Biomedical subjects
Publications and source records attributed to D L Holness.
The use of computer technology to store, retrieve, and analyze patient data is not new. This article reviews the use of computerized data bases in patch test result record keeping. Efforts of the North American Contact Dermatitis Group serve as an example of how to create, manage, and apply these data.
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In a soda ash plant, 58 workers exposed to mean airborne ammonia levels of 9.2 +/- 1.4 ppm were compared with 31 control workers with a mean exposure of 0.3 +/- 0.1 ppm. There were no differences between the groups in the reporting of respiratory or cutaneous symptoms, sense of smell, baseline lung function, or change in lung function over a work shift at the beginning and end of a workweek. No relationships between level or length of ammonia exposure and lung function results were demonstrated.
Eight workers handling fiberglass coated with uncured epoxy resin, out of a population of approximately 130 workers, developed dermatitis of their hands and forearms. Four also had involvement of the head and neck. Epicutaneous testing established the presence of contact allergy to epoxy resin in six, and one worker had continuous sensitivity to cresylglycidyl ether. Workers handling the coated material after it had been heat-cured were not affected, even if they had had problems with dermatitis while handling the uncured coated fiber.
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Fifty randomly selected workers in a sewage treatment plant using a heat treatment method for processing sewage sludge in Toronto, Canada were assessed. This investigation revealed that many workers reported "influenza-like" symptoms, cough, sputum production, wheezing, sore throat and skin complaints. The workers tended to have somewhat reduced lung function. Workers in the area of the plant where boiled sewage sludge was dried frequently reported an intermittent, acute illness characterized by cough, fever and sore throat. Workers in the area of the plant where the dried sludge was incinerated tended to have reduced lung function. The basis for the possible health effects demonstrated has not been established, and further investigation is suggested. The mean level of polychlorinated biphenyls (PCBs) detected in the workers' serum was 6 +/- 5 ppb. The PCB levels could not be related to symptoms or clinical findings in the workers studied.
Allergic contact dermatitis to glutaraldehyde was found in 13 health-care workers with hand dermatitis. Concomitant sensitivity to other chemicals was noted in 10. The positive patch test response was only evident for every 2nd observation in 4. The eruption persisted for more than 6 months in 10 subjects. In 5, the skin disease forced the worker to leave his occupation.
84 funeral service workers and 38 control workers were evaluated for the presence of skin disease by history, clinical examination and patch tests with formaldehyde and glutaraldehyde. No relationship between either personal or family history of cutaneous or respiratory manifestations of atopy and clinical parameters of cutaneous disease or patch test results was found. Cutaneous disease was reported in apprentices, active embalmers and inactive embalmers in decreasing order of frequency. Positive patch test reactions to formaldehyde and glutaraldehyde were found in 4% and 7% of the exposed workers, but in none of the controls. Although exposure to glutaraldehyde was less frequent, the prevalence of positive patch test reactions did not differ. This may suggest that glutaraldehyde poses a greater practical risk of cutaneous sensitization in this trade than formaldehyde.
Fifty-three hog confinement farmers and 43 control farmers were studied. Pulmonary function, total and respirable personal dust levels, and responses to a health status questionnaire were obtained for all farmers. The hog farmers' total and respirable personal dust exposures were significantly higher than the respective levels of the control farmers. Higher dust levels were associated with the use of floor (scatter) feeding, indoor feed grinding, and the use of high moisture corn feed. Pork producers reported respiratory symptoms significantly more often than controls. Lung function did not differ between the two groups of farmers, nor could dust exposure levels be related to lung function.
Time-weighted average (TWA) personal total and respirable dust exposures were determined gravimetrically for 48 subjects in 4 cabinet-making plants. TWA personal formaldehyde exposures also were obtained, with the use of 3M 3750 passive monitors. Selective area sampling for formaldehyde was undertaken using two methods. The results obtained with the passive monitors were compared to the standard chromotropic acid impinger method. Considerable variation was noted in the dust exposures. Cabinet-makers exposed to softwoods were found to have a mean exposure of approximately one half of the current applicable ACGIH TWA-TLV, while hard-wood exposure was twice the applicable TWA-TLV. The highest dust exposures were recorded for those workers sanding, the mean total dust being 2.91 mg/m3 (S.E. 0.70) and respirable dust 0.63 mg/m3 (S.E. 0.20). Sanding operations also were found to produce a higher proportion of respirable dust (22%) than other woodworking operations (6%-14%). Workers in assembly areas also were found to have higher dust exposures, likely reflecting the fact that conventional dust collection devices for stationary woodworking equipment are not appropriate for hand held tools and hand sanding. The importance of making respirable dust measurements is discussed. The poor correlation between paired total and respirable dust concentrations indicates that both measurements should be made. Some potential limitations to respirable wood dust sampling using 10 mm nylon cyclones are noted, however. Area dust concentrations were found to be significantly lower than personal exposures, emphasizing the importance of personal sampling data. Formaldehyde vapor exposures were very low, with a mean of 0.06 ppm (S.E. 0.01).
An accidental discharge of a total flooding Halon 1301 fire extinguishing system is described. The release of the Halon was accompanied by a sudden very loud noise, considerable air turbulence and a dense fog, resulting in worker anxiety and loss of visibility. The workers in the area at the time of the discharge reported higher frequencies of lightheadedness, headache, nasal complaints and disorientation than those entering the area later. Halon 1301 usually is regarded as having a low toxicity, although at concentrations above those used in occupied spaces, effects on consciousness and cardiac rhythm have been reported. In the present report no significant illness or injury due to the Halon exposure was found. A fine oily deposit found on horizontal surfaces in the area subsequent to the discharge consisted of mineral oil and iron, suggesting that this material was scoured out of the piping as the Halon discharged. The disorientation and anxiety produced by an accidental discharge can be minimized through education programs designed to ensure that personnel know what to expect and how to abort the discharge if it results from a false alarm. Situations leading to triggering of fire detectors by events other than fires should be investigated and reduced.
Thirty-six smelter workers examined in this pilot study were found to have a higher prevalence of cough and dyspnea and lower baseline lung function than did 31 controls. They also experienced decreases in forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1) over the workweek while the controls did not. Baseline airflow rates and change in FVC and FEV1 over the workweek varied with levels of sulfur dioxide and particulates. Twenty-three smelter workers and 21 controls were seen on a second occasion, six months into an extended shutdown. The smelter workers continued to have a higher prevalence of cough and dyspnea and lower baseline lung function than the controls. There was, however, a slight increase in lung function in both the exposed workers and the controls during the shutdown. The results suggest that smelter workers may develop both acute and chronic work-related pulmonary effects and that the chronic effects may be nonreversible.
The effect of wood dust exposure on 50 cabinet makers was examined. Woodworkers reported more nasal and eye symptoms and more cough, sputum and wheezing than did 49 control workers. More irritated cells were present in the woodworkers' nasal cytological smears. In contrast to the control workers, the woodworkers had a significant decline in lung function over the workshift. An inverse correlation between baseline lung function and an exposure index (mean area dust level multiplied by length of exposure) was demonstrated in the woodworkers. Greater dust exposure was not associated with larger falls in lung function over the work shift.
Respiratory variables in 95 isocyanate workers and 37 control workers were compared. The exposed workers had a slightly higher frequency of cough and shortness of breath than the controls and a significantly lower frequency of family history of asthma, hay fever, and bronchitis. The isocyanate workers had slightly lower baseline lung function than the control workers but demonstrated significantly larger declines in their pulmonary function over the work shift. Both groups showed some intraday and intraweek variation in lung function. The changes in lung function over the work shift varied with different job categories, the largest changes occurring in finishing-area workers. A gradation of response was observed when exposure was categorized as nil, low, or high, but no exposure-effect relationships could be demonstrated by regression analysis of either area or personal results.
The acute effect of cotton dust on respiratory function was assessed. Respiratory questionnaires, preshift and postshift pulmonary function testing and air sampling were completed for 176 cotton textile workers and 33 controls. The results showed a dose-response relationship between vertical elutriator dust measurements and change in forced expiratory volume at 1 s (FEV1) over the work shift. Dust levels of 0.2 mg/m3 or less were not associated with significant acute falls in FEV1.
Respiratory histories and preshift and postshift spirometry were recorded for 90 cotton felt workers and 54 brick workers. Environmental monitoring included area sampling by vertical elutriator and cyclone and personal sampling for respirable dust by cyclone. The prevalence of mill fever and byssinosis was 31% and 5%, respectively, in the cotton workers. Significant dose-response effects were detected for both elutriator and cyclone dust measurements and change in forced expiratory volume at 1 s over the shift. A dose-response relationship was also found for the brick workers.
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A study of 84 funeral service workers and 38 control subjects in Toronto, Canada, revealed that the embalmers reported chronic bronchitis, dyspnea, and nasal, eye, and skin irritation more frequently than controls. Apprentices reported symptoms and exhibited signs of irritation more frequently than experienced embalmers, but both of these groups were more affected than the inactive embalmers or the controls. Airborne formaldehyde levels were 0.36 +/- 0.19 ppm (mean +/- standard deviation) during 22 embalming procedures. General ventilation was shown to significantly lower the levels. No significant change in forced vital capacity, forced expiratory volume in 1 sec, FEF50 or FEF75 was demonstrated with formaldehyde exposure nor were the baseline lung function results significantly different from those 38 unexposed controls. Based on patch testing, 4% and 10% were sensitive to formaldehyde and glutaraldehyde, respectively, whereas none of the controls exhibited positive reactions.