Ramazzini; blog on work and health

A video on the history of health and safety in the USA:

Video shared by mark d catlin, who has many more Videos and clips of workplace and environmental health and safety topics.

Patients with painter’s disease (chronic solvent-induced encephalopathy - CSE or chronic toxic encephalopathy - CTE) have perceptible deviations in their brain as a result of the contact with organic solvents. This is the conclusion of researchers of the Academic MedicalCenter, Amsterdam in the Netherlands. They are the firsts to show a link between the symptoms, the degree of exhibition to the detrimentalsubstances and structural changes in the brain.

Diagnosis CTE or CSEwas controversial for a long time. Employees who have been exposed to organic solvents in for example paint, printing ink or detergents can suffer impaired concentration, memory problems and dysfunctional mental and motorialspeed. Although the syndrome as such has been described according to criteria of the World Health Organisation, damage to the brain was never shown indisputably in patients so far.

Research of the departments of psychiatry, radiology, nuclear medicine and the Netherlands Center for Occupational Diseases of the AMC using imaging techniques like fMRI and SPECTchanges this. They looked at ten patients with CTE/CSE, ten painters without symptoms who had been exposed to solvents, and eleven carpenters who had been exposed to solvents.

The results are published in the Annals of Neurology on April 15th, 2008. The article by Ieke Visser et al. is titled:
Cerebral impairment in chronic solvent-induced encephalopathy

Here is the abstract:
Objectives
Worldwide, many workers experience occupational exposure to organic solvents, which may induce chronic solvent-induced encephalopathy (CSE) or chronic toxic encephalopathy. This disease is also reffered to as painter’s disease.

The symptomatology of CSE might be explained by disturbances within the frontostriatothalamic (FST) circuitry. A group of researchers of the Academic Medical Center, Amsterdam in the Netherlands tested the hypothesis of FST circuitry abnormalities in CSE, as well as associations with performance of psychomotorspeed, attention, and solvent exposure. To detect preclinical, solvent-related effects, we also studied the FST circuitry in solvent-exposed, but asymptomatic workers.

Methods
They compared 3 groups: 10 CSE patients, 10 asymptomatic but solvent-exposed house painters (EC), and 11 nonexposedasymptomatic carpenters with fMRI. Dopamine D2 receptor (D2R) binding, central nervous system tissue metabolites, and fractional anisotropy were measured within the FST circuitry, using single-photon emission computed tomography, magnetic resonance spectroscopy, and diffusion tensor imaging. Performance of psychomotor speed and attention, and severity of solvent exposure were assessed.

Results
Striatal D2R binding was reduced in CSE. In the solvent-exposed asymptomatic patients, striatal D2R binding and levels of N-acetylaspartate + N-acetylaspartyl-glutamate in frontalgray matter were reduced. In both exposed groups, a trend was seen for reduced choline in frontal gray matter. In CSE, the fractional anisotropy in the thalamus, caudate nucleus, and striatal D2R binding significantly predicted reduced performance of attention and psychomotor speed. In CSE, striatal D2R binding showed a negative correlation with solvent exposure.

Interpretation
This is the first study in CSE showing pronounced disturbances within the FST circuitry that are related to the clinical findings and to exposure severity to solvents. The comparable, but milder, abnormalities within the FST circuitry in the exposed asymptomatic workers may imply a presymptomatic phase of CSE.

This research can not yet be used for the appraisal of individual patients. More scientific research in larger groups is necessary. At this moment it’s not yetpossible to test individual employees or patients. There is no such test available to assess individual painters to establish the diagnosis CTE/CSE. The AMC considers to set up larger scientific follow-up studies. 

Today I learned from colleagues about a nice tool to use while searching in PubMed. It’s called PubReMiner and you can start here.

Just fill the box with your search string and you can dates between which you want to search. Then hit the PubReMiner button and you get a nice overview of the results: how many hits in what years, which journals, which autors, countries, additional MESH terms. You can add those to your search. If you are done, click the button which says Goto PubMed with Query  at the top of the page and you can see the abstract of the articles you found.

I think I’ll be going to use this a lot. The interesting thing for me is that it’s developed by a Dutch colleague: Jan Koster, from AMC Amsterdam.

I found an interesting overview of the health risks of aircraft crew and frequent flying passengers. Here is a link to the article Risk Factors, Health Risks, and Risk Management for Aircraft Personnel and Frequent Flyers

I made up a summery of the contents of this article, which also includes indications for risk management:

In general, flight-crew personnel and passengers are exposed to a variety of risk factors, including: 

1. Physical stressors: Electromagnetic fields (EMFs), and ionizing radiation of cosmic origin (protons, neutrons, and γ-radiation), which are at appreciably higher levels than at ground level.
2. Chemical stressors: Chemical pollutants and environment agents at altitude, such as ozone, the combustion products of jet fuels (e.g., CO, CO2, polycyclic aromatic hydrocarbons [PAHs], etc.), and the chemicals used to construct the interior of aircraft, are sources of exposure. In a closed aircraft, it is important that a clean supply of air is maintained from the exterior.
3. Biological stressors: Food poisonings might occur due to the consumption of foods contaminated with microorganisms, such as Escherichia coli, vibrios, Salmonella, and Serratia marcescens. Legionella species are also often detected in flight (Ott et al., 2004), and micro-organisms such as those of flu and tuberculosis may be transmitted from infected individuals to healthy people through aircraft air filtering systems.
4. Psychological stressors: Stress is characterized by non specific adverse biological responses to emotional disturbances, tiredness, and the disruption of circadian rhythm before, during, and after flight. Immune functions are altered in stressful situations, and these increase the likelihood of infection.
5. Others: Other risk factors due to the aviation environment include acceleration forces, disorientation due to irregular flight, hypoxia, noise, and changes in pressures and temperatures.

Cosmic radiation
At high altitude, which is the domain of commercial airliners, cosmic-ray exposure rates are hundreds of times greater than at ground level. A crew member who works 1100 block hours (a flight begins when the aircraft leaves the blocks before takeoff and ends when it touches the blocks after landing) per a year would receive an annual radiation dose between 0.3 and 9 mSv. The higher value, 9 mSv (microsievert), is less than the occupational exposure limit of 20 mSv recommended by the International Commission on Radiological Protection. However, for pregnant women, the ICRP recommended that occupational exposure to ionizing radiation should not exceed 2 mSv.

Epidemiological evidence
Epidemiological evidence shows that airline astronauts, pilots, and cabin attendants are at high risk of cancer, cardiovascular diseases, cataract, psychosis, hearing loss, infection, and developmental disorders. 

Many epidemiological studies support the association between flight personnel and cancer risk by demonstrating elevated levels of micronuclei and cytogenetic aberrations, using techniques such as fluorescent in situ hybridization (FISH) (Scheid et al., 1993; Heimers, 2000; Romano et al., 1997; Cavallo et al., 2002). A meta-analysis of all follow-up studies that reported standardized incidence ratio (SIR) for cancer among female flight attendants was performed by applying Bayesian hierarchical models, and showed significant excesses of melanoma and breast cancer (Buja et al., 2006). In male pilots, relative risks (RRs) were also elevated for mortality from melanoma and for the incidence of prostate cancer in another meta-analysis (Ballard et al., 2006).

After a review of 20 relevant epidemiological investigations, Ott and Huber (2006) reported that crew members and frequent flyers may be at higher risk of developing cancers of the skin (e.g., malignant melanoma, basalioma, etc.), prostate cancer, or leukemia. 

In the Netherlands the number of deadly accidents at work are decreasing according to the Central Bureau of Statistics (CBS):

2003: 108 → 2004: 93 → 2005: 74

Relatively most people died in agriculture and fishing (6.9 per 100.000), followed by construction (6.1 per 100.000), transport (3.6 per 100.000), industrial work (1.8 per 100.000) and services (1.6 per 100.000)

Britain’s Most Dangerous Jobs
Paul MacKenzie-Cummins for CareerBuilder.co.uk

Here are the most dangerous and high-risk jobs in the UK (data from Risk Placement Services):

1. Fisherman or Merchant Seafarers: around 103 per 100,000 fishermen and 52 in every 100,000 merchant seafarers die while working
2. Bomb Disposal or Mine Clearance Expert
3. Oil or Gas Rigger
4. Construction Workers: 3.7 workers per 100,000
5. Lorry and Commercial Drivers
6. Deep-sea Diver
7. War Zone Security Guard
   
    
   

The chance of an average worker sustaining a fatal work injury is slim – there were just 3.9 fatal occupational injuries per 100,000 workers in the United States in 2006. There were 5,703 overall work-related fatalities in 2006.

Top 10 of most perilous jobs according to the Bureau of Labor Statistics, the following jobs had the highest fatality rates for 2006 (USA):

1. Fishers and related fishing workers:
Fatality rate (per 100,000 workers): 141.7 - Number of fatalities: 51 - Average salary: $19,104

2. Aircraft pilots and flight engineers
Fatality rate (per 100,000 workers): 87.8 - Number of fatalities: 101 - Average salary: $129,250

3. Logging workers
Fatality rate (per 100,000 workers): 82.1 - Number of fatalities: 64 - Average salary: $22,320

4. Structural iron and steel workers
Fatality rate (per 100,000 workers): 61.0 - Number of fatalities: 36 - Average salary: $39,168

5. Refuse and recyclable material collectors
Fatality rate (per 100,000 workers): 41.8 - Number of fatalities: 38 - Average salary: $23,770

6. Farmers and ranchers
Fatality rate (per 100,000 workers): 37.1 - Number of fatalities: 291 - Average salary: $15,603

7. Electrical power-line installers and repairers
Fatality rate (per 100,000 workers): 34.9 - Number of fatalities: 38 - Average salary: $45,331

8. Roofers
Fatality rate (per 100,000 workers): 33.9 - Number of fatalities: 82 - Average salary: $28,474

9. Driver/sales workers and truck drivers
Fatality rate (per 100,000 workers): 27.1 - Number of fatalities: 940 - Average salary: $30,931 (for heavy or tractor-trailer drivers)

10. Miscellaneous agricultural workers
Fatality rate (per 100,000 workers): 21.7 - Number of fatalities: 158 - Average salary: $24,140

The top five most threatening industries based on fatality rates are:

Since two years I use the best desktop search tool I know: Copernic Desktop Search.

With this tool it’s incredible easy to find the article, picture, presentation, e-mail that you need, but can’t remember where you put it. It’s a free download program and it indexes everything on your computer everytime you are not working on it. Just give it a try: the interface is also very nice!

This is what Wikipedia says on it:
Copernic Desktop Search is a desktop search utililty for the Microsoft Windows family of operating systems. It is designed to allow the user to instantly find a wide variety of items including documents, pictures, music, videos, e-mails, contacts, browser bookmarks/favourites and entries in the Internet browser history on the computer, external drives and network shares.

In this video it’s presented by CNet: http://www.cnettv.com/9742-1_53-20554.html 

Click on this link to see a good instruction video on Google Reader for RSS-feeds from capturetheconversation.com

Instruction video on Google Reader

High risk occupations for non-Hodgkin’s lymphoma in New Zealand: case-control study

A recent article by A ’t Mannetje in OEM concludes that crop farmers and meat workers remain high risk occupations for non-Hodgkin’s lymphoma (NHL) in New Zealand, and has identified several other occupations and industries of high NHL.

An elevated NHL risk was observed for field crop and vegetable growers (OR 2.74, 95% CI 1.04 to 7.25) and horticulture and fruit growing (OR 2.28, 95% CI 1.37 to 3.79), particularly for women (OR 3.44, 95% CI 0.62 to 18.9; OR 3.15, 95% CI 1.50 to 6.61). Sheep and dairy farming was not associated with an increased risk of NHL.

Meat processors had an elevated risk (OR 1.97, 95% CI 0.97 to 3.97), as did heavy truck drivers (OR 1.98, 95% CI 0.92 to 4.24), workers employed in metal product manufacturing (OR 1.92, 95% CI 1.12 to 3.28 ) and cleaners (OR 2.11, 95% CI 1.21 to 3.65).

After semi-Bayes adjustment the elevated risks for horticulture and fruit growing, metal product manufacturing and cleaners remained statistically significant, representing the most robust findings of this study.

Occupational asthma, respiratory issues and dermatitis in hairdressers and nail bars

Workers in hairdressers, beauty salons and nail bars are at potential risk of developing skin and respiratory ill health conditions if good working practices and effective exposure control methods are not applied. This inspection initiative in London focused on HSE’s priorities for preventing dermatitis and asthma caused or made worse by work.

Between October 2006 and April 2007, Local Authority Environmental Health Practitioners inspected 205 hairdressing and nail salons and returned the inspection checklists to HSL for analysis.

Health and safety in nail bars:

This report on health and safety in nail bars was funded by the Health and Safety Executive (HSE). Nail bars are a rapidly expanding small business sector. 71 nail technicians answered a researcher-administered, self-reported occupational health questionnaire. Their data were compared with that from 64 control subjects.

• Compared with the control group, the nail technicians reported a statistically significant, increased prevalence of work-related symptoms, including nasal, neck, shoulder, wrist/hand and lower back problems.
• Compared with the control group, the nail technicians reported elevated levels of work-related lower respiratory symptoms, headaches, upper back and leg and foot problems. These were not statistically significant.
• Very few of the nail technicians interviewed used products containing methyl methacrylate (MMA) and over half were aware of advice or information discouraging the use of acrylic nail products containing MMA. Over a quarter of the nail technicians did not know whether the products they used contained ethyl methacrylate (EMA) or MMA.