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Occupational injuries among emergency responders

Emergency responders frequently incur injuries while providing medical, fire, and law enforcement services. National surveillance systems provide fragmented perspectives on responder injuries because they omit specific classes of workers (e.g., government or volunteers); they report only selected injuries; and employment information is incomplete.We characterized injuries among emergency medical services (EMS), firefighting, and police occupations by using data from the National Electronic Injury Surveillance System - Occupational Supplement (NEISS-Work) for injuries treated in U.S. hospital emergency departments in 2000-2001.Sprains and strains were the leading injury (33-41%) among EMS, firefighter, and police occupations. Police officers and career firefighters had the highest injury rates (8.5 and 7.4 injuries per 100 full-time equivalent workers, respectively).The physical demands of emergency response are a leading cause of injuries that may benefit from similar interventions across the occupations. To assess risk, improved exposure data need to be acquired, particularly for volunteers. Am. J. Ind. Med. Published 2009 Wiley-Liss, Inc.

Agricultural tractor overturn deaths: Assessment of trends and risk factors

Tractor overturn deaths have been recognized as a public health concern for decades. Studies have reported on the hazards associated with tractor overturns, but none have reported on trends in tractor overturn fatality rates in the United States (US).Tractor overturn fatality data from the Bureau of Labor Statistics Census of Fatal Occupational Injuries were used in Poisson regression models to: identify risk factors associated with overturn fatalities; examine trends in tractor overturn fatality rates between 1992 and 2007; and assess trends in overturn fatality rates for specific risk factors.Characteristics found to be associated with tractor overturn fatality rates were age, type of farm, region, and the victim's relationship to the farm (P < 0.0001). Older age groups, crop farms, farms in the Midwest and Northeast, and family workers all had higher fatal tractor overturn risks. Overall, tractor overturn fatality rates declined 28.5% between 1992 and 2007. Significant decreases in tractor overturn fatality rates were found for the Northeast and South regions, hired workers, crop farms, and in every age group except those less than 25 years of age.Tractor overturn fatality rates decreased between 1992 and 2007. These decreases were not consistent between different categories of the agricultural workforce or regions of the US. Changes in tractor overturn fatality rates may be partially explained by increases in the prevalence of ROPS on farm tractors in the US. ROPS promotion programs are needed to reduce tractor overturn fatalities, especially among those subpopulations at highest risk. Am. J. Ind. Med. Published 2009 Wiley-Liss, Inc.

Effectiveness of the training program for workers at construction sites of the high-speed railway line between Torino and Novara: Impact on injury rates

There are very few published studies evaluating the impact of safety and health training on injury outcomes in the construction industry. The aim of this study was to assess the impact of the training program on injury rates at a major railway construction project.The population consisted of 2,795 workers involved in a safety training program at the construction sites of the high-speed railway line Torino-Novara. Two types of analyses were carried out in order to assess the effectiveness of the training program in reducing the number of injuries: (i) a pre-post analysis, which took into account the fact that workers were enrolled at different times and the training intervention did not occur at the same time for all subjects; (ii) an interrupted time-series model, which corrected for the time trend and considered the autocorrelation between individual observations.Twenty-nine percent of workers who spent at least 1 day at the construction sites attended at least one training module. Pre-post analysis: At the end of the training program, the incidence of occupational injuries had fallen by 16% after the basic training module and by 25% following the specific modules. Time-series model: Training led to a 6% reduction in injury rates, which was not statistically significant.The training program that was implemented had a moderately positive impact on the health of workers. Further studies are being conducted to obtain a more complete assessment of the actual effectiveness of the program in reducing the incidence of injuries. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Incidence of tuberculosis and HIV and progression of silicosis and lung function impairment among former basotho gold miners

Pulmonary tuberculosis and HIV incidence, mortality, and the progression of silicosis and lung function impairment are described over a 1-year period in migrant ex-gold miners from Lesotho.Seven hundred seventy-nine Basotho miners were followed for 1 year starting 18 months after lay-off from a South African gold mine in 1998. At baseline and follow-up, they underwent a respiratory symptom interview, physical examination, HIV test, chest radiograph, and spirometry.Five hundred thirteen of 779 (65.9%) participants attended both baseline and follow-up visits. HIV incidence was 5.4/100 person-years (95% CI: 3.4-8.2). Prevalence of silicosis (ILO score [ge]1/1) was 26.6% at baseline and 27.0% at follow-up. Active tuberculosis diagnosed at baseline was a strong predictor of radiological progression of silicosis. Lung function as measured by FEV1 declined an average of 91 ml between visits (95% CI: 67-116 ml). Calculated minimum incidence of tuberculosis was 3,085/100,000/years (95% CI: 1,797-4,940) at follow-up. Of those seen at baseline, 18 died before their scheduled follow-up visit (mean age: 51 years).High rates of mortality and of HIV infection and pulmonary tuberculosis were found in this cohort after leaving the South African goldmines. Continuing lung function loss was also apparent. A partnership between the South African mining industry and governments in labor-sending areas of Southern Africa is needed to provide continuity of care and access to HIV and tuberculosis treatment and prevention services. Active silicosis surveillance and an improved statutory compensation system are also needed. These findings can serve as a baseline against which the impact of such interventions can be assessed. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Effectiveness of an occupational health intervention program to reduce whole body vibration exposure: An evaluation study with a controlled pretest-post-test design

An effective intervention program aiming to reduce whole body vibration (WBV) exposure at work will reduce the number of low back complaints in the near future.An evaluation study with a controlled pretest-post-test design. Nine companies and 126 drivers were included in the study. Cluster randomization on company level divided the drivers and their employers in an intervention group and a "care-as-usual" group. At baseline (T0) and intervention program was implemented and evaluated after 7 months (T1). The main outcome measure was WBV exposure. Process measures included knowledge, attitude, and (intended) behavior towards reduction of WBV exposure for the drivers and knowledge and WBV policy for the employers.At T1, no significant reduction was found in WBV exposure within both groups compared with T0.Probably due to poor to moderate compliance, the intervention program was not effective in reducing the WBV exposure on group level but small reductions in WBV exposure are possible when intervention compliance is high. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

Farmer exposure to organic solvents during the maintenance and repair of farm machinery: A pilot study

The maintenance/repair of farm machinery is a common farming activity. Dermal exposure to organic solvents has not been well documented. A pilot study was conducted to characterize exposure to organic solvents.A survey questionnaire was administered to 31 Kentucky farmers in 2008. Dermal exposure assessment was conducted in 10 farmers while farmers performed farm machinery maintenance/repair tasks using a solvent sampling patch. Benzene, toluene, xylene, and n-hexane were analyzed.All four organic solvents were identified from the samples with toluene (<0.5-36,000 µg/patch) and xylene (15-5,700 µg/patch) at significantly higher levels. Twenty-six farmers reported the use of personal protective equipment <50% of their time repairing/maintaining farm machinery on the questionnaire; only two farmers wore gloves during the exposure assessment.Farmers routinely use solvent products for farm machinery maintenance/repair. Dermal exposure to organic solvents is a potential hazard. Further studies to characterize and evaluate exposure in larger samples of farmers are needed. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

Work-related carpal tunnel syndrome in Washington State workers' compensation: Utilization of surgery and the duration of lost work

Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability.This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n = 8,224) filed during 1990-1994 (followed through 2000) and receiving lost-work compensation.Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P 6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery.There is a need to scrutinize the role of surgery and physical-rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post-operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

Occupational injuries among aides and nurses in acute care

Occupational injuries are common among nursing personnel. Most epidemiologic research on nursing aides comes from long-term care settings. Reports from acute care settings often combine data on nurses and aides even though their job requirements and personal characteristics are quite different. Our objective was to assess risk of work-related injuries in an acute care setting while contrasting injuries of aides and nurses.A retrospective cohort of aides (n = 1,689) and nurses (n = 5,082) working in acute care at a large healthcare system between 1997 and 2004 were identified via personnel records. Workers' compensation filings were used to ascertain occupational injuries. Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (95% CI).Aides had higher overall injury rates than nurses for no-lost work time (RR = 1.2, 95% CI: 1.1-1.3) and lost work time (RR = 2.8, 95% CI: 2.1-3.8) injuries. The risk of an injury due to lifting was greater among aides compared to nurses for both non-lost work time and lost work time injuries. Injury rates among aides were particularly high in rehabilitation and orthopedics units. Most of the injuries requiring time away from work for both groups were related to the process of delivering direct patient care.Our findings illustrate the importance of evaluating work-related injuries separately for aides and nurses, given differences in injury risk profiles and injury outcomes. It is particularly important that occupational safety needs of aides be addressed as this occupation experiences significant job growth. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Excessive longitudinal FEV1 decline and risks to future health: A case-control study

Accelerated loss of forced expiratory volume in 1 s (FEV1) in an individual is considered an indicator of developing lung disease.We investigated longitudinal FEV1 slopes, calculated by simple linear regression, and adverse health outcomes after 10-30 years, among 1,428 chemical plant workers. Cases were defined by FEV1 slopes below 5th percentile values for the cohort. Cases were matched with controls (107 pairs) for race, gender, smoking status, year of birth, age, height, and calendar year at first test. Matched pair statistics were used for comparisons.Cases had a higher proportion, compared to controls, of diagnosis of COPD or emphysema (17.8% vs. 1.9%, P = 0.0002), medication use for respiratory diseases (24.3% vs. 4.7%, P < 0.0001), dyspnea (15% vs. 3.7%, P = 0.0042), and wheezing or rhonchi on examination (10.3% vs. 1.9%, P = 0.0225).Chemical plant workers who experienced accelerated FEV1 declines experienced four to nine times as many adverse health conditions over 10-30 years. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Assessing the contribution of working conditions to socioeconomic disparities in health: A commentary

Occupational health researchers can play a pivotal role in increasing our understanding of the role of physical and psychosocial working conditions in producing socioeconomic health disparities and trends of increasing socioeconomic health disparities, contributing to interventions to reduce such disparities, and helping to improve public education materials on this subject. However, a number of methodological challenges in this field need to be considered.Commentary, including a review of selected studies.Research needs to be guided by models of the associations between social (socioeconomic position (SEP), race/ethnicity, immigration status, and gender) and occupational variables and health, to avoid inappropriate control for confounding, and to specify causal pathways (mediation) and interaction effects. Different approaches to the theory and measurement of SEP also need to be tested. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Occupational obstructive airway diseases caused by the natural gas odorant tetrahydrothiophene - two case reports

Tetrahydrothiophene (THT) is frequently used to odorize natural (city) gas. Only sparse data on adverse health effects of THT on humans are available.We performed a literature search and clinical investigations including case history and cardiopulmonary diagnostic tests in two symptomatic THT-exposed outpatients.The two THT-exposed city workers developed transient neurologic symptoms such as nausea, vomiting, headaches, as well as skin and mucosa irritation, chronic rhinitis, chronic obstructive pulmonary disease, arterial hypertension, and cardiac arrhythmia. The neurological symptoms and respiratory disorders were found to be caused by intermittently high THT exposures. In favor of a causal relationship were severe work-related neurological and respiratory symptoms in previously healthy workers, results of animal experiments, and another report with very similar findings in the literature. The etiology of arterial hypertension and cardiac arrhythmia, however, remains unclear.Our two case reports demonstrate that repeated high THT-exposures can - in addition to neurotoxic symptoms - elicit chronic obstructive pulmonary disease. We recommend improved primary and secondary preventive measures, including the establishment of a TLV. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Workers are people too: Societal aspects of occupational health disparities - an ecosocial perspective

Workers are people too. What else is new? This seemingly self-evident proposition, however, takes on new meaning when considering the challenging and deeply important issue of occupational health disparities - the topic that is the focus of 12 articles in this special issue of the American Journal of Industrial Medicine. In this commentary, I highlight some of the myriad ways that societal determinants of health intertwine with each and every aspect of occupation-related health inequities, as analyzed from an ecosocial perspective. The engagement extends from basic surveillance to etiologic research, from conceptualization and measurement of variables to analysis and interpretation of data, from causal inference to preventive action, and from the political economy of work to the political economy of health. A basic point is that who is employed (or not) in what kinds of jobs, with what kinds of exposures, what kinds of treatment, and what kinds of job stability, benefits, and pay - as well as what evidence exists about these conditions and what action is taken to address them - depends on societal context. At issue are diverse aspects of people's social location within their societies, in relation to their jointly experienced - and embodied - realities of socioeconomic position, race/ethnicity, nationality, nativity, immigration and citizen status, age, gender, and sexuality, among others. Reviewing the papers' findings, I discuss the scientific and real-world action challenges they pose. Recommendations include better conceptualization and measurement of socioeconomic position and race/ethnicity and also use of the health and human rights framework to further the public health mission of ensuring the conditions that enable people - including workers - to live healthy and dignified lives. Am. J. Ind. Med. © 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.

Pleural plaques in dentists from occupational asbestos exposure: A report of three cases

White asbestos (chrysotile) has been used in dentistry since 1930 when it was introduced as a lining material for casting rings.All three patients presented with pleural plaques on chest X-rays as well as on CT-scans. They were working as dentists for 35-45 years. Under the instructions of the first dentist we represented precisely the whole process of manipulating a kind of paper that contained asbestos. In order to measure asbestos fibers concentration we used the membrane filter method and phase contrast optical microscopy. Dry asbestos sheets were scanned with x-ray diffraction and electron microscope.Analysis of the filter demonstrated 0.008 fibers/cm3 during the sampling period. X-ray diffraction analysis revealed that the material consisted of chrysotile exclusively. Electron microscope pictures confirmed the presence of chrysotile.Everyday occupational exposure for many years even to low asbestos levels, under poor ventilation conditions in a closed space, could cause pleural lesions. 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.

Utilizing hospital discharge data (HD) to compare fatal and non-fatal work-related injuries among Hispanic workers in New Jersey

This study explores the utilization of Hospital Discharge (HD) data to obtain estimates of work-related non-fatal injuries rates in NJ to determine if Hispanics workers have an increased risk of specific work-related injuries. In addition, HD data are used to compare the rate ratios between fatal and non-fatal injuries in this population to demonstrate the effectiveness of using HD as a surveillance tool for monitoring injury trends and performing evaluations.Several types of fatal and non-fatal injuries were modeled using Poisson regression with the following predictor variables: gender, ethnicity, and year. The estimated number of workers by ethnicity employed in NJ each year was obtained from the U.S. Census Bureau, DataFerrett, Current Population Survey, November 2006, a data mining tool which accesses CPS data.These analyses, utilizing estimates of working population at-risk, indicate that Hispanic workers have an increased risk of four particular work-related injuries compared with non-Hispanics, and Hispanics were injured at a younger age than non-Hispanics. In addition the rankings of the rate ratios from the comparison between non-fatal and fatal risk estimates were similar; indicating that occupational surveillance of non-fatal injuries is a viable component to be considered.HD data are effective for monitoring trends over time across ethnic groups and injury types. Therefore, non-fatal injury surveillance should be considered for targeting specific worker populations for interventions to reduce exposure to workplace hazards, and can be a valuable surveillance tool in efforts to reduce occupational injuries. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Possibilities and challenges in occupational injury surveillance of day laborers

Day laborers in the US, comprised largely of undocumented immigrants from Mexico and Central America, suffer high rates of occupational injury according to recent estimates. Adequate surveillance methods for this highly transient, largely unregulated group do not currently exist. This study explores chart abstraction of hospital-based trauma registry records as a potential injury surveillance method for contingent workers and day laborers. We sought to determine the degree of completeness of work information in the medical records, and to identify day laborers and contingent workers to the extent possible.Work-related injury cases from a hospital-based trauma registry (2001-2006) were divided by ethnicity (Hispanic vs. non-Hispanic origin) and presence of social security number (SSN: yes, no), resulting in four groups of cases. Medical records were abstracted for 40 cases from each group; each case was assigned values for the variables "day labor status" (yes, no, probably not, probable, unknown) and "employment type" (contingent, formal, unknown).Work information was missing for 60% of Hispanic cases lacking SSN, as compared with 33-47% of the other three groups. One "probable" day laborer was identified from the same group. Non-Hispanics with SSN were less frequently identified as contingent workers (5% as compared with 15-19%).This method revealed severe limitations, including incomplete and inconsistent information in the trauma registry and medical records. Approaches to improve existing resources for use in surveillance systems are identified. The potential of an active surveillance approach at day labor hiring centers is also briefly discussed. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Language preference and non-traumatic low back disorders in washington state workers' compensation

Workers in the United States with limited English proficiency likely perform more hazardous work, experience higher rates of work-related injury and illness, and have worse disability outcomes.We conducted a descriptive study of employment characteristics, timeliness and utilization of workers' compensation (WC) insurance benefits, cost and occupational health outcomes for Washington State WC state fund, non-traumatic low back disorders (LBD) claimants by language preference.A greater proportion of Spanish language preferring (SLP) LBD claims filed were accepted and resulted in lost work time than English language preferring (ELP) LBD claims. There were significant differences in the demographic, employment, and occupational characteristics between the SLP and ELP compensable claimant populations. The SLP LBD compensable claimants had greater time loss duration, greater medical and total claim costs, more use of physical therapy and vocational services than the ELP LBD compensable claimants. With the exception of the timeliness for providing the first time loss payment, the time periods for provision of insurance benefits did not differ between the SLP and ELP populations. SLP compensable claimants received less back surgery and had comparable permanent partial disability payments to the ELP population. Employers were more likely to protest the acceptance of a SLP compensable than one in an ELP LBD compensable claim.For those injured workers accessing the Washington State WC system, we observed differences based on language preference for pre-injury, and workers compensation outcomes. Further research is needed to explain the observed differences. Am. J. Ind. Med. 2009. © 2009 Wiley-Liss, Inc.

Latino worker perceptions of construction risks

Construction is a hazardous occupation, with Latino (Hispanic) workers at a greater risk for death than other ethnicities/races. Latinos accounted for over half of construction injuries involving days away from work in Nevada in 2006.This study recruited 30 Latino construction workers from three Southern Nevada trade unions to participate in four focus groups conducted in Spanish to determine their perceived risks for injury. Audiotapes were transcribed into English transcripts, which were analyzed for themes.Themes included language/communication difficulties, traditional Latino values, construction trade skill level differences, and health literacy. Participants were unfamiliar with the workers' compensation system.Small contractors in particular should provide more effective safety training in Spanish and appropriate safety equipment. Unions should offer English language training using simulation and more information about workers' compensation rights. Occupational health providers should consider Latino beliefs and communication needs when assessing health status or providing care. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Translating questionnaire items for a multi-lingual worker population: The iterative process of translation and cognitive interviews with English-, Spanish-, and Chinese-speaking workers

The increasing ethnic diversity of the US workforce has created a need for research tools that can be used with multi-lingual worker populations. Developing multi-language questionnaire items is a complex process; however, very little has been documented in the literature.Commonly used English items from the Job Content Questionnaire and Quality of Work Life Questionnaire were translated by two interdisciplinary bilingual teams and cognitively tested in interviews with English-, Spanish-, and Chinese-speaking workers.Common problems across languages mainly concerned response format. Language-specific problems required more conceptual than literal translations. Some items were better understood by non-English speakers than by English speakers. De-centering (i.e., modifying the English original to correspond with translation) produced better understanding for one item.Translating questionnaire items and achieving equivalence across languages require various kinds of expertise. Backward translation itself is not sufficient. More research efforts should be concentrated on qualitative approaches to developing useful research tools. Am. J. Ind. Med. 2009 Published 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.

Temporary workers in Washington State

Evidence regarding the unequal burden of occupational injuries between workers employed by temporary agencies and those in standard employment arrangements is unclear. Studies range from no significant differences in risk to substantial increased risk for temporary workers. The purpose of this study is to compare the workers' compensation experience of a large cohort of temporary agency employed workers with those in standard forms of employment.Washington State Fund workers' compensation data were obtained for claims with injury dates from January 1, 2003 to June 30, 2006, resulting in 342,540 accepted claims. General descriptive statistics, injury rates (per 10,000 FTE), and rate ratios (temp agency/standard employer) were computed by injury type and industry.Temporary agency employed workers had higher rates of injury for all injury types, and higher median time loss (40 vs. 27 days) but lower time loss costs (median $1,224 vs. $1,914, P < 0.001) and lower medical costs ($3,026 vs. $4,087, P < 0.001) than standard arrangement workers. Temporary agency workers had substantially higher rates for "caught in" and "struck by" injuries in the construction (IRR 4.93; 95% CI 2.80-8.08) and manufacturing (IRR 4.05; 95% CI 3.25, 5.00) industry sectors.Temporary agency employed workers have higher claims incidence rates than those in standard employment arrangements. The rate ratios are twofold higher in the construction and manufacturing industry sectors. More research is needed to explore potential reasons for this disparity in occupational injuries. Industry or some measure of job exposure should be included when comparing injury rates in different types of employment in order to better identify areas for prevention. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Occupational injury disparities in the US hotel industry

Hotel employees have higher rates of occupational injury and sustain more severe injuries than most other service workers.OSHA log incidents from five unionized hotel companies for a three-year period were analyzed to estimate injury rates by job, company, and demographic characteristics. Room cleaning work, known to be physically hazardous, was of particular concern.A total of 2,865 injuries were reported during 55,327 worker-years of observation. The overall injury rate was 5.2 injuries per 100 worker-years. The rate was highest for housekeepers (7.9), Hispanic housekeepers (10.6), and about double in three companies versus two others. Acute trauma rates were highest in kitchen workers (4.0/100) and housekeepers (3.9/100); housekeepers also had the highest rate of musculoskeletal disorders (3.2/100). Age, being female or Hispanic, job title, and company were all independently associated with injury risk.Sex- and ethnicity-based disparities in injury rates were only partially due to the type of job held and the company in which the work was performed. Am. J. Ind. Med. © 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.

Declining health insurance access among US hispanic workers: Not all jobs are created equal

Approximately 18% of the U.S. population are uninsured, a proportion that may continue to rise, particularly among Hispanics, as the cost of medical care increases faster than the growth in wages.Health insurance trends were analyzed by race-ethnic category, and among Hispanic workers by occupation type and industrial sector, using data on employed respondents [ge]18 years from 1997 to 2007 National Health Interview Survey (NHIS) (mean annual n = 17,392, representing 123 million US workers on average over this 11 year period).From 1997 to 2007, the relative decline in health insurance coverage for US workers was greatest among Hispanics (7.0%). Hispanic workers in the Construction and Services industries had the greatest overall decline in coverage (24.9% and 14.7%), as well as Hispanic blue collar workers (14.0%).Hispanic workers in general, and those employed in blue collar, construction, and services sectors in particular, are at greater risk for poor access to health care due to a lack of health insurance coverage. Am. J. Ind. Med. 2009 © 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.

Using surveillance data to promote occupational health and safety policies and practice at the state level: A case study

Following the investigation of a birth defects cluster involving migrant farmworkers employed in North Carolina and Florida, it became clear that greater efforts were needed to protect agricultural workers from pesticide exposure.Documentation is drawn from peer-reviewed published articles, government reports and news accounts.The birth defects cluster was identified and investigated by state and federal pesticide poisoning surveillance system staff. Following the investigation, efforts were initiated to highlight pesticides as an important public health issue needing more attention. A series of subsequent events led to the creation and passage of important legislation recently enacted in North Carolina. The legislation resulted in funding to promote various activities to prevent harm from pesticides including strengthening surveillance, improving the quality of pesticide compliance inspections, and increasing and improving pesticide safety training. The legislation also broadened the coverage of anti-retaliation rules to include agricultural workers, and increased recordkeeping requirements pertaining to pesticide applications.The important and positive impacts that can occur through surveillance activities are highlighted. As such, it is important to continue to support and improve occupational illness and injury surveillance programs. Am. J. Ind. Med. 2009. Published 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.

Racial and ethnic disparities in low birth weight delivery associated with maternal occupational characteristics

Work characteristics and maternal education have both been associated with low birth weight (LBW) delivery. We sought to examine the relative contribution of these two factors to LBW delivery and determine whether ethnic/racial differentials in educational attainment and work characteristics might play a role in well-described disparities in LBW.Scores for work substantive complexity (SC) derived from the O*NET were imputed to maternal occupation for Connecticut singleton births in 2000. Risks for LBW were estimated separately for black, Hispanic, and white mothers using logistic regression controlling for maternal covariates.Using white mothers as a referent, working is associated with reduced LBW risk in black mothers compared to those not in work (OR 2.06 vs. 3.07). LBW in working black women was strongly associated with less that a high school education (OR 4.80, 95% CI 1.68-13.7), and with low work SC in blacks in those with a college education or greater (OR 4.48, 95% CI 1.24-16.2). Examination of work SC scores, controlling for age and educational level, showed lower values for blacks; increased work SC was seen in Hispanics after adjustment for lower educational attainment. A decrease in risk for LBW was seen in black mothers, compared with whites, as work SC increased. By contrast, college-educated black mothers had a greater risk for LBW than those with high school or some college education.Maternal employment and work in a job with greater SC were associated with a reduced risk of LBW in black mothers. Improved LBW risk was also seen with employment in Hispanics. Low work SC in those with higher educational attainment was strongly associated with LBW in blacks, but not whites or Hispanics. Education/work mismatch may play a role in racial disparities in birth outcomes. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

Smoking and the Asian American workforce in the National Latino and Asian American Study

Smoking among the Asian American workforce has not been extensively researched. This study examines smoking prevalence among a nationally representative sample of Asian Americans with an emphasis on occupational classification.Cross-sectional data come from the National Latino and Asian American Study. Multivariate logistic regression analyses were used to determine smoking prevalence by occupation, gender, and nativity, among 1,528 participants self-identifying as in the labor force.Blue collar workers reported the highest smoking prevalence (32%) followed by unemployed (19%), other (17%), service (14%), and white collar (10%). Among both employed males and females, blue collar workers had the highest prevalence (45% and 18%, respectively). By nativity, smoking was highest among blue collar workers for immigrants (25%) and highest among the unemployed for U.S. born (16%). Blue collar employment was significantly associated with being a current smoker (OR = 2.52; 95% CI: 1.23-5.16; P < 0.05) controlling for demographics (e.g., age, gender, ethnic group, nativity, etc.).Findings reveal that smoking differs by occupation among Asian Americans. Future research should examine factors explaining differences while considering gender and nativity. Am. J. Ind. Med. © 2009 Wiley-Liss, Inc.

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

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

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

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

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

Different reporting patterns for occupational diseases among physicians: a study of French general practitioners, pulmonologists and rheumatologists

Abstract Purpose Physicians can play an important role in the reporting of occupational diseases (ODs), which are still under-reported in many countries. We aimed to identify physicians’ difficulties in recognizing and reporting ODs and to study the characteristics of the physicians that do report ODs. Methods We conducted a telephone study in 2006–2007 among general practitioners (GPs), pulmonologists and rheumatologists in south-eastern France, concerning their knowledge, attitudes and practice in occupational health. Simple and multiple logistic regressions were performed to study factors associated with the issue of medical certificates for the claim process. Results Three hundred and ninety-one GPs, 95 pulmonologists and 96 rheumatologists participated. GPs reported significantly less often than specialists that they questioned their patients on past occupational exposure. They more frequently reported difficulties in identifying the occupational origin of diseases, and lack of knowledge on the OD reporting system. Issue of medical certificates for OD reporting was significantly more frequent among specialists than among GPs, among physicians considering that ODs are a public health problem, among those acquainted with the forms required to establish certificates, using internet to obtain information, having trade union activities, or having contact with occupational physicians (OPs). Conclusion Initial and continuing training should be developed to encourage physicians, in particular GPs, to question patients on their working conditions and to become better acquainted with claim procedures. Physicians should also be provided with tools for identification of ODs that are suited to their practices, and collaboration with OPs should be fostered. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0457-yAuthors Sandrine Arnaud, INSERM, U912 (SE4S) Marseille FranceS. Cabut, INSERM, U912 (SE4S) Marseille FranceA. Viau, INSERM, U912 (SE4S) Marseille FranceM. Souville, Université Aix-Marseille Laboratoire de Psychologie Sociale, UPRES EA 849 Aix-en-Provence FranceP. Verger, INSERM, U912 (SE4S) Marseille France Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Clinical and HRCT screening of heavily asbestos-exposed workers

Abstract Purpose To characterize asbestosis today and to clarify the indications for high-resolution computed tomography (HRCT) in the surveillance of heavily exposed workers. Methods Six hundred and twenty-seven workers were screened and HRCT findings were classified and divided in two groups: pulmonary fibrosis (n = 86) and no fibrosis (n = 541). Results Most (65/86 = 76%) of the detected fibrosis cases were mild. The magnitude of asbestos exposure showed an unexpected inverse relation with fibrosis. In multivariate analyses, age, forced expiratory volume in 1 s/forced vital capacity ratio, and poor diffusing capacity were associated with HRCT fibrosis, but asbestos exposure was not. Conclusions Asbestosis seems to be characterized by mild fibrosis today even in heavily exposed workers. To avoid radiation exposure in HRCT, age and lung function data may be used only to a limited extent to select imaging candidates. Selection and recollection biases may distort the relation between asbestos exposure and fibrosis. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0462-1Authors Tuula Vierikko, Tampere University Hospital The Department of Diagnostic Radiology Teiskontie 35 33521 Tampere FinlandRitva Järvenpää, Tampere University Hospital The Department of Diagnostic Radiology Teiskontie 35 33521 Tampere FinlandPauliina Toivio, The Finnish Institute of Occupational Health (FIOH) Tampere FinlandJukka Uitti, The Finnish Institute of Occupational Health (FIOH) Tampere FinlandPanu Oksa, The Finnish Institute of Occupational Health (FIOH) Tampere FinlandTuula Lindholm, The Finnish Institute of Occupational Health (FIOH) Helsinki FinlandTapio Vehmas, The Finnish Institute of Occupational Health (FIOH) Helsinki Finland Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

A review of the data quality and comparability of case–control studies of low-level exposure to benzene in the petroleum industry

Abstract Purpose Published case–control studies of risks of leukaemia following low exposures to benzene in the distribution of petroleum (gasoline) have not all identified the same level of risk, but the studies have had differences in cohort inclusion, case determination and availability of occupational and lifestyle data. We reviewed the quality and comparability of the data from three (of four) studies. Methods Through site visits, discussions with the investigators and reading study reports, we reviewed and audited the methods used for selecting cases and controls, for estimating individual exposures and for analysing and interpreting the data. Case–control comparisons of exposures were examined using customised graphs. Results We found that • there were no issues of subject selection, methods or general data quality that were likely to have distorted their internal comparisons; • we could not check in detail whether the metric for exposure assessments was the same across the studies; • the exposure assessments for the Australian study required the least backward estimation, and the Canadian, which also had fewest cases, the most; • evidence of an increased risk at higher exposures in Australia was convincing. Conclusions The findings are consistent with some effect of benzene at higher lifetime exposures. A proposed pooled analysis should improve quantification of any exposure–response relationship. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0463-0Authors B. G. Miller, Institute of Occupational Medicine Research Avenue North Riccarton, Edinburgh EH14 4AP UKW. Fransman, Institute of Occupational Medicine Research Avenue North Riccarton, Edinburgh EH14 4AP UKD. Heederik, University of Utrecht Institute for Risk Assessment Sciences Utrecht The NetherlandsJ. F. Hurley, Institute of Occupational Medicine Research Avenue North Riccarton, Edinburgh EH14 4AP UKH. Kromhout, University of Utrecht Institute for Risk Assessment Sciences Utrecht The NetherlandsE. Fitzsimons, University of Glasgow Department of Haematology Glasgow UK Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Comparing working conditions and physical and psychological health complaints in four occupational groups working in female-dominated workplaces

Abstract Background Dominant theories of working conditions and their effects on poor employee health have been criticized for failing to consider how psychosocial factors interact and how such relationships may differ across occupational groups. Goal This paper examines the associations between psychosocial factors and physical and psychological health complaints while at the same time taking into account differences between occupational groups in female-dominated professions. Method Four female-dominated occupational groups were included: nurses, health care assistants, cleaners, and dairy industry workers. The relationships between influence, emotional and quantitative demands, social support, back pain, and behavioural stress were examined using structural equation modelling. Results Results supported a group-specific model: the overall pattern remained the same across groups while psychosocial factors had different impacts on poor health and interacted differently across groups. The results also indicated links between psychosocial factors and poor physical health. Conclusion The study confirmed the importance of differentiating between female-dominated occupations rather than talking about women’s working conditions as such. The study also emphasized the importance of considering psychosocial risk factors when examining physical health, in this case back pain. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0464-zAuthors Karina Nielsen, The National Research Centre for the Working Environment Lersø Parkalle 105 2100 Copenhagen DenmarkKaren Albertsen, The National Research Centre for the Working Environment Lersø Parkalle 105 2100 Copenhagen DenmarkSten-Olof Brenner, University of Kristianstad The National Research Centre for the Working Environment Kristianstad SwedenLars Smith-Hansen, The National Research Centre for the Working Environment Lersø Parkalle 105 2100 Copenhagen DenmarkChristian Roepsdorff, The National Research Centre for the Working Environment Lersø Parkalle 105 2100 Copenhagen Denmark Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 82 Journal Issue Volume 82, Number 10 / November, 2009

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.

Occupational therapy students' attitudes towards inclusion education in Australia, United Kingdom, United States and Taiwan

This international, cross-cultural study investigated the attitudes of occupational therapy students from Australia, United Kingdom, United States and Taiwan towards inclusive education for students with disabilities. The possible impact of professional education on students' attitudes was also explored. A total of 485 students from 11 entry-level occupational therapy education programmes from Australia, the United Kingdom, the United Sates and Taiwan participated in the study. Among them, 264 were freshmen (first-year students) and 221 were seniors (final-year students). Data collected from a custom-designed questionnaire were analysed both quantitatively and qualitatively.In general, the occupational therapy students reported having positive attitudes towards inclusion. Considerable differences, however, existed among the student groups from the four countries. Professional education appeared to have a significant impact on students' attitudes towards inclusion from first year to senior year. Although students were in favour of inclusion, they also cautioned that their support for inclusive practices depended on various factors such as adequate preparation, support and assistance to students with disabilities.Limitations of the study included the small, convenience sample and different degree structures of the participating programmes. Future research studies need to compare occupational therapy students' attitudes with students from other health care professions. A longitudinal study on the impact of the professional education programme on students' attitudes towards inclusive education is warranted. Copyright © 2009 John Wiley & Sons, Ltd.

Identifying indicators of well-being for caregivers of children with disabilities

This study identified key indicators of well-being for caregivers of children with disabilities, Thirty-nine caregivers completed life satisfaction and psychological well-being (WB) measures, and qualitative interviews. Data analysis included descriptive statistics of WB measures and categorical analysis of qualitative data. Data triangulation was achieved by importing theoretically derived codes for initial qualitative coding and quantitizing qualitative categories. Core indicators focused on positive family functioning and a reasonable family lifestyle, caregiver's personal growth and capacity to manage life demands, and the importance of daily balance. Study limitations included no standardized assessments of the child with disabilities' functioning, and the inclusion of caregivers with a range of years of experience. Findings suggest therapists need to attend to how interventions foster or impede positive family functioning and assist caregivers in balancing daily occupations to support capacity to caregiving. Future research should examine how well-being varies over time as caregivers adapt from initial and later caregiving. Copyright © 2009 John Wiley & Sons, Ltd.

Occupational therapists use of cognitive interventions for clients with Alzheimer's disease

The aim of this study was to establish a profile of occupational therapy practice for cognitive interventions for clients with Alzheimer's disease (AD) in an urban setting. Seventy-four occupational therapists working with older adults with AD in diverse settings in the city of Montreal were randomly selected and were sent a self-administered questionnaire by mail. Sixty-five (87.8%) therapists responded. Findings indicated that 52.3% of occupational therapists are performing cognitive interventions with persons with AD. Of those, 82.4% report using cognitive rehabilitation, 61.8% using cognitive stimulation and 50.0% using cognitive training. Intervention use varied across settings and differed according to severity of AD. The sessions are usually provided individually and often include the client's caregiver. Generalizability of the results is limited to urban areas, and possible differences in service provision should be taken into consideration. Further research is needed to measure the effectiveness of these interventions provided by occupational therapists and to compare occupational therapy practices in urban and rural areas. 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.

Development of the Chinese language paediatric daily occupation scale in Taiwan

The aim of this study was to describe the development of the paediatric daily occupation scale (PDOS) that was validated with Taiwanese children aged from birth to 72 months. Item-scale correlation coefficient was also used to select items. The psychometric properties of PDOS were examined based on the results of 957 children who participated in the study. The Chinese child development inventory (CCDI) was used as a standard to examine the concurrent validity of PDOS on two different samples.The PDOS, completed by parents, contains 340 items with good internal consistency (Cronbach's [agr] = 0.99), test-retest reliability (r = 0.99) and concurrent validity (r = 0.88 between PDOS and CCDI). The sensitivity of PDOS (83%) in detecting children with developmental problems was much higher than CCDI (33%).Because the PDOS is developed and examined on children from greater Taipei area, when using the PDOS with children from different socio-cultural environments, the results need to be interpreted cautiously. Further research of the PDOS to justify its use as a screening tool for early detecting of children with developmental problems is suggested. Copyright © 2009 John Wiley & Sons, Ltd.

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Work-related musculoskeletal conditions: evidence from the THOR reporting system 2002-2005

Background Musculoskeletal disorders (MSDs) are commonly encountered in current occupational health practice and comprise up to 45% of the workload for occupational physicians (OPs). Aims To compare the reported incidence of work-related (WR) MSDs by specialist OPs and specialist rheumatologists and to relate it to self-reported and general practitioners-reported WR MSDs. Methods Analysis of data reported to surveillance schemes within The Health and Occupation Reporting network and comparison to denominator data derived from the Labour Force Survey and occupational/work activity classifications. Results There are significant differences between the patterns of WR MSDs seen by the different specialist groups. Thus OPs report three times as many back and lower limb conditions. However, both specialist groups report similar numbers of cases of hand–arm vibration syndrome (12/9%) and ‘vague and ill-defined’ upper limb conditions (16/14%). The absolute risk of physician reported that WR MSDs increases 5-fold between ages 15–24 and 45–64. Conclusions The specialist reporting schemes give an indication of current practice and are useful both to update and to strategically inform planning. The data are amenable, with appropriate statistical analysis, for comparison with self-reporting and to the characterization of risk in broad categories of occupation and work activity.

Chronic and acute psychological strain in naval personnel

Background Previous surveys have shown that there is a greater prevalence of psychological strain in Naval personnel than in the general population and have described the main psychosocial stressors associated with strain. Aims To determine the prevalence of acute strain and of repeated episodes of strain over 6- and 12-month periods. Methods Six and twelve months after completing a Phase I Work and Well-Being questionnaire, 2596 personnel were reassessed using a follow-up General Health Questionnaire-12. Results The response rates at 6 and 12 months ranged from 51 to 60%. There was no evidence of response bias at follow-up. The prevalence of acute strain was 31% at Phase I. After 6 months, approximately half of strain cases had recovered. Only 10% had strain over the entire period. Change in strain was linked to change in work role. Conclusions Accumulation of strain and recovery occur within 6 months depending on change in work role. Management of strain might best be achieved by management of work demands and deployment length. Further studies will investigate the rate of accumulation of strain over the course of demanding deployments. Exposure to psychosocial stressors such as effort reward imbalance accounted for much of the difference between chronic strain sufferers and those with no strain.

Occupational outcomes in soldiers hospitalized with mental health problems

Background Little is known about the longer term occupational outcome in UK military personnel who require hospital-based treatment for mental health problems. Aims To examine the documented occupational outcomes following hospital-based treatment for mental health problems within the British Army. Methods Hospital admission records were linked to occupational outcome data from a database used for personnel administration. Results A total of 384 records were identified that were then linked to occupational outcome after an episode of hospitalization. Seventy-four per cent of those admitted to hospital with mental health problems were discharged from the Army prematurely, and 73% of the discharges occurred in the first year following hospitalization. Discharge from the Army was associated with holding a junior rank, completing <5 years military service, having a combat role, being male and receiving community mental health team treatment prior to admission. Conclusions Hospitalization for a mental health problem in a military context is associated with a low rate of retention in service. Outcome was not influenced greatly by duration of hospital stay; however, those who reported receiving individual rather than group-based therapy while in hospital appeared to do better.

Occupational dermatoses in restaurant, catering and fast-food outlets in Singapore

Background The restaurant industry is a rapidly growing sector in Singapore and workers in this industry are trained in culinary skills but not on recognition of safety and health hazards and their control measures. Anecdotal clinical evidence has suggested an increased prevalence of occupational dermatoses among restaurant workers. Aims To determine the prevalence and risk factors for contact dermatitis and burns among restaurant, catering and fast-food outlet (FFO) staff. Methods Workers were interviewed and then clinical examination and patch and/or prick tests were conducted in selected individuals. Results In total, 335 of 457 workers (73% response) were interviewed and 65 (19%) had occupational dermatitis or burns and were examined. Of these, contact dermatitis was the commonest diagnosis, with a 12-month period prevalence of 10% (35 workers) and 3-month period prevalence of 8% (26 workers). All 35 workers had irritant contact dermatitis (ICD) and there were no cases of allergic contact dermatitis. The adjusted prevalence rate ratios of risk factors for ICD were 2.78 (95% CI 1.36–5.72) for frequent hand washing >20 times per day, 3.87 (95% CI 1.89–7.93) for atopy and 2.57 (95% CI 1.21–5.47) for contact with squid. The 3-month period prevalence for burns was 6% (20 workers). Ten workers had other occupational dermatoses such as work-related calluses, paronychia, heat rash and allergic contact urticaria to prawn and lobster. Conclusions ICD and burns are common occupational skin disorders among restaurant, catering and FFO workers.

Workplace violence: a survey of paediatric residents

Background Paediatric residents are often exposed to verbal abuse and/or physical assaults from patients and patients’ families during the course of their training. Residents may benefit from further training on how to prevent and respond to workplace violence. Aims To determine the prevalence of workplace violence in paediatric residency training programmes. Methods In 2007, a 25-item web-based questionnaire about experiences of verbal and/or physical abuse while on duty was distributed to 1211 paediatric residents at all training levels from 25 paediatric programmes. Results A total of 541 questionnaires were returned giving a 45% response rate. In total, 33% of the respondents had been verbally abused or physically assaulted by patients and/or patients’ families during their residency programme, although verbal abuse was much more common than physical assaults. In total, 71% of respondents reported having no teaching about workplace violence during their residency training. The majority (74%) indicated that they would like to receive more training in managing angry patients and families. Conclusions Paediatric residents are often exposed to verbal threats during the course of their work. They are also at risk of physical assaults by angry patients and/or families. Paediatric residents require more training on how to prevent and respond to workplace violence, and this important topic should be incorporated into the paediatric residency curriculum.

Current perception threshold and the HAVS Stockholm sensorineural scale

Background It is important to determine which tests of sensorineural dysfunction identify the neurological damage from hand–arm vibration exposure. Aims To examine the association between the hand–arm vibration syndrome (HAVS) Stockholm sensorineural scale stages and tests of peripheral neurological function including measurement of current perception threshold (CPT) and nerve conduction. Methods All the subjects were men who were assessed for HAVS with a medical and occupational history and physical examination to determine the Stockholm stage, CPT testing at frequencies of 5, 250 and 2000 Hz for the median and ulnar nerves and measurement of nerve conduction carried out in a blinded fashion. Results A total of 155 of the 157 recruited subjects agreed to take part in the study, a 99% participation rate. CPT was statistically significantly increased (P < 0.001) in both Stockholm sensorineural Stages 1 and ≥2 in comparison to Stage 0 for every frequency and nerve combination. However, CPT could not discriminate well between Stages 1 and ≥2. There was no association between median or ulnar neuropathy measured by nerve conduction and the Stockholm stages. Polychotomous multinomial logistic regression indicated that the CPT measurements at 2000 Hz, corresponding to damage to large myelinated nerve fibres, were most predictive of both Stockholm Stages 1 and ≥2 in comparison to Stage 0. Conclusions Neuropathy measured by nerve conduction was unrelated to the Stockholm scale stages. CPT was increased above Stage 0 but did not distinguish well between the higher stages of the Stockholm scale.

Noise-induced hearing loss in French police officers

Background There is a lack of data about police officers’ hearing thresholds and the risk of noise-induced hearing loss (NIHL) associated with this occupation. In France, 129 000 national police officers, 96 000 state police force members and 16000 municipal police officers may be affected by occupational noise exposure. Aims To evaluate the association between police employment and NIHL. Methods We undertook a cross-sectional study using review of medical records. Audiometric and otological data and information on potential confounders were extracted from medical records. Global hearing loss and selective 4000 Hz hearing loss were analysed. Results Of total, 1692 subjects (887 policemen and 805 civil servants) participated in the study. After adjusting for potential cofounders, police officers were 1.4 times more likely to have a selective 4000 Hz hearing loss than civil servants (95% CI 1.1–1.9). This difference was greater between motorcycle police officers and civil servants (OR = 3; 95% CI 1.4–6.3). Conclusions These data suggest that occupational noise exposure in police work, particularly in motorcycle police officers, may induce hearing loss. Noise sources need to be more accurately defined to confirm high-level noise exposures, to better define significant sources of noise and to identify effective solutions.

Cardiorespiratory fitness and the metabolic syndrome in firefighters

Background The leading cause of mortality in on-duty firefighters is sudden cardiac death. While the reason for this remains unclear, low cardiorespiratory fitness and the metabolic syndrome have been associated with increased risk of cardiovascular disease-related events. Aims To document the levels of cardiorespiratory fitness and the metabolic syndrome, as well as to determine if there is a relationship between these variables, in firefighters. Methods Maximal cardiorespiratory fitness was assessed using the Bruce treadmill protocol in 214 male firefighters from Colorado. As part of a comprehensive cardiovascular disease risk evaluation, each firefighter was also screened for the metabolic syndrome using the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) guidelines. Results At the time of their evaluation, 32 firefighters (15%) met the NCEP/ATP III diagnostic criteria for the metabolic syndrome, and 54 firefighters (25%) failed to achieve a generally accepted minimum cardiorespiratory fitness level of 42.0 ml/kg/min. A significant inverse trend of increasing cardiorespiratory fitness with decreasing metabolic abnormalities was found (P < 0.001). Conclusions Increased levels of cardiorespiratory fitness are associated with an improved metabolic profile in male firefighters. Comprehensive cardiovascular disease risk factor management and cardiorespiratory fitness improvement are essential for firefighter health and safety.

Occupational injury in the United Arab Emirates: epidemiology and prevention

Background The United Arab Emirates (UAE) is developing rapidly, with many foreign construction, farm and industrial workers. Aims To assess the epidemiology of occupational injury hospitalizations using a trauma registry. Methods Surgical admissions from March 2003 to April 2005 were recorded in the registry at the main trauma hospital in Al Ain city (population 348 000). Prevention-related variables were analysed using SPSS and severity was quantified by injury severity scores (ISS). Results There were 614 occupational injury hospitalizations, an incidence of ~136/100 000 workers/year. Males accounted for 98% of injuries, the 25–44 age group for 69% and non-nationals for 96%. External causes included falls 51%, falling objects 15%, powered machines 11%, animal-related 7% and burns 6%. Median ISS was 4 for all six main external causes. Extremities were most frequently injured, followed by chest, head and neck, abdomen and face. Mean hospitalization duration was 9.4 days, with 36% hospitalized for >1 week. Conclusions The main external causes were proportionately much more frequent than in industrialized countries. Effective countermeasures are needed to reduce the incidence and severity of occupational injury among vulnerable migrant workers in the UAE.

Prevalence of self-reported musculoskeletal symptoms in salespersons

Background Salespersons are required to stand for long periods of time during work. Prolonged standing is one physical factor contributing to the development of musculoskeletal symptoms in the working population. Aims To estimate the 12-month prevalence of self-reported musculoskeletal symptoms in the head/neck, shoulders, elbows, wrists/hands, upper back, low back, hips, knees and ankles/feet in salespersons. Methods A cross-sectional survey using a descriptive questionnaire was used to evaluate musculoskeletal symptoms in 1310 female salespersons in 18 department stores. Results Of the 1200 subjects (92%) who completed the questionnaire, 1189 were eligible for inclusion in the study. The 1-year prevalence of self-reported musculoskeletal symptoms was 77%. The ankle/foot (35%) was the most frequently affected body region followed by low back (34%), knees (33%), hips (28%), shoulders (28%), head/neck (26%), upper back (21%), wrists/hands (14%) and elbows (3%). The older the salespersons were, the more likely they were to report knee symptoms (P < 0.05). Salespersons with a body mass index (BMI) >23 kg/m2 were more likely to report knee symptoms than those with a BMI <18.5 kg/m2 (P < 0.05). Conclusions Musculoskeletal symptoms are common among salespersons with a high proportion experiencing symptoms in the low back, knees and ankles/feet. The prevalence of musculoskeletal symptoms in the knees is associated with age and BMI. Attention should be given to developing specific measures to reduce or prevent musculoskeletal symptoms in salespersons.

Sickness absence frequency among women working in hospital care

Background Frequent short sickness absences result in understaffing and interfere with work processes. We need more knowledge about factors associated with this type of absence. Aims To investigate associations between the frequency of previous sickness absence and self-reported perceptions of health and work. Methods Cross-sectional study of female hospital care workers in which health, work characteristics and coping styles were assessed by questionnaire and linked to the number of sickness absence episodes recorded in the preceding 5 years using negative binomial regression analysis for counts distinguishing between short (1–7 days) and long (>7 days) episodes of absence after adjusting for age and duration of employment in December 2007 and hours worked between 2003 and 2007. Results Of 350 women employed for at least 5 years, 237 (68%) answered the questionnaire. The hours worked over the 5 year period [rate ratio (RR) = 1.2] and problem solving coping style score (RR = 1.1) were positively associated with the number of short sickness absence episodes. Age (RR = 0.8) and good general health (RR = 0.7) were inversely related to the number of both short and long episodes. Self-reported mental health and work characteristics were not shown to be related to the frequency of sickness absence. Conclusions Hours worked, problem-solving coping style, age and general health showed associations with the frequency of previous sickness absence among women who had worked at least 5 years in health care. Future prospective studies on the frequency of sickness absence should consider the impact of these factors further.

Clinical research

Wastewater workers and hepatitis A virus infection

Background The main occupational hazard of wastewater workers (WWs) is the direct exposure to the variety of infectious agents present in sewage material, with hepatitis A virus (HAV) being the most frequent one. Most epidemiological studies have shown a higher risk of hepatitis A among WWs, although some studies have produced conflicting evidence. Aims To evaluate the hypothesis of increased risk of HAV infection in WWs. Methods The prevalence of antibodies to HAV in 869 WWs was compared to 311 other subjects and analysed to detect the main potentially confounding variables. Results Univariate analysis demonstrated that occupational exposure to sewage was not significantly associated with the prevalence of anti-HAV(+). The anti-HAV(+) prevalence was strongly associated with age and shellfish consumption (P < 0.05) when the subcategories of workers were examined separately (WWs and control group) and jointly. In the logistic regression model, a significant association between anti-HAV(+) prevalence and duration of employment (P < 0.05) was found. The interaction term (age x duration of employment) was significant (P < 0.001) when included in the logistic model. Conclusions This study shows that working in a wastewater treatment plant does not seem to be related to a greater prevalence of antibodies to hepatitis A. Moreover, the relative risk of HAV infection among WWs seems to be correlated with low anti-HAV(+) prevalence in the general population.

Sharps injuries among medical students

Background Medical students may be at risk of sharps injuries for several reasons. These exposures can transmit a range of blood-borne pathogens including hepatitis B, hepatitis C and human immunodeficiency virus. Aims To evaluate medical students’ knowledge regarding the prevention and management of sharps injuries and their experience of such exposures in the calendar year 2007. Methods A cross-sectional, web-based, survey of fourth and fifth year medical students enrolled at the University of Aberdeen in Scotland. All students were at the mid-point of their year of study. An invitation e-mail and two electronic reminders were sent, on specified days, to the study population. These contained a summary of the study and the link to the anonymous questionnaire. Results Of the 395 medical students e-mailed, 238 (60%) responded. When compared with fourth year medical students, final year students had higher mean knowledge scores for sharps injury management (P < 0.01). Of total, 18% reported resheathing used needles and 31% reported disposing of sharps for others, indicating poor compliance with standard precautions. In the event of an injury, 29% stated that they would scrub the wound. Only 44% were familiar with policies for reporting exposures. In all, 11% of students had experienced at least one contaminated sharps injury in 2007 and, of those, 40% had reported the most recent incident. Conclusions Medical students are at risk of sharps injuries and their knowledge regarding the prevention and management of these exposures is limited: training on these issues should be increased.

Educational programmes and sharps injuries in health care workers

Background Sharps injuries in health care personnel still represent a significant problem worldwide. Many studies show a reduction in sharps injuries following the introduction and use of different protection devices, but few studies focus on the role of training programmes in the prevention of such injuries. Aims To analyse the influence of training programmes on sharps injuries in health care workers (HCW). Methods The study was carried out in a 350-bed university hospital in north-eastern Italy with 700 HCW. Training courses on biological risk for physicians, nurses, ancillary operators and laboratory technicians have been in place since 1998. Data on all sharps injuries reported by HCW between 1998 and 2006 were analysed together with information on HCW who attended the training courses. Results Between 1998 and 2006, there was a reduction in the incidence of sharps injuries from 11 to 4% (P < 0.01). During the same period, the number of trained HCW increased from 26 to 69% (P < 0.01). Trained personnel had a statistically significant lower relative risk (RR) for injury with RR = 0.06 (95% CI 0.02–0.18). Conclusions A continuous educational effort for HCW leads to a reduction of sharps injuries.

Disability from occupational diseases in Greece

Background Occupational diseases (ODs) are often under-reported. OD Medical Committees of the Greek Social Security Institute (Idryma Kinonikon Asfaliseon—IKA) are believed to be the only reliable source of data on ODs in Greece. Aims To analyse the results of OD Medical Committees of IKA on the claims for OD Disablement Benefit (ODDB) during a 5 year period. Methods Two hundred and ninety-nine claims for ODDB were submitted to IKA from 2003 to 2007. These claims were examined on a monthly basis. Results One hundred and seventy-one cases of ODs (153 men and 18 women, mean age = 57 ± 8 years) were recorded (recognition rate = 61%); 125 of these qualified for ODDB (pension rate = 42%). The main diagnosis was allergic contact dermatitis (40% of total cases of ODs), followed by lead toxicity (12%) and asthma (11%). Of the six main diagnoses, the most serious was lead toxicity (mean disability percentage = 59 ± 19%, n = 21). Conclusions This study reveals flaws in the existing system of recognition of ODs in Greece, illustrated mainly by the small number of claims for ODDB. Possible explanations are delays in establishing a new widened list of ODs, lack of a unified recording and notification system, lack of motivation on behalf of the patients and the small number of occupational physicians.

Occupational medicine in Brazil

Interpretation questioned

Rehabilitation for Work Matters

Oxford Handbook of Clinical Rehabilitation

Shift work risk of stroke and metabolic syndrome

The interplay between physical activity at work and during leisure time - risk of ischemic heart disease and all-cause mortality in middle-aged Caucasian men.

Related Articles The interplay between physical activity at work and during leisure time - risk of ischemic heart disease and all-cause mortality in middle-aged Caucasian men. Scand J Work Environ Health. 2009 Oct 21;:466-474 Authors: Holtermann A, Mortensen OS, Burr H, Søgaard K, Gyntelberg F, Suadicani P OBJECTIVE: Our aim was to test the hypothesis that a high level of physical activity during leisure time increases the risk of ischemic heart disease (IHD) mortality among men with high physical work demands. METHODS: We carried out a 30-year follow-up of the Copenhagen Male Study of 5249 caucasian, male workers aged 40-59 years; 274 men with overt cardiovascular disease were excluded from the follow-up. RESULTS: During the follow-up period, 591 men (11.9%) died from IHD. Cox analyses of men with low (N=1236), medium (N=2651), and high (N=858) physical work demands showed that those with high demands had a higher risk of IHD mortality compared to men with low demands [age-adjusted hazard ratio 1.51, 95% confidence interval (95% CI) 1.18-1.94]. In all three groups, men with a low level of physical activity during leisure time had a higher risk of IHD than men with a medium or high level. Overall, the age-adjusted hazard ratio for IHD mortality associated with a high level of leisure time physical activity was 0.49 (95% CI 0.34-0.70). Among workers with high physical work demands, the hazard ratio for IHD mortality (adjusted for confounders) was 0.82 (95% CI 0.42-1.56) for a high level of leisure time physical activity and 0.62 (95% CI 0.40-0.97) for a moderate level. CONCLUSION: We did not find support for the hypothesis that a high level of physical activity during leisure time increases the risk of IHD mortality among men with high physical work demands and with no pre-existing clinical cardiovascular disease. In contrast, moderate and high levels of activity during leisure time seemed to be protective against IHD mortality among people with medium and high physical activity at work. PMID: 19851700 [PubMed - as supplied by publisher]

Fate of abstracts presented at an International Commission on Occupational Health (ICOH) congress - followed by publication in peer-reviewed journals?

Related Articles Fate of abstracts presented at an International Commission on Occupational Health (ICOH) congress - followed by publication in peer-reviewed journals? Scand J Work Environ Health. 2009 Oct 9;:461-465 Authors: Rollin L, Darmoni S, Caillard JF, Gehanno JF OBJECTIVES: Presentations at international meetings offer an excellent way to disseminate current research findings. One measure of the quality of research is its subsequent publication. Our study aimed to determine the publication rate of abstracts presented at a congress of the International Commission of Occupational Health (ICOH), and to identify predictive factors of publication and differences between presented abstracts and -subsequently published papers. METHODS: We identified a random sample of 318 abstracts presented at the 2000 ICOH meeting from the book of abstracts. Using Medline and Embase, we assessed their publication rate in the period ranging from 1998 to 2006 and investigated the factors associated with publication rate. RESULTS: Of 318 abstracts originating from 51 countries, 105 articles [33%, 95% confidence interval (95% CI) 27-38)] were subsequently published in 67 journals indexed in Medline or Embase. Mean time to publication was 17 months (95% CI 13-21). Multivariate analysis revealed that abstracts with quantitative data and written by authors originating from developed countries were significantly more published. From the time of abstract presentation to publication in a peer-reviewed journal, both the study sample size and the first author frequently changed (respectively 25% and 29%), but the overall conclusions remained stable, except in one case. CONCLUSIONS: Most of the abstracts presented at the 2000 ICOH congress were not subsequently published as full research reports. If this is the case for most abstracts submitted to conferences, this may limit the ability of a reader to judge the validity, reliability, and generalizability of the research presented. Caution is advised when referencing or generalizing from abstracts that have not been subsequently published in full. PMID: 19851699 [PubMed - as supplied by publisher]

Data Sharing, Federal Rule of Evidence 702, and the Lions in the Undergrowth

Many concerns would find it useful to have a publicly available database recording exposures to particular substances, with contextual information. The European Union's Registration, Evaluations, Authorisation, and restriction of Chemicals regulation has increased interest in this. It has been suggested that journals should require detailed publication of exposure data with papers. But there are problems for researchers, for whom the data are a valuable resource which has been obtained with effort and often ingenuity. The publication could also raise problems of confidentiality and liability, and those who have to put the effort in publication are not those who benefit. Also, there are the problems of hostile critics misusing the information—for example, industry reanalysing data to counter any regulatory implications of a study—and this raises serious wider issues of editorial policy. Two books have recently given examples of industry misuse of science, ‘Doubt is their product’ by David Michaels and ‘Defending the indefensible’ by McCullogh and Tweedale. Michaels gives examples of hostile data reanalysis, and among other things, he discusses the impact on journals of US Federal Rule of Evidence 702, which encourages expert witnesses to try to get their testimony material into peer-reviewed journals. This certainly lies behind some submissions to this journal, and Michaels says that it has led to the creation of peer-reviewed journals which have strong industry influence. On the other hand, work funded by industry is not always wrong, papers from other sources are not always free from bias, and the problem for journals is to continue to apply consistent scientific standards in a sea of conflicting interests. It does not seem feasible or desirable for journals to insist on the publication of all the underlying data, although researchers might be encouraged to form consortia to share data.

Trends in Wood Dust Inhalation Exposure in the UK, 1985-2005

Objectives: Wood dust data held in the Health and Safety Executive (HSE) National Exposure DataBase (NEDB) were reviewed to investigate the long-term changes in inhalation exposure from 1985 to 2005. In addition, follow-up sampling measurements were obtained from selected companies where exposure measurements had been collected prior to 1994, thereby providing a follow-up period of at least 10 years, to determine whether changes in exposure levels had occurred, with key staff being interviewed to identify factors that might be responsible for any changes observed. Methods: Analysis of the temporal trend in exposure concentrations was performed using Linear Mixed Effect Models on the log-transformed NEDB data set and expressed as the relative annual change in concentration. Results: For the NEDB wood dust data, an annual decline of geometric mean (GM) exposure of 8.1% per year was found based on 1459 exposure measurements collected between 1985 and 2003. This trend was predominantly observed in data from inspection visits (measurements collected on a mandatory basis by a Specialist HSE Inspector) (n = 1009), while data from representative surveys (measurements collected on a voluntary basis to provide information on current practices and exposures) remained relatively stable. Ten follow-up surveys in individual workplaces in 2004–2005 resulted in 70 new measurements and for each of the companies resurveyed, the GM of the wood dust exposure decreased between sampling surveys. Conclusion: Analysis of the temporal trend in UK wood dust exposure concentrations revealed declines of 8% per annum. Interviews with key long-serving employees and management suggest that factors such as technological changes in production processes, response to new legislation, and enforcement agency inspections, together with global economic trends, could be linked to the downward trends observed.

Beryllium Decontamination with Different Solvents on Different Structures

The objective of the present work was to estimate the efficiency of moistened wipes in removing beryllium with different solutions including CitranoxTM, AlconoxTM, NaCl 5%, ResolveTM, and LedizolvTM on various types of surfaces such as unpainted metal, wood frames, painted metal, concrete, painted concrete, and PlexiglasTM from three different occupational settings. Of the three plants that were investigated, only surfaces in the aluminium smelter were decontaminated down to the clearance reference level of 0.2 µg 100 cm–2, with all the solvents used. In the machine tooling and milling department, the clearance level of 0.2 µg 100 cm–2 was reached after the three decontaminations, with all the solvents. In the machine plant for the military, aerospace, and telecommunications industries, the beryllium concentrations on the concrete wall, before decontamination with the high-pressure gun, were usually >3 µg 100 cm–2, and concentrations as high as 31 µg 100 cm–2 were measured. After the high-pressure cleanup, the beryllium concentrations were sometimes reduced by a factor of 10, but never reached the clearance level. Beryllium compounds that had adhered to most types of structures that we attempted to decontaminate were reduced to below the clearance reference value except on concrete floors. There did not seem to be any difference between the decontamination actions for all the solvents used in this study.

Quantification and Statistical Modeling--Part I: Breathing-Zone Concentrations of Monomeric and Polymeric 1,6-Hexamethylene Diisocyanate

We conducted a repeated exposure-assessment survey for task-based breathing-zone concentrations (BZCs) of monomeric and polymeric 1,6-hexamethylene diisocyanate (HDI) during spray painting on 47 automotive spray painters from North Carolina and Washington State. We report here the use of linear mixed modeling to identify the primary determinants of the measured BZCs. Both one-stage (N = 98 paint tasks) and two-stage (N = 198 paint tasks) filter sampling was used to measure concentrations of HDI, uretidone, biuret, and isocyanurate. The geometric mean (GM) level of isocyanurate (1410 µg m–3) was higher than all other analytes (i.e. GM < 7.85 µg m–3). The mixed models were unique to each analyte and included factors such as analyte-specific paint concentration, airflow in the paint booth, and sampler type. The effect of sampler type was corroborated by side-by-side one- and two-stage personal air sampling (N = 16 paint tasks). According to paired t-tests, significantly higher concentrations of HDI (P = 0.0363) and isocyanurate (P = 0.0035) were measured using one-stage samplers. Marginal R2 statistics were calculated for each model; significant fixed effects were able to describe 25, 52, 54, and 20% of the variability in BZCs of HDI, uretidone, biuret, and isocyanurate, respectively. Mixed models developed in this study characterize the processes governing individual polyisocyanate BZCs. In addition, the mixed models identify ways to reduce polyisocyanate BZCs and, hence, protect painters from potential adverse health effects.

Quantification and Statistical Modeling--Part II: Dermal Concentrations of Monomeric and Polymeric 1,6-Hexamethylene Diisocyanate

We conducted a quantitative dermal and inhalation exposure assessment of monomeric and polymeric 1,6-hexamethylene diisocyanates (HDI) in 47 automotive spray painters from North Carolina and Washington State. We report here the use of linear mixed modeling (LMM) to identify the primary determinants of dermal exposure. Dermal concentrations of HDI, uretidone, biuret, and isocyanurate were significantly higher in 15 painters who did not wear coveralls or gloves (N = 51 paint tasks) than in 32 painters who did wear coveralls and gloves (N = 192 paint tasks) during spray painting. Regardless of whether protective clothing was worn, isocyanurate was the predominant species measured in the skin [geometric mean (GM) = 33.8 ng mm–3], with a 95% detection rate. Other polyisocyanates (GM ≤ 0.17 ng mm–3) were detected in skin during <23% of the paint tasks. According to marginal R2 statistics, mixed models generated in this study described no <36% of the variability in dermal concentrations of the different polyisocyanates measured in painters who did not wear protective clothing. These models also described 55% of the variability in dermal concentrations of isocyanurate measured in all painters (N = 288 paint tasks). The product of analyte-specific breathing-zone concentration (BZC) and paint time was the most significant variable in all the models. Through LMM, a better understanding of the exposure pathways governing individual polyisocyanate exposures may be achieved. In particular, we were able to establish a link between BZC and dermal concentration, which may be useful for exposure reconstruction and quantitatively characterizing the protective effect of coveralls and gloves. This information can be used to reduce dermal exposures and better protect automotive spray painters from potential adverse health effects.

Guidance Values for Surface Monitoring of Antineoplastic Drugs in German Pharmacies

Objectives: Antineoplastic drugs are widely used in anticancer therapy due to their cytotoxic activity but many of them are classified as carcinogenic, mutagenic, or teratogenic to humans. In order to evaluate personal exposure, surface monitoring has been successfully applied for several years. In this study, we present a statistical description of our data set from 102 German pharmacies and propose ‘threshold guidance values (TGVs)’ to facilitate interpretation of monitoring results. Methods: Our database included 1008 results for platinum (PT) and 1237 for 5-fluorouracil (FU) collected in 102 pharmacies in Germany. Wipe sampling on site was performed with one validated procedure. PT concentrations were measured by voltammetry and FU by gas chromatography/mass spectrometry. Data were stratified into 10 locations and statistically evaluated. Results: Contamination was detected on all surfaces in the pharmacies with high levels on storage shelves and floors. The median values for the different locations ranged from 0.20 to 1.70 pg cm–2 (mean: 0.57 pg cm–2) for PT and from 2.50 to 10.00 pg cm–2 (mean: 5.34 pg cm–2) for FU. The mean 75th percentiles were 3.92 pg cm–2 (PT) and 28.90 pg cm–2 (FU). The TGV 1 value was set at the median value and results below demonstrate good working practices. Contaminations above the TGV 2, which was assigned at the 75th percentile, show a clear need for optimizing the handling procedures. Conclusions: The introduction of TGVs helps to reduce occupational exposure and allows pharmacy personnel to benchmark their own contamination levels. This provides a basis for improvement in occupational safety precautions and for regular contamination controls.

Recombinant Factor C (rFC) Assay and Gas Chromatography/Mass Spectrometry (GC/MS) Analysis of Endotoxin Variability in Four Agricultural Dusts

Endotoxin exposure is a significant concern in agricultural environments due to relatively high exposure levels. The goals of this study were to determine patterns of 3-hydroxy fatty acid (3-OHFA) distribution in dusts from four types of agricultural environments (dairy, cattle feedlot, grain elevator, and corn farm) and to evaluate correlations between the results of gas chromatography/mass spectrometry (GC/MS) analysis (total endotoxin) and biological recombinant factor C (rFC) assay (free bioactive endotoxin). An existing GC/MS-MS method (for house dust) was modified to reduce sample handling and optimized for small amount (<1 mg) of agricultural dusts using GC/EI-MS. A total of 134 breathing zone samples using Institute of Occupational Medicine (IOM) inhalable samplers were collected from agricultural workers in Colorado and Nebraska. Livestock dusts contained approximately two times higher concentrations of 3-OHFAs than grain dusts. Patterns of 3-OHFA distribution and proportion of each individual 3-OHFA varied by dust type. The rank order of Pearson correlations between the biological rFC assay and the modified GC/EI-MS results was feedlot (0.72) > dairy (0.53) > corn farm (0.33) > grain elevator (0.11). In livestock environments, both odd- and even-numbered carbon chain length 3-OHFAs correlated with rFC assay response. The GC/EI-MS method should be especially useful for identification of specific 3-OHFAs for endotoxins from various agricultural environments and may provide useful information for evaluating the relationship between bacterial exposure and respiratory disease among agricultural workers.

Exposure to Polycyclic Aromatic Hydrocarbons (PAHs), Mutagenic Aldehydes, and Particulate Matter in Norwegian a la Carte Restaurants

Objectives: The aim of the study was to characterize the exposure regarding polycyclic aromatic hydrocarbons (PAHs) and higher mutagenic aldehydes in the breathing zone of the cook during work in Norwegian à la carte restaurants. Levels of particle exposure were also measured to make the results comparable to other studies. Methods: Personal measurements of the levels of PAHs, higher aldehydes, and total particles were performed in three restaurants in the city of Trondheim in the middle of Norway. Results: Naphthalene was detected within the range of 0.05–0.27 µg m–3 air, and the total mean value for all three restaurants was 0.18 µg m–3 air. The measured levels of mutagenic aldehydes were between 1.03 and 17.67 µg m–3 air. The mean mass concentration of total particles measured in the three restaurants was 1.93 mg m–3, and the levels registered were within the range 0.32–7.51 mg m–3. Conclusions: Working as a cook in a Norwegian à la carte restaurant with some manual panfrying involves exposure to components in cooking fumes which may cause adverse health effects. Additional studies are necessary in order to identify relations between exposure levels and the adverse health effects of cooking fumes.

Development of a Sampler for Total Aerosol Deposition in the Human Respiratory Tract

Studies that seek to associate reduced human health with exposure to occupational and environmental aerosols are often hampered by limitations in the exposure assessment process. One limitation involves the measured exposure metric itself. Current methods for personal exposure assessment are designed to estimate the aspiration of aerosol into the human body. Since a large proportion of inhaled aerosol is subsequently exhaled, a portion of the aspirated aerosol will not contribute to the dose. This leads to variable exposure misclassification (for heterogenous exposures) and increased uncertainty in health effect associations. Alternatively, a metric for respiratory deposition would provide a more physiologically relevant estimate of risk. To address this challenge, we have developed a method to estimate the deposition of aerosol in the human respiratory tract using a sampler engineered from polyurethane foam. Using a semi-empirical model based on inertial, gravitational, and diffusional particle deposition, a foam was engineered to mimic aerosol total deposition in the human respiratory tract. The sampler is comprised of commercially available foam with fiber diameter = 49.5 µm (equivalent to industry standard 100 PPI foam) of 8 cm thickness operating at a face velocity of 1.3 m s–1. Additionally, the foam sampler yields a relatively low-pressure drop, independent of aerosol loading, providing uniform particle collection efficiency over time.

Experimental Characterization of a Plume of Passive Contaminant above a Thermal Source: Capture Efficiency of a Fume Extraction Hood

Industrial ventilation problems can be linked to the formation of thermal plumes that develop due to natural convection above various heat sources. These plumes, independent of the energy losses and thermal constraints caused, can also be the carrier of polluting products. This article describes an experimental study of the dynamic, thermal, and mass fields that develop from a hot rectangular (0.5 x 1.25 m) horizontal source. The metrology available allows the measurement of not only the local temperatures and velocities but also the concentration of a tracer gas (helium). Mathematical models have been developed enabling representation of the fields concerned; their characterization by isothermal, iso-velocity, or iso-concentration curves; calculation of the flow rate carried by the plume at a given height; calculation of the enthalpy transport; and so on. Moreover, a pollutant capture device has been introduced, and the measurement technique used allows the determination of various efficiencies of practical interest. The ratio of capture flow to free plume flow at a particular height appears to correlate well with the mean efficiencies obtained for distinct source temperatures.

Airborne Fungal and Bacterial Components in PM1 Dust from Biofuel Plants

Fungi grown in pure cultures produce DNA- or RNA-containing particles smaller than spore size (<1.5 µm). High exposures to fungi and bacteria are observed at biofuel plants. Airborne cultivable bacteria are often described to be present in clusters or associated with larger particles with an aerodynamic diameter (dae) of 2–8 µm. In this study, we investigate whether airborne fungal components smaller than spore size are present in bioaerosols in working areas at biofuel plants. Furthermore, we measure the exposure to bacteria and fungal components in airborne particulate matter (PM) with a D50 of 1 µm (called PM1 dust). PM1 was sampled using Triplex cyclones at a working area at 14 Danish biofuel plants. Millipore cassettes were used to sample ‘total dust’. The PM1 particles (29 samples) were analysed for content of 11 different components and the total dust was analysed for cultivable fungi, N-acetyl-β-D-glucosaminidase (NAGase), and (1 -> 3)-β-D-glucans. In the 29 PM1 samples, cultivable fungi were found in six samples and with a median concentration below detection level. Using microscopy, fungal spores were identified in 22 samples. The components NAGase and (1 -> 3)-β-D-glucans, which are mainly associated with fungi, were present in all PM1 samples. Thermophilic actinomycetes were present in 23 of the 29 PM1 samples [average = 739 colony-forming units (CFU) m–3]. Cultivable and ‘total bacteria’ were found in average concentrations of, respectively, 249 CFU m–3 and 1.8 x 105 m–3. DNA- and RNA-containing particles of different lengths were counted by microscopy and revealed a high concentration of particles with a length of 0.5–1.5 µm and only few particles >1.5 µm. The number of cultivable fungi and β-glucan in the total dust correlated significantly with the number of DNA/RNA-containing particles with lengths of between 1.0 and 1.5 µm, with DNA/RNA-containing particles >1.5 µm, and with other fungal components in PM1 dust. Airborne β-glucan and NAGase were found in PM1 samples where no cultivable fungi were present, and β-glucan and NAGase were found in higher concentrations per fungal spore in PM1 dust than in total dust. This indicates that fungal particles smaller than fungal spore size are present in the air at the plants. Furthermore, many bacteria, including actinomycetes, were present in PM1 dust. Only 0.2% of the bacteria in PM1 dust were cultivable.

N-Acetyl-S-(n-Propyl)-L-Cysteine in Urine from Workers Exposed to 1-Bromopropane in Foam Cushion Spray Adhesives

1-Bromopropane (1-BP) has been marketed as an alternative for ozone depleting and other solvents; it is used in aerosol products, adhesives, metal, precision, and electronics cleaning solvents. Mechanisms of toxicity of 1-BP are not fully understood, but it may be a neurological and reproductive toxicant. Sparse exposure information prompted this study using 1-BP air sampling and urinary metabolites. Mercapturic acid conjugates are excreted in urine from 1-BP metabolism involving debromination. Research objectives were to evaluate the utility of urinary N-acetyl-S-(n-propyl)-L-cysteine (AcPrCys) for assessing exposure to 1-BP and compare it to urinary bromide [Br(–)] previously reported for these workers. Forty-eight-hour urine specimens were obtained from 30 workers at two factories where 1-BP spray adhesives were used to construct polyurethane foam seat cushions. Urine specimens were also obtained from 21 unexposed control subjects. All the workers' urine was collected into composite samples representing three time intervals: at work, after work but before bedtime, and upon awakening. Time-weighted average (TWA) geometric mean breathing zone concentrations were 92.4 and 10.5 p.p.m. for spraying and non-spraying jobs, respectively. Urinary AcPrCys showed the same trend as TWA exposures to 1-BP: higher levels were observed for sprayers. Associations of AcPrCys concentrations, adjusted for creatinine, with 1-BP TWA exposure were statistically significant for both sprayers (P < 0.05) and non-sprayers (P < 0.01). Spearman correlation coefficients for AcPrCys and Br(–) analyses determined from the same urine specimens were highly correlated (P < 0.0001). This study confirms that urinary AcPrCys is an important 1-BP metabolite and an effective biomarker for highly exposed foam cushion workers.

Permeation of Hair Dye Ingredients through Gloves