Kurt Rasmussen

Identification of neck-shoulder disorders in a 1 year follow-up study. Validation Of a questionnaire-based method.

&NA; A cohort of 243 female sewing machine operators were studied by questionnaire and clinical examinations with the purpose to study the efficiency of a screening questionnaire‐based method to identify prevalent and incident cases of neck‐shoulder disorders. The cross‐sectional correlation between self‐reported neck‐shoulder complaints scores and clinical signs of a neck‐shoulder disorder was high. An assessed cut‐of point of complaints could identify 90% of all cases fulfilling the criteria of rotator cuff tendinitis, while the complaint score with regard to clinical signs of myofascial pain syndrome was about 67%. In the follow‐up analyses, incident clinical signs of disorders at 1 year follow‐up were used as ‘golden standard’ in the validation of screening criteria, which included a defined increase of symptoms. Apparently increase of symptoms did not seem to be the optimal criteria for identification of incident cases. Alternatively a cut‐of point of regional complaints in close relation to clinical examinations is recommended.

Incidence of unintentional injuries in farming based on one year of weekly registration in Danish farms.

BACKGROUND In Denmark, farming ranks as the industry with the highest incidence rate of fatal injuries. For nonfatal injuries, insufficient registration practices prevent valid comparisons between occupations. This study examines the occurrence of farm accidents and injuries, as well as work-specific factors, via weekly registration in a representative sample of 393 farms in one county during 1 year. METHODS From a random sample of 794 farms, (10% of farms in the county of Ringkoebing, Denmark) 393 farms with 1,597 residents and employees participated in a 1-year self-registration of work-related unintentional incidents. The procedure included a detailed registration of hours spent on all main working tasks. Weekly recording of incident occurrence or nonoccurrence resulted in the completion of 19,782 registration forms. Three months after incident occurrence, a telephone interview was conducted about the related work situation and resulting injuries. RESULTS During the 12-month period, 479 occupational accidents were reported, of which 389 resulted in an injury. The absolute number of injuries increased with number of work hours, but there was no relative increase of incidence by work hours. Persons below the age of 50 had slightly less than a doubled risk compared with those over 50 years of age. No other marked, reliable age effect was found. There was, however, a seasonal variation, with summer and autumn having a double relative incidence compared with winter and spring. Among farm owners, 35% experienced at least one injury per year, while this was the case for 17% of farm laborers. When adjusting for work hours, the increased frequency of injuries among farm owners was reduced to a factor of 1.5. Animal-related work was the most common injury mechanism. Repair and maintenance work was found to be the most dangerous task relative to the number of task-specific work hours. Subgroups of tasks with a markedly increased injury rate were moving animals within the farm, veterinary procedures, and repair of field machinery and stable equipment. CONCLUSIONS Farm injuries occur among 32% of full-time farmers and farm laborers each year. A quarter of these require professional treatment. This area calls for preventive action.

Psychosocial factors and safety behaviour as predictors of accidental work injuries in farming

Abstract Farming is one of the most hazardous occupations in terms of the incidence and seriousness of accidental injuries. Research with other occupational groups has drawn attention to the role of psychosocial factors and stress. Such research needs to be extended to agriculture. Since stress may be a problem faced by farmers, there is a particular need to investigate the associations between farm accidents and work stressors and stress reactions. Using multivariate logistic regression analyses, this study aimed to uncover the best psychosocial predictors of injury, while controlling for exposure-related confounders. From a randomly selected sample of 794 farms, 10% of all farms in Ringkoebing County, Denmark, 393 farmers completed completed weekly accident registration over 12 months. The study sample consisted of 310 farmers who also completed questionnaires on psychosocial factors. Results indicated that farm stressors (including perceived economic problems), stress symptoms, and safety behaviour were predictors of occupational farm accidents. Higher levels of stressors and stress symptoms and poor safety behaviour were all associated with an elevated risk of injury. In the case of stress symptoms, the relation with accidents occurred via an interaction with safety behaviour. The combination of high levels of stress symptoms and poor safety behaviour was associated with a particularly high accident risk.

Automatic headspace gas chromatographic method for the simultaneous determination of trichloroethylene and metabolites blood and urine

Trichloroethylene, trichloroethanol and trichloroacetic acid (TCA) were quantitated in blood and urine by automated headspace gas chromatography using a fused-silica capillary column coated with 3-micron silicone SE-30 and an electron-capture detector. Total trichloroethanol was determined after enzymatic hydrolysis with beta-glucuronidase and analysed together with trichloroethylene and TCA as chloroform, which are produced by decarboxylation. Analytical conditions were developed under which the thermal decomposition of TCA was optimal. The automated headspace gas chromatography is rapid and good precision is possible. Sample preparation is simple and the sensitivity of the procedure (0.02 microgram/ml) makes it suitable to estimate occupational exposure to trichloroethylene and other halocarbons in humans.

A genotoxic study of metal workers exposed to trichloroethylene

SummaryMetal workers exposed to trichloroethylene for the degreasing of metals were studied to evaluate the genotoxicity of this exposure. For 15 workers presently exposed to high doses of trichloroethylene there was no difference from unexposed persons with respect to sperm count and morphology, and a small increase of two fluorescent bodies (YFF%) in spermatozoa. In contrast, there was a highly significant increase in frequency of structural aberrations (breaks, gaps, translocation, deletions, inversions) and hyperdiploid cells in cultured lymphocytes from trichloroethylene degreasers. As control groups, physicians from chemically non-exposed surroundings and a concurrently sampled reference from cytogenetic investigations were used. This study indicates positive correlations between exposure to trichloroethylene and somatic chromosome aberrations, whereas no effect on male germ cells could be demonstrated.

Occupational Exposure to Chlorinated Organic Solvents and its Effect on the Renal Excretion of N-Acetyl-Beta-D-Glucosaminidase

Organic chlorinated hydrocarbon solvents are known to be nephrotoxic. However, very little is known about renal integrity after occupational exposure to these solvents. Increased urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion caused by necrosis of renal tubular cells can be used as a marker for nephropathy. In this study trichloroethylene (TRI), trichloroethane and freon 113 exposed persons from metal industries have been clinically investigated, and urine samples analysed for NAG activity and for trichloroacetic acid concentration. In order to analyse for possible subclinical kidney damage a group of diabetic patients with subclinical nephropathy served as positive controls. A significant higher NAG activity (p less than 0.001) was found in the group of exposed workers as compared to the control group. About 10% of the exposed workers had an enhanced NAG value, corresponding to the level of diabetic patients with subclinical nephropathy. Increased NAG activity was observed in previously TRI-exposed persons, which might indicate induction of an autoimmune renal necrosis.

Return to Work after Percutaneous Coronary Intervention: The Predictive Value of Self-Reported Health Compared to Clinical Measures

Aims Coronary heart disease is prevalent in the working-age population. Traditional outcome measures like mortality and readmission are of importance to evaluate the prognosis but are hardly sufficient. Ability to work is an additional outcome of clinical and societal significance. We describe trends and predictors of Return To Work (RTW) after PCI and describe a possible benefit using patient-reported measures in risk stratification of RTW. Methods A total of 1585 patients aged less than 67 years treated with PCI in 2006–2008 at the Aarhus University Hospital were enrolled. Clinical information was provided through the West Denmark Heart Registry, and 4 weeks after PCI we mailed a questionnaire regarding self-rated health (response rate 83.5%). RTW was defined at weekly basis using extensive register data on transfer payments. Predictors of RTW were analysed as time to event. ROC curves constructed by logistic regression of predicting variables were evaluated by the c-statistic. Results Four weeks before PCI 50% of the patients were working; the corresponding figures were 25% after 4 weeks, 36% after 12 weeks, and 43% after one year. The patients’ self-rated health one month after the procedure was a significant better predictor of RTW compared to other variables including LVEF, both at short (12 weeks) and long (one year) term. Conclusions The patients self-rated health four weeks after the procedure was a stronger predictor than left ventricular ejection fraction (LVEF), and consequently useful when patients seek medical advice with respect to RWT.

Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel – a cross-sectional study

BackgroundReviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance personnel and the core work force in Denmark. In addition, to examine the association between physical and psychosocial work environment factors and different measures of health among ambulance personnel.MethodsData were taken from a nationwide sample of ambulance personnel and fire fighters (n = 1,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality.ResultsAmbulance personnel have half the prevalence of poor self-rated health compared to the core work force (5% vs. 10%). Levels of mental health were the same across the two samples whereas a substantially higher proportion of the ambulance personnel reported musculoskeletal pain (42% vs. 29%). The ambulance personnel had higher levels of emotional demands and meaningfulness of and commitment to work, and substantially lower levels of quantitative demands and influence at work. Only one out of ten aspects of physical work environment was consistently associated with higher levels of musculoskeletal pain. Emotional demands was the only psychosocial work factor that was associated with both poorer mental health and worse sleep quality.ConclusionsAmbulance personnel have similar levels of mental health but substantially higher levels of musculoskeletal pain than the work force in general. They are more exposed to emotional demands and these demands are associated with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence of positive organizational support mechanisms that can prevent negative effects from the high levels of emotional demands.

Subclinical affection of liver and kidney function and solvent exposure

SummaryThe role of solvents as hepato- and nephrotoxic agents under present-day exposure levels is still unclear. The purpose of this study involving 99 metal degreasers was to examine dose-response relationships between long-term exposure of mainly trichloroethylene and a battery of liver function tests and one nephrotubular enzyme test. Serum γ-glutamyltransferase and urinary N-acetyl-β-glucosaminidase were elevated by increasing solvent exposure at bivariate level. The significance of this relationship, however, was not able to withstand a multiple regression analysis, with age and alcohol abuse as confounding variables. The conclusion is that of a nonsignificant association between solvent exposure and tests screening for early liver and kidney dysfunction.

Work-related stressors and occurrence of adverse events in an ED☆

OBJECTIVE The purpose of this study was to investigate the relationship between 12 work-related stressors and the occurrence of adverse events in an emergency department (ED). METHODS Nurses and physicians, working in an ED at a Danish regional hospital, filled out a questionnaire on occurrence and emotional impact of 12 work-related stressors after each shift during a 4-week period. The questionnaire also instructed the participants to describe any adverse events that they were involved in during the shift. RESULTS Two hundred fourteen adverse events were reported during the 979 studied shifts. During the same period, only 27 adverse events were reported to the mandatory national reporting system, and only 10 of these were duplicates. A high variability of stressors and emotional impact among the different groups of participants was found. Linear regression analysis showed an association between involvement in adverse events and the occurrence and emotional impact of stressors across groups, whereas no significant association was found for age, seniority, shift type, or length. CONCLUSION The study showed an association between the occurrence and impact of 12 work-related stressors and involvement in adverse events across the groups of participants. Furthermore, the study showed that most adverse events were not reported to the mandatory national reporting system.