Unknown risk: co-exposure to lead and other heavy metals among children living in small-scale mining communities in Zamfara State,Nigeria

The lead poisoning crisis in Zamfara State, Northern Nigeria has been called the worst such case in modern history and it presents unique challenges for risk assessment and management of co-exposure to multiple heavy metals. More than 400 children have died in Zamfara as a result of ongoing lead intoxication since early in 2010. A review of the common toxic endpoints of the major heavy metals advances analysis of co-exposures and their common pathologies. Environmental contamination in Bagega village, examined by X-ray fluorescence of soils, includes lead, mercury, cadmium, arsenic and manganese. Co-exposure risk is explored by scoring common toxic endpoints and hazard indices to calculate a common pathology hazard risk ranking of Pb?>?As?>?Hg?>>?Cd?>?Mn. Zamfara presents an extreme picture of both lead and multiple heavy metal mortality and morbidity, but similar situations have become increasingly prevalent worldwide.     

Back pain among workers in the United States: National estimates and workers at high risk

Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as “workers”, and those with back pain every day for a week or more during that period were defined as “cases.” A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.     

Field evaluation of a portable blood lead analyzer in workers living at a high altitude: a follow-up investigation

BACKGROUND: Field-portable instruments can offer expeditious analytical results to health professionals in field settings and in areas lacking laboratory infrastructure. This study further evaluated an electroanalytical field-portable instrument, which rapidly analyzes blood lead concentrations. METHODS: A portable anodic stripping voltammetry (ASV) instrument was evaluated utilizing paired samples from 243 employees working at an elevation of approximately 3,800 meters in Peru. Each worker donated two venous blood samples, one of which was analyzed by the ASV device and the other by a reference analytical method, graphite furnace atomic absorption spectrometry (GFAAS). RESULTS: According to the GFAAS results, the mean blood lead concentration measured was 46(+/-16) mug/dl; this was significantly greater than the mean ASV measurement of 32(+/-11) mug/dl (paired t-test; P < 0.0001). The accuracy of the ASV estimation decreased as the measured blood lead concentration increased. CONCLUSIONS: The results from this investigation were significantly different from the previous study, which was conducted near sea level. The exact causes for the discrepancies between the portable ASV results from the two studies are unclear, but are thought to be related to differences in blood chemistry between the Midwestern United States and Peruvian Andes worker cohorts. Portable ASV blood lead measurements from populations living at high altitudes should be viewed with caution. Am. J. Ind. Med. 46:656-662, 2004. Published 2004 Wiley-Liss, Inc.     

Sexual risk behaviours and barriers to HIV testing among clients of female sex workers in Guatemala: a qualitative study

Few interventions have targeted clients of female sex workers in Central America, despite their potential role in HIV/STI prevention. Semi-structured interviews were conducted with 30 clients of female sex workers on attitudes towards prevention of HIV/STIs, barriers to condom use and behaviour towards HIV/STI testing and treatment in Escuintla, Guatemala. Despite high knowledge of condoms as an HIV/STI preventive measure, the decision to use them was often based on the client's social judgment of the woman's sexual conduct. Regular clients reported lower condom use. Clients' risk perception diminished with the awareness of the public HIV/STI clinic addressed to female sex workers. Most preferred private clinics to increase confidentiality and were reluctant to take the HIV test for fear of a positive result. Outreach programmes offering HIV/STI counselling and testing to clients of female sex workers could increase their test uptake and health-seeking behaviour and reduce potential transmission to the general population.     

A heroic struggle to understand the risk of cancers among workers in the electronics industry: the case of Samsung

Abstract

Occupational and environmental determinants of benign thyroid disease and follicular thyroid cancer were evaluated in a series of cases in 1977–1987. Of the cases initially diagnosed as follicular thyroid cancer, only 31 remained after a reclassification, whereas 44 were found to be benign thyroid disease. Both series were compared with 387 randomly selected population controls. Occupational solvent exposure was strongly associated with benign thyroid disease (odds ratio, OR, 2.8; 95% confidence interval, 95% CI, 0.9–9.0 for women and OR 18.9; 95% CI 2.2–161 for men). Eight of the nine men found to have benign disease had been exposed to solvents, and six of them to trichloroethylene. For both types of cases, a private well at the birth address increased the risk, OR 2.0; 95% CI 0.9–4.0 and OR 3.0; 95% CI 1.2–7.2, respectively, whereas the risk was lower for those living in coastal areas. Less fish and shellfish in the diet increased the risk for malignant thyroid disease only. Although based on small numbers, the study indicates etiologic roles of occupational and environmental factors for both conditions studied. The influences of occupation and diet differ, however, for the two outcomes.     

A tap water turbidity crisis in Tel Aviv,Israel, due to technical failure: toxicological and risk management issues

Herein, we report on the actual events linked to an ammonia spillage into the main waterline of the Tel-Aviv metropolitan area and its surrounding municipalities. Based upon a large magnitude increase of unknown origin in the turbidity and ammonia levels of the main drinking water supply, area residents were warned of possible serious contamination and advised to refrain from drinking tap water until further notice. Turbidity was later linked only to CaCO3, which was precipitated from the water due to the rise in pH caused by the excessive ammonia levels. The source of the ammonia (a malfunction of the measurement buoy in the ammonia tank) was not identified until several days after the warning was issued. The toxicological implications of the turbidity and ammonia elevations are considered and reconciled with the management strategies that followed. Of consequence to the management of this crisis was the approach of Ministry of Health officials to regard the ammonia, from the onset, as an indicator of several possible sources of origin rather than as a contaminant. Decision-making policies were hampered by ineffective communication between the national water supplier and government health officials. An outcome of this crisis was a heightened awareness of the potential of a water crisis occurring during peace time and not only in association with terrorist activities, to which Israeli citizens are highly sensitized. Finally, the present paper may serve to guide municipal environmental and health officials more appropriately in the event of similar drinking water crises in Israel or elsewhere.     

A diagnosis of left ventricular hypertrophy on ECG is associated with a high cardiovascular risk: findings from a 40- to 69-year-old cohort in general practice

OBJECTIVE: Left ventricular hypertrophy (LVH) is an independent cardiovascular (CV) risk factor in both sexes. We studied if a diagnosis of LVH on electrocardiogram (ECG) was associated with a 'high CV risk condition' among 40- to 69-year-old individuals cared for by GPs. METHODS: We studied 4250 individuals, 5.4% of whom had LVH. Cross-sectional frequencies, and age- and gender-adjusted statistical differences have been calculated. RESULTS: All the study variables were significantly worse for 'LVH' than 'non-LVH' individuals (except smoking). The 'LVH' had both a mean '5-year CV risk' significantly greater than 'non-LVH' individuals (27.0% versus 8.6%), and a significantly higher prevalence of a '5-year CV risk >15%' (89% versus 15%). CONCLUSIONS: A diagnosis of LVH on ECG among the adult individuals of an opportunistic cohort from general practice was associated with a 6-fold greater prevalence of a 'high CV risk condition'.