Showing papers in "Journal of Occupational and Environmental Medicine in 1991"

The effects of behavioral risks on absenteeism and health-care costs in the workplace.

Abstract: The impact of behavioral risk factors on absenteeism and health-care costs was analyzed among 45,976 employees in a large, diversified industrial work force. A cross-sectional design was used to evaluate health risk appraisal and physical-examination data collected from 1984 through 1988. Employees with any of six behavioral risks had significantly higher absenteeism (range = 10% to 32%) compared with those without risks. These differences led to significantly higher illness costs (defined as compensation, health care, and non-health care benefits) for those with risks compared with those without risks. Annual excess illness costs per person at risk were smoking, $960; overweight, $401; excess alcohol, $389; elevated cholesterol, $370; high blood pressure, $343; inadequate seatbelt use, $272; and lack of exercise, $130. Only one factor, lack of exercise, was not significant after adjusting for age, education, pay category, and the six other behavioral risks. The total cost to the company of excess illness was conservatively estimated at $70.8 million annually. These findings suggest that the cost of key behavioral risks provides an opportunity to manage health-care cost increases through health promotion, financial incentives for healthy lifestyle, and environmental changes that affect health behaviors.

Acquired dyschromatopsia among styrene-exposed workers.

Abstract: We investigated the occurrence of color vision loss in 75 styrene-exposed workers and in 60 referents. Color vision was evaluated by adopting the Lanthony D 15 desaturated panel, a test specifically suited to detect mild acquired dyschromatopsia. The results of the test were expressed as Color Confusion Index. Styrene exposure was evaluated with both environmental and biological monitoring. Airborne levels of the solvent were 3.2 to 549.5 mg/m3. In styrene-exposed workers color vision was significantly impaired when compared with referents matched for age. A significative correlation was found between environmental and urinary levels of styrene and Color Confusion Index excluding the influence of age in multiple regression analysis, indicating the possibility of a dose-effect relationship. The findings suggest that styrene can induce an early appearance of a dose-dependent color vision loss.

Mortality and cancer incidence in aluminum reduction plant workers.

Abstract: An historical cohort study was conducted among 4,213 men who worked for 5 or more years at a Soderberg aluminum reduction plant in British Columbia (BC), Canada. Standardized mortality and incidence ratios were used to compare the mortality and cancer incidence of the cohort with that of the BC population and to examine risk by cumulative exposure to coal-tar pitch volatiles (CTPV) and electromagnetic fields. Significantly elevated rates were observed for bladder cancer incidence (standardized incidence ratio [SIR] = 1.69) and brain cancer mortality (standardized mortality ratio = 2.17). The risk of bladder cancer was strongly related to cumulative exposure to CTPV (P less than .01). The risk for non-Hodgkin's lymphoma also increased with increasing exposure (P less than .05), although the overall rate was similar to that of the general population (SIR = 1.06). The lung cancer rate was as expected (SIR = 0.97), but showed a weak association with CTPV exposure that was not statistically significant. No individual cause of death or incident cancer site was related to exposure to electromagnetic fields. Analysis of the joint effect of smoking and CTPV exposure on lung and bladder cancer showed the exposure response relationships to be independent of smoking.

Pulmonary function and respiratory symptoms in wildland firefighters.

Abstract: We studied cross-seasonal changes in pulmonary function and respiratory symptoms in 52 wildland firefighters in Northern California. The mean cross-seasonal change in forced expiratory volume in 1 second (FEV1) was -1.2% (95% confidence interval [CI] -0.5%, -2.0%) with a corresponding mean change in forced expiratory volume (FVC) of -0.3% (95% CI 0.4%, -1.0%). Decreases in FEV1 and FVC were most strongly associated with hours of recent fire-fighting activity (P = .002 and .01, respectively). When the study group was divided into three categories based on recent fire-fighting activity, firefighters in the high activity category (mean +/- SE, 73 +/- 7 hours of fire-fighting in previous week) had a -2.9% (130 mL) change in FEV1 and a -1.9% (102 mL) change in forced vital capacity (FVC). There was a significant cross-seasonal increase in most respiratory symptoms evaluated. Several symptoms (eye irritation, nose irritation, and wheezing) were associated with recent fire-fighting. These findings suggest that wildland firefighters experience a small cross-seasonal decline in pulmonary function and an increase in several respiratory symptoms. Research is under way to identify the fire conditions and specific components of exposure that produce pulmonary irritants, and to examine the potential reversibility of acute pulmonary change.

Symptoms and microenvironmental measures in nonproblem buildings.

Abstract: Symptoms commonly defined as the sick building syndrome were studied in a cross-sectional investigation of 147 office workers in five building areas using a linear-analog self-assessment scale questionnaire to define symptoms at a specific point in time. At the same time, the environment in the breathing zone was characterized by measuring thermal parameters (dry-bulb temperature, relative humidity, air speed, and radiant temperature), volatile organic compounds, respirable suspended particulates, noise and light intensity, and carbon dioxide and carbon monoxide levels. Demographic characteristics of the occupants and building characteristics were recorded. Up to 25% of the variance in regression models could be explained for mucous membrane irritation and central nervous system symptoms. These two symptom groups were related to the concentrations of volatile organic compounds, to crowding, to layers of clothing, and to measured levels of lighting intensity. Chest tightness was also related to lighting intensity. Skin complaints were related only to gender. Gender, age, and education failed to demonstrate a consistent relationship with symptom categories. This study suggests that the sick building syndrome may have specific environmental causes, including lighting and volatile organic compounds.

Use of population-based data to assess risk factor profiles of blue and white collar workers.

Abstract: In light of increasing interest in the workplace as a site for primary prevention of chronic disease, more information concerning the current health status of workers is needed. This report compares "blue collar" (n = 2118) and "white collar" (n = 1900) respondents from a population-based random sample survey conducted in two southeastern New England communities. The specific responses were to a household interview and physiological measures emphasizing the risk factors for cardiovascular disease. These risk factors were elevated blood cholesterol, elevated blood pressure, smoking, being overweight and physical inactivity. Designation as blue or white collar was based upon the Standard Occupational Classification Manual. Gender specific comparisons of physiological status and self-reported knowledge attitudes and behaviors related to cardiovascular disease revealed that blue collar workers are at higher risk only for certain controllable risk factors, namely smoking and body mass index (women only). Contrary to other reports in the literature we have not found any significant difference in blood pressure or total cholesterol between the two groups. Even when people in high risk categories (systolic blood pressure greater than or equal to 140 mm/Hg, diastolic blood pressure greater than or equal to 90 mm/Hg cholesterol greater than or equal to 240 mg/dL) were studied the distributions were equally similar in both blue and white collar workers among each gender group. These findings indicate that educational interventions should target all segments of the population regardless of the nature of their occupation. More emphasis should be placed on offering programs to increase knowledge and improve health-related attitudes of blue collar workers.(ABSTRACT TRUNCATED AT 250 WORDS)

Median nerve latencies in poultry processing workers: an approach to resolving the role of industrial "cumulative trauma" in the development of carpal tunnel syndrome.

Abstract: Much attention has been paid recently to a claimed connection between stressful repetitive motion at the work site and the development of carpal tunnel syndrome. Little of this has made its way into the widely appreciated medical literature. To try to discover a reasonable basis for the presence or absence of such an association we measured median nerve motor and sensory latencies in a random sample of employees in a medium industry of the kind thought to be associated with the emergence of carpal tunnel syndrome. A control group made up of applicants for positions of this sort was used. No association between employment experience and the development of slowing of the median motor latency was encountered in any group. No association was discovered for sensory latencies for men or for the left hands of women. A small association was discovered for the sensory latency in right hands of long-term female employees. This was similar in magnitude to the increased risk of prolongation associated with aging. Our data provide very little evidence for the concept of cumulative trauma as a prominent cause of carpal tunnel syndrome in American industry. These results are discussed in light of the recent Australian false epidemic of repetition strain injury.

Neurobehavioral effects of the on-call experience in housestaff physicians.

Abstract: Sixty-tree medical residents were tested on a battery of computer-based, self-administered neurobehavioral tests before and after a 36-hour in-hospital call plus postcall day to assess the central nervous system effects of the call experience and its accompanying sleep deprivation. Statistically significant decreases in performance were found postcall on tests of sustained visual attention (P less than 0.0001), speed and coding ability (P less than 0.0001) and short-term recall (P less than 0.0001). Hand-eye coordination improved (P less than 0.02).

Pregnancy outcomes in women potentially exposed to occupational solvents and women working in the electronics industry.

Abstract: Associations of occupational solvent exposure and/or work in electronics production with adverse pregnancy outcomes were examined in a large cross-sectional community-based reproductive health study of 1038 California women pregnant between 1980 and 1985. Occupational solvent exposure was determined by two different methods: Bureau of Census codes judged by experts to probably include solvent exposure and self-reported exposure. First trimester solvent exposure classified by either method (n = 52) was significantly associated with spontaneous abortion, adjusted odds ratio 3.34 (95% confidence interval 1.42, 7.81). Among 29 women reporting regular and daily solvent exposure, the adjusted odds ratio increased to 4.44 (95% confidence interval 1.86, 10.58). Work in electronics assembly was significantly associated with delivering a low birth weight infant (adjusted odds ratio 5.38; 95% confidence interval 1.42, 20.46) but was not associated with spontaneous abortions. Further research using biologic monitoring and/or other objective measures of exposure is needed to validate these findings.

The cost-effectiveness of work-site wellness programs for hypertension control, weight loss, and smoking cessation.

Abstract: The cost-effectiveness of work-site wellness programs for reducing cardiovascular disease risks of employees was examined at three manufacturing plants. A fourth plant was used as a control site to estimate levels of risk reduction achieved from wellness screening and preexisting services, without further interventions. The cardiovascular disease risks included in the study were hypertension, obesity, and cigarette smoking. The annual direct cost per employee for postscreening interventions was $2.97 for site 1 (control site), $17.68 for site 2 (health education), $30.96 for site 3 (health education plus follow-up counseling), and $38.31 for site 4 (health education, follow-up counseling plus plant organization for health promotion). Of the three experimental sites, sites 3 and 4 were more effective and more cost-effective than was site 2, both in terms of engaging employees at risk of cardiovascular disease into treatment or program participation and of reducing their risks or preventing relapse. For engaging employees into treatment/program participation, sites 3 and 4 were nine to ten times more cost-effective than was site 2; for reducing risks/preventing relapse, sites 3 and 4 were five to six times more cost-effective than was site 2. At sites 3 and 4, the total direct cost per percent of risks reduced/relapse prevented was less than one dollar ($.67 and $.74, respectively) per employee per year. Program costs may vary considerably across companies because of differences in salary structures and overhead costs. These are held constant in this report for comparison across program models.

Use of vibration testing in the early evaluation of workers with carpal tunnel syndrome.

Abstract: Workers with symptoms of carpal tunnel syndrome (CTS) were evaluated by vibrometry to measure decreased digital vibratory perception and by questionnaire with comparison to a control group. Those workers with CTS confirmed by electromyography or surgery had significantly lower levels on vibrometry testing (P less than .001), and those with symptoms only also showed significantly lower vibrometry values (P less than .01 to .001). Early detection by vibrometry coupled with ergonomic intervention is suggested to be a cost-effective method to control cumulative trauma syndrome of the upper extremity.

Occupation, socioeconomic status, and brain tumor mortality: a death certificate-based case-control study.

Abstract: The relationships between brain tumor mortality and occupation and socioeconomic status (SES) were evaluated in a death certificate-based case-control study The cases consisted of 904 white men aged 20 years and older who died of a brain tumor in Washington state between 1969 and 1978 For each case a white male control of the same age was chosen A consistent pattern of increasing risk with increasing SES was seen for all brain tumors as well as for gliomas and astrocytomas After adjustment for SES, stationary engineers were found to be at excess risk across all histologies based on six cases vs no controls with lower 95% confidence intervals of 23 for all brain tumors, 28 for gliomas (based on three cases), and 21 for astrocytic tumors (based on two cases) Excesses of astrocytic tumors also were observed for petroleum refinery workers (OR = 88, CI = 22-352), forestry workers (OR = 85, CI = 11-634), and cleaning service workers (OR = 27, CI = 11-67)

Health promotion in small business: what works and what doesn't work.

Abstract: Wellness programs were tested in three sites, representing three different types of small businesses. The sites ranged in size from 296 to 5 employees. The program at each site included: 1) wellness screening, 2) referral to community physicians for high blood pressure or cholesterol, 3) on-site wellness programs, and 4) long-term follow-up counseling. At sites 2 and 3, the respective company paid the full cost of these services; at site 1, the company's financial support was limited to 50% of the cost of screening. Results showed that participation in screening was severely reduced in the third company, and participation in follow-up and wellness programs dropped to zero. In contrast, there was full participation in all facets of the program at the two sites that paid all costs. Twelve-month follow-up data showed improvements in blood pressure, cholesterol, cigarette smoking, weight control, and oxygen uptake.

Alcohol and other drug use in occupational fatalities.

Abstract: High costs and the potential risk to public health of drug-related workplace accidents are major concerns. Studies conducted to evaluate this problem are restricted by concerns for individual rights and fears of jeopardizing labor relations. However, in collaboration with the Medical Examiner's office. Alberta Occupational Health and Safety examined a unique set of data on 459 deaths occurring at work. The only illicit drug found was cannabis for which 10 workers tested positive. Forty workers tested positive for alcohol, 28 for prescription, and 22 for nonprescription drugs. Evidence of alcohol use was found in a higher percentage of fatalities due to motor vehicle accidents, falls, and being caught in or under equipment than in other types of workplace fatalities.

Industrial accident experience of one company on 8- and 12-hour shift systems

Abstract: The accident reports of a company were analyzed for 10 years before and after change from 8- to 12-hour shifts. Age-sex standardized ratios were calculated for each year for on- and off-the-job accidents by severity. Times of occurrence of on-the-job accidents were also examined. Overall accident rates were reduced on the 12-hour shift schedule, but statistical significance was reached only for lower accident categories. Off-the-job injuries increased on the 12-hour shift. There were significant gender differences in accident rates on 8-hour but not 12-hour shifts. A distinct circadian pattern of accident frequency was observed. We concluded that the introduction of a 12-hour shift system did not result in increased accidents.

Whole-body vibration exposure in subway cars and review of adverse health effects.

Abstract: New York City Transit Authority subway operators have a high prevalence of back problems. To evaluate a possible dose-response relationship for whole-body vibration, we studied subway car vibrations measured and analyzed according to the International Standard Organization 2631 and Verein Deutscher Ingenieure 2057 standards. Vibration transducers in triaxial orientation were mounted in a disc pad directly on the subway operator's seat. The relatively high lateral and vertical accelerations, primarily the combined effects, may all contribute to the high rate of musculoskeletal complaints, especially of the lower back. Other factors aggravating whole-body vibrations include primitive ergonomic cab and seat design, forced body posture, high noise levels, and organizational work stress.

Effect of a total work-site smoking ban on employee smoking and attitudes.

Abstract: A "smoke-free" policy was adopted at the Duke University Medical Center but not at the adjacent University Campus. Three months after the smoking prohibition went into effect, a cross-sectional telephone survey was conducted, using randomly selected groups of 400 employees from each campus. Subjects were queried about current and previous smoking histories and their opinion of the smoking ban. As determined retrospectively from this survey, at the time of the announcement of the policy and 6 months before implementation, 23.6% of employees at the Medical Center were smokers, compared with 20.3% on the University Campus. Three months after implementation of the Medical Center smoking prohibition, smoking cessation rates were 12.6% at the Medical Center and 6.9% on the University Campus dating back 9 months to the time of policy announcement (P less than 0.10). Mean cigarette consumption during work hours declined over this same period from 8.1 +/- 6.8 (mean +/- SD) to 4.3 +/- 4.4 at the Medical Center but showed little change on the University Campus (9.3 +/- 7.5 v 8.7 +/- 8.0). Overall, 75.8% of subjects at the Medical Center "somewhat" or "strongly" agreed with the policy compared with 73.2% on the University Campus. A follow-up survey of the cohort of current or recent ex-smokers identified on the initial survey was conducted 6 months later. This survey revealed a smoking cessation rate of 22.5% at the Medical Center and 6.9% on the University Campus, dating back 15 months to the time of policy announcement (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Industrial noise exposure and ambulatory blood pressure and heart rate.

Abstract: Studies on the effects of long-term exposure to industrial noise on resting blood pressure have yielded inconsistent results. Ambulatory blood pressure and heart rate were monitored simultaneously with noise exposure in normotensive male industrial workers in Israel (85 aged 25 to 44 and 77 aged 45 to 65 years). In the younger group, average ambulatory systolic blood pressure was 3.2 mm Hg higher and diastolic blood pressure 2.3 mm Hg higher in subjects exposed to more than 85 dBa (P less than .001), after adjusting for potential confounding variables. In those aged 45 to 65, ambulatory systolic blood pressure was 3.3 mm Hg lower and diastolic blood pressure unchanged in noise-exposed subjects. Ambulatory heart rate was 2.7 and 2.6 beats per minute higher at the higher noise level (P = .002) in the respective age groups. These findings suggest that industrial noise exposure is associated with higher ambulatory blood pressure and heart rates in men under 45 years old, but the effect on blood pressure appears to diminish considerably with age.

Work stress in emergency medical technicians.

Abstract: To better understand the dynamics underlying their high turnover rate, emergency medical technicians (EMTs) were asked to participate in a union-sponsored study. Fifty-two percent of 200 EMT union members returned the three mailed questionnaires: the Occupational Stress Index, which assesses stress, strain, and coping; the Staff Burnout Scale for Health Professionals; and a survey that probed areas of job satisfaction. The sample had high stress, strain, and burnout scores. Coping skills were within the normal range. Burnout, stress, strain, and coping (BSS&C) were significantly related to job satisfaction, worry about infectious diseases, and perceptions of being poorly treated by emergency room personnel and fire fighters. BSS&C also were related to being upset by "runs" related to injuries from violence, drug overdoses, and exposure. Job dissatisfaction was related to attitudes that the job adversely affects one's family, that the EMT quarters are uncomfortable, and that administrators are not knowledgeable of the job demands and skills of EMTs. Areas of great discontent were the low salary of the profession and the inadequacy of the equipment.

Toluene diisocyanate-induced asthma: clinical findings and bronchial responsiveness studies in 113 exposed subjects with work-related respiratory symptoms.

Abstract: We report the clinical findings and the results of inhalation challenge with toluene diisocyanate (TDI) and methacholine in 113 subjects with a history of exposure to TDI and work-related respiratory symptoms. Only some of the subjects (40.7%) had isocyanate asthma, diagnosed by a positive TDI inhalation challenge. Most reactors had a dual (30.4%) or a late (41.3%) response. The interval between the last occupational exposure and the specific challenge was significantly shorter in reactors, and among this group the number of immediate reactions to TDI decreased progressively with an increasing interval. The reactors had a significantly higher proportion of positive responses to methacholine and a significantly lower mean PD15 FEV-1 (provocative dose of methacholine which provoke a 15% decrease in forced expiratory volume in 1 second) (reactors: 557 micrograms, SEM 92.3; nonreactors: 1346 micrograms, SEM 128, P less than .01). Methacholine challenge could not identify subjects with isocyanate asthma.

Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes.

Abstract: This study assessed the total cost per case of chiropractic claims and medical claims for conditions with identical diagnostic codes. The sample consisted of 3062 claims or 40.6% of the 7551 estimated back injury claims from the 1986 Workers' Compensation Fund of Utah. For the total data set, cost for care was significantly more for medical claims, and compensation costs were 10-fold less for chiropractic claims.

Fatal injuries at work in California.

Abstract: We examined deaths due to injury on the job reported from three readily accessible data sources in California for a 1-year period. Of 682 deaths identified as of February 1990 as having occurred on the job in 1983, county coroners identified 607 (89.0%), workers' compensation records identified 294 (43.1%), and the California Occupational Safety and Health Administration investigated 141 (20.7%). Most fatal injuries at work resulted from events that are not covered by current California Occupational Safety and Health Administration standards: transportation vehicle accidents and homicides. Demographic patterns suggest that fatal injuries on the job are nonrandom events, which may be prevented by additions to existing standards or increased enforcement of workplace safety standards and by efforts to target groups at highest risk. Improved surveillance of fatal occupational injuries will require changes in existing reporting mechanisms, similar to those proposed by the US Bureau of Labor Statistics.

Prolonged asthma after smoke inhalation: a report of three cases and a review of previous reports.

Abstract: The development of prolonged obstructive airways disease after smoke inhalation is of concern to fire victims and fire fighters. Three cases of asthma that developed following the inhalation of pyrolysis products are presented along with a review of previous reports of airway injury from smoke inhalation. Polyvinyl chloride pyrolysis products seem to pose a high risk, but other toxic inhalants are also implicated. There is substantial evidence that prolonged airway hyper-responsiveness and asthma may follow numerous inflammatory insults including smoke inhalation. Studies to identify specific individual risk factors and asthmagenic pyrolysis products are needed. Early, postexposure anti-inflammatory treatment may modify the outcome.

A study of the hematologic effects of chronic low-level exposure to benzene.

Abstract: A study of 200 persons working with benzene showed no differences in commonly measured hematologic outcomes when compared with 268 nonbenzene workers in the same plant. Exposures ranged from 0.01 ppm to a high of 1.40 ppm 8-hour time weighted average over a 10-year period. Several other factors (age, sex, race, and smoking), however, were associated with these outcomes, indicating the importance of considering confounding factors when comparing hematology results. Exposure to low levels of benzene does not appear to produce an increased level of abnormal hematology measures detectable in routine medical surveillance.

An update of mortality due to brain neoplasms and other causes among employees of a petrochemical facility.

Abstract: In an update of an earlier investigation of brain tumors, mortality patterns were examined for 7849 male employees who worked at a petrochemical plant from 1941 through 1983 The update added 6 years of observation (1978 to 1983) During this period, the brain tumor (BT) mortality risk declined relative to the US population, but continued to be higher than expected in hourly workers (5 observed/34 expected) Similar to the earlier studies, BT occurrence was not explained by patterns of production work assignments Mortality rates for hourly and salaried workers from all causes combined, total cancer and respiratory cancer were lower than US population rates Lower rates for these causes were also seen for white and nonwhite production and maintenance workers Liver cancer rates were greater than expected in white production workers (3 observed/16 expected) and included two men assigned more than 40 years ago to vinyl chloride-related departments Mortality rates due to malignant melanoma were elevated in white maintenance workers (5 observed/20 expected) and may be explained by heavy sun exposure in outdoor work

Blood cell proliferation response to beryllium: analysis by receiver-operating characteristics.

Abstract: As testing for beryllium-induced proliferation of bronchoalveolar lavage cells is not suitable for screening, we evaluated the proliferative response of blood cells to beryllium Twenty-seven patients with chronic beryllium disease, documented by histology and a positive lung proliferative response to beryllium, were compared to 30 controls A significant difference (p less than 05) was observed between beryllium disease patients and controls with 100 or 10 microM beryllium salts To evaluate the optimum test parameters and stimulation index cutoff, receiver operating characteristic curves (true positive v false positive) were generated Maximum predictive value positive (26%) was observed at a stimulation index cutoff of 25 which corresponds to a 38% sensitivity and 97% specificity This suggests that the blood cell proliferation response to beryllium has a limited role in screening for chronic beryllium disease

Mortality among Vietnam veterans: with methodological considerations.

Abstract: The Department of Veterans Affairs previously conducted a proportionate mortality study of Army and Marine Vietnam-era veterans who died during 1965 through 1982. In the present study, 11,325 veterans who died during 1982 through 1984 and 50,743 veterans from the previous analysis made up the final sample of 62,068 veterans. When compared with all non-Vietnam veterans, Army Vietnam veterans had statistically significant excesses of deaths from external causes (proportionate mortality ratio [PMR] = 1.03), laryngeal cancer (PMR = 1.53), and lung cancer (PMR = 1.08). Marine Vietnam veterans had a significantly elevated PMR for external causes (PMR = 1.06) with a significant excess of homicide deaths (PMR = 1.16) when compared to all non-Vietnam veterans. The elevated PMRs for lung cancer and non-Hodgkin's lymphoma among Marine Vietnam veterans reported in the earlier VA study persisted when compared with Marine non-Vietnam veterans. However, it was found that these elevations probably were due to a deficit among the Marine non-Vietnam veterans rather than an excess among Marine Vietnam veterans.

A total ban on workplace smoking is acceptable and effective.

Abstract: The acceptability and effectiveness of a total workplace smoking ban in Telecom Australia was evaluated in a series of studies. Staff in a sample of representative areas were surveyed prior to the introduction of the bans, then 6 and 18 months afterward. By 18 months 81% of all staff, including 53% of smokers, approved of the bans. Sixty-six percent of staff reported a total ban was operative, and 31% reported a total ban except for a smoking room, leaving only 3% reporting lesser restrictions. Smokers were smoking between three and four less cigarettes per work day, and the numbers of smokers had decreased by about double the community rate. The policy had little perceived effect on productivity but resulted in some tension between staff that progressively decreased and now is limited to the few areas where there were problems with compliance. A subsample of managers and staff were interviewed and factors relevant to successful implementation of the policy were identified. These included a clear statement of policy, strong managerial support via equipping managers with leadership and negotiating skills, and the use of occupational health nurses. It is important to provide assistance to affected staff to help them adjust to the ban both before as well as in the months after implementation.

Mortality among workers exposed to external ionizing radiation at a nuclear facility in Ohio.

Abstract: In a cohort mortality study of white men employed by the Mound Facility (1947 through 1979), observed deaths did not exceed those expected based on US death rates for the overall cohort or for the subcohort monitored for external ionizing radiation Among the radiation-monitored subcohort, mortality for workers with cumulative radiation doses of at least 10 mSv was not significantly increased when compared with mortality for coworkers with cumulative doses of less than 10 mSv A significant dose-response based on a Mantel-Haenszel test of trend was observed for all leukemias However, when a death from chronic lymphatic leukemia, a type of leukemia generally not regarded as radiogenic, was removed from the analyses, the strength of the dose-response was reduced