Occupational impairment and disability among applicants for Social Security disability benefits in Pennsylvania

OBJECTIVE

The study goal was to assess the extent of workplace-related disease and injury among Social Security Disability Insurance applicants.

METHODS

A convenience sample of 240 consecutive applicants to the Pennsylvania Bureau of Disability Determination was studied to assess the prevalence of work-related disorders. An applicant had a work-related condition if there was a clear statement of a workplace illness or injury associated with the impairment, or if the applicant had worked at an occupation with a high likelihood of exposures known or suspected to contribute to the condition of interest.

RESULTS

Of the 240 applicants, 166 (69%) were awarded disability insurance benefits; a total of 27 (11%) had work-related conditions, including 14 of the 166 (8%) who were found to be disabled. Forty percent of the 27 had a disorder that was musculoskeletal in origin. Of 59 applicants with cancer, 10.2% had some work-related etiological component. Of an estimated 71,680 adult disability insurance applicants in Pennsylvania in 1990, 5134 new insurance beneficiaries had a projected occupationally related disability.

CONCLUSIONS

A substantial number of applicants for disability insurance benefits suffer from an impairment caused or exacerbated by prior workplace exposures. These individuals may serve as sentinel events for initiating follow-up surveillance and prevention activities.

Neurobehavioral test methods for environmental health studies of adults

The Agency for Toxic Substances and Disease Registry convened a workshop in Atlanta, GA, that evaluated approaches and methods to ascertain whether there are neurobehavioral sequelae to children and adults exposed to hazardous substances in the environment. This article, developed from that Workshop, recommends testing methods [to identify neurotoxic insult] for immediate use in environmental health field studies of adults. A list of broad functional domains or modalities affected by chemicals was identified from the occupational and related literature (learning and memory, coding, sustained attention, higher intellectual function, strength, coordination, speed, vision, somatosensory, and affect). A core set of tests was selected that should assess those functions with the greatest demonstrated sensitivity to established neurotoxic chemicals, and a secondary set was selected to assess a broader group of functions. The core tests should be used in all investigations where neurotoxic effects would be targeted for identification; secondary tests would be used where suggested by questionnaire or symptom data or by knowledge of the effects of chemicals at the hazardous waste site.

Residential proximity to electricity transmission and distribution equipment and risk of childhood leukemia, childhood lymphoma, and childhood nervous system tumors: systematic review, evaluation, and meta-analysis

In 1979, Wertheimer and Leeper reported an increased risk of cancer mortality among children living near 'electrical wiring configurations' suggestive of high current flow. Since then, numerous, often inconclusively small, investigations with conflicting results have studied the possible association between exposure to electric and magnetic fields (EMF) and health effects. The high prevalence of exposure to EMF has drawn attention to the issue of carcinogenesis. We report here the results of a meta-analysis of 13 epidemiologic studies of residential proximity to electricity transmission and distribution equipment and risk of childhood leukemia, lymphoma, and nervous system tumors. The combined relative risks for leukemia, lymphoma, and nervous system tumors are 1.49 (95 percent confidence interval [CI] = 1.11-2.00); 1.58 (CI = 0.91-2.76); and 1.89 (CI = 1.34-2.67) respectively. The reports of the primary studies were evaluated for epidemiologic quality and adequacy of exposure assessment. We found no statistically significant relation between combined relative risk estimates and 15 indicators of epidemiologic quality. Assessment of EMF exposure in the primary studies was found to be imperfect and imprecise. Additional high quality epidemiologic research, incorporating comprehensive assessments of EMF exposure collected concurrently with surrogate measures of exposure, is needed to confirm these results.

Hemolytic anemia following succimer administration in a glucose-6-phosphate dehydrogenase deficient patient

Because of its favorable side effects profile, the oral chelating agent dimercaptosuccinic acid is often used for treatment of lead intoxication. We report a case of a 45-year-old black male with glucose-6-phosphate dehydrogenase deficiency and a 17 year history of occupational lead exposure who developed hemolysis during treatment with dimercaptosuccinic acid for symptomatic lead intoxication.

Dimercaptosuccinic acid in the treatment of depression following lead exposure

Long-term exposure to lead is known to cause a variety of neurotoxic manifestations, including symptoms of depression. Dimercaptosuccinic acid (DMSA), a recently approved oral chelating agent, can diminish the body burden of lead, but few cases of documented clinical improvement following treatment have been reported. We report a case of moderate to severe depression in a long-term lead worker that appeared to respond dramatically to DMSA. This response suggests a possible therapeutic role for DMSA in the treatment of depression in lead-exposed patients.

Decrements in neurobehavioral performance associated with mixed exposure to organic and inorganic lead

In 1990, 222 current employees of a chemical facility in the eastern United States that manufactured tetraethyl lead were administered a neurobehavioral test battery, tests of olfactory function and peripheral vibration threshold, and questionnaires that assessed neuropsychiatric symptoms. A cumulative variable of exposure to inorganic and organic lead was derived from 12 years of personal industrial hygiene sampling data and an occupational history interview that assessed work in each of 29 exposure zones in the lead area. The range of assigned exposure intensities in these 29 zones was 4-119 micrograms/m3 for organic lead and 1-56 micrograms/m3 for inorganic lead. Cumulative lead exposure and exposure duration were defined as categorical variables (four groups) in multiple linear regression models. The adjusted mean differences in neurobehavioral test scores were estimated by comparing the average scores of the moderate, high, and highest exposure groups with the low exposure (reference) group. After adjustment for premorbid intellectual ability, age, race, and alcohol consumption, neurobehavioral test scores were poorer as measures of both cumulative lead exposure and exposure duration increased; many of the associations evidenced dose-response relations. Associations were observed in most cognitive and functional domains tested, but were most common in two domains: manual dexterity and verbal memory/learning. On the affected neuropsychologic measures, the groups with the highest exposure averaged scores 5-22% lower than those of the reference groups. Overall, the data revealed generally consistent and coherent associations between two measures of lead exposure and poorer neurobehavioral test performance.

An investigation of a workplace cluster of Bell's palsy

We undertook a study to confirm the existence of an apparent cluster of Bell's palsy in an industrial plant ("W4"), and to test etiologic hypotheses regarding chemical exposures, immune suppression, and infectious etiologies. Cases were enumerated by questionnaire. Employees with a history of Bell's palsy ("cases") were invited to participate in a study that included medical history, T cell studies, viral and Lyme disease serologies, and blink reflex studies. Thirty-three unaffected volunteers from W4 and 32 from a comparison building were also tested. Extensive environmental studies were carried out in W4, evaluating infectious, chemical, and radiation exposures. The lifetime incidence of self-reported Bell's palsy was 11.6/10,000 person-years (P-Y) in W4 and 2.4 cases/10,000 P-Y in the comparison building (RR = 4.8, P < .05); the comparison rate was similar to that reported in previous population studies. When restricted to cases occurring after the onset of work, the W4 incidence was 29.2 cases/10,000 P-Y, compared to 4.8 cases/10,000 P-Y in the comparison building (RR = 6.1, P < .05). The cases and noncases did not differ with respect to clinical histories or infectious disease titers. The W4 noncases had small but significant decreases in T lymphocyte (1974 +/- 86 vs 2291 +/- 103) and CD4 (1083 +/- 318 vs 1459 +/- 494) counts compared to the remote noncases. The cases had significantly prolonged RR1, LR1, and LFC values compared to both groups of noncases. No medical or environmental factors were identified that could explain an excess of disease.

Investigation of a reported cluster of bladder cancer cases in the Pottstown/Phoenixville area of Pennsylvania

A urologist in Phoenixville, Pennsylvania, noted an apparent excess of invasive bladder cancer cases in his practice area during 1988 and 1989. Background incidence data for the local area were derived from state Cancer Registry statistics. Seventeen additional cases were noted during review of local hospital tumor registry data. Exposure evaluation included complete occupational histories for 15 index cases and correlation of residential histories with a review of local industries, water quality data, and toxic waste sites. The data were compared with incidence data from 1984 and 1985, and no increase in bladder cancer incidence for this area in 1988 and 1989 was evident. There was, however, a higher bladder cancer incidence among white males in the study area and Chester County, compared with Pennsylvania as a whole. Residential histories and environmental analysis did not reveal a common environmental carcinogen. A high incidence of occupational exposure to suspected bladder carcinogens was noted. In addition, all but 4 of the index cases smoked cigarettes. The study was limited by an extreme paucity of water supply analysis data. Effective environmental monitoring would promote more effective research into environmental carcinogenesis.

Occupational health and safety in Brazil

BACKGROUND

Brazil is the world's fifth largest and sixth most populous nation. Its economy is varied, with strong manufacturing, agriculture, mining, and service sectors. Therefore, a wide variety of workplace hazards confronts its work force. This paper describes Brazil's occupational safety and health regulatory scheme, workers' compensation system, plant-level practices, training, and data collection.

METHODS

We reviewed and analyzed Brazilian regulatory legislation and government and non-governmental organization (NGO) activity in occupational safety and health, as well as the structure and function of the workers' compensation system. We also reviewed available data on injuries and diseases from major sources, including the now-defunct Instituto Nacional do Previdencia Social (INPS) and the workers' compensation scheme, Seguro de Acidente de Trabalho (SAT).

RESULTS

The incidence of workplace injuries has decreased in recent years and is now reported to be about 5 per 100 workers per year. The case fatality rate has been constant at about 5 fatalities per 1000 injuries. Less than 6% of reported injuries are classified as "diseases." Brazil's rates are comparable to those of Mexico and Zimbabwe, and two to four times higher than in most industrialized countries.

CONCLUSIONS

Brazil has a high incidence of occupational injuries and diseases; these injuries and diseases are underreported; there is a large informal sector at special risk; and Brazil illustrates the disparity that exists in many countries between legislation on the books and legislation that is actually implemented.

Costs of occupational injury and illness in Pennsylvania

A variety of state and federal data sources are used to estimate two critical components of the annual economic costs of occupational injuries and illnesses in Pennsylvania: foregone earnings of affected workers and medical costs. Foregone earnings costs resulting from occupational injuries and illnesses are estimated at between $1.22 billion and $2.02 billion in 1988. A number of potential adjustments to these estimates widen the range considerably. Estimates of medical costs range from $740 million to $797 million. Combining these two estimates gives total estimated costs of $1.96 billion to $2.82 billion.

Cost-effectiveness analysis of mass screening for breast cancer in Japan

The official Japanese recommendation for breast cancer screening is physical examination by a physician, in contrast to US recommendations of mammography. In this analysis of breast cancer screening, the authors used Japanese data in a cost-effectiveness model to compare the following five strategies: (1) no screening (N); (2) physical examination alone (PE); (3) mammography (MG); (4) PE followed by MG if PE findings were abnormal (PE----MG); and (5) PE combined with MG for all screened women (PE + MG). None of these programs would save medical expenditures. The total discounted net costs per patient (in US dollars) were as follows: N, +54; PE, +412; MG, +517; PE----MG, +340; and PE + MG, +731. The number of years of life saved per cohort of 100,000 asymptomatic Japanese women would range from 708 (PE----MG) to 3724 (PG + MG). The additional cost of each strategy (compared with N) per additional year of life would be +49,700 for PE, +40,400 for PE----MG, +14,300 for MG, and +18,000 for PE + MG. The least costly screening option (PE----MG) does not have the lowest cost per additional year of life saved (MG does). MG would be preferable to the current Japanese recommendation of PE alone.

Occupational and environmental health in eastern Europe: challenges and opportunities

As the nations of Eastern Europe undergo political and economic transitions, they face considerable occupational and environmental health challenges. Although occupational health services are relatively well developed, environmental health services and policies are not. There are major needs in the areas of education and training, supplies and equipment, and policy development. In addition, privatization poses a variety of new challenges and dangers to occupational and environmental health. This commentary discusses the challenges that face Eastern European nations, and describes opportunities for collaboration among scientists, policymakers, labor, management, and community groups in the United States and Eastern Europe.

Radiologic detection of pleural thickening

The purpose of this study was to investigate four aspects of the radiologic detection of pleural thickening: the specificity of chest X-rays read by B readers, the effects of threshold definitions of positivity, the extent of variability among different X-ray readers, and the effect of film quality. A series of 421 chest X-rays corresponding to consecutive autopsies was reviewed by six B readers working independently and using modified International Labour Organization forms. The prevalence of true pleural thickening was approximately 6%. Using a strict definition of positivity, the average specificity was 0.85. Specificity decreased when a more liberal definition was used. (The average sensitivity was 0.32, which appeared to increase with a more liberal definition of positivity; because of small numbers of true positives, the sensitivity estimates were unstable.) Kappa statistics for interreader agreement ranged from 0.06 to 0.40, suggesting considerable interreader variability. Decreasing film quality was associated with decreasing sensitivity, but specificity was not affected by film quality. Because the chest X-ray has suboptimal test characteristics in the diagnosis of pleural thickening and because there is considerable interreader variability, we conclude that caution is required in interpreting radiologic detection of pleural thickening using ILO procedures.

Asthma in respiratory therapists

STUDY OBJECTIVE

To test the hypothesis that work as a respiratory therapist is associated with an increased risk of developing asthma.

DESIGN

Cross-sectional questionnaire study comparing respiratory therapists with controls (physical therapists and radiologic technologists). Subsequent validation of reported asthma with methacholine challenge studies.

SUBJECTS

All respiratory therapists and physical therapists and a random 50% sample of radiologic technologists working in the state of Rhode Island as of June 1986.

METHODS

All subjects received a mail questionnaire with questions about the presence or absence of asthma, time of onset, and important covariates. Responses were analyzed for all subjects, and again after excluding those subjects with pre-existing asthma. Subjects who reported physician-diagnosed asthma were asked to have methacholine challenge testing.

RESULTS

Respondents included 194 respiratory therapists (response rate, 69.5%) and 517 controls (response rate, 75.3%). After excluding respiratory therapists from the hospital at which the hypothesis was generated, there were 34 respiratory therapists (18.7%) and 30 controls (5.8%) reporting physician-diagnosed asthma. After controlling for age, smoking status, family history, atopic history, and other covariates using logistic regression, respiratory therapy carried an odds ratio of 3.2 (95% CI, 1.9 to 5.5). With analysis restricted to those who developed asthma after entering their profession, the odds ratio for respiratory therapy was 4.6 (95% CI, 2.0 to 10.4). In the validation study, 10 of 14 respiratory therapists (71%) and 6 of 10 controls (60%) had evidence of bronchial hyperreactivity.

CONCLUSIONS

These results suggest a previously unrecognized excess of asthma in respiratory therapists. The excess develops after entry into the profession, and does not appear to be explained by confounding, information bias, or selection bias.

An overview of Japanese occupational health

This paper provides an overview of Japanese occupational health and evaluates the current situation from three perspectives. Major occupational health hazards are assessed using four sources of data, showing patterns similar to those found in other advanced industrial societies. Institutional structures for occupational health policy are then examined, illustrating strengths and weaknesses of the Japanese legal and administrative systems. Trade union activities are presented, indicating the constraints of enterprise unions, and the tendency for a greater orientation toward compensation than prevention. Significant occupational health problems persist among marginal workers in Japan, including women and various minority groups. The analysis demonstrates a record for occupational health in Japan considerably more mixed than the conventional view.