Journal of occupational medicine. : official publication of the Industrial Medical Association最新文献

Reviewing Workers' Compensation records for back injury from a large university hospital for a 2-year period, we found a yearly incidence of lost work time back injury among nurses of 2.0% per year, exceeded only by physical plant staff, who had a rate of 3.5%. Nurses' aides had an injury rate 3.3-fold higher than registered nurses and licensed practical nurses and higher than any other occupational group. We compared 100 cases of nurses with back injury in the previous 2 years with 197 noninjured control subjects using a mailed 40-item questionnaire. Multivariate logistic modelling showed that prior nonback injury and performing combined lifting activities were statistically significant risk factors for back injury, and being overweight approached significance, after adjusting for the effects of age, gender, and each of the evaluated risk factors.

Occupational exposures to cadmium are associated with increased risk of lung cancer and renal disease. The Occupational Safety and Health Administration (OSHA) published two standards for cadmium on September 14, 1992 that reduced the permissible occupational exposure limit. In the cadmium industry, women were less likely to be exposed to high levels of cadmium and more likely to hold job titles containing the word "hand" than were men. Only small numbers of female workers were exposed to any level of cadmium. OSHA's risk assessment relied, in part, on morbidity and mortality data from male workers and in part on rodent (animal) data from both sexes. OSHA did not evaluate illness rates specific to female workers. Several factors may alter the risk of these illnesses and their sequelae among workers, including differences in smoking, route of exposures, ability to wear personal protective equipment, and lifestyle.

A mortality cohort study (1951-1988) was conducted on 526 female workers in two lead and zinc mines in southwestern Sardinia (Italy), 310 of whom had been exposed to silica. Women exposed to silica showed a nonsignificant 38% increase in the standardized mortality ratio (SMR) for nonmalignant respiratory diseases, which was highest and statistically significant among women at the mine with the highest exposure to silica (SMR = 217; 95% confidence interval [CI] = 104, 400; based on 10 observed and 4.6 expected deaths). Five deaths from lung cancer also occurred among those exposed to silica (SMR = 283; 95% CI = 91,660), but the excess was not related to the level or duration of exposure. No information was available concerning lifestyle risk factors in this cohort. However, smoking was quite rare among Sardinian women at the time cohort members worked, so it may be presumed that very few of them were smokers.

Investigation of cancer rates--including trends over time, geographic variations, and differences by race, gender, and age--may identify patterns suggesting environmental exposures of potential occupational origin. National mortality data spanning the 40-year period from 1950 to 1989 were used to assess the patterns of several cancers for which occupational components have been identified among men, including cancers of the lung and bladder, non-Hodgkin's lymphoma, and leukemia, and for cancers of particular concern to women, such as breast and ovarian cancer, but for which occupational factors have not been well characterized. Newly available preliminary data show substantial geographic variation in cancer mortality rates at the county level during the 1970s and 1980s. Future analyses of the patterns, correlations with industrial indicators, and analytic studies should be fruitful in identifying occupational and other risk factors for cancers among women.

This study updates a retrospective cohort mortality analysis of workers from a South Carolina textile plant where chrysotile asbestos was the primary exposure. The update adds 15 years of observation to the original study, adds analyses of white women and black men, and allows comparison of mortality risks between race/gender groups. The total cohort includes 3,022 workers: 1,229 white women (363 deaths), 1,247 white men (607 deaths), and 546 black men (289 deaths). Statistically significant risks for lung cancer were observed among white women (standardized mortality ratio [SMR] = 2.07; 90% confidence interval [CI] = 1.55-2.71) and white men (SMR = 2.24; 90% CI = 1.83-2.72); both of these groups exhibited positive exposure-response trends. Although the lung cancer risk among black men was lower than expected (SMR = 0.70; 90% CI = 0.42-1.08), a statistically significant increase was observed at high levels of exposure. Statistically significant excess risk for pneumoconiosis and other respiratory diseases were observed for all race/gender groups. Despite the relatively high percentage of white women lost to follow-up and missing death certificates, both of which allow underestimation of the true relative risk, statistically significant excess risks were observed for lung cancer and pneumoconiosis among this group.

A survey of published epidemiologic studies from eight journals during 1971 to 1990 was conducted to assess the proportion and characteristics of occupational cancer studies that have included women and minorities. A total of 1233 reports included 562 (46%) with subjects limited to white men. The remaining 671 (54%) had subjects from other race-gender groups. Thirty-five percent included white women, but only 14% presented any analyses of white women specifically and only 7% presented more than five risk estimates. The proportions with analyses of nonwhite women (any = 2%; detailed = 1%) or men (any = 7%; detailed = 3%) were also small. Studies with detailed analyses of women and minorities tended to use weaker methodologies (ie, proportionate mortality or cross-sectional design) than the studies of white men and were less able to provide convincing data on the occupational cancer risks of women and minorities.

In the epidemiological approach to occupational cancers, large bodies of data must be analyzed to find rare cases of cancer. The exposure status of workers must therefore be assessed. Inaccuracies will lead to bias toward the null value in certain cases. Job title has often been used as a proxy for exposure status. This study was undertaken to examine content (ie, tasks and activities) associated with job title among men and women in a large Québec municipality. Occupational accident reports were studied for 1589 accidents, and 113 men and women workers were interviewed about job content. Women and men did not seem to have the same accident rates. From interview data, it appeared that women and men with the same job title did not perform the same tasks. Thus, they might have different exposures. The data reported here support caution in using job title to estimate exposure for both genders if the job-exposure matrix has not previously been validated separately by gender. In addition, it may be unwise to adjust relationships between job title and cancer incidence for gender, thus treating gender as a confounder when it may be a proxy for specific exposures.