Showing papers in "Journal of Occupational and Environmental Medicine in 2006"

How much work-related injury and illness is missed by the current national surveillance system?

Abstract: Objective: We sought to estimate the undercount in the existing national surveillance system of occupational injuries and illnesses. Methods: Adhering to the strict confidentiality rules of the U.S. Bureau of Labor Statistics, we matched the companies and individuals who reported work-related injuries and illnesses to the Bureau in 1999, 2000, and 2001 in Michigan with companies and individuals reported in four other Michigan data bases, workers’ compensation, OSHA Annual Survey, OSHA Integrated Management Information System, and the Occupational Disease Report. We performed capture–recapture analysis to estimate the number of cases missed by the combined systems. Results: We calculated that the current national surveillance system did not include 61% and with capture–recapture analysis up to 68% of the work-related injuries and illnesses that occurred annually in Michigan. This was true for injuries alone, 60% and 67%, and illnesses alone 66% and 69%, respectively. Conclusions: The current national system for work-related injuries and illnesses markedly underestimates the magnitude of these conditions. A more comprehensive system, such as the one developed for traumatic workplace fatalities, that is not solely dependent on employer based data sources is needed to better guide decision-making and evaluation of public health programs to reduce work-related conditions. (J Occup Environ Med. 2006;48:357–365)

Community Exposure to Perfluorooctanoate: Relationships Between Serum Concentrations and Exposure Sources

Abstract: Objective:The objective of this study was to determine serum (perfluorooctanoate [PFOA]) in residents near a fluoropolymer production facility: the contributions from air, water, and occupational exposures, personal and dietary habits, and relationships to age and gender.Methods:The authors conducte

Cancer Risk Among Firefighters: A Review and Meta-analysis of 32 Studies

Abstract: Objective: The objective of this study was to review 32 studies on firefighters and to quantitatively and qualitatively determine the cancer risk using a meta-analysis. Methods: A comprehensive search of computerized databases and bibliographies from identified articles was performed. Three criteria used to assess the probable, possible, or unlikely risk for 21 cancers included pattern of meta-relative risks, study type, and heterogeneity testing. Results: The findings indicated that firefighters had a probable cancer risk for multiple myeloma with a summary risk estimate (SRE) of 1.53 and 95% confidence interval (CI) of 1.21–1.94, non-Hodgkin lymphoma (SRE 1.51, 95% CI 1.31–1.73), and prostate (SRE 1.28; 95% CI 1.15–1.43). Testicular cancer was upgraded to probable because it had the highest summary risk estimate (SRE 2.02; 95% CI 1.30–3.13). Eight additional cancers were listed as having a “possible” association with firefighting. Conclusions: Our results confirm previous findings of an elevated metarelative risk for multiple myeloma among firefighters. In addition, a probable association with non-Hodgkin lymphoma, prostate, and testicular cancer was demonstrated. (J Occup Environ Med. 2006;48: 1189–1202)

Community Exposure to Perfluorooctanoate: Relationships Between Serum Levels and Certain Health Parameters

Abstract: Objective Determine whether certain biomarkers of toxicity and/or a past diagnosis of liver or thyroid disease were associated with serum perfluorooctanoate concentrations [PFOA] in a community with longstanding environmental exposure to PFOA.

Arsenic methylation and bladder cancer risk in case-control studies in Argentina and the United States.

Abstract: Objective: We sought to assess whether the metabolism of arsenic impacts a person’s susceptibility to bladder cancer. Methods: Urinary methylation products were measured in subjects from Argentina (114 cases and 114 controls) and the United States (23 cases and 49 controls). Results: In Argentina, the adjusted odds ratio (OR) for subjects with a high proportion of ingested arsenic excreted as monomethylarsonate (%MMA) was 2.17 (95% confidence interval [CI] 1.02–4.63) in smokers and 0.48 (95% CI 0.17–1.33) in nonsmokers. In the United States, the adjusted ORs for high %MMA in subjects with arsenic intakes less than and greater than 100 g/d were 1.20 (95% CI 0.27–5.38) and 2.70 (95% CI 0.39–18.6). Conclusions: Overall, these results are consistent with data from Taiwan suggesting that some individuals who excrete a higher proportion of ingested arsenic as MMA are more susceptible to arsenic-related cancer. (J Occup Environ Med. 2006;48: 478–488)

The association between health risk change and presenteeism change.

Abstract: Objective:This prospective study investigates whether changes in health risks are associated with changes in presenteeism (on-the-job productivity loss).Method:A total of 7026 employees of a national financial services company responded to a health risk appraisal (HRA), which included a modi

Underreporting of work-related injury or illness to workers' compensation: individual and industry factors.

Abstract: OBJECTIVE:: We quantified the underreporting of work-related injury or illness to workers' compensation (WC). METHODS:: Using data from 2612 wage-earning respondents who participated in the 2002 Washington State Behavioral Risk Factor Surveillance System, we assessed work-related injury or illness in the previous year and identified the factors associated with WC claim filing by logistic regression. RESULTS:: The self-reported rate of work-related injury or illness of respondents was 13%. Among those who had a work-related injury or illness, 52% filed a WC claim. After adjustment for age, gender, and race, those who filed WC claims were more likely to be overweight and married. WC claim filing varies considerably across industry and occupation groups holding all other measured factors constant. CONCLUSIONS:: Individual and industry/occupation factors are related to underreporting of work-related injury or illness to the WC system. Language: en

Sleep apnea and commercial motor vehicle operators: statement from the joint Task Force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine, and the National Sleep Foundation.

Abstract: M edical research supports the finding that obstructive sleep apnea (OSA) is a significant cause of motor vehicle crashes (MVCs) resulting in twoto sevenfold increased risk. Recent reports indicate OSA is present in a greater prevalence in operators of commercial motor vehicle (CMV) operators than in the general population. Although U.S. commercial drivers are required by federal statute to undergo medical qualification examinations at least every 2 years, the most recent OSA recommendations for medical examiners were prepared during a 1991 conference sponsored by the Federal Highway Administration (FHWA). Since then, the clinical diagnosis, evaluation, treatment, and follow-up criteria have changed significantly. Lacking current recommendations from the U.S. Department of Transportation (DOT), commercial driver medical examiners (CDMEs) must rely on outdated guidance and are thus forced to fill in the many existing gaps when evaluating CMV operators for this safety-sensitive type of work. In addition to causing difficulties for the medical examiner, the current guidelines, or lack thereof, foster an environment in which drivers who possibly have OSA are afraid to be evaluated because it might result in their removal from work. This set of circumstances may lead to the underrecognition of this condition and an increase in MVCs. From OccuMedix, Inc. (Dr Hartenbaum), Dresher, Pennsylvania; the Department of Medicine, Division of Pulmonary/Critical Care Medicine (Dr Collop), Johns Hopkins University, Baltimore, Maryland; the Department of Medicine, Divisions of Sleep Medicine and Pulmonary, Allergy & Critical Care Medicine (Dr Rosen), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Division of Pulmonary Critical Care and Sleep Medicine (Dr Phillips), University of Kentucky College of Medicine, Lexington, Kentucky; the Department of Medicine, Division of Respirology (Dr George), University of Western Ontario, and the Sleep Laboratory, London Health Sciences Centre, South Street Hospital, London, Ontario, Canada; the Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine (Dr Rowley), Wayne State University School of Medicine, Harper University Hospital, Detroit, Michigan; The Sleep and Behavior Medicine Institute and Pulmonary Physicians of the North Shore (Dr Freedman), Bannockburn, Illinois; Biobehavioral and Health Sciences Division (Dr Weaver), University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; the Department of Medicine, Divisions of Sleep, Pulmonary and Critical Care Medicine (Dr Gurubhagavatula), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; the Department of Medicine, Director (Dr Strohl), Center for Sleep Disorders Research, Case Western Reserve University School of Medicine, Louis Stokes DVA Medical Center, Cleveland, Ohio; the IHC Health Services to Business (Dr Leaman), Intermountain WorkMed, Salt Lake City, Utah; and Arkansas Occupational Health (Dr Moffitt), Springdale, Arkansas; Alertness Solutions (Dr Rosekind), Cupertino, CA. Address correspondence to: Natalie Hartenbaum, MD, MPH, FACOEM, President and Chief Medical Officer, OccuMedix, Inc., P.O. Box 197, Dresher, PA 19025; E-mail: occumedix@comcast.net. Copyright © 2006 by American College of Occupational and Environmental Medicine

Contribution of Burnout to the Association Between Job Strain and Depression: the Health 2000 Study

Abstract: Objective:The objective of this study was to investigate the contribution of burnout to the association between job strain and depression.Methods:A representative sample of 3270 Finnish employees aged 30 to 64 years responded to the Maslach Burnout Inventory–General Survey and the Beck Depre

Further development and validation of the Occupational Fatigue Exhaustion Recovery (OFER) scale.

Abstract: Objective:Refinement of the Occupational Fatigue Exhaustion Recovery (OFER) scaleMethod:The responses of 510 nurses to the OFER scale, two of whose scales contained additional items, were examined with CFA and regression analysesResults:Analyses of the expanded pool of items identified three subsc

Evaluation of flavorings-related lung disease risk at six microwave popcorn plants.

Abstract: Objective: After investigating fixed airways obstruction in butter flavoringexposed workers at a microwave popcorn plant, we sought to further characterize lung disease risk from airborne butter-flavoring chemicals. Methods: We analyzed data from medical and environmental surveys at six microwave popcorn plants (including the index plant). Results: Respiratory symptom and airways obstruction prevalences were higher in oil and flavorings mixers with longer work histories and in packaging-area workers near nonisolated tanks of oil and flavorings. Workers were affected at five plants, one with mixing-area exposure to diacetyl (a butter-flavoring chemical with known respiratory toxicity potential) as low as 0.02 ppm. Conclusions: Microwave popcorn workers at many plants are at risk for flavoring-related lung disease. Peak exposures may be hazardous even when ventilation maintains low average exposures. Respiratory protection and engineering controls are necessary to protect workers. (J Occup Environ Med. 2006;48:149–157)

Long-term longitudinal study on the relationship between alternating shift work and the onset of diabetes mellitus in male Japanese workers.

Abstract: Objective:This study investigated the effect of alternating shift work (ASW) on the onset of diabetes mellitus in Japanese workers compared with onset in day-shift work (DSW).Methods:A longitudinal study was carried out on a DSW group (n = 3203) and ASW group (n = 2426) of a steel company wh

Effective treatment of manganese-induced occupational Parkinsonism with p-aminosalicylic acid: a case of 17-year follow-up study.

Abstract: Objective:Chronic manganese (Mn) intoxication induces syndromes resembling Parkinson disease. The clinical intervention has largely been unsuccessful. We report a 17-year follow-up study of effective treatment of occupational Mn parkinsonism with sodium para-aminosalicylic acid (PAS).Methods:The pat

Effect of smoking status on productivity loss.

Abstract: Objective:The objective of this study was to describe health-related productivity losses in nonsmokers, former smokers, and current smokers using a large, cross-sectional database of U.S. employees.Methods:Volunteers completed the Wellness Inventory, an instrument measuring productivity losses relat

Psychosocial work environment predictors of short and long spells of registered sickness absence during a 2-year follow up.

Abstract: Objective: The objective of this study was to investigate the impact of psychosocial work environment factors on short and long absence spells. Methods: Questionnaire data on work environment exposures and registered absence data during 2-year follow up were analyzed with Poisson regression for 1919 employees from the private and public sector. Results: Short spells (1–10 working days) were predicted by low supervisor support, low predictability, and low meaning at work among men and high skill discretion among women. Long spells (10 days) were predicted by low decision authority, low supervisor support, and low predictability among men and high psychologic demands and low decision authority among women. The variables predictability and meaning at work were developed for this study. Conclusion: Specific psychosocial work environment factors have both common and different effects on short and long absence spells. Effects also differ by gender. (J Occup Environ Med. 2006;48:591–598)

Effects of a smoke-free law on hair nicotine and respiratory symptoms of restaurant and bar workers.

Abstract: Objective Bar and restaurant workers' exposure to secondhand smoke (SHS) was compared before and 3 and 6 months after implementation of a smoke-free ordinance. Methods Hair nicotine, self-reported exposure to SHS, and respiratory symptoms were assessed on 105 smoking and nonsmoking workers from randomly selected establishments in Lexington, Kentucky. Thirty-eight percent were current smokers with more than half smoking 10 or fewer cigarettes per day. Workers provided a hair sample at baseline and at the 3-month interview. Results There was a significant decline in hair nicotine 3 months postlaw when controlling for cigarettes smoked per day. Bar workers showed a significantly larger decline in hair nicotine compared with restaurant workers. The only significant decline in SHS exposure was in the workplace and other public places. Regardless of smoking status, respiratory symptoms declined significantly postlaw. Conclusions Hospitality workers demonstrated significant declines in hair nicotine and respiratory symptoms after the law. Comprehensive smoke-free laws can provide the greatest protection to bar workers who are the most vulnerable to SHS exposure at work.

Depression and pesticide exposures in female spouses of licensed pesticide applicators in the agricultural health study cohort.

Abstract: Studies over the past forty years show an association between neurological effects and exposure to organophosphate (OP) insecticides 1–3. In the past decade, several studies have suggested a possible association between pesticide exposure and depressive symptoms, particularly among cases of acute poisoning 4–7. Depression associated with a pesticide poisoning may persist for years after the poisoning 4,8. Some studies have shown long-term effects on mood in the absence of an acute pesticide poisoning 6,9–11, but others have not 12–14. Thus reported effects of pesticide exposure on depression are inconsistent, and information on effects from low-dose, long-term exposure is especially meager. The association of depression with pesticide exposure has been demonstrated primarily in studies of men, and the few studies of women have suffered from limited power 4,5,11. The epidemiology of depression in women is different than in men 15. Women have a lifetime prevalence rate of depression of 20% compared to 10% in men 16, and depression in women occurs at younger ages, lasts longer, and is more frequently associated with stressful life events than depression in men 15–18. Risk factors for depression in women include a family or personal past history of mood disorders, loss of a parent before age 10, a childhood history of physical or sexual abuse, persistent psychosocial stresses and the loss of social support 15,16. Female farm spouses have additional burdens associated with financial hardship, heavy seasonal workloads, working off as well as on the farm, and exposures to chemicals that may be associated with depression 19,20. A few studies have characterized the chemical and environmental exposures of farm spouses. In a cross-sectional survey conducted in Colorado between 1993 and 1997, 37% of female spouses of principal farm operators reported working in crop production 21. A cross-sectional survey of 657 farm women in southeast Louisiana reported that 88.9% were involved in the management and oversight of the farm operation, 60.3% cared for farm animals, 70.8% cared for and used farm equipment and 42.5% were involved in crop management 19. Previously published data from the Agricultural Health Study (AHS), a longitudinal study of commercial pesticide applicators and farm residents, showed that 68% of Iowa spouses and 54% of North Carolina spouses mixed or applied pesticides with a median cumulative exposure of 50 lifetime days 22. The AHS provided the opportunity to study pesticide exposures occurring in the course of farm work undertaken by women and to evaluate whether cumulative pesticide exposure, or a history of acute pesticide poisoning, was associated with physician diagnosed depression.

Health-related quality of life, psychosocial work conditions, and absenteeism in an industrial sample of blue- and white-collar employees: a comparison of potential predictors.

Abstract: Problem:There is a scarcity of data simultaneously evaluating the relationship of health behavior, health perception, work characteristics, and demographic variables with sickness absenteeism in industrial employees.Method:Predictors and possible confounders (smoking, physical activity, alcohol inta

Adipose tissue concentrations of persistent organic pollutants and the risk of prostate cancer.

Abstract: OBJECTIVE: We sought to study the concentrations of certain persistent organic pollutants with endocrine-disrupting properties in cases with prostate cancer and controls with benign prostate hyperp ...

Short-term effects of air pollution on heart rate variability in senior adults in Steubenville, Ohio.

Abstract: Objective:We examined the association between ambient air pollution levels and heart rate variability (HRV) in a panel study of 32 subjects.Methods:We used linear mixed models to analyze the effects of fine particles (PM2.5), sulfate (SO42−), elemental carbon (EC), and gases on log-transform

Skin absorption of inorganic lead (PbO) and the effect of skin cleansers.

Abstract: Objective: The aim of this study was to investigate the percutaneous penetration of lead oxide (PbO) powder and the effect of rapid skin decontamination with two different detergents. Methods: Franz cells were used to study in vitro PbO skin penetration through human skin during a 24-hour period. The tests were performed without or with decontamination using either Ivory Liquid soap or a new experimental cleanser 30 minutes after the start of exposure. Results: We confirm that PbO can pass through the skin with a median penetration of 2.9 ng/cm 2 (25–75th percentiles 0.35–6). The cleaning procedure using

Total dust and endotoxin in poultry operations: comparison between cage and floor housing and respiratory effects in workers.

Abstract: Objective: The objective of this study was to assess respiratory outcomes and environmental exposure levels of workers in cage-housed and floorhoused poultry operations. Methods: Poultry operations were evaluated for total dust, endotoxin, and ammonia, and respiratory symptoms and lung function tests of workers were conducted. Results: Workers in floor-housed poultry operations had significantly greater exposures to total dust and ammonia, whereas workers from cage-housed poultry operations reported greater frequency of current and chronic symptoms overall and significantly greater current and chronic phlegm (39% vs 18% and 40% vs 11%, respectively). Endotoxin concentration (EU/mg) was a significant predictor (P 0.05) of chronic phlegm for all poultry workers. Conclusions: Greater endotoxin concentration in the presence of significantly lower total dust, in conjunction with greater respiratory symptoms in workers from cage-housed poultry operations, as compared with workers from floor-housed poultry operations, appears to indicate that differences in environmental exposures may impact respiratory outcomes of workers. (J Occup Environ Med. 2006;48:741–748)

Association of healthcare costs with per unit body mass index increase.

Abstract: Objective The objective of this study was to quantify the healthcare costs per unit increase in body mass index (BMI). Methods This cross-sectional study included 35,932 employees and spouses in a manufacturing company who participated in an indemnity/PPO plan and one health risk appraisal during 2001 and 2002. Results Within the BMI range of 25 to 45 kg/m, medical costs and pharmaceutical costs increased dollar 119.7 (4%) and dollar 82.6 (7%) per BMI unit, respectively, adjusted for age and gender. The adjusted medical costs related to diabetes and heart disease increased by dollar 6.2 and dollar 20.3 per BMI unit. The likelihood of having any medical claim increased 11.6% per BMI unit for diabetes and 5.2% for heart disease. Conclusions Each unit increase in BMI is associated with higher healthcare costs and increased likelihood of having claims for most major diagnostic codes and for diabetes and heart diseases.

Runs of ventricular and supraventricular tachycardia triggered by air pollution in patients with coronary heart disease.

Abstract: Objective:The authors conducted an investigation of the association between air pollution and arrhythmia.Methods:A prospective panel study (October 2000–April 2001) was conducted in Erfurt, Germany. Fifty-seven men with coronary heart disease were subjected to six 24-hour electrocardiogram recording

Cancer incidence in Florida professional firefighters, 1981 to 1999.

Abstract: Objective The objective of this study was to examine the cancer risk associated with firefighting. Methods Standardized incidence ratio analysis (SIR) was used to determine the relative cancer risk for firefighters as compared with the Florida general population. Results Among 34,796 male (413,022 person-years) and 2,017 female (18,843 person-years) firefighters, 970 male and 52 female cases of cancer were identified. Male firefighters had significantly increased incidence rates of bladder (SIR = 1.29; 95% confidence interval = 1.01-1.62), testicular (1.60; 1.20-2.09), and thyroid cancers (1.77; 1.08-2.73). Female firefighters had significantly increased incidence rates of overall cancer (1.63; 1.22-2.14), cervical (5.24; 2.93-8.65), and thyroid cancer (3.97; 1.45-8.65) and Hodgkin disease (6.25; 1.26-18.26). Conclusions Firefighting may be associated with an increased risk of selected site-specific cancers in males and females, including an overall increased cancer risk in female firefighters.

The impact of rheumatoid arthritis on medical expenditures, absenteeism, and short-term disability benefits.

Abstract: Objectives: The objectives of this study were to estimate medical expenditures, absenteeism, and short-term disability costs for workers with rheumatoid arthritis (RA) and to estimate the relative costs of RA over a 12-month period. Methods: Using data from nine U.S. employers, direct and indirect costs for 8502 workers with RA were compared with costs for a matched group without RA. Regression analyses controlled for factors that were different even after propensity score matching. Results: Average total costs for workers with RA were $4244 (2003 dollars) greater than for workers without RA. RA was the fourth most costly chronic condition per employee compared with cancers, asthma, bipolar disorder, chronic obstructive pulmonary disease, depression, diabetes, heart disease, hypertension, low back disorders, and renal failure. Conclusions: RA is a costly disorder and merits consideration as interventions are considered to improve workers’ health and productivity.

Objective tests of symptom exaggeration in independent medical examinations.

Abstract: Objective: This study used the Medical Symptom Validity Test (MSVT) to examine exaggeration of memory impairment in disability claimants. Methods: The MSVT was administered to patients with soft tissue injuries undergoing an independent medical examination (IME). Their results were compared with those from groups of volunteers who were either trying their best on the test or simulating memory impairment. Results: Non-French-speaking volunteers, who were tested in French, showed near perfect performance on the effort subtests, but 42% of IME patients failed the effort tests in English. Their overall results were very similar to those of simulators. Conclusion: This study suggests that exaggeration of cognitive symptoms is widespread in disability-related evaluations. It would be unwise to accept self-reported memory complaints at face value. Criteria-normed symptom validity testing should be done to rule out symptom exaggeration.

Prioritizing industries for occupational injury and illness prevention and research, Washington State Workers' compensation claims, 1999-2003.

Abstract: OBJECTIVE: The objective of this study was to identify high-risk industry groups for effective allocation of occupational safety and health prevention and research resources. METHODS: We used all compensable Washington state workers' compensation claims to rank North American Industry Classification System (NAICS) industry groups by a "prevention index" (PI). The PI is the average of the rank orders of each industry group's claim count and claim incidence rate. RESULTS: Of the 274 industry groups ranked by PI for all compensable workers' compensation claims, the following industry groups ranked the highest: NAICS 2381 Foundation, Structure, and Building Exterior Contractors, NAICS 4841 General Freight Trucking, and NAICS 2361 Residential Building Construction. Industry group PI rankings are reported for the seven most common costly occupational injury types. CONCLUSIONS: Use of a PI can focus prevention and research resources where they can be of most benefit. Language: en

Effectiveness of an incentive-based online physical activity intervention on employee health status.

Abstract: Objective:The objective of this study was to test whether a financial incentive integrated with health benefits for an online physical activity program was associated with increased employee participation and improved health status among participants compared with nonparticipants.Methods:Par

Specific molds associated with asthma in water-damaged homes.

Abstract: Objective: We sought to determine if specific molds were found in significantly higher concentrations in the water-damaged homes of asthmatic children compared with homes with no visible water damage. Methods: The mold concentrations in the dust in asthmatic children's bedrooms in water-damaged homes (N = 60) and control homes (N = 22) were measured by moid-specific quantitative polymerase chain reaction. Results: Two molds, Scopulariopsis brevicaulis and Trichoderma viride, had significantly (P < 0.05) higher concentrations in asthmatics' homes compared with control homes and three other molds (Penicillium crustosum group, Stachybotrys chartarum, and Wallemia sebi) had P values <0.1. Conclusions: A relative moldiness index was developed to predict the likely development of asthma in water-damaged homes in Cleveland.