Martin Forde

Prevalence of Musculoskeletal Disorders in Union Ironworkers

The prevalence of musculoskeletal disorder (MSD) symptoms and doctor-diagnosed musculoskeletal disorders (DDMDs) were estimated among union construction ironworkers by a telephone-administered questionnaire. Of 1996 ironworkers eligible, 1566 were contacted and 981 were interviewed. The prevalence of self-reported MSD symptoms was high for the lower back (56%), wrist/hands/fingers (40%), knees (39%), and shoulders (36%). The most common DDMDs were tendonitis (19%), ruptured disk in the back (18%), bursitis in the shoulder (15%), and carpal tunnel syndrome (12%). Generally, the prevalence of DDMDs and MSD symptoms increased with duration of employment. In age-adjusted logistic regression analyses, those who worked 25 to 35 years were more likely to have tendonitis (odds ratio [OR] 7.1, 95% confidence interval [CI] 3.1–16.6), shoulder bursitis (OR 13.7, 95% CI 3.1–60.4), knee bursitis (OR 5.1, 95% CI 1.0–25.1), and ruptured intervertebral back disk (OR 6.7, 95% CI 2.6–17.5). The effect of prior injury was also consistently high (upper extremities, OR 4.6; lower extremities OR 5.1; lower back, OR 6.0). Among workers without prior injuries, MSD symptoms were more frequent for the lower back in structural ironwork (OR 1.7, 95% CI 1.1–2.6), and for the upper extremity in concrete reinforcement ironwork (OR 1.9, 95% CI 1.2–2.9). These findings suggest that some musculoskeletal morbidity in construction ironworkers may be work related and thus preventable.

Pathomechanisms of work-related musculoskeletal disorders: conceptual issues.

Work-related musculoskeletal disorders (WRMSDs) by definition are a subset of musculoskeletal disorders (MSDs) that arise out of occupational exposures. While traditional exposure assessment techniques have proved to be successful in identifying ergonomic exposures that are epidemiologically linked to these disorders, some are troubled by the lack of one-to-one correspondence between specific occupational exposure profiles and specific MSDs. In the absence of more sophisticated hypotheses that might explain the occurrence of WRMSDs in a variety of exposure patterns, the aetiologic relationships may (again) be called into question. Another unanswered question is whether specific types of WRMSDs have qualitatively different exposure-response relationships. A clearer understanding of the underlying pathomechanisms associated with specific WRMSDs could help future researchers better determine how and when various occupational exposure profiles become pathogenic. Such knowledge could also be used to design exposure assessment tools to capture exposure information more relevant to the risk of WRMSDs. The main goals of this paper are to summarize several recently described pathomechanisms, most of which have been discussed primarily in clinical and experimental literature that might not be widely read by occupational health scientists. Suggestions are made as to how future research could evaluate whether these phenomena are relevant to the effects of physical exposures and the underlying disease processes of common WRMSDs.

Quantification of Ergonomic Hazards for Ironworkers Performing Concrete Reinforcement Tasks During Heavy Highway Construction

A study was conducted to assess the ergonomic hazards of ironwork job tasks associated with concrete reinforcement work at a large highway construction site. PATH (posture, activity, tools, and handling) analysis, a work-sampling method, was used to provide task-based estimates of the percentage of time ironworkers spent in specified postures of the trunk, arms, and legs; performed activities; used tools; and handled loads. A total of 2128 PATH observations were made of 17 ironworkers performing 5 job tasks: (1) ground-level reinforcement bar (rebar) construction, (2) wall rebar construction, (3) ventilation rebar construction, (4) preparation work, and (5) supervising. Nonneutral trunk postures were observed frequently (exceeding 30%) and manual material handling (MMH) was the most commonly observed activity (exceeding 20%) for all job tasks except supervising. The percentage of time workers spent in specific postures, activities performed, tool use, and MMH activities differed significantly between the five main job tasks, even when supervising was excluded from the analysis. It was concluded that ironworkers are exposed to significant ergonomic hazards when performing concrete reinforcing tasks, and that opportunities exist for the implementation of ergonomic interventions. Further, the results of this study can be used to target specific hazardous tasks for ergonomic interventions and confirms the need to use a task-based exposure assessment strategy to properly assess ergonomic risk profiles for nonstructured jobs such as construction.

Evaluation of pyrethroid exposures in pregnant women from 10 Caribbean countries

Pyrethroid pesticides are commonly used in tropical regions such as the Caribbean as household insecticides, pet sprays, and where malaria is endemic, impregnated into mosquito-repellent nets. Of particular concern is exposure during pregnancy, as these compounds have the potential to cross the placental barrier and interfere with fetal development, as was shown in limited animal studies. The objective of this study was to evaluate exposure to pyrethroids to pregnant women residing in 10 English-speaking Caribbean countries. Pyrethroid exposures were determined by analyzing five pyrethroid metabolites in urine samples from 295 pregnant women: cis-DBCA, cis-DCCA, trans-DCCA, 3-PBA, and 4-F-3-PBA. Pyrethroid metabolite concentrations in Caribbean pregnant women were generally higher in the 10 Caribbean countries than levels reported for Canadian and U.S. women. In Antigua & Barbuda and Jamaica participants the geometric mean concentrations of cis-DBCA was significantly higher than in the other nine countries together (p<0.0001 and <0.0012 respectively). For cis- and trans-DCCA, only Antigua & Barbuda women differed significantly from participants of the other nine Caribbean countries (p<0.0001). Urinary 4-F-3-PBA and 3-PBA levels were significantly higher in Antigua & Barbuda (p<0.0028 and p<0.0001 respectively) as well as in Grenada (p<0.0001 and p<0.007 respectively). These results indicate extensive use of pyrethroid compounds such as permethrin and cypermethrin in Caribbean households. In Antigua & Barbuda, the data reveals a greater use of deltamethrin. This study underscores the need for Caribbean public health authorities to encourage their populations, and in particular pregnant women, to utilize this class of pesticides more judiciously given the potentially adverse effects of exposure on fetuses and infants.

Strengthening integrated research and capacity development within the Caribbean region

BackgroundThe Caribbean region, like other developing regions of the world, faces significant challenges in conducting research, especially in the context of limited resource capacities and capabilities. Further, due to its diverse and multiple island states, research capacity is scattered and unevenly spread within the region. The Caribbean EcoHealth Programme (CEHP) is a research program that is structured to improve the capacity and capability of health professionals in the Caribbean region to respond in integrative and innovative ways to on-going and emerging environmental health challenges by means of multi-sectoral interventions.MethodsCore parts of the CEHP’s mission are to (1) conduct collaborative research in areas that the region has identified as critical; (2) build and strengthening integrated approaches to research; and (3) develop and enhance basic research capacity within the Caribbean region.Fundamental to the success of the CEHP’s human and resource development mission has been its use of the Atlantis Mobile Laboratory (AML). The AML has allowed the CEHP program to move throughout the Caribbean and be able to respond to calls for specific research and capacity building opportunities.ResultsThe CEHP’s five main research projects have generated the following results: (1) the Persistent Organic Pollutants (POPs) study has evaluated human exposures to POPs, heavy metals, pesticides, and zoonotic infections; (2) the Burden of Illness (BOI) studies have developed protocols for the testing of foodborne microorganisms, strengthen laboratory analytical capabilities, and determined the prevalence and incidence of food-borne illness; (3) the Rainwater Harvesting (RWH) study has evaluated the microbial and chemical quality of rainwater harvesting systems; (4) the Ecotoxicology Water (ETW) studies have provided much needed data on the quality of recreational and drinking water supplies, and (5) the Food Safety Training Program has developed Diploma and M.Sc Agri-Food Safety and Quality Assurance programmes.ConclusionsThe CEHP program provides a successful example of how a collaborative instead of researcher driven research agenda can lead to not only the generation of needed information, but also leave within the region where the research has been carried out the capacity and capabilities to continue to do so independent of outside interventions.

Seroprevalence of Seven Zoonotic Pathogens in Pregnant Women from the Caribbean

Studies examining the prevalence of zoonotic agents in the Caribbean are very limited. The objective of this study was to examine the seroprevalence of seven zoonotic agents among individuals residing on 10 English-speaking Caribbean countries. Sera from healthy, pregnant women were collected from Antigua-Barbuda, Belize, Bermuda, Dominica, Grenada, Jamaica, Montserrat, St. Kitts-Nevis, St. Lucia, and St. Vincent-Grenadines and tested for the presence of IgG antibodies to dengue virus, hepatitis E virus, hantaviruses, leptospiral agents, spotted fever group rickettsiae (SFGR), typhus group rickettsiae (TGR), and Coxiella burnetii (Q fever). The highest seroprevalence values were observed for dengue virus, SFGR, and leptospirosis, although the lowest seroprevalence values were observed for hepatitis E virus, C. burnetii, and TGR. Antibodies to hantaviruses were not detected in any individuals.

Evaluation of a public health intervention to lower mercury exposure from fish consumption in Bermuda.

Objectives To assess the efficacy of a public health intervention to reduce blood mercury (Hg) concentration levels in pregnant Bermudian women. Methods In 2003, we conducted a study entitled “Prenatal exposure of the Bermudian Population to Environmental Contaminants” which provided Bermuda’s first baseline data on prenatal exposure to several environmental contaminants, including Hg. The mean Hg concentration from 42 healthy newborns measured in umbilical cord blood was 41.3 nmol/L, ranging from 5–160 nmol/L. This concentration was much higher than expected, being approximately 8 times the general levels found in Canada and the U.S. Furthermore, we estimated that 85% of total Hg measured was in the form of methylmercury (MeHg), indicating that seafood consumption was the primary source of Hg exposure during pregnancy in Bermuda. Locally sourced seafood was identified as the most significant possible contributory source of Hg exposure. In 2005 the authors began a complementary research programme to study the levels of Hg in local commercial fish species. Coming out of this research were specific local fish consumption guidelines issued by the Department of Health advising pregnant women to avoid those local fish species found to be high in Hg while still encouraging consumption of fish species having lower Hg levels. Results In 2010, under another research initiative, we returned to Bermuda to carry out another evaluation of Hg in human blood. Hg was measured in the blood of 49 pregnant women. The arithmetic mean Hg blood concentration was 6.6 nmol/L and the geometric mean 4.2 nmol/L. The maximum concentration found was 24 nmol/L. Conclusions Hg exposure of Bermudian pregnant women has dropped significantly by a factor of around 5 since the foetal cord blood study in 2003.

Mercury Levels in Barbadian Fisher Folk and Commonly Caught Fish Species

ABSTRACT Ocean fish are an important staple food for many Caribbean persons. Some species, however, have high Hg concentration levels and represent a significant source of Hg exposure. This study assessed Hg concentrations in fish species commonly caught and consumed in Barbados as well as Hg exposure of those who work in the fishing industry. Total Hg concentrations were measured in 100 fish samples. Human Hg concentrations were determined from hair snippets taken from 46 fisher folk and fish consumption habits evaluated using interview-administered questionnaires. Mercury levels varied by fish species with predatory fish species having the highest concentrations. Low Hg concentrations were found in dolphinfish (Coryphaena hippurus) and flyingfish (Hirundichthys affinis). Reported fish consumption rates were high and varied significantly between men and women, 2675 ± 1600 and 1275 ± 600 (g/week), respectively (p = 0.01). The median hair Hg concentration was 3.1 ± 2.3 μg/g (range: 0.01–15.6 μg/g) and significantly associated with consumption of “high-risk” fish species (p = .02). These results show that it is possible to make informed choices concerning fish consumption habits in order to maximize benefits while minimizing the effect of Hg exposures, especially for sensitive groups such as pregnant women and infants.

Network of Ethical Relationships model for global North–South population health research

ABSTRACT Although a substantial body of literature exists that details how to address ethical issues and provide oversight for traditional research study designs, there currently is very little guidance available to researchers on how to deal with the unique and novel challenges that arise when conducting research that goes outside of these well-defined boundaries. One such example is North–South (N-S) team-based global population health (GPH) research. This paper presents a Network of Ethical Relationships (NER) model which can allow GPH researchers better understand and resolve ethical issues that arise in N-S collaborative research efforts. The NER model elucidates some of the core relationships involved in GPH research and sheds light on the complex milieu of moral, institutional, societal and legal processes in which it is embedded. The utility of the NER model is examined by reviewing 14 GPH research teams, looking at two relationships in more detail – Researcher–Ethics Board, and Researcher–Funder relationships. The paper argues that improved dialogue and flexibility in the application of formal ethical rules and procedures can lead to research being conducted in a more ethical manner since it better accounts for the multitude of voices and perspectives influencing researchers’ choices and actions.