Roles of age, length of service and job in work-related injury: a prospective study of 63,620 person-years in female workers

BACKGROUND

The roles of age, length of service and job in various work-related injury types are unknown and deserve investigations among female workers. This study assessed their roles in the occurrence of injury.

METHODS

Three-year prospective study of all 22,952 permanently employed women at the French national railway company: 63,620 person-years, 756 injuries with working days lost, coded using the company's injury classification derived from that of the French health insurance scheme. We investigated the incidence of four types of injury: fall on same level, fall to lower level, materials/equipment/objects handling, and other injuries. Data were analyzed using negative binomial regression.

RESULTS

Workers aged <25 were subject to a higher risk for all types of injuries. Older workers (45-55 years) were subject to a higher injury risk for fall on same level and fall to lower level. For fall on same level as for fall to lower level the relative risk decreased steadily with increasing length of service with the company, from 1.60 for 1 year to 0.50-0.60 for ≥30 years. For injuries due to materials/equipment/objects handling the relative risk decreased from 1.05 for one year to 0.49 for 5-9 years, and then increased to about 1.50 for 20-29 years and ≥30 years.

CONCLUSIONS

Younger and shorter lengths of service were at risk for various types of injuries. Higher length of service was at risk for injury due to materials/equipment/objects handling. Preventive measures should consider the respective risks associated with age, years of employment and job.

Social disparities in musculoskeletal disorders and associated mental malaise: findings from a population-based survey in France

AIMS

Various types of musculoskeletal disorders (MSDs) have comorbid mental disorders, which may in turn have a negative influence on disease course and role impairment, but the contribution of social factors to this type of comorbidity is a much under-researched area. This study investigates whether there is a socially patterned association of MSDs with different dimensions of mental malaise.

METHODS

The sample included 3,368 economically active participants aged 18-64 years, randomly selected from the Lorraine region in north-eastern France. Information was provided through a post-mailed questionnaire on fatigue, sadness/depression (Duke questionnaire) and cognitive disability during the last eight days.

RESULTS

MSDs were significantly more prevalent in manual workers, clerks and other occupations than in upper and intermediate professionals, and similar occupational disparities were found for cognitive disability, fatigue and sadness/ depression. Stratifying the sample, we found the occupational disparities in cognitive disability to be much stronger among participants suffering from MSDs than among participants not suffering from MSDs, and the occupational disparities in fatigue and sadness/depression to be limited to the subsample of subjects suffering from MSDs.

CONCLUSIONS

The findings demonstrate that the association of MSDs with mental malaise is much stronger in the lower occupational groups than in the higher groups. Given that psychological factors are implicated in disease prognosis and in the development of disabilities, awareness of the social dimension of the association and treatment of the comorbid mental disorders could open a promising avenue for reducing social inequalities in disability related to MSDs.

Roles of age, length of service and job in work-related injury: a prospective study of 446 120 person-years in railway workers

OBJECTIVES

Because work-related injuries are common and yet the mechanisms through which various types of injuries relate to age, length of service and job remain unknown, this study assessed the role of age, length of service and job in work-related injury.

METHODS

Prospective study of all 164,814 permanently employed male workers at the French national railway company during 1998-2000, based on the company's injury database: 446,120 person-years, 15,195 injuries with working days lost, coded using the company's injury classification, which is derived from that of the French health insurance scheme. We investigated the incidence of 10 types of injury: fall on same level, fall to lower level, handling materials/machine parts during assembly, handling objects, lifting/handling equipment, collision with/by moving objects, collision with/by vehicles, operating machines/equipment, using hand tools and other injuries. Data were analysed using negative binomial regression.

RESULTS

Workers aged <25 years were subject to a higher injury risk from handling materials/machine parts during assembly, and collision with/by moving objects or vehicles. Older workers, especially those aged 50-55 years, were subject to a higher risk of fall and injury resulting from lifting/handling materials/equipment/objects or from collision with/by moving objects/vehicles. Using hand tools was a risky task for workers aged <30 or > or =40 years. The relative risk decreased steadily with increasing length of service with the company, from 2.6 for 1 year to 1.0 for > or =30 years, and the slope of the trend is stronger for fall to lower level, lifting/handling materials/equipment and collision with/by moving objects.

CONCLUSION

Younger and older ages and shorter length of service are at risk for various types of injuries. Preventive measures should improve working conditions, especially for younger/older ages, provide knowledge through specific training during the first years in a job and help workers to be more aware of risks associated with their age, years of employment and job.

Impaired neuromotor functions in hospital laboratory workers exposed to low levels of organic solvents

Solvents are ubiquitous in industrial societies in a wide range of processes, and long-term exposure to these organic compounds may impair neuromotor functions such as equilibrium function. However, there is limited knowledge of effects on posture and gaze control after organic solvent exposures below workplace threshold limit values. The aim of this study was to evaluate the consequences of low-level co-exposure to organic solvents on balance and gaze control in hospital laboratory workers. Twelve hospital laboratory female subjects mainly exposed to toluene and ethanol, with median exposure duration of 24 years, and 12 non-exposed female controls were submitted to posturography and oculomotricity testings including sensory organization and motor control tests and saccade and smooth pursuit tests. Although current measured exposure values to toluene and ethanol were much below workplace threshold limit values (current median exposure levels of 32.5 mg/cubic meter and 39.9 mg/cubic meter, respectively), exposed workers displayed a weaker balance and a less precise gaze control. They presented, on the one hand, a reduced ability to resolve sensorial conflict situations compared to controls, particularly when situations were managed by the vestibular information, and, on the other hand, longer saccadic reaction time. Organic solvents might have an impact on vestibular pathways involved in postural control and exert a depressant central pathway effect implicated in the management of oculomotor response. Evaluating balance control in sensory conflicting situations and saccadic reaction time is proposed as a way to reveal subclinical neurotoxicological effects due to low-level exposure to organic solvents.

Association of physical job demands, smoking and alcohol abuse with subsequent premature mortality: a 9-year follow-up population-based study

This study assessed the relationships of physical job demands (PJD), smoking, and alcohol abuse, with premature mortality before age 70 (PM-70) among the working or inactive population. The sample included 4,268 subjects aged 15 or more randomly selected in north-eastern France. They completed a mailed questionnaire (birth date, sex, weight, height, job, PJD, smoking habit, alcohol abuse (Deta questionnaire)) in 1996 and were followed for mortality until 2004 (9 yr). PJD score was defined by the cumulative number of the following high job demands at work: hammer, vibrating platform, pneumatic tools, other vibrating hand tools, screwdriver, handling objects, awkward posture, tasks at heights, machine tools, pace, working on a production line, standing about and walking. The data were analyzed using the Poisson regression model. Those with PM-70 were 126 (3.81 per 1,000 person-years). The leading causes of death were cancers (46.4% in men, 57.1% in women), cardiovascular diseases (20.2% and 11.9%), suicide (9.5% and 7.1%), respiratory diseases (6.0% and 4.8%), and digestive diseases (2.4% and 4.8%). PJD3, smoker, and alcohol abuse had adjusted risk ratios of 1.71 (95% CI 1.02-2.88), 1.76 (1.08-2.88), and 2.07 (1.31-3.26) respectively for all-cause mortality. Manual workers had a risk ratio of 1.84 (1.00-3.37) compared to the higher socio-economic classes. The men had a two-fold higher mortality rate than the women; this difference became non-significant when controlling for job, PJD, smoker and alcohol abuse. For cancer mortality the factors PJD3, smoker, and alcohol abuse had adjusted risk ratios of 2.00 (1.00-3.99), 2.34 (1.19-4.63), and 2.22 (1.17-4.20), respectively. Health promotion efforts should be directed at structural measures of task redesign and they should also concern lifestyle.

Associations of job, living conditions and lifestyle with occupational injury in working population: a population-based study

OBJECTIVES

To assess the roles of job demands, living conditions and lifestyle in occupational injury.

METHODS

The sample included 2,888 workers, aged > or =15 years, randomly selected from the north-eastern France. The subjects completed a mailed questionnaire. Data were analyzed with adjusted odds ratios (ORa) computed with the logistic model.

RESULTS

In total, 9.2% of workers had an injury during the previous 2 years. The high job demands: tasks at height, handling objects, pneumatic tools, other vibrating hand tools, work in adverse climate, physical workload, vibrating platform, machine tools, cold, heat, awkward posture, noise, hammer, and pace had crude odds ratios between 1.81 and 5.25 for injury. A strong exposure-response relationship was found between the cumulated job demands (CJD, defined by their number) and injury: OR 1.88 (95% CI 1.23-2.87) for CJD1, 4.39 (2.98-4.46) for CJD2-3, and 9.93 (6.70-14.7) for CJD > or = 4, versus CJD0. These ORs decreased to 1.68, 3.70, and 7.15 respectively, when adjusted for sex, age, and living conditions/lifestyle confounders; and to 1.54, 2.99, and 5.45 respectively when also adjusted for job category. The following factors had significant ORa: age <30 years (1.54, 1.12-2.12), male (1.64, 1.18-2.30), smoking (1.60, 1.22-2.10), musculoskeletal disorders (1.54, 1.17-2.04), and frequent drug use for fatigue (2.03, 1.17-3.53). The workmen, farmers/craftsmen/tradesmen, and foremen had a 5.7-8.7-fold while the clerks and technicians a 2.7-3.6-fold higher risk compared with upper class. The risk associated with CJD was twofold higher among the workers aged > or =40 or with frequent drug use for fatigue compared with the others. Obesity had ORa 2.05 (1.11-3.78) among the subjects aged > or =40, and excess alcohol use had ORa 2.44 (1.26-4.72) among those free of disease.

CONCLUSIONS

This study identified a wide range of job demands and living conditions/lifestyle which predicted injury. Preventive measures should be conducted to reduce job demands and to help workers to be aware of the risk and to improve their living conditions/lifestyle.

Relationships of physical job tasks and living conditions with occupational injuries in coal miners

This study assessed the relationships of job tasks and living conditions with occupational injuries among coal miners. The sample included randomly selected 516 underground workers. They completed a standardized self-administred questionnaire. The data were analyzed via logistic regression method. The rate of injuries in the past two years was 29.8%. The job tasks with significant crude relative risks were: power hammer, vibrating hand tools, pneumatic tools, bent trunk, awkward work posture, heat, standing about and walking, job tasks for trunk and upper/lower limbs, pain caused by work, and muscular tiredness. Logistic model shows a strong relationship between the number of job tasks (JT) and injuries (adjusted ORs vs. JT 0-1: 2.21, 95%CI 1.27-3.86 for JT 2-6 and 3.82, 2.14-6.82 for JT>or=7), and significant ORs>or=1.71 for face work, not-good-health-status, and psychotropic drug use. Musculoskeletal disorders and certain personality traits were also significant in univariate analysis. Therefore job tasks and living conditions strongly increase the injuries, and occupational physicians could help workers to find remedial measures.

Contributions of occupational hazards and human factors in occupational injuries and their associations with job, age and type of injuries in railway workers

OBJECTIVES

To assess the contributions of environmental hazards, technical dysfunctions, lack of work organization, know-how and job knowledge, and other human factors in occupational injuries and their relationships with job, age and type of accidents in railway workers.

METHODS

The sample included 1,604 male workers, having had at least one occupational injury with sick leave during a 2-year period in voluntary French railway services. A standardized questionnaire was filled in by the person-in-charge of prevention, with the injured worker. Data analysis was performed via the chi(2) independence test and adjusted odds ratios (OR) with Mantel-Haenszel test.

RESULTS

The environmental hazards were implicated in 24.7%, technical dysfunctions in 16.0%, lack of work organization in 13.7%, lack of know-how in 17.6%, lack of job knowledge in 5.2%, and the other human factors in 31.9% of occupational injuries. The injuries caused by lack of know-how or job knowledge were more represented in workers aged less than 30 (ORs adjusted for job 1.45, 95% CI 1.02-2.06 and 2.06, 1.22-3.49, respectively), those by environmental hazards in energy and electrical traction maintenance operators and train drivers (ORs adjusted for age 2.04, 1.16-3.58 and 1.80, 1.01-3.20, respectively), and those by lack of work organization in mechanical maintenance operators and in energy and electrical traction maintenance operators (ORs adjusted for age 2.24, 1.13-4.45 and 1.83, 1.30-2.57, respectively). The causes considered were strongly related with the type of injuries.

CONCLUSIONS

This study found that environmental hazards, technical dysfunctions, lack of work organization, lack of knowledge and other human factors had important contributions in injuries, and they were related to job, age and type of injuries. These findings are useful for prevention. Training is necessary for young workers. The occupational physician could help the workers to be more aware of the risks.

Determinants of accident proneness: a case-control study in railway workers

BACKGROUND

Accident proneness or workers who have more frequent occupational injuries is common but the role of occupational and individual factors has rarely been studied.

AIM

To assess the relationships of certain occupational and individual characteristics with frequency of occupational injuries.

METHOD

This case-control study included 1305 male workers with occupational injuries during 1999-2000 and 1305 controls from a railway company. A standardized questionnaire was completed by the occupational physician in the presence of the subject. The data were analysed using logistic regression.

RESULTS

Having more than one injury was associated with short service in the present job, younger age, sleep disorders, smoking, requesting a job change, physical disability and lack of physical activity. Safety training was negatively related to injury frequency. Short service in the present job was the only significant factor for single injuries.

CONCLUSION

This study identified a number of work and individual factors that predicted occupational injury frequency and may be useful in designing preventative measures. Occupational physicians could assist workers to be more aware of the risks and to find remedial measures.

Prevalence of sensory and cognitive disabilities and falls, and their relationships: a community-based study

This study assessed the prevalence of sensory and cognitive disabilities and falls for various age groups, sexes, and socio-occupational categories, and their associations in the Lorraine population. The sample included 6,159 subjects, aged 15 years or more, randomly selected from the Lorraine population. They filled in a mailed questionnaire including socio-demographic characteristics, job, falls with physical injuries at the time of the survey, and sensory and cognitive disabilities. Data analysis was made via the adjusted odds ratios. The prevalences of sensory and cognitive disabilities were 3.0 and 4.7%, respectively, that of falls with physical injuries 2.4%: 1.2% for falls on the same level and 1.2% for falls to a lower level. Subjects aged over 70 were markedly affected, but the other age groups had relatively high prevalences as well; the workmen had the highest prevalence, followed by the foremen, farmers, craftsmen and tradesmen, and employees. A twofold risk independently of age, sex and job was found for the subjects with sensory or cognitive disabilities for all falls combined. These findings show the high prevalences of sensory and cognitive disabilities and falls with physical injuries, and their strong associations in the general population. Preventive measures are needed to detect and follow up the persons with these disabilities, limit their risk of falls and reduce occupational hazards.

Long-term exposure to solvents impairs vigilance and postural control in serigraphy workers

OBJECTIVES

To investigate the effects of solvent exposure (mainly aromatic hydrocarbons) on central regulation of vigilance and postural control, particularly in occasional difficult situations that provide sensorial conflicts.

METHODS

Twenty-two workers occupationally exposed to solvents for an average of approximately 6 years and 21 controls were compared by the use of a questionnaire on their state of vigilance and quality of sleep and on performance measurements of postural control under six different sensorimotor conditions. Their current median exposure levels to aromatic hydrocarbons was 80.1 mg/m(3).

RESULTS

Exposed workers reported reduced alertness but not disturbance of sleep quality compared with controls. Moreover, they had the worst postural performance in all sensory conditions and demonstrated a reduced ability to resolve sensory conflict situations. The precision of stance was clearly affected by solvent exposure in contrast with energy consumption required to regulate proper balance control.

CONCLUSIONS

The depressive effect of aromatic hydrocarbon exposure on cortical and subcortical structures controlling vigilance and postural stability could lead to increased risk of occupational accident, especially due to falls. The detection of central neurotoxic effects by posturographic and vigilance tests could be useful in preventive strategies.

Chronic exposure to anesthetic gases affects balance control in operating room personnel

Exposure to anesthetic gases is known to alter certain structures and functions of the central nervous system. As the effects of long-term exposure on balance control mechanisms have been the subject of few investigations, these were evaluated in 53 operating room personnel exposed to anesthetic gases and in 53 non-exposed individuals. Balance control was assessed by static and dynamic posturography. Exposed workers had the worst static and dynamic postural performances, particularly in the eyes closed condition, suggesting increased dependency on vision and decreased use of proprioception. This poorer ability to modify the weight and to switch the different cues controlling balance suggests central information processing disorders. By impairing information and its central integration, exposure to anesthetics gases leads to inappropriate organization of sensorimotor stabilization strategies.

Correlates of occupational injuries for various jobs in railway workers: a case-control study

Few studies have simultaneously addressed the role of occupational factors, individual characteristics and living conditions in occupational injuries, and to the best of our knowledge none on railway workers. This survey assessed the roles of these factors in various types of injuries and for various jobs in French railway workers. This case-control study was conducted on 1,305 male workers with an occupational injury during a one-year period and 1,305 male controls. A standardized questionnaire was administrated by an occupational physician. Data were analyzed by the logistic regression method. The significant factors found for all the injuries combined were: young age (<30 yr) (adjusted odds ratio 1.47, 95% CI 1.01-2.14), 5 yr or less in present job (1.43, 1.15-1.78), sleep disorders (1.30, 1.08-1.57), current smoker (1.27, 1.08-1.50), and no do-it-yourself or gardening activity (1.23, 1.02-1.48). Young age, sleep disorders, and smoking were common for several types of injuries. The role of these factors differed between various job categories. Among injured workers sick leaves of eight days or over were more frequent in current smokers and overweight subjects. In conclusion, young age, lack of experience, job dissatisfaction, sleep disorders, smoking, and lack of physical activity increase the risk of occupational injuries. The risks induced were related with jobs. Preventive measures concerning work conditions and these factors could be conducted in railway workers generally, and especially in workers most at risk. The occupational physician could make workers more sensitive to these risks and help them to improve their living conditions during medical examinations.

Relationships of job and some individual characteristics to occupational injuries in employed people: a community-based study

This study assessed the associations of job and some individual factors with occupational injuries among employed people from a general population in north-eastern France; 2,562 workers were randomly selected from the working population. A mailed auto-questionnaire was filled in by each subject. Statistical analysis was performed with loglinear models. The annual incidence rate of at least one occupational injury was 4.45%. Significant contributing factors for occupational injuries were job category (60.8%), sex (16.2%), regular psychotropic drug use (8.5%), age groups (7.5%), and presence of a disease (7.0%). The men had higher risk than the women (adjusted odds-ratio 1.99, 95% CI 1.43-2.78). Compared to executives, intellectual professionals and teachers, labourers had the highest risk (6.40, 3.55-11.52). They were followed by farmers, craftsmen and tradesmen (6.18, 2.86-13.08), technicians (3.14, 1.41-6.70), employees (2.94, 1.59-5.48) and other subjects (3.87, 1.90-7.88). The young (< or = 29 yr) showed an increased risk. Similar odds-ratios were observed for regular psychotropic drug use (1.54, 1.16-2.05) and the presence of a disease (1.50, 1.11-2.02). Univariate analysis showed that smoking habit, overweight and excess alcohol use were also associated with injuries. The loglinear model results showed that there were associations between some of these independent factors. It was concluded that job, sex, young age, smoking habit, excess alcohol use, overweight, psychotropic drug use, and disease influenced the occupational injuries. Preventive measures concerning work conditions, risk assessment and job knowledge should be conducted in overall active population, especially in men, young workers, smokers, alcohol users, overweight workers and in individuals with a disease or psychosomatic disorders.

Sensorial organisation favouring higher visual contribution is a risk factor of falls in an occupational setting

The contribution of intrinsic balance control factors to fall mechanisms has received little investigation in studies on occupational accidents. The aim of this study was to assess whether postural regulation in falling workers might have specificities in terms of sensorimotor strategies and neuromuscular responses to balance perturbations. Nine multi-fall-victims (MF), 43 single-fall-victims (SF) and 52 controls (C) were compared on performance measurements of static and dynamic postural control. MF and SF had the worst postural performance both in the static and slow dynamic tests, particularly in eyes closed conditions, suggesting a high dependency on visual cues and a lower use of proprioception. Moreover, the sensorial analysis showed that MF and SF relied less on vestibular input in the development of balance strategy and had more difficulties in maintaining a correct upright stance when proprioceptive input was altered. Finally, MF showed longer latency responses to unexpected external disturbance. Overall, postural control quality increased in the order MF, SF and C. MF and SF adopted particular sensorimotor organisation, placing them at an increased risk of falling in specific sensory environments. Strategies incorporating visual information involve using the cognitive processes causing delayed and less accurate fall avoidance responses, in contrast to adaptative strategies based on proprioceptive and vestibular information.

Relationships between certain individual characteristics and occupational injuries for various jobs in the construction industry: a case-control study

BACKGROUND

There is little published about the role of individual characteristics in occupational injuries. Construction workers have a high rate of injury; we assessed 11 personal characteristics in this professional sector.

METHODS

A case-control study was conducted on 880 male workers who had had at least one occupational injury during a 2-year period and 880 controls. A questionnaire was administered by an occupational physician. Statistical analysis was made via logistic regression method.

RESULTS

Young age (<30 years), sleep disorders and current smoker influenced all the injuries combined. Sleep disorders and young age were common risk factors for several jobs. Physical disabilities and no sporting activity had a role in masons, and 5 years or less in present job in plumbers and electricians only. Sleep disorders influenced both the injuries with and without hospitalization; young age, current smoker, and physical disability influenced those without hospitalization only.

CONCLUSIONS

Young age, sleep disorders, smoking, disabilities, sporting activity, and experience influenced the occupational injuries. The risk for each worker depended on his job. Occupational physicians could inform the workers of these risks and encourage them to take remedial action.

Relationships of job, age, and life conditions with the causes and severity of occupational injuries in construction workers

OBJECTIVES

To assess the relationships of job, age, and life conditions with the causes and severity of occupational injuries in male construction labourers.

METHODS

The sample included 880 male construction workers having had at least one occupational injury with subsequent sick leave. The survey used a standardised questionnaire, filled in by the occupational physician in the presence of the subject: socio-demographic data, job, safety training, smoking habit, alcohol consumption, sporting activities, physical disabilities, hearing, vision, and sleep disorders. Statistical analysis was via the logistic regression method.

RESULTS

Logistic models showed that falls and injuries from the handling of objects or hand tools was similar for all jobs, while masons, plumbers and electricians had a higher risk of injury from moving objects, and carpenters, roofers and civil-engineering workers were more exposed to injury from construction machinery and devices. Age <30 was related to injury from hand tools [adjusted OR (95%CI) 2.20 (1.28-3.79)]; sleep disorders and hearing disorders to those from moving objects [ORs 2.29 (1.27-4.12) and 1.85 (1.01-3.41) respectively]; no sporting activity to those from the handling of objects [OR 1.54 (1.09-2.17)]; and being overweight to falls on the same level [OR 2.04 (1.30-3.21)] and falls to a lower level [OR 1.55 (1.13-2.13)]. Injuries from the handling of objects were less frequent in overweight workers [OR 0.62 (0.46-0.84)]. Injuries with hospitalisation or sick leave > or =60 days were associated with age > or =30 and hearing disorders.

CONCLUSIONS

The causes of injuries were related to jobs. Prevention through working conditions could be made against the revealed risks. The risks for each worker depended on age, body mass index, hearing disorders, sleep disorders, and sporting activities. The occupational physician could inform the workers of these risks and encourage them to practise sporting activities and reduce their hearing disorders and sleep disorders.

Falls and working individuals: role of extrinsic and intrinsic factors

Falls are frequent occupational accidents involving workers and lead to important social and economic consequences both for the individual and for the employer. Different factors can modify balance control and lead to falling, especially environment-related and individual factors. The literature would appear to indicate that there have been few studies on the intrinsic factors involving the mechanisms of generating falls. This review determines the main factors involved in the mechanisms of falling, whether related to the environment, work or the individual. Knowledge of the extrinsic and intrinsic factors contributing to the fall could allow securer environment planning and occupational conditions for employers, and the use of balance rehabilitation methods for individuals to reduce the risk of falls.

Influence of trauma induced by judo practice on postural control

Although high-level sports develop specific physiological and sensorimotor abilities involved in balance control, they also increase the risk of injuries. The influence on postural control of lower limb trauma induced by judo practice was examined in healthy and previously injured judoists (PIJ). During static and dynamic tests, performed with or without vision, PIJ achieved the best performances in maintaining proper balance, except for those with the most severe antecedents of trauma. The severity of the pathology appeared to be the most important parameter prejudicial to balance control while the location, frequency and diversity of trauma had only a modest impact. This shows that PIJ develop excellent sensory and cognitive adaptation abilities to constraints involving new patterns of compensation and of body scheme.

Occupational exposure to blood: search for a relation between personality and behavior

OBJECTIVE

To describe the behavior of French nurses after occupational exposure to blood (OEB); to study the reasons for not reporting an OEB to the occupational medicine service or the hospital authorities, and to explore the links between personality traits and both the risk of having an OEB and the likelihood of reporting it.

DESIGN

A descriptive and correlational study using a cross-sectional survey for data collection.

SETTING

Six nursing schools (four initial training institutes and two specialty training schools, one for surgical nurses and one for nurse anesthetists) and six hospitals in Lorraine.

PARTICIPANTS

942 nurses and 459 nursing students were approached, and 964 (69%) replied to the questionnaire.

METHODS

The participants received an anonymous two-part questionnaire. The first part explored the knowledge of the risk and Standard Precautions and collected details of the history of OEB. Reporting of OEB to the occupational medicine service or the hospital authorities and the nature of serological monitoring after OEB also were explored. The second part was composed of the Zuckerman sensation-seeking scale, exploring four areas: disinhibition, danger- and adventure-seeking, seeking new experiences, and susceptibility to boredom.

RESULTS

947 nurses were vaccinated against hepatitis B, but only 528 (56%) had checked that they were effectively immunized. Only 166 respondents (17%) stated they routinely used gloves during all procedures in which they were exposed to blood. There were 505 recorded OEB during the study period (0.24 per person per year). The most frequently reported OEB were those involving hollow needles (57%). Approximately one half (48.5%) of all OEB were reported. "Good local antisepsis immediately after the accident" was the reason most often given to justify nonreporting. Only 57% of OEB victims sought to determine the serological status of the source patient for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus immediately after accident. Only 40% and 31% of OEB victims checked their own HIV and HCV serostatus 3 and 6 months after OEB, respectively. Few staff adopted safer-sex measures after OEB, and some continued to donate blood in subsequent months. Logistic regression identified two variables significantly and independently linked to the risk of having at least one OEB in the 27 months preceding the date on which the questionnaire was completed: having a permanent position and having a higher degree of disinhibition. Taking into account the number of OEB during this period (Poisson regression), four variables were significantly and independently linked to the risk of having a larger number of OEB: having a permanent position; having a higher degree of disinhibition; being more susceptible to boredom; and having less nursing experience. In logistic regression, three variables emerged as being significantly and independently linked to reporting all OEB: younger age; having had at least one percutaneous injury (excluding splashes); and having lower susceptibility to boredom.

CONCLUSION

Nursing personnel continue to ignore or be unaware of many factors surrounding OEB, meaning that information and counseling must continue unabated. Knowledge of the risk, of the benefit of respecting Standard Precautions, and of the importance of notification and serological follow-up is still inadequate. Finally, certain personality traits, such as a high level of disinhibition and susceptibility to boredom, appear to be linked to the risk of OEB. Subjects strongly susceptible to boredom are less likely to report such accidents.

Occupational cancer in France: epidemiology, toxicology, prevention, and compensation

This article is a description of the current situation in France with regard to occupational cancer: research, prevention, and occupation. Toxicologic experiments are carried out using (italic)in vitro(/italic) and (italic)in vivo(/italic) tests, particularly using transgenic mice. Several epidemiologic studies have been conducted over the last decades: population-based case-control studies; mortality studies and cancer incidence studies carried out in historical cohorts of workers employed in the industry; and case-control studies nested in occupational cohorts. French ethical aspects of toxicologic and epidemiologic studies are described. The results thus obtained are used to establish regulations for the prevention and the compensation of cancers attributable to occupational exposure. This French regulation for prevention of occupational cancer involves several partners: (italic)a(/italic)) the states authorities, including labor inspectors, responsible for preparing and implementing the labor legislation and for supervising its application, particularly in the fields of occupational health and safety and working conditions; (italic)b(/italic)) the Social Security Organisation for the analysis of present or potential occupational risks based on tests, visits in plants, complaints or requests from various sources, and statistics. These activities are performed within the framework of the general French policy for the prevention of occupational cancer. This organization includes the National Institute for Research and Safety, particularly involved in research in the various fields of occupational risks--animal toxicology, biologic monitoring, exposure measurements epidemiology, psychology, ergonomy, electronic systems and machineries, exposure to chemicals, noise, heat, vibration, and lighting; and (italic)c(/italic)) companies where the regulation defines the role of the plant manager, the occupational physician, and the Health, Safety and Working Conditions Committee (comprising the manager, employees' representatives, the occupational physician, and the safety department) in dealing with any problem regarding safety, occupational hygiene, and working conditions. These organizations along with medical practitioners are involved with the compensation of occupational cancers. The regulation for compensation includes the tables of occupational cancer, the possibility of recognition of a cancer case when the requirements of the tables are not met, and the postprofessional follow-up of workers exposed to a carcinogenic agent.

Relationship between blood antioxidants and occupational exposure to polycyclic aromatic hydrocarbons in coke oven workers

BACKGROUND

We investigated if blood Cu++/Zn++ superoxide dismutase, glutathione peroxidase, and catalase activities are increased and total plasma antioxidant concentration is decreased in coke oven workers exposed to polycyclic aromatic hydrocarbons.

METHODS

Ninety-six coke oven workers participated in the study. Nonexposed workers (n = 105) were randomly sampled among power plant workers in the same age range. The examination included a questionnaire on health status, occupational history, smoking, and dietary habits. Blood samples completed the examination. Coke oven workers were classified into low-, middle-, and high-exposure groups based on the benzo[a]pyrene (B[a]P) air concentrations and were further classified into the categories "topside" and "non-topside," according to their proximity to the ovens.

RESULTS

Erythrocyte glutathione peroxidase activity increased with age (r = 0.18, P = 0.061) in power plant workers, whereas plasma glutathione peroxidase activity decreased with age (r = -0.18, P = 0.068) and erythrocyte glutathione peroxidase activity was inversely correlated with the number of cigarettes per day (r = -0.28, P = 0.08) in coke oven workers. Comparison of blood antioxidant enzyme activities and total plasma antioxidant concentration between coke oven and power plant workers showed that erythrocyte glutathione peroxidase activity was significantly lower in coke oven workers, even after adjustment for potential confounding factors. No differences were found either in other blood antioxidant enzyme activities or in total plasma antioxidant concentration between coke oven and power plant workers. Moreover, no trends toward decreased glutathione peroxidase activity among the three subgroups of B[a]P exposure were observed, and no differences either in blood antioxidant enzyme activities or in total plasma antioxidant concentration between the two groups of job categories were found.

CONCLUSIONS

Production of reactive oxygen species seems not to be increased in coke oven workers.

Relations between occupational exposure to coal mine dusts, erythrocyte catalase and Cu++/Zn++ superoxide dismutase activities, and the severity of coal workers' pneumoconiosis

OBJECTIVES

To better understand the relations between occupational exposure, blood antioxidant enzyme activities, total plasma antioxidant concentration, and the severity of coal workers' pneumoconiosis (CWP).

METHODS

Blood samples were obtained from miners without CWP exposed to low dust concentrations for > or = 4 years at the time of the study (n = 105), or exposed to high dust concentrations for > or = 14 years at the time of the study (n = 58), and from retired miners with CWP (n = 19). Miners without CWP were classified into three subgroups according to their estimated cumulative exposure to dust. Chest x ray films were obtained for each miner. Miners were classified in five subgroups according to their International Labour Organisation (ILO) profusion grades. Univariate tests were completed by multiple linear regression analyses.

RESULTS

The estimated cumulative exposure to dust was strongly positively related to erythrocyte catalase activity and strongly negatively related to Cu++/Zn++ SOD activity only in miners exposed to high dust concentrations for > or = 14 years at the time of the study (F tests p = 0.006 and p = 0.004 respectively). Moreover, catalase activity was strongly related to the severity of CWP expressed as five subgroups of ILO profusion grades (F test p = 0.003); the greatest difference in the mean values was found between the group of 1/1 to 1/2 ILO profusion grades and the group of 2/1 to 3/3 ILO profusion grades.

CONCLUSION

These results are in good agreement with the hypothesis that production of reactive oxygen species may be an important event in the exposure to coal mine dusts and the severity of CWP. Erythrocyte catalase and Cu++/Zn++ SOD activities are more closely related to recent exposure to high dust concentrations than to cumulative exposure, and could be considered as biological markers of exposure rather than as markers of early adverse biological effect.

Sick-building symptoms in office workers in northeastern France: a pilot study

STUDY OBJECTIVES

To verify that sick building symptoms are present in north-eastern France office workers; to try to identify new confounding factors.

METHODS

The design was that of a cross-sectional study with control group. We studied with the same methods the personnel of an air-conditioned building (n=425), and of a naturally ventilated building (n=351). Air temperature and humidity, bacterial and fungal densities were measured by the same technical staff in the two buildings. A standard questionnaire on irritative and respiratory symptoms, personal and family history, and lifestyle was completed by the participants.

RESULTS

In univariate analysis, exposure to air-conditioning was associated with an increased prevalence of symptoms (odds ratios-OR-between 1.54 and 2.84). A significant increase in sickness absence was also found among subjects working in air-conditioned offices. As a series of factors were suspected to interfere with these associations, logistic regression was applied. This method confirmed exposure to be an independent determinant of 7 symptoms, and also identified two determinants not previously described: a family history of respiratory diseases and "do-it-yourself' activities.

IN CONCLUSION

we found the sick building symptoms to be present in a group of French office workers exposed to air-conditioning. We confirmed the influence of a number of confounding factors and described two further confounders - do-it-yourself activities at home and a history of familial respiratory disease.

Demographic evaluation of the fertility of aluminium industry workers: influence of exposure to heat and static magnetic fields

A demographic analysis of the fertility of French aluminium industry workers was performed in order to evaluate the potential effects on male fertility of occupational exposure to heat and static magnetic fields occurring in certain workshops. Two groups of aluminium workers were studied: one group of 692 potroom workers exposed to heat and to static magnetic fields, and a control group of 588 workers from the same plants, who had not been exposed to these factors. The birthrate was significantly higher in the 'exposed' group than in the 'control' group. The relative birthrate ratio ('exposed' versus 'control') was 1.1 (P < 0.001). These results do not show any decrease in the fertility of potroom workers exposed to heat and static magnetic fields, when compared to other workers in the aluminium producing industry.

[An epidemiologic study of sleep-disordered breathing in the male population of Lorraine: preliminary results]

The prevalence of sleep-disordered breathing (SDB) was evaluated in a male population sample of Lorraine (university staff), with a protocol including a self-completed standardized questionnaire, anthropometry (including neck, waist and hip circumferences) and non-invasive ear, nose, and throat examination. Among 357 subjects present in the institution at the moment of the survey, 334 (93.6%) accepted to participate, and 300 (84%) returned the questionnaires. The anthropometric results corresponded to the French normative values according to gender and age. We chose a value of 32 as limit of the body mass index (BMI) between weight excess and obesity; this limit was exceeded by 7.2% of the subjects. The mean age of the sample was 44.8 (SD 10.1) years; the waist-to-hip ratio was of 0.907 +/- 0.053. The ENT examination found a high prevalence of nasal septum deviations (52.6%), of soft palate (25.2%), and uvula (42%) abnormalities; 32.1% of the subjects had experienced amygdalectomy. The non-responses to the questionnaire were infrequent (less than 2%), except for the questions regarding a history of hypertension (2.6%), weight fluctuations the last 5 years (7.6%), and the number of years in school (12%). The questionnaire included, for each question, the optional answer "don't know"; this answer was chosen for the questions concerning the duration of snoring (37.1%), stopping breathing during sleep (12.7%) and the parental history of narcolepsy (18.7 and 20.7%) and sleep apnoea (33.7 and 36.4%). 5.7% of the subjects declared sleep apnoeas at least once per week: 16.1% had unrefreshing sleep; 10.6% admitted to excessive daytime sleepiness; 41.9% were habitual snorers. These results indicate a prevalence of SDB in our sample which is comparable to the figures obtained in other European studies. Further analysis of our data will indicate if, besides weight excess and its troncular distribution, cigarette smoking and respiratory symptoms, the "minor" ENT abnormalities play a role in the pathogenesis of SDB.

Erythrocyte antioxidant enzyme activities in coal miners from three French regions

This study investigated whether differences in the prevalence and severity of coal workers' pneumoconiosis (CWP) between three coal mines could be related to differences in oxidative stress exposure as evaluated in vivo through red-blood-cell antioxidant enzyme activities. Blood samples were obtained from 229 miners selected according to their occupation and their pneumoconiotic status. The following biomarkers were evaluated: erythrocyte catalase, Cu2+/Zn2+ superoxide dismutase (Cu2+/Zn2+ SOD), and glutathione peroxidase activities. Antioxidant enzyme activities did not differ significantly between the group of surface workers in Lorraine and the group of underground miners without CWP in Lorraine and in the other coal mines. Erythrocyte Cu2+/Zn2+ SOD activity was slightly decreased in the group of active underground miners with simple pneumoconiosis as compared with the group of miners without CWP in Nord/Pas-de-Calais. No effect was seen between retired miners at different stages of CWP. Our findings indicate that differences in the prevalence and severity of CWP do not seem to be related to various oxidative activities of coal dust particles, at least as reflected by measurements of antioxidant enzyme activities in circulating erythrocytes in this study.

[Accidents among students in professional or technological schools in Lorraine]

BACKGROUND

School accidents in adolescents in professional and technological secondary schools are relatively frequent. This work investigates these accidents in Lorraine (a French region) to identify preventive measures.

METHODS

A cross-sectional study was carried out in 4,751 adolescents from five volunteering schools. Only accidents occurring during one school-year and declared to the Social Security Services as work accidents were studied.

RESULTS

Incidence of accidents per 1,000 subjects was 52.0: 21.3 for accidents during sports and physical training (SPT), 7.8 for those occurring during school training (except SPT), and 22.9 for spare time accidents. The incidence increased strongly with age and differed greatly between the type of schools. Girls had more accidents during SPT than boys. Injuries during school training were wounds and contusions of upper limb while the injuries during SPT and spare time were mainly articular disorders, contusions, and wounds of the upper limb, the lower limb, and the head and neck. A physician was consulted in almost 100% of the injuries, a radiological examination was performed for 75%, and a surgical intervention for 14% of the injuries. Absence from school, exemption from workshops and from SPT were frequent. The predominant risk factors were the type of activities, especially activities the adolescents were not accustomed to, personal behavior and risks taken by adolescents.

CONCLUSION

Accidents are frequent, in particular among older adolescents. It is important to identify activities at risk, and to target prevention and awareness campaigns, assessment training to evaluate risks of each activity, and promoting safe behavior, although environmental factors cannot be excluded.

[Respiratory disorders during sleep]

Sleep-disordered breathing includes snoring, upper airway resistance syndrome, sleep hypopneas and apneas, and is a borderline pathology between several disciplines (neurology, pneumology, cardiology, oto-rhino-laryngology, etc.). The common element is an abnormal increase in upper airway resistance during sleep. In mild cases, this increase accelerates airflow and induces vibrations of the pharyngeal structures (snoring); in severe cases the airway is occluded and airflow ceases (obstructive apnea). Sleep apnea syndrome (SAS) is present in 4% of males and 2% females in the general population. The risk factors are an age above 50, male sex, weight excess, presence of respiratory symptoms, tobacco smoking, alcohol consumption, use of hypnotic drugs... Snoring is much more frequent than sleep apnea, present in up to 50% of males aged 50 yr or more; most snorers do not have apneas ("simple" snorers). Apneas end with a micro-arousal; this sleep disruption explains the excess daytime sleepiness of patients with SAS. The daytime sleepiness is responsible for the increased rate of accidents (traffic, domestic, work...) in SAS patients. The second effect of apneas is desaturation, leading to heart rhythm abnormalities, coronary or cerebrovascular accidents, pulmonary vasoconstriction, systemic hypertension, etc. Screening for SAS is justified by its prevalence, by the potentially severe consequences and by the existence of an efficacious treatment: continuous positive airway pressure.

Catalase and superoxide dismutase activities as biomarkers of oxidative stress in workers exposed to mercury vapors

For this article we investigated the role of three blood antioxidant enzyme activities and total antioxidant status (TAS) as biological markers of oxidative stress in workers exposed to mercury (Hg(o)) vapors. Twenty-two female workers took part in the study. The examination included a questionnaire on age, educational level, occupational history, actual health status, previous accidents and diseases, smoking and dietary habits, and alcohol consumption. Blood and urine sampling for biological analyses completed this examination. The workers were classified into three subgroups according to their creatinine-corrected Hg concentration in urine. Blood antioxidant enzyme activities and TAS were compared between groups with nonparametric distribution-free methods. A significant difference existed in catalase activity and a slight, but not significant, difference existed in Cu2+/Zn2+ superoxide dismutase (Cu2+/Zn2+ SOD) activity between the three groups. No differences were observed in either the glutathione peroxidase activity or the TAS between these groups. Catalase and Cu2+/Zn2+ SOD activities were increased in the groups of workers with higher creatinine-corrected urinary Hg concentrations when compared with the group of lower creatinine-corrected urinary Hg concentrations. Catalase activity was positively correlated with the creatinine-corrected concentration of Hg in urine, and Cu2+/Zn2+ SOD activity was slightly correlated with the creatinine-corrected concentration of Hg in urine. The role of erythrocyte catalase and Cu2+/Zn2+ SOD activities we have measured is in agreement with the hypothesis of the involvement of reactive oxygen species production as an important event in chronic exposure to Hg(o) vapors in humans. In spite of the small size of the sample, these results indicate that erythrocyte catalase and Cu2+/Zn2+ SOD activities could be considered as markers of biological effect in workers exposed to Hg(o) vapors.

[Unidimensionality of a functional measure for patient with an injured upper limb]

The construction of an instrument including a number of tests requires an analysis of its structure and its unidimensionality (which allows calculation of global score), and the determination of the difficulty level of various tests. This study examined a tool including 67 tests designed to evaluate the functional ability of patients with an injured upper limb. The patients seen in a rehabilitation centre during 12 months (173 subjects) were evaluated by the occupational therapists familiar with the tool. The statistical analyses were made using the principal component analysis method (PCAM), the Cronbach's coefficient and the Rasch model. The PCAM showed 3 principal factors which explained 44%, 10% and 4% of the total variance respectively in the case of patients with injured dominant limb. The predominance of the first axis and the high ratio of first by second eigenvalues suggested the unidimensionality of the tool. The Cronbach's value of 0.97 attested the good congruence of the items. The results obtained with the Rasch model seemed to be consistent with the hypothesis of the unidimensionality of the tool. This analysis also provided the difficulty scale of various tests. Similar results were obtained in patients with injured non dominant limb or with all the sample. The methods used provide complementary results.

Blood antioxidant enzymes as markers of exposure or effect in coal miners

OBJECTIVE

To investigate if blood Cu++/Zn++ superoxide dismutase, glutathione peroxidase, catalase, and total plasma antioxidant activities could be markers of biological activity resulting from exposure to respirable coal mine dust in active miners, and of pneumoconiosis in retired miners.

METHODS

Blood samples were randomly obtained from active surface workers (n = 30) and underground miners (n = 34), and from retired miners without (n = 21), and with (n = 33) pneumoconiosis. Antioxidant enzyme activities and total plasma antioxidants were measured in erythrocytes and plasma. Non-parametric tests were completed by analyses of covariance to compare antioxidants between groups, taking into account potential confounding factors (age, smoking history (pack-years)).

RESULTS

Erythrocyte Cu++/Zn++ superoxide dismutase activity was significantly higher in the group of underground miners than the group of surface workers. The differences in total plasma antioxidants and plasma glutathione peroxidase activity between both groups were related to age. Glutathione peroxidase activity increased in the plasma of retired miners with pneumoconiosis, compared with retired miners without pneumoconiosis. No differences were found either in erythrocyte antioxidant enzyme activities or in total plasma antioxidants between the groups of retired miners without and with pneumoconiosis.

CONCLUSIONS

In this study, erythrocyte Cu++/Zn++ superoxide dismutase activity may be considered as a marker of effect of respirable coal mine dust in exposed workers. This result is in agreement with the hypothesis that reactive oxygen species are involved in cell injury induced by coal mine dust, and may be predictive of the degree of inflammation and pneumoconiosis induced by coal mine dust. The increase in glutathione peroxidase activity in the plasma of retired miners with pneumoconiosis may be the result of a response to the increasing hydrogen peroxide (H2O2) production due to the disease process.

[The sleep apnea syndrome]

The authors presents an pathologic entity whose importance has been outlined in the last few years: sleep apnea syndromes. They insisted on the level of study of this syndrome in western countries. They presents the etiology, the pathophysiology and the main complication and they emphasizes the risks of traffic accidents due to the fall asleep and the cardiovascular complication. The therapeutical possibilities depending on the evolutive stage has been surveyed.

Mortality of iron miners in Lorraine (France): relations between lung function and respiratory symptoms and subsequent mortality

An increased mortality from lung and stomach cancer was found in previous studies on Lorraine iron miners. A detailed analysis, however, was not possible due to the lack of data for survivors. In this study the cohort included 1178 workers selected at random from all the 5300 working miners aged between 35 and 55 at the start of the follow up period, which ranged from 1975 to 1985. Occupational exposures and tobacco consumption, lung function tests, and respiratory symptoms were assessed for each subject in 1975, 1980, and 1985. This study confirmed the excess of lung cancer (standardised mortality ratio (SMR) = 389, p < 0.001) and of stomach cancer (SMR = 273, p < 0.05). There was no excess of lung cancer in non-smokers and moderate smokers (< 20 pack-years) or the miners who worked only at the surface or underground for less than 20 years. A significant excess (SMR = 349, p < 0.001) was found in moderate smokers when they worked underground for between 20 and 29 years. Heavy smokers (over 30 pack-years) or subjects who worked underground for more than 30 years experienced a high risk: SMR = 478 (p < 0.001) for moderate smokers who worked underground for over 30 years; 588 (p < 0.001) for heavy smokers who worked underground for between 20 and 29 years; and 877 (p < 0.001) for heavy smokers who worked underground for over 30 years. This showed an interaction between smoking and occupational exposure. The excess mortality from lung cancer was because there were some subjects who died young (from 45 years old). Comparison with the results of a previous study showed that additional hazards produced by diesel engines and explosives increased the mortality from lung cancer. The SMR was higher than 400 (p < 0.001) from 45 years old instead of from 56 years. A relation was found between a decrease in vital capacity (VC), forced expiratory volume in one second (FEV1) and of FEV1/VC and mortality from all causes and from lung cancer in heavy smokers or men who had worked underground for more than 20 years. Respiratory symptoms were related to mortality from lung cancer among smokers (moderate and heavy) who worked underground for more than 20 years. It is considered that the risk of lung cancer in the Lorraine iron miners was mainly due to dust, diesel engines, and explosives although the role of low exposure to radon daughters could not be totally excluded.

[Work and sterility. State of epidemiological research]

Among the factors of man or woman sterility some of them may be due to occupation. The identification of these factors may be performed through epidemiological studies; the fertility indices taken into account and the epidemiological strategies used are briefly described. As examples the results of studies on man hypofertility induced by dibromochloropropane and ionising radiations are presented.

Mortality from lung cancer and cardiovascular diseases among stainless-steel producing workers

The mortality pattern of workers involved in the production of stainless steel (SS) was studied from 1968 to 1984 in order to investigate a possible risk of lung cancer in relation to exposure to chromium compounds, polycyclic aromatic hydrocarbons, and silica. The role of heat exposure in mortality from cardiovascular diseases also was examined. The cohort was comprised of 4,227 workers. Complete individual job histories were provided by the company (UGINE SA). The smoking habits of 24 percent of the cohort members were known from the interview of workers still active during the data collection. The observed numbers of deaths were compared with the expected ones based on national rates with adjustment for age, sex, and calendar time (standardized mortality ratio, SMR). No significant excesses of lung cancer were observed among workers employed in the manufacture of ferroalloys (SMR = 0.68) and in the melting and casting of SS (SMR = 1.04), whereas a significant excess appeared among SS foundry workers (SMR = 2.29). This excess was higher and remained significant among workers with more than 30 years since first employment in the foundry area (SMR = 3.34). Among subjects exposed to heat, no excess was observed for all cardiovascular diseases or for ischemic heart diseases.

A mortality study among mild steel and stainless steel welders

A mortality study was carried out in conjunction with the European mortality study among welders coordinated by the International Agency for Research on Cancer (IARC). The study was aimed at assessing risks for lung cancer in relation to exposure to asbestos, welding fumes containing chromium and nickel, and tobacco smoke. The study included a cohort of 2721 welders and an internal comparison group of 6683 manual workers employed in 13 factories in France. The mortality of the two cohorts was studied from 1975 to 1988 by the historical prospective method. Job histories of welders were traced including welding processes used, metals welded, and proportion of worktime spent in welding. Data on smoking habits were collected from medical records. The observed number of deaths were compared with those expected (standardised mortality ratio (SMR)) based on national rates with adjustments for age, sex, and calendar time. The smoking habits of 87% of the whole study population were known. The distribution of welders and controls according to smoking was not statistically different. The overall mortality was slightly higher for welders (SMR = 1.02, 95% confidence interval (95% CI) 0.89-1.18) than for controls (SMR = 0.91, 95% CI 0.84-0.99). For lung cancer, the SMR was 1.24 (95% CI 0.75-1.94) for welders, whereas the corresponding value was lower for controls (SMR = 0.94, 95% CI 0.68-1.26). The SMR for lung cancer was 1.59 among non-shipyard mild steel welders (95% CI 0.73-3.02). This contrasted with the results for all stainless steel welders (SMR = 0.92, 95% CI 0.19-2.69), and for stainless steel welders predominantly exposed to chromium VI (SMR = 1.03, 95% CI 0.12-3.71). Moreover, SMRs for lung cancer for mild steel welders tended to increase with duration of exposure and time since first exposure, leading to significant excesses for duration > or = 20 years and latency > or = 20 years. Such a pattern was not found for stainless steel welders.

Mortality in retired coke oven plant workers

A previous study on 536 retired coke oven plant workers in Lorraine Collieries (France) reported an excess of deaths from lung cancer (standardised mortality ratio (SMR) = 251) compared with the French male population. Occupational exposures during working life were retraced for each subject, but the number of deaths during the observation period (1963-82) was small, and smoking habits were known only for dead subjects. In 1988, the cohort was re-examined (182 deaths occurred between 1963 and 1987) and smoking habits were determined for all the subjects. This study confirmed the excess of lung cancer (SMR = 238, p < 0.001). It showed an excess of mortality from all causes (SMR = 141, p < 0.001), overall cancers (SMR = 133, p < 0.05), and cardiovascular diseases (SMR = 133, p < 0.05). A significant excess of deaths was found for subjects who worked near the ovens for all causes (145, p < 0.01), lung cancer (SMR = 252, p < 0.01), colon cancer (SMR = 381, p < 0.05), and cardiovascular diseases (SMR = 155, p < 0.05). A significant excess mortality was also found from all causes (176, p < 0.05) and stomach cancer (SMR = 538, p < 0.01) in subjects who worked in byproducts, from lung cancer (SMR = 433, p < 0.001) in those in the workshops, and from cirrhosis of the liver and alcoholism (SMR = 360, p < 0.01) in those underground; but, due to small numbers, these figures were not robust. An excess of mortality from all causes (SMR = 163, p<001), lung cancer (SMR = 228, p<0.05) and cardiovascular diseases (SMR = 179, p<0.01) was shown also for non-exposed or slightly exposed subjects. The fact that, on the whole, mortality of various exposed groups was similar to that of non-exposed or slightly exposed workers may be explained in part by the selection at hiring and the healthy worker effect. As an increased risk of lung cancer was noted among subjects who worked in the old generations of plant compared with the other workers (although the relative risk was not significant) it is concluded that the role of occupational hazards could not be excluded.

A mortality study of cobalt production workers: an extension of the follow-up

The follow-up of a cohort of workers employed in an electrochemical plant producing cobalt and sodium, previously studied from 1950-1980, has been extended from 1981-1988. The standardized mortality ratio (SMR) for all causes of death was 0.85 (95% confidence interval [CI] = 0.76-0.95, 309 observed) for the whole cohort, and 0.95 (95% CI = 0.83-1.08, 247 observed) for the subcohort of workers born in France. With regard to lung cancer mortality among cobalt production workers, which is the main objective of the study, the SMRs were, respectively, 0.85 (95% CI = 0.18-2.50, 3 observed) and 1.16 (95% CI = 0.24-3.40, 3 observed). Neither did any excess of mortality from diseases of the circulatory and of the respiratory systems appear among cobalt production workers. Maintenance workers, however, exhibited high SMRs for lung cancer, reaching statistical significance for duration of exposure and time since first exposure > or 30 years. This study does not support the hypothesis of a relationship between lung cancer and cobalt exposure.

Lung function in retired coke oven plant workers

Lung function was studied in 354 coke oven plant workers in the Lorraine collieries (Houillères du Bassin de Lorraine, France) who retired between 1963 and 1982 and were still alive on 1 January 1988. A spirometric examination was performed on 68.4% of them in the occupational health service. Occupational exposure to respiratory hazards throughout their career was retraced for each subject. No adverse effect of occupational exposure on ventilatory function was found. Ventilatory function was, however negatively linked with smoking and with the presence of a respiratory symptom or discrete abnormalities visible on pulmonary x ray films. The functional values were mostly slightly lower than predicted values and the most reduced index was the mean expiratory flow, FEF25-75%. The decrease in forced expiratory volume in one second (FEV1) was often parallel to that in forced vital capacity (FVC), but it was more pronounced for subjects who had worked underground, for smokers of more than 30 pack-years, and for subjects having a respiratory symptom. Pulmonary function indices were probably overestimated because of the exclusion of deceased subjects and the bias of the participants.

Transient non-cardiogenic pulmonary edema following massive ingestion of ethylene glycol butyl ether

A case of acute poisoning with ethylene glycol butyl ether (EGBE) is reported in a chronic alcohol abuser. On admission the 53-year-old patient was comatose with metabolic acidosis, shock, and noncardiogenic pulmonary edema confirmed by haemodynamic study. Following supportive treatment and haemodialysis the outcome was favorable. The relationship between respiratory failure and EGBE is examined.

Morbidity in retired coke oven plant workers

The effect of past occupational exposure on morbidity was studied in 354 coke oven workers in Lorraine Collieries (France) who retired between 1963 and 1982, and were still alive in 1988; 96% of them participated in this study. Occupational exposure to respiratory hazards during the working life was retraced for each subject. No significant association between the occupational exposure and the frequency of ischemic cardiopathies, arterial hypertension, gastro-duodenal ulcers, and respiratory symptoms was revealed. However, subjects who had worked on the Ovens, in the Workshops, and in the Byproducts showed a prevalence of arterial hypertension significantly higher than the non- or slightly exposed subjects. The healthy worker effect phenomenon, the exclusion of deceased subjects, and the small size of this retiree population may conceal possible differences between exposure groups.

A study of the prevalence of acute respiratory disorders among workers in the textile industry

An epidemiological study of 774 workers in seven eastern France cotton textile factories was conducted to determine the prevalence of acute respiratory disorders. From nine non-textile companies, 464 workers, stratified as to sex, age and tobacco consumption participated in the study as a control population. A questionnaire designed to elicit the respiratory symptoms (in particular the Monday tightness characterizing byssinosis) was administered to the 1238 workers. Peak-expiratory-flow (PEF) measurement was made for each subject, exposed and non-exposed, before the start of the shift on the day of the worker's return to work and repeated at the end of the shift. The PEF's variations during the workshift were studied. Present Monday tightness was mentioned by 48 cotton exposed workers (6.2%) and by 9 non-exposed (1.9%) (P less than 0.001). A 10% decrease in PEF during the shift was present in 63 cotton exposed workers (8.1%) and in 10 non-exposed (2.1%) (P less than 0.001). For the exposed population, Monday tightness was analysed using multiple logistic regression, showing an absence of a link with smoking, an increased occurrence after 20 years of exposure (OR = 7.3) and a link with current job (more frequent among those with the dustiest jobs) (OR = 4.9). The multiple logistic analysis of a 10% decrease in PEF showed effects of smoking habits (OR = 1.86). It also showed a link with "highly polluted job" history (OR = 2.7), but especially with present job (OR = 3.4). The absence of a constant link between Monday tightness and drop of the PEF was found.

Mortality study among workers producing ferroalloys and stainless steel in France

A mortality study was carried out among the workers of a plant that had produced ferrochromium and stainless steel, and was still producing stainless steel, in order to determine whether exposure to chromium compounds, to nickel compounds, and to polycyclic aromatic hydrocarbons (PAH) could result in a risk of lung cancer for the exposed workers. The cohort comprised 2269 men whose vital status were recorded between 1 January 1952 and 31 December 1982. The smoking habits of 67% of the cohort members were known from medical records. The observed numbers of deaths were compared with the expected ones based on national rates with adjustment for age, sex, and calendar time. A low mortality, achieving statistical significance, was found from all causes (observed = 137, standardised mortality ratio (SMR) = 0.82) and from benign respiratory diseases (observed = one, SMR = 0.15). With regard to mortality from lung cancer, a non-significant excess appeared in the whole cohort (observed = 12, SMR = 1.40). Among the exposed workers, however, a significant lung cancer excess was found (observed = 11, SMR = 2.04) that contrasted with a low SMR (0.32) in the non-exposed group. This excess is unlikely to be explained by smoking, as the tobacco consumption of these two groups was similar. No trend was observed for mortality from lung cancer either according to time since first exposure, or according to duration of exposure. A nested case-control study clearly suggested that this excess of deaths from lung cancer was attributable to former PAH exposures in the ferrochromium production workshops rather than to exposures in the stainless steel manufacturing areas.

Chromosome aberrations in peripheral blood lymphocytes of welders and characterization of their exposure by biological samples analysis

Chromosomal aberrations in cultured lymphocytes obtained from 55 welders and 55 matched controls were analyzed. Depending on the welding techniques and the nature of the consumables and metals welded, three separate groups of welders were examined. Chromium, nickel, and manganese levels in serum and urine were measured to assess the exposure to welding fumes. A statistically significant increase of chromosomal aberrations was found in one of the three analyzed groups of welders. This group used the semi-automatic metal active gas welding process with cored wire containing nickel for welding mild steel. These welders had significantly higher concentrations of serum and urine manganese and, unlike the other welders, significantly elevated concentrations of nickel, both in serum and urine. However, no significant correlations between nickel or manganese levels and the frequency of chromosomal aberrations were found. There was a significant correlation between the length of welding employment of these welders and the frequency of chromosomal breaks, although there was no significant correlation between age and the frequency of chromosomal aberrations. The other two groups of welders, for which the analyses of biologic fluids proved chromium and manganese exposure, had no statistically significant higher frequency of chromosomal aberrations. One of these groups used the manual metal arc welding process with coated electrodes for welding mainly mild steel and the other group used the tungsten inert gas welding process for welding stainless steel. A significant correlation between the daily amount of cigarettes smoked and the frequency of chromosomal breakages, in controls as in welders, was observed. The present data indicate that certain welding processes may generate fumes that seem to have a clastogenic activity.

Respiratory hazards in hard metal workers: a cross sectional study

A cross sectional study was conducted on 513 employees at three hard metal plants: 425 exposed workers (351 men, 74 women) and 88 controls (69 men, 19 women). Cough and sputum were more frequent in workers engaged in "soft powder" and presintering workshops compared with controls (12.5% and 16.5% v 3.5%). Spirometric abnormalities were more frequent among women in sintering and finishing workshops compared with control women (56.8% v 23.8%) and abnormalities of carbon monoxide test were more frequent in exposed groups than in controls; this difference was more pronounced in women (31.4% v 5.6%) than in men (18.5% v 13%). No significant correlation was observed between duration of exposure and age adjusted lung function tests. Slight abnormalities of chest radiographs (0/1, 1/1 according to ILO classification) were more frequent in exposed men than controls (12.8% v 1.9%) and mostly in soft powder workers. In subjects with abnormal chest radiographs FVC, FEV1 and carbon monoxide indices (fractional uptake of CO or CO transfer index or both) were lower compared with those with normal chest radiographs. Although relatively mild, the clinical, radiological, and functional abnormalities uncovered call for a regular supervision of workers exposed to hard metal dust.

Arc welders' respiratory health evolution over five years

The respiratory health of 138 arc welders and 106 control subjects in the same company was studied in 1981 and in 1986. Most of the subjects welded mild steel using the Metal Inert Gas (MIG) process. The controls were workers in the same company, not exposed to any known pulmonary risk. The welders and controls in the analysis had not changed their professional activity nor their smoking habits during these five years. The examinations consisted of a questionnaire on respiratory symptoms, a thoracic auscultation, a chest X-ray and lung function tests: flow-volume curve and steady state CO transfer test. The examinations in 1986 confirmed the risk of non specific radiological impairment (pulmonary reticulo-micronodulation) and of obstruction in the small bronchi, which had already been observed in 1981 in the arc welders in this company. These impairments did not seem to have evolved more than in the controls, but do however justify regular surveillance of the respiratory health of arc welders.

Risk of lung, larynx, pharynx and buccal cavity cancers among carbon electrode manufacturing workers

Among workers employed in factories producing carbon graphite products the risk of cancer due to exposure to polycyclic aromatic hydrocarbons was estimated. In one cohort (plant A), a cancer incidence study was carried out; the number of cases were not significantly increased for lung cancers [7 cases, standardized incidence ratio (SIR) 79] or for cancers of the upper respiratory and alimentary tract (10 cases, SIR 103). In another cohort (plant B), a mortality study was carried out; neither the mortality from lung cancer [13 deaths, standardized mortality ratio (SMR) 118] nor that from upper respiratory and alimentary tract cancers (10 deaths, SMR 125) was significantly higher than expected. Within each cohort, a case-referent study was carried out. In plant A the odds ratios were high but nonsignificant for lung cancers (odds ratio 3.42) and upper respiratory and alimentary tract cancers (odds ratio 2.19) and they showed a nonsignificant relationship with duration of exposure. In plant B, the odds ratios were low for every cancer site.