Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine

Published by Lippincott, Williams & Wilkins
Online ISSN: 1076-2752
Publications
Article
A steering committee and investigators from the American College of Occupational and Environmental Medicine (ACOEM) designed and carried out the ACOEM Practice Guidelines Dissemination Project to encourage adoption of the ACOEM Occupational Medicine Practice Guidelines. The project also involved research on guideline acceptance as well as potential improvements and additions to the guidelines. To increase guideline adoption and use in improving the appropriateness and consistency of practice and case management, the design was based on existing research on guideline format, education, and adoption efforts. This article summarizes that information and the needs assessment done prior to case-based guidelines training. Other articles in this issue report on guideline adoption and use and the results of the market research on the ACOEM guidelines.
 
Article
To gain further insight into the kinetics of airway inflammatory response and explore the possibility of nitric oxide as a surrogate marker of the lower airway inflammatory response to ozone, nine subjects with mild atopic asthma were exposed to filtered air or 0.2 ppm ozone for 2 hours with intermittent exercise. Lung function was measured at baseline and immediately after exposures. Sputum induction was performed at 6 hours and at 24 hours after exposures, and exhaled nitric oxide levels were measured at baseline, immediately, 6, and 24 hours after both exposures. A significant decline in forced expiratory volume in one second and inspiratory capacity was detectable following exposure to ozone. In addition, a 2-fold increase was observed in the percentage of polymorphonuclear leukocytes 6 hours after exposure to ozone, with no changes in other biomarkers at this time point. By 24 hours after ozone exposure, the neutrophilia had subsided but there was an increase in albumin, total protein, myeloperoxidase, and eosinophil cationic protein. Exhaled nitric oxide levels, histamine, interleukin-8, and growth-related oncogene-alpha in sputum did not change significantly following ozone exposure. It was concluded that short-term ozone exposure induces an acute inflammatory response in asthmatic airways, characterized by early polymorphonuclear leukocyte influx followed by plasma extravasation and activation of eosinophils and neutrophils. Exhaled nitric oxide is not a useful marker for detecting inflammatory response to ozone in persons with mild asthma.
 
Article
The authors conducted an investigation of a cluster of eight new-onset asthma cases identified in a chemical plant through the Sentinel Event Notification Systems for Occupational Risks (SENSOR) program. Workplace investigation involved interviews with the asthma cases, review of medical records, and medical and industrial hygiene surveys in the plant. Altogether, 11 work-related asthma cases were identified among the plant workers-approximately 10% of the workers exposed to the potential causative agents: 3-amino-5-mercapto-1,2,4-triazole (AMT) or N-(2,6-difluorophenyl)-5-methyl-[1,2,4]triazolo[1,5-a]pyrimidine-2-sulfonamide (DE-498; trade name Flumetsulam). Of these cases, six had physician-diagnosed occupational asthma (OA) based on work-related respiratory symptoms and nonspecific bronchial hyperresponsiveness (NSBH), and of these, three had work-related expiratory peak flow changes. The findings of this investigation, together with findings from concurrent animal studies, suggest that this outbreak of new-onset asthma was associated with exposure to AMT. A cluster of eight new-onset asthma cases was identified in a chemical plant through the SENSOR program. Subsequent workplace investigation identified AMT, used in the production of a herbicide N-(2,6-difluorophenyl)-5-methyl- [1,2,4]triazolo[1,5-a]pyrimidine-2-sulfonamide, as the most likely causal agent.
 
Article
Early biochemical and histological changes in rat lungs were investigated after oral administration of 136 mg/kg 1,2-dichloroethane in oleum solution. The experiment was performed using 80 male Wistar rats. Bronchoalveolar lavage fluid and lung homogenate were examined on posttreatment days 1, 5, 15, and 30. In bronchoalveolar lavage fluid, the activities of lactate dehydrogenase, alkaline phosphatase, and acid phosphatase were elevated on day 1. The activities of superoxide dismutase, catalase, and glutathione peroxidase, and the content of malondialdehyde in lung homogenate, were also increased on day 1. The histological investigation indicated congestion, edema, and lung interstitial inflammatory changes. It was concluded that oral administration of 1,2-dichloroethane causes mild-to-moderate transitory toxic injury of the lung. Lipid peroxidation and the levels of key antioxidant enzymes are increased in the earliest posttreatment period.
 
Article
To evaluate the association between cumulative exposure to 1,3-butadiene (BD) or styrene (STY) and lung cancer among synthetic rubber industry workers. Internal Cox regression analyses were performed both with and without natural logarithm transformation of exposure variables and both with and without the inclusion of those unexposed to monomers. Among women, analyses using untransformed BD exposure showed no trend. Analyses using natural logarithm-transformed BD exposure indicated a positive trend when the unexposed were included (P < 0.05) and an inverse trend when the unexposed were excluded (P < 0.05). No exposure-response trends were seen for BD among men or for STY among women or men. These results suggest that the association between BD and lung cancer, seen in some analyses of female employees, is not causal. STY did not appear to be associated with lung cancer.
 
Article
To evaluate the variation of some biomarkers related to the level of enzymatic activity dependent on the different polymorphisms. We studied 27 butadiene-exposed workers and 37 controls using different biomarkers of the genotoxic effect. The genotypes were determined using polymerase chain reaction and restriction fragment length polymorphism-polymerase chain reaction techniques; the subjects were assigned to a specific group based on the microsomal epoxide hydrolase (mEH) activity predicted by their genotype (low, intermediate, high). The studied biomarkers were not able to discriminate between exposed and control individuals, but sister chromatid exchange (SCE) and high frequency cells were influenced by smoking habits. Smokers having fast microsomal epoxide hydrolase activity showed higher SCE frequency (7.61) respect to those presenting intermediate (5.86) or slow (6.65) enzymatic activity. On the basis of these results, can we suppose the existence of an "intermediate genotype" advantage (at least for induction of SCE)?
 
Article
The aim of the study was to examine associations of social support with early retirement and reported retirement preference. Logistic regression analyses of early retirement (retired before the age of 55) were based on a cohort of 10,489 respondents (5960 female, 4529 male) aged 40-55 years. Analyses of retirement preference (planning of early retirement) were based on a sub-cohort of 7759 full-time employees (4233 female, 3526 male). The measures for social support were the social network size (number of close personal relationships) and social network heterogeneity (number of different roles as sources of social support). Among women, early retirement was associated with small social networks (OR 5.1, 95% CI = 2.8-9.2) and low social network heterogeneity (OR 9.1, 95% CI = 3.2-25.9). Among men, the corresponding associations were somewhat smaller (1.5; 0.9-2.6 and 8.0; 1.8-35.7, respectively). Adjustments for age, occupational training, and spouse at home did not considerably affect these associations. Among men, the association between social network heterogeneity and early retirement was not statistically significant after additional adjustments had been made for marital status and perceived health status. The characteristics of the social network were not associated with a retirement preference among employed men. Among women, the lack of social relations was associated with low retirement preference. Our findings suggested that social support is not independently associated with a retirement preference among men. Socially isolated women prefer retirement less often than other women do. Being retired before the age of 55 years may be predicted by limited social support or it may restrain one's possibilities to establish and maintain social relationships.
 
Article
For more than a decade after the Gulf War, there has been concern that wartime exposures have resulted in significant morbidity among Gulf War veterans. After the end of the war, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) initiated health registries to provide systematic clinical evaluations of Gulf War veterans who chose to participate. By September 1999, there were 32,876 participants in the DoD Comprehensive Clinical Evaluation Program and 70,385 participants in the VA Gulf War Registry Health Examination Program. We identified demographic and military service factors, as well as potential war-related exposures associated with subsequent registry participation after 10 years of observation. Veterans potentially exposed to oil well fire smoke, those near Khamisiyah, Reserve and National Guard, Army veterans, and veterans in the theater of operations during intense combat periods were most likely to elect to participate in a registry. These findings support the hypothesis that certain occupational factors and wartime exposures may influence subsequent health care-seeking behavior.
 
Article
The integration of women into non-traditional military occupations raises questions concerning the impact of such jobs on women's reproductive health. This study examines the extent to which US Navy women in their reproductive years report exposures to potential occupational and environmental hazards, and the degree to which such exposures are associated with self-reported adverse live-birth outcomes. Data from a survey of pregnant Navy women provided both maternal and paternal exposure information on more than 1000 active-duty women. Self-reported exposures to heavy metals, pesticides, petroleum products, and other chemicals were associated with adverse live-birth outcomes at the bivariate level. Only a father's exposure to pesticides at work predicted an adverse live-birth outcome (preterm delivery) in multivariate models. Maternal occupational exposures may exert their influence through maternal health and/or pregnancy complications and may act as mediators of health-reproductive outcome relationships.
 
Article
To evaluate the relationship between modifiable health risks, and health and productivity related expenditures and predict cost savings from improvements in the health risk profile of a large US employer. Information was collected on 11 modifiable health risks for active employees who completed a health assessment and enrolled in a noncapitated health plan. These risks were related to employer medical care costs and employee productivity. Multivariate analyses were performed to estimate costs associated with high risk, as well as potential savings from reducing risk prevalence among employees. Health risks with the greatest impact on total medical care costs included obesity, high blood pressure, high blood glucose, high triglycerides, and inadequate exercise. Modifiable health risks are associated with higher employer costs. Targeted programs that address these risks are expected to yield substantial savings.
 
Article
Explore relationships between World Trade Center (WTC) exposures and sarcoidosis. Sarcoidosis has been reported after exposure to the WTC disaster. We ascertained biopsy-proven post-9/11 sarcoidosis among WTC Health Registry enrollees. Cases diagnosed after Registry enrollment were included in a nested case-control study. Controls were matched to cases on age, sex, race or ethnicity, and eligibility group (eg, rescue or recovery worker). We identified 43 cases of post-9/11 sarcoidosis. Twenty-eight incident cases and 109 controls were included in the case-control analysis. Working on the WTC debris pile was associated with sarcoidosis (odds ratio 9.1, 95% confidence interval 1.1 to 74.0), but WTC dust cloud exposure was not (odds ratio 1.0, 95% confidence interval 0.4 to 2.8). Working on the WTC debris pile was associated with an elevated risk of post-9/11 sarcoidosis. Occupationally exposed workers may be at increased risk.
 
Article
There is much concern over the potential for short- and long-term adverse mental health effects caused by the terrorist attacks on September 11, 2001. This analysis used data from the Millennium Cohort Study to identify subgroups of US military members who enrolled in the cohort and reported their mental health status before the traumatic events of September 11 and soon after September 11. While adjusting for confounding, multivariable logistic regression, analysis of variance, and multivariate ordinal, or polychotomous logistic regression were used to compare 18 self-reported mental health measures in US military members who enrolled in the cohort before September 11, 2001 with those military personnel who enrolled after September 11, 2001. In contrast to studies of other populations, military respondents reported fewer mental health problems in the months immediately after September 11, 2001.
 
Article
We studied the evolution of lower respiratory symptoms at 1 month (initial) and 19 months (follow-up) after the collapse of the World Trade Center on September 11, 2001 (9/11). A total of 1588 New York police officers completed initial self-administered questionnaires. The level of 9/11 exposure and pre-9/11 health was available in 1373. Of those, 471 (426 with no pre-9/11 chronic respiratory disease) completed a follow-up telephone survey. Prevalence of cough was 43.5% at both initial and follow-up assessments, but increased were the prevalence of phlegm (14.4% to 30.7%, P<0.001), shortness of breath (18.9% to 43.6%, P<0.001), and wheeze (13.1% to 25.9%, P<0.001). Rates of delayed-onset (present on follow-up assessment only) cough, phlegm, shortness of breath, and wheeze were 21%, 21.9%, 31.7%, and 17.3%, respectively. Most of the lower respiratory symptoms increased between 1 month and 19 months after 9/11.
 
Article
The influence of unemployment and adverse work conditions on the course of psychopathology after a mass disaster is unclear. We recruited a representative sample of adults living in the New York City metropolitan area six months after the September 11 attacks and completed follow-up interviews on 71% of the baseline sample six months later (N = 1939). At follow-up, posttraumatic stress disorder (PTSD) persisted in 42.7% of the 149 cases with PTSD at baseline. In multivariable models, unemployment at any time since baseline predicted PTSD persistence in the entire cohort (P = 0.02) and among persons employed at follow-up (P = 0.02). High levels of perceived work stress predicted PTSD persistence among persons employed at follow-up (P = 0.02). Persons unemployed in the aftermath of a disaster may be at risk for poor mental health in the long-term.
 
Article
The objective of this study was to assess both malignant and nonmalignant mortality risks of workers exposed to creosote. For background, a literature review is also presented. The retrospective cohort study consisted of 2179 employees at 11 plants in the United States where wood (primarily railroad ties and utility poles) is treated with creosote-based preservatives. The observation period covered 1979-2001. Mortality data in the cohort study were analyzed in terms of cause-specific standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs), with expected deaths based on U.S. national cause-, gender-, race-, year-, age-specific mortality rates. In addition to the cohort investigation, a nested case-control study of lung cancer and multiple myeloma was conducted. Information on tobacco consumption and detailed employment (job titles) was obtained for cases and matched controls. Jobs were classified into 5 categories according to potential for exposure to creosote. Odds ratios (ORs) and 95% CIs were calculated for job categories and length of exposure. Overall mortality for the entire cohort was lower than expected (293 observed deaths vs. 325.37 expected, SMR = 90.1, 95% CI = 80.0-101.0). Close to 90% employees were hourly, whose potential for exposure was generally much higher than that of salaried employees. Among hourly employees, except for multiple myeloma, none of the specific cancer sites showed any significant increase. Furthermore, detailed analysis by length of employment did not reveal any significant mortality excess or upward trend. Six deaths were from multiple myeloma, whereas 1.50 deaths were expected (SMR = 401.1, 95% CI = 147.2-873.1). However, analysis by length of employment did not show any upward trend for multiple myeloma. No significant mortality increase was reported for any nonmalignant disease, and analysis by length of employment did not reveal any upward trend. In the case-control study, an increased risk of lung cancer was associated with tobacco consumption (OR = 4.92) but not with any job/exposure category. For example, the lung cancer odds ratio for routine exposure to creosote-based wood preservatives was 0.58 (95% CI = 0.11-3.03). Similarly, case-control analyses of multiple myeloma did not reveal any association with employment at the plants or with exposure to creosote-based wood preservatives or to creosote-treated products. Based on the present investigation and other studies, there was no evidence that employment at the 11 wood-treating plants or exposure to creosote-based wood preservatives was associated with any significant mortality increase from site-specific cancers or nonmalignant diseases. Some results should be interpreted with caution because they were based on small numbers.
 
Article
Understanding postdisaster workplace adjustment may help guide interventions for postdisaster emotional functioning and recovery. One to two years after the September 11, 2001, terrorist attacks, 12 focus groups were conducted with 85 employees of companies directly affected by the 9/11 attacks on New York City, to discuss mental health issues surrounding return to the workplace after the disaster. Risk communication, tension between workplace productivity and employees' emotional needs, and postdisaster work space were topics discussed in the focus groups. Employees identified many effective responses by their companies after 9/11 relating to these areas of concern as well as gaps in response. Recommended risk communication procedures were applied but not systematically. Little direction was available for balancing workplace productivity and employees' emotional needs or for strategic management of postdisaster workspace, suggesting areas for future disaster workplace research.
 
Article
We sought to estimate the lifetime risk of asbestos-related cancer for residents of Lower Manhattan attributable to asbestos released into the air by the 9/11 attack on New York City's World Trade Center (WTC). Exposure was estimated from available data and reasoned projections based on these data. Cancer risk was assessed using an asbestos risk model that differentiates asbestos fiber-types and the US Environmental Protection Agency's model that does not differentiate fiber-types and combines mesothelioma and lung cancer risks. The upper limit for the expected number of asbestos-related cancers is less than one case over the lifetime of the population for the risk model that is specific for fiber-types and 12 asbestos-related cancers with the US Environmental Protection Agency's model. The cancer risk associated with asbestos exposures for residents of Lower Manhattan resulting from the collapse of the WTC is negligible.
 
Article
We sought to contrast mood disorder symptoms in F-111 aircraft Deseal/Reseal maintenance personnel with appropriate comparisons. Participants completed a comprehensive health assessment, including measures of mood disorder, self-reported mood symptom questionnaire items, and review of anxiolytic and depression medication. Multiple logistic regression was conducted for each outcome using exposure group and potential confounders as explanatory variables. There was high agreement between self-reported mood disturbance and objective tests. The exposed group was more likely to self-report previous diagnoses of depression/anxiety, had higher use of antidepressant medications, and had increased risk of diagnosis of depression/anxiety. Results were consistently strong against both comparison groups, with the exposed more likely to have mental distress and social dysfunction when compared with the Australian population. There is robust evidence for an association between F-111 Deseal/Reseal exposure and impaired mental health.
 
Article
We collected information on lifetime occupational histories, smoking, and alcohol consumption from 15,463 incident cancer cases. Occupational risk factors for bladder cancer are presented in this report. A matched case-control design was used. All cases were diagnosed with bladder cancers, with controls being internal controls consisting of all other cancer sites, excluding lung and unknown primary. Data were analyzed using conditional logistic regression for matched sets data and the likelihood ratio test. Excess bladder cancer risks was observed in a number of occupation and industries, particularly those involving exposure to metals, including aluminum, paint and solvents, polycyclic aromatic hydrocarbons, diesel engine emissions, and textiles. The results of our study are in line with those from the literature and further suggest that exposure to silica and to electromagnetic fields may carry an increased risk of bladder cancer.
 
Article
Employees are often exposed to and bothered by environmental tobacco smoke (ETS) in the workplace; however, little is known about correlates of workers' perceptions of their exposure. In this study, 20,801 employees in 114 work sites in the United States were surveyed; variables related to perceptions of exposure and being bothered by ETS were entered into regression models. Many of the workplaces had total or partial restrictions on smoking in the workplace; however, over half of the respondents (52.4%) reported they were exposed to ETS at work. Smoking policy, smoking status, age, gender, living with a smoker, and occupation contributed to models for perceived exposure and being bothered by tobacco smoke. Work site smoking restrictions seem to have an impact on employee attitudes concerning exposure to ETS. About 35% of employees were bothered regularly by smokiness at their workplaces, which made their working conditions both uncomfortable and exposed them to an unsafe working environment.
 
Article
To assess patterns and trends in mortality among men employed in U.S. operating segments of a petroleum company. We defined a cohort of 127,266 men with at least 1 day of employment during the period of 1979 through 2000. Computerized human resources databases were the basis of the cohort definition as well as the source of demographic and most work history information. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) were calculated for 94 causes of death, including analyses by operating segment and job type. Most SMR results are below unity. The main exception is mesothelioma (SMR = 1.49; 95% CI = 1.15 to 1.90), which has elevations three times greater than expectation among some groups of men working in manufacturing sites who were hired before 1960. SMRs for cancers of the blood and blood-forming organs are generally close to unity, whereas men in the chemicals segment have 17 deaths due to acute non-lymphocytic leukemia (SMR = 1.81; 95% CI = 1.06 to 2.90), with no temporal or job type patterns. Men in the downstream segment have an elevation of aplastic anemia (SMR = 2.19; 95% CI = 0.95 to 4.32), based on eight deaths. There are eight deaths from malignant melanoma among downstream drivers (SMR = 2.46; 95% CI = 1.06 to 4.84), and motor vehicle accident rates are slightly elevated among some groups of younger and shorter-term operators. This comprehensive study indicates an overall favorable mortality profile for this workforce. For a few elevations, the study helps guide decisions about future surveillance, focused studies, and other follow-up actions.
 
Article
To identify work ability trajectories among Finnish firefighters during a 13-year follow-up. We examined whether baseline musculoskeletal pain and depressive symptoms (DPS) predicted membership of the trajectories. We studied 411 male firefighters who responded to a questionnaire at both baseline and at least one of two follow-ups. The outcome variable was perceived work ability (0 to 10). The predictors were musculoskeletal and depressive symptoms. Covariates included age, diseases, lifestyle habits, and work-related factors. One fourth of the firefighters belonged to the Diminished work ability trajectory. Musculoskeletal and depressive symptoms, lifestyle risks and diseases, and, in separate analyses, low back pain, were strong predictors of this. When planning preventive actions and workplace health promotion among firefighters, even one site musculoskeletal pain and mild signs of depression should be taken into account. Prevention of adverse lifestyle habits is also essential.
 
Article
: To describe changes in aging firefighters' aerobic capacity at 3- and 13-year follow-ups, and to investigate the lifestyle factors predicting them. We evaluated the sufficiency of aerobic capacity for the demands of rescue diving. : We studied 78 male Finnish firefighters aged 30 to 44 years at baseline. The outcome variable was aerobic capacity (L·min and mL·kg·min). The predictors were exercise, smoking, and drinking habits. : The average annual change (range) in absolute and relative aerobic capacity was -1.12% (-3.43 to 1.39) and -1.33% (-3.98 to 1.63). Exercising at least 4 to 5 times a week was the best protective factor, and regular smoking and more than 15 units of alcohol a week were risk factors for decline in aerobic capacity. : To prevent the excessive decline of aerobic capacity related to work demands, we must pay particular attention to exercise regularity.
 
Article
To investigate the change trajectories of positive and negative moods and their relationship to work ability, self-rated health, and life satisfaction in a three-wave 13-year follow-up study. The data, consisting of Finnish firefighters (n = 360), were collected via questionnaires in 1996, 1999, and 2009. Four distinct mood trajectories were identified by latent class growth modeling: (1) high positive, (2) high positive but decreasing, (3) moderately positive, and (4) high negative. The trajectory groups were differentially related to well-being. Members of the high positive trajectory had better well-being than members of other latent mood trajectories. Different trajectories exist in positive and negative moods, and these trajectories are differentially related to well-being. Developing work environments in which a positive mood can flourish is beneficial in terms of better well-being among employees.
 
Article
: To evaluate the risk of asthma associated with occupational exposures in a population-based cohort. : The risk of asthma was analyzed in 792 subjects who were asthma free at the age of 13 years. Occupational histories were obtained from subjects at the age of 44 years and occupational exposures determined with an asthma-specific job exposure matrix. Cumulative exposure to latex and risk of asthma was examined using Cox proportional hazards regression. : Development of asthma was modestly related to exposure at any time to high molecular weight latex (odds ratio, 1.4; 95% confidence interval, 0.9-2.3). Cumulative latex exposure of 6 to 15 years was associated with a hazard ratio of 1.6 for the development of asthma and after 16 years increased to 2.65 (95% confidence interval, 1.28-5.47). : There is a significant association between cumulative occupational exposure to latex and new-onset asthma.
 
Article
This study analyzes the relationship between arsenic exposure through drinking water and bladder cancer mortality. The county-specific white male bladder cancer mortality data (1950-1979) and county-specific groundwater arsenic concentration data were obtained for 133 U.S. counties known to be exclusively dependent on groundwater for their public drinking water supply. No arsenic-related increase in bladder cancer mortality was found over the exposure range of 3 to 60 microg/L using stratified analysis and regression analyses (both unweighted and weighted by county population and using both mean and median arsenic concentrations). These results, which provide a direct estimate of arsenic-related cancer risk for U.S. residents, exclude the National Research Council's 2001 risk estimate that was based on Southwest Taiwan data and required adjusting for differences between the body mass and water consumption rates of U.S. and Taiwanese residents.
 
Article
To identify occupational cancer risk factors, lifetime occupational, smoking, and alcohol-consumption histories were collected by means of a self-administered questionnaire from 15,463 male cancer patients aged 20 years and over as ascertained from the British Columbia population-based cancer registry; all cases were histologically confirmed. The study methodology, descriptive results, and cancer risks from cigarette smoking are reported. Assessment of questionnaire validation and reliability showed very high correlations between all variables analysed. Non-response bias, assessed among 221 non-responders and 432 matched controls, revealed no statistically significant differences for smoking status, education, or for 11 usual (longest-held job) occupational groups, except for managerial occupations and for four pooled groups that represented 6.7% of all occupations. Except for pancreatic cancer, a significant relationship was found for all cancer sites known to be strongly associated with cigarette smoking.
 
Article
We have, as part of a program aimed at detecting occupational risk factors in British Columbia, collected lifetime occupational histories from 15,643 incident cancer cases, of whom 1519 had a diagnosis of prostate cancer. Occupational risks for this cancer site are examined using this large data set, and the results are presented in this report.
 
Article
To examine the associations between the lifestyle factors-sports, alcohol, nutrition, overweight, and smoking, the eating styles of dietary restraint, external eating, and emotional eating on the one hand, and the change in body mass index (BMI) on the other hand. Using a Web-based lifestyle questionnaire, responses were obtained from 1562 employees. We found a consistent main effect of emotional eating and doing sports on change in BMI. High emotional eating was related to weight gain, whereas a high level of sporting was related to weight loss. Restrained eating and external eating were not found to have a significant influence on change in BMI. Additionally, a consistent moderator effect of sporting on emotional eating was found (P < .05). The association between BMI change and emotional eating was less strong for employees with high engagement in strenuous sports compared with those with low engagement in strenuous sports. This indicates that strenuous physical activity can indeed attenuate the positive association between emotional eating and body weight gain. Emotions may drive people with overweight and obesity to overeat. Sports activities may attenuate but do not solve the problem. If we want to cure the disease, psychological treatment strategies have to be developed.
 
Article
To determine the effects of a physician-organized wellness regime (POWR) on a cohort of firefighters while applying the 2007 National Fire Protection Association Standard 1582. A prospective evaluation comparing baseline with postintervention injury rate data among 252 Howard County, Maryland firefighters with analysis of return on investment. After implementation of POWR, the Howard County fire department showed a 40% reduction in recordable injuries during year 1, which increased to 60% during year 2. Return on investment was shown to be 4.6:1 by the second year. Moreover, the subpopulation of overweight firefighters showed statistically significant weight loss during the intervention period. POWR, a specific type of wellness initiative, can lead to substantial cost savings from an injury-sparing perspective alone and has potential to decrease cardiac risk factors among a high-risk population of firefighters.
 
Article
The objective of the study was to determine the relationship between physical leisure-time activities and the occurrence of long-term sick leaves in nurses' aides. Of 5563 Norwegian nurses' aides who were not on sick leave when they completed a questionnaire in 1999, 4744 (85.3%) completed a second questionnaire 15 months later. Brisk walks (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.63 to 0.98), aerobics or gymnastics (OR, 0.71; 95% CI, 0.49 to 1.02), and other physical leisure activities (OR, 0.81; 95% CI, 0.66 to 1.00) for 20 minutes or more at least once a week predicted fewer long-term sick leaves (> 14 days), after adjustments for baseline health complaints, demographic and familial characteristics, former and current smoking, and work factors. In conclusion, regular physical leisure-time activity may be associated with a reduced risk of long-term sickness absence in nurses' aides.
 
Article
To study roles of Clara cell protein 16 (CC16) and surfactant protein-D (SP-D) as serum biomarkers in the early diagnosis and the pathogenesis of silicosis. Thirty healthy volunteers, 30 silica-exposed workers, and 30 workers with suspected silicosis and phase I silicosis were included. Serum CC16 and SP-D concentrations were determined using enzyme-linked immunosorbent assay. Serum CC16 concentrations decreased in silica-exposed workers when compared with in controls, but serum SP-D levels increased, and this trend was obvious in phase 0 and I groups. Discriminant analysis showed that the accuracies of classifying group membership into control, phase 0, phase 0, and phase I were 86.7%, 46.7%, 66.7%, and 70%, respectively, and the total classification accuracy rate was 67.5%. Serum CC16 and SP-D may be useful biomarkers for early diagnosis, and serum SP-D concentration may associate with the pathogenesis of silicosis.
 
Baseline (1992) Information on Disability Pension (DP) and Old-Age Pension for All Individuals in the Swedish Twin Cohort, Stratified by Sex 
Article
To investigate annual prevalence of disability pension (DP) from 1992 to 2007 and associations with sociodemographic factors in 1992. All twins born between 1928 and 1958 were identified from the Swedish Twin Registry and linked to national records on DP. Descriptive statistics and logistic regressions were applied. The annual prevalence of DP was 10.7% (9.6% to 11.3%). High age (odds ratio [OR] 9.17; 95% confidence interval [CI] 8.43 to 9.98), low education (OR 4.84; 95% CI 4.31 to 5.42), and being unmarried (OR 2.36; 95% CI 2.22 to 2.50) were associated with DP. The associations remained after adjusting for familial factors. The fact that the associations remained after control for familial factors indicates that factors not shared by family members, such as choices in adulthood, are of relevance for the associations found.
 
Article
Cardiovascular disease is the leading cause of death, and the role of occupation continues to generate interest. Using the National Occupational Mortality Surveillance system, proportionate mortality ratio (PMR) analyses were used to examine the association between occupation and ischemic heart disease among 16- to 60-year-old males. We used data from 1982-1992 from 27 states. Separate analyses were conducted for blue-collar and white-collar occupations. Among the blue-collar occupations with the highest PMRs for ischemic heart disease mortality were sheriffs, correctional institution officers, policemen, firefighters, and machine operators. Physicians (blacks only) and clergy (both races) were among the white-collar occupations with the highest PMRs for ischemic heart disease. Although more study is needed, consideration should be made for targeting high-PMR occupations, with improvement in work organization to reduce occupational stress and promotion of healthy lifestyles through cardiovascular disease prevention programs.
 
Distribution of Hydrofluoric (HF) Acid Events Compared With Other Acid and Non-Acid Events, By Year. Hazardous Substances Emergency Events Surveillance, 1993-2001.
A Ranking of Injuries Sustained During Hydrofluoric (HF) Acid Events Compared With Injuries Sustained in Other Acid and Non-Acid Events. Hazardous Substances Emergency Events Surveillance, 1993-2001.
A Ranking of the Health Outcomes for Hydrofluoric (HF) Acid Victims Compared With the Health Outcomes For All Other Acid and Non-Acid Victims. Hazardous Substances Emergency Events Surveillance, 1993-2001.
Article
Hydrofluoric (HF) acid is 1 of the strongest and most corrosive acids known. Human exposure commonly occurs from occupational releases and can result in severe injuries and death. Data from the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance (HSEES) system were used to conduct a descriptive analysis on the acute health effects of HF acid exposure. Of the total HSEES events (n = 49,106), HF acid releases occurred in 0.3% of events (n = 134). HF acid events were 2 times more likely to involve injuries when compared with other acid events and 3 times more likely when compared with nonacid events. Employees such as those in trucking services, petroleum refining, and chemical manufacturing need to understand the dangers of HF acid and should have the appropriate personal protective equipment available to prevent exposure.
 
Article
The current study summarizes a 17-year reevaluation of testicular function and reproductive performance of 15 production workers with dibromochloropropane (DBCP)-induced testicular dysfunction. Sperm count recovery was evident within 36 to 45 months in three of the nine azoospermic and in three of the six oligozoospermic men with no improvement thereafter. A significant increase in plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and a nonsignificant decrease in testosterone level were detected in the severely affected individuals. There was no increase in the rate of spontaneous abortions and congenital malformations among pregnancies conceived during or after exposure. A low prevalence of male infants conceived during paternal exposure was found as compared with the preexposure period (16.6% versus 52.9%; P<.025). Restoration of fertility was followed by a gradual increase of this value to 41.4%.
 
Handwriting of a manganism patient receiving para-aminosalicylic acid (PAS) therapy. (A) Handwriting at the time of hospital admission before PAS therapy; (B) handwriting at the end of 15-week PAS treatment; and (C) handwriting after 17 years of PAS treatment.  
T1-weighted magnetic resonance images (MRIs) in the globus pallidus of the patient. (A) Axial T1-weighted MRI, (B) coronal T1-weighted MRI, and (C) sagittal T1-weighted MRI.  
Article
Chronic manganese (Mn) intoxication induces syndromes resembling Parkinson disease. The clinical intervention has largely been unsuccessful. We report a 17-year follow-up study of effective treatment of occupational Mn parkinsonism with sodium para-aminosalicylic acid (PAS). The patient, female and aged 50 at the time of treatment, was exposed to airborne Mn for 21 years (1963-1984). The patient had palpitations, hand tremor, lower limb myalgia, hypermyotonia, and a distinct festinating gait. She received 6 g PAS per day through an intravenous drip infusion for 4 days and rested for 3 days as one therapeutic course. Fifteen such courses were carried out between March and June 1987. At the end of PAS treatment, her symptoms were significantly alleviated, and handwriting recovered to normal. Recent follow-up examination at age 67 years (in 2004) showed a general normal presentation in clinical, neurologic, brain magnetic resonance imaging, and handwriting examinations with a minor yet passable gait. This case study suggests that PAS appears to be an effective drug for treatment of severe chronic Mn poisoning with a promising prognosis.
 
Article
Cytokeratin 18 (CK18) is a novel serologic biomarker for occupational liver disease. The purpose of this study is to determine the prevalence of CK18 elevation in elastomer/polymer workers exposed to acrylonitrile, 1,3-butadiene, and styrene. A total of 82 chemical workers were evaluated. Cytokeratin 18 was determined by enzyme-linked immunosorbent assay and proinflammatory cytokines were measured by multi-analyte chemiluminescent detection. Thirty-nine percent (32 of 82) had elevated CK18 levels, which were not explained by alcohol or obesity, except in potentially four cases. The pattern of CK18 elevation was consistent with toxicant-associated steatohepatitis (TASH) in the majority of cases (78%). Tumor necrosis factor α, interleukin-6, interleukin-8, monocyte chemotactic protein-1, and plasminogen activator inhibitor-1 were increased in these workers compared with those with normal CK18 levels. These results suggest a high prevalence of occupational liver disease and TASH in elastomer/polymer workers with elevated proinflammatory cytokines.
 
Article
We prospectively examined whether preemployment family factors predict adulthood work stress manifested as effort-reward imbalance (ERI). The study sample comprised 746 participants from the Cardiovascular Risk in Young Finns Study. Data were collected by questionnaires. The parents reported their socioeconomic position and life satisfaction in 1983 when the participants were at age 6 to 21. The participants reported ERI in 2001 at age 24 to 39. High rewards were predicted by high parental life satisfaction in men and by high parental socioeconomic position in women. The association between higher parental socioeconomic position and higher efforts was mediated by participant's education. Preemployment family factors were not associated with the total ERI. Although preemployment family factors were associated with the reward and effort components, they seemed to have little effect on the total ERI.
 
Article
Toxic or environmental exposures have been suggested as a possible cause of symptoms reported by Gulf War veterans. To further explore this hypothesis, we analyzed findings in 18,495 military personnel evaluated in the Department of Defense Comprehensive Clinical Evaluation Program. The program was established in 1994 to evaluate Persian Gulf veterans eligible for Department of Defense medical care who had health concerns after service in the Persian Gulf during Operation Desert Shield/Desert Storm. The evaluation included a structured clinical assessment, a physician-administered symptom checklist, and a patient questionnaire addressing self-reported exposures, combat experiences, and work loss. Among 18,495 patients examined, the most common symptoms were joint pain, fatigue, headache, memory or concentration difficulties, sleep disturbances, and rash. Symptom onset was often delayed, with two-thirds of symptoms not developing until after individuals returned from the Gulf War and 40% of symptoms having a latency period exceeding one year. There was no association between individual symptoms and patient demographics, specific self-reported exposures, or types of combat experience. Increased symptom counts were associated with work loss, the number of self-reported exposures, the number of types of combat experience, and certain ICD-9 diagnostic categories, particularly psychological disorders. Prolonged latency of symptom onset and the lack of association with any self-reported exposures makes illness related to toxic exposure less likely.
 
Article
Studies indicate that persons employed in various retail occupations such as convenience stores and restaurants experience an increased risk for being a victim of an occupational homicide. A large proportion of workers aged 19 and under are employed in these types of occupations. The purpose of this study was to determine if the workers from this age group employed in retail trades have a significantly greater risk for being a victim of a homicide. Data from the Bureau of Labor Statistics' Census of Fatal Occupational Injuries were analyzed in this study. The cases included in this study were victims of an occupational homicide that occurred during the period of 1992 to 1996. Proportionate mortality ratios were used to identify the industries in which workers aged 19 and under were experiencing significantly higher proportion of fatalities. Relative risks were calculated to determine if, based on the number of person-years of exposure, workers aged 19 and under in retail trades were experiencing a significantly greater relative risk for being a victim of an occupational homicide. Results indicate that workers aged 19 and under experience a significantly greater proportion of fatalities due to violence in the retail trade. Workers 19 years and under employed in retail trade occupations do experience a significantly greater proportion of fatalities than their counterparts in other industries. Prevention strategies presented include providing employee training and implementing various security measures.
 
Article
To identify if 1,6-hexamethylene diisocyanate (HDI) workers demonstrated an increased prevalence of occupational asthma or accelerated decline in pulmonary function. Employees from two plants manufacturing or producing 1,6-HDI monomer and/or HDI polyisocyanates were matched to a control population by age, gender, race, and smoking status. A random coefficient regression analysis compared the decline in pulmonary function test values over time. Retrospective medical review was used to identify potential cases of occupationally induced asthma. No significantly accelerated annual decline in force expiratory volume after 1 second in the HDI exposure group compared to the matched control group was observed. No cases of adult onset asthma, beyond those present at time of hire, and no cases of occupational asthma were identified. This study provides support for the current American Conference of Governmental Industrial Hygienists threshold limit value time-weighted average of 5 ppb.
 
Article
Petroleum workers are exposed to benzene or benzene-containing petroleum products. As such, studies of these workers provide an opportunity for investigating the relationship between benzene and non-Hodgkin's lymphoma (NHL). However, few cohort studies of petroleum workers report results of NHL separately. One reason is that NHL is usually grouped with other lymphopoietic cancers in the analysis. Another reason is the relatively small number of NHL cases in some studies. To determine the risk of NHL in petroleum workers, we identified 26 cohorts of petroleum workers in the United States, the United Kingdom, Canada, Australia, Italy, and Finland. Authors of the original studies were contacted, and data on the number of observed deaths and person-years of observation were requested. Data from these studies were reviewed individually as well as combined in a pooled analysis (meta-analysis). In particular, results for individual cohorts, most of which had never been reported before, were presented. The combined multinational cohort consisted of more than 308,000 petroleum workers (6.6 million person-years), and the observation period covered an interval of 60 years from 1937 to 1996. A total of 506 NHL deaths were observed, compared with 561.68 expected. The standardized mortality ratio was 0.90 and the 95% confidence interval was 0.82 to 0.98. Analyses were performed by type of facility and industrial process. Stratum-specific standardized mortality ratios (95% confidence intervals) were 0.96 (0.86 to 1.07) for US refinery workers, 1.12 (0.90 to 1.37) for non-US refinery workers, 0.64 (0.50 to 0.82) for product (gasoline) distribution workers, and 0.68 (0.47 to 0.95) for crude oil workers. When individual cohorts were stratified by length of observation, no pattern was detected. In general, exposure levels before 1950 were much higher than thereafter. However, analysis of workers by hire date (< 1950, > or = 1950) revealed no difference in NHL mortality. Furthermore, none of the individual studies showed significant exposure-response relations. In summary, results from individual studies, as well as from the pooled analysis, indicated that petroleum workers were not at an increased risk of NHL as a result of their exposure to benzene or other benzene-containing petroleum products in their work environment. This conclusion was supported by cohort studies of workers in other industries who were exposed to benzene as well as by population-based case-control studies of NHL and occupational exposures.
 
Article
We observed 42,076 men and 11,706 women first employed at the Michigan locations of The Dow Chemical Company between 1940 and 1994. Follow-up was 98% complete, and we identified 16,242 deaths. Significant deficits in standardized mortality ratios were observed for all causes, all malignant neoplasms, and more than a dozen other causes of death when compared with rates in the United States. We observed significant elevations for several causes of death among employees of a magnesium foundry. There is little modern exposure information, because the foundry was sold nearly 40 years ago. This routine surveillance activity provided a generally favorable overview of the health experience of our employees and did not suggest a need for an additional focused study.
 
Top-cited authors
Ronald J Ozminkowski
  • Analytic Strategies & Consulting LLC
Ron Goetzel
  • Johns Hopkins Bloomberg School of Public Health
Bert Vogelstein
  • Johns Hopkins Medicine
Ronald C. Kessler
  • Harvard Medical School
Dee Edington
  • Edington Associates