years (RR 1.36; 1.04–1.77) in women when compared to the reference group Conclusions While NFR increased with age until the age of 55, this was followed by decreased levels of NFR among older employees. Explanations for the decreasing levels of NFR in the highest age group can be found in several domains such as the work environment, private situation and compensation strategies. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0491-9Authors D. C. L. Mohren, Maastricht University CAPHRI School for Public Health and Primary Care, Department of Epidemiology P.O. Box 616 6200 MD Maastricht The NetherlandsN. W. H. Jansen, Maastricht University CAPHRI School for Public Health and Primary Care, Department of Epidemiology P.O. Box 616 6200 MD Maastricht The NetherlandsIJ. Kant, Maastricht University CAPHRI School for Public Health and Primary Care, Department of Epidemiology P.O. Box 616 6200 MD Maastricht The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Quality of life and its influencing factors among medical professionals in China

Abstract Purpose The present study is to evaluate quality of life (QOL) among Chinese medical professionals and explore its main influencing factors. Methods A total of 2,721 medical professionals were selected from two provinces by using stratified cluster sampling method. The Chinese version of Short Form-36 Health Survey (SF-36) was used to measure QOL; Occupation Stress Inventory-Revised Edition (OSI-R) was used for occupational stress and coping resources. Other potential influencing factors for QOL were collected using a structured questionnaire. Multivariate analysis approach was applied to determine the influencing factors for QOL. Results QOL in the medical professionals was less desirable in comparison with the general population. Occupational stress, long working hour, occupation (being nurse), department (working in surgery) were unfavorable factors for PCS and MCS, and recreation, performance recognized, drinking and physical activity were protective factors for PCS, while rational coping, recreation, social support, performance recognized, drinking and physical activity were favorable factors for MCS. Conclusions The results suggest that occupational factors, behavioral factors and coping resources, as well as age, play significant roles in QOL in the medical professionals. Accordingly, interventional program designed to target relieving occupational stress, adjusting behavioral habits and increasing coping resources may be useful to improve QOL among medical professionals. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0496-4Authors Siying Wu, Fujian Medical University Department of Epidemiology and Health Statistics, School of Public Health Fuzhou Fujian ChinaWei Zhu, Zhengzhou University Department of Social Medicine, College of Public Health Zhengzhou Henan ChinaHuangyuan Li, Fujian Medical University Department of Occupational and Environmental Medicine, School of Public Health Fuzhou Fujian ChinaIgnatius Tak-Sun Yu, The Chinese University of Hong Kong School of Public Health and Primary Care 4/F, School of Public Health, Prince of Wales Hospital Shatin Hong Kong SAR, ChinaSihao Lin, Fujian Center for Prevention and Control of Occupational Diseases and Chemical Poisoning Fuzhou Fujian ChinaXiaorong Wang, The Chinese University of Hong Kong School of Public Health and Primary Care 4/F, School of Public Health, Prince of Wales Hospital Shatin Hong Kong SAR, ChinaShujuan Yang, The Chinese University of Hong Kong School of Public Health and Primary Care 4/F, School of Public Health, Prince of Wales Hospital Shatin Hong Kong SAR, China Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Occupational position and its relation to mental distress in a random sample of Danish residents

Abstract Purpose To analyze the distribution of depressive, anxiety, and somatization symptoms across different occupational positions in a random sample of Danish residents. Methods The study sample consisted of 591 Danish residents (50% women), aged 20–65, drawn from an age- and gender-stratified random sample of the Danish population. Participants filled out a survey that included the 92 item version of the Hopkins Symptom Checklist (SCL-92). We categorized occupational position into seven groups: high- and low-grade non-manual workers, skilled and unskilled manual workers, high- and low-grade self-employed, and unemployed. Results Compared to the reference group of high-grade non-manual workers, the depressive symptom score was statistically significantly elevated among unskilled manual workers (P = 0.043) and the unemployed (P < 0.001), after adjustment for age, gender, cohabitation, life events, and low household income. The anxiety symptom score was elevated only among the unemployed (P = 0.004). The somatization symptom score was elevated among unskilled manual workers (P = 0.002), the low-grade self-employed (P = 0.023), and the unemployed (P = 0.001). When we analyzed caseness of severe symptoms, we found that unskilled manual workers (OR = 3.27, 95% CI = 1.06–10.04) and the unemployed (OR = 6.20, 95% CI = 1.98–19.42) had a higher prevalence of severe depressive symptoms, compared to the reference group of high-grade non-manual workers. The unemployed also had a higher prevalence of severe somatization symptoms (OR = 6.28, 95% CI = 1.39–28.46). Conclusions Unskilled manual workers, the unemployed, and, to a lesser extent, the low-grade self-employed showed an increased level of mental distress. Activities to promote mental health in the Danish population should be directed toward these groups. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0492-8Authors Reiner Rugulies, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkIda E. H. Madsen, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkMaj Britt D. Nielsen, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkLis R. Olsen, Glostrup Hospital Department of Child and Adolescent Psychiatry Copenhagen DenmarkErik L. Mortensen, University of Copenhagen Department of Environmental Health, Institute of Public Health and Center for Healthy Aging Copenhagen DenmarkPer Bech, Frederiksborg General Hospital Psychiatric Research Unit Hillerød Denmark Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Self-reported exhaustion: a possible indicator of reduced work ability and increased risk of sickness absence among human service workers

Abstract Objective The aim of this study was to assess the construct and predictive validity of a new instrument for self-rating of stress-related Exhaustion Disorder (s-ED). Methods Public healthcare workers and social insurance officers, 85% females, were included (N = 2,683) in a longitudinal study. The s-ED instrument, based on clinical criteria for Exhaustion Disorder, was used at baseline to classify participants into three categories: non-s-ED, light/moderate s-ED and pronounced s-ED. Other assessments include burnout, anxiety, depression and work ability. Sick leave at follow-up after 2 years was defined as 14 days of ongoing sick leave (SA14) or a period of 60 days of sick leave during the last 12 months (SA60). Associations at baseline were expressed as prevalence ratios, and adjusted relative risks (RR) were calculated using Cox regression. Results At baseline, 16% reported s-ED. Scores of depression, anxiety and burnout and the rate of poor work ability increased with increasing severity of s-ED. Self-reported exhaustion at baseline increased the risk of reporting sickness absence at follow-up; pronounced s-ED RR 2.7; CI 1.8–4.0 for SA14 and RR 3.4; CI 2.3–5.2 for SA60. Conclusions Self-rated ED corresponded well to established scales for mental health, indicating sufficient construct validity. Individuals reporting s-ED at baseline were more likely to report sickness absence at follow-up, confirming its predictive properties. The s-ED instrument may be a useful tool for occupational health services in identifying human service workers at risk of having or developing a potentially disabling stress-related mental illness. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0490-xAuthors K. Glise, The Institute of Stress Medicine Carl Skottsbergsgata 22B 413 19 Göteborg SwedenE. Hadzibajramovic, The Institute of Stress Medicine Carl Skottsbergsgata 22B 413 19 Göteborg SwedenI. H. Jonsdottir, The Institute of Stress Medicine Carl Skottsbergsgata 22B 413 19 Göteborg SwedenG. Ahlborg, The Institute of Stress Medicine Carl Skottsbergsgata 22B 413 19 Göteborg Sweden Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Dimensional structure of the demand control support questionnaire: a Brazilian context

Abstract According to Karasek, job strain results from an interaction between high demands and low decision latitude. Purpose To reassess the dimensional structure and evaluate the internal consistency of demand control support questionnaire (DCSQ), a shortened version of job content questionnaire that was not sufficiently evaluated in validation studies. Methods The study investigated 825 workers who completed the DCSQ in Rio de Janeiro, Brazil; to 399 workers, the questionnaire was self-administered at a hospital (2004–2005), and 426 workers were interviewed at nine restaurants (2006–2007). Confirmatory factor analysis using structural equation models was used to test theoretical structure of dimensionality. Internal consistency was evaluated by composite reliability and convergent validity by average variance extracted. Results Confirmatory factor analysis supported the instrument in three dimensions: demands, skill discretion and decision authority. The best fit model was achieved by removing social support at work and the item repetitive work (skill discretion). A cross-loading from learning new things on demands and an error measurement correlation between work fast and work intense were confirmed. Composite reliability was acceptable for all dimensions, except for demands (0.58), which also showed inadequate average variance extracted (0.32). This final model was confirmed in separate analyses according to work setting, but the loadings of demands were lower for restaurant workers. Conclusion Our results indicated that skill discretion and decision authority formed two distinct dimensions. Additionally, the item repetitive work should be removed, as well as one of the items work fast or work intense (demands). Future research is still required to confirm these findings. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0488-4Authors Yara Hahr Marques Hökerberg, Oswaldo Cruz Foundation Clinical Epidemiology Laboratory, Evandro Chagas Clinical Research Institute Av. Brasil, 4365, Manguinhos Rio de Janeiro RJ 21040-900 BrazilOdaleia Barbosa Aguiar, University of the Rio de Janeiro State Institute of Social Medicine Rio de Janeiro BrazilMichael Reichenheim, University of the Rio de Janeiro State Institute of Social Medicine Rio de Janeiro BrazilEduardo Faerstein, University of the Rio de Janeiro State Institute of Social Medicine Rio de Janeiro BrazilJoaquim Gonçalves Valente, University of the Rio de Janeiro State Institute of Social Medicine Rio de Janeiro BrazilMaria de Jesus Fonseca, Oswaldo Cruz Foundation National School of Public Health Rio de Janeiro BrazilSonia Regina Lambert Passos, Oswaldo Cruz Foundation Clinical Epidemiology Laboratory, Evandro Chagas Clinical Research Institute Av. Brasil, 4365, Manguinhos Rio de Janeiro RJ 21040-900 Brazil Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Occupational chronic solvent encephalopathy in Finland 1995–2007: incidence and exposure

Abstract Purpose The aim of the study was to define the incidence of chronic solvent encephalopathy (CSE) in Finland during 1995–2007, evaluate the duration and nature of exposure, and identify the work tasks where CSE is encountered. Methods Data were from the register and patient records at the Finnish Institute of Occupational Health. The Finnish Job-Exposure Matrix (FINJEM) and National Statistics were used to estimate the incidence of CSE in exposed workforce. Results CSE cases during 1995–2007 numbered 129. The annual incidence has decreased from 8.6 to 1.2/million employed, i.e. from 18 to 3 patients per year. The number of suspected patients has, however, remained constant (mean 38.6/year). The mean age at diagnosis was 52.8, the mean duration of exposure 28.4 years, and the mean occupational exposure limit years (OELY) 10.5. During 1995–2007, the mean age increased annually by 0.6 and years of exposure by 0.8, but OELY remained constant. In comparison to FINJEM, the highest incidence was in workers exposed to aromatic hydrocarbons. Relative to workforce in occupations with solvent exposure, CSE was most frequent in wooden surface finishers and in industrial, metal, or car painters followed by floor layers and lacquerers. Conclusions The incidence of CSE has declined due to legislative, technical, and hygienic actions. CSE is most probable in spray painting tasks with main exposure to aromatic hydrocarbons, when occupational solvent exposure exceeds 20 years, and the age of the worker is above 45. Our results indicate slower CSE development at lower exposure levels. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0493-7Authors Petra Keski-Säntti, Brain and Work Research Centre Finnish Institute of Occupational Health Topeliuksenkatu 41 a A 00250 Helsinki FinlandAri Kaukiainen, Occupational Medicine Finnish Institute of Occupational Health Topeliuksenkatu 41 a A 00250 Helsinki FinlandHanna-Kaisa Hyvärinen, Brain and Work Research Centre Finnish Institute of Occupational Health Topeliuksenkatu 41 a A 00250 Helsinki FinlandMarkku Sainio, Brain and Work Research Centre Finnish Institute of Occupational Health Topeliuksenkatu 41 a A 00250 Helsinki Finland Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Effect of dust exposure and nitrogen oxides on lung function parameters of German coalminers: a longitudinal study applying GEE regression 1974–1998

Abstract Purpose Workplace limits for dust and nitrogen oxides are under review in Germany and the EU. We conducted a study on German coal miners to determine the effects of exposure on lung function. Methods Longitudinal inception cohort study (1974–1998) on miners who began working underground at two coal mines between 1974 and 1979. We determined the number of shifts worked underground, the exposure to coal mine dust, quartz dust, nitrogen oxides (NO, NO2), smoking behavior, and three lung function parameters (FVC, FEV1, FEV1/FVC). General estimation equation (GEE) models were fitted. Results 1,369 miners worked an average 3,017 shifts (S) underground. The mean respirable coal mine dust concentration was 1.89 mg/m³ (quartz: 0.067 mg/m³), and the nitrogen oxide concentrations were 0.58 ppm (NO) and 0.007 ppm (NO2). On average, 9 measurements of lung function were available per miner. Compared to reference values, the findings were unexceptionable (103, 101, and 99%) on average. GEE-regression models did not reveal detrimental dust exposure effects. Nitrogen oxides (NO x = NO + NO2) showed small but clearly insignificant effects on lung function: ∆ FVC = −0.0008 ml/(220 ppmS), P = 0.86, ∆ FEV1 = −0.003 ml/(220 ppmS), P = 0.50 and ∆ FEV1%FVC = −0.07%/(220 ppmS), P = 0.22. Conclusions The effect of dust exposure on lung function described in older British and American coal miner studies was not confirmed. This can be explained partly by differences in methods (here: longitudinal studies, no prior exposure), but also by lower dust levels. NO x exposures showed no relevant influence on lung function—a result confirming findings from British coal mining. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0489-3Authors P. Morfeld, Institute for Occupational Medicine of Cologne University Cologne GermanyB. Noll, Institute for Occupational Medicine of Cologne University Cologne GermanyS. F. Büchte, Institute for Occupational Medicine of Cologne University Cologne GermanyR. Derwall, RAG Deutsche Steinkohle, Servicebereich Belegschaft Bottrop GermanyV. Schenk, RAG Deutsche Steinkohle, Servicebereich Belegschaft Bottrop GermanyH. J. Bicker, RAG Deutsche Steinkohle, Arbeitsmedizinisches Zentrum Bottrop GermanyH. Lenaerts, RAG Deutsche Steinkohle, Arbeitsmedizinisches Zentrum Herne GermanyN. Schrader, RAG Deutsche Steinkohle, Arbeitsmedizinisches Zentrum Herne GermanyD. Dahmann, Institut für Gefahrstoff-Forschung Bochum Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Case–control study of knee osteoarthritis and lifestyle factors considering their interaction with physical workload

Abstract Aims The aim of this study is to examine the dose–response relationships between age, “lifestyle factors” (body mass index, tobacco smoking, sports), and symptomatic knee osteoarthritis in a population-based case–control study. Additionally, the study aims to investigate the mode of interaction between body mass index (BMI) and physical workload (occupational kneeling/squatting and lifting/carrying of loads) with respect to the risk of symptomatic knee osteoarthritis. Methods In five orthopedic clinics and five practices, 295 male patients aged 25–70 with radiographically confirmed knee osteoarthritis associated with chronic complaints were recruited. The control group comprised 327 male control subjects. In a structured personal interview, body weight at different ages, body height, cumulative amount of smoking, and cumulative duration of different sports activities until the date of first diagnosis of knee osteoarthritis were elicited. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression analysis. An interaction analysis for the parameters BMI and kneeling/squatting respective lifting/carrying of loads was performed. Population attributable risks (PAR) for knee osteoarthritis were determined for BMI solely and for the combination of BMI with occupational kneeling/squatting and lifting/carrying of loads, respectively. Results Age and overweight were strongly associated with the diagnosis of knee osteoarthritis. Compared with persons less than 35 years old, persons who were at least 65 years old had an odds ratio (OR) of 19.0 (95% CI 6.1–58.7) for knee osteoarthritis. Persons with a BMI ≥ 28.41 kg/m2 had a strongly elevated risk of knee osteoarthritis (OR 10.8; 95% CI 4.8–24.3) compared to persons with a BMI < 22.86 kg/m2. Heavy tobacco smoking (≥55.5 pack years) was associated with a decreased knee osteoarthritis risk in comparison with never-smoking (OR 0.2; 95% CI 0.1–0.5). Ball games (handball, volleyball, basketball) and cycling were associated with symptomatic knee osteoarthritis (OR 4.0; 95% CI 1.8–8.9 and OR 3.7; 95% CI 1.7–7.8 in the highest category of cumulative duration, respectively); to a weaker degree jogging, swimming, and soccer also were positively related to symptomatic knee osteoarthritis. Combining the two parameters, BMI and kneeling/squatting into one variable led to a multiplicative interaction mode for symptomatic knee osteoarthritis. For persons with elevated BMI in combination with moderate to high exposure to occupational kneeling/squatting, the population attributable risk (PAR) was 4%. The PAR for elevated BMI in combination with moderate to high exposure to occupational lifting/carrying of loads was 7%. Conclusions In accordance with the literature, we find a strong association between BMI and knee osteoarthritis risk. Considering the relatively high prevalence of occupational manual materials handling, prevention of knee osteoarthritis should not only focus on body weight reduction, but should also take into account work organizational measures particularly aiming to reduce occupational lifting and carrying of loads. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0486-6Authors Ilias Vrezas, Cyprus University of Technology Cyprus International Institute for Environmental and Public Health in Association with Harvard School of Public Health Corner of Athinon Road & N. Xiouta Street 3041 Lemesos CyprusGine Elsner, Johann Wolfgang Goethe-University Institute of Occupational Medicine Theodor-Stern-Kai 7 60590 Frankfurt/Main GermanyUlrich Bolm-Audorff, Giessen University Labour Inspection, Division of Occupational Health, Simone-Veil-Str. 5, 65197 Wiesbaden, Germany, and Associated Professor of Occupational Health Giessen GermanyNasreddin Abolmaali, Johann Wolfgang Goethe-University Institute of Diagnostic and Interventional Radiology Theodor-Stern-Kai 7 60590 Frankfurt/Main GermanyAndreas Seidler, Federal Institute of Occupational Safety and Health Nöldnerstr. 40-42 10317 Berlin Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Exposure to poultry dust and health effects in poultry workers: impact of mould and mite allergens

Abstract Purpose The aim of the study was to evaluate exposure to moulds and house dust mite Dermatophagoides pteronyssinus in poultry farms, and related health effects in poultry workers (PW). Methods The study involved 41 PW and 45 control office workers. Working environment was evaluated for D. pteronyssinus allergen (Der p 1), moulds and endotoxin. In workers, eye, skin and respiratory symptoms, ventilatory lung function, atopy markers (skin prick test to inhalatory allergens, total IgE) and specific IgG to moulds were assessed. Results Der p 1 levels ranged <0.1–3.3 μg/g, exposure to fungi was 4.9 × 103–6.8 × 104 cfu/m3, with prevailing Aspergillus, Penicillium and Mucor species, and endotoxin levels ranged 230–284 EU/m3. In comparison to control subjects, significantly higher prevalence of work-related nose, asthma, eye and skin symptoms, and slight decline in ventilatory lung function was found in PW. PW had significantly higher prevalence of IgG antibodies to moulds comparing to controls (63 vs. 36%, respectively, P = 0.01), especially to Alternaria and Aspergillus species. The prevalence of atopy markers in PW was lower than in population-based studies. Conclusions Hazardous levels of Der p 1, endotoxin and moulds were determined in poultry houses. High prevalence of work-related symptoms and IgG antibodies to moulds was found in PW. Healthy worker effect is proposed as an explanation of low atopy markers prevalence among PW. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0487-5Authors Davor Rimac, Institute for Medical Research and Occupational Health Ksaverska cesta 2 10000 Zagreb CroatiaJelena Macan, Institute for Medical Research and Occupational Health Ksaverska cesta 2 10000 Zagreb CroatiaVeda M. Varnai, Institute for Medical Research and Occupational Health Ksaverska cesta 2 10000 Zagreb CroatiaMarija Vučemilo, University of Zagreb School of Veterinary Medicine Heinzelova 55 Zagreb CroatiaKristina Matković, University of Zagreb School of Veterinary Medicine Heinzelova 55 Zagreb CroatiaLjerka Prester, Institute for Medical Research and Occupational Health Ksaverska cesta 2 10000 Zagreb CroatiaTatjana Orct, Institute for Medical Research and Occupational Health Ksaverska cesta 2 10000 Zagreb CroatiaIvančica Trošić, Institute for Medical Research and Occupational Health Ksaverska cesta 2 10000 Zagreb CroatiaIvan Pavičić, Institute for Medical Research and Occupational Health Ksaverska cesta 2 10000 Zagreb Croatia Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 1 / January, 2010

Organizational justice, psychological distress, and work engagement in Japanese workers

Abstract Purpose To investigate the cross-sectional association between organizational justice (i.e., procedural justice and interactional justice) and psychological distress or work engagement, as well as the mediating roles of other job stressors (i.e., job demands and job control, or their combination, effort–reward imbalance [ERI], and worksite support). Methods A total of 243 workers (185 males and 58 females) from a manufacturing factory in Japan were surveyed using a self-administered questionnaire including the Organizational Justice Questionnaire, Job Content Questionnaire, Effort–Reward Imbalance Questionnaire, K6 scale, Utrecht Work Engagement Scale, and other covariates. Multiple mediation analyses with the bootstrap technique were conducted. Results In the bivariate analysis, procedural justice and interactional justice were significantly and negatively associated with psychological distress; they were significantly and positively associated with work engagement. In the mediation analysis, reward at work (or ERI) significantly mediated between procedural justice or interactional justice and psychological distress; worksite support significantly mediated between procedural justice or interactional justice and work engagement. Conclusion The effects of organizational justice on psychological distress seem to be mediated by reward at work (or ERI) while those regarding work engagement may be mediated by worksite support to a large extent, at least in Japanese workers. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0485-7Authors Akiomi Inoue, The University of Tokyo Department of Mental Health, Graduate School of Medicine 7-3-1 Hongo Bunkyo-ku Tokyo 113-0033 JapanNorito Kawakami, The University of Tokyo Department of Mental Health, Graduate School of Medicine 7-3-1 Hongo Bunkyo-ku Tokyo 113-0033 JapanMasao Ishizaki, Kanazawa Medical University Department of Social and Environmental Medicine (Hygiene) 1-1 Daigaku Uchinada Ishikawa 920-0293 JapanAkihito Shimazu, The University of Tokyo Department of Mental Health, Graduate School of Medicine 7-3-1 Hongo Bunkyo-ku Tokyo 113-0033 JapanMasao Tsuchiya, The University of Tokyo Department of Mental Health, Graduate School of Medicine 7-3-1 Hongo Bunkyo-ku Tokyo 113-0033 JapanMasaji Tabata, Ishikawa Health Service Association 115 Kaminomachi-higashi Kanazawa Ishikawa 920-0365 JapanMiki Akiyama, Tokyo Healthcare University Division of Nursing, Faculty of Healthcare 4-1-17 Higashi-gotanda Shinagawa-ku Tokyo 141-8648 JapanAkiko Kitazume, The University of Tokyo Department of Psychiatric Nursing, Graduate School of Medicine 7-3-1 Hongo Bunkyo-ku Tokyo 113-0033 JapanMitsuyo Kuroda, The University of Tokyo Department of Mental Health, Graduate School of Medicine 7-3-1 Hongo Bunkyo-ku Tokyo 113-0033 Japan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 1 / January, 2010

The cardiovascular response to an acute 1800-μT, 60-Hz magnetic field exposure in humans

Abstract Purpose Previously published literature has suggested an effect of extremely low-frequency (ELF) magnetic fields (MF) on human heart rate (HR) and heart rate variability (HRV). The combined response of the microcirculation and macrocirculation to ELF MF exposure has not previously been studied in humans. This study investigated the effects of 1-h exposure to an 1800-μT, 60-Hz MF on human microcirculation (represented in this study as skin blood perfusion), HR, low-frequency HRV, and high-frequency HRV. Methods Fifty-eight volunteers were recruited to partake in a double-blinded, counterbalanced study consisting of two testing sessions (real and sham) administered on separate days. Each session included four consecutive blocks of measurements, separated by 15-min rest periods, allowing measurement of cumulative and residual MF effects. Within subjects, ANOVA were conducted on each of the measured parameters. Results A decrease of skin blood perfusion and HR, and an increase of HRV were observed over blocks (p < 0.05). No session by block interactions were found for any of the cardiovascular parameters which would have suggested a MF effect (p > 0.05). A session by block interaction (p < 0.001) and a MF order effect (sham or real exposure first, p < 0.05) were observed for skin surface temperature. Conclusions The MF used in this experiment did not affect cardiovascular parameters. Although an alternative explanation for why skin surface temperatures decreased in the sham and not in the real exposure condition is presented, the possibility of a MF effect cannot be excluded. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0484-8Authors David A. McNamee, Lawson Health Research Institute Bioelectromagnetics, Imaging Program 268 Grosvenor Street N6A 4V2 London ON CanadaMichael Corbacio, Lawson Health Research Institute Bioelectromagnetics, Imaging Program 268 Grosvenor Street N6A 4V2 London ON CanadaJulie K. Weller, Lawson Health Research Institute Bioelectromagnetics, Imaging Program 268 Grosvenor Street N6A 4V2 London ON CanadaSamantha Brown, Lawson Health Research Institute Bioelectromagnetics, Imaging Program 268 Grosvenor Street N6A 4V2 London ON CanadaFrank S. Prato, Lawson Health Research Institute Bioelectromagnetics, Imaging Program 268 Grosvenor Street N6A 4V2 London ON CanadaAlex W. Thomas, Lawson Health Research Institute Bioelectromagnetics, Imaging Program 268 Grosvenor Street N6A 4V2 London ON CanadaAlexandre G. Legros, Lawson Health Research Institute Bioelectromagnetics, Imaging Program 268 Grosvenor Street N6A 4V2 London ON Canada Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Relationship between indoor chemical concentrations and subjective symptoms associated with sick building syndrome in newly built houses in Japan

Abstract Objectives This study explored possible associations between chemical substances and sick building syndrome (SBS)-type symptoms of residents living in new houses in Japan. Methods We randomly sampled 5,709 newly built conventional homes. In the end, 1,479 residents in 425 households completed a questionnaire survey and agreed to environmental monitoring for indoor aldehydes and volatile organic compounds (VOCs) to be conducted in their homes. If the residents had complained about at least one SBS-related symptom, they were classified as suffering from SBS. Multiple logistic regression analysis was used to select predictive chemical factors of SBS symptoms. Results About 14% of the subjects suffered from SBS. Many aldehydes and VOCs were associated factors of optical, nasal, and gular symptoms in univariate analysis. After adjustment for other possible risk factors, formaldehyde dose-dependently showed to be a significant risk factor for SBS. Several chemicals had tendency to be associated with SBS symptoms. Conclusions Chemicals detected in Japanese newly built houses tend to increase the risk of subjective symptoms in residents suffering from SBS. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0475-9Authors Tomoko Takigawa, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Public Health 2-5-1 Shikata-cho, Kita-ku Okayama 700-8558 JapanBing-Ling Wang, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Public Health 2-5-1 Shikata-cho, Kita-ku Okayama 700-8558 JapanYasuaki Saijo, Asahikawa Medical College Department of Health Science Midorigaoka E2-1-1-1 Asahikawa 078-8510 JapanKanehisa Morimoto, Osaka University Graduate School of Medicine Department of Social and Environmental Medicine 2-2 Yamadaoka Suita 565-0871 JapanKunio Nakayama, Osaka University Graduate School of Medicine Department of Social and Environmental Medicine 2-2 Yamadaoka Suita 565-0871 JapanMasatoshi Tanaka, Fukushima College 1-1 Chigoike Miyashiro Fukushima 960-8505 JapanEiji Shibata, Aichi Medical University School of Medicine Department of Health and Psychosocial Medicine Nagakute-cho Aichi Prefecture 480-1195 JapanTakesumi Yoshimura, Fukuoka Institute of Health and Environmental Sciences 39 Mukouzano Dazaifu 818-0135 JapanHisao Chikara, Fukuoka Institute of Health and Environmental Sciences 39 Mukouzano Dazaifu 818-0135 JapanKeiki Ogino, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Public Health 2-5-1 Shikata-cho, Kita-ku Okayama 700-8558 JapanReiko Kishi, Hokkaido University Graduate School of Medicine Department of Public Health Kita 15, Nishi 7, Kita-ku Sapporo 060-8638 Japan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 2 / February, 2010

Mortality in the Baltimore union poultry cohort: non-malignant diseases

Abstract Background Workers in poultry plants have high exposure to a variety of transmissible agents present in poultry and their products. Subjects in the general population are also exposed. It is not known whether many of these agents cause disease in humans. If they do, we reason this would be readily evident in a highly exposed group such as poultry workers. We report here on mortality from non-malignant diseases in a cohort of poultry workers. Methods Mortality was compared with that of the US general population, and with that of a comparison group from the same union. Risk was estimated by standardized mortality ratio, proportional mortality ratio, and directly standardized risk ratio. Results Poultry workers as a group had an overall excess of deaths from diabetes, anterior horn disease, and hypertensive disease, and a deficit of deaths from intracerebral hemorrhage. Deaths from zoonotic bacterial diseases, helminthiasis, myasthenia gravis, schizophrenia, other diseases of the spinal cord, diseases of the esophagus and peritonitis were non-significantly elevated overall by all analyses, and significantly so in particular race/sex subgroups. Conclusions Poultry workers may have excess occurrence of disease affecting several organs and systems, probably originating from widespread infection with a variety of microorganisms. The results for neurologic diseases could well represent important clues to the etiology of these diseases in humans. The small numbers of deaths involved in some cases limit interpretation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0478-6Authors Eric S. Johnson, UNT Health Science Center Department of Epidemiology, School of Public Health Fort Worth TX USALillian C. Yau, Tulane University Department of Biostatistics, School of Public Health & Tropical Medicine New Orleans LA USAYi Zhou, Tulane University Department of Biostatistics, School of Public Health & Tropical Medicine New Orleans LA USAKaran P. Singh, UNT Health Science Center Department of Biostatistics, School of Public Health Fort Worth TX USAHarrison Ndetan, UNT Health Science Center Department of Biostatistics, School of Public Health Fort Worth TX USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Sustainability of an interdisciplinary secondary prevention program for hairdressers

Abstract Objective Two hundred and fifteen hairdressers suffering from occupational skin diseases (OSD) have attended a 6-month combined dermatological and educational prevention program with an education and counseling scheme as well as an intervention in the respective hairdressers’ shops. The aim of this program, conducted from 1994 to 1997, was to enable the affected hairdressers to remain at work without suffering from major OSD. Methods To assess the sustainability of this interdisciplinary medical and educational training program, the intervention group (IG, N = 215) and a control group (CG, hairdressers with OSD who solely received dermatological treatment, N = 85) were followed up 9 month and 5 years after their individual project participation by a standardized questionnaire. A subcohort of the intervention group (IG1994, participants in 1994, N = 62) was followed up again 10 years after their participation. Results The follow-up survey 9 months after the beginning of the program (response rate: IG: N = 163, 75.8%; CG: N = 80, 94.1%) showed that 71.8% (N = 117) of the intervention group could remain in work as opposed to 60.0% (N = 48) in the control group. In the intervention group 14.7% gave up work due to OSD versus 22.5% in the control group (no statistically significant effect). In the 5-year follow-up (response rate: IG: N = 172, 80%; CG: N = 55, 64.7%) 58.7% (N = 101) of the IG remained at work versus 29.1% (N = 16) of the CG. In the IG 12.8% had stopped work because of OSD versus 27.3% in the CG (p < 0.001, Cramer’s V = 0.26). Ten years after intervention, the follow-up showed a stabilization of the effects shown by the 5-year follow-up results. In addition to the criteria ‘remaining’ or ‘not remaining at work’ the results show that our interdisciplinary intervention program led to an increased and sustained knowledge on OSD and more adequate prevention at the work place in the IG. The results confirm that interdisciplinary training can be successful in effecting self-protection against workplace hazards by using positive approaches that include the learning of “safe” behavior and insuring transferability to real workplace settings (“empowerment”). Combined preventive measures as studied in this program have recently become the standard offered by different statutory accident liability insurances for patients in different wet work occupations with OSD in Germany. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0480-zAuthors B. Wulfhorst, University of Osnabrueck Department of Dermatology, Environmental Medicine and Health Theory, Faculty of Human Sciences Sedanstrasse 115 49069 Osnabrück GermanyM. Bock, University of Osnabrueck Department of Dermatology, Environmental Medicine and Health Theory, Faculty of Human Sciences Sedanstrasse 115 49069 Osnabrück GermanyG. Gediga, University of Muenster Department of Psychology, Institute IV: Evaluation and Statistics Fliednerstr. 21 48149 Muenster GermanyC. Skudlik, University of Osnabrueck Department of Dermatology, Environmental Medicine and Health Theory, Faculty of Human Sciences Sedanstrasse 115 49069 Osnabrück GermanyH. Allmers, University of Osnabrueck Department of Dermatology, Environmental Medicine and Health Theory, Faculty of Human Sciences Sedanstrasse 115 49069 Osnabrück GermanyS. M. John, University of Osnabrueck Department of Dermatology, Environmental Medicine and Health Theory, Faculty of Human Sciences Sedanstrasse 115 49069 Osnabrück Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 2 / February, 2010

Cadmium and tubular dysfunction marker levels in urine of residents in non-polluted areas with natural abundance of cadmium in Japan

Abstract Objectives Literature survey has suggested that cadmium (Cd) in the general environment is more abundant in the northern part of the coast on the sea of Japan. The present survey was initiated to examine if the exposure to Cd in the area has been higher than other parts of Japan, and if so, the higher exposure has been associated with tubular dysfunction among the local residents. Methods In three prefectures of Akita, Yamagata and Ishikawa in the region, adult women (about 700 subjects per prefecture) were invited to participate in the survey. Each of the participants provided informed consents, offered spot urine samples and filled questionnaires (on age etc.). The urine samples were analyzed for Cd, α1-microglobulin (α1-MG), β2-microglobulin (β2-MG) and N-acetyl-β-d-glucosaminidase, together with creatinine and specific gravity. The results were combined with published data on two other prefectures of Niigata and Toyama (both in the area), as well as Japan as a whole (all Japan-A excluding Niigata prefecture, which was studied separately in the present study), and subjected to analysis for possible difference from all Japan-A in terms of the levels of internal Cd burden, and prevalence of β2-MG-uria. Results Geometric means (GMs) for urinary Cd in the five prefectures were in a range from a low of 1.20 to a high of 2.65 μg/l, being higher than the GM (0.99 μg/l) for all Japan-A. GMs for α1-MG (2.15–2.80 mg/l) and β2-MG (99–107 μg/l) were only slightly higher or even lower than all Japan-A values depending on the prefectures. Elevation in the prevalence of β2-MG-uria was significant in Akita prefecture, but the elevation in β2-MG was not associated with elevation in Cd in urine. Literature survey on general population Cd epidemiology showed that Cd, α1-MG and β2-MG levels in urine of the residents in the five prefectures were within the levels reported for non-polluted areas, and such was also the case for prevalence of β2-MG-uria. Conclusions In an over-all evaluation, no clear-cut evidence was available for increased prevalence of Cd exposure-associated renal tubular dysfunction among general populations in the five prefectures in the northern part on the coast of Sea of Japan than in other prefectures in Japan, despite moderate elevation in urinary Cd levels. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0483-9Authors Jiro Moriguchi, Kyoto Industrial Health Association (Health Service Center) 4-1 Mibu-Shujakucho Nakagyo-ku, Kyoto 604-8871 JapanYoshiro Inoue, Akita Health Care Association Akita 010-8543 JapanSigetosi Kamiyama, Morinomiyako Occupational Health Association Miyagino-ku, Sendai 983-0031 JapanSonoko Sakuragi, Kyoto Industrial Health Association (Health Service Center) 4-1 Mibu-Shujakucho Nakagyo-ku, Kyoto 604-8871 JapanMasaru Horiguchi, Kanazawa Social Insurance Hospital Health Care Center Kanazawa 920-0013 JapanKatsuyuki Murata, Akita University School of Medicine Department of Environmental Health Sciences Akita 010-8543 JapanYoshinari Fukui, Kyoto Industrial Health Association (Main Office) 67 Nishinokyo-Kitatsuboicho Nakagyo-ku, Kyoto 604-8472 JapanFumiko Ohashi, Kyoto Industrial Health Association (Main Office) 67 Nishinokyo-Kitatsuboicho Nakagyo-ku, Kyoto 604-8472 JapanMasayuki Ikeda, Kyoto Industrial Health Association (Main Office) 67 Nishinokyo-Kitatsuboicho Nakagyo-ku, Kyoto 604-8472 Japan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Asthma and lower respiratory symptoms in New York State employees who responded to the World Trade Center disaster

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 Journal Volume Volume 83 Journal Issue Volume 83, Number 1 / January, 2010

Gender moderates the health-effects of job strain in managers

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

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

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

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

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

Psychoactive substances consumption in French fishermen and merchant seamen

Abstract Objectives The aim of this study is to assess tobacco consumption, nicotine dependence as diagnosed by Fagerström test, alcohol consumption, alcohol dependence as diagnosed by CAGE questionnaire and drug consumption in French seamen. Results are presented according to job category: fishermen and merchant seamen. Methods French seamen were recruited from a stratified survey of 19 ports in France. Subjects completed a questionnaire during their annual medical check-up. The questionnaire covered demographic and professional items, tobacco, alcohol and drug consumption behaviour. Nicotine and alcohol dependence were, respectively, assessed by the Fagerström Test for Nicotine Dependence (FTND) and a French version of the CAGE questionnaire. A urine test was used to detect cannabis derivatives. Results Prevalence rates for current smoking and daily alcohol consumption were higher in fishermen than merchant seamen. The prevalence of nicotine dependence on FTND was likewise higher in fisherman smokers, who also showed more intense smoking behaviour. The category of seamen did not correlate with alcohol addiction, but differences in alcohol-related behaviour emerged between fishermen and merchant seamen. Prevalence of cannabis and other drug use was higher in merchant seamen, although the two categories of seaman did not differ with respect to recent use of cannabis. Demographic factors cannot fully explain these differences, as multivariate analysis showed significantly greater risks in marine fisheries. Conclusions Alcohol and tobacco consumption are a major public health problem for seafarers. Fishermen seem to be more liable to high consumption. Working conditions may explain these differences. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0473-yAuthors Emmanuel Fort, Université de Lyon 69003 Lyon FranceAmélie Massardier-Pilonchéry, Université de Lyon 69003 Lyon FranceAlain Bergeret, Université de Lyon 69003 Lyon France Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Karl-Heinz Schaller awarded with Franz Koelsch Medal 2009

Karl-Heinz Schaller awarded with Franz Koelsch Medal 2009 Content Type Journal ArticleCategory AcknowledgementDOI 10.1007/s00420-009-0470-1Authors Hans Drexler, University of Erlangen-Nuremberg Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine Schillerstr. 25 and 29 91054 Erlangen Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 1 / January, 2010

Changes in physical performance among construction workers during extended workweeks with 12-hour workdays

Abstract Purpose To investigate changes of physical performance during long working hours and extended workweeks among construction workers with temporary accommodation in camps. Methods Nineteen construction workers with 12-h workdays and extended workweeks participated. Physical performance in the morning and evening of the second and eleventh workdays was tested by endurance, ability to react to a sudden load, flexibility of the back, handgrip strength and sub-maximal HR during a bicycle test. HR was registered throughout two separate workdays. Results HR during each of the two separate workdays corresponded to a relative workload of 25%. Sub-maximal HR was lower, reaction time faster and handgrip strength higher in the end of each test day. In the end of the work period, sub-maximal HR was lower, reaction time faster and sitting balance was better. Conclusion No trends of decreased physical performance were found after a workday or a work period. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0471-0Authors Anne Faber, National Research Centre for the Working Environment Lersø Park Alle 105 2100 Kbh Ø Copenhagen DenmarkJesper Strøyer, National Research Centre for the Working Environment Lersø Park Alle 105 2100 Kbh Ø Copenhagen DenmarkNis Hjortskov, National Research Centre for the Working Environment Lersø Park Alle 105 2100 Kbh Ø Copenhagen DenmarkBente Schibye, National Research Centre for the Working Environment Lersø Park Alle 105 2100 Kbh Ø Copenhagen Denmark Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 1 / January, 2010

Lack of correlation between cadmium level in local brown rice and renal failure mortality among the residents: a nation-wide analysis in Japan

Abstract Objectives Cadmium is a ubiquitous hazardous element with nephro-toxicity after long-term exposure. The present study was initiated to examine possible effects of dietary cadmium (Cd) intake on health of local residents across Japan. For this purpose, Cd in locally harvested brown rice (Cd-BR) was taken as the parameter of Cd exposure, and two measures of mortality, i.e., standardized mortality ratio (SMR) and age-adjusted renal insufficiency mortality rate (AARIMR) were employed as parameters of over-all health effects including effects on kidney. Methods Japan consists of 47 prefectures. Data on Cd in 37,250 brown rice samples harvested in 1997–1998 in the 47 prefectures were made available from the Ministry of Agriculture, Forestry and Fisheries, Japan. SMR and AARIMR data (for the year 2000) by two genders in the 47 prefectures were cited from publications of the Ministry of Health, Labour and Welfare, Japan. Possible correlation of Cd in brown rice (Cd-BR) with SMR and AARIMR was examined by Poisson regression analysis. Results The geometric mean (GM) Cd-BR for Japan as a whole was 0.040 mg/kg with a geometric standard deviation (GSD) of 2.72. Prefectural GM values varied from a low of <0.01 mg/kg to a high of 0.089 mg/kg. Nevertheless, SMR (in a range of 89.9–119.5 for men and 87.1–111.7 for women) did not correlate with Cd-BR significantly. AARIMR (in a range of 5.3–11.9 and 3.2–8.4 for men and women, respectively) tended to decrease as a function of increasing Cd-BR both in men and women, although the correlation was insignificant in both genders. Conclusions No evidence was obtained in the present analysis to suggest that either mortality as a whole or the mortality due to renal failure is affected by dietary intake of Cd in rice. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0472-zAuthors Naoru Koizumi, Geroge Mason University School of Public Policy Arlington VA 22201 USAFumiko Ohashi, Kyoto Industrial Health Association 67 Nishinokyo-Kitatsuboicho, Nakagyo-ku Kyoto 604-8472 JapanMasayuki Ikeda, Kyoto Industrial Health Association 67 Nishinokyo-Kitatsuboicho, Nakagyo-ku Kyoto 604-8472 Japan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Information and feedback to improve occupational physicians’ reporting of occupational diseases: a randomised controlled trial

Abstract Purpose To assess the effectiveness of supplying occupational physicians (OPs) with targeted and stage-matched information or with feedback on reporting occupational diseases to the national registry in the Netherlands. Methods In a randomized controlled design, 1076 OPs were divided into three groups based on previous reporting behaviour: precontemplators not considering reporting, contemplators considering reporting and actioners reporting occupational diseases. Precontemplators and contemplators were randomly assigned to receive stage-matched, stage-mismatched or general information. Actioners were randomly assigned to receive personalized or standardized feedback upon notification. Outcome measures were the number of OPs reporting and the number of reported occupational diseases in a 180-day period before and after the intervention. Results Precontemplators were significantly more male and self-employed compared to contemplators and actioners. There was no significant effect of stage-matched information versus stage-mismatched or general information on the percentage of reporting OPs and on the mean number of notifications in each group. Receiving any information affected reporting more in contemplators than in precontemplators. The mean number of notifications in actioners increased more after personalized feedback than after standardized feedback, but the difference was not significant. Conclusions This study supports the concept that contemplators are more susceptible to receiving information but could not confirm an effect of stage-matching this information on reporting occupational diseases to the national registry. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0468-8Authors Annet F. Lenderink, University of Amsterdam Netherlands Centre for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center (AMC) PO Box 22660 1100 DD Amsterdam The NetherlandsDick Spreeuwers, University of Amsterdam Netherlands Centre for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center (AMC) PO Box 22660 1100 DD Amsterdam The NetherlandsJac J. L. van der Klink, University of Groningen Department of Health Sciences, University Medical Center Groningen Groningen The NetherlandsFrank J. H. van Dijk, University of Amsterdam Netherlands Centre for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center (AMC) PO Box 22660 1100 DD Amsterdam The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Validity of new biomarkers of internal dose for use in the biological monitoring of occupational and environmental exposure to low concentrations of benzene and toluene

Abstract Objectives This study analyzes the validity of new, more sensitive and specific urinary biomarkers of internal dose, namely, urinary benzene for benzene and urinary toluene and S-benzylmercapturic acid (SBMA) for toluene, to assess their efficacy when compared to traditional biomarkers for biological monitoring of occupational exposure to low concentrations of these two toxic substances. Methods Assessment was made of 41 workers occupationally exposed to benzene and toluene, 18 fuel tanker drivers and 23 filling-station attendants, as well as 31 subjects with no occupational exposure to these toxic substances (controls). Exposure to airborne benzene and toluene was measured using passive Radiello® personal samplers worn throughout the work shift. In urine samples collected from all subjects at the end of the workday, both the traditional and the new internal dose biomarkers of benzene and toluene were assessed, as well as creatinine so as to apply suitable adjustments. Results Occupational exposure to benzene and toluene resulted significantly higher in the fuel tanker drivers than the filling-station attendants, and higher in the latter than in controls. Significantly higher concentrations of t,t-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), urinary benzene, SBMA and urinary toluene were found in the drivers than the filling-station attendants or the controls. Instead, urinary phenol and hippuric acid were not different in the three groups. In the entire sample, airborne benzene and toluene values were significantly correlated, as were the respective urinary biomarkers, showing coefficients ranging from 0.36 to 0.98. Subdividing the subjects by smoking habit, higher coefficients were evident in non-smokers than in smokers; at multiple regression analysis t,t-MA, SPMA and urinary benzene and toluene were dependent on the number of cigarettes smoked daily and on airborne benzene and toluene, respectively. Instead, SBMA was dependent only on airborne toluene. Conclusions Our research confirmed the validity of t,t-MA and SPMA for use in the biological monitoring of exposure to low concentrations of benzene. Urinary benzene showed comparable validity to SPMA; both parameters are affected by smoking cigarettes in the hours before urine collection, so it is best to ask subjects to refrain from smoking for 2 h before urine collection. Urinary toluene was found to be a more specific biomarker than SBMA. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0469-7Authors Piero Lovreglio, University of Bari Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro “E.C. Vigliani” Policlinico, Piazza Giulio Cesare, 11 70124 Bari ItalyAnna Barbieri, University of Bologna Dipartimento di Medicina Interna, dell’Invecchiamento e Malattie Nefrologiche, Unità Operativa di Medicina del Lavoro Via Palagi 9 40138 Bologna ItalyMariella Carrieri, University of Padova Dipartimento di Medicina Ambientale e Sanità Pubblica Via Giustiniani 2 35128 Padova ItalyLaura Sabatini, University of Bologna Dipartimento di Medicina Interna, dell’Invecchiamento e Malattie Nefrologiche, Unità Operativa di Medicina del Lavoro Via Palagi 9 40138 Bologna ItalyMaria Enrica Fracasso, University of Verona Dipartimento di Medicina e Salute Pubblica, Sezione di Farmacologia Piazzale L. A. Scuro 10 37134 Verona ItalyDenise Doria, University of Verona Dipartimento di Medicina e Salute Pubblica, Sezione di Farmacologia Piazzale L. A. Scuro 10 37134 Verona ItalyIgnazio Drago, University of Bari Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro “E.C. Vigliani” Policlinico, Piazza Giulio Cesare, 11 70124 Bari ItalyAntonella Basso, University of Bari Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro “E.C. Vigliani” Policlinico, Piazza Giulio Cesare, 11 70124 Bari ItalyMaria Nicolà D’Errico, University of Bari Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro “E.C. Vigliani” Policlinico, Piazza Giulio Cesare, 11 70124 Bari ItalyGiovanni Battista Bartolucci, University of Padova Dipartimento di Medicina Ambientale e Sanità Pubblica Via Giustiniani 2 35128 Padova ItalyFrancesco Saverio Violante, University of Bologna Dipartimento di Medicina Interna, dell’Invecchiamento e Malattie Nefrologiche, Unità Operativa di Medicina del Lavoro Via Palagi 9 40138 Bologna ItalyLeonardo Soleo, University of Bari Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Medicina del Lavoro “E.C. Vigliani” Policlinico, Piazza Giulio Cesare, 11 70124 Bari Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

The relationship between upper extremity musculoskeletal symptoms attributed to work and risk factors in office workers

Abstract Purpose Office workers are exposed to various individual, work-related and psychosocial factors during work that have been associated with the development of musculoskeletal symptoms. There is an increasing in evidence that suggests that musculoskeletal symptoms in the upper extremity are very common among office workers. The aim of this study was to examine the effects of individual, work-related physical and psychosocial factors on the prevalence of shoulder, elbow and wrist/hand symptoms attributed to work in office workers. Methods A self-administered questionnaire was delivered to 2,000 office workers in 54 workplaces in Bangkok, registered at the Social Security Office of Thailand. Results A total of 1,428 subjects (71%) returned the questionnaire, of whom 1,185 were eligible for the study. Alcohol consumption, frequency of working in an uncomfortable posture and relationships with colleagues were each significantly related to the prevalence of experiencing shoulder symptoms. No significant association between the investigated factors and the prevalence of experiencing elbow symptoms was found. Frequency of working in the position that hands were above the shoulder level and self-rated perception of air circulation in the office were significantly associated with the prevalence of experiencing wrist/hand symptoms. Conclusions Various individual, work-related and psychosocial factors were identified to be associated with high prevalence of musculoskeletal symptoms attributed to work in the shoulder and wrist/hand among office workers. Further research investigating the causal relation between these factors and musculoskeletal symptoms should be conducted. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0466-xAuthors Prawit Janwantanakul, Chulalongkorn University Department of Physical Therapy, Faculty of Allied Health Sciences Bangkok ThailandPraneet Pensri, Chulalongkorn University Department of Physical Therapy, Faculty of Allied Health Sciences Bangkok ThailandWiroj Jiamjarasrangsi, Chulalongkorn University Department of Preventive and Social Medicine, Faculty of Medicine Bangkok ThailandThanes Sinsongsook, Samutprakarn Hospital Department of Occupational Medicine Samutprakarn Province Thailand Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Hydroxypyrene in urine of football players after playing on artificial sports field with tire crumb infill

Abstract Background Artificial sports fields are increasingly being used for sports. Recycled rubber from automotive and truck scrap rubber tires are used as an infill material for football grounds. There are concerns that football players may be at risk due to exposure from released compounds from rubber infill. Compounds from crumb infill may be inhaled and dermal exposure may occur. A study was performed to assess the exposure of football players to polycyclic aromatic hydrocarbons due to sporting on synthetic ground with rubber crumb infill. Methods In this study, football players were trained and had a match on the artificial turf pitch during 2.5 h. They had an intensive skin contact with rubber infill. All urine of seven nonsmoking football players was collected over a 3-day period, the day before sporting, the day of sporting and the day after sporting. Urine samples were analyzed for 1-hydroxypyrene. Confounding exposure from environmental sources and diet was controlled for. Results The individual increase of the amount of excretion over time was used as a measure to assess the uptake of PAH. It appeared that the baseline of excreted 1-hydroxypyrene in 4 of 7 volunteers was sufficient stable and that 1 volunteer out of 4 showed after the 2.5-h period of training and match on the playground an increase in hydroxypyrene in urine. However, concomitant dietary uptake of PAH by this volunteer was observed. Conclusions This study provides evidence that uptake of PAH by football players active on artificial grounds with rubber crumb infill is minimal. If there is any exposure, than the uptake is very limited and within the range of uptake of PAH from environmental sources and/or diet. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0465-yAuthors Joost G. M. van Rooij, IndusTox Consult PO Box 31070 6503 CB Nijmegen The NetherlandsFrans J. Jongeneelen, IndusTox Consult PO Box 31070 6503 CB Nijmegen The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 1 / January, 2010

Chronic stress experience in young physicians: impact of person- and workplace-related factors

Abstract Objectives The objectives of the present study are to investigate and compare the relative impact of workplace-related factors and personal characteristics on chronic psychosocial stress experience in young physicians. Methods In a prospective study, a cohort of Swiss medical school graduates was followed up, beginning in 2001. In their fourth and eighth year after graduation, 443 physicians assessed their workplace conditions, the experienced effort–reward imbalance, the received professional and emotional support as well as their personal characteristics. The chronic stress experience was measured by the Trier Inventory for the Assessment of Chronic Stress–Screening Subscale of Chronic Stress (TICS–SCSS), 7 years after graduation. The model of influencing factors on chronic stress experience was tested with a hierarchical regression analysis. Results The mean in chronic stress (TICS–SCSS) in our study sample is significantly higher (p < 0.001) compared to an age-matched population representative sample. In the prediction of chronic stress, the workplace-related factor effort–reward imbalance as well as the personal characteristic overcommitment turned out to be the most important risk factors. Stress protective are high satisfaction with career support, sense of coherence and occupational self-efficacy. The whole set of variables used in the regression model explains 51% of the variance of chronic stress experience. In the prediction of chronic stress, gender has no significant moderator effect. Conclusions It is a matter of concern that young physicians report to feel chronically stressed early in their professional career. Actions have to be taken to reduce the stress level mainly in regard to re-establish reciprocity between perceived effort invested and rewards received, in the form of esteem, monetary gain and career opportunities including job security. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0467-9Authors Barbara Buddeberg-Fischer, Zurich University Hospital Department of Psychosocial Medicine Haldenbachstrasse 18 8091 Zurich SwitzerlandMartina Stamm, Zurich University Hospital Department of Psychosocial Medicine Haldenbachstrasse 18 8091 Zurich SwitzerlandClaus Buddeberg, Zurich University Hospital Department of Psychosocial Medicine Haldenbachstrasse 18 8091 Zurich SwitzerlandRichard Klaghofer, Zurich University Hospital Department of Psychosocial Medicine Haldenbachstrasse 18 8091 Zurich Switzerland Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

A longitudinal study of vibration white finger, cold response of digital arteries, and measures of daily vibration exposure

Abstract Purpose To investigate prospectively the relation between vibration-induced vascular disorders and measures of daily exposure to hand-transmitted vibration (HTV). Methods Two hundred and forty-nine HTV workers and 138 control men of the same companies participated in a 3-year follow-up study. The diagnosis of vibration induced white finger (VWF) in the HTV workers and that of Raynaud’s phenomenon in the controls was based on the medical history, the administration of color charts and the results of a cold test with measurement of finger systolic blood pressures. Vibration magnitudes from the tools were measured as r.m.s acceleration, frequency weighted according to international standard ISO 5349-1, and also unweighted over the frequency range 6.3–1,250 Hz. Daily vibration exposure was expressed in terms of daily exposure duration and frequency-weighted or unweighted r.m.s. acceleration normalized to a reference period of 8 h (A w(8) or A uw(8), respectively). Results The incidence of VWF varied from 5 to 6% in the HTV workers versus 0–1.5% for Raynaud’s phenomenon in the controls. After adjusting for potential confounders, A uw(8) gave better predictions of the incidence of VWF and the cold response of the digital arteries over time than A w(8) or daily exposure duration. These findings were observed in the entire sample of HTV workers, in those with no VWF at the initial investigation, and in those with normal cold test results at baseline. Conclusions The findings of this longitudinal study suggest that a measure of daily vibration exposure calculated from unweighted r.m.s. acceleration over the frequency range 6.3–1,250 Hz performs better for the prediction of vascular disorders in users of vibratory tools than a measure derived from r.m.s. acceleration frequency weighted according to ISO 5349-1. This study provides epidemiological evidence that more weight should be given to intermediate and high-frequency vibration for evaluating the severity of hand-transmitted vibration. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0461-2Authors Massimo Bovenzi, Università di Trieste Unità Clinica Operativa di Medicina del Lavoro, Dipartimento di Scienze di Medicina Pubblica, Azienda Ospedaliero-Universitaria “Ospedali Riuniti di Trieste” Centro Tumori, Via della Pietà 19 34129 Trieste Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Evaluation of cognitive technologies in geriatric rehabilitation: a case study pilot project

The aim of this study was to develop and evaluate low-cost technology for cognitive rehabilitation in older individuals with dementia and document changes stemming from a clinical case study using these tools. An activity board, a calendar, a routine organizer and a software program were used and evaluated by specialists (n = 7). A pre-post-case study with an elderly male with dementia was undertaken for four months. All rehabilitation resources were classified as appropriate by the specialists. Post-intervention scores demonstrated improvement in cognitive functioning and daily activities at home. There is a need for further research to assess the therapeutic effects in patients with dementia applying equipment and software to improve cognitive function. Copyright © 2010 John Wiley & Sons, Ltd.

An evaluation of a problem-based learning experience in an occupational therapy curriculum in the UK

The objectives of the study was to evaluate an adapted approach to problem-based learning (PBL) on a pre-registration Masters course in Occupational Therapy at the University of East Anglia in the UK. The adaptation, named placement PBL, required students to write and select the material based on their placement experiences, for the cohort's learning. The evaluation purpose was to determine the students' views of the efficacy of placement PBL for facilitating their learning in the final 3 months of their pre-registration education. Placement PBL was evaluated using both questionnaires and focus groups, with two cohorts of students for data collection. Placement PBL was seen to provide current, relevant and complex learning scenarios that help students to move from a theoretical understanding to application of theory in the complexity of actual service situations. The authors conclude that placement PBL has the potential to prepare students for the transition from student to qualified practitioner. Both researchers were also the PBL tutors which may have affected the students' honesty in their feedback. Further research is indicated for ongoing evaluations of the effectiveness of PBL in helping students to become confident occupational therapy clinicians, and comparative studies with other learning approaches. Copyright © 2010 John Wiley & Sons, Ltd.

Preliminary reliability and repeatability of the Brazilian version of the Revised Knox Preschool Play Scale

The aim of this study was to create an adaptation of the Revised Knox Preschool Play Scale (RKPPS) for the Brazilian population, as well as to apply the instrument with statistical analysis to verify the preliminary intra-rater and inter-rater reliability and repeatability of the instrument. The instructions presented by Beaton et al. regarding adaptation of instruments were followed to perform a cross-cultural adaptation of the RKPPS. A preliminary test of the Portuguese version was performed on 18 children with no motor, cognitive or sensory impairment. The video recordings of this administration were analysed on two separate occasions by two examiners within a 5-month interval, using the scores suggested by Pfeifer. The Spearman's test was used in the statistical analysis of the obtained data. The author of the RKPPS agreed with the small necessary cultural adaptations. The Spearman test revealed a high correlation coefficient and good significance levels for both intra- and inter-raters values. This study demonstrated the reliability and repeatability of the Brazilian version of the RKPPS. This is a preliminary study and further studies are needed in order to validate the scale to be administered in the Brazilian population. Copyright © 2010 John Wiley & Sons, Ltd.

Post-stroke fatigue: qualitative study of three focus groups

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.

Indicators of need for occupational therapy in patients with chronic pain: occupational therapists' focus groups

This study explores occupational therapists' (OT) perceptions of indicators for occupational therapy interventions among patients with chronic pain. An exploratory design was applied to six focus groups of OTs (n = 25) for data collection. Analysis was performed using content analysis through identification of meaning units, codes, categories and themes. Limitations of occupational performance was a major theme that included participant restrictions caused by physical, emotional and environmental barriers. Five subthemes of need were identified: 1) pain behaviour that prevented engagement in activities; 2) lack of knowledge about pain mechanisms and strategies to deal with pain; 3) occupational imbalance in work, leisure and home; 4) emotional stress and depression due to pain; and 5) physical or environmental strain resulting in limitations in occupational performance. Because of the variety and the diverse trends of approaches towards interventions for patients with chronic pain that exist in different cultures and settings, this study should be replicated in other contexts to increase the transferability of the findings. Copyright © 2009 John Wiley & Sons, Ltd.

OCCUPATIONAL MEDICINE CALENDAR

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In this issue of Occupational Medicine

From dust and ashes: the 1950s

The SOM journal in the 1950s

GMC guidance on confidentiality: is it ethical?

William Hogarth: The fellow 'prentices at their looms, a drawing for Plate 1 of Industry and Idleness, 1747

Shift work: coping with the biological clock

The internal circadian clock adapts slowly, if at all, to rapid transitions between different shift schedules. This leads to misalignment (desynchrony) of rhythmic physiological systems, such as sleep, alertness, performance, metabolism and the hormones melatonin and cortisol, with the imposed work–rest schedule. Consequences include sleep deprivation and poor performance. Clock gene variants may influence tolerance of sleep deprivation. Shift work is associated with an increased risk of major disease (heart disease and cancer) and this may also, at least in part, be attributed to frequent circadian desynchrony. Abnormal metabolism has been invoked as a contributory factor to the increased risk of heart disease. There is recent evidence for an increased risk of certain cancers, with hypothesized causal roles of light at night, melatonin suppression and circadian desynchrony. Various strategies exist for coping with circadian desynchrony and for hastening circadian realignment (if desired). The most important factor in manipulating the circadian system is exposure to and/or avoidance of bright light at specific times of the ‘biological night’.

Directly read

Predictors of the discrepancy between calendar and biological age

Background The rate of ageing can differ considerably between individuals. This might result in major differences between calendar age (CA) and biological age (BA). Aims To identify work- and health-related predictors of the discrepancy between CA and BA. Methods The sample analysed in this study consisted of 371 subjects of different occupational groups (teachers, office workers, nursery school teachers and managers). BA was measured with the vitality measuring station, which recorded 45 vitality indicators of physical, mental and social functions. Work ability index, effort–reward imbalance and relaxation inability were measured to determine work- and health-related predictors. Results The greatest discrepancy between CA and BA (9 years) was found for the subgroup of managers, followed by female teachers (5 years). Managers showed also the best results in work ability, the effort–reward balance and relaxation ability. By means of multiple regression analysis, particularly mental attitudes and resources towards work, occupational reward and the body fat percentage were identified as relevant predictors for the discrepancy between CA and BA. Conclusions Our study indicates that not only health- but also work-related factors are associated with vitality and BA of employees. We assume that measures focused on promoting of health (healthy diet and physical activities) and improving working conditions (e.g. job satisfaction and social support and stress prevention) may also affect the ageing process positively.

Factors associated with visits to occupational health physicians in Finland

Background In Finland, employers can offer primary care to employees in addition to obligatory occupational health services (OHS). Aims To analyse factors associated with visits to seek primary care from occupational health physicians (OH physicians) and compared with visits to physicians in municipal health centres, private clinics and hospital outpatient clinics. Methods The subjects of this population-based cross-sectional survey comprised 1753 randomly selected employed Finns aged 25–64 years covered by OHS including primary care. The associations between visits to physicians during the past 6 months and factors related to work and perceived health were tested using Poisson regression analysis. Results Provision of primary care in OHS increased visits to OH physicians but decreased visits to municipal health centre physicians. Among both genders, long-standing illnesses impairing work ability had the strongest associations with visits to all physicians. Among men, the factors associated with visits to OH physicians were long-standing illnesses without effect on work ability, requirement of sickness certificate from the first day of sickness, OHS arranged in private clinics and moderate stress symptoms. Among women, lower vocational level, OHS arranged in private clinics or joint-model OHS units, moderate stress symptoms and workplace harassment were associated with visits to OH physicians. Conclusions Primary care in OHS enables OH physicians to reach workers with work-related health problems, thus enabling interventions on working conditions and work ability. Moreover, OHS seem to be a very important health care provider in Finland.

Hearing symptoms and audiometry in professional divers and offshore workers

Aims The aims are to compare hearing loss between professional divers and offshore workers and to study whether hearing loss symptoms reflected physical disorder. A secondary objective was to study total threshold shift assessment as a method of detecting noise-induced hearing loss (NIHL). Methods Participants (151 divers and 120 offshore workers) completed a questionnaire for symptoms and screening audiometry. Audiograms were assessed for total threshold shift at 1, 2, 3, 4 and 6 kHz and the prevalence of referral (within population 5th centile) or warning levels (within population 20th centile) of hearing loss. Audiograms were assessed for an NIHL pattern at four levels by two occupational physicians. Results Hearing loss symptoms were commoner in divers at all levels of hearing loss regardless of differences between groups on audiometry. Hearing loss in offshore workers was within the population age-adjusted norm. Thirteen per cent of divers were within the 5th percentile for threshold shift for the population norm in contrast to 4% of offshore workers and this was predominantly left sided (OR 3.16, 95% CI 1.13–8.93). This difference was lost after adjustment for history of regular exposure to explosion or gunfire. Divers were more likely to have a pattern of severe NIHL on the left (OR 4.61, 95% CI 1.39–15.39, P < 0.05). Approximately 50% of participants with severe NIHL did not have a referral level of hearing loss. Conclusions Divers suffer more NIHL than a control population. Current guidance on the assessment of total threshold shift for the detection of significant NIHL was inadequate in the sample studied.

Vestibular effects of diving -- a 6-year prospective study

Background Permanent injuries to the vestibular end organs may occur in diving due to decompression illness (DCI) or barotraumas. This may lead to distressing long-term symptoms, including dizziness and disequilibrium. Aims To look for evidence of vestibular disorders in working divers and to relate this to diving exposure or injuries. Methods A cohort of 67 men aged 28 ± 5 years (mean ± SD) completing a basic course for working divers answered a questionnaire and underwent clinical otoneurological examination, electronystagmography (ENG), including alternate bithermal caloric tests and platform posturography. The procedure was repeated after 3 and 6 years. Results At follow-up, none of the divers had experienced inner ear barotraumas or inner ear DCI. Two cases of untreated probable DCI were diagnosed retrospectively in 27 232 dives. Middle ear barotrauma was reported by 36%. There was no correlation between diving frequency and postural sway at follow-up. Transient dizziness during or shortly after a dive was reported by 63 and 15%, respectively. The prevalence of dizziness on land and ENG abnormalities did not change during follow-up. No vestibular disorders were diagnosed. Conclusions Transient vestibular symptoms and middle ear barotraumas are common in diving. This study found no evidence of long-term vestibular effects. Vestibular disorders in divers are probably related to singular events, like inner ear barotraumas or inner ear DCI, rather than frequent diving per se.

Mini-Monitor

Occupational health needs of commercial fishermen in South West England

Background Work in commercial fishing is physically demanding and hazardous, but unlike merchant seamen, fishermen are not required to hold a certificate of medical fitness. Aims To investigate the case for regulatory medical standards for commercial fishermen and to identify priorities for the prevention and management of occupational injuries at sea. Methods We surveyed a convenience sample of fishermen at three major fishing ports in South West England using a standardized interview-administered questionnaire. Results Interviews were completed by 210 (68%) of 307 fishermen approached. Over their careers, 56 subjects (27%) had been returned to shore as an emergency for medical reasons, a rate of 14.6 (95% confidence interval 11.5–18.2) per 1000 man-years. Most emergency evacuations were for acute injuries, and only five were for illness. A few participants suffered from chronic disease that would call into question their fitness to go to sea. Fifty-five fishermen had suffered injuries in the past 12 months, including 12 that had caused loss of more than 3 days from work. Subjects had self-stitched 4 of 15 reported hand lacerations, while others had been bound with ‘gaffer’ tape. Conclusions Prevention of hand lacerations should be a high priority, with first-aid training and equipment for fishing crews to improve their care when prevention fails. No firm conclusions can be drawn about the value of regular medical screening for commercial fishermen, but such screening should be considered a lower priority than accident prevention.

The strange case of Irving Selikoff

Suicides among seafarers in UK merchant shipping, 1919-2005

Background Little has been reported on suicides among seafarers and how they have changed over time. Aims To establish the causes, rates and trends in suicides at work among seafarers in UK merchant shipping from 1919 to 2005 and to compare suicide rates with the general UK population and with seafarers employed in non-UK shipping. Methods Examination of seafarers’ death inquiry files, death registers and death returns (for a total population of 11.90 million seafarer-years); literature reviews and national suicide statistics. Results The suicide rate (for suicides at work and unexplained disappearances at sea) in UK shipping fell from 40–50 per 100 000 in the 1920s to <10 per 100 000 in recent years, with an interim peak during the 1960s. Suicide rates were higher for ratings (all ranks below officers) than for officers, for Lascars (Asian seafarers) than for British seafarers and for older than for younger seafarers and were typically lower than those in Asian and Scandinavian merchant fleets. The suicide rate (for suicides at work) among seafarers was substantially higher than the overall suicide rate in the general British population from 1919 to the 1970s, but following reductions in suicide mortality among seafarers, it has become more comparable since. Conclusions Although merchant seafaring was previously a high-risk occupation for suicides at work, there has been a sharp fall in the suicide rate in the past 40 years. Likely reasons for this include reductions over time in long intercontinental voyages and changes over time in seafarers’ lifestyles.

Quality of life in health care workers with latex allergy

Background Exposure to latex gloves and glove powder makes health care workers (HCWs) particularly susceptible to developing an allergy to latex. Aims To assess the impact on the quality of life (QOL) of HCWs who are allergic to latex products before removal from latex exposure and after removal from exposure. Methods We studied 39 latex allergic HCWs from the Health & Safety Executive south area. Twenty-nine attended for an assessment with the occupational physician and were asked to fill out a questionnaire. Spirometry, immunoglobulin E levels and latex radioallergosorbent test levels were measured. Results In total, 29/39 (74%) of patients responded. All of the participants had a type 1 allergy to latex. All individuals reported a significant improvement of symptoms once latex was removed from their working environment. Of those that reported skin complaints, 83% reported that their skin no longer had an impact on their QOL once latex was removed. Over 90% (n = 26) of all participants stated that their eye/nose symptoms had no longer an impact on their QOL and 86% (n = 25) of all participants stated that their respiratory symptoms had no impact on their QOL following the removal of latex from their working environment. Overall, 45% of the respondents had changed jobs: 61% of this group changed to a completely nonclinical post. Conclusions On average, 86% of latex allergic HCWs reported that their QOL had improved significantly since their removal from latex. In employees who are latex allergic/sensitized, taking latex avoidance measures results in cessation or diminution of symptoms.

Working hours and risk of gestational hypertension and pre-eclampsia

Background The potential impact of employment on maternal health, particularly in relation to gestational hypertension and pre-eclampsia, has been subject to research. However, there is limited evidence on associations between shift work and long working hours on the incidence of these conditions. Aims To evaluate potential associations between maternal shift work and long working hours during pregnancy and gestational hypertension or pre-eclampsia. Methods Multistage stratified systematic sampling was used to recruit 24 200 post-partum women from the Taiwan national birth registration database in 2005. Subjects underwent home interview 6 months after their deliveries by structured questionnaire to obtain characteristics of maternal employment and potential confounders. Diagnosis of gestational hypertension and pre-eclampsia was obtained from the birth registration. Results There was no association between employment status and gestational hypertension or pre-eclampsia. Also, no significant association between gestational hypertension or pre-eclampsia and maternal shift work or long working hours during pregnancy was found in all or primiparous women. Conclusions There was no convincing evidence that maternal shift work or long working hours had a higher risk of gestational hypertension or pre-eclampsia. However, further research is warranted to confirm these negative findings.

Hearing protection device usage at a South African gold mine

Background Occupational noise-induced hearing loss (NIHL) occurs in many industries despite interventions such as hearing conservation programmes. Aims To determine the actual and reported use of hearing protection devices (HPDs) in noise-exposed gold mine workers and their reported knowledge, attitudes and practices relating to NIHL and HPDs. Methods A cross-sectional descriptive study was conducted in which 101 noise-exposed mine workers were interviewed and their use of HPDs observed. Results Thirteen percent of respondents erroneously indicated that their workplaces were not noisy, 16% did not appreciate noise as a hearing loss hazard, 6% did not know that HPDs protect hearing and 3% believed that HPDs did not protect hearing. While 93% of respondents reported using HPDs, only 50% were observed to be doing so. Observed use was less among lower skilled workers, and, despite training, 8% of respondents claimed never to have been informed about the benefits of HPDs. Consistent and continuous use was reported by 24% and 31% of respondents, respectively. Reasons for not using HPDs included discomfort. Most respondents (57%) preferred training methods other than the current computer-assisted training. Conclusions The persistence of NIHL may be explained by limited use of HPDs, along with the suboptimal knowledge of noise as a hazard, workplace noisiness and the benefits of HPDs among some workers. Concurrent with engineering controls, a range of HPDs should be available free of charge, and HPD training reviewed particularly for lower skilled workers.

Laboratory worker knowledge, attitudes and practices towards smallpox vaccine

Background Recent cases of laboratory-acquired vaccinia virus (VV) infection highlight the need for laboratory safety. Aims To determine laboratory worker adherence to the Advisory Committee for Immunization Practices smallpox vaccination recommendations, assess potential barriers to vaccination and determine the influence of training on laboratory worker attitudes. Methods Ninety-two laboratory workers in Pennsylvania were contacted and asked to complete an online survey about VV usage; 45 responded. Results Eighty-seven per cent had received a smallpox vaccination in their lifetime; 73% received vaccination in the past 10 years. More workers had been given training regarding the potential risks, versus the potential benefits of vaccination, and most perceived that adverse outcomes were more likely to occur following vaccination versus accidental infection. Conclusions The results of this study suggest that the main barrier to vaccination may be fear associated with possible vaccine adverse effects and a willingness to risk accidental infection rather than be vaccinated. More information and training about the potential benefits of vaccination, as well as the potential adverse outcomes associated with accidental infection, is therefore warranted.

Muscle performance, work ability and physical functioning in middle-aged men

Background Limited data exist on the associations between muscle performance and work ability measures in working age adults. Aims To evaluate how the results of simple muscle performance tests correlate with self-reported work ability and physical functioning in middle-aged men. Methods Muscle performance was measured with handgrip, sit-up, arch-up, squatting and lifting tests. The Physical Functioning scale and the Role Limitations due to Physical Health Problems scale of the RAND-36 health questionnaire were used to assess functioning and the Work Ability Index (WAI) questionnaire to assess perceived work ability in a subgroup of 51 subjects. Results A total of 104 men aged 45–55 years employed in physically active work participated. Muscle performance was weakly associated with WAI and functioning measures, accounting for 10% of the variance at most. Dynamic lifting test results for both arms correlated with WAI scores (right: r = 0.31, left: r = 0.34). Scores of the dynamic lifting test for both arms correlated with the Physical Functioning scores (right: r = 0.23, left: r = 0.28) and with the Role Limitations due to Physical Health Problems scores (right: r = 0.25, left: r = 0.28). Results of the squatting test were associated with the Physical Functioning scores (r = 0.24). Conclusions The study failed to provide support for the use of muscle performance tests in work-related fitness evaluations in middle-aged men employed in physical jobs.

(Lack of) Impacts on work absence and performance

Reply

Alcohol

Shift work and health - how to proceed?

Shift work and health - how to proceed? Scand J Work Environ Health. 2010 Feb 3; Authors: Härmä M, Kecklund G PMID: 20126970 [PubMed - as supplied by publisher]

Shift work and cancer - considerations on rationale, mechanisms, and epidemiology.

Shift work and cancer - considerations on rationale, mechanisms, and epidemiology. Scand J Work Environ Health. 2010 Feb 2; Authors: Costa G, Haus E, Stevens R This paper summarizes the rationale for, possible mechanisms of, and problems related to risk assessment of the association between shift work and cancer. The mechanisms by which circadian disruption may favor the induction and/or promotion of malignant tumors are complex and multifactorial. The multilevel endocrine changes caused by circadian disruption with melatonin suppression through light at night (LAN) lead to the oncogenic targeting of the endocrine-responsive breast in women and possibly the prostate in men. Repeated phase shifting with internal desynchronization may lead to defects in the regulation of the circadian cell cycle, thus favoring uncontrolled growth. Sleep deprivation leads to the suppression of immune surveillance that may permit the establishment and/or growth of malignant clones. The epidemiological studies published so far, although dealing with large cohorts and controlling for several personal confounders, have defined the exposure to shift and/or night work rather loosely and consequently do not allow for the proper assessment of the risk connected with circadian disruption. PMID: 20126969 [PubMed - as supplied by publisher]

REACH--how is it going?

The Role of the Occupational Hygienist in Development-Oriented Public Health Engineering Projects

Organizations dedicated to applying engineering solutions to improve health in developing countries may lack sufficient expertise in the public health aspects of these efforts to ensure successful project design and implementation. The occupational hygienist is a valuable complement to the efforts needed for development-oriented public health engineering projects.

Characterization and Assessment of Dermal and Inhalable Nickel Exposures in Nickel Production and Primary User Industries

The aim of this study was to measure the levels of nickel in the skin contaminant layer of workers involved in specific processes and tasks within the primary nickel production and primary nickel user industries. Dermal exposure samples were collected using moist wipes to recover surface contamination from defined areas of skin. These were analysed for soluble and insoluble nickel species. Personal samples of inhalable dust were also collected to determine the corresponding inhalable nickel exposures. The air samples were analysed for total inhalable dust and then for soluble, sulfidic, metallic, and oxidic nickel species. The workplace surveys were carried out in five different workplaces, including three nickel refineries, a stainless steel plant, and a powder metallurgy plant, all of which were located in Europe. Nickel refinery workers involved with electrolytic nickel recovery processes had soluble dermal nickel exposure of 0.34 µg cm–2 [geometric mean (GM)] to the hands and forearms. The GM of soluble dermal nickel exposure for workers involved in packing nickel salts (nickel chloride hexahydrate, nickel sulphate hexahydrate, and nickel hydroxycarbonate) was 0.61 µg cm–2. Refinery workers involved in packing nickel metal powders and end-user powder operatives in magnet production had the highest dermal exposure (GM = 2.59 µg cm–2 soluble nickel). The hands, forearms, face, and neck of these workers all received greater dermal nickel exposure compared with the other jobs included in this study. The soluble nickel dermal exposures for stainless steel production workers were at or slightly above the limit of detection (0.02 µg cm–2 soluble nickel). The highest inhalable nickel concentrations were observed for the workers involved in nickel powder packing (GM = 0.77 mg m–3), although the soluble component comprised only 2% of the total nickel content. The highest airborne soluble nickel exposures were associated with refineries using electrolytic processes for nickel recovery (GM = 0.04 mg m–3 total nickel, containing 82% soluble nickel) and those jobs involving contact with soluble nickel compounds (GM = 0.02 mg m–3 total nickel content, containing 76% soluble nickel). The stainless steel workers were exposed to low concentrations of relatively insoluble airborne nickel species (GM = 0.03 mg m–3 total nickel, containing 1% soluble nickel). A statistically significant correlation was observed between dermal exposures for all anatomical areas across all tasks. In addition, the dermal and inhalable (total) nickel exposures were similarly associated. Overall, dermal exposures to nickel, nickel compounds, and nickel alloys were relatively low. However, exposures were highly variable, which can be explained by the inconsistent use of personal protective equipment, varying working practices, and different standards of automation and engineering controls within each exposure category.

Assessment of Dermal Exposure and Skin Condition of Workers Exposed to Nickel at a South African Base Metal Refinery

Objectives: The objectives of this study were to assess dermal exposure of cell workers to nickel at a South African base metal refinery and to characterize their skin condition by measuring the skin hydration and trans epidermal water loss (TEWL) indices. Methods: The skin hydration index of the index finger, palm, neck, and forehead was measured before, during and at the end of the shift. The TEWL index was measured before and at the end of the shift. Dermal exposure samples were collected with GhostwipesTM from the index finger and palm of the dominant hand, before, during, and at the end of the shift. Neck and forehead samples were collected before and at the end of the shift. Wipe samples of various surfaces in the workplace were also collected. Wipes were analyzed for nickel according to NIOSH method 9102, using inductively coupled plasma-atomic emission spectrometry. Results: Hydration indices measured on the hands decreased significantly during the shift, but recovered to normal levels by the end of the shift. TEWL indices for the index finger and palm of the hands are indicative of a low barrier function even before commencement of the shift, which further deteriorated significantly during the shift. During the shift, substantial nickel skin loading occurred on the index finger and palm of the hand. Levels on the neck and forehead were much lower. Various workplace surfaces, which workers come into contact with, were also contaminated with nickel. Conclusions: The skin condition and high levels of nickel on the skin were most probably caused by inadequate chemical protection provided by protective gloves. Although, the permeability of nickel through intact skin is considered to be low, a decreased barrier function of dehydrated or slightly damaged skin will increase its permeability for nickel. The ethnicity of these exposed workers may contribute significantly toward the low incidence of allergic contact dermatitis observed. Several measures to lower dermal exposure to nickel are also recommended.

Dermal and Inhalation Exposure to Methylene Bisphenyl Isocyanate (MDI) in Iron Foundry Workers

Diisocyanates are a group of chemically reactive agents, which are used in the production of coatings, adhesives, polyurethane foams, and parts for the automotive industry and as curing agents for cores in the foundry industry. Dermal and inhalation exposure to methylene bisphenyl isocyanate (MDI) is associated with respiratory sensitization and occupational asthma. However, limited research has been performed on the quantitative evaluation of dermal and inhalation exposure to MDI in occupationally exposed workers. The objective of this research was to quantify dermal and inhalation exposure levels in iron foundry workers. Workers involved in mechanized moulding and mechanized production of cores were monitored: 12 core makers, 2 core-sand preparers, and 5 core installers. Personal breathing-zone levels of MDI were measured using impregnated filter sampling. Dermal exposure to MDI was measured using a tape-strip technique. Three or five consecutive tape-strip samples were collected from five exposed skin areas (right and left forefingers, left and right wrists, and forehead). The average personal air concentration was 0.55 µg m–3, 50-fold lower than the Swedish occupational exposure limit of 30 µg m–3. The core makers had an average exposure of 0.77 µg m–3, which was not significantly different from core installers’ and core-sand preparers’ average exposure of 0.16 µg m–3 (P = 0.059). Three core makers had a 10-fold higher inhalation exposure than the other core makers. The core makers’ mean dermal exposure at different skin sites varied from 0.13 to 0.34 µg while the two other groups’ exposure ranged from 0.006 to 0.062 µg. No significant difference was observed in the MDI levels between the skin sites in a pairwise comparison, except for left forefinger compared to left and right wrist (P < 0.05). In addition, quantifiable but decreasing levels of MDI were observed in the consecutive tape strip per site indicating MDI penetration into the skin. This study indicates that exposure to MDI can be quantified on workers’ skin even if air levels are close to unquantifiable. Thus, the potential for uncured MDI to deposit on and penetrate into the skin is demonstrated. Therefore, dermal exposure along with inhalation exposure to MDI should be measured in the occupational settings where MDI is present in order to shed light on their roles in the development of occupational isocyanate asthma.

Quantitative Plasma Biomarker Analysis in HDI Exposure Assessment

Quantification of amines in biological samples is important for evaluating occupational exposure to diisocyanates. In this study, we describe the quantification of 1,6-hexamethylene diamine (HDA) levels in hydrolyzed plasma of 46 spray painters applying 1,6-hexamethylene diisocyanate (HDI)-containing paint in vehicle repair shops collected during repeated visits to their workplace and their relationship with dermal and inhalation exposure to HDI monomer. HDA was detected in 76% of plasma samples, as heptafluorobutyryl derivatives, and the range of HDA concentrations was ≤0.02–0.92 µg l–1. After log-transformation of the data, the correlation between plasma HDA levels and HDI inhalation exposure measured on the same workday was low (N = 108, r = 0.22, P = 0.026) compared with the correlation between plasma HDA levels and inhalation exposure occurring ~20 to 60 days before blood collection (N = 29, r = 0.57, P = 0.0014). The correlation between plasma HDA levels and HDI dermal exposure measured on the same workday, although statistically significant, was low (N = 108, r = 0.22, P = 0.040) while the correlation between HDA and dermal exposure occurring ~20 to 60 days before blood collection was slightly improved (N = 29, r = 0.36, P = 0.053). We evaluated various workplace factors and controls (i.e. location, personal protective equipment use and paint booth type) as modifiers of plasma HDA levels. Workers using a downdraft-ventilated booth had significantly lower plasma HDA levels relative to semi-downdraft and crossdraft booth types (P = 0.0108); this trend was comparable to HDI inhalation and dermal exposure levels stratified by booth type. These findings indicate that HDA concentration in hydrolyzed plasma may be used as a biomarker of cumulative inhalation and dermal exposure to HDI and for investigating the effectiveness of exposure controls in the workplace.

Comparison of Direct and Indirect Methods of Measuring Airborne Chrysotile Fibre Concentration

Transmission electron microscopy observations most frequently form a basis for estimating asbestos fibre concentration in the environment and in buildings with asbestos-containing materials. Sampled fibres can be transferred to microscope grids by applying either a direct [ISO (1995) Draft International ISO/DIS 10312. Ambient air. Determination of asbestos fibres. Direct transfer transmission electron microscopy procedure. Geneva, Switzerland: International Standardization Organization] or an indirect [AFNOR (1996) Détermination de la concentration en fibres d'amiante par microscopie électronique à transmission—Méthode indirecte. Cedex, France: AFNOR, p. 42; ISO (1997) Draft International ISO/DIS 13794. Ambient air. Determination of asbestos fibres. Indirect-transfer transmission electron microscopy procedure. Geneva, Switzerland: International Standardization Organization] method. In the latter case, ISO Standard 13794 recommends filtering calcination residues either on a polycarbonate (PC) filter (PC indirect method) or on a cellulose ester (CE) membrane (CE indirect method). The PC indirect method requires that fibres deposited on a PC filter be covered by a carbon layer, whereas in the CE indirect method, the CE membrane has to be directly processed using a method described in ISO Standard 10312. The purpose of this study was to compare results obtained using, on the one hand, direct preparation methods and, on the other hand, PC indirect or CE indirect methods, for counting asbestos fibres deposited on filters as a result of liquid filtration or air sampling. In direct method-based preparation, we observed that an etching time of 6–14 min does not affect the measured densities, except for fibres <1 µm deposited by liquid filtration. Moreover, in all cases, the direct method gives higher densities than the PC indirect method because of possible fibre disappearance when using the carbon evaporator implemented in the PC indirect method. The CE membrane used for sample preparation in the CE indirect method is collapsed prior to passing it through the carbon evaporator, so the fibres are less likely to disappear at this stage. We then note that the resulting fibre densities for chrysotile-loaded filters prepared using the direct method are close to those obtained with filters prepared using the CE indirect method. Our study therefore shows that, under the implemented experimental conditions, the PC and CE indirect preparation methods described in ISO Standard 13794 are not equivalent.

Large Particle Penetration through N95 Respirator Filters and Facepiece Leaks with Cyclic Flow

The aim of this study was to investigate respirator filter and faceseal penetration of particles representing bacterial and fungal spore size ranges (0.7–4 µm). First, field experiments were conducted to determine workplace protection factors (WPFs) for a typical N95 filtering facepiece respirator (FFR). These data (average WPF = 515) were then used to position the FFR on a manikin to simulate realistic donning conditions for laboratory experiments. Filter penetration was also measured after the FFR was fully sealed on the manikin face. This value was deducted from the total penetration (obtained from tests with the partially sealed FFR) to determine the faceseal penetration. All manikin experiments were repeated using three sinusoidal breathing flow patterns corresponding to mean inspiratory flow rates of 15, 30, and 85 l min–1. The faceseal penetration varied from 0.1 to 1.1% and decreased with increasing particle size (P < 0.001) and breathing rate (P < 0.001). The fractions of aerosols penetrating through the faceseal leakage varied from 0.66 to 0.94. In conclusion, even for a well-fitting FFR respirator, most particle penetration occurs through faceseal leakage, which varies with breathing flow rate and particle size.

Airborne Nanoparticle Exposures while Using Constant-Flow, Constant-Velocity, and Air-Curtain-Isolated Fume Hoods

Tsai et al. (Airborne nanoparticle exposures associated with the manual handling of nanoalumina and nanosilver in fume hoods. J Nanopart Res 2009; 11: 147–61) found that the handling of dry nanoalumina and nanosilver inside laboratory fume hoods can cause a significant release of airborne nanoparticles from the hood. Hood design affects the magnitude of release. With traditionally designed fume hoods, the airflow moves horizontally toward the hood cupboard; the turbulent airflow formed in the worker wake region interacts with the vortex in the constant-flow fume hood and this can cause nanoparticles to be carried out with the circulating airflow. Airborne particle concentrations were measured for three hood designs (constant-flow, constant-velocity, and air-curtain hoods) using manual handling of nanoalumina particles. The hood operator's airborne nanoparticle breathing zone exposure was measured over the size range from 5 nm to 20 µm. Experiments showed that the exposure magnitude for a constant-flow hood had high variability. The results for the constant-velocity hood varied by operating conditions, but were usually very low. The performance of the air-curtain hood, a new design with significantly different airflow pattern from traditional hoods, was consistent under all operating conditions and release was barely detected. Fog tests showed more intense turbulent airflow in traditional hoods and that the downward airflow from the double-layered sash to the suction slot of the air-curtain hood did not cause turbulence seen in other hoods.

CFD Simulation of Contaminant Decay for High Reynolds Flow in a Controlled Environment

This study examines the usage of computational fluid dynamics (CFDs) for estimating the time-elapsed decay of contaminants within a chamber experiencing high Reynolds flow. CFD results were compared with measurements taken at a controlled facility. In addition, parameters of the CFD simulation were examined; namely the effects of turbulence and inertial transport at high Reynolds number ventilating flows, as well as inlet duct configuration and its effect on the inlet velocity profile. The agreement between the computational and experimental clearance times was quite good, with percent errors as low as –5.32% at high flow rate and –11.8% at the lower flow rate. This study determined that for high Reynolds flow, diffusive transport effects may be ignored as the majority of mass is transported via the bulk stream, i.e. momentum transport. In addition, resolving the inlet velocity profile was of prime importance for accurate simulation of ventilating flows and prediction of contaminant washout. This was done by including the inlet duct geometry in the computational domain. In addition, it was found that despite different flow rates, the predicted contaminant washout took ~12–13% longer than predicted assuming instantaneous mixing. Furthermore, percent error between computational and experimental data as low as –5.32% shows that CFD is a useful tool for studying ventilation phenomena.

Experimental Investigation of the Concept of a 'Breathing Zone' using a Mannequin Exposed to a Point Source of Inertial/Sedimenting Particles Emitted with Momentum

An inhaling mannequin, CALTOOL, was used in a specially ventilated room to compare the concentrations inhaled with those sampled by samplers mounted across the breathing zone. The CALTOOL is made from metal sheets and consists of a cylindrical torso (42 x 24 x 54 cm) with a circular cylinder as head. A circular nozzle simulates the mouth. This nozzle is part of a cassette that holds a filter. The inhalation rate is not periodic but kept constant at nominally 20 l min–1. The CALTOOL was placed in a horizontal air stream (~10 cm s–1) either facing or back to the wind. In front of the lower chest of the CALTOOL, a particle source was mounted which emitted particles with a momentum directed upwards at an angle of 45° towards the CALTOOL. Five monodisperse aluminium oxide powders were used as test aerosols. The mass median aerodynamic diameters of the test aerosols ranged ~10 to 95 µm. Six conically shaped aerosol samplers were mounted horizontally and over the breathing zone of the CALTOOL, one on each shoulder, three across the upper torso, and one at the lower torso centre. Four to six runs per test aerosol and CALTOOL orientation in the airflow were conducted. The samples were analysed gravimetrically. The concentration ratio aerosol sampler to the CALTOOL cassette was determined for the investigated mounting positions. The results showed that when the CALTOOL was exposed to particles emitted with momentum from a point source in front of the lower chest, the variation in concentration over the breathing zone was large. The ratio of the concentration sampled by an aerosol sampler mounted somewhere within the breathing zone to the CALTOOL cassette concentration, would, for specific particle sizes, easily differ by a factor of 3, but may extend up to 10–100, depending on the particular conditions. The basic concept of a breathing zone consisting of a hemisphere of radius 25–30 cm is therefore not well suited for workers handling a point source emitting large particles. For such sampling situations, it is suggested that the radius of the breathing zone is reduced to 10 cm, which may be achieved by a head-mounted sampler.

Evaluation of an Electrically Heated Vest (EHV) Using a Thermal Manikin in Cold Environments

We studied the heating efficiency of an electrically heated vest (EHV), its relationship to the microclimate temperature distribution in a three-layer clothing ensemble, and the effect of an EHV on the clothing's total thermal insulation by both theoretical analysis and thermal manikin measurements. The heat losses at different ambient conditions and heating states were recorded and the heating efficiency of the EHV was calculated. It was found that the EHV can alter the microclimatic temperature distribution of the three-layer clothing ensemble. The EHV can provide an air temperature of 34°C around the manikin's torso skin. The highest temperature on the outside surface of the EHV was around 38°C, which indicates that it is safe for the consumer. The higher the heating temperature, the lower the heating efficiency obtained. This was due to much more heat being lost to the environment, and hence, the heat gain from the EHV was smaller. The heating efficiency decreased from 55.3% at 0°C to 27.4% at –10°C when the heating power was set at 13 W. We suggest adjusting the heating power to 5 W (step 1) at an ambient temperature of 0°C, while at –10°C using 13 W (step 3) to provide the consumer a thermal comfort condition.

Respirable Dust Measurements in the Brick Manufacturing Industry