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Showing papers in "Journal of Occupational and Environmental Medicine in 1998"


Journal ArticleDOI
TL;DR: It is concluded that common modifiable health risks are associated with short-term increases in the likelihood of incurring health expenditures and in the magnitude of those expenditures.
Abstract: This investigation estimates the impact of ten modifiable health risk behaviors and measures and their impact on health care expenditures, controlling for other measured risk and demographic factors. Retrospective two-stage multivariate analyses, including logistic and linear regression models, were used to follow up 46,026 employees from six large health care purchasers for up to 3 years after they completed an initial health risk appraisal. These participants contributed 113,963 person-years of experience. Results show that employees at high risk for poor health outcomes had significantly higher expenditures than did subjects at lower risk in seven of ten risk categories: those who reported themselves as depressed (70% higher expenditures), at high stress (46%), with high blood glucose levels (35%), at extremely high or low body weight (21%), former (20%) and current (14%) tobacco users, with high blood pressure (12%), and with sedentary lifestyle (10%). These same risk factors were found to be associated with a higher likelihood of having extremely high (outlier) expenditures. Employees with multiple risk profiles for specific disease outcomes had higher expenditures than did those without these profiles for the following diseases: heart disease (228% higher expenditures), psychosocial problems (147%), and stroke (85%). Compared with prior studies, the results provide more precise estimates of the incremental medical expenditures associated with common modifiable risk factors after we controlled for multiple risk conditions and demographic confounders. The authors conclude that common modifiable health risks are associated with short-term increases in the likelihood of incurring health expenditures and in the magnitude of those expenditures.

405 citations


Journal ArticleDOI
TL;DR: This outbreak of disease associated with exposure to Stachybotrys chartarum and Aspergillus species represents a likely human response to inhaled fungal toxins in indoor environments and represents a public health issue currently inadequately addressed by building, health, or housing codes.
Abstract: The authors present an outbreak of disease associated with exposure to Stachybotrys chartarum and Aspergillus species A courthouse and two associated office buildings had generated discomfort among employees for two years since initial occupancy Multiple interventions had been unsuccessful An initial evaluation of 14 individuals identified three with potential asthma and three with symptoms consistent with interstitial lung disease A clinical screening protocol to identify individuals who should be removed from work identified three likely and seven possible cases of building-related asthma Detailed environmental and engineering assessments of the building identified major problems in mechanical system design, building construction, and operational strategies leading to excess moisture and elevated relative humidities Moisture-damaged interior surfaces in both buildings were contaminated with S chartarum, A versicolor, and Penicillium species Aspergillus species, especially A versicolor, at concentrations of 10(1) to 10(4)/m3 dominated the indoor air under normal operating conditions Bulk samples also revealed large quantities of Stachybotrys A questionnaire survey of the three case and two control buildings documented between three- and 15-fold increases in symptoms A nested case-control study suggested emphysematous-like disease in individuals meeting questionnaire definitions for cases Replication of analysis strategies used in similar previous investigations suggested an association between worsening symptoms and decreased diffusing capacity of the lung Performance on neuropsychological measures was similar for both cases and controls, although workers with symptoms reported increased levels of current but not past psychiatric symptomatology Chemical analyses demonstrated the presence of satratoxins G and H Cytotoxic laboratory analyses demonstrated the presence of agents with biological effectiveness in bulk materials No association was seen between IgE or IgG antibodies and the presence of disease This outbreak represents a likely human response to inhaled fungal toxins in indoor environments Moisture indoors represents a public health issue currently inadequately addressed by building, health, or housing codes

241 citations


Journal ArticleDOI
TL;DR: Eleven cases of VCD in which there was a temporal association between VCD onset and occupational or environmental exposure are reported, suggesting IVCD should be considered in patients presenting with respiratory symptoms occurring after irritant exposures.
Abstract: Vocal cord dysfunction (VCD) is a poorly understood entity that is often misdiagnosed as asthma. We report eleven cases of VCD in which there was a temporal association between VCD onset and occupational or environmental exposure. We conducted a case-control study to determine if the characteristics of irritant-exposed VCD (IVCD) cases differed from non-exposed VCD controls. Chart review of VCD patients at the authors' institution produced 11 cases that met IVCD case criteria. Thirty-three control VCD subjects were selected by age matching. There were statistical differences between the groups in ethnicity and chest discomfort. There were no statistical differences between the groups for gender, tobacco, smoking habits, symptoms, or pulmonary function parameters. Varied irritant exposures were associated with IVCD. IVCD should be considered in patients presenting with respiratory symptoms occurring after irritant exposures.

193 citations


Journal ArticleDOI
TL;DR: Logit analysis of a choice-based sample shows that women and employees of small firms are more likely than others to file for worker's compensation and that filing rates vary considerably across industries and diagnostic categories.
Abstract: This study estimates the rate at which workers suffering from occupational illnesses file for workers' compensation lost wage benefits and identifies some of the factors that affect the probability that a worker with an occupational illness will file. A database of reports of known or suspected cases of occupational illness is matched with workers' compensation claims data. Overall, between 9% and 45% of reported workers file for benefits. Data limitations prevent a more precise estimate of this rate, but a large proportion of workers with occupational illnesses clearly does not utilize the worker's compensation system. Logit analysis of a choice-based sample shows that women and employees of small firms are more likely than others to file for worker's compensation and that filing rates vary considerably across industries and diagnostic categories. Acute conditions related to the current job are no more likely to lead to claims than chronic conditions with long latency periods between exposure and development of disease.

190 citations


Journal ArticleDOI
TL;DR: While UEDs represent a relatively small percentage of all workers' compensation cases, the health care and indemnity costs are considerable and mean duration and pattern of work disability revealed that these disorders can result in chronic work disability similar to that observed in low back pain.
Abstract: Upper extremity disorders (UEDs) account for a significant number of work-related illnesses in the US workforce. Little information exists on the distribution of UEDs, their associated health care and indemnity costs, or patterns of work disability. The study presented is an analysis of upper extremity claims within the federal workforce. In this study, the universe consisted of all claims accepted by the US Department of Labor, Office of Workers' Compensation Programs (OWCP), from October 1, 1993, through September 30, 1994. A total of 185,927 claims of notices of injury were processed during the study period, and of these, 8,147 or 4.4% had an UED diagnosis coded according to the International Classification of Diseases, Clinical Modification (ICD-9-CM). 5,844 claims involved a single UED diagnosis and were the only claims field by these employees between October 1, 1990, and September 30, 1994. These single claims with single diagnoses comprised the sample for further analysis. Mononeuritis and enthesopathies of the upper limb were the most common diagnoses, accounting for 43% and 31% of the claims, respectively. Women had a higher proportion of carpal tunnel syndrome, "unspecified" mononeuritis, and "unspecified" enthesopathies. The majority of claimants for both the mononeuritis- and enthesopathy-related diagnoses were between 31 and 50 years of age, received only health care benefits, and did not incur wage loss. Health care costs for mononeuritis and enthesopathy claims were $12,228,755 (M = $2,849). Carpal tunnel syndrome (CTS) and enthesopathy of the elbow were the most costly diagnoses, accounting for 57% and 16% of the total, respectively. Surgical services represented the highest expenditures in CTS claims. Physical therapy accounted for the majority of health care costs for enthesopathy cases. The mean number of workdays lost for CTS and enthesopathy claims were 84 and 79, and the average indemnity costs were $4,941 and $4,477, respectively. These findings indicate that while UEDs represent a relatively small percentage of all workers' compensation cases, the health care and indemnity costs are considerable. Also mean duration and pattern of work disability revealed that these disorders can result in chronic work disability similar to that observed in low back pain. The results highlight the need to determine whether interventions that account for the majority of costs significantly impact long-term outcomes. There is also a need to identify risk factors for prolonged disability in those who experience problems with delayed recovery.

176 citations


Journal ArticleDOI
TL;DR: It is concluded that indirect and direct costs to an employer increase with increasing BMI, and employers may benefit from helping employees achieve a healthy weight.
Abstract: This study was undertaken to determine if a progressive correlation exists between body mass index (BMI), health care costs, and absenteeism and to identify an economically optimal BMI. We studied 3,066 First Chicago NBD employees by using health risk appraisals and personnel data. Analysis was comp

169 citations


Journal ArticleDOI
TL;DR: Results provide reasonable assurance that, in this production setting, there were no significant hormonal changes associated with PFOA at the serum levels measured, compared with those levels reported to cause effects in laboratory animal studies.
Abstract: Perfluorooctanoic acid (PFOA), a potent synthetic surfactant used in industrial applications, is a peroxisome proliferator that has resulted in dose-related increases in hepatic, pancreatic acinar, and Leydig cell adenomas in laboratory animals. In addition, PFOA increased serum estradiol levels through the induction of hepatic aromatase activity. In 1993 and 1995, we conducted two cross-sectional studies of 111 and 80 production workers, respectively, and specifically measured their serum PFOA in relation to several reproductive hormones to determine whether such an effect occurs in humans. PFOA was not significantly associated with estradiol or testosterone in either year's study. A 10% increase in mean estradiol levels was observed among employees who had the highest levels of serum PFOA, although this association was confounded by body mass index. Neither was PFOA consistently associated with the other measured hormones. Our results provide reasonable assurance that, in this production setting, there were no significant hormonal changes associated with PFOA at the serum levels measured. Limitations of this investigation include its cross-sectional design, the few subjects exposed at the highest levels, and the lower levels of serum PFOA measured, compared with those levels reported to cause effects in laboratory animal studies.

160 citations


Journal ArticleDOI
TL;DR: The Occupational Cohort Mortality Analysis Program (OCMAP) has been redesigned for optimal microcomputer use and extended to include new computing algorithms to offer a comprehensive, flexible, and efficient analysis of incidence or mortality rates and standardized measures in relation to multiple and diverse work history and exposure measures.
Abstract: The Occupational Cohort Mortality Analysis Program (OCMAP) has been redesigned for optimal microcomputer use and extended to include new computing algorithms. The new program, OCMAP-PLUS, offers a comprehensive, flexible, and efficient analysis of incidence or mortality rates and standardized measures in relation to multiple and diverse work history and exposure measures. New features include executable code, minimization of memory requirements, disk file storage of person-day arrays, stratified analyses by geographic area, employment status and up to eight exposure variables, a data imputation algorithm for study members with unknown race, and enhanced algorithms for constructing several time-dependent exposure measures. New modules create grouped data files for Poisson and logistic regression and risk set files for use in relative risk regression analysis. The Mortality and Population Data System (MPDS) provides external comparison rates and proportional mortalities. Analysis from two recent cohort mortality studies illustrate several new features.

151 citations


Journal ArticleDOI
TL;DR: Recent trends in the length of disability (LOD) for LBP claims and associated costs are examined, using a large sample of claims from the privately insured US workers' compensation market.
Abstract: Previously published epidemiologic studies of low back pain (LBP) have reported that the prevalence of low back disability has increased dramatically. These studies based their findings on either the number of disability claims filed, the disability duration, or both. This information was from countries other than the United States or from the US Social Security Disability Insurance data, with findings reported only to the early 1980s. More recent studies of US workers' compensation LBP claims reported a decrease in the incidence rate from the late 1980s to the mid-1990s. No studies have been found that report on the trends of disability duration for workers' compensation LBP claims. This study examined recent trends in the length of disability (LOD) for LBP claims and associated costs, using a large sample of claims from the privately insured US workers' compensation market. LOD and cost information were derived for injuries from 1988, 1990, 1992, 1994, and 1996. For each year, the distributions of LOD and cost were skewed, with the small percentage of claims that lasted more than one year (4.6%-8.8%, depending on the year) accounting for a large percentage of the total disability days (77.6%-90.1%) and cost (64.9%-84.7%). From 1988 to 1996, the average LOD decreased 60.9%, from 156 days to 61 days. The probability of being on disability for a long period of time has decreased over the years. Over the study period, the average cost of a claim decreased 41.4%, while the median cost increased 19.7%. The most influential change in the LOD and cost distributions was a reduction in expensive claims with a long disability duration. The evolution of LOD and cost is also detailed for different disability durations for the study period.

141 citations


Journal ArticleDOI
TL;DR: The majority of WMSDUE claimants did not lose sufficient time to qualify for indemnity, and for those who did receive lost time wages, a disability duration of more than three months was typical.
Abstract: There is little information on the length of disability (LOD) reported for work-related musculoskeletal disorders of the upper extremity (WMSDUE). For this study, LOD, cost, and the relationship between LOD and cost were derived from a large workers' compensation company's claims data for 1994 WMSDUE (n = 21,338). The average LOD was 87 days, with a median of zero days. For those claims with at least one day of compensable disability (25.2%), the average and median LOD were 294 and 99 days, respectively. The distribution of cost was skewed, with the average cost of a claim being 13 times higher than its median. Approximately 60% of the claims cost $1000 or less. Additionally, the 6.8% of the claims with an LOD greater than one year accounted for 59.9% of the cost and 75% of the total disability days. The majority of WMSDUE claimants did not lose sufficient time to qualify for indemnity. For those who did receive lost time wages, a disability duration of more than three months was typical.

128 citations


Journal ArticleDOI
TL;DR: Prolonged latency of symptom onset and the lack of association with any self-reported exposures makes illness related to toxic exposure less likely.
Abstract: Toxic or environmental exposures have been suggested as a possible cause of symptoms reported by Gulf War veterans. To further explore this hypothesis, we analyzed findings in 18,495 military personnel evaluated in the Department of Defense Comprehensive Clinical Evaluation Program. The program was established in 1994 to evaluate Persian Gulf veterans eligible for Department of Defense medical care who had health concerns after service in the Persian Gulf during Operation Desert Shield/Desert Storm. The evaluation included a structured clinical assessment, a physician-administered symptom checklist, and a patient questionnaire addressing self-reported exposures, combat experiences, and work loss. Among 18,495 patients examined, the most common symptoms were joint pain, fatigue, headache, memory or concentration difficulties, sleep disturbances, and rash. Symptom onset was often delayed, with two-thirds of symptoms not developing until after individuals returned from the Gulf War and 40% of symptoms having a latency period exceeding one year. There was no association between individual symptoms and patient demographics, specific self-reported exposures, or types of combat experience. Increased symptom counts were associated with work loss, the number of self-reported exposures, the number of types of combat experience, and certain ICD-9 diagnostic categories, particularly psychological disorders. Prolonged latency of symptom onset and the lack of association with any self-reported exposures makes illness related to toxic exposure less likely.

Journal ArticleDOI
TL;DR: When employers were given vignettes of job applicants identical except for diagnosis, a label of depression significantly reduced the chances of employment, compared with one of diabetes, despite both being seen as equally credible illnesses.
Abstract: Employers have previously been shown to hold negative attitudes toward mental illness. The purpose of this survey of human resource officers in UK companies was to ascertain whether these attitudes prejudice employment opportunities for subjects with mental illness--specifically, depression--and, if so, some of the beliefs upon which these attitudes are based. When employers were given vignettes of job applicants identical except for diagnosis, a label of depression significantly reduced the chances of employment, compared with one of diabetes, despite both being seen as equally credible illnesses. This stigmatization is based upon perceptions of potential poor work performance, rather than expectations of future absenteeism, but is not concordant with previous research. It is suggested that greater dissemination of information may alleviate some of this stigma.

Journal ArticleDOI
TL;DR: NDI Plus underlying cause of death codes are comparable to codes developed using standard but more cumbersome procedures and may enhance the validity of comparisons of an occupational cohort's mortality rates with national or state rates.
Abstract: This study evaluated the comparability of underlying cause of death codes obtained from NDI Plus, a new feature of the National Death Index (NDI), with codes assigned by two study nosologists or by a National Center for Health Statistics (NCHS) nosologist. Two study nosologists and an NCHS nosologist independently reviewed the death certificates of 493 decedents and assigned each an International Classification of Diseases code for the underlying cause of death. Using the NCHS codes as the reference standard, we determined discrepancy rates for NDI Plus codes; for each study nosologist's original codes; and for "final study codes," derived by comparing the two sets of study nosologists' codes and resolving discrepancies by using the NCHS code. For all causes of death combined, the discrepancy rate was 4% for NDI Plus codes, 4% for the final study codes and 6%-7% for the study nosologists' original codes. The discrepancy rate for selecting the appropriate cancer site was 1% for NDI Plus codes and 3% for the final study codes. For noncancer conditions, the discrepancy rate was 5% for NDI Plus codes and 4% for the final study codes. NDI Plus underlying cause of death codes are comparable to codes developed using standard but more cumbersome procedures. The use of NDI Plus codes may enhance the validity of comparisons of an occupational cohort's mortality rates with national or state rates.

Journal ArticleDOI
TL;DR: Conclusions drawn from this study are that long-term participation in a WHP that includes high-risk screening and intensive one-on-one counseling results in lower total and lifestyle-related health care costs, as well as lower utilization of hospital services.
Abstract: Total and lifestyle-related medical care costs for employees of a major corporation participating in a worksite health promotion (WHP) program over a three-year period were compared with the costs for non-participants in a cross-sectional study. The study population consisted of 8,334 active employees based in the Cincinnati headquarters of The Procter & Gamble Company. Adjusting for age and gender, participants (n = 3,993) had significantly lower health care costs (29% lower total and 36% lower lifestyle-related costs) when compared with non-participants (n = 4,341) in the third year of the program. Similarly, in the third year of the program, participants had significantly lower inpatient costs, fewer hospital admissions, and fewer hospital days of care when compared with non-participants. No significant differences in costs were found between participants and non-participants during the first two years of the WHP program. Conclusions drawn from this study are that long-term participation in a WHP that includes high-risk screening and intensive one-on-one counseling results in lower total and lifestyle-related health care costs, as well as lower utilization of hospital services.

Journal ArticleDOI
TL;DR: This evaluation demonstrates that a sample of employees working in a casino gaming area were exposed to ETS at levels greater than those observed in a representative sample of the US population, and that the serum and urine cotinine of these employees increased during the workshift.
Abstract: Environmental and medical evaluations were performed to evaluate occupational exposure to environmental tobacco smoke (ETS) among casino employees. Air concentrations of both nicotine and respirable dust were similar to those published in the literature for other non-industrial indoor environments. The geometric mean serum cotinine level of the 27 participants who provided serum samples was 1.34 nanograms per milliliter (ng/mL) (pre-shift) and 1.85 ng/mL (post-shift). Both measurements greatly exceeded the geometric mean value of 0.65 ng/mL for participants in the Third National Health and Nutrition Examination Survey (NHANES III) who reported exposure to ETS at work. This evaluation demonstrates that a sample of employees working in a casino gaming area were exposed to ETS at levels greater than those observed in a representative sample of the US population, and that the serum and urine cotinine of these employees increased during the workshift.

Journal ArticleDOI
TL;DR: Examination of possible workplace determinants of sickness absence among French workers in the food processing industry finds that male and female workers were combined into a single analysis that adjusted for sex, many of the associations operant for a single sex could no longer be seen.
Abstract: More than twice as many workdays are lost to illness than for personal or family reasons. We examine possible workplace determinants of sickness absence among French workers in the food processing industry. These workers are exposed to a variety of environmental and organizational constraints: cold, uncomfortable postures, assembly-line work, and irregular schedules. In 1987-1988, a medical examination and questionnaire were administered to 558 men and 790 women as part of a study of 17 poultry slaughterhouses and 6 canning factories. Women's and men's working conditions were very different, and their sickness absences for musculoskeletal and respiratory illnesses were related to some of their specific working conditions: cold exposure, ill-adapted work stations, and problems with their supervisors and co-workers. If male and female workers were combined into a single analysis that adjusted for sex, many of the associations operant for a single sex could no longer be seen.

Journal ArticleDOI
TL;DR: It is suggested that employment as a law enforcement officer is associated with an increased cardiovascular disease morbidity and this relationship persists after considering several conventional risk factors.
Abstract: It remains uncertain if law enforcement officers experience an elevated cardiovascular disease morbidity and, if so, whether their profession contributes to this incidence. Consequently, the self-reported incidence of cardiovascular disease (CVD) (coronary heart disease, myocardial infarction, stroke, coronary artery bypass graft surgery, angioplasty) and CVD risk factors (age, diabetes, elevated body mass index (> or = 27.8 kg.m-2), hypercholesterolemia, hypertension, tobacco use) in 232 male retirees, > or = 55 years of age, from the Iowa Department of Public Safety were compared with 817 male Iowans of similar age. CVD incidence was higher in the law enforcement officers than the general population (31.5% vs 18.4%, P < 0.001). Using multiple logistic regression, factors found to be associated with CVD included the law enforcement profession (odds ratio [OR] = 2.34; 95% confidence interval [95% CI] = 1.5-3.6), hypercholesterolemia (OR = 2.37; 95% CI = 1.7-3.3); diabetes (OR = 2.22; 95% CI = 1.4-3.6), hypertension (OR = 1.79; 95% CI = 1.3-2.5), tobacco use (OR = 1.67; 95% CI = 1.07-2.6), and age (OR = 1.06; 95% CI = 1.03-1.08). These results suggest that employment as a law enforcement officer is associated with an increased cardiovascular disease morbidity and this relationship persists after considering several conventional risk factors.

Journal ArticleDOI
TL;DR: Results indicated that US pilots and navigators have experienced significantly increased mortality due to cancer of the kidney and renal pelvis, motor neuron disease, and external causes, while mortality was significantly decreased for 11 causes.
Abstract: The airline industry may be an occupational setting with specific health risks. Two environmental agents to which flight crews are known to be exposed are cosmic radiation and magnetic fields generated by the aircraft's electrical system. Other factors to be considered are circadian disruption and conditions specific to air travel, such as noise, vibration, mild hypoxia, reduced atmospheric pressure, low humidity, and air quality. This study investigated mortality among US commercial pilots and navigators, using proportional mortality ratios for cancer and noncancer end points. Proportional cancer mortality ratios and mortality odds ratios were also calculated for comparison to the proportional mortality ratios for cancer causes of death. Results indicated that US pilots and navigators have experienced significantly increased mortality due to cancer of the kidney and renal pelvis, motor neuron disease, and external causes. In addition, increased mortality due to prostate cancer, brain cancer, colon cancer, and cancer of the lip, buccal cavity, and pharynx was suggested. Mortality was significantly decreased for 11 causes. To determine if these health outcomes are related to occupational exposures, it will be necessary to quantify each exposure separately, to study the potential synergy of effects, and to couple this information with disease data on an individual basis.

Journal ArticleDOI
TL;DR: The effects of physical activity during pregnancy on low birth weight, small for gestational age (SGA), and prematurity were assessed from a sample of 1797 women in a follow-up study at the antenatal clinic of two hospitals in southern Thailand.
Abstract: Heavy maternal workloads are considered to be hazardous to the fetus. The effects of physical activity during pregnancy on low birth weight (LBW), small for gestational age (SGA), and prematurity were assessed from a sample of 1797 women in a follow-up study at the antenatal clinic of two hospitals in southern Thailand. The women were interviewed twice, at 17 and 32 gestational weeks. Outcome data were obtained from medical records and the newborn gestational age determined using Dubowitz's score. The risk of SGA was elevated for women working > 50 hours/week, squatting in work, commuting > 1 hour/day, and having high psychological job demands; the risk of preterm delivery was increased with obstetrical complications. Women who worked long hours and had demanding work conditions had an elevated risk of giving birth to SGA infants but not of preterm delivery.

Journal ArticleDOI
TL;DR: Thyroid profiles and blood test parameters of liver, kidney, and bone marrow function were evaluated to assess any measurable chronic effects of perchlorate exposure on those organs and multiple regression was used to assess the effects of exposure variables and demographic variables on organ function parameters.
Abstract: Employees at an ammonium perchlorate production facility in Nevada and a larger control population from the same chemical complex without direct AP exposure were monitored extensively for airborne perchlorate exposure. Single-shift and working-lifetime cumulative dose estimates were made using stand

Journal ArticleDOI
TL;DR: It is concluded that organophosphate pesticides have a small effect on male reproductive hormones, suggestive of a secondary hormonal disturbance after testicular damage.
Abstract: Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels, as well as urinary levels of FSH, LH, and E1C, a metabolite of testosterone, were measured to investigate the adverse reproductive effects of organophosphate pesticides among Chinese factory workers who were occupationally exposed to ethylparathion and methamidophos. Thirty-four exposed workers were randomly chosen and recruited from a large pesticide factory, and 44 unexposed workers were selected from a nearby textile factory. A quantitative pesticide exposure assessment was performed among a subset of the exposed and unexposed workers. Information on potential confounders was collected in an interview. A single blood sample was collected at the end of a work shift, when each subject also donated a semen sample. Three first-voided urine samples were collected from each worker on 3 consecutive days. Urinary p-nitrophenol level at 1 hour after the work shift correlated with serum (r = 0.71, P < 0.01) and urinary (r = 0.51, P = 0.04) FSH levels. Stratifying by the subjects' exposure status, we found a significant negative correlation among the exposed group between urinary FSH level and sperm count (r = -0.61, P < 0.01) and between urinary FSH level and sperm concentration (r = -0.53, P = 0.03). Pesticide exposure alone was significantly associated with serum LH level (beta [coefficient of exposure effect] = 0.79; 95% confidence interval [CI] = 0.42, 1.16) but not with serum FSH or testosterone or with any urinary hormone levels. With adjustment for age, rotating shift work, current cigarette smoking, and current alcohol consumption, exposure significantly increased the serum LH level by 1.1 mIU/mL (95% CI = 0.34, 1.82). Meanwhile, the serum FSH level was slightly elevated (beta [coefficient of exposure effect] = 1.38; 95% CI = -0.09, 2.85) and the serum testosterone level was decreased (beta = -55.13; 95% CI = -147.24, 37) with increased pesticide exposure. Age and rotating shift work appeared to act as confounders. We conclude that organophosphate pesticides have a small effect on male reproductive hormones, suggestive of a secondary hormonal disturbance after testicular damage.

Journal ArticleDOI
TL;DR: Although specific agents responsible for each individual case could not be identified, probably both specific sensitizing agents and non-specific irritants from metal working fluids, additives, or contaminants contributed to this spectrum of occupational respiratory illness.
Abstract: Occupational respiratory diseases have been reported following exposure to metal working fluids. We report a spectrum of respiratory illnesses occurring in an outbreak in 30 workers of an automobile parts engine manufacturing plant. Workers presented with respiratory complaints and, after clinical a

Journal ArticleDOI
TL;DR: Although exposure assessment was based solely on the occupation and industry reported on the death certificate, these results add to other epidemiologic and experimental findings in lending some support to the hypothesis of an association between occupational exposure to lead and brain cancer risk.
Abstract: A recent report in the literature suggested a link between occupational exposure to lead and brain cancer. To explore the hypothesis, we applied a job-exposure matrix for lead to the occupation and industry codes given on the death certificate of 27,060 brain cancer cases and 108,240 controls who died of non-malignant diseases in 24 US states in 1984-1992. Brain cancer risk increased by probability of exposure to lead among Caucasian men and women with high-level exposure, with a significant twofold excess among Caucasian men with high probability and high level of exposure to lead (odds ratio = 2.1; 95% confidence interval, 1.1-4.0). Risks were also elevated in the low- and medium-probability cells for African-American men with high-level exposure to lead. Trend by intensity level was statistically significant among African-American men (all probabilities combined). Although exposure assessment was based solely on the occupation and industry reported on the death certificate, these results add to other epidemiologic and experimental findings in lending some support to the hypothesis of an association between occupational exposure to lead and brain cancer risk. Analytic studies are warranted to further test this hypothesis.

Journal ArticleDOI
TL;DR: It is suggested that occupational noise exposure alone does not alone account for the racial hearing differences, and race/ethnicity, after being adjusted for years of employment, was the major-effect variable.
Abstract: The National Institute of Occupational Safety and Health rates noise-induced hearing loss as one of the top 10 work-related problems, involving at least 11 million workers. This retrospective study examines the differences between pure-tone hearing loss and race/ethnicity in 216 white and 70 non-whi

Journal ArticleDOI
TL;DR: It is concluded that the lack of conflicting exposure to daylight in the morning may have facilitated the rapid adjustment to night work.
Abstract: Previous research indicates that night workers' circadian rhythms do not adapt to night work and that disturbed sleep and wakefulness persist, even after weeks of working on night shift. We studied adjustment to 14 days of consecutive night work at an oil platform and the readjustment to day life at home, using the Karolinska sleep/wake diary. The platform workers adapted to night work within a few days, as indicated by the rapid reduction of night-work sleepiness, and by the gradual delay of bedtime to an hour commensurate with the behavior of day workers. Readaptation to day life was slower and more difficult, adding evidence of a complete adaptation to night work. We conclude that the lack of conflicting exposure to daylight in the morning may have facilitated the rapid adjustment to night work.

Journal ArticleDOI
TL;DR: In vitro toxicity did not correlate with crystalline silica content, surface area, composition, volume, particles/cm2, or fibrous geometry, but particle size but not shape could be a determinant of in vitro toxicity.
Abstract: The relationship between particle characteristics and in vitro toxicity was investigated using Chinese hamster ovary cells. Test dusts included respirable natural (Nat) and flux-calcined (FC) diatomaceous earth (DE), quartz, cristobalite, TiO2, and chrysotile and crocidolite asbestos. All dusts elicited a qualitatively similar, concentration-dependent response: particle uptake, induction of micro- and polynuclei, and reduction in cell proliferation. However, similar mass concentrations of the dusts yielded a 35-fold range of toxicity: chrysotile > crocidolite > Nat DE > FC DE > quartz > Cristobalite > TiO2. In vitro toxicity did not correlate with crystalline silica content, surface area, composition, volume, particles/cm2, or fibrous geometry. Toxicity was closely associated with the number of particles/cm2 culture surface that had at least one dimension > 7.5 mu. Thus particle size but not shape could be a determinant of in vitro toxicity. Particle size might also impact in vivo pathogenesis.

Journal ArticleDOI
TL;DR: The pattern of findings suggests the importance of assessing protection of individual body sites, as well as composite protection, in the face and lower arms among outdoor workers.
Abstract: Due to the lack of information regarding how US workers protect themselves from ultraviolet radiation, this study explored solar protection behaviors among three groups of outdoor workers. This cross-sectional research involved two separate studies. Study 1 consisted of observations of 312 outdoor workers, and Study 2 was a paper and pencil survey (n = 240). For each data set, occupational groups were compared on ultraviolet radiation protection. Observational data indicated that 50.4% of the workers had adequate protection. Across occupational groups, the ranking from highest to lowest levels of protection was consistent for both data sets. Face and lower arms were consistently the least protected sites. The pattern of findings suggests the importance of assessing protection of individual body sites, as well as composite protection.

Journal ArticleDOI
TL;DR: It is concluded that LAA is preventable through the implementation of a comprehensive effort to reduce exposure to allergens and was reduced to zero during the last two years of observation.
Abstract: Laboratory animal allergy (LAA) is a significant occupational hazard for workers in a number of research settings, including the pharmaceutical industry. Prevention of allergy and asthma is important because the illness can affect health and career. In a major pharmaceutical company, in an effort to

Journal ArticleDOI
TL;DR: It is suggested that a delayed effect on the vestibulo-cerebellar system was induced by acute sarin poisoning; females might be more sensitive than males.
Abstract: To evaluate delayed (long-term) effects of acute sarin poisoning on postural balance, nine male and nine female victims of the Tokyo Subway Sarin Poisoning in Japan (sarin cases) were examined by computerized posturography 6-8 months after the poisoning. Their plasma cholinesterase activities (ChE) on the day of the poisoning (March 20, 1995) were 13-95 (mean 68.2) IU/l for females and 19-131 (mean 75.9) IU/l for males, which were not significantly different between the two sexes. In females, the postural sway of low frequency (0-1 Hz) in the anterior-posterior direction and area of sway with eyes open was significantly larger in the cases than in the controls. Romberg quotients for the low-frequency sway in the anterior-posterior direction for females and low-frequency sway and length of sway in the medio-lateral direction for males were significantly related to log ChE. It is suggested that a delayed effect on the vestibulo-cerebellar system was induced by acute sarin poisoning; females might be more sensitive than males.

Journal ArticleDOI
TL;DR: Determining appropriate preventive action will reduce the number of workers injured and may result in financial savings for industries and health care systems.
Abstract: Estimates of nonfatal work-related injuries range from 6 to 13 million annually, and the most serious of these injuries are presented to hospital emergency departments (EDs). To describe work-related injury ED visits in the United States, we examined data from the 1995-1996 National Hospital Ambulatory Medical Care Survey, which is a national probability sample survey of visits to EDs of non-federal, short-stay, and general hospitals. In 1995-1996, an annual average of 4 million work-related injury ED visits were made by persons 16 years of age and over. The average annual rate of work-related injury visits was 3.5 per 100 workers, and the rate of nonwork-related injury visits was 11.2 per 100 persons. Persons 16-19 years of age had a higher work-related injury visit rate (6.9 per 100 full-time equivalents [FTEs]) than did those 20 years of age and over (3.4 per 100 FTEs). Males had higher work-related injury visit rates (4.3 per 100 FTEs) than females (2.4 per 100 FTEs). The leading cause of injury and diagnosis for work-related injury ED visits were "cuts" (16%) and "open wound" (22%), respectively. Determining appropriate preventive action will reduce the number of workers injured and may result in financial savings for industries and health care systems.