James E. Cone

Physician reports of work-related asthma in California, 1993-1996.

BACKGROUNDnWork-related asthma is a leading cause of occupational respiratory illness.nnnMETHODSnWork-related asthma was studied in California over a 36-month period, from March 1, 1993 to February 29, 1996. The surveillance system identified cases from Doctors First Reports (DFRs), a mandated physician reporting system. Structured follow-up telephone interviews of DFR asthma cases were conducted to collect work history, exposure, and medical information. Statewide employment data was used to calculate disease rates among industry groups.nnnRESULTSnBased on 945 cases of work-related asthma, the average annual reporting rate for work-related asthma in California was 25/million workers. We estimate that the actual rate is 78/million, adjusted for likely underreporting. Janitors and cleaners (625/million) and firefighters (300/million) had the highest reporting rates of work-related asthma. Half of all work-related asthma cases were associated with agents not known to be allergens.nnnCONCLUSIONSnA greater proportion of work-related asthma associated with irritant exposures was identified than has previously been reported. The surveillance data provide a very conservative estimate of the incidence of work-related asthma.

Psychological, psychosocial, and psychophysiological sequelae in a community affected by a railroad chemical disaster

Psychological, psychosocial, and psychophysiological sequelae were studied in a community which had experienced a railroad chemical spill of 19,000 gallons of the toxic pesticide metam sodium. Two hundred twenty exposed residents were compared to 114 controls and paired on age, education, gender, race, and number of children. A clinical interview and physiological measurements (blood pressure, pulse, and cortisol level) were taken, the MMPI-2, IES Scale, Mood Scale, Environmental Worry, Perceived Social Support, and Perceived Control Scale and a questionnaire were administered. Results indicated greater levels of depression, anxiety, and somatic symptoms in the spill residents in addition to greater environmental worry and lower perceived social support. Spill residents had higher blood pressure and less fluctuation of cortisol levels than controls. No difference on litigation status was obtained except on the IES, Intrusion and the POMS scales. Chemical disasters are associated with a wide variety of psychological, psychosocial, and physiological distress.

Statistical design and monitoring of the carotene and retinol efficacy trial (CARET)

CARET is a chemoprevention trial of beta-carotene and vitamin A with lung cancer as the primary outcome. Participants at high risk for lung cancer are drawn from two populations: asbestos-exposed workers and heavy smokers. The intervention is a daily combination of 30 mg beta-carotene and 25,000 IU vitamin A as retinyl palmitate. Nearly 18,000 participants will be followed for a mean 6 years, yielding over 100,000 person-years of follow-up. We project that this sample size will have 80% power to detect a 23% decrease in the incidence of lung cancer cases. The purpose of this paper is to present the values of the key sample size parameters of CARET; our schemes for monitoring CARET for sample size adequacy, incidence of side effects, and efficacy of the study vitamins; an overview of the data collected; and plans for the primary, secondary, and ancillary analyses to be performed at the end of the trial. These approaches to the design, monitoring, and analysis of CARET are applicable for many other prevention trials.

Occupational Infection with Human Immunodeficiency Virus (HIV): Risks and Risk Reduction

As the epidemic of the acquired immunodeficiency syndrome (AIDS) expands, the prevalence of the human immunodeficiency virus (HIV) infection in health care environments will increase and health care workers in many locations are likely to be at increased risk for exposure. The Fifth Annual Advances in Occupational Cancer Conference, held in December 1988 in San Francisco, addressed occupational HIV infection. Symposium participants concluded that the risk of HIV infection for health care workers is low but not zero. Implementation of universal blood and body fluid precautions was agreed to as an appropriate method of preventing exposure to HIV, especially for preventing needlestick accidents. Current standards for hospital waste disposal were judged to be adequate to prevent transmission of HIV, and confidential testing for HIV antibody in health care workers with follow-up counseling was recommended where indicated. It was also agreed that the risk of occupational exposure to HIV does not free health care workers from the responsibility to provide care to infected persons.

Acquired intolerance to solvents following pesticide/solvent exposure in a building: a new group of workers at risk for multiple chemical sensitivities?

We evaluated workers from one building who had symptoms most likely associated with pesticide applications to control cockroach infestation. Many of these workers subsequently developed acquired intolerances to pesticides, solvents, or other agents, suggesting multiple chemical sensitivities. This may represent a new group of workers potentially at risk for the development of multiple chemical sensitivities.

Affective and personality disturbances among female former microelectronics workers.

The production and manufacture of microelectronic components, carried out primarily by women workers, require extensive use of organic solvents. Affective and personality disturbances frequently have been associated with organic solvent toxicity. A group of women, former microelectronics workers (N = 70), primarily of Hispanic origin (77.1%) but raised in the United States, were evaluated for affective and personality disturbance with the MMPI. Profiles were analyzed, and diagnostic classification was performed blind. Results showed that (1) 85.7% of the profiles indicated abnormally high clinical elevations; and (2) MMPI profile classification revealed four clinical diagnostic groups: somatoform (24.3%), depression (15.7%), anxiety (28.6%), and psychotic (14.3%). These findings indicate significant psychopathology among these women, who formerly had worked in a microelectronics plant. The patterns of impairment present similarities to previous reports of organic solvent toxicity.

Analysis of the Tony!™ Variable Geometry VDT Keyboard

This study utilizes a variable geometry keyboard to analyze the optimal configuration for a split QWERTY-type keyboard. The measured criteria were muscle activity as measured by EMG and reported operator discomfort. A variable geometry keyboard, simultaneously adjustable in opening angle (yaw) and lateral angle (roll) was obtained. The upward slope (tilt) was preset at 10%. The study manipulated the keyboard geometry to assess the difference in musculoskeletal activity between using (1) a conventional, flat, linear keyboard; (2) a neutral, undeviated wrist position; and (3) two forearm positions that essentially eliminate pronation. Eight experienced subjects with no prior history of wrist injury or other pathology were tested. EMG activity of four relevant muscle groups was measured on each subject for each of the four keyboard positions. The study suggested an 18° opening angle and a 30°–60° lateral angle as optimal when compared with a flat, standard keyboard (they minimize objective EMG activity and subjective discomfort).

Developing a comprehensive pesticide health effects tracking system for an urban setting: New York City's approach.

In recent years, there have been substantial investments and improvements in federal and state surveillance systems to track the health effects from pesticide exposure. These surveillance systems help to identify risk factors for occupational exposure to pesticides, patterns in poisonings, clusters of disease, and populations at risk of exposure from pesticide use. Data from pesticide use registries and recent epidemiologic evidence pointing to health risks from urban residential pesticide use make a strong case for understanding better the sale, application, and use of pesticides in cities. In this article, we describe plans for the development of a pesticide tracking system for New York City that will help to elucidate where and why pesticides are used, potential risks to varied populations, and the health consequences of their use. The results of an inventory of data sources are presented along with a description of their relevance to pesticide tracking. We also discuss practical, logistical, and methodologic difficulties of linking multiple secondary data sources with different levels of person, place, and time descriptors.

INSTALLING NEEDLE DISPOSAL BOXES CLOSER TO THE BEDSIDE REDUCES NEEDLE-RECAPPING RATES IN HOSPITAL UNITS

OBJECTIVEnTo compare the proportion of recapped needles, an injury surrogate measure, in disposal boxes on two different types of hospital units, both before and after an intervention.nnnDESIGNnProspective nonrandomized intervention trial.nnnSETTINGnA major public teaching hospital.nnnPARTICIPANTSnSpecific hospital units. We selected two types of hospital units for study: the first type of hospital unit (medical-surgical ward) had existing mounted in-bathroom needle disposal boxes, and the second type of hospital unit (intensive care unit) had unmounted needle disposal boxes in the room but not necessarily near the patients bedside.nnnINTERVENTIONnThe installation, in the medical-surgical wards only, of mounted needle disposal boxes on the wall near the patients bed. The box location in the intensive care units remained the same. In both types of unit, a new mailbox-slot disposal box (SAGE) also was substituted for the previous round-top container.nnnRESULTSnThe baseline proportion of recapped needles in the first medical-surgical unit was 32.6% (+/- 3.8%) and in the second medical-surgical unit it was 27.4% (+/- 4.0%) in the bathroom needle disposal boxes, which was similar to the observed proportion (34.7 +/- 6.4%) in the intensive care unit boxes. Following the intervention, the proportion of recapped needles was significantly reduced in the disposal containers adjacent to the bedside in medical-surgical units, to 27% (a difference of 2.9 standard errors of the baseline distribution) in the first unit and 18.2% (a difference of 4.6 standard errors) in the second. In the intensive care unit, where boxes were not moved but new mailbox-types were simply substituted, no significant change was noted (36.6%, a difference of 0.59 standard errors). A statistically significant reduction was observed in the proportion of needles recapped in both wards combined following the intervention (30.2% to 26.2%, a difference of 2.9 standard errors).nnnCONCLUSIONnEnvironmental changes alone are an effective means of altering the risk to healthcare workers from sharp instruments. The use of needle-box counts provides a sensitive and stable instrument to measure injury surrogates and, indirectly, behavioral change in hospital workers.

Comparison of digit symbol and symbol digit modalities tests for assessing neurotoxic exposure

Abstract The WAIS-R Digit Symbol subtest and the Symbol Digit Modalities Test (SDMT) scores are compared on 157 former micro-electronics workers with organic solvent exposure and 113 nonexposed comparison subjects. The majority of both groups were Hispanic females (88% and 91%) with similar educational levels (M 11.6 and 12.1 years) and age (M 44.7 and 43.8 years). Both the SDMT and the Digit Symbol test differentiated the solvent exposed former micro-electronics workers from the nonexposed comparison subjects, with the exposed scoring lower than the comparison subjects on both the Digit Symbol test (M 47.4 vs. 54.4) and the SDMT (M 39.1 vs. 43.1). Scores between the SDMT and the Digit Symbol test correlated highly for the former workers (r = .78) and the comparison subjects (r = .73) No gender effects were found, although age and educational level were associated with performance on both tests.