Marcial Velasco Garrido

Lung function in asbestos-exposed workers, a systematic review and meta-analysis

BackgroundA continuing controversy exists about whether, asbestos exposure is associated with significant lung function impairments when major radiological abnormalities are lacking. We conducted a systematic review and meta-analysis in order to assess whether asbestos exposure is related to impairment of lung function parameters independently of the radiological findings.MethodsMEDLINE was searched from its inception up to April 2010. We included studies that assessed lung function parameters in asbestos exposed workers and stratified subjects according to radiological findings. Estimates of VC, FEV1 and FEV1/VC with their dispersion measures were extracted and pooled.ResultsOur meta-analysis with data from 9,921 workers exposed to asbestos demonstrates a statistically significant reduction in VC, FEV1 and FEV1/VC, even in those workers without radiological changes. Less severe lung function impairments are detected if the diagnoses are based on (high resolution) computed tomography rather than the less sensitive X-ray images. The degree of lung function impairment was partly related to the proportion of smokers included in the studies.ConclusionsAsbestos exposure is related to restrictive and obstructive lung function impairment. Even in the absence of radiological evidence of parenchymal or pleural diseases there is a trend for functional impairment.

Mortality study of chemical workers exposed to dioxins: follow-up 23 years after chemical plant closure

Objectives To examine the long-term effects of dioxin-exposure, particularly with regard to cancer mortality, in a follow-up 23 years after closure of the chemical plant (Hamburg, Germany). Methods The study comprised all persons (1191 men/398 women) employed in the plant on a full-time basis for a minimum of 3 months between 1952 and 1984 when the plant was closed down. Mortality follow-up was performed for the period from 1952 up to the reference date of 31 December 2007. Subjects entered the cohort at the date of their first employment in the plant. We calculated standardised mortality ratios (SMRs) using the population of Hamburg as reference. Results The vital status could be determined for 96.5% of the study group (1145 men and 389 women). For men, there was an increase in overall mortality (ICD-9 1–999) (SMR=1.14, 95% CI 1.06 to 1.23), all-cancer mortality (SMR=1.37, 95% CI 1.21 to 1.56) and specific mortality from respiratory cancer (ICD-9 161, 162, 163) (SMR=1.64, 95% CI 1.32 to 2.03), oesophageal cancer (ICD-9 150) (SMR=2.56, 95% CI 1.27 to 4.57), rectum cancer (ICD-9 154) (SMR=1.96, 95% CI 0.98 to 3.51), as well as diseases of the circulatory system (ICD-9 390–459) (SMR=1.16, 95% CI 1.02 to 1.31). For women, there was an increase in breast cancer mortality (ICD-9 174) (SMR=1.86, 95% CI 1.12 to 2.91). Conclusions The results of this extended follow-up are consistent with those of previous analyses of the cohort and with those of other cohorts. Our findings support the carcinogenic effect of dioxin compounds.

IgE Reactivity, Work Related Allergic Symptoms, Asthma Severity, and Quality of Life in Bakers with Occupational Asthma

In Germany, bakers with occupational asthma willing to stay in their job are included in an interdisciplinary program of the Social Accident Insurance for Foodstuff and Catering Industry (BGN). The primary aim is to reduce flour dust exposure, and to provide adequate medical treatment. Our aim was to evaluate the programs effect on the diseases course using routinely collected data. Forty three bakers with allergic occupational asthma and with the available baseline level of IgE (f4, f5) were investigated. Changes in IgE related to wheat and rye flour exposure were measured by ImmunoCAP test during follow-up visits. A questionnaire on work-related allergic complaints (WRAC), the Asthma Control Test (ACT), a 10-point scale of asthma severity grade, and quality of life instruments (EQ-5D-5L, Mini-AQLQ) were administered. We found an improvement of asthma severity in 88.4 % of the bakers. WRAC were reported by 65 %; 77 % had good asthma control (ACT ≥ 20); and 81 % had regular asthma medication. A relevant reduction of ≥2 CAP-classes for both allergens was seen in 12 % of the subjects. Health-related and asthma-specific quality of life was high. We conclude that satisfactory asthma control is probably the result of adequate medical management. In a subgroup of bakers with decreased specific IgE, it may also be attributed to reduced allergen exposure.

Healthy offshore workforce? A qualitative study on offshore wind employees’ occupational strain, health, and coping

BackgroundOffshore work has been described as demanding and stressful. Despite this, evidence regarding the occupational strain, health, and coping behaviors of workers in the growing offshore wind industry in Germany is still limited. The purpose of our study was to explore offshore wind employees’ perceptions of occupational strain and health, and to investigate their strategies for dealing with the demands of offshore work.MethodsWe conducted 21 semi-structured telephone interviews with employees in the German offshore wind industry. The interviews were transcribed and analyzed in a deductive-inductive approach following Mayring’s qualitative content analysis.ResultsWorkers generally reported good mental and physical health. However, they also stated perceptions of stress at work, fatigue, difficulties detaching from work, and sleeping problems, all to varying extents. In addition, physical health impairment in relation to offshore work, e.g. musculoskeletal and gastrointestinal complaints, was documented. Employees described different strategies for coping with their job demands. The strategies comprised of both problem and emotion-focused approaches, and were classified as either work-related, health-related, or related to seeking social support.ConclusionsOur study is the first to investigate the occupational strain, health, and coping of workers in the expanding German offshore wind industry. The results offer new insights that can be utilized for future research in this field. In terms of practical implications, the findings suggest that measures should be carried out aimed at reducing occupational strain and health impairment among offshore wind workers. In addition, interventions should be initiated that foster offshore wind workers’ health and empower them to further expand on effective coping strategies at their workplace.

A cross-sectional survey of physical strains among offshore wind farm workers in the German exclusive economic zone

Objectives To assess the physical strains of employees in the German offshore wind industry, according to job type and phase of the wind farm (under construction or operation). Design Web-based cross-sectional survey. Setting Offshore wind farm companies operating within the German exclusive economic zone. Participants Male workers with regular offshore commitments and at least 28 days spent offshore in the past year (n=268). Outcome measures Physical strains (eg, climbing, noise, working overhead, with twisted upper body or in confined spaces, vibration, heavy lifting, humidity, odours). Results The most frequently mentioned physical strain was ’climbing’ with 63.8% of the respondents reporting to be always or frequently confronted with climbing and ascending stairs during offshore work. Work as a technician was associated with a greater exposition to noise, vibrations, humidity, cold, heat, chemical substances, lifting/carrying heavy loads, transport of equipment, working in non-ergonomic positions and in cramped spaces, as well as climbing. Indeed, statistical analyses showed that, after adjusting for phase of the wind farm, age, nationality, offshore experience, work schedule and type of shift, compared with non-technicians, working as a technician was associated with more frequently lifting/carrying of heavy loads (OR 2.58, 95% CI 1.58 to 4.23), transport of equipment (OR 2.06 95% CI 1.27 to 3.33), working with a twisted upper body (OR 2.85 95% CI 1.74 to 4.69), working overhead (OR 2.77 95% CI 1.67 to 4.58) and climbing (OR 2.30 95% CI 1.40 to 3.77). Working in wind farms under construction was strongly associated with increased and decreased exposure to humidity (OR 2.32 95% CI 1.38 to 3.92) and poor air quality (OR 0.58 95% CI 0.35 to 0.95), respectively. Conclusions Workers on offshore wind farms constitute a heterogeneous group, including a wide variety of occupations. The degree of exposure to detrimental physical strains varies depending on the type of job. Technicians are more exposed to ergonomic challenges than other offshore workers.

Workplace health promotion for employees working in offshore wind parks in the German exclusive economic zone: a mixed-methods study

Objectives To investigate the awareness and use of health promotion offers among offshore wind workers and to study associations with demographic and workplace characteristics. To examine employees’ reasons for (non-)participation and their wishes for health promotion activities offshore. Design Mixed-methods study presenting the results from semistructured telephone interviews and a web-based cross-sectional survey. Setting Offshore wind parks in the German exclusive economic zone in the North and Baltic Seas. Participants 21 offshore workers in the qualitative study (19 male/2 female; all German). 303 offshore workers in the quantitative study (287 male/13 female; 275 German/24 other nationalities). Outcome measures Awareness and use of workplace health promotion offers and associations with demographic and workplace characteristics (age, work schedule and wind park phase); reasons for (non-)participation; needs and wishes for health promotion offers. Results Few workers indicated being aware of health promotion programmes at their workplace. Single offers were reported, with fitness facilities being the most common offer employees recognised and had used (n=168, 55.6%). Employees with a regular work schedule were more likely to have used fitness facilities offshore (adjusted OR (AOR)=3.22, 95% CI 1.53 to 6.80). Workers in the construction phase were more likely to have used massages (AOR=8.19, 95% CI 2.82 to 23.77). Younger workers were less likely to belong to the group of those who were aware of fitness facilities but had not used them (AOR=0.43, 95% CI 0.19 to 0.98). Employees expressed various needs and wishes for behavioural and environmental preventive measures offshore. Conclusions The results demonstrate a perceived need among the workers for the development of health promotion programmes offshore. Since the awareness and use of offers may partly depend on personal and organisational characteristics, this should be taken into account in the planning of health promotion activities.

Linking quantitative demands to offshore wind workers’ stress: do personal and job resources matter? A structural equation modelling approach

BackgroundEmployees in the offshore wind industry are exposed to various job demands, increasing the workers’ risk of experiencing strain reactions. However, personal and job resources might play a role in the stressor-strain context. The aim of this study was (1) to examine the link between offshore employees’ quantitative demands and stress, and (2) to study the role of personal and job resources (psychological detachment from work, social support, and influence at work) in this stressor-strain relationship.MethodsTwo hundred fifty offshore wind workers responded to an anonymous web-based survey, assessing the workers’ quantitative demands, social support, influence at work, psychological detachment from work, and stress. Descriptive statistical analyses and structural equation modelling were applied to test the hypotheses.ResultsCorrelation analyses revealed substantial associations between employees’ quantitative demands, personal and job resources, and stress. Results of structural equation modelling indicated a good fit of the hypothesized model. Quantitative demands were positively related to stress, and psychological detachment from work partially mediated this relationship. Social support was negatively related to stress, while influence at work was not. Neither social support nor influence at work moderated the stressor-strain or stressor-detachment relationship.ConclusionsThe results contribute to the current knowledge on the topic. They can be used to design health promotion interventions aimed at reducing offshore employees’ quantitative demands, fostering their ability to mentally detach from work, and enhancing social support at the offshore workplace.

Dioxinexposition und Mortalität: Neue Erkenntnisse aus der Hamburger Dioxin Kohorte

ZusammenfassungIn Hamburg wurden von 1952 bis 1984 Herbizide und Pestizide hergestellt. Dabei fielen in den verschiedenen Produktionsstufen unterschiedlich hohe Kontaminationen von Dioxinen und Dioxinverbindungen an. Durch diese Auswertung, 23 Jahre nach Schließung des Chemiewerkes, liegen nun Ergebnisse unter anderem zur Dosis-Wirkung in diesem Dioxin-belasteten Kollektiv vor (Manuwald et al. 2012), die eine kritische Auseinandersetzung mit der in der Anerkennungspraxis der Berufskrankheit Nummer 1310 gängigen Konvention einer rückgerechnete Konzentration von bis mindestens 200 ppt 2,3,7,8-TCDD erfordern. Einerseits findet sich ein ähnlich hohes Risiko unter 200 ppt TCDD, andererseits sind die retrospektiven Schätzungen der Expositionshöhen auf Basis von Messungen nach Ende der Exposition mit hohen Unsicherheiten behaftet.AbstractFrom 1952 to 1984 herbicides and pesticides were produced in a chemical plant in Hamburg. The plant generated dioxin and dioxin compounds as contaminant by-products. A recent analysis, 23 years after the closure of the plant provides new insights in cancer mortality and dose-response relationships for the exposed cohort (Manuwald et al. 2012). In the light of these findings there is a need to critically review the current convention of 200 ppt 2,3,7,8-TCDD used for the recognition of diseases under the occupational disease position 1310. Our results indicate already an excess cancer mortality below this threshold. In addition, the retrospective estimation of the exposition level based on measurements taken after the end of exposition is burdened with great uncertainty.