Spontaneous abortions among women working in laboratories, and congenital malformations and birth weights of the children were examined in a retrospective case-referent study. In the spontaneous abortion study there were 535 women (206 cases and 329 referents), and in the malformation study 141 women (36 cases and 105 referents). The analysis of the birth weights concerned 500 women (referents). Significant associations with spontaneous abortion were found for exposure to toluene (odds ratio [OR], 4.7, 95% confidence interval [CI], 1.4 to 15.9), xylene (OR 3.1, CI 1.3 to 7.5) and formalin (OR 3.5, CI 1.1 to 11.2) > or = 3 days a week, adjusted for the covariates. Most of the women exposed to formalin and xylene were working in pathology or histology laboratories. No association with congenital malformation was found.
Two cases of Waldenstrom's macroglobulinemia (WM) that occurred in employees from one university academic department were investigated using approaches for both cluster and single case investigation. Common personal characteristics and potential past hazardous exposures were evaluated. The patients shared a young age at diagnosis, worked in the same building, and had similar duration of time between first entering the building and diagnosis of WM. No evidence was found to support the original hypothesis that exposure to radioactive material could be related to the occurrence of WM. Although this investigation did not identify a common causal agent among two cases of a rare disease, investigations of disease clusters may be useful for developing etiologic hypotheses even when a full-scale epidemiologic study is not undertaken. Detailed descriptions of case characteristics can help generate ideas for further research.
With its long tradition of population registration, Denmark has outstanding possibilities for occupational health research. The municipality registers date back to 1924, the national death and cancer registers to 1943, and unique personal identification numbers were introduced in 1968. For studies on occupational cancer, the cancer register has been linked with census data, pension data, and personnel files from various companies. Suspected associations between occupational exposures and cancer have been studied. For example, women in dry cleaning exposed to tetrachloroethylene had an excess risk of liver cancer (observed = 14; expected = 5.2; standardized incidence ratio (SIR) = 2.7; 95% CI = 1.5-4.5), and oncology nurses handling antineoplastic drugs had an excess risk of leukemia (SIR = 10.7), based on two cases. The linked registers have also been used to systematically search for associations between occupations and cancer risks (eg, female hairdressers). Cancer patterns differ greatly across countries and across main occupational groups within countries. Future efforts should focus not only on traditional approaches to occupational cancer research but also incorporate indirect influences of the work environment (eg, smoking, parity, age at first birth) and labor market participation on cancer risk.
This article presents the preliminary results of a follow-up study (1950-1992) of 1,146 subjects (person-years = 30,954; 23,055 for women) receiving compensation for mercury poisoning. In a province of Tuscany in central Italy, severe exposure to mercury occurred during fur hat production. A deficit in all causes of mortality was observed in both sexes, whereas mortality due to cancer was slightly higher than expected. Mortality from stomach cancer was significantly elevated for men and women. A significant excess of lung cancer was observed in women only. Whereas the excess of stomach cancer probably reflects elevated rates in the study area rather than exposure to mercury, the excess of lung cancer mortality does appear to be related to mercury exposure. Smoking habits or other exposures at work do not seem to explain the excess of lung cancer.
We conducted a mortality odds ratio (MOR) analysis among women employed in the telephone industry, using death certificates from 24 reporting states for 1984 through 1989. Usual occupation and industry from the death certificates were coded using the 1980 Bureau of the Census occupational and industrial classification system. There were 2444 cancer deaths among women in the telephone industry (code 441). Among younger (age < 49) white women, significant excess risks were observed from cancers of the rectum (MOR = 3.3; 95% confidence interval [CI] = 1.2 to 8.7), connective tissue (MOR = 4.4; 95% CI = 2.2 to 8.8), breast (MOR = 1.6; 95% CI = 1.3 to 2.1), corpus uteri (MOR = 3.3; 95% CI = 1.5 to 7.5), ovary (MOR = 2.1; 95% CI = 1.3 to 3.5), and brain (MOR = 2.1; 95% CI = 1.2 to 3.7). Cancer of the connective tissue showed an almost sixfold risk (MOR = 5.5; 95% CI = 2.0 to 14.8) for the age group of 30 to 39 years. Excess risks of cancer of the connective tissue were observed among engineers and technicians, office workers, telephone operators, and mechanics and repairers (MOR = 8.5, 4.9, 1.7, and 4.4, respectively), suggesting a possible relationship with modern technological exposures in the telephone industry. Risks for cancers of the breast, corpus uteri, ovary, and brain were also elevated among these jobs. We did not have information on other risk factors for these cancer sites; therefore, socioeconomic status or lifestyle may explain these observed associations, particularly for the cancers of the reproductive system.(ABSTRACT TRUNCATED AT 250 WORDS)
Overexpression of the epidermal growth factor receptor (EGFr) has been implicated in the pathogenesis of a wide variety of human malignancies and may be related to asbestos-induced carcinogenesis. Overexpression of the EGFr can be detected immunologically by quantitation of the extracellular domain (ECD) in the extracellular fluid in vitro and in serum in vivo. An enzyme-linked immunosorbent assay (ELISA) for the EGFr ECD was used to examine banked serum samples of 38 asbestosis patients who subsequently developed cancer, 72 age-sex-race-smoking-asbestos exposure matched asbestosis controls without cancer, and 20 age-sex-race-smoking matched nonasbestosis noncancer controls. The mean serum level for the EGFr ECD in the cancer cases (636 +/- 299 fmol/ml) was statistically significantly elevated (P < 0.05) in comparison to the mean level in the asbestosis controls (546 +/- 147 fmol/ml) or the nonasbestosis controls (336 +/- 228 fmol/ml). Defining a positive elevation of the serum EGFr ECD as any value more than 2 standard deviations above the nonasbestosis control mean, 7 (18%) of the cancer cases were positive compared to 4 (6%) of the asbestosis controls and one (5%) of the nonasbestosis controls. In addition, all of these cancer cases had positive serum samples prior to the time of disease diagnosis (average = 5.1 years). These results suggest that serum EGFr ECD may be elevated at an early stage of carcinogenesis in some asbestosis patients and that further prospective study of the utility of this biomarker is warranted.
This study determined the cost-effectiveness of one- versus two-stage hypertension screening at small to medium-sized blue collar, multicultural work sites using voluntary health organization and public health unit personnel. Workers with diastolic blood pressure (DBP) > or = 90 mm Hg were randomly allocated to one- or two-stage screening with differing physician referral protocols based on blood pressure level and treatment status. At first screening of 7856 workers, 12.5% had DBP > or = 90 mm Hg or < 90 and on medication with 64% aware of having hypertension, 42% on medication and 30% controlled (DBP < 90 mm Hg). One year later, there were no significant differences in effects or cost-effectiveness between groups. Both had significant DBP decrease (8.5 mm Hg), 54% had seen a physician within the recommended time, and 50% were controlled on medication or any treatment. One-stage screening, being easier to implement, is the preferred option.
We conducted a cross-sectional environmental and medical survey of 355 male sugarcane workers in Hawaii to determine whether exposure to biogenic silica fibers (BSF) affected their respiratory health. Exposures to BSF ranged from nondetectable to more than 0.700 BSF/mL and varied by job and department. Respiratory symptoms, chest radiograph findings, and pulmonary function were not associated with BSF exposures. Cigarette smoking was associated with respiratory symptoms and pulmonary obstruction. Fifteen workers had pleural thickening or pleural plaques and 3 of these workers were exposed to BSF for more than 10 years. BSF exposure does not appear to influence the respiratory health of sugarcane workers; however, further study is warranted.
There is a current trend for corporations to switch from in-house medical departments to outside contract organizations for provision of occupational health services. Although this may be driven by a desire to reduce expenses, there is little objective data on which to base this decision. This study compares the costs to a corporation of an in-house medical department with the costs for the same services if rendered by outside providers. Costs of the in-house department were obtained from company records. Prevailing charges for outside provider services were determined by an invoice survey and from other sources. We found that the cost for the in-house medical department was 42% less than that of the outside providers at the prevailing rates. Thus, the in-house medical department is more cost-effective than the outside providers. We also discuss other advantages of an in-house department that are more difficult to quantify.
Communication to workers of epidemiology study results is gaining increasing emphasis because of the need to notify study subjects and the responsibility to warn workers of potential workplace hazards. Industry has a unique responsibility in this regard both for ethical reasons and for gains in improving workers' knowledge of workplace hazards. We describe our recent efforts to notify 9648 workers potentially interested in the results of an epidemiology study that found increased rates for cancer. We found that both study and nonstudy subjects were equally interested the findings. We conclude that most workers view the notification as evidence of the company's commitment to maintain a safe workplace, and are pleased that the company undertook the study and reported the results to them. Unfavorable comments comprised less than 1% of the responses.
Magnitude and direction of second-order self-selection bias were assessed in a sample of 93,807 IBM employees who participated in the company's Voluntary Health Assessment (VHA) Program, by comparing repeat participants with one-time participants and by simulating selection into the repeat sample. One-time and repeat VHA participants differed systematically but not uniformly in several health characteristics. Repeat participants improved significantly in risk-relevant behaviors and health risk measures. Simulation of selection bias by excluding healthier or less healthy participants from the repeat VHA sample showed findings of gain to be robust. In studies of gain, second-order selection bias cannot automatically be assumed to inflate gain nor to be of sufficient magnitude to affect conclusions about program effects. Simulation is a useful tool for gauging direction and magnitude of selection bias.
Numerous occupational studies of cancer risks related to agriculture, agricultural practices, and agricultural exposures have been conducted among male farmers and farmworkers. Relatively few studies of female farmers and farmworkers have been conducted. Excesses of non-Hodgkin's lymphoma, leukemia, multiple myeloma, soft tissue sarcoma, and cancers of the breast, ovary, lung, bladder, cervix, and sinonasal cavities have been observed in women in agriculture or with agricultural exposures. Agents that contribute to ill health in exposed men may also affect exposed women, sometimes in unexpected ways.
We examined the prevalence of urolithiasis in 5574 men and women employees in 21 industrial plants in Israel who were screened for cardiovascular risk factors between 1985 and 1987 (the CORDIS Study). Among the data gathered were previous physician diagnosis of urolithiasis and ergonomic and demographic data. Urolithiasis was much more frequent in men than in women (age-adjusted prevalence of 4.5% in men and 1.2% in women, P <.0001). Older subjects had higher prevalence than young subjects. There were ethnic differences, and the highest prevalence was in subjects of European origin. Of the occupational factors, only industrial sector was related to prevalence of urolithiasis. Urolithiasis was more frequent among employees in wood industries than in other sectors (P <.05). We concluded that there is an effect of industrial sector on the prevalence of urolithiasis. To determine the cause and magnitude of the association of wood industries with increased prevalence of urolithiasis, ergonomic and chemical factors should be investigated.
This article summarizes published data on employment and cancer patterns in the motor vehicle manufacturing (MVM) industry and presents results from a new study of female MVM workers. Historically, female MVM employees worked primarily in aerospace; electric and electronic equipment manufacturing; and paint, plastic, and trim operations. Women are now moving into vehicle assembly and metal parts production. Investigations of cancer have focused on men and reported excesses of lung cancer in foundry operations, of gastrointestinal cancer in metal processing operations involving exposure to machining fluids, and of colorectal cancer in wood pattern making. Numbers of women were insufficient for a meaningful evaluation of their cancer patterns. A recent study found that white women employed at a MVM company, compared to the female general US population, had small excesses of lung cancer (standardized mortality ratio (SMR) = 1.26; 95% confidence interval (CI) = 0.96-1.63) and of colorectal cancer (SMR = 1.27, 95% CI = 0.87-1.78) and a deficit of breast cancer (SMR = 0.68, 95% CI = 0.48-0.92). The lung cancer increase was concentrated among women in assembly jobs (SMR = 1.58, 95% CI = 1.07-2.26); the colorectal cancer increase, among women in nonproduction jobs (SMR = 1.78, 95% CI = 0.97-2.98); and the breast cancer deficit, among women in production-related jobs (SMR = 0.60, 95% CI = 0.37-0.91). Further investigation is needed to determine if these patterns are due to the occupational environment and to clarify causes of cancer among women in the MVM industry.
Tuberculosis (TB) morbidity and mortality have increased substantially since the mid-1980s in areas with a high prevalence of medically underserved populations, human immunodeficiency virus, foreign-born persons, residents of long-term care facilities and crowded correctional institutions, and alcoholics and intravenous-drug abusers. The occupational risk has likewise increased for those exposed to these high-risk people in the course of their work. The magnitude of the occupational hazard is present unclear, although implications are disturbing. We used available data bases containing occupational exposure information, and telephone surveys, in an attempt to elucidate the magnitude of risk of occupationally acquired TB. We obtained up-to-date employee conversion rates at high-risk institutions, identified changing rates of TB infection and disease over time, documented high conversion rates following accidental exposures, and revealed a relative lack of reported TB disease and deaths. Numerous barriers to worker protection against TB are identified and recommendations are made to reduce the risk of occupationally acquired tuberculosis.
Data on the occupation and industry in which 242,196 females worked in Canada between 1965 and 1971 are available from a national survey of employers by Statistics Canada. As an example of the future utility of this cohort, computerized record linkage was conducted with the Canadian National Mortality Data Base through 1979. This article presents selected results. Associations are measured by standardized relative risks. Those meeting specific criteria (two or more observed deaths, relative risk > 2.0, and 95% confidence interval excluding 1.00) include (a) buccal cavity and pharyngeal cancer among mechanics and repairers, tobacco preparers and product makers, and telephone systems industry workers; (b) lung cancer among service station attendants, motor vehicle mechanics, and petroleum refinery workers; and (c) breast cancer among workers manufacturing electrical industrial equipment and printing and publishing industry workers. The mortality experience of the cohort through 1991 is currently being determined by another record linkage, thus providing up to 25 years of follow-up and over 8,500 cancer deaths anticipated among females.
