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Showing papers in "American Journal of Industrial Medicine in 2005"


Journal ArticleDOI
TL;DR: The proportion of the population exposed to occupational noise was estimated using noise exposure data from the US National Institute for Occupational Safety and Health (NIOSH), adjusted by data on the distribution of the work force by occupational category and economic sector, and economic activity rates in each WHO subregion as discussed by the authors.
Abstract: Background Excessive noise is a global occupational health hazard with considerable social and physiological impacts, including noise-induced hearing loss (NIHL). This paper describes the worldwide morbidity of occupational NIHL in the year 2000. Methods The proportion of the population exposed to occupational noise was estimated using noise exposure data from the US National Institute for Occupational Safety and Health (NIOSH), adjusted by data on the distribution of the work force by occupational category and economic sector, and economic activity rates in each WHO subregion. These values for the exposed population and risk measures for NIHL were used to develop estimates of the attributable fraction (AF) of adult-onset hearing loss resulting from occupational noise exposure. The AFs were applied to WHO estimates of total disability-adjusted life years (DALYs) from adult-onset hearing loss to estimate the DALYs due to occupational noise. Results Worldwide, 16% of the disabling hearing loss in adults (over 4 million DALYs) is attributed to occupational noise, ranging from 7% to 21% in the various subregions. The effects of the exposure to occupational noise are larger for males than females in all subregions and higher in the developing regions. Conclusions Occupational noise is a significant cause of adult-onset hearing loss. The majority of this NIHL burden can be minimized by the use of engineering controls to reduce the generation of noise at its source. Am. J. Ind. Med. 48:446–458, 2005. © 2005 Wiley-Liss, Inc.

833 citations


Journal ArticleDOI
TL;DR: Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs).
Abstract: Background The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated. Methods The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs. Results Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIVinfections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributabletooccupationalexposuretopercutaneousinjuriesfractionreaches39%,37%, and 4.4% respectively. Conclusions Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated. Am. J. Ind. Med. 48:482–490, 2005. 2005 Wiley-Liss, Inc.

724 citations


Journal ArticleDOI
TL;DR: Occupational exposures to ergonomic stressors represent a substantial source of preventable back pain and specific research on children is needed to quantify the global burden of disease due to child labor.
Abstract: Background There is little information about the global burden of non-traumatic low back pain (LBP) attributable to the effects of physical and psychosocial occupational stressors. Methods Based on a review of the epidemiological evidence, occupation-specific relative risks were used to compute attributable proportions by age, gender, and geographical sub-region for the economically active population aged 15 and older. The reference group was professional/administrative workers; other risk categories were Low, clerical and sales; Moderate, operators (production workers) and service; and High, farmers. Results Worldwide, 37% of LBP was attributed to occupation, with twofold variation across regions. The attributable proportion was higher for men than women, because of higher participation in the labor force and in occupations with heavy lifting or whole-body vibration. Work-related LBP was estimated to cause 818,000 disability-adjusted life years lost annually. Conclusions Occupational exposures to ergonomic stressors represent a substantial source of preventable back pain. Specific research on children is needed to quantify the global burden of disease due to child labor. Am. J. Ind. Med. 48:459–469, 2005. © 2005 Wiley-Liss, Inc.

447 citations


Journal ArticleDOI
TL;DR: Occupational carcinogens are an important cause of death and disability worldwide and their levels of exposure were estimated using workforce data and the CAREX (CARcinogen EXposure) database.
Abstract: Background The worldwide mortality and morbidity from lung cancer, leukemia, and malignant mesothelioma arising from occupational exposures to carcinogens are described. Cases reported in the year 2000 that resulted from relevant past and current exposures are assessed. Methods The proportions of workers exposed to the carcinogens of interest, and their levels of exposure, were estimated using workforce data and the CAREX (CARcinogen EXposure) database. These were combined with relative risk measures (for lung cancer and leukemia) or absolute risk measures (for malignant mesothelioma) to develop estimates of deaths, disability-adjusted life years (DALYs) and attributable fraction (for lung cancer and leukemia). Results There were an estimated 152,000 deaths (lung cancer: 102,000; leukemia: 7,000; and malignant mesothelioma: 43,000) and nearly 1.6 million DALYS (lung cancer: 969,000; leukemia: 101,000; and malignant mesothelioma: 564,000) due to exposure to occupational carcinogens. Conclusions Occupational carcinogens are an important cause of death and disability worldwide. Am. J. Ind. Med. 48:419–431, 2005. © 2005 Wiley-Liss, Inc.

295 citations


Journal ArticleDOI
TL;DR: Support was observed for hypothesized excess neurodegenerative disease associated with a variety of occupations, 60 Hz magnetic fields and welding.
Abstract: AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 48:63–77 (2005) Potential Occupational Risks for Neurodegenerative Diseases Robert M Park, MS , 1 A Paul A Schulte, PhD , 1 Joseph D Bowman, PhD , CIH , 2 James T Walker, PhD , 3 Stephen C Bondy, MA , PhD , 4 Michael G Yost, MS , PhD , 5 Jennifer A Touchstone, MS , 5 and Mustafa Dosemeci, PhD6 Background Associations between occupations and neurodegenerative diseases (NDD) may be discernable in death certificate data Methods Hypotheses generated from 1982 to 1991 study were tested in data from 22 states for the years 1992–1998 Specific occupations and exposures to pesticides, solvents, oxidative stressors, magnetic fields, and welding fumes were evaluated Results About one third (26/87) of the occupations hypothesized with neurodegenerative associations had statistically significant elevated mortality odds ratios (MOR) for the same outcome Occupations with the largest MORs were (a) for presenile dementia (PSD)— dentists, graders/sorters (non-agricultural), and clergy; (b) for Alzheimer’s disease (AD)—bank tellers, clergy, aircraft mechanics, and hairdressers; (c) for Parkinson’s disease (PD)—biological scientists, clergy, religious workers, and post-secondary teachers; and (d) for motor neuron disease (MND)—veterinarians, hairdressers, and graders and sorters (non-agricultural) Teachers had significantly elevated MORs for all four diseases, and hairdressers for three of the four Non-horticultural farmers below age 65 had elevated PD (MOR ¼ 223, 95% CI ¼ 147–326), PSD (MOR ¼ 222, 95% CI ¼ 110–405), and AD (MOR ¼ 176, 95% CI ¼ 104–281) Sixty hertz magnetic fields exhibited significant exposure-response for AD and, below age 65, for PD (MOR ¼ 187, 95% CI ¼ 114–298) and MND (MOR ¼ 163, 95% CI ¼ 110–239) Welding had elevated PD mortality below age 65 (MOR ¼ 177, 95% CI ¼ 108–275) Conclusions Support was observed for hypothesized excess neurodegenerative disease associated with a variety of occupations, 60 Hz magnetic fields and welding Am J Ind Med 48:63–77, 2005 Published 2005 Wiley-Liss, Inc { KEY WORDS: Alzheimer’s disease; hairdresser; motor neuron disease; magnetic field; Parkinson’s disease; pesticide; welding Abbreviations: AD, Alzheimer’s disease; ALS, amyotrophic lateral sclerosis; BOC, Bureau of the Census; EMF, electromagnetic field; MND, motor neuron disease; MOR, mortality odds ratio; NDD, neurodegenerative disease; PD, Parkinson’s disease; PMR, proportionate mortal- ity ratios; PSD, presenile dementia Education and Information Division, National Institute for Occupational Safety and Health, Cincinnati, Ohio Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Cincinnati, Ohio Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio Department of Community & Environmental Medicine, University of California, Irvine, California Published 2005 Wiley-Liss, Inc This article is a US Government work and, as such, is in the public domain in the United States of America Department of Environmental Health, University of Washington, Seattle,Washington Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland *Correspondence to: Robert M Park, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Education and Information Division, MS C-15, 4676 Columbia Parkway, Cincinnati, OH 45226 E-mail: rhp9@cdcgov Accepted 27 March 2005 DOI 101002/ajim20178 Published online in Wiley InterScience (wwwintersciencewileycom)

204 citations


Journal ArticleDOI
TL;DR: Exposure to occupational hazards accounts for a significant proportion of the global burden of disease and injury, which could be substantially reduced through application of proven risk prevention strategies.
Abstract: BACKGROUND: Around the globe, work has a heavy impact on health. To better advise policy makers, we assessed the global burden of disease and injury due to selected occupational hazards. This article presents an overview, and describes the methodology employed in the companion studies. METHODS: Using the World Health Organization (WHO) Comparative Risk Assessment methodology, we applied relative risk measures to the proportions of the population exposed to selected occupational hazards to estimate attributable fractions, deaths, and disability-adjusted life years (DALYs). Numerous occupational risk factors had to be excluded due to inadequate global data. RESULTS: In 2000, the selected risk factors were responsible worldwide for 37% of back pain, 16% of hearing loss, 13% of chronic obstructive pulmonary disease (COPD), 11% of asthma, 8% of injuries, 9% of lung cancer, and 2% of leukemia. These risks at work caused 850,000 deaths worldwide and resulted in the loss of about 24 million years of healthy life. Needlesticks accounted for about 40% of Hepatitis B and Hepatitis C infections and 4.4% of HIV infections in health care workers. CONCLUSIONS: Exposure to occupational hazards accounts for a significant proportion of the global burden of disease and injury, which could be substantially reduced through application of proven risk prevention strategies.

200 citations


Journal ArticleDOI
TL;DR: The substantial reduction in age-work injury association in the fully adjusted model suggests that differences in the types of jobs young workers hold play a critical role in their high-risk status.
Abstract: Background Many population-based studies find that the rate of work injuries is higher among adolescent and young adult workers compared to older adults. The present study examines age-related differences in work injuries, with an emphasis on adjusting for the potential confounding effects of job characteristics. Methods Age-related differences in work injuries were examined in a representative sample of 56,510 working Canadians aged 15 years and over. Respondents reported work-related injuries and job characteristics (e.g., occupation) in the past 12 months. Total hours worked in the past year were computed for each worker and accounted for in the logistic regressions. Analyses were stratified by gender. Results For men, adjusting for job characteristics substantially reduced, but did not eliminate the elevated risk status of adolescent and young adult workers. For women, only young adult women showed an elevated risk of work injury with job characteristics controlled. Conclusions This is one of the few multivariate studies specifically examining contributors to age-related differences in work injuries in a population-based sample of workers. The substantial reduction in age-work injury association in the fully adjusted model suggests that differences in the types of jobs young workers hold play a critical role in their high-risk status. Am. J. Ind. Med. 48:50–56, 2005. © 2005 Wiley-Liss, Inc.

196 citations


Journal ArticleDOI
TL;DR: Most room cleaners experience severe back or neck pain, and severe pain showed strong associations with physical workload, work intensification, and ergonomic problems.
Abstract: Background Occupational injury rates among hotel workers exceed the national service sector average. This study assesses the prevalence of back and neck pain, and its associations with physical workload, ergonomic problems, and increasing work demands. Methods Nine hundred forty-one unionized hotel room cleaners completed a survey about health and working conditions. Associations between job demands and pain were determined by logistic regression models adjusting for individual characteristics, cumulative work demands, care-taking responsibilities at home, and psychosocial job factors. Results The 1-month prevalence of severe bodily pain was 47% in general, 43% for neck, 59% for upper back, and 63% for low back pain. Workers in the highest exposure quartiles for physical workload and ergonomic problems were between 3.24 and 5.42 times more likely to report severe pain than workers in the lowest quartile. Adjusted odds ratios for work intensification ranged from 1.74 (upper back) to 2.33 (neck). Conclusions Most room cleaners experience severe back or neck pain. Severe pain showed strong associations with physical workload, work intensification, and ergonomic problems. Am. J. Ind. Med. © 2005 Wiley-Liss, Inc.

176 citations


Journal ArticleDOI
TL;DR: The disturbed cardiovascular regulatory pattern associated with job strain may help explain the increased risk of cardiovascular diseases linked with occupational exposure.
Abstract: Background Despite the epidemiological evidence linking job strain to cardiovascular disease, more insight is needed into the etiologic mechanisms. This, in turn, would help to more precisely identify risk. Methods We measured Job Strain using the Job Content Questionnaire, 8/day diary reports, and nationally standardized occupational code linkage, as well as autonomic regulation utilizing heart rate variability including spectral-derived components and QT interval variability in 36 healthy mid-aged males with varying strain jobs. The subjects wore Holter-monitors for 48 hr; this included a work and rest day. Results Job strain (P = 0.02) and low decision latitude (P = 0.004) were associated with a reduction in cardiac vagal control (HFP) persisting throughout the 48 hr. Job strain was also associated with elevations in sympathetic control during working hours (P = 0.003). Conclusions The disturbed cardiovascular regulatory pattern associated with job strain may help explain the increased risk of cardiovascular diseases linked with occupational exposure. Am. J. Ind. Med. 48:182–193, 2005. © 2005 Wiley-Liss, Inc.

168 citations


Journal ArticleDOI
TL;DR: A literature review of mortality and morbidity studies related to suicide among pesticide-exposed populations, and of human and animal studies of central nervous system toxicity related to organophosphate pesticides found a causal association between OP use and suicide.
Abstract: BACKGROUND: Suicide using pesticides as agent is recognized as a major cause of pesticide poisoning. METHODS: A literature review of mortality and morbidity studies related to suicide among pesticide-exposed populations, and of human and animal studies of central nervous system toxicity related to organophosphate (OP) pesticides was performed. RESULTS: Suicide rates are high in farming populations. Animal studies link OP exposure to serotonin disturbances in the central nervous system, which are implicated in depression and suicide in humans. Epidemiological studies conclude that acute and chronic OP exposure is associated with affective disorders. Case series and ecological studies also support a causal association between OP use and suicide. CONCLUSIONS: OPs are not only agents for suicide. They may be part of the causal pathway. Emphasizing OPs solely as agents for suicide shifts responsibility for prevention to the individual, reducing corporate responsibility and limiting policy options available for control.

167 citations


Journal ArticleDOI
TL;DR: Opioid-related deaths in this population may be preventable through use of prudent guidelines regarding opioid use for chronic pain, and it is possible that tolerance or opioid-induced abnormal pain sensitivity may be occurring in some workers who use opioids for chronicPain.
Abstract: Background The use of opioids for chronic non-cancer pain has increased in the United States since state laws were relaxed in the late 1990s. These policy changes occurred despite scanty scientific evidence that chronic use of opioids was safe and effective. Methods We examined opiate prescriptions and dosing patterns (from computerized databases, 1996 to 2002), and accidental poisoning deaths attributable to opioid use (from death certificates, 1995 to 2002), in the Washington State workers' compensation system. Results Opioid prescriptions increased only modestly between 1996 and 2002. However, prescriptions for the most potent opioids (Schedule II), as a percentage of all scheduled opioid prescriptions (II, III, and IV), increased from 19.3% in 1996 to 37.2% in 2002. Among long-acting opioids, the average daily morphine equivalent dose increased by 50%, to 132 mg/day. Thirty-two deaths were definitely or probably related to accidental overdose of opioids. The majority of deaths involved men (84%) and smokers (69%). Conclusions The reasons for escalating doses of the most potent opioids are unknown, but it is possible that tolerance or opioid-induced abnormal pain sensitivity may be occurring in some workers who use opioids for chronic pain. Opioid-related deaths in this population may be preventable through use of prudent guidelines regarding opioid use for chronic pain. Am. J. Ind. Med. 48:91–99, 2005. © 2005 Wiley-Liss, Inc.

Journal ArticleDOI
TL;DR: The global burden of fatal and non-fatal unintentional occupational injuries for the year 2000 is estimated, showing occupational injuries constitute a substantial global burden and greatly underestimate the impact of occupational risk factors leading to injuries in the overall burden of disease.
Abstract: BACKGROUND: Occupational injuries are a public health problem, estimated to kill more than 300,000 workers worldwide every year and to cause many more cases of disability. We estimate the global burden of fatal and non-fatal unintentional occupational injuries for the year 2000. METHODS: The economically active population (EAP) of about 2.9 billion workers was used as a surrogate of the population at risk for occupational injuries. Occupational unintentional injury fatality rates for insured workers, by country, were used to estimate WHO regional rates. These were applied to regional EAP to estimate the number of deaths. In addition to mortality, the disability-adjusted life years (DALYs) lost, which measure both morbidity and mortality, were calculated for 14 WHO regions. RESULTS: Worldwide, hazardous conditions in the workplace were responsible for a minimum of 312,000 fatal unintentional occupational injuries. Together, fatal and non-fatal occupational injuries resulted in about 10.5 million DALYs; that is, about 3.5 years of healthy life are lost per 1,000 workers every year globally. Occupational risk factors are responsible for 8.8% of the global burden of mortality due to unintentional injuries and 8.1% of DALYs due to this outcome. CONCLUSIONS: Occupational injuries constitute a substantial global burden. However, our findings greatly underestimate the impact of occupational risk factors leading to injuries in the overall burden of disease. Our estimates could not include intentional injuries at work, or commuting injuries, due to lack of global data. Additional factors contributing to grave underestimation of occupational injuries include limited insurance coverage of workers and substantial under-reporting of fatal injuries in record-keeping systems globally. About 113,000 deaths were probably missed in our analyses due to under-reporting alone. It is clear that known prevention strategies need to be implemented widely to diminish the avoidable burden of injuries in the workplace.

Journal ArticleDOI
TL;DR: The CRA estimates of burden due to individual risk factors appear appropriate for the limited number of exposures and conditions included, but are a major underestimate of the overall number of work-related deaths at a global level due to exclusion of risk factors because of data limitations.
Abstract: BACKGROUND: Over the last decade, there have been several attempts to estimate the global burden of ill health due to work activity. The most recent of these is the Comparative Risk Assessment (CRA) project of the World Health Organization. METHODS: Published estimates of global burden of injury and disease due to occupational factors were summarized, compared, and contrasted with the aim of putting the CRA estimates into context, identifying the most reliable and appropriate estimate for total burden due to occupational risks, and making recommendations regarding future work. RESULTS: The best estimate of global work-related deaths of workers is approximately two million per year, with disease responsible for the vast majority of these, but even this is likely to be a considerable underestimate of the true number of deaths because of shortcomings in the available data. CONCLUSIONS: The CRA estimates of burden due to individual risk factors appear appropriate for the limited number of exposures and conditions included, but are a major underestimate of the overall number of work-related deaths at a global level due to exclusion of risk factors because of data limitations. Improvements in global estimates are likely to come from the use of different methodologies and improvements in the availability and use of local data.

Journal ArticleDOI
Kyle Steenland1
TL;DR: It is clear that the current standard for exposure to silica at current US standard is far from sufficiently protective of workers' health, and kidney disease emerges as perhaps a higher risk than either mortality from silicosis or lung cancer, although the data are based on fewer studies.
Abstract: Background Evidence in recent years indicates that silica causes lung cancer, and probably renal disease, in addition to its well-known relationship to silicosis. There is also suggestive evidence that silica can cause arthritis and other auto-immune diseases. Silica has, therefore, joined a handful of other toxic exposures such as tobacco smoke, dioxin, and asbestos which cause multiple serious diseases. Methods The available exposure-response data for silica and silicosis, lung cancer, and renal disease are reviewed. We compare the corresponding excess risks (or absolute risks in the case of silicosis) of death or disease incidence by age 75 for these three diseases, subsequent to a lifetime (45 years) of exposure to silica at current US standard (0.1 mg/m 3 respirable crystalline silica). Results The absolute risk of silicosis, as defined by small opacities greater than or equal to ILO classification 1/1 on an X-ray, ranges from 47% to 77% in three cohort studies with adequate follow-up after employment. The absolute risk of death from silicosis is estimated at 1.9% (0.8%-2.9%), based on a pooled analysis of six cohort studies. The excess risk of lung cancer death, assuming US male background rates, is 1.7% (0.2%-3.6%), based on a pooled analysis often cohort studies. The excess risk of end-stage renal disease (assuming male background rates) is 5.1% (2.2%- 7.3%), based on a single cohort. The excess risk of death from renal disease is estimated to be 1.8% (0.8%-9.7%), based on a pooled analysis of three cohorts. Conclusions Keeping in mind that the usual OSHA acceptable excess risk of serious disease or death for workers is 0.1%, it is clear that the current standard is far from sufficiently protective of workers' health. Perhaps surprisingly, kidney disease emerges as perhaps a higher risk than either mortality from silicosis or lung cancer, although the data are based on fewer studies.

Journal ArticleDOI
TL;DR: Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect.
Abstract: Background The “graying of the workforce” has generated concerns about the physical capacity of older workers to maintain their health and productivity on the job, especially after an injury occurs. There is little detailed research on age-related differences in work outcomes after an occupational injury. Methods A self-report survey about occupational, health, and financial outcomes, and related factors was administered 2–8 weeks post-injury to workers aged < 55 and ≥ 55 who had lost time due to a work injury. Results Despite more severe injuries in older workers, most outcomes were similar in both age groups. In multivariate models, age was unrelated or inversely related to poor outcomes. Injury severity, physical functioning, and problems upon return to work were associated with adverse work injury outcomes. Conclusions Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect. Am. J. Ind. Med. 47:104–112, 2005. © 2005 Wiley-Liss, Inc.

Journal ArticleDOI
TL;DR: Wastewater treatment workers reported a wide range of symptoms that may be work-related, and microbial exposures such as endotoxin seem to play a causal role.
Abstract: Background Wastewater treatment workers can be exposed to biological and chemical agents resulting in work-related health effects. The aim of this study was to investigate work-related symptoms in these workers. Methods Questionnaire data of 468 employees from 67 sewage treatment plants is evaluated. Personal endotoxin exposure (8 hr measurements; n = 460) was measured in a sample of workers in three different periods over 1 year. Results Endotoxin exposure ranged from 0.6 to 2093 endotoxin units (EU)/m3, the geometric mean exposure was low (27 EU/m3). Factor analysis yielded three clusters of correlated symptoms: “lower respiratory and skin symptoms,” “flu-like and systemic symptoms,” and “upper respiratory symptoms.” Symptoms appeared to be more prevalent in workers exposed to endotoxin levels higher than 50 EU/m3. A significant dose-response relationship was found for “lower respiratory and skin symptoms” and “flu-like and systemic symptoms” (P < 0.05). Conclusions Wastewater treatment workers reported a wide range of symptoms that may be work-related. Microbial exposures such as endotoxin seem to play a causal role. Am. J. Ind. Med. 48:30–39, 2005. © 2005 Wiley-Liss, Inc.

Journal Article
TL;DR: The worldwide mortality and morbidity from asthma, chronic obstructive pulmonary disease (COPD), and pneumoconioses arising from these occupational exposure are described and focus on cases reported in the year 2000.

Journal ArticleDOI
TL;DR: In this article, the authors describe the worldwide mortality and morbidity from asthma, chronic obstructive pulmonary disease (COPD), and pneumoconioses arising from these occupational exposure and focus on cases reported in the year 2000.
Abstract: Background Occupational non-malignant respiratory disease arises from exposure of workers to airborne agents, mostly particulate or dusts. We describe the worldwide mortality and morbidity from asthma, chronic obstructive pulmonary disease (COPD), and pneumoconioses arising from these occupational exposure and focus on cases reported in the year 2000. Methods The proportions of workers exposed to the agents, and their levels of exposure, were estimated using workforce data and the CAREX (CARcinogen EXposure) database. These were combined with relative risk measures (for asthma and COPD) or absolute risk measures (for the pneumoconioses) to develop estimates of deaths, disability-adjusted life years (DALYs) and attributable fraction (for asthma and COPD). Results There were an estimated 386,000 deaths (asthma: 38,000; COPD: 318,000; pneumoconioses: 30,000) and nearly 6.6 million DALYS (asthma: 1,621,000; COPD: 3,733,000, pneumoconioses: 1,288,000) due to exposure to occupational airborne particulates. Conclusions Occupational airborne particulates are an important cause of death and disability worldwide. Am. J. Ind. Med. 48:432–445, 2005. © 2005 Wiley-Liss, Inc.

Journal ArticleDOI
TL;DR: Clinical, demographic, economic, and workplace factors were associated with work absence and strategies to reduce work absence following carpal tunnel release should address multiple dimensions of the worker and workplace.
Abstract: Background The objective was to identify factors across multiple domains associated with return to work in a community-based cohort of workers with carpal tunnel syndrome. Methods Workers scheduled for carpal tunnel release were recruited into this prospective study. Subjects completed questionnaires preoperatively and at 2, 6, and 12 months postoperatively. The questionnaires contained demographic, clinical, and psychosocial factors and physical and psychosocial workplace stressors. Predictors of work absence at 6 and 12 months were examined in bivariate and multivariate logistic regression analyses. Results Six months following surgery of 181 subjects, 29 (19%) were out of work. Twelve months postoperatively 33 subjects (22%) were out of work. In bivariate analyses, the factors associated with work absence at 6 months, at P ≤ 0.01, included preoperative physical functional status, change in self-efficacy between preoperative assessment and 2 months, lower income, workers' compensation, representation by an attorney, work exposure to force and repetition, higher psychological job demands and lower control, lower social support by coworkers, lower job security and more supportive organizational policies and practices. The factors associated with work absence at 12 months in bivariate analyses included preoperative physical functional status, lower self-efficacy at 2 months, workers' compensation, and less supportive organizational policies and practices. Multivariate analyses documented a multidimensional model, with predictors from multiple domains. Conclusions Clinical, demographic, economic, and workplace factors were associated with work absence. Strategies to reduce work absence following carpal tunnel release should address multiple dimensions of the worker and workplace. Am. J. Ind. Med. 47:120–130, 2005. © 2005 Wiley-Liss, Inc.

Journal ArticleDOI
TL;DR: Employees at this copper-beryllium alloy facility had similar prevalences of sensitization and CBD as workers at facilities with higher beryllium air levels, and relationships between sensitized individuals and CBD and work areas/processes were examined.
Abstract: Background Chronic beryllium disease (CBD), which primarily affects the lungs, occurs in sensitized beryllium-exposed individuals. At a copper–beryllium alloy strip and wire finishing facility we performed a cross-sectional survey to examine prevalences of beryllium sensitization and CBD, and relationships between sensitization and CBD and work areas/processes. Methods Current employees (185) were offered beryllium lymphocyte proliferation testing (BeLPT) for sensitization, clinical evaluation for CBD (if sensitized), and questionnaires. We obtained historical airborne beryllium measurements. Results Participation was 83%. Prevalences of sensitization and CBD were 7% (10/153) and 4% (6/153), respectively; this included employees with abnormal BeLPTs from two laboratories, four diagnosed with CBD during the survey, and one each diagnosed preceding and following the survey. Potential BeLPT laboratory problems were noted; one laboratory was twice as likely to have reported an abnormal result (P < 0.05, all tests), and five times as likely to have reported a borderline or uninterpretable result (P < 0.05, first blood draw and all tests). CBD risk was highest in rod and wire production (P < 0.05), where air levels were highest. Conclusions Sensitization and CBD were associated with an area in which beryllium air levels exceeded 0.2 mg/m 3 , and not with areas where this level was rarely exceeded. Employees at this copper–beryllium alloy facility had similar prevalences of sensitization and CBD as workers at facilities with higher beryllium air levels. Am. J. Ind. Med.

Journal ArticleDOI
TL;DR: Upper-extremity MSD appears to be significantly under-reported, and rates are not decreasing over time, and capture-recapture methods provide an improved surveillance method for monitoring temporal trends in injury rates.
Abstract: Background Musculoskeletal disorders (MSD) are thought to be declining based on Bureau of Labor Statistics survey data, but there is also evidence of MSD under-reporting, raising the possibility of contrary trends. The magnitude of MSD under-reporting over time, and its industry distribution have not been adequately described. Methods Capture-recapture analysis of 7 years of Connecticut MSD (1995–2001), utilizing Workers' Compensation and physician reporting data was performed. Results Only 5.5%–7.9% of MSD cases appear to be reported to Workers Compensation annually. The capture-recapture estimated average annual rate for upper-extremity MSD was 133.1 per 10,000 employed persons, far above BLS rates. By industry, Manufacturing, State Government, and the Finance/Insurance/Real Estate sectors all had significantly higher MSD rates than Wholesale/Retail Trade. Conclusions Upper-extremity MSD appears to be significantly under-reported, and rates are not decreasing over time. Capture-recapture methods provide an improved surveillance method for monitoring temporal trends in injury rates. Am. J. Ind. Med. 48:40–49, 2005. © 2005 Wiley-Liss, Inc.

Journal ArticleDOI
TL;DR: Mineral oil- and glycol-based fogs are associated with acute and chronic adverse effects on respiratory health among employees and reducing exposure, through controls, substitution, and elimination where possible, is likely to reduce these effects.
Abstract: Background Theatrical fogs (glycol or mineral oil aerosols) are widely used in the entertainment industry to create special effects and make lighting visible. Methods We studied 101 employees at 19 sites using fogs and measured personal fog exposures, across work shift lung function, and acute and chronic symptoms. Results were also compared to an external control population, studied previously. Results Chronic work-related wheezing and chest tightness were significantly associated with increased cumulative exposure to fogs (mineral oil and glycols) over the previous 2 years. Acute cough and dry throat were associated with acute exposure to glycol-based fogs; increased acute upper airway symptoms were associated with increased fog aerosol overall. Lung function was significantly lower among those working closest to the fog source. Conclusions Mineral oil- and glycol-based fogs are associated with acute and chronic adverse effects on respiratory health among employees. Reducing exposure, through controls, substitution, and elimination where possible, is likely to reduce these effects. Am. J. Ind. Med. 47:411–418, 2005. © 2005 Wiley-Liss, Inc.

Journal ArticleDOI
TL;DR: Health care workers are at risk for work-related asthma, and health care providers need to recognize this risk of WRA, as early diagnosis will decrease the morbidity associated with WRA.
Abstract: Background Asthma morbidity has increased, posing a public health burden. Work-related asthma (WRA) accounts for a significant proportion of adult asthma that causes serious personal and economic consequences. Methods Cases were identified using physician reports and hospital discharge data, as part of four state-based surveillance systems. We used structured interviews to confirm cases and identify occupations and exposures associated with WRA. Results Health care workers (HCWs) accounted for 16% (n = 305) of the 1,879 confirmed WRA cases, but only 8% of the states' workforce. Cases primarily were employed in hospitals and were nurses. The most commonly reported exposures were cleaning products, latex, and poor air quality. Conclusions Health care workers are at risk for work-related asthma. Health care providers need to recognize this risk of WRA, as early diagnosis will decrease the morbidity associated with WRA. Careful product purchasing and facility maintenance by health care institutions will decrease the risk. Am. J. Ind. Med. 47:265–275, 2005. © 2005 Wiley-Liss, Inc.

Journal ArticleDOI
TL;DR: This study adds substantial evidence that hearing loss acts as a risk for agricultural injuries, and it is notable that self-reported hearing might be a stronger predictor of injuries than pure tone audiometry (PTA).
Abstract: BACKGROUND: Previous studies suggested that hearing impairment based on self-report might increase the risk of agricultural injuries. However, self-reported hearing measures may be subject to inaccuracy and subjective perception. We assessed the association of agricultural injuries with hearing loss and other hearing characteristics using measured hearing. METHODS: Study subjects were 150 farmers who participated in the Iowa Certified Safe Farm study. Injury information was collected by telephone interviews at 2-5 month intervals from September 1999 to October 2002. Hearing levels were measured annually using the pure tone audiometry from 1998 to 2002. Adjusted rate ratios of injuries were calculated using the multivariate Poisson regression model. RESULTS: Hearing loss in the better ear (RR = 1.62), hearing asymmetry (RR = 1.67), and fair/poor self-reported hearing (RR = 1.96) were significantly associated with the risk of agricultural injuries. It is notable that self-reported hearing might be a stronger predictor of injuries than pure tone audiometry (PTA). Exposure to noise elevated the risk of injuries in those farmers with hearing loss or hearing asymmetry. The occasional use of hearing protection was significantly associated with agricultural injuries. CONCLUSIONS: This study adds substantial evidence that hearing loss acts as a risk for agricultural injuries. Prevention of hearing loss and noise exposure may be important in reducing the burden of agricultural injuries.

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TL;DR: Workplace interventions should be based on elements identified by many nurses as being problematic, and a considerable increase in the prevalence of PSI and of adverse psychosocial work factors in comparison to the prevalence reported by a comparable group of nurses in 1994.
Abstract: Background In the last 15 years, the health care system has undergone significant restructuring. The study’s objective was to examine the psychosocial work environment and the health of nurses after major restructuring in comparison with two reference populations. Methods This cross-sectional study involved 2,006 nurses from 16 health centers. A questionnaire measured current work characteristics: psychological demands, decision latitude, and social support at work from Karasek’s Job Content Questionnaire, organizational changes, and health effects. Prevalence ratios and binomial regression were used to examine the associations between current work characteristics, changes and psychological distress (PSI). Results There was a considerable increase in the prevalence of PSI and of adverse psychosocial work factors in comparison to the prevalence reported by a comparable group of nurses in 1994. These adverse factors were also more prevalent among nurses

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TL;DR: A cohort or longitudinal study of heart disease among long haul truck drivers, that obtains data for occupational exposures as well as lifestyle risk factors, could help explain inconsistencies between the findings of this and previous studies.
Abstract: Background Studies of truck drivers and cardiovascular disease (CVD), myocardial infarction, or ischemic heart disease (IHD) are limited, although studies of other professional drivers reported increased risk. Methods US mortality data from 1979 to 1990 for ages 15–90 were used to calculate proportional mortality ratios (PMRs) for heart disease and lung cancer for short and long haul truck drivers. Analysis was performed for Black (998 short haul and 13,241 long haul) truck drivers and White (4,929 short and 74,315 long haul) truck drivers separately. Results The highest significantly elevated proportionate heart disease (IHD, acute myocardial infarction (AMI), and other forms of heart disease) and lung cancer mortality was found for White and Black male long haul truck drivers age 15–54. Mortality was not significantly elevated for short haul truck drivers of either race or gender, nor for truck drivers who died after age 65, except for lung cancer among White males. An indirect adjustment suggested that smoking could explain the excess IHD mortality, but no direct data for smoking or the other known risk factors for heart disease were available and occupational exposures were not measured. Conclusions The highest significant excess proportionate mortality for lung cancer, IHD and AMI was found for long haul truck drivers who were under age 55 at death. A cohort or longitudinal study of heart disease among long haul truck drivers, that obtains data for occupational exposures as well as lifestyle risk factors, could help explain inconsistencies between the findings of this and previous studies. Am. J. Ind. Med. 47:113–119, 2005. Published 2005 Wiley-Liss, Inc.

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TL;DR: The findings of this study underscore the need for use of appropriate eye protection and implementation, and enforcement of eye protection policies in the workplace to prevent work-related eye injuries.
Abstract: Background Eye injuries account for 3.3% of all occupational injuries resulting in lost workdays in private industry in the United States. Work-related eye injuries among individuals 15 years of age and older treated in hospital emergency departments (EDs) in the United States in 1999 were investigated in this study. Methods Work-related eye injuries treated in hospital EDs in the US were identified from the Work-Related Injury Statistics Query System (Work-RISQS). National estimates of the numbers and rates per 10,000 full-time worker equivalents (FTE) of work-related eye injuries were determined by gender and age. The characteristics of these injuries were described, including the injury event, the main source of injury, injury diagnosis, and the disposition of the injured patient. Results In 1999, there were approximately 280,000 (95% confidence interval (CIs) ± 66,400) work-related eye injuries treated in hospital EDs, with individuals 20–34 years of age at highest risk for work-related eye injury. Foreign-bodies in the eye and chemical burns were among the most common types of work-related eye injuries. Conclusions The findings of this study underscore the need for use of appropriate eye protection and implementation, and enforcement of eye protection policies in the workplace to prevent work-related eye injuries. Am. J. Ind. Med. 48:57–62, 2005. © 2005 Wiley-Liss, Inc.

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TL;DR: Wood dust exposure is a potential risk factor for lung cancer when stratified by histopathological type and among those exposed to cigarette smoke and wood dust, 21% of the cases were attributable to biologic interaction.
Abstract: Background Wood dust was designated as a human carcinogen based on increased sinus and nasal cancer rates among exposed workers. However, data on an association with lung cancer have been inconclusive. Methods Self-reported wood dust exposure was compared between 1,368 lung cancer patients and 1,192 cancer-free adults, in a lung cancer case-control study. Epidemiological information was collected through a detailed personal interview. Results Using several definitions of wood dust exposure we consistently observed statistically significant elevated adjusted risk estimates; for example, the adjusted odds ratio (OR) for combined wood dust related occupations and industries was 3.15 (95% confidence intervals (CI) 1.45–6.86) and for an overall summary exposure measure it was 1.60 (95% CI 1.19–2.14). The association was maintained when stratified by histopathological type. Among those exposed to cigarette smoke and wood dust, 21% of the cases were attributable to biologic interaction. Conclusions Wood dust exposure is a potential risk factor for lung cancer. Am. J. Ind. Med. 47:349–357, 2005. © 2005 Wiley-Liss, Inc.

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TL;DR: An analysis of the cost effectiveness of alternative means of preventing silicosis suggests that engineering control programs would be cost effective in both developed and developing countries for reducing silica exposure to save lives.
Abstract: Background The failure to recognize occupational health as an economic phenomenon limits the effectiveness of interventions ostensibly designed to prevent disease and injury. Hence, consideration of economic efficiency is essential in the evaluations of interventions to reduce hazardous working conditions. In this paper, we present an analysis of the cost effectiveness of alternative means of preventing silicosis. Method To evaluate the cost-effectiveness of specific interventions for the prevention of occupationally induced silicosis, we have used the simulation models based on the generalized cost effectiveness analysis (GCEA) developed by the WHO-CHOICE initiative for two representative subregions – namely AMROA (Canada, United States of America), and WPROB1(China, Korea, Mongolia). Results In both of the two subregions, engineering controls are the most cost-effective with ratios varying from $105.89 per healthy year or disability adjusted life year saved in AMROA to approximately $109 in WPROB1. In the two subregions, the incremental cost-effectiveness ratio of Engineering Controls (EC) looks most attractive. Although Dust Masks (DM) looks attractive in terms of cost, the total efficacy is extremely limited. Conclusion To the extent that this analysis can be generalized across other subregions, it suggests that engineering control programs would be cost-effective in both developed and developing countries for reducing silica

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TL;DR: Job rotation seemed to coincide with a reduced need for recovery and was associated with an increased risk of low back complaints, and no effects were found on sick leave due to musculoskeletal complaints.
Abstract: Background Job rotation might be an effective preventive measure to reduce the prevalence ofmusculoskeletalcomplaints,althoughits effect hasnotbeenyet established. The aim of the present study is to evaluate the effect of job rotation in refuse collecting on need for recovery, prevalence of musculoskeletal complaints, and sick leave due to musculoskeletal complaints. Methods A 1-year prospective study among refuse collectors was performed, using standardized questionnaires. Job rotation was performed between collecting two-wheeled containersanddrivingarefusetruck.Theexperimentalgroupsofrotatingrefusecollectors at t0 and t1 (group R-R) and non-rotating refuse collectors at t0 and rotating refuse collectors att1(group NR-R)were comparedwith areferencegroupofnon-rotatingrefuse collectors at t0 and t1 (group NR-NR). Results The adjusted need for recovery of group R-R was marginally significantly lower than need for recovery of the referencegroup. Groups R-R and NR-R had a more than two times higher risk for complaints of the low back than the reference group. No other significant results were found. Conclusions Job rotation seemed to coincide with a reduced need for recovery and was associated with an increased risk of low back complaints. No effects were found on sick leave due to musculoskeletal complaints. The results might be influenced by the healthy workerselectioneffectinthereferencegroupanditsinverseintherotatinggroups. Am. J. Ind. Med. 47:394–402, 2005. 2005 Wiley-Liss, Inc.