ISSN:0271-3586    

DOI:10.1002/ajim.4700210302

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractByssinosis has been compensable in the Republic of South Africa (RSA) since 1973. The legal and administrative provisions for byssinosis compensation are reviewed. A series of 32 cases of presumed byssinosis was submitted to the compensation authorities by the authors. Identical reports were submitted to an independent medical panel. The findings and outcomes in these cases are presented and compared. Seventeen of the 32 claims initially received compensation and four were subsequently accepted following appeals. Analysis of the medical basis of decision making indicated that seven claims were refused and at least four had their awards reduced as a consequence of inconsistent decisions. Arguable decisions resulted in five claims being refused and one award being reduced. Our experience illustrates problems inherent in the compensation system in South Africa. Initiation of a claim is expensive relative to wages in the industry, and awards are low since they are linked to wages (mean $60.47 per week). Processing of a claim took a mean of 13.8 months, while appeals for refusal to compensate took a further 29.8 months. It is argued that consensus medical definitions of compensable occupational disease should be used routinely and that provision must be made to facilitate entry of claimants into the compensation system.

ISSN:0271-3586    

DOI:10.1002/ajim.4700210303

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractIn sarcoidosis and idiopathic pulmonary fibrosis, it has been reported that lymphocyte proportions in lung lavage predict the subsequent clinical course. Recent evidence has suggested that lymphocytes are important in the alveolitis of asbestosis. We hypothesized that a greater relative proportion of T‐lymphocytes in lung lavage of asbestos‐exposed subjects is associated with immune activation and may predict the subsequent clinical course. We assessed lymphocyte subsets in lung lavage and peripheral blood (PB) of 97 asbestos‐exposed subjects and 10 unexposed normals, using flow cytometry analysis of monoclonal antibody‐treated cells. T‐cell alveolitis was defined as follows: [%lymphocytes in lavage × %CD3 in lavage]>2 SD above that product in normals. Eighteen subjects had T‐cell alveolitis (group 1) and 79 did not (group 2). There were no significant differences between the groups in age, smoking status, duration of exposure, lung function results, or frequency of plaques or profusion ≥ 1/0. Percent CD2 was higher in lavage of group 1 compared with group 2. There was a trend for higher %Ia in lavage of group 1 compared with group 2. These results identify a subgroup of asbestos‐exposed subjects with T‐cell alveolitis but no present excess of asbestos‐related disease who may be at risk for future asbe

ISSN:0271-3586    

DOI:10.1002/ajim.4700210304

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractThis retrospective follow‐up study evaluated the mortality experience of 4,323 men employed at a plant in Alabama (AL) that manufactures agricultural and other chemicals. On average, there were 18 years of follow‐up per subject during the study period of 1951 to 1987. The observed numbers of deaths among cohort members were compared with the numbers expected on the basis of United States (US) and AL general population mortality rates. The all causes standardized mortality ratio (SMR), computed using US rates as the referent, was 97 (233 observed/240 expected deaths) for whites and 68 (47/69) for blacks. White subjects had more than expected deaths from buccal cavity and pharynx (BCP) cancer [SMR = 388; 95% confidence interval (CI) = 125–905] and from esophageal cancer (SMR = 417; 112–1,067). Their lung cancer mortality rate was 50% higher than the rate of US white men and 14% higher than the rate of AL white men. Each of these three cancers has strong nonoccupational determinants, the roles of which were not assessed and which may have been responsible in whole or in part for the observed increases. The excesses of lung and esophageal cancer were concentrated among short‐term employees, an observation which also argues against a causal link with occupational factors. Black men experienced no increased mortality from BCP, esophageal or lung cancers, but results for blacks were imprecise. For white and black subjects combined, there were 3 observed versus 0.62 expected deaths due to soft tissue sarcoma (p = 0.05). The job histories of subjects with this type of cancer did not suggest any shared occupational

ISSN:0271-3586    

DOI:10.1002/ajim.4700210305

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractOccupational medicine programs use medical surveillance tests to measure physiologic parameters that may be affected by workplace exposures. Surveillance tests can detect early detrimental changes before workers manifest recognizable symptoms. Hepatic function testing is one type of surveillance test used to monitor workers exposed to hepatotoxins. However, a significant proportion of these test reports return showing abnormal hepatic function without a readily apparent etiology. Follow‐up investigation of abnormal liver enzyme tests is a commonly encountered problem in occupational medicine clinics. The algorithm proposed in this paper will outline a systematic approach for investigating abnormal hepatic function tests from asymptomatic worker

ISSN:0271-3586    

DOI:10.1002/ajim.4700210306

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractTo assess the feasibility of using hospital records for occupational disease surveillance and to evaluate the quality of the industry/occupation (I/O) information available in these records, the computer file of all discharge diagnoses from a large health maintenance organization during 1985 was reviewed. The frequencies of discharge diagnoses previously listed as Sentinel Health Events (Occupational), or SHE (O), were calculated and three possible SHE(O) diagnoses—lung cancer, bladder cancer, and toxic hepatitis—were selected for further review. Outpatient charts of patients discharged for each diagnosis were abstracted with regard to I/O information and the discharged patients were interviewed by telephone to obtain a lifetime occupational history. The accuracy of the I/O information obtained from the hospital chart was compared to that obtained by patient interview by number of digits matched on standard classification codes. The frequencies of matches for occupation and industry were greater for “usual” than for “last” categories with both cancer diagnoses, but were similar for “usual” and “last” categories with toxic hepatitis. To assess the proportion of each possible SHE(O) diagnosis that was related to workplace exposures, the I/O information obtained by interview was rated in a blinded fashion by an experienced occupational medicine physician. The highest probability ratings for work‐relatedness were noted for lung cancer, primarily due to asbestos exposure. The results of this study suggest that hospital records can be used to identify possible SHE(O); if adequate I/O information is available, then work‐relatedness can be assessed. However, the accuracy of I/O obtained from hospital charts is relatively low. The efficient and accurate collection of I/O information from hospital records will require the use of a simple, easily coded instrument to be routinely ad

ISSN:0271-3586    

DOI:10.1002/ajim.4700210307

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractBlood superoxide dismutase (SOD) and plasma malondialdehyde (MDA) (an indicator of lipid peroxidation [LPO]) were determined in 97 randomly selected asbestos exposed workers (age range: 25–60 years, mean duration of exposures 19.8 ± 8.3 years) and in 42 healthy male controls. MDA, SOD, and MDA/SOD ratio in asbestos exposed workers were significantly higher than in controls. Among both the controls and exposed workers neither age nor smoking was related to SOD or MDA levels. SOD was significantly positively correlated with MDA among the exposed workers. Such correlation was not observed among the controls. SOD but not MDA was significantly positively correlated with the duration of exposure to asbestos. Mean levels of SOD or MDA in exposed workers with radiographic signs of lung fibrosis or pleural thickening did not differ significantly from those without such signs. The results confirm the possible involvement of LPO and development of anti‐oxidant mechanism(s) of prolonged exposure to asbestos in humans. However, SOD seems not to be the essential anti‐asbestos‐induced LPO. Relation between these factors and lung fibrosis is still

ISSN:0271-3586    

DOI:10.1002/ajim.4700210308

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractWe describe two cases of hard metal pulmonary disease (one fatal) in workers employed in the same area of a metal coating plant using the detonation gun process for applying a durable metal surface to metal parts. In this form of welding, a mixture of powdered metals, including tungsten carbide and cobalt, is heated by ignition of a flammable gas and propelled from the end of the “gun” at high temperature and velocity to form a welded metal coating. This process is done in an enclosed chamber and with each application, large volumes of fine aerosols are created. Inhalation exposure to hard metal may occur during the mounting and removal of the metal parts between applications, in spite of engineering controls and industrial hygiene surveillance. One of the cases presented with minimal chest x‐ray abnormalities and an obstructive pattern on pulmonary function testing, although subsequent open lung biopsy showed diffuse interstitial pulmonary fibrosis. The fact that two cases of hard metal pulmonary interstitial disease occurred where thorough exposure control procedures and a surveillance program for cobalt were in place may indicate the need for revisions of the current technology used when hard metal is applied in the detonation gun pr

ISSN:0271-3586    

DOI:10.1002/ajim.4700210309

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractRecently, many British Columbia sawmills stopped using traditional chlorophenate anti‐sapstain fungicides and substituted 2‐(thiocyanomethylthio) benzothiazole (TCMTB) and copper‐8‐quinolinolate (Copper 8). We conducted a cross‐sectional study with two aims: to ascertain which acute health effects, if any, were associated with the use of the substitute fungicides; and to determine the effectiveness of first‐aid records as a means of detecting acute health outcomes. Workers in five coastal sawmills were asked to complete a self‐administered questionnaire about symptoms considered potentially related and unrelated to fungicide exposure, and about injuries commonly reported in sawmills. In addition, we collected first‐aid records from the mills, and asked senior workers to estimate the duration of exposure to fungicides for each job.Symptoms found to be consistently elevated in TCMTB mills included dry skin around the eyes, blood‐stained mucus from the nose, nose bleed, peeling skin, burning or itching skin, and skin redness or rash. No symptoms were consistently elevated in the Copper 8 mills. Symptoms related to TCMTB exposure were recorded only 12 times in first‐aid logs during the study period (versus 335 questionnaire self‐reports). This low symptom‐recording frequency may be a function of established patterns of first‐aid use in which illness symptoms are reported less

ISSN:0271-3586    

DOI:10.1002/ajim.4700210310

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractThis paper analyzes the role of threshold limit values (TLVs) in national air pollution policy during the 1980s, a period in which the Environmental Protection Agency (EPA) sought to delegate to individual states the authority to evaluate and regulate airborne toxic substances. We focus on 20 carcinogens and 11 substances with non‐genotoxic health effects that were regulated by local air toxics programs using TLVs. Data from EPA's National Air Toxics Information Clearinghouse indicate that maximum TLV‐based Ambient Air Level guidelines (AALs) frequently exceed minimum TLV‐based AALs by a factor of>1,000. Cancer potency data from EPA's Integrated Risk Information System suggest significant risks remain at TLV‐based AALs. Cancer risks at the median TLV‐based AAL exceed 1,000 cases per million exposed persons for cadmium (1,040), nickel and its compounds (1,420), propylene oxide (1,550), coke oven emissions (1,860), benzene (2,500), arsenic and its compounds (7,300),N‐nitrosodimethylamine (21,000), asbestos (21,500), and ethylene dibromide (55,000). We also summarize published studies that report non‐genotoxic health effects in workers exposed at levels near the TLV for 11 substances whose AALs were based on TLVs. Contrary to the assumption frequently made by state air toxics program, TLVs cannot be taken to represent no observed effect levels (NOELs) for regula

ISSN:0271-3586    

DOI:10.1002/ajim.4700210311

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY