Stroke family care workers. Value of support worker should not be dismissed on basis of only one trial.
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Caregivers↗
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Finding ways to encourage health care workers to wash hands often. Product placement and health care worker education on compliance were not enough to change behaviors.
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Hand Disinfection↗
A comprehensive dose reconstruction methodology for former rocketdyne/atomics international radiation workers.
Incomplete radiation exposure histories, inadequate treatment of internally deposited radionuclides, and failure to account for neutron exposures can be important uncertainties in epidemiologic studies of radiation workers. Organ-specific doses from lifetime occupational exposures and radionuclide intakes were estimated for an epidemiologic study of 5,801 Rocketdyne/Atomics International (AI) radiation workers engaged in nuclear technologies between 1948 and 1999. The entire workforce of 46,970 Rocketdyne/AI employees was identified from 35,042 Kardex work histories cards, 26,136 electronic personnel listings, and 14,189 radiation folders containing individual exposure histories. To obtain prior and subsequent occupational exposure information, the roster of all workers was matched against nationwide dosimetry files from the Department of Energy, the Nuclear Regulatory Commission, the Landauer dosimetry company, the U.S. Army, and the U.S. Air Force. Dosimetry files of other worker studies were also accessed. Computation of organ doses from radionuclide intakes was complicated by the diversity of bioassay data collected over a 40-y period (urine and fecal samples, lung counts, whole-body counts, nasal smears, and wound and incident reports) and the variety of radionuclides with documented intake including isotopes of uranium, plutonium, americium, calcium, cesium, cerium, zirconium, thorium, polonium, promethium, iodine, zinc, strontium, and hydrogen (tritium). Over 30,000 individual bioassay measurements, recorded on 11 different bioassay forms, were abstracted. The bioassay data were evaluated using ICRP biokinetic models recommended in current or upcoming ICRP documents (modified for one inhaled material to reflect site-specific information) to estimate annual doses for 16 organs or tissues taking into account time of exposure, type of radionuclide, and excretion patterns. Detailed internal exposure scenarios were developed and annual internal doses were derived on a case-by-case basis for workers with committed equivalent doses indicated by screening criteria to be greater than 10 mSv to the organ with the highest internal dose. Overall, 5,801 workers were monitored for radiation at Rocketdyne/AI: 5,743 for external exposure and 2,232 for internal intakes of radionuclides; 41,169 workers were not monitored for radiation. The mean cumulative external dose based on Rocketdyne/AI records alone was 10.0 mSv, and the dose distribution was highly skewed with most workers experiencing low cumulative doses and only a few with high doses (maximum 500 mSv). Only 45 workers received greater than 200 mSv while employed at Rocketdyne/AI. However, nearly 32% (or 1,833) of the Rocketdyne/AI workers had been monitored for radiation at other nuclear facilities and incorporation of these doses increased the mean dose to 13.5 mSv (maximum 1,005 mSv) and the number of workers with >200 mSv to 69. For a small number of workers (n=292), lung doses from internal radionuclide intakes were relatively high (mean 106 mSv; maximum 3,560 mSv) and increased the overall population mean dose to 19.0 mSv and the number of workers with lung dose>200 mSv to 109. Nearly 10% of the radiation workers (584) were monitored for neutron exposures (mean 1.2 mSv) at Rocketdyne/AI, and another 2% were monitored for neutron exposures elsewhere. Interestingly, 1,477 workers not monitored for radiation at Rocketdyne/AI (3.6%) were found to have worn dosimeters at other nuclear facilities (mean external dose of 2.6 mSv, maximum 188 mSv). Without considering all sources of occupational exposure, an incorrect characterization of worker exposure would have occurred with the potential to bias epidemiologic results. For these pioneering workers in the nuclear industry, 26.5% of their total occupational dose (collective dose) was received at other facilities both prior to and after employment at Rocketdyne/AI. In addition, a small number of workers monitored for internal radionuclides contributed disproportionately to the number of workers with high lung doses. Although nearly 12% of radiation workers had been monitored for neutron exposures during their career, the cumulative dose levels were small in comparison with other external and internal exposure. Risk estimates based on nuclear worker data must be interpreted cautiously if internally deposited radionuclides and occupational doses received elsewhere are not considered.
Adult↗
Beryllium sensitization and disease among long-term and short-term workers in a beryllium ceramics plant.
OBJECTIVE: Workers at a beryllium ceramics plant were tested for beryllium sensitization and disease in 1998 to determine whether the plant-wide prevalence of sensitization and disease had declined since the last screening in 1992; an elevated prevalence was associated with specific processes or with high exposures; exposure-response relationships differed for long-term workers hired before the last plant-wide screening and short-term workers hired since then. METHODS: Current workers were asked to complete a questionnaire and to provide blood for the beryllium lymphocyte proliferation test (BeLPT). Those with an abnormal BeLPT were classified as sensitized, and were offered clinical evaluation for beryllium disease. Task- and time-specific measurements of airborne beryllium were combined with individual work histories to compute mean, cumulative, and peak beryllium exposures for each worker. RESULTS: The 151 participants represented 90% of 167 eligible workers. Fifteen (9.9% of 151) had an abnormal BeLPT and were split between long-term workers (8/77 = 10.4%) and short-term workers (7/74 = 9.5%). Beryllium disease was detected in 9.1% (7/77) of long-term workers but in only 1.4% (1/74) of short-term workers (P = 0.06), for an overall prevalence of 5.3% (8/151). These prevalences were similar to those observed in the earlier survey. The prevalence of sensitization was elevated in 1992 among machinists, and was still elevated in 1998 among long-term workers (7/40 = 18%) but not among short-term workers (2/36 = 6%) with machining experience. The prevalence of sensitization was also elevated in both groups of workers for the processes of lapping, forming, firing, and packaging. The data suggested a positive relationship between peak beryllium exposure and sensitization for long-term workers and between mean, cumulative, and peak exposure and sensitization for short-term workers, although these findings were not statistically significant. Long-term workers with either a high peak exposure or work experience in forming were more likely to have an abnormal BeLPT (8/51 = 16%) than the other long-term workers (0/26, P = 0.05). All seven sensitized short-term workers either had high mean beryllium exposure or had worked longest in forming or machining (7/55 = 13% versus 0/19, P = 0.18). CONCLUSIONS: A plant-wide decline in beryllium exposures between the 1992 and 1998 surveys was not matched by a decline in the prevalence of sensitization and disease. Similar to findings from other studies, beryllium sensitization/disease was associated with specific processes and elevated exposures. The contrast in disease prevalence between long-term and short-term workers suggests that beryllium sensitization can occur after a short period of exposure, but beryllium disease usually requires a longer latency and/or period of exposure. The findings from this study motivated interventions to more aggressively protect and test workers, and new research into skin exposure as a route of sensitization and the contribution of individual susceptibility.
Air Pollutants, Occupational↗
HIV prevention programmes for female sex workers in Andhra Pradesh, India: outputs, cost and efficiency.
BACKGROUND: Female sex workers and their clients play a prominent role in the HIV epidemic in India. Systematic data on the outputs, cost and efficiency for HIV prevention programmes for female sex workers in India are not readily available to understand programme functioning and guide efficient use of resources. METHODS: Detailed output and cost data for the 2002-2003 fiscal year were obtained using standardised methods at 15 HIV prevention programmes for female sex worker in the state of Andhra Pradesh in southern India. The services provided and their relation to the total and unit economic costs were analysed using regression techniques. The trends for the number of sex workers provided services by the programmes since inception up to fiscal year 2004-2005 were examined. RESULTS: The 15 programmes provided services to 33941 sex workers in fiscal year 2002-2003 (range 803-6379, median 1970). Of the total number of contacts with sex workers, 41.6% were by peer educators and 58.4% by other programme staff. The number of sex worker contacts in a year by peer educators varied 74-fold across programmes as compared with a 2.7-fold variation in sex worker contacts by other programme staff. The annual economic cost of providing services to a sex worker varied 6-fold between programmes from Indian Rupees (INR) 221.8 (4.58 US dollars) to INR 1369 (28.29 US dollars) with a median of INR 660.9 (13.66 US dollars) and mean of INR 517.8 (10.70 US dollars). Personnel salaries made up 34.7% of the total cost, and recurrent goods made up 38.4% of which 82.1% was for condoms. The cost per sex worker provided services had a significant inverse relation with the number of sex workers provided services by a programme (p < 0.001, R2 = 0.75; power function). There was no correlation between the full time equivalents of programme staff and the number of sex workers provided services by the programmes, but there was a modest inverse correlation between the number of sex workers served and the average time spent with each sex worker in the year adjusted for the full-time equivalents of programme staff (p = 0.011, R2 = 0.40; exponential function). The average number of sex workers provided services annually by the first batch of 7 programmes started in early 1999 plateaued after the fourth fiscal year to 3500, whereas the 8 second-batch programmes started in late 2000 reached an average of 2000 sex workers in 2004-2005 with an increasing trend up to this fourth fiscal year. CONCLUSION: The HIV prevention efforts in this Indian state would benefit from standardisation of the highly variable services provided by peer educators, who form an important part of the sex worker programmes. The cost per sex worker served decreases with increasing number of sex workers served annually, but this has to be weighed against an associated modest trend of decrease in time spent with each sex worker in some programmes.
AIDS Serodiagnosis↗
Work-related injury sustained by foreign workers in Singapore.
INTRODUCTION: Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED). MATERIALS AND METHODS: Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. RESULTS: There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P < 0.0001) than the mean age 37.8 years (SD 14) of local workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of foreign workers, more (P < 0.0001) common than 4.3% of local workers, resulting in 2 out of 3 foreign workers death. Though the pattern of injuries was similar between foreign and local workers, foreign workers needed longer (P = 0.03) sick leave and more (P = 0.01) foreign workers were hospitalised, giving a ratio of 2 foreign workers for every 1 local worker hospitalised. CONCLUSION: Foreign workers had no difficulty accessing ED and hospital care for work-related injuries. The pattern and severity of injuries were similar between foreign and local workers but more foreign workers were hospitalised.
Accidents, Occupational↗
Epidemiologic study of occupational injuries among foreign and native workers in Taiwan.
This study was designed to compare the risk of occupational injuries in foreign workers compared to native workers in Taiwan. The cohort of foreign workers under study was constructed by records of legally registered workers migrated from foreign countries to Taiwan from July 1, 1991 to December 31, 1993. The native Taiwanese workers for comparison were labor-insured workers working in the same industries as foreign workers in 1992. The number of occupational injuries in the first year of employment were obtained by matching the cohort of foreign workers with the labor insurance payment records by name, birth date and passport number. The 1-year incidence rate of occupational injuries in the first year of employment was calculated and a standardized morbidity ratio (SMR) was used for comparison with adjustment for age distribution and to accommodate the small sample size of foreign workers. The risk to occupational injuries among total (SMR = 0.86) and male (SMR = 0.58) foreign workers was not higher; indeed, it was even lower, than that among native workers in Taiwan. However, the risk to female migrant workers, especially in the construction industry, was significantly higher than that of female Taiwanese workers (SMR = 1.60). Stratified by industry, the incidence was high in the fabricated metal products manufacturing industry and in machinery and equipment manufacturing industry for male foreign workers, while a high incidence for the female foreign workers occurred in construction industry and rubber products manufacturing industry. The risk of occupational injuries was greater for foreign workers who had been in Taiwan for only a short time. Most of the injuries occurred within the first 6 months of employment. Eighty-four out of the 394 occupational injuries among foreign workers resulted in disabilities. None of the accidents was fatal, but most of the disabilities were severe. The most common disabling injuries were cut or crushed fingers. The finding of a similar distribution of occupational injuries among foreign and native workers indicates that control measures are needed to reduce occupational injuries for all foreign and native workers in Taiwan.
Accidents, Occupational↗
[Some experiments on the allergic reaction among workers in a pharmaceutical factory (author's transl)].
A survey was made on workers handling powdered drugs in a pharmaceutical factory. In this factory, two kinds of anti-inflammatory enzyme (bromelain and trypsin), one anti-inflammatory agent (flufenamic acid), one antispasmodic (flopropion) and two kinds of antibiotics (ampicillin and cephalexin) are mainly produced. Twenty four workers were examined by interviews and checked by Cornell Medical Index, and 18 of them complained of respiratory symptoms. These 18 workers were physically examined by skin scratch tests, pulmonary function tests and serum immunological tests. Among 24 workers, 9 handled powdered drugs (A group), 5 handled the same in the past and had already been transferred to other sections for their symptoms (B group), 3 engaged in the process of capsul-filling (C group) and 7 handled several times occasionally during one year (D group). Their average months spent in handling powdered drugs were, in the case of anti-inflammatory enzyme, A group 53.2, B group 66.2, and in the case of antibiotics, 5 workers in A group 24.0, 2 workers in B group 7.0, 3 workers in C group 25.7. Twenty workers complained of symptoms which were mainly irritation of mucosa including the respiratory system and itching of the skin while they were working, and accelerated nasal discharge, urticaria and asthma after working. Group A and group B were higher than group D in the rate of respiratory complaints in C.M.I. (p less than 0.001). Fourteen workers pointed out anti-inflammatory enzyme as a cause of main symptoms, 7 workers flufenamic acid, 3 workers flopropion, 4 workers antibiotics. Three workers who had past history of asthma or articular rheumatism had been transferred to other sections. Of 18 workers who were physically examined, 11 workers showed positive reactions to skin scratch tests with handling drugs. On 8 workers of them, some kinds of drugs which were pointed out as drugs causing main symptoms reacted positively. Numbers of workers with increased immunoglobin values were, IgE 3, IgM 2, IgA 4, IgM 2. Two workers showed decreased FVC and FEV (1.0 sec.) values in pulmonary function tests. The causes of the occupational allergic reaction in this factory are guessed as follows: 1) control of powdered materials was incomplete in the process of production, 2) various kinds of sensitizing drugs were handled by the same workers.
Adult↗
Respiratory function and immunological status in cocoa and flour processing workers.
Respiratory function and immunological status were studied in 40 cocoa and 53 flour processing workers employed as packers in a confectionery industry and in 65 unexposed control workers in the same industry. A high prevalence of chronic respiratory symptoms was recorded in exposed workers, varying from 5.0% to 30.0% in cocoa workers and from 5.7% to 28.3% in flour workers. Occupational asthma was diagnosed in 2 (5%) of the cocoa workers and in 3 (5.7%) of the flour workers. None of the control workers suffered from occupational asthma. The prevalence of almost all chronic respiratory symptoms was significantly greater in cocoa and flour workers than in control workers. There was also a high prevalence of acute symptoms that developed during the work shift, being highest for cough (cocoa: 57.5%; flour: 50.9%) and eye irritation (cocoa: 50.0%; flour: 54.7%). Significant across-shift reductions of ventilatory capacity were recorded in exposed workers, being largest for flow rates at 50% and the last 25% of the vital capacity on maximum expiratory flow-volume (MEFV) curves (FEF50, FEF75). The prevalence of positive skin tests for cocoa (60.2%) was significantly higher than the prevalence of positive skin tests for flour (25.8%) among the 93 exposed workers (p < 0.05). Control workers had significantly lower prevalences of positive skin tests to cocoa (4.6%) and flour (12.3%) than exposed workers (p < 0.01). Increased total serum IgE levels were found in 17.5% of cocoa and in 18.7% of flour workers; none of the control workers had increased IgE levels. Bronchoprovocation testing demonstrated significant decreases in lung function following inhalation of cocoa dust extract and flour dust in workers with respiratory symptoms and large across-shift reductions in lung function. Dust concentrations in the working environment were higher than those recommended by Croatian standards. These data suggest that workers employed in the processing of cocoa and flour may be at a high risk for the development of allergic sensitization and respiratory impairment.
Adult↗
Carcinoembryonic antigen, alpha-fetoprotein, and prostate-specific antigen in the sera of industrial workers exposed to phenol, formaldehyde, urea, and mixed vapors.
Exposure to certain industrial agents has been thought to have carcinogenic potential, both for employees who work closely with agents and for the general population that comes into contact with them. The objective of the present study is to evaluate the changes at the cellular level or at the level of cellular metabolism products present in the biological fluid, and to detect early stages of the carcinogenic process resulting from the exposure of industrial environmental hazards. Carcinoembryonic antigen (CEA), alpha-fetoproteins (AFP), and prostate-specific antigen (PSA) were measured in sera of workers (n = 51), who were divided into 4 groups: group I, workers exposed to phenol; group II, workers exposed to formaldehyde; group III, workers exposed to urea; and group IV, workers exposed to mixed vapor, plus a reference control healthy group (n = 15). The results showed that 75% of the workers exposed to phenol, 75% of the workers exposed to urea, 83.3% of workers exposed to formalin, and 92.3% of the workers exposed to mixed vapors had raised values of serum CEA (S-CEA) above normal value of the control group. Also, 23% of workers exposed to mixed vapors, 44% of workers exposed to formalin, 50% of workers exposed to phenol, and 62.5% of workers exposed to urea had raised values of serum AFP (S-AFP) above normal value of control group. Finally, 16.6% of workers exposed to phenol, 23% of workers exposed to mixed vapors, and 33.3% of workers exposed to formalin had raised values of serum PSA (S-PSA) above the normal value of control group; there were no raised values of S-PSA in workers exposed to urea. No significant difference was found in the activities of AST and ALT in group I, but a highly significant increase was found in the AST activities for groups II and IV and the ALT activities for groups III and IV. A significant difference was found in the activity of ALT in group II and in AST for group III. There was no significant difference in the levels of albumin in groups I, II, and III, whereas albumin levels were significantly decreased in group IV. No significant change was found in the level of urea and creatinine in all groups except for group III, where serum levels of creatinine were significantly decreased. From our findings, we concluded that S-CEA can be used as an important prognostic screening marker for early prediction for malignancy, and for management of workers with lung cancer who are exposed to the environmental hazards in industrial factories. Furthermore, S-AFP can be used also as a biomarker if it is carried out and correlated with S-CEA.
Adult↗
Convergent evolution of worker policing by egg eating in the honeybee and common wasp.
Mutual policing, where group members suppress each others' reproduction, is hypothesized to be important in the origin and stabilization of biological complexity. Mutual policing among workers in social insects can reduce within-colony conflict. However, there are few examples. We tested for worker policing in the common wasp Vespula vulgaris. Workers rapidly removed worker-laid eggs but left most queen-laid eggs (four out of 120 worker eggs versus 106 out of 120 queen eggs remained after 1h). Ovary dissection (1150 workers from six colonies) revealed that a small but significant number of workers have active ovaries (4%) equivalent to approximately five to 25 workers per colony. Consistent with effective policing of worker reproduction, microsatellite analysis of males (270 individuals from nine colonies) detected no workers' sons. Worker policing by egg eating has convergently evolved in the common wasp and the honeybee suggesting that worker policing may have broad significance in social evolution. Unlike the honeybee, relatedness patterns in V. vulgaris do not explain selection for policing. Genetic analysis (340 workers in 17 nests) revealed that workers are equally related to the queen's and other workers' sons (worker-worker relatedness was 0.51 +/- 0.04, 95% confidence interval). Worker policing in V. vulgaris may be selected due to the colony-level benefit of conflict suppression.
Animals↗
[A study on physique, exercise frequency and physical strength of middle-aged forestry workers].
This study was conducted to compare physical strength, physique, exercise frequency and type of work of 4,334 male and 439 female middle-aged office and outdoor forestry workers. Both male and female outdoor workers were taller and had lower Broca's indices than their office counterparts, while the body weight of outdoor male workers was lighter and that of female outdoor workers heavier than those of male and female office workers, respectively. The number of outdoor workers not engaging in frequent exercise was found to be significantly greater than that of office workers. Male outdoor workers had significantly higher maximal oxygen uptake (cardio-respiratory endurance), grip strength (muscular strength) and standing trunk flexion (static flexibility) than the male office workers whereas the opposite was true for whole body reaction time (agility), eyes-closed one-leg balancing (static balance) and sit-ups (muscular endurance). Female outdoor workers had higher maximal oxygen uptake (cardio-respiratory endurance), grip strength (muscular strength) and standing trunk flexion (static flexibility) than the female office workers, whereas the opposite was the case for whole body reaction time (agility), eyes-closed one-leg balancing (static balance) and sit-ups (muscular endurance). All of these differences among females were significant except for maximal oxygen uptake (cardio-respiratory endurance). When indoor and outdoor workers of the same sex with similar physiques and exercise frequencies were compared male outdoor workers had higher maximal oxygen uptake (cardio-respiratory endurance) and greater standing trunk flexion (static flexibility) whereas female outdoor workers had greater grip strength (muscular strength) and standing trunk flexion (static flexibility). From these results, it was suggested that maximal oxygen uptake (cardio-respiratory endurance) and standing trunk flexion (static flexibility) in the male workers and grip strength (muscular strength) and standing trunk flexion (static flexibility) in the female workers were related to their working situations. Both the physical strength of workers and personal characteristics must be carefully considered in order to preserve the health of both indoor and outdoor forestry workers.
Adult↗
Risk of high blood pressure in salt workers working near salt milling plants: a cross-sectional and interventional study.
BACKGROUND: Workers working close to salt milling plants may inhale salt particles floating in the air, leading to a rise in plasma sodium, which, in turn, may increase the blood pressure and the risk of hypertension. METHODS: To test the above hypothesis, occupational health check-up camps were organized near salt manufacturing units and all workers were invited for a free health examination. The workers who worked with dry salt in the vicinity of salt milling plants were defined as "non-brine workers," while those working in brine pans located far away from milling plants were defined as "brine workers." Blood pressure (BP) was measured during each clinical examination. In all, 474 non-brine workers and 284 brine workers were studied. RESULTS: Mean systolic blood pressure of non-brine workers (122.1 +/- 13.3 mm Hg) was significantly higher than that of brine workers (118.8 +/- 12.8 mm Hg, p < 0.01). Mean diastolic blood pressure of non-brine workers (71.5 +/- 10.4 mm Hg) was significantly higher than that of brine workers (69.7 +/- 9.4 mm Hg, p = 0.02). The prevalence of hypertension was significantly higher in non-brine workers (12.2%) than in brine workers (7.0%, p = 0.02). Nineteen salt workers were monitored while they used face masks and spectacles, for six days. Systolic, as well as diastolic, blood pressure of these workers began declining on the third day and continued to decline on the fourth day, but remained stationary up to the sixth day. The concentration of salt particles in the breathing zone of these workers was 376 mg/m3 air. CONCLUSION: Inhalation of salt particles in non-brine workers may be an occupational cause of increased blood pressure.
Adult↗
Mortality, morbidity and health selection among metal workers.
Workers are selected into and out of physically demanding jobs with regard to their health. The study of occupational mortality and morbidity is hampered by this selection. Furthermore, social selection and rapid turnover are involved in health selection. Because different stages of disease form only one continuum (dissatisfaction-death), the correct interpretation of the results also requires measures softer than mortality. Earlier studies have concluded that soft and hard measures of health follow one another as explanations for the termination-of-employment rate. The aim of this study was to determine which age and exposure categories are the most prone to health selection. Mortality and morbidity were studied on three different exposure levels defined primarily according to the physical demands of the work: heavy level (iron foundries); medium level (manufacture of metal products); and light level (manufacture of electrical devices). The population comprised 15,714 men hired in 1950-1976 to work in the three branches of the metal industry. Another cohort, a cross-sectional one, of 1292 workers (who had been hired earlier and were still working in 1950) in the three industrial branches was used to clarify selection due to disability and mortality. Data for the mortality and disability analyses were obtained from national death and disability registers. The period of follow-up was 1950-1978. A questionnaire on occupational history, morbidity, and the causes of turnover was sent to 400 current and 600 former workers from each industrial branch. A questionnaire concerning occupational history was also sent to the nearest relatives of a total of 450 decidents. The occupational histories of the current and former workers were compared for changes in the exposure level throughout their complete occupational histories. The occupations during the workers' life-times were also classified into three exposure levels on the basis of physical demands (heavy, medium, and light). The three exposure levels showed different patterns of change according to age throughout the workers' complete occupational histories. Selection into and out of jobs within and between different exposure levels appeared to be a continuous process, a chain of selection. This conclusion was ascertained when the complete occupational histories were analyzed according to the exposure levels (heavy, medium, light) of the occupations from which the workers came and to which they transferred. The foundry workers entered the industry from either heavy or medium-level occupations, and most of them sought lighter work in medium-level occupations. The metal product workers either began their work lives within the metal product industry or they transferred to it from work that entailed the same exposure level. After leaving a job, the metal product workers generally moved to medium (i.e., the same level) or light occupations. The electrical workers switched from medium-level work, or they began their worklives within that industrial branch. When they left a job, they chose medium or light work in the metal industry. Due to the chain of selection from one exposure level to another, the mortality and morbidity rates for a certain exposure level can be underestimated or overestimated if complete occupational histories are not available. The selection process was different for different diseases and was manifested as different stages of disease. Ache or pain in the musculoskeletal system within the last 12 months was more frequent among the foundry and metal product workers than among the electrical workers. Both the currently employed and former foundry workers had significantly more earlier-diagnosed musculoskeletal diseases than the electrical workers. The younger age classes of foundry workers (< 45 years) had a higher occurrence of musculoskeletal diseases than the metal product workers; in the older age classes the opposite was true. (ABSTRACT TRUNCATED)
Adolescent↗
Violence and threats of violence experienced by public health field-workers.
CONTEXT: Public health workers may work with clients whose behaviors are risks for both infectious disease and violence. OBJECTIVE: To assess frequency of violent threats and incidents experienced by public health workers and risk factors associated with incidents. DESIGN: Anonymous, self-administered questionnaires. SETTING: Texas sexually transmitted disease (STD), human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), and tuberculosis (TB) programs. PARTICIPANTS: Questionnaires were completed by 364 (95.5%) of 381 public health workers assigned to the programs. The STD program employed 131 workers (36%), the HIV/AIDS program, 121 workers (33%), and the TB program, 112 workers (31%). MAIN OUTCOME MEASURES: The frequencies with which workers had ever experienced (while on the job) verbal threats, weapon threats, physical attacks, and rape, and risk factors associated with those outcomes. RESULTS: A total of 139 (38%) of 364 workers reported 611 violent incidents. Verbal threats were reported by 136 workers (37%), weapon threats by 45 (12%), physical attacks by 14 (4%), and rape by 3 (1%). Five workers (1%) carried guns and/or knives while working. In multiple logistic regression, receipt of verbal threats was associated with worker's male sex (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.5-4.0), white ethnicity (OR, 2.4; 95% CI, 1.4-4.1), experience of 5 years or longer (OR, 2.2; 95% CI, 1.3-3.8), weekend work (OR, 1.8; 95% CI, 1.1-3.1), and sexual remarks made to the worker by clients (OR, 2.0; 95% CI, 1.2-3.5). Receipt of weapon threats was associated with worker's male sex (OR, 5.7; 95% CI, 2.4-15.3), white ethnicity (OR, 4.0; 95% CI, 1.8-9.3), age of 40 years or older (OR, 2.5; 95% CI, 1.1-5.8), work experience of 5 years or longer (OR, 2.7; 95% CI, 1.2-6.0), rural work (OR, 3.6; 95% CI, 1.3-10.1), being alone with the opposite sex (OR, 3.7; 95% CI, 1.6-9.7), and interaction with homeless clients (OR, 5.2; 95% CI, 1.7-18.8). Physical attacks were associated with sexual remarks made to the worker by clients (OR, 4.2; 95% CI, 1.4-13.9). No risk factors predicting rape were identified. CONCLUSIONS: Violence directed toward public field-workers is a common occupational hazard. An assessment of what situations, clients, and locations pose the risk of violence to public health workers is needed.
Adult↗
Markers of insulin resistance in day and shift workers aged 30-59 years.
OBJECTIVES: To examine relationships between shift work and markers (metabolic abnormalities) of insulin resistance (IR). METHODS: A cross-sectional study of 2,824 day and 826 shift workers. All the subjects were male blue-collar workers aged 30-59 years. Four IR markers [(1) hypertension (systolic blood pressure >or=140 mmHg or diastolic blood pressure >or=90 mmHg or under treatment for hypertension); (2) hyperglycemia (fasting serum glucose >or=7.00 mmol/l or under treatment for diabetes); (3) hypertriglyceridemia (fasting serum triglyceride >or=1.70 mmol/l or under treatment for hyperlipidemia); (4) hypo-HDL-cholesterolemia (fasting serum HDL-cholesterol <1.04 mmol/l)] were checked. Subsequently, IR syndrome, a cluster of IR markers, was expediently diagnosed by the number (N) of IR markers found in each worker. N>or=1, N>or=2 or N>or=3 was used as a cutpoint for the diagnosis. The prevalence of each IR marker and IR syndrome was compared between the two worker groups. Age, body mass index (kg/m(2)), job, drinking, smoking, and exercise were used as confounding factors. Job, work schedule and lifestyles were based on self-administered questionnaires. RESULTS: Hypertriglyceridemia (28.7% in day workers, 31.2% in shift workers) was most prevalent (4.6%), and hyperglycemia (5.4%) was least, in the four IR markers in both worker groups. Approximately half of the subjects had at least one IR marker in both groups (N>or=1; 46.0% and 46.6%, respectively). However, a full cluster of IR markers was rare in both groups (N=4; 0.2% and 0.1%, respectively). Prevalence of IR syndrome by any cutpoints increased with age in day workers, but shift workers aged 50 years or older had lower prevalence than shift workers younger than 50 years. In subjects younger than 50 years, all IR markers (except for hypo-HDL-cholesterolemia) and IR syndrome by any cutpoints were more prevalent in shift workers than in day workers. Contrariwise, in subjects aged 50 years or older, lower prevalence of all IR markers and IR syndrome in shift workers than in day workers was found. These results were not influenced by statistical adjustments for the confounding factors by multiple logistic regression analysis. CONCLUSIONS: Shift work may be associated with IR syndrome in workers younger than 50 years. These relations may be underestimated mainly by broad definition of shift work and healthy-worker effects.
Adult↗
Respiratory function and immunological status in paper-recycling workers.
The respiratory function and immunological status of workers employed in the paper recycling industry were studied. The mean age of the 101 studied workers was 41 years, and the mean duration of their exposure was 17 years. A group of 87 unexposed workers of similar age, duration of employment, and smoking history was studied for the prevalence of chronic respiratory symptoms. Lung function in the paper workers was measured by recording maximum expiratory flow volume (MEFV) curves and recording forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and maximum expiratory flow rates at 50% and the last 25% of the FVC (FEF50, FEF25). Immunological studies were performed in all 101 paper workers and in 37 control workers (volunteers). These included skin-prick tests with paper-dust extracts and other nonoccupational allergens, as well as the measurement of total serum immunoglobulin E. Significantly higher prevalences of all chronic respiratory symptoms were found in paper compared with control workers (P < 0.01). The highest prevalences were found for chronic cough (36.6%), chronic phlegm (34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), and dyspnea (18.8%). Occupational asthma was diagnosed in four (4.0%) of the paper workers. A logistic regression analysis performed on chronic respiratory symptoms of paper workers indicated significant effects of smoking and exposure, with the smoking effect being the most important. Multivariate analysis of lung-function parameters indicate significant effects of exposure. For paper workers, the measured FEF50 and FEF25 were significantly decreased, compared with predicted values, suggesting obstructive changes located primarily in smaller airways. Among 101 tested paper workers, 16 (15.8%) had positive skin-prick tests to at least one of the paper extracts; none of the control workers reacted to these extracts. Increased serum IgE levels were found in 21% of the paper workers and in 5% of control workers (P < 0.05). Paper workers with positive skin-prick tests to any of the paper and/or other tested extracts had higher prevalences of chronic respiratory symptoms and lower measured lung-function tests compared with predicted than did those with negative skin-prick tests, but the differences were not statistically significant. The measured concentrations of total and respirable dust in this industry were higher than those recommended by Croatian standards. Our study suggests that work in the paper-recycling industry is associated with respiratory impairment and that sensitive workers employed in this industry may be at particular risk of developing chronic respiratory abnormalities.
Adult↗
Enhanced preventive programme at a beryllium oxide ceramics facility reduces beryllium sensitisation among new workers.
BACKGROUND: A 1998 survey at a beryllium oxide ceramics manufacturing facility found that 10% of workers hired in the previous 6 years had beryllium sensitisation as determined by the beryllium lymphocyte proliferation test (BeLPT). In response, the facility implemented an enhanced preventive programme to reduce sensitisation, including increased respiratory and dermal protection and particle migration control. AIM: To assess the programme's effectiveness in preventing sensitisation. METHODS: In 2000, the facility began testing newly hired workers for beryllium sensitisation with the BeLPT at time of hire and during employment. The sensitisation rate and prevalence for workers hired from 2000 to 2004 were compared with that for workers hired from 1993 to 1998, who were tested in the 1998 survey. Facility environmental conditions for both time periods were evaluated. RESULTS: Newly hired workers in both cohorts worked for a mean of 16 months. Of the 97 workers hired from 2000 to 2004 with at least one employment BeLPT result, four had abnormal results at time of hire and one became sensitised during employment. Of the 69 workers hired from 1993 to 1998 and tested in 1998, six were found to be sensitised. The sensitisation rate for the 2000-4 workers was 0.7-2.7/1000 person-months of employment, and that for the 1993-8 workers was 5.6/1000 person-months, at least 2.1 (95% confidence interval (CI) 0.6 to 8.4) and up to 8.2 (95% CI 1.2 to 188.8) times higher than that for the 2000-4 workers. The sensitisation prevalence for the 2000-4 workers was 1% and that for the 1993-8 workers was 8.7%, 8.4 (95% CI 1.04 to 68.49) times higher than that for the 2000-4 workers. Airborne beryllium levels for production workers for the two time periods were similar. CONCLUSIONS: A comprehensive preventive programme reduced beryllium sensitisation in new workers during the first years of employment, despite airborne beryllium levels for production workers that were similar to pre-programme levels.
Adolescent↗