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Respiratory morbidity in rubber workers: II. Pulmonary function in curing workers.

Pulmonary function tests were conducted on 121 curing and 189 control workers in 1972; 87% of the 1972 cohort was resurveyed one year later. The curing workers were subdivided into high and low exposure groups on the basis of environmental sampling. Cross-sectionally, in the 1972 cohort, the residual forced vital capacity was significantly decreased (P greater than .01) among the the heavily exposed workers (266 ml). Longitudinally, the mean one-year loss of forced expiratory volume in one second (FEV1.0) (173 ml/yr) in the curing workers with more than ten years of exposure was significantly greater (P less than .01) than in the control groups. Pulmonary function tests before and after a day's work were conducted on 29 curing-room workers. The eight heavily exposed curing workers had a significant decrease (P less than .05) in FEV1.0 of 115 ml. Our findings are sufficient to conclude that heavy exposure to curing fume affects pulmonary function. We recommend reduction of exposure and further longitudinal studies, especially in regard to those most heavily exposed.

Adult↗

Procedures to protect health-care workers from HIV infection: category I (health-care) workers.

At the heart of the recommendations to prevent HIV transmission in workers who perform high-risk tasks are the universal blood and body fluid precautions. These precautions are meant to be followed by all health-care workers in the care of all patients and by public safety workers (e.g., firefighters, police officers, and correctional facility personnel) whenever they perform specific tasks that expose them to blood, body fluids, or tissues. Universal precautions apply to blood, semen, vaginal secretions, body tissues, cerebrospinal fluid, synovial fluid, pleural fluids, peritoneal fluid, pericardial fluid, and amniotic fluid. These fluids have either been implicated in HIV transmission or their risk of transmission is unknown. Other fluids or excretions are excluded from universal precautions because epidemiologic studies have failed to implicate them in HIV transmission. These include feces, nasal secretions, sputum, sweat, tears, urine, vomitus, breast milk, and saliva, unless they contain visible blood. However, routine precautions (handwashing, gloves, etc.) to prevent exposure to other diseases transmitted by these media should be followed. Other precautions are directed at health-care workers who perform specialized at-risk procedures, e.g., surgeons, dentists, laboratory workers, etc. In general, recommendations for these workers include the universal precautions plus additional emphasis on the use of barrier measures. Although the risk of environmentally mediated HIV transmission is negligible, it is theoretically possible, and recommendations to kill or inactivate HIV on environmental surfaces should be followed. Fortunately, HIV is easily inactivated in the environment. The cheapest and most convenient method is a 1:10 or 1:100 dilution of household bleach.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗

Why are manual workers at high risk of upper limb disorders? The role of physical work factors in a random sample of workers in France (the Pays de la Loire study).

OBJECTIVE: To investigate the reasons for the excess risk of upper limb musculoskeletal disorders among manual workers compared with other workers in a random sample of 2656 French men and women (20-59 years old) participating in a study on the prevalence of work related upper limb disorders conducted by France's National Institute of Health Surveillance. METHODS: Prevalence ratios (PR) of physician-diagnosed musculoskeletal disorders of the shoulder, elbow, wrist, and hand (any of six leading disorders, rotator cuff syndrome, carpal tunnel syndrome) in manual versus non-manual workers were calculated using Cox regression models with a constant time of follow up and robust variance. RESULTS: 11.3% of men and 15.1% of women were diagnosed with an upper limb disorder. The risk was especially high in manual workers (PRs: 1.40 to 2.10). Physical work factors accounted for over 50% of occupational disparities overall, 62% (men) to 67% (women) for rotator cuff syndrome, and 96% (women) for carpal tunnel syndrome. The authors calculated that under lower levels of physical work exposures, up to 31% of cases among manual workers could have been prevented. CONCLUSIONS: In working men and women, upper limb musculoskeletal disorders are frequent. Physical work exposures, such as repetitive and forceful movements, are an important source of risk and in particular account for a large proportion of excess morbidity among manual workers.

Adult↗

Cancers in concrete workers: results of a cohort study of 33,668 workers.

OBJECTIVES: To study cancer morbidity patterns in concrete workers. METHODS: A cohort of 33,503 concrete workers was enrolled in the study from 1971-86. The average duration of follow up was 19.4 years (582,225 person-years). The workers' cancer morbidity was compared with the morbidity of the general population. RESULTS: A total of 3572 incident cancers were observed. Significantly increased standardised incidence ratios (SIRs) were found for all malignant neoplasms (SIR 107; 95% confidence interval (95%CI) 103 to 110), cancer of the lip (SIR 179; 95%CI 134 to 234), cancer of the stomach (SIR 139; 95%CI 122 to 158), cancer of the lung (SIR 125; 95%CI 114 to 137), and cancer of the prostate (SIR 108; 95%CI 101 to 116). Reduced risk was found for cancer of the large intestine (SIR 80; 95%CI 69 to 93) and cancer of the testis (SIR 50; 95%CI 26 to 87). Smoking was more prevalent among the concrete workers than in the general population (50% v 35%). CONCLUSION: The study has shown a slightly increased overall risk of cancer among concrete workers. The increased risk of lung cancer could entirely be due to differences in smoking habits between concrete workers and the general population. There is a possibility that the smoking also has contributed to the increased risks of stomach cancer and lip cancer, but occupational factors may have contributed to these cancer sites.

Adolescent↗

Occupational asthma in electronics workers caused by colophony fumes: follow-up of affected workers.

Thirty-nine electronics workers were investigated by bronchial provocation testing to soldering fluxes containing colophony and were followed up one to four years later. At presentation and on follow-up each worker had nonspecific bronchial reactivity measured with inhaled histamine, and also had detailed measurements of lung function and estimation of total immunoglobulin levels. They completed a questionnaire designed to detect residual disability. The workers were divided into three groups. Twenty had left work after their initial diagnosis, eight had been moved to alternative work within their original factories, and 11 were thought to have asthma unrelated to colophony exposure as they failed to react to colophony at presentation. Histamine reactivity had returned to normal in half the workers who had left their original factories, but in only one worker who had moved within her original factory. This suggested that the nonspecific bronchial reactivity to histamine was the result rather than the cause of the occupational asthma, and that indirect exposure at work was sufficient to delay recovery of histamine reactivity. However, only two of the 20 affected workers who had left their original factories were symptom free on follow-up, and most had a considerable reduction in their quality of life by continuing asthma, which was particularly provoked by exercise, respiratory infections, and nonspecific irritants. Continuing symptoms may have been caused by domestic sources of colophony, or possibly the failure to eliminate colophony from the lungs.

Adult↗

Health care workers: vectors of influenza virus? Low vaccination rate among hospital health care workers.

The influenza vaccination rate among health care workers is not very high and needs to be improved. The authorities of our university hospital decided to encourage vaccination among health care workers and to include it in the hospital quality of care program. A survey about knowledge of influenza disease and its vaccination was undertaken, and 37.2% of the workers participated in the survey. Among them, 31.8% were vaccinated. The vaccination rate was higher when workers were older, men, physicians, technicians, or laboratory workers, vaccinated in the previous flu season and had fewer contacts with patients. The variables with the highest impact on the vaccination rate were vaccination the previous year, belief that vaccination is highly effective, and affirmation that prevention is important. Our study shows that an active vaccination campaign is also necessary for health workers to put them in the stream of usually vaccinated people.

Adult↗

Mortality among retired fur workers. Dyers, dressers (tanners) and service workers.

A retrospective cohort mortality study was conducted on 807 fur dyers, fur dressers (tanners), and fur service workers who were pensioned between 1952 and 1977 by the Fur, Leather and Machine Workers Union of New York City. Workplace exposures of fur workers varied with job category. Dyers were exposed to oxidative dyes used in commercial hair dyes; dressers and service workers were exposed to tanning chemicals. In a comparison with the New York City population, no significant increases in mortality were observed among the fur dyers. Among fur dressers, mortality from all malignant neoplasms [standardized mortality ratio (SMR) 151] and lung cancer (SMR 232) was significantly elevated, as was mortality from cardiovascular disease (SMR 126) among fur service workers. When examined by ethnic origin, the elevated SMR values and directly age-adjusted rate ratios suggested that foreign-born fur dressers and eastern European-born fur workers experienced the highest risks for lung and colorectal cancers, respectively. These data support previous findings of increased mortality from colorectal cancer in the foreign-born population of the United States and suggest a possible occupational etiology for the observed lung cancer excess.

Adult↗

[A follow-up study on pulmonary functions of workers exposed to various forms of dust. Observation on the workers of pneumoconiosis in Kitakyushu].

Serial spirograms of 121 dust workers whose chest X-rays were found to be "class 1" of the diagnostic criteria for pneumoconiosis were obtained during 1978-80. Yearly changes of pulmonary function variables (%VC, FEV1, FEV1/FVC%,V25/H, and V50/V25) by age, smoking habit, total years of exposure to dust, and work history were evaluated. The average age of the dust workers was 48.0 +/- 5.5 years, and the average years of exposure to dust was 21.6 +/- 6.8 years in 1978. Eighty-two dust workers smoked with the mean smoking history of 24.7 pack-years. No significant differences of spirograms were found between the smoking and non-smoking groups. Among the smokers, however, linear regression of FEV1/FVC% by age gradually decreased during 1978-80. All the pulmonary function variables showed no correlation with smoking history as well as total years of dust exposure. All the dust workers were classified into eight types of work by their histories; crushing and quarrying operators, brick mason, foundry and grinding operators, asbestos workers, underground miners, refractory material workers, pyrites roasters, and welders. The underground miners showed lower FEV1/FVC% and V25 than the average. However, the difference of such pulmonary function variables by eight types of work was not significant by analysis of variance. Since aging is the most dominant factor for pulmonary dysfunction, a longer observation on this group will be needed.

Age Factors↗

The healthy worker effect in actively working communications workers.

The healthy worker effect is examined in a large population of actively working communications workers. The mortality experience of 338,306 white male workers at the American Telephone and Telegraph Company grouped by age, duration of service, and general cause categories is compared with the mortality experience of US white males in 1976. Observed were statistically significant and often substantial deficits in mortality among these active workers in almost all categories. For cancers and cardiovascular diseases, mortality ratios tended to decrease across age in the subgroups with longer service durations; these ratios consistently increased across duration of service in older ages. In subgroups with long service durations, the secondary selection of the healthy worker effect in this active worker population appears to increase with increasing age.

Adult↗

Long-term mortality of oil refinery workers. II. Comparison of the experience of active, terminated and retired workers.

In occupational epidemiology a retrospective cohort study normally includes active, terminated, and retired employees and the mortality results may vary considerably if any of the three groups is excluded from the study. From a large refinery cohort of 12,526 white male workers followed between January, 1937 and January, 1978, the mortality experience of three groups (the active, terminated and retired) has been examined; detailed results, along with the merits and problems of studying these groups separately, are presented. The standardized mortality ratios (SMRs) for all causes are 0.68, 1.04 and 0.89 for the active, the terminated and the retired, respectively, and for all cancer, 0.85, 0.98 and 1.05. Significantly decreased SMRs are seen for most of the causes among the active and may be attributed to the "healthy worker effect." Exclusive study of active workers, although it may yield certain useful information, particularly on diseases of the young and those with short latency periods, is primarily a study of the healthy worker effect. Many favorable effects of the active worker will be encountered. The retirees as a whole experienced no significant excess mortality for any causes, although examination of a subgroup, the early retirees, did reveal a significant excess of deaths from diseases of the nervous system and sense organs. The retired may appear to be an ideal group for study because they usually have worked for an extended period of time, they may have experienced long-term occupational exposure and they have lived long enough to develop diseases with long latency periods; however, serious problems arise from studying only the retirees and these are discussed. The terminated group contributed 41% of the person-years, 49% of the total number of individuals and 38% of the deaths and is far too important to be omitted. Contrary to previous reports, the terminated did not demonstrate a significantly adverse mortality experience when compared with the general population, although they did not show the healthy worker effect that was seen among the active.

Adult↗

Social Security benefits of female retired workers and two-worker couples.

This article makes available for the first time actual program data on benefits of couples in which both spouses receive benefits as retired workers. Traditional data have always classified two retired workers married to each other as separate "worker-only" beneficiaries. In this study of 1976 data, however, the benefits of husbands and wives were linked. It was found that average benefits for all couples--those in which the wife received a benefit as a retired worker and those in which she received a benefit only as a spouse--were about 8 percent higher than the amount usually reported from administrative records. Average benefits for couples in which the wife received a retired-worker benefit were about 18 percent higher than those for couples in which she received only a spouse's benefit. This article also examines the benefit levels and entitlement status of never-married, divorced, and widowed female retired workers according to their marital status. This information is likewise not routinely available from administrative records. Widows were about as likely as wives to be entitled only on the basis of their own earnings. Among all women, benefits were found to be highest for dually entitled widows and lowest for wives entitled only to a spouse's benefit.

Age Factors↗

Comparison of lung cancer risks for dust workers, asbestos-cement workers and control groups.

In a prospective study, 1630 men exposed to dust for long periods (foundry workers and workers in metal, ceramics, glass, stone and other industries) and 1630 controls not exposed to dust were registered between the years 1950 and 1960; the population comprised workmen living in Vienna and born in 1910 or before. Controls were matched according to age and smoking habits. Causes of deaths were followed up to 1976 from official death certificates, mainly issued by hospitals with routine autopsy. General mortality was higher in the dust-exposed group, and there was a significant excess of deaths from lung cancer: 1.5 times higher than that for controls, 1.6 times higher than that for other Viennese men of the same age and 2.1 times higher than that for Austrian men. There were no excess deaths from lung cancer up to the age of 60. It is evident that only long exposure times raise the lung cancer risk for dust-exposed workers. In a historical prospective study of asbestos-cement workers and control groups, using the same criteria of sex, age and exposure time, the preliminary data show an age-standardized relative risk of 1.5 for asbestos-cement workers compared with cement workers, but no excess risk in comparison with the local and general population.

Age Factors↗

Workers' compensation experience of North Carolina residential construction workers, 1986-1994.

A total of 31,113 workers' compensation claims among 7,400 North Carolina Homebuilders Association (NCHA) members and their subcontractors for the period 1986-1994 were analyzed to calculate workers' compensation claim incidence density rates. For the 7 years studied, the average rate (cases/200,000 work hours) for all claims was 16.40 and the rate for medical or lost time cases was 10.78. Highest rates for cases involving medical costs or paid lost time by mechanism of injury were observed for being struck by an object (3.1), lifting/movement (1.97), falls from a different level (1.13), striking against an object (0.87), and falls on the same level (0.46). Rates by mechanism of injury were highest for muscle strains (2.34), wounds/punctures (2.33), bruises/contusions (1.24), fractures/dislocations (0.98), and injuries to the eyes (0.81). Among medical cost or lost work time cases, body parts with highest injury rates were back/shoulders (1.99), fingers (1.31), leg/knee (1.00), hand/wrist (1.00), foot/ankle (0.86), and eyes (0.82). Injury rates were found to vary substantially among the residential construction trades. For more serious injuries involving medical costs greater than $2,000 or any lost work time, rates were highest for welders and cutters (28.1), insulators (24.3), roofers (19.4), and carpenters (15.3). The same general trends by trade were observed for cases involving paid lost time except that roofers were highest, with a rate of 9.1, followed by insulators (8.5), welders and cutters (5.8), and carpenters (5.8). Rates of falls from a different level resulting in medical costs or lost work time were highest for roofers (5.54), insulators (3.53), carpenters (2.05), and drywall installers (1.99). Descriptive information for falls from a different level resulting in paid lost time during 1993-1994 (n = 219) were reviewed to better determine the causes and circumstances of injuries. Falls from a roof accounted for 25.4 percent of the cases followed by falls involving scaffolds (23.9%) and ladders (20.6%), and falls from ceiling joists, floor joists, or framing (14.8%). Twenty-six work-related deaths occurred with vehicle accidents (n = 6) being the major known cause of death, followed by falls (n = 3), being struck by an object (n = 3), electric shock (n = 2), and contact with energy or chemicals (n = 2). Consistent with other analyses of workers' compensation data, chronic occupational diseases are not well captured in the workers' compensation claims among home builders; therefore, a companion study has examined mortality patterns among North Carolina construction workers.

Humans↗

Occupationally acquired HIV: the vulnerability of health care workers under workers' compensation laws.

Approximately 800,000 needlesticks and other sharp injuries from contaminated medical devices occur in health care settings each year, of which an estimated 16,000 are contaminated by human immunodeficiency virus (HIV). Health care workers who are occupationally infected by HIV are at risk of being left without workers' compensation coverage. In some states, the definition of an occupational disease is so restrictive that infected health care workers are unlikely to qualify for benefits. For those who are able to meet the definition, compensation is often inadequate. Recourse is also limited by statutory provisions that preclude health care workers from bringing civil suits against their employers. We recommend the amendment of legislation to provide more equitable remedies, including: (1) broadening the definition of occupational disease; (2) eliminating provisions that require a claimant to prove that (a) a specific occupational incident resulted in infection and (b) HIV is not an ordinary disease of life; (3) expanding the time for filing a claim; (4) assuring that lifetime benefits will be provided to the disabled health care worker; and (5) assuring that claims will remain confidential.

Blood-Borne Pathogens↗

Long-term mortality study of oil refinery workers: V. Comparison of workers hired before, during, and after World War II (1940-1945) with a discussion of the impact of study designs on cohort results.

The mortality experience of a large refinery cohort (1937-1978) was examined by dividing it into three subcohorts according to hire dates: those hired before 1940, those hired during the period 1940-1945, and those hired after 1945. These three periods are approximately equivalent to before, during, and after World War II and span a total hiring period of more than 75 years. The results showed that a substantial portion of the cohort (3,330 or 27%) had been recruited during 1940-1945, and they contributed 980 or 28% of the total deaths. However, their mortality experience was quite different from the rest. A series of significant increases were seen among the external causes for accidents, suicide, and homicide. In terms of overall mortality and in contrast to the rest of the cohort, no "healthy worker effect" was seen (SMR = 1.00). They also showed increases in several types of cancer including cancers of the pancreas and prostate and leukemia. These unusual experiences cannot be explained either on the basis of their war-related deaths or on their period of employment (one-half were terminated within 1 year from date of hire), and data is insufficient to separate the role of hiring practices or their socioeconomic status. However, their life-styles were probably quite different judged from the fact that alcoholism-related deaths were increased as much as fivefold. Almost two-thirds of the total deaths occurred among 4,080 workers in the before 1940 subcohort. Further, the 5,117 workers of the after-1945 subcohort contributed only 5% of the total deaths. Thus, the results of the original refinery cohort (1937-1978) primarily reflect the experience of those employees hired before 1940. Given the same cohort method (historical prospective), cohort results vary widely according to different study designs, and this has implications for "generalizable" risk assessment or risk projections. A prospective study of new hires with 30 years of follow-up is rather inefficient because it would yield only a small number of deaths, with a strong healthy worker effect. The same is true for studies based on active workers with a short period of follow-up. Studies based on time of hire, however, provide a means for controlling time-related occupational exposures.

Accidents↗

Who supports the support workers? Cross-sectional survey of support workers' experience and views.

Support groups provide information and emotional support to families. Despite a recent growth in the number and size of these groups, there are no formal structures in place to provide support for the support worker. We performed a cross-sectional survey using a self-completion postal questionnaire, with the aim of identifying the structure, training needs and support given to workers. The participants were support workers from 112 United Kingdom-based organisations listed on the 'Contact a Family' website (www.cafamily.co.uk). We received 104 replies from 50/112 organisations (44%). Of these, 94/104 (90%) worked from home as volunteers. Two-thirds, 69/104, admitted times when they struggled to cope. A total of 43 (41%) admitted occasions of concern over the care given by a client to their affected relative. No group employed a professional to act in a clinical supervisory role. Our study suggests that support workers are highly committed to their role; these workers need support to ensure that they give appropriate advice under difficult circumstances.

Adaptation, Psychological↗

Honeybee colony integration: worker-worker interactions mediate hormonally regulated plasticity in division of labor.

Adult workers in honeybee (Apis mellifera) colonies exhibit plasticity in hormonally regulated, age-based division of labor by altering their pattern of behavioral development in response to changes in colony conditions. One form of this plasticity is precocious development: levels of juvenile hormone increase prematurely and bees begin foraging as much as 2 weeks earlier than average. We used two experimental paradigms inspired by developmental biology to study how bees obtain information on changing colony needs that results in precocious foraging. An analog of "cell culture," with bees reared outside of colonies in different sized groups, revealed that worker-worker interactions exert quantitative effects on endocrine and behavioral development. "Transplants" of older bees to colonies otherwise lacking foragers demonstrated that worker-worker interactions also affect behavioral development in whole colonies. These results provide insights to a long-standing problem in the biology of social insects and further highlight similarities in the integration of activity that exist between individuals in insect colonies and cells in metazoans.

Age Factors↗

Agricultural workers' return to work following spinal cord injury: a comparison with other industry workers.

PURPOSE: To investigate the impact of spinal cord injury on employment outcomes as experienced by agricultural workers in comparison with persons employed in other industries. Because of the challenges associated with working in many of the agricultural industries, it was anticipated that agricultural workers would achieve inferior return-to-work outcomes. METHOD: Survey of all employed persons who experienced a traumatic spinal cord injury in southeastern Australia between 1990 and 1996 (inclusive). RESULTS: Contrary to expectation, agricultural workers had a significantly higher rate of return to work (61.7% vs. 41.1%). However, an investigation into the hours spent working and agricultural workers' satisfaction with their employment activities, indicated that most were underemployed and had the potential to achieve even better outcomes. CONCLUSION: Results indicate that more can be done to help injured agricultural workers achieve their employment potential.

Adult↗