Silicosis and industrial bronchitis by exposure to silica powders and cement

OBJECTIVE

to identify the association between the exposure of workers to inorganic dust in a quarry and a cement factory and pulmonary diseases.

METHODS

a transverse study on data from 32 quarry workers (QWs) and 57 cement production line workers (CFWs) to inorganic-dust exposure was performed. Pulmonary function tests and chest X ray were done in both groups.

RESULTS

there were differences between QWs and the CFWs; QWs were younger, shorter and thinner. The number of sick individuals might be considered significantly different, showing a smaller proportion on the cement production line. The quarry workers have been on the company for a shorter period of time and, in the end, they present more serious pulmonary problems with an average of 3 years working.

CONCLUSIONS

the amount of free-silica that is managed on the quarry affects the workers in some way, even when literature states that the evolution of industrial bronchitis and silicosis have a period development of approximately 10 years.

[Laboral talc pneumoconiosis as a low frequency disease]

OBJECTIVE

To identify the association between exposition to talcum powder and talcosilicosis in a cosmetic factory.

METHODS

A descriptive and prospective survey including 24 workers from the bottling and grinding areas was performed. All patients had chest roentgenography. They were separated into two groups: the first patients exposed up to a period of five years and the second with more than five years exposure. Environmental monitoring of high flow polyvinyl chloride filters and galvimetric analysis was performed. The dust analysis was performed in 12 inhaling powders, eight environmental and four in workers. A Fisher exact test was applied.

RESULTS

All of the exposed workers displayed radiographic findings compatible with talcosis; 18 (75%) patients had light talcosis and 6 (25%) moderate. The Fisher test was 13.7 with a p value of 0.004. Dust analysis showed: five were reported over the maximum allowed levels corresponding to the areas of compact cosmetics grinders, powder grinders, powder dispensers and the talcum final line. The analyzed talcum powder contained more than 95% of free silica.

CONCLUSIONS

The association was confirmed between the exposure and the presence of talcosis.

[The influence of preventive programs on laboral injuries]

OBJECTIVE

To evaluate the impact of preventive programs at enterprises affiliated to the Instituto Mexicano del Seguro Social (IMSS) during 2004.

METHODS

Transversal study in 987 enterprises.

VARIABLES

labor injuries (LI) of temporal disability, permanent disability and death.

ANALYSIS

simple and relative frequencies, rates and Anova application to differences.

RESULTS

64.4% of the enterprises decrease LI (p < 0.04), with a decrement of 2602 LI (16%); the rate of LI per 100 workers declined from 4.19 to 3.60 (p < 0.08), with a decrease of 43,369 disability days (10.93%), which represents $8,456,955 MXP. States with larger decreases were: Queretaro (80%) p < 0.05; Sinaloa (63%) p < 0.05, and Morelos (61%) p < 0.05. Permanent incapacities diminished at 12.1%, p < 0.09; the rate of permanent disability per 1000 workers diminished from 1.37 to 1.32 and death cases increased from 42 to 49.

CONCLUSIONS

the expenses on consultancy by IMSS was estimated as $9,341,955 MXP. The savings on temporal and permanent incapacities was $33,691,255 MXP with a cost containment of $19,701,310 MXP. Preventive programs are profitable, because they generate benefits to the workers, the IMSS and the enterprises.

Pleural mesothelioma in paraoccupational, environmental and occupational patients exposed to asbestos

OBJECTIVE

To identify the characteristics of pleural mesothelioma in patients exposed to asbestos.

METHODS

A transverse study in 3700 cases of lung cancer was conducted. There were identified 21 cases with mesothelioma. Age, gender, smoking history, cancer development, dissemination, cytohistochemistry, lethality and total lung capacity were studied. ANOVA test was used.

RESULTS

The incidence was of 0.45/100,000 patients. Four (19%) corresponded to occupational exposure (OE), seven (33%) para-occupational (PE) and ten (48%) environmental (EE). The mean age at detection was 50 years for PE, 55 years for EE and 64 years for OE. Twenty cases were male. Thirteen patients (62%) were active cigarette smokers. The latency time in PE mesothelioma was 34.5 years, in OE 40 years, and in EE more than 40 years. In 19 (90%) cases the tumor was disseminated. Diagnosis was confirmed by cytohistochemistry. Malignant mesothelioma was reported in 19 (90%) cases. The survival period was 5 months for OE patients, 10 in PE and 16 in EE.

CONCLUSIONS

There is a low incidence of malignant mesothelioma in our population. Male was the predominant group. Occupational and paraoccupational exposure predominated in patients.

[Pneumoconiosis in affiliated workers have irreversible sequelae]

OBJECTIVE

to analyze the frequency and importance of pneumoconiosis in affiliated workers to Instituto Mexicano del Seguro Social.

MATERIAL AND METHODS

it was carried out a transverse, observational and comparative study; the behavior of the qualified pneumoconiosis was revised 1994-2004. The analyzed variables were sex, age, occupation, permanent disability and economic activity. It was carried out the analysis of absolute frequencies and rates.

RESULTS

it was registered 14,827 cases; the rate for 10,000 workers oscillated from 0.48 to 2.39. The 99 % were presented in males, with 14,262 cases with permanent disability (rate: 96.89 per 100 cases of pneumoconiosis); employments with more frequency were miners, quarry workers and bricklayers. The average of permanent disability for pneumoconiosis in the period was of 11.09 to 15 %. States with a higher number of cases were Coahuila, Zacatecas and Hidalgo. Economic activities with a greater incidence were the extraction and benefit of mineral coal, graphite and metallic and non-metallic minerals.

CONCLUSION

cases of pneumoconiosis have been decreasing, but even the determination of diagnosis is delayed, and due to this most workers have irreversible sequelae.

[Industrial bronchitis in workers exposed to hydroalcohol]

OBJECTIVE

To identify the association between industrial bronchitis and exposure to hydroalcohol.

METHODS

In a prospective study, 80 workers exposed to hydroalcohol answered a standardized questionnaire and had two spirometry tests based on the American Thorax Society (ATS) criteria, to evaluate functional capacity and predominant spirometric patterns. The test included the parameters: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the ratio FEV1/FVC, the peak expiratory flow (PEF), the forced expiratory flow 25-50 (FEF50) and the forced expiratory flow 25-75% (FEF 25%-75%). Fisher exact test was used to identify differences. An environmental sampling of hydroalcohols was done as well.

RESULTS

85 % Of workers were women and 15 % men, with respiratory symptoms as follows: 25 % with cough and expectoration, 14 % thoracic pressure feeling, 23 % dyspnea; 36 % eye, nose or throat irritation. The spirometry results were: 25 % for pulmonary normal pattern; 66 % had obstructive pattern; 3 % had restrictive patterns and 6 % mixed pattern. 25 % of workers with obstructive pattern and 10 % of normal pattern had symptoms. It was obtained an OR = 1.9 (95 % CI = 1.135-3.195; p = 0.021) for the time of exposure to hydroalcohols and the presence of industrial bronchitis. The monitoring of hydroalcohols reported: 131.1 mg/m3 for isopropyl alcohol and 438.3 mg/m3; 49 workers (61 %) had bronchitis symptoms and 58 (72 %) showed obstructive or mixed patterns in the spirometry tests. The exposure to hydroalcohols was below the limits established by the Mexican Official Norm.

Workplace accident-related finger-fracture at the Mexican Institute of Social Security. Resolution time, economic impact and sequelae

OBJECTIVE

To identify resolution time and economic impact of occupational finger fracture with permanent disability.

METHODS

A cross-sectional study was conducted in 2004; the main variables were age; sex; disability days and sequelae. The International Classification of Diseases (ICD 10) was used for the study. The analysis included frequency, exceeded disability days and estimation of cost of disabilities, pensions and direct costs. Chi square test was used to identify the differences.

RESULTS

13,410 Fractures occurred nationwide: multiple finger fractures (803); thumb fractures (1982) and other finger fractures (10,625). Days of resolution time were: 70.5 days for multiple finger fractures and 51.1 days for another finger fractures. Permanent disability partial rate of thumb fracture was 5.3/100, 15.8/100 multiple finger fractures and 5.9 fractures of other finger. The estimated cost by temporary disability in the Instituto Mexicano del Seguro Social was on $10,669,000 U.S., while permanent disability costs in cases of settlements and annual pension payments were $758,536 U.S.

CONCLUSIONS

Finger-fracture is a prevalent pathology whichever needs that medical procedures are review, also identify factors that decrease resolution time and establish improve actions that create boundaries on the workers damage health. It must be considered that this condition affects enterprise' productivity and decrease the quality of life from workers.

[Reliability and validity of a generic job exposure matrix applied on a small-business]

OBJECTIVE

to evaluate the reliability and validity of a generic job exposure matrix (JEM) applied in a small business.

METHODOLOGY

procedures to evaluate a JEM integrated by six sections: the number of exposed workers per area, frequency of exposure, time of exposure time, level of exposure, safety controls, and proximity to source of exposure, was evaluated. The JEM also obtains information about possible health effects from exposure to occupational/environment agents. Two observers estimated the risk of exposure to epoxy resins on 31 workers of an epoxy resin facility in Mexico City. The rater agreements between the two observers were assessed through percent agreement (PA), weighted kappa (kappa(w)) and the intraclass correlation coefficient (ICC).

RESULTS

disagreements were greater for the number of exposed workers (PA = 61.3, kappa(w) = 0.24, ICC = 0.33), level of exposure (PA= 66.7, kappa(w) = 0.25, ICC= 0.56), and safety controls (PA = 54.8, kappa(w) = 0.23, ICC = 0.69) sections. Percent agreement and kappa(w) were 64% and 0.58, respectively. In accordance with Landis and Koch, Altman, Fleiss, and Byrt classifications for the interpretation of kappa value, the weighted kappa (0.58) ranged from moderate to a fair good level.

CONCLUSIONS

despite the discordance in some sections, the JEM proved to be useful to identify the risk of exposure in this type of small business.

Comparison of a technique using a new percutaneous osteosynthesis device with conventional open surgery for displaced patella fractures in a randomized controlled trial

OBJECTIVE

To compare the percutaneous patellar osteosynthesis system (PPOS) technique with open surgery for patella fractures.

DESIGN

Randomized controlled trial.

SETTING

Referral orthopedic and trauma center.

PATIENTS

Fifty-three patients with displaced patellar fractures.

INTERVENTION

Stabilization and fixation of patellar fractures with PPOS or open surgery.

MAIN OUTCOME MEASUREMENTS

Knee-flexion and -extension angles, pain, surgical time, and assessment of knee function based on the Knee Society Clinical Rating Scale (KSCRS).

RESULTS

Comparison of PPOS and open-surgery groups at 4 weeks showed the following: pain, 3.7 +/- 1.6 versus 6.2 +/- 1.4 arbitrary units, P < 0.001; flexion angle, 46 +/- 20.7 versus 12.7 +/- 6.0 degrees, P < 0.001; extension angle, -2.5 versus -3.8 degrees, P < 0.001. At 8 weeks, the following was demonstrated: pain, 1.3 +/- 1.6 versus 4.1 +/- 2.1 arbitrary units, P < 0.001; flexion angle, 87 +/- 17.3 versus 34 +/- 26 degrees, P < 0.001; extension angle, 0 versus -3 degrees, P < 0.001. Surgical time was 35.3 +/- 7.8 versus 66.2 +/- 14.1 minutes, P < 0.001. KSCRS assessment was 84 +/- 4 versus 70 +/- 8, P < 0.001 at 8 weeks; 85 +/- 2 versus 73 +/- 8, P < 0.001 at 12 months; and 85 +/- 1 versus 82 +/- 7, P = 0.246 at 24 months. Frequency of total complications (infections, fragment displacement, and wire-related pain) was significantly lower in the PPOS than in the open-surgery group (P < 0.02).

CONCLUSIONS

PPOS for patella fractures was associated with shorter surgical time, less pain, better mobility angles, higher functional score up to 2 years, and a lower incidence of complications than open surgery.

[Malingering among workers seeking disability insurance]

OBJECTIVE

Describe the frequency and characteristics of Mexican Social Security workers with malingering disorder that request disability pension.

MATERIAL AND METHODS

Comparative survey made among 136 workers seen during 2001, which were divided into three groups: malingering workers (MW), workers without disability (WOD), and workers with disability (WWD). We administered the Z Test for scaled variables and Z2 Test for nominal variables to identify group differences

RESULTS

The incidence ofmalingering was of 2.2/100,000 workers. Mean age was 41.9 +/- 10.1 years, 440 was the average number of days of labor disability; 51 (37%) workers were malingerers. 35 (26%) workers were work disabled and 50 (37%) without disability. Malingerers had higher level of schooling compared with WOD and WWD (p < 0.02); most worked at the Social Security (p < 0.05), with lower number of previous jobs (p < 0.05), presented longer work disability (p < 0.05). Depressive symptoms were not frequently noted (p < 0.025) and all had normal electroencephalogram and brain computed tomography studies.

CONCLUSIONS

Malingering workers who request work disability pensions follow a particular pattern that differs from other workers that request disability assessment at the Social Security Institute of Mexico.

[Risk factors associated with work-related accidents in the construction industry in the Valley of Mexico]

OBJECTIVE

Our aim was to describe construction-industry, work-related accident prevalence in, associated factors in, and potential impact on affiliated workers of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social, IMSS) in the Valley of Mexico.

MATERIALS AND METHODS

Prevalent cases in a retrospective case-control design.

CASES

These include 385 construction-industry workers who were found to have construction work-related accidents in 2001. Controls comprised 385 active construction-industry workers without work-related accident background paired by gender, workplace, and worksite.

RESULTS

Work-related accident prevalence in construction workers was 5.5%; most important risk factors and etiology fraction (Ef) included the following: age 16-20 years odds ratio, OR = 1.58, 95% confidence interval (95% CI) 1.40-10.7, p = 0.001, Ef 0.36; eventual insurance, OR = 3.7, 95% CI, 2.16-26.45, p = 0.001), Ef, 0.72, and no training for job, OR = 5.3, 95% CI, 4.9-69.2, p = 0.01), Ef: 0.81. Variables not showing significance were included salary, work shift, and workday.

CONCLUSIONS

Work-related accident prevalence maintains its preponderance in the Valley of Mexico construction industry; identified risk factors are potentially modifiable, among which job training acquires unquestionable relevance.

[Potential under-registration of occupational accidents in the Mexican Institute of Social Security]

OBJECTIVE

To assess the potential under-registration of work-related accidents in the Mexican Institute of Social Security.

MATERIAL AND METHODS

A countrywide cross-sectional study was carried out with information collected from 27 district offices of the Mexican Institute of Social Security (MISS), on workers seen at MISS emergency rooms during November 2001 because of a probable accident at work. We compared these reports to official records of work-related accidents to estimate the proportion of incomplete reports. Data analysis consisted of descriptive statistics for each variable; the annual estimation of incomplete reporting proportions was made by multiplying by twelve months; 95% confidence intervals were estimated using Poisson's exact method for a proportion.

RESULTS

Data from 27 out of 37 MISS district offices revealed that 7211 cases were not recognized as work accidents, accounting for an underestimation of 26.3%, ranging between 0 and 68% among the different district offices. The accidents that were most frequently left unregistered were mild and blunt injuries.

CONCLUSIONS

Under-registration can affect worker compensation plans and the financial balance of the institution's occupational risk insurance. Research is needed to investigate and eliminate the causes of under-registration. Employers, the industry, and health institutions should be involved in this effort. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Disabling spondyloarthrosis risk factors in valley of Mexico workers

BACKGROUND

The objective of this study was to describe the most prevalent physically disabling conditions for insured workers belonging to the Mexican Social Security Institute (IMSS) in the Valley of Mexico and to identify risk factors for disabling spondyloarthrosis.

METHODS

Retrospective cases and prevalent controls from IMSS clinics in the Mexico City metropolitan area were studied. Eighty cases were IMSS workers reporting disability due to spondyloarthrosis; 80 controls were active workers at the same workplace and shared the economic activity of the cases. The 1995 IMSS Disability Report was reviewed. From this report congenital conditions of the musculoskeletal system, obesity, history of trauma, and sociodemographic patient characteristics were assessed.

RESULTS

The most important risk factors were a history of spina bifida (odds ratio [OR] = 29.3, 95% confidence interval [95% CI] = 5.3-161; p = 0.0009), supernumerary vertebrae (OR = 21.3, 95% CI = 5.3-95; p = 0.0001), history of low back (lumbar) trauma (OR = 3.9, 95% CI = 1.9-8.3; p = 0.0004), flatfoot (OR = 11.7, 95% CI = 1.9-69, p = 0.02), and obesity (OR = 2.0, 95% CI = 1.06-4.03; p = 0.04).

CONCLUSIONS

A history of congenital deformity of the musculoskeletal system, spinal column trauma, and obesity were risk factors most associated with work disability due to spondyloarthrosis.

Effect of the quality of health care on permanent inability secondary to femoral fractures due to occupational accidents

OBJECTIVE

To construct and validate an indicator for evaluating the quality of care for femoral fractures, and to assess the contribution of the quality of health care as a determinant of partial permanent inability secondary to femoral fractures due to occupational accidents.

MATERIALS AND METHODS

The study was conducted from January to December 1995 at Mexican Institute of Social Security. The instrument was designed with experts' contribution along different stages and validated using implicit criteria and factorial analysis. A case-control study was then conducted to evaluate the contribution of the quality of care to inability secondary to femoral fractures. Cases were 108 active workers with permanent inability secondary to femoral fracture; controls were 94 active workers with fracture of femur but no permanent inability. Logistic regression modeling was used to establish the association between quality of care and partial permanent inability, adjusting by relevant variables.

RESULTS

The ultimate indicator of quality of care consisted of the following: Timely care, presurgical management, surgical management, and fracture complications. A final score over 229 points meant that the worker had received good quality of care. Workers getting 229 or less points had received poor quality of care. Forty-eight (44%) cases and 66 (70%) controls received good quality of medical care. The likelihood of partial permanent inability was almost three times higher among workers given poor quality of care (OR 2.95; 95% CI 1.5-5.5). According to the multivariate model, predictors of partial permanent inability were: Having exposed or epiphysiary fractures, being re-submitted to surgery, having less than 90 days of rehabilitation care, and receiving deficient medical care.

CONCLUSIONS

The constructed instrument was validated. The level of the quality of care received by workers is a determining factor for the generation of partial permanent inability. In workers having femoral fractures, it is important to consider timely medical care and early rehabilitation, to reduce the high incidence and prevalence of this medical problem in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.