Medical Magazine

Objectives To assess the effect of exposure to hydrogen fluoride (HF) on the airway mucosa in an industrial setting. Methods A cross-sectional study encompassing 33 industrial workers in a flame soldering plant and 44 assembly workers unexposed to HF was performed by means of a questionnaire on symptoms and diagnosis regarding upper and lower airways as well as through conduct of a clinical examination of the exposed group. Air concentrations of HF that were monitored in winter amounted to 1.0 mg/m3 and in summer time to 0.15 mg/m3. Results A threefold risk for epistaxis (RR = 3.6, 95% confidence interval 1.1-11.0) was observed in the exposed group. Time from the start of exposure to HF until debut of a nose bleeding period varied from 1 month to 6 years. Mean induction (latency) time was 42 months. Mean duration of symptoms was 26 months, range 3-72 months, indicating that the exposure level in summer time was sufficient to maintain the propensity of almost daily nose bleeding. Conclusion HF is an irritating vapor, even at relatively low air concentrations. We recommend an 8 hr TLV lower than 1.0 mg/m3. Am. J. Ind. Med. 52:240-245, 2009.

P#229　l Graff1 *　Georgi Bozhkov1　Karin Hedenl#246　f2　Olof Johannesson2　Ulf Flodin1
[1]Centre of Occupational and Environmental Medicine, University Hospital, Linköping, Sweden;[2]Sensia Health AB, Norrköping, Sweden

Background Hearing loss is prevalent among adults in the farming community, with some evidence it begins in childhood. Our objective was to compare hearing thresholds of Ohio farm youth to published data on national norms. Methods Baseline data were collected on youth (n = 212) in 1994-1996 with follow-up (n = 132) in 2003-2004 including pure-tone air conduction thresholds at 0.5, 1, 2, 3, 4, 6, and 8 kHz. Results When compared to nationally-representative data, study youth had a higher prevalence of hearing loss. The high-frequency range was most affected, particularly at 6 kHz where nearly 50% of the farm youth exhibited some degree of hearing loss at baseline testing. The prevalence of noise-induced threshold shifts, characterized by an audiometric notch, was nearly twice that of the national sample. Conclusions These data suggest that hearing loss, which is common among adult farmers, may be problematic for farm youth as well. Am. J. Ind. Med. 52:233-239, 2009.

Katherine M. Renick　MS1 *　J. Mac Crawford　PhD2　J.R. Wilkins III　DrPH3
[1]The Ohio State University, College of Public Health, Office of Research, Columbus, Ohio;[2]Division of Environmental Health Sciences, The Ohio State University, College of Public Health, Columbus, Ohio;[3]Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, Ohio

Background Few studies have investigated occupational lung cancer risk in relation to specific histopathological subtypes. Methods A case-control study was conducted to evaluate the relationship between lung cancer and occupation/industry of employment by histopathological subtype. A total of 2,998 male cases and 10,223 cancer controls, diagnosed between 1983 and 1990, were identified through the British Columbia Cancer Registry. Matched on age and year of diagnosis, conditional logistic regression analyses were performed for two different estimates of exposure with adjustment for potentially important confounding variables, including tobacco smoking, alcohol consumption, marital status, educational attainment, and questionnaire respondent. Results For all lung cancers, an excess risk was observed for workers in the primary metal (OR = 1.31, 95% CI, 1.01-1.71), mining (OR = 1.53, 95% CI, 1.20-1.96), machining (OR = 1.33, 95% CI, 1.09-1.63), transport (OR = 1.50, 95% CI, 1.08-2.07), utility (OR = 1.60, 95% CI, 1.22-2.09), and protective services (OR = 1.27, 95% CI, 1.05-1.55) industries. Associations with histopathological subtypes included an increased risk of squamous cell carcinoma in construction trades (OR = 1.25, 95% CI, 1.06-1.48), adenocarcinoma for professional workers in medicine and health (OR = 1.73, 95% CI, 1.18-2.53), small cell carcinoma in railway (OR = 1.62, 95% CI, 1.06-2.49), and truck transport industries (OR = 1.51, 95% CI, 1.00-2.28), and large cell carcinoma for employment in the primary metal industry (OR = 2.35, 95% CI, 1.11-4.96). Conclusions Our results point to excess lung cancer risk for occupations involving exposure to metals, polyaromatic hydrocarbons and asbestos, as well as several new histopathologic-specific associations that merit further investigation. Am. J. Ind. Med. 52:221-232, 2009.

Amy C. MacArthur　MHSc1 *　Nhu D. Le　PhD1　Raymond Fang　MSc1　Pierre R. B　MD1 2
[1]Cancer Control Research Program, BC Cancer Agency, Vancouver, BC, Canada;[2]Division of Biostatistics and Epidemiology, Environmental Health Sciences Bureau, Healthy Environments and Consumer Safety Branch, Health Protection Branch, Health Canada, Ottawa, ON, Canada

Background Occupational sprain and strain injuries are one of the most common types of nonfatal occupational injuries and a significant source of lost workdays. This study examines factors associated with severe work-related sprain/strain injuries to the back, shoulder, and knees. Methods A synthetic case-control study was performed (controls were selected from the same pool of utility workers as cases). Cases included all electric utility workers who had experienced a severe work-related sprain/strain injury to the back, knee, or shoulder. Primary controls were selected from all workers who had sustained a minor injury. Secondary controls were selected from employees with a minor sprain/strain injury to the back, knee, or shoulder. Multivariate logistic regression models were used to estimate odds ratios and 95% confidence intervals. Results Workers 41 years and older were more likely to have experienced severe shoulder sprain/strain injuries [Age 41-50: OR = 3.62, 95% CI: 1.71-7.65; age 51 and older: OR = 4.49, 95% CI: 1.89-10.67] and severe back sprain/strain injuries [Age 41-50: OR = 1.70, 95% CI: 1.06-2.33; age 51 and older: OR = 1.5, 95% CI: 0.90-2.52]. Line workers and maintenance workers had an increased risk of serious sprain/strain injuries. Gender and day of week were not significantly associated with sprain/strain injuries. Discussion Though this study is limited by available data, future studies may benefit from this preliminary examination of occupational and demographic characteristics associated with serious sprain/strain injuries among electric utility workers. Am. J. Ind. Med. 52:210-220, 2009.

Michael A. Kelsh　PhD　MPH1 *　Tiffani A. Fordyce　BA1　Edmund C. Lau　MS1　Pamela J. Mink　PhD　MPH2　Libby M. Morimoto　PhD　MPH1　Elizabeth T. Lu　MS3　Janice W. Yager　PhD　MPH4 a
[1]Exponent, Inc., Health Sciences, Menlo Park, California;[2]Exponent, Inc., Health Sciences Group, Washington, DC;[3]Exponent, Inc., Health Sciences Group, Oakland, California;[4]Electric Power Research Institute (EPRI), Palo Alto, California

Background Musculoskeletal pain is associated with demographic, occupational and physical factors. Methods Our study investigated the prevalence and factors associated with musculoskeletal pain in 911 women working in small-scale agriculture in rural northern KwaZulu-Natal, South Africa in 2006 using a questionnaire survey. Results In total, 67% (n = 574) of women reported any chronic musculoskeletal pain. The 12-month prevalence of pain ranged from 63.9% to 73.3% and the prevalence of specific chronic pain lasting more than 3 months ranged from 42.8% to 48.3%. Older age, carrying heavy loads, working with hands above shoulder height, and frequently squatting and kneeling were associated with chronic musculoskeletal pain. Conclusion The prevalence of pain reported in our study, was similar to other developing countries, but considerably higher than in developed countries. Ergonomic interventions including improved and adapted work techniques and tools should be considered to reduce the prevalence of pain in our study population. Am. J. Ind. Med. 52:202-209, 2009.

S. Naidoo　MBChB1 *　H. Kromhout　PhD2　L. London　MD3　R.N. Naidoo　PhD1　A. Burdorf　PhD4
[1]Department of Occupational and Environmental Health, Faculty of Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa;[2]Institute for Risk Assessment Sciences, Environmental Epidemiology Division, Utrecht University, Utrecht, The Netherlands;[3]Occupational and Environmental Health Research Unit, Department of Public Health, University of Cape Town, Cape Town, South Africa;[4]Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Background Data on the economic consequences of occupational injuries is scarce in developing countries which prevents the recognition of their economic and social consequences. This study assess the direct heath care costs of work-related accidents in the Mexican Institute of Social Security, the largest health care institution in Latin America, which covered 12,735,856 workers and their families in 2005. Methods We estimated the cost of treatment for 295,594 officially reported occupational injuries nation wide. A group of medical experts devised treatment algorithms to quantify resource utilization for occupational injuries to which unit costs were applied. Total costs were estimated as the product of the cost per illness and the severity weighted incidence of occupational accidents. Results Occupational injury rate was 2.9 per 100 workers. Average medical care cost per case was $2,059 USD. The total cost of the health care of officially recognized injured workers was $753,420,222 USD. If injury rate is corrected for underreporting, the cost for formal injured workers is 791,216,460. If the same costs are applied for informal workers, approximately half of the working population in Mexico, the cost of healthcare for occupational injuries is about 1% of the gross domestic product. Conclusions Health care costs of occupational accidents are similar to the economic direct expenditures to compensate death and disability in the social security system in Mexico. However, indirect costs might be as important as direct costs. Am. J. Ind. Med. 52:195-201, 2009.

Fernando Carlos-Rivera　MScE1　Guadalupe Aguilar-Madrid　MD　Dr PH2　Pablo Anaya Gómez-Montenegro　MHA1　Cuauhtémoc A. Juárez-Pérez　MD　MSc2　Francisco Raúl Sánchez-Román　MD　MSc2　Jaqueline E.A. Durcudoy Montandon　MSc2　Víctor Hugo Borja-Aburto　MD　PhD2 *
[1]RAC Salud Consultores, Mexico City, Mexico;[2]Instituto Mexicano del Seguro Social, Unidad de Investigación en Salud en el Trabajo, Mexico City, Mexico

Background Previous studies have shown that older farmers and farm workers have been identified at high risk for farm fatalities, most notably involving tractor overturns. Older farmers also incur more severe non-fatal injuries. Methods Data from two national surveillance systems are presented to describe fatal and non-fatal injuries occurring to older farmers 55+ years of age. Tractor-related fatality investigations for older farmers are examined for characteristics of the tractors not available in the injury surveillance systems. Results Older farmers and farm workers averaged 26,573 lost-time injuries annually in 2001 and 2004, with an injury rate of 4.5 injuries/100 workers/year compared to an overall farming injury rate of 4.8 injuries/100 workers/year. Fatality data show that older farmers accounted for over half of all farming deaths between 1992 and 2004 (3,671 of 7,064 deaths), and had a fatality rate of 45.8 deaths/100,000 workers/year compared to the overall farming fatality rate of 25.4 deaths/100,000 workers/year. Most common mechanisms of fatal injury to older farmers were tractors (46%), trucks (7%), and animals (5%). Conclusions Although older farmers and farm workers are at lower risk of overall injury compared to their younger counterparts, injuries to farmers 55 years and older tend to be much more severe. To effectively minimize the risk faced by older farmers, prevention programs must encourage safe work behaviors and practices and the implementation/installation of appropriate safety devices and equipment. Am. J. Ind. Med. 52:185-194, 2009.

John R. Myers　MS*　Larry A. Layne　MA　Suzanne M. Marsh　MPA
Division of Safety Research, NIOSH, Morgantown, West Virginia

Objectives We examined the relationship between chronic rhinosinusitis and occupation. Methods We analyzed data from the 1998, 2001, and 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Men and women aged 20-59 who participated in the three KNHANES were included to analyze the relationship between chronic rhinosinusitis and occupation. Trained interviewers visited subjects’ homes and administered a standardized questionnaire on diagnosed diseases. Subjects were asked if they had experienced chronic rhinosinusitis during the previous year or had had rhinosinusitis for three or more consecutive months. Occupational classification followed the major groups of the Korean Standard Classification of Occupations (KSCO). We calculated the prevalence ratios (PRs) of chronic rhinosinusitis by major groups compared with clerical workers in the three KNHANES. Poisson regression with robust standard error was conducted, adjusting for age in 10-year strata. Results There were significantly increased PRs of chronic rhinosinusitis in plant and machinery operators and assemblers, elementary occupations, crafts and related trade workers, and the unemployed. Conclusions These results support the relationship between chronic rhinosinusitis and occupational exposure at the macro level. Am. J. Ind. Med. 52:179-184, 2009.

Dong-Hee Koh　MD　DrPH1　Hyoung-Ryoul Kim　MD　PhD2 *　Soon-Sil Han　MPH3
[1]Occupational Safety and Health Research Institute (OSHRI), Korea Safety and Health Agency (KOSHA), Incheon, South Korea;[2]Department of Preventive Medicine, Catholic Industrial Medical Center, The Catholic University of Korea, Seoul, South Korea;[3]Yonsei Graduate School of Public Health, Yonsei University, Seoul, South Korea