ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Recently, elevated dioxin levels, over 5 parts per trillion (ppt) 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), from Agent Orange was reported in 95% of 43 selected residents of Bien Hoa City, a city in southern Vietnam near a former air base used for Agent Orange-spraying missions. Agent Orange herbicide, contaminated with TCDD, was sprayed in Vietnam between 1962 and 1971 primarily for use as a defoliant. Typical blood TCCD levels are 2 ppt in Vietnamese, but levels are as high as 413 ppt in Bien Hoa City. Elevated TCDD was found in children born many years after Agent Orange spraying ended and in immigrants from non-Agent Orange-sprayed parts of Vietnam, which documented new exposures. Extremely elevated soil TCDD samples, over 1 million ppt, and elevated TCDD in sediment were found in some nearby areas such as Bien Hung Lake. The primary route of intake of almost all dioxins in humans is food. However, in our prior studies in Bien Hoa, food was unavailable for dioxin analysis so the route of intake was not confirmed. In the 1970s, while Agent Orange was still being sprayed, elevated human milk TCDD levels as high as 1850 were detected in milk from Vietnamese people living in Agent Orange-sprayed areas where consumption of fish was high. Furthermore, also in the 1970s, elevated TCDD levels (up to 810 ppt) were found in fish and shrimp from the same area as the milk donors. In the 1980s, we found elevated TCDD and also other organohalogen levels in human tissue, pork, fish, a turtle, and a snake in Southern Vietnam. For these reasons, we recently collected food from Bien Hoa and analyzed it for dioxins, polychlorinated biphenyls (PCBs), DDT and its metabolites, and other organochlorines. We found marked elevation of TCDD, the dioxin characteristic of Agent Orange, in some of the food products, including ducks with 276 ppt and 331 ppt wet weight, chickens from 0.031–15 ppt wet weight, fish from 0.063–65 ppt wet weight, and a toad with 56 ppt wet weight. Usual TCDD levels in food are less than 0.1 ppt. Total TEQ for ducks was from 286–343 ppt wet weight or 536 ppt and 550 ppt lipid; for chickens from 0.35–48 ppt wet weight or 0.95–74 ppt lipid, for fish from 0.19–66 ppt wet weight or 3.2 ppt and 15,349 ppt lipid, and the toad was 80 ppt wet weight and 11,765 ppt lipid. Interestingly, this study did not find elevated levels of TCDD in the pork and beef samples. Clearly, food, including duck, chicken, some fish, and a toad, appears responsible for elevated TCDD in residents of Bien Hoa City, even though the original Agent Orange contamination occurred 30–40 years before sampling. Elevated levels of PCBs and DDT and its metabolites were found in some food samples. Furthermore, measurable levels of hexachlorocyclohexanes (HCH) and hexachlorobenzene (HCB) were found in a wide range of measurable levels. All of the 11 dioxin-like PCBs measured and presented plus 6 dioxins in addition to TCDD and 10 dibenzofurans contributed to the total dioxin toxicity (TEQ). However, when elevated, TCDD frequently contributed most of the TEQ. Thirty-six congeners from 7 classes of chemicals were measured in each of the 16 specimens providing a total of 576 congener levels.

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Explain whether and how corporate drug costs were related to major demographic features of bank employees in this study.Identify those lifestyle-related risk factors—ascertained using a health risk appraisal instrument—that significantly influenced pharmaceutical costs.State which of the biological risk factors examined were—and which were not—associated with increased drug expenditures.Specify how employees’ perceptions of their own health and quality of life may influence corporate drug costs.This study demonstrates the relationship between self-reported health risk factors on a health risk appraisal and pharmaceutical expenditures for a large employer. A total of 3554 employees who were participants in a pharmacy benefit plan for the entire year of 2000 completed a health risk appraisal. As the number of self-reported health risk factors increased from zero to six or more, corporate pharmaceutical costs increased in a stepwise manner: $345, $443, $526, $567, $750, $754, and $1121, respectively. After controlling for age, gender, and the number of self-reported diseases, each additional risk factor was associated with an average annual increase in pharmacy claims costs of $76 per employee. Specific health risks were associated with significantly higher expenditures. The results provide estimates of incremental expenditures associated with common, potentially modifiable risk factors. Pharmaceutical expenditures should be considered by corporations in their estimates of total health-related costs and in prioritizing disease management initiatives based on health risk appraisal data.

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Compare the effects of integrated case management and usual care on patient satisfaction in employees with work-related upper extremity disorder (WRUED), and consider the implications of higher levels of satisfaction.Describe those patient-related and work-related factors that predict the severity of upper limb symptoms and the degree of functional limitation 6 and 12 months after intervention.Enumerate the factors influencing the interval before return to work in employees with WRUED who are managed by traditional or integrated case management.An integrated case management (ICM) approach (ergonomic and problem-solving intervention) to work-related upper-extremity disorders was examined in relation to patient satisfaction, future symptom severity, function, and return to work (RTW). Federal workers with work-related upper-extremity disorder workers’ compensation claims (n= 205) were randomly assigned to usual care or ICM intervention. Patient satisfaction was assessed after the 4-month intervention period. Questionnaires on clinical outcomes and ergonomic exposure were administered at baseline and at 6- and 12-months postintervention. Time from intervention to RTW was obtained from an administrative database. ICM group assignment was significantly associated with greater patient satisfaction. Regression analyses found higher patient satisfaction levels predicted decreased symptom severity and functional limitations at 6 months and a shorter RTW. At 12 months, predictors of positive outcomes included male gender, lower distress, lower levels of reported ergonomic exposure, and receipt of ICM. Findings highlight the utility of targeting workplace ergonomic and problem solving skills.

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Review the ways in which mortality rates in autoworkers differ from those in the general US population.Describe how standardized mortality ratios in autoworkers relate to gender, race, and duration of employment.Discuss the implications of these findings for occupational influences on mortality in this study population.We evaluated mortality among 198,245 motor vehicle industry workers during the period of 1973 to 1995. Workers’ mortality rates were lower than expected overall (40,131 observed/43,859 expected deaths, standardized mortality ratio [SMR] = 92, CI = 91–92) and for all major cause of death categories except cancer (SMR = 100, CI = 98–102). Mortality rates were higher than expected for lung cancer overall (SMR = 110, CI = 107–113) and among employees in transmission/gear manufacturing (SMR = 121, CI = 112–130), casting operations (SMR = 122, CI = 110–135), engine manufacturing (SMR = 111, CI = 101–123), and vehicle assembly (SMR = 111, CI = 105–117); for stomach cancer in engine manufacturing (SMR = 147, CI = 110–192); and for prostate cancer in casting operations (SMR = 128, CI = 102–158). Excesses of lung cancer in transmission, vehicle assembly, and casting operations and of stomach cancer in engine manufacturing have been observed in other investigations. Further information on employees’ occupational exposures and personal attributes is required to clarify the interpretation of these results.

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Temporal factors and the prevalence of exposure to transient risk factors for occupational traumatic hand injury were analyzed among 1166 subjects participating in a case-crossover study. Temporal factors included time of injury and elapsed time to injury since the start of the work shift. Transient exposures included work equipment, work practice, and worker-related factors. The highest frequency of injury was observed from 08:00 am to 12:00 pm (54.6%), with a peak from 10:00 to 11:00 am (14.9%). The median time into the work shift for injury was 3.5 hours. Subjects injured 2 to 3 hours into their work shift most often reported using a machine, tool, or work material that performed differently than usual (23.9%). These results suggest that acute hand injuries occur earlier in the workday and safety programs should place increased vigilance on these times.

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The methacholine challenge test protocol was assessed in the reanalysis of three occupational studies. We evaluated the impact of truncating the range of methacholine on responsiveness, as defined by slope and PC20.In original analysis, reactivity was similar for apprentices and auto body shop workers, whereas boilermakers were more responsive. Truncating high concentrations did not change the classification of subjects with PC20<8 or 16 in any population. However, when responsiveness was measured by slope, the mean responsiveness increased, from −7.9 to −15.3 for apprentices and −7.2 to −10.0 for auto-body shop workers. Results support the American Thoracic Society’s recommended maximum of 16 mg/mL and provide evidence that extending the dose range beyond that does not increase sensitivity, whereas stopping before 16 may exaggerate response. Furthermore, to ensure validity, neither slope nor PC20should be extrapolated beyond data.

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This study investigated risk factors for laceration injuries among workers employed in line-paced manufacturing assembly operations. Most lacerations (76% of 576) occurred on the hands and fingers (grouped as “hand” lacerations). On average, 37% of surveyed workers reported at least one laceration to the hand in the preceding year, resulting in an overall hand laceration rate of 83 per 100 workers per year. An inverse relationship was found between level of job routinization and hand lacerations, with progressively higher rates of hand lacerations occurring among workers assigned to less routine (more variable) work patterns. Fabricated metal parts handling and job variability may be related to increased risk of hand lacerations in line-paced work environments where personal protective equipment is the primary strategy to control exposure to sharp objects.

ISSN:1076-2752    

出版商:OVID    

年代:2003

数据来源: OVID