Medical Magazine

Background The aims of the study are to estimate the prevalence of the common mental disorders according to occupational category and to describe the consequences of these disorders on their work, in the French population. Methods It took place in France from 1999 to 2003. The sample consisted of about 36,000 people aged 18 years and older. Data were collected face-to-face using the Mini International Neuropsychiatric Interview (MINI). Results Anxiety disorders were most common (17% in men and 26% in women), while prevalence estimates for mood disorders were 10% in men and 14% in women. Prevalence of troubles were consistently higher among those in the lowest occupational categories. Among those reporting mental disorders, about 50% said that their work was affected. The repercussions on job varied by occupational category and differently for men and women. Conclusion This study shows the social and occupational inequalities in the prevalence of mental disorders and their important work consequences in the French working population. Am. J. Ind. Med. 52:141-152, 2009.

Christine Cohidon　MD　PhD1 *　Ellen Imbernon　MD2　Marcel Gorldberg　MD　PhD2 3
[1]French Institute for Public Health Surveillance, Occupational Health Department/Umrestte, Lyon, France;[2]French Institute for Public Health Surveillance (InVS), Occupational Health Department, Saint-Maurice, France;[3]Institut National de la Santé et de la Recherché Médicale (INSERM), Villejuif, France

Rationale Current literature suggests that flour exposed workers continue to be at risk of allergic sensitization to flour dust and respiratory ill health. Objectives A cross-sectional study of 225 workers currently potentially exposed to flour dust in British bakeries was performed to identify predictors of sensitization to wheat flour and enzymes. Results Work-related nasal irritation was the most commonly reported symptom (28.9%) followed by eye irritation (13.3%) and work-related cough or chest tightness (both 10.2%). Work-related chest tightness was significantly associated (OR 7.9, 1.3-46.0) with co-sensitization to wheat flour and any added enzyme. Working at a bakery with inadequate control measures was not a risk factor for reporting work-related respiratory symptoms (OR 1.3, 0.4-3.7). Fifty-one workers were atopic and 23 (14%) were sensitized to workplace allergens. Atopy was the strongest predictive factor (OR 18.4, 5.3-64.3) determining sensitization. Current versus never smoking (OR 4.7, 1.1-20.8) was a significant risk factor for sensitization to wheat flour or enzymes in atopic workers only, corrected for current level and duration of exposure. This effect was not seen in non-atopic workers (OR 1.9, 0.2-17.9). Evidence of sensitization to less commonly encountered allergens was also seen to Aspergillus niger derived cellulase, hemicellulase and xylanase mix, in addition to glucose oxidase and amyloglucosidase mix. Conclusions The combination of health surveillance and exposure control in this population has been insufficient to prevent clinically significant workplace sensitization. Smoking may pose an additional risk factor for sensitization in atopic workers. Am. J. Ind. Med. 52:133-140, 2009.

Joanne Harris-Roberts　PhD1　Edward Robinson　BSc1　Judith C. Waterhouse　HND2 3　Catherine G. Billings　PhD3　Alison R. Proctor　MSc3　Micah Stocks-Greaves1　Shamim Rahman　PhD1　Gareth Evans　PhD1　Andrew Garrod　MRSC4　Andrew D. Curran　PhD1　David Fishwick　MD1 2 3 *
[1]Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire, UK;[2]University of Sheffield, Western Bank, Sheffield, UK;[3]Centre for Workplace Health, Respiratory Function Unit, Royal Hallamshire Hospital, Sheffield, UK;[4]Health and Safety Executive, Redgrave Court, Bootle, UK

Objective A longitudinal cohort of automobile manufacturing workers (n = 1,214) was examined for: (1) prevalence and persistence of specific upper extremity musculoskeletal disorders (UEMSDs) such as lateral epicondylitis and de Quervain’s disease, and non-specific disorders (NSDs) defined in symptomatic individuals without any specific disorder, and (2) disorder prognoses based on symptom characteristics and other factors. Methods Eight specific disorders were identified through case definitions based on upper extremity physical examinations and symptom surveys administered on three occasions over 6 years. Results At baseline, 41% of the cohort reported upper extremity symptoms; 18% (n = 214) of these had NSDs. In each survey, tendon-related conditions accounted for over half of the specific morbidity. Twenty-five percent had UEMSDs in multiple anatomical sites, and most with hand/wrist disorders had two or more hand/wrist UEMSDs. Persistence for all specific disorders decreased with length of follow-up. Specific UEMSDs were characterized by greater pain severity and functional impairment, and more lost work days than NSDs. Conclusions Upper extremity symptoms and diagnoses vary over time. NSDs may be the early stages of conditions that will eventually become more specific. NSDs and overlapping specific UEMSDs should be taken into account in UEMSD classification. Am. J. Ind. Med. 52:124-132, 2009.

Judith E. Gold　ScD1 2 *　Angelo d’Errico　MD3　Jeffrey N. Katz　MD4　Rebecca Gore　PhD2　Laura Punnett　ScD2
[1]Department of Public Health, Temple University, Philadelphia, Pennsylvania;[2]Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts;[3]Epidemiologic Unit, Piedmont Region, Grugliasco (TO), Italy;[4]Division of Rheumatology, Immunology and Allergy and Department of Orthopaedic Surgery Brigham and Women’s Hospital, Boston, Massachusetts

Background Recent literature identified upper extremity musculoskeletal symptoms at a prevalence of >40% in college populations. The study objectives were to determine weekly computer use and the prevalence of upper extremity musculoskeletal symptoms in a graduate student population, and make comparisons with previous graduate and undergraduate cohorts. Methods One hundred sixty-six graduate students completed a survey on computing and musculoskeletal health. Associations between individual factors and symptom status, functional limitations, academic impact, medication use, and health services utilization were determined. Logistic regression analyses evaluated the association between symptom status and computing. Cross-study comparisons were made. Results More symptomatic participants experienced functional limitations than asymptomatic participants (74% vs. 32%, P < 0.001) and reported medication use for computing pain (34% vs. 10%, P < 0.01). More participants who experienced symptoms within an hour of computing used health services compared to those who experienced symptoms after an hour of computer use (60% vs. 12%, P < 0.01). Years of computer use (OR = 1.59, 95% CI 1.05-2.40) and number of years in school where weekly computer use was more than 10 hr (OR = 1.56, 95% CI 1.04-2.35) were associated with pain within an hour of computing. Cross-study comparisons found college populations more similar than different. Conclusion The overall findings reinforced previous literature documenting the prevalence of upper extremity musculoskeletal symptoms in college populations, suggesting an important population for participating in public health interventions designed to support healthy computing practices and identify risk factors important to evaluate in future cohort studies. Am. J. Ind. Med. 52:113-123, 2009.

Cammie Chaumont Menéndez　PhD　MPH　MS1 *　Benjamin C. Amick III　PhD1 2　Mark Jenkins　MD3　Cyrus Caroom　BA1 4　Michelle Robertson　PhD　CPE5　Ronald B. Harrist　PhD1　Jeffrey N. Katz　MD　MS6
[1]The University of Texas School of Public Health, Southwest Center for Occupational and Environmental Health, Houston, Texas;[2]The Institute for Work and Health, Toronto, Canada;[3]Rice University, Houston, Texas;[4]Baylor College of Medicine, Houston, Texas;[5]Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts;[6]Department of Orthopaedic Surgery and Division of Rheumatology, Immunology and Allergy, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, Maryland

Background While survey studies have examined bias much is unknown regarding specific subpopulations, especially women workers. Methods A population based phone, Internet, and mail survey of workplace falls during pregnancy was undertaken. Participation by industry and occupation and survey approach and bias, reliability, and incomplete data were examined. Results Of the 3,997 women surveyed, 71% were employed during their pregnancy. Internet responders were most likely to be employed while pregnant and to report a workplace fall at 8.8% compared to 5.8% and 6.1% for mail and phone respondents. Internet responders had the most missing employment data with company name missing for 17.9% compared to 1.3% for phone responders. Mail surveys were best for recruiting those employed in eight of nine industries, and this was especially true for service occupations. Conclusions To decrease bias and increase participation, mixed approaches may be useful with particular attention for collecting occupational data. Am. J. Ind. Med. 52:105-112, 2009.

Kari Dunning　PhD1 *　Grace K. LeMasters　PhD2
[1]Department of Rehabilitation, University of Cincinnati College of Allied Health, Cincinnati, Ohio;[2]Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio

Background Home care/hospice nurses may be at elevated risk of blood exposure because of the nature of their work and work environment. However, little is known about the incidence of blood exposure in this population. Methods A mail survey (n = 1,473) was conducted among home care/hospice nurses in North Carolina in 2006. Results The adjusted response rate was 69%. Nine percent of nurses had at least one exposure/year. Overall incidence was 27.4 (95% confidence interval: 20.2, 34.6)/100,000 visits. Nurses who had worked in home care 5 years had higher exposure rates than other nurses – seven times higher for needlesticks and 3.5 times higher for non-intact skin exposures. Nurses who worked part time/contract had higher exposure rates than nurses who worked full time – seven times higher for needlesticks and 1.5 times higher for non-intact skin exposures. The rates for part-time/contract nurses with 5 years experience were extremely high. Sensitivity analysis showed that it is unlikely that response bias had an important impact on these results. Conclusions Approximately 150 North Carolina home care/hospice nurses are exposed to blood annually. If these results are representative of other states, then approximately 12,000 home care/hospice nurses are exposed each year nationwide. Improved prevention efforts are needed to reduce blood exposure in home care/hospice nurses. Am. J. Ind. Med. 52:99-104, 2009.

Jack K. Leiss　PhD1 *　Jennifer T. Lyden　MPH1　Rahel Mathews　MPH1　Kathleen L. Sitzman　PhD　RN2　Abenah Vanderpuije　MPH1　Deepak Mav　PhD1　Mary Agnes Kendra　PhD　RN3　Cynthia Klein　PhD1　Carolyn J. Humphrey　MS　RN1
[1]Center for Health Research, Constella Group, LLC, Durham, North Carolina;[2]School of Nursing, Weber State University, Ogden, Utah;[3]College of Nursing, University of Akron, Akron, Ohio

Objectives To understand current status of occupational exposure to blood and body fluids (BBF), and awareness of knowledge about occupational bloodborne pathogen exposures and universal precaution among hospital-based health care workers (HCWs). Methods A cross-sectional study was conducted during April to May 2004 to study incidence of occupational exposure to BBF among 1,144 hospital-based HCWs. Results The total incidence and the average number of episodes exposure to BBF was 66.3/100 HCWs per year and 7.5 per person per year in the past year, respectively. The incidence (per 100/HCWs per year) and the average number of episodes (per HCW per year) of percutaneous injury (PCI), mucous-membrane exposure (MME), and exposure to BBF by damaged skin was 50.3 and 1.8; 34.4 and 1.7; and 37.9 and 4.0, respectively. The leading incidence and the average number of episodes of PCI occurred in delivery room (82.6 and 1.8). The highest percentage of PCI’s that occurred during the previous 2 weeks occurred during a surgical operation (22.8%). Of all sharp instruments, the suture needle contributed the highest percentage of PCI’s (24.7%) among HCWs in the last 2 weeks. Over two-thirds (68.3%) of respondents were immunized with Hepatitis B vaccine; less than one-half (47%) of HCWs wore gloves while doing procedures on patients. The respondents demonstrated a lack of knowledge regarding transmission of bloodborne diseases and universal precautions. Conclusions Risk for potential exposure to BBF appears high in HCWs, and almost all of episodes are not reported. It is urgent to establish the Guideline for Prevention and Control of Occupational Exposure to Bloodborne Pathogens among HCWs. Am. J. Ind. Med. 52:89-98, 2009.

Min Zhang　BM　MMS1 2　Huanqiang Wang　BM　MPH1　Jianying Miao　BSc3　Xieyi Du　BSc　Mcs1　Tao Li　BM　MMS1　Zhenglai Wu　BM　MMS2 *
[1]National Institute for Occupational Health and Poison Control, China CDC, Beijing, China;[2]Department of Epidemiology, Peking Union Medical College, Beijing, China;[3]Fujian Province Center for Occupational Disease and Chemical Poison Prevention and Control, Fujian Province, China

The firefighters are at increased risk of respiratory disease as a result of exposure to smoke and dust. The aim of this study was to determine the prevalence and risk associated with respiratory symptoms among city firefighters in São Paulo, Brazil. Methods A cross-sectional study utilizing the European Community Respiratory Health Survey (ECRHS) questionnaire was administered to firefighters and police officers, in order to evaluate their respiratory symptoms. Results Complete respiratory data were obtained from 1,235 firefighters and 1,839 police officers. Among the firefighters, there were 55.5% never-smokers, 22.4% current smokers and 18.2% former smokers (P < 0.05). Among the police officers, there were 63.4%, 18.6%, and 9.6% who were never-smokers, current smokers and former smokers (P < 0.05), respectively. Compared to police, firefighters experienced an increase in wheezing [OR = 1.63 (95% CI: 1.43-1.87)], wheezing with breathlessness [OR = 1.34 (95% CI: 1.10-1.64)], wheezing without a cold [OR = 1.60 (95% CI: 1.32-1.95)], waking with tightness in the chest [OR = 1.20 (95% CI: 1.02-1.42)], and rhinitis [OR = 1.12 (95% CI: 1.03-1.22)]. The prevalence of adult-onset asthma in never-smokers was 9.3% and 6.7% for firefighters and police officers [OR = 1.23 (95% CI: 1.01-1.56)]. An independent association was observed between years employed, smoking, history of rhinitis, and work as a firefighter and respiratory and nasal symptoms. We observed a high prevalence of asthma-like symptoms in firefighters who presented respiratory symptoms beginning immediately after firefighting. Conclusion These results suggest that the prevalence of respiratory symptoms and asthma in firefighters is higher than those in police officers. Work-as a firefighter, rhinitis and years employed were risk factors for respiratory symptoms of asthma. Am. J. Ind. Med. 52:261-269, 2009.

Marcos Ribeiro　MD1 *　Ubiratan de Paula Santos　MD1　Marco Antonio Bussacos2　Mario Terra-Filho　MD1
[1]Occupational and Environmental Group, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil;[2]Division of Statistics and Epidemiology, Fundacentro, São Paulo, Brazil

Background Experimental and clinical evidence suggest that stress can lead to ill-health through the disregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Studies to date have produced equivocal results likely due to different methodologies and failure to account for confounding factors. This investigation aimed to assess the relation between self-reported work-related stressors and salivary cortisol and to clarify the role of the potential confounders. Methods Thirty-six call-handlers completed a self-administered job content questionnaire and collected seven daily salivary samples on two workdays and a weekend. The diurnal salivary cortisol output was expressed as cortisol awakening response (CAR), and cortisol output in the rest of the day. Salivary cortisol data were normalized by means of square root transformation. The generalized estimating equations method was used to assess the relation between job strain and cortisol levels after adjusting for gender, weekdays and adherence to the sampling schedule. Results Job strain significantly influenced the total amount of cortisol response to waking (high strain vs. low strain: 1.1 (0.3-2.0) nmol/L). The cortisol response to waking showed gender-specific differences [women excreting greater cortisol than men: 1.1 (0.3-1.9) nmol/L], and weekday differences [workdays vs. weekend: 1.0 (0.3-1.6) nmol/L]. Non-compliance with the sampling protocol was associated with lower salivary cortisol than in adherent subjects. Conclusions Our results provide further evidence for the HPA axis involvement in the physiological response to work stress. The measure of the CAR showed to be the sensitive index to assess the physiological response to psychosocial factors. Gender, weekday, and protocol compliance were confounding factors. Am. J. Ind. Med. 52:251-260, 2009.

Giovanni Maina　MD1 *　Antonio Palmas　MD1　Massimo Bovenzi　MD2　Francesca Larese Filon　MD2
[1]Dipartimento di Traumatologia Ortopedia e Medicina del Lavoro, Università di Torino, Torino, Italy;[2]Unità Clinico Operativa di Medicina del Lavoro, Dipartimento di Scienze di Medicina Pubblica, Università di Trieste, Trieste, Italy

A 58-year-old woman was referred to our hospital due to progressive skin darkening, which began 5 months previously. The patient had strikingly diffuse blue-gray discoloration of the skin, most prominent in sun-exposed areas, especially her face and hands. The oral mucosa, tongue, gums, eye conjunctiva, ears, nail beds, and trunk were also involved. Bluish-gray discoloration of all nails was aggravated by cold weather. She had ingested 1 L of colloidal silver solution daily for approximately 16 months as a traditional remedy. Her serum silver concentration was 381 ng/ml which was a very high (reference level: <15 ng/ml). Light microscopic examination of a punch biopsy specimen from her nose revealed fine, minute, round, and brown-black granules deposited in the basement membrane of hair follicular epithelium. Scanning electron microscopic examination showed electron-dense granules deposited in the intercellular space of sweat glands. Energy disperse X-ray spectrometry analysis demonstrated peaks for silver and sulfur in the dense black deposits. The ingestion of colloidal silver appears to be an increasing practice among patients using alternative health practices. All silver-containing products including colloidal silver should be labeled with a clear warning to prevent argyria, especially in alternative health practices. Am. J. Ind. Med. 52:246-250, 2009.

Yangho Kim1 *　Ho Seok Suh2　Hee Jeong Cha3　Suk Hwan Kim1　Kyoung Sook Jeong4　Dong Hoon Kim5
[1]Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea;[2]Department of Dermatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea;[3]Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea;[4]Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, South Korea;[5]Electron Microscopic Laboratory, Dongguk University College of Medicine, Gyeongju, South Korea