Showing papers in "Journal of Occupational and Environmental Medicine in 1989"

Reliability and validity of expected outcomes and barriers for habitual physical activity.

Abstract: We conducted two studies to examine the reliability and validity of self-report scales for assessing outcome-expectancy values and perceived barriers for participating in regular physical activity. In study one with college students (N = 243), independent and reliable psychometric factors were identified as outcome-expectancy values (psychologic, body image, and health) and perceived barriers (time, effort, and obstacles). alpha internal consistency coefficients ranged from .47 to .78, and test-retest stability correlations were .66 to .89. In prospective analyses, subscales significantly predicted supervised running (R2 = .27) and free-living physical activity estimated by seven-day recall at two-, five-, and nine-week intervals (R2 ranged from .13 to .24). In study two with employees at CONOCO World Headquarters (N = 968), similar independent scales were derived for outcome-expectancy values (psychologic, body image/health, competition, fun, and social) and perceived barriers (time, effort, obstacles, and limiting health). alpha internal consistencies ranged from .66 to .85. In cross-sectional analyses the scales combined with sociodemographic factors were significantly correlated with membership (R2 = .18) and participation (R2 = .17) in the on-site health and fitness program. In each instance outcome-expectancy values and perceived barriers explained variance in physical activity not accounted for by sociodemographics (R2 values increased .12). Membership in health and fitness programs outside the work site was also predicted (R2 = .07) by the scales. The scales provide a reliable and valid measurement technology that can be implemented with college or work site populations. Existing social psychology theories of behavior that include outcome-expectancy values or perceived barriers can now be examined as explanations for the adoption and maintenance of a physical activity program.

Risk factors in the psychosocial work environment for neck and shoulder pain in secretaries.

Abstract: The relationship between psychologic work variables and reported neck and shoulder pain was examined among secretaries. A battery of questionnaires concerning the experienced psychologic work environment as well as musculoskeletal pain symptoms was completed by 420 secretaries at a large medical center. A relatively "poor" psychologic work environment was compared with an environment that was experienced as "good." A "poorly" experienced psychologic work environment was related to a higher frequency of neck and shoulder pain. The relative risk for frequent neck pain was 2.85 (95% confidence interval 1.28 to 6.32) and for frequent shoulder pain 3.32 (95% confidence interval 1.53 to 7.23). Furthermore, the subindexes of work content and social support at work were found to be related to pain, whereas no clear relationship was found for work demands. The results of this study demonstrate the possible importance of the psychologic work environment in the development of musculoskeletal pain disorders. Future investigations should replicate these findings as well as isolate specific mechanisms so that preventive measures may be instituted.

Self-reported exercise behavior of employees: a validity study.

Abstract: The aim of the present study was to assess the validity of different self-reported questions for measuring exercise behavior of 551 employees. Values of maximum oxygen intake, body mass index, muscular endurance, and a fitness profile, based on the individual results obtained from each of the three physiologic parameters, were used as validity criteria for the self-reported measures. The influence of fitness profile on the measures of exercise habits indicated that the fit employees reported a more active pattern of exercise behavior, participated in more strenuous physical activity, and expended a greater amount of energy in a typical week than the unfit employees. There was no gain obtained in explaining fitness categorization with a more elaborate method compared with a simple question in measuring exercise behavior. The results of the present study show that the suggested simple method (one question) for assessing exercise behavior of employees is valid and can be useful for nurses and company physicians when evaluating the baseline behavior of a group of employees to assess the impact of exercise promotion programs at the work site.

Predictors of stress-related illness in city bus drivers.

Abstract: This study examines the relation between stress and illness among bus drivers in a large American city. Several factors are identified that predict stress-related ill health for this occupational group. Canonical correlation techniques are used to combine daily work stress and recent stressful life events into a single life/work stress variate. Likewise, somatic symptoms and serious illness reports are combined into a single canonical illness variate. This procedure simplifies the analysis of multiple stress and illness indicators and also permits the statistical control of potential contaminating influences on stress and illness measures (eg, neuroticism). Discriminant function analysis identified four variables that differentiate bus drivers who get ill under high stress (N = 137) from those who remain healthy under stress (N = 137). Highly stressed and ill bus drivers use more avoidance coping behaviors, report more illness in their family medical histories, are low in the disposition of "personality hardiness," and are also low in social assets. The derived stepwise discriminant function correctly classified 71% of cases in an independent "hold-out" sample. These results suggest fruitful areas of attention for health promotion and stress management programs in the public transit industry.

Screening blood test identifies subclinical beryllium disease.

Abstract: We evaluated the beryllium-specific lymphocyte transformation test as a workplace screening tool for early beryllium disease. Fifty-one of 58 workers with current beryllium exposure completed questionnaires and gave blood specimens for the lymphocyte transformation test. Six workers (11.8%) had elevated test results ranging from 5.7-fold to 16.7-fold stimulation. Of five who underwent clinical evaluation, four had beryllium disease, demonstrated by granulomata on transbronchial lung biopsy and elevated lymphocyte transformation tests by bronchoalveolar lavage cells (ranging from 18.6-fold to 44.3-fold stimulation). Our data show that (1) minimally symptomatic cases of beryllium disease can be identified by this peripheral blood test, (2) not all individuals with a positive peripheral blood lymphocyte transformation test have beryllium disease at the time of their initial evaluation, and (3) lymphocyte transformation test reproducibility is good, justifying further evaluation of this test for screening. We conclude that the peripheral blood lymphocyte transformation test may prove useful in preventing clinical chronic beryllium disease by early diagnosis in a subclinical phase.

Mortality patterns among workers exposed to acrylamide.

Abstract: A cohort of 8854 men, 2293 of whom were exposed to acrylamide, was examined from 1925 to 1983 for mortality. This cohort consisted of four plant populations in two countries: the United States and The Netherlands. No statistically significant excess of all-cause or cause-specific mortality was found among acrylamide workers. Analysis by acrylamide exposure levels showed no trend of increased risk of mortality from several cancer sites. These results do not support the hypothesis that acrylamide is a human carcinogen.

Threshold limit values: historical perspectives and current practice.

Abstract: A 1989 Occupational Safety and Health Administration standard mandates that workplace air concentrations be held below new permissible exposure limits for 376 substances. As more than 350 of these limits came from the 1987 list of "Threshold Limit Values" (TLVs), the medical basis of the TLVs is of direct importance to the health of millions of workers. However, the TLV development process has been gravely flawed by lack of scientific rigor, inadequate medical input, and lack of attention to financial conflicts of interest. The adoption by the Occupational Safety and Health Administration of many poorly supported values as permissible exposure limits reflects also the underutilization of industrial medicine in identifying health effects of exposures below the TLVs. It is thus the responsibility of the medical profession to act on the presumption that the TLV permissible exposure limits are unsafe limits until a sound underlying body of medical and scientific literature exists for the substances on the list. It is industry's responsibility to commit itself seriously to medical and exposure monitoring and to begin to remedy the knowledge deficit that exists about the less immediate health effects of most industrial materials.

Clinical ecology in the workplace.

Abstract: The field of clinical ecology is based on a putative diagnosis of "environmental illness," applied to persons who have multiple symptoms and are believed to be sensitive to numerous items in the environment. Increasingly this diagnosis is being used by workers for an occupational disability claim. Medical records of 90 workers claiming work-related "environmental illness" were reviewed. The majority were women. They worked in a variety of occupations with no unifying feature of the type of work or the claimed causative exposure. Symptoms were multiple and unaccompanied by objective clinical findings. Careful review of medical records showed that most had their symptoms before the claimed occupational exposure. Examining physicians who were not clinical ecologists invariably arrived at other diagnoses, usually psychiatric. This retrospective review lends no support to the clinical ecology concept of "environmental illness."

The correlation between work environment and the occurrence of cervicobrachial symptoms.

Abstract: The correlation between symptoms from the neck and upper extremities and some individual and work-related factors was analyzed in 2814 industrial workers. Physical stress by type of job was the factor most strongly correlated with ongoing cervicobrachial symptoms. Symptoms from the neck and upper extremities were twice as common in workers who used vibrating hand tools. Mental stress at the onset of the symptoms was associated with an increased prevalence of trapezius myalgia and with lateral humeral epicondylitis and "radial tunnel syndrome" in the dominant arm. Women had about double the rate of cervicobrachial symptoms as did men. Short stature increased the rate of symptoms from the neck, shoulders, and hands as did overweight. Playing of racquet sports decreased the risk of symptoms from the neck and hands.

Differences between a supervised and independent strength and conditioning program with chronic low back syndromes.

Abstract: The purpose of this study was to evaluate changes in physiologic parameters seen in a group of patients with chronic low back syndrome assigned to supervised and independent strength and conditioning programs. Forty patients with chronic low back syndrome were assigned either to a control group (independent exercise) or to an experimental group (supervised exercise). All subjects underwent pre-testing for aerobic fitness, strength and responses to visual analog pain rating scales. Twenty control subjects were given predesigned exercise programs and told to exercise four times per week for 6 months. Twenty experimental subjects were given predesigned exercise programs but were monitored by a strength and conditioning specialist for the same period. Statistically significant results were seen for increases in aerobic fitness and strength, decreases in reported pain, and percent body fat in the experimental group. Since the experimental group completed 90.75 sessions out of 96, compared with 31.95 for the control group, it could be concluded that supervision increases chances for compliance and success as measured by these parameters.

A distinct pattern of personality disturbance following exposure to mixtures of organic solvents.

Abstract: To assess systematically the pattern of psychologic distress in chemically exposed workers complaining of personality changes, we administered the Minnesota Multiphasic Personality Inventory to 22 men with a history of exposure to mixtures of organic solvents. Results indicated clinically significant profile elevations in more than 90% of the exposed workers. Moreover, a consistent response profile was noted, indicating a high rate of somatic disturbances, anxiety, depression, social isolation, and fear of losing control. In addition, those workers with the longest exposure duration had the highest elevations on the scale measuring disturbances of thinking, social alienation, poor concentration, and anxiety. Comparisons between these subjects and a group of former prisoners of war with posttraumatic stress disorder revealed strikingly similar clinical profiles. We present a case history that illustrates the nature of this psychologic disturbance.

Urinary creatinine excretion is not stable: a new method for assessing urinary toxic substance concentrations.

Abstract: Urinary concentrations of toxic substances require correction to adjust for the misleading effects of varying states of hydration. The most common method in current use involves calculation of substance-to-creatinine concentration ratios. For accuracy, this method assumes creatinine excretion rates to be stable despite varying rates of urinary flow. However, this underlying assumption has been challenged in recent studies. Our evaluation of separate data regarding individual voids confirmed that creatinine excretion rate depends significantly (p less than .0001) on urinary flow. We calculated a logarithmic regression model identical to one reported previously. The partial correlation coefficient for log flow was .21 after adjusting for inter-individual differences in creatinine excretion rates. We propose a simple method to correct creatinine concentrations in "spot" urine samples for the effects of varying hydration. The new method retains many benefits of the classical correction by substance-creatinine ratios.

Occupational risks for brain cancer: a New Zealand Cancer Registry-based study.

Abstract: Occupational risks for brain cancer were evaluated in a New Zealand Cancer Registry-based case-control study. The case subjects were 452 men aged 20 years or older registered under classifications 191 (Cancer of the brain) and 192 (Cancer of other and unspecified parts of the nervous system) of the International Classification of Disease (9th ed) from 1980 to 1984 for whom occupational information was available. The remaining 19,452 men with other cancers registered during an excess of professional and technical workers. An increased risk among workers in agriculture, forestry, and fishing was due to an excess of brain cancer in farmers, with the highest risk found for livestock farmers. Although many comparisons have been made, some of the findings support previous studies and several new hypotheses are suggested.

Compliance with colorectal cancer screening in a high-risk occupational group.

Abstract: A Detroit-area union offers an early detection colorectal cancer screening program consistent with that recommended by the American Cancer Society. Analyses compared men who have complied with the American Cancer Society recommendations with men who have not so complied. Older men, nonsmokers, and woodworkers were most likely to participate in all screening examinations. Primary reasons for nonparticipation were the belief that the examination was unnecessary, anxiety/affective concerns; and time/motivation problems. Particularly important to the success of such programs is a sensitive health education component to address personal concerns related to the procedure, and also the dissemination of information about the efficacy of the examination for early detection of colorectal cancer.

Effect of overuse injury and the importance of training on the use of adjustable workstations by keyboard operators.

Abstract: The introduction of adjustable workstations for keyboard operators has been widely recommended to eradicate constrained working postures leading to the development of musculoskeletal disorders. A questionnaire evaluating the use of adjustable workstations was analyzed for 514 keyboard operators. Anthropometric dimensions and workstation settings were measured for 15 operators. There was no difference between sufferers and nonsufferers of overuse injury on the basis of adjustability of their equipment. However, sufferers were less satisfied with their equipment and there was evidence that inappropriate postures were being adopted. The availability of adjustable equipment per se does not necessarily solve the problem. The design of the equipment must be based on suitable anthropometric data and operators must be trained in the correct use of the equipment. The results of this study indicate a perceived need for training and/or information on workstation adjustment among operators, with a preference for information that is supplied verbally, rather than in literature form.

Costs of workers' compensation claims for hearing loss.

Abstract: Much has been written about the merits, needs, adequacy, and effectiveness of hearing conservation programs but very little about the cost of noise-induced hearing loss. Using claims for hearing loss submitted to a Canadian compensation board for a 5-years period (1979 to 1983), we estimated the current cost per claim to be $14,106. We observed an annual increase of 20.4% for noise-induced hearing loss claims and project that if 80% of the 450 claims submitted in 1987 are accepted, it will commit the Workers' Compensation Board in Alberta to a cost of $5,373,360--a considerable commitment for a disease that makes up only 0.3% of all claims. As a measure of morbidity we determined the years of potential hearing loss. The 207 workers between the ages of 18 and 70 years who were pensioned had a potential hearing loss value of 2529 years. Some authors have expressed the view that hearing loss is currently inadequately compensated and our review of the literature suggests that a fertile climate is emerging for increasing litigation. This tendency is likely to lead to further escalation of costs if prevention is not taken more seriously.

Allergic contact dermatitis from glutaraldehyde exposure.

Abstract: A hospital maintenance employee developed an airborne contact dermatitis when cleaning respiratory therapy equipment. Patch-testing determined that she is allergic to glutaraldehyde, an ingredient in a popular commercial germicidal product. The increasing concern over acquired immunodeficiency syndrome (AIDS) and other infectious diseases has resulted in more intensive cleaning, sterilizing, and disposal procedures in health care facilities. This, in turn, may lead to an increased risk of contact dermatitis among health care workers. Glutaraldehyde is commonly used as a sterilizing agent in medical facilities. It is effective against most micro-organisms, including viruses, and is generally harmless to medical equipment. This report concerns a case of airborne allergic contact dermatitis caused by glutaraldehyde.

Cohort and case-control analyses of workers exposed to vinyl chloride: an update.

Abstract: The mortality in a cohort of workers at a vinyl chloride polymerization plant has been updated, extending the period of observation in the original study from 1974 to 1986. Workers at this plant may have been exposed to vinyl chloride monomer and/or polyvinyl chloride dust, or may have had no exposure to either substance. Seventy-six percent of the work force worked in jobs with potential exposure to vinyl chloride monomer. Among the total cohort, statistically significant excess risks were observed for liver, lung, and brain cancer. For the subcohort of workers exposed to vinyl chloride monomer, the standardized mortality ratio (SMR) for liver cancer was 333 (90% confidence interval (CI) 202 to 521). However, there were no significant excesses of either brain (SMR = 145, 90% CI 78 to 249) or lung cancer (SMR = 115, 90% CI 96 to 141). To investigate dose response, nested case-control studies for liver, brain, and lung cancer were conducted among the total cohort (including the nonexposed). For these studies there were two exposure variables, cumulative dose of vinyl chloride monomer and cumulative dose of polyvinyl chloride dust. Cumulative dose was defined as the product of level and duration of exposure. The only significantmore » association between disease risk and cumulative dose was for liver cancer and cumulative dose of vinyl chloride monomer. Further division of the liver cancers into angiosarcoma (n = 12) and other liver cancers (n = 7), based on review of death certificates and medical records, showed that the dose response existed only for angiosarcomas.« less

Effects of active and completed litigation on treatment results: workers' compensation patients compared with other litigation patients.

Abstract: Outcomes of multidisciplinary pain treatment in workers' compensation claimants and in the claimants of other insurance companies were studied. Patients were also segregated as to state of completion of the litigation process. No differences were found between the groups in organic and psychologic pathology. Significant improvement in outcome measures was found for the total group, but the workers' compensation claimants with completed litigation failed to show any significant improvement in these measures. The system itself and legal factors can be obstacles to rehabilitation of the patient with chronic pain. Early intervention is recommended to improve treatment outcome.

Pulmonary alveolar proteinosis and cement dust: a case report.

Abstract: Pulmonary alveolar proteinosis developed in a 29-year-old white man within 2 years of working as a cement truck driver. Pulmonary alveolar proteinosis (PAP), an uncommon respiratory disorder characterized by the accumulation of phospholipid material within the alveoli, has been described in association with exposure to silica, aluminum oxide, and a variety of dusts and fumes. Although a link between exposure to Portland cement and PAP has not been previously noted, this type of cement contains nearly 20% silica. Lung biopsy material, originally used to diagnose PAP, was reviewed under electron dispersive spectroscopy. Analysis indicated the presence of silica particles within the alveolar fluid and macrophages. A number of items support a causal relationship between exposure to cement dust and PAP: (1) the temporal sequence between assuming job duties and the development of the illness, (2) improvement following removal from further exposure, (3) dusty, unprotected working conditions, (4) the presence of silica within the cement, and (5) the alveolar fluid from periodic acid-Schiff-positive lung tissue.

Incidence of chloracne among chemical workers potentially exposed to chlorinated dioxins.

Abstract: Company medical charts were reviewed for 2192 chemical workers who were potentially exposed to chlorinated dioxins during 1940 to 1982 to determine whether they were ever diagnosed as having chloracne. Nearly 16% of the 2072 workers with medical records were found to have been so affected. The incidence of chloracne was noted to have been highest among the youngest workers, and among those who worked in the production of chlorinated phenols rather than with products derived from those materials. Chloracne incidence was found to increase with several measures of intensity and cumulative dose of tetra- and hexa- to octachlorinated dioxins, but these analyses were hampered somewhat by the limitations of both the exposure and medical outcome data.

Measurement of vibration of hand-held tools: weighted or unweighted?

Abstract: The standards for hand-arm vibration have evolved from research studies in the late 1960s and were based on discomfort and tolerance levels. The lower frequencies were more intolerant and were weighted accordingly. The vascular and neurologic components of the hand-arm vibration syndrome may develop independently, and recent epidemiologic studies have shown both underestimation and overestimation in the incidence of Raynaud's phenomenon from the International Standard Organization dose-response criteria with respect to different tools. The validity of the current International Standard Organization, British Standards Institute, American National Standards Institute, and The American Conference of Governmental Industrial Hygienists Threshold Limit Values is therefore questionable. The weighted and unweighted frequency spectra of various hand-held tools are presented in this paper. It is concluded that, until such time as more dose-effect data become available, unweighted measurements should be determined. Furthermore, the frequencies measured should be extended to 5 kHz.

Epistaxis due to glutaraldehyde exposure.

Abstract: Glutaraldehyde is commonly used as a cold disinfecting agent in the hospital setting and may cause irritation of skin, mucous membranes, and the upper respiratory tract in exposed workers. We report an unusual case of recurrent epistaxis associated with other symptoms of upper respiratory tract irritation and skin rash in a hospital employee using glutaraldehyde for sterilization of endoscopy equipment. A visit to the workplace revealed inadequate personal protective measures and inadequate local ventilation. High-risk work practices contributing to the hazard included soaking of endoscopy equipment in uncovered basins, manual pouring of concentrated glutaraldehyde solutions without the use of proper protective measures, and the use of paper masks, which provide inadequate protection from solvent vapors. The patient's symptoms resolved with the implementation of personal protective measures and engineering controls.

Chromosome aberrations in peripheral blood lymphocytes of welders and characterization of their exposure by biological samples analysis

Abstract: Chromosomal aberrations in cultured lymphocytes obtained from 55 welders and 55 matched controls were analyzed Depending on the welding techniques and the nature of the consumables and metals welded, three separate groups of welders were examined Chromium, nickel, and manganese levels in serum and urine were measured to assess the exposure to welding fumes A statistically significant increase of chromosomal aberrations was found in one of the three analyzed groups of welders This group used the semi-automatic metal active gas welding process with cored wire containing nickel for welding mild steel These welders had significantly higher concentrations of serum and urine manganese and, unlike the other welders, significantly elevated concentrations of nickel, both in serum and urine However, no significant correlations between nickel or manganese levels and the frequency of chromosomal aberrations were found There was a significant correlation between the length of welding employment of these welders and the frequency of chromosomal breaks, although there was no significant correlation between age and the frequency of chromosomal aberrations The other two groups of welders, for which the analyses of biologic fluids proved chromium and manganese exposure, had no statistically significant higher frequency of chromosomal aberrations One of these groups usedmore » the manual metal arc welding process with coated electrodes for welding mainly mild steel and the other group used the tungsten inert gas welding process for welding stainless steel A significant correlation between the daily amount of cigarettes smoked and the frequency of chromosomal breakages, in controls as in welders, was observed The present data indicate that certain welding processes may generate fumes that seem to have a clastogenic activity« less

Comparison of participants and nonparticipants in a work site cancer awareness and screening program.

Abstract: In 1985, Pennzoil Company offered a company-paid cancer awareness and screening program focusing on breast and colorectal cancers for its employees. Following a lecture/slide presentation, employees filled out a risk assessment questionnaire. Those at risk for breast and/or colorectal cancers were invited for consultation, mammography, and/or short colonoscopy. Overall completion rates were 49% for mammography, 20% for the fecal occult blood test, and 31% for short colon oscopy, but these rates varied by risk status. Moreover, the same demographic and risk factors were not consistently associated with completion of the same screening procedure across risk groups. Based on these findings, we suggest that different interventions may need to be developed depending on the risk characteristics of subgroups within the target population.

Public health implications of the variability in the interpretation of 'B' readings for pleural changes.

Abstract: During 1985 in Minnesota, an initial reading of 566 radiographs found 30% of them to be positive for pleural changes. However, only 4% were considered positive by at least two out of three readers from National Institute for Occupational Safety and Health panel reading the radiographs under blind conditions. The implications of this variability in radiographic readings for public health decisions was illustrated in Minnesota, where selective overreading of radiographs of female subjects created an illusion of a generalized environmental problem rather than an occupational exposure. One solution to this dilemma is establishment of criteria to minimize false-positive pleural findings. The study also supports the need for more careful consideration of other disease processes in the interpretation of "B" readings.