To assess whether pesticide use practices were associated with injury mortality among 51,035 male farmers from North Carolina and Iowa enrolled in the Agricultural Health Study.
We used Cox proportional hazards models adjusted for age and state to estimate fatal injury risk associated with self-reported use of 49 specific pesticides, personal protective equipment, specific types of farm machinery, and other farm factors collected 1–15 years preceding death. Cause-specific mortality was obtained through linkage to mortality registries.
We observed 338 injury fatalities over 727,543 person-years of follow-up (1993–2008). Fatal injuries increased with days per year of pesticide application, with the highest risk among those with 60+ days of pesticide application annually (Hazard Ratio (HR) =1.87; 95% Confidence Interval (CI) = 1.10, 3.18). Chemical-resistant glove use was associated with decreased risk (HR=0.73; 95%CI=0.58, 0.93), but adjusting for glove use did not substantially change estimates for individual pesticides or pesticide use overall. Herbicides were associated with fatal injury, even after adjusting for operating farm equipment, which was independently associated with fatal injury. Ever use of five of 18 herbicides (2,4,5–T, paraquat, alachlor, metribuzin, and butylate) were associated with elevated risk. In addition, 2,4–D and cyanazine were associated with fatal injury in exposure-response analyses. There was no evidence of confounding of these results by other herbicides.
The association between application of pesticides, particularly certain herbicides, and fatal injuries among farmers should be interpreted cautiously but deserves further evaluation, with particular focus on understanding timing of pesticide use and fatal injury.
pesticides; mortality; wounds; injuries
While acute pesticide poisoning can be associated with persistent adverse central nervous system (CNS) effects, little is known about the effect of episodic and unusually high pesticide exposure events (HPEEs) that typically do not result in acute poisoning. The objective of this investigation was to examine the association between HPEEs and CNS function among licensed pesticide applicators enrolled in the Agricultural Health Study (AHS).
In 2006–2008, 693 male participants, with no history of a physician-diagnosed pesticide poisoning, completed nine neurobehavioral tests to assess memory, motor speed, sustained attention, verbal learning, and visual scanning and processing. Information on HPEEs and pesticide poisonings was obtained from previous AHS interviews. Associations between HPEEs and neurobehavioral outcomes were estimated with linear regression controlling for age and outcome-specific covariates.
A history of at least one HPEE was reported by 156 (23%) participants. Adverse associations were observed between HPEEs and two of the nine neurobehavioral tests. On a test of visual scanning and processing (Digit-Symbol), participants with HPEEs were 4.2 seconds slower (95% CI: −7.27, −1.11) than those without HPEEs, equivalent to the effect of 3.9 years of age in this population. On a test of visual scanning and motor speed (Sequences A), participants with HPEEs were 2.5 seconds slower (95% CI: −4.53, −0.41) than those without HPEEs, equivalent to the effect of 3.9 years of age. No significant associations were observed between HPEEs and the other neurobehavioral tests.
HPEEs may contribute to adverse CNS outcomes independent of diagnosed pesticide poisoning.
agricultural workers; epidemiology; neurobehavioral testing; pesticide exposure
Prospective studies on bystanding to workplace bullying and the health outcomes are scarce.
To investigate the work environmental risk factors of depressive symptoms among bystanders to bullying in both women and men in four large industrial organizations in Sweden.
The number of respondents at four large industrial enterprises with more than one year at the workplace at T1: n = 2,563 (Women: n = 342; Men: n = 2,227). Bystanders to bullying at T1: n = 305 (Women: n = 30; Men: n = 275). The total number of those with symptoms of depression at T2: Women: n = 30; Men: n = 161. Two thousand one hundred and seventy-seven employees answered the questionnaire on T1 and T2 with an 18-month interval. “To have depressive symptoms” was defined as not having depressive symptoms at T1 but having depressive symptoms at T2.
The number of men who were bystanders to bullying was larger compared to women. However, the proportion of women who were bystanders to bullying and developed depressive symptoms 18 months later was higher in comparison with men (33.3 and 16.4 %, respectively). Further, “Being a bystander to bullying” 1.69 (1.13–2.53), “Rumors of changes in the workplace” 1.53 (1.10–2.14), “Reduced role clarity” 2.30 (1.21–4.32), “Lack of appreciation of being in the group” 1.76 (1.22–2.53) increased the risk of future symptoms of depression. “Job Strain” was not an adjusted risk factor for depression.
Our results support previous findings that bystanding to workplace bullying is related to future depressive symptoms.
Job strain; Longitudinal; Industry; Bystanding workplace bullying; Depression; Model; Theory
To examine the influence of employment social support type (e.g. co-worker, supervisor, general support) on risk of occurrence of low back pain, and prognosis (e.g. recovery, return to work status) for those who have low back pain.
Systematic search of seven databases (MEDLINE, Embase, PsychINFO, CINAHL, IBSS, AMED and BNI) for prospective or case–control studies reporting findings on employment social support in populations with nonspecific back pain. Data extraction and quality assessment were carried out on included studies. A systematic critical synthesis was carried out on extracted data.
Thirty-two articles were included that describe 46 findings on the effect of employment social support on risk of and prognosis of back pain. Findings show that there is no effect of co-worker, supervisor or general work support on risk of new onset back pain. Weak effects of employment support were found for recovery and return to work outcomes; greater levels of co-worker support and general work support were found to be associated with less time to recovery or return to work.
The evidence suggests that the association between employment support and prognosis may be subject to influence from wider concepts related to the employment context. This review discusses these wider issues and offers directions for future research.
Work social support; Social network; Back pain; Systematic review; Employment
To investigate the influence of lifestyle, health, and work conditions in the association between education and productivity loss at work and sick leave.
Employees of six companies filled out a questionnaire on demographics, lifestyle-related, health, and work-related factors, and productivity loss at work and sick leave at baseline (n = 915) and after 1-year (n = 647).
Employees with a low education were more likely to report productivity loss at work (OR = 1.49, 95 % CI 0.98–2.26) and sick leave (OR = 1.81, 95 % CI 1.15–2.85). After adjustment for lifestyle, health, and work conditions, the association between education and productivity loss at work did not attenuate. Work conditions attenuated the association between low education and sick leave (OR = 1.62, 95 % CI 1.01–2.61), and additional adjustment for health and lifestyle-related factors further reduced the strength of the association (OR = 1.42, 95 % CI 0.86–2.34).
Work conditions and lifestyle-related factors partly explained the association between education and sick leave, but did not influence the association between education and productivity loss at work. The educational differences in sick leave prompt for interventions that address behavioral aspects as well as work-related and lifestyle-related factors.
Productivity loss at work; Sick leave; Education; Inequalities
To reach insurance physician (IPs) consensus on factors that must be taken into account in the assessment of the work ability of employees who are sick-listed for 2 years.
A Delphi study using online questionnaires was conducted from October 2010 to March 2011.
One hundred and two insurance physicians reached a consensus on important factors for return to work (RTW) of employees on long-term sick leave; from those factors, the most relevant for the assessment of work ability was determined. From a total of 22 relevant factors considered for the return to work of long-term sick-listed employees, consensus was reached on nine relevant factors that need to be taken into account in the assessment of the work ability of employees on long-term sick leave. Relevant factors that support return to work are motivation, attitude towards RTW, assessment of cognitions and behaviour, vocational rehabilitation in an early stage and instruction for the sick-listed employee to cope with his disabilities. Relevant factors that hinder RTW are secondary gain from illness, negative perceptions of illness, inefficient coping style and incorrect advice of treating physicians regarding RTW.
Non-medical personal and environmental factors may either hinder or promote RTW and must be considered in the assessment of the work ability of long-term sick-listed employees. Assessment of work ability should start early during the sick leave period. These factors may be used by IPs to improve the quality of the assessment of the work ability of employees on long-term sick leave.
Long-term sick leave; Sick-listed employees; Work ability assessment; Physicians’ perspective; Disability assessment
Early recognition improves the prognosis of isocyanate asthma. A major unanswered question is whether IgE-dependent mechanisms are of diagnostic value? Our objective was to appraise serological methods using various methylenediphenyl diisocyanate (MDI)-albumin conjugates and weigh up the data versus the outcome of standardized comprehensive clinical diagnostics to evaluate the viability of immunological analysis in supportive MDI-asthma diagnosis (OAI).
Specific IgE (sIgE) and IgG (sIgG) binding was measured with fluorescence enzyme immunoassay in 43 study subjects (using conjugates prepared in-vapor, in-solution and commercial preparations). The differential clinical diagnosis included standardized measurement of pulmonary function, non-specific bronchial hyper-responsiveness, specific MDI-prick test (MDI-SPT) and specific inhalation challenge (MDI-SIC).
Detailed diagnostic scheme allows the differential OAI and MDI-induced hypersensitivity pneumonitis (PI). The presumed OAI diagnoses were confirmed in 84 % (45 % cases having demonstrable sIgE antibodies) with RR 5.7, P > 0.001, when OAI diagnosis is correlated with MDI-SIC/MDI-SPT (RR 1.28 for MDI-SIC alone); sIgG antibodies were clinically relevant for PI and not for the OA diagnosis. MDI-specific IgE data generated with commercial ImmunoCAP preparations show high correlation with our in-vapor generated MDI conjugates.
Isocyanate-specific IgE antibodies are not always detectable but their presence is strongly predictive of OAI and supportive for the diagnosis. MDI-SPT can be a valuable parameter differentiating OAI and PI. We have confirmed and extended published data showing that isocyanate-albumin conjugates perform better in specific antibody assays when prepared with volatile phase formulations and would like to stress additionally the necessity for further refinements and standardization in clinical diagnostics procedures.
Electronic supplementary material
The online version of this article (doi:10.1007/s00420-012-0772-6) contains supplementary material, which is available to authorized users.
Occupational asthma; Isocyanates; MDI, 4,4′-methylenediphenyl diisocyanate. (diphenylmethane-4,4′-diisocyanate); Specific IgE antibodies; Specific IgG antibodies; Immunological diagnosis; Albumin conjugates; Asthma diagnosis; Hypersensitivity pneumonitis; Isocyanate alveolitis
The potential for ill-informed causal inference is a major concern in published longitudinal studies evaluating impaired neurological function in children prenatally exposed to background levels of methyl mercury (MeHg). These studies evaluate a large number of developmental tests. We propose an alternative analysis strategy that reduces the number of comparisons tested in these studies.
Using data from the 9-year follow-up of 643 children in the Seychelles Child Development Study (SCDS), we grouped 18 individual endpoints into one overall ordinal outcome variable as well as by developmental domains. Subsequently, ordinal logistic regression analyses were performed.
We did not find an association between prenatal MeHg exposure and developmental outcomes at 9 years of age.
Our proposed framework is more likely to result in a balanced interpretation of a posteriori associations. In addition, this new strategy should facilitate the use of complex epidemiological data in quantitative risk assessment.
methyl mercury; child development; risk assessment; Seychelles Child Development Study
Surgeons’ poor physical health and high physical job demands might threaten good quality of care. We aimed to compare the prevalence of physical complaints of surgeons, their physical work ability and the physical job demands of surgeons with that of other hospital physicians.
All medical doctors (n = 958) of one academic medical center were invited to complete the online questionnaire to assess the physical work ability and the prevalence of regional musculoskeletal complaints. A purposive sample of 44 surgeons and 82 other hospital physicians were systematically observed during work to quantify the physical job demands for an average working day.
More surgeons found their work to be physically strenuous (41 vs. 13 %, p < .000) and more were bothered by working in uncomfortable or exhausting postures (73 vs. 27 %, p < .001). Both groups reported that most of their physical complaints were in the neck (39 and 32 %) and arm regions (36 and 27 %). The majority of surgeons (86 %) and other hospital physicians (79 %) experienced difficulties coping with their job demands because of their physical state once a month or less. Compared with other hospital physicians, surgeons stand longer (4 vs. 3 h, p = .004) and perform fine repetitive movements longer (80 vs. 3 min, p < .001) during an average working day.
Exposure to several physical job demands that are perceived as uncomfortable and exhausting and the presence of physical health complaints reduce surgeons’ work functioning.
Musculoskeletal diseases; Occupational health; Physicians; Workload; Occupational exposure; General surgery
To examine relationships between work-based cultural activities and mental employee health in working Swedes.
A positive relationship between frequent cultural activity at work and good employee health was expected.
Random sample of working Swedish men and women in three waves, 2006, 2008 and 2010, on average 60 % participation rate.
A postal questionnaire with questions about cultural activities organised for employees and about emotional exhaustion (Maslach) and depressive symptoms (short form of SCL). Employee assessments of “non-listening manager” and work environment (“psychological demands” and “decision latitude”) as well as socioeconomic variables were covariates. Cross-sectional analyses for each study year as well as prospective analyses for 2006–2008 and 2008–2010 were performed.
Main outcome and results
Lower frequency of cultural activities at work during the period of high unemployment. The effects of relationships with emotional exhaustion were more significant than those with depressive symptoms. The associations were attenuated when adjustments were made for manager function (does your manager listen?) and demand/control. Associations were more pronounced during the period with low unemployment and high cultural activity at work (2008). In a prospective analysis, cultural activity at work in 2008 had an independent statistically significant “protective” effect on emotional exhaustion in 2010. No corresponding such association was found between 2006 and 2008.
Cultural activities at work vary according to business cycle and have a statistical association with mental employee health, particularly with emotional exhaustion.
Implications for future research
There are particularly pronounced statistical protective effects of frequent cultural activity at work on likelihood of emotional exhaustion among employees.
Emotional exhaustion; Depression; Self-rated health; Work stress; Cultural activity
To measure short-term and long-term validity of self-reported duration of kneeling and squatting at work and to examine the possibility of differential misclassification due to knee complaints.
Work-related kneeling and squatting were analysed for 190 male subjects (mean age, 35.0 and SD, 11.5) in field by both measurements and questionnaires. Posture capturing was performed with an ambulatory measuring system (CUELA). Immediately after the measurement (t0), each participant was asked to estimate frequency and duration of five specific knee postures taken during the measurement period. After 6 months (t1), the survey was repeated (n = 125). Health status of all subjects was recorded by Nordic questionnaire. Statistical analysis was performed by using nonparametric tests, correlations, and Bland–Altman plots.
At both time points, subjects were able to recall the occurrence of knee postures rather well (100.0–57.6 % agreement) but many of them failed in quantifying their knee load. We found poor-to-moderate correlations between measurements and self-reports for all examined postures in both surveys (0.23 < ρ < 0.63). The durations of knee postures were both over- and underestimated but overestimations predominated (t0, 74.7 % and t1, 87.2 % overestimations). High-exposed subjects seemed to misjudge their exposure to a greater extent than low-exposed ones, while knee complaints seemed to have no impact on the assessment behaviour.
As our study showed, self-reported knee loading may deviate widely from measured exposure. These limitations of self-reporting emphasise the arguments in favour of using objective data whenever possible, for example by complementing self-reported occurrence of knee postures with quantitative measurement data.
Electronic supplementary material
The online version of this article (doi:10.1007/s00420-012-0758-4) contains supplementary material, which is available to authorized users.
Exposure assessment; Method comparison; Kneeling and squatting; Field study; Knee pain
The purpose of this study was to assess the association of organizational factors with work-related sleep problems (WRSP) among Korean workers.
The data were derived from the First Korean Working Conditions Survey conducted in 2006 with a representative sample of the Korean working population (n = 10,039).
The overall prevalence of WRSP was 5.1 % (95 % confidence interval (CI) 4.7–5.5). Those who experienced sexual harassment at work (adjusted odds ratio (aOR) 3.47: 95 % CI 1.77–6.81), discrimination due to sex (aOR 2.44: 95 % CI 1.36–4.36) or age (aOR 2.22: 95 % CI 1.52–3.23), violence at work (aOR 1.98: 95 % CI 1.06–3.68), threat of violence (aOR 1.96: 95 % CI 1.05–3.66), poor work-life balance (aOR 1.78: 95 % CI 1.44–2.20), low job satisfaction (aOR 1.69: 95 % CI 1.37–2.09), high cognitive (OR 1.64: 95 % CI 1.32–2.03) and emotional (aOR 1.53: 95 % CI 1.22–1.91) demands, job insecurity (aOR 1.32: 95 % CI 1.07–1.63), and high work intensity (aOR 1.55: 95 % CI: 95 % CI 1.25–1.92) had an increased risk of WRSP compared to their respective counterparts (p < 0.01). Low social support was not significantly associated with WRSP (aOR 0.88: 95 % CI 0.67–1.15).
The results revealed that poor psychosocial working conditions may be related to a high prevalence of WRSP among representative Korean workers.
Sleep problems; Work organization; Korean Working Conditions Survey; Psychosocial job characteristics; Korea
Despite the importance of skin exposure, studies of skin symptoms in relation to exposure and respiratory symptoms are rare. The goals of this study were to describe exposure–response relationships for skin symptoms, and to investigate associations between skin and respiratory symptoms in bakery and auto body shop workers.
Data from previous studies of bakery and auto body shop workers were analyzed. Average exposure estimates for wheat allergen and isocyanates were used. Generalized linear models were constructed to describe the relationships between exposure and skin symptoms, as well as between skin and respiratory symptoms.
Data from 723 bakery and 473 auto body shop workers were analyzed. In total, 5.3 % of bakery and 6.1 % of auto body shop workers were female; subjects’ mean age was 39 and 38 years, respectively. Exposure–response relationships were observed in auto body shop workers for itchy or dry skin (PR 1.55, 95 % CI 1.2–2.0) and work-related itchy skin (PR 1.97, 95 % CI 1.2–3.3). A possible exposure–response relationship for work-related itchy skin in bakery workers did not reach statistical significance. In both groups, reporting skin symptoms was strongly and significantly associated with reporting respiratory symptoms, both work-related and non-work-related.
Exposure–response relationships were observed for skin symptoms in auto body shop workers. The lack of significant exposure–response associations in bakery workers should be interpreted cautiously. Workers who reported skin symptoms were up to four times more likely to report respiratory symptoms. Improved awareness of both skin and respiratory outcomes in exposed workers is needed.
Electronic supplementary material
The online version of this article (doi:10.1007/s00420-012-0760-x) contains supplementary material, which is available to authorized users.
Occupational exposure; Skin symptoms; Respiratory symptoms; Exposure–response relationships
The association between exposure to bacteria and endotoxins in sewage dust and the serum concentrations of pneumoproteins in sewage treatment plant workers were studied.
Forty-four workers from eight sewage treatment plants and 38 reference workers participated in the study. Microbial aerosol was collected by personal inhalable samplers. The concentrations of bacteria and endotoxins were determined by fluorescence microscopy and the Limulus assay, respectively. Pneumoproteins (Clara cell protein: CC16, and Surfactant proteins A and D: SP-A, SP-D) were determined by ELISA in blood samples collected post-shift.
The exposure to dust ranged from 0.02 to 9.3 (geometric mean (GM) 0.3 mg/m3, of bacteria from 0.3 to 4,900 × 103 (GM 27 × 103) cells/m3 and endotoxins from 1 to 3,160 (GM 28) EU/m3. The exposed workers had lower CC16 [arithmetic mean (AM) 4.9 ng/ml] compared to the referents (AM 6.4 ng/ml, p < 0.01). No significant difference was observed for SP-D and SP-A. Exposure to bacteria was positively associated with CC16 (p < 0.05) and SP-D (p < 0.05), adjusting for possible confounders.
This study showed that exposed workers had lower serum concentration of CC16 as compared to the referents, which may reflect a long-term effect on secretion of these pneumoproteins. The positive association between exposure to bacteria and the serum concentrations of CC16 and SP-D may be explained by a transient increased permeability of the lung–blood barrier.
Pneumoproteins; Sewage dust; Exposure; Bacteria; Endotoxins
The aims of this study were to investigate (1) the concurrent relationship between short-term and long-term stress reactivity measured by cortisol excretion and (2) the relationship of these physiological stress effects with self-reported stress and need for recovery after work (NFR).
Participants were production workers in the meat-processing industry. Short-term cortisol excretion was calculated by summing 18 saliva samples, sampled over a 3-day period. Samples were delivered by 37 participants. Twenty-nine of them also supplied one hair sample of at least 3 cm in length for an analysis of long-term (3 months) cortisol excretion. All of them filled in a short questionnaire on self-reported stress and NFR. Self-reported stress was assessed by a three-item stress screener; NFR was assessed by an 11-item scale.
Short-term and long-term cortisol excretion are significantly, but moderately, associated (r = 0.41, P = 0.03). Short-term and long-term cortisol excretion correlated weakly to self-reported stress and NFR (correlations varied from −0.04 to 0.21).
Short-term and long-term physiological stress excretion levels are moderately associated. Physiological stress effects assessed from saliva and hair cannot be used interchangeably with self-reported stress because they only correlate weakly. To better predict long-term cortisol excretion in workers, the predictive value of short-term cortisol excretion must be evaluated in a prognostic longitudinal study in a working population.
Hair; Saliva; Cortisol; Stress; Measurement
To determine whether certain subgroups of fire fighters are prone to work-related diminished health requirements.
The health requirements for fire-fighting were tested in a workers’ health surveillance (WHS) setting. These health requirements included psychological, physical and sense-related components as well as cardiovascular risk factors. The odds ratio (OR) and 95% confidence interval (95% CI) for the presence of the diminished health requirements were calculated for the subgroups of gender, professionalism and age.
The prevalence of diminished psychological requirements was equivalent among the subgroups, and no significant high-risk group was identified. As compared to men fire fighters, women fire fighters were more likely to have diminished physical requirements (OR 28.5; 95% CI 12.1–66.9) and less likely to have cardiovascular risk factors (OR 0.3; 0.1–0.5). As compared to volunteer fire fighters, professionals were less likely to have diminished physical requirements (OR 0.5; 0.3–0.9), but professionals had a higher prevalence of cardiovascular risk factors with an odds ratio of 1.9 (1.1–3.2). As compared to the youngest fire fighters, the oldest fire fighters were more likely to have diminished sense-related requirements (OR 7.1; 3.4–15.2); a similar comparison could be made between oldest and middle-aged fire fighters (OR 5.1; 2.5–10.5). In addition, the oldest fire fighters were more likely to have cardiovascular risk factors when compared to the youngest (OR 4.4; 1.7–11.1) and to the middle-aged fire fighters (OR 3.1; 1.2–7.9).
Subgroups (gender, professionalism and age) of fire fighters are prone to at least one specific work-related diminished health requirement. Therefore, parts of the WHS could be applied with more attention to these high-risk groups.
Fire fighter; Adverse health effect; High-risk; Subgroup
We hypothesise that due to a lower quality of working life and higher job insecurity, the health and work-related attitudes of temporary workers may be less positive compared to permanent workers. Therefore, we aimed to (1) examine differences between contract groups (i.e. permanent contract, temporary contract with prospect of permanent work, fixed-term contract, temporary agency contract and on-call contract) in the quality of working life, job insecurity, health and work-related attitudes and (2) investigate whether these latter contract group differences in health and work-related attitudes can be explained by differences in the quality of working life and/or job insecurity.
Data were collected from the Netherlands Working Conditions Survey 2008 (N = 21,639), and Hypotheses were tested using analysis of variance and cross-table analysis.
Temporary work was associated with fewer task demands and lower autonomy and was more often passive or high-strain work, while permanent work was more often active work. Except for on-call work, temporary work was more insecure and associated with worse health and work-related attitude scores than permanent work. Finally, the quality of working life and job insecurity partly accounted for most contract differences in work-related attitudes but not in health.
Especially agency workers have a lower health status and worse work-related attitudes. Job redesign measures regarding their quality of working life and job insecurity are recommended.
Labour contracts; Quality of working life; Job insecurity; Health; Job attitudes
Vaccination of healthcare workers (HCWs) was made a high priority during the phase six pandemic of the novel influenza A H1N1 (pH1N1) virus. We surveyed adherence to pH1N1 vaccination and the incidence of pH1N1 infection between vaccinated and unvaccinated HCWs.
Employees at the S. João Hospital in Porto, Portugal, were offered pH1N1 vaccinations free of charge. Pandemrix® was the vaccine administered. As part of the pandemic plan, employees with influenza-like symptoms (ILS) were called upon to take an RT-PCR H1N1 test. If the test results were positive, they had to stay off work for at least 7 days. Sociodemographic data, vaccination status, contact with infectious patients, ILS and pH1N1 test results were documented in a standardised manner.
The survey population comprised 5,592 employees. The vaccination rate was 30.8% (n = 1,720) for pH1N1 and 50.4% (n = 2,819) for the 2009/2010 seasonal trivalent inactivated influenza vaccine (TIV). One mild anaphylactic reaction occurred after pH1N1 vaccination. Minor local side effects occurred more often after pH1N1 vaccination than after 2009/2010 seasonal TIV (38.0% vs. 12.3%). Pandemic H1N1 infection was diagnosed in 97 HCWs (1.7%). Compared to employees with no regular patient contact, nurses (2.8%) had the highest risk of pH1N1 infection (adjusted OR 3.8; 95% CI 1.2–6.8). Vaccination reduced the pH1N1 infection risk (OR 0.12; 95% CI 0.05–0.29). Vaccine effectiveness was 90.4% (95% CI 73.5–97.3%).
Vaccination reduced the pH1N1 infection risk considerably. The pandemic plan to contain the pH1N1 infection was successful. Nurses had the highest risk of pH1N1 infection and are therefore a target group for vaccination measures.
Pandemic influenza A H1N1; Healthcare workers; Vaccination
Lead is a known neurotoxicant. Several studies have suggested that occupational exposure to lead may lead to depression, anxiety and other psychiatric illness, but few studies have examined environmental lead exposure and depression. We evaluated the relationship between blood lead levels (BLL) and depression in a sample representative of the United States population.
We analyzed data from 4,159 adults ages ≥20 who participated in the 2005-2006 cycle of the National Health and Nutrition Examination Survey (NHANES). Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9). Relative risks were calculated using Poisson regression and odds ratios were calculated with ordinal logistic regression using SUDAAN, controlling for pertinent covariates.
The risk of depression was only slightly elevated with increasing blood lead levels when lead was modeled as a categorical variable, with adjusted relative risks of 1.16 (95% confidence interval (CI) = 0.99-1.36), 1.20 (CI=1.07-1.36) and 1.16 (CI=0.87-1.54) for 0.89-1.40 μg/dL,1.41-2.17 μg /dL, and >2.17 μg/dL, respectively, as compared to 0-0.88 μg/dL using Poisson regression. Similar results were obtained with ordinal logistic regression. Analyses using BLL as a continuous variable did not show a significant relationship with depression.
This cross-sectional study did not provide consistent evidence for an association between environmental lead exposure and depression within the investigated blood lead levels.
blood lead levels; depression; NHANES; PHQ-9
Tannery workers are exposed to hazardous chemicals. Tannery work is outsourced to newly industrialized countries (NICs) where attention into occupational health hazards is limited. In this study, we investigated the skin exposure to hazardous chemicals in tannery workers and determined the prevalence of occupational skin diseases (OSDs) at tanneries in a NIC.
A cross-sectional study on the observation of the working process and an inventory and risk assessment of the chemicals used. Classification of chemicals as potential sensitizers/irritants and a qualitative assessment of exposure to these chemicals. Workers were examined and interviewed using Nordic Occupational Skin Questionnaire-2002/LONG.
The risk of OSDs at the investigated tanneries was mainly related to the exposure of the workers’ skin to chemicals in hot and humid environmental conditions. In 472 workers, 12% reported a current OSD and 9% reported a history of OSD. In 10% of all cases, an OSD was confirmed by a dermatologist and 7.4% had an occupational contact dermatitis (OCD). We observed that personal protective equipment (PPE) used was mainly because of skin problems in the past and not as a primary protection against OSD.
We observed a high frequency and prolonged exposure to many skin hazardous factors in tannery work although PPE was relatively easily available and which was generally used as a secondary preventative measure. The observed point-prevalence in this study was at the same level as that reported for other high-risk OSDs in Western countries and other tanneries in NICs. However, the observed point-prevalence in this study was lower than that reported in India and Korea. The results of our study and those of other studies at tanneries from other NICs were probably influenced by Healthy Worker Survivor Effect (HWSE).
Occupational skin diseases; Tannery workers; Skin exposure
To investigate the risk factors associated with work-related allergy-like symptoms in medical doctors.
Self-administered questionnaire survey and CAP test were conducted among medical school students in the 4th grade of their 6-year medical course in 1993–1996 and 1999–2001. Follow-up questionnaires were sent in 2004 to the graduates. These questionnaires enquired into personal and family history of allergic diseases, lifestyle, history of allergy-like symptoms including work-relatedness and occupational history as medical doctors. Relationships between allergy-like symptoms and relevant factors were evaluated by multivariate logistic regression analysis.
Of 261 respondents at the follow-up survey, 139 (53.3%) and 54 (20.7%) had a history of any allergy-like symptoms and any work-related allergy-like symptoms, respectively. Female gender and family history of allergic diseases were significantly associated with any allergy-like symptoms. Personal history of allergic disease, exposure to domestic animals, eczema caused by rubber gloves, metallic accessories, or cosmetics during schooling days, and membership of the surgical profession were significant risk factors for work-related allergy-like symptoms. On the contrary, to work-related allergy-like symptoms, gender, age, and smoking status were not significantly related, and consumption of prepared foods was inversely related.
Personal history of atopy and eczema induced by common goods and the history of keeping domestic animals may be predictors of work-related allergy-like symptoms in doctors. After graduation from medical school, physicians start with exposure to various allergens and irritants at work, which relate to work-related allergy-like symptoms, especially for surgeons.
Electronic supplementary material
The online version of this article (doi:10.1007/s00420-011-0682-z) contains supplementary material, which is available to authorized users.
Occupational allergy; Doctor; Dermatitis; Rhinitis; Asthma; Environment; Occupational Medicine/Industrial Medicine; Environmental Health; Rehabilitation
There is debate to what extent employers are entitled to interfere with the lifestyle and health of their workers. In this context, little information is available on the opinion of employees. Within the framework of a workplace health promotion (WHP) program, moral considerations among workers were investigated.
Employees from five companies were invited to participate in a WHP program. Both participants (n = 513) and non-participants (n = 205) in the program filled in a questionnaire on individual characteristics, lifestyle, health, and opinions regarding WHP.
Nineteen percent of the non-participants did not participate in the WHP program because they prefer to arrange it themselves, and 13% (also) preferred to keep private life and work separate. More participants (87%) than non-participants (77%) agreed with the statement that it is good that employers try to improve employees’ health (χ2 = 12.78, p = 0.002), and 26% of the non-participants and 21% of the participants think employer interference with their health is a violation of their privacy. Employees aged 50 year and older were more likely to agree with the latter statement than younger workers (OR = 1.56, 95% CI 1.02–2.39).
This study showed that most employees support the importance of WHP, but in a modest group of employees, moral considerations may play a role in their decision whether or not to participate in WHP. Older workers were more likely to resist employer interference with their health. Therefore, special attention on such moral considerations may be needed in the communication, design, and implementation of workplace health promotion programs.
Ethics; Participation; Workplace; Health promotion; Lifestyle
Blood lead (B–Pb), one of the most used toxicological biomarker all kind, has serious limitations. Thus, the objective is to evaluate whether plasma lead (P–Pb) is more adequate.
A long-term follow-up study of five cases of lead poisoning. P–Pb was analysed by inductively coupled plasma mass spectrometry. Kinetics after end of exposure was modelled.
P–Pb at severe poisoning was about 20 μg/L; haematological effects at about 5 μg/L. Biological half-time of P–Pb was about 1 month; B–Pb decay was much slower.
P–Pb is a valuable biomarker of exposure to and risk, particularly at high exposure.
Human; Urine; Pb; Kinetics; Modelling; Risk