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

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

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

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

Hearing problems among a cohort of nationally certified EMS professionals

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

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

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

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

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

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

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

Agricultural tractor overturn deaths: Assessment of trends and risk factors

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

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.

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.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sustainability of an interdisciplinary secondary prevention program for hairdressers

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

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

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

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

Abstract Purpose To investigate whether New York State employees who responded to the World Trade Center disaster were more likely to report asthma or lower respiratory symptoms (LRS; cough, wheeze, chest tightness, shortness of breath) than non-exposed employees, 2 years post-September 11. Methods Participants (578 exposed, 702 non-exposed) completed mailed questionnaires in 2003. A unique exposure assessment method was used; exposure scores were divided at the mean (at/below, above). Poisson regression was used. Results Exposure was associated with LRS, but not asthma. Participants with exposure scores at/below the mean had a twofold increased risk of most LRS. Those with scores above the mean had a three to fourfold increased risk. For scores above the mean, the magnitude of effect was consistently higher for smoke exposure. Conclusions Moderately exposed responders may experience health impacts from exposures in later stages of a disaster. Exposure to smoke may have had a greater lower respiratory impact than resuspended dust. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0474-xAuthors Matthew P. Mauer, New York State Department of Health Bureau of Occupational Health, Center for Environmental Health Flanigan Square, Room 230, 547 River Street Troy NY 12180 USAMichele L. Herdt-Losavio, New York State Department of Health Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health Troy NY USAG. Anders Carlson, New York State Department of Health Division of Environmental Health Investigation, Center for Environmental Health Troy NY USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 1 / January, 2010

Gender moderates the health-effects of job strain in managers

Abstract Purpose To investigate cross-sectional associations between main, interactive and gender-dependent effects of the demand–control–support (DCS) model and subjective health in managers. Methods Data of 424 German, Austrian and Swiss managers were collected at leadership seminars and through presentation of the study at meetings of staff managers and senior executives. Hierarchical regression models controlling for age, hierarchy and non-linear relationships were computed to assess associations between main, interactive and gender-dependent effects of the DCS dimensions (measures of job demands, job control, social support) and subjective health (measures of self rated health and psychosomatic complaints). Results Social support was associated with both indicators of subjective health. Inconsistent results were obtained for the main effects of job demands and job control. Concerning the interaction effects of the model, a significant three-way interaction was observed: high job control and high social support seem to buffer the adverse health effects of high job demands. This interaction was moderated by gender. Female managers experience more psychosomatic complaints working in high demand, low control, low support settings than their male colleagues. While women seem to experience a higher buffering effect from social support than from job control, male managers may benefit equally from social support and job control. Conclusions In managers, gender moderates the health-related effects of the psychosocial work environment. The gender-dependent effects of the DCS model may play a crucial role in the understanding of female managers’ adverse health perceptions. Increasing social support for female managers may help to overcome gender inequalities in management positions. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0477-7Authors M. C. Gadinger, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyJ. E. Fischer, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyS. Schneider, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyD. D. Terris, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyK. Krückeberg, Henley Management College Grennlands, Henley-on-Thames Oxfordshire RG9 3AU UKS. Yamamoto, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim GermanyG. Frank, Medical Practice for General Medicine Uferstrasse 60 69120 Heidelberg GermanyW. Kromm, Mannheim Institute for Public Health, Social and Preventive Medicine Ludolf-Krehl-Strasse 7-11 68167 Mannheim Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Focusing ethical dilemmas of evidence-based practice in SMF-exposed MRI-workers: a qualitative analysis

Abstract Purpose To analyze ethical dilemmas for occupational health physicians and other stakeholders involved in the implementation of a surveillance program in workers exposed to static magnetic fields (SMF) used in magnetic resonance imaging. Methods The ethical analysis was carried out according to the model proposed by Westerholm and others, which takes into account two elements: (i) the stakeholders involved in the decision process and (ii) the ethical principles of beneficence, autonomy and justice. The analysis is based on the assessment of ethical costs (violating the consistent principle) and ethical benefits (fulfillment of the consistent principle) for workers, employers, occupational health physicians, community, workers’ representatives and medical inspectors. Results According to the European Directive 2004/40/EC (Official Journal of the European Union, Luxemburg), employers must ensure that health surveillance is carried out to prevent adverse health effects in SMF-exposed workers. However, limited scientific evidence on health effects from SMF influences the decision of undertaking appropriate health surveillance. The uncertainties entail a number of ethical conflicts, such as the choice of reliable indicators, the interpretation of abnormal data, the complexity of the decision-making process resulting in a fitness judgment and the diversion of funds for more effective practices. Conclusions The analysis shows that the decision-making process aiming at the provision of evidence-based health surveillance to SMF-exposed workers is characterized by controversial ethical costs and ethical benefits for workers and the other stakeholders. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0476-8Authors Giuliano Franco, Università di Modena e Reggio Emilia Dipartimento di Medicine e delle specialità mediche Largo del Pozzo 71-41100 Modena ItalyErika Mora, Università di Modena e Reggio Emilia Dipartimento di Medicine e delle specialità mediche Largo del Pozzo 71-41100 Modena ItalyRiccardo Perduri, Università di Modena e Reggio Emilia Dipartimento di Medicine e delle specialità mediche Largo del Pozzo 71-41100 Modena Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Work-related fatigue: the specific case of highly educated women in the Netherlands

Abstract Purpose This study aims to establish the prevalence of high work-related fatigue (need for recovery, NFR) among employees and to explain group differences categorized by gender, age, and education. The study particularly aims to clarify prevalence and explanatory factors in highly educated women. Methods In 2005 and 2006, large representative samples of 80,000 Dutch employees (net response rate 33.0%; N = 47,263) received the Netherlands working conditions survey questionnaire. First, we calculated the prevalence of high NFR for men and women with different age and education levels. The average prevalence of high NFR was 28.8% and was highest among highly educated women (35.2%) in particular those aged 50–64 years (40.3%). Second, logistic regression analyses were used to compare subgroups’ NFR in relation to situational factors, working conditions, and health. Three comparisons were made: (1) highly educated women versus men; (2) highly educated versus lower educated women and; (3) older highly educated versus younger highly educated women. Results The situational, working conditions and health factors in our model did not explain the gender differences among highly educated employees (OR = 1.37; CI = 1.3–1.5, adjusted for all factors OR = 1.32; CI = 1.2–1.5). Despite that lower autonomy and workplace violence explained highly educated women’s NFR, working fewer hours counterbalanced this. Time pressure in work largely explained the differences in NFR among women at different education levels (crude OR 1.44; CI = 1.4–1.5, adjusted OR 1.14; CI = 1.0–1.3). In the age comparison, lower health ratings, more adverse working conditions, and working as a teacher explained older highly educated women’s high prevalence of high NFR (crude OR 1.32; CI = 1.2–1.5, adjusted OR 0.94; CI = 0.8–1.2). Conclusion NFR has high prevalence in highly educated women (35.2%) in particular those aged 50–64 years (40.3%). Our model did not explain gender differences in NFR, because working fewer hours counterbalanced the effects of lower autonomy and external workplace violence. Our model, in particular time pressure, largely explained differences in NFR between women at different education levels. Age differences in the prevalence of high NFR among highly educated women’s were fully explained by our model. Main factors were lower health ratings, adverse working conditions, and working as a teacher. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0481-yAuthors Petra Verdonk, Maastricht University Caphri, Social Medicine Universiteitssingel 40 P.O. Box 616 6200 MD Maastricht The NetherlandsWendela E. Hooftman, TNO Quality of Life, Division Work and Employment Polarisavenue 151 P.O. Box 718 2130 AS Hoofddorp The NetherlandsMarc J. P. M. van Veldhoven, Tilburg University Human Resource Studies Warandelaan 2 P.O. Box 90153 5000 LE Tilburg The NetherlandsLouise R. M. Boelens, Bureau Boelens Willem Barentszstraat 56 3572 PL Utrecht The NetherlandsLando L. J. Koppes, TNO Quality of Life, Division Work and Employment Polarisavenue 151 P.O. Box 718 2130 AS Hoofddorp The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case–control study

Abstract Purpose Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case–control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer. Methods Of 58 patients, 31 diagnosed with sinonasal adenocarcinoma (cases) between 1973 and 2007 were identified and underwent standardized interview on clinical data. A total of 85 patients diagnosed over the same period with carcinoma of the oral cavity served as controls. Results The ethmoid was confirmed as the predominant site of adenocarcinoma associated with wood dust exposure, whereas the nasal cavity was most commonly affected in patients denying any exposure to wood dust. Cases were significantly engaged in mainly woodworking occupations compared to controls. The main initial clinical symptoms were nasal obstruction 6 months (71%) and epistaxis 4 years (41.9%) prior to diagnosis. Hardwood dust from beech and oak proved to be the most common occupational exposure, with a mean exposure period of 32.3 years and a latency of 43.5 (34–58) years. Conclusions Our investigation confirms the importance of regular screenings for persons exposed to wood dust even years after the end of occupational or private exposure. Banal clinical symptoms such as epistaxis and nasal obstruction might be predictive, requiring early and thorough investigation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0479-5Authors Susanne Ingrid Mayr, Friedrich-Alexander University of Erlangen-Nuremberg Department of Otolaryngology, Head and Neck Surgery Waldstraße 1 91054 Erlangen GermanyKamber Hafizovic, Friedrich-Alexander University of Erlangen-Nuremberg Department of Otolaryngology, Head and Neck Surgery Waldstraße 1 91054 Erlangen GermanyFrank Waldfahrer, Friedrich-Alexander University of Erlangen-Nuremberg Department of Otolaryngology, Head and Neck Surgery Waldstraße 1 91054 Erlangen GermanyHeinrich Iro, Friedrich-Alexander University of Erlangen-Nuremberg Department of Otolaryngology, Head and Neck Surgery Waldstraße 1 91054 Erlangen GermanyBirgitta Kütting, Friedrich-Alexander University of Erlangen-Nuremberg Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine Schillerstr. 25 91054 Erlangen Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Exposure of children to polycyclic aromatic hydrocarbons in Mexico: assessment of multiple sources

Abstract Purpose Biological monitoring of polycyclic aromatic hydrocarbons (PAHs) has expanded rapidly since urinary 1-hydroxypyrene (1-OHP) was suggested as a biological index for pyrene. Taking into account that pyrene is often present in PAHs mixtures, 1-OHP has also been considered an indirect indicator of exposure to these mixtures. Sources of PAHs in developing countries are numerous; however, exposure of children to PAHs has not been studied in detail. Therefore, the aim of this study was to assess exposure of children to PAHs in different scenarios: (a) children living next to highways with heavy traffic; (b) sanitary landfill; (c) brick kiln communities and (d) children exposed to biomass combustion. Methods A total of 258 children (aged 3–13) participated in the study. The analyses were performed by HPLC with fluorescence detector. Urinary 1-OHP concentrations were then adjusted by urinary creatinine. Results The highest levels of 1-OHP in this study were found in children exposed to biomass combustion (mean value 3.25 μmol/mol creatinine), but exposure was also detected in children living in communities with brick kiln industry (mean 0.35 μmol/mol creatinine), or in a community next to a sanitary landfill (with waste combustion) (0.30 μmol/mol creatinine) and in children exposed to traffic (mean value 0.2 μmol/mol creatinine and 0.08 μmol/mol creatinine). Conclusions Considering our results and taking into account that millions of children in Mexico are living in scenarios similar to those studied in this work, the assessment of health effects in children exposed to PAHs is urgently needed; furthermore, PAHs have to be declared contaminants of concern at a national level. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0482-xAuthors Rebeca I. Martínez-Salinas, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoM. Elena Leal, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoLilia E. Batres-Esquivel, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoGabriela Domínguez-Cortinas, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoJacqueline Calderón, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoFernando Díaz-Barriga, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. MexicoIván N. Pérez-Maldonado, Universidad Autónoma de San Luis Potosí Departamento de Toxicología Ambiental, Facultad de Medicina Avenida Venustiano Carranza 2405 78210 San Luis Potosí, S.L.P. Mexico Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Psychoactive substances consumption in French fishermen and merchant seamen

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

Karl-Heinz Schaller awarded with Franz Koelsch Medal 2009

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The psychometric properties of demand-control and effort–reward imbalance scales among Brazilian nurses

Abstract Purpose To compare the psychometric adequacy of the demand-control-support (DCS) and the effort–reward imbalance (ERI) questionnaires in relation to their respective theoretical models among workers within the same psychosocial work environment. Methods A self-report questionnaire was administered to 1,509 nursing personnel at two Brazilian hospitals. Analyses were based on internal consistency, corrected item-total correlation, and confirmatory factor analysis models for ordinal data (conducted with Mplus software) to test the fit of each model. Results Internal consistency was satisfactory (>0.70) for most scales of the DCS and ERI questionnaires, except for the job decision latitude scale (α = 0.50). With reference to corrected item-total correlations, adequate performance was observed for most items of both questionnaires. The item ‘Do you have to do same thing over and over again’ had a very low corrected item-total correlation (−0.09) and the removal of this item increased the internal consistency of the skill discretion subscale. Overall, fit indices (of factorial validity) for the DCS and the ERI questionnaires were adequate. However, a low correlation between subscales of the decision latitude scale (−0.164) was observed. For the psychological job demands and overcommitment scales, the best adjustment of the model was obtained when correlated errors between items were considered. Conclusions Strengths and limitations were observed in both the DCS and the ERI scales. The questionnaires could be improved by the revision of some items. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0460-3Authors Rosane Härter Griep, Instituto Oswaldo Cruz, Fiocruz Laboratory of Health and Environment Education Av. Brasil 4365, Manguinhos Rio de Janeiro RJ 21045-900 BrazilLucia Rotenberg, Instituto Oswaldo Cruz, Fiocruz Laboratory of Health and Environment Education Av. Brasil 4365, Manguinhos Rio de Janeiro RJ 21045-900 BrazilAna Glória G. Vasconcellos, School of Public Health, Fiocruz Av. Leopoldo Bulhões 1480, Manguinhos Rio de Janeiro RJ 21041-210 BrazilPaul Landsbergis, Mount Sinai School of Medicine Department of Community and Preventive Medicine Box 1043 One Gustave Levy Place New York NY 10029 USACláudia M. Comaru, Instituto Oswaldo Cruz, Fiocruz Laboratory of Health and Environment Education Av. Brasil 4365, Manguinhos Rio de Janeiro RJ 21045-900 BrazilMárcia Guimarães M. Alves, Fluminense Federal University Health Planning Department, Institute of Community Health Rua Marquês do Paraná 303, Centro Niterói RJ 24033-900 Brazil 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

Nanoparticle dermal absorption and toxicity: a review of the literature

Abstract Introduction Nanotechnologies are among the fastest growing areas of scientific research and have important applications in a wide variety of fields. The data suggest that in the future workers and consumers exposed to nanoparticles will significantly increase. Dermal absorption and toxicity of nanoparticles At now there are gaps in understanding about the human and environmental risk that manufactured nanoparticles pose for occupational exposed people and for consumers. There is a need for assessing the health and environmental impacts, the nanoparticles life cycle, the human exposure routes, the behavior of nanoparticles in the body, and the risk for workers. Possible routes of entry into the body include inhalation, absorption through the skin or digestive tract, injection, and absorption or implantation for drugs delivery systems. In particular, dermal absorption and skin penetration of nanoparticles needs a better evaluation because few and contradictory data are present in the literature, mainly on titanium dioxide. Conclusions There are limited data on carbon-based nanoparticles and very few data on other metal nanoparticles increasingly used in industry. The article reviews the literature on the percutaneous absorption of nanoparticles and their effect on skin. Content Type Journal ArticleCategory Review ArticleDOI 10.1007/s00420-009-0458-xAuthors Matteo Crosera, Università di Trieste Dipartimento di Scienze Chimiche Via L. Giorgieri 1 34127 Trieste ItalyMassimo Bovenzi, Università di Trieste UCO Medicina del Lavoro, Dipartimento di Scienze di Medicina Pubblica Trieste ItalyGiovanni Maina, Università di Torino Laboratorio di Tossicologia Industriale, CTO Torino ItalyGianpiero Adami, Università di Trieste Dipartimento di Scienze Chimiche Via L. Giorgieri 1 34127 Trieste ItalyCaterina Zanette, Università di Trieste Dipartimento di Scienze della Vita Trieste ItalyChiara Florio, Università di Trieste Dipartimento di Scienze della Vita Trieste ItalyFrancesca Filon Larese, Università di Trieste UCO Medicina del Lavoro, Dipartimento di Scienze di Medicina Pubblica Trieste Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 82 Journal Issue Volume 82, Number 9 / October, 2009

Nasal blown secretion evaluation in specific occupational nasal challenges

Abstract Purpose To investigate the usefulness of nasal blown secretion evaluation during specific nasal provocation test (sNPT) in diagnosing occupational rhinitis (OR). Methods To validate the method, nasal blown secretions from 103 healthy subjects and 30 allergic rhinitis patients were analyzed. Furthermore, we analyzed nasal blown secretions, collected before and after sNPT, of 29 subjects with work-related rhinitis symptoms (WRRS) who underwent the diagnostic pathway for OR. Rhinoscopy and nasal symptom score were used to define a positive sNPT. Results A total of 89.6% WRRS subjects provided suitable nasal secretions. Eosinophils significantly increased after positive sNPTs compared to negative ones (P = 0.006). Four percent and/or 1 × 104 eosinophils/ml was the cut-off for a significant post-sNPT eosinophil increase. A total of 4/13 (33%) WRRS subjects with negative sNPT, assessed by rhinoscopy and nasal symptom score, presented a significant post-sNPT nasal eosinophil increase, and were identified as possible OR. Conclusion Eosinophil evaluation in nasal blown secretions is an important tool in monitoring the response to occupational specific nasal challenges. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0459-9Authors Patrizia Pignatti, Institute of Research and Care, Scientific Institute of Pavia Allergy and Immunology Unit and ISPESL Occupational Immunology and Allergy Laboratory, Fondazione ‘Salvatore Maugeri’ Via Salvatore Maugeri 10 Pavia 27100 ItalyGianni Pala, Institute of Research and Care, Scientific Institute of Pavia Allergy and Immunology Unit and ISPESL Occupational Immunology and Allergy Laboratory, Fondazione ‘Salvatore Maugeri’ Via Salvatore Maugeri 10 Pavia 27100 ItalyMarta Pisati, Institute of Research and Care, Scientific Institute of Pavia Allergy and Immunology Unit and ISPESL Occupational Immunology and Allergy Laboratory, Fondazione ‘Salvatore Maugeri’ Via Salvatore Maugeri 10 Pavia 27100 ItalyLuca Perfetti, Institute of Research and Care, Scientific Institute of Pavia Allergy and Immunology Unit and ISPESL Occupational Immunology and Allergy Laboratory, Fondazione ‘Salvatore Maugeri’ Via Salvatore Maugeri 10 Pavia 27100 ItalyGabriella Banchieri, Institute of Research and Care, Scientific Institute of Pavia Allergy and Immunology Unit and ISPESL Occupational Immunology and Allergy Laboratory, Fondazione ‘Salvatore Maugeri’ Via Salvatore Maugeri 10 Pavia 27100 ItalyGianna Moscato, Institute of Research and Care, Scientific Institute of Pavia Allergy and Immunology Unit and ISPESL Occupational Immunology and Allergy Laboratory, Fondazione ‘Salvatore Maugeri’ Via Salvatore Maugeri 10 Pavia 27100 Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

French cohort of the uranium processing workers: mortality pattern after 30-year follow-up

Abstract Objective To investigate mortality among nuclear workers with potential internal exposure to uranium. Methods The cohort included 2,709 workers employed at the AREVA NC Pierrelatte plant for at least 6 months (72,787 person-years). This plant processed uranium enrichment during the period 1960–1996 and chemical conversion since 1980. Mortality was compared to the national and regional mortality rates available for the period 1968–2005. For causes of death of interest with respect to occupational exposure, mortality trends according to occupational characteristics were assessed. Results As expected, an important healthy worker effect (all causes SMR = 0.55 (95% CI: 0.50–0.61), n = 411; all cancers SMR = 0.70 (95% CI: 0.60–0.81), n = 193) was observed. Among cancer sites a priori related to uranium exposure, only mortality for lymphatic cancer was increased among potentially exposed workers (SMR = 1.49 (95% CI: 0.68–2.82); n = 9). An important increase in mortality from pleural cancer was observed (SMR = 2.85 (95% CI: 0.93–6.66), n = 5); none of the deceased workers were exposed to radiation whereas all handled asbestos. Conclusion In spite of limited statistical power, results show consistency with previous studies of nuclear workers potentially exposed to uranium. Further investigation based on more precise uranium exposure data should allow the estimation of uranium hazard effects among this cohort. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0455-0Authors Irina Guseva Canu, Service de Radiobiologie et d’Epidémiologie Institut de Radioprotection et de Sûreté Nucléaire BP 17 92262 Fontenay-aux-Roses FranceElisabeth Cardis, Barcelona Biomedical Research Park Center for Research in Environmental Epidemiology Barcelona SpainCamille Metz-Flamant, Service de Radiobiologie et d’Epidémiologie Institut de Radioprotection et de Sûreté Nucléaire BP 17 92262 Fontenay-aux-Roses FranceSylvaine Caër-Lorho, Service de Radiobiologie et d’Epidémiologie Institut de Radioprotection et de Sûreté Nucléaire BP 17 92262 Fontenay-aux-Roses FranceBernard Auriol, Service Santé au Travail Etablissement AREVA NC de Pierrelatte Pierrelatte FrancePascal Wild, PW Statistical Consulting Laxou FranceDominique Laurier, Service de Radiobiologie et d’Epidémiologie Institut de Radioprotection et de Sûreté Nucléaire BP 17 92262 Fontenay-aux-Roses FranceMargot Tirmarche, Service de Radiobiologie et d’Epidémiologie Institut de Radioprotection et de Sûreté Nucléaire BP 17 92262 Fontenay-aux-Roses France Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Factors associated with occupational stress among Chinese doctors: a cross-sectional survey

Abstract Objectives Doctors constitute the main workforce in hospitals and are known to experience occupational stress. High level of stress is believed to affect doctors’ physical and mental health. Thus, it is essential to study doctors’ occupational stress well to improve their quality of lives. The aim of this study was to explore factors associated with occupational stress among Chinese doctors in public hospitals. Methods A cross-sectional study was conducted during the period of May/June 2008. The study population comprised 1989 doctors registered and working in the 20 national hospitals in Liaoning province, China. A questionnaire pertaining to occupational stress that was assessed based on the Chinese Version Personal Strain Questionnaire (PSQ), demographic characteristics, work situations, occupational roles, and personal resources was distributed to these doctors. A total of 1,587 effective respondents (673 men, 914 women) became our subjects (effective response rate 79.8%). The general linear model (GLM) was employed to explore the factors related to occupational stress. All data analysis was performed separately in men and women. Results The average PSQ score was 86.92 in the total study population, 89.4 in men and 85.1 in women among Chinese doctors. GLM showed that PSQ was significantly associated with, in standard estimate (β) sequence, role boundary, role insufficiency, responsibility, social support, rational/cognitive coping, doctor–patient relationship and role overload in men; whereas with role insufficiency, role boundary, social support, responsibility, self-care, role overload, education, chronic disease, and doctor–patient relationship in women. Conclusions These results indicate that the major factors associated with occupational stress differed between male and female doctors in China. Overall, role boundary and role insufficient were the most crucial factors in male and female doctors, respectively. Therefore, occupational health education and occupational training programs with the purpose to improve doctor’s knowledge and ability to copy with their task should be considered to lessen occupational stress among Chinese doctors. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0456-zAuthors Hui Wu, China Medical University Department of Social Medicine, School of Public Health No. 92 Beier Road, Heping District 110001 Shenyang Liaoning People’s Republic of ChinaYang Zhao, China Medical University Department of Dean’s Office No. 92 Beier Road, Heping District 110001 Shenyang Liaoning People’s Republic of ChinaJia-Na Wang, China Medical University Department of Social Medicine, School of Public Health No. 92 Beier Road, Heping District 110001 Shenyang Liaoning People’s Republic of ChinaLie Wang, China Medical University Department of Social Medicine, School of Public Health No. 92 Beier Road, Heping District 110001 Shenyang Liaoning People’s Republic of China Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Physical activity, job demand–control, perceived stress–energy, and salivary cortisol in white-collar workers

Abstract Purpose The aim of the present study is to examine the association between physical activity and perceived job demand, job control, perceived stress and energy, and physiological arousal reflected by morning and evening concentrations of cortisol in saliva among white-collar workers. Methods Physical activity during the last week was assessed during work and leisure time by a Danish version of the International Physical Activity Questionnaire and saliva samples were collected. The study group comprised 389 white-collar workers, aged 25–67 years, and of which 257 were women. Results We found that physical activity during leisure time was associated with higher perceived energy, and for men also with lower perceived stress. Further, we found that physical activity at leisure time affected the association between salivary cortisol and perceived stress and energy so that respondents being physically active at leisure time and perceiving higher energy showed higher evening saliva cortisol. Conclusion Physically active employees perceive less stress and more energy. The association between stress–energy and salivary cortisol was affected by vigorous physical activity. No association between job control–demand and the degree of physical activity was found. Based on the present data, we recommend office workers—exposed to high job strain and inactivity at the job—to perform physical activity, preferably of high intensity, in order to reduce stress and increase energy. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0440-7Authors Åse Marie Hansen, National Research Centre for the Working Environment 2100 Copenhagen Ø DenmarkAnne Katrine Blangsted, National Research Centre for the Working Environment 2100 Copenhagen Ø DenmarkErnst Albin Hansen, Norwegian School of Sport Sciences Department of Physical Performance Oslo NorwayKaren Søgaard, National Research Centre for the Working Environment 2100 Copenhagen Ø DenmarkGisela Sjøgaard, National Research Centre for the Working Environment 2100 Copenhagen Ø Denmark Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Occupational stress and burnout of judges and procurators

Abstract Purpose This study aims to examine the associations between occupational stress and burnout among judges and procurators. Methods The Chinese versions of the job content questionnaire (JCQ), Siegrist’s effort–reward imbalance questionnaire (ERI), and the Copenhagen Burnout Inventory (CBI) were administered to examine occupational stress and personal, work-related, and client-related burnout among 211 judicial officers, comprising 87 judges and 98 procurators, in Taiwan. Logistic regression was applied to determine the association between burnout and occupational stress among judges and procurators, adjusting for potential confounders of age, gender, marriage, number of children, work experience, working hours, and the significant occupational stress scale of each model for the other. Results The judicial officers with average age of 36.84 years and work experience of 8.57 years had high averaging scores of job control (70.31), psychological demand (32.23), effort (18.98), reward (48.37), and overcommitment (17.04) as well as personal (49.97), work-related (51.36), and client-related (43.57) burnout. The high psychological demand, effort, and overcommitment were significantly associated with both personal and work-related burnout, while the low workplace social support was significantly associated with client-related burnout among the judicial officers. The judges had a significant higher risk of client-related burnout than the procurators. Conclusions In general, occupational stress was associated with personal and work-related burnout for both judges and prosecutors. Client-related burnout was more common for judicial officers with low social support and the judges. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0454-1Authors Feng-Jen Tsai, National Taiwan University Institute of Occupational Medicine and Industrial Hygiene, College of Public Health Room 722, 7F., No.17, Xu-Zhou Rd., Jhongjheng District Taipei City 100 Taiwan, ROCChang-Chuan Chan, National Taiwan University Institute of Occupational Medicine and Industrial Hygiene, College of Public Health Room 722, 7F., No.17, Xu-Zhou Rd., Jhongjheng District Taipei City 100 Taiwan, ROC Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Effects of a health-educational and psychological intervention on socio-cognitive determinants of skin protection behaviour in individuals with occupational dermatoses

Abstract Purpose Occupational skin diseases are a significant public health concern. Little is known about the cognitive representations individuals with occupational skin disease have towards measures of personal skin protection and occupational safety and whether they change during an intervention. We aimed to evaluate whether social cognitions as embodied by the theory of planned behaviour become more favourable during a tertiary inpatient individual prevention programme (TIP) and whether the model’s predictions hold in a setting to which the model has not been applied. Methods We used a longitudinal design. A questionnaire, assessing the theory of planned behaviour variables attitude, subjective and descriptive norm, perceived behavioural control and behavioural intention was developed and administered to 101 patients before (at admission) and after (at discharge) a 3-week inpatient TIP. Results The scales showed good internal consistency. Before the TIP, patients had favourable cognitions towards skin protection measures and these improved during the TIP. Attitude, perceived behavioural control and intention to perform skin protection significantly increased during TIP. Attitude and perceived behavioural control were significant predictors of behavioural intention in multiple regression analyses with perceived behavioural control being the strongest predictor in the equations. Descriptive norm was a significant predictor of intention only at admission but not at discharge. Conclusion This is the first study attempting to explain the motivation to perform skin protection measures in patients with occupational skin disease by applying an otherwise well established health-behaviour theory. The results emphasise the importance of health-educational and psychological interventions for patients with occupational skin disease. Promoting personal control over and attitudes towards skin protection measures may enhance the occupational health of individuals with occupational skin disease. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0448-zAuthors Uwe Matterne, University Hospital Heidelberg Department of Clinical Social Medicine, Occupational and Environmental Dermatology Thibautstrasse 3 69115 Heidelberg GermanyThomas L. Diepgen, University Hospital Heidelberg Department of Clinical Social Medicine, Occupational and Environmental Dermatology Thibautstrasse 3 69115 Heidelberg GermanyElke Weisshaar, University Hospital Heidelberg Department of Clinical Social Medicine, Occupational and Environmental Dermatology Thibautstrasse 3 69115 Heidelberg Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Authors’ response to Kreiss et al. (2009)

Authors’ response to Kreiss et al. (2009) Content Type Journal ArticleCategory ReplyDOI 10.1007/s00420-009-0436-3Authors David Allen Galbraith, Palo Alto Medical Foundation 795 El Camino Real Palo Alto CA USADavid Weill, Stanford University Medical Center 300 Pasteur Drive, Room H3143 Stanford CA USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Author’s response to Harber et al. (2008)

Author’s response to Harber et al. (2008) Content Type Journal ArticleCategory ErratumDOI 10.1007/s00420-009-0445-2Authors David Allen Galbraith, Palo Alto Medical Foundation 795 El Camino Real Palo Alto CA USADavid Weill, Stanford University Medical Center 300 Pasteur Drive, Room H3143 Stanford CA USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 83 Journal Issue Volume 83, Number 1 / January, 2010

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.

In this issue of Occupational Medicine

The importance of thinking in occupational medicine

Ben Shahn Death of a Miner (1949)

Armed Forces occupational health--a review

Background The Armed Forces operate in a particularly arduous physical and psychological environment. The occupational health (OH) of all personnel is of paramount importance to sustain the service's fighting ability. Aims Firstly, to bring readers up to date with the current organization and delivery of OH to uniformed personnel in the Armed Forces. Secondly, to review the research that has led to an improvement in OH services and the ways in which the Armed Forces are responding to the various challenges. Methods A description of the type and delivery of OH to the Armed Forces is followed by a review of the relevant contemporaneous literature from both open publications and research dissertations. Results Although there are some similarities with civilian OH, the principal requirement to prepare and sustain service personnel for operations on land, sea and air adds considerable complexity to the task. Research undertaken by Armed Forces OH professionals has added to the evidence base and enabled attrition in all aspects of the Armed Forces to be reduced. Conclusions To meet the challenges of the 21st century, Armed Forces OH practitioners must continue to provide the best evidence-based advice to enhance force preparation and sustainment. All consultations in the Armed Forces involve an OH consideration from the simplest consultations through to the input from specialist OH practitioners. While the assessment of fitness to work in home bases and on deployed operations remains the primary output of OH, the provision of support to command policy, procurement and research are also key to the ability to operate worldwide.

Work-related mental ill-health and 'stress' in the UK (2002-05)

Background There is concern about the frequency of work-related mental ill-health and ‘stress’ within the UK. Aims To provide a measure of the incidence of work-related mental ill-health reported by specialist psychiatrists and occupational physicians to UK voluntary reporting schemes during the period 2002–05. Additionally, an investigation of determinants, notably factors identified by reporters as precipitants in cases of work-related mental ill-health was undertaken. Methods The study used data collected by The Health and Occupation Reporting Network (THOR) from 2002 to 2005. Cases were analysed by age, gender, industry and precipitating event. Results Estimated annual average incidence rates and 95% confidence intervals of work-related mental ill-health diagnoses reported to THOR between 2002 and 2005 by psychiatrists were 89 (78, 101) per million and by occupational physicians were 1589 (1443, 1735) per million. For both groups of reporters, anxiety and depression continued to make up the largest proportion of diagnoses. The majority of cases were attributed to factors such as workload and difficulties with other workers. There was some suggestion that the type of factors associated with the mental ill-health case reports varied between industrial sectors. Conclusions Work-related anxiety and depression and stress continue to constitute a significant proportion of all work-related mental ill-health diagnoses in the UK, with workload and interpersonal relationships reported as significant risk factors. Further investigations may determine whether guidance for employers and employees on work-related mental ill-health would benefit from being more industry specific.

Mental health issues in Chinese offshore oil workers

Background Offshore oil platform work is regarded as a stressful occupation, and occupational stress has been shown to be an important risk factor for mental illness. Little, however, is known about the main and interactive effects of occupational stress and coping styles on the mental health of Chinese offshore oil platform workers. Aims To explore the association of mental health with occupational stress, coping styles and their interaction among Chinese offshore oil platform workers. Methods A cross-sectional survey was conducted among 561 Chinese offshore oil platform workers. They were sent a self-administered questionnaire exploring their socio-demographic characteristics, occupational stress, coping styles and mental health. Hierarchical multiple regression was used to assess the main and interactive effects of occupational stress and coping styles on mental health. Results After controlling for age, educational level, marital status and years of offshore working, poor mental health was significantly positively associated with occupational stress, ‘internal behaviour’ coping methods and the interaction between occupational stress and internal behaviour coping. Conclusions The results of this study suggest that the mental health of Chinese offshore oil platform workers is associated with occupational stress, some coping styles and interactions of occupational stress and some coping styles.

Perceptions of illness and their impact on sickness absence

Background A patient's perception of their illness can influence their coping ability, compliance with treatment and functional recovery. Psychological interventions to address negative beliefs may facilitate an earlier return to work. Aims To compare perceptions of illness, fitness to return to work and time to return to work among employees with those of their occupational physicians (OPs). Methods A cross-sectional study of employees off sick for >2 weeks, with the return to work date ascertained at 3 months. Employees and their OPs completed similar questionnaires that included the Brief Illness Perception Questionnaire. Results Of total, 84 employees (76% response rate) and nine OPs participated. Employees reported a greater impact on their life (P < 0.01), a longer duration of illness (P < 0.01), more symptoms (P < 0.01), more concern about their illness (P < 0.01), more emotional impact of their illness (P < 0.01) and that their illness was more serious (P < 0.01) than did the OPs. They attributed their illness to work more often than their OPs (P < 0.05) and predicted more accurately when they would be fit to return to work (P < 0.01). Employees who returned to work believed that their illness was shorter lasting (P < 0.01), more treatable (P < 0.01), more controllable (P < 0.05), less serious (P < 0.01), had less emotional impact (P < 0.01), perceived fewer symptoms (P < 0.05) and had less concern (P < 0.05) than those who failed to return to work. Conclusions Employees had more negative perceptions about their illness than OPs. Positive perceptions were associated with an earlier return to work. Unhelpful negative beliefs about illness need to be addressed by OPs.

A bit like turtles

Impacts on work absence and performance: what really matters?

Background A number of factors influence an individual's decision to take sickness absence or to remain at work while ill. The relationship between health, work characteristics, individual perceptions of work and sickness absence and performance is complex and further clarification of the interactions between these factors is necessary. Aims To assess the relative impact of health, work characteristics and perceptions of work on absence and performance. Methods Cross-sectional survey of two public sector organizations (n = 505). Data were analysed using multivariate linear regression to assess the individual and combined influence of each class of independent variables on the following: days sickness absence, spells of sickness absence, VAS performance and presenteeism. Results Characteristics of work were weakly associated with days absence and performance. Perceptions of work were more strongly associated with performance than absence. Measures of mental health, rather than physical health, had the greatest influence on ability to work. Poor health had a greater impact on work performance than work absence. When considered together, health variables accounted for the largest proportion of explained variance in both absence and performance when compared with characteristics of work and work perceptions. Conclusions Using absence as a marker of health-associated compromise at work may lead to an underestimation of the impact of health on work. This study demonstrates the need to manage the impact of health problems on the workforce not only from a bio-medical perspective but also in terms of the psychological pressures and the social context in which employees work.

Multidimensional intervention and sickness absence in assistant nursing students

Background When handling patients, nursing assistant (NA) students and nurse students are frequently exposed to risk factors for low back pain (LBP) including sudden loads and twisting and bending of the spine. Furthermore, LBP is a major cause of sickness absence. Aims To ascertain if a multidimensional prevention programme combining physical training, patient transfer technique and stress management prevents sickness absence and LBP in NA students. Methods The study was a 14-month cluster randomized controlled study. The participants were NA students from 37 randomly selected classes located at two schools of health and social care in Copenhagen, Denmark. The participants completed a comprehensive questionnaire regarding sickness absence, LBP and psychosocial factors on commencement and after completion of the study. Results Of 766 female NA students, 668 (87%) completed the baseline questionnaire. Sickness absence during the study period increased in both groups but the increase was significantly lower in the intervention group than the control group, mean (standard deviation) number of days 12 (20) versus 18 (34), P < 0.05. The intervention group reported no change in the mean level of general health perception, energy/fatigue or psychological well-being at follow-up, while the control group reported a decline on those scales. There were no significant differences in the prevalence of LBP at follow-up between the intervention and control group. Conclusions Compared to the control group, the intervention group had significantly less sickness absence. The intervention had no preventive effect on LBP prevalence.

Why I became a part time occupational physician...

High job control enhances vagal recovery in media work

Background Job strain has been linked to increased risk of cardiovascular diseases. In modern media work, time pressures, rapidly changing situations, computer work and irregular working hours are common. Heart rate variability (HRV) has been widely used to monitor sympathovagal balance. Autonomic imbalance may play an additive role in the development of cardiovascular diseases. Aims To study the effects of work demands and job control on the autonomic nervous system recovery among the media personnel. Methods From the cross-sectional postal survey of the employees in Finnish Broadcasting Company (n = 874), three age cohorts (n = 132) were randomly selected for an analysis of HRV in 24 h electrocardiography recordings. Results In the middle-aged group, those who experienced high job control had significantly better vagal recovery than those with low or moderate control (P < 0.01). Among young and ageing employees, job control did not associate with autonomic recovery. Conclusions High job control over work rather than low demands seemed to enhance autonomic recovery in middle-aged media workers. This was independent of poor health habits such as smoking, physical inactivity or alcohol consumption.

HSE Management Standards and stress-related work outcomes

Background The UK Health and Safety Executive’s (HSE) Management Standards (MS) approach has been developed to help organizations manage potential sources of work-related stress. Although there is general support for the assessment model adopted by this approach, to date, there has been no empirical investigation of the relationship between the actual MS (as measured by the final revised version of the HSE Indicator Tool) and stress-related work outcomes. Aims To investigate the relationship between the HSE MS and the following stress-related work outcomes: ‘job satisfaction’, job-related anxiety and depression and errors/near misses. Methods An anonymous cross-sectional questionnaire was distributed by either e-mail or post to all employees within a community-based Health and Social Services Trust. Respondents completed the HSE Indicator Tool, a job-related anxiety and depression scale, a job satisfaction scale and an aggregated measure of the number of errors/near misses witnessed. Associations between the HSE Indicator Tool responses and stress-related work outcomes were analysed with regression statistics. Results A total of 707 employees completed the questionnaire, representing a low response rate of 29%. Controlling for age, gender and contract type, the HSE MS (as measured by the HSE Indicator Tool) were positively associated with job satisfaction and negatively associated with ‘job-related anxiety’, ‘job-related depression’ and ‘witnessed errors/near misses’. Conclusions This study provides empirical evidence to support the use of the MS approach in tackling workplace stress.

General practitioners' use of sickness certificates

Background At present, sickness certification is largely undertaken by general practitioners (GPs). Guidance from the Department of Work and Pensions (DWP) is available to help with this task; however, there has been little formal evaluation of the DWP's guidance in relation to day-to-day general practice. Aims To assess GPs’ training, knowledge and application of the DWP's sickness certification guidelines. Methods A structured questionnaire was sent to GPs within a (former) primary care trust (PCT). It probed demographics, training and knowledge of sickness certification guidelines. Case histories and structured questions were used to assess current practice. Results In this group of 113 GPs, there was a low awareness and use of the DWP's guidelines and Website relating to sickness certification. The majority of the GPs (63%) had received no training in sickness certification, and the mean length of time for those who had received training was 4.1 h. Most GPs also felt that patients and GPs have equal influence on the duration of sickness certification. Conclusions This evidence of variable practice indicates that GPs should have more guidance and education in sickness certification. Closer sickness certification monitoring through existing GP computer systems may facilitate an improvement in practice that benefits patients and employers. The DWP, medical educators and PCTs may all have an additional role in further improving sickness certification practice.

Attitudes and barriers to evidence-based guidelines among UK occupational physicians

Background The Faculty of Occupational Medicine and NHS Plus are working to increase the availability and uptake of evidence-based guidelines (EBGs) among occupational physicians in the UK. Physicians’ attitudes and beliefs may influence their uptake of EBG; additionally, there are barriers that may make physicians feel unable to practise evidence-based medicine (EBM). Aims To determine the attitudes of occupational physicians in the UK towards EBG, what prevents them from practising EBM and their workplace Internet access. Methods Self-administered questionnaires were posted to 357 physicians chosen randomly from the Society of Occupational Medicine membership list. Responders were stratified according to occupational medicine professional grade. The data were analysed using Cronbach's alpha, analysis of variance, chi-square and Kruskal–Wallis test. Results A total of 259 occupational physicians responded giving a response rate of 73%. The attitude questionnaire showed good reliability. Occupational medicine specialists were more positive towards EBG than general practitioners. Overall, the respondents were more positive towards EBG than physicians in previous studies. The most common barriers to practising EBM were lack of time and limited availability of guidelines. The majority of respondents had workplace Internet access. Conclusions UK occupational physicians have a positive attitude towards EBG. However, this study has identified a need to make EBG more readily accessible to them. In addition, occupational physicians require adequate time to practise EBM in their daily work. Educational workshops should be developed to enhance their literature search techniques, critical appraisal skills and application of EBM in clinical practice. Online training programmes should be considered to take advantage of their Internet access.

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Oxygen Depletion and Formation of Toxic Gases following Sea Transportation of Logs and Wood Chips

Several recent accidents with fatal outcomes occurring during discharge of logs and wood chips from ships in Swedish ports indicate the need to better understand the atmospheric conditions in holds and connecting stairways. The principal aim of the present study was to assess the air levels of oxygen and toxic gases in confined spaces following sea transportation of logs and wood chips. The focus of the study was the conditions in the stairways, as this was the location of the reported accidents. Forty-one shipments of logs (pulpwood) and wood chips carried by 10 different ships were investigated before discharge in ports in northern Sweden. A full year was covered to accommodate variations due to seasonal temperature changes. The time from completion of loading to discharge was estimated to be 37–66 h (mean 46 h). Air samples were collected in the undisturbed air of altogether 76 stairways before the hatch covers were removed. The oxygen level was measured on-site by handheld direct-reading multi-gas monitors. On 16 of the shipments, air samples were additionally collected in Tedlar® bags for later analysis for carbon dioxide, carbon monoxide, and hydrocarbons by fourier transform infrared spectroscopy. The mean oxygen level was 10% (n = 76) but in 17% of the samples the oxygen level was 0%. The oxygen depletion was less pronounced during the cold season. The mean CO2 and CO levels were 7.5% (n = 26) and 46 p.p.m. (n = 28), respectively. More than 90% of the hydrocarbons were explained by monoterpenes, mainly -pinene (mean 41 p.p.m., (n = 26). In conclusion, the measurements show that transport of logs and wood chips in confined spaces may result in rapid and severe oxygen depletion and CO2 formation. Thus, apparently harmless cargoes may create potentially life-threatening conditions. The oxygen depletion and CO2 formation are seemingly primarily caused by microbiological activity, in contrast to the oxidative processes with higher CO formation that predominate in cargoes of wood pellets. Improved technical and organizational measures are considered necessary to prevent future accidents. Recommendations given regarding safe entry procedures and technical preventive methods may also apply to other oxygen-depleting products.

Rate and Peak Concentrations of Off-Gas Emissions in Stored Wood Pellets--Sensitivities to Temperature, Relative Humidity, and Headspace Volume

Wood pellets emit CO, CO2, CH4, and other volatiles during storage. Increased concentration of these gases in a sealed storage causes depletion of concentration of oxygen. The storage environment becomes toxic to those who operate in and around these storages. The objective of this study was to investigate the effects of temperature, moisture, and the relative size of storage headspace on emissions from wood pellets in an enclosed space. Twelve 10-l plastic containers were used to study the effects of headspace ratio (25, 50, and 75% of container volume) and temperatures (10–50°C). Another eight containers were set in uncontrolled storage relative humidity (RH) and temperature. Concentrations of CO2, CO, and CH4 were measured by gas chromatography (GC). The results showed that emissions of CO2, CO, and CH4 from stored wood pellets are more sensitive to storage temperature than to RH and the relative volume of headspace. Higher peak emission factors are associated with higher temperatures. Increased headspace volume ratio increases peak off-gas emissions because of the availability of oxygen associated with pellet decomposition. Increased RH in the enclosed container increases the rate of off-gas emissions of CO2, CO, and CH4 and oxygen depletion.

Emission of Volatile Aldehydes and Ketones from Wood Pellets under Controlled Conditions

Different qualities of biofuel pellets were made from pine and spruce sawdust according to an industrial experimental design. The fatty/resin acid compositions were determined by gas chromatography-mass spectrometry for both newly produced pellets and those after 2 and 4 weeks of storage. The aldehydes/ketones compositions were determined by high performance liquid chromatography at 0, 2, and 4 weeks. The designs were analyzed for the response variables: total fatty/resin acids and total aldehydes/ketones. The design showed a strong correlation between the pine fraction in the pellets and the fatty/resin acid content but the influence decreased over storage time. The amount of fatty/resin acids decreased ~40% during 4 weeks. The influence of drying temperature on the aldehyde/ketone emission of fresh pellets was also shown. The amounts of emitted aldehydes/ketones generally decreased by 45% during storage as a consequence of fatty/resin acid oxidation. The matrices of individual concentrations were subjected to multivariate data analysis. This showed clustering of the different experimental runs and demonstrated the important mechanism of fatty/resin acid conversion.

Effects of Headspace and Oxygen Level on Off-gas Emissions from Wood Pellets in Storage

Few papers have been published in the open literature on the emissions from biomass fuels, including wood pellets, during the storage and transportation and their potential health impacts. The purpose of this study is to provide data on the concentrations, emission factors, and emission rate factors of CO2, CO, and CH4 from wood pellets stored with different headspace to container volume ratios with different initial oxygen levels, in order to develop methods to reduce the toxic off-gas emissions and accumulation in storage spaces. Metal containers (45 l, 305 mm diameter by 610 mm long) were used to study the effect of headspace and oxygen levels on the off-gas emissions from wood pellets. Concentrations of CO2, CO, and CH4 in the headspace were measured using a gas chromatograph as a function of storage time. The results showed that the ratio of the headspace ratios and initial oxygen levels in the storage space significantly affected the off-gas emissions from wood pellets stored in a sealed container. Higher peak emission factors and higher emission rates are associated with higher headspace ratios. Lower emissions of CO2 and CO were generated at room temperature under lower oxygen levels, whereas CH4 emission is insensitive to the oxygen level. Replacing oxygen with inert gases in the storage space is thus a potentially effective method to reduce the biomass degradation and toxic off-gas emissions. The proper ventilation of the storage space can also be used to maintain a high oxygen level and low concentrations of toxic off-gassing compounds in the storage space, which is especially useful during the loading and unloading operations to control the hazards associated with the storage and transportation of wood pellets.

Evaluation of Five Decontamination Methods for Filtering Facepiece Respirators

Concerns have been raised regarding the availability of National Institute for Occupational Safety and Health (NIOSH)-certified N95 filtering facepiece respirators (FFRs) during an influenza pandemic. One possible strategy to mitigate a respirator shortage is to reuse FFRs following a biological decontamination process to render infectious material on the FFR inactive. However, little data exist on the effects of decontamination methods on respirator integrity and performance. This study evaluated five decontamination methods [ultraviolet germicidal irradiation (UVGI), ethylene oxide, vaporized hydrogen peroxide (VHP), microwave oven irradiation, and bleach] using nine models of NIOSH-certified respirators (three models each of N95 FFRs, surgical N95 respirators, and P100 FFRs) to determine which methods should be considered for future research studies. Following treatment by each decontamination method, the FFRs were evaluated for changes in physical appearance, odor, and laboratory performance (filter aerosol penetration and filter airflow resistance). Additional experiments (dry heat laboratory oven exposures, off-gassing, and FFR hydrophobicity) were subsequently conducted to better understand material properties and possible health risks to the respirator user following decontamination. However, this study did not assess the efficiency of the decontamination methods to inactivate viable microorganisms. Microwave oven irradiation melted samples from two FFR models. The remainder of the FFR samples that had been decontaminated had expected levels of filter aerosol penetration and filter airflow resistance. The scent of bleach remained noticeable following overnight drying and low levels of chlorine gas were found to off-gas from bleach-decontaminated FFRs when rehydrated with deionized water. UVGI, ethylene oxide (EtO), and VHP were found to be the most promising decontamination methods; however, concerns remain about the throughput capabilities for EtO and VHP. Further research is needed before any specific decontamination methods can be recommended.

Particle Emission and Exposure during Nanoparticle Synthesis in Research Laboratories

Real-time size, mass and number particle concentrations, and emission rates in university laboratories producing nanoparticles by scalable flame spray pyrolysis are quantified. Measurements were conducted in four laboratories using various technological set-ups and during production of particles of a range of compositions with differing physical–chemical properties, from NaCl salt, BiPO4, CaSO4, Bi2O3, insoluble TiO2, SiO2, and WO3 to composites such as Cu/ZnO, Cu/SiO2, Cu/ZrO2, Ta2O5/SiO2, and Pt/Ba/Al2O3. Production time ranged from 0.25 to 400 min and yields from 0.33 to 183 g. Temporal and spatial analyses of the particle concentrations were performed indicating that elevated number concentrations in the workplace can occur. Airborne submicron number concentrations increased from background levels of 2100 up to 106 000 cm–3 during production, while the mass concentration ranged from a background of 0.009 to 0.463 mg m–3. Maximum particle number emission rates amounted to 1.17 x 1012 min–1. The size distributions displayed concentration peaks mainly between 110 and 180 nm. However, changes in the operating conditions and the production of certain nanoparticles resulted in concentration peaks in the nanoparticle size range <100 nm. The effectiveness and limitations of current technology in assessing researchers’ exposure to nanoparticles during production are examined, and further measures for workers’ protection are proposed.

Airborne Asbestos Concentrations Associated with Heavy Equipment Brake Removal

Asbestos-containing brake linings were used in heavy-duty construction equipment such as tractors, backhoes, and bulldozers prior to the 1980s. While several published studies have evaluated exposures to mechanics during brake repair work, most have focused on automobiles and light trucks, not on heavy agricultural or construction vehicles. The purpose of this study is to characterize the airborne concentration of asbestos to workers and bystanders from brake wear debris during brake removal from 12 loader/backhoes and tractors manufactured between 1960 and 1980. Asbestos content in brake lining (average 20% chrysotile by polarized light microscopy) and brake wear debris [average 0.49% chrysotile by transmission electron microscopy (TEM)] was also quantified. Breathing zone samples on the lapel of mechanics (n = 44) and area samples at bystander (n = 34), remote (n = 22), and ambient (n = 12) locations were collected during 12 brake changes and analyzed using phase contrast microscopy (PCM) [National Institute for Occupational Safety and Health (NIOSH) 7400] and TEM (NIOSH 7402). In addition, the fiber distribution by size and morphology was evaluated according to the International Organization for Standardization method for asbestos. Applying the ratio of asbestos fibers:total fibers (including non-asbestos) as determined by TEM to the PCM results, the average airborne chrysotile concentrations (PCM equivalent) were 0.024 f/cc for the mechanic and 0.009 f/cc for persons standing 1.2–3.1 m from the activity during the period of exposure (~0.5 to 1 h). Considering the time involved in the activity, and assuming three brake jobs per shift, these results would convert to an average 8-h time-weighted average of 0.009 f/cc for a mechanic and 0.006 f/cc for a bystander. The results indicate that (i) the airborne concentrations for worker and bystander samples were significantly less than the current occupational exposure limit of 0.1 f/cc; (ii) ~2% of respirable fibers were >20 µm in length; and (iii) ~95% of chrysotile in the brake linings degraded in the friction process. The industrial hygiene data presented here should be useful for conducting retrospective and current exposure assessments of individuals, as well as hazard assessments of work activities that involve repairing and replacing asbestos-containing brakes in heavy construction equipment.

Direct Detection of Salmonella Cells in the Air of Livestock Stables by Real-Time PCR

A SYBR® Green real-time quantitative polymerase chain reaction (qPCR) assay for specific detection and quantification of airborne Salmonella cells in livestock housings is presented. A set of specific primers was tested and validated for specific detection and quantification of Salmonella-specific invA genes of DNA extracted from bioaerosol samples. Application of the method to poultry house bioaerosol samples showed concentrations ranging from 2.2 x 101 to 3 x 106 Salmonella targets m–3 of air. Salmonella were also detected by a cultivation-based approach in some samples, but concentrations were two to three magnitudes lower than the concentrations detected by molecular biological results. Specificity of results was demonstrated by cloning analyses of PCR products, which were exclusively assigned to the genus Salmonella. However, by molecular methods, microorganisms are detected independently of their viability status, leading to an overestimation of concentration. Hence, the survival rate of Salmonella cells was measured on filter surfaces during filtration samplings where 82% of the cells died within 20 min of filtration. The results clearly show the specificity and practicability of the established qPCR assay for analysis and quantification of salmonellae in bioaerosols. The results demonstrate airborne Salmonella workplace concentrations in poultry production of up to 3.3% of 4',6-Diamidino-2-phenylindole-counted total cell numbers.