Diurnal rhythm of physiologic functions in workers exposed to noise

To reveal the mechanisms of adaptation to occupational factors, the authors screened the workers exposed to noise for changes of pulse rate, blood pressure, catecholamines content, auditory threshold within a day. The study showed that adaptation to unfavorable work conditions deteriorates within a day (from morning to night shifts). Reliability of catecholamines level was conditioned by the night fall of catecholamines level and its changes within a day. Compromised adaptation to chronic unfavorable occupational factors result in unstable catecholamines level. Functional state of hearing is mediated by vegetative state including catecholamines content.     

Criteria for the health surveillance of workers exposed to repetitive movements

In the light of the experience and guidelines developed by other countries and of Italian legislative and operational conditions, the authors outline a strategy for a health surveillance programme for work-related musculoskeletal disorders of the upper limbs. In particular, the paper defines the various aims of the health surveillance programme and identifies significant relevant criteria for its implementation (i.e. existence of risks or effects). A screening schedule is presented based on subsequent investigations (first and second level surveillance); the authors discuss the principal methods used for processing the results of the health surveillance programme, in collective (i.e. statistical comparisons, planning of periodical investigations) and individual terms (job fitness judgements, reporting of suspected occupational diseases).     

Occupational health status of sawmill workers in Nigeria

Primary traumatic anterior dislocation of the shoulder in young patients has a high recurrency rate. There are varying opinions on the pathology behind the recurrences. The aim of this study was to describe the MRI characteristics of the acute lesion, and at 6-month follow-up. Thirty patients aged 18-30 years with primary traumatic anterior dislocation of the shoulder were randomized into two groups. One group was treated with acute arthroscopic lavage within 10 days. The control group was treated with traditional non-operative therapy. All patients underwent acute MRI within 10 days and before the arthroscopic lavage, and again at the 6-month follow-up, for evaluation of the lesions. The acute MRI verified Hill-Sachs lesions in all patients. At the 6-month follow-up MRI, there was no change in the size of the Hill-Sachs lesion. This was also the case with the six patients in the control group with recurrent dislocations during the first 6 months. Twenty-nine patients (97%) had joint effusion at the acute MRI, which was very useful for evaluation of the soft tissue pathology. The glenohumeral ligaments were detached in 20/30 patients (66%), and the labrum in 22/30 patients (70%). A capsulolabral detachment classified as a Baker 3 lesion was seen in 16/30 (53%) of the patients, including all six patients with recurrent dislocation. At the 6-month control only 3/30 (10%) of the patients had joint effusion for adequate evaluation of the labrum and ligamentous pathology. A Hill-Sachs lesion was found in 100% of the patients after primary dislocation, and recurrent dislocations did not change the size of the lesion. The study supports the opinion that this lesion is overlooked in the clinical situation. The joint effusion at the acute MRI was of utmost importance for evaluation of the soft tissue pathology. The 6-month MRI control was therefore considered inconclusive when evaluating capsulolabral lesions, due to lack of effusion. MRI arthrography with contrast administration would have been very helpful at the 6-month examination.     

A prospective study of the cold response of digital vessels in forestry workers exposed to saw vibration

A 49-year-old man was admitted to our hospital for investigation of splenomegaly and lymphocytosis. He had no significant past history and was not a smoker. Physical examination revealed massive splenomegaly and no palpable superficial lymph nodes. Hematological examination showed a hemoglobin concentration of 10.5g/dl, a platelet count of 9.8 x 10(4)/microliter, and a leukocyte count of 21.2 x 10(3)/microliter with 70% abnormal lymphocytes. In May-Giemsa stained blood films, the abnormal lymphocytes had round nuclei, abundant, pale cytoplasm, and slightly serrated edges. Phase-contrast microscopic and scanning electron microscopic examinations revealed many long surface villi. Tartrate-resistant acid phosphatase activity in these cells was negative. The abnormal lymphocytes had a CD5-, CD10-, CD11a+, CD11c+, CD19+, CD20+, CD22+ phenotype. These features were similar to those described for a variant form of hairy cell leukemia (HCL-Japanese variant). However, studies of Ig gene rearrangement and expression of sIg revealed a polyclonal proliferation of B cells. On the basis of these findings, this case was diagnosed as hairy B-cell lymphoproliferative disorder, a recently described condition characterized by polyclonal B-cell lymphocytosis and features resembling HCL-Japanese variant. Serological assays for antibodies against Epstein-Barr virus suggested a past infection. Splenectomy alleviated the anemia and thrombocytopenia, but not the lymphocytosis.     

Management of healthcare workers exposed to pertussis

The epidemiology of pertussis has changed in recent years. First, pertussis in adults is far more common than previously thought. Second, in many instances, the disease in adults is atypical or asymptomatic. Third, adult pertussis occurs despite a prior history of full immunization and, indeed, in persons with a prior history of natural disease. Large outbreaks of pertussis have occurred in healthcare facilities through failure to recognize and isolate infected infants and children, failure to recognize and treat disease in staff members, and failure to institute control measures rapidly. Appropriate use of work restriction and erythromycin prophylaxis may decrease the likelihood of institutional outbreaks.     

Mortality of aerospace workers exposed to trichloroethylene

We assessed the differential effects of a chronotherapeutic agent (controlled-onset extended release [COER] verapamil), administered at bedtime versus a conventional, homeostatic therapy (nifedipine gastrointestinal therapeutic system [GITS]) taken in the morning, on early morning and 24-hour blood pressure (BP), heart rate (HR), and the HR x systolic BP product. The study was a multicenter (n = 51), randomized, double-blind prospective clinical trial with a 10-week treatment period. Dose titration was performed by study investigators based on systolic and diastolic BP values at the doctor's office. Ambulatory BP monitoring was performed at placebo baseline, after 4 weeks of stable double-blind therapy, and at end of the study. Twenty-four-hour BP profiles were studied in 557 hypertensive patients. Changes in BP, HR, slope of the rate of rise of BP and HR, and the HR-systolic BP product during the 4 hours from 1 hour before to 3 hours after awakening were evaluated. The study was powered to show equivalence between the 2 regimens, predefined as a difference between treatment groups in mean change from baseline in early morning BP of +/- 5 mm Hg systolic and +/- 3 mm Hg diastolic. Changes in the early morning BP fell within the definition of equivalence for the 2 treatment strategies (-12.0/-8.2 mm Hg for COER-verapamil and -13.9/-7.3 mm Hg for nifedipine GITS). Changes in both the early morning HR and rate-pressure product were significantly greater following COER-verapamil therapy versus nifedipine GITS (HR, -3.8 beats/minute vs +2.6 beats/minute, p < 0.001 and HR-systolic BP product, -1,437 beats/min x mm Hg vs -703 beats/min x mm Hg, respectively, p < 0.001). Changes in ambulatory BP demonstrated clinically similar reductions for the awake period, but nifedipine GITS lowered systolic BP to a greater extent than COER-verapamil during sleep (-11.0 vs -5.8 mm Hg, p < 0.001). COER-verapamil and nifedipine GITS had equivalent effects (+/- 5/3 mm Hg) on early morning BP. In addition, both extended-release calcium antagonists effectively lowered 24-hour BP. However, COER-verapamil had greater effects than nifedipine GITS on early morning hemodynamics (HR, HR-systolic BP product, rate of rise of BP and HR) and lesser effects during sleep due to its intrinsic pharmacologic properties and chronotherapeutic delivery system.     

Respiratory disease in workers exposed to colophony solder flux fumes: continuing health concerns

The objectives of this study were to establish the prevalence of respiratory, eye, nose and throat symptoms of likely work-relation in workers exposed to colophony solder flux fumes and to assess their lung function. A cross-sectional study was conducted in four medium-sized electronics firms in which control measures to capture solder flux fume were absent or visibly ineffective. All female solders and women working adjacent to soldering stations completed an administered questionnaire concerning symptoms, work history and current soldering frequency. Measurements were made of their forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) during the course of a working shift, using a Vitallograph-Compact portable spirometer. Using weekly hours of soldering as a crude index of current exposure, workers were classified into high (> or = 37 h/wk) and low (< or = 20 h/wk) exposure groups, and their health responses were compared in the analysis. Individuals with symptoms suggestive of work-related asthma were also asked to provide serial peak flow measurements over a further 2-week period, and adequate returns were charted and read by two physicians experienced in the diagnosis of occupational asthma. Data were collected on 152 female workers (overall participation rate = 97%). Symptoms of recurrent, persistent wheeze and/or chest tightness were reported by 75 (49%) of interviewees; 36 (24%) gave a history typical of occupational asthma and six more (4%) a history of pre-existing asthma worsened at work. Twenty-one (14%) of the workforce complained of recurrent breathlessness on moderate exertion; 41 workers (27%) had work-related symptoms of the nose or throat and 25 (16%) had work-related eye symptoms. The odds ratios for 'all wheeze', shortness of breath, and work-related eye, nose and chest symptoms were all significantly greater (raised about 4-5 fold) in women who soldered > or = 37 h/wk when compared with those soldering < or = 20 h/wk. After adjustment by logistic regression for atopy, age and smoking status even higher risk estimates were generally obtained. The odds ratios (OR) and 95% confidence intervals (CI) for high vs. low were: for 'all wheeze', OR = 7.2, CI = 2.5-20.7; for work-related eye symptoms, OR = 5.2, CI = 1.4-19.8; for work-related nasal symptoms, OR = 4.0, CI = 1.4-11.1 and for occupational asthma symptoms, OR = 5.2, CI = 1.4-14.2. Mean FEV1 and FVC percentage difference from expected were slightly lower in full-time solderers than in part-time solderers, but the differences were not significant. Thirty-seven of the 51 workers (73%) who were asked to carry out serial peak flow measurements completed an adequate return: 27 of these records confirmed the presence of asthma, and in all of the cases the history suggested onset post-dating employment in soldering. Eleven peak flow records were indicative of occupational asthma. The health problems associated with colophony solder flux were documented over 18 years ago, but are still clearly apparent in situations where adequate control has not been achieved.     

Biomonitoring of workers exposed to lead. Genotoxic effects, its modulation by polyvitamin treatment and evaluation of the induced radioresistance

A population monitoring study was performed, by using the micronucleus (MN) assay in human peripheral lymphocytes, to investigate whether occupational exposure to lead is genotoxic to workers. In addition to the exposed workers group, two more groups were studied, an external group from a factory without exposure to lead and an internal control group, from the same factory as the exposed workers, but that were not directly exposed to lead. Measures of lead levels at working place and in blood were calculated, and blood samples were collected to carry out a MN study. The results from these studies indicate that the blood from workers directly exposed contained high levels of lead, compared with the other groups, and a significant increase in the frequency of both the total number of MN and the number of binucleated cells carrying MN appeared. In addition, a study on the antimutagenic effects of a polyvitamin rich diet was conducted by measuring the frequency of MN after the workers had a four month daily intake of a polyvitamin-polymineral complex. These results clearly show a significant reduction of the MN frequency evaluated after this treatment, obtaining values that were even lower than those obtained in the internal control group. Finally, a challenge assay was carried out to determine response to gamma-radiation as indication of any kind of radiosensitivity or radioresistance. The results of this experiment did not show any significant variation in the increase of the frequency of MN after challenge irradiation in the lead exposed workers; nevertheless this increase was significantly reduced in the sample obtained after the polyvitamin treatment indicating a radioresistance response.     

Cholinesterase activities of workers exposed to organophosphorus insecticides in Pakistan and Haiti and an evaluation of the tintometric method

Five reference laboratories were established in Pakistan for monitoring cholinesterase (ChE) activities of workers exposed to organophosphorus compounds. ChE activities were determined by the Michel and tintometric method. Observations of ChE activities were made during two malaria seasons. The first season showed that although a significant depression of cholinesterase occurred among some of the workers, the ChE activities of workers were within the normal range during the following season. The reason for the difference is discussed. Similar studies were undertaken in Haiti. Mean and standard deviations (SD) were calculated for comparison of the tintometric versus the Michel method. The data show a correlation between the methods. For further evaluation of the tintometric method, organophosphorus and oxon analog inhibition of cholinesterase were determined in vitro. The tabulated data show that the tintometric method is adequate for determining whether a worker is exposed to dangerous amounts of insecticides.     

The risk of lead and health conditions of exposed workers in the Siena region]

With careful selection of patients, complete resection of pulmonary metastases from breast carcinoma may be a useful therapeutic option. Such a treatment appears to offer a significant survival benefit when compared with medical treatment alone, or with incomplete resection.     

Levels of erythropoietin in serum of workers exposed to manganese

In workers exposed to manganese, compared with the no influence the change erythropoietin serum and concentration haemoglobin. Increased number red blood cell in 1 mm3 of peripheral blood in workers exposed to manganese and increased haematocrit value we can acknowledge result condensation blood.     

Medical surveillance studies of workers exposed to low level benzene

The paper presents th results of an investigation of haematotoxicity in workers exposed to low benzene concentrations. Forty-seven female workers in the shoemaking industry, exposed to solvent mixture and twenty-seven non-exposed controls were examined. Benzene concentrations in the working atmosphere ranged from 1.9 to 14.8 ppm. Significant differences in the levels of benzene in blood and phenols in pre- and post-shift urine between the exposed and control groups confirmed benzene exposure. Haemoglobin level and mean corpuscular haemoglobin concentration were significantly lower, and mean corpuscular volume was higher in the shoemaking workers than in controls. In the subgroup of shoemaking workers exposed to benzene concentrations of 5 ppm or lower, no differences in haematological parameters were found. In conclusion, exposure to a benzene concentration lower than 5 ppm does not appear to produce an increased level of abnormal haematological outcomes detectable in routine medical surveillance. The results of the study corroborate the present maximum permissible concentrations (5 ppm) as a protective limit preventing the onset of haematotoxic non-leukemogenic effects of chronic benzene exposure.     

Early neuropsychological dysfunctions in workers exposed to benzene and its homologues

Empiric therapy is practical and must be begun promptly; the specific regimen chosen must be based upon local conditions and epidemiology. It must be recalled that subgroups of patients are not necessarily equivalent to the majority, i.e., there are low-risk patients for whom ambulatory and/or oral therapy is appropriate and, conversely, there are high-risk patients who have a potential for a high mortality and who, while perhaps few in number, are of critical importance. Further, many of these patients are very complex, and this leads to a high level of physician concern and insecurity. This physician concern, in turn, leads to a tendency to modify regimens, given that the physician all too often is dealing with inadequate diagnostic information owing to the patient situation. The physician's choice of modification is highly dependent upon knowledge of the regimen the patient is already receiving. There is a need for clear definition of endpoints, and these must be established before the study is initiated. All too many published studies are too small to evaluate the endpoint that has been defined, and many others, although sufficient in size, have all of the problems inherent in studies conducted at multiple sites by multiple individuals with differing degrees of commitment or enthusiasm toward the study at hand. A few implications for study design and evaluation seem evident: it is critical to define endpoints and execute the study accordingly. This means determining the size of the population needed and determining the presence or absence of risk groups. Patients to be excluded e.g., those in whom infection is doubted must be selected on the basis of objective data by an observer blinded to both the outcome and the treatment. Similarly, the classification of response should preferably be done by an observer not influenced by knowledge of the therapy being given. Finally, and similarly, the decision to modify therapy (especially if modification is equivalent to defining failure with the regimen) should not be influenced by knowledge of the therapy being administered.     

Health care utilization as a function of subjective health status, job satisfaction and gender among health care workers in Guangzhou, southern China

Job satisfaction, subjective health and health care utilization was studied on 72 doctors and 127 nurses working at two hospitals in Guangzhou in the People's Republic of China (P.R.C.), along with medication use and consultations with physicians over the 14 days preceding data collection. Female doctors were, on average, ten years older than male doctors. Nurses (all female) were comparable to male doctors in terms of age. Current and general subjective health, and job satisfaction differed between doctors and nurses. Nurses were less satisfied than doctors and reported poorer perceived health, until gender and age were controlled. Female doctors had poorer ratings of general and current subjective health and lower job satisfaction than their male colleagues. Path analysis tested whether lower job satisfaction leads to decrements in perceived current health which in turn increased consultation with a physician and medication use. When male and female subjects were examined separately, job satisfaction was inversely related to consultation behaviour among males and positively related to perceived current health in both genders. Among females job satisfaction and consultation behaviour related to current perceived health but were not related to each other. The hypothesized path was upheld for nurses. Lack of power prevented the same path being significant for male or female doctors. In combination, doctors showed significant relationships between the four main variables studied.     

Borderline mental disorders in workers exposed to poisons and their prevention

Studies covered psychic state in workers exposed to poisons. The authors represent clinical and epidemiologic principles of the disorders formation, the prevalence and structure of the disorders caused by various hazards. The article necessitates up-to-date data-processing system for occupational selection, clinical, psychophysiologic, biochemical and experimental psychologic evaluation of current state in workers engaged into liquidation of chemical weapons.