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Pulmonary infections acquired in the workplace. A review of occupation-associated pneumonia.

The risk of humans acquiring pneumonia as a result of their occupation appears to have declined during the twentieth century in developed countries, such as the United States. Thus, some conditions that are traditionally associated with the workplace, such as woolsorters' disease, represent illnesses that are of historical interest only. Nevertheless, the problem of occupation-associated pneumonia remains substantial. First, large outbreaks of zoonotic infections continue to occur, especially psittacosis among poultry farmers and abattoir workers. Second, clusters of illnesses caused by recently recognized pathogens are now being reported, including legionnaires' disease in industrial workers and Chlamydia pneumoniae infections in military personnel. Finally, epidemics of old conditions are appearing in new settings, such as tuberculosis among nursing home workers. Thus, the transmission, control, and treatment of pneumonias acquired in the workplace represent intriguing and challenging areas of concern to the epidemiologist and clinician.

Humans↗

Persons with cancer and their return to the workplace.

Over 5 million persons are living today with a diagnosis of cancer. Maintaining employment after a diagnosis of cancer and even during therapy is a major challenge for an increasing number of individuals. The majority of preretirement persons with cancer who have attempted a return to the workplace have confronted a variety of issues and barriers. Social scientists and legal and health care professionals have attempted to identify particular practices and issues that have affected the return to work experiences of those with a diagnosis of cancer. There has not been a program in nursing research that has systematically tested clinical interventions which effect return-to-work outcomes in persons with cancer. Understanding the return-to-work experience is an essential prerequisite to planning clinical nursing therapeutics and assistance to persons with cancer who consider maintaining their worker role. Environmental and personal factors that influence a successful return to the workplace, plus the human responses manifested in the return experience are reviewed in this article. Clinical implications are drawn for nurses who can facilitate the return-to-work for an individual with cancer through interventions that eliminate or alter barriers to the successful return.

Adaptation, Psychological↗

[Risk of workplace injuries by occupation in Italy in the 1990's].

BACKGROUND: In Italy it is not possible to assess the incidence of workplace injuries by occupation due to the absence of denominator data. OBJECTIVES: To evaluate severe workplace injuries by occupation, age and gender, via discussion of the validity of the available methods and informative systems. METHODS: The database included injuries in the industrial and artisan sectors in Italy during the period 1995-1999, as classified by INAIL (National Institute for the Insurance against Occupational Accidents and Diseases). A proportional case-control study was used. Three types of severe injuries were analyzed: fatal (3,685), permanently disabling (88,254) and injuries resulting in temporary disability for more than 40 days (238,609). Controls were represented by minor injuries with temporary disability lasting between 8 and 13 days (512,643). The relative risks were calculated by occupation and stratified by age and sex. The control group was chosen in order to minimize distortions and represented a balance between empirical criteria based on the experience of safety technicians and the quality and limits of INAIL archives. RESULTS: Among men in some construction occupations (operators of construction equipment, crane operators and masons), and in truck drivers, farm workers, messengers, and miners there were elevated risks in all age groups and for all levels of injuries severity. The model was more problematic to apply to women because the control group was less representative of the work population at risk. CONCLUSIONS: The case-control study model produced results consistent with those in the international literature, even if the use of minor injuries as the control group gives partly distorted risk estimates. The results supply information for decision making and for allocating resources for prevention and safety.

Accidents, Occupational↗

[Models of economic evaluation of health and safety interventions at workplace].

Economic analyses and evaluation of the effect of workers' health on the national economy have begun to play a significant role in decision-making processes in terms of relations between health and safety in the work environment and the financial policy of enterprises. The economic dimension of consequences of occupational diseases and accidents at work is more frequently associated with the financial policy of enterprises understood as an element of costs involved. This gains particular significance when enterprises must maintain and improve economic effectiveness especially in the case of limited resources and permanent competition on the market. Therefore, the evaluation of economic interventions in the area of health and safety at workplace and its results are so important in the enterprise decision-making process. Several models of economic evaluation are used in assessing effectiveness of actions aimed at improving health and safety at workplace against a background of the overall economic situation of enterprises. The author presents the principles of six models, which have been used in the evaluation process. These models are based on information about costs of interventions/programs designed to reduce harmful effects of working conditions on workers' health and information concerning the results of individual ventures. They also take account of the influence of changes in working conditions on reduced sick absence, increased effectiveness of enterprises, production costs, and changes in productivity. The relationship between costs of intervention and its effects in financial terms based on cost-benefit analysis is the measure of effectiveness of health investments. The models presented show in practice a number of limitations, resulting mostly from the way the data are recorded in individual enterprises. Therefore, it is recommended that evaluation should be preceded by a precise definition of its aims, the range of the intervention and effects to be attained, which should provide the basis for defining the means and resources necessary for its implementation. This mainly applies to availability of data on costs and effects as well as to calculation methods, which can be used in view of collected numerical data.

Health Promotion↗

[Present-day legislation and the handling of chemical substances and preparations at the workplaces performing drug synthesis and analysis].

The preparation discusses the present-day legislation concerning the handling of chemical substances and preparations in the Czech Republic (Law No. 356/2003 Coll., Regulation No. 369/2005 Coll.), the passages important for the operation of the workplaces performing synthesis and analysis of drugs, including the new duties of the employer. The legal regulation valid in the Czech Republic is compared in the selected parts with that valid in the Slovak Republic. The authors primarily recommend the workplaces engaged in drug synthesis and analysis to limit the use of chemical substances classified as highly toxic.

Czech Republic↗

The evolution of workplace health promotion in Europe: the Italian case.

In this paper the Authors describe the development of workplace health promotion in Europe and show how, despite the fact that they have developed independently of one other the professional disciplines of Occupational Safety and Health together with Public Health have provided a common platform from which has emerged this new philosophy--Workplace Health Promotion (WHP). Whilst the paper draws on the experience of countries throughout Europe, particular attention is paid to the developmental process in Italy.

Europe↗

NTP Toxicity Study Report on the atmospheric characterization, particle size, chemical composition, and workplace exposure assessment of cellulose insulation (CELLULOSEINS).

Cellulose insulation (CI) is a type of thermal insulation produced primarily from recycled newspapers. The newspapers are shredded, milled, and treated with fire-retardant chemicals. The blowing process for installing CI generates a significant quantity of airborne material that presents a potential inhalation hazard to workers. CI was selected for study based upon the high production volume, the potential for widespread human exposure, and a lack of toxicity data; insufficient information was available to determine whether inhalation studies in laboratory animals were technically feasible or necessary. Studies were conducted to characterize the chemical and physical properties of CI aerosols, to evaluate the potential acute pulmonary toxicity of CI, and to assess occupational exposure of CI installers. Workplace exposure assessments were conducted in collaboration with the National Institute for Occupational Safety and Health (NIOSH, 2001). EVALUATION OF THE CHEMICAL COMPOSITION, PARTICLE SIZE, AND PULMONARY TOXICITY OF CELLULOSE INSULATION: Chemical analyses were performed on samples of bulk CI from four major United States manufacturers. All samples of the bulk CI were found to contain primarily amorphous cellulose (60% to 65%) with a smaller crystalline component (35% to 40%). The crystalline phase was primarily native cellulose (75% to 85%) with a minor amount of cellulose nitrate (15% to 25%). Elemental analyses of acid digests of CI materials indicated that the major components (>0.1% by weight) included aluminum, boron, calcium, sodium, and sulfur. An acid-insoluble residue present in all four materials (3% to 5% of original sample weight) was found to consist primarily of aluminum silicate hydroxide (kaolinite; approximately 85%) with minor amounts (<5% each) of magnesium silicate hydroxide (talc), potassium aluminum silicate hydroxide (muscovite), and titanium oxide (rutile). Solvent extracts of the bulk materials were analyzed for organic components by gas chromatography with flame ionization detection. Analyses revealed a mass of poorly resolved peaks. Because of the very low concentrations, further quantitative and qualitative analyses were not performed. An aerosol generation system was designed to separate CI particles based upon aerodynamic size and to simulate the process used during CI installation at work sites. Less than 0.1% of each of the CI samples was collected as the small respirable particle fraction. The mean equivalent diameter of respirable particles ranged from 0.6 to 0.7 mum. The numbers of fibers in the respirable fractions ranged from 9.7 x 103 to 1.4 x 106 fibers/g of CI. The respirable particle fractions did not contain cellulose material and consisted mainly of fire retardants and small quantities of clays. The respirable fraction from one CI sample was administered by intratracheal instillation to male Fischer 344 rats at doses of 0, 0.625, 1.25, 2.5, 5, or 10 mg/kg body weight; the bronchoalveolar lavage (BAL) fluid cellularity was evaluated 3 days later. Based upon the relatively mild severity of the inflammatory response, a dose of 5 mg/kg body weight was selected for use in a subsequent 28-day study. Rats received CI, titanium dioxide (particle controls), or sterile saline (controls). BAL fluid was evaluated 1, 3, 7, 14, and 28 days after instillation, and lung histopathology was evaluated 14 and 28 days after treatment. CI caused a greater influx of inflammatory cells than titanium dioxide and caused significant increases in BAL fluid protein and lactate dehydrogenase. These CI-induced changes in BAL fluid parameters were transient and by day 14 were not significantly different than those observed in rats treated with titanium dioxide or phosphate-buffered saline. Unlike titanium dioxide, CI treatment caused a minimal to mild nonprogressive, minimally fibrosing granulomatous pneumonitis characterized by nodular foci of macrophages and giant cells. These results indicated that few respirable particles or fibers are likely generated during the CI application and that the acute pulmonary toxicity is minimal. EXPOSURE ASSESSMENT OF CELLULOSE INSULATION APPLICATORS: The CI exposure assessment was conducted with 10 contractors located across the United States. Air samples of total dust and respirable dust were collected for scanning electron microscopy (SEM) to characterize any fibers in the dust. Two SEM air samples for each day of CI activities were collected from the installer and hopper operator. Bulk CI samples were collected and analyzed for metal, boron, and sulfate content. Real-time and video exposure monitoring was conducted to further characterize the CI dust and workers' exposures. The exposure assessment also included a medical component. Investigators collected 175 personal breathing zone (PBZ) total dust, 106 area total dust, and 90 area respirable dust air samples during CI-related activities at the 10 contractor sites. Twenty-six employees' total dust 8-hour time-weighted averages (TWAs) exceeded the Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) of 15 mg/m3, and 42 exceeded the American Conference of Governmental Industrial Hygienists (ACGIH) threshold-limit value (TLV) of 10 mg/m3. Respirable dust air sampling and real-time monitoring with particle size discrimination indicated low levels of respirable dust generation. The SEM analyses revealed that fibers were an average 28 mum in length and ranged from 5 mum to 150 mum. CI installers' PBZ total dust, area total dust, and area respirable dust air samples were all significantly higher during dry attic applications than wet attic applications (P<0.01). Conversely, the hopper operators' total dust exposures were significantly higher during wet wall and ceiling applications than dry wall and ceiling applications (P=0.02). Analyses of variance tests revealed that exposure concentrations in total dust air samples collected in the PBZ of all CI workers, including installers working in attics, installers during wall applications, hopper operators during attic applications, and hopper operators during wall and ceiling applications, varied significantly during dry applications (P<0.01). The respirable dust air samples collected in attic areas, hopper areas during attic applications, and hopper areas during wall and ceiling applications also differed significantly during dry applications (P=0.03). Twenty-three workers participated in the medical phase of the investigation. The workers completed medical and work history questionnaires, performed serial peak flow tests, and completed multiple acute symptom surveys. The medical questionnaires indicated respiratory, nasal, and skin symptoms that employees attributed to CI exposure. The most common symptoms reported while working with CI included nasal symptoms (35%), eye symptoms (35%), and morning phlegm production (25%). There was a temporal association between CI exposure and eye symptoms, but there was little evidence of lower respiratory system health conditions associated with CI exposure. CONCLUSIONS: Chemical analyses of the four bulk CI samples revealed only minor differences in additives. The major elemental components detected were aluminum, boron, calcium, sodium, and sulfur, but they were attributed to the fire retardants aluminum sulfate, boric acid, and sodium sulfate. For all four CI samples, less than 0.1% by weight was collected as the small respirable particle fraction. The fractions consisted mainly of fire retardants and smaller quantities of clays and did not contain cellulose material. Intratracheal instillation of the respirable fraction in rats produced minimal to mild inflammatory responses in the lungs with no increase in severity by 28 days after dosage. Although a significant increase in lung collagen was detected at day 28 in treated rats, microscopic evaluation revealed only a minimal to mild increase in collagen fibrils associated with granulomatous nodules. The results of these studies indicated that few respirable particles or fibers are generated during the aerosolization of CI, and that even at very high doses of respirable CI particles, acute pulmonary toxicity is minimal. These results are supported by the NIOSH workplace exposure assessment conducted on CI workers. Based on the air sample data collected from the 10 contractor site visits, there is a potential for overexposure to CI; however, respirable dust concentrations were typically low. There was increased potential for 8-hour TWAs exceeding the OSHA PEL for total and respirable dust when employees were involved in CI application activities for longer periods of time. There was evidence of work-related eye and mucous membrane irritation among some workers, which were possibly caused by the additives present in CI, such as boric acid. There was little evidence of lower respiratory system health conditions associated with CI exposure. Based upon the results of the CI chemical characterization studies, the pulmonary toxicity study, and the worksite exposure assessment, the NTP concluded that additional studies of CI in laboratory animals are not warranted at this time. However, the animal pulmonary toxicity studies and worker health surveys focused on acute CI exposures and do not preclude the possibility of toxicity resulting from chronic exposure. Although exposure concentrations of respirable CI particulate matter were low, additional information is needed on the biodurability and reactivity of CI particles and fibers in the respiratory tract. CI should continue to be regarded as a nuisance dust, and workers should continue to wear protective masks to prevent inhalation exposure to CI dusts.

Aerosols↗

Managing the politics of the workplace.

The workplace--usually the hospital--is the laboratory for the new nurse's first year of practice. Lacking experience, the neophyte will need to learn organizational savvy and judgment and gain clinical experience with the help of a preceptor-mentor. Properly managing the first year of professional practice in the workplace will result in career success and satisfaction.

Conflict, Psychological↗

Employee attitudes to involuntary smoking at the workplace.

The Dublin Healthy Cities Project carried out this survey to establish employees' attitudes to involuntary smoking. A self administered questionnaire was sent to 750 randomly selected employees from the organisations involved with the Project. A response rate of 77% was achieved. 70% were non-smokers. 80% (Non-smokers 92%, smokers 50%) are bothered by involuntary smoking and 78% (non-smokers 85%, smokers 59%) were aware that it was harmful. 93% (non-smokers 99%, smokers 84%) felt that involuntary smoking should be restricted in the workplace and 99% (non-smokers 99%, smokers 97%) felt that it should be restricted in the canteens. 77% of smokers expressed a desire to quit the habit. This survey shows that employees are bothered by involuntary smoking in the workplace, they see it as being harmful to their health and they think it should be restricted.

Adult↗

Confidentiality of genetic information in the workplace.

This Article analyzes existing legal protections for the confidentiality of information collected through genetic screening or genetic monitoring in the workplace. It notes that there are a variety of protections, such as ethical codes for occupational physicians, statutes protecting health care information in the hands of the employers, and tort, contract and constitutional principles. It describes defenses to suits based on improper disclosure of medical information. The Article then analyzes legal bases for employee and third party access to the employee's genetic information. In response to gaps in existing legal protections, it suggests parameters for a model law protecting the confidentiality of genetic information collected in the workplace.

Confidentiality↗

Smoking cessation programs in the workplace. Review and recommendations for occupational health nurses.

The worksite offers occupational health nurses unique opportunities to assist workers in their smoking cessation efforts. For nurses to be effective in this endeavor, they must be knowledgeable about the various quit smoking strategies that have met with some success. Based on the review of the research, there is no "magic bullet" to offer smokers who want to quit. Occupational health nurses have an opportunity, therefore, to use multiple approaches and design programs to fit the specific needs of the smokers in their practice. Published reports of nurses' involvement in workplace smoking cessation programs are sparse. It is crucial that occupational health nurses spearhead smoking cessation efforts at the workplace and communicate the results of these enterprises.

Humans↗

Employees' sources of AIDS information: the workplace as a promising educational setting.

Employees' evaluations of AIDS education in the workplace are related to the nature of the program sponsored by employers. A survey of 3460 employees in eight corporate work sites and four public agencies indicated that workplace programs are more highly valued by employees than are other sources of AIDS information where the programs are extensive. The findings suggest conditions under which employers can be valued as AIDS educators and credible sources of AIDS information.

Acquired Immunodeficiency Syndrome↗

Implementing an AIDS policy. Retaining and promoting productivity in the workplace.

1. Managers must be knowledgeable about AIDS and able to act on issues that surface in the workplace. Some of these issues are discrimination, fear, and confidentiality. 2. Fear of AIDS is being managed better in places of business where education is provided to employees. This education results in a more productive work environment. 3. To deal with AIDS in the workplace in a socially responsible manner, every company must have guidelines and provide a source of education. This education must be readily available and easily understood by all employees, who may have differing educational levels.

Acquired Immunodeficiency Syndrome↗

[Carbon disulfide excretion in urine--a biological exposure test for the workplace and environmental concentration ranges].

The biological control procedure for carbon disulphide (CS2), the determination of free and bound CS2 in urine--a procedure already applied to hygienic surveillance--were modified by using gas chromatography and sulphide selective detection (FPD). The results obtained by the changed biological monitoring test in workplace and environmental surveillance are present and discussed. For CS2 concentrations at workplaces in the range of 8-54 mg/m3 a correlation coefficient of r = 0.56 (n = 11, p less than 0.07) was calculated for the mathematical connection of CS2 shift exposure and CS2 content in urine. For environmental exposures in the range of the CS2 immision short term threshold value (MIKK) of 0.03 mg/m3 the procedure may discriminate significantly exposure load from naturally occurring CS2 background.

Adult↗

Cancer at the workplace: health promotion and care programs.

The "Europe Against Cancer" initiative seeks to reduce the prevalence of cancer by 15% by the year 2000. This has stimulated an increased awareness of cancer by health care professionals. A training manual was designed to provide opportunities for workplace health care professionals in Northern Ireland to make an impact in the area of prevention and early detection of cancer. The training manual examines attitudes and knowledge about cancer and discusses relevant, effective programs for the prevention and early detection of cancer. It also seeks to enable the development of care and rehabilitation support programs in the workplace. The process of developing the training manual involving occupational health and health education staff is considered to be part of its success.

Attitude to Health↗

Reproductive hazards in the workplace.

To ensure comprehensive health care delivery to individuals in their childbearing years, nurses must consider the impact of workplace hazards on human reproduction. A number of variables, including the changing role of women in society, economic issues, and unexplained adverse reproductive outcomes are indications for routine assessment of reproductive health hazards in the workplace.

Counseling↗

Guidelines for medical screening in the workplace.

This chapter deals with general principles of conducting medical examinations to detect adverse health effects of workplace exposures and thereby prevent occupational disease or slow its progression. Much of the discussion is most relevant to screening for effects of chemical hazards, but many of the principles presented apply to physical and biological hazards as well. Procedural and administrative aspects of workplace medical examinations that are not "exposure specific" and are applicable to all medical programs are reviewed.

Environmental Monitoring↗

Drug testing in the workplace.

The author first discusses drug use in society at large versus the workplace, then focuses on the issue of drug testing in the workplace. Goals of and approaches to drug testing are discussed, legal issues highlighted, testing procedures detailed, testing programs introduced, and finally the role of employee assistance programs reviewed.

Humans↗