Potential Workplace Exposures Research Articles

Psychological Impact of COVID-19 Pandemic among Healthcare Personnel in United Arab Emirates

Given the magnitude of the COVID-19 pandemic, adverse psychological outcomes are expected to occur among healthcare personnel (HCPs). However, little is known about these outcomes within Ras al Khaimah, UAE. This study aims to assess the psychological impact of COVID-19 on healthcare personnel from different hospitals and clinics in Ras Al Khaimah (RAK), UAE. An online questionnaire was distributed to healthcare personnel within Ras al Khaimah, UAE, through an institutional email that enabled them to enroll in the study after giving informed consent. Likert scale was used to calculate the relation between demographic factors and 13 variables of psychological distress. An unpaired t-test was applied. This study shows that 31.7% of HCPs in RAK report moderate to high levels of anxiety due to concerns of potential workplace exposure, 41.6% are afraid of infecting their families and 13.1% find themselves feeling isolated from their families. Those who were younger than 45 years old, unmarried people and having more than two children were more likely to experience psychological distress than their counterparts. While the adverse psychological impact within this population is not as severe as what was noted in different populations in other countries, they must be addressed. It is important to ensure that HCPs have the appropriate physical and mental resources to persevere through similar stressful periods in the future.

Factors associated with testing positive for SARS-CoV-2 and evaluation of a recruitment protocol among healthcare personnel in a COVID-19 vaccine effectiveness study.

The objective of this study was to determine factors associated with testing positive for SARS-CoV-2 among healthcare personnel. Secondary objectives were to assess representativeness of recruited participants and the effectiveness of a multiple-contact protocol for recruiting healthcare personnel in this COVID-19 study. Survey study, conducted as part of an observational test-negative study of COVID-19 vaccine effectiveness. University of Utah Health system, including both inpatient and outpatient facilities. Clinical and non-clinical healthcare personnel at University of Utah Health. 1456 were contacted and 503 (34.5%) completed the survey. Cases were all eligible employees testing positive for COVID-19, with 3:1 randomly selected, matched controls (test negative) selected weekly. Online survey. Significant differences in the demographics of participants and the source population were observed; e.g., nursing staff comprised 31.6% of participants but only 23.3% of the source population. The multiple-contact recruitment protocol increased participation by ten percentage points and ensured equal representation of controls. Potential exposure to illness outside of work was strongly predictive of testing positive for SARS-CoV-2 (OR = 3.74; 95% CI: 2.29, 6.11) whereas potential exposure at work was protective against testing positive (OR: 0.51, 95% CI: 0.29, 0.88). Carefully designed recruitment protocols increase participation and representation of controls, but bias in participant demographics still exists. The negative association between potential workplace exposure and positive test suggests testing bias in the test-negative design. Healthcare personnel's potential exposures to COVID-19 outside of the workplace are important predictors of SARS-CoV-2 seropositivity.

103 ‘Remote Workplaces’ – How Wirelessly Connected Wearable Monitoring Devices Provide Insight and Context to the Occupational Hygienist on Potential Workplace Exposures

Abstract Over the past decade wearable devices have been popular amongst the wider population, particularly within the domestic fitness market. Manufacturers of occupational hygiene monitoring equipment have recently released wirelessly enabled wearable instruments designed for the industrial workforce that can provide data in real-time from local or remote workplaces. These instruments include portable gas detectors, heat stress monitors, noise dosimeters and hand arm vibration monitors. Occupational hygienists may be responsible for a company that has multiple sites often widely scattered, nationally and internationally. In their role they may be required to fly offshore to visit platforms in the oil and gas sector or drive long distances to reach isolated mine sites. The costs and additional travel risks can be considerable. Additionally, any interruptions in monitoring personal exposures on site may render the trip unsuccessful. Wearable instruments allow the occupational hygienist to detect change in a remote workplace in real-time, alerting the wearer and hygienist to an issue that needs to be addressed, enabling mitigation to take place in a timely manner. Furthermore, receiving instant access to sensor data allows determination of the correct response to unique, uncommon or unplanned maintenance activities that would be difficult to capture. This paper will review some of these monitoring devices, associated software and data outputs. Other technology currently available to the occupational hygienists to monitor for workplace hazards at remote worksites will also be addressed including: Their suitability for exposure assessments, use to evaluate controls, their limitations, and their long-term viability as a tool in the hygienist’s toolbox.

Asthma, chronic obstructive pulmonary disease, and asthma-COPD overlap among US working adults

Background Asthma-COPD overlap (ACO) is a respiratory condition with more severe respiratory symptoms, poorer quality of life, and increased hospital admissions compared with asthma or COPD alone. Objectives Estimate asthma, chronic obstructive pulmonary disease (COPD), and ACO prevalence among workers by industry and occupation and assess physical and mental health status, healthcare utilization, among workers with ACO. Methods The 2014–2018 National Health Interview Survey (NHIS) data for working adults aged ≥18 years employed (sample n = 99,424) in the 12 months prior to the survey were analyzed. Age-adjusted ACO, COPD and asthma prevalence and prevalence ratios adjusted for age, sex, race and smoking status were estimated. Results During 2014–2018, of the estimated 166 million (annual average) US workers, age-adjusted asthma, COPD, and ACO prevalence was 6.9%, 4.0%, and 1.1%, respectively. ACO prevalence was highest among workers aged ≥65 years (2.0%), females (1.6%), current smokers (1.9%), those living below the federal poverty level (2.3%), and workers in the accommodation and food services (1.6%) industry and personal care and service (2.3%) occupations. Workers with ACO had more frequent (p < 0.05) physician office visits, emergency department visits; and were more likely to be in poorer mental health, obese, have more lost workdays, more bed days, and comorbidities compared to workers with asthma alone and workers with COPD alone. Conclusion: Higher ACO prevalence among worker groups and increased healthcare utilization underscores the need for early identification of asthma and COPD, assessment of potential workplace exposures, and implementation of tailored interventions to reduce ACO among working adults.

Is the skin an important exposure route for workers during cyanogen fumigation?

Cyanogen is a toxic flammable gas used as a fumigant in numerous industries. Occupational exposure to cyanogen can occur during its production and use. The most serious human health risk from exposure to cyanogen is via the respiratory system. However, there is also potential for skin exposure in many workplace situations. The extent of skin absorption under occupational exposure scenarios has not been directly assessed. Understanding skin uptake potential may inform risk assessment and exposure control measures. We describe an in vitro experimental system using human epidermis and dynamic atmosphere exposure to cyanogen to mimic potential workplace exposures. The influence of clothing and ventilation on skin permeation outcomes were also assessed. No evidence of transdermal permeation was found at 100 or 1000 ppm exposures, while permeation of 0.99 ± 0.38 μg cm-2 was observed after 60 min exposure to 10 000 ppm. Fabric on skin and skin ventilation had no additional influence on transdermal permeation compared with naked skin, but fabric provided a reservoir for potential secondary exposures. Results show dermal uptake following cyanogen exposure is possible, but only at very high atmospheric concentrations (10 000 ppm after >15 min exposure). Importantly, this could have implications for fumigant applicators who may only be wearing personal respiratory protection. These empirical data may be used in conjunction with other relevant toxicological information in determining whether a Skin Notation is warranted for Workplace Exposure Standard setting. © 2019 Society of Chemical Industry.

Asthma Mortality Among Persons Aged 15-64 Years, by Industry and Occupation - United States, 1999-2016.

In 2015, an estimated 18.4 million U.S. adults had current asthma, and 3,396 adult asthma deaths were reported (1). An estimated 11%-21% of asthma deaths might be attributable to occupational exposures (2). To describe asthma mortality among persons aged 15-64 years,* CDC analyzed multiple cause-of-death data† for 1999-2016 and industry and occupation information collected from 26 states§ for the years 1999, 2003, 2004, and 2007-2012. Proportionate mortality ratios (PMRs)¶ for asthma among persons aged 15-64 years were calculated. During 1999-2016, a total of 14,296 (42.9%) asthma deaths occurred among males and 19,011 (57.1%) occurred among females. Based on an estimate that 11%-21% of asthma deaths might be related to occupational exposures, during this 18-year period, 1,573-3,002 asthma deaths in males and 2,091-3,992 deaths in females might have resulted from occupational exposures. Some of these deaths might have been averted by instituting measures to prevent potential workplace exposures. The annual age-adjusted asthma death rate** per 1 million persons aged 15-64 years declined from 13.59 in 1999 to 9.34 in 2016 (p<0.001) among females, and from 9.14 (1999) to 7.78 (2016) (p<0.05) among males. The highest significantly elevated asthma PMRs for males were for those in the food, beverage, and tobacco products manufacturing industry (1.82) and for females were for those in the social assistance industry (1.35) and those in community and social services occupations (1.46). Elevated asthma mortality among workers in certain industries and occupations underscores the importance of optimal asthma management and identification and prevention of potential workplace exposures.

Non work-related sickness absence in 2013 in a Spanish banking sector company

To describe the incidence and duration of episodes of non work-related temporary sickness absence (SA) between January and December of 2013, by diagnostic groups, in a banking sector company. Cross-sectional study of 3.193 episodes of SA (≥ day), excluding work-related injuries and illnesses. The distribution of the duration of SA episodes by medical diagnosis was analyzed by calculating the median duration, 25th and 75th percentiles, mean and standard deviation. The median duration of SA was 9 days for cases where there was a medical diagnosis (n=2.931, 91.8%); the 25th and 75th percentiles were 4 and 32 days, respectively. The most frequent pathologies were respiratory (19.9%), followed by musculoskeletal (19.1%) and pregnancy-related disorders (17.3%). Neoplasms had the longest median duration (49 days), followed by pregnancy-related disorders (39 days) and psychiatric disorders (23 days). Overall sickness absence incidence in our study population was lower, but had a longer duration, as compared to similar studies. The incidence and duration by diagnostic groups were very similar to that reported in the literature, except for pregnancy-related disorders, where both were clearly higher (incidence 4 to 11 times and duration 0.4 times larger) in our company (<0.001). This analysis is useful from a prevention perspective, and suggests the need to prioritize the study to the control of potential workplace exposures that might be affecting pregnant workers' health.

Melhorn, JM and Ackerman, WE (eds): Guides to the Evaluation of Disease and Injury Causation

Healthcare providers that evaluate or treat injuries and illnesses are frequently asked to opine regarding workplace causation, aggravation, or exacerbation of medical conditions. These types of determinations require an objective review of the pertinent medical information, potential workplace exposures, and alleged mechanisms of injury. Once the medical evidence is gathered, a careful analysis of the data is essential to render an authoritative decision. Most healthcare providers receive very little formal training in disease and injury causality paradigms; however, their opinions are routinely used by administrative entities to determine eligibility for various workers’ compensation and disability benefits. Given this potential gap in provider knowledge and training, the publication of Guides to the Evaluation of Disease and Injury Causation (Guides) could not have been more timely. Stated goals of the Guides include assisting the reader in the evaluation of causation and bridging the gap between occupational and non-occupational evidence-based causation. The Guides were edited and written by nationally recognized experts in the field. The book covers occupational and non-occupational medical conditions and includes numerous case examples which facilitate the learning process. The first seven chapters lay the foundation for causality determinations through detailed discussions of key concepts such as causality, apportionment, aggravation, exacerbation, proximate cause, and producing cause. These initial chapters also include critical information regarding methods for determining work-relatedness, strategies for conducting a causality examination, and a process for writing evidence-based reports. The final 15 chapters provide an evidence-based review of causation for a wide variety of medical conditions such as spinal disorders, upper and low extremity disorders, musculoskeletal disorders, neurological disorders, cardiovascular disorders, and mental illness. All of the major organ systems and many of their associated medical conditions that are frequently encountered in clinical practice are reviewed. The authors’ analyses include numerous references that are listed at the end of each chapter. The Guides is a well-written, well-referenced, and authoritative resource on the topic of injury and disease causation. It is easy to read and understand. The structured guidelines proffered by the Guides are its most important attribute as they allow the provider to readily use and apply them to real-world cases. Although ideally designed for healthcare professionals who must render opinions regarding causality and apportionment, the Guides would also be quite useful to claims managers, case managers, and lawyers who are involved in the administration of benefits or litigation of claims that are based on causality determinations. Guides to the Evaluation of Disease and Injury Causation should be in the tool kit of all professionals engaged in workers’ compensation or disability associated claims.

Alleged B. anthracis exposure claims in a workers' compensation setting.

Workers' compensation insurance in some states may not provide coverage for medical evaluation costs of workplace exposures related to potential bioterrorism acts if there is no diagnosed illness or disease. Personal insurance also may not provide coverage for these exposures occurring at the workplace. Governmental entities, insurers, and employers need to consider how to address such situations and the associated costs. The objective of this study was to examine characteristics of workers and total costs associated with workers' compensation claims alleging potential exposure to the bioterrorism organism B. anthracis. We examined 192 claims referred for review to the Ohio Bureau of Workers' Compensation (OBWC) from October 10, 2001, through December 20, 2004. Although some cases came from out-of-state areas where B. anthracis exposure was known to exist, no Ohio claim was associated with true B. anthracis exposure or B. anthracis-related illness. Of the 155 eligible claims, 126 included medical costs averaging dollar 219 and ranging from dollar 24 to dollar 3,126. There was no difference in mean cost for government and non-government employees (p = 0.202 Wilcoxon). The number of claims and associated medical costs for evaluation and treatment of potential workplace exposure to B. anthracis were relatively small. These results can be attributed to several factors, including no documented B. anthracis exposures and disease in Ohio and prompt transmission of recommended diagnostic and prophylactic treatment protocols to physicians. How employers, insurers, and jurisdictions address payment for evaluation and treatment of potential or documented exposures resulting from a potential terrorism-related event should be addressed proactively.

An Occupational Hygiene Investigation of Exposure to Acrylamide and the Role for Urinary &lt;italic&gt;S&lt;/italic&gt;-Carboxyethyl-Cysteine (CEC) as a Biological Marker

Acrylamide has a range of toxicological hazards including neurotoxicity and reproductive toxicity; however, occupational risk management is driven by its genotoxic and carcinogenic potential (it is classified within the EU as a Category 2 carcinogen, R45 and Category 2 mutagen, R46). Since there is the potential for skin absorption and systemic toxicity, biological monitoring may be a useful aid for the assessment of exposure via inhalation, ingestion and dermal absorption. However, there are currently no biological monitoring guidance values (BMGVs). This study describes an extensive survey of potential workplace exposure to acrylamide at the Ciba (Bradford) site to gather data suitable for a BMGV. This manufacturing site is typical within the industry as a whole and includes a cross section of activities and tasks representative of acrylamide exposure. Acrylamide is used in the manufacture of polyacrylamide based products for applications in water treatment; oil and mineral extraction; paper, paint and textile processes. Workers (62 plus 6 controls) with varying potential exposures provided a total of 275 pre shift and 247 post-shift urine samples along with 260 personal air samples. A small non-exposed control group was similarly monitored. Urine samples were analysed for S-carboxyethyl-cysteine (CEC). Airborne, surface and glove samples were analysed for acrylamide. Inhalation exposures were well controlled with values consistently below one-tenth of the UK Workplace Exposure Limit. Engineering controls, personal protective equipment and work practice, all contributed to good control of occupational exposure. CEC was found in urine samples from both exposed workers and non-occupationally exposed controls. At the low levels of exposure found, smoking made a significant contribution to urinary CEC levels. Nevertheless a correlation between urinary CEC and airborne acrylamide was found. A mixed effects model incorporating inhalation concentrations of acrylamide and smoking habits could predict some of the variation in observed post-shift urine results but could be improved through the use of additional surface contamination data. However, the data does not suggest that dermal absorption was a major contributor to the systemic dose. Based on the 90th percentile of the data, inclusive of the effects of smoking and environmental factors, a value of 4 mmol mol(-1) creatinine is proposed as a pragmatic BMGV associated with good occupational hygiene practice and control of workplace exposure. CEC in urine analysis has the utility for routine use as a means to estimate biological uptake where there is a potential for significant exposure or loss of workplace control.

Immune Mediators in a Murine Model for Occupational Asthma: Studies with Toluene Diisocyanate

Isocyanate-induced asthma, which is the most common type of occupational asthma, has been difficult to diagnose and control, in part, because the biological mechanisms responsible for the disease and the determinants of exposure are not fully defined. To help address these issues, we recently established a murine model of toluene diisocyanate (TDI) asthma using inhalation exposure paradigms consistent with potential workplace exposure. In order to confirm our hypothesis that TDI-induce asthma, like allergic asthma, is predominantly a Th2 response, the ability of mice that were deficient in CD4 or CD8 cells or specific Th1 and Th2 cytokines to develop TDI asthma was examined. The development of allergic asthma was evaluated by monitoring lungs for the presence of eosinophilia, goblet cell metaplasia, epithelial cell alterations, airway hyperreactivity (AHR), and Th2 and Th1 cytokine expression, as well as serum IgE levels and TDI-specific IgG antibodies. Transgenic CD8 or CD4 knockout (KO) mice exhibited significant reductions in AHR, cytokine expression, serum antibody levels, airway inflammation, and histopathological lesions, although in a number of the endpoints the effects were more attenuated in CD4 KO mice. IFNgamma depletion ablated the increase in AHR in TDI-allergic mice, but had only slight to moderate effects on airway histopathology, serum antibody levels, and cytokine expression compared to sensitized/challenged controls. IL-4 and IL-13 deficiency had moderate inhibitory effects, while combined IL-4/IL-13 depletion effectively prevented almost all asthma-associated pathologies. Taken together, these results indicate that TDI asthma, like immune-mediated asthma produced by large-molecular-weight materials, is driven primarily by CD4+ T cells and is dependent upon the expression of Th2 cytokines. However, as with protein-induced asthma models, certain pathologies are influenced by CD8+ T cells and Th1-derived cytokines, such as AHR and cytokine production.

Reconstruction of Benzene Exposure for the Pliofilm Cohort (1936-1976) Using Monte Carlo Techniques

The current cancer slope factor and occupational standards for benzene are based primarily on studies of the rubber hydrochloride (Pliofilm) workers. Previous assessments of this cohort by Rinsky et al. (1981, 1987), Crump and Allen (1984), and Paustenbach et al. (1992) relied on different assumptions about the available industrial hygiene data and workplace practices and processes over time, thereby yielding significantly different estimates of annual benzene exposures for many jobs. Given the inherent limitations and uncertainties involved in estimating historical exposures for this cohort, a probabilistic approach was used to better characterize their likely degree of benzene exposure. Ambient air exposures to benzene were based, in part, on the distribution of air sampling data collected at the Pliofilm facilities and assumptions about how workplace concentrations probably decreased over time as the threshold limit value (TLV) was lowered. The likely uptake of benzene from dermal exposures was estimated based on probability distributions for several exposure factors, including surface area, contact rate and duration, and skin absorption. The assessment also quantitatively accounts for improved engineering controls, extended work hours, incomplete Pliofilm production, and the use and effectiveness of respirators over time. All original data and assumptions are presented in this assessment, as is all new information obtained through additional interviews of former workers. Estimated benzene exposures at the 50th and 95th percentiles are reported as equivalent 8-h time-weighted average (TWA) airborne concentrations for 13 job categories from 1936 to 1965 (Akron I and II facilities) and 1939 to 1976 (St. Mary's facility). Data indicate that estimated equivalent airborne benzene concentrations for St. Mary's workers were highest for four job categories (Neutralizer, Quencher, Knifeman, Spreader), typically ranging from about 50 to 90 ppm during 1939-1946 (lower during 1942-1945), and 10 to 40 ppm during 1947-1976 at the 50th percentile. These estimates are 2-3 times greater than for other jobs in the Pliofilm process, and about 1.5 times less than those estimated at the 95th percentile. Estimates of equivalent airborne benzene concentrations for Akron I and II were about 1.5 times higher than for St. Mary's, but there is less confidence in these estimates, given the lack of industrial hygiene monitoring data for these facilities. Study results suggest that Paustenbach et al. (1992) generally over-estimated exposures for those job categories that had the highest exposure by about a factor of two to four. On the other hand, it was concluded that Rinsky et al. (1981, 1987) under-predicted benzene exposures for most jobs, and Crump and Allen (1984) both under- and overpredicted benzene exposures, depending on the specific job category and time period. The new estimates presented in this analysis incorporate what is considered to be the most likely range of plausible exposure values, and, accordingly, provide a better characterization of the potential workplace exposures for this cohort. These data could be combined with current or future mortality information to calculate a new cancer potency factor or occupational health standard for benzene.

Incidence of breast cancer in a Norwegian cohort of women with potential workplace exposure to 50 Hz magnetic fields.

The risk of breast cancer was investigated in a large dynamic population-based cohort of all 1.1 million economically active women in Norway with potential exposure to 50 Hz magnetic fields at the censuses of 1960, 1970, and 1980. The follow-up period for the cohort was 1961-1992. For each woman, date of birth and census information on occupation and socioeconomic status were ascertained. These data were linked to the breast cancer morbidity information in the Cancer Registry of Norway. Exposure to magnetic fields was assessed a priori using two different approaches. In the first approach, hours per week in a potential magnetic field above background level (0.1 microT) were classified by an expert panel. In the second approach, measured magnetic fields from a separate study of men at work were allocated to the women's census job titles. In both approaches, exposure was cumulated over the years of employment (work hours and microT-years, respectively). The Poisson regression analysis showed a risk ratio (RR) of 1.14 (95% confidence interval (CI) = 1.10-1.19) in the highest exposure category compared to the lowest when using the first approach, and the corresponding RR was 1.08 (95% CI = 1.01-1.16) when using the second approach. For women younger than 50 years, RR was 1.20 (95% CI = 1.11-1.29) and 1.12 (95% CI = 0.98-1.28), respectively. The results give some support to the hypothesis that exposure to 50 Hz magnetic fields may increase the risk of breast cancer. However, since no direct information on exposure was available, no firm conclusions can be drawn.

The Effects of Vibration on Hands and Arms: Clinical Brief

1. Prevention and early intervention are crucial for reducing unhealthy outcomes from exposures to vibration hazards. 2. Greater awareness by the worker of the interactions among stressors, heavy tools, awkward and forceful movements, cold temperatures, smoking, and other factors specific to the situation are essential. 3. Reviewing regular tool maintenance with the worker which stresses the recording of lubrication, rebalancing, calibration, and applicable support is important. 4. Health and safety committees and purchasing agents need to be supplied with vibration particulars of tools in advance of their purchase. This serves two purposes,--facilitating employee problem prevention and alerting equipment manufacturers to potential workplace exposure hazards.

Pancreatic cancer among workers processing synthetic resins.

A nested case-control study was conducted to investigate whether an excess of pancreatic cancer, identified in a cohort mortality study with follow-up from 1946 through 1988, was associated with potential workplace exposures at a New Jersey plastics manufacturing and research and development facility. The study population included 28 male pancreatic cancer cases and 140 randomly selected controls, matched on year of birth and at risk (alive) at the time of the case death. Using plant work history records, department assignments for the two groups were compared according to duration and time since first assignment. Workers assigned to a work area that processed vinyl resins and polyethylene (PE) were shown to be at increased risk. Men assigned more than 16 years to this department had a significantly increased risk ratio of 7.15 (95% confidence intervals [CI]: 1.28-40.1). No excess was seen with shorter duration assignments. Seven of the nine cases began working in this area in the 1940s. Average latency was 32 years, and all but three cases worked 20 years or more in this unit. Over the study period, significant exposure-related process changes occurred, in addition to the use of numerous chemical additives. Although vinyl and PE processing operations could not be analyzed separately, the pancreatic cancer excess is more likely to be related to vinyl processing. Identification of a causative agent or combination of agents would require investigations with more detailed exposure information.

A mortality study of a research, engineering, and metal fabrication facility in western New York State.

The mortality experience of 8,146 male employees of a research, engineering, and metal fabrication facility in Tonawanda, New York state was examined from 1946 to 1981. Potential workplace exposures included welding fumes, cutting oils, asbestos, organic solvents, and environmental ionizing radiation, as the result of disposal of wastes during the Manhattan Project of World War II. External comparisons with the US male population were supplemented by regional comparisons. For the total cohort, deficits were observed for all causes of death (standardized mortality ratio (SMR) = 87) and most non-cancer causes. The observed number of cancer deaths was close to expected (SMR = 99). There was an excess of connective and soft tissue cancer deaths, most notably in hourly employees hired prior to 1946. Among all hourly employees, there was an excess of respiratory cancer, which did not appear to be associated with length of employment. Mesothelioma was recorded as the cause of death for three decedents, two of whom were hourly employees who worked in production areas with high potential for asbestos exposure. The standardized mortality ratio for cirrhosis of the liver was elevated among long-term hourly employees hired prior to 1946. The roles of carbon tetrachloride exposure in the 1940s and alcohol consumption are discussed as possible contributory risk factors for the cirrhosis findings. The data do not provide evidence of radiation-induced cancers within this employee population.