Algae-induced occupational asthma in a thalassotherapist

BACKGROUND: Algae powders have been increasingly used in therapeutic preparations. Their potential as inducers of occupational asthma (OA), however, remains to be demonstrated. METHODS: A 33-year-old woman developed asthma following exposure to algae powder used for thalassotherapy. She had positive patch tests to nickel and cobalt in an evaluation for intermittent skin rash. At work, she had a normal forced expiratory flow in 1 s (FEV(1)) but moderate airway hyperresponsiveness. Bronchial provocation tests (BPT) were obtained. RESULTS: On BPT, an isolated early response was observed after a 1-min inhalation of dry algae powder, with a 50% fall in FEV(1) after exposure; the control BPT with lactose powder was negative. CONCLUSIONS: We report a case of algae-powder-induced OA. Such responses could be due to a sensitization to algae proteins or metal contaminants bioabsorbed by the vegetal particles.     

Evidence-based decision making in an endoscopy nurse with respiratory symptoms exposed to the new ortho-phthalaldehyde (OPA) disinfectant

BACKGROUND: ortho-Phthalaldehyde (OPA) can cause mucous irritation, respiratory symptoms and IgE-mediated hypersensitivity reactions. Very little information is available about OPA-related effects in health personnel. AIM: To report the decision-making process for the case of an endoscopy nurse complaining of cough and burning of the nose and throat during OPA exposure at work. METHODS: The problem focused on the relationship between OPA exposure and the respiratory symptoms and was investigated using an evidence-based (EB) medicine paradigm. RESULTS: A literature search was performed using the database Medline and the search engine Google. Papers and guidelines were assessed for their suitability in the EB case identification of suspected occupational asthma (OA). A multistep approach suggested by a guideline was considered most appropriate for practical use. The nurse shared the decision-making process and underwent evaluation of the clinical suspicion index and interventions for diagnosis of OA. Despite the high clinical suspicion index, the diagnosis of OA was excluded and any work restriction was avoided. Health surveillance follow-up showed a good clinical outcome and prompt recovery from respiratory symptoms after improvement of environmental control measures. CONCLUSION: The case study shows that the implementation of EB guidelines provides the occupational physician with an appropriate decision-making process for the identification and management of workers with suspected OA. Screening out of OA is highly relevant because diagnosis of disease requires removal from exposure and frequently impacts negatively on worker employment.     

Prevention of occupational asthma--practical implications for occupational physicians

BACKGROUND: Occupational factors have been estimated to contribute to approximately 10% of adult-onset asthma and occupational asthma (OA) is one of the most common occupational lung diseases in industrialized areas. Persistent asthma frequently occurs with significant socio-economic impacts. METHODS: A literature search was performed using PubMed. The key term searched was occupational asthma combined with prevention. RESULTS: Primary prevention has been effective for OA related to natural rubber latex, and may have reduced the incidence of diisocyanate-induced asthma. Medical health surveillance has been effective in settings such as the detergent enzyme industry, workers exposed to complex platinum salts and likely for diisocyanate workers in Ontario. Tertiary prevention is still required for workers with OA and can improve prognosis. CONCLUSIONS: OA is potentially preventable. Sufficient studies have demonstrated the rationale and benefit of primary preventive strategies. Medical health surveillance programs combined with occupational hygiene measures and worker education have been associated with improved outcomes but further studies are needed to understand the optimum frequency and measures for such programs and to identify the separate contribution of the components. Until primary and secondary prevention is better understood and implemented, there will also remain a need for tertiary preventive measures.     

Future advances in work-related asthma and the impact on occupational health

Work-related asthma (WRA) and WRA-like conditions refer to all situations in which asthma or asthma-like syndromes occur or worsen in the workplace. This occurs in approximately 10% of all adult-onset asthma subjects. Occupational asthma (OA) is a specific type of WRA that is 'caused' by the workplace, being mediated either by an allergic process with a latency period or by a non-allergic irritant-induced mechanism. Personal asthma can also 'worsen' at work (work-aggravated or exacerbated asthma), the reasons, mechanisms, extent and consequences of this situation being unknown. The author reviews various aspects of WRA with an emphasis on OA (about which more is known) and proposes key issues that need to be further studied, proposed and applied in at-risk workplaces in order to improve recognition, diagnosis and management of this condition. OA represents a unique situation that, unfortunately, is only very rarely provided to health-care providers: affected workers can be cured with minimal impact on quality of life. All efforts should be made to achieve this goal at an affordable socio-economic cost.     

Mortality and cancer incidence in Ontario glass fiber workers

BACKGROUND: In a previous cohort study of glass fiber manufacturing, we found a significant increase in lung cancer. This study extends the follow-up period. METHODS: We conducted a historical prospective study of 2557 men employed in producing glass wool. We obtained work histories, causes and dates of death, and date and site of cancer diagnoses. We computed standardized mortality and incidence ratios (SMR, SIR). RESULTS: The overall SMR for lung cancer was 163 (95% CI = 118-221). The SMR did not vary consistently by duration of employment and time since first employment. However, plant workers with >20 years' employment and >40 years since first exposure had an SMR for lung cancer of 282 (95% CI = 113-582). The SMR dropped with later date of first exposure, but the trend was non-significant. There was an unexpected overall increase in kidney cancer incidence. DISCUSSION: The increase in lung cancer is greater than in other cohorts of glass fiber workers. Since exposure data are lacking from the early years of the plant, we cannot state if the excess was due to glass fibers, other work exposures or other reasons.     

Environmental and biological monitoring of traffic wardens from the city of Rome

A molecular epidemiological study on Roman policemen is ongoing. The results of a first assessment of the occupational exposure to aromatic compounds of 66 subjects engaged in traffic control and of 33 office workers are presented in this paper. Passive personal samplers and urinary biomarkers were used to assess exposure to benzene and polycyclic hydrocarbons during work shifts. The results obtained indicate that benzene exposure in outdoor workers is about twice as high as in office workers (geometric mean 7.5 and 3.4 micrograms/m3, respectively). The distribution of individual exposure values was asymmetrical and skewed toward higher values, especially among traffic wardens. Environmental benzene levels recorded by municipal monitoring stations during work shifts (geometric mean 11.2 micrograms/m3) were in the first instance comparable to or greater than individual exposure values. However, several outlier values were observed among personal data that greatly exceeded average environmental benzene concentrations. Among the exposure biomarkers investigated, only blood benzene correlated to some extent with previous exposure to benzene, while a seasonal variation in the excretion of 1-hydroxypyrene and trans-muconic acid was observed in both study groups. In conclusion, these results suggest that outdoor work gives a greater contribution than indoor activities to benzene exposure of Roman citizens. Moreover, relatively high-level exposures can be experienced by outdoor workers, even in the absence of large-scale pollution episodes.     

Musculoskeletal disorders in farmers and farm workers

Farming is a physically arduous occupation and this places farm workers at potential risk of musculoskeletal disorders such as osteoarthritis (OA) of the hip and knee, low back pain (LBP), neck and upper limb complaints, and hand-arm vibration syndrome (HAVS). This review considers the epidemiological evidence concerning such risks. The strongest evidence relates to OA of the hip, for which the public health impact is likely to be considerable. There is also weaker, but suggestive evidence that farmers more often have knee OA and LBP than workers in occupations with fewer physical demands. Tractor drivers, in particular, seem to have more LBP. Relatively little information exists on the risks of soft tissue rheumatism in the limbs and neck. For some outcomes, the link with occupational risk factors (such as heavy loading of joints and whole-body vibration) is sufficient to suggest the course that future prevention should take, but for several outcomes more research is first needed.     

The interpretation of zinc protoporphyrin changes in lead intoxication: a case report and review of the literature

BACKGROUND: Zinc protoporphyrin (ZPP) has been used both as a screening and diagnostic test for overexposure to lead for nearly 30 years, although limitations for both purposes are recognized. METHODS: We present longitudinal findings for ZPP and whole-blood lead in a man with two episodes of acute lead intoxication and review the literature on the use of ZPP. RESULTS AND CONCLUSIONS: ZPP elevations in both chronic and acute exposure settings lag behind elevations in whole-blood lead by approximately 8-12 weeks. Therefore, ZPP measurement, in conjunction with whole-blood lead determination, has clinical utility in cases of substantial overexposure by providing information on how long an individual may have been overexposed to lead. A guide to the interpretation of various combinations of whole-blood lead and ZPP results is provided. However, while ZPP levels do correlate with whole-blood lead measurements in aggregate, the considerable individual variability of ZPP measurements, poor sensitivity at lower ranges of lead exposure, poor specificity and delayed changes in unstable exposure conditions indicate that this test contributes little to screening programs. Finally, our results confirm that basophilic stippling is seen in acute as well as chronic lead intoxication, and may provide the first indication of lead intoxication.     

Analysis of the clinical state of patients with occupational asthma following cessation of exposure to allergens

The purpose of this study was to evaluate the health state of patients with occupational asthma after cessation of occupational exposure to bakery allergens. A follow-up study of 56 subjects with occupational asthma was carried out. Subjects were examined twice: 1-6 months after removal from occupational exposure and 36 or 48 months later. Clinical state analysis both at diagnosis and re-examination was performed with the use of a questionnaire. Functional spirometric tests and skin prick tests and/or specific serum IgE were carried out during both examinations at points of time at which the subjects regarded their asthma symptoms as least severe. According to the subjective evaluation of the patients' clinical state, some improvement could be noticed 36 or 48 months after removal from work. Forced expiratory volume in one second (FEV1) and peak respiratory flow (PEF) did not change significantly. Total serum IgE concentration decreased in only two subjects, but the mean value of total IgE level did not significantly differ at the first and second examination after the cessation of occupational exposure. There was no significant difference in the number of positive skin prick tests to common and occupational allergens between the first and second examination. The majority of patients with occupational asthma reporting subjectively on their symptoms indicated an improvement in their clinical state 2-3 years after removal from occupational exposure. The intensity of skin prick tests was not reduced in the studied group. Non-specific bronchial hyper-responsiveness was not reduced in the majority of subjects with occupational asthma at least 2 years after cessation of occupational exposure.     

Cardiovascular effects of occupational exposure to carbon disulphide

The objective of this study was to investigate the effect of occupational exposure to carbon disulphide (CS2) on the total cholesterol, blood pressure and prevalence of coronary heart disease (CHD). A cross-sectional study involving 252 viscose rayon workers and 252 age and sex matched controls was carried out. Depending on the job and specific work place, the CS2 concentrations were between 10 and 64 mg/m3. A cumulative exposure index (CS2 index) was calculated for each worker by multiplying the number of years he had held a particular job with the CS2 concentrations in that job. CHD prevalence among the exposed was higher than among the controls; the difference reaching significance only for highly exposed workers. Cholesterol levels were significantly higher in both highly and moderately exposed groups. In conclusion, the results demonstrated that occupational exposure to CS2 increases total cholesterol and the risk for CHD. While the risk for CHD is increased in workers exposed to high CS2 concentration for many years (CS2 index > or = 300), even the relatively modest exposure (CS2 < 300) may increase the serum cholesterol.     

A follow-up study on the association of working conditions and lifestyles with the development of (perceived) mental symptoms in workers of a telecommunication enterprise

AIM: This study investigated the association of working conditions and lifestyle with mental health in Japanese workers. METHODS: A follow-up study was carried out in the Kanto district of Japan of workers in a telecommunications enterprise who received their first annual health check-up between 1992 and 1996 and were between 20 and 54 years old. Workers who reported mental symptoms, had a past history of disease, or current illness at their first check-up were excluded from the analysis. In total, the study included 23 837 workers. The association between working conditions and lifestyle and the development of mental symptoms was investigated by pooled logistic regression analyses. RESULTS: Working long hours and part-time work, as opposed to normal daytime hours of work, were factors associated with the development of mental symptoms in males, as were smoking, short sleeping hours, little physical exercise, rarely taking three meals a day, frequently eating within 1 h before sleep, much preference for salty meals and little preference for vegetables. Consumption of alcohol was negatively associated with the development of mental symptoms in males. Overall, the results suggested that the lower the Healthy Work and Lifestyle Score, the higher the risk of developing mental symptoms. CONCLUSIONS: Working conditions and lifestyle, especially food preferences, have an apparent influence on the mental health of Japanese workers. Moreover, the Healthy Work and Lifestyle Score indicates that working conditions and lifestyle appear to have a cumulative influence upon the mental health of Japanese workers.     

Silicosis in Turkish denim sandblasters

BACKGROUND: Sandblasting of jeans in small Turkish workshops has recently been recognized as a cause of silicosis. CASE SERIES: Between August 2004 and March 2006, we admitted 16 young men with a history of working in small workplaces producing sandblasted jeans. Of these, 14 presented with respiratory symptoms and the remaining two through awareness of their work colleagues. In the first two cases, open-lung biopsy was required to confirm the diagnosis of silicosis. Later cases were diagnosed through a combination of their work history and the clinical and radiological findings. The mean age at presentation was 23 years with mean duration of employment as a sandblaster being 3 years. The first two cases died and the remainder, except two, are still receiving treatment. CONCLUSION: The production of sandblasted jeans in small uncontrolled workplaces may entail significant exposure to silica and the development of rapidly fatal silicosis. Urgent action is required to prevent further cases and mortality.     

Window renovation and exposure to lead--an observational study

BACKGROUND: Renovation of windows in old houses has recently established itself as an industry. A recognizable occupational lead exposure exists, which has not been studied previously. AIM: To compare lead exposure amongst window renovators with other groups of lead-exposed workers. METHODS: Using blood lead results measured at the Health and Safety Laboratory (HSL), Sheffield, comparisons were made between three cohorts: window renovation workers, all male workers monitored by HSL during the period 1999-2001 and 63 male subjects involved in chemical paint-stripping of wood. RESULTS: Both the window renovation and the wood-stripping cohorts show significantly higher blood lead distributions than the 'all workers' cohort (P < 0.001). A similar pattern was also found for comparison of the prevalence of subjects above the UK suspension level of 60 microg/dl (2.89 microM) (window renovation, P < 0.001; wood-stripping, P < 0.0001). Blood lead results at or above the suspension level in wood-strippers were significantly higher compared to window renovators (P = 0.034). CONCLUSION: Window renovation is shown to present a potential for significant lead exposure, and suspension from work under The Control of Lead at Work Regulations 2002. Two groups of risk factors predominate: the well-documented potential for release of lead from old paint, and the peripatetic nature of the work.     

Absenteeism and mortality of workers exposed to electromagnetic fields in the French Electricity Company

The objective of this study was to describe the health status of electricity workers exposed to electromagnetic fields during their job. Two groups of exposed workers were studied from 1978 to 1993: the live line workers (n = 121) and the substation workers (n = 232.7) of the French Electricity Company (EDF). A control group was randomly selected from all the company non-management male employees; one control for each exposed subject was matched for the first year of employment. Absenteeism indices and mortality rates were computed and compared in the exposed and control groups. The absence rates were 1.98% in the substation workers and 2.5% in the control group (p < 0.001) and 2.7% in the live-line workers and 2.8% in the control group (NS). No effect of the length of exposure was found. However the medical causes of sickness absence were different: exposed employees had less psychiatric and respiratory diseases but more accidents at work than their control group. Relative risks of accidents at work were 1.2 95% confidence interval (CI) = 1.08-1.33[ for substation workers and 3.22 (CI = 1.78-5.88) for live line workers. EDF electromagnetic field exposed workers seemed not to be affected by any specific health problems except for an excess of accidents at work.     

Q fever in Ireland. A seroprevalence study of exposure to Coxiella burnettii among Department of Agriculture workers

OBJECTIVES: To estimate the risk of exposure to Coxiella burnettii among 'at risk' workers in Ireland. METHODS: A cross-sectional seroprevalence study, using the complement fixation technique (CFT), was carried out among technical and support staff of the Department of Agriculture in Ireland (n = 375). Participants were divided into low- (n = 34), moderate- (n = 158) and high-risk (n = 83) groups according to the likelihood of occupational exposure. A result of <1:8 on CFT was accepted as normal, i.e. no evidence of past exposure to the causative organism, C. burnettii. Participants with titres of 1:16 were clinically assessed for evidence of past or present infection and interviewed regarding the possibility of non-occupational exposure. RESULTS: The participation rate was 75% (n = 281). Overall, 24 of the 281 participants (8.5%, 95% confidence interval = 5.6-12.4%) tested positive (titres = 1:8). No statistically significant difference existed between the three groups (low, 8.8%; moderate, 9.5%; high, 7.2%). Of those reviewed (n = 10), no evidence of either past or present clinically significant illness was detected. Possible non-occupational exposure was identified in two cases. CONCLUSION: Laboratory evidence of past exposure to Q fever is common amongst readily identifiable 'at risk' occupational groups in Ireland, and appropriate preventative steps are warranted. Employees who do not have direct exposure to animals or animal products, but who work in a high risk environment appear to have a similar risk of exposure C. burnettii. Although clinical illness appears to be rare, health care workers should consider the possibility of Q fever in cases of unexplained illness arising in those working in 'high risk' environments.     

Occupational molybdenum exposure and a gouty electrician

BACKGROUND: Molybdenum is an essential trace element and a component of xanthine oxidase, which catalyses the formation of urate. The toxicity of molybdenum in humans is considered to be low, but hyperuricaemia and gout-like symptoms have been observed sporadically. METHODS: A case of hyperuricaemia and gouty arthritis in a young man with occupational exposure to molybdenum is described. Improvement during an exposure-free period was followed by a relapse after a reconstruction designed to quantify his molybdenum exposure. CONCLUSION: This case seems to represent the first observation of gout associated with occupational molybdenum exposure, but the association might also be entirely circumstantial.     

Racial discrimination, ethnicity and work stress

BACKGROUND: Previous research has suggested higher work stress among minority ethnic workers. AIMS: To determine levels of work stress in three ethnic groups, consider the contribution of racial discrimination to the groups' profiles of occupational and demographic associations with stress, and assess the association between work stress and well-being. METHODS: A household quota sample design was used, and 204 black African-Caribbean, 206 Bangladeshi and 216 white (UK born) working people took part in structured interviews. RESULTS: More black African-Caribbean respondents reported high work stress than either Bangladeshi or white respondents. Reported racial discrimination among black African-Caribbean female respondents was strongly associated with perceived work stress. Among the black African-Caribbean respondents, women who reported experiencing racial discrimination at work had higher levels of psychological distress. CONCLUSIONS: Perceived work stress may be underpinned by exposure to racial discrimination at work among black African-Caribbean women, and this may affect their psychological well-being.     

Superior orbital 'petrositis' and late ischaemic monocular blindness induced by intense UV radiation exposure

Many physical agents cause neuropathies. The most common are chronic pressure, vibration and temperature. In general, these lesions occur at work, as a result of accidents or through chronic exposure to the physical agent. Radiation leading to peripheral neuropathy is also related to radiotherapy in cancer treatment, as an undesirable side-effect. We present here a case report of short, intense UV radiation exposure at work, leading to delayed-onset ocular neuropathy. A clear cause-effect relationship is shown, demonstrated using magnetic resonance imaging scans. We suggest that the mechanism was thermal and ischaemic.     

Course of symptoms and median nerve conduction values in workers performing repetitive jobs at risk for carpal tunnel syndrome

BACKGROUND: Carpal tunnel syndrome (CTS) is a common occupational disorder associated with repetitive manual work. Little information exists about the possible relation between the variation of biomechanical hand/wrist exposure and the development of symptoms and median nerve conduction values. AIMS: To investigate the prevalence of CTS in a group of workers exposed to intensive use of the hands and the course of symptoms and median nerve conduction values after a period of reduced exposure to biomechanical risk factors. METHODS: CTS was assessed in assembly and non-assembly line workers by means of clinical examinations and nerve conduction studies (NCS). Ergonomic analysis was conducted for each assembly line workstation. RESULTS: Prevalence of CTS was significantly higher in assembly line workers compared to non-assembly line workers but there was a high prevalence of median nerve conduction abnormalities in both groups (60/102 hands and 40/110 hands, respectively). In a sizable proportion of both groups there was no relationship between symptoms and electrodiagnostic findings (45 hands and 48 hands in assembly and non-assembly line workers, respectively). When assembly line workers were re-examined after 2 years following a period of reduced work schedule, a significant proportion reported resolution of symptoms or had reverted to having normal NCS. CONCLUSIONS: In our study, repetitive work was associated with a higher level of CTS and abnormal NCS. These findings appeared to be reversible following a period of less repetitive work. Overall, there was generally poor correlation between symptoms and electrodiagnostic findings.     

Perceived work ability of home care workers in relation to individual and work-related factors in different age groups

This study analysed the relationship between age and items of the Work Ability Index (WAI) among 19- to 62-year-old female home care workers (n = 636). The first significant decrease in work ability occurred between the ages of 40 and 44 years, and a second, sharper decrease occurred after 55 years of age. The subjects' physical work ability deteriorated as early as 35 years of age. In addition, current work ability, number of diagnosed diseases and work impairment due to diseases proved to be the most age-sensitive measures of work ability. The subjects who perceived their health status as poor had the highest risk for poor work ability. Moreover, the age-adjusted odds ratio indicated that the WAI was strongly associated with age and musculoskeletal and psychosomatic symptoms. Ergonomics, possibilities to control one's own work, time pressure and management were the features of work that predicted work ability. The study demonstrated the need to promote the work ability of home care workers early in working life. Among both older and younger workers, preventive measures should focus on the above-mentioned factors.