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PubMed2002

Natural and anthropogenic processes that concentrate Mn in rural and urban environments of the lower Mississippi River delta.

This study evaluated natural processes and projected methylcyclopentadienyl manganese tricarbonyl fuel additives as sources of Mn accumulation in the environment. Data sets include fresh alluvium and sediments from the lower Mississippi River Delta and a soil metal survey of metropolitan New Orleans. The (1) railroad Mn, (2) industrial Mn, and (3) dynamic aquifer-stream transfer of Mn hypotheses were tested with the Mississippi River Delta data. Friction between Mn-rich steel wheels and rails contributes Mn (P = 0.017) to the environment, supporting (1). Sediment loads of Mn were similar (P = 0.77) upstream and downstream from the Louisiana industrial corridor, not supporting (2). The median Mn on the alluvium surface (59 mg/kg), in the aquifer (159 mg/kg), and in the riverbank aquifer discharge zone (513 mg/kg) support (3) as a mechanism for Mn enrichment of clay. The New Orleans soil metal survey data set shows a rural to urban increase of fourfold for Mn and three orders of magnitude for Pb. At 1999 U.S. highway fuel use, 8.3 mg of Mn per L would yield 5000 metric tons of Mn annually. If 13% of Mn were emitted, 650 tons of Mn would become aerosols annually, while 87% or 4350 tons would remain in engines. The 1999 toxic release inventory for Mn shows 370 tons as total emissions compared to the potential of 390 and 260 tons from vehicles, respectively, in urban and rural areas. A precautionary lesson from the use of Pb as a fuel additive is that the use of Mn as a fuel additive would be associated with an increased risk for neonates exceeding the estimated total tolerable daily intake of 2.1-16.5 micrograms Mn (especially in urban inner city environments) because neonates lack fully functional hepatic clearance for Mn.

Fresh Water↗
PubMed1985

Fatal and nonfatal accidents on the railways--a study of injuries to individuals, with particular reference to children and to nonfatal trauma.

This paper reports a five-year total population study of fatal railroad accidents involving individuals (that is, not including train crashes or derailments); and a consecutive unselected series of nonfatal isolated injuries in Queensland, Australia. There were 84 fatalities and 211 cases of significant nonfatal traumata. Fatal railway accidents involving children under 15 years of age are now more common in Australia than childhood poisonings and electrocutions. Two syndromes occur--(a) toddlers living near the tracks who simply wander onto the line; and (b) young teenage boys who are run down on level crossings, either as pedestrians or cyclists. Adult fatalities include (a) occupational deaths among railway workers (20%), (b) car-train collisions at level crossings (19%), (c) drunk pedestrians who walk into trains (17%), suicides (12%), and old folk who walk into trains (12%). Of 211 nonfatal cases studied, falls in and from both moving and stationary trains were the most common type of accident. Sudden jolting of the train (probably unpreventable) contributed to 26% of all falls. Twenty-two percent of nonfatal accidents resulted from a person being struck by a train. All persons who survived being struck by a train received serious injuries and required hospital admission. Fatalities involving adults include a high proportion of suicides. Some accidents, such as fingers being caught in windows and doors, can and are being overcome through improved design.

Accidents↗
PubMed1994

Cholera diffusion in Russia, 1823-1923.

All six cholera pandemics of the 19th and early 20th centuries struck Russia, causing millions of deaths. Cholera entered Russia from the south, with the Volga river system being a common and efficient route into the heart of the country. Diffusion was predominantly linear, along the navigable rivers and later, along the railroads. In contrast to Pyle's findings for the U.S.A., urban hierarchical diffusion was of only local significance in Russia.

Cholera↗
PubMed1994

National suicide prevention programme and railway suicide.

Suicidal behaviour is a public health problem closely related to other problems such as mental illness, abuse, violence and accidents. This approach is illustrated by the prevention of railway suicides. A theoretical framework is sketched, which allows for the use of principles from injury prevention in the prevention of suicide. ICD-9 encoded death certificates from 1974, 1980, 1986 and 1987 which concerned suicides and undetermined deaths on roads and railways were analysed (N = 294). Additional data were collected from autopsy, police and hospital protocols and from interviews with engine-drivers. Railroad victims dominated the sample (78% of cases). The mean age was 42 yr. Alcohol was detected in 27% of cases, drugs in 36% and severe illness (mostly psychiatric) in 57%. The relationship between types of collision and nature of injury is discussed. Environmental changes, such as changing the locomotive front design, are suggested as strategies for reducing accidents and suicides on railways.

Accidents, Traffic↗
PubMed1992

Urinary mutagenic activity in workers exposed to diesel exhaust.

We measured postshift urinary mutagenicity (mutu; n = 306 samples) on a population of railroad workers (n = 87) with a range of diesel exhaust exposures. Postshift urinary mutagenicity was determined by a sensitive microsuspension procedure using Salmonella strain TA98 +/- S9. Number of cigarettes smoked on the study day and urinary cotinine were highly correlated with postshift urinary mutagenicity. Diesel exhaust exposure was measured over the work shift by constant-flow personal sampling pumps. Respirable particle concentrations were adjusted for the contribution of environmental tobacco smoke, as estimated from nicotine concentration on treated filters. The relative ranking of jobs by this adjusted respirable particle concentration (ARP) was correlated with relative contact the job groups have with operating diesel locomotives. After adjustment for cigarette smoking (active and passive) in multiple regressions, there was no independent association of diesel exhaust exposure, as estimated by ARP, with postshift urinary mutagenicity among smokers or nonsmokers. An important finding is the detection of "baseline" mutagenicity in most of the nonsmoking workers. Despite the use of individual measurements of diesel exhaust exposure, the absence of a significant association in this study may be due to the low levels of diesel exposure, the lack of a specific marker for diesel exhaust exposure, and/or urinary mutagenicity levels from diesel exposure below the limit of sensitivity for the mutagenicity assay.

Adult↗
PubMed1995

Diesel exhaust, diesel fumes, and laryngeal cancer.

A hospital-based, case-control study of 235 male patients with laryngeal cancer and 205 male control patients was conducted to determine the effects of exposure to diesel engine exhaust and diesel fumes and the risk of laryngeal cancer. All patients were interviewed directly in the hospital with a standardized questionnaire that gathered information on smoking habits, alcohol consumption, employment history, and occupational exposures. Occupations that involve substantial exposure to diesel engine exhaust include mainly truck drivers, as well as mine workers, firefighters, and railroad workers. The odds ratio for laryngeal cancer associated with these occupations was 0.96 (95% confidence interval, 0.5 to 1.8). The odds ratio for self-reported exposure to diesel exhaust was 1.47 (95% confidence interval, 0.5 to 4.1). An elevated risk was found for self-reported exposure to diesel fumes (odds ratio, 6.4; 95% confidence interval, 1.8 to 22.6). No association was observed between jobs that entail exposure to diesel fumes, such as automobile mechanics, and the risk of laryngeal cancer. These results show that diesel engine exhaust is unrelated to laryngeal cancer risk. The different findings for self-reported diesel fumes and occupations that involve exposure to diesel fumes could reflect a recall bias.

Alcohol Drinking↗
PubMed2006

Ataxia: an early indicator in high altitude cerebral edema.

Wu, Tianyi, Shouquan Ding, Jinliang Liu, Jianhou Jia, Ruichen Dai, Baozhu Liang, Jizhui Zhao, and Detang Qi. Ataxia: an early indicator in high altitude cerebral edema. High Alt. Med. Biol. 7:275-280, 2006.--As a result of industrial development in the western region of China, in 2001 the Chinese government decided to build Qinghai-Tibetan Railway. The new railroad stretches 1118 km from Golmud (2808 m) to Lhasa (3658 m), with more than three-quarter of the distance above 4000 m, through the Mt. Kun Lun and Tanggula ranges. From the beginning of the project on June, 29, 2001, to the end of the year of 2003, about 74,735 construction workers worked in the harsh climate, in adverse circumstances and a low-barometric-pressure environment. The construction provided an opportunity for the investigation and study of acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). These altitude illnesses were very common in the construction workers. From July 1, 2001, to October 31, 2003, the overall incidence of AMS, HAPE, and HACE in the total workers was approximately 45%-95%, 0.49%, and 0.26%, respectively. Altitude illnesses were studied at two hospitals near the construction site. One hospital is located on the Fenghuoshan (Mt. Wind-gap) at an altitude of 4779 m (PB 428 torr), and the second hospital is situated in the Kekexili area at an altitude of 4505 m (PB 440 torr). Kekexili is a sparsely populated zone because the weather conditions are very bad all year round. These two hospitals received patients from the construction sites, where workers were working at altitudes between 4464 and 4905 m. A total of 8014 workers were treated at Fenghuoshan and 5488 were in Kekexili over the past 3 years. According to local guidance about proper medical care, workers ascending to high altitude should be examined physically, complete an AMS questionnaire, and be monitored for ataxia as an early warning sign of the impending, more serious aspects of HACE. The onset of HACE is frequently characterized by an ataxic gait, as reported since the middle of the 20th century (Gray et al., 1971; Wilson, 1973; Houston and Dickinson, 1975; Dickinson, 1979; Clarke, 1988; Hackett and Oelz, 1992; Hackett, 2002; Hackett and Roach, 2004). However, there are no detailed analyses of ataxia in HACE. This paper considers the relation between ataxia and HACE and its frequency, significance, and importance.

Altitude↗
PubMed1988

Cardiovascular risk factors predicting all causes of death in an occupational population sample.

A group of 768 men aged 40-59 at entry examination and belonging to an occupational sample of railroad employees in Rome have been examined for the measurement of some risk factors and followed-up for 20 years. In all 676 men, free from life-threatening diseases and with all measurements available, produced 166 fatal events in 20 years. Out of the 27 different personal characteristics considered only six contributed significantly to the multivariate prediction of all causes of death in the Cox proportional hazards computed by the forward stepwise technique. The factors predicting all causes of death were age, cigarette smoking, diabetes, blood pressure, mother's vital status and being on a diet prescribed by a doctor. The relative risk of those located in the upper decile of the estimated risk as compared to the bottom decile was 8.2. The results do not differ much from those obtained in a demographic sample studied in the same way.

Adult↗
PubMed2002

Thenar motor syndrome: median mononeuropathy of the hand.

OBJECTIVE: To evaluate a population with presumed carpal tunnel syndrome (CTS) for isolated involvement of the median motor nerve distal latency at or near the thenar eminence. DESIGN: This prospective study performed in various outpatient venues randomly selected 500 railroad workers with hand symptoms and presumed CTS entering into litigation. Electrodiagnostic studies were performed by using common techniques and distances. The dominant hand of each subject was evaluated. A prolonged median minus ulnar nerve distal latency differential (MUD) was the standard for determining CTS. Subjects with an isolated delay of motor MUD, with a normal sensory and midpalmar MUD, were classified as having thenar motor syndrome (TMS). RESULTS: After eliminating all subjects who did not meet the criteria of the electrodiagnostic studies, there remained a cohort of 126 subjects. There were 38 who met the criteria for TMS, and all others were classified as true CTS. Both groups were overweight, and the body mass index of the true CTS group was significantly higher (P < 0.006). CONCLUSIONS: TMS is a distinct electrodiagnostic entity. As an artifact of the study design (the exclusion of subjects with prior surgery), the relative frequency of TMS was increased. Aside from body mass index, no anthropometric or demographic difference between TMS and true CTS was demonstrated. Although no occupation source was identified, a possible pathogenesis includes local trauma superimposed on a common anatomic variant.

Adult↗
PubMed1998

Acquisition of noise-induced hearing loss by railway workers.

OBJECTIVE: The rate of growth of hearing loss was examined in a population of workers exposed to noise. Of special interest was the course of loss in the first 10 yr of work, for which international standards provide little information. Based on the International Standards Organization (ISO) 1999 compilation, it was hypothesized that the proportional growth of hearing loss would be constant in log years. DESIGN: Of 5000 workers compensated for hearing loss by a railroad, 500 were selected at random for analysis. For these workers, 2660 audiograms were available. The audiograms were distributed unsystematically over work careers, and for most workers were sparsely distributed. Thresholds were age corrected using ISO 1999 Annex B and averaged as a function of years on the job for two partitions, 0.5, 1, 2, and 3 kHz and 2 and 4 kHz. The average curves were compared with projections based on the ISO 1999 data as suggested by Dobie (1993a). A subset of workers with substantial hearing loss when hired was examined to evaluate the effect of pre-existing hearing loss. RESULTS: Hearing was worse at hire for this sample of workers than suggested by ISO 1999 Annex B for an unscreened sample of the general population at comparable ages. As a result, the early hearing loss was underpredicted by the ISO 1999 projection. Except at the earliest years of employment, the rate of growth toward the final hearing loss for the mean of the sample of workers was approximated by the projection from ISO 1999. The ISO 1999 projection is based on growth of the percentage of loss at the final audiogram obtained each year. In subgroups of workers, i.e., for the lower quartile and for the upper quartile of the sample, the projection based on ISO 1999 was similarly effective. Workers hired with prior loss showed growth of hearing loss that was flatter than that of either the mean of all workers or the ISO 1999 projection, but the growth curve for these workers approximated the average curve shifted to later years to bring the initial loss into correspondence with the predicted loss. CONCLUSIONS: For a group of workers exposed to a noisy environment, growth of hearing loss can be projected fairly well based on ISO 1999, without knowledge of the details of spectrum or level of noise exposure. This suggests that it would be possible to allocate the percentage of a known total hearing loss acquired in a group of workers on a year-by-year basis, given knowledge of work history for a claimant population in the absence of detailed knowledge of the exposure or detailed sequential audiometric data.

Adult↗
PubMed1991

Train versus pedestrian accidents.

Railroad-related trauma has been associated with injuries causing considerable morbidity. This is a retrospective study of 15 consecutive patients who were run over by trains. The initial injury produced a traumatic amputation of 10 extremities in eight patients. Limb salvage in two other patients with severe fractures failed, and subsequent lower extremity amputation was required. Despite efforts to salvage the most distal tissue possible, 8 of 12 extremities amputated in the acute traumatic period required revision to a more proximal level. Alcohol ingestion was involved in 13 of the 15 incidents in the study. No patient received posthospitalization alcohol rehabilitation. In addition, despite the young age of the patients in this series, only one patient was rehabilitated to a prosthetic ambulator.

Accidents↗
PubMed1994

A male incumbent worker industrial database. Part I: Lumbar spinal physical capacity.

STUDY DESIGN: A group of 160 incumbent male railroad workers volunteered for a study of lumbar spine physical capacity. METHODS: They were initially subjected to inclinometric measurements of sagittal and coronal regional mobility (T12-S1). They also were tested on isokinetic trunk strength measurement devices for sagittal (bending) and axial (twisting) trunk strength at multiple speeds. RESULTS: Results showed that they demonstrated mild deficits of lumbar sagittal extension mobility, trunk extensor strength, and sagittal/axial high speed (150-180 degrees/sec) trunk strength when compared with population averages from a previously derived normative database of a nonhomogeneous male population (matched for age and body weight). CONCLUSIONS: It was hypothesized that instructions about "correct lifting techniques," uniformly provided to these workers, may have resulted in an unintended decrement in trunk mobility and strength.

Adult↗
PubMed1994

A male incumbent worker industrial database. Part II: Cervical spinal physical capacity.

STUDY DESIGN: Quantified cervical physical examination data are provided for a group of 160 incumbent railroad workers from four laboring crafts. OBJECTIVES: The subjects were tested for cervical mobility and strength, according to standardized protocols as part of a comprehensive physical examination and functional testing procedure to establish normative data associated with the axial musculoskeletal system. RESULTS: Tri-planar cervical inclinometric mobility norms are provided, as are sagittal and coronal isometric cervical strength data.

Adult↗
PubMed1994

A male incumbent worker industrial database. Part III: Lumbar/cervical functional testing.

STUDY DESIGN: A group of 160 incumbent male railroad workers was administered a battery of isokinetic and isoinertial lumbar/cervical lifting tests that served as a paradigm for whole-person functional testing of manual handling tasks. RESULTS: Results demonstrated that the workers' performance was near normal or somewhat above population averages according to previously derived heterogeneous normative samples. However, there were some differences among the four laboring crafts that made up the present incumbent worker sample. CONCLUSIONS: The implications of these differences are discussed.

Activities of Daily Living↗
PubMed1998

Asymptomatic grotesque deformities of the cervical spine. An occupational hazard in railway porters.

STUDY DESIGN: A case report. OBJECTIVE: To illustrate an extremely rare occurrence of chronic, occupational, low-grade trauma leading to asymptomatic grotesque cervical spine deformities in railroad station porters. SUMMARY OF BACKGROUND DATA: Occupational trauma causing spinal deformities has been described in relation to thoracic and lumbar spines in miners. To the authors' knowledge, this is the first reported case of asymptomatic cervical spinal deformity in railway porters as a result of chronic occupational trauma. METHODS: A magnetic resonance imaging study was performed on both patients. RESULTS: The magnetic resonance images showed advanced degenerative changes in the cervical spine causing obvious deformities, along with apparently normal cord signal intensity. CONCLUSIONS: Chronic, occupational, low-grade trauma of the cervical vertebral region is extremely unusual in industrialized countries. Nevertheless, in view of the increasing mobility of people in general and of the labor force in particular, this complication of an occupational exposure deserves attention as an unusual cause of cervical spinal deformity.

Adult↗
PubMed1999

Absence of polyneuropathy among workers previously diagnosed with solvent-induced toxic encephalopathy.

An association between polyneuropathy and occupational exposure to trichloroethylene, trichloroethane, perchloroethylene, or similar solvents alone or in combination is controversial. We sought to determine whether workers previously diagnosed with solvent-induced toxic encephalopathy had objective evidence of polyneuropathy. Thirty railroad workers previously diagnosed with toxic encephalopathy were examined in the context of litigation against their employers. All described long-term occupational solvent exposure averaging 20 years in duration (range, 10 to 29 years) and producing acute intoxication on a regular basis. The diagnosis of subclinical or clinical polyneuropathy was established using a combination of symptoms, signs, and nerve conduction study (NCS) measures, consistent with standard clinical practice. Potential confounders were identified. NCS results were compared with historical controls, including unexposed workers matched by gender, age, and body mass index. Dose-response relationships were evaluated using simple linear and stepwise regression models. Three workers fulfilled clinical polyneuropathy criteria. The only worker fulfilling NCS criteria for confirmed clinical polyneuropathy had diabetes mellitus. Mean NCS values for most measures were similar to control values, and existing differences in sensory amplitudes disappeared when compared with the matched control group. NCS measures were not significantly influenced by exposure duration or job title. Separation into groups on the basis of the presence or absence of polyneuropathy symptoms, previous diagnosis of polyneuropathy, disability status, and severity or type of encephalopathy did not demonstrate significant NCS differences. The complaints of these workers claiming neurotoxic injury from occupational solvent exposure are not explained by peripheral nervous system dysfunction.

Adult↗
PubMed2000

Neurologic evaluation of workers previously diagnosed with solvent-induced toxic encephalopathy.

We examined 52 railroad workers with long-term occupational solvent exposures (average 22 years duration) who had been previously diagnosed by others as having solvent-induced toxic encephalopathy. All described episodes of transient intoxication associated with occupational solvent exposure. Persistent symptoms developed, an average, 16 years after exposure onset and included impaired memory (38), altered mood (21), imbalance (18), and headache (17). Thirteen workers had mild mental status abnormalities, but none fulfilled conventional clinical criteria for encephalopathy or dementia. None had abnormal blink reflex (51) or abnormal electroencephalographic (39) studies. Eight of 47 magnetic resonance imaging studies showed evidence of scattered ischemic lesions among workers with known diabetes mellitus (2), elevated blood pressure (4), or peripheral vascular disease (2). One magnetic resonance imaging scan showed mild cortical atrophy. In stepwise multiple linear and logistic regression models, no statistically significant (P < 0.05) dose-response relationships were found between exposure duration and symptoms or signs that were suggestive of encephalopathy. However, the number of symptoms (P < 0.001) and the number of signs (P = 0.05) were associated with current use of central nervous system-active medications. Further, lower Mini-Mental Status Examination scores were associated with a history of alcohol abuse (P = 0.01) and lower educational level (P = 0.03). The number of chief symptoms involving memory, mood, balance, or headache differed significantly among workers in different geographic sites (F(3.48) = 2.94, P = 0.04), a finding that was not explained by job title or exposure duration. There also was a significant (P = 0.0001) inverse relationship between initial exposure year (r2 = 0.60) or total years of exposure through 1987 (r2 = 0.56) and interval to major neurologic symptom onset, suggesting that factors other than solvent exposure account in part for worker complaints. We found no objective neurologic evidence supportive of toxic encephalopathy or any other uniform syndrome among these individuals, and most complaints were explained by neuropsychological factors or conditions unrelated to occupational solvent exposure.

Adult↗