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PubMed2000

A large rubella outbreak with spread from the workplace to the community.

CONTEXT: Childhood vaccination has reduced rubella disease to low levels in the United States, but outbreaks continue to occur. The largest outbreak in the past 5 years occurred in Nebraska in 1999. OBJECTIVES: To examine risk factors for disease, susceptibility of the risk population, role of vaccine failure, and the need for new vaccination strategies in response to the Nebraska rubella outbreak. DESIGN, SETTING, AND PATIENTS: Investigation of 83 confirmed rubella cases occurring in Douglas County, Nebraska, between March 23 and August 24, 1999; serosurvey of 413 pregnant women in the outbreak locale between October 1998 and March 1999 (prior to outbreak) and April and November 1999 (during and after outbreak). MAIN OUTCOME MEASURES: Case characteristics, compared with that of the general county population; area childhood rubella vaccination rates; and susceptibility among pregnant women before vs during and after the outbreak. RESULTS: All 83 rubella cases were unvaccinated or had unknown vaccination status and fell into 3 groups: (1) 52 (63%) were young adults (median age, 26 years), 83% of whom were born in Latin American countries where rubella vaccination was not routine. They were either employed in meatpacking plants or were their household contacts. Attack rates in the plants were high (14.4 per 1000 vs 0. 19 per 1000 for general county population); (2) 16 (19%), including 14 children (9 of whom were aged <12 months) and 2 parents, were US-born and non-Hispanic, who acquired the disease through contacts at 2 day care facilities (attack rate, 88.1 per 1000); and (3) 15 (18%) were young adults (median age, 22 years) whose major disease risk was residence in population-dense census tracts where meatpacking-related cases resided (R(2) = 0.343; P<.001); 87% of these persons were born in Latin America. Among pregnant women, susceptibility rates were 13% before the outbreak and 11% during and after the outbreak. Six (25%) of 24 susceptible women tested were seropositive for rubella IgM. Rubella vaccination rates were 90.2% for preschool children and 99.8% for school-aged children. CONCLUSIONS: A large rubella outbreak occurred among unvaccinated persons in a community with high immunity levels. Crowded working and living conditions facilitated transmission, but vaccine failure did not. Workplace vaccination could be considered to prevent similar outbreaks. JAMA. 2000;284:2733-2739.

Adolescent↗
PubMedDate not supplied

Exploratory analysis as a sequel to suspected increased rate of cancer in a small residential or workplace community.

A suspicion that the incidence of cancer is rising in a residential or workplace community is often a cause of alarm among members of that community. The seemingly excessive number of diagnoses encountered may he due to: (i) a known explanatory variable, such as ageing of the community members; (ii) random occurrence of an event which is rare under stable conditions; (iii) exposure to an undefined carcinogenic agent. An exploratory analysis is suggested in order to consider the support indicated by the data with respect to each of the two last possibilities while controlling the first. The analysis involves several procedures which differ with respect to the targeted temporal pattern of the diagnoses. These procedures are mainly based on the a priori probability that a diagnosis is made within the time interval observed between consecutive diagnoses. When the number of diagnoses is found to be excessively large, the temporal pattern of the diagnoses may indicate whether the event is likely to be an incidental occurrence or due to the effect of a carcinogen.

Bias↗
PubMed1996

Making the "new American workplace" safe and healthy: a joint labor-management-researcher approach.

The American workplace is now in the midst of the most significant change since the advent of mass production. Whether these changes will lead to improvements in worker health and safety is not clear. This paper describes an approach to intervention and research-participatory action research (PAR)-that has the potential to redesign work organizations to improve performance while also improving health and safety. In the PAR method, researchers, managers, workers, and unions collaborate in a process of data-guided problem solving intended both to improve the system's performance and to contribute to general scientific knowledge. A case study example illustrates the use of a PAR approach in an automobile parts facility where labor, management, and researchers jointly conducted a longitudinal project aimed at reducing the major sources of stress and enhancing employee well-being. Results from the 6 year project suggest that, properly implemented, PAR has the potential to both lead to improved intervention and contribute to theoretical advances in occupational safety and health. The PAR approach to intervention research is contrasted with the total quality approach (TQA), and some suggestions are made for improving PAR research designs.

Automobiles↗
PubMed1996

Fatal and nonfatal injuries related to violence in Washington workplaces, 1992.

This study describes injuries related to assaults and violence that occurred in Washington State workplaces in 1992. Nonfatal injuries are emphasized. High-risk industries and occupations are described. Fatalities caused by work-related violence were identified using the 1992 U.S. Department of Labor Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries. Nonfatal injuries were identified using the BLS Annual Survey of Occupational Injuries and Illnesses and the Washington State workers' compensation system. Thirteen occupational fatalities resulted from assaults or violent acts in 1992. BLS data identified 784 nonfatal injuries that resulted in one or more day off work; workers' compensation data identified 2,395 claims. Industries experiencing the highest claim rates were Social Services (148 per 10,000) and Health Services (106 per 10,000). Nonfatal violent injuries were common and appeared to have different risk factors than fatal injuries. Industries in which injuries occurred were often predictable and suggested specific strategies for prevention efforts.

Absenteeism↗
PubMed1998

Lung cancer risk and workplace exposures in black men and women.

There are little data on workplace exposures and lung cancer risk in blacks. An ongoing case-control study of lung cancer that included 550 black men and women with lung cancer and 386 age-matched controls was examined by reported occupational exposures and job titles. In men, significant associations were observed with reported exposure to asbestos [odds ratio (OR), 1.8; 95% confidence intervals (CI) 1.03-3.1] and coal dust (OR, 2.8; 95% CI 1.1-7.0). Elevated but nonsignificant risks of 1.4 or more were detected for the following occupations: police/security guards, farmers/farm workers, laborers, and motor-vehicle drivers. In women, nonsignificant increased risks were found with reported exposure to paint (OR, 1.8) and gas fumes (OR, 4.9). Women employed as farmers/farm workers and building maintenance workers had elevated but nonsignificant risks.

Adult↗
PubMed1993

Dealing with alcohol problems in the workplace.

The employee assistance program (EAP) is the principal vehicle for intervention in the workplace directed at employees with alcohol problems. As broad-gauged programs, EAPs represent "mainstreaming" of alcohol-problem concerns into health care management. However, alcohol problems are defined broadly within EAPs, going beyond other definitions of alcohol dependence. The historical context is important for understanding EAPs and their dynamics. External environmental changes have impacted EAPs considerably over the past decade. Particularly important have been the increased prominence of employee drug abuse, managed care, and increasing prevalence of dual diagnoses. Results of research about EAPs conducted over the past decade are reviewed. The persistent issue of EAP efficacy is considered, highlighting the variable structure of EAPs and the multiplicity of motives for their voluntary adoption. Prospects for continuing research are considered in light of problems in research funding, the ambiguous identity of EAPs, and the practical orientations of those who might facilitate such research.

Alcohol Drinking↗
PubMed1994

Passive smoking in the workplace: classical and Bayesian meta-analyses.

There are currently several classical and Bayesian methods of meta-analysis available for combining epidemiological results. We describe and compare these in a consistent framework, and apply them to published studies of the relative risk of lung cancer associated with exposure to environmental tobacco smoke in the workplace. We find that although all methods give reasonably similar combined estimates of relative risk of lung cancer associated with this exposure (none of which is significantly raised above unity, in either a frequentist or a Bayesian sense), the approximations arising from classical methods appear to be nonconservative and should be used with caution. The Bayesian methods, which account more explicitly for possible inhomogeneity in studies, give slightly lower estimates again of relative risk and wider posterior credible intervals, indicating that inference from the non-Bayesian approaches might be optimistic.

Bayes Theorem↗
PubMed2003

Problems with trials and intervention studies on barrier creams and emollients at the workplace.

The potential effect of barrier creams or emollients in the prevention of work-related hand eczema has mostly been documented in a laboratory setting on experimentally damaged skin. Publications on real intervention studies of barrier creams or emollients in a workplace setting are scarce: only four such studies could be identified. The relatively short follow-up of most studies, and the small numbers of subjects enrolled, may reflect the organisational complexity of such studies. The observed effect is a combination of the intervention effect to be measured, and a number of disturbing variables. These disturbing variables are not just measurement error, but also phenomena such as the course of the disease, confounding and effect modification. In hand-eczema studies, the outcome parameters that should form the basis of the intervention effect are ill defined. Moreover, the study itself (i.e. the investigators) influences the results because there is rarely a single intervention: unknowingly, there are improvements in glove wearing, hand-washing habits or occupational hygiene in general. The performance of a blind study is often difficult or impossible. Large numbers of subjects have to be enrolled if a meaningful reduction in incidence of hand eczema is to be detected. One can demonstrate this by calculating the required enrollment in a study among employees in a nursing home.

Clinical Trials as Topic↗
PubMed2006

Olfactory dysfunction and its measurement in the clinic and workplace.

OBJECTIVES: To provide an overview of practical means for quantitatively assessing the sense of smell in both the clinic and workplace. To address basic measurement issues, including those of test sensitivity, specificity, and reliability. To describe and discuss factors that influence olfactory function, including airborne toxins commonly found in industrial settings. METHODS: Selective review and discussion. RESULTS: A number of well-validated practical threshold and suprathreshold tests are available for assessing smell function. The reliability, sensitivity, and specificity of such techniques vary, being influenced by such factors as test length and type. Numerous subject factors, including age, sex, health, medications, and exposure to environmental toxins, particularly heavy metals, influence the ability to smell. CONCLUSIONS: Modern advances in technology, in conjunction with better occupational medicine practices, now make it possible to reliably monitor and limit occupational exposures to hazardous chemicals and their potential adverse influences on the sense of smell. Quantitative olfactory testing is critical to establish the presence or absence of such adverse influences, as well as to (a) detect malingering, (b) establish disability compensation, and (c) monitor function over time.

Air Pollutants, Occupational↗
PubMed1994

Ambulatory blood pressure monitoring in physicians working in a hospital: is there an increase in the number of subjects with high workplace blood pressures?

Sixty-two physicians from our hospital who were normotensives, as supported by casual blood pressure measurements, underwent 24-h blood pressure monitoring which included their normal work, home rest and sleep periods. During working hours, 19% of the subjects showed mean diastolic and/or diastolic plus systolic blood pressures higher than those admitted as normal by the WHO for casual measurements for out of work subjects. Both mean systolic and diastolic blood pressure measurements, during the work at the hospital, were significantly higher in males (P < 0.01 and P < 0.005, respectively) than the mean of the readings obtained during the 24-h period, but this phenomenon did not occur among the females. Male's mean systolic (129.8 +/- 10.6 vs. 117.1 +/- 9.7 mmHg, P < 0.0001) and diastolic pressures (83.4 +/- 8 vs. 74.9 +/- 7.3 mmHg, P < 0.001) were significantly higher during the working period in relation to those of the female group. Discussing the influence of the kind of work on blood pressure, we came to the conclusion of the existence in our environment of a group of subjects (generally males), presenting high blood pressure values during their working period at the hospital and normal or borderline values during the rest of the day. This should be of interest, since it has been reported that subjects with high workplace blood pressure have an increased risk of hypertension and target-organ damage.

Adult↗
PubMed2004

Compliance to a Workplace Violence Prevention Program in small businesses.

BACKGROUND: Robberies are the leading motive for work-related homicide and assault. Interventions to reduce robberies and related injuries have been limited to convenience stores, and evaluations have not addressed compliance as a factor in program effectiveness. SETTING/PARTICIPANTS: A total of 314 intervention and 96 control businesses were included in this intervention evaluation. INTERVENTION: The Workplace Violence Prevention Program provided a customized robbery and violence prevention program to a stratified random sample of 314 small, high-risk businesses in Los Angeles City. An additional 96 comparison businesses did not receive the intervention. The intervention included individualized consultation, printed materials, training brochures, and a video. Interventions were conducted from August 1997 through August 2000. MAIN OUTCOME MEASURES: For both intervention and comparison businesses, a comprehensive security program assessment was conducted at baseline and at 3- and 12-month follow-up visits. Crime rates in intervention and comparison businesses were examined for 12 months pre- and post-intervention with the use of police reports. RESULTS: By the second follow-up visit, compliance to the intervention program was significant for each program component. Employee training was the most frequently implemented intervention component. Neighborhood crime level, primary language spoken by the business owner, and the number of employees were all related to compliance. Although crime rates generally increased for all businesses from the pre- to post-intervention periods, businesses with high compliance to the program experienced a decrease in overall violent crime and robbery. CONCLUSIONS: Participating businesses were willing to voluntarily implement components of the intervention program, and greater implementation was related to reductions in robbery and violent crime.

Crime↗
PubMed2004

Workplace design guidelines for asymptomatic vs. low-back-injured workers.

While numerous efforts have attempted to provide quantitative guidelines for the prevention of initial low back disorders during material handling tasks, none have appeared in the literature that address the issue of recurrent low back disorders due to materials handling when returning to the workplace. A study comparing the spine loads of low back pain patients and asymptomatic controls was conducted. Subjects lifted weights varying from 4.5-11.4 kg at four vertical heights, two horizontal distances and five task asymmetries collectively representing common industrial lifting situations. Spine loading was calculated using a validated EMG-assisted biomechanical model. Spine loads observed during lifting tasks were compared to spine tolerance values believed to initiate low back injuries. In addition, the percentage of patients successfully performing the lift was noted and used as an indication of the willingness of the subject to perform the task. These evaluations are summarized in a series of three lifting guidelines indicating safe, medium risk and high risk lifting tasks for low back patients as well as asymptomatic workers. It is believed that adherence to these guidelines can minimize the risk of recurrent low back disorders due to occupational lifting.

Back Injuries↗
PubMed2005

Paddling upstream: a contextual analysis of implementation of a workplace ergonomic policy at a large newspaper.

Efforts to implement workplace ergonomic programs aimed at reducing the burden of work-related musculoskeletal disorders (WMSD) have to address multiple physical and psychosocial aspects of work environments yet often contextual factors limit their success. We describe the processes involved in an ergonomic program to reduce neck and upper limb WMSDs at a large Canadian newspaper. Using qualitative data collection and analysis methods, we illustrate the impact of key contextual characteristics of: (1) the program (management commitment, union involvement, experience and skill of program leaders, and researcher involvement); (2) the organization (drive for productivity, management control, organizational culture); and (3) the broader social context (economic climate, nature of newspaper work, technology and nature of WMSD). We argue for increased attention to identification and response to the contextual factors affecting program implementation in order to more successfully address upstream determinants of WMSD.

Canada↗
PubMedDate not supplied

Occupational safety: effects of workplace radiofrequencies on hearing function.

BACKGROUND: The effects of radio frequency (RF) and microwave radiation on humans have been the subject of continuous investigation. Clinical investigations related to occupational RF/microwave exposure have been reported by investigators (1). Since one of the major groups occupationally exposed to RF and microwave radiation includes those working in radio broadcasting and TV transmitter stations, this study investigates whether RF affects auditory systems of people exposed to RF. METHODS: The study is carried out with people working in radio broadcasting stations and living in employee residential houses close to the broadcasting stations. All subjects in the control group were similar in age, work regime, socioeconomic status, and lack of experience in working with RF sources. Brainstem Evoked Response Audiometer (BERA) and Pure Tone Audiometry (PTA) were used to measure the effects of RF under investigation on hearing functions of the subjects. In BERA measurements, I-III, III-V and I-V interpeak latencies were evaluated. In pure tone audiometric measurements, 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and 8000 Hz frequencies of hearing threshold were measured in subjects of experimental and control groups. Interpeak latencies and bone conduction hearing thresholds of subjects in the experimental group were compared with those of the control group. RESULTS: BERA results showed that I-III, I-V and III-V interpeak latencies of people occupationally exposed to RF were not higher than subjects in control groups (p>0.05). Results of BERA indicated no statistically significant differences between exposure and control subjects. In audiometric evaluation, hearing threshold of people occupationally exposed to RF were found higher than the control group subjects for frequencies of 4000 Hz and 8000 Hz in terms of bone and air conduction of right and left ear (p < 0.01). CONCLUSIONS: The results of traditional audiometer indicated that RF promotes sensorineural hearing loss and affects cochlea parts related to 4000 Hz and 8000 Hz. These findings may have immediate implications and considerations for workplace safety in order to provide an occupationally safe environment to employees working in such settings.

Audiometry, Pure-Tone↗
PubMed2006

Tobacco and carcinogens in the workplace.

Workplace exposures to carcinogens long have been associated with cancers, and corrective measures to limit exposures have resulted in reductions in such cancers and improved worker health. Some exposures are currently of historical interest, and many current or past exposures are associated with conflicting evidence as to causality. We present a brief overview of the effects of exposure to asbestos, tobacco, and other known carcinogens.

Asbestos↗
PubMed2006

Hand dermatitis and nail disorders of the workplace.

Dermatitis and nail bed disorders form a large percentage of occupational conditions that affect the hands. This article briefly discusses some of the more common causes and presentations of these conditions. Most of these of the conditions can occur in the workplace and outside of it, so a careful evaluation is necessary to determine the work relatedness of a given condition.

Adrenal Cortex Hormones↗
PubMed2004

Levels of cocaine and its metabolites in washed hair of demonstrated cocaine users and workplace subjects.

In a study of subjects in drug rehabilitation programs, cocaine and cocaine metabolite levels were determined in the hair of 75 subjects who had produced cocaine-positive urine results. The hair was analyzed after being washed with the 3.75 h wash procedure developed by this laboratory. In addition, results of testing 73 non-users are presented, as well as levels of cocaine, benzoylecgonine (BE), cocaethylene, and norcocaine from workplace population samples. The data support a recommendation of reporting as positive a sample with cocaine of 500 pg/mg hair and either a 5% ratio of benzoylecgonine (BE) to cocaine in samples, or the presence of cocaethylene at 50 pg/mg hair, or norcocaine at 50 pg/mg hair for samples < or =2000 pg cocaine/mg hair. For samples with cocaine present at >2000 pg/mg hair, the data indicate that a ratio of 5% BE may be an overly conservative approach. In appropriately washed hair samples, cocaine users can produce hair levels of <5% BE and thus a minimum BE cutoff in lieu of a ratio could be considered.

Adult↗