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

To evaluate the incremental effectiveness of a work-site blood pressure control program, we conducted a randomized, controlled trial at four work sites with established health promotion programs. Workers with blood pressures of 140/90 mm Hg or higher were eligible. Eighty subjects were assigned to receive a referral to a community physician, monthly 10-minute work-site counseling sessions including blood pressure readings, and personalized mailings, whereas 79 control subjects received only a physician referral. Results for 74 intervention and 71 control subjects were obtained after 1 year. As compared with control subjects, intervention subjects experienced average declines of 8.5/3.9 mm Hg. Adjusted for age, sex, and baseline blood pressure, the decreases were 7.6 mm Hg for systolic and 2.4 mm Hg for diastolic blood pressure. These results suggest that counseling of high-risk persons and personalized mailing programs can have an incremental benefit in controlling blood pressure.

There is little information available of the costs of upper extremity cumulative trauma disorders. Cost data were collected from computerized records of the Liberty Mutual Insurance Company for upper extremity cumulative trauma disorder workers' compensation claims (N = 6,067) and for all claims (N = 731,087) initiated from 45 states during 1989. The data were not analyzed until July 1992, allowing more accurate "closing cost" data to be used in the analysis. Upper extremity cumulative trauma disorder cases represented 0.83% of all claims and 1.64% of all claims costs. The mean cost per case for upper extremity cumulative trauma disorders was $8070; median cost per case was $824. Medical costs represented 32.9% of the total costs; indemnity costs were 65.1%. The total compensable cost for upper extremity cumulative trauma disorders in the United States was estimated to be $563 million.

Nonfatal work-related injury (NFI) rates are 49% higher among oil and gas field workers than among workers in all US industries combined, and these injuries are more severe (the rate of lost workdays in the oil and gas field services industry is 2.8 times that of all US industries combined). We analyzed the 1988 to 1990 incident reports submitted by drilling companies to the International Association of Drilling Contractors, an industry-wide international trade association representing 95% of the world's oil and gas drilling companies. We determined geographic and occupation-specific incidence rates by full-time equivalents, calculated per job category and year. Of the 5,251 reports, 5,218 (99.4%) were of NFI and 33 (0.6%) of fatal work-related injuries (FI). The overall NFI rate was 1.2/100 full-time equivalents and the overall FI rate was 7.5/100,000 full-time equivalents. Reported NFI in US territory was 4 times more common than in non-US territory. Reported FI in US and non-US waters were 4 and 5 times more common than on land, respectively. Three job categories--floormen, roustabouts, and derrickmen--accounted for 74% of the NFI and 64% of FI, with a rate ratio, compared with rates for all other occupations, of 10.5, 8.5, and 7.0 for NFI and 5.0, 9.4, and 4.0 for FI. Among all occupations, the body part most frequently injured was the upper extremity (1,631/5,218 [31%]). The four key NFI types and circumstances identified included the upper extremities "caught in" (857/5,218 [16%]),the back "strained" (592/5,218[11%]), the lower extremities "struck by" (538/5,218 [10%]), and the lower extremities injured while "slipping" (402/5,218 [8%]). Results of these analyses revealed several high-risk occupations in this industry and identified high-risk activities that can be targeted for further study.

Our objective was to identify risk factors for development of immunologically mediated respiratory disease in workers exposed to hexahydrophthalic anhydride. We performed a medical and immunologic survey study of 57 workers in a workplace molding operation utilizing hexahydrophthalic anhydride. The main outcome measurements were the development of a respiratory disease due to specific IgE antibody (asthma and/or rhinitis) or specific IgG antibody (hypersensitivity pneumonitis or hemorrhagic rhinitis). Of the 57 workers, 7 had both IgE- and IgG-mediated disease, whereas 9 had only IgE-mediated disease. Although neither smoking, age, nor race were risk factors for development of immunologically mediated disease, exposure level and specific antibody were. In conclusion, development of immunologically mediated respiratory disease due to hexahydrophthalic anhydride is most closely associated with exposure level and development of specific IgE or IgG antibodies.

The United States undertook an extensive mobilization of military forces in Southwest Asia after the invasion of Kuwait by Iraq in August 1990. With this massive buildup and the short duration of the Persian Gulf War, an epidemiological comparison of military casualties was of interest. Information extracted from the Worldwide Casualty System maintained by the Department of Defense was used to describe the casualties. Of the 219 (212 men and 7 women) US casualties, 154 were killed in battle and 65 died from nonbattle causes. Thirty-five of the battle deaths were a result of friendly fire. Eighty-three percent of all casualties were white and the mean age at death for all casualties was 26.9 years. The Army had the highest proportion of both battle (58%) and nonbattle (71%) casualties and the Marine Corps had the highest battle casualty rate (0.52 per 1000 personnel) and nonbattle casualty rate (0.31).

Cancer incidence during 1953 to 1991 in 811 Finnish silicotic patients diagnosed between 1936 and 1977 was evaluated. In comparison with the general population, excesses were observed for all cancers (standardized incidence ratio, 1.7 [95% confidence interval, 1.4 to 1.9]), all lung cancers (2.9 [2.4 to 3.5]), squamous cell lung cancers (3.3 [2.3 to 4.5]), and skin cancers: melanoma (3.0 [0.8 to 7.6]) and nonmelanoma (2.9 [1.2 to 6.1]). Confounding by tobacco smoking did not explain the lung cancer increment. The consistency of the association between silicosis and lung cancer across a large number of studies suggests that silicosis represents a direct or indirect lung cancer hazard. The skin cancer excess, a relatively novel finding, may be explained either by carcinogens in foundries, or silica-induced lowering of immunocompetence, which would lead to a more pronounced effect of solar ultraviolet radiation.