Employment RSS : Gourt

Measured occupational solar UVR exposures of lifeguards in pool settings

The aim of this study was to measure ultraviolet radiation (UVR) exposures of lifeguards in pool settings and evaluate their personal UVR protective practices.Lifeguards (n = 168) wore UVR sensitive polysulfone (PS) film badges in wrist bracelets on 2 days and completed a survey and diary covering sun protection use. Analyses were used to describe sun exposure and sun protection practices, to compare UVR exposure across locations, and to compare findings with recommended threshold limits for occupational exposure.The measured UVR exposures varied with location, ranging from high median UVR exposures of 6.2 standard erythemal doses (SEDs) to the lowest median of 1.7 SEDs. More than 74% of the lifeguards' PS badges showed UVR above recommended threshold limits for occupational exposure. Thirty-nine percent received more than four times the limit and 65% of cases were sufficient to induce sunburn. The most common protective behaviors were wearing sunglasses and using sunscreen, but sun protection was often inadequate.At-risk individuals were exposed to high levels of UVR in excess of occupational limits and though appropriate types of sun protection were used, it was not used consistently and more than 50% of lifeguards reported being sunburnt at least twice during the previous year. Am. J. Ind. Med. 2009 © 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.

Transfer of occupational health problems from a developed to a developing country: Lessons from the Japan-South Korea experience

Many corporations move their manufacturing facilities or technologies from developed to developing countries. Stringent regulations have made it costly for industries to operate in developed, industrialized countries. In addition, labor costs are high in these countries, and there is increasing awareness among the general public of the health risks associated with industry. The relocation of hazardous industries to developing countries is driven by economic considerations: high unemployment, a cheaper labor force, lack of regulation, and poor enforcement of any existing regulations make certain countries attractive to business. The transfer of certain industries from Japan to Korea has also brought both documented occupational diseases and a new occupational disease caused by chemicals without established toxicities. Typical examples of documented occupational diseases are carbon disulfide poisoning in the rayon manufacturing industry, bladder cancer in the benzidine industry, and mesothelioma in the asbestos industry. A new occupational disease due to a chemical without established toxicities is 2-bromopropane poisoning. These examples suggest that counter-measures are needed to prevent the transfer of occupational health problems from a developed to a developing country. Corporate social responsibility should be emphasized, close inter-governmental collaboration is necessary and cooperation among non-governmental organizations is helpful. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

Mortality among sheet metal workers participating in a medical screening program

The Sheet Metal Occupational Health Institute Trust (SMOHIT) was formed in 1985 to examine the health hazards of the sheet metal industry in the U.S. and Canada through an asbestos disease screening program. A study of mortality patterns among screening program participants was undertaken.A cohort of 17,345 individuals with 20 or more years in the trade and who participated in the asbestos disease screening program were followed for vital status and causes of death between 1986 and 2004. Data from the screening program included chest X-ray results by International Labour Office (ILO) criteria and smoking history. Standardized mortality ratios (SMRs) by cause were generated using U.S. death rates and Cox proportional hazards models were used to investigate lung cancer risk relative to chest X-ray changes while controlling for smoking.A significantly reduced SMR of 0.83 (95% CI = 0.80-0.85) was observed for all causes combined. Statistically significant excess mortality was observed for pleural cancers, mesothelioma, and asbestosis in the SMR analyses. Both lung cancer and COPD SMRs increased consistently and strongly with increasing ILO profusion score. In Cox models, which controlled for smoking, increased lung cancer risk was observed among workers with ILO scores of 0/1 (RR = 1.17, 95% CI = 0.89-1.54), with a strong trend for increasing lung cancer risk with increasing ILO profusion score >0/0.Sheet metal workers are at increased risk for asbestos-related diseases. This study contributes to the literature demonstrating asbestos-related diseases among workers with largely indirect exposures and supports an increased lung cancer risk among workers with low ILO profusion scores. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

Mortality patterns among workers exposed to arsenic, cadmium, and other substances in a copper smelter

To evaluate the long-term mortality experience of workers exposed to arsenic, cadmium, and other substances at a copper mine and smelter in Copperhill, Tennessee studied earlier as part of an industry-wide study.Subjects were 2,422 male workers employed three or more years in the smelter or mill between 1/1/46 until the plant strike and scale-down of operations in April 1996. Vital status was determined through 2000 for 99.4% of subjects and cause of death for 91.3% of 878 deaths. Historical exposures were estimated for lead, SO2, arsenic, cadmium, dust, and cobalt. We computed standardized mortality ratios (SMRs) based on U.S. and local county rates and modeled internal relative risks (RRs).We observed overall deficits in deaths based on national and local county comparisons from all causes, all cancers and most of the cause of death categories examined. We found limited evidence of increasing mortality risks from cerebrovascular disease with increasing duration and cumulative arsenic exposure, but no evidence of an exposure-response relationship for cadmium exposure and bronchitis.Our limited evidence of an association between inhaled arsenic exposure and CVD is an exploratory finding not observed in other epidemiology studies of more highly exposed occupational populations. Possible alternative explanations include chance alone and uncontrolled confounding or effect modification by co-exposures or other factors correlated with arsenic exposure and unique to the Copperhill facility. Am. J. Ind. Med. 2009 © 2009 Wiley-Liss, Inc.

Assessment of airborne and dermal exposure to 2-ethoxyethyl acetate in an occupational environment

Because of its chemical-physical properties, 2-ethoxyethyl acetate (EEAc) can penetrate through the skin. However, no actual occupational environmental studies or empirical dermal exposure measurements have been performed.Twenty workers from a commercial label silk screening shop were recruited and they completed a questionnaire of demographic information. Environmental monitoring of EEAc exposure via respiratory and dermal routes was performed for five consecutive working days.Airborne EEAc concentration was over the permissible exposure limit of 5 ppm in 90% of the participants. The dermal EEAc concentration was highest on the palms. The EEAc concentration correlated with skin exposure level (P < 0.001). The dermal EEAc concentrations in individuals who did not wear gloves were higher than in those who wore gloves.EEAc on the skin is strongly associated with airborne EEAc. Wearing impermeable gloves during high-risk tasks (cleaning process) can reduce EEAc dermal exposure on the palms. Am. J. Ind. Med. 2009. © 2009 Wiley-Liss, Inc.

Building a strong foundation for occupational health and safety: Action research in the workplace

Action research (AR) holds promise as a method to improve occupational health and safety.This case study explores the challenges and accomplishments during the first 6 months of an AR occupational health and safety committee at a manufacturing facility.Critical steps in the formative phase of the AR project included: (1) addressing differing power levels and perceived ownership of management and production committee members; (2) developing a collaborative approach to communication and problem solving; and (3) transitioning from dependence on university leadership to shared leadership among the committee.AR can lead to greater empowerment to address occupational health and safety issues, and to improved dialoge between labor and management. AR can increase the likelihood that the problem will be understood, and effective solutions will be developed and their application supported and used throughout the organization. Am. J. Ind. Med. 2009. © 2009 Wiley-Liss, Inc.

Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: Dose-response relationships

Since previous studies have provided conflicting results, we investigated the relationship between the risk of benign asbestos-related diseases and different aspects of asbestos exposure in previous asbestos workers who underwent low-dose computed tomography (CT).CT scans were carried out in 772 subjects. A questionnaire was employed to collect data on smoking habits and duration, peak and cumulative exposure, and time since first exposure to asbestos. Multiple logistic regression models with stepwise selection of variables were used to evaluate the associations.Fourteen (1.8%) cases of asbestosis, 187 (24.2%) of pleural plaques (PP), and 50 (6.5%) of diffuse pleural thickening (DPT) were found. The significant risk factors were: cumulative exposure for asbestosis (P for trend = 0.004); time since first exposure (P for trend <0.001), and peak exposure (P for trend <0.001) for PP; and time since first exposure for DPT (P for trend = 0.024).Parenchymal asbestosis and PP are associated with different aspects of asbestos exposure. DPT appears to be less specific for asbestos exposure. Am. J. Ind. Med. 2009. © 2009 Wiley-Liss, Inc.

Compensation costs of work-related back disorders among union carpenters, Washington State 1989-2003

We measured resources used to provide medical care and to estimate lost productivity represented by payments for lost work time or impairment for work-related back injuries among a large cohort of union carpenters over 15 years.Using administrative data we identified a cohort of carpenters, their hours worked, their workers' compensation claims and associated costs. After adjustment for inflation and discounting to 2006 dollars, yearly costs for injuries and payment rates based on hours worked were calculated. Using negative binomial regression, dollars paid per claim were modeled based on age, gender, union tenure, and predominant type of work of the carpenter and whether the injury resulted from overexertion or acute trauma.Workers' compensation costs for back injuries exceeded $128 million dollars between 1998 and 2003, representing payments of $0.97 for each hour of work. Costs per hour of work declined substantively over time due largely to declining overexertion injury rates. Traumatic injuries, though less common than overexertion injuries, were more expensive. Costs increased with the number of prior back injuries and with increasing age, beginning as early as age 30.Increasing costs even among relatively young carpenters likely reflect the heavy nature of their work rather than simply the effects of biological aging. Musculoskeletal back problems remain a common, and consequently costly, source of injury among these carpenters that needs to be addressed through engineering modifications; there are also clearly needs for prevention of the often more costly back injuries associated with acute trauma. Am. J. Ind. Med. 2009. © 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.

Associations between two job stress models and measures of salivary cortisol

Abstract Purpose To investigate the association between two job stress models—the job demand-control model and the effort-reward imbalance model—and repeated measures of salivary cortisol among male and female call-centre operators. Methods Daily cortisol profiles consisting of seven time points were measured across two workdays and one leisure day to determine the cortisol awakening response and the cortisol output in the day in 104 volunteers. The employees completed two self-administered questionnaire—the Karasek’s demand-control questionnaire and the Siegrist’s effort-reward imbalance questionnaire—to assess psychosocial hazards at work. The relations between the perceived workload measures and salivary cortisol levels were analyzed by means of generalized estimating equations method after adjusting for potential confounders (gender, age, educational level, marital status, morning awakening time, sleep duration and quality, weekdays, work schedule, adherence to sampling procedure). Results The total cortisol amount excreted in the awakening period was positively associated with the job strain measures (high strain vs. low strain: 1.4 (2.4–0.3) nmol/l). In contrast, individuals scoring higher in effort-reward imbalance at work had both lower cortisol awakening response (high imbalance vs. low imbalance: −0.7 (−1.3 to −0.2) nmol/l) and lower diurnal secretory activity (−9.2 (−17.7 to −0.7) nmol/l). Gender, weekday and adherence to sampling schedule significantly influenced the cortisol excretion in the morning period. Conclusions Our results indicate that the two work stress models differentially affect salivary cortisol output. This finding suggests that combining the information from two complementary job stress models results in improved knowledge on the psychobiological correlates of the psychosocial work environment. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0439-0Authors Giovanni Maina, Università di Torino Torino ItalyMassimo Bovenzi, Università di Trieste Trieste ItalyAntonio Palmas, Università di Torino Torino ItalyFrancesca Larese Filon, Università di Trieste Trieste Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Letter to the Editor

Letter to the Editor Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00420-009-0435-4Authors Kathleen Kreiss, National Institute for Occupational Safety and Health (NIOSH) Division of Respiratory Disease Studies Mail Stop H2800, 1095 Willowdale Road Morgantown WV 26505 USAAnn Hubbs, National Institute for Occupational Safety and Health (NIOSH) Health Effects Laboratory Division Mail Stop L2015, 1095 Willowdale Road Morgantown WV 26505 USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Assessment of salivary cortisol as stress marker in ambulance service personnel: comparison between shifts working on mobile intensive care unit and patient transport ambulance

Abstract Purpose The aim of this study was to describe and compare salivary cortisol of ambulance personnel on days with different work demands as well as to correlate the individual perception of demands to the physiological outcome cortisol. Methods Diurnal cortisol profiles on a day in emergency service and on a day in patient transport were monitored for 24 subjects working in an urban ambulance station. Changes of cortisol were also observed during 42 operations in emergency service and 24 operations in patient transport and were compared to the individual perception of physical and emotional demands. Results Rise of cortisol in the morning on days in emergency service was significantly higher than in patient transport suggesting adjustment to forthcoming demanding tasks. There were only few situations with strong endocrine reaction in emergency service as well as in patient transport. The magnitude of this reaction was not related to the individual perception of demand. Conclusion Ambulance service personnel seem to be used to critical situations. There was few awareness of the “physiological” stress response indicating that stress is probably not perceived in work situations characterised by routines. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0428-3Authors Eva M. Backé, Federal Institute of Occupational Health and Safety (BAuA) Nöldnerstrasse 40-42 10317 Berlin GermanyGerlinde Kaul, Federal Institute of Occupational Health and Safety (BAuA) Nöldnerstrasse 40-42 10317 Berlin GermanyAndré Klußmann, University of Wuppertal (ASER e.V.) Institute of Occupational Medicine, Safety Engineering and Ergonomics Corneliusstrasse 31 42329 Wuppertal GermanyFalk Liebers, Federal Institute of Occupational Health and Safety (BAuA) Nöldnerstrasse 40-42 10317 Berlin GermanyCarmen Thim, Federal Institute of Occupational Health and Safety (BAuA) Nöldnerstrasse 40-42 10317 Berlin GermanyPeter Maßbeck, German Red Cross Secretariat Carstennstrasse 58 12205 Berlin GermanyUlf Steinberg, Federal Institute of Occupational Health and Safety (BAuA) Nöldnerstrasse 40-42 10317 Berlin Germany Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Urinary 1-hydroxypyrene levels in offshore workers

Abstract Objectives To compare differences in pre- and post-shift urinary 1-hydroxypyrene (1OHP) levels as a measure of internal dose of polycyclic aromatic hydrocarbons (PAHs) between two groups of oil production workers offshore assumed to be exposed to PAH, and to compare the exposed group to an unexposed control group. Methods Participants’ (n = 42) urine samples, collected over a study period of three consecutive 12-h work days (pre-shift on the first day and post-shift on the third day), were analyzed using high performance liquid chromatography (HPLC) with fluorescence detection. Analysis of covariance was used in the statistical models. Results (1) Post-shift 1OHP levels were significantly higher in the exposed workers compared to the controls. (2) Tank workers and process operators did not show statistically significant different post-shift 1OHP levels. Conclusion Altogether, this study indicates the presence of a low level PAH exposure among offshore oil production workers. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0437-2Authors Nancy Brenna Hopf, University of Cincinnati Cincinnati OH USAJorunn Kirkeleit, University of Bergen Section for Occupational Medicine, Department of Public Health and Primary Health Care Kalfarveien 31 5018 Bergen NorwayStacy L. Kramer, University of Cincinnati Cincinnati OH USABente Moen, University of Bergen Section for Occupational Medicine, Department of Public Health and Primary Health Care Kalfarveien 31 5018 Bergen NorwayPaul Succop, University of Cincinnati Cincinnati OH USAMary Beth Genter, University of Cincinnati Cincinnati OH USATania Carreón, University of Cincinnati Cincinnati OH USAJames Mack, University of Cincinnati Cincinnati OH USAGlenn Talaska, University of Cincinnati Cincinnati OH USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Overweight and obesity among Dutch workers: differences between occupational groups and sectors

Abstract Purpose To describe the prevalence of overweight and obesity among different occupational groups and sectors in a representative sample of the Dutch working population, and to test whether these differences still exist after adjustment for socio-demographic variables. Methods Cross-sectional data among 7,588 working adults were used. Univariate analyses of variance was performed to test differences in body mass index (BMI) values between occupational groups (n = 7) and sectors (n = 28). Adjusted analyses were carried out to examine the role of socio-demographic factors in the differences in overweight and obesity between occupational groups and sectors. Results On average, the mean BMI was 24.3 kg/m2 with 31% being overweight and 6% being obese. Those working in trade, industrial, or transportation occupations as well as the legislators and senior managers had the highest BMI and a relatively high prevalence of overweight (36.7 and 35.5%, respectively) and obesity (6.9 and 7.5%, respectively). In contrast, those working in scientific and artistic professions had the most favorable BMI profile with 25.7% being overweight and 4.2% being obese. After adjusting for sex, age, and education, the proportion of variance changed from about 0.01 to 0.10 with age being the main contributor of the differences in overweight and obesity. Conclusions BMI profile and prevalence of overweight and obesity differs between occupations and sectors. Despite the differences are explained partly by socio-demographic factors, based on a given distribution of age, sex, and education within each occupational group and sector, occupational group- and sector-specific strategies to prevent and reduce overweight are recommended. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0438-1Authors Karin I. Proper, EMGO Institute for Health and Care Research, VU University Medical Center Department of Public and Occupational Health Amsterdam The NetherlandsVincent H. Hildebrandt, TNO Quality of Life Leiden The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Does sickness presenteeism have an impact on future general health?

Abstract Purpose The primary aim of this prospective study was to investigate whether working despite illness, so called “sickness presenteeism”, has an impact on the future general health of two different working populations during a follow-up period of 3 years. Methods The study was based on two bodies of data collected at a number of Swedish workplaces from 1999 to 2003. The first material comprised 6,901 employees from the public sector and the second 2,862 subjects from the private sector. A comprehensive survey was issued three times: at baseline, after 18 months and after 3 years. Apart from the explanatory variable sickness presenteeism, several potential confounders were considered. The outcome variable was good/excellent versus fair/poor self-reported health. Results Sickness presenteeism at baseline was consistently found to heighten the risk of fair/poor health at both the 18-month and 3-year follow ups even after adjusting for the detected confounders. Conclusions To the best of the authors’ knowledge, this study is the first to show that sickness presenteeism appears to be an independent risk factor for future fair/poor general health. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0433-6Authors Gunnar Bergström, Karolinska Institutet Division of Intervention and Implementation Research, Department of Public Health Sciences 171 77 Stockholm SwedenLennart Bodin, Karolinska Institutet Division of Intervention and Implementation Research, Department of Public Health Sciences 171 77 Stockholm SwedenJan Hagberg, Karolinska Institutet Section for Personal Injury Prevention, Department of Clinical Neuroscience Stockholm SwedenTomas Lindh, Stockholm County Council Department of Occupational and Environmental Health, Centre for Public Health Stockholm SwedenGunnar Aronsson, Stockholm University Department of Psychology Stockholm SwedenMalin Josephson, Uppsala University Section of Occupational and Environmental Medicine, Department of Medical Sciences Uppsala Sweden Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Biological monitoring of tungsten (and cobalt) in workers of a hard metal alloy industry

Abstract Objectives To evaluate a combined biomonitoring approach based on both cobalt and tungsten determination in workers of the hard metal alloy sector. Methods We enrolled 55 workers from a factory producing cutting tools for carpentry. Combined workroom air and biological monitoring of both cobalt and tungsten relied on inductively coupled plasma mass spectrometry determinations. Metals were determined on plasma, blood and urine samples. Urine samples from 34 unexposed subjects were also analyzed. Results Tungsten was determined in every collected sample. Workers showed significantly higher urinary tungsten levels than controls (pre-shift values of 4.12 vs. 0.06 μg/l on average; P < 0.0005). Both airborne and biological levels of tungsten prevailed among workers involved in wet-grinding activities. The element was excreted at higher urinary levels than cobalt and showed lower circulating (blood, plasma) concentrations. Exposure–dose relationships were apparent for tungsten biomarkers. Conclusions Obtained results may contribute to the development of biomarkers of exposure to tungsten. The association of such biomarkers to traditional determinations of cobalt in blood and/or urine may substantially improve the exposure assessment of workers employed in cemented carbide industries. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0434-5Authors Giuseppe De Palma, University of Brescia Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene Brescia ItalyPaola Manini, Research Center at the University of Parma National Institute of Occupational Safety and Prevention (ISPESL) Parma ItalyMichela Sarnico, University of Brescia Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene Brescia ItalyStefania Molinari, Via Piemonte 50/4 Udine ItalyPietro Apostoli, University of Brescia Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene Brescia Italy 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 ReplyDOI 10.1007/s00420-009-0431-8Authors 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

Evaluation of different methods to determine total serum lipids for normalization of circulating organochlorine compounds

Abstract Objectives Serum levels of persistent organochlorine compounds may be predictive of their body burden, if adjusted by total serum lipids. Their value may be predicted by three different formulae, requiring only values of serum cholesterol and triglycerides. The study was aimed at: (i) evaluating the validity of these formulae; (ii) evaluating the influence of different estimates on serum levels of lipid adjusted persistent organochlorine compounds. Methods We determined the levels of cholesterol, triglycerides and phospholipids by enzymatic assays on serum samples from 121 subjects living in a polluted area of Northern Italy. On the same samples and on an additional set from 69 pregnant women of the same area, we determined also polychlorinated biphenyls, hexachlorobenzene and p,p′-dichlorodiphenyldichloroethylene. In women, analytes were determined also on adipose tissue samples. Results Formulae provided results comparable to those obtained as sum of cholesterol, triglycerides and phospholipids. In women, we found highly significant relationships among lipid adjusted pollutant levels in serum and adipose tissue, independently from the used formula. Conclusions Formulae allow a valid adjustment of organochlorine compounds in serum. The algorithm proposed by Phillips et al. provides some slight advantage over the others, in terms of simplicity of use. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0426-5Authors Roberto Bergonzi, University of Brescia Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene Brescia ItalyGiuseppe De Palma, University of Brescia Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene Brescia ItalyCesare Tomasi, University of Brescia Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene Brescia ItalyMaria Cristina Ricossa, University of Brescia Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene Brescia ItalyPietro Apostoli, University of Brescia Department of Experimental and Applied Medicine, Section of Occupational Health and Industrial Hygiene Brescia Italy Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Psychosocial work conditions and registered sickness absence: a 3-year prospective cohort study among office employees

Abstract Purpose To investigate associations between a wide variety of psychosocial work conditions and sickness absence in a medium-sized company. Methods Prospective cohort study of 395 employees working in an insurance office. Self-reported psychosocial work conditions were measured by questionnaire in January 2002 and linked to registered sickness absence in the period January 2002 to December 2004 adjusting for earlier sick leave and psychological distress. Results The questionnaires of 244 employees were eligible for analysis. Decision authority and co-worker support were associated with sickness absence days, but their associations with sickness absence episodes were not significant. Role clarity was associated with the number of sickness absence days, but only with the number of short sickness absence episodes in women. Conclusions The wide variety of investigated psychosocial work conditions contributed little to the explanation of sickness absence in the medium-sized insurance office. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0425-6Authors C. A. M. Roelen, ArboNed Occupational Health Service PO Box 158 8000 AD Zwolle The NetherlandsP. C. Koopmans, University Medical Center, Groningen, University of Groningen Department of Health Sciences PO Box 196 9700 AD Groningen The NetherlandsU. Bültmann, University Medical Center, Groningen, University of Groningen Department of Health Sciences PO Box 196 9700 AD Groningen The NetherlandsJ. W. Groothoff, University Medical Center, Groningen, University of Groningen Department of Health Sciences PO Box 196 9700 AD Groningen The NetherlandsJ. J. L. van der Klink, University Medical Center, Groningen, University of Groningen Department of Health Sciences PO Box 196 9700 AD Groningen The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Chronic fatigue of the small enterprise workers participating in an occupational health checkup center in southern Taiwan

Abstract Purpose There has been increasing interest in the occupational health of workers in small enterprises, especially in developing countries. This study examines the association between psychosocial job characteristics and fatigue, and attempts to identify risk factors for fatigue among workers of small enterprises in southern Taiwan. Methods A structured questionnaire was administered to workers receiving regular health examinations between August 2005 and January 2006. The questionnaire collected demographic information and data on working conditions, personal health status and life styles. It also collected information on psychosocial job characteristics, fatigue and psychological distress using three instruments. Results A total of 647 workers with mean age of 43.7 were completed. Probable fatigue was found in 34.6% of the sample. Fatigue was found by multiple logistic regressions to be associated with the lack of exercise, working in shifts, depression score and lack of social support at workplace. Conclusions This study found associations between life style, psychosocial job characteristics and fatigue. Because the high prevalence of probable fatigue was found in such small enterprises, the authors suggest that a short interview with some quick questionnaires in health checkup for these small enterprise workers are helpful to early detect psychosocial and fatigue problems. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0429-2Authors Fu-Wei Wang, Kaohsiung Veterans General Hospital Department of Family Medicine Kaohsiung TaiwanYu-Wen Chiu, Kaohsiung Medical University Hospital Department of Community Medicine #100 Shih-Chuan First Road Kaohsiung 80708 TaiwanMing-Shium Tu, Kaohsiung Veterans General Hospital Department of Family Medicine Kaohsiung TaiwanMing-Yueh Chou, Kaohsiung Veterans General Hospital Department of Family Medicine Kaohsiung TaiwanChao-Ling Wang, Kaohsiung Medical University Hospital Department of Community Medicine #100 Shih-Chuan First Road Kaohsiung 80708 TaiwanHung-Yi Chuang, Kaohsiung Medical University Hospital Department of Community Medicine #100 Shih-Chuan First Road Kaohsiung 80708 Taiwan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 82 Journal Issue Volume 82, Number 7 / July, 2009

Evaluation of a Swedish version of the Quick Environmental Exposure and Sensitivity Inventory

Abstract Purpose To psychometrically evaluate a Swedish version of the Quick Environment Exposure Sensitivity Inventory (QEESI), originally developed in the United States, which is a sensitive and fast questionnaire instrument with five scales used to investigate chemical intolerance. Methods Ninety non-intolerant, 67 mildly intolerant, and 126 moderately/severely intolerant individuals to environmental chemicals responded at test and retest (n = 69, 64, 120, respectively) occasions to the Swedish version of the QEESI. Results Good internal consistency (α = 0.74–0.95) and test–retest reliability (r = 0.78–0.93) was found in all scales, except for the internal consistency in the Masking Index (Kuder-Richardson coefficient = 0.10). All scales, but the Masking Index, further showed good convergent validity (somewhat lower in the Other Intolerences scale) and predominantly unidimensionality. Conclusions The Swedish version of the QEESI is reliable and valid for investigation of chemical intolerance, but the Masking Index scale does not represent a unified concept of exposure to masking agents. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0427-4Authors Steven Nordin, Umeå University Department of Psychology SE-901 87 Umeå SwedenLinus Andersson, Umeå University Department of Psychology SE-901 87 Umeå Sweden Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Response to Galbraith and Weill

Response to Galbraith and Weill Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00420-009-0432-7Authors Philip Harber, UCLA Los Angeles CA USARobert Harrison, CA Department of Health Services Oakland CA USAArthur Gelb, Lakewood Medical Center and UCLA Lakewood CA USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Psychosocial factors at work and perceived health among agricultural meat industry workers in France

Abstract Objective The objective of this study was to describe the perceived health status of the meat industry employees—i.e., working in the slaughtering, cutting, and boning of large animals and poultry—and its relation to their organisational and psychosocial constraints at work. Methods This postal survey included all 3,000 employees of the meat industry (beef, pork and poultry) in four districts in Brittany, France, whose companies were affiliated with the agricultural branch of the national health insurance fund. The questionnaire asked for social and demographic data and information describing their job and the organisation of their work. The psychosocial factors at work were described according to Karasek’s questionnaire (demand, latitude and social support at work). Perceived health was measured with the Nottingham Health Profile perceived health indicator. Results This study shows the high prevalence of poor health reported by the workers in this industry. This poor perceived health was worse in women and increased regularly with age. Among the psychosocial factors studied, high quantitative and qualitative demand at work, inadequate resources for good work and to a lesser extent, inadequate prospects for promotion appear especially associated with poor perceived health. Other factors often associated with poor perceived health included young age at the first job and work hours that disrupt sleep rhythms (especially for women). Conclusion Our results show that this population of workers is especially vulnerable from the point of view of perceived physical and psychological health and is exposed to strong physical, organisational and psychosocial constraints at work. They also demonstrate that poor perceived health is associated with some psychosocial (such as high psychological demand and insufficient resources) and organisational factors at work. These results, in conjunction with those from other disciplines involved in studying this industry, may help the companies to develop preventive activities. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0430-9Authors Christine Cohidon, Université Claude Bernard Lyon 1 French Institute for Public Health Surveillance (InVS), Occupational Health Department, UMRESTTE (InVS-UCBL-Inrets) 8 Avenue Rockefeller 69373 Lyon Cedex 08 FrancePatrick Morisseau, Mutualité Sociale Agricole du Morbihan Vannes FranceFrancis Derriennic, French Institute for Public Health Surveillance (InVS) Saint-Maurice FranceMarcel Goldberg, French Institute for Public Health Surveillance (InVS) Saint-Maurice FranceEllen Imbernon, French Institute for Public Health Surveillance (InVS) Saint-Maurice France Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 82 Journal Issue Volume 82, Number 7 / July, 2009

Effect of Functional Capacity Evaluation information on the judgment of physicians about physical work ability in the context of disability claims

Abstract Purpose To test whether Functional Capacity Evaluation (FCE) information lead insurance physicians (IPs) to change their judgment about the physical work ability of claimants with musculoskeletal disorders (MSDs). Methods Twenty-seven IPs scored twice the physical work ability of two claimants for 12 specified activities, using a visual analogue scale. One claimant performed an FCE, the other served as a control. Outcome measure was the difference between experimental and control group in number of shifts in the physical work ability for the total of 12 specified activities. Results The IPs changed their judgment about the work ability 141 times when using FCE information compared to 102 times when not using this information (P-value = 0.001), both in the direction of more and less ability. Conclusions The IPs change their judgment of the physical work ability of claimants with MSDs in the context of disability claim procedures more often when FCE information is provided. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0423-8Authors Haije Wind, University of Amsterdam Academic Medical Center, Coronel Institute of Occupational Health P.O. Box 22700 1100 DE Amsterdam The NetherlandsVincent Gouttebarge, University of Amsterdam Academic Medical Center, Coronel Institute of Occupational Health P.O. Box 22700 1100 DE Amsterdam The NetherlandsP. Paul F. M. Kuijer, University of Amsterdam Academic Medical Center, Coronel Institute of Occupational Health P.O. Box 22700 1100 DE Amsterdam The NetherlandsJudith K. Sluiter, University of Amsterdam Academic Medical Center, Coronel Institute of Occupational Health P.O. Box 22700 1100 DE Amsterdam The NetherlandsMonique H. W. Frings-Dresen, University of Amsterdam Academic Medical Center, Coronel Institute of Occupational Health P.O. Box 22700 1100 DE Amsterdam The Netherlands Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Comparison of urinary concentrations of 3-phenoxybenzoic acid among general residents in rural and suburban areas and employees of pest control firms

Abstract Objectives The purpose of this study is to determine the levels of urinary 3-phenoxybenzoic acid (3-PBA) among general populations in rural and suburban areas and employees of pest control firms to evaluate the differences in the level of environmental or occupational pyrethroid (PYR) pesticides to which those populations are exposed. Methods Spot urine specimens were collected from male residents in a rural area (n = 143) and male residents in a suburban area (n = 66) in August of 2005 and 2007, respectively. Male employees of pest control firms, who also provided their urine specimens at the time of a health-checkup in August 2007, were classified either as sprayers (n = 14) or as non-sprayers (n = 16) according to the presence of spraying during the pre-checkup week. Urinary concentrations of 3-PBA were determined using gas chromatography–mass spectrometry and corrected for the urinary creatinine concentrations. An analysis of covariance was used to examine the statistical difference in 3-PBA concentrations between these four groups after adjustment for age, body mass index, and current smoking/drinking habits. Results Multiple comparisons indicated no differences in adjusted 3-PBA concentrations between the groups of general residents from the rural areas (0.33 μg/g cre in geometric mean) and suburban area (0.51 μg/g cre). The group of sprayers showed a much higher level of 3-PBA concentrations (25.0 μg/g cre) than the other three groups. A statistically significant difference, though to a lesser extent, was also exhibited in 3-PBA concentrations between the group of non-sprayers (5.6 μg/g cre) and that of general residents. Conclusions The results indicated that the levels of background low-dose exposure to PYRs are not likely to differ evidently among general populations according to the area of residence. Moreover, employees of pest control firms, who have been away from PYR spraying operations for a week or more, still retain much higher urinary 3-PBA concentrations than general populations. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0424-7Authors Akiko Kimata, Nagoya University Graduate School of Medicine Program in Radiological and Medical Laboratory Sciences 1-1-20 Daikominami, Higashi-ku Nagoya 461-8673 JapanTakaaki Kondo, Nagoya University Graduate School of Medicine Program in Radiological and Medical Laboratory Sciences 1-1-20 Daikominami, Higashi-ku Nagoya 461-8673 JapanJun Ueyama, Nagoya University Graduate School of Medicine Program in Radiological and Medical Laboratory Sciences 1-1-20 Daikominami, Higashi-ku Nagoya 461-8673 JapanKanami Yamamoto, Nagoya University Graduate School of Medicine Program in Radiological and Medical Laboratory Sciences 1-1-20 Daikominami, Higashi-ku Nagoya 461-8673 JapanJunko Yoshitake, Nagoya University Graduate School of Medicine Program in Radiological and Medical Laboratory Sciences 1-1-20 Daikominami, Higashi-ku Nagoya 461-8673 JapanKenji Takagi, Nagoya University Graduate School of Medicine Program in Radiological and Medical Laboratory Sciences 1-1-20 Daikominami, Higashi-ku Nagoya 461-8673 JapanKoji Suzuki, Fujita Health University School of Health Sciences Faculty of Medical Technology Aichi 470-1192 JapanTakashi Inoue, Fujita Health University School of Health Sciences Faculty of Medical Technology Aichi 470-1192 JapanYoshinori Ito, Nagoya University Graduate School of Medicine Department of Preventive Medicine/Biostatistics and Medical Decision Making Nagoya 466-8550 JapanNobuyuki Hamajima, Nagoya University Graduate School of Medicine Department of Preventive Medicine/Biostatistics and Medical Decision Making Nagoya 466-8550 JapanMichiro Kamijima, Nagoya University Graduate School of Medicine Department of Occupational and Environmental Health Nagoya 466-8550 JapanMasahiro Gotoh, Nagoya University Graduate School of Medicine Department of Occupational and Environmental Health Nagoya 466-8550 JapanEiji Shibata, Aichi Medical University School of Medicine Department of Health and Psychological Medicine Aichi 480-1195 Japan Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

The national study to prevent blood exposure in paramedics: rates of exposure to blood

Abstract Objective The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers. Methods A survey on blood exposure was mailed in 2002–2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately. Results The incidence rate for needlestick/lancet injuries was 100/1,000 employee-years [95% confidence interval (CI), 40–159] among the national sample and 26/1,000 employee-years (95% CI, 15–38) for the California sample. The highest exposure rate was for non-intact skin, 230/1,000 employee-years (95% CI, 130–329). The rate for all exposures was 465/1,000 employee-years (95% CI, 293–637). California needlestick/lancet rates, but not national, were substantially lower than rates in earlier studies of paramedics. Rates for all percutaneous injuries among paramedics were similar to the mid to high range of rates reported for most hospital-based healthcare workers. Conclusions Paramedics in the United States are experiencing percutaneous injury rates at least as high as, and possibly substantially higher than, most hospital-based healthcare workers, as well as substantially higher rates of exposure to blood on non-intact skin. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0421-xAuthors Winifred L. Boal, National Institute for Occupational Safety and Health (NIOSH) Cincinnati OH USAJack K. Leiss, Cedar Grove Institute for Sustainable Communities Mebane NC USAJennifer M. Ratcliffe, Constella Group Durham NC USASara Sousa, Constella Group Durham NC USAJennifer T. Lyden, Advance Health Solutions La Jolla CA USAJia Li, National Institute for Occupational Safety and Health (NIOSH) Cincinnati OH USAJanine Jagger, University of Virginia Charlottesville VA USA Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Cholinesterase activity, pesticide exposure and health impact in a population exposed to organophosphates

Abstract Objective Biological monitoring is an essential component for assessing the exposure of individuals to organophosphate pesticides. The aim of this study was to determine cholinesterase activity, pesticide exposure and health effects in the exposed population. Methods A total of 90 individuals occupationally exposed to OPs and 30 controls were recruited in this study. Erythrocyte acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities were measured in two periods of low- and high-exposure. Results There were statistically significant decrease in AChE and BuChE activities in the high-exposure period (20.73 ± 0.99 U/gHb and 3.73 ± 0.19 U/mL, respectively, P < 0.001) compared to the low-exposure period (29.81 ± 1.19 U/gHb and 4.92 ± 0.19 U/mL, respectively). All enzyme activities in the exposed group were statistically lower than in the control group. Analysis of the relation between cholinesterase activity and symptoms showed significant evidences. Conclusions The results suggested the association between occupational pesticide exposure and inhibition of cholinesterases. Thus, medical monitoring of cholinesterase inhibition and intervention programs regarding safety practices during field work are important issues aimed at minimizing adverse health effects of pesticide. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0422-9Authors Sirivarasai Jintana, Mahidol University Division of Clinical Pharmacology and Toxicology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital 270 Rama VI Road, Ratchatavee District Bangkok 10400 ThailandKaojarern Sming, Mahidol University Division of Clinical Pharmacology and Toxicology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital 270 Rama VI Road, Ratchatavee District Bangkok 10400 ThailandYoovathaworn Krongtong, Mahidol University Department of Pharmacology and Toxicology Graduate Programe, Faculty of Science Bangkok 10400 ThailandSura Thanyachai, Mahidol University Division of Medical Genetic, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital Bangkok 10400 Thailand Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131 Journal Volume Volume 82 Journal Issue Volume 82, Number 7 / July, 2009

Predicting long-term sickness absence and early retirement pension from self-reported work ability

Predicting long-term sickness absence and early retirement pension from self-reported work ability Content Type Journal ArticleCategory ErratumDOI 10.1007/s00420-009-0420-yAuthors Lea Sell, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkUte Bültmann, University Medical Center Groningen Department of Health Sciences Antonius Deusinglaan 1, Building 3217, Room 605 9713 AV Groningen The NetherlandsReiner Rugulies, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkEbbe Villadsen, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkAnne Faber, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkKaren Søgaard, University of Southern Denmark Institute of Sports Science and Clinical Biomechanics Campusvej 55 5230 Odense M Denmark Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Sleep length and quality, sleepiness and urinary melatonin among healthy Danish nurses with shift work during work and leisure time

Abstract Background Sleep problems are common effects of shift work. The aim of the present study was to evaluate how different types of shift affect sleep and sleepiness, and to relate sleepiness to urinary 6-sulfatoxymelatonin. Methods A total of 166 volunteer healthy Danish nurses working day, evening, or night, respectively fixed and mixed schedules were included. Self-reports of sleep were assessed together with real-time sleepiness and spot urine samples analyzed for 6-sulfatoxymelatonin on a workday and a leisure day. Results On a day off the nurses slept longer, with a better quality and reported less sleepiness compared to a workday. Nurses on nightshift reported poorer sleep quality than nurses on other shifts. Sleepiness was highest for nurses on mixed schedules. Concentrations of urinary 6-sulfatoxymelatonin and sleepiness were generally correlated except for nurses working fixed nights. Conclusions The poorest sleep quality was observed for nurses in mixed schedules working nights. The lack of correlation between sleepiness and 6-sulfatoxymelatonin on mixed night shift may indicate that the influence of endogenous melatonin is limited. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00420-009-0419-4Authors Anne Helene Garde, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkÅse Marie Hansen, National Research Centre for the Working Environment Lersø Parkallé 105 2100 Copenhagen DenmarkJohnni Hansen, Danish Cancer Society Institute of Cancer Epidemiology Copenhagen Denmark Journal International Archives of Occupational and Environmental HealthOnline ISSN 1432-1246Print ISSN 0340-0131

Unilateral and bilateral upper extremity weight-bearing effect on upper extremity impairment and functional performance after brain injury

The purpose of the study was to investigate the effect of upper extremity (UE) weight bearing on UE impairment functional performance of persons with acquired brain injury (BI).A quasi-experimental design was used to examine a convenience sample of 99 persons with acquired BI and 22 without BI (WBI) living in a community re-entry centre. A computerized force-sensing array pressure map system was used to determine the UE pressure during unilateral and bilateral conditions. Differences between groups were examined using t-tests. Correlations were computed between UE weight bearing and hand function, and functional performance as measured by the Fugl-Meyer scale and functional independence measure (FIM) scale.The group of people with BI exerted significantly lower UE weight bearing during unilateral conditions as compared with persons WBI [left: t (119) = 2.34, p = 0.021; right: t (119) = 4.79, p = 0.043). UE weight-bearing measures correlated strongly with FIM motor scores with bilateral UE conditions yielded the highest significant correlation (bilateral left r = 0.487, p < 0.001; bilateral right r = 0.469, p < 0.01).The results indicated that UE weight-bearing pressure differs in unilateral and bilateral conditions, between persons with and WBI and between persons with stroke and traumatic brain injury. These findings may have implications for occupational therapists that use unilateral versus bilateral motor training for rehabilitation.There is a need to replicate the study design with a randomized and stratified sample of persons with BI. Copyright © 2009 John Wiley & Sons, Ltd.

Occupational therapy and neuromotor interventions

No abstract.

A review of bilateral training for upper extremity hemiparesis

Upper extremity hemiparesis is the most common post-stroke disability. Longitudinal studies have indicated that 30-66% of stroke survivors do not have full arm function 6 months post-stroke. The current gold standard for treatment of mild post-stroke upper limb impairment is constraint-induced therapy but, because of the inclusion criteria, alternative treatments are needed which target more impaired subjects. Bilateral arm training has been investigated as a potential rehabilitation intervention. Bilateral arm training encompasses a number of methods including: (1) bilateral isokinematic training; (2) mirror therapy using bilateral training; (3) device-driven bilateral training; and (4) bilateral motor priming. Neural mechanisms mediating bilateral training are first reviewed. The key bilateral training studies that have demonstrated evidence of efficacy will then be discussed. Finally, conclusions are drawn concerning clinical implications based on the reviewed literature. Copyright © 2009 John Wiley & Sons, Ltd.

Changes in hemiplegic grasp following distributed repetitive intervention: a case series

The purpose of this pilot study was to investigate the efficacy of a distributed model of repetitive and focused intervention on grasp force, and clinical and functional hand measures in persons with chronic hemiplegia and limited hand recovery from self-reported stroke.A case series design was used. Focused repetitive unilateral and bilateral interventions were provided in a distributed manner (three times a week for 6 weeks) to three persons with upper limb hemiplegia of more than 1 year. Data from instrumented grasp force, and clinical and functional measures were obtained at weeks 0, 3, 6 and 9.Each participant improved in at least one measure of grasp force, as well as in clinical skill and function. All participants improved in the quality of handwriting. Improved outcomes remained above baseline levels following 3 weeks of non-intervention. The findings are compatible with current evidence of adaptive cortical plasticity following increased repetition. The findings show that, for these three persons, distributed repetitive practice was sufficient to effect change.Localization by cerebral area affected is not possible, nor is it possible to parse the effectiveness of any component of the intervention.A larger group study is warranted to determine whether similar results may be found for other persons with chronic hemiplegia. Future studies should incorporate kinematic handwriting analysis and a greater range of functional tasks. Copyright © 2009 John Wiley & Sons, Ltd.

Task-specific training: evidence for and translation to clinical practice

There is mounting evidence of the value of task-specific training as a neuromotor intervention in neurological rehabilitation. The evidence is founded in the psychology of motor skill learning and in the neuroscience of experience-dependent and learning-dependent neural plastic changes in the brain in animals and humans. Further, there is growing empirical evidence for the effectiveness of task-specific training in rehabilitation and for neural plastic changes following task-oriented training. In this paper, we position the evidence for task-specific training in the context of rehabilitation; review its relevance for occupation-based neurological rehabilitation, particularly in relation to upper limb function and everyday activities; and recommend evidence-driven strategies for its application. We recommend that task-specific training be routinely applied by occupational therapists as a component of their neuromotor interventions, particularly in management related to post-stroke upper limb recovery. Specifically, we propose five implementation strategies based on review of the evidence. These are: task-specific training should be relevant to the patient/client and to the context; be randomly assigned; be repetitive and involve massed practice; aim towards reconstruction of the whole task; and be reinforced with positive and timely feedback. Copyright © 2009 John Wiley & Sons, Ltd.

OCCUPATIONAL MEDICINE CALENDAR

In this issue of Occupational Medicine

Consensus on work-related asthma

Sickness absence in the UK: welfare reform, measurement and statutory sick pay

On tenterhooks

Diego Rivera Detroit Industry (1932-1933): North wall fresco, lower panel 5.398 m x 13.716 m. Detroit Institute of Arts, Detroit, USA.

Questionnaire assessment of airway disease symptoms in equine barn personnel

Background People working in cattle, swine and poultry barns have a higher prevalence of respiratory symptoms and decreased lung function. There is scant evidence regarding the respiratory health of humans working in horse barns, although it is well documented that stabled horses have a high prevalence of airway disease. Aims To determine whether people spending time in horse barns have a higher prevalence of self-reported respiratory symptoms than non-exposed controls. Methods A cross-sectional questionnaire study was conducted from May 2005 to January 2006 to investigate the prevalence of self-reported respiratory symptoms in 82 barn-exposed subjects and 74 control subjects. Logistic regression and the chi-square test were used to analyse the data. Results There was a significantly higher prevalence of self-reported respiratory symptoms in the barn-exposed group (50%) versus the control group (15%). Exposure to horse barns, smoking and family history of asthma or allergies was independent risk factors for respiratory symptoms. High exposure to the horse barn yielded a higher odds ratio for self-reported respiratory symptoms (8.9). Conclusions Exposure to the equine barn is a risk factor for respiratory symptoms. Investigation of organic dust exposures, lung function and horse dander allergies in the barn-exposed group will be necessary to determine how best to protect the health of this group.

Respiratory health of welders in a container yard, Sri Lanka

Background The fumes and gases released during welding can lead to respiratory ill-health. Aims To assess prevalence of respiratory symptoms (RS) and respiratory function (RF) of welders in comparison to a control group (CG). Methods A cross-sectional study was conducted among welders and controls selected from office support staff of a medical faculty. RS were determined by administering a questionnaire and RF with the use of an electronic spirometer. Results Forty-one welders and 41 controls participated. Chronic bronchitis was significantly higher among welders (27%; n = 11) than in controls (7%; n = 3) with an odds ratio of 4.6 [95% confidence interval (CI): 1.1–23.3]. Forced vital capacity (FVC), forced expiratory volume in the first second of forced vital capacity (FEV1.0), forced mid-expiratory flow rate (FEF25–75%) and peak expiratory flow rate (PEFR) were slightly higher among welders (2.97 l, 2.6 l, 3.4 l/s and 339 l/min, respectively) than in the CG (2.79 l, 2.4 l, 3.38 l/s and 323 l/min, respectively), the differences of which were not statistically significant. On comparison of the observed values of welders with the predicted normal values, the observed FVC (2.97 versus 3.35 l, respectively) and PEFR (339 versus 538 l/min) had significantly lower values. Conclusions Welders are at a higher risk of developing chronic bronchitis with non-impairment of lung function in comparison to the CG.

Audit of quality of diagnostic procedures for occupational asthma

Background Previous studies have reported deficiencies in the quality of the diagnosis of occupational asthma. A low quality of diagnostic procedures means that the occupational cause of asthma is less likely to be revealed. Aims To assess the current quality of the diagnosis of occupational asthma before referral to a specialist occupational medicine centre. Methods The quality of diagnostic procedures was assessed by reviewing the files of 150 patients who were referred to the Finnish Institute of Occupational Health in 2003 with a suspicion of an occupational cause of their asthma. The quality indicators used were assessment of workplace exposures, spirometric studies, bronchodilator response, serial workplace measurements of peak expiratory flow (PEF) and the time since first symptoms to the final diagnosis. For each indicator, criteria to differentiate between sufficient and insufficient care were developed. Results Exposure assessments, spirometric studies and bronchodilator responses were performed in 92, 87 and 79% of cases in the total study group, respectively. Workplace measurements of PEF had been performed in 51% of the cases, and the quality of measurements was sufficient in 52%. Workplace exposures had been assessed significantly more often in occupational health care than in other health care units. The median time from the beginning of symptoms to the final diagnosis was 3.2 years. Conclusions Although the diagnostic procedures were mostly of sufficient quality, the performance of serial measurements of PEF at the workplace and the time to diagnosis should be substantially improved.

Occupational exposure and sensitization to fungi among museum workers

Background Museum employees are exposed to fungi and storage mites in the workplace. Aims To evaluate the prevalence and risk factors of sensitization to moulds, as well as clinical symptoms associated with allergy in museum workers. Methods A total of 103 employees of the Polish National Museum (NM) in Warsaw, potentially exposed to fungi during their work, were assessed using a questionnaire and skin prick tests to common allergens and fungal extracts. The level of total and serum-specific IgE to moulds was evaluated, and spirometry was performed in all subjects. Mycological analysis of the workplace was also performed. Results Penicillium, Aspergillus, Cladosporium, Alternaria, Trichoderma, Acremonium and Paecilomyces were the most frequent species isolated from investigated exhibits of NM. Thirty per cent of museum employees were sensitized to at least one of the fungal allergens. Logistic regression analysis revealed that duration of occupational exposure lasting >5 years, family history of atopy, presence of a cat at home, sinusitis, allergic rhinitis and a history of frequent respiratory infections were risk factors for the development of sensitization to fungi in this working group. Conclusions This study suggests an important role of fungi as occupational allergens for museum workers. The prevalence of allergic symptoms among employees of NM was relatively high. Further studies are necessary to elucidate the importance of particular fungal species in the development of occupational allergy.

Occupational allergy to Artemia fish fry feed in aquaculture

Background Artemia (brine shrimp) is used as feed for fish fry and shrimp in aquaculture. Two employees in a Norwegian aquaculture research farm reported having chest symptoms when working in an Artemia hatch room. Aims To determine the presence and prevalence of Artemia sensitization at the farm and the extent of any Artemia-related respiratory and hand skin symptoms and to identify the allergens involved. Methods Participants completed a questionnaire and structured interview. Skin prick tests (SPTs) were performed, and immunoglobulin E (IgE) antibodies to Artemia, shrimp and recombinant tropomyosin were determined. Gel electrophoresis and immunoblots of Artemia extracts were also carried out. Results Thirty of 42 employees (71%) participated. Among the 24 subjects exposed to Artemia, four (17%) reported chest and/or hand skin symptoms during exposure and three of them were IgE sensitized to Artemia. Five (21%) of those exposed demonstrated IgE antibodies to Artemia and four (17%) had immediate-positive SPTs. A serum pool from these subjects exhibited IgE binding to a protein of ~97 kDa in the Artemia extract. Conclusions Occupational exposure to the Artemia fish fry feed can cause IgE sensitization and allergic symptoms affecting airways and skin.

Cutaneous and respiratory symptoms among professional cleaners

Background Occupational dermatitis is very common and has a large economic impact. Cleaners are at an increased risk for both work-related cutaneous and respiratory symptoms. Aims To compare the prevalence of occupational cutaneous symptoms among professional indoor cleaners to other building workers (OBW) and to determine associations with exposures and with respiratory symptoms among cleaners. Methods A questionnaire completed by indoor professional cleaners and OBW to compare rash and respiratory symptoms between these groups examined workplace factors such as training, protective equipment and work tasks. Results In total, 549 of the 1396 professional cleaners (39%) and 593 of the 1271 OBW (47%) completed questionnaires. The prevalence of rash was significantly higher in the cleaners compared to the OBW. For male cleaners, 21% (86/413) had a rash in the past 12 months compared to only 11% (13/115) of OBW (P < 0.05). The rashes experienced by the cleaners were more likely to be on their hands and worse at work. Cleaners washed their hands significantly more often than OBW. Cleaners with a rash were less likely to have received workplace training regarding their skin and were more likely to find the safety training hard to understand. Cleaners with a rash within the past year were significantly more likely to have work-related asthma symptoms than cleaners without a rash (P < 0.001). Conclusions This study demonstrates a strong link between work-related symptoms of asthma and dermatitis among cleaners. Effective preventive measures, such as the use of protective skin and respiratory equipment, should be emphasized.

Mortality in employees at a New Zealand agrochemical manufacturing site

Background Previous studies at the Dow AgroSciences (Formerly Ivon Watkins-Dow) plant in New Plymouth, New Zealand, had raised concerns about the cancer risk in a subset of workers at the site with potential exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin. As the plant had been involved in the synthesis and formulation of a wide range of agrochemicals and their feedstocks, we examined the mortality risk for all workers at the site. Aims To quantify the mortality hazards arising from employment at the Dow AgroSciences agrochemical production site in New Plymouth, New Zealand. Methods Workers employed between 1 January 1969 and 1 October 2003 were followed up to the end of 2004. Standardized mortality ratios (SMRs) were calculated using national mortality rates by employment duration, sex, period of hire and latency. Results A total of 1754 employees were followed during the study period and 247 deaths were observed. The all causes and all cancers SMRs were 0.97 (95% CI 0.85–1.10) and 1.01 (95% CI 0.80–1.27), respectively. Mortality due to all causes was higher for short-term workers (SMR 1.23, 95% CI 0.91–1.62) than long-term workers (SMR 0.92, 95% CI 0.80–1.06) and women had lower death rates than men. Analyses by latency and period of hire did not show any patterns consistent with an adverse impact of occupational exposures. Conclusions The mortality experience of workers at the site was similar to the rest of New Zealand.

Lung cancer mortality in arsenic-exposed workers from a cadmium recovery plant

Background There is evidence that arsenic is a late-stage human lung carcinogen. Aims To investigate lung cancer risks in a cohort of cadmium recovery workers in relation to period from ceasing exposure to arsenic. Methods The mortality experience (1940–2001) of a cohort of 625 male workers from a US cadmium recovery plant was compared with expectations based on US national mortality rates. Results There was a statistically significant (P < 0.05) negative trend in lung cancer standardized mortality ratios in relation to period from ceasing arsenic exposure. Conclusions The findings are consistent with the hypothesis that arsenic is a late-stage human carcinogen.

Pulmonary effects of spot welding in automobile assembly

Background Spot welding is a type of resistance welding in which pieces of metals are pressed together and an electric current is passed through them. Spot welders are at risk of contact with some potentially hazardous agents but there are few studies about the respiratory effects of spot welding. Aims Our objective was to study lung function and respiratory symptoms among spot welders and office workers at an automobile assembly factory in Iran. Methods This was a cross-sectional study of 137 male spot welders and 129 office workers. We used a questionnaire to record demographic data, smoking habits, work history and respiratory symptoms. Spirometry was performed to assess lung function status. Metal fume samples from the respiratory zone of spot welders were analysed. Results The concentrations of metal fume were less than the American Conference of Industrial Hygienists (ACGIH) threshold limit values. There were significantly lower values for average forced expiratory volume in 1st second (FEV1), FEV1/forced vital capacity and 25–75% forced expiratory flow in spot welders compared to controls. There was also a significantly raised prevalence of respiratory symptoms (sputum and dyspnoea) in spot welders. Fifteen per cent of spot welders and 1% of controls had an obstructive pattern in spirometry. Conclusions Our survey suggests that spot welders are at risk of developing respiratory symptoms and decreasing pulmonary function values despite their exposure to components of welding fume being within ACGIH guidelines.

IgE-mediated chlorhexidine allergy: a new occupational hazard?

Background Chlorhexidine is an effective antimicrobial agent commonly used in UK hospitals, primarily for skin decontamination. Recent UK infection control guidelines recommend the use of 2% chlorhexidine solution in specific clinical settings, thus increasing chlorhexidine use by health care workers (HCWs). Chlorhexidine has been widely reported to cause IgE-mediated allergic reactions (from urticaria and angioedema to anaphylaxis) among patients undergoing surgery/invasive procedures. Despite its widespread use in health care settings, there are no reports of clinically confirmed occupational IgE-mediated chlorhexidine allergy. Aims To identify cases of chlorhexidine allergy among health care workers. Methods A questionnaire was distributed among HCWs in wards and operating theatres at a UK district general hospital to raise awareness of potential chlorhexidine allergy and to invite those with possible clinical allergy to come forward for further testing. Diagnosis was based on an appropriate clinical history with positive serum-specific IgE to chlorhexidine and/or positive skin prick testing. Results Four cases of occupational IgE-mediated allergy to chlorhexidine were identified. Conclusions Despite its excellent antimicrobial properties, chlorhexidine is an occupational allergen. We suggest that chlorhexidine allergy be included in the differential diagnosis of HCWs presenting with work-related allergic symptoms. Increased awareness and easier access to chlorhexidine-specific IgE serological testing should facilitate early diagnosis of affected HCWs, allowing appropriate avoidance measures to be instigated—thus reducing the risk of potentially severe allergic reactions in the future.

Factors associated with farmers joining occupational health services

Background Agriculture is one of the most hazardous occupations in the world. The aim of an occupational health service (OHS) is to reduce the risk of work-related diseases, occupational diseases and injuries and to promote workers’ health. In Finland, they are part of the public health care system, but for farmers OHS is voluntary. Aims To explore factors associated with farmers joining farmers’ occupational health services (FOHS). This knowledge is important for improving the coverage of FOHS and to motivate farmers to join. Methods In 2004 and 2005, we interviewed a total of 1182 full-time farmers aged 18–64, chosen randomly from the register of the Information Centre of the Ministry of Agricultural and Forestry in Finland (Tike). A stepwise multivariate logistic regression model was used to calculate odds ratios and their 95% confidence intervals for factors associated with their joining FOHS. Results Among both genders, chronic illnesses, farm size and opinion on whether membership of FOHS should be obligatory were predictors of farmers joining FOHS. Among male farmers, the production sector, the existence of a quality system on the farm and vocational education were associated with interest in joining. Among female farmers, interest was associated with physical activity. Conclusions Emphasizing FOHS constitutes a preventive approach. All farmers should be motivated by FOHS to become aware of issues concerning safety and health at work. The potential channels for increasing its awareness are vocational education, quality systems and support from farmers who are already members.

Occupational asthma and the paper recycling industry

Background Occupational disease linked to the paper recycling industry has not been well documented. No previously confirmed formal diagnosis of occupational asthma (OA) caused by hydroxylamine has been made. Methods We have assessed and performed occupational assessment of eight workers involved in this industry. Two of these were later diagnosed with OA and are reported here. Results Both workers developed their respiratory symptoms within 2 years of the first use of the chemical hydroxylamine as part of the ‘de-inking’ process. Hydroxylamine was used as a substitute for glutaraldehyde on risk grounds, although no prior cases of OA had been found. The two workers had worked at the same plant for 11 and 20 years, respectively. Both gave histories of work-related wheeze, shortness of breath and cough. Both cases performed OASYS peak flow records over a 3-week period and had OASYS II index of 2.85 and 2.67, respectively. Both were redeployed on site to non-exposed areas and subsequently demonstrated improvement in bronchial reactivity. Case 2 subsequently consented to and underwent a blinded, placebo-controlled occupational challenge using hydroxylamine demonstrating a significant isolated late asthmatic response. Conclusions We believe that these are the first two confirmed cases of OA caused by hydroxylamine in the paper recycling industry.

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Attributable risk of carpal tunnel syndrome in the general population: implications for intervention programs in the workplace.

Related Articles Attributable risk of carpal tunnel syndrome in the general population: implications for intervention programs in the workplace. Scand J Work Environ Health. 2009 Jul 2; Authors: Roquelaure Y, Ha C, Fouquet N, Descatha A, Leclerc A, Goldberg M, Imbernon E OBJECTIVE: Carpal tunnel syndrome (CTS) represents one of the most significant and costly health problems occurring in the working population. An estimation of the potential impact of CTS prevention programs in the workplace would be useful for public policy. The aim of this study was to assess the work-related population-attributable fraction (PAF) of CTS in industrial sectors and occupational categories at high risk of CTS in the general population. METHODS: All cases of CTS occurring in patients living in a French region were included prospectively between 2002-2004. Using a mailed questionnaire, we gathered medical and occupational history from 815 women and 320 men. We calculated the age-adjusted relative risks and PAF of CTS in relation to industrial sectors and occupational categories. RESULTS: The PAF for women was higher in lower-grade, white-collar workers (24%, 95% CI 19-29) than blue-collar workers (19%, 95% CI 15-22). The PAF was higher for the service industries sector (16%, 95% CI 8-22) than manufacturing (10%, 95% CI 7-13) or agricultural (5%, 95% CI 3-7) sectors. The PAF was high for men in blue-collar workers (50%, 95% CI 41-57) and in the construction (13%, 95% CI 9-18) and manufacturing industries (17%, 95% CI 10-23). CONCLUSION: The study suggested that 5-50% of CTS cases might be avoided in the whole population if totally effective intervention programs were implemented in specific occupational categories or industrial sectors. PMID: 19572088 [PubMed - as supplied by publisher]

How Safe is Control Banding? Integrated Evaluation by Comparing OELs with Measurement Data and Using Monte Carlo Simulation

The present study aims to explore the protection level that can be achieved by the German control banding (CB) tool Einfaches Massnahmenkonzept Gefahrstoffe, ‘Easy-to-use workplace control scheme for hazardous substances’. The rationale of our integrated approach is based on the Bewertungsindex (BWI), which is the quotient of the exposure level and the occupational exposure limit (OEL), with BWI <1 indicating compliance. The frequency distributions of the BWI were calculated in order to reflect statistically the variability of workplace conditions. The corresponding statistical values of the frequency distributions (percentiles etc.) are interpreted as an indicator of the level of protection that is achieved. The occupational exposure data sets used in the calculation of the BWI frequency distribution were mainly collected from Bundesanstalt für Arbeitsschutz und Arbeitsmedizin field studies. The data sets taken into account were selected according to the criteria ‘hazard band, exposure potential, control approach’. Such a combination is called the ‘control banding scenario’ (CBS). Measurement data are only available for two CBS: in the case of the CBS ‘hazard band A, EPL3, CS1’ the only data that are available (n = 220) relate to propane-2-ol as used in the area of offset printing. Only 0.4 % of the BWI are above 1, this indicating a high level of compliance. In the case of the CBS ‘Hazard band B, EPL2, CS1’, exposure data are available from screen-printing firms (n = 50), optician workshops (n = 49), and from the area of furniture production (n = 13). The frequency distributions of the BWI reveal almost no instances of values being exceeded in the three branches. In a subsequent step, a Monte Carlo Simulation was employed to explore whether the BWI frequency distributions can be generalized using a probabilistic model. The frequency distributions of the exposure levels and the OELs were used as the input data for the model. The simulation results show that the model distribution, called Modellierter Bewertungsindex distribution, can reproduce the BWI distribution if the data basis is homogeneous (data from one branch) and less correlated. In case of a heterogeneous data set (pooled data from different branches), the simulation results can be interpreted as generic statements about the attainable protection level. It was found that CB does not (at least potentially) guarantee compliance in either case. On the other hand, the generic simulation showed that compliance was high for volatile liquids used in closed systems (CBS: ‘hazard band C, EPL3, CS3’) and for solids in the presence of local exhaust ventilation (CBS: ‘hazard band B, EPS3, CS2’).

Evaluation of COSHH Essentials: Methylene Chloride, Isopropanol, and Acetone Exposures in a Small Printing Plant

The current study evaluated the Control of Substances Hazardous to Health (COSHH) Essentials model for short-term task-based exposures and full-shift exposures using measured concentrations of three volatile organic chemicals at a small printing plant. A total of 188 exposure measurements of isopropanol and 187 measurements of acetone were collected and each measurement took ~60 min. Historically, collected time-weighted average concentrations (seven results) were evaluated for methylene chloride. The COSHH Essentials model recommended general ventilation control for both isopropanol and acetone. There was good agreement between the task-based exposure measurements and the COSHH Essentials predicted exposure range (PER) for cleaning and print preparation with isopropanol and for cleaning with acetone. For the other tasks and for full-shift exposures, agreement between the exposure measurements and the PER was either moderate or poor. However, for both isopropanol and acetone, our findings suggested that the COSHH Essentials model worked reasonably well because the probabilities of short-term exposure measurements exceeding short-term occupational exposure limits (OELs) or full-shift exposures exceeding the corresponding full-shift OELs were <0.05 under the recommended control strategy. For methylene chloride, the COSHH Essentials recommended containment control but a follow-up study was not able to be performed because it had already been replaced with a less hazardous substance (acetone). This was considered a more acceptable alternative to increasing the level of control.

Ultrafine Particle Characteristics in Seven Industrial Plants

Ultrafine particles are considered as a possible cause of some of the adverse health effects caused by airborne particles. In this study, the particle characteristics were measured in seven Swedish industrial plants, with a special focus on the ultrafine particle fraction. Number concentration, size distribution, surface area concentration, and mass concentration were measured at 10 different job activities, including fettling, laser cutting, welding, smelting, core making, moulding, concreting, grinding, sieving powders, and washing machine goods. A thorough particle characterization is necessary in workplaces since it is not clear yet which choice of ultrafine particle metric is the best to measure in relation to health effects. Job activities were given a different order of rank depending on what particle metric was measured. An especially high number concentration (130 x 103 cm–3) and percentage of ultrafine particles (96%) were found at fettling of aluminium, whereas the highest surface area concentration (up to 3800 µm2 cm–3) as well as high PM10 (up to 1 mg m–3) and PM1 (up to 0.8 mg m–3) were found at welding and laser cutting of steel. The smallest geometric mean diameter (22 nm) was found at core making (geometric standard deviation: 1.9).

Exposure to Hazardous Substances in a Standard Molecular Biology Laboratory Environment: Evaluation of Exposures in IARC Laboratories

Working in a molecular biology laboratory environment implies regular exposure to a wide range of hazardous substances. Several recent studies have shown that laboratory workers may have an elevated risk of certain cancers. Data on the nature and frequency of exposures in such settings are scanty. The frequency of use of 163 agents by staff working in molecular biology laboratories was evaluated over a period of 4 years by self-administered questionnaire. Of the agents listed, ethanol was used by the largest proportion of staff (70%), followed by ethidium bromide (55%). Individual patterns of use showed three patterns, namely (i) frequent use of a narrow range of products, (ii) occasional use of a wide range of products, and (iii) frequent and occasional use of an intermediate range of products. Among known or suspected carcinogens (International Agency for Research on Cancer Group 1 and 2A, respectively), those most frequently used included formaldehyde (17%), oncogenic viruses (4%), and acrylamide (32%). The type of exposure encountered in research laboratories is extremely diverse. Few carcinogenic agents are used frequently but many laboratory workers may be exposed occasionally to known human carcinogens. In addition, many of the chemicals handled by staff represent a health hazard. The results enabled the staff physician to develop an individual approach to medical surveillance and to draw a personal history of occupational exposures for laboratory staff.

Role of Associated Mineral Fibres in Chrysotile Asbestos Health Effects: The Case of Balangeroite

Objectives: To evaluate the biodurability of balangeroite, present as contaminant of chrysotile asbestos in the Balangero mine, in order to have indication whether it might have been a confounding factor in the association of the mesothelioma cases reported among mine workers and employees. Methods: The modifications taking place following incubation of the fibres in simulated phagolysosomal fluids have been measured on balangeroite, on one pure chrysotile sample (Val Malenco), on one chrysotile from Balangero with some associated balangeroite, and on two tremolite samples. Results: The incubation modifies both chrysotile and balangeroite with substantial release in the medium of the metal ions which occupy the octahedral site in the mineral structure of the fibre while tremolite is virtually unaffected. Conclusions: Considering the profound differences between the structure of balangeroite and amphiboles, previous results and observations on the poor ecopersistence of balangeroite, and the present data, we conclude that balangeroite traces may contribute to the overall toxicity of the airborne fibres in Balangero, but may not be compared to tremolite nor considered the sole responsible for the excess of mesothelioma found in Balangero.

A Survey of Occupational Exposure to 4,4'-methylene-bis (2-chloroaniline) (MbOCA) in the UK

Objectives: The main objective of the study was to gather information about the current controls and levels of exposure to 4,4'-methylene-bis (2-chloroaniline) (MbOCA) in a representative cross section of workplaces that use it to manufacture polyurethane elastomers. The study also aimed to investigate whether controls and guidance could be improved and to investigate exposure to isocyanates in these workplaces using biological monitoring. Methods: An occupational hygienist and a field scientist visited the two UK suppliers and 20 out of the 25 workplaces known to be using MbOCA in the UK during 2005 and 2006. They collected air samples, surface wipes, gloves, and urine samples and made observations to assess exposure and the adequacy of controls. All samples were analysed for MbOCA and urine samples were additionally analysed for isocyanate metabolites. A statistical analysis was made of the results. Results: Only 2.5% of the 80 personal inhalation exposures to MbOCA exceeded the workplace exposure limit of 5 µg m–3 8-h time-weighted average and 84% were below the limit of detection (LOD). Surface samples (n = 334) were collected from MbOCA users and suppliers and 60% had detectable levels of MbOCA ranging from 0.019 to 400 µg cm–2. The highest levels were around a hopper, ovens, and the weighing and pouring areas. MbOCA was also detected in 8 of the 75 samples collected from areas not likely to be in contact with MbOCA. At the two suppliers, samples (n = 28) were collected from the outside surfaces of recently imported kegs, pallets, and the floor around kegs. Six samples had detectable levels and four of these (0.2, 0.8, 1, and 6 µg cm–2) were from the floor and pallets in both suppliers. The other two positive results were found on the outside rim (18 µg cm–2) and side (23 µg cm–2) of a keg at one supplier indicating contamination by the manufacturer. Urine samples (n = 79) were collected and 49% were below the LOD for MbOCA and only three samples had levels of MbOCA that exceeded the biological monitoring guidance value (BMGV) of 15 µmol mol–1 creatinine. The highest urinary MbOCA concentrations were in samples from workers casting and moulding. The 90th percentile of the urine MbOCA results was 8.6 µmol MbOCA per mol creatinine. Urine samples were also analysed for the diamine metabolites of toluene diisocyanate and hexamethylene diisocyanate and 33% had detectable levels with 22 and 13% of results, respectively, above the BMGV for isocyanates (1 µmol isocyanate-derived diamine per mol creatinine). The maximum urinary concentration of toluene diamine and hexane diamine were 15.6 and 10.1 µmol mol–1 creatinine, respectively. Conclusions: The survey found that the measures used to control exposure to MbOCA could be improved. Although air levels of MbOCA were generally low, there was evidence of spread of surface contamination and poor maintenance of controls such as local exhaust ventilation. A BMGV based on the 90th percentile of data from workplaces with good control would be less than the 90% value of 8.6 µmol mol–1 creatinine found in this study and suggests that the current BMGV of 15 µmol mol–1 creatinine is no longer acting as a stimulus to reduce exposure. The metabolites of isocyanates found in urine samples in this study could arise from inhalation exposure to isocyanates or from dermal exposure to either isocyanates or their diamine breakdown product and need further investigation.

Sampling Strategies for Occupational Exposure Assessment under Generalized Linear Model

Objectives: Occupational exposure assessment is a major task in industrial hygiene studies. Although statistical analyses for magnitudes and variations of exposures to various types of working populations based on existing data sets are extensive, relatively few discussions on study designs appear in the literature, especially for sample size determination and number of repeated measurements. Methods: In this paper, we propose a general framework of sampling strategies on sample size requirement together with the number of repeated measurements using the mixed-effects generalized linear model (GLM). As illustrative examples, we discuss sampling strategies separately under the log-normal assumption for hypotheses testing on (i) mean exposure differences of multiple worker groups and (ii) presence of a long-term exposure trend. Results: Given a specified alternative hypothesis, the desired significance level and statistical power, the number of repeated measurements, within-worker and between-worker variances, and a correlation structure, we have derived and tabulated an explicit sample size requirement of the two hypothetical cases under log-normal distribution assumption. Conclusions: On the basis of the tabulated outcomes, the sample size requirement is much more dominant than the number of repeated measurements for a group exposure comparison. Thus, in this case, recruiting more workers with fewer repeated measurements may be more economical than the opposite approach. For testing the presence of a long-term exposure trend, the sample size required decreases substantially with the number of repeated measurements. Also, equally spaced sampling times would be optimal because the effect of between-worker variance is algebraically cancelled out in sample size calculations.

The Evaluation of CBRN Canisters for Use by Firefighters during Overhaul

Air-purifying respirators (APRs) have been proposed to provide an additional respiratory protection option for structural firefighters involved in overhaul operations and wildland firefighters, where particulate and aldehyde exposures have been documented. Previous studies (Anthony et al., 2007) developed test methods to evaluate APR cartridges and canisters for use in overhaul activities, where initial findings indicated that multi-gas cartridges may not be effective. This study evaluated the performance of three chemical, biological, radiological, and nuclear (CBRN) canisters (MSA, 3M, and Scott) and one multi-gas canister similar in appearance to CBRN canisters but without CBRN certification (3M FR-64040). Challenge concentrations typical of overhaul exposures were generated by combusting common household materials. Twelve tests were conducted, using random canister selection, where challenge air and air filtered by the canisters were tested. All tests examined penetration of CO; NO2; SO2; respirable dust; aldehydes, including formaldehyde, acrolein, and glutaraldehyde; and hydrogen cyanide. Six of the tests also investigated naphthalene, benzene, and hydrogen chloride, but challenge concentrations from the simulated overhaul smoke were near the limit of detection (LOD) and were two orders of magnitude below short-term or ceiling concentrations of concern and were eliminated from further study with the combustion materials used in this study. In all tests, an irritant index was computed to evaluate the aggregate penetration of contaminants in the smoke mixture, using 15- and 30-min occupational exposure limits as well as assessing individual penetrations. In all cases, the challenge concentration irritant index exceeded unity, ranging from 2.3 to 21. For all 12 tests, the APR canister reduced the overall irritant index to levels below unity, indicating that these canisters would provide protection for firefighters working in overhaul environments. However, in some tests, levels of carbon monoxide were higher than recommended for persons wearing APRs. Since these canisters do not protect against carbon monoxide, firefighters must still rely on direct reading warning to indicate high CO levels, indicating the need to leave the area if wearing an APR, as these APR canisters would be inappropriate.

Vibrotactile Perception and Effects of Short-Term Exposure to Hand-Arm Vibration

This study clarifies whether the established frequency weighting procedure for evaluating exposure to hand-transmitted vibration can effectively evaluate the temporary changes in vibrotactile perception thresholds due to pre-exposure to vibration. In addition, this study investigates the relationship between changes of the vibrotactile perception thresholds and the normalized energy-equivalent frequency-weighted acceleration. The fingers of 10 healthy subjects, five male and five female, were exposed to vibration under 16 conditions with a combination of different frequencies, intensities, and exposure times. The vibration frequencies were 31.5 and 125 Hz and exposure lasted between 2 and 16 min. According to International Organization for Standardization (ISO) 5349-1, the energy-equivalent frequency-weighted acceleration for the experimental time of 16 min is 2.5 or 5.0 m s–2 root-mean-square, corresponding to a 8-h equivalent acceleration, A(8), of ~0.5 and 0.9 m s–2, respectively. A measure of the vibrotactile perception thresholds was conducted before the different exposures to vibration. Immediately after the vibration exposure, the acute effect was measured continuously on the exposed index finger for the first 75 s, followed by 30 s of measures every minute for a maximum of 10 min. If the subject's thresholds had not recovered, the measures continued for a maximum of 30 min with measurements taken every 5 min. Pre-exposure to vibration significantly influenced vibrotactile thresholds. This study concludes that the influence on the thresholds depends on the frequency of the vibration stimuli. Increased equivalent frequency-weighted acceleration resulted in a significant change in threshold, but the thresholds were unaffected when changes in the vibration magnitude were expressed as the frequency-weighted acceleration or the unweighted acceleration. Moreover, the frequency of the pre-vibration exposure significantly influenced (up to 25 min after exposure) recovery time of the vibrotactile thresholds. This study shows that the frequency weighting procedure in ISO 5349-1 is unable to predict the produced acute changes in the vibrotactile perception. Moreover, the results imply that the calculation of the ‘energy-equivalent’ frequency-weighted acceleration does not reflect the acute changes of the vibration perception thresholds due to pre-exposure to vibration. Furthermore, when testing for the vibrotactile thresholds, exposure to vibration on the day of a test might influence the results. Until further knowledge is obtained, the previous practice of 3 h avoidance of vibration exposure before assessment is recommended.

NIOSH Definition of Closed-System Drug-Transfer Devices