Linda Rosenstock

Neuropsychological function in retired workers with previous long-term occupational exposure to solvents

OBJECTIVES: It is plausible that neurodegenerative processes of aging might have a contributing role in the development of chronic effects of exposure to organic solvents. This study evaluated the risk for neuropsychological deficits among retired workers, relative to their histories of exposure to occupational solvents. METHODS: This cross sectional study evaluated retired male workers, 62-74 years of age, including 89 people with previous long-term occupational exposure to solvents (67 retired painters and 22 retired aerospace manufacturing workers), and 126 retired carpenters with relatively minimal previous exposure to solvents. Subjects completed a standardised neuropsychological evaluation and psychiatric interview, structured interviews for histories of occupational exposure and alcohol consumption, and questionnaires assessing neurological and depressive symptoms. RESULTS: By comparison with the carpenters, the painters on average reported greater cumulative alcohol consumption and had lower scores on the WAIS-R vocabulary subtest, usually presumed to reflect premorbid intellectual functioning. These findings, however, were not sufficient to account for the other study findings. Controlling for age, education, vocabulary score, and alcohol use, the painters had lower mean scores on test measures of motor, memory, and reasoning ability; and a subgroup of aerospace workers with moderate to high cumulative exposure to solvents (n = 8) had lower mean scores on measures of visuomotor speed, and motor, attention, memory, and reasoning ability. Subjects were more likely to have an increased number of relatively abnormal test scores (three or more outlier scores on 17 test measures) among both the painter group (odds ratio (OR), 3.1; 95% confidence interval (95% CI) 1.5 to 6.2) and the subgroup of aerospace workers with higher cumulative exposure (OR 5.6; 95% CI 1.0 to 38). The painters, but not the aerospace workers, reported significantly more neurological and depressive symptoms. CONCLUSIONS: The findings are consistent with residual central nervous system dysfunction from long-term exposure to organic solvents, persisting years after the end of exposure.

Estimating underreported pesticide poisonings in Nicaragua

We undertook to estimate the degree of underreporting to a regional pesticide poisoning registry, and to estimate the true incidence of poisoning in an agricultural region of Nicaragua. We surveyed 633 workers at 25 of 33 agricultural cooperatives and any nearby private forms in a area geographically convenient to the regional health headquarters with a short structured interview about pesticide poisonings. Eighty-three percent of workers described current use of pesticides. Twenty-five percent described a pesticide poisoning in the preceding 12 months, and almost one-half (48%) described having been made ill by pesticides at some point in time. Sixty-nine (11%) described a poisoning in the preceding month, 23 of whom had received medical attention. The names of the medically treated were sought in the Regional Pesticide Poisoning Registry for the survey year of 1988. Only 8 of the 23 subjects were found reported to the registry when a total of 1,143 human pesticide poisonings were reported in the entire region. Using 65% as an estimate of underreporting to the registry, we calculate that 3,300 (95% CI 2100-7500) poisonings had received treatment in the region in 1988, of whom more than 2,100 remained unreported. Based on the ratio of total poisonings (treated and untreated) to registry-reported poisonings among our survey respondents, we estimate that 6,700 (95% CI 4100-18000) systemic poisonings, occurred in 1988 in the region. Underreporting of pesticide poisonings disguises the enormity of the problem in developing countries. Even in a region with a strong emphasis on illness reporting for targeted conditions, underreporting is substantial. This method for estimating underreporting is easily applied and provides a rough estimate of registry underreporting and actual incidence for conditions identifiable by a community-applied questionnaire.

Work organization research at the National Institute for Occupational Safety and Health

For 25 years, the National Institute for Occupational Safety and Health (NIOSH) has conducted and sponsored laboratory, field, and epidemiological studies that have helped define the role of work organization factors in occupational safety and health. Research has focused on the health effects of specific job conditions, occupational stressors in specific occupations, occupational difference in the incidence of stressors and stress-related disorders, and intervention strategies. NIOSH and the American Psychological Association have formalized the concept of occupational health psychology and developed a postdoctoral training program. The National Occupational Research Agenda recognizes organization of work as one of 21 national occupational safety and health research priority areas. Future research should focus on industries, occupations, and populations at special risk; the impact of work organization on overall health; the identification of healthy organization characteristics; and the development of intervention strategies.

The future of intervention research at NIOSH

The National Institute for Occupational Safety and Health (NIOSH) has recently made a commitment to increase both extramural and intramural support of control technology and intervention research. It is important for NIOSH to use intervention research more aggressively because it provides a mechanism to go beyond investigation, identification, and recommendations to actually determine if prevention has occurred. Intervention research can assess the effectiveness of the hierarchy of controls, workplace standards, and health and medical care, as well as provide important information on occupational disease and injury surveillance and health communication efforts. In pursuing intervention research, NIOSH will focus on enhancing its existing control technology and surveillance programs, seeking input from partners in industry and labor, pursuing interdisciplinary approaches, considering the cost and feasibility of controls, considering and integrating behavioral procedures, and widely disseminating the results.

42 CFR Part 84: Respiratory protective devices implications for tuberculosis protection.

This final rule was made available to the public at the Government Printing Office in Washington, DC, on June 2, 1995. It was published in the Federal Register on June 8, 1995, in Part II of that issue (60 FR 110:30336). This rule addresses the National Institute for Occupational Safety and Health (NIOSH) and Department of Labor/Mine Safety and Health Administration (MSHA) certification requirements for respiratory protective devices. Specifically, the rule replaces MSHA regulations at 30 CFR Part 11 with new public health regulations at 42 CFR Part 84, while also upgrading testing requirements for particulate filters. Concurrent with NIOSH publication of this new rule, MSHA published a final rule to remove existing regulations at 30 CFR Part 11, which are made obsolete by this final rule. NIOSH now will have exclusive authority for testing and certification of respirators with the exception of certain mine emergency devices, which will continue to be jointly certified by NIOSH and MSHA.

Occupational Injury Risk Assessment: Perspective and Introduction to the First Special Issue

Linda Rosenstock1,3 and Nancy Stout2,* 1 National Institute for Occupational Safety and Health, Hubert H. Humphrey Building, Room 715-H, 200 Independence SW, Washington, DC 20201; 2National Institute for Occupational Safety and Health, Division of Safety Research, 1095 Willowdale Road, Morgantown, WV 26505; 3Current address: School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA