Cohort mortality study of rubber and plastics product makers in Italy

A retrospective cohort mortality study was carried Out in 20industrial factories in the Local Health Unit Bologna Sud (EmiliaRomagna, Italy), where different rubber and plastics productswere manufactured. The cohort consisted of 925 subjects (578males and 347 females) employed for at least six months continuously;follow-up was between the beginning of operation of each factory,ranging between mid fifties and mid seventies, and 31 December1989. For those exposed more than one year cause specific StandardizedMortality Ratios (SMRs) were computed using regional rates forcomparison, 90% confidence intervals (Cl) were calculated assumingthe Poisson distribution. Among the 748 subjects employed formore than one year (457 males and 291 females) there were nolost to follow-up, 54 individuals were dead (41 males and 13females) and for three subjects the cause of death was unknown.The results showed that all causes mortality was above expectancyin the total cohort (SMR=123; 54 Obs; 90% Cl=97–154),among males (SMR=117; 41 Obs; 90% Cl=89–152) and females(SMR=143; 13 Obs; 90% Cl=85–228). Increased mortalityfor all malignant tumours was observed in the total cohort (SMR=150;25 Obs; 90% Cl=104–209) and for both genders. All ninelung cancer cases were observed among males, the SMR was equalto 218 and was statistically significant; seven cases occurredat duration of exposure less than 10 years and six at latencyup to 20 years. The interpretation in terms of causality ofthe present investigation is limited by the small number ofobservations and by exposure definition solely in terms of employmentin the study factories; nonetheless the results are indicatingthe existence, in this group of rubber and plastics productmakers, of an adverse health effect which deserve further investigation.     

A five-year study comparing early retirements on medical grounds in ambulance personnel with those in other groups of health service staff: Part I: Incidences of retirements

The objective of this study was to compare morbidity betweenambulance staff and other groups of health service workers,to facilitate planning of occupational health (OH) services.A retrospective study of employees of The Eastern Health andSocial Services Board, Northern Ireland was conducted. Subjectswere 181 men and 353 women assessed at OH between 1988–92and found eligible (on the basis of permanent incapacity) toapply for early retirement on medical grounds (EROMG). Ambulancepersonnel showed a high rate of EROMG (55.9/1,000 per annum)both compared with previous ambulance studies (5.7–22.5/1,000),and with other groups in the present study (manual 24.8/1,000,nursing 5.9/1,000 and non-manual 2.6/1,000). Indirect standardizationwas used to correct for age-sex differences between groups,by deriving standardized early retirement ratios (SERR). Ambulanceand manual staff showed high SERRs (636, Cl=558–714 and164, Cl=149–179), whereas nursing and non-manual staffshowed low SERRs (91, Cl=75–107 and 38, Cl=25–52),(all results except that for nursing staff being significantat <0.001). There is evidence that ambulance staff are agroup with high morbidity, and thus deserving of particularattention in terms of preventative and health promotional activities.Other issues requiring consideration in relation to ambulancestaff are redeployment and lowering of the retirement age.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Abdominal symptoms among sewage workers

The objective of this cross-sectional study was to investigatethe prevalence of abdominal symptoms and the abdominal medicalhistory among sewage workers. 142 male sewage workers and 137male referents in 11 Swedish municipalities were addressed witha questionnaire about abdominal symptoms, medical history, occupationalhistory and life style factors. The sewage workers sufferedless from nausea [adjusted odds ratio (adjOR)=0.18, 95% confidenceinterval (Cl)=0.04–0.84] than the referents. There wasno significant difference in the three months prevalence ofdiarrhoea (adjOR=1.7, 95% Cl=0.79–3.4), dyspepsia (adjOR=0.85,95% Cl=0.49–1.5) or irritable bowel syndrome (adjOR=1.4,95% Cl=0.53–3.5). The sewage workers were affected moreoften by peptic ulcers during their present jobs than the referents,although the increased risk was not significant (adjOR=1.4,95% Cl=0.31–6.1). The odds ratios were adjusted for age,use of tobacco products and alcohol consumption. The conclusionof this study was that sewage workers are less affected by nauseathan comparable referents.     

Musculoskeletal symptoms among seafood production workers in North Norway

AIMS: To investigate the prevalence of musculoskeletal complaints among male and female production workers in different types of seafood industries in North Norway and to analyse associations between musculoskeletal symptoms and some possible risk factors in the seafood industry. METHODS: A self-administered anonymous questionnaire, covering several aspects concerning occupational environment and health issues, was mailed to employees in seafood-processing plants in North Norway. RESULTS: A total of 1767 employees in 118 seafood-processing plants participated giving a 50% response rate. This included 744 production workers in whitefish, shrimp and salmon industries, and 129 administrative workers in all types of seafood industries. The prevalence of musculoskeletal symptoms was high among seafood production workers. The odds ratio for symptoms from upper limbs was significantly higher for females compared to men. Production workers had the highest relative risk for symptoms from wrist/hands (OR = 4.1-9.4) and elbows (OR = 3.5-5.2) when compared to administrative workers. The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hands among female (82%) and male (64%) production workers in the salmon industry compared to whitefish (62 and 47%, respectively) and shrimp industry (66 and 37%, respectively). CONCLUSIONS: Musculoskeletal symptoms were found among the majority of production workers in the whitefish, shrimp and salmon industry, the highest prevalence being among female workers. The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hands among workers in the salmon industry. Cold work was an important risk factor for musculoskeletal symptoms.     

Shift work and risk factors for coronary heart disease in Japanese blue-collar workers: Serum lipids and anthropometric characteristics

This study was conducted to determine if there is an associationbetween shift work and risk factors for coronary heart disease(CHD) in Japanese mate blue-collar shift workers. Health check-updata on serum lipid concentration and anthropometric indicesof 33 three-shift workers and 27 two-shift workers were comparedwith those of day workers. The average years in age of the shiftworkers and day workers were 34.5 (SD=7.1) and 32.7 (SD=7.6),respectively. Serum total cholesterol levels of three-shift,two-shift and day workers were 5.70 (SD=1.19) mmol/l, 4.81 (SD=1.01)mmol/l, 4.98 (SD=0.95) mmol/l, respectively, and the cholesterollevels of three-shift workers were significantly higher thanthe other workers (p<0.05). In addition, the abdominal tohip circumference ratios were 0.905 (SD=0.060) for three-shiftworkers and 0.877 (SD=0.054) for day workers, with a significantdifference (p<0.05). In the present Japanese population,three-shift workers had higher risks of CHD than day workers,which was characterized by higher levels of serum total cholesteroland tendency to central obesity. These findings held when lifestylefactors were taken into account.     

A Study of the Impact of Occupational and Domestic Factors on Insomnia among Industrial Workers of a Manufacturing Company in Japan

Insomnia is one of the most common health problems and has recentlybeen re-termed ‘Disorders of Initiating and MaintainingSleep’, or DIMS. The main purpose of the present studywas to investigate the relationship between daily psychosocialstressors, to which workers are exposed in occupational and/orprivate life, and insomnia among male industrial workers ina medium-sized company located in Nagasaki City, Japan. Allof the workers in the company (n=368, male=319) were asked toanswer six sleep related questions and 24 questions about workingand private conditions. Two hundred and seventy-one (85.0%)of them completed the questionnaire (average age was 40.9 yearsold). Twenty seven point seven per cent of the subjects complainedof insomnia in the last month prior to the survey and the prevalencewas in general accord with previous surveys. On the other hand,the proportion of hypnotic use (1.1%), especially in insomniacgroup (2.7%) was lower than previous reports. The results ofmultiple logis regression analysis demonstrated that four psychosocialfactors were significantly associated with insomnia: i.e. VDTwork overload (odds ratio [OR] 5.058; 95% confidence intervals[95% Cl] 2.381–10.745), limited space of bedroom (OR 2.612;95% Cl 1.283–5.683), over-involvement in job (OR 2.78;95% Cl 1.188–6.540), frequent alcohol beverages consumption(OR 2.595; 95% Cl 1.177–5.719).     

Communication between an occupational physician and other medical practitioners--an audit

Four hundred and seventy-two consecutive referral episodes relatingto 386 patients attending the Occupational Health Departmentof a general teaching hospital were analyzed to evaluate thefrequency, content and effect on management of communicationsbetween the occupational physician and other doctors. In all,250 episodes (53%) were associated with such a communication.The likelihood of a communication was strongly influenced byreason for referral, particularly in respect of long or shortterm sickness absence; univariate odds ratios (OR)=10.58, 95%Cl=8.13–27.08) and 2.65, 95% Cl=1.55–4.60) respectively;a medical diagnosis of psychiatric illness (OR=3.17, 95% Cl=1.69–5.97));and by number of consultations. Communication was also morelikely when the occupational outcome was ill health retirement,rehabilitation in work or modified work. Ninety-eight per centof specific requests for information or an opinion eliciteda reply. Information received from other doctors influencedthe occupational health physician's management in 52 referralepisodes (20%). Specific action by GPs as a result of communicationwas documented in 54 and by specialists in 37 episodes. Theimportance of communication between occupational health physicianand other doctors in the occupational health process is confirmed.     

Exposures to blood and body fluids in Brazilian primary health care

Background Primary health care workers (HCWs) represent a growingoccupational group worldwide. They are at risk of infectionwith blood-borne pathogens because of occupational exposuresto blood and body fluids (BBF). Aim To investigate BBF exposure and its associated factors amongprimary HCWs. Methods Cross-sectional study among workers from municipal primaryhealth care centres in Florianópolis, Southern Brazil.Workers who belonged to occupational categories that involvedBBF exposures during the preceding 12 months were interviewedand included in the data analysis. Results A total of 1077 workers participated. The mean incidencerate of occupational BBF exposures was 11.9 per 100 full-timeequivalent worker-years (95% confidence interval: 8.4–15.3).The cumulative prevalence was 7% during the 12 months precedingthe interview. University-level education, employment as a nurseassistant, dental assistant or dentist, higher workload score,inadequate working conditions, having sustained a previous occupationalaccident and current smoking were associated with BBF exposures(P 0.05). Conclusions Primary Health Care Centres are working environmentsin which workers are at risk of BBF exposures. Exposure surveillancesystems should be created to monitor their occurrence and toguide the implementation of preventive strategies.     

Smoking as a predictor of long-term work disability in physically active and inactive people

Data from a Norwegian 4-year prospective questionnaire studywere used to test our hypothesis that smoking is a weaker predictorof long-term work disability in physically active than inactivepersons. Of 1,788 respondents who were working and not olderthan 62 years in 1990, 1,426 (80%) also returned a questionnairein 1994. For respondents who were taking physical exercise lessthan once a week, smoking predicted long-term work disabilityfour years later [odds ratio (OR)=2.24; 95% confidence interval(Cl)=1.30–3.87; p<0.01], when adjusting for age, sex,workhours per week, heavy lifting at work, emotional symptomsand musculoskeletal pain at time 0. In respondents who wereexercising at least once a week, there was no association betweensmoking and long-term work disability.     

Reasons for Rejection: Why People Fail to Qualify as Firefighters

In the decade beginning 1 January 1985, 916 individuals (includingfive females) were medically examined with a view to joiningthe full-time service of Strathclyde Fire Brigade (SFB). Onehundred and nine (11.9%), including two females, were rejected.The five main causes of failure were: ocular (n = 46, 42.2%);lack of stamina (n = 21, 19.2%); ‘others’ (n = 12,11.0%); cardiovascular (n = 9, 8.3%) and orthopaedic (n = 6,5.5%). Thirty-two had chest X-rays. One abnormality was found— an azygous lobe — but it played no part in thedecision to decline the applicant. There was little life- orhealth-threatening pathology found. The most serious cases weremurmurs consistent with mitral stenosis and regurgitation (oneeach), one case of ocular melanoma, four cases of hypertensionand two cases of haematuria/ proteinuria (++). This study showsthat potentially serious findings can occasionally be detectedin a population of 18–30 year olds who might be expectedto be of better than average fitness, and that routine chestX-rays are not helpful in the selection process.     

Musculoskeletal Problems in the Tomato Growing Industry: 'Tomato Trainer's Shoulder'?

Tomato training entails highly repetitive shoulder muscle contractions,static contractions and work at shoulder level, factors linkedin other working groups with neck and shoulder complaints. Thefrequency of musculoskeletal complaints was compared using theNordic Questionnaire in 56 tomato trainers and 52 other matchedglasshouse workers whose job did not include these work taskfactors. A higher 12- month (odds ratio (OR) = 5.9; [95% confidenceinterval (Cl) = 2.4–16.7] and 7- day (OR = 3.6, Cl = 1.2–11.1)period prevalence of shoulder complaint was recorded in trainersthan in pickers and deleafers. Other upper limb and upper trunkcomplaints were also more common in tomato trainers, highlightingan area of ergonomic concern.     

Increased risk for hepatitis A among female day nursery workers in Belgium

To assess the risk for hepatitis A virus (HAV) infection inan occupational group potentially at risk for faeco-oral contactwith very young children, a prevalence study of total anti-HAVantibodies (lgG/lgM) was conducted among 591 female employeesin day nurseries in Flanders, Belgium, and in a reference groupof 560 healthy female blood donors, matched for age. Analysiswas also performed on formally exposed persons (n=413) versusblood donors (n=560). The overall prevalence of HAV markerswas 48.4% (95% Cl: 44.2–52.5) in exposed day nursery personnel,compared with 42.9% (95% Cl: 38.7–47.0) in blood donors.The age-specific prevalence rates showed a steeper rise fromthe age of 30 years among the exposed employees than among theblood donors, with significantly higher prevalences between35 and 44 years of age. The discrepancies levelled off above60 years of age. Standardization for parenthood using logisticregression did not affect the odds ratio. These results arein line with recent findings of a higher prevalence of HAV markersamong groups of workers professionally exposed to small children.Appropriate measures for the protection of these groups shouldbe taken.     

Erythrocyte cholinesterase activity levels in desert farm workers

In this study we have examined 532 migrant farm workers engagedmainly in the cultivation of vegetable crops, in both greenhousesand openfarms, and an equal number of controls. Erythrocyteacetylcholinesterase activity (AChE) was measured to determinethe degree of toxicity due to exposure to organophosphate andcarbamate pesticides in the farm workers employed either asforemen (41.5%) or farmers (58.5%). The mean ages of the farmworkers and controls were 35.2±7.4 (mean±SD) yearsand 34.6±7.1 years. AChE activity of the farm workersand controls was 3.89±0.64 Ul/ml (mean±SD) and4.15±0.29 Ul/ml. The haemoglobin adjusted erythrocytecholinesterase activity (HAChE) was 29.96±4.14(mean±SD)for farm workers and 32.10±2.26 for controls. AChE activitywas very highly significantly lower for the foremen (3.76±0.69)compared to farmers (3.98±0.59) (Student's t-test=4.13,p=0.0001). HAChE was also very highly significantly lower forforemen (29.24±4.37) compared to farmers (30.46±3.88)(Student's t-test=3.64, p=0.0001). The poorly controlled useof pesticides in the farms appeared to have caused sub-clinicalintoxication in the farm workers and indicated the need fortraining and implementation of hygiene practices.     

Salivary acetylcholinesterase as a biomarker for organophosphate exposure

Background Workers exposed to organophosphate (OP) pesticidesare required to undergo periodic statutory medical surveillancein several countries. Aim To study the relationship between serum, erythrocyte andsaliva acetylcholinesterase (AChE) levels and to explore theuse of salivary AChE as potential biomarker for OP exposure. Methods A cross-sectional study was conducted on 19 healthyadult male lead-exposed workers who were undergoing six monthlystatutory medical examination. Passive drool saliva sampleswere collected from each worker. Each blood sample was testedfor serum and erythrocyte AChE, and each saliva sample was testedfor AChE. Results Among the 19 subjects, the mean (±standard deviation)of salivary, erythrocyte and serum AChE/cholinesterase were22.7 (±17.4), 17171 (±1467), 8861 (±1876)U/l, respectively. There was a moderate correlation betweensalivary and erythrocyte AChE (r = 0.42, P = 0.071), but notsalivary and serum AChE (r = –0.17, P = 0.48). The levelof AChE in saliva was 1820 times lower than AChE in erythrocytes. Conclusion It is probably not feasible to use saliva as a replacementfor blood for the measurement of AChE levels. This is becauseof the much lower levels of AChE in saliva relative to erythrocytes,the weak correlation between the two measurements and the previouslyreported high intra-individual variation of salivary AChE.     

Blood Pressure Variability at Annual Periodic Health Examination for Employees and Cardiovascular Risk Factors

The employees with hypertension at the annual periodic healthexamination (HE) for employees in Japan usually receive a re-examinationof blood pressure (BP) on another day and are often found tobe normotensive. In this study, we analyzed data from the HEat the workplace to determine whether or not such employeesshould receive medical care. Two groups of subjects were selected.One group (group 1) was composed of 50 subjects with normotensionat the HE (controls). Another group (group 2) was composed of33 subjects with hypertension at the annual HE but with normotensionin re-examinations. Cardiovascular risk factors were significantlyhigher in group 2 than in group 1: mean values of the body massindex (group 1, 22.2±2.7 vs. group 2, 24.3±3.1kg/m² p<0.01), total cholesterol (group 1, 197±36vs. group 2, 222±42 mg/dl, p<0.01), and low densitylipoprotein (group 1, 118±32 vs. group 2, 137±38mg/dl, p<0.05). The proportion of the employees with high-normalBP in group 2 (42.5%) was significantly higher than that ingroup 1 (28.0%) (p<0.01). These indicate that the employeeswith hypertension at the annual HE but with normotension inthe re-examination require further medical attention and shouldreceive medical supervision. The occupational physician shouldsupervise these employees.     

Doctors, their mental health and capacity for work

Background Information about doctors’ mental ill-healthis limited. This study looks at doctors’ careers followingmental illness and the strategies that helped them return towork. Aim To examine the effect of mental ill-health on doctors’careers. Methods Questionnaire survey of members of the Doctors SupportNetwork (DSN). The DSN is a peer support group for doctors whohave experienced, or are experiencing, mental ill-health. Results One hundred and sixteen doctors (35% response rate)returned completed questionnaires (n = 116, 63% female, 37%male). Prior to their ill-health, 80% worked full time, 15%part-time, 2% were not working and 3% were medical students.Following illness, 33% worked full time (P < 0.05), 36% part-time(P < 0.05) and 29% were not working (P < 0.01). Flexibleworking practices were the most helpful reported strategy forenabling a doctor to return to work. Conclusions Following mental ill-health, a doctor’s capacityto work full time is reduced. Most doctors return to full-timeor part-time work. With improved support, more doctors may beable to return to work.     

Low back pain among Iranian industrial workers

BACKGROUND: Most epidemiological data concerning low back pain (LBP) are from high-income countries and there is very little information about LBP in the working population in developing countries. OBJECTIVES: To determine the prevalence of LBP in Iranian industrial workers. To explore associations between LBP and physical and psychosocial factors at work, as well as lifestyle factors. METHODS: Cross-sectional study of the largest car-manufacturing group in Iran. The prevalence of LBP, work exposures and lifestyle factors were recorded using the standardized Nordic questionnaire for analysis of musculoskeletal symptoms. Demographic data and lifestyle factors (age, sex, education, weight, work experience, smoking and fitness training) were also collected. RESULTS: Of the 18,031 employees, 78% participated. The majority of subjects in this study population were young males (<30 years) and a small proportion was female (4%). The 1-year prevalence of self-reported LBP in this Iranian industrial population was 21% (20% males and 27% females). The prevalence rate of absence due to LBP was 5% per annum. The multiple logistic regression models indicated that the following remained risk indicators for LBP in the previous 12 months: increasing age, no regular exercise, heavy lifting, repetitive work and monotonous work. CONCLUSION: LPB is a common problem in the working population even in a developing country. Age and gender as well as certain work-related physical and psychosocial factors influenced the prevalence of LBP but the differences between different categories of workers were small.     

The impact of Hymenoptera venom allergy on occupational activities

The objective of this study was to investigate the impact ofallergy to hymenoptera venom on the occupational activitiesof patients undergoing immunologic treatment for insect stinganaphylaxis. The design was a cross-sectional study conductedin a sample of 500 out of 1,500 patients undergoing venom inmunotherapyfor insect sting reaction in 13 allergy clinics in Israel. Aself-administered questionnaire was used to collect data aboutdemographic characteristics of patients, severity of the allergicreaction, and adverse effects on occupational activities. Ofthe 204 respondents who were part of the labour force, 48.5%reported adverse effects on routine occupational activities.The factors with a significant influence on the probabilityof adverse occupational effects were: (1) patient's type ofwork (blue collar vs. white collar: OR=;3.22, p<0.001; armyvs. white collar: OR=5.28, p=0.001); (2) severity of the allergicreaction (severe reaction vs. mild/moderate reaction: OR=2.34,p=0.007). Our findings suggest that severe insect sting allergyhas an adverse impact on patients' occupational activities.This factor requires special attention by the medical community.Social workers and occupational physicians should collaboratein the assessment and management of these patients.     

Increased risk of coronary heart disease in Japanese blue-collar workers

The purpose of this study was to test the hypothesis that blue-collar workers have an increased risk of coronary heart disease. Subjects were 653 male (mean age, 32.6 years) and 492 female (mean age, 26.3 years) workers employed during 1993 at a computer manufacturing company. The measurements determined were body mass index (BMI), waist to hip ratio (WHR), skinfold thickness, blood pressure, grip strength, back strength, vertical jump and trunk flexion. Male blue-collar workers had significantly higher WHR (P < 0.001), systolic blood pressure (P = 0.031), grip strength (P = 0.030), and standing flexion (P = 0.038) than do white-collar workers. Female blue-collar workers had significantly higher BMI (P = 0.018), WHR (P < 0.001), and grip strength (P = 0.007). Blue-collar workers took significantly less exercise, and habitually snacked (females only), smoked and drank more alcohol (males only) than white-collar workers. In conclusion, blue-collar workers have more intra-abdominal fat than white-collar workers of either sex. The difference may be due to factors contributing to the less healthy lifestyles of blue-collar workers.