Paul A. Landsbergis

Health and immunology study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment.

There is growing concern about adverse health effects of fungal bio-aerosols on occupants of water damaged buildings. Accidental, occupational exposure in a nonagricultural setting has not been investigated using modern immunological laboratory tests. The objective of this study was to evaluate the health status of office workers after exposure to fungal bio-aerosols, especially Stachybotrys chartarum (atra) (S. chartarum) and its toxigenic metabolites (satratoxins), and to study laboratory parameters or biomarkers related to allergic or toxic human health effects. Exposure characterization and quantification were performed using microscopic, culture, and chemical techniques. The study population (n = 53) consisted of 39 female and 14 male employees (mean age 34.8 years) who had worked for a mean of 3.1 years at a problem office site; a control group comprised 21 persons (mean age 37.5 years) without contact with the problem office site. Health complaints were surveyed with a 187-item standardized questionnaire. A comprehensive test battery was used to study the red and white blood cell system, serum chemistry, immunology/antibodies, lymphocyte enumeration and function. Widespread fungal contamination of water-damaged, primarily cellulose material with S. chartarum was found. S. chartarum produced a macrocyclic trichothecene, satratoxin H, and spirocyclic lactones. Strong associations with exposure indicators and significant differences between employees (n = 53) and controls (n = 21) were found for lower respiratory system symptoms, dermatological symptoms, eye symptoms, constitutional symptoms, chronic fatigue symptoms and several enumeration and function laboratory tests, mainly of the white blood cell system. The proportion of mature T-lymphocyte cells (CD3%) was lower in employees than in controls, and regression analyses showed significantly lower CD3% among those reporting a history of upper respiratory infections. Specific S. chartarum antibody tests (IgE and IgG) showed small differences (NS). It is concluded that prolonged and intense exposure to toxigenic S. chartarum and other atypical fungi was associated with reported disorders of the respiratory and central nervous systems, reported disorders of the mucous membranes and a few parameters pertaining to the cellular and humoral immune system, suggesting a possible immune competency dysfunction.

Job Strain and Health Behaviors: Results of a Prospective Study

Purpose. To assess the association between job demands, job decision latitude, and job strain (defined by Karasek as a combination of high demands and low decision latitude) and cardiovascular disease-related health behaviors such as cigarette smoking, alcohol use, lack of exercise, and overweight. Design. Cross-sectional and prospective. Setting. Nine New York City public and private sector worksites. Subjects. Two hundred eighty-five male employees, aged 30 to 60, in a wide variety of white-collar and blue-collar job titles. Measures. Medical examinations and surveys, which included demographic, health behavior, and job characteristics data. Results. Prospectively, among 189 men, increase in job decision latitude over 3 years was associated with decrease in cigarette smoking, by analysis of covariance, controlling for age, race, education, marital status, and number of children at home (F (8, 180) = 4.37, p = .005). The largest increase in latitude occurred among the 13 men who quit smoking. However, change in job characteristics was not associated with change in overweight or alcohol use. Cross-sectional analyses did not produce consistent associations. Conclusions. The effectiveness of smoking cessation may be aided by modification of structural features of the work environment, such as job decision latitude. This study is limited by the small number of subjects who were engaged in high risk behaviors.

The patterning of psychological attributes and distress by “job strain” and social support in a sample of working men

As a test of the “job strain” (job demands-control) model, 297 healthy men aged 30–60 were recruited at eight New York City worksites. The association among job demands and control, social support, and psychological outcomes was tested using both ANCOVA and moderated multiple regression, controlling for demographic variables. The job strain model was supported by various psychological outcome measures, with workers in “active” jobs reporting the highest level of Type A behavior, job involvement, and positive attributional style, workers in “low-strain” jobs reporting the lowest job dissatisfaction and trait anxiety, workers in “passive” jobs reporting the most external locus of control and trait anxiety, and workers in “high-strain” jobs reporting the highest job dissatisfaction. Low social support was associated with greater symptomatology, and a significant three-way interaction (demands×control×support) for job dissatisfaction was observed. While selection of subjects into jobs may partially explain these findings, the results support the hypothesis that working conditions influence psychological attributes and distress.

Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity

This clinical review will describe the epidemiology, clinical presentation, and management of the following work-related musculoskeletal disorders (WMSDs) of the distal upper extremity: deQuervains disease, extensor and flexor forearm tendinitis/tendinosis, lateral and medial epicondylitis, cubital tunnel syndrome, and hand-arm vibration syndrome (HAVS). These conditions were selected for review either because they were among the most common WMSDs among patients attending the New York State Occupational Health Clinics (NYSOHC) network, or because there is strong evidence for work-relatedness in the clinical literature. Work-related carpal tunnel syndrome is discussed in an accompanying paper. In an attempt to provide evidence-based treatment recommendations, literature searches on the treatment of each condition were conducted via Medline for the years 1985-1999. There was a dearth of studies evaluating the efficacy of specific clinical treatments and ergonomic interventions for WMSDs. Therefore, many of the treatment recommendations presented here are based on a consensus of experienced public health-oriented occupational medicine physicians from the NYSOHC network after review of the pertinent literature. A summary table of the clinical features of the disorders is presented as a reference resource.

Work-related stress and blood pressure: current theoretical models and considerations from a behavioral medicine perspective.

There is extensive evidence that the prevalence of human hypertension is related to psychosocial factors, possibly including chronic exposure to stress. A tripartite model, consistent with the literature on stress and health, may help to define this relationship better. Its 3 components are environmental stressors, individual factors affecting the perception of stress, and the individuals physiological susceptibility. To date, researchers have looked at individual parts of this model, but rarely at all 3. Some models of work stress (e.g., the job strain, effort-reward, and person-environment fit models) focus on work-related stressors alone or in conjunction with individual characteristics. Other models (e.g., the defense-defeat, John Henryism, and reactivity models) focus on individual differences in response, with little attention paid to the nature of the stressors. The authors suggest that it is timely to integrate these approaches and to look for physiological mechanisms.