Showing papers in "Journal of Occupational and Environmental Medicine in 2000"
TL;DR: In comparison with their peers, Gulf veterans had a higher prevalence of functional impairment, health care utilization, symptoms, and medical conditions and a higher rate of low general health perceptions.
Abstract: Despite numerous studies on veterans of the 1990 to 1991 Gulf War, the fundamental questions of how healthy they are and how their health compares with that of their military peers who were not deployed to the Gulf have not been fully answered. We conducted a health survey in which the health outcomes of a population-based sample of 15,000 Gulf veterans representing various military branches and unit components (regular, reserve, National Guard) were compared with those of 15,000 non-Gulf veterans who were randomly sampled to mirror the number in the same military strata in the Gulf veteran group. In comparison with their peers, Gulf veterans had a higher prevalence of functional impairment, health care utilization, symptoms, and medical conditions and a higher rate of low general health perceptions. A longitudinal follow-up of the health of these veterans will be needed to detect changes in health status and to detect diseases with a long latency period.
283 citations
TL;DR: Significant dose-response relationships were observed between exposures and pulmonary function decrements over a work shift and threshold limit exposure guidelines are not currently applied to this environment, but they are essential to implement and monitor effective environmental controls.
Abstract: Numerous articles have been published regarding the adverse respiratory health consequences of working in intensive livestock and poultry housing. Threshold limit exposure guidelines are not currently applied to this environment, but they are essential to implement and monitor effective environmental controls. Previous dose-response research work with swine workers has resulted in exposure limit recommendations of 2.5 mg/m 3 total dust, 0.23 mg/m 3 respirable dust, 100 EU/m endotoxin, and 7 ppm ammonia. No similar recommendations have been reported previously for poultry workers. Therefore, an industry-wide study was conducted to examine dose-response relationships of bioaerosol exposures and worker respiratory health. A total of 257 poultry workers were studied for respiratory symptoms, pulmonary function, and exposure to dust (total and respirable), endotoxin (respirable and total), and ammonia. Details of the sampling plan and environmental assessment are described elsewhere. Relationships between exposures and response were studied by correlation and multiple regressions. Significant dose-response relationships were observed between exposures and pulmonary function decrements over a work shift. Exposure concentrations associated with significant pulmonary function decrements were as follows: 2.4 mg/m 3 total dust, 0.16 mg/m 3 respirable dust, 614 EU/m 3 endotoxin, and 12 ppm ammonia.
267 citations
TL;DR: It was shown that only 25% of workers with a work-related musculoskeletal condition filed for workers' compensation and refutes the common perception that an individual with aWork-related problem is likely to file a workers' Compensation claim.
Abstract: Despite the availability of no fault insurance for wage replacement and medical care costs, the majority of workers diagnosed with an occupational disease do not apply for workers' compensation. The objective of the study was to determine the reasons why workers diagnosed with work-related musculoskeletal disease did not apply for workers' compensation benefits. A cross-sectional study of 1598 individuals diagnosed with neck, upper extremity, and low back work-related musculoskeletal disease from April to June 1996 was performed. All individuals were interviewed over the telephone using a standardized questionnaire. The questionnaire included questions about the precipitating event; demographics; health limitations; mood; pain level; and attitudes toward their health care provider, fellow workers, management, work environment, and filing for workers' compensation. Whenever possible, standardized questions from previous surveys were used. The interviewed individuals with work-related musculoskeletal disease were reported by health care practitioners as required by the state of Michigan's occupational disease reporting law. Workers reported during 12 weeks in the spring of 1996 by a Michigan health care professional as having a neck, back, or upper extremity musculoskeletal disorder were eligible to participate. Among the 2703 reports received, 490 individuals could not be reached, 22 did not speak English, 12 had died or were too incapacitated by other medical conditions, and 581 refused. We interviewed 59% of all eligible workers and 73% of all workers who were reachable and capable of responding in English. Only 25% of workers diagnosed with musculoskeletal disease filed a workers' compensation claim. The factors significantly associated with filing a claim were (1) increased length of employment (> 21 years: odds ratio [OR], 3.01, 95% confidence interval [CI], 1.31 to 6.90); 11 to 20 years: OR, 2.34, 95% CI, 1.01 to 5.47; 6 to 10 years: OR, 1.76, 95% CI, 0.73 to 4.25; 1 to 5 years: OR, 2.36, 95% CI, 1.03 to 5.42; or = $80,000: OR, 1.00); (3) workers' dissatisfaction with coworkers (OR, 1.76, 95% CI, 1.01 to 3.06); (4) physician restrictions on activity (OR, 2.16, 95% CI, 1.55 to 3.00); (5) type of physician providing treatment (specialist, including surgeon or orthopedist: OR, 3.63, 95% CI, 2.37 to 5.55); physical and occupational therapist: OR, 2.15, 95% CI, 1.35 to 3.43); family practitioner: OR, 1.33, 95% CI = 0.89 to 2.01; company physician: OR = 1.00); (6) off work > or = 7 days (OR, 14.85, 95% CI, 10.57 to 20.85); (7) decreased current health status (OR, 0.82, 95% CI, 0.70 to 0.96); and (8) increased severity of illness (OR, 1.24, 95% CI, 1.06 to 20.88). This study showed that only 25% of workers with a work-related musculoskeletal condition filed for workers' compensation and refutes the common perception that an individual with a work-related problem is likely to file a workers' compensation claim. The strongest predictors of who would file were those factors associated with the severity of the condition. Other factors were increasing length of employment, lower annual income, and worker dissatisfaction with coworkers. Our study population consisted mainly of unionized autoworkers, and our findings may not be generalizable to the total workforce.
195 citations
TL;DR: It is suggested that arsenic exposure is associated with skin lesions in the Bangladesh population and that urinary arsenic may be a stronger predictor of skin lesions than arsenic in drinking water in this population.
Abstract: The present study examined the associations between drinking water and urinary arsenic levels and skin lesions among 167 residents of three contiguous villages in Bangladesh. Thirty-six (21.6%) had skin lesions (melanosis, hyperkeratosis, or both), of which 13 (36.1%) occurred in subjects who were c
186 citations
TL;DR: It is shown that physical job and injury factors have a significant and time-varying impact on DOD, and younger age, longer pre-injury employment, less severe injuries, and a previous back injury predicted shorter disability.
Abstract: Little is known about predictors of duration of work disability (DOD). This cohort study of 433 workers' compensation claimants estimated DOD for job, injury, and demographic factors during consecutive disability phases using Cox regression analysis. DOD was calculated from administrative records. Results show that DOD increases with the time spent bending and lifting or pushing or pulling heavy objects at work, but it is unrelated to sitting, standing, or vibration. Younger age, longer pre-injury employment, less severe injuries, and a previous back injury predicted shorter disability, the latter factor only during the subacute/chronic disability phases. The effect of injury severity decayed over time. This study demonstrates the usefulness of a phase-specific analysis and shows that physical job and injury factors have a significant and time-varying impact on DOD.
139 citations
TL;DR: Information from the medical literature on aspects of flexor tendon entrapment of the digits likely to be of interest and relevant to occupational medicine practitioners are summarized.
Abstract: Flexor tendon entrapment of the digits is a disorder characterized by snapping or locking of the thumb or fingers (with or without pain). Most cases are secondary to thickening of the digit's A1 pulley, but other pathogeneses include tendon abnormalities at the level of the carpal tunnel, thickening of other pulleys, and abnormalities of the metacarpal-phalangeal joint. Its historical name, stenosing tenosynovitis of the digits, is inappropriate because histological studies document a lack of inflammation. Flexor tendon entrapment of the digits is a relatively common, uncomplicated, and non-controversial musculotendinous disorder of the distal upper extremity. The purpose of this invited review is to summarize information from the medical literature on aspects of this condition likely to be of interest and relevant to occupational medicine practitioners. Topics covered include normal anatomy and kinesiology, history, clinical observations related to diagnosis, pathology, pathophysiology, clinical observations on etiology, descriptive epidemiology, epidemiological studies, and case management. Models for the pathogenesis of flexor tendon entrapment of the digits are proposed, and opportunities for future research are presented.
134 citations
TL;DR: Results provide only partial support for an association between some psychosocial factors at work and the prevalence of smoking and sedentary behavior.
Abstract: This cross-sectional study examined whether psychosocial factors at work were associated with smoking, sedentary behavior, and body mass index. The study population was composed of 3531 men and 3464 women employed as white collar workers in 21 organizations. Data were collected at worksites. Psychological demands and decision latitude at work were measured with the Karasek 18-item questionnaire. Smoking, sedentary behavior, and mean body mass index were compared by quartiles of decision latitude and psychological demands and by job strain categories. Prevalence of smoking, mean number of cigarettes smoked per day, prevalence of sedentary behavior, and mean body mass index were not consistently associated with decision latitude, psychological demands, or high job strain. However, prevalence of smoking was elevated in women belonging to the highest quartile of psychological demands (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0 to 1.6) and in the active job strain groups in both men (OR, 1.6; 95% CI, 1.2 to 2.1) and women (OR, 1.4; 95% CI, 1.0 to 2.0). Prevalence of sedentary behavior was elevated in men in the lowest quartile of decision latitude (OR, 1.3; 95% CI, 1.0 to 1.7), in the passive group (OR, 1.3; 95% CI, 1.0 to 1.5), and in the high strain group (OR, 1.2; 95% CI, 1.0 to 1.6). In women, this prevalence was elevated in the third quartile of psychological demand (OR, 1.3; 95% CI, 1.1 to 1.6). These results provide only partial support for an association between some psychosocial factors at work and the prevalence of smoking and sedentary behavior.
133 citations
TL;DR: Evidence of effect modification by sex is found, with the slope in female deaths one third larger than in male deaths, whereas for social factors and race it is found only weak evidence of effect modifications.
Abstract: Interest has recently been focused on which populations are most at risk of premature mortality induced by air pollution. This coincides with greater concern about environmental justice. We analyzed total mortality in the four largest US cities with daily measurements of particulate matter less than 10 microns (PM10) and combined the results to determine whether race, sex, and education are potential modifiers of the effects of PM10 on mortality. We computed daily counts of deaths stratified by sex, race, and education in each city and investigated their associations with PM10 in a Poisson regression model. We combined the results by using inverse variance weighted averages. We found evidence of effect modification by sex, with the slope in female deaths one third larger than in male deaths, whereas for social factors and race we found only weak evidence of effect modification. In general, the effect modification appeared modest compared with other reports of substantial effect modification by medical conditions.
128 citations
TL;DR: Findings do not support the hypothesis that perchlorate in drinking water at concentrations as high as 100 to 120 micrograms/L suppresses thyroid function in newborns or school-age children.
Abstract: Perchlorate is known to suppress thyroid function by inhibiting uptake of iodide by the human thyroid at doses of 200 mg/day or greater. A study was conducted to investigate the potential effects of perchlorate in drinking water on thyroid function in newborns and school-age children. A total of 162 school-age children and 9784 newborns were studied in three proximate cities in northern Chile that have different concentrations of perchlorate in drinking water: Taltal (100 to 120 micrograms/L), Chanaral (5 to 7 micrograms/L), and Antofagasta (non-detectable: < 4 micrograms/L). Among schoolchildren, no difference was found in thyroid-stimulating hormone levels or goiter prevalence among lifelong residents of Taltal or Chanaral compared with those of Antofagasta, after adjusting for age, sex, and urinary iodine. No presumptive cases of congenital hypothyroidism were detected in Taltal or Chanaral; seven cases were detected in Antofagasta. Neonatal thyroid-stimulating hormone levels were significantly lower in Taltal compared with Antofagasta; this is opposite to the known pharmacological effect of perchlorate, and the magnitude of difference did not seem to be clinically significant. These findings do not support the hypothesis that perchlorate in drinking water at concentrations as high as 100 to 120 micrograms/L suppresses thyroid function in newborns or school-age children.
116 citations
TL;DR: It is suggested that even low-level perchlorate contamination of drinking water may be associated with adverse health effects in neonates and highlights the need for both further study and control of human low- level per chlorate exposure.
Abstract: The Colorado River below Lake Mead, which supplies drinking water for approximately 20,000,000 people, is contaminated by ammonium perchlorate. We identified populations who were exposed and unexposed to perchlorate-contaminated drinking water and compared median newborn thyroid-stimulating hormone (TSH) levels after adjusting for age in days at measurement and for race/ethnicity. Median newborn TSH levels in a city whose drinking water supply was 100% perchlorate-contaminated water from the Colorado River below Lake Mead were significantly higher than those in a city totally supplied with non-perchlorate-contaminated drinking water, even after adjusting for factors known or suspected to elevate newborn TSH levels. This ecological study demonstrates a statistically significant association between perchlorate exposure and newborn TSH levels. It suggests that even low-level perchlorate contamination of drinking water may be associated with adverse health effects in neonates and highlights the need for both further study and control of human low-level perchlorate exposure.
111 citations
TL;DR: It is indicated that cigarette smoking is highly associated with development of high-frequency hearing impairment in Japanese male office workers.
Abstract: The association of cigarette smoking with development of hearing impairment (loss of 30 dB at 1000 Hz and 40 dB at 4000 Hz) over a 5-year follow-up was studied in 1554 non-hearing-impaired Japanese male office workers who ranged in age from 30 to 59 years. After controlling for potential predictors of hearing impairment, the relative risk for low-frequency hearing impairment compared with never smokers was 1.12 (95% confidence interval [CI], 0.57 to 2.17) for ever-smokers, 1.21 (95% CI, 0.65 to 2.25) for current smokers of 1 to 20 cigarettes/day, 1.35 (95% CI, 0.70 to 2.61) for current smokers of 21 to 30 cigarettes/day, and 1.82 (95% CI, 0.98 to 3.38) for current smokers of 31 or more cigarettes/day (P for trend = 0.063). The respective multivariate-adjusted relative risks for high-frequency hearing impairment compared with never smokers were 1.70 (95% CI, 0.85 to 3.40), 1.82 (95% CI, 0.92 to 3.59), 2.00 (95% CI, 0.98 to 4.08), and 2.20 (95% CI, 1.09 to 4.42) (P for trend = 0.025). As the number of pack-years of exposure increased, the risk for high-frequency hearing impairment increased in a dose-dependent manner (P for trend = 0.011), but the risk for low-frequency hearing impairment did not (P for trend = 0.172). Our results indicate that cigarette smoking is highly associated with development of high-frequency hearing impairment in Japanese male office workers.
TL;DR: This study investigated the association between occupational pesticide exposure and semen quality among Chinese workers and found that male workers exposed to organophosphate pesticides had poorer semen quality following a work shift.
Abstract: This study investigated the association between occupational pesticide exposure and semen quality among Chinese workers Male workers, 32 who were exposed to organophosphate pesticides and 43 who were not exposed were recruited from two nearby factories and interviewed Following a work shift, semen and urine samples were collected for pesticide metabolite analysis Semen samples were analyzed for sperm concentration, percentage of motility, and percentage of normal structure Within the exposed group, the mean end-of-shift urinary p-nitrophenol levels were 022 and 015 mg/L for the high- and low-exposure subgroups, respectively Linear regression analysis of individual semen parameters revealed a significant reduction of sperm concentration (359 x 10(6) vs 628 x 10(6), p < 001) and percentage of motility (47% vs 57%, p = 003) but not percentage of sperm with normal structure (57% vs 61%, p = 013) Multivariate modeling showed a significant overall shift in the mean semen parameter Occupational exposure to ethylparathion and methamidophos seems to have a moderately adverse effect on semen quality
TL;DR: The nature of the association between the physician’s initial clinical management aspects and LBP disability duration merits further exploration.
Abstract: Clinical practice guidelines recommend a conservative approach to management of acute low back pain (LBP). The present study sought to determine whether health care utilization and the physician's initial management of work-related LBP were associated with disability duration. Clinical management information was obtained for 98 randomly selected, workers' compensation claimants with acute, uncomplicated, disabling work-related LBP. Length of disability was based on indemnity (wage replacement) payments. Disability was significantly associated with increased utilization of specialty referrals (P = 0.013) and provider visits (P < 0.001), use of magnetic resonance imaging (P = 0.003), and use of opioids for more than 7 days (P = 0.013). Effects of early diagnostic imaging (first 30 days of care) on length of disability were observed (P = 0.001). Patients whose treatment course did not involve extended opioid use and early diagnostic testing were 3.78 times more likely (95% confidence interval, 1.6 to 8.9) to have gone off disability status by the end of the study. The nature of the association between these initial clinical management aspects and LBP disability duration merits further exploration.
TL;DR: Excess breast cancer risk is suggested in a number of occupations and industries, notably those that entail exposure to solvents and pesticides, particularly in crop farmers and in the fruit and vegetable, publishing and printing, and motor vehicle repair industries.
Abstract: Lifetime occupational histories as well as information on known and suspected breast cancer risk factors were collected by means of a self-administered questionnaire from 1018 women with incident breast cancer ascertained from the British Columbia Cancer Registry, and from 1020 population controls. A matched case-control study design was used. Conditional logistic regression for matched sets data and the likelihood ratio were used in a two-step procedure and were performed separately for pre-menopausal women, post-menopausal women, and for all cases combined. Excess risk was noted for several white-collar occupations. Significantly increased risk was observed: (1) among pre-menopausal women: in electronic data-processing operators; barbers and hairdressers; in sales and material processing occupations; and in the food, clothing, chemical and transportation industries; (2) among post-menopausal women: in schoolteaching; in medicine, health, and nursing occupations; in laundry and dry-cleaning occupations; and in the aircraft and automotive, including gasoline service station, industries. Several significant associations were also seen in the combined group of pre- and post-menopausal women, particularly in crop farmers and in the fruit and vegetable, publishing and printing, and motor vehicle repair industries. The results of this study suggest excess breast cancer risk in a number of occupations and industries, notably those that entail exposure to solvents and pesticides.
TL;DR: Non-fatal injuries among Hispanic construction workers treated at an emergency department from 1990 to 1998 are described to suggest that minority status is a predictor of trade and that trade is a predictors of injury risk.
Abstract: This article describes non-fatal injuries among Hispanic construction workers treated at an emergency department from 1990 to 1998 Medical and interview data were analyzed to evaluate and explain the workers' apparently inflated risk of injury The majority of the injured Hispanic workers were employed in the less-skilled trades Compared with other injured workers, Hispanics had a higher proportion of serious injuries and were disadvantaged in terms of training and union status With the exception of union status, these differences largely disappeared after controlling for trade The physical, financial, and emotional consequences were more apparent 1 year later for injured Hispanics, even after controlling for trade These observations suggest that minority status is a predictor of trade and that trade is a predictor of injury risk In addition to reducing injury hazards, interventions should address the limited employment and union membership options that are available to minority workers in the construction industry
TL;DR: It is suggested that women in the military report less day-to-day job stress but more atypical life events, including those related to their jobs, and that these life events are associated with adverse menstrual consequences.
Abstract: Few studies have assessed multiple stress factors as a potential risk for menstrual disorders. This study evaluated whether work-related stress or life event stress was associated with alterations in menstrual function of military personnel. The study is unique in that it evaluated the association between race and three job factors--job stress, handling chemical mixtures, and being a military or civilian employee of the US Air Force. A comprehensive questionnaire was administered to 170 healthy, premenopausal employed women to examine the relationship between work-related or life event stress and menstrual disorders. Multiple logistic regression analyses showed no statistically significant association between work-related stress and menstrual disorders, whereas life event stress was significantly associated with dysmenorrhea (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.08 to 4.50) abnormal cycle length (OR, 3.42; CI, 1.12 to 10.50), and hypermenorrhea (OR, 2.99; 95% CI, 1.20 to 7.42). Having one or more menstrual disorders was significantly associated with life events by race interaction (OR, 6.52; 95% CI, 2.45 to 17.36). Non-Caucasians had significantly increased risks of hypermenorrhea (OR, 4.99; 95% CI, 2.07 to 12.05) and abnormal cycle length (OR, 4.12; 95% CI, 1.47 to 11.55). The prevalence of menstrual disorders in this military population was 31.2% for dysmenorrhea, 17.9% for hypermenorrhea, and 12.0% for abnormal cycle length. This study suggests that women in the military report less day-to-day job stress but more atypical life events, including those related to their jobs, and that these life events are associated with adverse menstrual consequences.
TL;DR: Hearing conservation programs for farmers should be directed toward reduction in noise exposure, both from occupational and non-occupational sources, according to source apportionment analysis for hearing loss in a large, multiphasic health survey.
Abstract: Those who work on farms continue to have a strikingly high prevalence of hearing loss, despite efforts to promote hearing conservation in agriculture. To develop improved hearing conservation programs, we performed a source apportionment analysis for hearing loss in a large, multiphasic health survey, the New York Farm Family Health and Hazard Survey. We used information from audiometric, otoscopic, and tympanometric examinations; detailed general health and farm exposure interviews; and a second interview that focused on additional potential determinants of hearing loss. Hearing loss on audiometry was significantly associated with increased age, male gender, education through high school or less, lifetime years of hunting with guns, lifetime years of use of a grain dryer, and a history of spraying crops during the previous year. Hearing conservation programs for farmers should thus be directed toward reduction in noise exposure, both from occupational and non-occupational sources. Additional study is needed to evaluate the association seen between crop spraying and hearing loss.
TL;DR: It is demonstrated that some characteristics of VDT workstations, after accounting for psychosocial stress, can be correlated with musculoskeletal discomfort.
Abstract: Associations between selected sites of musculoskeletal discomfort and ergonomic characteristics of the video display terminal (VDT) workstation were assessed in analyses controlling for demographic, psychosocial stress, and VDT use factors in 273 VDT users from a large administrative department. Significant associations with wrist/hand discomfort were seen for female gender; working 7+ hours at a VDT; low job satisfaction; poor keyboard position; use of new, adjustable furniture; and layout of the workstation. Significantly increased odds ratios for neck/shoulder discomfort were observed for 7+ hours at a VDT, less than complete job control, older age (40 to 49 years), and never/infrequent breaks. Lower back discomfort was related marginally to working 7+ hours at a VDT. These results demonstrate that some characteristics of VDT workstations, after accounting for psychosocial stress, can be correlated with musculoskeletal discomfort.
TL;DR: Studies in which silicotic patients were not identified from compensation registries and in which enumeration was complete did not support a causal association between silicosis and lung cancer, which argues against the carcinogenicity of crystalline silica.
Abstract: The relationship between crystalline silica and lung cancer has been the subject of many recent publications, conferences, and regulatory considerations. An influential, international body has determined that there was sufficient evidence to conclude that quartz and cristobalite are carcinogenic in humans. The present authors believe that the results of these studies are inconsistent and, when positive, only weakly positive. Other, methodologically strong, negative studies have not been considered, and several studies viewed as providing evidence supporting the carcinogenicity of silica have significant methodological weaknesses. Silica is not directly genotoxic and is a pulmonary carcinogen only in the rat, a species that seems to be inappropriate for assessing particulate carcinogenesis in humans. Data on humans demonstrate a lack of association between lung cancer and exposure to crystalline silica. Exposure-response relationships have generally not been found. Studies in which silicotic patients were not identified from compensation registries and in which enumeration was complete did not support a causal association between silicosis and lung cancer, which further argues against the carcinogenicity of crystalline silica.
TL;DR: Electromyographic signals from electrodes placed in the lumbar area of patients and non-pain control subjects indicated that surface electromyography assessment of the paraspinal muscle activity may be a useful objective diagnostic tool in the comprehensive evaluation of CLBP.
Abstract: This investigation examined surface electromyography as an additional tool in the comprehensive clinical evaluation of patients with chronic low back pain (CLBP). Electromyographic signals from electrodes placed in the lumbar area of 30 CLBP patients and 30 non-pain control subjects were compared. Patients and controls were matched for age, gender, and body mass index. Paired t test showed a statistically significant difference between the two groups. The muscle activity mean values were threefold higher in CLBP patients than in controls (P < 0.00001) in the static testing, and twofold higher in CLBP patients than in controls (P < 0.00001) in the dynamic testing. Our findings indicate that surface electromyography assessment of the paraspinal muscle activity may be a useful objective diagnostic tool in the comprehensive evaluation of CLBP.
TL;DR: It was indicated that petroleum workers were not at an increased risk of NHL as a result of their exposure to benzene or other benzene-containing petroleum products in their work environment, supported by cohort studies of workers in other industries who were exposed to Benzene as well as by population-based case-control studies of NHL and occupational exposures.
Abstract: Petroleum workers are exposed to benzene or benzene-containing petroleum products. As such, studies of these workers provide an opportunity for investigating the relationship between benzene and non-Hodgkin’s lymphoma (NHL). However, few cohort studies of petroleum workers report results of NHL sepa
TL;DR: US Occupational Safety and Health Administration investigation records for the period 1984 to 1994 for mention of hazardous substance 1480 (hydrogen sulfide) showed 80 fatalities from hydrogen sulfide in 57 incidents, with 19 fatalities and 36 injuries among coworkers attempting to rescue fallen workers.
Abstract: Alice Hamilton described fatal work injuries from acute hydrogen sulfide poisonings in 1925 in her book Industrial Poisons in the United States. There is no unique code for H2S poisoning in the International Classification of Diseases, 9th Revision; therefore, these deaths cannot be identified easily from vital records. We reviewed US Occupational Safety and Health Administration (OSHA) investigation records for the period 1984 to 1994 for mention of hazardous substance 1480 (hydrogen sulfide). There were 80 fatalities from hydrogen sulfide in 57 incidents, with 19 fatalities and 36 injuries among coworkers attempting to rescue fallen workers. Only 17% of the deaths were at workplaces covered by collective bargaining agreements. OSHA issued citations for violation of respiratory protection and confined space standards in 60% of the fatalities. The use of hydrogen sulfide detection equipment, air-supplied respirators, and confined space safety training would have prevented most of the fatalities.
TL;DR: The results indicate that baseline measures of ergonomic and psychosocial stress, pain severity, and pain coping style predict clinical outcome at shorter intervals, whereas number of past treatments/providers, recommendation for surgery and pain cope style predict longer-term outcome.
Abstract: This study prospectively examined the extent to which a set of medical, physical, ergonomic, occupational psychosocial, and individual psychosocial variables would predict clinical outcome associated with a diverse set of work-related upper extremity disorders in recently diagnosed individuals. This investigation was designed to develop a tool for use in a clinical setting to assist in identifying patients at risk for poorer outcome. Outcome was measured at 1, 3, and 12 months after completing a baseline questionnaire. Outcome status was based on a median split of a standardized composite index (symptoms, function, workdays lost, and mental health). Logistic regression indicated that predictors of poorer outcome at 1 month were: upper extremity comorbidity (risk ratio [RR], 1.58), pain severity (RR, 1.45), ergonomic risk exposure (RR, 1.07), low job support (RR, 1.03), and pain coping style (RR, 1.54). At 3 months, poorer outcome was predicted by: symptom severity (RR, 10.46), job stress (RR, 1.20), and pain coping style (RR, 1.98). The number of prior treatments/providers (RR, 1.77), past recommendation for surgery (RR, 6.43), and pain coping style were found to predict poorer outcome at 12 months. Sensitivity and specificity, respectively, for the models were 77.4% and 71.8% at 1 month, 80.6% and 82.4% at 3 months, and 80.6% and 83.3% at 12 months. The results indicate that baseline measures of ergonomic and psychosocial stress, pain severity, and pain coping style predict clinical outcome at shorter intervals, whereas number of past treatments/providers, recommendation for surgery and pain coping style predict longer-term outcome. The resulting prognostic screen provides a simple tool that assesses the multidimensional nature of work-related upper extremity disorders and predicts clinical outcome. Furthermore, the findings suggest the importance of early intervention that addresses both physical and psychosocial stressors at work. Specific recommendations to reduce the impact of observed risk factors are discussed.
TL;DR: This study was sufficiently sensitive to detect the effects of gender, birth weight, and the day of life on which the blood sample was taken on the neonatal T4 level, but it detected no effect from environmental exposures to perchlorate that ranged up to 15 micrograms/L (ppb).
Abstract: Environmental contamination of drinking water has been observed for perchlorate, a chemical able to affect thyroid function. This study examines whether that exposure affected the thyroid function of newborns. Neonatal blood thyroxine (T4) levels for days 1 to 4 of life were compared for newborns from the city of Las Vegas, Nevada, which has perchlorate in its drinking water, and those from the city of Reno, Nevada, which does not (detection limit, 4 micrograms/L [ppb]). This study is based on blood T4 analyses from more than 23,000 newborns in these two cities during the period April 1998 through June 1999. No difference was found in the mean blood T4 levels of the newborns from these two cities. Drinking water perchlorate levels measured monthly for Las Vegas ranged during this study period from non-detectable for 8 months to levels of 9 to 15 ppb for 7 months. Temporal differences in mean T4 level were noted in both cities but were unrelated to the perchlorate exposure. This study was sufficiently sensitive to detect the effects of gender, birth weight, and the day of life on which the blood sample was taken on the neonatal T4 level, but it detected no effect from environmental exposures to perchlorate that ranged up to 15 micrograms/L (ppb).
TL;DR: Patients in the early intervention group had fewer physician visits, fewer restricted workdays, fewer days away from work, and shorter case duration, providing a strong indication for the effectiveness of early therapy intervention.
Abstract: This study was designed to evaluate the effects of early physical therapy intervention on treatment outcomes for workers with acute low back injuries. A total of 3867 cases were randomly selected from the database of a large occupational health care provider. Cases were assigned to either the early therapy intervention group or one of the two comparison groups on the basis of their delay to physical therapy. The treatment outcomes for the three groups were compared. The results showed that patients in the early therapy intervention had more favorable outcomes than the two comparison groups. Specifically, patients in the early intervention group had fewer physician visits, fewer restricted workdays, fewer days away from work, and shorter case duration. These results provide a strong indication for the effectiveness of early therapy intervention. The financial implications of the findings is discussed.
TL;DR: The results suggest that circular or elliptical magnetic field polarization, or another factor linked to substations and 3-phase electricity, is associated with magnetic field induced melatonin suppression in humans.
Abstract: Melatonin suppression by 50/60-Hz magnetic fields represents a plausible biological mechanism for explaining increased health risks in workers. Personal exposure to magnetic fields and ambient light, and excretion of the melatonin metabolite 6-hydroxymelatonin sulfate (6-OHMS), were measured over 3 consecutive workdays in electric utility workers. There was a magnetic field-dependent reduction in adjusted mean nocturnal and post-work 6-OHMS levels among men working more than 2 hours per day in substation and 3-phase environments and no effect among those working 2 hours or less. No changes were observed among men working in 1-phase environments. The results suggest that circular or elliptical magnetic field polarization, or another factor linked to substations and 3-phase electricity, is associated with magnetic field induced melatonin suppression in humans.
TL;DR: Farmers; certain occupations and industries with exposures to cadmium, herbicides, and fertilizers; and men with low occupational physical activity levels have elevated prostate cancer risks.
Abstract: To provide new leads regarding occupational prostate cancer risk factors, we linked 36,269 prostate cancer cases reported to the Swedish National Cancer Registry during 1961 to 1979 with employment information from the 1960 National Census. Standardized incidence ratios for prostate cancer, within major (1-digit), general (2-digit), and specific (3-digit) industries and occupations, were calculated. Significant excess risks were seen for agriculture-related industries, soap and perfume manufacture, and leather processing industries. Significantly elevated standardized incidence ratios were also seen for the following occupations: farmers, leather workers, and white-collar occupations. Our results suggest that farmers; certain occupations and industries with exposures to cadmium, herbicides, and fertilizers; and men with low occupational physical activity levels have elevated prostate cancer risks. Further research is needed to confirm these findings and identify specific exposures related to excess risk in these occupations and industries.
TL;DR: The study suggests that a well-structured early return to work program is an integral part of a comprehensive effort to control the duration of disability associated with occupational injuries and illness and indicates that to be most effective, it must include participation by medical providers, safety professionals, injured employees, and supervisors.
Abstract: An Early Return to Work Program was initiated at The Johns Hopkins Hospital and Associated Schools of Medicine, Hygiene and Nursing in Baltimore, Maryland, in April 1992 as part of a comprehensive effort to control the incidence and costs of work-related illnesses and injuries. The program was similar to others that incorporate employee and supervisory training and job accommodation, but it also included an industrial hygienist trained in ergonomics to facilitate the placement of individuals with restrictions. The return to work program was studied over a 10-year period, comparing the number of lost workday cases, lost workdays, and restricted duty days before (1989 to 1992) and after (1993 to 1999) initiation of the program. A significant decrease (55%) was observed in the rate of lost workday cases before versus after the return to work program. Furthermore, the number of lost workdays decreased from an average of 26.3 per 100 employees before, to 12.0 per 100 employees after, the return to work initiative, and the number of restricted duty days went from an average of 0.63 per 100 employees to 13.4 per 100 employees (a twentyfold increase). The study suggests that a well-structured early return to work program is an integral part of a comprehensive effort to control the duration of disability associated with occupational injuries and illness. It also indicates that to be most effective, an early return to work program must include participation by medical providers, safety professionals, injured employees, and supervisors. Our work suggests that even with these elements in place, the effectiveness of return to work programs may be increased by including an individual trained in ergonomics to facilitate the job placement process.
TL;DR: Several aspects of spirometric testing in the workplace are reviewed, where spirometry is employed in the primary, secondary, and tertiary prevention of occupational lung disease, to ensure that each area of test performance and interpretation follow current recommendations/standards in the pulmonary and regulatory fields.
Abstract: This position statement reviews several aspects of spirometric testing in the workplace, where spirometry is employed in the primary, secondary, and tertiary prevention of occupational lung disease. Primary prevention includes pre-placement and fitness-for-duty examinations as well as research and monitoring of health status in groups of exposed workers; secondary prevention includes periodic medical screening of individual workers for early effects of exposure to known occupational hazards; and tertiary prevention includes clinical evaluation and impairment/disability assessment. For all of these purposes, valid spirometry measurements are critical, requiring: documented spirometer accuracy and precision, a rigorous and standardized testing technique, standardized measurement of pulmonary function values from the spirogram, adequate initial and refresher training of spirometry technicians, and, ideally, quality assessment of samples of spirograms. Interpretation of spirometric results usually includes comparison with predicted values and should also evaluate changes in lung function over time. Response to inhaled bronchodilators and changes in relation to workplace exposure may also be assessed. Each of these interpretations should begin with an assessment of test quality and, based on the most recent ATS recommendations, should rely on a few reproducible indices of pulmonary function (FEV1, FVC, and FEV1/FVC.) The use of FEF rates (e.g., the FEF25-75%) in interpreting results for individuals is strongly discouraged except when confirming borderline airways obstruction. Finally, the use of serial PEF measurements is emerging as a method for confirming associations between reduced or variable pulmonary function and workplace exposures in the diagnosis of occupational asthma. Throughout this position statement, ACOEM makes detailed recommendations to ensure that each of these areas of test performance and interpretation follow current recommendations/standards in the pulmonary and regulatory fields. Submitted by the Occupational and Environmental Lung Disorder Committee on November 16,1999. Approved by the ACOEM Board of Directors on January 4,2000.
TL;DR: Health promotion participants improved their subsequent-year health risk more than did non-participants and was associated with reduced illness-related absenteeism and (although inconsistently) with medical claims paid and short-term disability.
Abstract: Employer-sponsored health promotion can improve employee health and morale and reduce medical claims and absenteeism. Effectiveness depends on the participation of those employees who are at increased risk of ill health. HealthPlus Health Quotient is an incentive/disincentive approach to health promotion. The employer's contribution to the employee cafeteria-plan benefit package is adjusted on the basis of an annual health risk appraisal. We evaluated whether this financial incentive/disincentive predicted participation in health promotion activities, and whether participation improved future health risk and productivity. In the first year, participation was proportional to overall health risk (P < 0.01). Participation in targeted programs was proportional to levels of body fat, cholesterol, and blood pressure. Participation in activity-related health promotion was proportional to prior-year activity or fitness scores. Health promotion participants improved their subsequent-year health risk more than did non-participants. Participation was associated with reduced illness-related absenteeism and (although inconsistently) with medical claims paid and short-term disability.