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Hepatitis B infection among health workers in Uganda: evidence of the need for health worker protection.

Hepatitis B exposure was assessed in 311 health workers in Uganda, a highly endemic country. Health workers were selected by random sampling from a categorized list of health workers at district level, proportionate to the population of each district. Whereas 60.1% of health workers have evidence of hepatitis B infection, with 8.7% being chronic carriers and one (0.3%) acutely infected, 36.3% are still susceptible and could benefit from vaccination. Only 5.1% reported having had at least one dose of hepatitis B vaccine and 3.5% were apparently immune through vaccination. Needle stick injuries reported by 77% of health workers were the most common mode of exposure to blood and body fluids. Trends suggested duration of service as a predictor while age and history of blood transfusion remained significant independent risk factors for hepatitis B infection. 98% of health workers are willing to be vaccinated. These results confirm the need for protection and vaccination of health workers in Uganda against hepatitis B.

Adult↗

Work flow policy and within-worker and between-workers variability in performance.

Work flow policies are shown to induce a change in average between-workers variability (worker heterogeneity) and within-worker variability in performance times. In a laboratory experiment, the authors measured the levels of worker heterogeneity and within-worker variability under an individual performance condition, a work sharing condition, and a fixed assignment condition. The work sharing policy increased the levels of worker heterogeneity and worker variability, whereas the fixed assignment policy decreased them. These effects, along with work flow policy main effects on mean performance times and variability are examined. This article represents an initial step in understanding effects that may be important in the selection of an operating policy, the ignorance of which may lead to costly misestimates of performance.

Analysis of Variance↗

Studies of respiratory morbidity in rubber workers. Part IV. Respiratory morbidity in talc workers.

Pulmonary function tests, chest x-rays, and respiratory questionnaires were administered to eighty talc workers and 189 non-exposed rubber workers from three rubber tire manufacturing plants. The talc workers, who were exposed to talc at levels below the current threshold limit value (TLV) of 20 mppcf for nonfibrous talc, had a statistically significantly greater prevalence of productive cough and of positive criteria for chronic obstructive lung disease (COLD) than did the control workers. The talc workers with more than 10 years of exposure had significantly decreased residual FEV 1.0. Multiple regression analysis of FEV 1.0 in the talc workers estimated that each year of exposure to talc dust reduced the FEV 1.0 by 26 ml. Talc workers had a clear increase in respiratory morbidity, despite the absence of chest roentgenographic changes. Based on this study, a safe exposure level for talc appears to be 25 mg/m3 as a time-weighted average.

Bronchitis↗

Urinary mutagens in municipal refuse incinerator workers and water treatment workers.

Municipal refuse incineration workers may be exposed to mutagenic compounds from gaseous and particulate emissions and during ash removal operations. The frequency of urinary mutagens was measured by the Ames test among a sample of 104 refuse incinerator workers in seven incinerator plants during March-May 1988. The frequency was compared to that observed in 61 water treatment employees in 11 municipal water treatment facilities during the same period. Incinerator workers had a significantly higher risk for urinary mutagens and promutagens as compared to water plant workers after controlling for age. Among incinerator workers, increased risk of having urinary mutagens was associated with workers who wore protective clothing (defined as clothing other than masks or gloves) or whose job classification was equipment repair. It also showed a weak positive association with increasing age. There was an increased risk of urinary promutagens associated with not wearing gloves. The presence or absence of mutagenicity in workers' urine varied with plant location. Incinerator operating conditions affecting the production of toxicants and mutagens are discussed and the results of other studies involving toxicant exposure of humans near incinerators are cited.

Adult↗

[Health care of workers engaged in waste water treatment. 1) The exposure conditions to organic solvents in workers engaged in waste water treatment].

In the investigation of the exposure conditions to organic solvents of workers in 35 waste water treatment facilities, it was found that these workers treated various kinds of solvents. Almost all of the facilities treated chloroform, acetone, n-hexane, methanol and carbon tetrachloride. The average exposure concentration of the workers was, however, low. Exposure concentration to organic solvents (chloroform, xylene and carbon tetrachloride) was evaluated in one of the facilities. The average concentration of the respective solvents in the workers did not exceed the threshold limit value of Japan, but the concentration calculated on the basis of combined exposure exceeded the threshold limit value. On the other hand, high concentrations of organic solvents were detected in the room where the solvents were introduced but not in the working rooms, indicating that the workers engaged in waste water treatment were mainly exposed to organic solvents in the former room where they sorted and mixed the solvents and placed them in the incinerator. In conclusion, improvement in working conditions and health care for workers engaged in waste water treatment facilities should be made in order to prevent workers from becoming intoxicated by organic solvents.

Acetone↗

[Analysis of mortality patterns in an area supplying tunnel workers away from home. Part 2. Mortality patterns among tunnel workers].

In order to clarify the long-term effect of tunnel work on the health of its workers, we examined its cause-specific mortality pattern. The subjects were 418 males who died after the age of 30 in 1977 in the southern part of Oita Prefecture, where many men come and work away from home as tunnel workers. Death certificates, 418 in number, presented to the health center were used to examine the causes of death. Occupational careers and life histories of the subjects were obtained by interviewing their families or relatives in 1980. The interviews were successfully carried out with 356 subjects (85.2%). The subjects were divided into two groups. One group was consisted of 73 males who had engaged in the tunnel work (tunnel workers) and the other was of 283 males without experience of tunnel work (others). Proportional mortality ratio (PMR) and proportional mortality classified by age were compared between the two groups. The mean ages at death were also compared among these two groups and all Japanese males over 30 years of age. The results were as follows. The proportion of the deaths of "tunnel workers" among the total deaths in the area surveyed was correlated to the regional rate of tunnel workers and the distribution of pneumoconiosis due to tunnel work. These results show that many tunnel workers suffering from pneumoconiosis had returned to their home area before they died. Excess deaths from the ICD category I; infective and parasitic diseases (000-136), tuberculosis (010-019) and silicotuberculosis (010) were found among the "tunnel workers."(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Do recorded doses overestimate true doses received by Chernobyl cleanup workers? Results of cytogenetic analyses of Estonian workers by fluorescence in situ hybridization.

Studies of workers who were sent to Chernobyl after the 1986 reactor accident are being conducted to provide a better understanding of the effects of chronic low-dose radiation exposures. A crucial component to these investigations is an accurate assessment of the radiation doses received during the cleanup activities. To provide information on biological measurements of dose, fluorescence in situ hybridization (FISH) with whole-chromosome painting probes has been applied to quantify stable chromosome aberrations (translocations and insertions) among a defined cohort of 4,833 cleanup workers from Estonia. Cytogenetic analysis of 48-h lymphocyte cultures from 118 Estonian cleanup workers (10.3 cGy mean recorded dose; 25 cGy maximum), 29 Estonian population controls and 21 American controls was conducted by three laboratories. More than 258,000 painted metaphases were evaluated. Overall, we observed lower translocation frequencies than has been reported in previous studies using FISH among Chernobyl cleanup workers. In our data, a clear association with increased levels of translocations was seen with increasing age at blood drawing. There was no correlation, however, between aberration frequency and recorded measurements of physical dose or any category of potential high-dose and high-dose-rate exposure such as being sent to Chernobyl in 1986, working on the roof near the damaged nuclear reactor, working in special zones or having multiple tours. In fact, the translocation frequency was lower among the exposed workers than the controls, though not significantly so. To estimate the level of effect that would have been expected in a population of men having an average dose of approximately 10 cGy, blood from six donors was exposed to low-LET radiation, and more than 32,000 metaphases were scored to estimate dose-response coefficients for radiation-induced translocations in chromosome pairs 1, 2 and 4. Based on these results, we estimate that had this group of 118 men received an average whole-body dose of 10-11 cGy, as chronic or acute exposures, an increase in the mean frequency of chromosome translocations of more than 40-65% would have been observed in their lymphocytes compared to findings in nonirradiated controls. In spite of evaluating more than a quarter of a million metaphases, we were unable to detect any increase in the mean, median or range in chromosome aberrations in lymphocyte cultures from a group of Estonian men who took part in the cleanup of the Chernobyl nuclear power site and those who did not. We conclude that it is likely that recorded doses for these cleanup workers overestimate their average bone marrow doses, perhaps substantially. These results are consistent with several negative studies of cancer incidence in Chernobyl cleanup workers and, if borne out, suggest that future studies may not be sufficiently powerful to detect increases in leukemia or cancer, much less distinguish differences between the effects of chronic compared to brief radiation exposures.

Adult↗

The effects of removing a statutory barrier to workers' compensation for farm workers.

In 1983 the Washington State Supreme Court ruled unconstitutional a unique exemption that excluded farm workers from workers' compensation if they had not earned $150 in continuous work with the same employer. In order to examine the effect of removing this restriction, workers' compensation data were analyzed to examine the number of farm workers covered, the number of claims submitted, and claim acceptance rates before and after the ruling. Although the 1983 ruling appears to have had a significant impact on the treatment of claims, no increase in utilization of the workers' compensation system was observed. Further intervention is required if the objective of treating farm workers equitably is to be realized.

Agricultural Workers' Diseases↗

Workers' compensation experience of Colorado agriculture workers, 2000-2004.

BACKGROUND: Agriculture is among the most hazardous of occupations. The lack of information regarding agriculture injuries or fatalities has been recognized as an obstacle for effective injury prevention. Workers' compensation claims data for non-fatal injuries among agriculture and agri-business workers in the State of Colorado between the years of 2000 and 2004. METHODS: Workers' compensation claims are utilized to estimate injury claim incidence rates, determine the distributions of sources, causes, types and body locations of injuries, and estimate the costs of these injuries. RESULTS: Colorado agriculture and agri-business workers (e.g., cattle dealers, cattle or livestock raisers, dairy farmers) have high rates of injury claims, especially in sectors that involve interaction with animals or livestock. Grain milling operations had a high rate of injury claims among agri-business operations. Injuries related to animals, strains, machinery, and falls or slips were the most frequent among all occupations analyzed. CONCLUSIONS: Understanding the occurrence of injuries among Colorado agriculture and agri-business workers is critical to implementing and evaluating effective intervention programs for specific agriculture-related occupations. The development of safety interventions that address the worker-animal interface, fall protection systems, machinery usage, and overexertion prevention strategies is recommended.

Accidents, Occupational↗

Workers' compensation claims for needlestick injuries among healthcare workers in Washington State, 1996-2000.

OBJECTIVES: To characterize accepted workers' compensation claims for needlestick injuries filed by healthcare workers (HCWs) in non-hospital compared with hospital settings in Washington State. DESIGN: Descriptive study of all accepted workers' compensation claims filed between 1996 and 2000 for needlestick injuries. PARTICIPANTS: All Washington State HCWs eligible to file a state fund workers' compensation claim and those who filed a workers' compensation claim for a needlestick injury. RESULTS: There were 3,303 accepted state fund HCW needlestick injury claims. The incidence of needlestick injury claims per 10,000 full-time-equivalent HCWs in hospitals was 158.6; in dental offices, 104.7; in physicians' offices, 87.0; and in skilled nursing facilities, 80.8. The most common mechanisms of needlestick injury by work location were as follows: for hospitals, suturing and other surgical procedures (16.7%), administering an injection (12.7%), and drawing blood (10%); for dentists' offices, recapping (21.3%) and cleaning trays and instruments (18.2%); for physicians' offices, disposal (22.2%) and administering an injection (10.2%); and for skilled nursing facilities, disposal (23.7%) and administering an injection (14.9%). Nurses accounted for the largest (29%) proportion of HCWs involved, followed by dental assistants (17%) and laboratory technicians and phlebotomists (12%) in non-hospital settings. Rates of needlestick injury claims increased for non-hospital settings by 7.5% annually (95% confidence interval [CI95], 4.89% to 10.22%; P < .0001). Rates decreased for hospital settings by 5.8% annually, but the decline was not statistically significant (CI95, -12.50% to 1.34%; P < .1088). HCWs were exposed to hepatitis B, hepatitis C, and human immunodeficiency viruses in non-hospital settings. CONCLUSION: There was a difference in the incidence rate and mechanisms of needlestick injuries on review of workers' compensation claim records for HCWs in non-hospital and hospital settings.

Cost of Illness↗

Spontaneous abortions among dental assistants, factory workers, painters, and gardening workers: a follow up study.

This investigation was conducted to test the hypothesis that exposure of pregnant women to chemicals increases the risk of spontaneous abortion. The chemical risk factors under study to which dental assistants, factory workers, painters, and gardening workers were exposed were nitrous oxide, inorganic mercury, organic solvents, and pesticides. The study was carried out within the Danish county of Funen. It included all dental assistants employed in private or public dentistry. A comparable reference group was made up by employees less exposed to chemicals. Further study groups included all women painters within the county, women factory workers from selected factories, and about 50% of the women gardening workers within the county. Shop assistants and packers formed their control group. Information was obtained through a postal questionnaire study in May 1980 and from hospital records. Only among factory workers and painters was the odds ratio of spontaneous abortion found to be significantly increased. Neither among these women nor among dental assistants and gardening workers, however, was the reported exposure to any single chemical during pregnancy associated with a significantly increased odds ratio of spontaneous abortion.

Abortion, Spontaneous↗

Worker injuries: the effects of Workers' Compensation and OSHA inspections.

Detailed analysis of work exposure and worker attributes failed to explain changes in injury claims in three plants, each in a separate state, during 1973-1980. When relative exposure to hazard and worker attributes are controlled, changes in injury rates are largely explained by increases in Workers' Compensation greater than inflation and by inspections made by the Occupational Safety and Health Administration (OSHA). Rises in Workers' Compensation greatly increased the claims for injuries, while OSHA citations substantially decreased objectively verifiable injuries in the year following an inspection. Data on days lost due to injury in 167 industrial groupings in 20 states also indicate significant reductions of workdays lost in correlation with OSHA inspections, when increases due to Workers' Compensation are controlled. The results thus appear to be generalizable. Previous studies of OSHA failed to adequately control for Workers' Compensation effects, and thus underestimated the effects of OSHA.

Absenteeism↗

The dismissal of injured workers and workers' compensation arrangements in Australia.

In Australia, as in Canada and to a lesser extent the United States, the vocational rehabilitation of injured workers is an integral part of workers' compensation arrangements. An essential feature of the return-to-work process is the provision of suitable employment by employers for workers able to resume work following a work-related injury. This article highlights the importance of employment security measures within workers' compensation legislation for injured workers and of scheme management. The author examines the major approaches adopted by the various Australian jurisdictions, critically reviews the issue of compliance with employment security legislation, and suggests a number of proposals for reform. Given the number of similarities between Australian and North American workers' compensation schemes, policy lessons drawn from the Australian experiences may be relevant to the labor movement and legislators in Canada and the United States.

Australia↗

Radiation-induced chromosomal aberrations among TENORM workers: amang- and ilmenite-processing workers of Malaysia.

The usefulness of peripheral human lymphocytes as a bioindicator for ionizing radiation effect was tested in a survey of Malaysian workers in two industries producing technologically enhanced naturally occurring radioactive material (TENORM). Workers in amang processing plants who have been with the plant for an average of 12.9 years and who were exposed to radioactive dust showed significantly higher frequencies of chromosomal aberration compared to control and even ilmenite-processing workers. Such frequency was not significantly different between workers in ilmenite-processing plant and control. The differences in duration of employment, occupational hygiene, together with the difference in the percentage of 'old' and 'new' aberrations among the groups sampled were used to explain the high chromosomal aberration frequency among amang workers. The presence of significantly high chromosome damage (dicentrics and fragments) in workers who were chronically exposed to doses below 50 mSv per year or 20 mSv per year averaged over 5 years (ICRP, 1991) provided additional experimental data on the dose-effect relationship at these low-dose ranges. The results confirm the usefulness of using human lymphocytes as a bioindicator for chronic exposure to ionizing radiation and in cases where physical radiation detectors are not available.

Adult↗

Total energy expenditure (H218O), physical activity level and milk output of lactating rural Bangladeshi tea workers and nontea workers.

OBJECTIVE: To assess the total daily energy expenditure (TDEE), milk output and physical activity level (PAL) of chronically malnourished lactating women using the doubly labelled water method (DLW). DESIGN: Prospective, longitudinal study designed to assess the extent of malnutrition and energetics of lactating tea workers and nontea workers. SETTING: North-east Bangladesh on women working and living in the same tea estates. SUBJECTS: Of an original cohort of 150 lactating women, 30 were selected to participate in this study when they were at about 12 months postpartum. One mother subsequently dropped out. INTERVENTIONS: On day 1 each women provided a urine sample, was administered a dose of DLW and 6 h later provided another sample. Further urine samples were collected for 21 subsequent days. In addition, every 5 days the mother provided a milk sample and at the same time her baby provided a urine sample. RESULTS: Mean (s.d.) BMI was 17.4 (1.63). Mean TDEE and PAL were significantly higher in workers than nonworkers (8.42 (1.38) and 6.83 (2.09) MJ/day, P = 0.02 and 1.92 (0.34) and 1.59 (0.44), P = 0.03, respectively). Mean milk output was similar in the two groups (672 (180) ml and 749 (189) ml in workers and nonworkers, respectively). CONCLUSIONS: Based on international BMI cutoffs, 79% of mothers were suffering from some degree of chronic energy deficiency. A total of 35% of workers and 17% of nonworkers were engaged in strenuous physical activity. The mean milk output of both workers and nonworkers was not different and was high especially as most of the mothers were about 12 months postpartum. No relationship was found between menses return and any of the variables studied. SPONSORSHIP: World Health Organization, Nestle Foundation, UNICEF.

Adolescent↗