Occupational coronary heart disease among bridge and tunnel officers

Traffic-control officers employed in New York City tunnels prior to 1981 have been at increased risk of mortality from coronary heart disease. In this study, the authors assessed current coronary heart disease prevalence and evaluated associations between coronary heart disease and occupational factors among New York City bridge and tunnel officers. A clinical cardiovascular disease surveillance and cross-sectional occupational epidemiologic study was conducted. The authors used comprehensive evaluations to identify current and prior incidences of coronary heart disease. Occupational risk factors evaluated included job strain, current and historic exposure to carbon monoxide, and occupational physical inactivity. Current carbon monoxide exposure was assessed via workshift changes in carboxyhemoglobin. Coronary heart disease occurred in 29 (5.5%) of the 526 bridge and tunnel officers examined. Risk of coronary heart disease was associated positively with total years each bridge and tunnel officer work had worked in that capacity (odds ratio = 1.64 for each decade of employment, adjusted for nonoccupational coronary heart disease risk factors). Carboxyhemoglobin levels were low in the subjects, and job strain and physical inactivity were very prevalent. Occupational factors contributed to the risk of coronary heart disease in New York City bridge and tunnel officers. The authors were unable to identify the specific factors that led to the increase in risk described.     

Heart disease mortality among bridge and tunnel officers exposed to carbon monoxide

The authors investigated the effect of occupational exposure to carbon monoxide on mortality from heart disease in a retrospective study of 5,529 New York City bridge and tunnel officers employed between January 1, 1952 and February 10, 1981, at any one of nine major water crossings operated by the Triborough Bridge and Tunnel Authority of New York City. Among former tunnel officers, 61 deaths from arteriosclerotic heart disease were observed, as compared with 45 expected (standardized mortality ratio = 1.35, 90% confidence interval 1.09-1.68); expected rates were based on the New York City population. Using a proportional hazards model, the authors compared the risk of mortality from arteriosclerotic heart disease among tunnel officers with that of the less-exposed bridge officers. No association of arteriosclerotic heart disease with length of exposure was observed, but there was significant interaction of exposure with age. The elevated risk of arteriosclerotic heart disease among tunnel officers, as compared with that of bridge officers, declined after cessation of exposure, with much of the risk dissipating within as little as five years. The parallel findings of this study of occupational exposure to carbon monoxide and those studies showing the relation of cigarette smoking to cardiovascular mortality suggest that carbon monoxide may play an important role in the pathophysiology of cardiovascular mortality associated with cigarette smoking.     

Occupational strain and the incidence of coronary heart disease

The hypothesis that men in high "strain" occupations have an increased risk of developing coronary heart disease was tested during an 18-year follow-up study from 1965-1983 of a cohort of 8,006 men of Japanese ancestry in Hawaii. There were no significant associations between the incidence of coronary heart disease and the individual job components of high psychologic demands and low job control or for the high strain interaction of these two characteristics. There were, in fact, trends of associations opposite to that predicted by the job strain model which were of borderline significance in multivariate analyses. Stratified analyses by level of acculturation showed similar inverse associations of job strain and coronary heart disease for the more Westernized men and no association for the more traditional men. There were also no significant associations among the various job characteristics and the major risk factors for coronary heart disease in this cohort. The disagreement of these results with those from other studies may be due to methodologic differences of using men whose usual and current occupations were the same in this study compared with using only current occupation in the other studies, the use of different methods of measuring job strain, or the possibility that men in this cohort perceive or react to occupational strain differently.     

Perceived job stress and incidence of coronary events: 3-year follow-up of the Belgian Job Stress Project cohort

Psychosocial characteristics have been linked to coronary heart disease. In the Belgian Job Stress Project (1994-1999), the authors examined the independent role of perceived job stress on the short-term incidence of clinical manifest coronary events in a large occupational cohort. A total of 14,337 middle-aged men completed the Job Content Questionnaire to determine the dimensions of the extended job strain model, job demands, decision latitude, and social support. Jobs were categorized into high strain, low strain, active jobs, and passive jobs. During the 3-year follow-up, 87 coronary events were registered. At baseline, 17% of workers experienced high strain. Job demands and decision latitude were not significantly related to the development of coronary heart disease after adjustment for covariates. The 38% risk excess among subjects classified in the high-strain category did not reach statistical significance. However, coronary heart disease incidence was substantially associated with the social support scale independently of other risk factors, with an adjusted hazard ratio of 2.4 (95% confidence interval: 1.4, 4.0) between extreme tertiles. No convincing evidence for an association of job demands, decision latitude, or job strain with the short-term incidence of coronary heart disease was found. However, our study underscores the importance of a supportive social work environment in the prevention of coronary heart disease.     

列车乘务人员职业紧张与冠心病的关系

目的　研究职业紧张与冠心病之间的关系以及引起冠心病发病的主要职业紧张因素。方法　应用职业紧张测试表 ,对 5 83名男性列车乘务人员进行职业紧张与冠心病关系的人群调查。结果　在控制了非职业紧张因素条件下 ,职业紧张与冠心病有独立的相关关系 (RR =1 0 5 8,95 %CI :1 0 0 7～ 1 111) ,而且随着职业紧张程度的增加患冠心病的危险性也增高 ,引起冠心病发病的主要职业紧张因素是职务特征 (RR =1 12 5 ,95 %CI :1 0 48～ 1 196 )和经历与成就 (RR =1 172 ,95 %CI :1 0 99～ 1 2 5 6 )。结论　职业紧张是引起冠心病发病的一项不容忽视的重要危险因素     

Occupational disease in New York State: a comprehensive examination

In order to obtain information on the current magnitude of occupational disease in New York State, four data sources were reviewed: Workers' Compensation records, disease registries maintained by the state department of health, data from the Bureau of Labor Statistics (BLS), and data from the California's physician reporting system. A proportionate attributable risk approach is used to develop estimates of mortality due to occupational diseases. The distribution of occupational hazards was assessed using data from the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the New York State Department of Environmental Conservation (NYDEC). Finally, econometric estimates of the direct and indirect costs of occupational illness were developed. The best available data indicate that 5,000 to 7,000 deaths are caused each year in New York State by work-related illnesses, and at least 35,000 new cases of occupational illness develop each year in the State. It is also estimated that between 150,000 and 750,000 workers in New York State are employed in the 50 most hazardous industries. OSHA standards regulating exposure to selected chemicals were found to have been violated frequently. The annual costs of occupational disease in New York State are approximately $600,000,000; only a small fraction is covered by workers' compensation insurance. Of the 52,000 physicians in New York State, only 73 are board-certified in occupational medicine. Most of these are involved in administrative, teaching, and research aspects of occupational medicine. Of the 300 industrial hygenists in New York State, two-thirds are employed by major corporations. Recommendations are described to improve the recognition of occupational disease in New York State and to reduce the burden of this disease. A statewide network of occupational health clinical services is proposed and has been funded by the New York State Legislature. Other recommendations are also given.     

职业紧张对职业人群健康影响的研究进展

该文结合有关文献,对近年来职业紧张对职业人群健康影响的研究情况进行综述.研究结果表明:职业紧张因素对职业人群和劳动者个体身心健康存在一定的影响.职业紧张对人体神经系统造成一定的损害;对免疫功能有明显影响,可抑制机体的免疫功能.职业紧张是诱发高血压、冠心病的一项重要危险因素;职业紧张可能导致血清催乳素浓度的升高.     

Risk factors for mortality from all causes and from coronary heart disease among persons with diabetes. Findings from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study

Coronary heart disease is the leading cause of mortality among persons with diabetes mellitus, but the factors that account for this high coronary heart disease mortality remain unclear. In the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study, conducted from 1982 to 1984, 92 deaths from coronary heart disease were found to have occurred among 602 diabetic participants and 558 deaths from coronary heart disease were found to have occurred among 12,562 nondiabetic participants during the follow-up period (1971-1984; average follow-up, 10 years). Using proportional hazards analysis, the authors found age, male sex, severe overweight, and non-leisure-time physical inactivity to be significantly associated with coronary heart disease mortality among persons with diabetes. Age, male sex, current smoking, hypertension, and non-leisure-time physical inactivity were associated with all-cause mortality. Cholesterol showed a more complex relation to all-cause mortality. The strength of the associations between risk factors and all-cause and coronary heart disease mortality did not differ significantly among persons with and without diabetes. These results reinforce the importance of controlling coronary heart disease risk factors among persons with diabetes.     

N.Y. approves disability pay for prison guards with HIV

Governor George E. Pataki of New York signed legislation allowing State corrections personnel to apply for accidental disability benefits based on a claim that HIV, tuberculosis, or hepatitis was contracted on the job. This legislation affords civil service corrections personnel to have the same protection afforded to New York corrections officers, firefighters, and police officers. Pataki vetoed a similar measure extending coverage to police officers and firefighters in New York City who are not included under State Retirement and Social Security Law provisions.     

Health Effects of Exposure to High Concentrations of Automotive Emissions

On-site and remote health evaluations were performed on 550 employees of the Triborough Bridge and Tunnel Authority in New York City. Extremely high ambient air pollution was observed. Carbon monoxide averaged 63 ppm over a 30-day period with a maximum hourly concentration of 217 ppm in one facility. Eighty-five percent of the smoking and 47% of the nonsmoking tunnel workers had carboxyhemoglobin saturations in excess of 3%. A high percentage of the group had symptoms suggestive of chronic bronchitis; airway resistance was elevated in one third and almost all bridge and tunnel workers had an increase in closing volume, suggesting small airway disease.     

Compensation for occupational injury and disease in Norway: ranking of job groups

The health risk of various job groups in Norway was estimated by ranking them according to the annual occupational insurance costs per capita. This was done by dividing the costs of work-related injury and disease from 1991 to 1996 in various job groups by the number of workers in these groups. Occupational groups were also ranked according to total annual costs. The five occupational groups with the highest total costs were metalworkers, woodworkers, nursing-related workers, fisheries workers, and teachers. The groups with the highest annual cost per worker were shoe and leather workers, oil and gas extractors, fisheries workers, miners and quarry workers, and ship's officers. Fisheries workers and ship's officers were ranked among the top 10 positions on both lists and deserve priority in preventive measures.     

Epidemiology of occupation and coronary heart disease: Research agenda

Little is known about occupational risks for coronary heart disease. A few specific toxins encountered occupationally are known to affect the heart, most prominently carbon disulfide, nitroglycerin, and carbon monoxide. Of these, carbon monoxide is the most common occupational exposure; it is also a common environmental exposure due to vehicle exhaust. Environmental tobacco smoke, noise, heat, and cold are suspected occupational risk factors for cardiovascular disease. In addition, stress at work may increase heart disease, although little is known conclusively with this regard. Unemployment may also increase risk of heart disease. Shift work, which disrupts circadian rhythms, has also been linked to heart disease, although there again, the data are far from conclusive. Physical activity at work, either too much or too little, can also be a risk factor for heart disease. While in general, more physical activity results in less heart disease, heavy lifting (in occupational and nonoccupational settings) has been associated with increased risk of heart attack. Further epidemiologic research into all these areas is warranted. (This article is a US Government work and, as such, is in the public domain in the United States of America.) © 1996 Wiley-Liss, Inc.     

Effect of carbon monoxide on cardiovascular disease.

Carbon monoxide exposure from heavy smoking or heavy atmospheric carbon monoxide pollution depresses myocardial function in patients with coronary heart disease, aggravates angina pectoris, aggravates intermittent claudication of the calf or thigh, increases myocardial ischemia in patients with clinical and subclinical coronary heart disease, and contributes to an increased incidence of nonfatal and fatal myocardial infarction and sudden death from coronary heart disease. Carbon monoxide contributes to the increase in nonfatal and fatal myocardial infarction and in sudden death from coronary heart disease in cigarette smokers by (a) carboxyhemoglobin interfering with myocardial oxygen delivery at the time nicotine has caused an increase in myocardial oxygen demand, aggravating an episode of myocardial ischemia, (b) the negative inotropic effect of carboxyhemoglobin aggravating an attack of myocardial ischemia, (c) carboxyhemoglobin reducing the threshold for ventricular fibrillation during an episode of myocardial ischemia, and (d) carboxyhemoglobin increasing platelet stickiness, thereby, increasing a thrombotic tendency. Furthermore, experimental data indicate that exposure to carbon monoxide in concentrations found in heavy tobacco smokers or in persons with heavy occupational exposure to carbon monoxide plays a role in the pathogenesis of cardiovascular disease.     

南京市某炼铁厂职业病危害现状评价

目的评估南京市某炼铁厂职业病危害现状。方法2019-08,通过职业卫生现场调查、职业病危害因素检测、职业健康检查等方法对该厂职业病危害现状进行评价。结果粉尘作业岗位合格率100.0%,一氧化碳作业岗位合格率92.3%,噪声作业岗位合格率94.1%,高温作业岗位合格率75.0%;职业健康体检中,多人检出血压、血糖和电测听异常;结论该炼铁厂职业病危害控制效果良好,部分接触一氧化碳、噪声、高温的岗位职业病危害控制效果较差,需重点防控。     

某公司乙烯扩建工程项目职业病危害控制效果评价

目的识别、分析某公司乙烯装置工程产生的职业病危害因素,探讨防护对策和措施。方法通过职业卫生现场调查、职业病危害因素检测、职业健康检查等方法,对该项目的职业病危害因素进行分析,评价其职业病危害防护设施的控制效果。结果该扩建工程项目在生产过程中的职业病危害因素主要有液化石油气、一氧化碳、二氧化碳、氮氧化物、硫化氢、三苯、苯乙烯、抽余油、噪声、高温。现场检测结果显示压分车间分离岗位、裂解车间炉岗和急冷岗的岗位工人接触噪声40 h等效声级分别为77.1、77.6、75.9 dB(A),均低于80 dB(A),不属于噪声岗位。裂解炉为高温作业场所,WGBT指数为26.3℃。各岗位工人接触的职业病危害因素均符合国家规定的职业接触限值要求。结论该项目属职业病危害严重的建设项目。从职业卫生角度分析,该建设项目可行。     

某汽车厂铸造工人冠心病危险因素队列研究

目的通过对2174名汽车铸造工人(铸工)平均随访19.23人年的回顾性队列研究,探索铸造工人冠心病的发病情况并寻找职业因素对其影响,为控制铸工冠心病危险因素提供科学依据。方法选择某汽车铸造厂1980~2004年在册在岗、工龄≥1 a的铸造工人为研究对象。以铸工个人的生活嗜好、人口统计学资料、工种和职业危险因素暴露情况等为研究内容。分析铸造工人冠心病发病的危险因素,特别是职业因素。结果随访期间共发生冠心病152例,初发病率为363.63/10万人年。在收缩压模型中,一氧化碳(CO)的RR(95%CI)为1.65(1.29~2.09,P<0.01),粉尘的RR(95%CI)为1.20(1.03~1.39,P<0.05),在舒张压模型中,CO的RR(95%CI)为1.63(1.28~2.06,P<0.01),粉尘的RR(95%CI)为1.19(1.03~1.395,P<0.05)。结论年龄增加、血压升高、高血脂、吸烟、超重(肥胖)、糖尿病、冠心病家族史是冠心病的非职业危险因素;粉尘、CO等是铸工冠心病的职业危险因素。     

Peer Reviewed: Overreporting of Deaths From Coronary Heart Disease in New York City Hospitals, 2003

Introduction

New York City has one of the highest reported death rates from coronary heart disease in the United States. We sought to measure the accuracy of this rate by examining death certificates.

Methods

We conducted a cross-sectional validation study by using a random sample of death certificates that recorded in-hospital deaths in New York City from January through June 2003, stratified by neighborhoods with low, medium, and high coronary heart disease death rates. We abstracted data from hospital records, and an independent, blinded medical team reviewed these data to validate cause of death. We computed a comparability ratio (coronary heart disease deaths recorded on death certificates divided by validated coronary heart disease deaths) to quantify agreement between death certificate determination and clinical judgment.

Results

Of 491 sampled death certificates for in-hospital deaths, medical charts were abstracted and reviewed by the expert panel for 444 (90%). The comparability ratio for coronary heart disease deaths among decedents aged 35 to 74 years was 1.51, indicating that death certificates overestimated coronary heart disease deaths in this age group by 51%. The comparability ratio increased with age to 1.94 for decedents aged 75 to 84 years and to 2.37 for decedents aged 85 years or older.

Conclusion

Coronary heart disease appears to be substantially overreported as a cause of death in New York City among in-hospital deaths.     

Assessment of fitness for work in health care workers: biomechanical risk factors

In current practice the assessment of fitness for work in health care workers exposed to biomechanical risk factors is often based on conventional approaches rather than on evidence-based guidelines. However, an accurate evaluation of worker's psychophysical resources compared to job demand and potential occupational risk factors is essential in order to properly assess fitness for work. The latest published guidelines on the management of patients suffering from back pain reported that the evidence-based approach can minimize the period of inactivity by encouraging return to work (and to other non-dangerous physical activities) in a relatively short period of time. As for carpal tunnel syndrome, there is no scientific evidence supporting a restriction of physical activities requiring forceful movements of the hand/wrist.     

Acute lead poisoning in construction workers: the failure of current protective standards

Construction workers who use oxyacetylene torches to cut lead-painted metal are at high risk of acute and subacute lead poisoning. Poisoning results from inhalation of submicron-diameter particles of lead fume generated in paint burning. We describe a series of 14 cases of lead poisoning in ironworkers cutting a lead-painted bridge in New York City. Peak blood lead levels ranged from 2.32 to 5.80 mumol/l (48-120 micrograms/dl). Median duration of employment was 4 wk. Two workers required chelation therapy. Personal (breathing zone) exposures to airborne lead ranged from 600 to 4,000 micrograms/m3. Construction workers are specifically exempted from the provisions of the U.S. Occupational Safety and Health Administration (OSHA) lead standard. The data from this study indicate that such exemption is not warranted. A need exists for improved protection of construction workers against occupational exposure to lead.     

Peer Reviewed: Prevalence,Awareness, Treatment,and Control of High LDL Cholesterol in New York City, 2004

Introduction

Low-density lipoprotein (LDL) cholesterol is a major contributor to coronary heart disease and the primary target of cholesterol-lowering therapy. Substantial disparities in cholesterol control exist nationally, but it is unclear how these patterns vary locally.

Methods

We estimated the prevalence, awareness, treatment, and control of high LDL cholesterol using data from a unique local survey of New York City''s diverse population. The New York City Health and Nutrition Examination Survey 2004 was administered to a probability sample of New York City adults. The National Health and Nutrition Examination Survey 2003-2004 was used for comparison. High LDL cholesterol and coronary heart disease risk were defined using National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines.

Results

Mean LDL cholesterol levels in New York City and nationally were similar. In New York City, 28% of adults had high LDL cholesterol, 71% of whom were aware of their condition. Most aware adults reported modifying their diet or activity level (88%), 64% took medication, and 44% had their condition under control. More aware adults in the low ATP III risk group than those in higher risk groups had controlled LDL cholesterol (71% vs 33%-42%); more whites than blacks and Hispanics had controlled LDL cholesterol (53% vs 31% and 32%, respectively).

Conclusions

High prevalence of high LDL cholesterol and inadequate treatment and control contribute to preventable illness and death, especially among those at highest risk. Population approaches — such as making the food environment more heart-healthy — and aggressive clinical management of cholesterol levels are needed.