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.     

Neurophysiological findings among workers occupationally exposed to styrene

Ninety-six male workers occupationally exposured to styrene in 24 plants producing reinforced polyester plastic products were studied neurophysiologically. The mean age of the subjects was 29.6 +/- 7.4 years, and the duration of the exposure varied from 6 months to 14 years (mean 5.0 years). Mandelic acid concentration in the urine (mean of five values determined during five consecutive weeks) was used as the measure of exposure. The individual means of the mandelic acid concentrations varied from 7 to 4,715 mg/dm3 (median 808 mg/dm3). Neurotoxic effects of styrene exposure upon the central nervous system were revealed by abnormalities in the EEG. The overall prevalence of abnormal EEGs was 24% (23 out of 96), which is higher than that found among a normal population (p less than 0.05). Abnormal EEGs were found in one-third of the subjects with relevant styrene exposure (mandelic acid concentration over 700 mg/dm3), while low-level styrene exposure did not increase the prevalence of normal EEGs above that found in a normal population. Nerve conduction velocity measurements performed on 40 subjects did not reveal any definite relationship between neuropathy and styrene exposure. The EEG examination is useful in the investigation of the neurotoxic effects of styrene. Whenever a possibility exists of excessive styrene exposure or beginning poisoning, the workers should be submitted to an EEG examination.     

Immunological markers among workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin

OBJECTIVES: To examine the association of immune cell number and function with occupational exposure to substances contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). METHODS: A cross sectional medical survey. The exposed participants were employed at two chemical plants between 1951 and 1972 in the manufacture of 2,4,5-trichlorophenate and its derivatives. The reference group consisted of people with no occupational exposure to phenoxy herbicides who lived within the communities of the workers. Data from a total of 259 workers and 243 unexposed referents were included in the analysis of immune function. Laboratory tests for immune status included enumeration of circulating leukocyte and lymphocyte populations, proliferative responses of circulating lymphocytes to mitogens and antigens, and serum concentrations of the major immunoglobulins and complement factor C3. RESULTS: The workers had substantial exposure to substances contaminated with TCDD, as indicated by a lipid adjusted mean serum TCDD concentration of 229 ppt compared with a mean of 6 ppt in the unexposed referents. Workers were divided into categories based on their serum TCDD concentration. For all categories except the lowest, with values of serum TCDD comparable with the unexposed referents, there were increased odds of having lower counts of CD26 cells (activated T cells) (odds ratio (OR) 1.0, 95% confidence interval (95% CI) 0.5 to 1.8 for TCDD < 20 ppt; OR 1.6, 95% CI 0.8 to 3.2 for TCDD 20-51 ppt; OR 2.7, 95% CI 1.4 to 5.1 for TCDD 52-125 ppt; OR 2.6, 95% CI 1.4 to 4.9 for TCDD 125-297 ppt; OR 2.4, 95% CI 1.3 to 4.6 for TCDD 298-3389 ppt). A less consistent finding was decreased spontaneous proliferation of cultured lymphocytes. However, increases were found in proliferation of lymphocytes in response to concanavalin and pokeweed in workers in the high TCDD category. Age, cigarette smoking, and alcohol were significant predictors of several immunological outcomes. CONCLUSIONS: Associations between serum TCDD concentration and both a decrease in circulating CD26 cells and decreased spontaneous background proliferation were the major findings of this study. These results are unlikely to be of clinical importance but may reflect limited evidence for an association between immunological changes in workers and high serum concentrations of TCDD, or chance findings resulting from the evaluation of multiple immunological variables.     

Initial uptake kinetics in human skin exposed to dilute aqueous trichloroethylene in vitro

In vitro uptake of 14C-labeled trichloroethylene (TCE) from dilute (approximately 5-ppb) aqueous solutions into human surgical skin was measured using accelerator mass spectrometry (AMS). We analyzed 105 breast-tissue samples obtained from three subjects, representing 27 separate exposure experiments conducted at approximately 20 degrees C for 0, 1, 5, 15, 30, or 60 min. The AMS data obtained positively correlate with (p approximately 0) and vary significantly nonlinearly with (p = 0.0094) exposure duration. These data are inconsistent (p approximately 0) with predictions made for TCE by a proposed U.S. Environmental Protection Agency (USEPA) dermal-exposure model, even when uncertainties in its recommended parameter values for TCE are considered, but are consistent (p = 0.17) with a 1-compartment model for exposed skin-surface tissue governed in vitro by a maximum effective permeability of K*p = 0.28 cm h-1 (+/- 7.0%) and a first-order rate constant of k1 = 1.2 h-1 (+/- 16%). The apparent compartment depth is estimated to be approximately 40-100 microns, i.e., to comprise much or all of the epidermis. In contrast, the USEPA model implies only negligible TCE penetration beyond SC during a 1-h exposure. The K*p estimate based on the 1-compartment model fit is consistent with estimates for TCE based on in vivo studies, which supports the hypothesis that the USEPA model underpredicts short-term dermal uptake of TCE from water. It is shown that for humans, this fit also implies that normalized total uptake of TCE from water by short-term dermal contact in vivo is predicted to be fK*p, where f is approximately 80% for longer normothermic exposures and approximately 95% during a brief hot shower or bath. This study illustrates the power of AMS to facilitate analyses of contaminant biodistribution and uptake kinetics at very low environmental concentrations.     

Mental disorders in workers exposed to chemicals at work

The article considers data on boundary psychic disorders in subjects exposed to chemicals of I-II jeopardy classes. Chemical factor appears to increase risk of psychiatric diseases. The authors suggest periodic psychiatric examination of workers engaged into hazardous chemical production for better occupational selection, early diagnosis and treatment of boundary psychic disorders.     

Respiratory disease among workers exposed to man-made mineral fibers

Fibrous glass and mineral wool workers exposed to airborne man-made mineral fibers prior to 1964 were identified and followed for deaths caused by respiratory disease. Fiber exposure levels were estimated for each worker. Average fiber concentrations were very low in relation to a National Institute of Occupational Safety and Health recommendation that exposure to man-made mineral fibers less than 3.5 microns in diameter be limited to 3 fibers per cubic centimeter of air. Fibrous glass workers were exposed to about one hundredth and mineral wool workers to about one tenth of that amount. Respiratory cancer death rates were not excessive for the fibrous glass workers, but they were significantly elevated for the mineral wool workers. When respiratory cancer deaths were compared with fiber exposure levels, however, there was in no instance a strong positive correlation. There was a significant excess in nonmalignant respiratory disease deaths (excluding influenza and pneumonia) for fibrous glass workers and for the total cohort. When these nonmalignant respiratory disease deaths were compared with fiber exposure levels, however, there was in no instance a strong positive association. A special study was made of workers exposed to small diameter fibers. Respiratory cancer deaths were not in excess; however, there was an excess in nonmalignant respiratory disease deaths. This study provided no consistent evidence of a respiratory disease hazard related to exposure to man-made mineral fibers among the workers who produce these fibers. Results must be interpreted in relation to the relatively low exposure levels for these workers.     

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.     

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.     

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.     

Mortality due to pancreatic and lymphopoietic cancers in chlorohydrin production workers

Men assigned to the chlorohydrin unit of Union Carbide's South Charleston plant in the Kanawha Valley of West Virginia were followed up for mortality from 1940 to the end of 1988. This 10 year update was conducted to verify previous findings of excesses of cancer among the 278 men assigned to the chlorohydrin unit, which primarily produced ethylene chlorohydrin from 1925 to 1957. This process produced ethylene dichloride and bischloroethyl ether as byproducts. Mean duration of assignment was 5.9 years and mean duration of follow up was 36.5 years. Standardised mortality ratios (SMRs) were calculated based on comparisons with the United States white male population. Duration-response trends were assessed by internal comparisons with two different groups of unexposed chemical workers in the Kanawha Valley. The evidence that the earlier finding of an excess of pancreatic cancer was work related is strengthened by the occurrence of two additional cases (0.9 expected). The SMR for pancreatic cancer was 492 (95% CI 158-1140), based on eight observed v 1.6 expected deaths. There were no additional deaths due to leukaemia, but the three to four-fold excess risk for lymphopoietic cancers persisted due to new cases of non-Hodgkin's lymphoma and a death from multiple myeloma. The SMR for lymphatic and haematopoietic cancers was 294 (eight observed v 2.7 expected; 95% CI 127-580). Pronounced increases in risk were seen for total cancer, pancreatic cancer, all lymphatic and haematopoietic cancers, and leukaemia with increasing durations of assignment to the chlorohydrin unit. Most of the cases were first assigned to the unit in the 1930s when chemical manufacturing was in its infancy and exposures were less controlled. These data are insufficient to identify conclusively the causative agent or agents. The weight of evidence, however, based on probable exposure, known toxicity of the chemicals, and animal responses suggest that high exposures to ethylene dichloride, perhaps in combination with other chlorinated hydrocarbons, is the most likely explanation.     

Excess hepatobiliary cancer mortality among munitions workers exposed to dinitrotoluene

This study was conducted to determine the sex of buffalo embryos produced in vitro by amplifying male specific DNA sequences using the polymerase chain reaction (PCR). This method uses three different pairs of bovine Y-chromosome specific primers and a pair of bovine satellite specific primers. Buffalo in vitro fertilized embryos at the 4-cell to blastocyst stage were collected at days 3, 4, 6, and 8 postinsemination, and the sex of each embryo was determined using all three different Y-chromosome specific primers. The bovine satellite sequence specific primers recognize similar sequences in buffalo and are amplified both in males and in females. Similarly, Y-chromosome specific primers amplify the similar Y-chromosome specific sequences in male embryos of buffalo. Upon examining genomic DNA from lymphocytes of adult males and females, and embryos, the results demonstrate the feasibility of embryo sexing in buffaloes. Furthermore, sex determination by PCR was found to be a rapid and accurate method.     

Lung function changes among recycling workers exposed to organic dust

OBJECTIVE: To describe the feasibility of diagnosing fetal congenital heart defects by transvaginal ultrasonography during the first trimester of pregnancy. METHODS: Pregnant women presenting to the Ultrasonographic Unit at the Chaim Sheba Medical Center who had a diagnosis of fetal heart defects were reviewed retrospectively. Attention was paid to prenatal ultrasound studies, karyotype, and pathologic examinations. RESULTS: Using high-resolution transvaginal ultrasonography, we were able to detect fetal tachycardia (one case), ectopia cordis with ventricular septal defect (one case), atrioventricular septal defect (two cases), ventricular septal defect with persistent truncus arteriosus (one case), tetralogy of Fallot (two cases), and large right atrium with unguarded tricuspid valve (Uhl disease) (one case). Seven of these fetuses had normal karyotypes and all showed additional sonographic abnormalities, including septated cystic hygroma (three cases), hydrops (ascites and pericardial effusions) (two cases), omphalocele (one case), and bilateral agenesis of kidneys (one case). Only one fetus with an abnormal karyotype (45,XO) showed a combination of septated cystic hygroma with hydrops. CONCLUSIONS: High-resolution duplex Doppler transvaginal ultrasonography during the first trimester of pregnancy seems to be a useful diagnostic method for detecting some congenital heart diseases.     

Postural stability among manganese exposed workers

Postural stability was investigated by static posturography in 32 manganese exposed workers with exposure duration of 6.6 (range 1.1-15.7) years and 53 referent subjects. The mean current urine manganese concentration for the exposed was 6.0 micrograms/g creatinine (range 0.6 to 53.3). There was no significant differences between both groups for the postural sway parameters obtained during eyes open condition. However, significant differences were observed for L - length of sway path and Vel - mean velocity of the center of pressure along its path. The Romberg Ratios (the relationship between eyes closed/open conditions) for the exposed's Vel, L, and Ao were also significantly different from the referent. The study showed that manganese exposed workers had significantly poorer postural stability compared to a referent group. We postulate that this could be a subclinical effect of manganese on the basal ganglia (pallidus) resulting in the postural instability when the visual input is cut off. Based on the current urinary manganese levels, we were not able to obtain any significant association with the postural sway parameters.     

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).     

Mortality of workers hired during World War II

There has been some suggestion that men first hired during World War II do not show the typical healthy worker effect and may have been more unhealthy than their counterparts who entered military service. We have studied 41,000 workers at six plants to determine whether men hired during World War II had higher mortality than men hired just before or after WWII. No evidence was found of any "unhealthy WWII worker" effect.     

Mortality of short-term workers in two international cohorts

The purpose of this study was to compare the pattern of mortality of blue-collar workers employed less and more than 1 year in the man-made vitreous fiber (MMVF) and the reinforced plastic industries, the latter group being exposed to styrene. We conducted an analysis among 21,784 workers with less than 1 year of employment (short-term workers) and 19,117 workers with 1 or more years of employment (long-term workers) employed in eight European countries. We conducted analyses based on external as well as internal comparisons. In both cohorts, the standardized mortality ratio for all causes among short-term workers was approximately 40% higher, compared with that for longer-term workers. In internal comparisons, the difference was reduced to 9% in the MMVF cohort and 11% in the styrene cohort. Workers with less than 1 month of employment displayed an increased mortality in both cohorts and in most countries. The increased mortality among short-term workers was not concentrated shortly after they quit employment. In both cohorts, short-term workers had a higher mortality from external causes, while little difference was seen in mortality from ischemic heart disease and malignant neoplasms. Although extra-occupational factors may contribute to increase the mortality of short-term workers and, in particular, of those employed for less than 1 month, the difference observed in analyses adjusted for characteristics of employment suggested a relatively small difference in mortality from most causes.     

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.     

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.