M. Goldberg, Hunter College - CUNY, New York, NY; K. Wanzer, Mount Sinai Center for Occupational and Environmental Medicine, New York, NY.
Construction workers are exposed to many toxic substances known to cause chronic disease, including asbestos, silica, lead, and organic solvents. We undertook a survey of current medical surveillance programs for chronic disease to establish the extent to which such programs are available to construction workers, and to describe and evaluate existing programs. A literature search was conducted, as was a survey of occupational medicine clinics. In addition, information was sought on programs established by building trade unions and government agencies. Our survey attempted to establish the following information about existing programs: whether medical surveillance is ongoing or a one-time event, the content of the surveillance (medical exams, occupational histories), the sponsor of the program and how it is funded, program cost, and follow-up and intervention activities. To define more precisely the functioning of existing programs, one is described in greater detail: that of the Mount Sinai Center for Occupational and Environmental Medicine in New York City, which offers annual screenings that target asbestos-related disease. To characterize this program, in-depth interviews were conducted with labor-management fund administrators of participating unions, medical screening administrators, and participating physicians. The benefits of this program are described. Besides uncovering instances of asbestos-related disease, the medical screenings often detect health problems not related to asbestos exposure and in need of immediate attention. In addition, the information gathered during medical surveillance is important for developing occupational health policies and protective programs. One finding of the study is that, despite the high rate of occupational disease and illness among construction workers related to chronic exposure to toxic substances, there appear to be few programs designed to detect, track, and treat health problems resulting from the exposures.
E. Babayan, A. Aleksandryan, V. Kogan, R. Hovanesyan, Institute of General Hygiene and Occupational Diseases, Yerevan, Armenia; L. Saryan, Aurora Consolidated Laboratories, West Allis, WI; A. Khachatryan, NGO “EcoTox”, Yerevan, Armenia.
Aims: To assess possible formation of dioxins during the process of chloroprene production and to identify signs of poisoning by these substances.
Results: High-temperature processes at the chloroprene production enterprise (lime burning, calcium carbide manufacture, pyrolysis and chlorination of hydrocarbon materials, open burning of solid wastes, etc.) were conducted using air that was polluted with chlorine, chloroprene, and other organochlorine substances, thus facilitating the formation of polychlorinated dibenzodioxins. Transformer/ engine oils were regenerated at the same facility. Previously, defoliant was also produced with the use of 2,4-D. When production was functioning at full capacity and maximum amounts of harmful substances were released to the environment, emissions were calculated to be 2.5–3.2 g/toxic equivalent/year (g/TEQ/yr) in the 1960–70s. In the 1990s emissions decreased significantly; defoliant production, lime burning, and manufacture of carbide ceased. Production of polychloroprene rubber decreased 8–10-fold, dioxin emissions decreased up to 0.85–1.1 g/TEQ/yr. Chronic intoxication by chloroprene in workers by all its signs coincided with the signs of chronic poisoning by 2,3,7,8-tetrachlorodibenzo-p-dioxin described in scientific publications (general fatigue; weight loss; nervousness; chloracne; skin hyperpigmentation and rash; hair changes and falling out; toxic hepatitis with biochemical and lipid metabolism and enzyme disorders; toxic encephalopathy; polyneuropathy; vegeto-asthenic syndrome; inhibition of hormone production by hypophysis, adrenal and thyroid glands, and testicles, decrease of immunity, toxic myocarditis, coronary; renal and digestive disorders). Spontaneous abortions, premature labor, birth of mentally retarded children, and inborn malformations (prior to the 1960s) were common. In male workers, inhibition of spermatogenesis and sex hormone production, and decrease of sexual activity, were observed. An increase of chromosome aberrations in lymphocyte culture was revealed. Cohort studies confirmed potential carcinogenicity of chloroprene.
Conclusion: Chloroprene, as well as dioxins, exerts unidirectional action. The dioxin-mimetic action of chloroprene is a probable result of the combined action of these two chemicals.
F. Hayati, S. Maghsoodloo, Auburn University, Auburn, AL; C. Lemiere, Sacre-Coeur Hospital, University of Montreal, Montreal, Canada.
Occupational asthma (OA) is the most frequent occupational respiratory disease in the industrialized world. Occupational asthma is characterized by a progressive deterioration of lung function during the workweek with a significant improvement after removal from the workplace. Serial peak expiratory flow (PEF) monitoring at work and away from work is widely used for diagnosing OA. The interpretation of PEF monitoring is usually performed visually or using a computerized approach. The objective of this paper is to investigate the application of statistical process control (SPC) charts in monitoring of workers suspected for occupational asthma using PEF as the variable of interest.
The subjects were asked to record their PEF during periods of 2 weeks at work and away from work. For each subject a control chart of PEF at work and away from work were developed using Shewhart control chart method.
The preliminary examination of the PEF charts shows that control charts clearly establish range of function for each subject away from work and during work. The charts clearly identified workers suspected for occupational asthma. Statistical process control detection rules identified any unusual behavior in the asthma process. Comparing the lower control limit to the established asthma guidelines, asthma status can be classified.
This is the first report of the application of statistical process control charts to the monitoring of occupational asthma and demonstrates that SPC is an effective method to monitor workers suspected for occupational asthma.
A. Presson, U.S. DOL/OSHA, Washington, DC.
Response to natural rubber latex allergy, which some health care and other workers have developed after latex glove use in their workplace, is an evolving effort. OSHA has teamed with the Food and Drug Administration, National Institute for Occupational Safety and Health, the Veterans Administration, and other federal agencies as well as professional organizations, and has considered input from glove manufacturers and latex-affected workers to address workers’ concerns and to develop information to assist OSHA field staff in their interaction with workers in health care facilities and other workplaces. OSHA discusses these efforts, including recent developments regarding various workplace-related latex allergy issues and considerations for future involvement.
T. Slavin, W. Bunn III, International Truck and Engine Corp., Warrenville, IL.
A study was conducted to examine the relation between allergy severity levels and various safety, health, and productivity measures, and between allergy medications and the same outcome measures. Data were obtained on 10,714 employees in a heavy manufacturing environment using employee surveys and administrative databases that monitored employee absenteeism, workers compensation, short-term disability, and group health. Results show that safety, health, productivity, absenteeism, and workers’ compensation measures decline significantly as allergy severity levels increase. For example, the injury rate for high severity allergy sufferers was three times higher than for healthy workers. The relationship was also quantified for general, physical, and mental health outcomes and for several measures of productivity (effectiveness, ability to work required hours, concentrate, handle workload, work without mistakes, and bend and twist). Self-reported data were compared to cost and incidence data in several databases to confirm validity. In addition, allergy treatment approaches (use of non-sedating antihistamines, sedating antihistamines, no treatment, and other treatment options) were compared to health and productivity outcomes.
H. Packham, Enviroderm Services, Evesham, United Kingdom.
Occupational skin disease carries a significant cost for industry in the form of workman’s compensation, lost production, administrative costs, and lost skills. Faced with these mounting costs to industry and society as a whole, are there things we could be doing to reduce these costs? If we could detect problems at an early stage or better still when it is subclinical (invisible) we could reduce these costs. A skin health assessment program, if implemented correctly, could provide us with a very effective method for doing this.
Current methods are based around visual assessment. Unfortunately, this is a technique that looks solely at the surface of the skin and it will largely detect problems only when they are at a clinical and not subclinical stage. This allows action during the early clinical stages, but not normally for prevention of the problem by action at the subclinical stage.
Two techniques, which have been used in research for many years, provide a means of skin health assessment that can highlight subclinical damage for irritant contact dermatitis—the most common of the occupational skin diseases. The two techniques are (1) measurement of transepidermal water loss (moisture that passes through the skin and evaporates from the surface) and (2) hydration state of the stratum corneum (outermost layer of the skin). Transepidermal water loss measurement allows us to assess the state of the chemical barrier in the skin. Stratum corneum hydration is an indication of a general skin condition. These two measurements in combination with visual assessment give us the most powerful tool to date for the assessment of skin health, providing us with a program that not only allows for action at the earliest opportunity, but also at the subclinical stage.
H. Frasch, A. Barbero, NIOSH, Morgantown, WV; J. McDougal, Wright State University, Dayton, OH.
Governmental agencies have expressed concern regarding the potential for dermal absorption of diethyl phthalate (DEP). DEP is on the priority testing list of the Interagency Testing Committee under the Toxic Substances Control Act. The present research measured skin permeation parameters for DEP using neat chemical and saturated aqueous solution.
Hypothesis: Steady state flux of DEP through skin from saturated aqueous solution and from neat liquid will be the same.
Methods: Dermatomed abdominal hairless guinea pig (HGP) skin was used. From each HGP (n = 4), six skin punches were mounted on Franz-type diffusion cells. Saturated aqueous (HEPES-buffered Hanks balanced salt solution (HBSS)) solution of DEP was placed in donor compartments of three cells; pure DEP was placed in three cells. Accumulation of DEP in receptor fluid (HBSS) was measured over 5 hr. Skin sections from the same animals were equilibrated in DEP-saturated HBSS and in neat DEP. Uptake of DEP was measured. For each n, data from three replicates were averaged. The following were determined: steady-state flux (Jss); lag time (tlag); permeation coefficient (kp); skin-HBSS partition coefficient (K); DEP solubility in HBSS; neat DEP solubility in skin.
Results: Data are mean +/- SD. Jss (µg.hr-1.cm-2) was greater (P = 0.015) from saturated HBSS (31.4 +/- 11.7) than from neat DEP (9.8 +/- 3.5). tlag (hr) did not differ (0.63 +/- 0.23 vs 0.59 +/- 0.45). kp (cm.hr-1) from saturated HBSS: 3.4x10-2 +/- 9.7x10-3; from neat DEP: 8.7x10-6 +/- 3.2x10-6. K: 3.9 +/- 0.8. DEP solubility (µg/ml) in HBSS: 921 +/- 126; in skin: 8925 +/- 3339.
Conclusions: Skin may be a significant route of uptake of DEP. Jss from saturated aqueous solution was ~3x greater than from pure chemical, even though the estimated chemical potential for neat DEP was greater than for saturated solution. Increased skin permeability caused by hydration may be the mechanism.
D. Arfsten, A. Thitoff, E. Johnson, A. Jung, W. Jederberg, K. Still, Naval Health Research Center Toxicology Detachment, Wright-Patterson AFB, OH.
The risk for penetration injuries to battlefield personnel caused by depleted uranium (DU) projectiles has increased since the 1970s. Removal of DU projectiles from the body may not always be possible. Embedded DU solubilizes in the body over time and can translocate to various organs and tissues including the reproductive organs and developing fetus. Since DU is a toxic heavy metal and possibly mutagenic, fragments left inside the body could have a negative impact on reproductive organ function and/or reproductive success. To test this hypothesis, 8-week-old male and female Sprague-Dawley rats (P1 generation) were implanted with 0, 4, 8, 12, or 20 DU 1 x 2-mm pellets approximating 0.03, 0.06, 0.10, and 0.15% by weight of a 500-g rat, respectively. The animals were then cross-mated in various combinations at 30 days post-implantation. Parameters measured were reproductive success over a 7-day mating period, gestation weight gain, number of live-born pups, average pup weight at PND1, number of pups surviving to PND 4, and pup weight gain through PND20. Collection of urine and feces from P1 animals at 25 days post-implantation showed that DU was being excreted in the urine of DU-implanted animals. No evidence of toxicity was apparent for P1 DU-implanted animals at 30 days post-implantation. Our preliminary findings suggest no large differences between study groups for live birth indices, PND4 and PND20 viability indices, and average pup weight gain from PND4 to PND20. PND 4 F1 pups born to DU-implanted animals did not contain any detectable levels of uranium (limit of detection: 0.5 µg/mg tissue). Investigations are ongoing to determine the levels of DU detectable in PND4 pup tissues, specifically kidney, liver, GI tract, bone, brain, thymus, and ovaries/testes. Mating of DU-implanted animals at 120 days will also be carried out.
R. Hill, Clayton Group Services Inc., Lakewood, CO.
In response to a workers’ compensation claim of Hepatitis C (HCV), an investigation was conducted to determine the risk of contracting HCV from electronic transmitters used to monitor home-bound prisoners. The initial investigation revealed a HCV infection prevalence rate of 64–85% among IV drug abusers, which suggested a potentially high prevalence in a prison population. However, this workplace occurrence appeared unusual because HCV is known as a bloodborne pathogen, and not as an enteric nor airborne pathogen. The ensuing, detailed investigation looked at the potential for residual blood contamination on transmitters and potential sensitivity of the HCV virion to environmental factors and disinfectants, particularly as compared to HBV and HIV. The residual blood contamination survey, using a technique utilized by crime scene investigators, did not reveal any residual blood residues on the transmitters. In conclusion, the lack of blood residues on incoming transmitters and the suspected environmental sensitivity of HCV cause it to be very unlikely that the HCV case at this work place resulted from this source.
Posted May 30, 2004