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Preventing alcohol use problems among blue-collar workers: a field test of the Working People program.

A program designed to prevent alcohol misuse among working adults was developed and presented in four sessions to employees of a medium-sized printing company. The Working People program, based on a social-learning model, was field-tested with 108 employees in the context of a quasi-experimental design. Members of the Program Group (n = 38) and two Comparison Groups (n = 26 and 44) were assessed before and after the program on a questionnaire containing measures of alcohol consumption, attitudes and intentions regarding alcohol use, problem consequences of alcohol use, and health beliefs. Program effects were demonstrated on alcohol consumption, motivation to reduce consumption, and problem consequences of drinking. No effects were found on health beliefs or self-efficacy to reduce drinking. Although the findings are qualified by the self-selected nature of the samples, the results suggest that alcohol consumption can be reduced among adults who participate in this type of worksite program.

Adolescent↗

Monocrotophos--worker safety.

Monitoring data on field-worker exposure studies show that prolonged or continued use of monocrotophos in plant protection may lead to significant dermal exposure with an impact on cholinesterase activity. Although oral uptake (suicide) is more hazardous than dermal exposure (spray work), both exposure routes may be potentially fatal. On the other hand, prompt therapy is successful even after a heavy oral dose. The epidemiological review did not reveal a prominent risk scenario. Justification of monocrotophos use depends on agricultural need and appropriate safety measures. Eighteen cases of monocrotophos poisoning have been identified in the literature and from the manufacturer's case file. Seven cases were occupational, and nine resulted from suicide attempts. One case was a nonprofessional accident, and one was recorded without details. Further monocrotophos poisoning cases may be concealed in the unspecified data on poisoning among tropical farming communities. However, the fact remains, that only a small number of reliably reported poisoning cases are attributable to monocrotophos products, and the reports confirm the efficacy of basic medical attention to poisoning. This is in contrast to the high hazard classification and to the high perceived hazard of the products in question. Safetywise, monocrotophos appears to be better than its reputation. A level of safety precautions normally recommended for pesticide work is sufficient, even under large-scale professional use conditions, to utilize monocrotophos safely.

Cholinesterase Inhibitors↗

Recruitment and retention of psychosocial rehabilitation workers.

Recruitment and retention of direct service workers can be a major problem for administrators of community mental health organizations. This paper, based on a nationwide study of psychosocial rehabilitation workers and administrators, examines the congruity of worker and administrator perceptions of worker motivation for entering and leaving the field. Workers are motivated by the intrinsic nature of the work to enter into and stay in the field. Job burnout is as important as low pay in forcing workers out of the field. Administrators, however, perceive money to be a major factor motivating workers to enter the field and perceive external opportunities as forces that pull them away. Thus, administrators must address their workers' needs if their agencies are to offer quality services.

Adult↗

Pesticide use, exposure, and risk: A joint Israeli-Palestinian perspective.

The major predictors of health risk from pesticide exposure are quantity and toxicity of pesticides reaching end-users, field workers, and persons (including children) with casual and indirect exposures to field and food residues, drift, and contaminated groundwater. Past work in Israel and the Palestinian National Authority has documented risks for acute poisoning, daily illness, transient neurotoxic effects, and potential cancer hazards in workers, populations exposed to pesticide drift, and the general population. Risk assessment predicts that reduction in use of agents with high toxicity and pesticide substitution are desired strategies for achieving the largest reductions in risk, but successful implementation and program sustainability depend on maintaining crop yield and increasing farmer earnings. A joint pilot Israeli-Palestinian-NGO program aims to determine whether crop yields and profits can be sustained while reducing pesticide use, promoting integrated pest management, and restricting ecosystem damage. The project involves six components: (1) assessments of health risk and crop yield in relation to pesticide use and exposure; (2) training health-agricultural teams to introduce and evaluate crop growth and managements with reduced pesticide use; (3) tracing and stopping import and trade in banned or restricted pesticides; (4) restricting child labor; (5) promoting information delivery and worker and community right-to-know and right-to-act; and (6) establishing a uniform regional standard for protection of workers and the general public. Preliminary evidence (organochlorines and breast cancer, organophosphates and illness in field workers) indicates that (1) a reduction of use is the foremost determinant of a reduction in health risk; (2) cotton yield can be increased despite a reduction in pesticide use (organophosphates); and (3) a reduction in pesticide use (organophosphates and organochlorines) has to be part of a crop rotation program for food crops timed to seasonal fluctuations in supply, demand, and crop price.

Agricultural Workers' Diseases↗

Magnetic field exposure among utility workers.

The Electric and Magnetic Field Measurement Project for Utilities--the Electric Power Research Institute (EPRI) Electric and Magnetic Field Digital Exposure (EMDEX) Project (the EPRI EMDEX Project)--was a multifaceted project that entailed technology transfer, measurement protocol design, data management, and exposure assessment analyses. This paper addresses one specific objective of the project: the collection, analysis, and documentation of power-frequency magnetic field exposures for a diverse population of utility workers. Field exposure data measured by an EMDEX system were collected by volunteer utility employees at 59 sites in four countries between September, 1988, and September, 1989. Specially designed sampling procedures and data collection protocols were used to ensure uniform implementation across sites. Volunteers within 13 job classifications recorded which of eight work or three nonwork environments they occupied while wearing an EMDEX meter. Approximately 50,000 hours of magnetic field exposure records taken at 10 s intervals were obtained, about 70% of which were from work environments. Exposures and time spent in environments were analyzed by primary work environment, by occupied environment, and by job classification. Generally, for utility-specific job classifications related to the generation, transmission, and distribution of electricity, the field and exposure measurements in terms of workday mean field were higher than in more general occupations. The job classifications with the highest (median workday mean) exposure were substation operators (0.7 microT) and electricians (0.5 microT). Total variance also tended to be largest for utility-specific job classifications. For these workers, the contributions of between-worker and within-worker variances to total variance were about the same. Measurements in utility-specific environments were higher than in more general environments. Estimates of time-integrated exposure indicated that utility-specific job classifications received about one-half or more of their total exposure on the job. The nonwork field and exposure distributions for workers in all job categories were comparable with median nonworkday means of about 0.09 microT.

Documentation↗

Obstetric deaths in Bangladesh, 1996-1997.

OBJECTIVES: The purpose of this study was to measure and to describe obstetric deaths in Bangladesh. METHODS: We reviewed hospital records and interviewed health workers in clinic sites and field workers who cared for pregnant women. RESULTS: We obtained case reports of 28998 deaths of women aged 10-50, of which 8562 (29.5%) were maternal deaths. Most (7086, 82.8%) of these deaths were due to obstetric causes. The most common causes of direct obstetric death were eclampsia (34.3%), hemorrhage (27.9%), and obstructed and/or prolonged labor (11.3%). National direct obstetric death rate was estimated to be 16.9 per 100,000 women. CONCLUSIONS: Efforts to reduce fertility in Bangladesh have led to an estimated 49% reduction in the maternal mortality rate per 1000 women during the past 18 years. Variations in maternal mortality suggest the need to develop local strategies to improve obstetric care.

Adolescent↗

Hazards associated with aerial spraying of organophosphate insecticides in Israel.

Aerial application of organophosphates can result in exposure to drift and leaf residues for pilots, ground crews, field workers, and residents near sprayed fields. Exposure can be by either the airborne or dermal route, and can produce illness (headaches, fatigue, diarrhea, cramps, respiratory problems) even with low-grade depressions in cholinesterase. Alkyl phosphate metabolites have been shown to be "gold standard" measures of such exposures. Experience in Israel indicates that reduction of health hazards from exposure to drift and leaf residues may be attained by the use of a comprehensive "mix" of preventive measures. These measures include, first and foremost, reduction in total amount of organophosphates used, followed by substitution of less for more toxic organophosphates, reduction in length of spray season, banning the use of flaggers, and greater reliance on tractor spraying. Cotton yield per hectare cultivated has increased despite a reduction in use of pesticides of all kinds and organophosphates in particular. Enclosure and air-conditioning (to prevent heat stress) of cockpits, protective clothing, training and licensing of pilots have been implemented. Education and communication of information, in keeping with the right-to know principle on hazards and how they should be controlled and monitored, is a part of a comprehensive strategy. Aerial or ground spraying should produce no drift in adjacent residential communities. The criterion for achieving this goal is the absence of urine alkyl phosphate metabolites above the threshold of detection.

Air Pollutants↗

Turning wheels for youth.

Reconditioned bicycles donated from Japan to family planning associations (FPAs) in the West Indies and the Caribbean are being used to assist the promotion of reproductive health/family planning services at the grass roots. The FPAs of St. Vincent, Belize, Grenada, and St. Lucia, respectively, received 75 bicycles each with spare parts in mid-1996. The bicycles were donated through the Municipal Coordinating Committee for Overseas Bicycle Assistance, an association of Japanese local governments and JOICFP. A low-cost, non-fuel means of transport, the bicycles are a convenient means for mobilizing grass-roots health agents and motivators. The St. Lucia Planned Parenthood Association distributed the bicycles to field workers conducting educational activities on sexual and reproductive health, home visits, group activities and counseling throughout the island. Peer counselors are also using the bicycles to assist with peer educational activities in schools, home visits and for other social activities. The Grenada Planned Parenthood Association is utilizing the bicycles to assist with youth activities. The bicycles are mobilizing key personnel of the Under Twenty Clubs (UTCs) who assemble youths in weekly meetings, and peer educators who provide counseling to their peers on sexuality and personal development. The bicycles donated to the Belize Family Life Association have bolstered the activities of the community workers who provide community outreach services, organize community meetings, and conduct educational sessions. The bicycles also support peer education activities by helping youths reach out to their peers to recruit them for the education program and to distribute educational materials.

Americas↗

Contact dermatitis caused by pesticides among banana plantation workers in Panama.

To characterize dermatitis related to pesticide exposures among banana plantation workers in Panama, the authors studied 281 workers seen at The Occupational Health Department of the Social Security Hospital of Changuinola and Puerto Armuelles between 1988-1992 and in 1993. Exposure data were collected through a standardized occupational health history. Physical examination, a standard patch test, and a pesticide patch test (PPT) were carried out. Of the 244 men (86.8%) and 37 women (13.2%), 17 and 37, respectively, were packing station workers. The other 227 men were field workers, exposed to many pesticides (propiconazole, maneb, chlorothalonil, dithane, dalaphon, ametrine; and gramoxone). The 54 packing station workers were exposed to imazalil, thiabendazole, aluminum hydroxide solutions, and formaldehyde. The hands were the most frequently affected areas (82%), followed by the thorax and abdomen (9%), legs and feet (5%), and genital area (4%). There were 78 positive PPTs (27.8%) in 281 patients. The most frequent reactions were to the fungicides chloro-thalonil (51.4%), thiabendazole (12.8%), imazalil (10.2%), and aluminum hydroxide (10.2%), which accounted for 85% of all positive tests. The majority of the cases were related to exposures to fungicides; 246 with negative PPTs were classified as irritant contact dermatitis patients; 48 controls were negatives. Contact dermatitis related to pesticide exposure is a significant occupational health problem for banana workers in Panama.

Adult↗

Induced current density in the foetus of pregnant workers in high magnetic field environments.

There are moves to limit by legislation the amount of electric and magnetic fields that workers and the general public are exposed to. In work locations near wiring, cables & equipment carrying high electric currents, there are situations in which the proposed magnetic field limits could be exceeded. Since the limits for the general public are more conservative than those for workers and since the foetus or a pregnant worker should be afforded the status of a member of the general public, it is important to assess a worst-case scenario for the purposes of a general code of practice. Three different magnetic field exposures are modelled, which include the worst case - the body of a pregnant woman at a smallest distance of 30 cm to the conductor. All computations were done by using Multiple Multipole Program (MMP), which is based on the Generalized Multipole Technique (GMT) from ETH (Swiss Federal Institute of Technology), Zurich, Switzerland. In a worst-case scenario the proposed basic restrictions would be exceeded slightly in both maternal and foetal tissue. With appropriate pre-placement assessment, these over-exposures can be avoided.

Algorithms↗

[Statistical analysis of nutrients intake affecting serum lipid values of workers in an industry].

Relationships between serum lipid values and the quantity and quality of nutrient intakes of the employees in a steel factory were studied, and the following results were obtained. High density lipoprotein cholesterol (HDL-CL) and alpha-CL separated by electrophoresis in office workers were significantly lower than those of field workers and they were especially lower in cases of hypertriglyceridemia. HDL-CL, alpha-CL and Apo A values of workers with abnormal circulatory findings were demonstrated to drop down with increased cigarette smoking or carbohydrate intake. On the other hand, these values were apt to be elevated with increased alcohol or energy intake. beta-Lipoprotein and beta-CL separated by electrophoresis in workers with hyperlipidemia or abnormal electrocardiogram findings were shown to be at significantly high levels. Furthermore, beta-CL values in workers with abnormal circulatory findings were especially inclined to be elevated with increased cigarette smoking or fat intake.

Adult↗

Inter-rater reliability of a paediatric outcome measure in Nepal.

The Hospital and Rehabilitation Centre for Disabled Children (HRDC) in Nepal identified the need to evaluate their in-hospital and community programmes. An instrument was developed to provide information regarding the functional level of the children treated by the HRDC as well as to provide information regarding care-givers' attitudes towards disability. Inter-rater reliability of the measure was tested in three regions of Nepal with 49 children. Six HRDC field workers travelled in pairs to the childrens' homes and alternated in roles as test administrator and observer. Correlations between the scores documented by the administrator and observer were used to estimate inter-rater reliability. Inter-rater reliability coefficients, calculated using a weighted kappa statistic, varied from 0.60 to 1.0. We conclude that the instrument demonstrated an acceptable level of inter-rater reliability in the field setting. Future studies to measure construct and concurrent validity, test-retest reliability and responsiveness of the instrument are recommended as well as testing the instrument in different cultures.

Activities of Daily Living↗

Incorporating AIDS prevention activities into a family planning organization in Colombia.

Three AIDS prevention activities were incorporated into the services offered by PROFAMILIA in two operations research projects. The activities included: (1) informative talks given both to the general public and to members of target groups by PROFAMILIA's community marketing (CM) program field workers (or instructors); (2) the establishment of condom distribution posts in meeting places of target groups; and (3) mass-media information campaigns on AIDS prevention. Community-based distributors were able to successfully provide information on AIDS to their regular audiences as well as to deliver information and condoms to special target groups without negatively affecting family planning information/education/communication activities and contraceptive sales. A radio campaign that promoted condom use for AIDS prevention did not affect public perceptions about the condom and did not jeopardize PROFAMILIA's image.

Acquired Immunodeficiency Syndrome↗

Micronucleus monitoring of a floriculturist population from western Liguria, Italy.

A biomonitoring study was carried out to investigate whether exposure to complex pesticide mixtures in ornamental crop production represents a potential genotoxic risk. Exposed and control subjects were selected in western Liguria (Italy). The area was chosen for its intensive use of pesticides. The main crops produced were roses, mimosas, carnations and chrysanthemums, as ornamental non-edible plants, and tomato, lettuce and basil, as edible ones. The levels of micronuclei (MN) were analysed in peripheral blood lymphocytes of 107 floriculturists (92 men and 15 women) and 61 control subjects (42 men and 19 women). A statistically significant increase in binucleated cells with micronuclei (BNMN) was detected in floriculturists with respect to the control population (4.41 +/- 2.14 MN/1000 cells versus 3.04 +/- 2.14, P < 0.001). The mean number of BNMN varied as a function of sex and age. Smoking habit had no effect on MN frequency. A positive correlation between years of farming and MN frequency in peripheral blood lymphocytes was observed (r = 0.30, P = 0.02). The conditions of exposure were also associated with an increase in cytogenetic damage, with a 28% higher MN frequency in greenhouse workers compared with subjects working only outdoors in fields. Workers not using protective measures during high exposure activities showed an increase in MN frequency. Our findings suggest a potential genotoxic risk due to pesticide exposure.

Age Distribution↗

Health effects from exposure to organophosphate pesticides in workers and residents in Israel.

Major findings from our work on exposures and effects from organophosphate-containing pesticides in selected occupational and community patients and groups in Israel are reviewed as a basis for recommending control measures. The worker groups were pilots, ground-crews, and field workers; exposed nonworkers were adults and children living in kibbutzim with drift exposures, and household residents in houses treated by pest exterminators. In all groups, evidence of exposure-illness associations was found even though persons with acute poisoning were not seen. Complaints (headache, dizziness, fatigue, nausea, breathing problems, abdominal cramps, and tingling in extremities) were associated with within-normal depressions in cholinesterase activity. Whole blood and plasma cholinesterase activity were slightly more sensitive indicators of mixed exposure than red blood cell cholinesterase activity. High alkyl phosphate levels and symptoms were seen in individuals with within-normal limit depressions in cholinesterase activity. Complaints of weakness and tingling in hands and feet, together with low-grade changes in nerve conduction, suggest the possible influence of agents with a neurotoxic esterase-type activity independent of cholinesterase activity. Transient in-season neuropsychological changes in tests of mood status and performance were associated with exposure. Recommendations for exposure reduction include: accelerating the already declining use of pesticides in general, and organophosphates in particular; promoting the shift from more to less toxic organophosphates and other pesticides; and introducing rigid performance specifications for closed systems in loading and mixing at end-user sites. Dermal protection remains a problem. Cholinesterase activity levels and symptom interviews are useful for monitoring workers at risk, but alkyl phosphate levels are the definitive measure of exposure, surveys, investigations and surveillance.

Adolescent↗