Showing papers in "International Journal of Occupational and Environmental Health in 2004"

Preventing Needlestick Injuries among Healthcare Workers: A WHO-ICN Collaboration

Abstract: Effective measures to prevent infections from occupaonal exposure of healthcare workers to blood include mmunization against HBV, eliminating unnecessary injections, implementing Universal Precautions, eliminating needle recapping and disposing of the sharp into a sharps container immediately after use, use of safer devices such as needles that sheath or retract after use, provision and use of personal protective equipment, and training workers in the risks and prevention of transmission. Post-exposure prophylaxis with antiretroviral medications can reduce the risk of HIV transmission by 80%. In 2003, the World Health Organization and the International Council of Nurses launched a pilot project in three countries to protect healthcare workers from needlestick injuries. The results of the pilot will be disseminated worldwide, along with best policies and practices for prevention.

Work-home conflict in the European nursing profession.

Abstract: This study investigated predictors of the work-home conflict among registered nurses (n = 27,603) in eight European countries. Two scales were used to assess work-family conflict (WFC) and family-work conflict (FWC). Based on a distinction of time- and strain-based and individual factors for WFC, bivariate correlations and multiple linear regression analysis were computed. The relationship between WFC and intention to leave the nursing profession was also analyzed. Quantitative demands indicating intensity of work, regularity of working time, and being pressured to work overtime were the dominating predictors for WFC, explaining 13-23% of the observed variance. The association between WFC and intention to leave the nursing profession was pronounced in all countries except one. Most European countries lack qualified nurses. Attempts to retain nurses in their profession should take into consideration the WFC, the regularity of working time in particular, and overtime issues.

Severe acute respiratory syndrome (SARS) and healthcare workers.

Abstract: The recent outbreak of severe acute respiratory syndrome (SARS) was spread by international air travel, a direct result of globalization. The disease is caused by a novel coronavirus, transmitted f...

Genetically modified cotton and farmers' health in China.

Abstract: This study provides the first evidence of a direct link between the adoption of a genetically modified (GM) crop and improvements in human health. Estimation of the impact of Bacillus thuringiensis (Bt) cotton adoption on pesticide use from data from a survey of cotton farmers in northern China, 1999-2001, showed that Bt cotton adoption reduced pesticide use. Assessment of a health-production function showed that predicted pesticide use had a positive impact on poisoning incidence. Taken together, these results indicate that the adoption of Bt cotton can substantially reduce the risk and the incidence of poisonings.

Effort–Reward Imbalance among Nurses in Stable Countries and in Countries in Transition

Abstract: The effort-reward imbalance (ERI) model was used to analyze burnout and intention to leave the nursing profession (ITL) in nurses (n = 21,229) in seven European countries, as part of the NEXT-Study. Data were gathered using the short form of the ERI questionnaire. Burnout was assessed using the Copenhagen Burnout Inventory. Multivariate logistic regression analysis controlled for age and gender. ERI was very high in Poland, Germany, Italy, and Slovakia. High ERI was associated with burnout. Odds ratios (ORs) ranged from 2.6 to 13.2 for ERI and from 3.0 to 5.5 for overcommitment (OC). Nurses with high ERI also had high ORs for ITL (2.6-5.7). The association of OC and ITL was weaker (1.1-1.7). The strong and consistent associations of ERI model results with psychological health and with ITL support the relevance of the model for examining different outcome levels. Nurses in transitional countries, as expected, experienced high ERI. High ERI in stable countries suggests that their economic sectors, particularly health care, may be in transition.

Global Use of Asbestos and the Incidence of Mesothelioma

Abstract: In Western Europe, Scandinavia, North America, and Australia the manufacture and use of asbestos products peaked in the 1970s. Current incidences of mesothelioma range from 14 to 35 cases/million/year in 11 industrialized countries that had used asbestos 2.0 to 5.5 kg/capita/year about 25 years earlier. A significant linear correlation (r = 0.80, p 0.01) exists between the two variables. Accordingly, about 170 tons of produced and consumed asbestos will cause at least one death from mesothelioma, most often as a consequence of occupational exposure.

Incidence of Childhood Leukemia and Oil Exploitation in the Amazon Basin of Ecuador

Abstract: To determine whether there was any difference in childhood leukemia incidence rates between populations living in the proximity to oil fields and those living in areas free from oil exploitation in the Amazon basin of Ecuador, 91 cancer cases among children (0-14 years) from the provinces of Sucumbios, Orellana, Napo, and Pastaza during the period 1985-2000 were studied The relative risks for all leukemias indicated significantly elevated levels in the youngest age group (0-4 years), both genders combined (RR 348, 95% CI 125-967), and in all age groups (0-14 years) combined for females (RR 260, 95% CI 111-608) and both genders combined (RR 256, 95% CI 135-486) There was no significant difference between the two groups in all other cancer sites combined Study results are compatible with a relationship between childhood leukemia incidence and living in the proximity of oil fields in the Ecuadorian Amazon

Occupational exposures and non-Hodgkin's lymphoma in Southern Sweden.

Abstract: In a case-control study based on 859 consecutive non-Hodgkin's lymphoma (NHL) cases identified through a tumor registry between 1990 and 1998, the authors collected demographic, occupational, exposure, and education information. Exposures were identified through self-report, reported occupational history, and the use of ajob-exposure matrix. Conditional logistic regression analyses of the 859 cases and 1,310 controls showed increased risks in workers exposed to gasoline (odds ratio [OR] 1.46; 95% confidence interval [CI] 1.04, 2.05), aliphatic or alicyclic hydrocarbons (OR 1.75; CI 1.03, 2.99), aromatic hydrocarbons (OR 1.45; CI 1.13, 1.86), and solvents for more than five years (OR 1.59; CI 1.11,2.28), as well as automobile mechanics (OR 1.82; CI 1.18, 2.81) and painters (OR 1.77; CI 1.13, 2.76). Exposures to pesticides and farming were not associated with increased risk. Prior radiotherapy was associated with increased risk (OR 2.84; CI 1.85, 4.37). Concordance between analyses based on self-rep...

Taming the Brain Drain: A Challenge for Public Health Systems in Southern Africa

Abstract: In southern Africa, rapid out-migration of health professionals is compounding the problems of health systems already faced with budget constraints and the impacts of HIV/AIDS. These negative effects are unlikely to be offset by remittances from abroad. The same dynamics that affect the international migration of health professionals operate within nations, for instance as they move from public to private systems. "Push," "pull," and "stick" factors contribute to the migration. Some Canadian provinces have emerged as key destinations. The authors outline a program of research on how Canada and the international community might address the negative impacts of the brain drain. Policy options have been identified, but implementation may be complicated by provisions of GATS, fundamental economic disparities, and domestic political priorities.

Understanding "globalization" as a determinant of health determinants: a critical perspective.

Abstract: The purpose of this article is to explain how globalization has evolved, in order to provide a context for assessing the health care restructuring that is occurring worldwide. The authors begin by defining globalization and introducing a framework for considering pathways that can affect social organization and health. They then draw attention to current trends, such as the GATS (General Agreement on Trade in Services), that promise to open health services provision to increased pressures of globalization.

Chrysotile Asbestos as a Cause of Mesothelioma: Application of the Hill Causation Model

Abstract: Chrysotile comprises over 95% of the asbestos used today. Some have contended that the majority of asbestos-related diseases have resulted from exposures to the amphiboles. In fact, chrysotile is being touted as the form of asbestos which can be used safely. Causation is a controversial issue for the epidemiologist. How much proof is needed before causation can be established? This paper examines one proposed model for establishing causation as presented by Sir Austin Bradford Hill in 1965. Many policymakers have relied upon this model in forming public health policy as well as deciding litigation issues. Chrysotile asbestos meets Hill's nine proposed criteria, establishing chrysotile asbestos as a cause of mesothelioma.

Work-related Musculoskeletal Problems among Women Workers in the Semiconductor Industry in Peninsular Malaysia

Abstract: A cross-sectional study to identify the prevalence of musculoskeletal problems and work-related risk factors was conducted among 906 women semiconductor workers. Highest prevalences were pain in the lower limbs, neck/shoulders, and upper back, and highest exposures were prolonged (≥four hours per workshift) hand/wrist movement, standing, and lifting with hands. Afer logistic regression, lower-limb pain was significantly associated with standing, neck/shoulder pain with sitting and lifting, upper-back pain with climbing steps, low back pain with hand/wrist movement, and hand/wrist pain with lifting. Neck/shoulder pain was significantly higher for workers with shorter working durations, while lower-limb pain was significantly higher for workers with longer working durations. End-of-line assembly workers had significantly higher odds ratios for pain at all sites, while middle-of-line workers had higher odds ratios for pain in neck/shoulders and upper back, and wafer-fabrication workers had higher odd...

"Hormesis"--an inappropriate extrapolation from the specific to the universal.

Abstract: Although it is generally accepted that some chemicals may have beneficial effects at low doses, incorporating these effects into risk assessments generally ignores well-established factors related to exposure and human susceptibility. The authors argue against indiscriminate application of hormesis in assessments of chemical risks for regulatory purposes.

Health effects of wastewater reuse for agriculture in the suburbs of Asmara city, Eritrea.

Abstract: The health impact of utilization of raw domestic sewage for vegetable cultivation in the suburbs of Asmara, Eritrea, was assessed. Results showed heavy contamination of vegetables by fecal coliforms and Giardia cysts as well as other pathogenic bacteria such as Shigella and Salmonella. Stool samples from 75 occupationally exposed farmers revealed that 45% of them were harboring Giardia cysts. Dietary intake of raw greens (lettuce, cabbage) grown on the raw sewage appears to cause giardiasis, amebiasis, and diarrhea in the farming community as well as in the surrounding area. Comparison of hospital data from the affected area with data from other areas of Eritrea indicated that agriculture use of untreated wastewater was the major cause of the increase in giardiasis and other gastrointestinal diseases.

Work Organization, Area Labor-market Characteristics, and Depression among U.S. Nursing Home Workers: A Cross-classified Multilevel Analysis

Abstract: Associations between forms of work organization that follow globalization and depression were examined in U.S. nursing home assistants. A cross-sectional study of 539 nurse assistants in 49 nursing homes in three states in 2000 assessed nursing home ownership type, managerial style, wage policy, nurse assistants' emotional stresses, and area labor-market characteristics (county income inequality, median household income, and social capital) in relation to the prevalence of depression among the nurse assistants. A cross-classified multilevel analysis was used. For-profit ownership, emotional strain, managerial pressure, and lack of seniority pay increases were associated with depression. Labor-market characteristics were not associated with depression once work organization was taken into account. The deregulation of the nursing home industry that accompanies globalization is likely to adversely affect the mental health of nursing home assistants.

Labor markets and employment insecurity: Impacts of globalization on service and healthcare-sector workforces

Abstract: Global changes in the economies of most developed nations have impacted the way healthcare is organized, even within largely public systems, and the working conditions of healthcare workers Since the acceleration of globalization in the 1970s, service-sector workers in developed nations have faced high unemployment, increased skill requirements for most jobs, and a rise in non-traditional work arrangements These secular shifts in service-sector labor markets have occurred against the background of an erosion of the welfare state and growing income inequality As well, many healthcare systems, including Canada's, were severely downsized and restructured in the 1990s, exacerbating the underlying negative secular trends in the service sector, and worsening the working conditions for many healthcare workers Globalization has altered the labor market and shifted working conditions in ways that have been unfavorable to many healthcare workers

Workload as a Determinant of Staff Injury in Intermediate Care

Abstract: Care aides (CAs) and licensed practical nurses (LPNs) in intermediate care (IC) facilities experience high risks of injury. Workload measures were examined in eight IC facilities to ascertain their relationships with musculoskeletal injury rates, pain, burnout, and selfreported health. Workload was measured using 1) focus groups and telephone interviews to obtain CA/LPN perceptions; 2) systematic observation (numbers of tasks performed in shift); and 3) CA-to-resident staffing ratios. Controlling for resident dependency and facility funding, all workload measures were correlated with staff injury rates and burnout. Facilities with low injury rates had better CA/LPN-to-resident staffing ratios and fewer tasks. The differences in staffing reflected differences in how organizations prioritized and allocated resources. Thus, workload is an important determinant of injuries and increased staffing evels correlate with decreased injuries.

Malignant pleural mesothelioma--an update.

Abstract: Exposure to asbestos is the most frequent, but not exclusive, cause of malignant mesothelioma. Clinical features include dyspnea, cough, nonspecific chest pain, weight loss and night sweats. Diagnosis may be complicated by histologic difficulties. Thoracoscopic techniques are proving beneficial, but no one method of imaging has proven superior, and disease staging is inconsistent. Conventional treatments such as chemotherapy, surgery, and radiotherapy have had variable impacts, although chemotherapy is useful in palliation and can improve both survival and quality of life. There is hope for new antimetabolite agents. The role of radical surgery is yet to be evaluated in a large trial. New radiotherapeutic techniques to improve local control are promising. Multimodality treatments appear to be the most successful for management of potentially resectable disease. It is likely that biological markers will improve accuracy in staging and prognosis. With new treatments based on better understanding of the biology of the disease, there is cautious optimism for the future for patients with malignant pleural mesothelioma.

Medical evaluation of work-related illness: evaluations by a treating occupational medicine specialist and by independent medical examiners compared.

Abstract: Treating physicians' and independent medical examiners' (IMEs') opinions were compared to identify differences of opinion and to develop a basis for understanding the differences. Twenty-three patients of an occupational health center (OHC) who had been examined by an IME were studied. OHC and IME opinions regarding diagnosis, work-relatedness, treatment recommendations, and disability assessment were categorized by degree of agreement. There was agreement on all four issues for only one patient. Opinions were most divergent with regard to disability assessment and least divergent with regard to diagnosis. Disagreement was unidirectional: the IMEs made fewer diagnoses, deemed fewer illnesses work-related, made fewer treatment recommendations, and assessed lower levels of disability than the OHC examiners. The results suggest that differences in opinion between the OHC and IMEs are due to differences in perspective, rather than skill or training.

Work-related Symptoms and Inflammation among Sewage Plant Operatives

Abstract: Sewage operatives at five sewage treatment plants (n = 59) and controls not exposed to sewage (n = 55) were examined to determine work-related symptoms and inflammatory responses. Symptoms were elicited using a questionnaire, and spirometry was performed. Inflammatory markers were determined in blood and nasal lavage. Workplace endotoxin and hydrogen sulfide were measured and adeno- and enterovirus antibodies were evaluated in blood. Gastrointestinal and airway symptoms, joint pains, unusual tiredness, and toxic pneumonitis were more common among operatives, and the proportion of blood neutrophils was higher among operatives as compared with controls. A relationship was found between several reported symptoms and the inflammatory markers. Hydrogen sulfide levels were very low. Endotoxin levels were generally low, but high at some work sites.

Water fluoridation and the environment: current perspective in the United States.

Abstract: Evidence of water fluoridation's effects on plants, animals, and humans is considered based on reviews by scientific groups and individual communities, including Fort Collins, CO, Port Angeles, WA, and Tacoma-Pierce County, WA. The potential for corrosion of pipes and the use of fluoridation chemicals, particularly fluorosilicic acid, are considered, as is the debate about whether fluoridation increases lead in water, with the conclusion that there is no such increase. The arguments of anti-fluoridationists and fluoridation proponentsare examined with respect to the politics of the issue.

Hormesis--basic, generalizable, central to toxicology and a method to improve the risk-assessment process.

Abstract: Hormesis, a dose-response, phenomenon characterized by a low-dose stimulation and a high-dose inhibition, has been the object of controversy due to its challenging of basic understandings of the do...

Malignant mesothelioma surveillance: a comparison of ICD 10 mortality data with SEER incidence data in nine areas of the United States.

Abstract: With the implementation in 1999 of ICD-10 death certificate coding in the United States, mortality data specific to malignant mesothelioma became readily available on a national basis. To evaluate the accuracy and completeness of diagnosis and coding for mesothelioma on the death certificate, mortality information was compared with incidence data. A mortality/incidence ratio was calculated for each of the nine areas covered by the SEER Program, using National Vital Statistics mortality data from 1999 and 2000, and the SEER incidence data for 1998 and 1999. The mortality/incidence ratio for the two years combined for all areas was 0.82. Only two areas (Connecticut and Atlanta) had ratios <80%. The overall correlation coefficient between mortality and incidence rates was 0.96. Thus, mortality data coded using ICD-10 can be a valid source for mesothelioma surveillance and can be instituted without major cost if a national mortality statistics program based on ICD-10 is in place, making it feasible even for developing countries.

Industrial solvents and kidney disease.

Abstract: Scientific literature addressing the association of industrial exposures to solvents with glomerular kidney disease is reviewed. The role of the practicing physician in taking an occupational history of exposures to solvents in every case of glomerulonephritis is emphasized. Based on case studies and epidemiologic findings, it is highly probable that exposures to industrial solvents should be considered as a factor in the causation of kidney disease. The need for more frequent reporting is discussed.

Participatory mapping of occupational hazards and disease among asbestos-exposed workers from a foundry and insulation complex in Canada.

Abstract: A study of former asbestos-exposed foundry and insulation workers was carried out in Sarnia, Ontario, home to Canada’s petrochemical industry, using participatory mapping to document past exposures and subsequent diseases. Before it closed, government inspectors had monitored the use of asbestos at the facility, documenting levels that were thousands of times above the current legal limit. The study was undertaken by the Occupational Health Clinics for Ontario Workers (OHCOW) and Canadian Auto Workers (CAW) to provide evidence for worker compensation claims. Using facilitated hazard mapping, former Holmes workers graphically reconstructed their workplaces and detailed their exposures. Using facilitated body mapping, workers recorded and displayed their health problems. The study uncovered a grim pattern of occupational diseases. Following the release of the results, coupled with clinically confirmed diagnoses and corroborating evidence of exposure, hundreds of former Holmes employees and their families received compensation for occupational diseases that had previously gone unrecognized. Key words: body mapping; hazard mapping; participatory; asbestos; foundry; insulation; occupational disease; cancer; mesothelioma; Canada. INT J OCCUP ENVIRON HEALTH 2004;10:144‐153

Pulmonary effects of occupational exposure to Portland cement: a study from eastern Saudi Arabia.

Abstract: A cross-sectional study was conducted in a randomly selected factory producing Portland cement in eastern Saudi Arabia to determine the prevalence of respiratory symptoms and diseases and chest x-ray changes consistent with pneumoconiosis in the employees. A sample of 150 exposed and 355 unexposed employees was selected. A questionnaire about respiratory symptoms was completed during an interview. Chest x-rays were read according to the ILO criteria for pneumoconiosis. Dust level was determined by the gravimetric method. Concentrations of personal respirable dust ranged from 2.13 mg/m3 in the kilns to 59.52 mg/m3 in the quarry area. Cough and phlegm were found to be related to cigarette smoking, while wheezing, shortness of breath, and bronchial asthma were related to dust levels. It is recommended that engineering measures be adopted to reduce the dust level in this company, together with health monitoring of exposed employees.

The diagnosis and attribution of asbestos-related diseases in an Australian context: report of the Adelaide Workshop on Asbestos-Related Diseases. October 6-7, 2000.

Abstract: Predictions of future cases of mesothelioma in Australia to the year 2020 are in the order of a total of 10,000 new cases. Compensation claims are testing the attribution in a particular case between occupational asbestos exposure and lung cancer. The cost of the problem necessitates clarifying and standardizing the criteria for a confident diagnosis of asbestos-related disease. The possibility of differences in criteria that determine attribution of asbestos to a disease prompted a consensus meeting of pathologists, epidemiologists, physicians, oncologists, radiologists, and others to define current thinking and to agree on an Australian document based on the scientific evidence for establishing diagnoses and attribution data of asbestos-related diseases in Australia. The participants' findings are reported.

Organophosphate pesticide exposures of traditional and integrated pest management farmers from working air conditions: a case study in Thailand.

Abstract: Concentrations of organophosphate pesticides, including chlorpyrifos and methyl parathion, were measured in ambient air breathed by farmers in Tambon Bang Rieng, Thailand. An exposure assessment and comparison was made between the levels of pesticide exposure of traditional and integrated pest management (IPM) farmers. Thirty-three air samples were collected during pesticide spraying. Traditional farmers were exposed to higher levels of the pesticide(s), with an average concentration of 0.19 mg/m3, compared with 0.037 mg/m3 for the IPM farmers. It was estimated that a farmer of Tambon Bang Rieng would be exposed to 81-12,261 mg of the organophosphate pesticide(s) via inhalation throughout his or her lifetime. Moreover, traditional farmers absorbed more of pesticide via inhalation than did IPM farmers.

Re: Controlled use of asbestos.

Abstract: To the Editor:--Castleman's recent article, \"Controlled Use of Asbestos\" critiques industry's misrepresentation of the hazards associated with using asbestos. 1 We agree with Castleman when he states that, \"'Controlled use' of asbestos is the asbestos industry's way of referring to business as llsual with a false face.\" \"Controlled use\" is but the latest trend in a series of corporate misrepresentations relating to asbestos risks. Union Carbide Corporation (UCC) and its consultants have asserted that asbestos mined from the Coalinga deposit in California and sold by UCC as \"Calidria®\"is innocuous.2 They base these assertions on two arguments: 1) Calidria is unregulated .\"shortfiber\" chrysotile (less than 5 11m) and thus nontoxic, and 2) none of the Calidria mine or mill workers ever developed asbestos-related disease~ UCC successfully marketed Calidria® as short-fiber asbestos, while suppressing evidence that more than 50% of Calidria· fibers were actually longer than 5 pm. UCC concealed the results of animal studies, and to give the impression that Calidria was safe, they employed consultants to manipulateCalidria'inhalation data from previous studies. As a result of

Urinary hexane diamine to assess respiratory exposure to hexamethylene diisocyanate aerosol: a human inhalation study.

Abstract: The use of urinary hexane diamine (HDA) as a biomarker to assess human respiratory exposure to hexamethylene diisocyanate (HDI) aerosol was evaluated. Twenty-three auto body shop workers were exposed to HDI biuret aerosol for two hours using a closed exposure apparatus. HDI exposures were quantified using both a direct-reading instrument and a treated-filter method. Urine samples collected at baseline, immediately post exposure, and every four to five hours for up to 20 hours were analyzed for HDA using gas chromatography and mass spectrometry. Mean urinary HDA (μg/ g creatinine) sharply increased from the baseline value of 0.7 to 18.1 immediately post exposure and decreased rapidly to 4.7, 1.9 and 1.1, respectively, at 4,9, and 18 hours post exposure. Considerable individual variability was found. Urinary HDA can assess acute respiratory exposure to HDI aerosol, but may have limited use as a biomarker of exposure in the workplace.