External and internal monitoring in workers exposed to N,N-dimethylformamide

Work presented at the 23rd Congress on Occupational and Environmental Health in the Chemical Industry (Medichem 1995) The Chemical Industry as a Global Citizen — Balancing Risks and Benefits, 19–22 September 1995, Massachusetts Institute of Technology, Cambridge, Massachusetts     

Mangelnde Reziprozit?t in engen sozialen Beziehungen, Depressivit?t und eingeschr?nkte subjektive Gesundheit

Objectives:Associations of experienced non-reciprocity in close social relationships with health are analyzed in a group of middle-aged employed men and women using depressive symptoms and self-rated health as indicators. Methods:Non-reciprocity is measured by a newly developed questionnaire containing three scales: partnership, parent-child, and non-specific close relationships. Depressive symptoms are assessed by the German version of the CES-D scale and self-rated health by a single widely tested item. The factorial structure of the questionnaire measuring non-reciprocity is analyzed. Subsequently, associations are explored using logistic regression analyses with age, gender, socio-economic status, and social support as control variables.     

Separation from children as a specific risk factor to fathers' health and lifestyles

Objectives  

The study was to examine whether fathers living apart from their children following divorce or separation (fathers without children) differ in their health-related lifestyles and attitudes, and in their health status, from fathers in intact family settings (fathers with children).     

Reference values for the study of low doses of metals

The role of biological monitoring (BM) in the prevention of exposure to toxic metals has currently acquired considerable importance. However, in the near future the usefulness of BM in occupational medicine could be reduced by the fact that exposure to toxic substances will progressively decrease and consequently problems of comprehension will occur. BM can maintain its importance in the prevention field if sensitivity and specificity of the biological indicators (BI) are increased and if this activity is specifically directed towards groups of subjects. To achieve this last goal, one of the problems which must be solved is the identification of reference values (RV) which define the BI levels in the general population not occupationally or environmentally exposed to the toxic substance under study. It is necessary to refer to these values in order to compare the data obtained in a population which is presumed to be exposed. In this presentation, the example of blood cadmium is used in order to discuss the criteria required to identify RV. Herein the data of a personal case list are reported, particularly the variables which must be considered when selecting subjects to form reference groups. Conversely, the possibility of obtaining RV through meta-analysis studies, pooling the results published in international literature, are evaluated.     

Health-related quality of life in a rare disease: Hereditary hemorrhagic telangiectasia (HHT) or Rendu–Osler–Weber Disease

The levels of the health-related quality of life (HR-QoL) were analyzed in hereditary hemorrhagic telangiectasia (HHT) patients. The Short Form-36 Health Survey (SF-36) was administered to 50 HHT patients and scores were compared to a cohort of 2301 normal subjects. Clinical variables were patient age, illness duration, number of epistaxis episodes in the previous year and hemoglobin levels. Physical functioning, physical role limitations, bodily pain, social functioning, emotional role limitations and the physical component scores were lower among females. In multivariable analyses increasing age was related to lower physical functioning (P<0.04), physical role limitations (P<0.008), bodily pain (P<0.05) and emotional role limitations (P<0.01), while higher hemoglobin levels improved physical functioning(€P<0.03). The number of epistaxis episodes was negatively associated with physical role limitations (€P<0.009), vitality (P<0.002), social functioning (P<0.001), physical component summary (€P<0.001) and bodily pain (P<0.01). Illness duration was negatively related to the mental component summary (P<0.004). HHT patients had a lower HR-QoL with respect to normal controls in all domains except for bodily pain. Females had lower scores for several domains. Epistaxis was the most important clinical variable.     

Comprehensive pediatric primary care vs traditional care in an israeli population: Their influence on pediatric emergency room use and hospitalization

Emergency room (ER) utilization and hospitalization were studied as indicators of the impact of improvements in pediatric primary care services in an Israeli development town, Ofakim, population 12,000. One of the two pediatric services was upgraded in 1976 through the introduction of pediatric faculty, integration of preventive and curative services and conversion of the medical records to a problem-oriented format ( experimental clinic B ). The primary care system remained unchanged in the second clinic ( traditional clinic A ). During 1980, ER utilization by the B clinic population was 9.3/100 compared with 17.6/100 for the A clinic population. Fifty two percent of the B clinic population patients reaching the ER were hospitalized compared with 25% of A clinic patients.The lower ER utilization rate represents a significant saving for the health services, and educational interventions are suggested from the study. Analysis of ER utilization data seems to offer useful information for overall planning and monitoring of ambulatory services for a community.Corresponding author.     

Ultraviolet and volatility loss of herbicides

Herbicide 2,4-D formulated as a urea-type polymer was readily destroyed by long-wave uv (356-nm) irradiation, whereas conventional 2,4-D was more resistant. The opposite relationship was noted for polymeric and conventional formulations of dicamba. Polymerized 2,4-D was more resistant to thermal degradation (60°C) than non-polymerized formulations. Ultraviolet degradation of polymerized 2,4-D was eliminated by the incorporation of RYLEX-H and UVINUL D-50, industrial uv absorbers. Exposure of polymeric dicamba to 60°C heat, followed by trapping of the volatile component, indicated that 21 percent was lost by thermal degradation and 46.6 percent by volatilization. Comparable values for non-polymerized dicamba were 37.9 and 60.1 percent.     

Assessment of occupational exposure to 4,4′-methylene-bis-(2-chloroaniline) “MOCA” by a new sensitive method for biological monitoring

Summary A new specific and sensitive method for the urinary determination of 4,4-methylene-bis-(2-chloroaniline) (MOCA), a known carcinogen in rats, mice and dogs, has been developed. After a brief study on rats to determine some peculiarities in MOCA urinary excretion, this method was used to assess occupational exposure in French industrial firms. Both the manufacture of MOCA and its use as a curing agent in the production of polyurethane elastomers were surveyed. MOCA excretion levels were distributed from non-detectable (<0.5 g/l) up to 1600 g/l. Concentrations of N-acetyl metabolites, when present, were largely lower than MOCA levels. The results seemed to reflect workers' overall exposure fairly. Preventive measures following analytical determinations often led to an obvious lowering of excretion levels.     

Reduction in cadmium in blood and dietary intake among general populations in Japan

Blood samples and 24-h duplicates of food were collected in the years around 1980 and then in 1990's from inhabitants of nonpolluted regions in Japan. The 1990 study is still in progress with 286 blood samples and 125 food duplicates already collected from 7 regions. A preliminary analysis is made in the present study with the data obtained from the 7 study regions where the survey was conducted in 1980 and then in 1990, to examine possible changes in dietary cadmium intake (Cd-D) and consequently cadmium levels in blood (Cd-B) during this 10 year period. The food duplicate analysis showed that Cd-D in 1980 was 47.1 g/day (1.74):65 [GM (GSD):N] for men and 27.7 g/day (1.75):65 for women. The counterpart values in 1990 were 29.5 g/day (1.66):40 for men and 23.8 g/day (1.73):85 for women; the difference between the two values for the same sex is significant (P<0.05) both=" in=" men=" and=" in=" women,=" suggesting=" that=" there=" occurred=" about=" 37%=" and=" 14%=" reduction=" in=" dietary=" cadmium=" intake=" during=" this=" 10=" year=" period=" in=" men=" and=" in=" women,=" respectively.=" comparison=" in=" cd-b=" showed=" that=" cd-b=" for=" men=" and=" women=" in=" 1990=" were=" 1.79=">g/l (2.01):121 and 1.84 g/l; (1.67):165, respectively, whereas the counterpart values in 1980 were 3.84 g/l (1.64):123 and 3.57 g/l (1.42):141, respectively, indicating significant (P<0.01) reduction=" in=" cd-b=" in=" both=" sexes=" in=" parallel=" to=" the=" reduction=" in=" cd-d.=" the=" role=" of=" rice=" as=" a=" major=" source=" of=" cadmium=" among=" japanese=" population=" together=" with=" recent=" reduction=" in=" the=" importance=" is=" discussed;=" cd=" in=" rice=" accounted=" for=" 72%=" in=" late=" 1970's,=" whereas=" it=" is=" about=" 35%=" in=" the=" present=">     

An evaluation of psychometric properties of the client's questionnaire of the Wisconsin Quality of Life Index-Canadian version (CaW-QLI)

Psychometric properties of Client's questionnaire from the Canadian version of the Wisconsin Quality of Life-Index (CaW-QLI) were assessed with two groups, 89 English (E) and 94 French (F) individuals with schizophrenia or schizoaffective disorder. Sub-samples of 40E and 36F were re-interviewed within a 2-week period. Spearman correlations-SC between each domain and CaW-QLI global Score ranged from 0.39 to 0.76, while inter-domain correlations were low, confirming the multidimensional properties of the scale. Cronbach's (internal consistency) were 0.78(E) and 0.70(F) for the CaW-QLI global scores and, from 0.45 to 0.88 among seven of eight domains. Test–retest (Concordance Correlation Coefficient-CCC) ranged from 0.36 to 0.80 among the domains, and from 0.80(E) and 0.85(F) between CaW-QLI global scores. Regarding convergent validity, SC between CaW-QLI global score and Spitzer's QOL-Index were 0.72(E) and 0.58(F). As hypothesized, there were higher correlations between CaW-QLI global scores (E and F) and SF-36 scales related to mental health than those related to physical health. Minor changes in the scoring are proposed to enhance face and content validity.     

Drug problems and “at risk” women’s involvement in HIV risk behaviors

Objectives:This paper focuses on two research questions: Is there a relationship between womens number of drug problems and the extent to which they engage in HIV risk behaviors? What factors influence the extent to which women experience drug-related problems?Methods:This study is based on 250 adult at risk women (predominantly African American) in the Atlanta, Georgia metropolitan area. Street outreach efforts, targeted sampling, and ethnographic mapping procedures were used to identify potential study participants.     

Identification of obstacles for chronic pain patients to return to work: evaluation of a questionnaire

The Obstacles to Return-to-Work Questionnaire (ORQ) was developed and evaluated. A total of 154 patients with chronic musculoskeletal pain and prolonged work disability participated in the study. Factor analyses reduced the ORQ to 55 items grouped into 9 subscales. The subscales were named Depression, Pain intensity, Difficulties at work return, Physical workload and harmfulness, Social support at work, Worry due to sick leave, Work satisfaction, Family situation and support, and Perceived prognosis of work return. The subscales showed satisfactory reliability. In order to determine predictive validity a discriminant analysis was conducted with sick leave 9 months after assessment as the outcome. This analysis indicated that the scales Perceived prognosis of work return, Social support at work, Physical workload and harmfulness, Depression, and Pain intensity could significantly predict sick leave and correctly classified 79% of the patients. The Multidimensional Pain Inventory and the Disability Rating Index could also significantly predict sick leave in this sample and correctly classified as many patients as the ORQ. However, these questionnaires do not include any work-oriented items and they had a lower specificity than the ORQ. This study suggests that patients' perceptions and beliefs about work and returning to work may be a significant hindrance for actual recovery.     

Mutagenicity of 4,4′-methylene-bis-(2-chloroaniline) “MOCA” and its N-acetyl derivatives in S. typhimurium

Summary 4,4-methylene-bis-(2-chloroaniline) (MOCA) and two identified urinary N-acetyl and N,N-diacetyl derivatives were tested in a Salmonella/mammalian microsome assay. No mutagenic activity was observed without rat liver S9 mix activation. In the presence of rat liver S9 mix, the chemicals were mutagens, but the mutagenicity of N-acetyl derivatives to strain TA 100 was reduced when compared to that of MOCA, and a greater amount of S9 was required to exhibit the mutagenicity of the N,N-diacetyl-MOCA. These data suggest that N-acetylation does not account for the mutagenic effectiveness of MOCA.     

Percutaneous absorption of N,N-dimethylformamide in humans

Summary Skin penetration fo N,N-dimethylformamide (DMF) liquid or vapour was studied in volunteers. Exposure to liquid DMF was performed in two ways: in a dipping experiment, one hand was dipped up to the wrist in DMF for 2–20 min, while in a patch experiment, 2 mmol DMF was applied to the skin and allowed to be absorbed completely. The period of exposure to DMF vapour (50 mg · m^–3) was 4 h. The DMF metabolites N-hydroxymethyl-N-methylformamide (MF), N-hydroxymethylformamide (F), and N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC) were monitored in the urine. Liquid DMF was absorbed through the skin at a rate of 9.4 mg · cm^–2 · h^–1. Percutaneous absorption of DMF vapour depended strongly on ambient temperature and humidity and accounted for 13%–36% of totally excreted MF. The results suggest that skin absorption of liquid DMF is likely to contribute to occupational exposure substantially more than penetration of DMF vapour. The yield of metabolites after transdermal DMF absorption was only half of that seen after pulmonary absorption. Elimination of MF and F but not that of AMCC was delayed, which supports the contention that AMCC should be used instead of MF as the most suitable biomarker of DMF in cases where percutaneous intake can occur.     

In a Secular Spirit: Strategies of Clinical Pastoral Education

The Clinical Pastoral Education (CPE) model forthe provision of spiritual care represents theemergence of a secularized professionalpractice from a religiously-based theologicalpractice of chaplaincy. The transformation ofhospital chaplaincy into spiritual careservices is one means by which religioushealthcare ministry negotiates modernity, inthe particular forms of the secular realm ofbiomedicine and the pluralism of thecontemporary United States healthcaremarketplace. Spiritual is a labelstrategically deployed to extend the realm ofrelevance to any patient's belief system,regardless of his or her religious affiliation.Theological language is recast as a tool forconceptualizing the spiritual lens. Suchmoves transform chaplaincy from a peripheralservice, applicable only to the few religiouspatients, into an integral element of patientcare for all. Such a secularized professionalpractice is necessary to demonstrate therelevance and utility of spiritual care for allhospital patients in an era of cost-containmentpriorities and managed care economics.     

Bioethics in a Multicultural World: Medicine and Morality in Pluralistic Settings

Current approaches in bioethics largely overlook the multicultural social environment within which most contemporary ethical issues unfold. For example, principlists argue that the common morality of society supports four basic ethical principles. These principles, and the common morality more generally, are supposed to be a matter of shared common sense. Defenders of case-based approaches to moral reasoning similarly assume that moral reasoning proceeds on the basis of common moral intuitions. Both of these approaches fail to recognize the existence of multiple cultural and religious traditions in contemporary multicultural societies. In multicultural settings, patients and their families bring many different cultural models of morality, health, illness, healing, and kinship to clinical encounters. Religious convictions and cultural norms play significant roles in the framing of moral issues. At present, mainstream bioethics fails to attend to the particular moral worlds of patients and their family members. A more anthropologically informed understanding of the ethical issues that emerge within health care facilities will need to better recognize the role of culture and religion in shaping modes of moral deliberation.     

Air-borne B. subtilis enzymes in the detergent industry

Summary Air-borne dust was collected on stationary and portable filters in two factories producing biological detergents. In one factory (Factory A) the detergent base was mixed with enzyme (subtilisin) powder, and the handling of the enzyme was done without effective protection. In the other factory (Factory B) the enzyme was encapsulated in granules before mixing the with detergent base, and the production line was shielded to prevent the spread of dust.Both the amount of air-borne dust and the relative enzyme activity of the dust were greater in Factory A than in Factory B in spite of the considerably larger production of enzyme detergents in the latter factory. The workers studied in Factory A were, on the average, exposed to 5.4 GU (glycine units) per cubic millimetre in their breathing zones, and those studied in Factory B were exposed to enzyme activities about and below 1 GU/m³.Based on exposure measurements and medical examination of the exposed workers, a time-weighted hygienic limit value for subtilisins of 1 GU/m³ is proposed.     

Sublethal Effects of Trace Metals (Cd,Cr, Cu,Hg) on Embryogenesis and Larval Settlement of the Ascidian <Emphasis Type="Italic">Ciona intestinalis</Emphasis>

Toxicity of Cadmium (Cd), Chromium (Cr), Copper (Cu), and Mercury (Hg) on the early developmental stages of Ciona intestinalis was investigated. Developmental defects of larvae after exposure of gametes throughout their development to the larval stage were assessed. Gamete exposure to increasing metal concentrations resulted in a significant decrease of the percentage of normally hatched larvae, showing median effective concentrations (EC₅₀) of 721 g/L (6.42 M) for Cd, 12772 g/L (226 M) for Cr, 36.6 g/L (0.576 M) for Cu, and 44.7 g/L (0.223 M) for Hg. Larval attachment was significantly affected when gametes were exposed to the metals throughout development. The EC₅₀ reducing larval attachment by 50% were 752 g/L (6.7 M) for Cd, 15026 g/L (289 M) for Cr, 67.8 g/L (1.607 M) for Cu, and 78.1 g/L (0.389 M) for Hg. Therefore, on a molar basis Hg is three times more toxic than Cu, 20–30 times more than Cd, and 700–1000 times more toxic than Cr, for both responses.     

What is a normal family? Common assumptions and current evidence

The social and applied human sciences have been built upon the assumption that the normal family consists of a first-marriage conjugal couple cohabiting with biological children. It is taken for granted that the wife should be responsible for child and domestic work, and that the husband should be the family's economic provider and ultimate authority. In the professional literature such traditional family structure is often described as normal in the sense of most common, as well as normal in the sense of well-functioning. Current psychological, sociological, anthropological and historical studies, however, do not support the assumption that the traditional nuclear family is the most natural, common, and/or healthy form of family arrangement. The idealization of the traditional nuclear family has had implications for theory, research, mental health practice, and social policy. Scientists and practitioners have been slow to recognize pathology in traditional nuclear families. Families other than traditional nuclear ones have been rendered invisible or pathologized. It is time for contemporary social and applied human sciences to recognize that the traditional nuclear family is a culturally- and historically-specific construct. It is also time for contemporary social and applied human sciences to develop an account of, and a research agenda about, families that take into consideration their variations across time, place, social class, ethnicity, and culture.     

Investigations on neurotoxicity of chemical substances at the workplace

Summary A cross-sectional study was performed in order to investigate the influence of chronic lead-exposure on the peripheral nervous system. We examined 148 male workers of a storage battery manufacturing plant, who had been exposed to lead metal and inorganic lead compounds for 1 to 28 years (mean 11 years). Fifteen workers with non-occupational risks of peripheral neuropathy (former diseases, alcohol abuse, medication) were excluded from the study. The investigation program comprised: case history, physical examination, analyses of blood- and urine-samples and determination of maximal motor, mixed and sensory conduction velocity (NCV) of the ulnar and median nerve of the right forearm. Objectively no worker showed any signs of health effects related to lead exposure. The Biological Monitoring included the determination of (1) Blood-lead level (Pb-B), (2) Free erythrocyte porphyrins (FEP), (3) -Aminolevulinic acid dehydratase (ALA-D) and (4) -Aminolevulinic acid in urine (ALA-U). Further time-weighted-average (TWA)-values of Pb-B were calculated on the basis of several determinations over the period 1975–1981. The following actual (TWA) median values resulted: Pb-B 53 g/dl (54 g/dl), ALA-U 5.6 mg/l (8.4 mg/l), FEP 2.0 mg/l (2.0 mg/l). The Biologischer Arbeitsstoff Toleranz Wert (BAT) of 70 g//dl for Pb-B was exceeded in 15 workers (11%), and of 15 mg/l for ALA-U in 30 cases (23%). In comparison with age-matched controls, the lead workers showed a mild slowing of NCV with mean values between 0.8 and 2.0 m/s. Multiple stepwise regression analyses revealed statistically significant correlations between the four NCV and age as well as Pb-B. There were better correlations by using TWA than actual data of Pb-B. Consideration of the results of the regression analyses, together with an evaluation of the individual neurophysiological status as a function of internal lead exposure, a dose-effect-relationship was found only in the case of Pb-B exceeding 70 g/dl. From our study it is concluded that chronic lead exposure resulting in blood-lead levels of below 70 g/dl is no occupational risk causing a functionally significant slowing of nerve conduction velocities.With Grants from the Deutsche Forschungsgemeinschaft, Bonn (Project no. Va 23/19-1)