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PubMed2001

Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers.

OBJECTIVES: To examine whether underground construction workers exposed to tunnelling pollutants over a follow up period of 8 years have an increased risk of decline in lung function and respiratory symptoms compared with reference subjects working outside the tunnel atmosphere, and relate the findings to job groups and cumulative exposure to dust and gases. METHODS: 96 Tunnel workers and a reference group of 249 other heavy construction workers were examined in 1991 and re-examined in 1999. Exposure measurements were carried out to estimate personal cumulative exposure to total dust, respirable dust, alpha-quartz, oil mist, and nitrogen dioxide. The subjects answered a questionnaire on respiratory symptoms and smoking habits, performed spirometry, and had chest radiographs taken. Radiological signs of silicosis were evaluated (International Labour Organisation (ILO) classification). Atopy was determined by a multiple radioallergosorbent test (RAST). RESULTS: The mean exposure to respirable dust and alpha-quartz in tunnel workers varied from 1.2-3.6 mg/m3 (respirable dust) and 0.019-0.044 mg/m3 (alpha-quartz) depending on job task performed. Decrease in forced expiratory volume in 1 second (FEV1) was associated with cumulative exposure to respirable dust (p<0.001) and alpha-quartz (p=0.02). The multiple regression model predicted that in a worker 40 years of age, the annual decrease in FEV1 would be 25 ml in a non-exposed non-smoker, 35 ml in a non-exposed smoker, and 50-63 ml in a non-smoking tunnel worker (depending on job). Compared with the reference group the odds ratio for the occurrence of new respiratory symptoms during the follow up period was increased in the tunnel workers and associated with cumulative exposure to respirable dust. CONCLUSIONS: Cumulative exposures to respirable dust and alpha-quartz are the most important risk factors for airflow limitation in underground heavy construction workers, and cumulative exposure to respirable dust is the most important risk factor for respiratory symptoms. The finding of accelerated decline in lung function in tunnel workers suggests that better control of exposures is needed.

Adult↗
PubMed1995

Workers' compensation in the United States: high costs, low benefits.

Studies suggest that income replacement is low for many workers with serious occupational injuries and illnesses. This review discusses three areas that hold promise for raising benefits to workers while reducing workers' compensation costs to employers: improving safety, containing medical costs, and reducing litigation. In theory, workers' compensation increases the costs to employers of injuries and so provides incentives to improve safety. Yet, taken as a whole, research does not provide convincing evidence that workers' compensation reduces injury rates. Moreover, unlike safety and health regulation, workers' compensation focuses the attention of employers on individual workers. High costs may lead employers to discourage claims and litigate when claims are filed. Controlling medical costs can reduce workers' compensation costs. Most studies, however, have focused on costs and have not addressed the effectiveness of medical care or patient satisfaction. Research also has shown that workers' compensation systems can reduce the need for litigation. Without litigation, benefits can be delivered more quickly and at lower costs.

Health Care Costs↗
PubMed2005

Devastating injuries in healthcare workers: description of the crisis and legislative solution to the epidemic of back injury from patient lifting.

The purpose of this report is to describe a crisis in healthcare, disabling back injuries in US healthcare workers. In addition, outlined is the proven solution of safe, mechanized, patient lifting, which has been shown to prevent these injuries. A "Safe Patient Handling--No Manual Lift" policy must be immediately instituted throughout this country. Such a policy is essential to halt hazardous manual patient lifting, which promotes needless disability and loss of healthcare workers, pain and risk of severe injury to patients, and tremendous waste of financial resources to employers and workers' compensation insurance carriers. Healthcare workers consistently rank among top occupations with disabling back injuries, primarily from manually lifting patients. Back injury may be the single largest contributor to the nursing shortage. Reported injuries to certified nursing assistants are three to four times that of registered nurses. A national healthcare policy for "Safe Patient Handling--No Manual Lift" is urgently needed to address this crisis. Body mechanics training is ineffective in prevention of back injury with patient lifting. Mandated use of mechanical patient lift equipment has proven to prevent most back injury to nursing personnel and reduce pain and injury to patients associated with manual lifting. With the national epidemic of morbid obesity in our country, innovative devices are available for use in emergency medical systems and hospitals for patient lifting and transfer without injury to hospital personnel. The US healthcare industry has not voluntarily taken measures necessary to reduce patient handling injury by use of mechanical lift devices. US healthcare workers who suffer disabling work-related back injuries are limited to the fixed, and often inadequate, relief which they may obtain from workers' compensation. Under workers' compensation law, healthcare workers injured lifting patients may not sue their employer for not providing mechanical lift equipment. Discarding healthcare workers disabled by preventable back injuries is an abuse which legislators must remedy. In addition, Medicare reimbursement policies must also be updated to allow the disabled community to purchase electrically operated overhead ceiling lifts. The US lags far behind countries with legislated manual handling regulations and "No Lifting" nursing policies. England and Australia have had "No Lifting" nursing policies in place since 1996 and 1998, respectively. The National Occupational Research Agenda (NORA) recognized a model in 2003 for reduction of back injuries to nursing staff in US healthcare facilities. Also in 2003, the American Nurses Association called for elimination of manual patient handling because it is unsafe and causes musculoskeletal injuries to nurses. The first state legislation for safe patient handling passed both houses in California but was vetoed by the Governor in September 2004. California and other states are preparing to (re)introduce legislation in January 2005. A national, industry-specific policy is essential to quell the outflow of nursing personnel to disability from manual patient lifting.

Adult↗
PubMed1998

Morbidity among farm workers in a desert country in relation to long-term exposure to pesticides.

OBJECTIVES: Farm workers chronically exposed to low levels of pesticides seldom show signs and symptoms of clinical significance. This study investigates subclinical morbidity patterns among male farm workers in a desert country. METHODS: Migrant-established farm workers (N=226) were compared with referents (N=226) and with new farm workers (N=92) who had just entered the country to work on farms. Acetylcholinesterase activity was measured, the aiming test and digit symbol test were applied, and a morbidity profile was collected with a questionnaire. RESULTS: The erythrocyte acetylcholinesterase activity and hemoglobin-adjusted erythrocyte acetylcholinesterase activity were significantly depleted in the established farm workers. The results of the aiming and digit symbol tests were also significantly lower for the established farm workers. For the morbidity profile, irritated conjunctiva (47.3%), watery eyes (52.2%), blurred vision (63.3%), dizziness (55.2%), headache (63.7%), muscular pain (61.1%), and weakness (76.6%) were reported by established farm workers in statistically significantly higher numbers than by the referents and new farm workers. CONCLUSIONS: Morbidity patterns, such as the health complaints and objective parameters suggested in this study, would be suitable as criteria for identifying farm workers most at risk from pesticide toxicity and as criteria for initiating measures to control and reduce exposure.

Acetylcholinesterase↗
PubMed2002

Precipitin response of potato processing workers to work-related microbial allergens.

Serum samples from 61 potato processing workers and 30 urban dwellers not exposed to organic dusts (as a reference group) were examined in agar-gel precipitation test performed by Ouchterlony double diffusion method with the antigens of 12 microorganisms associated with organic dusts. Each serum was tested twice: not concentrated, and three-fold concentrated, for the detection of low levels of precipitins. The antibody response of workers to the antigen of coryneform bacterium Agromyces ramosus was high, at both not concentrated and 3-fold concentrated sera (respectively 29.5% and 45.9%)--significantly greater than in reference group (p < 0.001). Workers' response to the antigens of Gram-negative bacterium Alcaligenes faecalis and thermophilic actinomycete Thermoactinomyces vulgaris was lower (respectively 13.1% and 13.1% at not concentrated sera, 24.6% and 29.5% at 3-fold concentrated sera) but in all cases significantly greater than in reference group (p < 0.05 at not concentrated sera, p < 0.01 and p < 0.001 at 3-fold concentrated sera). The frequency of positive precipitin reactions of potato workers to antigen of Penicillium citrinum was high only at 3-fold concentrated sera (55.7%)--significantly higher compared to reference group (p < 0.001). The antibody response of potato workers to other antigens was either unspecific or low, showing no significant difference compared to reference group. Twenty eight out of 61 examined potato processing workers (45.9%) reported the occurrence of the work-related pulmonary symptoms. The frequency of positive precipitin reactions to Agromyces ramosus, Alcaligenes faecalis, Thermoactinomyces vulgaris, Penicillium citrinum and Acinetobacter calcoaceticus was significantly greater in the subgroup of 28 workers reporting work-related pulmonary symptoms compared to 33 asymptomatic workers (p < 0.05). Study results suggest that antigens of Agromyces ramosus, Alcaligenes faecalis, Thermoactinomyces vulgaris and Penicillium citrinum should be considered as potential occupational allergens, probably stimulating an adverse immunopathological reaction in the exposed potato processing workers.

Adult↗
PubMed1998

Respiratory findings in synthetic textile workers.

We studied 308 female and 92 male textile workers employed in a factory that produced synthetic fiber hosiery. The mean age of the women was 38 years, their mean duration of employment 16 years. The mean age of the men was 39 years with a mean duration of employment of 16 years. A control group of 160 female and 78 male nonexposed workers was also studied. Chronic and acute work related symptoms were recorded for all workers. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves from which the forced vital capacity (FVC), the 1-sec forced expiratory volume (FEV1) and maximum expiratory flow rates at 50% and the last 25% (FEF50, FEF75) were read. There was a higher prevalence of all chronic respiratory symptoms in exposed than in control workers, although the differences were statistically significant only for dyspnea, sinusitis, and nasal catarrh (P < 0.01) in female synthetic textile workers, and for nasal catarrh (P < 0.01) in male synthetic textile workers. Occupational asthma was recorded in 3 (0.9%) of the women textile workers, and in 1 (1.1%) of male textile workers. There was a high prevalence of acute symptoms during the work shift, which was greatest for cough (female: 46%; male: 59%), dryness of the throat (female: 49%; male: 40%), dryness of the nose (female: 53%; male: 43%) and eye irritation (female: 46%; male: 36%). Ventilatory capacity data among the synthetic textile workers demonstrated significantly decreased FEF75 compared to predicted (P < 0.05). Our data suggest that inhalation of dust in synthetic textile plants causes the respiratory impairment.

Adult↗
PubMed2003

Prevalence of hepatitis A virus infection among sewage workers in Georgia.

BACKGROUND: Wastewater (WW) workers could have opportunity for direct contact with raw sewage, which might contain hepatitis A virus (HAV). METHODS: A serologic survey of WW workers and a comparison population of roads and drainage workers (RD). Factors potentially associated with anti-HAV positivity were evaluated in univariate and multivariate analyses. RESULTS: Among the 365 WW workers, overall anti-HAV prevalence was 38%, similar to that (35%) of the 166 RD workers (P = 0.5). Prevalence varied by wastewater job type from 45% among the 164 field crew workers to 32% among the 201 treatment plant workers. In multivariate modeling, factors associated with anti-HAV positivity included age > or = 40 years (odds ratio [OR] = 2.4; 95% CI = 1.6-3.7), black compared to other races (OR = 2.4; 95% CI = 1.5-3.8), birth outside the United States (OR = 7.5; 95% CI = 3.0-18.6), a high school education or less (OR 2.1; 95% CI = 1.4-3.2) and work on the field crew compared to RD work (OR 1.6; 95% CI = 1.1-2.4). CONCLUSIONS: These results are consistent with no or a small increased risk of hepatitis A among WW workers, and do not provide a clear mandate for hepatitis A vaccination of these workers. Am. J. Ind. Med. 43: 172-178, 2003.

Adult↗
PubMed2003

Fatal injuries to teenage construction workers in the US.

BACKGROUND: The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations. METHODS: The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations. RESULTS: The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P < 0.05), firms with fewer than 11 employees (OR = 1.72, P < 0.05), and their employers were more likely to have been cited by OSHA for safety violations (OR = 1.66, P < 0.05) than for firms which were investigated because of a fatality in an adult worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections. CONCLUSIONS: Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify specific areas for new regulation but the number of fatalities reviewed was small.

Accidents, Occupational↗
PubMed2001

Intervention for prevention of low back pain in Japanese forklift workers.

BACKGROUND: The effectiveness of two different approaches for the prevention of low back pain (LBP) was compared in forklift workers. The first approach (personal) consisted of providing lumbar support, arctic jacket and physical exercise, and the second (facility approach) included the improvement of forklift seats and tires. METHODS: The self-reported prevalence of LBP was surveyed three times before and after the two forms of interventions, in 260 male blue-collar workers including 27 forklift workers, and 55 male white-collar workers of a copper smelter. RESULTS: The initial prevalence of LBP was 63% in the forklift workers, which was significantly higher than that found in the other blue-collar workers (32%) and in the white-collar workers (22%). One year after the first intervention (personal approach) to the forklift workers, the prevalence of LBP fell to 56%. The second intervention (facility approach), which was mainly comprised of a reduction in whole body vibration, was subsequently added, and 9 months later the prevalence of LBP in the forklift workers further decreased to 33%. The reduction of the prevalence from the initial survey was significant (P = 0.008), and that from the second survey was nearly significant (P = 0.070). CONCLUSIONS: These findings suggest that the facility approach is more effective for a reduction of LBP than the personal approach.

Adolescent↗
PubMed1980

Nickel concentrations in plasma and urine of shipyard workers.

Nickel concentrations were analyzed by electrothermal atomic absorption spectrophotometry in plasma from workers at a repair shipyard and a construction shipyard. Four groups of workers were studied: (a) 62 welders, (b) 31 painters, (c) 27 riggers/carpenters, and (d) 21 shipfitters/pipefitters. Controls were 15 hospital workers and 28 retirees at the repair shipyard. In the combined groups of all tested workers at the repair shipyard, increased plasma Ni concentrations (greater than 5.2 micrograms/liter) occurred in 32 of 82 subjects (39%): (p less than .05 vs increased plasma Ni concentrations in 13 of 59 workers at the construction shipyard [22%], and p less than .001 vs increased plasma Ni concentrations in 1 of 43 controls [2%]). At both shipyards, plasma Ni concentrations were higher in the groups of painters and shipfitters/pipefitters than in the groups of welders and riggers/carpenters. In random urine specimens from workers at the construction shipyard. Ni concentrations exceeded 5.2 micrograms/liter in 9 of 24 welders [38%], (p less than .01 vs increased urine Ni concentrations in 1 of 15 controls [hospital workers]). The ratios of plasma/urine nickel concentrations were higher in painters (p less than .05) and lower in welders (p less than .05) than in other workers at the construction shipyard. Increased concentrations of nickel in body fluids of shipyard workers are attributed to exposures to nickel compounds and alloys in the working environment.

Adult↗
PubMed1982

The possible role of direct ingestion on the overall absorption of cadmium or arsenic in workers exposed to CdO or As2O3 dust.

Six volunteers (two office and four cadmium (Cd)-exposed workers, all nonsmokers) from an electric condenser factory participated in a study involving the measurement of cadmium in air and in dust, the evaluation of hand and mouth contamination by cadmium, and the determination of fecal cadmium. The mean levels of total airborne cadmium measured with static and personal samplers were for the exposed workers 9.5 and 16.7 microgram/m3, respectively, and for the office workers 0.3 and 0.5 microgram/m3, respectively. In the office workers, hand contamination by Cd hardly changes over the workday (less than 10 microgram/hand), whereas in the exposed workers important hand contamination by Cd was observed (up to 1,200 microgram/hand during the workday and up to 300 microgram/hand before lunch or before leaving the factory). Mouth contamination by Cd is rather similar in both groups on Monday morning, but increases 20- to 50-fold on Friday afternoon in the Cd workers against a slight increase for the office workers. The concentration of Cd in the feces was not much different between Sunday and Friday in the office workers, whereas in the exposed workers it was higher on Friday than on Sunday. There is suggestive evidence from a comparative study of fecal cadmium in two Cd-exposed volunteers who carried out their jobs with and without gloves that direct cadmium intake from hand contamination may contribute to the overall Cd absorption. A limited study in a glassware factory (As2O3 exposure) involving the measurement of total airborne arsenic, the determination of urinary arsenic, and the evaluation of hand and mouth contamination by arsenic before and after the workshift suggests that the high urinary arsenic levels (300 microgram/g creatinine) are likely to be more related to an increased oral intake from contaminated hands than to an increased absorption from the lungs.

Air↗
PubMed1985

Saccadic eye movements among copper smelter workers.

Saccade accuracy was studied in 87 copper smelter workers. Findings were compared with those obtained in 52 lead-exposed automobile production workers and 52 controls examined as part of a separate study. Both groups of workers showed a decrease in saccade accuracy compared to controls. Saccade accuracy was reduced in copper smelter workers over 50 years of age compared to automobile production workers in this age group. Decreased saccade accuracy was not correlated with blood lead (Pb-B), zinc protoporphyrin (ZPP), or urinary arsenic (As-U) levels among copper smelter workers, but was significantly correlated with both Pb-B and ZPP in the group of automobile production workers. Saccade accuracy decreased significantly with age and duration of exposure only in the group of copper smelter workers. Complex exposures to lead and other toxic agents present in the smelter may account for the reduction in saccade accuracy among copper smelter workers.

Adolescent↗
PubMed1986

Fiber size and number in workers exposed to processed chrysotile asbestos, chrysotile miners, and the general population.

We analyzed chrysotile and chrysotile-associated amphibole (largely tremolite) asbestos fibers in 21 workers exposed to various types of processed (milled) chrysotile ore, 20 long-term chrysotile miners, and 20 members of the general population (controls). Significantly greater amounts of both chrysotile and tremolite were found in processed-ore workers and miners than in controls. On average, the mean fiber lengths and aspect ratios for the mining and processed-ore-exposed workers were similar and were significantly greater than the values seen in the controls; within the processed-ore group, there was a marked variation in these parameters, and some workers appeared to be exposed to fairly long, thin fibers. It was found empirically that the fiber size data, and to a lesser extent the concentration data, could be used to classify workers accurately into those with processed-ore exposure and controls. We conclude that fiber sizes in the lungs of processed-ore-exposed workers are similar to those of chrysotile miners and are considerably longer than those found in the general population; some processed-ore workers have longer fibers which might be responsible for higher disease incidences in certain working groups; tremolite accompanies chrysotile in a variable proportion of workers exposed to processed chrysotile products and might be important in the genesis of mesothelioma in such workers; and mineralogic analysis will usually detect exposure even when chrysotile has largely disappeared from lung tissue.

Air Pollutants, Occupational↗
PubMed1989

X-ray findings, lung function, and respiratory symptoms in black South African vermiculite workers.

Health effects have been documented among American vermiculite workers who mined and processed vermiculite contaminated with amphibole asbestos, viz., tremolite-actinolite. Workers mining and processing South Africa vermiculite (N = 172), which contains very little asbestos, underwent x-ray examination and lung function testing and completed a respiratory symptom questionnaire. The vermiculite workers were compared with other workers involved in the mining or refining of copper. Only two of the vermiculite workers showed evidence of small opacities of 1/0 or more (according to the ILO 1980 classification); lung function was comparable with the other groups of workers, and there was no excess of respiratory symptoms among the vermiculite workers. It is concluded that workers exposed to vermiculite that is minimally contaminated with asbestos are probably not at risk for pneumoconiosis, lung function impairment, or respiratory symptoms. It is likely that the health effects observed in other studies of vermiculite workers are the result of concomitant asbestos exposure. A risk of mesothelioma caused by the fiber content of the vermiculite cannot be excluded by this study.

Adult↗
PubMed1990

Altered immune status in aluminum reduction plant workers.

From 1978 to 1985, B-cell lymphoma occurred in five employees of an aluminum reduction plant (expected = 0.2; Poisson distribution). As immunodeficiency is a known risk factor for B-cell lymphoma, we did a pilot study to evaluate immune function in apparently healthy plant workers. Twenty-three volunteers were selected for study from 350 workers, representing a range of experience in the potroom and with exposures to strong magnetic fields and volatilized aromatic hydrocarbons. Potroom workers had significantly higher T8 levels (mean = 1,227) than non-potroom workers (mean = 597) (p less than .05, Wilcoxon rank sums) or established normal values (median = 450). T4 levels were higher for potroom workers (mean = 1,017) than for non-potroom workers (mean = 558) or for established norms (median = 756) (p less than .10, Wilcoxon rank sums). Ten of 20 potroom workers had abnormal T4/T8 ratios (less than 0.91) due to disproportionate elevation of the T8 subpopulation. These data suggest an underlying immune alteration in the aluminum workers studied. Further study is needed to assess the implications of abnormal T-cell subsets in a worker population with high rates of lymphoma.

Adult↗
PubMed1993

Perspective on the content of worker notifications.

The concept of worker notification has evolved over the years to a prevailing view that workers should be notified of all epidemiologic studies that make use of their medical information. To adequately communicate health information to workers, epidemiologists must consider the intended audience along with its need for risk information that is scientifically valid and clearly outlines areas of uncertainty. This goal is facilitated by full disclosure to workers of information pertinent to the planning, conduct, and interpretation of research efforts. Subjectivity in choosing unanticipated research findings for inclusion in worker notifications may permit bias toward a personal viewpoint, but this can be minimized by prestudy agreement on appropriate criteria for selecting which research findings to communicate. Epidemiologic theory and principles of causal inference should guide the development of appropriate criteria. The timeliness of worker communications has received limited attention, and workers have often been the "last to know" about important studies. This may influence workers' receptivity to the risk message. Sponsoring organizations should ensure that an acceptable communications plan is included in research protocols and that the plan accords priority to notifying workers about study results.

Causality↗
PubMed1994

Nasal septum lesions caused by chromium exposure among chromium electroplating workers.

A chromium electroplating worker, suffering from epistaxis during work, was found to have nasal septum perforation. To determine the etiology and prevalence of nasal septum lesions, we conducted a survey of seven chromium electroplating factories and examined 79 workers. Forty workers from three aluminum electroplating factories were also enrolled as the reference group. Subjects were thoroughly examined by an otolaryngologist and each of them provided a blood and urine sample. A questionnaire interview regarding symptoms of the upper respiratory tract, past medical history, life style, and work history was also conducted. Air chromium concentrations were measured by taking area samples for 4-6 hours. Based on field observation and chromium measurements, we divided chromium electroplating into three different exposure zones: workers directly dealing with electroplating tanks (n = 31), other process workers (n = 29), and office workers and drivers (n = 19). Among the 79 chromium electroplating workers, there were 16 cases of nasal septum perforation, and 42 with either scar formation or ulceration; 10 chromium electroplating workers developed skin ulcers after performing chrome plating. No workers from aluminum electroplating factories had any nasal septum or skin abnormalities. There was a consistent trend between the degree of chromium exposure and the signs and symptoms related to the nose, throat, and skin. Immediate improvement of occupational hygiene is warranted.

Adult↗
PubMed1995

Workers' response to risk notification.

Since 1988, the National Institute for Occupational Safety and Health (NIOSH) has notified workers who were subjects in occupational epidemiology studies of the study findings ("worker notification"). This paper describes seven notifications and the worker's reactions to them. The chemicals of interest in the studies were: carbon monoxide, o-toluidine, bis-chloromethyl ether, polychlorinated biphenyls, cadmium, acid mist, and dioxin. Materials describing the study results were sent to 15,958 subjects who were notified of their increased risk of arteriosclerotic heart disease, bladder cancer, lung cancer, melanoma, kidney dysfunction, laryngeal cancer, all cancers combined, or soft tissue sarcoma. Workers provided feedback via telephone calls, and for three notifications, by postcards containing workers' comments and ratings of the notification materials. The percentage of telephone calls received from notified workers ranged from 0.3% to 3.8%, and the percentage returning postcards ranged from 8.8% to 17.6%. The two largest categories of callers were those with questions about their disease risk (30%) or who reported on their health status (25%). Most of the comments on postcards (26%) were complimentary or expressed appreciation for receiving the letters; reports of ill health were second (20%). A majority (66%) rated the notification materials well done. Few of the callers (5%) requested information on legal issues. Most (85%) did not find the materials, which ranged in reading level from sixth to ninth grade, too hard to read, although 15% reported difficulty reading them. Although this response system was effective in producing some input from workers, its limitation is that respondents may not be representative of all notified workers. However, such information is useful because there are few data on the effects of notifications on workers.

Carcinogens↗