Occupational Health Check-ups Research Articles

209Glucose is associated with future atrial fibrillation and heart failure already at prediabetes levels, a 19 year follow up of 243,665 subjects

Abstract Background Dysglycaemia is associated with cardiovascular disease even below the diagnostic diabetes threshold. Atrial fibrillation (AF) has been found to be associated with the metabolic syndrome and life-style changes after AF have been found to reduce recurrence of AF. Purpose We explored the association glucose and risk of first event of AF, HF and combined event. Methods Subject with fasting glucose in the AMORIS cohort, obtained 1985–1996 at routine occupational health check-ups or primary care in the Stockholm area were included. Subjects with prevalent AF, HF, ischemic heart disease, revascularization and cerebrovascular disease were excluded. Glucose levels were categorised as low (<3.9 mmol/L), normal (3.9–6.0mmol/L), impaired (IFG; 6.1–6.9 mmol/L) and diabetes (≥7.0 mmol/L or a diabetes diagnosis) according to WHO definition in 2006. First events of AF, HF or a combined event was identified until December 2011 by linkage to national registries. Information on co-morbidities was obtained from the National Patient Register. Hazard ratios (HR and 95% CI) by glucose group for AF and heart failure were calculated using Cox proportional hazards with attained age as timescale and adjusting for gender, total cholesterol and triglycerides. The change in AF risk by increasing glucose level was described by using splines (Figure). Results 243 665 subjects with mean age 48.3 at index date, 54% male were included. During a mean follow-up time of 19.1 years and 4,7 million person years, 23 522 events of AF, 21 411 events of HF and 35 131 combined events occurred. The proportion with IFG and diabetes were 3.2% and 3.3% respectively. In the diabetes group about half were diagnosed prevalent cases (1.5%). Glucose was continuously associated with developement of AF (Table and Figure) and even more of HF (Table). Events (n) and HR by glucose category Atrial fibrillation Heart failure Combined event Event HR [95% CI] Event HR [95% CI] Event HR [95% CI] Low 405 0.97 [0.88–1.08] 326 0.97 [0.87–1.08] 598 1.00 [0.92–1.09] Normal 20 663 1.00 17 811 1.00 30 159 1.00 IFG 1185 1.20 [1.13–1.28] 1319 1.43 [1.35–1.51] 1901 1.30 [1.24–1.36] Diabetes 1269 1.28 [1.20–1.35] 1955 2.19 [2.08–2.29] 2473 1.73 [1.66–1.81] Events (n) of AF, HF and combined and HR (95% CI) by fasting glucose category. HR for AF by glucose level spline graph Conclusion Dysglycaemia, including glucose levels below the diabetes threshold, is continuously associated with future risk of both AF and HF. These data are important considering the large population with undetected dysglycaemia at risk for AF and HF where preventive measures including life-style changes could be of importance even before the onset of overt diabetes. Acknowledgement/Funding Swedish Heart and Lung foundation

Results of a Cluster Randomized Controlled Trial to Promote the Use of Respiratory Protective Equipment among Migrant Workers Exposed to Organic Solvents in Small and Medium-Sized Enterprises.

Background: Existing evidence shows an urgent need to improve respiratory protective equipment (RPE) use, and more so among migrant workers in small and medium-sized enterprises (SMEs). The study aimed to assess the effectiveness of a behavioral intervention in promoting the appropriate use of RPE among internal migrant workers (IMWs) exposed to organic solvents in SMEs. Methods: A cluster randomized controlled trial was conducted among 1211 IMWs from 60 SMEs in Baiyun district in Guangzhou, China. SMEs were deemed eligible if organic solvents were constantly used in the production process and provided workers with RPE. There were 60 SMEs randomized to three interventions on a 1:1:1 ratio, namely a top-down intervention (TDI), a comprehensive intervention, and a control group which did not receive any intervention. IMWs in the comprehensive intervention received a module encompassing three intervention activities: An occupational health education and training component (lectures and leaflets/posters), an mHealth component in the form of messages illustrative pictures and short videos, and a peer education component. The TDI incorporated two intervention activities, namely the mHealth and occupational health education and training components. The primary outcome was the self-reported appropriate RPE use among IMWs, defined as using an appropriate RPE against organic solvents at all times during the last week before measurement. Secondary outcomes included IMWs’ occupational health knowledge, attitude towards RPE use, and participation in occupational health check-ups. Data were collected and assessed at baseline, and three and six months of the intervention. Generalized linear mixed models were performed to evaluate the effectiveness of the trial. Results: Between 3 August 2015 and 29 January 2016, 20 SMEs with 368 IMWs, 20 SMEs with 390 IMWs, and 20 SMEs with 453 IMWs were assigned to the comprehensive intervention, the TDI, and the control group, respectively. At three months, there were no significant differences in the primary and secondary outcomes among the three groups. At six months, IMWs in both intervention groups were more likely to appropriately use RPE than the control group (comprehensive intervention: Adjusted odds ratio: 2.99, 95% CI: 1.75–5.10, p < 0.001; TDI: 1.91, 95% CI: 1.17–3.11, and p = 0.009). Additionally, compared with the control group, the comprehensive intervention also improved all three secondary outcomes. Conclusions: Both comprehensive and top-down interventions were effective in promoting the appropriate use of RPE among IMWs in SMEs. The comprehensive intervention also enhanced IMWs’ occupational health knowledge, attitude, and practice. Trial registration: ChiCTR-IOR-15006929. Registered on 15 August 2015.

The association between microcytic anemias and spirometric parameters.

Microcytic anemia is a type of anemia with smaller than normal red blood cells. Iron deficiency anemia and thalassemia are some of the major causes. The aim of the study was to compare the pulmonary function of the subjects with microcytic anemia to the respective results of the normal population. This was a cross-sectional study in Bandar Abbas, Iran, conducted on the patients attending yearly occupational health checkups. Complete blood cell count and a standard spirogram were attained from each consenting participant and occupational histories of exposure to dust, fumes, solvents, and noxious gases were obtained. At last, 2,199 subjects were included in the analysis, of which 335 cases had microcytic anemia. There was a significant association between having microcytic anemia and forced vital capacity (FVC) reduction, and to a lesser degree, the reduction of forced expiratory volume in the first second (FEV1). These parameters were also significantly increased together with the rise of mean corpuscular volume (MCV) in the sample population. It can be concluded that having microcytic anemia may reduce some spirometric parameters. Even though these changes are small, adjusting for the reduced values can help prevent an overestimation of lung disorders, mostly in borderline cases.

PRECEDE-PROCEED model based questionnaire and saliva tests for oral health checkup in adult.

Screening is a fundamental strategy for early detection, treatment, and prevention of progression of oral disease and those at high risk for oral disease. While numerous screening tools exist, questionnaires, and saliva tests are often suitable for screening. The questionnaire based on the PRECEDE-PROCEED model was developed, validated, and elucidated on the structural interrelationship between these two methods. In the current investigation, 311 adults had this questionnaire and saliva testing administered simultaneously during an occupational health checkup. The questionnaire was validated by classical test theory, item response theory, and path analysis. Through structural equation modeling, it was found that self-care guidance may be an important role of the family dentist. In addition, self-awareness of oral symptoms was significantly related to saliva test results. However, self-administered questionnaires and saliva tests together may provide more information than either of them alone for the detection, treatment, and prevention of progression of oral disease. Thus, simultaneous application of self-administered questionnaires and saliva tests is recommended during oral health checkups for adults.

Effects of p-Phenylene diamine on liver and kidney functions of occupational exposed workers

Objective: To study the effect of p-phenylenediamine (PPD) on liver and kidney function in occupational exposed workers. Methods: Workers in a hair dye production enterprise which used p-phenylenediamine as a raw material for production were selected as the main research population. Then we conducted a questionnaire survey on the basic conditions of workers and conducted occupational health checkups on general health status, liver and kidney function. Occupational health examination assessment results were tested in Taizhou Cancer Hospital. All data was built using EpiData 3.1 software, and statistical analysis was performed using software SPSS 20.0. Results: The liver function indicators including direct bilirubin, prealbumin, total protein, and white protein, globulin, aspartate aminotransferase, glutamyl transpeptidase, and total bilirubin in the workers exposed to high concentration of PPD were at high normal values, and these indicators were significantly different from low PPD concentration group (P<0.05) . The serum creatinine and serum uric acid in the renal function index were significantly higher in workers exposed to PPD than in workers exposed to low concentrations and in the control group (P<0.05) . Conclusion: Occupational exposed to PPD may have a hazard to the workers' liver and kidney function. Long-term occupational exposure to PPD may lead to increased cumulative exposure of workers, which may cause potential chronic liver and kidney damage in occupationally exposed populations.

Prevalence and risk factors of chronic obstructive pulmonary disease in dairy farmers: AIRBAg study

BackgroundThe AIRBAg study was designed to assess the prevalence of chronic obstructive pulmonary disease (COPD) in dairy farmers and to define its associated risk factors. MethodsBetween March 2012 and February 2017 randomly selected dairy farmers in the French region of Brittany were asked to complete a self-administered questionnaire and undergo an occupational health check-up with electronic mini-spirometry and standard spirometry. Those having one or more of the following features: chronic cough, chronic bronchitis, wheezing, dyspnea and/or a ratio FEV1/FEV6 < 80% were then referred to a pulmonologist for further check-up including spirometry with a reversibility test. Each COPD case was matched with three controls (dairy farmers and non-farm employees), for sex and age ( ± 5 years). Conditional multivariate logistic regression models were used to estimate the odds ratios between COPD occurrence and various risk factors. ResultsThe 1203 farmers examined included 525 (43.6%) who were "at risk of bronchial obstruction" and 432 (35.9%) of these saw the pulmonologist. This screening identified 16 (1.3%) cases of COPD, including eight non-smokers and five with an FEV1 < 80% of predicted values. Their average age was 54.6 ( ± 7.7) years and 10 of them were men. None complained of illness before the study. Multivariate analyses revealed no significant occupational risk factors for COPD. ConclusionsThis unexpected result may be because Breton dairy farms began to modernize early (1950s), giving rise to conditions with much lower exposure to airborne contaminants.

Haemoglobin A1c and hearing impairment: longitudinal analysis using a large occupational health check-up data of Japan

ObjectivesThe aim of this study was to determine whether haemoglobin A1c (HbA1c) level is associated with the incidence of hearing impairment accounting for smoking status and diabetic condition at baseline.MethodsParticipants...

Impaired glucose metabolism in regular occupational health checkups for a military population: surrounding the metabolic enemy

Introduction: Impaired glucose metabolism, including diabetes and pre-diabetes, is a major cardiovascular risk factor. The aim of this study was to evaluate the glucose metabolism status of employees based on regular occupational health checkups in a military population to plan a more effective program. Methods: From a registry of regular occupational health checkups covering the years 2011 through 2015 in a military medical organization, the study extracted data on age, gender, weight, height, body mass index (BMI), job (medical or non-medical), smoking, history and/or family history of diabetes and hypertension, systolic and diastolic blood pressures, fasting blood glucose (FBS), total cholesterol, triglyceride, and low-density and high-density lipoproteins. Results: Data were collected for 783 apparently healthy individuals, 536 (68.5%) male and 247 (31.5%) female. According to duplicated FBS tests, 17 cases (2.3%) were at diabetic level (FBS≥126 mg/dL), 100 (13.7%) had pre-diabetes (100≤FBS≤125 mg/dL), and 612 (78.2%) had normal FBS (&lt;100 mg/dL). Overall, 1.3% of cases had undiagnosed diabetes and 12.8% had undiagnosed pre-diabetes. Gender, age, BMI, systolic and diastolic blood pressures, and levels of serum triglyceride, total cholesterol, and low-density lipoprotein were significantly associated with impaired glucose metabolism. Non-medical staff had significantly higher prevalence abnormal FBS than medical employees. Importantly, the probability of impaired glucose metabolism increased with clustering of the risk factors. Discussion: A considerable proportion of apparently healthy middle-aged employees of a military medical organization had disturbed glucose metabolism, which was first diagnosed in regular occupational health checkups. A personalized multidimensional approach would enhance individualized risk-assessment models.

Health status of long-term sick leave and working female teachers in Germany: A cross-sectional study.

Limited research on the health situation of teachers on long-term sick leave is available. The aim of this study has been to describe the health status of female teachers on long-term sick leave (LSFT) in comparison to working female teachers (WFT) and to determine predictors for their state of mental health (MH) and cardiovascular fitness (CF). Twenty-eight LSFT and 300 WFT (average age: 53±5 years old) participated in a screening diagnostic inventory. Mental health, CF, blood pressure (BP), body mass index (BMI), body fat mass (BFM), health behavior (smoking, alcohol intake, physical activity) and disease burden (DB - number of medical diagnoses) were analyzed for the purpose of characterization of the health status. The multiple linear regression analysis was performed to identify predictors for the state of MH and CF. Adverse values for the MH but also for CF, BFM and the DB (median of medical diagnoses: LSFT: 5; WFT: 2) among the LSFT in comparison to the WFT were confirmed. Additionally, the part of smokers among LSFT (25%) was higher (WFT: 8%). In contrast, the WFT (61%) were much more affected by an elevated BP (LSFT: 26%). Disease burden proved as the strongest predictor for MH of the female teachers. Age, BMI and DB proved as predictors for CF. Health-related differences between long-term sick leave and working teachers were particularized and a link between physical and mental health among teachers was quantified. Therefore, health-related concepts for teachers should equally focus on physical and psychological aspects. The relevance of regular well-structured occupational health check-ups should be brought to the attention of the profession to prevent diseases and early retirements. Int J Occup Med Environ Health 2018;31(2):227-242.

Lower risk of progression from prediabetes to diabetes with health checkup with lifestyle education: Japan Ningen Dock study

Background and aimsTo investigate whether the progression from prediabetes to diabetes is lower among those who undertake Ningen Dock (comprehensive health checkups with lifestyle education and doctor's consultation) than those who undertake basic mandatory occupational health checkups. Methods and resultsSubjects aged 30–69 years with complete annual data from 2008 to 2012 for either Ningen Dock or basic health checkups were enrolled. Subjects with prediabetes (fasting plasma glucose 100–125 mg/dl or HbA1c 5.7–6.4%) at baseline were selected (14,928 in the comprehensive group and 10,433 in the basic group). The incidence of diabetes (fasting plasma glucose ≥ 126 mg/dl, HbA1c ≥ 6.5% or taking glucose-lowering drugs) and the reduction of risk factors were compared. After 4 years, 3226 cases of diabetes occurred among 25,361 subjects with prediabetes. The incidence of diabetes was lower in the comprehensive group than the basic group (2.9 vs. 3.8 cases/100 person-years, hazard ratio 0.75, 95% confidence interval 0.68–0.81 after adjustment). Moreover, more overweight subjects controlled their body mass index (16.2% vs. 13.2%) and more began a daily exercise habit (11.8% vs. 8.5%) in the comprehensive group than in the basic group. The incidence of diabetes was lower in subjects who could control their weight or start daily exercise at year 1 in the comprehensive group. ConclusionProgression from prediabetes to diabetes was significantly lower in subjects undertaking a comprehensive health checkup with lifestyle education. Lifestyle education at health checkup for people with prediabetes might prevent progression to diabetes by reducing modifiable risk factors.

Study protocol: a cluster randomized controlled trial to assess the effectiveness of a multi-pronged behavioural intervention to improve use of personal protective equipment among migrant workers exposed to organic solvents in small and medium-sized enterprises.

BackgroundIn China, most of migrant workers work in the small and medium-sized enterprises (SMEs) and are a vulnerable group for occupational health. Migrant workers are at increased risk of occupational health risks due to poor occupational health behaviours such as the low use of personal protective equipment (PPE). However, there is a lack of solid evidence regarding how to improve the use of PPE among migrant workers in SMEs. The current study will assess the effectiveness of a multi-pronged behavioural intervention designed to promote PPE utilization among migrant workers exposed to organic solvents in SMEs.Methods/DesignThis is a single blind, three-arm cluster randomized trial with 60 SMEs equally randomized to receive a top-down intervention (i.e. general health education and mHealth intervention provided by researchers) or a comprehensive intervention (which includes both top-down intervention and peer education) or a control condition (participants will not receive the intervention, but study measures will be obtained). Interventions will be conducted at the SMEs level for 6 months and all eligible migrant workers in these SMEs will be enrolled into the trial. The primary outcome is effective use of PPE during the last week. The secondary outcomes are occupational health knowledge and attitude and participation in occupational health check-up. Data will be collected and assessed at baseline; 3 months post baseline and the end of the intervention.DiscussionThis theory- and evidence based intervention will contribute to the limited evidence of behaviour change intervention in improving PPE utilization of migrant workers in SMEs, and provide timely evidence for the development of basic occupational health services in China and elsewhere with similar industrialization contexts.Trial registrationChiCTR-IOR-15006929. Registered on 16 August 2015.

OCCUPATIONAL HAZARDS IN MINING AND MANUFACTURING SECTOR: AN ANALYSIS ON DISEASE CLAIMS IN MALAYSIA

This paper examines the law regulating occupational illnesses or diseases suffered by workers at the work place. Its main focus is on the claims by workers to SOCSO for illness suffered or diseases contracted whilst performing their work or in the course of their employment. The main statute for compensation claim is Employees Social Security Act 1969 and the discussion will be made on the problem arising under section 28(1) and 28(4) of the 1969 Act. The issue involved is in establishing whether a correlation exists between the disease and the work performed by the workers. Such an issue could be the hindrance towards the success of such workers’ claims. Hence, this paper will explore the issue by analyzing statistics and decided court cases. The analysis of the court cases revealed that most of the claims were turned down when the claimants failed to show that the injury or death were the result of the employment. The author also suggests an alternative to have a scheduled and monitored occupational health check-up on the workers’ health to ensure whether any health problems occurs is due to the work.

Dust is in the Air. Part II: Effects of Occupational Exposure to Welding Fumes on Lung Function in a 9-Year Study

Adverse health effects of work-related contact with respirable hazardous substances are of great public interest. Because related prospective and long-term follow-up studies are rare, the extent of acute and chronic pulmonary health risks of occupational exposure to welding fumes is discussed controversially in the scientific literature. The objective of the present longitudinal study during a 9-year period was to investigate the annual changes of lung function in welders. Anthropometric measures and smoking behaviour, and spirometric tests (FVC, FEV1, and MEF50) obtained during routine occupational health checkups of female and male workers (n=1,982) in Austria during the years 2002-2010 were analyzed. The study participants displayed average lung function values lower than the age- and sex-specific norm. Decrease in respiratory capacity was dependent on smoking habits and duration of occupational exposure. Specifically for welders (n=1,326), decrease of pulmonary function was significantly associated with heavy smoking (FVC -70.7ml, p=0.07; FEV1 -167.4ml, p<0.001; MEF50 -356.2ml/s, p<0.001), but not with moderate smoking habits, and also with duration of occupational exposure to welding fumes per year (FVC -0.89ml, p=0.36; FEV1 -2.91ml, p<0.001; MEF50 -4.7ml/s, p=0.047). Individual smoking habits as well as duration of occupational exposure to welding fumes showed a negative impact on lung function parameters. To reduce the risk of work-associated respiratory morbidity, smoking cessation is highly recommended to personnel engaged in welding fumes- and dust-exposed occupations.

Three-dimensional echocardiography in classification of Ebstein’s anomaly: a case report on agenesis of the tricuspid valve posterior leaflet

Cardiologia CROATICA We present an echocardiographic evaluation of a 27-yearold young male patient who was referred to our institution after a loud systolic murmur was found during his occupational health check-up.. Besides the murmur, his physical exam, and results of his laboratory tests were normal. He has no significant complaints. His first 2D transthoracic echocardiogram (TTE) revealed severely dilated right ventricle (RV area greater than left ventricular area), volume overloaded and excentrically hypertrophied (wall thickness >6 mm), with severe tricuspid regurgitation (vena contracta 12 mm), large abundant sail-like anterior leaflet of the tricuspid valve (TV), apically displaced short septal leaflet (17 mm), and in the same time normal left ventricular systolic function and dimensions. These findings, especially apical displacement of septal leaflet indicate Ebstein’s anomaly. Ebstein’s anomaly is a rare congenital heart defect that occurs in only about <1% of congenital heart disease. In normal human hearts the apical displacement of the septal and posterior TV leaflets is <8 mm/m body surface area from the level of anterior mitral valve insertion. Differential diagnosis includes TV dysplasia, TV prolapse, TV endocarditis, and arrhythmogenic right ventricular cardiomyopathy, to name a few. With 2D TTE we were positive that this patient had some form of Ebstein’s anomaly, however we could not generate important information about valvular apparatus, such as morphology of the leaflets, the true origin of septal and posterior leaflets as well as precise coaptation. Those information are necessary in order to complete classification of TV pathology. Therefore we obtained 3D TTE and 3D TEE, and with multiplanar review mode and 3D reconstruction revealed complete agenesis of the posterior leaflet leaving almost unguarded tricuspid orifice with a large zone of lack of coaptation as the origin of severe tricuspid regurgitation. Subsequent 3D analysis also verified absence of complete posterior leaflet subvalvular apparatus, or in the context of embryological development, complete absence of posterior leaflet delamination. We used 2D echocardiography to study morphology and function of right ventricle, but 3D echocardiography provided additional important information regarding the morphology and orientation of TV and its apparatus. Only 3D TEE obtained agenesis of the posterior leaflet. According to parameters derived by 2D TTE and 3D TEE this patient was classified as type I Ebstein’s anomaly.

Prevalence of tobacco consumption among working population after the law 42/2010, Spain

The aim of this study was to analyze the impact on tobacco consumption among working population of the Law 42/2010, which amends smoking regulations in Spain. Data were obtained from 413,473 Occupational Health check-ups, conducted between July of 2009 and June of 2011, in the Society for Prevention of a Mutual Insurance Company. We analyzed changes in the biannual percentage of smokers and the magnitude of tobacco consumption among smokers in the overall set of medical check-ups, by gender, age, occupational level (manual vs. non-manual workers), and in the specific occupational subgroup of waiters, barmen and similar workers (chi-square test). In the overall set of medical check-ups, the percentage of smokers decreased by 5% (from 40.3% to 35.3%) over the period of study (p <0.001) and the group of smokers with lower daily consumption (< 10 cigarettes) became the most frequent (p <0.001). In the group of waiters, barmen and similar workers the differences in the biannual percentage of smokers did not reach statistical significance (p =0.07). In this group, smokers of < 10 cigarretes/ day also became the most common consumption group (increasing from 40.5% to 48.8%) and the percentage of 21-40 cigarretes/day decreased from 10.6% to 4% (p =0.008). These results suggest that the new regulation has been accompanied by a significant reduction in smoking among Spanish workers and strongly support population-level measures against tobacco consumption.

Chronic fatigue of the small enterprise workers participating in an occupational health checkup center in southern Taiwan

There has been increasing interest in the occupational health of workers in small enterprises, especially in developing countries. This study examines the association between psychosocial job characteristics and fatigue, and attempts to identify risk factors for fatigue among workers of small enterprises in southern Taiwan. A structured questionnaire was administered to workers receiving regular health examinations between August 2005 and January 2006. The questionnaire collected demographic information and data on working conditions, personal health status and life styles. It also collected information on psychosocial job characteristics, fatigue and psychological distress using three instruments. A total of 647 workers with mean age of 43.7 were completed. Probable fatigue was found in 34.6% of the sample. Fatigue was found by multiple logistic regressions to be associated with the lack of exercise, working in shifts, depression score and lack of social support at workplace. This study found associations between life style, psychosocial job characteristics and fatigue. Because the high prevalence of probable fatigue was found in such small enterprises, the authors suggest that a short interview with some quick questionnaires in health checkup for these small enterprise workers are helpful to early detect psychosocial and fatigue problems.

Register-based study among employees showed small nonparticipation bias in health surveys and check-ups

Objectives To examine nonparticipation to a questionnaire survey and occupational health check-ups by sociodemographic variables and health status, measured by medically confirmed sickness absence, and whether the associations between other study variables and participation were affected by health status. Study Design and Setting Questionnaire surveys and health check-ups were conducted among the City of Helsinki employees. Sample information was derived from the employer's personnel register and analyzed by participation and giving consent to link the data to external administrative registers. Results Participation to the questionnaire survey was more common among the older, higher occupational classes, those with higher income, permanent employment, and those with no absence due to medically confirmed sickness. Among women in particular, the differences were small. Consent giving followed generally similar patterns than survey response. Nonparticipation to health check-ups was related to low income and temporary employment contract. In both questionnaire survey and health check-ups, associations between other study variables and participation were not affected by health status. Conclusions Questionnaire surveys and health check-ups were broadly representative of the target population. Associations between other study variables and participation did not differ by health status. This suggests that even when the data are not fully representative associations between the study variables need not to be biased.

The Risk of Pterygium in Salt Workers

To find out if exposure to direct and reflected sunlight in brine pans (ground water rich in salt, kept in wide pans in open air for salt manufacturing), increases the risk of pterygium in exposed salt workers. It was a cross sectional observational study, in which 865 salt workers were examined in the Free Occupational Health Check-up camps held near salt sites; 304 persons from the same area engaged in other work were examined as controls. The prevalence of pterygium in different age groups was compared between brine workers (who worked in the brine pans), dry salt workers, (who were engaged in the loading, weighing, milling, packing or transportation of the dry salt but never worked in brine pans) and non-salt-worker controls. The prevalence of pterygium was significantly higher in brine workers (21.0%) as compared to dry salt workers (9.1%) (Yates corrected chi(2) = 23.45, p = 0.000001) and non-salt-worker controls (9.4%) (Yates corrected chi(2) = 15.69, p = 0.00007). It increased with age and duration of employment in the salt industry. Brine workers have a higher risk of developing pterygium probably due to their exposure to sunlight reflected both from the surface of brine and from the surface of salt crystals.

Risk of high blood pressure in salt workers working near salt milling plants: a cross-sectional and interventional study.

BackgroundWorkers working close to salt milling plants may inhale salt particles floating in the air, leading to a rise in plasma sodium, which, in turn, may increase the blood pressure and the risk of hypertension.MethodsTo test the above hypothesis, occupational health check-up camps were organized near salt manufacturing units and all workers were invited for a free health examination. The workers who worked with dry salt in the vicinity of salt milling plants were defined as "non-brine workers," while those working in brine pans located far away from milling plants were defined as "brine workers." Blood pressure (BP) was measured during each clinical examination. In all, 474 non-brine workers and 284 brine workers were studied.ResultsMean systolic blood pressure of non-brine workers (122.1 ± 13.3 mm Hg) was significantly higher than that of brine workers (118.8 ± 12.8 mm Hg, p < 0.01). Mean diastolic blood pressure of non-brine workers (71.5 ± 10.4 mm Hg) was significantly higher than that of brine workers (69.7 ± 9.4 mm Hg, p = 0.02). The prevalence of hypertension was significantly higher in non-brine workers (12.2%) than in brine workers (7.0%, p = 0.02). Nineteen salt workers were monitored while they used face masks and spectacles, for six days. Systolic, as well as diastolic, blood pressure of these workers began declining on the third day and continued to decline on the fourth day, but remained stationary up to the sixth day. The concentration of salt particles in the breathing zone of these workers was 376 mg/m3 air.ConclusionInhalation of salt particles in non-brine workers may be an occupational cause of increased blood pressure.

Late sequelae after phosgene poisoning: a literature review.

The vast majority of phosgene intoxications (including cases with pulmonary edema) have a good prognosis. However, nearly all patients complain of exertional dyspnea and reduced physical fitness for several months to years after the accident; normalization of lung function values, too, may require several years. Occasional impairment of pulmonary function appears to be dependent more on smoking habits than on the severity of the original intoxication. Pre-existing chronic bronchitis may undergo severe and progressive deterioration after toxic pulmonary edema due to phosgene. Occupational health check-ups (including pulmonary function tests) are recommended for all persons handling irritant gases. Every patient having undergone the inhalation of phosgene or other irritants will ask the question of possible late sequelae. Due to new forms of treatment (glucocorticoids, positive pressure ventilation) the prognosis of severe cases has considerably improved during the last decades. The paper tries to summarize the present state of our knowledge.