British Journal Of Industrial Medicine[JOURNAL]
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200 papers
Residual cognitive deficits 50 years after lead poisoning during childhood.
White RF, Diamond R, Proctor S … +2 more , Morey C, Hu H
Br J Ind Med · 1993 Jul · PMID 8343422 · Full text
The long term neurobehavioural consequences of childhood lead poisoning are not known. In this study adult subjects with a documented history of lead poisoning before age 4 and matched controls were examined with an abbr...
The long term neurobehavioural consequences of childhood lead poisoning are not known. In this study adult subjects with a documented history of lead poisoning before age 4 and matched controls were examined with an abbreviated battery of neuropsychological tests including measures of attention, reasoning, memory, motor speed, and current mood. The subjects exposed to lead were inferior to controls on almost all of the cognitive tasks. This pattern of widespread deficits resembles that found in children evaluated at the time of acute exposure to lead rather than the more circumscribed pattern typically seen in adults exposed to lead. Despite having completed as many years of schooling as controls, the subjects exposed to lead were lower in lifetime occupational status. Within the exposed group, performance on the neuropsychological battery and occupational status were related, consistent with the presumed impact of limitations in neuropsychological functioning on everyday life. The results suggest that many subjects exposed to lead suffered acute encephalopathy in childhood which resolved into a chronic subclinical encephalopathy with associated cognitive dysfunction still evident in adulthood. These findings lend support to efforts to limit exposure to lead in childhood.
A nine year follow up study of renal effects in workers exposed to cadmium in a zinc ore refinery.
van Sittert NJ, Ribbens PH, Huisman B … +1 more , Lugtenburg D
Br J Ind Med · 1993 Jul · PMID 8343421 · Full text
Renal changes with time have been studied in 14 workers engaged in the production of cadmium (Cd) in a zinc ore refinery. These workers were examined once a year in the period 1980 to 1985 and 13 of them also in 1989. Fo...
Renal changes with time have been studied in 14 workers engaged in the production of cadmium (Cd) in a zinc ore refinery. These workers were examined once a year in the period 1980 to 1985 and 13 of them also in 1989. Four of the workers (group A) had been employed in an old Cd plant before 1973 and had received higher exposures to Cd than the other workers (group B). Average urinary Cd concentrations over the whole study period in workers of group A ranged from 6.9 to 9.2 micrograms/g creatinine (median 8.4 micrograms/g) and in workers of group B from 0.64 to 7.1 micrograms/g creatinine (median 1.9 micrograms/g). Renal effects were assessed by the determination of urinary N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (beta 2-M), retinol binding protein, albumin, total protein, and serum creatinine concentrations and activity. Urinary beta 2-M concentrations in three of four workers of group A were close to or marginally above the upper normal limit during the study period. The beta 2-microglobinuria was not, however, progressive. No values outside normal limits were detected for any of the other renal tests in workers of groups A and B, related to exposure to Cd. Dose-response relations showed that urinary Cd correlated significantly with urinary NAG activity and total protein and beta 2-M. The earliest change induced by Cd was seen for urinary NAG activity within normal limits of NAG excretion. The regression lines were similar in the surveys between 1981 and 1989, indicative of no progression to higher values for any of the renal tests. The current biological exposure index (BEI) of 10 micrograms/g creatinine for workers exposed to Cd, set by the American Conference of Governmental Industrial Hygienists (ACGIH), therefore seems justified, although the safety margin is small. The World Health Organisation recommended limit and ACGIH (1992-3) proposed limit of 5 micrograms/g creatinine would provide a much larger safety margin, and could be regarded as an action point for increased health surveillance.
Incidence of renal stones among cadmium exposed battery workers.
Järup L, Elinder CG
Br J Ind Med · 1993 Jul · PMID 8343420 · Full text
The health effects of occupational exposure to cadmium were studied in a group of 902 workers employed for at least one year in a Swedish battery factory between 1931 and 1982. Data on air cadmium concentrations for diff...
The health effects of occupational exposure to cadmium were studied in a group of 902 workers employed for at least one year in a Swedish battery factory between 1931 and 1982. Data on air cadmium concentrations for different periods were combined with company employment records to obtain individual cumulative exposure estimates. A questionnaire including questions on the occurrence of kidney stones was sent to all 601 living workers and to the next of kin of 267 of the deceased workers. The response rate was 88%. 73 workers reported renal calculi that appeared after initial employment. A dose-response relation was found between cumulative exposure to cadmium and age standardised cumulative incidence. Incidence rate ratios (IRRs) were then computed for three exposure categories (< 250, 250- < 5000, and 5000 micrograms/m3 x years) standardised for calendar time, age, and smoking with the low exposure group as reference level. The IRRs were 1.0, 1.6 [95% confidence interval (95% CI) 0.7-3.4], and 3.0 (95% CI 1.3-6.8) respectively. beta 2 Microglobulin measurements were available for 33 workers who formed stones; 13 of these workers had tubular proteinuria (beta 2 microglobulin > or = 34 micrograms/mmole creatinine)--that is, a prevalence of 39%. There was also an indication of a steeper dose-response relation among workers with tubular proteinuria.
Mortality among workers in the diatomaceous earth industry.
Checkoway H, Heyer NJ, Demers PA … +1 more , Breslow NE
Br J Ind Med · 1993 Jul · PMID 8343419 · Full text
A cohort mortality study was conducted among workers from two plants in the diatomaceous earth mining and processing industry in California. Diatomaceous earth consists of the skeletal remains of diatoms. Exposure to amo...
A cohort mortality study was conducted among workers from two plants in the diatomaceous earth mining and processing industry in California. Diatomaceous earth consists of the skeletal remains of diatoms. Exposure to amorphous (non-crystalline) and crystalline silica in the form of quartz results from open pit mining and exposure to crystalline silica (principally cristobalite) occurs in the processing of the material. Lung cancer and non-malignant respiratory diseases have been the health outcomes of greatest concern. The main study cohort included 2570 white men (533 Hispanic and 2017 non-Hispanic workers) who were employed for at least 12 months cumulative service in the industry and who had worked for at least one day during the follow up period, 1942-87. Vital status was ascertained for 91% of the cohort and death certificate information was retrieved for 591 of 628 (94%) identified deaths. The all causes combined standardised mortality ratio (SMR) was slightly increased (SMR = 1.12; 628 observed) compared with rates among US white males. The principal contributors to this excess were increased risks from lung cancer (SMR = 1.43; 59 observed) and non-malignant respiratory disease (NMRD) excluding infectious diseases and pneumonia (SMR = 2.59; 56 observed). The excess of lung cancer persisted when local county rates were used for comparison (SMR = 1.59). Internal rate comparisons by Poisson regression analysis were conducted to assess potential dose-response relations for lung cancer and NMRDs. Mortality trends were examined in relation to duration of employment in dust exposed jobs and with respect to an index of cumulative exposure to crystalline silica. The crystalline silica index was a semiquantitative measure that combined information on duration of exposure, differences in exposure intensity between jobs and calendar periods, the crystalline content of the various product mixes, and the use of respiratory protection devices. Increasing gradients of risk were detected for lung cancer and NMRD with both exposure indices. The relative risk trends for lung cancer and NMRD with crystalline silica exposure lagged 15 years were respectively: 1.00, 1.19, 1.37, and 2.74, and 1.00, 1.13, 1.58, and 2.71. Based on a review of available but limited data on cigarette smoking in the cohort and from application of indirect methods for assessing confounding variables, it seems unlikely that smoking habits could account for all of the association between exposure to dust and lung cancer. The intense and poorly controlled dust exposures encountered before the 1950s were probably the most aetiologically significant contributors to risks from lung cancer and NMRDs. The absence of an excess of lung cancer among workers hired since 1960, and the finding of no deaths attributed to pneumoconiosis as an underlying cause of death among workers hired since 1950 indicate that exposure reductions in the industry during the past 40 years have been successful in reducing excess risks to workers. Further mortality follow up of the cohort and the analysis of radiographic data will be needed to determine conclusively the long term patterns of disease risks in this industry.
Death rates of miners and ex-miners with and without coalworkers' pneumoconiosis in south Wales. 1955.
Carpenter RG, Cochrane AL, Clarke WG … +2 more , Jonathan G, Moore F
Br J Ind Med · 1993 Jul · PMID 8343418 · Full text
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Cancer incidence and mortality in the Swedish polyurethane foam manufacturing industry.
Hagmar L, Welinder H, Mikoczy Z
Br J Ind Med · 1993 Jun · PMID 8392362 · Full text
Toluene diisocyanate (TDI) and methylene diphenyldiisocyanate (MDI) are used in large quantities in the polyurethane foam manufacturing industry. Both substances are mutagenic and at least TDI is carcinogenic to animals,...
Toluene diisocyanate (TDI) and methylene diphenyldiisocyanate (MDI) are used in large quantities in the polyurethane foam manufacturing industry. Both substances are mutagenic and at least TDI is carcinogenic to animals, but the occupational hazard with respect to cancer is not known. Cancer incidence and mortality patterns were therefore investigated in a cohort of 4154 workers from nine Swedish plants manufacturing polyurethane foam, employed for at least one year. Each workplace and job task in the nine plants was categorically assessed for each calendar year by an experienced occupational hygienist, for "no exposure", "low or intermittent exposure", or "apparent exposure" to TDI and MDI. The observed deficit for all cause mortality (standardised mortality ratio (SMR) 0.78, (95% confidence interval (95% CI) 0.66-0.93) became smaller (SMR 0.92) excluding the first 10 years since the start of exposure and was ascribed to a healthy worker effect. No increased risk for death from bronchial obstructive diseases was found. An almost statistically significant deficit occurred for all malignant neoplasms (standardised incidence ratio (SIR) 0.81, 95% CI 0.63-1.02); slight (not significant) increased risks were found for rectal cancer (SIR 1.66) and non-Hodgkin's lymphoma (SIR 1.53). The SIR for non-Hodgkin's lymphoma increased to 2.80 (95% CI 0.76-7.16) when the first 10 years since first exposure were excluded from the observation period. The corresponding figure for rectal cancer was 1.92 (95% CI 0.52-4.92). Further restricting the analysis to those who had experienced an apparent exposure to TDI or MDI increased the SIR for both rectal cancer (3.19, 95% CI 0.66-9.33), and non-Hodgkin's lymphoma (3.03, 95% CI 0.37-10.9). These estimates were based, however, on few incident cases. As the cohort is still young and little time has elapsed since the start of exposure, future follow ups will enable a more conclusive evaluation.
Smoking adjusted mortality due to asthma in a population of Swedish working women.
Hörte LG, Torén K
Br J Ind Med · 1993 Jun · PMID 8329325
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Lymphocyte subsets in subjects exposed to asbestos: changes in circulating natural killer cells.
Borm PJ, Schins PF
Br J Ind Med · 1993 Jun · PMID 8329324 · Full text
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Exposure dependent increase in DNA single strand breaks in leucocytes from workers exposed to low concentrations of styrene.
Walles SA, Edling C, Anundi H … +1 more , Johanson G
Br J Ind Med · 1993 Jun · PMID 8329323 · Full text
Single strand breaks in DNA were monitored in leucocytes from 17 men occupationally exposed to styrene. Personal air monitoring was carried out during one workday with two diffusion samplers and a portable photoionisatio...
Single strand breaks in DNA were monitored in leucocytes from 17 men occupationally exposed to styrene. Personal air monitoring was carried out during one workday with two diffusion samplers and a portable photoionisation detector placed in the breathing zone. Exposure to styrene was also monitored by analysing styrene in blood and urine and mandelic acid in urine. Single strand breaks were measured in leucocytes by the alkaline elution technique. The biological samples were collected before a shift, at the end of a shift, and the next morning, before the next shift. An exposure dependent increase in single strand breaks was seen at the end of a shift but not before a shift or the next morning. Linear regression analysis indicated that the amount of DNA damage was roughly doubled after eight hours of exposure to 18 ppm styrene or at a urine concentration of 240 mg mandelic acid/g creatinine compared with the damage in non-exposed men. This study indicates that monitoring of single strand breaks with the alkaline elution technique may be a sensitive marker of genotoxic effects. To our knowledge, this is the first time that such a marker has been shown to correlate with exposure to less than 20 ppm styrene.
Further follow up of mortality in a United Kingdom oil distribution centre cohort.
Rushton L
Br J Ind Med · 1993 Jun · PMID 8329322 · Full text
Results of an extension of follow up (1976 to 1989) of a cohort of workers employed for at least one year between 1 January 1950 and 31 December 1975 at oil distribution centres in Britain are presented. Over 99% of the...
Results of an extension of follow up (1976 to 1989) of a cohort of workers employed for at least one year between 1 January 1950 and 31 December 1975 at oil distribution centres in Britain are presented. Over 99% of the workers were successfully traced to determine their vital status at 31 December 1989. The mortality observed was compared with that expected from the death rates of all the male population of England and Wales. The mortality from all causes of death for the total study population was less than that of the comparison population, and reduced mortality was also found for many of the major non-malignant causes of death. No healthy worker effect was found for ischaemic heart disease, and raised mortality from this disease was found in particular for one company and in several job groups. Raised mortality was also found for aortic aneurysm. Mortality from all neoplasms was lower than expected overall, largely due to a deficit of deaths from malignant neoplasm of the lung. Raised mortality patterns from all neoplasms, malignant neoplasm of the lung, and several non-malignant disease groups were found for general manual workers although the mortality from many of these diseases for all men in this social class in the national population is also high. There was increased mortality from malignant neoplasms of the larynx and prostate but these tended to be in isolated subgroups. Mortality from malignant neoplasm of the kidney was raised overall and in drivers in particular. Mortality from leukaemia was high at one company and in drivers overall.
Further follow up of mortality in a United Kingdom oil refinery cohort.
Rushton L
Br J Ind Med · 1993 Jun · PMID 8329321 · Full text
The results of an extension of follow up (1976 to 1989) of a cohort of workers employed for at least one year between 1 January 1950 and 31 December 1975 at eight oil refineries in Britain are reported. Over 99% of the w...
The results of an extension of follow up (1976 to 1989) of a cohort of workers employed for at least one year between 1 January 1950 and 31 December 1975 at eight oil refineries in Britain are reported. Over 99% of the workers were successfully traced to determine their vital status at 31 December 1989. The mortality observed was compared with that expected from the death rates of all the male population of England and Wales and Scotland. The mortality from all causes of death for the total study population was lower than that of the comparison population, and reduced mortality was also found for many of the major non-malignant causes of death. Raised mortality patterns were found for diseases of the arteries, in particular aortic aneurysm, and accidental fire and explosion, for the total study population, and across several refineries and other subgroups. Mortality from all neoplasms was lower than expected overall, largely due to a deficit of deaths from malignant neoplasm of the lung. Raised mortality from all neoplasms was found for labourers and in particular for malignant neoplasms of the oesophagus, stomach, and lung, although the mortality was also high for all men in this social class in the national population. Regional variations may have accounted for some of the high mortality. There were other raised mortality patterns in malignant neoplasms of the intestine, rectum, larynx, and prostate but these tended to be isolated and not consistent across refineries and other subgroups. As in the earlier follow up there was raised mortality from melanoma in several job groups.
Cor pulmonale and silicosis: a necropsy based case-control study.
Murray J, Reid G, Kielkowski D … +1 more , de Beer M
Br J Ind Med · 1993 Jun · PMID 8329320 · Full text
The presence of cor pulmonale at death in relation to other factors such as emphysema, silicosis, and thromboembolism was analysed in a case-control study of 732 South African gold miners. Marked emphysema was the highes...
The presence of cor pulmonale at death in relation to other factors such as emphysema, silicosis, and thromboembolism was analysed in a case-control study of 732 South African gold miners. Marked emphysema was the highest risk factor with an odds ratio of 21.32 (95% confidence interval (95% CI) 5.02-90.7), then extensive silicosis (OR 4.95, 95% CI 2.92-8.38) and thromboembolic disease (OR 1.92, 95% CI 1.37-2.69). Age and smoking were not significant predictors of cor pulmonale.
Mortality and cancer morbidity of production workers in the United Kingdom flexible polyurethane foam industry.
Sorahan T, Pope D
Br J Ind Med · 1993 Jun · PMID 8329319 · Full text
OBJECTIVE: To describe cause specific mortality and site specific cancer morbidity among workers employed in factories that produce polyurethane foams, and to determine if any part of the experience may be due to occupat...
OBJECTIVE: To describe cause specific mortality and site specific cancer morbidity among workers employed in factories that produce polyurethane foams, and to determine if any part of the experience may be due to occupation, and in particular to exposure to diisocyanates. DESIGN: Historical prospective cohort study. SETTING: 11 factories in England and Wales. SUBJECTS: 8288 male and female production employees with some employment in the period 1958-79, and with a minimum period of employment of six months. MAIN OUTCOME MEASURES: Observed and expected numbers of deaths for the period 1958-88, and corresponding figures for cancer registrations for the period 1971-86. RESULTS: Compared with the general population of England and Wales, standardised mortality ratios (SMRs) for all causes and all neoplasms were 97 (observed deaths (Obs) 816) and 88 (Obs 221) respectively. Statistically significant excesses were found among women for cancer of the pancreas (expected deaths (Exp) 2.2, Obs 6, SMR 271, 95% CI 100-595) and cancer of the lung (Exp 9.1, Obs 16, SMR 176, 95% CI 100-285). Similar excesses were not found among male employees, and the SMRs for cancers of the lung and pancreas among the total study population were 100 (Obs 81) and 136 (Obs 14) respectively. Overall incidence of cancer was also below expectation (SRR 94, Obs 277), although statistically significant excesses among women were found for cancers of the larynx and kidney, based on three and four cases respectively. Incident cancers of the lung and pancreas among women were also in excess, although these findings were not independent of the findings for mortality. Poison regression did not indicate that ever having been employed in jobs attracting either higher or lower exposure to isocyanates was a risk factor for the mentioned cancers. A nested case-control design was used to investigate any associations with nine other occupational exposures. No statistically significant association was found. CONCLUSIONS: In general, cancer rates in this population were lower than those for the general population. All increased cancer rates among women occurred at sites of cancer known to be related to cigarette smoking, and these excesses are probably due to a combination of cigarette smoking, chance, and factors unrelated to the industry under study.
Somatosensory evoked potentials in workers exposed to toluene and styrene.
Stĕtkárová I, Urban P, Procházka B … +1 more , Lukás E
Br J Ind Med · 1993 Jun · PMID 8329318 · Full text
Somatosensory evoked potentials (SEPs) were used to evaluate possible subclinical impairment of the nervous system due to occupational exposure to toluene and styrene. A group of 36 rotogravure printers with severe expos...
Somatosensory evoked potentials (SEPs) were used to evaluate possible subclinical impairment of the nervous system due to occupational exposure to toluene and styrene. A group of 36 rotogravure printers with severe exposure to toluene, 20 workers with severe exposure to styrene in a glass laminate manufacturing plant, and a comparison group of healthy subjects were studied. The severity of exposure was documented by measurements of toluene and styrene concentrations in breathing zone air, by hippuric acid concentration in urine in the group exposed to toluene, and by urinary mandelic acid concentration in the group exposed to styrene. Somatosensory evoked potentials were measured by stimulation of the median nerve at the wrist and the tibial nerve at the ankle. Peripheral conduction velocities (CVs) in both extremities and central conduction time (CCT) after tibial nerve stimulation were significantly decreased in both exposed groups. Significantly prolonged latencies of peripheral and cortical SEPs to median nerve stimulation as well as cortical SEPs to tibial nerve stimulation were found in workers exposed to styrene. Some abnormalities in SEPs at peripheral or spinal and cortical levels were found in eight workers exposed to toluene and six workers exposed to styrene. Of these, in three workers exposed to toluene and two to styrene increased CCT and delayed latencies of cortical responses at normal conduction values in the periphery were found. A trend for increased frequency of abnormal SEPs with duration of exposure to toluene and styrene and alcohol abuse was found. Abnormalities in SEPs in the exposed groups are most probably of multifactorial origin. Central SEP abnormalities in both exposed groups could indicate early signs of subclinical dysfunction at spinal and cortical levels and could be due to toluene or styrene exposure probably potentiated by alcohol consumption in the group exposed to toluene.
High resolution pulmonary computed tomography scans quantified by analysis of density distribution: application to asbestosis.
Eterović D, Dujić Z, Tocilj J … +1 more , Capkun V
Br J Ind Med · 1993 Jun · PMID 8329317 · Full text
A new method for quantitative evaluation for high resolution computed tomography (HRCT) of the lungs was developed by assessment of the distribution of radiological densities within the lung slices. To enable effective r...
A new method for quantitative evaluation for high resolution computed tomography (HRCT) of the lungs was developed by assessment of the distribution of radiological densities within the lung slices. To enable effective reduction of data and improve the sensitivity of detection of abnormalities, the density distributions were analysed by curve fitting through the gamma variate model. The output of two variables proved most representative: the most frequent density (Hoansfield units; HU) and width of distribution (HU). The method was applied to seven patients with early asbestosis (positive histological finding and International Labour Office (ILO) profusion score up to 0/1), 15 patients with advanced stage of asbestosis (positive histological finding and ILO score above 1/2), and 13 normal controls. All patients with early asbestosis had isolated reduction of diffusing lung capacity to carbon monoxide (DLCO), whereas all patients with advanced asbestosis had reduced DLCO and restrictive disease; two of them also had an obstruction pattern. The most frequent densities were significantly greater in the advanced asbestosis group (-567 HU) when compared with both the early asbestosis group (-719 HU; p = 2 x 10(-6)), and controls (-799 HU; p = 0), and they also discriminated significantly between the early asbestosis group and controls (p = 0.0002). Significantly stronger linear correlations were established between DLCO and the most frequent densities (r = 0.86) than between DLCO and HRCT score (r = 0.57) or ILO score (r = 0.34). It is concluded that fitting the curve of the density distribution enables a more objective assessment of HRCT pulmonary scans, especially in the early stage of asbestosis.
Manganese encephalopathy: utility of early magnetic resonance imaging.
Nelson K, Golnick J, Korn T … +1 more , Angle C
Br J Ind Med · 1993 Jun · PMID 8329316 · Full text
The use of magnetic resonance imaging (MRI) provides visual evidence of cerebral deposits of paramagnetic metals. The usefulness of MRI is described in connection with the manganese poisoning of a 44 year old arc welder...
The use of magnetic resonance imaging (MRI) provides visual evidence of cerebral deposits of paramagnetic metals. The usefulness of MRI is described in connection with the manganese poisoning of a 44 year old arc welder who had been engaged in the repair and recycling of railroad track made of manganese steel alloy.
Mortality from lung cancer among copper miners.
Chen R, Wei L, Huang H
Br J Ind Med · 1993 Jun · PMID 8329315 · Full text
A cohort mortality study of lung cancer in 7088 copper miners was made from 1 January 1969 to 31 December 1988. There was an excess of deaths from lung cancer in the copper miners. The standardised mortality ratio (SMR)...
A cohort mortality study of lung cancer in 7088 copper miners was made from 1 January 1969 to 31 December 1988. There was an excess of deaths from lung cancer in the copper miners. The standardised mortality ratio (SMR) was 147 (p < 0.01). The SMR increased with calendar period. There was a higher risk of deaths from lung cancer in the miners employed in the 1950s. Age at the start of exposure had no effect on the risk of lung cancer. The risk of death from lung cancer increased with the duration of exposure and the time since first exposure. The SMR for lung cancer was 173 in underground miners and 193 for drilling miners (both p < 0.01). These data show that exposure to dust is associated with an excess of deaths from lung cancer in copper miners whereas exposure to radiation does not seem to carry such risk.
Mineral fibres: correlation between oxidising surface activity and DNA base hydroxylation.
Nejjari A, Fournier J, Pezerat H … +1 more , Leanderson P
Br J Ind Med · 1993 Jun · PMID 8329314 · Full text
In relation to their potential genotoxic properties, the ability of inorganic particles to induce activated species of oxygen with strong oxidative properties can be studied by various methods. In this study the oxidativ...
In relation to their potential genotoxic properties, the ability of inorganic particles to induce activated species of oxygen with strong oxidative properties can be studied by various methods. In this study the oxidative surface properties of 10 different natural and synthetic mineral fibres were investigated by: (1) an electron paramagnetic resonance technique in which formate was used to trap oxidative species; and (2) a high performance liquid chromatography (HPLC) based method in which deoxyguanosine was used as a trapping agent and the formation of 8-hydroxy-deoxyguanosine (8 OHdG) was analysed. Ground iron-containing fibres such as crocidolite and amosite were the most reactive, whereas fibres without iron--for example, ceramic fibres, xonotlite, and Tismo L--were completely inactive. A good correlation was found when the results from the two methods were compared (r = 0.86).
Hypersensitivity pneumonitis presenting as sarcoidosis.
Forst LS, Abraham J
Br J Ind Med · 1993 Jun · PMID 8329313 · Full text
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Health, employment, and financial outcomes in workers with occupational asthma.
Gannon PF, Weir DC, Robertson AS … +1 more , Burge PS
Br J Ind Med · 1993 Jun · PMID 8329312 · Full text
OBJECTIVE: To study the health, employment, and financial outcome of occupational asthma. DESIGN: A follow study of workers with confirmed occupational asthma. SETTING: A specialist occupational lung disease clinic. SUBJ...
OBJECTIVE: To study the health, employment, and financial outcome of occupational asthma. DESIGN: A follow study of workers with confirmed occupational asthma. SETTING: A specialist occupational lung disease clinic. SUBJECTS: All workers had a diagnosis of occupational asthma made at least one year earlier. Diagnosis was confirmed by serial peak expiratory flow measurement, specific bronchial provocation testing, or specific immunology. MAIN OUTCOME MEASURES: Respiratory symptoms, medication, pulmonary function, employment state, and financial position. RESULTS: 112 of a total of 140 eligible workers were followed up. 32% of patients remained exposed to the causative agent. These workers had more symptoms at follow up than those removed and a greater number were taking inhaled steroids. Continued exposure was also associated with a fall in % predicted forced expiratory volume in one second (FEV1) of 3% compared with that at presentation. Their median loss of annual income due to occupational asthma was 35%. Those removed from exposure were worse off financially (median loss 54% of annual income), had fewer respiratory symptoms than the group who remained exposed, and their % predicted FEV1 had improved by 4.6%. Statutory compensation and that obtained by common law suits did not match the loss of earnings due to the development of occupational asthma. Of the workers removed from exposure, those who no longer complained of breathlessness had been diagnosed significantly earlier after the onset of their first symptom (48 v 66 months, p = 0.001) and had a significantly higher FEV1 at presentation (90% v 73% predicted, p = 0.008) compared with those who were still breathless. They had developed symptoms earlier after first exposure (48 v 66 months, p > 0.05) and had been removed from exposure sooner (eight v 12 months, p > 0.05). CONCLUSION: Removal from exposure after diagnosis of occupational asthma is beneficial in terms of symptoms and lung function, but is associated with a loss of income. Early diagnosis is important for symptomatic improvement after removal from exposure. Inadequate compensation may contribute to the workers' decision to remain exposed after diagnosis.
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