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At least 19 recordsLinked to original sources
PubMedDate not supplied

Behaviour of urinary beryllium in general population and in subjects with low-level occupational exposure.

Occupational exposure to beryllium (Be) is nowadays much lower than in the past. While the classic Be diseases, such as berylliosis, are clearly on the decline, attention is currently being focussed on the immunological and carcinogenic effects of Be, which suggest that subjects with low-level occupational exposure should also be accurately controlled. Urinary Be (BeU) values were determined in a sample of the general population and in a group of dental technicians exposed to environmental Be concentrations ranging from 0.04 to 1.7 micrograms/m3. The mean BeU values of these workers (0.34 micrograms/l) were higher than those of the general population (0.26 micrograms/l) and the subgroup of dental technicians exposed to higher Be air concentration showed higher BeU levels. Although at present the relationships between external and internal dose and between internal dose and early effects, are not known, we believe that biological monitoring supplies useful information on occupational Be exposure.

Adult↗
PubMedDate not supplied

Controlling for potential confounding by occupational exposures.

Occupational exposure is an important potential confounder in air pollution studies because it is plausible that individuals who live in highly polluted areas also work in more polluted environments. While the original investigators made some efforts to control for possible confounding by occupational variables, it was felt that these could be improved upon. The reanalysis team attempted to control for occupational confounding by supplementing the original data sets with two new variables, an indicator of the "dirtiness" of a subject's job and an indicator of possible exposure to occupational lung carcinogens. The attribution of these variables was based on the job title recorded by the original investigators and on the judgment of our experts concerning typical exposure patterns in different occupations. We fitted Cox proportional-hazards models identical to those that had been used by the original investigators while also including one or both of the new occupational covariates in the models. In none of the analyses did the inclusion of the occupational variables materially change the results. It would therefore appear that, in general, the results reported by the original investigators were not distorted by inadequate control of occupational variables. We also carried out some analyses using the dirtiness index as a stratification variable to assess effect modification. There was some indication, albeit inconsistent, that the effect of air pollution on mortality was greater among subjects with dirty jobs than among those with clean jobs.

Adult↗
PubMed1986

A case-referent study of lung cancer, occupational exposures and smoking. I. Comparison of title-based and exposure-based occupational information.

The role of occupational exposures and smoking in the development of lung cancer has been studied among 176 male incident lung cancer cases and 176 referents admitted to two county hospitals in southeast Norway during 1979-1983. After the allocation of all occupational titles in the Nordic Classification of Occupations into three exposure groups according to potential exposure to respiratory carcinogens and other contaminants, each subject was classified according to exposure status of main occupation and number of years in each exposure category. An excess risk of lung cancer was observed both among those in possibly exposed occupations and among those definitely exposed. A more than threefold excess risk was observed among subjects with more than 30 years in exposed occupations. Exposure to 22 agents/processes was further assessed by a separate questionnaire and estimated simultaneously in a logistic regression model. Elevated risks were associated with exposure to asbestos and several other agents/processes, which largely correlated to each other. Smoking was strongly associated with all histological subtypes of lung cancer, while for occupational exposures the risk ratio was highest for small cell carcinoma and lowest for adenocarcinoma. Very high risk ratios for lung cancer were observed among heavy smokers in exposed occupations.

Adult↗
PubMed1997

Exposure to potential occupational asthmogens: prevalence data from the National Occupational Exposure Survey.

Few data are available about the prevalence of occupational exposures to agents which can cause occupational asthma or aggravate preexisting asthma (asthmogens). Using potential occupational exposure data from the National Occupational Exposure Survey (NOES) of 1980-1983, we investigated the number of asthmogen exposures, asthmogen-exposure(s) per production worker, and unprotected occupational asthmogen exposures in different industries and occupations. Data for the entire United States were used to generate estimates of occupational exposure at two selected state and local levels. It was estimated that 7,864,000 workers in the surveyed industries were potentially exposed to one or more occupational asthmogen(s) in the United States. The average number of observed potential exposures per asthmogen-exposed worker was 4.4, and varied from 11.9, in the Water Transportation industry, to 1.2 in Local and Suburban transportation. The largest number of observed potential exposures was recorded in the Apparel and Other Finished Products (garment) industry. This work and further analyses using this approach are expected to contribute to a better understanding of the epidemiology of occupational asthma, and to serve as a guide to target future occupational asthma surveillance efforts.

Allergens↗
PubMed1998

Proposal for the assessment of quantitative dermal exposure limits in occupational environments: Part 1. Development of a concept to derive a quantitative dermal occupational exposure limit.

Dermal uptake of chemicals at the workplace may contribute considerably to the total internal exposure and so needs to be regulated. At present only qualitative warning signs--the "skin notations"--are available as instruments. An attempt was made to develop a quantitative dermal occupational exposure limit (DOEL) complementary to respiratory occupational exposure limits (OELs). The DOEL refers to the total dose deposited on the skin during a working shift. Based on available data and experience a theoretical procedure for the assessment of a DOEL was developed. A DOEL was derived for cyclophosphamide and 4,4-methylene dianiline (MDA) according to this procedure. The DOEL for MDA was tested for applicability in an actual occupational exposure scenario. An integrated approach is recommended for situations in which both dermal and respiratory exposures contribute considerably to the internal exposure of the worker. The starting point should be an internal health based occupational exposure limit--that is, the maximum dose to be absorbed without leading to adverse systemic effects. The proposed assessment of an external DOEL is then either based on absorption rate or absorption percentage. The estimation of skin penetration seems to be of crucial importance in this concept. If for a specific substance a maximal absorption rate can be estimated a maximal skin surface area to be exposed can be assessed which may then serve the purpose of a DOEL. As long as the actual skin surface exposed is smaller than this maximal skin surface area the internal OEL will not be exceeded, and therefore, no systemic health problems would be expected, independent of the dermal dose/unit area. If not, the DOEL may be interpreted as the product of dermal dose/unit area (mg/cm2) and exposed skin surface area (cm2). The proposed concept for a DOEL is relevant and can be made applicable for health surveillance in the occupational situation where dermal exposure contributes notably to the systemic exposure. Further research should show whether this concept is more generally applicable.

Humans↗
PubMed1997

Congenital malformation and maternal occupational exposure to glycol ethers. Occupational Exposure and Congenital Malformations Working Group.

Glycol ethers are found in a wide range of domestic and industrial products, many of which are used in women's work environments. Motivated by concern about their potential reproductive toxicity, we have evaluated the risk of congenital malformations related to glycol ether exposure during pregnancy as part of a multicenter case-control study, conducted in six regions in Europe. The study comprised 984 cases of major congenital malformations and 1,134 controls matched for place and date of birth. Interviews of the mothers provided information about occupation during pregnancy, sociodemographic variables, and other potential risk factors (medical history, tobacco, alcohol, drugs). A chemist specializing in glycol ethers evaluated exposure during pregnancy, using the job description given by the mother, without knowledge of case or control status. We classified malformations into 22 subgroups. The overall odds ratio (OR) of congenital malformation associated with glycol ether exposure was 1.44 [95% confidence interval (CI) = 1.10-1.90], after adjustment for several potential confounders. The association with exposure to glycol ethers appeared particularly strong in three subgroups: neural tube defects (OR = 1.94; 95% CI = 1.16-3.24), multiple anomalies (OR = 2.00; 95% CI = 1.24-3.23), and cleft lip (OR = 2.03; 95% CI = 1.11-3.73). In this last subgroup, risk, especially of an isolated defect, tended to increase with level of exposure.

Abnormalities, Drug-Induced↗
PubMed2004

[Justification for screening laboratory tests not related to occupational exposure ordered by occupational medicine physicians: an analytical study].

The aim of the study was to analyze whether laboratory tests not related with occupational exposure ordered by occupational medicine physicians are justified. In Poland, prophylactic standards in occupational medicine are determined by law and the minimum range of laboratory tests and consultations by specialists is laid down. The extension of its range to include screening in all workers is disputable. The authors analyze the usefulness of the most common laboratory tests performed in screening (blood count, erythrocyte sedimentation rate, lipid profile, glucose in blood, urine). In part of those examinations, the benefit to a patient, e.g., the detection of a pathology, is questionable if they are not supported by a thorough analysis of the patient's state of health and risk factors.

Diagnostic Tests, Routine↗
PubMed1997

Osteoarthritis of the hip and knee and mechanical occupational exposure--a systematic overview of the evidence.

OBJECTIVE: To clarify examine the epidemiologic evidence linking work related exposure to osteoarthritis (OA) of the hip and knee. METHODS: We investigated MEDLINE and EMBASE 1966-1994 with search terms of osteoarthritis, osteoarthrosis, arthrosis; risk factors, exposure; occupational diseases, agricultural workers' diseases, work. From 123 original studies on risk factors for OA, 17 studies were identified as providing a comparison group and relating the presence or absence of radiologically diagnosed OA to occupational factors. The quality of the methodology of each study was evaluated independently by 4 reviewers using a standardized protocol. RESULTS: Common methodological problems were encountered in areas such as representatives, recall of exposure, and evaluation of exposure and outcome. These problems often made a cause-effect relationship difficult to interpret. However, 7 of the 17 studies met our criteria for good methodological quality. A critical analysis of their results led to the following conclusions: (1) A consistently positive relationship exists between work involving knee bending and knee OA in men (range of odds ratio: 1.4-6). (2) The evidence suggesting a relationship between knee OA and occupational exposure in women is inconclusive. (3) A consistently positive but weak relationship exists between work related exposure (i.e., farming in particular) and hip OA in men. We felt we could not conclude with confidence that this relationship is strong due to the potential biases that exist in each of these studies. (4) No study attempted to investigate occupational exposure and hip OA in women. CONCLUSION: Studies suggest a strong positive relationship between work related knee bending exposure and knee OA. The evidence between work related exposure, farming in particular, and hip OA is consistently positive but weak.

Female↗
PubMed1986

A case-referent study of lung cancer, occupational exposures and smoking. III. Etiologic fraction of occupational exposures.

The proportion of lung cancer related to occupational exposure to respiratory carcinogens and other workplace contaminants has been studied in a hospital-based case-referent study of 176 incident cases and 176 referents, recruited from the medical ward of two county hospitals in southern Norway. On the basis of job title and exposure information, three different approaches for the estimation of etiologic fraction were used, all based upon a trichotomous categorization of the exposure variable. Among the definitely exposed subjects, the etiologic fraction for lung cancer related to occupational exposure factors was from 22 to 35%, increasing to 37-47% when the "possibly exposed" categories were included. When asbestos was the only factor to be eliminated, the etiologic fraction estimate suggested a 23% reduction in the lung cancer incidence in the study population. More than 90% of the lung cancer cases would theoretically have been prevented if smoking had been completely removed. The relative merits of preventing one or several of the study factors simultaneously is discussed.

Adult↗
PubMed2000

Selected topics related to occupational exposures. Part V. Occupational cardiovascular disease

Cardiovascular disease is common in the United States. Several occupational exposures, such as carbon disulfide and organic nitrates, are believed to cause occupational cardiovascular disease. In addition some other agents, such as lead and cadmium, may indirectly cause cardiovascular disease through their effects on blood pressure. For other agents (ie, carbon monoxide, solvents, and chlorofluorocarbons), acute exposure and high levels may cause cardiovascular disease but may not cause cardiovascular disease through long-term or low levels. A primary care physician who has a patient with a new or unstable cardiovascular disease should obtain an occupational history to assess whether occupational exposures may be playing a role. An occupational history may indicate potential cardiovascular risks. Such risks can include exposure to certain chemicals and metals, physical factors, exertion, or psychological stress. The primary care physician should be able to assess the situation and advise the patient, as well as the employer, about restrictions or accommodations that may need to be made.

Journal Article↗
PubMed2000

A survey of the use of post-exposure prophylaxis for occupational exposure to human immunodeficiency virus.

The objective of this study was to review the appropriateness of the use of post-HIV exposure prophylaxis for incidents involving occupational exposure to body fluids. The design was a retrospective analysis of the 32 incidents for which at least one dose of post-exposure prophylaxis was given, reported to the occupational health department of a London teaching hospital between 20 August 1997 and 20 January 1999. The main outcome measures were the proportion of prescriptions for exposure to a known HIV positive source, and criteria for prescribing when the source patient's HIV status was unknown. Only 31% of prescriptions were for exposure to a known HIV positive source. The reasons for prescribing post-exposure prophylaxis in the other 69% of cases were unclear. Safety data for short courses of anti-retroviral drugs in this setting could help to assess the appropriateness of their use to allay anxiety in healthcare workers, pending clarification of the source patient's HIV status. Closer collaboration between departments and more detailed guidance would improve consistency of practice, and may save some unnecessary prescriptions for expensive and toxic drugs.

Anti-HIV Agents↗
PubMed2000

Post-exposure prophylaxis after occupational and non-occupational exposures to HIV: an overview of the policies implemented in 27 European countries.

The aim of this survey, which was part of an English-French project supported by the Commission of the European Communities, was to compare access to HIV post-exposure prophylaxis (PEP) in the occupational and non-occupational contexts in 27 European countries. A protocol was designed in May 1998 in collaboration with all country consultants. Data were collected at country level by each consultant through interviews, review of local and national recommendations and results of national or local surveys. The final comparative analysis was carried out from the individual country reports and a review of the literature. The large majority of European countries have detailed procedures regarding occupational PEP: 20/27 have produced national guidelines, three have adopted the US CDC recommendations and only four have no official recommendations. Although no standard protocol exists, the more common one is a four-week implementation of a triple combination therapy. In the context of non-occupational exposure to HIV, only five countries have guidelines with specific recommendations and one country has adopted the CDC recommendations. In the majority of cases (13 countries), PEP is never recommended but is only available in a few circumstances, sometimes with major limitations. In the last eight countries, such PEP is not currently available. Although the estimations of HIV transmission risks in occupational and non-occupational contexts are really comparables, easy access to PEP after accidental sexual or blood exposures is not guaranteed for the general population in the majority of European countries.

Anti-HIV Agents↗
PubMed1992

Biological exposure limit for occupational exposure to coal tar pitch volatiles at cokeovens.

Biological monitoring is an efficient tool in the evaluation of exposure to chemical agents. However, the dose-response of adverse health effects using biological exposure indices and biological limit values are rarely available. This paper presents an estimation of the occupational exposure limit value of 1-hydroxypyrene in urine, a biological exposure indicator of polycyclic aromatic hydrocarbons (PAH). A large-scale study of the exposure of cokeoven workers to PAH, in which both air sampling (benzene soluble matter and individual PAH including benzo(a)pyrene) and biological monitoring (1-hydroxypyrene in urine) were applied, made it possible to establish an empirical mathematical relationship between the air sampling data and biological monitoring data. It was calculated that cokeoven workers with a urinary concentration of 1-hydroxypyrene of 2.3 mumol/mol creatinine after a 3-day working period equals the airborne threshold limit value (TLV) of coal tar pitch volatiles (CTPV). Epidemiological studies have quantified the relative risk of lung cancer for topside and non-topside cokeoven workers. The published environmental exposure data of topside and non-topside cokeoven workers were used to determine the time-average exposure. The data of 1-hydroxypyrene in the urine of cokeoven workers and data of epidemiological studies from different coke plants were combined according to the concentrations of PAH in the air. Thus, it was possible to establish an indirect relationship between lung cancer mortality risk and the biological exposure indicator for cokeoven workers. Exposure at the level of the suggested tentative biological exposure limit (BEL) of 2.3 mumol/mol creatinine is estimated to be equal to a relative risk of lung cancer of approximately 1.3.

Coal↗
PubMed2004

[Post-exposure prevention after occupational exposure to HBV, HCV and HIV].

After occupational exposure to HBV, HCV, and HIV, the patient from whom the potentially infectious material originates (index patient) as well as the exposed person should undergo serological and, if needed, molecular screening. Active and passive immunoprophylaxis after exposure to HBV is an effective tool against infection with hepatitis B virus in unvaccinated persons. The post-exposure prophylaxis (PEP) should be given within 24 h after exposure of an unprotected person to HBV-positive material. Once acute hepatitis B infection is diagnosed, therapy is not recommended for immunocompetent persons. At present, PEP against HCV infection is not available. Monotherapy with interferon-alpha avoids chronification in most patients suffering from acute hepatitis C. After exposure with an increased risk for transmission of HIV (percutaneous needle stick injury, cut), PEP should be recommended and can also be offered for further indications. PEP should be started as early as possible and carried out for 28 days. The recommended PEP consists of two inhibitors of the reverse transcriptase and one inhibitor of the protease.

HIV Infections↗
PubMed2000

Selected topics related to occupational exposures. Part III. Occupational dermatology

Occupational skin disorders are very common and are a surprisingly frequent cause of lost work time. Failure to suspect an occupational cause can lead to repeated treatment failure and needlessly prolong patient misery and frustration. Primary care providers play a key role in recognizing possible occupational causes and arranging appropriate education, preventive measures, and treatment. Occupational skin conditions often occur in nonindustrial settings in workers such as hairdressers, health care personnel, and food handlers. Irritant contact dermatitis is by far the most prevalent occupational skin condition and is emphasized in this article. Allergic contact dermatitis, infections, skin cancers, and acneform eruptions may also have significant occupational associations. We will present criteria that suggest on occupational exposure, list common offending agents, and review the clinical presentations and relevant pathophysiology. We provide guidance on a directed history and physical examination and suggest when diagnostic testing is most likely to have value. Finally we outline preventive measures such as contact avoidance, barrier creams, and protective gloves and address therapy and indications for referral.

Journal Article↗
PubMedDate not supplied

[Reporting and compensation of mesothelioma caused by occupational exposure to asbestos in Romagna (1986-1994). Work Group for Surveillance of Mesothelioma in Romagna].

A working group for the surveillance of mesothelioma was established in the Romagna Region of Italy. For the present report of the early data on compensation, 94 cases notified to the Romagna Cancer Registry between 1986 and 1994 (mean age, 66.7 years; male: female ratio, 1.8; frequency of pleural location, 76%; frequency of cyto-histologic confirmation, 79%) were considered. Information on asbestos exposure, occupational history, and compensation status was obtained from the patients or their relatives, the general practitioners, the local occupational health services, the National Institute of Social Insurance, the National Board for Insurance against Industrial Accidents (INAIL), and the Trade Unions. Asbestos exposure was associated with 42/94 cases (45%). Of these, 11 (26%) had been reported to INAIL. All such cases had cyto-histological confirmation. The greater frequency of reporting was found among cases known to the occupational health service (7/7) as well as those with definite, documented asbestos exposure (9/13). Only two cases had been reported by hospital physicians. Seven cases were compensated. In addition to cyto-histological confirmation, also the male sex, patient's age under the mean of 66, pleural location, and documented asbestos exposure were found to be prerequisites for compensation. Not only in these subgroups but also among cases known to the occupational health service as well as those diagnosed in 1990-94, most cases reported were compensated. These early data suggest that a more accurate diagnostic process as associated with prompt notification to the occupational health service for thorough assessment of asbestos exposure may improve the compensation process.

Adult↗