Journal of Occupational Medicine and Toxicology - Latest Articles

Obesity effect on a multimodal physiotherapy program for low back pain suffers: patient reported outcome

Antonio Cuesta-Vargas — 2013-05-10T00:00:00Z

Background: Several studies have linked obesity to the increased likelihood of lower back pain, but there are no studies focussing on the effectiveness of a multimodal physiotherapy programme (MPP) in obese subjects who suffer from chronic non-specific lower back pain (CNLBP). The aim of this study was to compare the effectiveness of an MPP in obese (G1) (body mass index (BMI):≥30) and non-obese (G2) (BMI:<30) patients with CNLBP. Methods: A quasi-experimental study with pre- and post-intervention evaluations of an MPP (lasting 8 weeks) was conducted on obese and non-obese patients with CNLBP. A total of 53 people were included in the study: G1, composed of 19 patients (10 men and 9 women) with a BMI of 33.75 and a mean age of 52.94 years, and G2, composed of 34 patients (18 men and 16 women) with a mean age of 49.19 years and an average BMI of 25.56. All patients were measured to calculate pre-intervention (baseline) and post-intervention (8 weeks) changes in disability (RMQ) and health related quality of life in physical and mental health component state of SF12 and quality of life (EQ-5D and EQ-VAS). Results: Post-intervention, non-obese group shown significant high improve than obese group in disability (RMQ: 4.00), physical component state of SF-12: (-7.26) and quality of life (EQ-VAS.: -10.49). Conclusions: In patients with CNLBP, a BMI more than or equal to 30 minimises the effects of an MPP lasting 8 weeks.

The effect of introducing IGRA to screen French healthcare workers for tuberculosis and potential conclusions for the work organisation

Adrien Moucaut — 2013-05-07T00:00:00Z

IntroductionIn France, pre-employment screening for tuberculosis (TB) is performed for healthcare workers (HCW). Screening is repeated when exposure to TB patients or infectious material occurs. The results of these TB screenings were analysed in a retrospective analysis.MethodTuberculin skin tests (TST) and interferon-gamma release assays (QuantiFERON® Gold In-Tube – QFT) were used to perform the TB screenings. The screening results of 637 HCWs on whom QFT was performed were taken from the records of the University Hospital of Nantes. Results: In three (0.5%) HCW, the QFT was indeterminate. In 22.2%, the QFT was positive. A second QFT was performed in 118 HCWs. The reversion rate was 42% (5 out of 17). The conversion rate was 6% (6 out of 98). A TST was performed on 466 (73.5%) of the HCWs. Results for TST > 10 mm were 77.4%. In those with a TST < 10 mm, QFT was positive in 14% and in those with a TST ≥ 10 mm, QFT was positive in 26.7%. Depending on the definition for conversion in the QFT, the annual attack rate was 4.1% or 7.3%. X-ray and pneumology consultation was based on positive QFT rather than TST alone (52 out of 56). No active TB was detected. Conclusion: The TST overestimated the prevalence of LTBI in this cohort. The decision about X-ray and consultation regarding preventive treatment should be based on the QFT rather than the TST results. The high reversion rate should be taken into consideration when consulting with HCWs regarding preventive treatment. The high conversion rate seems to indicate that preventive measures such as wearing masks should be improved.

Ischemic heart disease risk factors in lead exposed workers: research study

Masoumeh Ghiasvand — 2013-04-22T00:00:00Z

Background: Review of other epidemiological studies reveal inconsistent results of relationships between high blood lead level and risk of hypertension, hyperlipidemia and hyperglycemia. In this study we wanted to find if there is a relationship between blood lead level and these ischemic heart disease risk factors. Methods: This cross-sectional study was conducted in a battery recycling plant, and 497 male workers with the mean age of 41.7 (±6.50) years were recruited from all over the plant (those from the products and maintenance sections were classed as “high lead exposed group” and those from amongst the office, laboratory, security services and food services sections as “low lead exposed group”). Personal information such as demographics and work history was obtained through a questionnaire.Mean (±Standard deviation) for quantitative variables, Frequency (Percent) for qualitative variables, and Odd’s ratio (OR) with 95% confidence interval (95% CI) for estimating the effect of blood lead level on lipid profile[triglyceride (TG), cholesterol(CHOL), low density lipoprotein – Cholesterol(LDL-C),high density lipoprotein –Cholesterol(HDL-C)], hypertension(HTN) and fasting blood sugar (FBS) level. Logistic regression modeling was used for multivariate analysis and adjusting the effect of different variables (age, body mass index(BMI), eating habits, cigarette smoking). Results: The mean Blood Lead Level (BLL) was >40 μg/dl in 281 (56.6%) subjects, ≤40 μg in 216 (43.4%) subjects and the mean BLL was 43.3 μg/dl (n = 497). The mean job experience involving lead exposure was 13 years. There was no significant correlation between BLL and FBS (p = 0.68), between BLL and TG (P = 0.32), between BLL and HDL-C (p = 0.49), between BLL and LDL-C (p = 0.17), between BLL and CHOL(p = 0.96), between BLL and systolic blood pressure (p = 0.12). The adjusted Odd’s ratio for the effect of BLL >40.0 μg/dl on diastolic blood pressure was1.03 (95% CI: 1.01–1.05) with p = 0.05. Conclusion: This study showed an association of high BLL with diastolic blood pressure but not with TG, FBS, and HDL-C, LDL-C and CHOL . This result persisted even after adjustment was made for age, BMI and job experience, smoking and eating habits. Attention to health-protective policies, individual behavioral changes and regular periodic medical examination with focus on diastolic blood pressure in lead exposed workers is likely to decrease the public health burden of ischemic heart disease.

Instrument for stress-related job analysis for hospital physicians: validation of a short version

Monika Keller — 2013-04-17T00:00:00Z

Background: Working conditions in hospitals may endanger physicians' health and impair patient care. For this reason, an instrument was developed in the form of a questionnaire, in order to record problems in physicians' working conditions and to suggest possible ways of improving them. Methods: A survey was performed with 571 hospital physicians. The questionnaire used is a shortened version of the extensive Instrument for Stress-related Job Analysis for Hospital Physicians. This short version contains 14 scales with 30 items on stressors and resources. For validation purposes, several scales were also used for well-being. Results: The factor structure of the short version of the instrument for hospital physicians was confirmed by confirmatory factor analysis. Cronbach's α and the analyses of interrater agreement with the parameter rwg(J) largely gave moderate to good results. The intercorrelations between the scales are mostly slight to moderate, indicating that the scales are largely independent. The bivariate correlations with different well-being variables are highly significant for most questionnaire scales. In multiple hierarchical regression analyses the scales explained a considerable amount of variance for different well-being variables. Taken together, this emphasizes the relevance of the scales for the stress process. Conclusions: The short version of the Instrument for Stress-related Job Analysis for Hospital Physicians is a reliable and valid instrument, which can be used practically and economically for normal hospital work.

Hydrogen sulphide inhalational toxicity at a petroleum refinery in Sri Lanka: a case series of seven survivors following an industrial accident and a brief review of medical literature

Mitrakrishnan Shivanthan — 2013-04-11T00:00:00Z

This case series details clinical observations in 7 survivors of accidental hydrogen sulphide inhalation toxicity at a petroleum refinery in Sri Lanka. One survivor developed status epilepticus and severe neurotoxicity whilst another survivor developed delayed respiratory failure; both patients required intensive care management. One victim manifested mild bronchospasms in the immediate post-exposure period and another developed mild perioral numbness 2 days following the exposure. A brief literature review explores the manifestations, pathophysiology and available modalities of treatment of hydrogen sulphide inhalation toxicity. Background: Hydrogen sulphide (H2S) is a highly toxic gas. Accidental deaths following H2S exposure is a known hazard amongst petroleum workers exposed to by-products of refineries. Toxicity results mainly due to cellular respiratory poisoning which impairs oxidative phosphorylation. The heart, brain and the lungs are the organs most commonly affected in H2S inhalational toxicity leading to varied clinical presentations.

Quantitative neurosensory findings, symptoms and signs in young vibration exposed workers

Lars Gerhardsson — 2013-03-27T00:00:00Z

Background: Long-term exposure to hand-held vibrating tools may cause the hand arm vibration syndrome (HAVS) including vibration induced white fingers and sensorineural symptoms. The aim was to study early neurosensory effects by quantitative vibrotactile and monofilament tests in young workers with hand-held vibration exposure. Methods: This cross-sectional study consisted of 142 young, male machine shop and construction workers with hand-held exposure to vibrating tools. They were compared with 41 non-vibration exposed subjects of the same age-group. All participants passed a structured interview, answered several questionnaires and had a physical examination including the determination of vibrotactile perception thresholds (VPTs) at two frequencies (31.5 and 125 Hz) and Semmes Weinstein’s Monofilament test. Results: In the vibration exposed group 8% of the workers reported episodes of tingling sensations and 10% numbness in their fingers. Approximately 5–10% of the exposed population displayed abnormal results on monofilament tests. The vibrotactile testing showed significantly increased VPTs for 125 Hz in dig II bilaterally (right hand, p = 0.01; left hand, p = 0.024) in the vibration exposed group.A multiple regression analysis (VPT - dependent variable; age, height, examiner and five different vibration dose calculations – predictor variables) in dig II bilaterally showed rather low R2-values. None of the explanatory variables including five separately calculated vibration doses were included in the models, neither for the total vibration exposed group, nor for the highest exposed quartile.A logistic multiple regression analysis (result of monofilament testing - dependent variable; age, height, examiner and five vibration dose calculations – predictor variables) of the results of monofilament testing in dig II bilaterally gave a similar outcome. None of the independent variables including five calculated vibration doses were included in the models neither for the total exposed group nor for the highest exposed quartile. Conclusion: In spite of the fairly short vibration exposure, a tendency to raised VPTs as well as pathologic monofilament test results was observed. Thus, early neurophysiologic symptoms and signs of vibration exposure may appear after short-term exposure also in young workers.

Fatal snake bites ¿ sociodemography, latency pattern of injuries

Chidananda Rao — 2013-03-25T00:00:00Z

Background: India is a thickly populated country; apart from having biodiversity among people, climate does change from place to place. Western Ghats of South India harbors variety of plantations and diverse creatures. Agriculture is the primary occupation of the people and some tribes living in these regions. Here majority are callous/ ignorant in employing neither advanced farming techniques nor safety precautions, hence are exposed to bites and stings by animals. Of these, snake bites cause significant mortality and morbidity. Proper care for some of these individuals is out of reach. Identification of offending snake, snake bite injury or findings of envenomation is a key not only for the administration of antisnake venom but also for the victim to realize that he needs an expert care. Unless he believes it to be a critical snake bite and not a thorn prick, scorpion sting or a spider bite he will not approach a health care provider. To know about these dangerous signs that may help the victim to realize it as a case of snake bite, current study is employed on fatal cases in this region. Methods: 60 fatal snakebite cases were studied retrospectively for 5 years with an objective to know the socio-demography, latency and pattern of injuries in rural Southern India. Results: Most of the victims were males, in the age group of 31-50 years and were at risk of snake bites while farming. Large sample of subjects approached traditional therapists and were deprived of essential care in the critical first few hours after snake bite. Fang marks (90%), local ecchymoses (50%) and internal hemorrhage (28.3%), were the frequent demonstrable signs appreciated at autopsy. Conclusion: Snakebite is a neglected, endemic, occupational (farming) disease of the poor and there is need for National Snakebite Prevention Programme for curtailing this menace.

How to optimize the benefits of computer assisted sperm analysis in experimental toxicology

Carsten Schleh — 2013-03-11T00:00:00Z

Exposure at the working place to various substances, that may affect semen quality is possible and should be investigated in detail. One appropriate method for this is computer-assisted sperm analysis (CASA) which offers multiple benefits in comparison to manual evaluation. However, several pitfalls exist, which make the evaluation of data obtained from CASA difficult to interpret. In the present commentary, we focus on these problems, show some examples, and try to define minimum standards which should be taken into consideration whenever working with computer-assisted sperm analysis.

A prospective investigation of injury incidence and risk factors among army recruits in combat engineer training

Joseph Knapik — 2013-03-05T00:00:00Z

Background: United States Army combat engineer (ENG) training is an intense 14-week course designed to introduce new recruits to basic soldiering activities, Army values and lifestyle, and engineering skills and knowledge. The present investigation examined injury rates and injury risk factors in ENG training. Methods: At the start of their training, 1,633 male ENG recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, and injury history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. Risk factors were identified using Cox regression. Results: Ninety-two percent of the recruits successfully graduated from the course and 47% of the recruits experienced one or more injuries during training. Univariate Cox regression demonstrated that recruits were at higher injury risk if they reported that they were older, had a higher or lower body mass index, had smoked in the past, had performed less exercise (aerobic or muscle strength) or sports prior to ENG training, had experienced a previous time-loss lower limb injury (especially if they had not totally recovered from that injury), or had a lower educational level. Conclusions: The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during ENG training. The identified risk factors provide a basis for recommending future prevention strategies.

Persistence of antibodies in laboratory staff immunized with quadrivalent meningococcal polysaccharide vaccine

Johannes Elias — 2013-03-04T00:00:00Z

Background: Occupational exposure to live meningococci can potentially cause invasive meningococcal disease in laboratory staff. While, until recently, immunization with quadrivalent polysaccharide vaccine represented one cornerstone of protection, data on long-term persistence of antibodies in adults remain scarce. Methods: We analyzed the relationship of antibody levels and time following quadrivalent polysaccharide vaccination (Mencevax® ACWY, GlaxoSmithKline) in a cross-sectional sample of 20 laboratory workers vaccinated at ages between 16.4 to 40.7 years from Germany. Sera were obtained 0.4 to 158.5 (median 35.3) months after vaccination. At the time of sampling, laboratory workers had been regularly exposed to meningococci for periods between 3.2 to 163.8 (median 41.2) months. Serum bactericidal assay (SBA) with rabbit complement and a microsphere-based flow analysis method were used to determine bactericidal titers and concentrations of IgG, respectively, against serogroups A, C, W135, and Y. Decay of antibodies was modeled using linear regression. Protective levels were defined as SBA titers ≥ 8. Results: Half-lives of SBA titers against serogroups A, C, W135, and Y were estimated at 27.4, 21.9, 18.8, and 28.0 months, respectively. Average durations of protection were estimated at 183.9, 182.0, 114.6, and 216.4 months, respectively. Inter-individual variation was high; using lower margins of 95% prediction intervals, minimal durations of protection against serogroups A, C, W135 and Y were estimated at 33.5, 24.6, 0.0, and 55.1 months, respectively. The proportion of staff with protective SBA titers against W135 (65.0%) was significantly lower than proportions protected against A (95.0%), C (94.7%), and Y (95.0%). Consistently, geometric mean titer (97.0) and geometric mean concentration of IgG (2.1 μg/ml) was lowest against serogroup W135. SBA titers in a subset of individuals with incomplete protection rose to ≥ 128 (≥ 8 fold) after reimmunization with a quadrivalent glycoconjugate vaccine. Conclusions: The average duration of protection following immunization with a quadrivalent polysaccharide vaccine in adults was ≥ 115 months regardless of serogroup. A substantial proportion (approximately 23% according to our decay model) of adult vaccinees may not retain protection against serogroup W135 for five years, the time suggested for reimmunization.