Nancy L. Sprince

Mortality patterns from lung cancer and nonneoplastic respiratory disease among white males in the Beryllium Case Registry

Study was undertaken of mortality patterns among white males entered into the Beryllium Case Registry (BCR) while alive with a diagnosis of beryllium-related nonneoplastic respiratory symptoms or disease. Analyses demonstrate an excessive risk of lung cancer among those subjects in the BCR who had been previously diagnosed with acute chemical pneumonitis or bronchitis secondary to short-term beryllium exposure. In the evaluation of the excessive lung cancer risk in this population, consideration should be given to the competing effects from the high case fatality rate of nonneoplastic respiratory disease. This excessive risk of lung cancer could not be explained on the basis of cigarette smoking per se. The findings of the present study utilizing subjects in the BCR are consistent with results of animal studies that over 30 years ago first demonstrated beryllium to be a carcinogen and with numerous epidemiologic studies demonstrating an increased risk of lung cancer among workers occupationally exposed to beryllium and its compounds.

Occupational injuries among older workers with visual, auditory, and other impairments. A validation study.

This study aims to validate a previously defined model of the risk of occupational injuries among older workers with visual, auditory, or other impairments. That model was based upon the Health and Retirement Study (HRS). The previous logistic regression model was recalculated using data from the 1994 National Health Interview Survey (NHIS). The parameter estimates for impaired hearing (.181 in NHIS, 1.55 in HRS), impaired vision (2.42 in NHIS, 1.48 in HRS), and self-employment (0.22 in NHIS, 0.49 in HRS) were in same direction and of roughly the same magnitude. The previously defined model was confirmed using NHIS data. The data suggest that as the workforce ages, more attention must be paid to the accommodation of disabilities in the workplace, especially sensory impairments-poor vision and hearing.

CURRENT (1975) PROBLEM OF DIFFERENTIATING BETWEEN BERYLLIUM DISEASE AND SARCOIDOSIS

For many years it has been well-recognized that differentiating between beryllium disease and sarcoidosis is difficult because of the similar clinical, roentgenologic, and histopathologic features. A 1961 report by Hardy emphasized these similarities and the importance of a significant history of exposure to beryllium t o aid in differential diagnosis. In addition, she pointed out that no eye, tonsil, parotid, or cystic bone lesions or isolated bilateral hilar adenopathy had been reported in beryllium disease as of 1961. In 1975 a review of the Beryllium Case Reigstry data has added information about beryllium disease which makes the distinction even more difficult. The data include a previously reported case of beryllium disease with both parotitis and central nervous system granuloma2 as well as two cases of isolated bilateral hilar adenopathy and a previously unreported case of beryllium disease associated with restrictive myocardial disease. As the clinical, x-ray, and pathologic pictures continue to merge, several helpful differential points remain. Epidemiologic studies have shown that the chance occurrence of sarcoidosis in a person exposed to beryllium in industry is unlikely.3 In addition, the Kveim test has been reported as consistently negative in patients with chronic beryllium d i ~ e a s e ~ ~ and, to our knowledge, there have been no documented cases of uveitis in beryllium disease. In view of the great similarity in the clinical presentation of sarcoidosis and beryllium disease this paper will emphasize the importance of measuring beryllium in tissue in making the distinction and will include a comparison of beryllium content in lung tissue from normals, patients with sarcoidosis, and patients with beryllium disease, further documenting the usefulness of tissue content in differential diagnosis.

Non-fatal injuries among urban and rural residents: The National Health Interview Survey, 1997–2001

Objective: Although death rates from injuries are higher in rural areas compared with large metropolitan areas, little is known about how non-fatal injury rates vary by rurality. Data from the 1997–2001 US National Health Interview Surveys were used to explore associations between rurality and non-fatal injury. Design: A nationally representative survey. Methods: The annual injury rates per 1000 adults and 95% CIs were computed for medically attended injuries. Counties of residence were coded according to urban influence codes into four categories: large urban, small urban, suburban and rural. A linear-by-linear trend test was used to determine whether injury rates increase monotonically with county rurality. Logistic regression was used to control potential confounders. Results: Compared with large urban counties, small urban counties experienced 8% higher injury odds (95% CI 1% to 15%); suburban counties 20% higher injury odds (95% CI 10% to 31%); and rural counties 30% higher injury odds (95% CI 17% to 43%) after adjusting for age, gender, marital status, education and health insurance. Conclusions: Rural residents had higher non-fatal injury rates than urban and suburban residents. Exploring this discrepancy can further contribute to new hypotheses regarding rural injury risk and ultimately lead to better suited interventions for rural residents.

Pulmonary function in beryllium workers: assessment of exposure.

The inhalation of beryllium causes a serious lung disease characterised by pronounced radiographic and functional impairments and occurs in workers engaged in the extraction and manufacture of the metal. This paper describes the beryllium exposure levels and refining processes in a large beryllium factory operating since the 1930s. Lifetime beryllium exposure histories were estimated for the 309 workers present at a health survey conducted in 1977. Beryllium exposure levels in the plant were high for many years, with some estimated exposure levels in excess of 100 micrograms/m3. As late as 1975, there were exposures to beryllium above 10 micrograms/m3 in some jobs. After about 1977, the plant was in compliance with the permissible exposure limit of 2.0 micrograms/m3. The median cumulative exposure in this cohort was 65 micrograms/m3-years and the median duration of exposure was 17 years. From these data a series of exposure parameters, functions of the exposure histories that characterise biologically important dimensions of exposure were calculated for each worker.

Beryllium exposure and pulmonary function: a cross sectional study of beryllium workers.

A cross sectional study of 297 white male workers employed in a large beryllium plant was conducted to test the hypothesis that long term exposure to beryllium is associated with decrements in pulmonary function. Spirometric measurement of pulmonary function, chest radiographs, and arterial blood gas measurements were collected. After controlling for age, height, and smoking in multivariate regression models, decrements in FVC and FEV1 were found to be associated with cumulative exposure to beryllium in the period up until 20 years before the health survey. These decrements were observed in workers who had no radiographic abnormalities. The alveolar-arterial oxygen difference was associated with cumulative exposure in the 10 years immediately before survey, after controlling for age and smoking. These findings suggest that beryllium may have both short and long term pulmonary effects that are distinct from the classic forms of acute and chronic beryllium disease.

U.S. beryllium case registry through 1977.

A synopsis of the cases reported to the Beryllium Case Registry between 1973 and 1977 is presented. As of 1973, there were 832 cases of beryllium disease entered into the Registry. In the five years since that report, 55 additional cases have been added, 40 men and 15 women. Exposures occured in the electronics and nuclear industries in the production and use of beryllium containing alloys and beryllium oxide ceramis. Pathological changes in the lung tissue are described. Cases continue to be reported in which the diagnosis was sarcoidosis until the history of beryllium exposure led to the finding of beryllium in the lung tissue or mediastinal lymph node biopsy. Data from the Registry support the fact that chronic beryllium disease is a continued occupational hazard.

Asbestos-Related Diseases

High-risk populations include construction trades, joiners, plumbers, electricians, painters, boilermakers, shipyard workers, railroad workers, asbestos miners and Navy veterans. There were 2,515 mesothelioma deaths in Great Britain in 2014 (a similar number to the 2,556 deaths in 2013) and 2,549 deaths in 2012. The latest projections suggest that there will continue to be around 2,500 deaths per year for the rest of this current decade before annual numbers begin to decline. The World Health Organization (WHO) has estimated that 107,000 people worldwide die each year from mesothelioma, lung cancer, and asbestosis. Mesothelioma is still increasing in most European countries and in Japan but has peaked in the USA and Sweden [5] . The incidence of asbestos-related disease will continue to increase in developing countries because of the continued unregulated use of asbestos. Exposure to cigarette smoke increases the risk of developing lung cancer in patients with a history of asbestos exposure [6] .

A Health Evaluation Study of Kraft Pulp Mill Workers

A health evaluation study of Kraft Pulp Mill Workers in Prince Rupert measured the responses of a large sample of Mill workers (n=326) based on a health questionnaire, a medical examination, pulmonary function tests, rest-ing EKG and blood chemistry analysis. A smaller sub group (n=84) were tested on their response to exercise. On site measurement was made of contaminant gases in several mill areas shortly after the physiological and medical tests. Based upon the chemical analyses carried out, an Environmental Hazard Index was developed to quantify the degree of workers to mixed contaminants of various work sites. After the confounding influence of age, smoking, alcohol intake, family history of coronary artery disease and activity pattern were account -ed for, the residuals of the physiological and clinical dependent variables was related to the mean Environmental Hazard Index of groups of workers in different work sites. By this type of analysis, intriguing relationships become apparent between deficiences in physiological function and the size of the Environmental Hazard Index. This paper illustrates the relative ease with which deficiencies in any work place may be detected. This contrasts markedly to the ease with which practical solutions to remedy deficiences may be developed if any company is to retain its viability. Nevertheless a solution to the hazard considered in this paper may be the development of an individual Worker Health Hazard Registry which tags each workers daily exposure and accumulates it to identify a danger point at which physiological deficiences occur. The worker would then be found other work at a contamination free site until his personal hazard index had declined to a low level.