Showing papers in "Journal of Occupational and Environmental Medicine in 1994"

The economic impact of depression in a workplace.

Abstract: Epidemiological studies hold that depressive disorders are among the most common forms of mental illness in the population and should produce a substantial economic impact upon corporate America. However, only a few studies have examined the economic impact of depression in the workplace. A study of the medical and disability costs of depressive disorders was conducted at the First Chicago Corporation. In this analysis, short-term disability data, medical plan costs and Employee Assistance Program referral data for depressive disorders were compared with selected common chronic medical conditions. The average length of disability and the disability relapse rate was greater for depressive disorders than for the comparison medical groups. Depressive disorders were also found to have the largest medical plan costs of all behavioral health diagnoses. Finally, depressive disorders proved to be the most common Axis-I-level diagnosis encountered in the Employee Assistance Program. These findings have important implications for medical benefit plan design, disability plan management, and occupational health professionals' training. The observed higher prevalence of these disorders in women force their recognition as a women's health issue.

Cigarette smoking prevalence by occupation in the United States. A comparison between 1978 to 1980 and 1987 to 1990

Abstract: We analyzed data from 1987 to 1990 National Health Interview Surveys and compared them with 1978 to 1980 National Health Interview Surveys data to determine changes in cigarette smoking prevalence by occupation. During this period, cigarette smoking prevalence declined from 31.7% to 24.2% among white-collar workers, from 43.7% to 39.2% among blue-collar workers, and from 37.2% to 34.5% among service workers. For occupational groups, the largest significant declines in smoking prevalence occurred among male sales workers (10.5 percentage points), female and male managers and administrators (9.9 and 8.7 percentage points), female professional and technical workers (8.0 percentage points), and male transportation equipment operatives (7.5 percentage points). Analyses of 1987 to 1990 detailed occupation codes revealed that roofers (57.8%) and crane and tower operators (57.6%) had the highest prevalences of cigarette smoking, whereas physicians (5.4%) and clergy (6.5%) had the lowest smoking prevalences. Since 1978 to 1980, the differences in smoking prevalence by occupation have widened, providing further evidence that smoking has moved from a relatively common behavior practiced by most segment of society to one that has become more concentrated among selected subpopulations. Health professionals need to play an important role in encouraging smoking cessation among workers and in advising management and labor about the benefits of strong work-site smoking policies.

Injury hazards in the construction industry.

Abstract: Although many occupational injury studies have been conducted on the construction industry, fatal injuries and lost work time injuries in this industry continue to rank among the highest in the nation. This paper presents an analysis of nonfatal (1981 through 1986) and fatal (1980 through 1989) traumatic occupational injuries in the construction industry using the Supplementary Data System and the National Traumatic Occupational Fatalities data bases. The lost workday case rate in construction was 10.1 per 100 full-time workers, which was nearly 2.5 times the occupational injury rate for all industries combined. The construction industry had an overall fatality rate of 25.6 per 100,000 full-time workers. This rate was more than 3.5 times the occupational fatality rate for all industries in the United States for the same period. To prevent occupational injuries and fatalities in the construction industry, intervention measures need to target specific occupations: machine operators, transportation workers, and crafts-people. Intervention measures also need to target such causes of injury as falls, electrocutions, and motor vehicle incidents.

Respiratory health status in swine producers relates to endotoxin exposure in the presence of low dust levels.

Abstract: We conducted an assessment of respiratory health status including questionnaire and spirographic measurements in 54 male swine producers age 36.3 +/- 11.1 years (mean +/- SD) who worked an average of 10.7 +/- 6.3 years in the industry and spent 4.7 +/- 2.1 hours per day in the swine barns, and we also measured atmospheric contaminants including carbon dioxide, ammonia, total dust, respirable dust, and airborne endotoxin. Mean atmospheric dust contaminant levels were as follows: carbon dioxide, 2632 +/- 807 ppm; ammonia, 11.3 +/- 4.2 ppm; total dust, 2.93 +/- 0.92 mg/m3; respirable dust, 0.13 +/- 0.05 mg/m3; and endotoxin, 11,332 +/- 13,492 endotoxin units/m3. Of these, endotoxin related to forced vital capacity (P < .05) and endotoxin x hours per day was related to forced vital capacity (P < .05) and to forced expiratory volume in 1 second (P = .06). Respiratory symptoms and lung function studies did not relate to categories of low, medium, and high exposure to respirable dust. However, categories of endotoxin (available on 46 workers) related to respiratory symptoms (cough, P = .02; chronic bronchitis, P = .06; and to forced vital capacity, P < .01). These data suggest that respiratory health status relates to endotoxin levels but not to dust level exposures in the presence of low dust levels and indicates that control measures should include endotoxin as well as dust control.

Intervention research in occupational health and safety.

Abstract: This paper reviews occupational health and safety intervention studies published between 1988 and 1993 to gauge the nature and extent of research in this area. Generally, the studies often lacked a theoretical basis, used small samples, and tested interventions lacking the intensity to cause the desired change. Most designs were either nonexperimental or quasi-experimental with uncontrolled sources of bias. Recommendations for future research include methods of minimizing the problems and biases caused by these weaknesses. Nonmethodological issues such as the costs of implementing interventions and the cultural and political dimensions of the workplace are also addressed. Although many methodological issues associated with field-based research are not easily addressed, researchers should make a stronger attempt to address these issues if the field of occupational health and safety intervention research is to be productive. Language: en

Evaluation of exposure data from men and women with the same job title.

Abstract: In the epidemiological approach to occupational cancers, large bodies of data must be analyzed to find rare cases of cancer. The exposure status of workers must therefore be assessed. Inaccuracies will lead to bias toward the null value in certain cases. Job title has often been used as a proxy for exposure status. This study was undertaken to examine content (ie, tasks and activities) associated with job title among men and women in a large Quebec municipality. Occupational accident reports were studied for 1589 accidents, and 113 men and women workers were interviewed about job content. Women and men did not seem to have the same accident rates. From interview data, it appeared that women and men with the same job title did not perform the same tasks. Thus, they might have different exposures. The data reported here support caution in using job title to estimate exposure for both genders if the job-exposure matrix has not previously been validated separately by gender. In addition, it may be unwise to adjust relationships between job title and cancer incidence for gender, thus treating gender as a confounder when it may be a proxy for specific exposures.

Laboratory work and pregnancy outcome

Abstract: Spontaneous abortions among women working in laboratories, and congenital malformations and birth weights of the children were examined in a retrospective case-referent study. In the spontaneous abortion study there were 535 women (206 cases and 329 referents), and in the malformation study 141 women (36 cases and 105 referents). The analysis of the birth weights concerned 500 women (referents). Significant associations with spontaneous abortion were found for exposure to toluene (odds ratio [OR], 4.7, 95% confidence interval [CI], 1.4 to 15.9), xylene (OR 3.1, CI 1.3 to 7.5) and formalin (OR 3.5, CI 1.1 to 11.2) > or = 3 days a week, adjusted for the covariates. Most of the women exposed to formalin and xylene were working in pathology or histology laboratories. No association with congenital malformation was found.

A review of recent research on health effects of human occupational exposure to organic solvents : a critical review

Abstract: The health impact of workplace solvent exposure remains an issue of substantial interest and concern to occupational health professionals. As a result of research performed in the 1970s and 1980s, policies and programs were developed throughout the world to control excessive exposure to solvents. To an extent, these programs have been responsible for reduction of the occurrence of solvent-associated encephalopathy and other health effects. In this review of research performed since 1985, particular attention is given to issues of reversibility of neurotoxicity following exposure cessation. Furthermore, health effects involving other organ systems, particularly reproductive, renal, and hepatic disorders, are discussed. Future research directions are discussed. Finally, the practical implications of these recent research findings are described with a focus on the management of prevention programs at the work site.

Epidemiology of back injury in university hospital nurses from review of workers' compensation records and a case-control survey

Abstract: Reviewing Workers' Compensation records for back injury from a large university hospital for a 2-year period, we found a yearly incidence of lost work time back injury among nurses of 2.0% per year, exceeded only by physical plant staff, who had a rate of 3.5%. Nurses' aides had an injury rate 3.3-fold higher than registered nurses and licensed practical nurses and higher than any other occupational group. We compared 100 cases of nurses with back injury in the previous 2 years with 197 noninjured control subjects using a mailed 40-item questionnaire. Multivariate logistic modelling showed that prior nonback injury and performing combined lifting activities were statistically significant risk factors for back injury, and being overweight approached significance, after adjusting for the effects of age, gender, and each of the evaluated risk factors.

The cost of compensable upper extremity cumulative trauma disorders.

Abstract: There is little information available of the costs of upper extremity cumulative trauma disorders Cost data were collected from computerized records of the Liberty Mutual Insurance Company for upper extremity cumulative trauma disorder workers' compensation claims (N = 6,067) and for all claims (N = 731,087) initiated from 45 states during 1989 The data were not analyzed until July 1992, allowing more accurate "closing cost" data to be used in the analysis Upper extremity cumulative trauma disorder cases represented 083% of all claims and 164% of all claims costs The mean cost per case for upper extremity cumulative trauma disorders was $8070; median cost per case was $824 Medical costs represented 329% of the total costs; indemnity costs were 651% The total compensable cost for upper extremity cumulative trauma disorders in the United States was estimated to be $563 million

Updated and expanded Swedish cohort study on trichloroethylene and cancer risk.

Abstract: There is limited evidence for mutagenicity and carcinogenicity of trichloroethylene (TRI) in experimental test systems. Whether TRI is a human carcinogen is unclear, however. This paper presents an update and extension of a previously reported cohort of workers exposed to TRI, in total 1670 persons. Among men (n = 1421), the overall standardized mortality ratio (SMR) and cancer morbidity ratio (SIR) were close to the expected, with SMR, 0.97; 95% confidence interval (CI), 0.86 to 1.10; and SIR, 0.96; 95% CI, 0.80 to 1.16, respectively. The cancer mortality was significantly lower than expected (SMR, 0.65; 95% CI, 0.47 to 0.89), whereas an increased mortality from circulatory disorders (cardiovascular, cerebrovascular) was of borderline significance (SMR, 1.17; 95% CI, 1.00 to 1.37). No significant increase of cancer of any specific site was observed, except for a doubled incidence of nonmelanocytic skin cancer without correlation with the exposure categories. In the small female subcohort (n = 249), a nonsignificant increase of cancer and circulatory deaths was observed (SMR, 1.53 and 2.02, respectively). For both genders, however, excess risks were largely confined to groups of workers with lower exposure levels or short duration of exposure or both. It is concluded that this study provides no evidence that TRI is a human carcinogen, ie, when the exposure is as low as for this study population.

Industries and occupations at high risk for work-related homicide.

Abstract: Homicide is the third leading cause of injury death in the workplace. The death certificate-based National Traumatic Occupational Fatalities surveillance system and estimates of annual employment were used to calculate average annual rates of work-related homicide for detailed industries and occupations for the nation for 1980 to 1989. Workers in the taxicab industry had the highest rate of work-related homicide (26.9 per 100,000 workers). High rates were also identified for workers providing public and private security, and in a number of retail trade and service industries. For many high-risk industries, the risk was excessive for male workers only. Differences between rates for black and nonblack workers varied across industries and occupations. Immediate efforts to protect workers, and long-term efforts to describe and study work-related homicide thoroughly and to evaluate interventions are needed. Language: en

Multiple chemical sensitivity syndrome: a clinical perspective. I. Case definition, theories of pathogenesis, and research needs.

Abstract: Multiple chemical sensitivity syndrome (MCS) does not appear to fit established principles of toxicology. Yet social, political, and economic forces are demanding that MCS be defined medically, even though to date scientific studies have not identified pathogenic mechanisms for the condition or any objective diagnostic criteria. Consequently, a working definition of MCS can rely only on an individual's subjective symptoms of distress and attribution to environmental exposures rather than currently measurable objective evidence of disease. Nevertheless, patients labeled with MCS are clearly distressed and many are functionally disabled. In this review, four theories of causation are explored: (1) MCS is a purely biologic/physical or psychophysiologic reaction to low-level chemical exposures. (2) MCS symptoms may be elicited by low-level environmental chemical exposures, but the sensitivity is initiated by psychologic stress. (3) MCS is a misdiagnosis and chemical exposure is not the cause. The symptoms may be due to misdiagnosed physical or psychologic illness. (4) MCS is an illness belief system manifest by culturally shaped illness behavior. Areas for further research regarding the etiologies of MCS are suggested. Recognizing that the cause of the syndrome may be multifactorial, strategies are proposed for clinical evaluation and management in Part II of this manuscript using a biopsychosocial model of illness.

Women at work: agriculture and pesticides.

Abstract: Numerous occupational studies of cancer risks related to agriculture, agricultural practices, and agricultural exposures have been conducted among male farmers and farmworkers. Relatively few studies of female farmers and farmworkers have been conducted. Excesses of non-Hodgkin's lymphoma, leukemia, multiple myeloma, soft tissue sarcoma, and cancers of the breast, ovary, lung, bladder, cervix, and sinonasal cavities have been observed in women in agriculture or with agricultural exposures. Agents that contribute to ill health in exposed men may also affect exposed women, sometimes in unexpected ways.

A prospective, nonrandomized study of iontophoresis, wrist splinting, and antiinflammatory medication in the treatment of early-mild carpal tunnel syndrome

Abstract: Carpal tunnel syndrome (CTS) has become the industrial epidemic syndrome of the decade and its incidence is continuing to rise. Because of public awareness. CTS is being diagnosed much earlier in the course of the disease. Iontophoresis of dexamethasone sodium phosphate has been used for years in the treatment of many musculoskeletal inflammatory disorders and clinicians have reported using this modality in the treatment of CTS. Iontophoresis is a method of transdermal administration of ionized drugs in which electrically charged molecules are propelled through the skin by an external electrical field. However, conditions of treatment and evaluation have not been standardized. A prospective, nonrandomized study utilizing a standardized treatment protocol incorporating wrist splinting with nonsteroidal antiinflammatory medications and iontophoresis of dexamethasone sodium phosphate revealed a success rate comparable with splinting plus injection of dexamethasone into the carpal tunnel space. In a 6-month follow-up of 23 cases (hands) of early-mild CTS, 4 of 23 hands (17%) were successfully treated with splints plus nonsteroidal antiinflammatory medications alone. Of those that failed this treatment program and chose to proceed with iontophoresis of dexamethasone, 11 of 19 hands (58%) had a positive response rate to iontophoresis, leaving a combined failure rate (failing both splints, nonsteroidal antiinflammatory medications and iontophoresis) of 35%. Iontophoresis may become an alternative to steroid injections to the carpal tunnel region if further studies substantiate these findings. It provides an excellent complication and side-effect profile compared with other methods of delivering dexamethasone. No complications occurred (including no significant elevation of serum glucose in insulin-dependent diabetics.)

Asthma experience in an occupational and environmental medicine clinic. Low-dose reactive airways dysfunction syndrome.

Abstract: The etiology of adult-onset asthma is incompletely understood. High-intensity exposure to irritants is one accepted risk factor and such cases are termed Reactive Airways Dysfunction Syndrome. The contribution to asthma of less intense and less acute exposure to irritants remains to be clarified. We report on 10 cases of nonsensitization adult-onset asthma in settings of exposure to noticeable but distinctly "tolerable" levels of inhalation irritants. This series of 10 cases represent 31% of verified asthma cases seen in our environmental and occupational medicine referral clinic over a 5-year period. We believe further exploration of this phenomenon of low dose Reactive Airways Dysfunction Syndrome is warranted.

Inclusion of women and minorities in occupational cancer epidemiologic research

Abstract: A survey of published epidemiologic studies from eight journals during 1971 to 1990 was conducted to assess the proportion and characteristics of occupational cancer studies that have included women and minorities. A total of 1233 reports included 562 (46%) with subjects limited to white men. The remaining 671 (54%) had subjects from other race-gender groups. Thirty-five percent included white women, but only 14% presented any analyses of white women specifically and only 7% presented more than five risk estimates. The proportions with analyses of nonwhite women (any = 2%; detailed = 1%) or men (any = 7%; detailed = 3%) were also small. Studies with detailed analyses of women and minorities tended to use weaker methodologies (ie, proportionate mortality or cross-sectional design) than the studies of white men and were less able to provide convincing data on the occupational cancer risks of women and minorities.

Reliability and validity of a newly developed test of physical work performance.

Abstract: This study examined the interrater reliability and validity of a newly developed test of physical work abilities, the Physical Work Performance Evaluation. Eleven physical therapists were trained to administer and score this evaluation. From this group, two therapists at a time simultaneously and independently evaluated 50 patients with musculoskeletal disorders as they performed the tasks of the Physical Work Performance Evaluation. At the conclusion of the evaluation, each therapist determined the safe level of physical work for each patient. A comparison of the two independent evaluations was used to determine reliability. To determine validity, the predicted level of work was compared with the actual level of work. Kappa coefficient between the two therapists on the level of work was .83. Spearman rho correlations between the predicted and actual levels of work ranged from .41 to .55. Only 14 to 18% were working above the level predicted by the Physical Work Performance Evaluation. These results indicate high interrater reliability. Given the lack of a perfect standard for validity comparisons, these results also provide evidence in support of convergent validity. The test can be used in making decisions regarding return to work after injury, preemployment placement, and vocational exploration.

Cancer mortality in female and male dry-cleaning workers.

Abstract: A cohort study of dry-cleaning workers (1109 women, 592 men) in the mid-1980s revealed significant excess bladder cancer mortality. This article updates vital status through 1990. Significant excesses were seen for bladder cancer (nine deaths, standardized mortality ratio [SMR] = 2.54, 95% confidence interval [CI] = 1.16-4.82), esophageal cancer (10 deaths, SMR = 2.14, 95% CI = 1.02-3.94), and intestinal cancer (26 deaths, SMR = 1.56, 95% CI = 1.02-2.29). In a subcohort exposed only to perchloroethylene (PCE), those with 5 or more years of employment and 20 or more years since first exposure had a significant increased risk of esophageal cancer (four deaths, SMR = 7.17, 95% CI = 1.92-19.82). Women had significant excess esophageal cancer (five deaths, SMR = 3.24, 95% CI = 1.05-7.58) and elevated SMRs for intestinal, pancreatic, and bladder cancer mortality. This study confirms the esophageal cancer risk among dry-cleaning workers seen in another study and suggests an association with PCE. It further documents the risks for intestinal, pancreatic, and bladder cancers in this industry.

Are the job demands on physical work capacity equal for young and aging firefighters

Abstract: The job demands on physical work capacity and the frequency of the firefighting and rescue tasks were rated by 156 professional firefighters (age range, 22 to 54 years) who responded to a questionnaire. Smoke-diving requiring the use of personal protective equipment was considered to demand most aerobic power. The clearing of debris with heavy manual tools, and roof work set the highest demands on muscular performance and motor coordination, respectively. During the past 5 years, 83 to 88% of the respondents had performed these tasks on average four times a year. The rating and frequency of the tasks were not significantly affected by age. The results suggest that the job demands on physical work capacity remain the same throughout the occupational career of the firefighters.

Risk factors for injury during basic military training. Is there a social element to injury pathogenesis

Abstract: A retrospective case-control study into the risk factors for injury during basic military training was conducted at the Recruit Training Unit, Royal Australian Air Force Base Edinburgh, South Australia. Case subjects were recruits suffering a musculoskeletal injury during the course, severe enough to result in backcoursing (being delayed and joining a later course) and usually requiring the loss of 5 days of training. Control subjects were 629 recruits selected randomly from recruits who were not case subjects from the same period of Jan 1, 1985 to Dec 31, 1990. Two hundred thirty-eight cases were identified (2.7% of the recruit population), of which 123 were overuse-type injuries and 115 acute-type injuries. Most injuries occurred in the first 2 weeks of training. Bivariate and logistic regression analysis of possible risk factors for injury was conducted, both for all case subjects and for the subgroup of case subjects with overuse injuries. Statistically significant associations were identified for female gender, body mass index > 26.9, winter training, a history of lower limb injury, and the presence of a lower limb deformity. All these associations were stronger for overuse injury, and preenlistment physical activity was also significantly associated with overuse injury. No significant association was found for height, weight, age, smoking, or gender makeup of courses. Most striking was a large rise in overuse injury incidence in women over the period of study, from 0.2% in 1985 to 8.8% in 1990. Reasons for this increase may include "social pathogenesis." Language: en

Physical work load and its assessment among the nursing staff in nursing homes.

Abstract: A study was conducted to investigate the physical work load and the prevalence of musculoskeletal complaints of nurses in nursing homes. Thirty-six female subjects selected from three nursing homes in the Netherlands participated in an observational study. In addition, the total nursing staff (n = 668) was invited to take part in a questionnaire survey (response was 94%). It was noticed that almost 60% of the observed time was spent on nonpatient-related activities. Moreover, activities alternated rapidly and seldom lasted longer than 4 minutes on average. Twenty percent of the observed time was spent in "poor" work postures as defined by the Ovako Working Posture Analyzing System (Action Category 2 to 4). Activities contributing most to these poor work postures were patient care and household and preliminary tasks. Perceived exertion as scored on the Borg-CR10 scale was highest during patient-related activities. This holds also for a relative increase of heart rate. Questionnaire results showed prevalences of 41%, 35%, and 20% respectively, for back, arm/neck, and leg complaints. From this study it can be concluded that not only patient-related activities should be taken into consideration for the improvement of work postures and other potential strenuous aspects of nursing work. Household and preliminary tasks, ergonomic layout of the ward, and work pressure also deserve attention.

The detection of increased amounts of the extracellular domain of the epidermal growth factor receptor in serum during carcinogenesis in asbestosis patients.

Abstract: Overexpression of the epidermal growth factor receptor (EGFr) has been implicated in the pathogenesis of a wide variety of human malignancies and may be related to asbestos-induced carcinogenesis. Overexpression of the EGFr can be detected immunologically by quantitation of the extracellular domain (ECD) in the extracellular fluid in vitro and in serum in vivo. An enzyme-linked immunosorbent assay (ELISA) for the EGFr ECD was used to examine banked serum samples of 38 asbestosis patients who subsequently developed cancer, 72 age-sex-race-smoking-asbestos exposure matched asbestosis controls without cancer, and 20 age-sex-race-smoking matched nonasbestosis noncancer controls. The mean serum level for the EGFr ECD in the cancer cases (636 +/- 299 fmol/ml) was statistically significantly elevated (P < 0.05) in comparison to the mean level in the asbestosis controls (546 +/- 147 fmol/ml) or the nonasbestosis controls (336 +/- 228 fmol/ml). Defining a positive elevation of the serum EGFr ECD as any value more than 2 standard deviations above the nonasbestosis control mean, 7 (18%) of the cancer cases were positive compared to 4 (6%) of the asbestosis controls and one (5%) of the nonasbestosis controls. In addition, all of these cancer cases had positive serum samples prior to the time of disease diagnosis (average = 5.1 years). These results suggest that serum EGFr ECD may be elevated at an early stage of carcinogenesis in some asbestosis patients and that further prospective study of the utility of this biomarker is warranted.

Occupationally acquired tuberculosis: what's known

Abstract: Tuberculosis (TB) morbidity and mortality have increased substantially since the mid-1980s in areas with a high prevalence of medically underserved populations, human immunodeficiency virus, foreign-born persons, residents of long-term care facilities and crowded correctional institutions, and alcoholics and intravenous-drug abusers. The occupational risk has likewise increased for those exposed to these high-risk people in the course of their work. The magnitude of the occupational hazard is present unclear, although implications are disturbing. We used available data bases containing occupational exposure information, and telephone surveys, in an attempt to elucidate the magnitude of risk of occupationally acquired TB. We obtained up-to-date employee conversion rates at high-risk institutions, identified changing rates of TB infection and disease over time, documented high conversion rates following accidental exposures, and revealed a relative lack of reported TB disease and deaths. Numerous barriers to worker protection against TB are identified and recommendations are made to reduce the risk of occupationally acquired tuberculosis.

Effectiveness and cost-effectiveness of employer-issued back belts in areas of high risk for back injury.

Abstract: Back belts have gained popularity under the assumption that their use will reduce low back injuries and thereby decrease the costs. This study sought to examine that hypothesis. A retrospective survey instrument was administered to 1316 workers who perform lifting activities at Tinker Air Force Base, Midwest City, Oklahoma, to identify belt use, lifting requirements, injury, and treatment history. Analysis was also performed on costs applicable to providing the belts, treatment of injury, and lost or limited duty work days. Results show an odds ratio of 1.01 (confidence interval 1.01, 1.02) and P value of .0005 of low back injury with the number and weight of lifts performed in an 8-hour period as well as an odds ratio of 5.56 (confidence interval 3.35, 9.26) with prior history of injury. A protective effect, odds ratio of .65, P value of .019 is noted between lifting and attendance at a back training program. Use of a back belt appears to be marginally effective (odds ratio .60, P value .0508) in reducing injuries when controlling for other related factors. Cost analysis over all diagnoses of low back injury shows less intensive treatment and lower cost per injury for workers injured without a belt versus those injured while wearing a belt. It appears that predictors of low back injury are those expected based on risk assumed (amount of time spent performing lifts, history of injury) and that training programs are effective in prevention of problems. Data suggest that back belts appear to be minimally effective in preventing injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Biological monitoring of exposure to polycyclic aromatic hydrocarbon in an electrode paste plant

Abstract: We have compared several biomarkers for polycyclic aromatic hydrocarbon (PAH) exposure among electrode paste plant workers and workers not occupationally exposed to PAH. The PAH exposure was quantitated from samples collected with person-attached sampling devices. The mean particulate PAH exposure level in the plant was 14.4 micrograms/m3. The level of pyrene was significantly correlated with both PAH level and the level of selected carcinogenic PAHs in this type of exposure. The mean concentration of the biomarker 1-hydroxypyrene in the PAH exposed workers' urine was 6.98 mumol of 1-hydroxypyrene per mole of creatinine compared with 0.08 and 0.14 mumol of 1-hydroxypyrene per mole of creatinine in the two reference groups. PAH-DNA adducts were measured in DNA from white blood cells by the ultrasensitive enzyme radioimmunoassay (USERIA) and the 32P-postlabeling technique. Only urinary 1-hydroxypyrene was significantly increased in the PAH-exposed group.

An evaluation of Duke University’s LIVE FOR LIFE health promotion program on changes in worker absenteeism

Abstract: The effect of an employer-sponsored health promotion program on worker absenteeism is examined over a 4-year period in a group of 4972 Duke University hourly employees. Program participants experienced an average of 4.6 fewer absentee hours in the third year of program availability than did nonparticipants, after controlling for baseline absenteeism, gender, race, education, and age. These results suggest that employer-sponsored health promotion initiatives can have a favorable influence on absenteeism.

Surveillance of construction worker injuries through an urban emergency department

Abstract: To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work-site investigations or prevention programs, an emergency department-based surveillance program was established. Construction workers with work-related injuries or illnesses were identified by reviewing the medical records of all patients treated at the George Washington University Emergency Department between November 1, 1990 and November 31, 1992. Information regarding the worker, the injury, and the injury circumstances were abstracted from medical records. Information was obtained on 592 injured construction workers from numerous trades. Lacerations were the most commonly treated injuries among these workers, followed by strains and sprains, contusions, and eye injuries. Injuries were most commonly caused by sharp objects (n = 155, 26%), falls (n = 106, 18%), and falling objects (n = 70, 12%). Thirty-five percent of injuries were to the hands, wrists, or fingers. Among the twenty-eight injuries severe enough to require hospital admission, eighteen (64%) were caused by falls. Laborers and Hispanic workers were overrepresented among these severe cases. Emergency Department records were a useful surveillance tool for the initial identification and description of work-related injuries. Although E codes were not that useful for formulating prevention strategies, detailed review of injury circumstances from Emergency Department records was valuable and has helped to establish priorities for prevention activities. Language: en

Effects of shift work on sleep among French nurses. A longitudinal study.

Abstract: In industrialized countries, the proportion of shift workers is currently estimated to be approximately 20% of the working population. The problem of sleep may be one of the major consequences of shift work. To study the relation between shift work and sleep quality in a female population, 469 nurses at 6 public hospitals in various French regions were interviewed about their working conditions and health in 1980. They were followed up and interviewed again in 1985 and 1990. First, the results showed that nurses had more sleep disorders on alternating schedule including night work at the beginning of the study in 1980, and there was no more association between shift work and sleep quality after 1980. Second, sleep disorders predicted transfer from shift work to day work between 1980 and 1985 and sleep disorders decreased strongly after such transfer. The absence of relation between time schedules and sleep in 1985 and 1990 can be explained by the fact that the follow-up sample was selected, ie, the nurses who continued to work on shift work were able to adapt to it.

Detection of serum p53 protein in lung cancer patients.

Abstract: Serum levels of p53 protein were examined in 23 cases of lung cancer (many with potential asbestos exposure), 23 unexposed matched hospital control subjects, 58 unmatched general population control subjects, and 4 people with nonmalignant lung disease using an enzyme-linked immunosorbent assay and Western immunoblotting. Average levels of serum p53 in the lung cancer patients (0.55 ng/mL) were higher than in the cases of nonmalignant lung disease (0.42 ng/mL) or in the matched (0.32 ng/mL) or unmatched (0.31 ng/mL) control subjects, but the differences were not statistically significant. However, three of the cases of lung cancer (13%) were found to have serum p53 levels much greater than those of the control subjects (> 2 SD above the mean) and to have confirmatory positive Western blots for p53. The tumors from these subjects demonstrated increased levels of p53 in the tissue by immunohistochemistry and/or the presence of mutations in the p53 gene. These results suggest that p53 protein can be detected in serum in a portion of lung cancer cases with p53 alterations in the tumor tissue.