External Practicum-Year Residency Training in Occupational and Environmental Medicine: the University of Pennsylvania Medical Center Program

We describe a competency-based training program that allows physicians employed full-time in occupational and environmental medicine to satisfy the supervised practicum year of training required by the American Board of Preventive Medicine (ABPM). The program is designed for trainees with greater clinical experience than the 1 clinical year required by the ABPM. To date, 25 physicians from clinic-based, academic, corporate, and government employment across most geographic regions of the United States have been admitted into the program. Most completed a master's in public health (MPH) in a distance-learning, on-job, on-campus, or executive program. The practicum-year training has been highly successful, as evidenced by improvements in resident self-assessment of competency, resident satisfaction with the training, faculty evaluation of resident performance, and success rate in the ABPM examination. The program has opened a new pathway for physicians making a mid-career shift to occupational and environmental medicine to obtain high-quality, in-depth education and board certification.

Occupational health and safety in national development--the case of Australia

Over the last 15 years occupational health and safety has undergone a rapid transformation in Australia. This review discusses the changes, emphasizing, the sociopolitical and economic context, national developments in policy and practice, and the dialogue between the public and occupational health and safety agencies and professionals about occupational health and safety matters. First came the classical phase when activities followed the accepted hygienic, medical, and inspection traditions laid down early in the century. A phase followed in which modern legislation was introduced, new institutions were created, and research and data gathering on important issues was intensified. Finally came the current phase characterized by a performance paradigm. Emphasis was given to regulatory reform and the use of nonregulatory initiatives to facilitate better occupational health and safety.

What is the strategic value of occupational and environmental medicine? Observations from the United States and Australia

The world of work is changing rapidly. Occupational health and safety and environmental health increasingly are seen as a joint product with goods and services, requiring line-management responsibility. This new specialty is encouraged to be strategic rather than tactical to optimize its value in the core business of industry-related medical needs. Because employers, governments, and workers bear major costs, they have a strategic interest in outcomes. Strategic opportunities exist for reduction of the impact of occupational injury and disease; stewardship of the environment, product, and process; the reduction of non-occupational health care costs; for having occupational and environmental health and safety follow best business practices and be prominent in the leadership of change; for optimizing human relations/labor policies and practices; and for meeting regulatory requirements. The strategic position of the specialty can be strengthened through discussion, dialogue and vision development, role definition, establishment and use of performance indicators, improved career structures and training, and a proactive approach to qualify initiatives, research, marketing, and strategic alliances.

Concomitant positive patch test results with standard screening tray in North America 1985-1989

Responses to patch test substances may occur contemporaneously. Such simultaneous reactions may reflect concomitant sensitization to 2 dissimilar allergens to which concurrent exposure has taken place (e.g., ethylenediamine dihydrochloride and neomycin). It may occur when the individual has been exposed to only 1 of the substances and exhibits a response to other substances of similar chemical structure (i.e., cross-sensitization such as between para-phenylenediamine and benzocaine). Such simultaneous responses may also be chance occurrences, reflecting multiple sensitization or the result of altered response due to the "angry back syndrome". This investigation established that such concurrence of response is not uncommon and adds further documentation to the literature of these associations in patch test responses.

Skin elicitation threshold of ethylbutyl thiourea and mercaptobenzothiazole with relative leaching from sensitizing products

We studied 3 contact sensitizers present in rubber products, ethylbutyl thiourea (EBT), 2-mercaptobenzothiazole (MBT) and 2,2-dithio-bis-benzothiazole (MBTS), to relate the amount of sensitizer eliciting allergic contact dermatitis to the quantity leaching from a product into various biological fluids: normal saline, human plasma and 3 synthetic sweat solutions of pH 5.5 to 7.5. To determine the amount of sensitizer remaining after leaching, Soxhlet extraction with acetonitrile was subsequently performed. High-performance liquid chromatography was used for chemical analysis. 12 MBT-sensitive patients were patch tested with serial dilutions of MBT and MBTS in petrolatum. A Latin Square design was used in statistical analysis of variance of the patch test results. Large amounts of thioureas leached from 2 rubber articles eliciting thiourea dermatitis, the literature suggesting that these would have been well above the elicitation threshold. Leaching of MBTS was relatively greater than MBT into most media, whereas MBT was a more potent elicitor than MBTS at equivalent concentrations. The lowest eliciting concentration of MBT in 1 subject was 0.01%. Such information should prove helpful to manufacturers in designed products that do not release allergens sufficiently to cause reactions in consumers.

Association of nonmelanoma skin cancer and actinic keratosis with cumulative solar ultraviolet exposure in Maryland watermen

To establish the relationship between ultraviolet-B radiation and squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and actinic keratosis (AK), a cross-sectional prevalence survey was performed in a sample of 808 white, male watermen 30 years of age and older residing in the Eastern Shore of Maryland. A measure of personal cumulative ultraviolet-B exposure was determined for each subject from data collected through interviews and field and laboratory measurements. A personal interview elicited skin type, medication history, and other factors. Clinical diagnoses and histologic confirmation were done for current and previously removed skin tumors. The ratio of subjects with SCC to subjects with BCC was approximately 1:1; however, the ratio of BCC to SCC was 1.25:1 because BCC cases were more prone to multiple lesions. Watermen with SCC or AK but not BCC had higher average annual ultraviolet-B doses than age-matched controls. This was particularly marked in watermen younger than 60 years of age. Logistic regression showed that an older age, childhood freckling, and blue eyes significantly increased the risk of the development of all three types of skin tumor. Ease of sunburning was associated with BCC and AK, but not with SCC. Watermen in the upper quartile of cumulative ultraviolet-B exposure had a 2.5 times higher risk for the development of SCC when compared with the lower 3 quartiles. This suggests that high levels of ultraviolet-B exposure are important in SCC occurrence. The risk of AK developing was 1.5 times higher for those whose cumulative ultraviolet-B exposure exceeded the median. The relationship of BCC to cumulative ultraviolet-B exposure was not clear and this suggests that different etiologic mechanisms operate for SCC and BCC.

Methylchloroisothiazolinone-methylisothiazolinone reactions in patients screened for vehicle and preservative hypersensitivity

More than 1100 patients were tested with methylchloroisothiazolinone-methylisothiazolinone, 100 ppm, in aqueous and petrolatum-based patch test materials from 1985 to 1987 by members of the North American Contact Dermatitis Group. Thirteen reactions to the aqueous materials and 10 to the petrolatum-based materials were observed. Irritant reactions were infrequent, and about half the reactions were deemed relevant. From 1984 to 1985, patch tests with this substance at a concentration of 250 ppm in petrolatum were conducted. Thirteen persons were identified as allergic, but three others were sensitized by the patch test procedure. Sensitization as not observed in tests with aqueous or petrolatum-based substance at a concentration of 100 ppm, and this concentration appears to be the best compromise between safety and sensitive detection of allergy. Use tests are helpful but not infallible as a guide in establishing relevance with methylchloroisothiazolinone-methylisothiazolinone. Wash-off products are frequently well tolerated by patients with positive reactions to this substance.

Quantitative carcinogenesis in man: solar ultraviolet B dose dependence of skin cancer in Maryland watermen

Skin cancer is the most common form of cancer in humans and occurs primarily on sun-exposed areas of the body. In a study of 808 Caucasian Maryland watermen, we examined the prevalence of nonmelanoma skin cancer in relation to age and exposure to solar ultraviolet B (UVB) radiation. For each study subject, the exposure to solar UVB radiation for each year of life after the age of 16 years was calculated. We obtained the data for this analysis by combining a detailed occupational history with laboratory and field measurements. Prevalence of the three major types of nonmelanoma skin neoplasms was analyzed: squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and actinic keratosis (AK). Average annual exposure to UVB radiation was strongly correlated with the prevalence of SCC, but not with the prevalence of BCC or AK. This finding is consistent with dose saturation (plateau in dose-response relationship) for the induction of BCC and AK in humans with high annual exposure to UVB radiation. In addition, two small groups of apparently hypersusceptible individuals were present in the population. One group had SCC despite low annual exposure to UVB radiation, and the other group had multiple skin cancers despite average exposure to UVB radiation.

Corneal changes associated with chronic UV irradiation

The association between exposure to UV radiation and corneal disease was investigated in 838 watermen who work on the Chesapeake Bay, Maryland. Individual ocular exposure was calculated by combining a detailed occupational history with laboratory and field measurements. Pterygium was found in 140, climatic droplet keratopathy in 162, and pinguecula in 642. Logistic regression analysis showed that pterygium and climatic droplet keratopathy were significantly associated with a broad band of UV radiation exposure (UV-B, 290 to 320 nm; A1, 320 to 340 nm; and A2, 340 to 400 nm), but the association with pinguecula was weaker. Simple measures such as wearing a hat or spectacles protect the eye and could potentially reduce the amount of pterygium and climatic droplet keratopathy attributable to UV radiation exposure.

Cyclobuta-dithymidine induction by solar-simulating UV radiation in human skin: II. Individual responses

The purpose of this study was to examine cyclobuta-dithymidine (T*T) photoproduct induction and persistence in human skin exposed in situ to simulated solar UV radiation. Small areas of untanned skin in nineteen individuals were exposed using a solar UV apparatus that simulates both the spectrum and intensity of the UV portion of summer midday sunlight at 39 degrees N latitude. The equivalent of approximately 60 min of sunlight exposure (72KJ/m2) was administered, and T*T photoproducts were quantitated by enzyme-linked immunosorbent assay (ELISA) of DNA extracted from skin punch biopsies. Net yields of T*T photoproducts were determined in 10 individuals, with the majority (7 of 10) between 0.02 and 0.12 T*T per kilobase (Kb). The three remaining individuals had higher levels of photoproducts but were not unusually sensitive to solar UV as determined by minimal erythema dose (MED). Percentage loss of T*T photoproducts 4 h after exposure was determined in nine individuals to be 80.2 +/- 14.0%.

Cigarette smoking and risk of nuclear cataracts

The current study was undertaken to assess the relationship of smoking to the risk of lens opacities. The risk was evaluated separately for nuclear and cortical opacities and for both types together. We studied 838 watermen in Maryland by detailed ocular examination for the presence and severity of each cataract type. All subjects were interviewed regarding smoking history, and a cumulative smoking dose was calculated. The results suggest a significantly increased risk of pure nuclear opacities associated with cigarette smoking. The increase in smoking dose was associated with increasing severity of nuclear opacity. The risk of nuclear opacities increased with increasing cigarette dose and decreased if the subject had quit smoking. The effect of smoking was most striking in those less than 80 years old. No increased risk of nuclear opacities was observed with earlier age when smoking started, after adjusting for dose and cessation of smoking. Further investigations are warranted on the biochemical and physical damage to the nucleus of the lens from smoking cigarettes.

Prevalence and relevance of allergic reactions in patients patch tested in North America--1984 to 1985

Between Jan. 1, 1984, and May 1, 1985, 1199 patients with suspected allergic contact dermatitis were patch tested with 32 "standard" allergens, 707 patients with 19 "vehicle and preservative" allergens, and 613 patients with 10 "special study" allergens. Ten dermatologists representing nine geographic centers collected and analyzed data with the use of the American Academy of Dermatology's mainframe computer in Evanston, Illinois. The most common sensitizers identified were nickel, p-phenylenediamine, quaternium-15, neomycin, thimerosal, formaldehyde, cinnamic aldehyde, ethylenediamine, potassium dichromate, and thiuram mix. Each positive reaction was assessed for its clinical relevance.

The irritancy and allergenicity of 2-n-octyl-4-isothiazolin-3-one (Skane M-8), with recommendations for patch test concentration

Preparations of 2-n-octyl-4-isothiazolin-3-one (Skane M-8) at 1000 p.p.m. a.i. and 500 p.p.m. a.i. in pet. induced allergy in a cumulative insult human patch test. Challenge patch testing using 250 p.p.m. a.i. Skane M-8 elicited allergy in 6 out of 6 sensitized individuals. Sensitized individuals did not cross react with Kathon biocide, (Kathon CG), a mixture of 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one. All pretrolatum preparations to which Tween 85 was added at 2.5% produced mild irritation in cumulative insult patch tests, but no irritation was observed with Tween 85 at 0.625%. We conclude that Skane M-8, 250 p.p.m. a.i. with Tween 85 0.625% in petrolatum is appropriate for patch testing for Skane M-8 allergy.

Follow-up of subjects who developed chloracne following TCDD exposure at Seveso

Three follow-up surveys from 1976 to 1985 were carried out on 193 subjects who developed chloracne following the Seveso accident (1976). A comparison group, age and sex matched, was selected randomly from the list of residents of the town of Varedo (in the same health district but out of the dioxin-contaminated zone). At each follow-up a questionnaire was administered and biochemical tests, skin examination, and electrophysiologic measurements were performed. Biochemical indicators of hepatic function and nerve conduction studies did not show significant differences either between groups or for temporal trends. Chloracne was shown to be clinically reversible: all the chloracne cases (except for one subject) clinically recovered by 1983. The discrepancy between our results and those from other previous experiences can be related to a different type of exposure, the young age of the target population, and the interval since exposure.

Polychlorinated biphenyl congeners in adipose tissue lipid and serum of past and present transformer repair workers and a comparison group

The concentrations of individual PCB's were determined in both serum and adipose tissue lipid from 35 transformer repair workers currently exposed to PCBs, mainly Aroclor 1260, 17 previous transformer repair workers, and 56 comparison workers never occupationally exposed to PCBs. The analysis used fused-silica capillary gas chromatography with electron capture detector (FSCGC/ECD) and FSCGC with negative ion chemical ionization mass spectrometry to verify PCB congener levels. Eighty-nine PCB peaks were identified and confirmed. More congeners were detected in adipose tissue. In serum approximately 50% of peaks were below the level of detection. Statistical techniques to account for left and interval censoring allowed comparison of concentration distributions even where data were incomplete. We found that unquantifiable levels were unlikely to contribute substantially to the true values for total [PCBs] over and beyond the contribution of the measured values. However, the total serum [PCBs] determined by FSCGC/ECD greatly exceeded that from standard packed cell gas chromatography (PCGC/ECD). The underestimation was less marked for adipose samples. In serum the total [PCBs] was highest in currently exposed workers and lowest in unexposed workers, with past-exposed workers clearly intermediate. In adipose tissue [PCBs] in the currently exposed group was much higher than in the other two groups, in whom the distribution of results was broadly similar. In all worker groups hexachlorinated and heptachlorinated species predominated followed by octachlorinated and pentachlorinated. The relative distribution of individual PCB congeners in the three groups was similar although the amounts varied. The seven major peaks in serum and adipose tissue were 2,3,5,6,3',4',5'/2,3,4,5,2',4',5' hepta-CB; 2,3,4,2',3',5' hexa-CB; 2,4,6,3',4',5'/2,4,5,2',4',5'/2,3,4,5,2',5' hexa-CB; 2,3,4,5,2',3',4' hepta-CB; 2,3,4,5,2',3',5',6'/2,3,4,5,6,2',3',5', octa-CB; 2,4,5,3',4',/3,4,5,2',3' penta-CB; and 2,3,4,2',3',4'/2,3,5,6,2',4',5'/2,3,4,5,2',4',6' multi-CB. The distribution of PCB peaks in our populations differs from that in capacitor workers (exposed to less highly chlorinated PCBs) and from Yu-Cheng patients suggesting differing toxic potentials from PCBs in these three circumstances.

Visual assessment of facial elastosis using photographs as a measure of cumulative ultraviolet exposure

Because solar ultraviolet (UV) exposure is ubiquitous, it is difficult to quantify in human populations. We developed a method to index cumulative UV damage, based upon visual manifestations of facial actinic elastosis. Four photographic slides were taken of each subject's facial skin. These slides were projected on a screen and graded by consensus of 2 raters using a 5-point relative severity scale. Rating disagreements were resolved by a skilled dermatologist who acted as adjudicator. High photographic quality was maintained by standardization of camera settings, lighting, and photographic techniques. Inter- and intrarater variability in grading was minimized by training using standard slides and by practice. This index has been tested in 2 large epidemiologic studies. The method proved highly reliable and, within categories of age and tanning ability, a valid measure of cumulative UV exposure. In addition, this method appeared superior to others in speed, ease of use and cost.

Effect of ultraviolet radiation on cataract formation

To investigate the relation of ultraviolet radiation and cataract formation, we undertook an epidemiologic survey of 838 watermen (mean age, 53 years) who worked on Chesapeake Bay. The annual ocular exposure was calculated from the age of 16 for each waterman by combining a detailed occupational history with laboratory and field measurements of sun exposure. Cataracts were graded by ophthalmologic examination for both type and severity. Some degree of cortical cataract was found in 111 of the watermen (13 percent), and some degree of nuclear cataract in 229 (27 percent). Logistic regression analysis showed that high cumulative levels of ultraviolet B exposure significantly increased the risk of cortical cataract (regression coefficient, 0.70; P = 0.04). A doubling of cumulative exposure increased the risk of cortical cataract by a factor of 1.60 (95 percent confidence interval, 1.01 to 2.64). Those whose annual average exposure was in the upper quartile had a risk increased by 3.30 (confidence interval, 0.90 to 9.97) as compared with those in the lowest quartile. Analysis using a serially additive expected-dose model showed that watermen with cortical lens opacities had a 21 percent higher average annual exposure to ultraviolet B (t-test, 2.23; P = 0.03). No association was found between nuclear cataracts and ultraviolet B exposure or between cataracts and ultraviolet A exposure. We conclude that there is an association between exposure to ultraviolet B radiation and cataract formation, which supports the need for ocular protection from ultraviolet B.

Counting recognized occupational deaths in the United States

The number of recognized occupational fatalities in the United States counted by the Bureau of Labor Statistics (BLS) Annual Survey, the most widely known source, is grossly underreported. For 1984, the BLS reported 3,740 occupational deaths, the National Institute for Occupational Safety and Health reported 6,258, and the National Safety Council estimated 11,500. We analyzed the 1984 BLS survey counts for 26 states, by comparing them to death certificate data for trauma, and to reported deaths to workers compensation. The BLS survey, based on self-reporting by employers, showed underreporting in almost all states, which in some cases was severe. Fatalities in small firms employing less than 11 workers were particularly underrepresented. The low BLS total is not explained by a smaller number of workers covered in the survey than in the other published figures. By using existing data sources, we estimate the minimum number of recognized occupational deaths in the United States in 1984 at 7,771. Adjusting the number from death certificates for underreporting gives an estimate of 8,234 from trauma. When corrected for underreporting, death certificate data should be a better basis for counting occupational deaths than the BLS survey.

Allergic contact dermatitis to nickel: bioavailability from consumer products and provocation threshold

Twelve subjects sensitive to nickel underwent patch testing with serial dilutions of nickel sulfate in petrolatum and in water. The provocation threshold (the lowest amount of nickel producing a reaction) varied from 5.2 mg (2.5%) to 0.47 microgram (0.01%) when tested in petrolatum. The provocation threshold was higher with aqueous solutions. The lowest provocation threshold in a statistically significant number of individuals was 1.5 micrograms. Nickel bioavailability from dermatitis-inducing earrings and a necklace was determined by immersing them in plasma, normal saline solution, and synthetic sweat at different pH values over 7 days. Nickel leaching under these conditions exceeded the provocation threshold 1.4- to 93-fold, depending on object and solution. The time course varied with solution. After leaching, surface nickel was measured by the action of dilute nitric acid and total nickel was determined by complete dissolution in aqua regia. Nickel was more bioavailable from earrings than from the necklace, presumably reflecting different metallurgy. Plasma was the most effective solution for removing available nickel from earrings, a possible explanation for the frequent induction of sensitization by ear piercing. Comparison of provocation threshold and leaching results may help determine risks from consumer products.

The carcinogenic potential of selected petroleum-derived products

In this chapter the authors examine the toxicologic and epidemiologic literature for a broad range of petroleum-derived products in order to assess the carcinogenic potential of these compounds. Types of evidence used, classes of compounds, and qualitative assessments of carcinogenicity are presented.

Studies of transformer repair workers exposed to PCBs: I. Study design, PCB concentrations, questionnaire, and clinical examination results

A cross-sectional study compared 55 transformer repairmen, 38 currently, and 17 previously exposed to polychlorinated biphenyls (PCBs) with 56 non-exposed subjects. PCBs exposures occurred from air and contaminated surfaces, predominantly from Aroclor 1260 with some exposure to Aroclor 1242. Each worker underwent: a questionnaire; standardized medical examination; delayed hypersensitivity testing; and determination of serum and adipose tissue lipid total PCB concentrations. Adipose and serum [PCBs] were significantly higher in the currently exposed, but previously exposed workers did not differ significantly from comparison subjects. No subjects had a classical syndrome of PCB poisoning. A number of neurobehavioral and irritant symptoms were significantly more prevalent in the exposed group, but were probably not related to PCBs. Comedones were more frequent in the exposed group, but no evidence of classical chloracne was noted. Cutaneous delayed hypersensitivity responses to mumps and to trichophyton antigens did not differ between the groups. The association of PCBs with job functions were explored.

Studies of transformer repair workers exposed to PCBs: II. Results of clinical laboratory investigations

Thirty-eight transformer repairmen currently exposed to polychlorinated biphenyls (PCBs), 17 former transformer repairmen, and 56 comparison workers not known to be exposed to PCBs were studied. Measurements were made of serum liver function tests, gamma-glutamyl transpeptidase (GGT), lipid profile, thyroid function tests, and other serum biochemistry; hemoglobin; white cell count; 24-hour excretion of delta-aminolevulinic acid, porphyrins, 17-hydroxycorticosteriods and 17-ketosteroids; sperm count; spirometry; and antipyrine half-life to evaluate microsomal mixed function oxidase induction. The total exposed group differed significantly from the comparison group in albumin, LDH, T4, T4-RT3 index, and actual/predicted FEV1. Significant differences among all three exposure groups were seen for albumin, T4, T4-RT3 index, and 17-hydroxycorticosteroid excretion. Differences in FEV1 were attributable to smoking. Significant correlations between serum PCBs and serum lipids were removed by adjustment for confounding variables. After adjustment for confounding variables, there was a statistically significant positive correlation between serum PCBs and GGT and a negative correlation between adipose PCBs and 17-hydroxycorticosteroid excretion. These may reflect subtle metabolic effects of PCBs.

The dermatologist and the right to know

Recently the Federal Occupational Safety and Health Administration has promulgated a Hazard Communication Standard, as have many states and local governments. Regulations give physicians access to Material Safety Data Sheets and also to trade-secret information regarding chemical substances that their patients may come into contact with at work. This article describes how to access and interpret this information.

Lack of evidence for aspirin use and prevention of cataracts

A population-based cross-sectional survey of 838 men aged 30 years and over was conducted to examine the effect of aspirin, and other potential risk factors, on the prevalence of cataracts. Lens opacities were graded on clinical examination for location (cortical, nuclear, and posterior or subcapsular) and severity. The results do not support the claim that large doses of aspirin, or frequent use of aspirin, protects against or retards the growth of lens opacities.

Irritant dermatitis from tri-butyl tin oxide and contact allergy from chlorocresol

A shipwright developed a delayed bullous irritant dermatitis from contact with a bis-tri-butyl tin oxide (TBTO) containing antifouling paint. He subsequently developed sensitization to 4-chloro-m-cresol, a constituent of a steroid cream. No cross sensitivity to 4-chloro-3,5 xylenol was seen. Low concentrations of 4-chloro-m-cresol in pet. may elicit a true positive reaction. TBTO is a strong irritant which will produce delayed bullous reactions in industrial use and on patch testing at 0.1% aqueous.

Influence of serum cholesterol and albumin on partitioning of PCB congeners between human serum and adipose tissue

The influence of serum lipids and proteins on partitioning of individual polychlorinated biphenyl (PCB) congener peaks between human serum and adipose tissue lipid was assessed using regression analysis. Subjects were 55 repair workers who were either currently or previously exposed, and 56 comparison workers without occupational exposure to PCBs. Seven congeners (2,4,5,4'-tetra CB, 2,3,5,2',3',6'-hexa CB, 2,3,4,2',3',6'-hexa CB, 2,3,4,2',4',5'-hexa CB, 3,4,5,3',4'-penta CB, 2,3,4,5,2',3',4'-hepta CB, and 2,3,4,5,2',3',4',5'-octa CB) which had been quantified in both serum and adipose tissue in at least one-third of the total study population were selected for evaluation. Initially the crude correlations between the serum PCB and certain candidate variables were assessed; more than one congener was correlated with serum cholesterol, albumin, triglycerides, low-density lipoproteins, very low-density lipoproteins, age, body fat content, and average servings of fish per day. Stepwise regression of log serum congener concentration on log adipose congener concentration and these variables was performed. Only cholesterol, albumin, and average servings of fish per day were significant for at least one congener peak. Congeners behaved in two groups, depending on their order of chromatographic elution. For 2,4,5,4'-tetra CB, 2,3,5,2',3',6'-hexa CB, and 2,3,4,2',3',6'-hexa CB, log serum concentration was not significantly correlated with log adipose congener concentration, and there was no consistent pattern for significant candidate variables. For congeners 2,3,4,2',4',5'-hexa CB, 3,4,5,3',4'-penta CB, 2,3,4,5,2',3',4'-hepta CB, and 2,3,4,5,2',3',4',5'-octa CB, log serum congener concentration was consistently significantly correlated with log adipose congener concentration and serum cholesterol positively, and with serum albumin negatively. For these four congeners the explanations of variation (R2) in serum congener concentration using adipose congener concentration alone were 3, 23, 20, and 30%, respectively, and after adding cholesterol and albumin were 13, 56, 43, and 46%. Thus we conclude that serum cholesterol and albumin can influence the distribution or partition of PCBs between serum and adipose tissue.

Dermatological screening

Occupational skin diseases are the most frequently reported occupational diseases in the US today. In addition, nonoccupational skin diseases are also prevalent among workers. Dermatological screening examinations may be performed to detect conditions that place the worker at increased risk, so that risk might be reduced; detect early signs of specific occupational diseases; or systematically record cutaneous abnormalities so that increases in prevalence or incidence associated with workplace exposures can be identified. Some of the available dermatological screening methods will be discussed, with attention to ways in which the effectiveness of screening may be enhanced. Conditions for which such procedures may be useful include dermatitis, acne, chloracne, pigmentary changes, melanoma, and nonmelanoma skin cancer. The importance of biological monitoring in relation to cutaneous exposure is also discussed.

Evaluation of the photosensitive patient

During the last few decades, a number of centers around the world have contributed to our knowledge of photosensitivity disorders. However, diagnostic methods, particularly with respect to phototesting and photopatch testing, have often differed in important details between centers. The potential advantages of using relatively standardized techniques are now being recognized. This article discusses the following areas of evaluation of the photosensitive patient: history, examination, phototesting, photopatch testing, and histopathologic and other laboratory studies.

Cutaneous and ocular hazards of roofers

The major known health problems from roofing occur from the use of coal-tar pitch products. This article examines the severe eye and skin irritations prevalent among roofers and also explores other issues, such as the potential carcinogenicity of roofing material.

Inhibition of esterase activity and an undercounting of circulating monocytes in a population of production workers

A cross-sectional review of routine employee health status examinations has identified an undercounting of circulating monocytes associated with an inhibition of a surface monocyte esterase, alpha-naphthyl butyrate esterase. It is postulated that this inhibition is associated with an organophosphate used in the production process. Correlation with routine measures of health status are presented.

Risk factors for occupational hand injury

A case-control study of occupational hand injury was conducted in an effort to identify risk factors for disabling injury. Case employees in this study were municipal employees who had sustained restricted activity or lost work time as a result of hand injuries while at work. Each case employee was individually matched to a control employee of the same sex who held the same job and was at work on the same date and shift that the case employee's injury occurred. A conditional logistic regression model was used to adjust for confounding variables. Performing a task that was not a usual job requirement, using defective materials, presence of cardiovascular disease, sleeping nine or more hours per night, and being less than 25 years of age were identified to be risk factors after adjustment.

Industrial exposure to organophosphorus compounds. Studies of a group of workers with a decrease in esterase-staining monocytes

When an automated counting instrument using an esterase stain was employed, decreased monocyte counts were observed in a group of process workers exposed to organophosphate esters. Their monocyte counts were not found to be depressed with manual counting or with an automated counter using another staining method. The apparent depression was transient. In these workers and a comparison group, theoretical adverse consequences of decreased monocyte esterase and also possible changes in other esterases were explored. No anergy was seen with mumps or staphylococcal phage lysate hypersensitivity skin tests. Histology of the mumps reaction was similar in both groups. The depressed monocyte counts were significantly associated with a mild reduction in erythrocyte cell acetylcholinesterase, but no reduction was seen in plasma pseudocholinesterase or lymphocyte neurotoxic esterase.

Polychlorinated biphenyl exposure and effects in transformer repair workers

Fifty-five present and past transformer repair workers exposed to polychlorinated biphenyls (PCBs) and 56 unexposed comparison workers were evaluated in a clinical-epidemiologic study. The groups were similar in most demographic variables. Adipose tissue lipid and serum PCBs concentrations were higher in current exposed workers (geometric means adipose 2.1 ppm, serum 12.2 ppb). Concentrations in comparison (0.6 ppm and 4.6 ppb) and previously exposed (0.83 ppm and 5.9 ppb) workers were lower. Statistically significant differences in serum albumin and lactic dehydrogenase, but not in other liver function tests, were seen between the exposed and comparison groups; however, after adjustment for confounding variables, no correlations were observed between liver function tests and either adipose or serum PCBs concentrations. Statistically significant correlation both before and after adjustment for confounding variables were seen with adipose PCBs and 24-hr urinary 17-hydroxycorticosteroid excretion and with serum PCBs and serum gamma-glutamyl transpeptidase. Both associations could reflect microsomal enzyme induction among other possibilities. No differences were seen in fasting serum triglycerides, total cholesterol, LDL, HDL or VLDL cholesterol between the two exposure groups. A statistically significant correlation between serum PCBs and serum triglycerides, total cholesterol, and VLDL cholesterol was removed by adjusting for confounding variables. No correlation was seen between adipose PCBs concentrations and any serum lipid component. Partition phenomena could account for these findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of physician counseling on the smoking behavior of asbestos-exposed workers

Physician antismoking advice has been shown to increase smoking cessation, particularly among patients who have medical problems or perceive themselves to be at risk. The present study tested three hypotheses: (a) providing 3 to 5 min of behavioral counseling regarding a cessation strategy would be more effective than simply warning the smoker to quit smoking; (b) smokers with abnormal pulmonary function would be more likely to comply with medical advice than would smokers with normal pulmonary function; and (c) that smokers with abnormal pulmonary function who receive behavioral counseling would be the group most likely to achieve prolonged abstinence. Asbestos-exposed smoking men undergoing screening in a mandated program for naval shipyard workers were categorized as having normal or abnormal pulmonary status on the basis of chest X ray and pulmonary function tests (PFT). They were then randomly assigned within PFT categories to receive either a simple warning or 3 to 5 min of behavioral cessation counseling from the physician who gave them the results of their pulmonary tests. Subjects' smoking status was evaluated at 3- and 11-month intervals following the physician intervention. Smokers who received behavioral counseling were more likely to quit and remain abstinent over the 11-month period (8.4% abstinent) than were smokers given a minimal warning (3.6% abstinent). Prolonged abstinence rates among abnormal PFT subjects (3.7%) did not differ from those of normals (5.9%). The group with normal PFT who received behavioral counseling achieved the highest level of abstinence (9.5%). Maintaining adequate physician compliance with the counseling protocol proved difficult; implications of this for future efforts are discussed.

The skin and occupational diseases

The skin is a major potential route for the absorption of hazardous materials encountered in the workplace. Percutaneous absorption is influenced by a large number of factors. In some situations, it may be the major route of absorption. Methods are available to determine this in industrial situations. Occupational dermatoses are the most frequent of all occupational diseases. Sources of information about these diseases are reviewed and limitations discussed. There is a particular need for analytic epidemiologic studies. In the case of occupational skin disease, such studies particularly need a sound design, appropriate comparison groups, the systematic collection of cutaneous observations, and attention to potential confounding factors.

Occupational skin disease

Occupational skin diseases are the most frequent occupational diseases. Certain industries are at a particularly high risk. Important factors to consider include percutaneous absorption and alterations in resistance to microbial agents. The most common condition is contact dermatitis, usually irritant but frequently causing allergy. Other selected conditions include photosensitization, acne and chloracne, fiberglass dermatitis, pigmentary changes, and skin tumor. The approach to the patient and diagnostic criteria for occupational skin disease are described.

Behavioral, attitudinal, and physiologic characteristics of smoking and nonsmoking asbestos-exposed shipyard workers

The smoking characteristics of shipyard workers participating in an Asbestos Medical Surveillance Program (N = 3,991) were assessed. Sources of data were: (1) a self-assessment questionnaire on the smoking history and respiratory symptomatology of the 871 current smokers who participated in the smoking study, and (2) chest roentgenograms and pulmonary function test results and medical records for the entire population. The study population included 1,711 current smokers, 988 former smokers and 1,292 never smokers. The annual "quit rate" for former smokers had increased from less than 1% in 1961 to 4.2% in 1978. Of the 871 current smokers who participated in the smoking study, 19% had resumed smoking after having given up cigarettes for one year or longer. Men in the smoking study were reasonably well informed about the health consequences of smoking. While they perceived themselves to be susceptible to disease, and the disease to be serious, the benefits they saw in quitting were related more to economics and aesthetics than to health. When the results were age adjusted, no differences in rate of pulmonary function abnormalities and chest film abnormalities were found between current smokers who voluntarily participated in the smoking study and those who did not. All pulmonary function testing abnormality and chest film abnormality rates were significantly lower for former smokers and never smokers.

Neurotoxic effects of occupational exposure to organotins

The authors gave 22 chemical workers neurological, psychiatric, and neuropsychological examinations and placed them in one of two groups according to their degree of exposure to trimethyltin chloride spillage during January 1978. Other chemicals to which they had been exposed were dimethyltin dichloride and methyl chloride. Specific and nonspecific symptoms of intoxication of the CNS showed a significantly greater frequency in the highly exposed group, including cycles of depression and destructive rage, each lasting a few hours. These observations should alert diagnosticians to this type of occupational exposure.

Skin and eye diseases among arc welders those exposed to welding operations

The prevalence of skin and eye abnormalities was determined in 77 journeymen welders, 75 members of other trades exposed to welding operations and 58 non-exposed comparison workers. Characteristics including possible risk factors for skin cancer were compared among the groups. Localized cutaneous erythema was frequent in welders and occasional in other exposed workers. Small cutaneous scars were frequent in welders. There was no significant difference in the prevalence of actinic elastosis by occupational group; however, the degree of elastosis was significantly associated with type of complexion, original hair color, eye color, childhood freckling poor ability to tan and ease of sunburning. There were no significant difference among the groups in the prevalence of various dermatoses, skin tumors, alterations in visual acuity or clinical ocular abnormalities on slit lamp biomicroscopy and fundoscopy apart from variations in the amount of dust in the lids. The observed prevalences of skin and eye diseases may provide useful comparative data.

A carcinogenic bioassay of certain roofing materials

The carcinogenic potentials of certain present day roofing materials and dust produced during the removal of an old coal tar pitch roof were evaluated using a mouse skin bioassay. Traditional coal tar pitch and dust from removal of an old roof were significantly more carcinogenic than coal derived roofing bitumen, but all were strongly carcinogenic. The benzo(a)pyrene concentration of these materials ranged from 0.064 to 0.08%, but each was significantly more carcinogenic than 0.1% benzo(a)pyrene alone. No tumors were produced by the application of petroleum derived roofing asphalt.

The excretion of trace metals in human sweat

The concentrations of zinc, copper, iron, nickel, cadmium, lead, manganese, sodium and chloride in the sweat of six males and three females were determined after collections utilizing a total body washdown technique. From our results, sweat appears to be an important excretory pathway for zinc and copper. The mean concentrations of nickel and cadmium in sweat were higher than those reported for urine, that of lead was similar to urine. The loss of manganese in sweat is significant. Levels of zinc and iron were lower in sweat from females, possibly reflecting compensation for menstrual and other losses. Collections were made in six subjects simultaneously utilizing a total body washdown method and collections from one arm in an occlusive arm-bag. The arm-bag collection method gave higher and more variable results and is not recommended as an indicator of loss from the entire skin surface.

Phototoxic keratoconjunctivitis from coal-tar pitch volatiles

Roofers working with coal-tar pitch develop burning eyes and conjunctivitis which they subjectively associate with sun exposure. A coal-tar pitch distillate instilled in the conjunctivae of rabbits produced minimal or mild irritation in the absence of ultraviolet radiation, but irradiation with long-ultraviolet produced marked photophobia and severe keratoconjunctivitis.