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

OBJECTIVES: Previous studies into occupational risk factors for non-Hodgkin's lymphoma (NHL) in New Zealand have indicated that farmers and meat workers are at increased risk for these neoplasms. A new nationwide case-control study was conducted to assess whether previously observed associations persist and to identify other occupations that may contribute to the risk of NHL in the New Zealand population. METHODS: A total of 291 incident cases of NHL (age 25-70 years) notified to the New Zealand Cancer Registry during 2003 and 2004, and 471 population controls, were interviewed face-to-face. The questionnaire collected demographic information and a full occupational history. The relative risk for NHL associated with ever being employed in particular occupations and industries was calculated by unconditional logistic regression adjusting for age, sex, smoking, ethnicity and socioeconomic status. Estimates were subsequently semi-Bayes adjusted to account for the large number of occupations and industries being considered. RESULTS: 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. CONCLUSIONS: This study has confirmed that crop farmers and meat workers remain high risk occupations for NHL in New Zealand, and has identified several other occupations and industries of high NHL risk that merit further study.

Occupational bladder cancer in New Zealand: a 1-year review of cases notified to the New Zealand Cancer Registry.

AIM: To identify which cases of adult bladder cancer notified to the New Zealand Cancer Registry in 2001 had a probable occupational cause. METHODS: Occupational Safety and Health (OSH), in conjunction with the Massey University Centre for Public Health Research, interviewed and obtained an occupational history for 210 (162 men, 48 women) cases. RESULTS: Of the 162 male cases (response rate 65%), 45 (28%) were considered to be 'probable' occupational cancers. Of the 48 female cases (response rate 76%), three cases (6%) were considered to be 'probable' occupational cancers. The largest occupational group for men was truck drivers, which made up 51% of probable cases. Other common groups were engineering and metal workers (18%), crop farmers/orchardists (7%), textile and leather workers (7%), painters/furniture finishers (7%), and plastics manufacturing workers (4%). The three female cases considered to be of occupational origin included two textile workers and one telephonist. CONCLUSIONS: The percentage of cases considered to be of occupational origin is similar to that reported in Europe and the United States, indicating that occupational cancer is a major occupational health problem in New Zealand as it is in other parts of the world.

Failure after 5 years of self-regulation: a health and safety audit of New Zealand engineering companies carrying out welding.

The aim of this study was to audit the degree of compliance with new health and safety legislation 5 years after enactment in a typical cross-section of New Zealand manufacturing industries. To this end, 299 randomly selected enterprises using a welding process were visited by Occupational Safety and Health Officers of the Department of Labour. An interviewer-administered questionnaire concerning the nature of the hazards encountered in that enterprise and the chosen control measures employed to protect the health of their employees was undertaken and analysed. Only 40% of New Zealand businesses in this sample undertaking welding had adopted the most basic of regulatory requirements to control health and safety risks. This percentage seemed independent of employer size. Fundamental safety issues (e.g. welding in confined spaces) were ignored by >50% of enterprises. In conclusion, self-management of health and safety risks had not occurred in over half the enterprises surveyed.

The distribution of occupations in two populations with upper limb pain.

Occupations of two geographically distinct populations of patients with upper limb pain were examined. Relative risks for being in an occupation were calculated for subjects with epicondylitis, carpal tunnel syndrome, and pain syndromes in one population and nonspecific occupational overuse syndrome (OOS) in the other. Population A subjects (806 female, 154 male Auckland clinic referrals) with epicondylitis and carpal tunnel syndrome had higher rates of manual occupations compared with the Auckland employed population, consistent with previous research. Both Population A and Population B subjects (1,188 female, 499 male national notifications to the Department of Labour) with pain syndrome or nonspecific OOS had increased rates of clerical occupations. Relative risks ranged from 2.24 (95% CI 1.69,2.97) to 3.92 (3.50 ,4.40). Word processor operators, data-entry operators, and mail sorters were overrepresented in both populations. An unexplained association between nonspecific upper arm pain and being in some clerical occupations requires further research.

Hazards associated with the boat building industry in New Zealand: an OSH audit.

AIM: To randomly audit the boat building industry in New Zealand to assess the occupational health status and level of knowledge of employees. METHODS: A survey was conducted using a nurse and inspector administered questionnaire. 151 workers from 120 randomly selected firms participated in the survey. RESULTS: 31.5% respondents thought they had had some sort of work related health problem since working in that job. 22% reported wheezing during the last twelve months. 14-16% met criteria for occupational causation, and 4% met a measure of severe wheezing related to work. 25.6% of workers had dermatitis. Only a quarter of these met criteria for occupational causation. No respondents reported symptoms suggestive of chronic solvent neurotoxicity. Solvents and epoxy resins comprised the majority of chemicals with which there was contact. Observation suggested little use of Material Safety Data Sheets as a source of knowledge about toxicity of the chemicals used. Although 94.3% reported wearing gloves, this did not correlate with numbers reporting dermatitis suggesting non-compliance or glove failure. CONCLUSION: New Zealand boat builders and their employees remain at risk for occupational health problems by virtue of their employment.

Organic solvent induced chronic toxic encephalopathy: extent of recovery, and associated factors, following cessation of exposure.

AIMS: to determine extent and nature of recovery of solvent induced chronic toxic encephalopathy (CTE). METHOD: 21 confirmed cases had repeat neuropsychological and clinical assessments 6-42 (mean 27) months after ceasing exposure. An exposure score was calculated for each. RESULTS: less than half (42.8%) showed evidence of improvement, which showed no association with time away from solvents or exposure score. The more severely affected at first diagnosis were nearly four times more likely to improve (RR 3.85 (95%CI 1.03, 14.38), p = 0.03). Those with no subjective improvement were five times more likely to have been on antidepressants (RR 5.25 (95%CI 0.83, 33.2), p=0.02). CONCLUSIONS: The largely irreversible nature of Type 2 CTE is confirmed. The study results suggest that severity of effect and partial recovery are not dose related but multifactorial, with individual susceptibility probably important. Concomitant depression may also adversely influence recovery.

Chronic solvent neurotoxicity in New Zealand: notified cases between 1993 and 1997.

AIM: To report on cases of chronic solvent neurotoxicity notified to the Department of Labour between 1993 and 1997. METHODS: Previously published diagnostic criteria were used to classify notified cases as "verified", "not verified" or "not proven". Verified cases were further classified as Type 1 or 2(2) and analysed according to occupation, solvent type and length of exposure. RESULTS: Of 193 notified cases, 76 were classified as "verified". The majority were male (74/76) and European (69/76). Mean length of exposure to solvents for Type I cases was 10.6 years (SD 4.7) and for Type II cases 19.8 years (SD 8.4). Forty-three cases were classified as "mild" and 33 as "moderate". The most frequent occupation was spraypainting (39%), followed by printing (16%) and boatbuilding (9%). There was no correlation between severity of symptoms and type of solvent. There was a non-significant trend of increasing severity of symptoms with length of exposure. CONCLUSION: Exposure to solvents is an important health hazard in New Zealand workplaces.

Dietary intakes of middle-aged European, Maori and Pacific Islands people living in New Zealand.

AIM: To compare dietary intakes of Maori, Pacific Islands and European men and women in New Zealand. METHODS: A food frequency questionnaire was used to calculate nutrient intakes of 5523 New Zealand workers aged 40 years and over (3997 men, 1524 women) from a cross-sectional survey carried out between 1988 to 1990. RESULTS: Compared with European men and women, Maori women and Pacific Islands men and women consumed larger amounts of total energy per day. Age-adjusted nutrients expressed as percentage contribution to total energy intakes showed that Maori and Pacific Islands men and women consumed less carbohydrate, fibre and calcium, and more protein, fat, saturated fat and cholesterol than European men and women, respectively. These results were consistent with fewer servings of cereal and cheese per month, and more servings of red meats, fish and eggs in Maori and Pacific Islands participants compared with Europeans, after adjusting for age and total energy intakes. Pacific Islands men and women also consumed more servings of chicken, fewer cups of milk and fewer servings of fruit per month compared to Europeans. Maori men and women consumed more slices of bread and fewer servings of vegetables per month compared to European men and women. CONCLUSIONS: There were striking differences in dietary habits, food selections and cooking practices between European, Maori and Pacific Islands participants. Dietary intakes of Maori workers were closer to those of Europeans than those of Pacific Islands participants. Ethnic differences were due to larger portion sizes and increased frequency of most foods in Maori and Pacific Islands participants.

Associations between body morphology and microalbuminuria in healthy middle-aged European, Maori and Pacific Island New Zealanders.

OBJECTIVE: To examine the relationship between albuminuria and measures of body morphology. DESIGN: Cross-sectional study of European, Maori and Pacific Island workers aged 40 y and over. SUBJECTS: 3960 non-diabetic, non-hypertensive, non-lipidaemic, non-proteinuric middle-aged men and women. MEASUREMENTS: Height, weight, waist, hip, fasting and 2 h glucose, systolic and diastolic blood pressure, urinary creatinine and urinary albumin measurements. RESULTS: After adjusting for age and gender, the relative risks (95% confidence interval) of microalbuminuria were 4.87-fold (3.10-7.64) higher in Maori, and 4.96-fold (3.40-7.24) higher in Pacific Islanders compared to European New Zealanders. In contrast, age and gender adjusted relative risks (95% confidence interval) for high albumin:creatinine ratios were 6.38 (4.27, 9.53) in Maori and 5.14 (3.54, 7.48) in Pacific Islanders compared to European workers. Workers with microalbuminuria had higher urinary creatinine concentrations than those with urinary albumin in the normal range. Age and gender adjusted partial correlation coefficients between urinary albumin concentrations and the inverse of urinary creatinine concentrations were highest in European and Maori workers. Apart from Pacific islanders, urinary creatinine concentrations accounted for over 20% of the variation in urinary albumin concentrations in healthy individuals. Other independent predictors of urinary albumin concentrations were waist measurements, short stature and body mass index in Europeans and Pacific Islanders, and systolic blood pressure levels and gender in Europeans. After adjusting for age, gender, waist, height, 2 h glucose, urinary creatinine, systolic blood pressure and body mass index Maori and Pacific Islanders still had significantly higher urinary albumin concentrations than Europeans. CONCLUSION: Urinary creatinine concentrations were significantly associated with urinary albumin concentrations in all ethnic groups, and, with the exception of Pacific Islanders, accounted for a large proportion of the variation in urinary albumin concentrations in healthy individuals. Urinary albumin concentrations were associated with measures of obesity and short stature in Europeans and Pacific Islanders, and systolic blood pressure levels and gender in Europeans. However, measures of body morphology did not completely explain the higher urinary albumin concentrations in Maori or Pacific Islanders.

Reproducibility and validity of a food frequency questionnaire in European and Polynesian New Zealanders.

The reproducibility and validity of a self-administered 142-item food-frequency questionnaire (FFQ) was assessed in a population comprising 124 European and 52 Polynesian (17 Maori and 35 Pacific Island) New Zealanders aged 40-65 years. Reproducibility correlation coefficients, determined by administration of the same questionnaire on two occasions 3 years apart, were higher in European than Maori and Pacific Island participants, ranging from 0.47 to 0.87 in Europeans (median 0.66) and from 0.41 to 0.79 in Maori and Pacific Island people (median 0.44). In general, there were no significant differences in mean nutrient intakes calculated from the two FFQs by Europeans or Maori and Pacific Island participants despite their cultural and language differences. When the FFQ was compared with a 3-day food diary in a subsample of 101 Europeans, 15 Maori and 22 Pacific Islanders, the validity was good for most nutrients, with overestimation of a few nutrients in each ethnic group. Correlation coefficients between the 3-day food diary and FFQ ranged from 0.41 to 0.81 in Europeans (median 0.48) and from 0.36 to 0.56 in Maori and Pacific Island people (median 0.55). Ratios of energy intake to resting metabolic rate suggested that Maori and Pacific Island people were more likely to underestimate their habitual energy intake by the 3-day diet diary method compared to Europeans, but that Europeans were more likely to underestimate total energy intake by the food frequency method and Pacific Island participants to overestimate it. Obese Europeans and Maori were more likely to under-report dietary intakes by the 3-day diary method. We conclude that our FFQ performed better in European than Maori and Pacific Island participants.

Contrast sensitivity in organic-solvent-induced chronic toxic encephalopathy.

This is a study of visual contrast sensitivity in a series of subjects with previously diagnosed occupational organic-solvent-induced chronic toxic encephalopathy. Contrast sensitivity was measured for 16 subjects using the Vistech VCTS 6500 chart. The results were compared with age-stratified normal data. Six of the 16 subjects (37.5%) recorded abnormal contrast sensitivity results. Monocular abnormalities were found for two (33%) of these subjects. Statistically significant abnormalities in contrast sensitivity were observed at the intermediate spatial frequencies of three cycles per degree (cpd; P < .0005), 6 cpd (P < .025), and 12 cpd (P < .01). We conclude that contrast sensitivity is abnormal in some cases of occupational organic-solvent-induced chronic toxic encephalopathy. Intermediate spatial frequency channel neurones in the visual system may be more vulnerable to solvent toxicity than those of low or high spatial frequency. Contrast sensitivity testing may be a useful adjunct in the diagnostic process for this disease. Further research involving larger numbers of subjects is recommended.

Serum 25-hydroxyvitamin D3 is related to physical activity and ethnicity but not obesity in a multicultural workforce.

BACKGROUND: Recent research suggests that body vitamin D levels are decreased in coronary heart disease and diabetes, but it is unclear which cardiovascular risk factors are related to vitamin D status. AIMS: To examine the relation between vitamin D status and major cardiovascular risk factors. METHODS: Serum 25-hydroxyvitamin D3, a marker of recent sun exposure and vitamin D status, was measured in 390 New Zealand residents (95 Pacific Islanders, 74 Maori and 221 others mostly of European descent), who were part of a larger cross-sectional survey of a workforce (n = 5677) aged 40-64 years. RESULTS: Serum 25-hydroxyvitamin D3 levels were significantly lower in Pacific Islanders (mean (SE) = 56 (3) nmol/L; p = 0.0001) and Maoris (68 (3) nmol/L; p = 0.036) compared with Europeans (75 (2) nmol/L) after adjusting for age, sex and time of year. Also adjusting for ethnic group, 25-hydroxyvitamin D3 was higher in people doing vigorous (aerobic) leisure physical activities (71 (2) nmol/L; p = 0.0066) and moderate (non-aerobic) activities (68 (3) nmol/L; p = 0.12) compared with those who were inactive (63 (2) nmol/L). However, 25-hydroxyvitamin D3 was unrelated to body mass index, serum lipids, blood pressure or cigarette smoking. CONCLUSIONS: People with increased skin pigmentation, such as Polynesians, and people who are inactive, have decreased body levels of vitamin D; this might partly explain their increased risk of cardiovascular disease.

Serum 25-hydroxycholecalciferol concentration in newly detected hypertension.

Although blood concentrations of the active metabolite 1,25-dihydroxyvitamin D are raised in hypertension, concentrations of 25-hydroxyvitamin D, the main vitamin D metabolite, do not appear to have been reported in newly detected hypertension. Serum levels of 25-hydroxycholecalciferol were measured in 186 newly detected hypertensive patients (blood pressure > 160/95 mm Hg and never on antihypertensive medication) and normotensive controls individually matched by sex, age (+/- 2 years), ethnicity, and date of interview. Serum 25-hydroxycholecalciferol levels were similar in cases (mean (SD) = 64 (21) nmol/L) and controls (67 (28) nmol/L, P = .20). We conclude that serum 25-hydroxycholecalciferol, a marker of body vitamin D, is normal in hypertension.

Serum 25-hydroxyvitamin D3 levels decreased in impaired glucose tolerance and diabetes mellitus.

A cross-sectional survey was carried out in a New Zealand Polynesian and Caucasian workforce of 5677 staff aged 40-64 years to determine whether serum concentrations of 25-hydroxyvitamin D3 are altered in people with newly diagnosed diabetes mellitus and impaired glucose tolerance (IGT). Serum 25-hydroxyvitamin D3 concentration was significantly lower in newly detected cases with diabetes and IGT (n = 238) compared with controls individually matched by sex, age (+/- 2 years), ethnicity, and date of interview (mean (S.D.): 69 (31) vs. 76 (34) nmol/l; P = 0.0016). Among controls, serum concentrations were significantly lower in Maori (mean (S.E.) = 65 (5) nmol/l; P = 0.0013) and Pacific Islanders (59 (4) nmol/l; P = 0.0001) compared with Europeans (82 (3) nmol/l), after adjusting for age, sex, and time of year. We conclude that diabetes and IGT are associated with low serum concentrations of 25-hydroxyvitamin D3 and that low concentrations of this hormone in New Zealand Polynesians may partly explain their increased prevalence of diabetes/IGT compared with Europeans.