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HIV-1 infection among female commercial sex workers in rural Thailand.

OBJECTIVE: To reconstruct past HIV-1 incidence and identify risk factors for HIV-1 seroconversion among female commercial sex workers in a semi-rural setting in northern Thailand. DESIGN: Retrospective cohort of sex workers attending a sexually transmitted disease (STD) clinic at Mae Chan District Hospital, Chiang Rai Province, Thailand. METHODS: Information included demographic data, HIV-1 antibody testing and STD diagnosis was collected in 821 sex workers attending the STD clinic from 1989 through 1993. HIV-1 incidence among initially HIV-1-seronegative sex workers who underwent repeat HIV-1 antibody testing during follow-up was determined and possible predictive factors for seroconversion including diagnosis of other STD were examined. RESULTS: HIV-1 seroprevalence among 556 sex workers who underwent antibody testing was 52%, rising from 29% at initial test in 1989 to 53-63% for 1990-1993. Among 96 initially HIV-1-negative sex workers who underwent repeat testing, 64 HIV-1 seroconversions occurred, giving an incidence rate of 12.6/100 person months (PM). Incidence increased from 12.0/100 PM for 1989 and 1990 to 17.0/100 PM for 1991, with a subsequent decline to 9.3/100 PM for 1992-1993. The cumulative risk of seroconversion 6 months following initial negative HIV-1 antibody test was 57%. There were higher rates among younger sex workers (14-19 years old) and those from Hilltribes, but only a diagnosis of chancroid was significantly associated with HIV-1 seroconversion (P = 0.014). CONCLUSION: An explosive epidemic of HIV-1 occurred among sex workers in a semi-rural area of northern Thailand from 1989. These HIV-1 incidence estimates, which are among the highest rates of sexual transmission ever reported, highlight the extreme vulnerability of female sex workers to HIV infection, even in a non-urban setting.

Adolescent↗

Mortality and career radiation doses for workers at a commercial nuclear power plant: feasibility study.

Career radiation doses for 8,961 male workers at the Calvert Cliffs Nuclear Power Plant (CCNPP) were determined for both utility (n = 4,960) and contractor (n = 4,001) employees. Workers were followed from the time of first employment at CCNPP (including plant construction) to the end of 1984 (mean follow-up = 5.4 y). Plant operation began in 1975. The mean duration of employment was 1.9 y at CCNPP and 3.1 y in the nuclear industry. Career radiation doses were determined from dosimetry records kept by the utility company and the U.S. Nuclear Regulatory Commission (NRC). For all exposed workers, the average career dose was 21 mSv and was higher for contractor (30 mSv) than utility (13 mSv) workers. Career doses were also higher among those employed in the nuclear industry for greater than or equal to 15 y (111 mSv) and among workers classified as health physicists (56 mSv). Cumulative doses of greater than or equal to 50 mSv were received by 12% of the workers; the maximum career dose reported was 470 mSv. The availability of social security numbers for practically all employees facilitated record-linkage methods to determine mortality; 161 deaths were identified. On average the workers experienced mortality from all causes that was 15% less than that of the general population of the U.S., probably due to healthier members of the population being selected for employment. Our investigation demonstrates that historical information is available from which career doses could be constructed and that, in principle, it is feasible to conduct epidemiologic studies of nuclear power plant workers in the U.S. Although difficult, the approach taken could prove useful until such time as a comprehensive registry of U.S. radiation workers is established.

Adult↗

The Bali STD/AIDS Study: evaluation of an intervention for sex workers.

BACKGROUND: Prostitution has been an important factor in the spread of HIV infection in Asia. Interventions need to be developed to reduce the risk of transmission of sexually transmitted infections in this area. GOALS: To educate female sex workers about sexually transmitted infections and assess the impact of the educational intervention. STUDY DESIGN: Brothel areas in Denpasar, Bali, Indonesia, were divided into areas of high and low program (interventional) effort. The intervention included educational sessions for sex workers, treatment of sex workers for sexually transmitted disease (STD), condom distribution, and printed information for clients of the sex workers. A high-effort area was one in which a more intensive educational intervention occurred. A clinic was available for STD treatment in both areas. Behavioral surveys and STD testing were used to evaluate the programs. Six hundred female sex workers participated in behavioral surveys and STD examinations every 6 months for four rounds of data collection. Each round, about half of the women were new to the study. A total of 1586 women participated in at least one evaluation round. Changes were evaluated in AIDS knowledge, STD knowledge, and condom use, as well as in the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, and Trichomonas vaginalis. Testing for HIV was conducted anonymously. RESULTS: Improvements were noted in the knowledge of sex workers about AIDS and STDs and in the reduction of some bacterial STDs. Women who remained in the study area for more than one round had increased knowledge of HIV infection/STDs and condom use and had reduced levels of syphilis, gonorrhea, and trichomonas infection (P < 0.01). The additional education received by women in the high-effort program area was associated with a reduction in the prevalence of syphilis. Prevalence of HIV remained low throughout the study. The high level of turnover of female sex workers contributed to the maintenance of significant levels of STDs in this population. CONCLUSIONS: Developers of HIV/STD prevention programs for sex workers need to consider the mobility of the sex worker population. Interventions combining behavioral and medical approaches can contribute to prevention of these diseases.

Acquired Immunodeficiency Syndrome↗

Pulmonary function in long-term asbestos workers in China.

The relationship of pulmonary function to exposure to asbestos and radiographic abnormalities has been controversial, especially when smoking is present as a confounder. The aim of the study was to provide further understanding on the radiographic-physiologic associations in nonsmoking and smoking asbestos workers. Radiographic asbestosis, pleural lesion, and pulmonary function were studied in 269 Chinese asbestos workers, with average exposure years of 23 for male workers and 18 for female workers. Their functional data were compared with those of 274 controls without exposure to dust. Although most of the male workers were smokers, none of the female workers smoked. In comparison with controls, asbestos workers had significantly lower lung volume and diffusing capacity, irrespective of gender. Female workers and smoking male workers had lower measurements of forced expiratory volume in 1 second and instantaneous forced expiratory flow at 50% and 25% of forced vital capacity. After adjustment for relevant covariates, asbestos exposure, asbestosis, and pleural abnormalities were associated with decreased parameters of pulmonary function, including lung volume, diffusing capacity, and airway flow. These data indicate that asbestos-related functional defects manifested by lung restriction and mild airway obstruction correlate with exposure to asbestos and with parenchymal and pleural abnormalities, independent of smoking.

Adult↗

Evaluation of blink reflex results obtained from workers previously diagnosed with solvent-induced toxic encephalopathy.

We reviewed blink reflexes recorded from 51 railroad workers with long-term occupational exposure to solvents who were diagnosed by others with solvent-induced toxic encephalopathy. No worker fulfilled conventional clinical criteria for dementia or trigeminal mononeuropathy. All workers had normal R1 and R2 blink reflex latencies. R1 latencies correlated significantly with several nerve conduction measures, including F wave latencies, suggesting that some intersubject variability reflected intrinsic conduction properties, not isolated brain-stem function. Although normal, the workers' R1 latencies were significantly prolonged compared with historical control groups, including gender-matched control subjects of similar mean age (11.2 ms vs 9.9 ms; P < 0.0001). Stepwise multiple regression models demonstrated significant associations of R1 latency with age and use of CNS-active prescription medications (P = 0.003), but duration of occupational solvent exposure did not enter into the models. Paradoxically, workers using CNS-active medications had significantly shorter R1 latencies compared with workers not using such medications (10.9 vs 11.7 ms; P = 0.01). Job title, another potential surrogate measure of exposure, was not significantly related to reflex latencies. The geographical site of predominant solvent exposure did influence R1 latency, and workers from one site had longer exposure duration and longer R1 latencies than remaining workers. However, an interaction between age and exposure duration (r = 0.39; P = 0.003) confounded interpretation of this observation. Disability or work status, mental status findings, or classification of encephalopathy did not influence blink reflex latencies. The overall results do not support, but do not entirely exclude, a possible relationship between subclinical blink reflex abnormalities and occupational exposure to solvents. Nevertheless, it is clear from these results that the small group differences in R1 latency between exposed workers and control subjects are of no diagnostic importance and of uncertain physiologic importance, and they may reflect unrecognized confounders and technical factors.

Adult↗

Obstructive pulmonary function defects among Taiwanese firebrick workers in a 2-year follow-up study.

The purpose of the study was to follow up an earlier observation of pulmonary function among workers employed in firebrick-manufacturing factories. A 2-year follow-up study of pulmonary function among 442 workers in 30 firebrick-manufacturing factories was designed. Excluding 79 workers with a history of other occupational dust exposure, changes in pulmonary function of 291 firebrick workers were compared with pulmonary function in 72 control subjects over a period of 2 years. Baseline pulmonary function values (i.e., forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] and forced expiratory flow after 50% of vital capacity has been expelled [FEF50%] in smoking firebrick workers, and FEV1/FVC and FEF75% in nonsmoking firebrick workers) were significantly lower than those in the comparison group. The statistical method for repeated measurements was used for comparison of the difference between follow-up and baseline lung function. There was no significant difference in FVC and FEV1 changes between firebrick workers and those in the comparison group during the 2-year follow-up period. The decreases in FEV1/FVC, peak expiratory flow rate, maximal midexpiratory flow, and FEF50% in the firebrick workers were significantly greater than in the comparison group, after adjustment for smoking status. The FEV1, maximal midexpiratory flow, FEF50%, and FEF75% also showed a dose-response relationship with job titles. The decrement of pulmonary function in the 2-year follow-up period was the worst in burning work, followed by crushing and molding. The results show that workers in firebrick-manufacturing factories with exposure to silica-containing dusts may contract obstructive pulmonary function defects.

Adult↗

Association between dioxins/furans exposures and incinerator workers' hepatic function and blood lipids.

This study examined the effects of dioxins/furans on blood lipids and hepatic function and assessed potential interaction between hepatitis B virus (HBV) infection and dioxins on hepatic function for 133 male workers of municipal waste incinerators. We found that total cholesterol levels in workers with blood dioxins/furans levels of 15.4-59.0 pg TEQ/g lipid (high-exposure workers) averaged 13.5 mg/dL higher than workers with 5.5-15.3 pg TEQ/g lipid (low-exposure workers). The adjusted odds ratio for total cholesterol abnormality (>220 mg/dL) was 2.8 (95% confidence interval = 1.0-7.9) between high and low-exposure workers. High-exposure workers showed consistently, although not statistically significantly, higher abnormality in gamma-glutamyltransferase (>52 U/L), alanine aminotransferase (>41 U/L), and aspartate aminotransferase (>37 U/L) than did low-exposure workers. However, there was no statistically significant interaction between dioxins/furans and HBV on these hepatic enzymes among incinerator workers.

Adult↗

Allergic sensitization, symptoms, and lung function among bakery workers as compared with a nonexposed work population.

Only few studies have assessed relative risks on occupational asthma and allergy among bakery workers, and none of them have included respiratory and work-related symptoms as well as sensitization to occupational allergens and pulmonary function. A random sample of 246 workers from traditional and industrial bakeries in two regions of Belgium were compared with a reference population of 251 workers from a petrochemical plant in the same region. Data on skin test positivity, symptoms, and lung function were collected by standardized procedures. Differences between the two subpopulations were analyzed using multiple logistic and linear regression analyses. On average, bakery workers did not more often have skin test positivity than reference workers (39.4% and 42.6%, respectively). However, bakery workers had a strongly increased risk of sensitization to specific bakery allergens (OR 22.0, 95% CI = 6.3-77.1.), whereas their risks of positive skin tests to common allergens, including wheat pollen and storage mite, were significantly decreased (OR 0.6, 95% CI = 0.4-0.9). Bakery workers had significantly more often respiratory and work-related symptoms. Accordingly, they had lower lung function parameters. Atopy and sensitization to bakers' allergens were independent and additional risk factors for work-related symptoms. Bakery workers are at increased risk of respiratory and allergic symptoms and skin test reactivity to specific bakers' allergens wheat flour and alpha-amylase. Wheat pollen and storage mite should not be regarded as baker's allergens. Nevertheless, pulmonary function of bakery workers can be characterized as mild airway obstruction only.

Adult↗

Nepotism and brood reliability in the suppression of worker reproduction in the eusocial Hymenoptera.

In many eusocial Hymenoptera, workers prevent each other from producing male offspring by destroying worker-laid eggs. Kin selection theory predicts that such 'worker policing' behaviour can evolve by increasing the average relatedness between workers and their male brood. Alternatively, if worker-laid eggs are of low relative viability, their replacement would increase the developmental reliability of the brood. Less colony investment in terms of time and resources would be lost on poor males. This gain is independent of the relatedness of the males. Unfortunately, both nepotistic and group efficiency benefits can simultaneously accrue with the replacement of worker-laid eggs. Therefore, worker behaviour towards eggs cannot completely resolve whether both processes have been equally evolutionarily important. Adequate resolution requires the presentation of worker-produced brood of various ages. The stage at which brood are replaced can discriminate whether worker policing occurs owing to a preference for closer genetic kin, a preference for the more reliable brood or both.

Animals↗

Worker policing by egg eating in the ponerine ant Pachycondyla inversa.

We investigated worker policing by egg eating in the ponerine ant Pachycondyla inversa, a species with morphologically distinct queens and workers. Colonies were split into one half with the queen and one half without. Workers in queenless colony fragments started laying unfertilized male eggs after three weeks. Worker-laid eggs and queen-laid eggs were introduced into five other queenright colonies with a single queen and three colonies with multiple queens, and their fate was observed for 30 min. Significantly more worker-laid eggs (range of 35-62%, mean of 46%) than queen-laid eggs (range of 5-31%, mean of 15%) were eaten by workers in single-queen colonies, and the same trend was seen in multiple-queen colonies. This seems to be the first well-documented study of ants with a distinct caste polymorphism to show that workers kill worker-laid eggs in preference to queen-laid eggs. Chemical analyses showed that the surfaces of queen-laid and worker-laid eggs have different chemical profiles as a result of different relative proportions of several hydrocarbons. Such differences might provide the information necessary for differential treatment of eggs. One particular alkane, 3,11-dimeC27, was significantly more abundant on the surfaces of queen-laid eggs. This substance is also the most abundant compound on the cuticles of egg layers.

Aggression↗

Allergic contact urticaria from natural rubber latex in healthcare and non-healthcare workers.

To compare the prevalence of natural rubber latex (NRL) sensitization and allergic contact urticaria from NRL in healthcare and non-healthcare workers, we studied all 1171 patients who attended our clinic during 2001 and 2002. Prick testing for NRL and patch testing with European standard series were performed in all patients and an additional rubber series in those who had contact with rubber. Specific immunoglobulin E (IgE) levels against NRL and tropical fruits were measured when prick testing was positive. Sensitization to NRL (positive prick test and specific IgE levels) was much more common in healthcare workers than that in non-healthcare workers, 16.7 versus 2.3%. Among the non-healthcare workers, sensitization to NRL was more common in food handlers (17.1%), construction workers (6.6%), painters (6.2%), hairdressers (5.1%) and cleaners (3.8%). The difference in the prevalence of specific IgE to tropical fruits was not significant. Allergic contact urticaria from NRL was also much more frequent in healthcare workers, 71.4 versus 28.6%. In conclusion, sensitization to NRL and allergic contact urticaria from NRL are more common in healthcare workers, but this is a growing problem in non-healthcare workers and should be investigated in all workers with a history of NRL intolerance or who have contact with NRL.

Dermatitis, Occupational↗

Work-related bladder cancer risks in male Japanese workers: estimation of attributable fraction and geographical correlation analysis.

One hundred and forty-nine relative risks (RRs) on occupations and bladder cancer were extracted from 27 case-control studies and geometric means were calculated for 27 occupations as summary RRs. Those in high risk occupations, among whom the summary RRs significantly exceeded unity, were found to be petroleum workers (RR = 3.51), dye workers (RR = 3.38), machinists (RR = 2.76), drivers (RR = 2.22), rubber workers (RR = 2.19), printers (RR = 2.12), clothing/tailors (RR = 2.10), wood workers/carpenters (RR = 1.70), miners (RR = 1.68), textile workers (RR = 1.63), mechanics (RR = 1.54), engineers (RR = 1.54), leather workers (RR = 1.49), painters (RR = 1.48) and chemical workers (RR = 1.44). The estimated numbers of male bladder cancers in 1980 in the high risk and other occupations were 820 and 2065 cases, respectively. The estimated number of work-related bladder cancer was 548 cases, the attributable fraction being 19% in active employees and 12% in the entire population. The geographical distribution of male bladder cancer deaths in Japan was positively correlated with the distributions of workers in the transport/communications industry and in tertiary industries including services, wholesale, retail, finance and insurance, whereas it was negatively correlated with the distribution of workers in the agricultural industry. These findings suggest that workers in certain industries may be at high risk of bladder cancer, but lifestyle modification associated with urbanization and industrialization could be an alternative explanation.

Analysis of Variance↗

Towards a molecular definition of worker sterility: differential gene expression and reproductive plasticity in honey bees.

We show that differences in the reproductive development of honey bee workers are associated with locus-specific changes to abundance of messenger RNA. Using a cross-fostering field experiment to control for differences related to age and environment, we compared the gene expression profiles of functionally sterile workers (wild-type) and those from a mutant strain in which workers are reproductively active (anarchist). Among the set of three genes that are significantly differentially expressed are two major royal jelly proteins that are up-regulated in wild-type heads. This discovery is consistent with sterile workers synthesizing royal jelly as food for developing brood. Likewise, the relative underexpression of these two royal jellies in anarchist workers is consistent with these workers' characteristic avoidance of alloparental behaviour, in favour of selfish egg-laying. Overall, there is a trend for the most differentially expressed genes to be up-regulated in wild-type workers. This pattern suggests that functional sterility in honey bee workers may generally involve the expression of a suite of genes that effectively 'switch' ovaries off, and that selfish reproduction in honey bee workers, though rare, is the default developmental pathway that results when ovary activation is not suppressed.

Animals↗

Worker reproduction and policing in insect societies: an ESS analysis.

Insect societies are vulnerable to exploitation by workers who reproduce selfishly rather than help to rear the queen's offspring. In most species, however, only a small proportion of the workers reproduce. Here, we develop an evolutionarily stable strategy (ESS) model to investigate factors that could explain these observed low levels of reproductive exploitation. Two key factors are identified: relatedness and policing. Relatedness affects the ESS proportion of reproductive workers because laying workers generally work less, leading to greater inclusive fitness costs when within-colony relatedness is higher. The second key factor is policing. In many species, worker-laid eggs are selectively removed or 'policed' by other workers or the queen. We show that policing not only prevents the rearing of worker-laid eggs but can also make it unprofitable for workers to lay eggs in the first place. This can explain why almost no workers reproduce in species with efficient policing, such as honeybees, Apis, and the common wasp, Vespula vulgaris, despite relatively low relatedness caused by multiple mating of the mother queen. Although our analyses focus on social insects, the conclusion that both relatedness and policing can reduce the incentive for cheating applies to other biological systems as well.

Altruism↗

A preliminary study of the mental health of young migrant workers in Shenzhen.

The aim of this study is to examine the mental health status of young migrant workers in Shenzhen. Using the Symptoms Check List-90 (SCL-90), Eysenck Personality Questionnaire, Social Support Scale and Mental Health Questionnaire for Laborers, 371 migrant workers who came from inland areas of China and 100 local workers were investigated. The SCL-90 profile of migrant workers was also compared to the SCL-90 norms provided by general people in China. The SCL-90 results showed that the total scores, the average scores of the positive symptoms, the three factor scores of obsessionality, interpersonal sensitivity and phobia in migrant workers were significantly higher than those in the local workers. According to the multivariate analysis, the amount of contribution to mental health, in descending order, was neuroticism, psychological pressure, income, home sickness, marital or love problems, extroversion and introversion, living conditions and social status. The mental health status of young migrant workers in Shenzhen was poorer than that of their local counterparts, as well as people in China on the SCL-90. It is recommended that mental health workers should help migrant workers adjust to the new urban environment by providing psychological counseling and other relevant treatment facilities.

Acculturation↗

A 'segmented' sex industry in New Zealand: sexual and personal safety of female sex workers.

OBJECTIVE: Assess differences in personal circumstances, risk exposure and risk-taking among female sex workers in different sectors of the New Zealand sex industry in regard to issues of sexual safety, drug use, violence and coercion. METHOD: A cross-sectional survey of 303 female sex workers was carried out in Christchurch, New Zealand, May-September 1999. RESULTS: There was evidence of 'segmentation': street workers were younger, had started work at a younger age and had less education than indoor workers. More street than indoor workers used money from sex work for drugs and used drugs at work. There was a high level of condom use but little 'negotiation' about them with clients. High levels of violent experiences were reported, but street workers reported more, and more extreme forms of, violence than indoor workers. IMPLICATIONS: Although knowledge of condom use and sexual safety appears generally high and women in both sectors report taking the initiative for safer sex, drug use, violence and coercion remain of concern. While sexual safety will need ongoing health promotion and education interventions to support and ensure the uptake of safer sex practice by new workers and prevent any relapse by more experienced workers, issues of violence and coercion also require attention to the power relationships between individuals. Legislation and policy directed at these issues should encourage the control women can exert over their work practice. Reducing exposure to personal risk may require different measures in different sectors.

Adolescent↗

Risk of fatal and non-fatal occupational injury in foreign workers in Spain.

STUDY OBJECTIVE: In the past decade, Spain has experienced dramatic growth of its immigrant population. Available information on the occupational conditions of foreign workers is scarce. This study aims to add to this information by describing occupational injuries in foreign workers in Spain. DESIGN, SETTING, PARTICIPANTS: Data were analysed from the 2003 Ministry of Labour and Social Issues registry of non-fatal and fatal occupational injury in insured workers. The population at risk was estimated from the Social Security Affiliation Registry as of 31 December 2003. Comparing Spanish with foreign workers and also considering age and sex, incidence rates and relative risks, and their confidence intervals at 95%, were calculated within each population group. MAIN RESULTS: In women and in men, and in every age group, foreign workers had an increased risk of non-fatal and fatal occupational injury compared with Spanish workers. The differences were especially notable in foreign women workers and in older workers. CONCLUSIONS: Many factors probably combine to cause the differences found in this study. Better data collection on the situation of foreign workers is needed to understand these facts and apply appropriate public health solutions.

Accidents, Occupational↗

Construction work and risk of occupational disability: a ten year follow up of 14,474 male workers.

AIMS: Most industrialised countries have public income maintenance programmes to protect workers in case of disability but studies addressing disability risk of specific professional groups are rare. The objective of this study was to establish a detailed pattern of the nature and extent of occupational disability among construction workers. METHODS: A cohort study was set up including 14,474 male workers from the construction industry in Württemberg (Germany) aged 25-64 years who underwent occupational health exams between 1986 and 1992. The cohort was linked to the regional pension register of the manual workers' pension insurance institution to identify workers who were granted a disability pension during the 10 year follow up. All-cause and cause specific standardised incidence ratios (SIR) and 95% confidence intervals (CI) were calculated using disability rates from the general workforce and from all blue collar workers in Germany as references. RESULTS: In total, 2247 (16%) members of the cohort were granted a disability pension. Major causes of disability were musculoskeletal (45%) and cardiovascular diseases (19%). In comparison with the general workforce, construction workers experienced a higher risk of disability from cancer (SIR = 1.26; 95% CI 1.08 to 1.47), respiratory diseases (SIR = 1.27; 95% CI 1.03 to 1.55), musculoskeletal diseases (SIR = 2.16; 95% CI 2.03 to 2.30), injuries/poisoning (SIR = 2.52; 95% CI 2.06 to 3.05), and all causes combined (SIR = 1.47; 95% CI 1.41 to 1.53). When compared with the blue collar reference group, increased risks of disability among construction workers were found for musculoskeletal diseases (SIR = 1.53; 95% CI 1.44 to 1.63), injury/poisoning (SIR = 1.83; 95% CI 1.50 to 2.21), and all causes combined (SIR = 1.11; 95% CI 1.07 to 1.16). CONCLUSIONS: Musculoskeletal diseases and external causes are major factors limiting the work capability of construction workers and lead to an increased proportion of occupational disability.

Adult↗