Showing papers in "American Journal of Industrial Medicine in 2004"

Occupational fatalities of Hispanic construction workers from 1992 to 2000.

Abstract: Background Hispanic construction employment has dramatically increased, yet published data on occupational risk is lacking. Methods Data from the Census of Fatal Occupational Injuries (CFOI) and current population survey (CPS) were examined from 1992 to 2000. Fatality rate, relative risk (RR), and risk index were calculated using CFOI fatality data and CPS data on hours worked, adjusted to full-time-equivalents (FTE). Data between 1996 and 2000 were combined to allow reliable comparisons of age and occupational groups. RR and 95% confidence intervals were calculated. Results In 2000, Hispanics constituted less than 16% of the construction workforce yet suffered 23.5% of fatal injuries. RRs were: helpers, construction trades, 2.31 (95% CI: 1.41–3.80); roofers 1.77 (95% CI: 1.38–2.28); carpenters 1.39 (95% CI: 1.08–1.79); and construction laborers 1.31 (95% CI: 1.17–1.46). Conclusions Hispanic construction workers consistently faced higher RRs, for every year from 1992 to 2000 and for every age group. In 2000, Hispanic construction workers were nearly twice (1.84, 95% CI: 1.60–2.10) as likely to be killed by occupational injuries as their non-Hispanic counterparts. Am. J. Ind. Med. 45:45–54, 2004. © 2003 Wiley-Liss, Inc.

Blood and body fluid exposure risks among health care workers: results from the Duke Health and Safety Surveillance System.

Abstract: Background Health care workers (HCWs) are at risk of exposures to human blood and body fluids (BBF) Needlestick injuries and splashes place HCWs at risk for numerous blood-borne infections including human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) Utilizing a new comprehensive occupational health surveillance system, the objective of this research was to better define the BBF exposure risk and risk factors among employees of a large tertiary medical center Methods A population of 24,425 HCWs employed in jobs with potential BBF exposures was followed for BBF exposure events from 1998 to 2002 BBF exposure rates were calculated for strata defined by age, race, gender, occupation, work location, and duration of employment Poisson regression was used for detailed analyses of risk factors for BBF exposure Results The study population reported 2,730 BBF exposures during the study period, resulting in an overall annual rate of 55 events/100 FTEs and a rate of 39 for percutaneous exposures Higher rates were observed for males, persons employed less than 4 years, Hispanic employees, and persons less than 45 years of age Much higher rates were observed for house staff, nurse anesthetists, inpatient nurses, phlebotomists, and surgical/operating room technicians Poisson regression results strengthened and extended results from stratified analyses Rates of percutaneous exposures from hollow needles were found to decrease over the study period; however, exposure rates from suture needles appear to be increasing Conclusion While continued training efforts need to be directed toward new HCWs, our data also suggest that employees who have been in their job 1–4 years continue to be at higher risk of BBF exposures This research also points to the need for better safety devices/products and work practices to reduce suture-related injuries Am J Ind Med 46:637–648, 2004 © 2004 Wiley-Liss, Inc

Elbow and wrist/hand symptoms among 6,943 computer operators: a 1-year follow-up study (the NUDATA study).

Abstract: Background The aim of this study was to examine relations between computer work aspects and elbow and wrist/hand pain conditions and disorders. Methods In a 1-year follow-up study among 6,943 technical assistants and machine technicians self-reported active mouse and keyboard time, ergonomic exposures and associations with elbow and wrist/hand pain were determined. Standardized clinical examinations were performed among symptomatic participants at baseline and at follow-up. Results For continuous duration of mouse time adjusted linear effects were statistically significant for all investigated pain conditions. For continuous duration of keyboard time the corresponding effects were statistically significant for wrist/hand pain conditions except incident ‘severe’ wrist/hand pain. There were no threshold effects above 0 hr per week (hr/w) of mouse exposure in association with pain conditions, while keyboard exposure showed a threshold effect with 12-month wrist/hand pain at follow-up. Clinical diagnoses were not associated with exposure. Conclusions Detailed examination of self-reported exposures showed that mouse and keyboard time predicted elbow and wrist/hand pain from low exposure levels without a threshold effect, but mouse and keyboard time were not predictors of clinical conditions. Am. J. Ind. Med. 46:521–533, 2004. © 2004 Wiley-Liss, Inc.

Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: findings from the Health and Retirement Survey.

Abstract: Involuntary job loss in the years immediately preceding retirement can be a stressful event that has been shown to be associated with adverse health and behavioral consequences [Gallo et al., 2000, 2001]. Older workers are at increased risk for negative outcomes for a number of reasons. First, workers nearing retirement age are often ill prepared to finance post-employment consumption [Bernheim, 1997]. Second, high pre-displacement wages and non-portable experience may limit reemployment opportunities, resulting in extended unemployment spells [Fallick, 1996; Farber, 1996; Polsky, 1999; Chan and Stevens, 2001]. Research also indicates that the wages of older workers are significantly reduced upon reemployment [Couch, 1998]. Finally, older individuals also have a greater burden of preexisting financial, social, and medical factors than do younger individuals. Given substantial epidemiologic evidence indicating the significant role of stress in cardiovascular diseases [Dorian and Taylor, 1984; Rozanski et al., 1999; Kubzansky and Kawachi, 2000], it is plausible that workers who experience involuntary job loss may be at increased risk of such diseases, including myocardial infarction (MI) and stroke. For many older individuals, involuntary job loss is not only associated with a substantial loss of income, but also the severance of work-based social interactions [Iversen and Klausen, 1986] and the stigma of unemployment, which may produce stress. Such stress may, in turn, lead to negative emotions, such as anxiety and depression. Recent reviews of published research [Rozanski et al., 1999; Kubzansky and Kawachi, 2000] conclude that chronic states of anxiety and prolonged depression are consistently associated with elevated risk of coronary heart disease (CHD) events, including both fatal and non-fatal MI. A number of studies have investigated the relationship between national unemployment rates and the prevalence of various health outcomes related to cardiovascular risk. This research, which was conducted on populations rather than on individuals, has revealed significant associations between unemployment and cardiovascular mortality [Jin et al., 1995; Weber and Lehnert, 1997] and cerebrovascular mortality [Brenner, 1983; Ahmed et al., 1989; Franks et al., 1991]. However, such ecologic studies present aggregate data, and thus cannot confirm that job loss increases cardiovascular disease in individuals. At the individual level, both cross-sectional and longitudinal studies of the association between unemployment and cardiovascular and cerebrovascular disease have been undertaken. The cross-sectional research [Cook et al., 1982; Iversen et al., 1987; Martikainen, 1990; Brackbill et al., 1995] has found modestly increased prevalence of CHD [Cook et al., 1982], cardiovascular symptoms [Iversen et al., 1987], prevalence of hypertension [Brackbill et al., 1995], and cardiovascular and cerebrovascular mortality [Martikainen, 1990] among unemployed versus employed workers. The longitudinal research is limited to four relevant studies [Kasl and Cobb, 1980; Iversen et al., 1989; Janlert, 1992; Schnall et al., 1992], and has reported mixed results. In a Danish study of 880 laid-off shipyard workers and 441 controls from another shipyard where no layoffs occurred, Iversen et al. [1989] found among the laid-off workers higher rates of hospital admissions for cardiovascular diseases in a 3-year follow-up period. In a study of 297 laid-off Swedish building laborers, Janlert [1992] reported that those who remained unemployed within the 2-year follow-up had significantly increased blood pressure over the follow-up period relative to reemployed workers. In contrast, the remaining longitudinal studies [Kasl and Cobb, 1980; Schnall et al., 1992], both conducted in the United States, found less evidence of an association between job loss and subsequent cardiovascular risk. Studying workers displaced in a plant closing, Kasl and Cobb [1980] reported that, while blood pressure was modestly increased during the anticipation phase prior to plant closing, this increase did not persist after termination. Schnall et al. [1992], in a study of 139 laid-off employees from a brokerage firm, found limited support for increased blood pressure levels in the anticipation phase, as reported by Kasl and Cobb [1980], but discovered no evidence of a persistent elevation in these levels. The authors of a recent, comprehensive review of the literature [Weber and Lehnert, 1997] have concluded that job loss should not be viewed as a risk factor for poor cardiovascular outcomes. There are several reasons why the existing research leaves our understanding of the relationship between involuntary job loss and cardiovascular/cerebrovascular disease limited. First, much of the evidence is ecologic, and thus does not represent the experience of individuals. Second, while several studies indicate a cross-sectional association between unemployment and cardiovascular disease, the causal direction of these associations cannot be inferred. Third, longitudinal studies, whose methodology is better suited to assess any causal relationship, are few, and offer somewhat contrary findings. Fourth, each of the relevant longitudinal studies of involuntary job loss and cardiovascular risk examined a relatively small, selected group of younger individuals, and with one exception [Iversen et al., 1989], assessed changes in blood pressure and serum cholesterol rather than MI or stroke. Moreover, just two of the longitudinal studies [Kasl and Cobb, 1980; Schnall et al., 1992] were conducted in the United States, and none studied older workers. And finally, we could find no study that examined the influence of involuntary job loss on the onset of specific cardiovascular or cerebrovascular outcomes, such as subsequent MI or stroke, as we do in this research. The objective of this study is to estimate the risk of onset of MI and of stroke associated with involuntary job loss among workers nearing retirement relative to individuals who continue to work. This is a companion study to our earlier studies investigating the impact of job loss on subsequent physical functioning and mental health [Gallo et al., 2000], and subsequent alcohol consumption [Gallo et al., 2001].

Exposure variability: concepts and applications in occupational epidemiology.

Abstract: Background Standard approaches to assessing exposures forepidemiologic studies tend to concentrate resources on obtaining detailed data for each study participant at the expense of characterizing within-person variability. Methods This paper presents some basic, generalizeable concepts concerning exposure anditsvariability,describesmethodsthatcanbeusedtoanalyze,describe,andunderstand that variability, and reviews related implications for the design and interpretation of epidemiologic studies. Results and Conclusions Insufficient attention to the balance of within- and betweenperson variation in exposure can reduce the efficiency of measurement efforts and attenuateestimatesofexposure-diseaseassociation.Exposurevariabilityshouldconsequently be considered carefully in the planning, analysis, and interpretation of epidemiologic studies.Greaterattentiontothesematterscanleadtomoremeaningfulcharacterizationof exposureitself,and,mostimportantly,improvethechancesthatepidemiologicstudiescan identify and accurately characterize healthhazards. Am. J. Ind. Med. 45:113–122, 2004. 2003 Wiley-Liss, Inc.

Co‐worker fatalities from hydrogen sulfide

Abstract: Background Hydrogen sulfide is a colorless, odorless gas that may cause rapid loss of consciousness and respiratory depression without warning It has produced toxicity in workers in numerous industries and occupations Methods A review of the United States Bureau of Labor Statistics (USBLS) Census of Fatal Occupational Injuries (CFOI) for occupational deaths related to hydrogen sulfide from 1993 to 1999 was performed Results Fifty-two workers died of hydrogen sulfide toxicity in this 7-year period Deaths were most commonly reported in workers who were white (85%), male (98%), and in their first year of employment with the company (48%) Common industries included waste management, petroleum, and natural gas In 21% of cases, a co-worker died simultaneously or in the attempt to save the workers Conclusions Hydrogen sulfide toxicity is uncommon, but potentially deadly Toxicity is predominantly in new workers and co-worker fatalities occur in a significant minority of cases Proper training and education on the warning signs of hydrogen sulfide toxicity may help reduce worker fatalities Am J Ind Med 45:346–350, 2004 © 2004 Wiley-Liss, Inc

Relationships between certain individual characteristics and occupational injuries for various jobs in the construction industry: a case-control study.

Abstract: Background There is little published about the role of individual characteristics in occupational injuries. Construction workers have a high rate of injury; we assessed 11 personal characteristics in this professional sector. Methods A case-control study was conducted on 880 male workers who had had at least one occupational injury during a 2-year period and 880 controls. A questionnaire was administered by an occupational physician. Statistical analysis was made via logistic regression method. Results Young age (<30 years), sleep disorders and current smoker influenced all the injuries combined. Sleep disorders and young age were common risk factors for several jobs. Physical disabilities and no sporting activity had a role in masons, and 5 years or less in present job in plumbers and electricians only. Sleep disorders influenced both the injuries with and without hospitalization; young age, current smoker, and physical disability influenced those without hospitalization only. Conclusions Young age, sleep disorders, smoking, disabilities, sporting activity, and experience influenced the occupational injuries. The risk for each worker depended on his job. Occupational physicians could inform the workers of these risks and encourage them to take remedial action. Am. J. Ind. Med. 45:84–92, 2004. © 2003 Wiley-Liss, Inc.

Acute occupational pesticide-related illness in the US, 1998-1999: surveillance findings from the SENSOR-pesticides program.

Abstract: Background Concern about the adverse public health and environmental effects of pesticide use is persistent. Recognizing the importance of surveillance for acute occupational pesticide-related illness, we report on surveillance for this condition across multiple states. Methods Survey data collected between 1998 and 1999 were obtained from the seven states that conduct acute occupational pesticide-related illness surveillance as part of the SentinelEventNotificationSystemforOccupationalRisks(SENSOR)program.Datawere collected by these state programs in a standardized manner and analyzed. Acute occupational pesticide-related illness incidence rates for those employed in agriculture and those employed in non-agricultural industries were also calculated. Results Between 1998 and 1999, a total of 1,009 individuals with acute occupational pesticide-related illness were identified by states participating in the SENSOR-pesticides program. The mean age was 36 years, and incidence rates peaked among 20‐24 year-old workers.Theoverallincidenceratewas1.17per100,000fulltimeequivalents(FTEs).The incidence rate among those employed in agriculture was higher (18.2/100,000 FTEs) compared to those employed in non-agricultural industries (0.53/100,000 FTEs). Most of the illnesses were of low severity (69.7%). Severity was moderate in 29.6% of the cases, and high in four cases (0.4%). Three fatalities were identified. Insecticides were responsible for 49% of all illnesses. Conclusions Surveillance is an important tool to assess acute pesticide-related illness, andtoidentifyassociatedriskfactors.Ourfindingssuggestthattheseillnessescontinueto be an important occupational health problem, especially in agriculture. As such, greater effortsareneededtopreventacuteoccupationalpesticide-relatedillness. Am. J. Ind. Med.

The Workers' Compensation System: Worker friend or foe?

Abstract: Background The workers' compensation system was designed to help injured workers who have substantial medical expenses and perhaps have lost a great deal of income. This study determines both similarities and differences in how workers experience their interactions with the workers' compensation systems in Florida and Wisconsin. Methods Ethnographic open-ended interviews with 204 workers from Florida and 198 workers in Wisconsin were conducted. All the workers had back injuries in 1990 and were either paid workers' compensation temporary disability benefits for at least 4 weeks or received permanent disability benefits or compromise settlements. Results Some interactions with the workers' compensation system were positive. However, the majority of respondents in both states experienced their encounters with the workers' compensation system as cumbersome, frustrating, and demeaning. Conclusions Mistrust, stigmatization, payment delays, and refusal of insurer personnel to pay benefits contribute to workers' negative experiences with the workers' compensation system. These insurer behaviors raise the costs to injured workers of workers' compensation benefits and thus may reduce the propensity of eligible workers to apply for benefits. Am. J. Ind. Med. 45:338–345, 2004. © 2004 Wiley-Liss, Inc.

Polyisocyanates in Occupational Environments: A Critical Review of Exposure Limits and Metrics

Abstract: Background Determination of polyisocyanates is important because they are a major contributorofexposuretotheisocyanatefunctionalgroupinmanyworkplaceenvironments and are capable of inducing sensitization and asthma. However, with multiple different measurement metrics in use, comparison of isocyanate exposure data between studies and development of occupational exposure limits (OELs) for polyisocyanates is difficult. Methods An analysis of existing problems in the measurement and regulation of isocyanates is presented based on the published analytical, toxicological, and regulatory literature, and the authors’ own analytical data and experience with isocyanates. Results This analysis supports a need for standardization of isocyanate measurement metrics and provides a framework for the development of an OEL for polyisocyanates. Conclusions Thetotalisocyanategroup(mgNCO/m 3 )isrecommendedasthemostfeasible and practical metric (unit) by which to express polyisocyanate exposures for research, control, and regulatory purposes. The establishment of a comprehensive isocyanate OEL that simplifies the current agent-by-agent approach and expands coverage to polyisocyanates is also recommended. Am. J. Ind. Med. 46:480–491, 2004. 2004 Wiley-Liss, Inc.

Chronic obstructive pulmonary disease in never-smoking animal farmers working inside confinement buildings.

Abstract: Background In animal farming, respiratory disease has been associated with indoor air contaminants and an excess in FEV 1 decline. Our aim was to determine the characteristics and risk factors for chronic obstructive pulmonary disease (COPD) in never-smoking European farmers working inside animal confinement buildings. Methods A sample of participants in the European Farmers' Study was selected for a cross-sectional study assessing lung function and air contaminants. Dose-response relationships were assessed using logistic regression models. Results COPD was found in 18 of 105 formers (45.1 SD 11.7 years) (17.1%); 8 cases (7.6%) with moderate and 3 cases (2.9%) with severe disease. Dust and endotoxin showed a dose-response relationship with COPD, with the highest prevalence of COPD in subjects with high dust (low = 7.9%/high = 31.6%) and endotoxin exposure (low = 10.5%/ high = 20.0%). This association was statistically significant for dust in the multivariate analysis (OR 6.60, 95% CI 1.10-39.54). Conclusion COPD in never-smoking animal farmers working inside confinement buildings is related to indoor dust exposure and may become severe.

Physical workload, ergonomic problems, and incidence of low back injury: A 7.5-year prospective study of San Francisco transit operators

Abstract: Background: The etiologic role of biomechanical factors for low back injury (LBI) needs to be confirmed in prospective studies that control for psychosocial factors. Methods: Complete baseline information on 1,233 vehicle operators was gathered during medical examinations and by questionnaire. First LBI during 7.5 years of follow-up was ascertained from insurance records. Hazard ratios and etiologic fractions were analyzed with Cox regression models stratified by injury severity and controlling for age, sex, height, weight, ethnicity, and biomechanical and psychosocial job factors. Severe LBI was defined as medically diagnosed postlaminectomy syndrome, spinal stenosis, herniated lumbar disc, sciatica, or spinal instability. Results: An exponential dose-response relationship was found between weekly driving hours and incidence of first LBI. Indicators of physical workload were more strongly associated with more severe low back injuries compared to less severe injuries. Rates of severe LBI increased 39% for every 10-hr increase in weekly driving (hazard ratio 1.39, 95% confidence interval 1.15-1.68). Higher risks of severe LBI were also found among operators performing heavy physical labor on cable cars (hazard ratio 2.76, 95% confidence intervals 1.24-614) or reporting more ergonomic problems at baseline HR for upper quartile 1.65 (95% confidence interval 1.08-2.50). Estimates of etiologic fractions suggest that reduction of ergonomic problems to the low level currently experienced by 25% of drivers would result in a 19% reduction of severe LBI among all drivers. A change from full- (more than 30 hr) to part-time driving (20-30 hr) could reduce the number of severe LBI by 59%, although this gain would be reduced to 28% at the company level if injuries expected among additional employees, hired to maintain full service are included. Conclusions: Duration of professional driving and ergonomic problems are independent and preventable risk factors for LBI even after adjustment for psychosocial factors. (C) 2004 Wiley-Liss, Inc.

Relationship of work schedules to gastrointestinal diagnoses, symptoms, and medication use in auto factory workers.

Abstract: Background Gastrointestinal (GI) complaints are common in shift workers. This study examines the relationship between work schedules and GI symptoms, medications, and diagnoses. Methods In a cross-sectional survey of 343 US auto factory workers, four work schedule variables were examined: assigned shift, numberof hours worked, numberof night hours, and schedule variability. Multiple regression tested the relationship between GI outcomes and work schedule variables while controlling for covariates. Results The evening shift was associated with more GI symptoms and GI diagnoses. Unexpectedly, more consistent work times were associated with having a GI diagnosis. As schedule variability increased the probability of GI medication use increased in low noise exposure. Conclusion Findings suggest that evening shift and widely varying work start and end times may increase risks for GI disturbances. Am. J. Ind. Med. 46:586–598, 2004. 2004 Wiley-Liss, Inc.

Working conditions and health among female and male employees at a call center in Sweden

Abstract: Call centres (CCs) are one of the most rapidly growing forms of workplaces in Sweden. The overall aim of this thesis was to describe work characteristics, physical and psychosocial exposures, and health related outcomes, for CC operators in selected CC in Sweden. The purpose was also to study the test-retest reliability and internal consistency of questions, and the inter-rater reliability of observations and measurements in studies of CCs. This thesis is based on two projects, where study I was a cohort study and studies II-V were a cross-sectional survey. Fifty-seven CC operators were compared with a reference group of 1459 professional computer users from other occupations, study I, and 1183 operators (848 women and 335 men) (response rate 77%) from 28 CCs were studied in studies II-V . Questionnaires covering organisation and work characteristics, physical and psychosocial exposures, individual characteristics and symptoms during the previous month was used, studies I-V. Structured observations in accordance with an ergonomic checklist were used to assess workstation design during the subject’s ordinary work, study I and II. Operators at external CCs spent longer time on customer calls and had less varied tasks. Additional remuneration, call logging and monitoring was more common at external CCs. There were deficiencies in workspace, keyboard- and input device placement. External CCs showed somewhat more problems in the work environment compared with the internal CCs. The CC group spent longer continuous time in front of the computer than other professional computer users. Emotional and cognitive demands and time pressure were reported considered high. Emotional demands and limited decision latitude were dominating features in CC work. A higher proportion of the CC group reported musculoskeletal symptoms compared to other professional computer users. Three out of four operators reported symptoms in the Neck/shoulder or Arm/hand region, with no major differences between internal and external CCs. Comfort of the work environment showed the strongest association with symptoms in the Neck/shoulder or Arm/hand, in both types of CCs. Other exposures associated with symptoms in the Neck/shoulder or Arm/hand in either type of CC were: low complexity of work, long total time of customer calls per day, continuous computer work without a break, high psychological demands, low decision latitude, lack of social support from colleagues and lack of support from a supervisor. The thesis confirms previously suggested associations between unfavourable work characteristics and management, as well as poor physical and psychosocial environment, and musculoskeletal symptoms in computer-interactive tasks. Among operators at internal CCs, symptoms were particularly related to the nature of calls during work, whereas at external CCs critical exposures were the time spent seated with continuous computer work. About half of the questions were classified as having fair to good or higher testretest reliability and can be recommended in further analyses. Other questions should be used with care. A majority of the variables on the ergonomic checklist are classified as having fair to good or higher inter-rater reliability.

Effectiveness of community health workers for promoting use of safety eyewear by Latino farm workers

Abstract: BACKGROUND: To evaluate The Community Health Worker 'promotor de salud' (CHW) model is evaluated as a tool for reducing eye injuries in Latino farm workers. METHODS: In 2001, 786 workers on 34 farms were divided into three intervention blocks: (A) CHWs provided protective eyewear and training to farm workers; (B) CHWs provided eyewear but no training to farm workers; (C) eyewear was distributed to farm workers with no CHW present and no training. RESULTS: Pre- and post-intervention questionnaires demonstrated greater self-reported use of eyewear in all blocks after the intervention (P < 0.0001), with Block A showing the greatest change compared to B (P < 0.0001) and C (P = 0.03); this was supported by field observations. Block A showed the greatest improvement in knowledge on questions related to training content. CONCLUSION: CHWs were an effective tool to train farm workers in eye health and safety, improving the use of personal protective equipment and knowledge.

Upper extremity pain and computer use among engineering graduate students.

Abstract: Background The objective of this study was to investigate risk factors associated with persistent or recurrent upper extremity and neck pain among engineering graduate students. Methods A random sample of 206 Electrical Engineering and Computer Science (EECS) graduate students at a large public university completed an online questionnaire. Results Approximately 60% of respondents reported upper extremity or neck pain attributed to computer use and reported a mean pain severity score of 4.5 (� 2.2; scale 0–10). In a final logistic regression model, female gender, years of computer use, and hours of computer use per week were significantly associated with pain. Conclusions The high prevalence of upper extremity pain reported by graduate students suggests a public health need to identify interventions that will reduce symptom severity and prevent impairment. Am. J. Ind. Med. 46:297–303, 2004. 2004 Wiley-Liss, Inc.

Health symptoms and exposure to organophosphate pesticides in farmworkers

Abstract: Background Few studies have examined the relationship between reported health symptoms and exposure to organophosphate (OP) pesticides. Methods Fisher's exact test was used to assess the relationship between self-reported health symptoms and indicators of exposure to OP pesticides in 211 farmworkers in Eastern Washington. Results The health symptoms most commonly reported included headaches (50%), burning eyes (39%), pain in muscles, joints, or bones (35%), a rash or itchy skin (25%), and blurred vision (23%). Exposure to pesticides was prevalent. The proportion of detectable samples of various pesticide residues in house and vehicle dust was weakly associated with reporting certain health symptoms, particularly burning eyes and shortness of breath. No significant associations were found between reporting health symptoms and the proportion of detectable urinary pesticide metabolites. Conclusions Certain self-reported health symptoms in farmworkers may be associated with indicators of exposure to pesticides. Longitudinal studies with more precise health symptom data are needed to explore this relationship further. Am. J. Ind. Med. 46:599–606, 2004. © 2004 Wiley-Liss, Inc.

Respiratory symptoms and airway obstruction in swine veterinarians: A persistent problem

Abstract: Objective There are many occupational hazards associated with the practice of swine veterinarians. To reassess the prevalence of respiratory complaints and pulmonary function abnormalities in this group. Methods This was a cross-sectional study conducted during the American Association of Swine Veterinarians annual meeting. Subjects completed a respiratory symptom/work history questionnaire and performed spirometry. Results Participants included 122 veterinarians (median age = 42.5 years). Work-related symptoms included rhinitis symptoms (69%), cough and chest tightness (53%), wheezing (31%). Airway obstruction was seen in 24% of participants. Veterinarians with airway obstruction reported working more hours per week in hog barns than did practitioners with normal pulmonary function (P = 0.009). Conclusions Respiratory symptoms were common in the swine veterinarians tested as was airway obstruction. The association with these findings and hog barn exposure suggests that working in these facilities is still a risk factor for airway disease.

Airflow obstruction attributable to work in industry and occupation among U.S. race/ethnic groups: A study of NHANES III data

Abstract: Objectives To estimate the fraction of airflow obstruction attributable to workplace exposure by U.S. race/ethnic group. Methods U.S.population-basedthirdNationalHealthandNutritionExaminationSurvey (NHANES III) data on 4,086 Caucasians, 2,774 African-Americans, and 2,568 MexicanAmericans, aged 30‐75, were studied. Airflow obstruction was defined as FEV1/ FVC<75% and FEV1<80% predicted. Weighted prevalence, and prevalence odds ratios (OR) adjusted for the effect of age, smoking status, pack-years, body mass index, education, and socio-economic status were estimated using SUDAAN software. Results Industries with the most cases of airflow obstruction attributable to workplace exposure include: armed forces; rubber, plastics, and leather manufacturing; utilities; textilemillmanufacturing;healthcare;foodproductsmanufacturing;sales;construction; and agriculture. The fraction of cases with airflow obstruction associated with work in industry varied by race/ethnic group and was estimated as 22.2% (95% CI 9.1‐33.4) among Caucasians, 23.4% (95% CI 2.2‐40.0) among African-Americans, and 49.6% (32.1‐62.6) among Mexican-Americans. Conclusions This study found differences in the fraction of airflow obstruction cases associated with employment pattern among major U.S. race/ethnic population groups. Am. J. Ind. Med. 46:126–135, 2004. Published 2004 Wiley-Liss, Inc. {

Healthcare and the long haul: Long distance truck drivers--a medically underserved population.

Abstract: Background Long distance trucking is associated with significant health risks However, to our knowledge no published data exist regarding healthcare service access by the estimated two million long-haul truckers in the United States Methods A cross-sectional study was designed to assess access to healthcare among these workers Five hundred-twenty-one anonymous self-administered surveys were completed at 16 truck stops in 14 states from July through August 2002 Results Forty-seven percent of those surveyed lack a regular healthcare provider, 20% frequent emergency rooms and urgent care centers, 32% were unable to receive needed healthcare within the last year, and 56% had difficulty utilizing healthcare services at home Individuals lacking health insurance (31%) experienced more difficulty with healthcare access than the insured within the last year, were more often without a regular provider (P = 0002 and P < 0001), and utilized urgent care centers and emergency rooms more often than the insured (25 vs 17%) Conclusions Long distance truck drivers are at risk for poor health outcomes and experience significant difficulty accessing healthcare services Further studies concerning how to best provide healthcare to this vulnerable, underserved population are needed Am J Ind Med 46:463–471, 2004 © 2004 Wiley-Liss, Inc

Impairment of cell and plasma redox state in subjects professionally exposed to chromium

Abstract: Background Chromium (Cr) is widely used in chemical, tannery, building, and metal industries More recently, it has been demonstrated that Cr induces oxidative stress in mouse brain Nevertheless very few data exist on in vivo oxidative damage in humans exposed to Cr Methods Changes in antioxidant parameters both in plasma (acid ascorbic redox state and total antioxidant capacity) and in red blood cells (glutathione (GSH) redox state) of 40 subjects (age 3765 ± 746; M/F 20/20) professionally exposed to Cr who were recruited from metal, chemistry, and building industries were evaluated We also evaluated the levels of lipoperoxidation (thiobarbituric acid-reactive material, TBA-RM) and thiol levels in plasma to assess the extent of oxidative stress state To evaluate Cr exposure rate, we measured urinary-chromium (U-Cr) by an electrothermic atomization-atomic absorption spectrometry (ETA-AAS) method Results In this study, we found that Cr exposure induced a decrease both in GSH (P < 00005) and GSH/oxidized glutathione (GSSG) ratio (P < 00001) in red blood cells from workers with respect to control subjects Furthermore, we also demonstrated a significant decrease of plasma acid ascorbic levels (457 ± 149 vs 535 ± 165 μmol/L; P < 005) and in total plasma antioxidant capacity (1,1263 ± 2122 vs 1,2669 ± 2078 μmol/L; P < 005) in subjects exposed to Cr No difference was found with regard to TBA-RM and thiol levels Conclusions This study demonstrated that in humans, an oxidative stress occurs for Cr exposures as low as those considered safe This oxidative stress appears to be able to affect intracellular and plasmatic antioxidant defense Am J Ind Med 46:120–125, 2004 © 2004 Wiley-Liss, Inc

Atopic and non-atopic asthma in a farming and a general population.

Abstract: Background In a previous study inverse associations between asthma and exposure to fungal spores and endotoxins in atopic farmers and positive associations with the same factors in non-atopic farmers were documented No external reference population had been included We therefore, compared this farming population with the general population from an adjacent region Methods Random samples of a farming (n=2,106) and a rural (n=351) and urban (n = 727) general population were selected Atopy was assessed by serum IgE and asthma by questionnaires Results The asthma prevalence was 40% among farmers, 57% in the rural, and 76% in the urban population Atopy was similar (9-10%) Most asthmatics were not atopic, 67-75% Farmers had asthma less often than the general population OR 052 (95% CI 036-075); both atopic (OR 033 (95% CI 015-069)) and non-atopic asthma (OR 060 (95% CI 039-093)) Conclusion This may indicate a protective effect of the farm environment on asthma but a healthy worker effect may also play a role

The association between HLA-DPB1Glu69 and chronic beryllium disease and beryllium sensitization.

Abstract: Background Several case-control studies have found an association between chronic beryllium disease (CBD) and HLA-DPB1 gene variants. However, the relationship between HLA-DPB1 and beryllium sensitization, and whether the presence of one or two HLA-DPB1Glu69 alleles is differentially associated with CBD and beryllium sensitization have not been completely resolved. Methods Restriction fragment length polymorphism (RFLP) analysis was used to address these questions in a large population-based cohort consisting of 884 beryllium workers (90 with CBD, 64 beryllium sensitized). Results HLA-DPB1Glu69 was associated with both CBD (OR = 9.4; 95% CI = 5.4, 16.6) and sensitization (OR = 3.3, 95% CI = 1.9, 5.9). Further, workers with CBD and sensitization were more likely to be homozygous HLA-DPB1Glu69 compared to workers without disease or sensitization (P < 0.001). Conclusions Follow-up of this cohort, scrutiny of HLA-DPB1 haplotypes, and evaluation of gene–environment and gene–gene interactions will be important for fully understanding the immunogenetic nature of this occupational disease. Am. J. Ind. Med. 46:95–103, 2004. Published 2004 Wiley-Liss, Inc.

Quantitative exposure-response for silica dust and lung cancer in Vermont granite workers.

Abstract: Background Excess lung cancer mortality among the exposed Vermont granite workers has been reported. These studies were based on job and tenure surrogates, with the potential for misclassification and inability to evaluate quantitative exposure-response. Methods Industrial hygiene data collected from 1924 to 1977 was analyzed in conjunction with mortality data to examine quantitative exposure-response for silica, lung cancer, and other lung diseases. A person-years analysis was undertaken by cumulative exposuregroup, including lagged and unlagged tabulations. Poisson models were fitted to untransformed and log transformed exposure. Results The results indicated a clear relationship of lung cancer, tuberculosis, pneumoconiosis, non-malignantlung disease, and kidney cancer with cumulative exposure.An exposureto0.05mg/m 3 fromage20to64wasassociatedwithalifetimeexcessriskoflung cancer for white males of 27/1,000. Conclusions The results of this study of workers exposed almost exclusively to silica and no other major occupational confounding exposures indicate a clear exposure-response for lung cancer. Am. J. Ind. Med. 45:129–138, 2004. Published 2004 Wiley-Liss, Inc. {

Asbestos in brakes: Exposure and risk of disease

Abstract: Asbestos has been incorporated into friction products since the early 1900s. Epidemiological studies have been equivocal in their analysis of the incidence of disease among mechanics servicing brakes. Decomposition of asbestos occurs during the normal usage of the brake due to thermal decomposition into forsterite, although not all asbestos is so converted. Short fibers, below 5 microm in length, are also found in brake products. Several facts are discussed including the toxicity of the remaining asbestos fibers, short asbestos fibers, and the health implications of exposure to forsterite. Control methodologies, when used appropriately, have reduced exposure to asbestos during brake servicing, but have not been able to entirely eliminate exposure to asbestos, thus bring into question the controlled use of asbestos for friction product such as brakes. Even the so called "controlled" use of asbestos containing brakes poses a health risk to workers, users, and their families.

The beryllium lymphocyte proliferation test: Relevant issues in beryllium health surveillance.

Abstract: Background The beryllium lymphocyte proliferation test (Be-LPT) measures beryllium-specific cellular immune response, and is useful in medical surveillance of beryllium sensitivity and chronic beryllium disease (CBD). Methods Current and former employees (n = 12,194) of 18 United States Department of Energy (DOE) sites were tested for beryllium sensitization at four laboratories with Be-LPT expertise. Beryllium sensitized individuals were offered evaluations for CBD. The sensitivity, specificity, and positive predictive value (PPV) of the Be-LPT were determined, as was inter- and intra-laboratory agreement. Results False positives were calculated to be 1.09%, with a laboratory range of 0.00–3.35% for the 10-year investigation. Be-LPTs performed on inter-laboratory split blood specimens from sensitized individuals showed a false negative rate of 31.7%. The intra-laboratory repeatability of abnormal Be-LPT results ranged from 80.4–91.9%. The sensitivity of the Be-LPT was determined to be 0.683, with a specificity of 0.969. The PPV of one abnormal Be-LPT was 0.253. Conclusions The Be-LPT is efficacious in medical surveillance of beryllium-exposed individuals. The PPV of the Be-LPT is comparable to other widely accepted medical tests. Confirmation of an abnormal result is recommended to assure appropriate referral for CBD medical evaluation. Am. J. Ind. Med. 46:453–462, 2004. Published 2004 Wiley-Liss, Inc.

Assessment of occupational safety and health programs in small businesses.

Abstract: Background Occupational safety and health (OSH) programs are a strategy for protecting workers' health, yet there are few peer-reviewed reports on methods for assessing them, or on the prevalent characteristics of OSH programs, especially in small businesses. Methods We adapted an occupational safety and health administration (OSHA) survey instrument to assess: management commitment and employee participation, workplace analysis, hazard prevention and control, and education and training. This was supplemented by a series of open-ended questions. We administered the survey in 25 small worksites. Results Scores for each element ranged widely, with distribution of most scores being positively skewed. Barriers to addressing OSH included lack of time and in-house expertise, and production pressures. External agents, including corporate parents, liability insurers, and OSHA, played an important role in motivating OSH programs. Conclusions Small businesses were able to mount comprehensive programs, however, they may rely on outside resources for this task. Being small may not be a barrier to meeting the requirements of an OSHA program management rule. Am. J. Ind. Med. 45:371–379, 2004. © 2004 Wiley-Liss, Inc.

Screening for beryllium disease among construction trade workers at Department of Energy nuclear sites.

Abstract: Background To determine whether current and former construction workers are at significant risk for occupational illnesses from work at the Department of Energy's (DOE) nuclear weapons facilities, screening programs were undertaken at the Hanford Nuclear Reservation, Oak Ridge Reservation, and the Savannah River Site. Methods Medical examination for beryllium disease used a medical history and a beryllium blood lymphocyte proliferation test (BeLPT). Stratified and multivariate logistic regression analyses were used to explore the risk of disease by age, race, sex, trade, duration of DOE employment, reported work in buildings where beryllium was used, and time since last DOE site employment. Results Of the 3,842 workers included in this study, 34% reported exposure to beryllium. Overall, 2.2% of workers had at least one abnormal BeLPT test, and 1.4% were also abnormal on a second test. Regression analyses demonstrated increased risk of having at least one abnormal BeLPT to be associated with ever working in a site building where beryllium activities had taken place. Conclusions The prevalence of beryllium sensitivity and chronic beryllium disease (CBD) in construction workers is described and the positive predictive value of the BeLPT in a population with less intense exposure to beryllium than other populations that have been screened is discussed. The BeLPT findings and finding of cases of CBD demonstrate that some of these workers had significant exposure, most likely, during maintenance, repair, renovation, or demolition in facilities where beryllium was used. Am. J. Ind. Med. 46:207–218, 2004. © 2004 Wiley-Liss, Inc.

Osteoarthritis of the hip joint and farm work.

Abstract: Background Different types of farming and farm work were studied in relation to the occurrence of osteoarthritis of the hip joint in a cohort of farmers. Methods A group of 427 farmers with hip joint osteoarthritis were identified together with a matched control group of farmers without hip or knee problems. All were invited to an interview and physical examination. After a dropout of 10%, and removing those who had had predisposing diseases or trauma, the observations for 369 pairs were available for analyses. Results Farmers with larger dairy and swine confinement operations (sows) had an increased risk of acquiring osteoarthritis of the hip. In a logistic regression multivariate model, those who milked more than 40 cows daily had an increase in risk (OR = 4.5, 95% CI 1.9–11.0) in relation to those who did not work in dairy production. Those who had worked more than 5 hr daily in animal barns over a long period of time also had an increase in risk (OR = 13.3, 95% CI 1.2–145.0) in relation to those who did not work with animals. In another model, those who had large farm areas (>100 ha) had a significantly decreased risk (OR = 0.14, 95% CI 0.05–0.43) in relation to those who had smaller farm areas. Conclusions Farmers operating farms with large plant production area and few animal contacts had a significantly lower risk of incurring osteoarthritis of the hip than did farmers in general. The presence of animal production showed a significant positive relationship to the risk of developing hip joint osteoarthritis. Am. J. Ind. Med. 45:202–209, 2004. © 2004 Wiley-Liss, Inc.

Nonfatal occupational injuries from slips, trips, and falls among older workers treated in hospital emergency departments, United States 1998.

Abstract: Background Falls are a leading cause of injury among older adults. As the workforce demographics shift to an older population, the dearth of information on occupational falls among older adults must be addressed. Methods A national probability sample of hospital emergency departments (EDs) (National Electronic Injury Surveillance System) was utilized to characterize falls at work. Results Older workers were found not to be at increased risk of a fall injury, but were more likely than younger workers to be hospitalized post-injury. Same-level falls were the most common type of incident among older workers. Falls from height were more prevalent among men than women. The narrative case descriptions for same-level falls to the floor primarily implicated floor contamination and tripping hazards. Conclusions Fall prevention programs targeted to older workers must examine extrinsic sources of falls, particularly surface traction, contaminant control, and footwear. Am. J. Ind. Med. 46:32–41, 2004. © 2004 Wiley-Liss, Inc.