Richard Townsend Gun

Risk factors for prolonged disability after whiplash injury: a prospective study

Study Design. A prospective study of 135 patients with whiplash injury. Objectives. To identify factors predictive of prolonged disability following whiplash injury. Summary of Background Data. Although patients with whiplash associated disorders lack demonstrable physical injury, many exhibit prolonged disability. Disability appears unrelated to the severity of the collision. Methods. A total of 147 patients with recent whiplash injury were interviewed for putative risk factors for disability, and 135 were reinterviewed 12 months later to assess degree and duration of disability. Bivariate and multivariate analyses were undertaken to measure the association between putative risk factors and measures of outcome (change in Neck Pain Outcome Score [NPOS] and visual analogue pain score [VAPS], return to work, still requiring treatment, settlement of claim). Results. The bodily pain score and role emotional scores of the Short Form-36 health questionnaire showed a consistent significant positive association with better outcomes. After adjustment for bodily pain score and role emotional scores, consulting a lawyer was associated with less improvement in NPOS (P < 0.05), but there was no association with change in VAPS. Consulting a lawyer was associated with a lesser chance of claim settlement (P < 0.01) and a greater chance of still having treatment (P < 0.01) after 1 year, but there was no significant association with a return to work. The degree of damage to the vehicle was not a predictor of outcome. Conclusions. Short Form-36 scores for bodily pain and role emotional are useful means of identifying patients at risk of prolonged disability. The findings support the implementation of an insurance system designed to minimize litigation.

The importance of immediate cooling—a case series of childhood burns in Vietnam

Numerous experimental studies have shown several benefits of treating burns by the immediate application of cool water. In this study of 695 children with burns, treated in the National Burn Institute (NBI), Hanoi, Vietnam, patients were assessed on admission according to first aid measures at the time of injury, i.e. the removal of the cause and immediate cooling with cold water. A total of 33% of the children who had had immediate cooling of the burn with water had deep burns, compared with 49% of the children who had not had immediate cooling. The prevalence ratio of deep burns was thus 0.68 (95% confidence interval (CI) 0.55-0.85); that is, there was an estimated reduction of 32% in the need for skin grafting, a reduction which was statistically significant. After adjusting for the effect of cooling the burn, removal of the causal agent reduced the odds of requiring skin grafting, but the reduction was not statistically significant. It is concluded that early cooling will prevent a significant percentage of superficial burns from progressing to deep burns. This will not only reduce the probability that skin grafting and expensive treatment will be required, but will reduce the risk of other consequences of deep burns, which may be fatal. Public health programs to promote immediate cooling of burns with cool water are at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children.

Update of mortality and cancer incidence in the Australian petroleum industry cohort.

Objectives: To update the analysis of the cohort mortality and cancer incidence study of employees in the Australian petroleum industry. Methods: Employees of Australian Institute of Petroleum member companies were enrolled in the cohort in four industry-wide surveys between 1981 and 1999. Mortality of 16 547 males and 1356 females was determined up to 31 December 2001 and cancer incidence to 31 December 2000. Cause specific mortality and cancer incidence were compared with those of the Australian population by means of standardised mortality ratios (SMRs) and standardised incidence ratios (SIRs). Associations between increased incidence of specific cancers and employment in the petroleum industry were tested by trends according to period of first employment, duration of employment, latency, and hydrocarbon exposure, adjusting for personal smoking history where appropriate. Results: There was a significant elevation of the incidence of mesothelioma (SIR 1.77, 95% CI 1.05 to 2.79), melanoma (SIR 1.37, 95% CI 1.19 to 1.58), and prostate cancer (SIR 1.18, 95% CI 1.04 to 1.34). The SIRs of all leukaemias and of acute non-lymphocytic leukaemia (ANLL) were not significantly different from unity, but all 11 ANLL cases were clustered in the middle to high hydrocarbon exposure categories. Tanker drivers had a significantly elevated incidence of kidney cancer (12 cases v 5.84 expected, SIR 2.05, 95% CI 1.06 to 3.59). Lung cancer incidence was significantly reduced (SIR 0.69, 95% CI 0.57 to 0.83) Conclusions: Most cases of mesothelioma are probably related to past exposure to asbestos in refineries. No occupational cause has been identified for the excess of melanoma, or prostatic or bladder cancer. The possibility of a causal relationship between cancer of the kidney and hydrocarbon exposure warrants further study. It is uncertain whether benzene exposures, particularly past levels of exposure, have been high enough to cause ANLL.

Update of a prospective study of mortality and cancer incidence in the Australian petroleum industry

Aims: To update the analysis of the cohort mortality and cancer incidence study of employees in the Australian petroleum industry. Methods: Employees from 1981 to 1996 were traced through the Australian National Death Index and the National Cancer Statistics Clearing House. Cause specific mortality and cancer incidence were compared with those of the Australian population by means of standardised mortality ratios (SMRs) and standardised incidence ratios (SIRs). Associations between increased incidence of specific cancers and employment in the petroleum industry were tested by trends according to period of first employment, duration of employment, latency, and hydrocarbon exposure, adjusting for personal smoking history where appropriate. Total follow up time was 176 598 person-years for males and 10 253 person-years for females. Results: A total of 692 of the 15 957 male subjects, and 16 of the 1206 female subjects had died by the cut off date, 31 December 1996. In males, the all-cause SMR and the SMRs for all major disease categories were significantly below unity. There was a non-significant increase of the all-cancer SIR (1.04, 95% CI 0.97 to 1.11). There was a significant increase of the incidence of melanoma (SIR 1.54, 95% CI 1.30 to 1.81), bladder cancer (SIR 1.37, 95% CI 1.00 to 1.83), and prostate cancer (SIR 1.19, 95% CI 1.00 to 1.40), and a marginally significant excess of pleural mesothelioma (SIR 1.80, 95% CI 0.90 to 3.22), leukaemia (SIR 1.39, 95%CI 0.91 to 2.02), and multiple myeloma (SIR 1.72, 95% CI 0.96 to 2.84). Conclusions: Most cases of mesothelioma are probably related to past exposure to asbestos in refineries. The melanoma excess may be the result of early diagnosis. The excess bladder cancer has not been observed previously in this industry and is not readily explained. The divergence between cancer incidence and cancer mortality suggests that the “healthy worker effect” may be related to early reporting of curable cancers, leading to increased likelihood of cure and prolonged mean survival time.

Maternal occupational exposure to organic solvents during early pregnancy and risks of neural tube defects and orofacial clefts

Objectives Though toxicological experiments demonstrate the teratogenicity of organic solvents in animal models, epidemiologic studies have reported inconsistent results. Using data from the population-based National Birth Defects Prevention Study, the authors examined the relation between maternal occupational exposure to aromatic solvents, chlorinated solvents and Stoddard solvent during early pregnancy and neural tube defects (NTDs) and orofacial clefts (OFCs). Methods Cases of NTDs (anencephaly, spina bifida and encephalocoele) and OFCs (cleft lip ± cleft palate and cleft palate alone) delivered between 1997 and 2002 were identified by birth defect surveillance registries in eight states; non-malformed control infants were selected using birth certificates or hospital records. Maternal solvent exposure was estimated by industrial hygienist review of self-reported occupational histories in combination with a literature-derived exposure database. ORs and 95% CIs for the association between solvent class and each birth defect group and component phenotype were estimated using multivariable logistic regression, adjusting for maternal age, race/ethnicity, education, pre-pregnancy body mass index, folic acid supplement use and smoking. Results The prevalence of exposure to any solvent among mothers of NTD cases (n=511), OFC cases (n=1163) and controls (n=2977) was 13.1%, 9.6% and 8.2%, respectively. Exposure to chlorinated solvents was associated with increased odds of NTDs (OR=1.96, CI 1.34 to 2.87), especially spina bifida (OR=2.26, CI 1.44 to 3.53). No solvent class was strongly associated with OFCs in these data. Conclusions The findings suggest that maternal occupational exposure to chlorinated solvents during early pregnancy is positively associated with the prevalence of NTDs in offspring.

Glutaraldehyde Exposures and Symptoms among Endoscopy Nurses in South Australia

Abstract Dermal, respiratory, and other health problems have been associated with the use of glutaraldehyde as a high level disinfectant for endoscopy procedures in hospitals. Given the increasing concern about the safety of glutaraldehyde, a cross-sectional study of exposures among 135 endoscopy nurses in 26 South Australian hospitals was undertaken. Nurses were interviewed with a health/work practice questionnaire, worksite inspections were undertaken, and exposure measurements were conducted. A control group of 132 unexposed nurses in the same hospitals was also interviewed. Inhalational exposure while using glutaraldehyde was determined using Occupational Safety and Health Administration Method 64, and dermal exposure was assessed with skin pads secured to the forearm. Personal inhalational exposures were generally low [overall geometric mean (GM) = 0.032 ppm]. Operating theaters showed significantly lower airborne concentrations than areas dedicated to endoscopy. Both in operating theaters and in end...

The role of regulations in the prevention of occupational injury

Abstract To measure the impact of safety regulations on the occurrence of occupational injury, an investigation was made of 98 worksites where severe or moderately severe injuries had recently been reported, and, where possible, of matching worksites where a similar accident had not occurred, at least for a period of 2 years. 53 of the 98 injuries were considered to be attributable to a violation of a regulation. Matching worksites were obtained for 43 of these 53 cases, and of these 30 (70 ± 14%) were found to be in compliance with the regulation violated at the corresponding accident site. On the basis of this figure it is estimated that failure of compliance with regulations would result in a 2.24-fold increase in the injury rate. Interviews with management at the complying worksites suggested that compliance was more often related to a conscious effort to comply with regulations than a fortuitous outcome of what appeared to be sound engineering practice or “common sense”. Compliance was significantly associated with management awareness of regulatory requirements, but not with possession of a copy of the relevant regulations. Compliance was significantly associated with training of management in safety, and with observance of a priori determined principles of good safety management. Of the 98 injuries investigated, 48 were considered to be amenable to regulatory control. Investigation of all non-accident worksites studied ( n = 78), yielded practical information in 25 on means of reducing the risk of the injury which had occurred at the corresponding accident site. It is concluded that regulations have a substantial relevance to occupational injury in that (i) the injury rate would be at least halved if all regulations were complied with; (ii) there was nevertheless a substantial rate of compliance with regulations, without which the rate of severe injuries may be more than doubled; (iii) substantial benefit may be gained from increasing the ambit of regulations; and (iv) management training and good management practices are most likely to prevent those injuries which are associated with violation of regulations. It is also recommended that accident investigations should include inspection of comparable worksites, not only to detect similar risk factors to those responsible for accidents, but to identify control measures developed by other companies.

Mortality and cancer incidence of Australian participants in the British nuclear tests in Australia

Objectives: To investigate the mortality and cancer incidence of Australian nuclear test participants, and to identify any association with exposure to ionising radiation. Methods: A retrospective cohort study was carried out in which the mortality and cancer incidence rates of participants (n = 10 983) were compared with rates in the general male Australian population. Dose reconstructions were carried out by a panel of health physicists. Mortality and cancer rates were compared with the general population and between groups of subjects categorised by assessed radiation exposure. Results: All-cause mortality was not raised. Mortality and incidence were significantly raised for cancers of the head and neck, lung, colon and rectum, and prostate, and for all cancers combined. For oesophageal cancer, melanoma, all leukaemias and non-chronic lymphatic leukaemia (non-CLL leukaemia), incidence was significantly raised, but mortality was non-significantly raised. No association was found between radiation exposure and overall cancer incidence or mortality, or with any cancer or cancer deaths occurring in excess. Conclusions: There is no evidence that the excess cancers and cancer deaths were caused by radiation exposure at the test sites. Possible contributing factors are high smoking prevalence and demographic differences from the Australian population with whom rates were compared. Asbestos is a likely contributor to some cancers in naval personnel.

A case-control study of possible risk factors in the causation of occupational injury

Abstract Under the occupational health and safety legislation current in most Australian States, legal responsibility is placed on management to identify and control hazards at their own worksites, and accordingly the success of the strategy must depend on effective management practice. To evaluate the role of management practices and other factors, an investigation was made of 98 worksites where severe or moderately severe injuries had recently been reported, and, where possible, of matching worksites where a similar accident had not occurred, at least for a period of 2 years. Matching worksites were identified for 78 of the accident sites. Using a case-control design, estimates were made of a number of factors, including the association of certain management practices, deemed a priori to be desirable in the interests of safety, with the risk of injury. Associations between the “desirable” management practices, safety training of management and operator training, and reduced risk of injury were weak and inconsistent. The risk of injury was unrelated to age of operator or experience of operator. Safety bonuses were associated with increased risk of injury, and production bonuses and written Standard Operating Procedures (SOPs) with decreased risk of injury, but the associations were not statistically significant. The finding that the implementation of “desirable” management practices has, at best, a weak association with reducing the risk of injury puts into question the untested assumption of the Robens Committee of the need for “personal responsibility and voluntary, self-generating effort”, and that campaigns to increase the uptake of such measures as safety in management, training of managers and job training of operators are unlikely to be of great benefit. Management has largely made a commitment to safety already, but this is insufficient unless it is accompanied by valid and specific information on safety technology. It is suggested there is still an important role for prescriptive regulations aimed at specific hazards, notwithstanding the Robens view that there should not be “too much reliance on state regulation”.

Tobacco and alcohol-related mortality in men: estimates from the Australian cohort of petroleum industry workers

Objective: To measure the association between major causes of mortality and tobacco use; and the association between major causes of mortality and alcohol use, after adjusting for tobacco use.